Clinicoradiological versus pathological neck staging in locally advanced oral cavity cancers

Comprehensive neck dissection is recommended in oral cancers with clinically positive necks. However, the clinical staging of the neck is inaccurate and leads to overtreatment. This study aims to assess the feasibility and validity of ultrasound and ultrasound-guided fine-needle aspiration cytology to identify cervical lymph node metastases. The prospective study included 50 consecutive operable patients with clinical T3/T4a and N + oral cavity squamous cell carcinomas. Preoperative nodal assessment with palpation, ultrasound and ultrasound-guided FNAC were compared with histopathological findings. The sensitivity, specificity, predictive values and accuracy were calculated. Amongst 50 clinical N+ necks, 38% were USGFNAC positive and 52% were histopathological positive. A total of 1180 lymph nodes were harvested (median 24) and 58 nodes (4.91%) were pathologically positive. Sensitivity/specificity were 62%/47%, 72%/13% and 47%/93% in palpation, USG and USGFNAC respectively. Positive/negative predictive values were 38%/70%, 31%/48%, and 79%/77% while the accuracy was 52%, 34% and 78% with palpation, USG and USGFNAC respectively. Around 50% of the palpable nodes in locally advanced oral cancers are metastatic. Ultrasound-guided FNAC of suspicious nodes is highly accurate in correct nodal staging. But USFNAC for every patient with oral cancer is not feasible in high-volume centres and teaching institutes. •Clinical examination is inaccurate for ‘N’ staging in oral cavity cancer.•Comprehensive neck dissection for all cN + stage is not justified.•Only 50% of clinical N+ neck are pathologically positive.•Only 5% of all resected lymph nodes are positive.•Ultrasound guided FNAC is highly specific but not feasible in practice.