RE-EVALUATION OF NECK STAGING BY COMPUTED TOMOGRAPHY SCAN, MAGNETIC RESONANCE IMAGING AND ELECTIVE NECK DISSECTION IN CLINICALLY N0 NECK IN HEAD AND NECK CANCERS AND ITS HISTO-PATHOLOGICAL CORRELATION

SMITA RAY; PREMANAND PANDA; PRAGNYA PARAMITA MISHRA

doi:10.22159/ijcpr.2025v17i4.7030

Authors

SMITA RAY Department of ENT, Hi-tech MCH, Rourkela, Odisha, India
PREMANAND PANDA Department of Radiology, JP Hospitals and Research Centre, Rourkela, Odisha, India
PRAGNYA PARAMITA MISHRA Department of Pathology, Hi-tech MCH, Rourkela, Odisha, India

DOI:

https://doi.org/10.22159/ijcpr.2025v17i4.7030

Keywords:

Head and neck cancer, Lymphnode, Computed tomography, Magnetic resonance imaging, Metastasis

Abstract

Objective: Thirty percent of all cancer cases are head and neck cancer. The most frequent way that these tumors spread is through lymphatic metastasis. In patients with head and neck tumors, cervical lymph node assessment is a crucial step in the staging process. Furthermore, the prognosis of patients with head and neck malignancies is greatly influenced by the identification of cervical lymph node metastases. The modalities available to detect metastatic lymph nodes are ultrasound, computed tomography, magnetic resonance imaging, and scintigraphy. Our study is done to compare the efficacy of clinical examination, computed tomography, magnetic resonance imaging, and histopathological correlation after elective neck dissection and staging of lymph node metastasis in head and neck cancers.

Methods: This prospective study was carried out in the Department of Otorhinolaryngology at Hitech Medical College and Hospital, Rourkela, Odisha, between January 2023 and December 2024 in association with the department of radiodiagnosis. A total of 30 patients of all age groups and both sexes with clinically N0 neck with proven head and neck cancer and requiring surgery as the primary mode of treatment were included in the study. All CT and MRI images were assessed by a radiologist without prior knowledge of the clinical status of the patient. The result of the clinical examination, CT scan, and MRI was compared with the histopathological report.

Results: In the present study, the majority of patients ranged between the age group of 40-60 years (66.6%), with a mean age of 49.3 years. There was a marked male preponderance with a 2.75:1 male-to-female ratio, and the most common primary site was the larynx (40%). the maximum number of patients presented to the outpatient department when the primary was at the stage of T3 in the case of laryngeal tumors and T2 in the case of oral cavity tumors. When comparing the results of clinical examinations to histopathology, there were 30 clinically N0 necks, while 13 cases were found to be histopathologically positive. So, true positives were 17 (56.66%), and false negatives were 13 (43.33%). Out of 13 histopathologically proven positive necks, CT could diagnose metastasis in 7 cases, which showed a statistically significant correlation between CT scan and histopathology (p value 0.01). Out of 13 histopathologically proven positive necks, MRI could diagnose metastasis in 6 cases, which showed a statistically significant correlation between CT scan and histopathology (p value 0.02).

Conclusion: This study concludes that palpation alone was an inaccurate technique for assessment of the neck. Computed tomography and magnetic resonance imaging had a higher accuracy for diagnosing metastatic disease than clinical examination. Both have comparable efficacy in detecting occult metastasis in the neck. Histopathological confirmation is indispensable in view of the low sensitivity of both modalities.

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References

1. Ferlay J, Colombet M, Soerjomataram I, Parkin DM, Pineros M, Znaor A. Cancer statistics for the year 2020: an overview. Int J Cancer. 2021 Aug 15;149(4):778-89. doi: 10.1002/ijc.33588, PMID 33818764.

2. World Health Organization. WHO report on cancer: setting priorities, investing wisely and providing care for all. Geneva: World Health Organization; 2020.

3. Sathishkumar K, Chaturvedi M, Das P, Stephen S, Mathur P. Cancer incidence estimates for 2022 and projection for 2025: result from national cancer registry programme India. Indian J Med Res. 2022 Oct-Nov;156(4-5):598-607. doi: 10.4103/ijmr.ijmr_1821_22, PMID 36510887.

4. Kulkarni MR. Head and neck cancer burden in India. Int J Head Neck Surg. 2013;4(1):29-35. doi: 10.5005/jp-journals-10001-1132.

5. Foote RL, Olsen KD, Davis DL, Buskirk SJ, Stanley RJ, Kunselman SJ. Base of tongue carcinoma: patterns of failure and predictors of recurrence after surgery alone. Head Neck. 1993 Jul-Aug;15(4):300-7. doi: 10.1002/hed.2880150406, PMID 8360051.

6. Ferlito A, Rinaldo A, Robbins KT, Leemans CR, Shah JP, Shaha AR. Changing concepts in the surgical management of the cervical node metastasis. Oral Oncol. 2003 Jul;39(5):429-35. doi: 10.1016/s1368-8375(03)00010-1, PMID 12747966.

7. Tankere F, Camproux A, Barry B, Guedon C, Depondt J, Gehanno P. Prognostic value of lymph node involvement in oral cancers: a study of 137 cases. Laryngoscope. 2000 Dec;110(12):2061-5. doi: 10.1097/00005537-200012000-00016, PMID 11129021.

8. Shah JP. Cervical lymph node metastases diagnostic therapeutic and prognostic implications. Oncology (Williston Park). 1990;4(10):61-5. PMID 2149826.

9. Golder WA. Lymph node diagnosis in oncologic imaging: a dilemma still waiting to be solved. Onkologie. 2004;27(2):194-9. doi: 10.1159/000076912, PMID 15138355.

10. O Brien CJ, McNeil EB, McMahon JD, Pathak I, Lauer CS, Jackson MA. Significance of clinical stage extent of surgery and pathologic findings in metastatic cutaneous squamous carcinoma of the parotid gland. Head Neck. 2002 May;24(5):417-22. doi: 10.1002/hed.10063, PMID 12001070.

11. Kau RJ, Alexiou C, Stimmer H, Arnold W. Diagnostic procedures for detection of lymph node metastases in cancer of the larynx. ORL J Oto Rhino Laryngol Relat Spec. 2000;62(4):199-203. doi: 10.1159/000027746, PMID 10859520.

12. Stevens MH, Harnsberger HR, Mancuso AA, Davis RK, Johnson LP, Parkin JL. Computed tomography of cervical lymph nodes staging and management of head and neck cancer. Arch Otolaryngol. 1985 Nov;111(11):735-9. doi: 10.1001/archotol.1985.00800130067007, PMID 4051864.

13. Feinmesser R, Freeman JL, Noyek AM, Birt D. Metastatic neck disease reply. Arch Otolaryngol Head Neck Surg. 1988;114(7):808-9. doi: 10.1001/archotol.1988.01860190112038.

14. Sako K, Pradier RN, Marchetta FC, Pickren JW. Fallibility of palpation in the diagnosis of metastases to cervical nodes. Surg Gynecol Obstet. 1964 May;118:989-90. PMID 14143467.

15. Van Den Brekel MW, Castelijns JA, Stel HV, Golding RP, Meyer CJ, Snow GB. Modern imaging techniques and ultrasound-guided aspiration cytology for the assessment of neck node metastases: a prospective comparative study. Eur Arch Otorhinolaryngol. 1993;250(1):11-7. doi: 10.1007/BF00176941, PMID 8466744.

16. Bhau SS, Bhau KS, Arshad S, Kalsotra P, Zaffar S, Rashid A. Clinicoradiological and histopathological comparative study of nodal metastasis in head and neck cancers. AIMDR. 2016;2(4):93-9. doi: 10.21276/aimdr.2016.2.4.27.

17. Thoenissen P, Heselich A, Burck I, Sader R, Vogl T, Ghanaati S. The role of magnetic resonance imaging and computed tomography in oral squamous cell carcinoma patients preoperative staging. Front Oncol. 2023;13:972042. doi: 10.3389/fonc.2023.972042, PMID 36959788.

18. Watkinson JC, Todd CE, Paskin L, Rankin S, Palmer T, Shaheen OH. Metastatic carcinoma in the neck: a clinical radiological scintigraphic and pathological study. Clin Otolaryngol Allied Sci. 1991 Apr;16(2):187-92. doi: 10.1111/j.1365-2273.1991.tb01974.x, PMID 1649018.

19. Curtin HD, Ishwaran H, Mancuso AA, Dalley RW, Caudry DJ, McNeil BJ. Comparison of CT and MR imaging in staging of neck metastases. Radiology. 1998 Apr;207(1):123-30. doi: 10.1148/radiology.207.1.9530307, PMID 9530307.