Is preoperative ultrasonography accurate in measuring tumor thickness and predicting the incidence of cervical metastasis in oral cancer?

Mark Taylor, S.; Drover, Chris; MacEachern, Ron; Bullock, Martin; Hart, Robert; Psooy, Brian; Trites, Jonathan

doi:10.1016/j.oraloncology.2009.10.005

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Volume 46, Issue 1 , Pages 38-41, January 2010

Is preoperative ultrasonography accurate in measuring tumor thickness and predicting the incidence of cervical metastasis in oral cancer?☆

S. Mark Taylor
- Division of Otolaryngology-Head and Neck Surgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V7
- Corresponding author. Address: Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Suite 3044-Dickson Bldg, 5820 University Avenue, Halifax, Nova Scotia, Canada B3H 1V7. Tel.: +1 902 473 5752; fax: +1 902 473 4016.
Chris Drover
- Division of Otolaryngology-Head and Neck Surgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V7
Ron MacEachern
- Department of Radiology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V7
Martin Bullock
- Department of Pathology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V7
Robert Hart
- Division of Otolaryngology-Head and Neck Surgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V7
Brian Psooy
- Department of Radiology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V7
Jonathan Trites
- Division of Otolaryngology-Head and Neck Surgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada B3H 1V7

Received 7 September 2009; received in revised form 7 October 2009; accepted 8 October 2009. published online 23 November 2009.

Summary

The need for elective neck dissection in patients with early stage oral cancer is controversial. A preoperative predictor of the risk of subclinical nodal metastasis would be useful. Studies have shown a strong correlation between histological tumor depth and the risk of nodal metastasis.

To determine if preoperative ultrasonography is an accurate measure of tumor depth in oral carcinoma. To assess if preoperatively measured tumor depth predicts an increased risk of subclinical metastatic neck disease and thus the need for elective neck dissection.

Twenty one consecutive patients with biopsy proven squamous cell carcinoma of the tongue/floor of mouth were analyzed prospectively. Each patient received a preoperative ultrasonography to assess tumor depth which was compared to histological measures. Univariate analysis was used to correlate tumor thickness and T stage with neck metastasis.

There was a significant correlation between the preoperative ultrasonography and histological measures of tumor depth (correlation coefficient 0.981, P<0.001). The overall rate of lymph node metastasis was 52%. The rate of metastasis was 33% in N0 necks. In the group with tumors<5mm in depth, the neck metastatic rate was 0%, as compared with 65% in the group⩾5mm. Using univariate analysis tumor depth and T stage were significant predictors of cervical metastasis (P=0.0351 and P=0.0300, respectively).

Preoperative ultrasonography is an accurate measure of tumor depth in oral carcinoma. Tumor thickness is a significant predictor of nodal metastasis and elective neck dissection should be considered when this thickness is⩾5mm.

Keywords: Oral, Cancer, Ultrasonography, Metastasis, Tumor thickness