Abstract: Introduction: The Oral Squamous cell carcinoma spreads by lymphatics. Hence it is the important prognostic factor in oral carcinoma. The involvement of lymph nodes guides in the treatment of oral carcinoma and neck dissection. By knowing the level of involvement of oral carcinoma, the staging can be done and the type of neck dissection can be planned accordingly and decrease the morbidity of the radical neck dissection.
Aim: To determine the clinico pathological correlation of pattern of cervical lymph nodes metastases in oral cavity cancers.
Methodology: It is a prospective study of histologically proven oral carcinoma of 50 patients. Data for the study collected from the patients coming to the General Surgery OPD at SS Institute of Medical sciences and Research Centre, Davangere, over a period of two years from October 2016 to August 2018. Inclusion Criteria included are patients with clinical suspicion of oral cancer with positive/negative lymph nodes, previously untreated oral cancers, histologically proven oral carcinoma cases. Exclusion Criteria are patients not willing to give informed consent, patients who are unfit for general anaesthesia, prior treatment of other head and neck cancers by surgery, chemotherapy and radiotherapy, previous surgery in the neck, presence of distant metastasis. Clinical neck examination done along with other necessary radiological investigations. The neck examination is compared with histological examination. The analysis done by Sensitivity, Specificity and Accuracy of the neck examination.
Results: In our study, Pathologically level II (56.3%) was the most commonly involved lymph node station in patients with oral cancer. Most of the patients presented in an advanced stage clinically. Stage IV was the commonest with 20(40%) patients. The Sensitivity and Specificity of the clinical neck examination were 76.9% and 61.8% respectively in patients with oral cancer. The accuracy of clinical examination is 78%. In our study, tumour stage had a positive correlation (r=0.987) with the pathological nodal status, that was significant (p=<0.001). In our study, there was significant positive correlation (0.435) between pathological T stage and pathological level of involvement in oral cancer and it was significant (p=0.0001). The drawbacks of the study were there might be sampling errors and small size of the study.
Conclusion: In our study it was found that there was had increased sensitivity and specificity on clinical examination. Course of pre operative antibiotics can increase the specificity of clinical neck examination. From our study we recommend that supraomohyoid neck dissection as a staging procedure. The use of pre operative radiological imaging can increase the involved lymph node and can be used in staging.
