title: Preoperative ultrasonography for evaluation of clinically N0 neck in oral cavity carcinoma.
abstract: The aim of this study was to evaluate preoperative ultrasound criteria to detect lymph node (LN) cervical metastasis in patients with clinically node-negative neck (cN0) oral cavity squamous cell carcinoma (OCSCC). A prospective, single-center, observational study was conducted in 90 patients undergoing cancer excision with or without elective neck dissection (END) between 2005 and 2012. A surgeon and an experienced radiologist performed preoperative cervical ultrasonography in all cases. The primary objective was to obtain an a priori sensitivity of 90% and specificity >50% in cN0 OCSCC staging. The sonographic criteria for LN assessment were as follows: number; neck levels; clusters; aspect; heterogeneity; longitudinal diameter (L); transverse diameter (T); L/T ratio; and combination in series or in parallel of T and L/T ratio. The gold standard for comparison was the LN histological identification of metastasis after END or the occurrence in the follow-up at least 36 months. Statistically significant sonographic criteria in univariate analysis (P < 0.05) were as follows: multilevel lymph nodes, T diameter >6.5 mm, and the combination T > 6.5 mm or L/T < 1.3 ratio; and in multivariate logistic regression analysis were (P < 0.05): combination T > 6.5 mm and L/T < 1.3 ratio, LN in level II, and moderately-poorly differentiated OCSCC. By using selected sonographic criteria, ultrasound can be a valid preoperative diagnostic method to optimize staging cervical metastasis and to help decide about neck dissection.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Virgen Macarena University Hospital, Seville, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Rollon-Mayordomo
authors.affiliation: Department of Oral and Maxillofacial Surgery, Puerta del Mar Hospital, Cadiz, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Creo-Martinez
authors.affiliation: Department of Radiology, Virgen Macarena University Hospital, Seville, Spain.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Marin-Lapeira
authors.affiliation: Department of Oral and Maxillofacial Surgery, Puerta del Mar Hospital, Cadiz, Spain.
authors.forename: Juan-Andres
authors.initials: JA
authors.lastname: Rodriguez-Ruiz
authors.affiliation: Department of Surgery, School of Medicine, University of Seville, Seville, Spain. Electronic address: pinfante@us.es.
authors.forename: Pedro
authors.initials: P
authors.lastname: Infante-Cossio
mesh_terms: D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D037981:Neck Dissection; D009367:Neoplasm Staging / Q000379:methods*; D011300:Preoperative Care; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014463:Ultrasonography
keywords: Diagnosis; Lymph node cervical metastasis; Oral cavity squamous cell carcinoma; Ultrasonography