Clinical, Radiological and Histological Features and Their Association with Extranodal Extension in Buccoalveolar Complex Squamous Cell Carcinoma

 

 Permissions and Reprints

Abstract

Objectives The study was aimed to (1) evaluate the effectiveness of clinical examination, intraoperative finding, and contrast-enhanced computed tomography (CECT) to detect extranodal extension (ENE) in buccoalveolar complex squamous cell carcinoma (BAOSCC), (2) to know various factors influencing ENE, and (3) to evaluate survival outcome in patients with ENE.

Materials and Methods This was a retrospective cohort study, which included 137 patients with BAOSCC who underwent curative treatment between May 2019 and April 2021. Collaborative findings suggestive of ENE were noted during preoperative clinical examination, CECT, and intraoperatively, and their efficacy was compared with postoperative histopathology. Also, the various factors associated with ENE were evaluated and compared.

Statistical Analysis Univariate and multivariate analysis of parameters was done using multiple logistic regression analysis and significant correlation was determined using chi-square test between ENE positive and negative categories. Analysis of prognosis and survival was done by Kaplan–Meier curve plotting using regression analysis and its significance was compared.

Results The overall prevalence of ENE was 18.98% and that of lymph node involvement was 40.88%. CECT (73.1%) was found to be more sensitive in detecting ENE compared to intraoperative examination (46.2%) and clinical examination (34.6%).In comparison with clinical examination (91.9%) or CECT (78.38%), intraoperative examination (93.7%) showed the highest specificity in detecting ENE. Clinical nodal size ≥ 3 cm (p ≤ 0.001), fixity (p ≤ 0.001), and clinical number of nodes (p ≤ 0.001) had significant association with ENE. The presence of thick nodal walls on CECT increased the probability of predicting ENE 15 times (p = 0.180, confidence interval: 0.3–765.4). After a mean follow-up of 18 months, subjects without nodal positivity had a survival advantage over patients with positive lymph nodes (86.4% vs. 53.3%) and those with ENE (86.4% vs. 23.2%), respectively.

Conclusion The results demonstrated that clinical examination can be used as an adjuvant to radiological imaging for prediction of ENE preoperatively. Clinical finding suggesting size of node ≥ 3 cm and ≥ 2 nodes are strong predictor of ENE, in addition to other known predictors. Patients with ENE had an unfavorable prognosis when compared with subjects with metastatic nodes without ENE. Presence of ENE remains one of the strongest factors predicting recurrence and thus poor prognosis.

Ethical Approval

The study is approved by the Institutional Review Board of Christian Medical College, Vellore, Tamil Nadu, India (IRB No: 12886).

Publication History

Article published online:
04 August 2023

© 2023. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

• References

• 1 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68 (06) 394-424
  CrossrefPubMedGoogle Scholar
• 2 Mehta N, Sharma R, Madhok R, Agrawal T, Sharma V. A clinical, radiological, and histopathological correlation of neck nodes in patients undergoing neck dissection. Int J Appl Basic Med Res 2018; 8 (01) 9-13
  CrossrefPubMedGoogle Scholar
• 3 Safi AF, Grandoch A, Nickenig HJ, Zöller JE, Kreppel M. Importance of lymph node ratio for locoregional recurrence of squamous cell carcinoma of the buccal mucosa. Head Neck 2017; 39 (12) 2488-2493
  CrossrefPubMedGoogle Scholar
• 4 Huang SH, O'Sullivan B. Overview of the 8th Edition TNM Classification for Head and Neck Cancer. Curr Treat Options Oncol 2017; 18 (07) 40
  CrossrefPubMedGoogle Scholar
• 5 Su Z, Duan Z, Pan W. et al. Predicting extracapsular spread of head and neck cancers using different imaging techniques: a systematic review and meta-analysis. Int J Oral Maxillofac Implants 2016; 45 (04) 413-421
  CrossrefPubMedGoogle Scholar
• 6 Ishii J, Nagasawa H, Yamane M. et al. Ultrasonography and computed tomography of extracapsular invasion in cervical lymph nodes of squamous cell carcinoma in the oral cavity. J Med Ultrason 2004; 31 (02) 75-79
  CrossrefPubMedGoogle Scholar
• 7 Amin MB, Greene FL, Edge SB. et al. The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin 2017; 67 (02) 93-99
  CrossrefPubMedGoogle Scholar
• 8 Sakai O, Curtin HD, Romo LV, Som PM. Lymph node pathology. Benign proliferative, lymphoma, and metastatic disease. Radiol Clin North Am 2000; 38 (05) 979-998 , x
  PubMedGoogle Scholar
• 9 Willis RA. Epidermoid carcinoma of the head and neck, with special reference to metastasis. J Pathol 1930; 33: 501-526
  CrossrefGoogle Scholar
• 10 Bernier J, Cooper JS, Pajak TF. et al. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck 2005; 27 (10) 843-850
  CrossrefPubMedGoogle Scholar
• 11 Bernier J, Cooper JS. Chemoradiation after surgery for high-risk head and neck cancer patients: how strong is the evidence?. Oncologist 2005; 10 (03) 215-224
  CrossrefPubMedGoogle Scholar
• 12 Rajappa SK, Maheshwari U, Ram D. et al. Extracapsular extension in oral cavity cancers-predictive factors and impact on recurrence pattern and survival. Int J Oral Maxillofac Implants 2019; 48 (08) 989-994
  CrossrefPubMedGoogle Scholar
• 13 Matsumoto F, Mori T, Matsumura S. et al. Prognostic significance of surgical extranodal extension in head and neck squamous cell carcinoma patients. Jpn J Clin Oncol 2017; 47 (08) 699-704
  CrossrefPubMedGoogle Scholar
• 14 Mair MD, Shetty R, Nair D. et al. Depth of invasion, size and number of metastatic nodes predicts extracapsular spread in early oral cancers with occult metastases. Oral Oncol 2018; 81: 95-99
  CrossrefPubMedGoogle Scholar
• 15 Anand N, Chaudhary N, Mittal MK, Prasad R. Comparison of the efficacy of clinical examination, ultrasound neck and computed tomography in detection and staging of cervical lymph node metastasis in head and neck cancers. Indian J Otolaryngol Head Neck Surg 2007; 59 (01) 19-23
  CrossrefPubMedGoogle Scholar
• 16 Shetty D, Jayade BV, Joshi SK, Gopalkrishnan K. Accuracy of palpation, ultrasonography, and computed tomography in the evaluation of metastatic cervical lymph nodes in head and neck cancer. Indian J Dent 2015; 6 (03) 121-124
  CrossrefPubMedGoogle Scholar
• 17 Jhony JK, Pg B, Patil S, Mk S, George NA. A prospective observational study to determine the correlation of clinical, ultrasonography, and pathological examination of cervical lymph nodal staging in oral squamous cell carcinoma. Indian J Surg Oncol 2021; 12 (03) 512-516
  CrossrefPubMedGoogle Scholar
• 18 Beltz A, Zimmer S, Michaelides I. et al. Significance of extranodal extension in surgically treated HPV-positive oropharyngeal carcinomas. Front Oncol 2020; 10: 1394
  CrossrefPubMedGoogle Scholar
• 19 Faraji F, Aygun N, Coquia SF. et al. Computed tomography performance in predicting extranodal extension in HPV-positive oropharynx cancer. Laryngoscope 2020; 130 (06) 1479-1486
  CrossrefPubMedGoogle Scholar
• 20 Souter MA, Allison RS, Clarkson JH, Cowan IA, Coates MH, Wells JE. Sensitivity and specificity of computed tomography for detection of extranodal spread from metastatic head and neck squamous cell carcinoma. J Laryngol Otol 2009; 123 (07) 778-782
  CrossrefPubMedGoogle Scholar
• 21 Url C, Schartinger VH, Riechelmann H. et al. Radiological detection of extracapsular spread in head and neck squamous cell carcinoma (HNSCC) cervical metastases. Eur J Radiol 2013; 82 (10) 1783-1787
  CrossrefPubMedGoogle Scholar
• 22 Chai RL, Rath TJ, Johnson JT. et al. Accuracy of computed tomography in the prediction of extracapsular spread of lymph node metastases in squamous cell carcinoma of the head and neck. JAMA Otolaryngol Head Neck Surg 2013; 139 (11) 1187-1194
  CrossrefPubMedGoogle Scholar
• 23 Hao SP, Ng SH. Magnetic resonance imaging versus clinical palpation in evaluating cervical metastasis from head and neck cancer. Otolaryngol Head Neck Surg 2000; 123 (03) 324-327
  CrossrefPubMedGoogle Scholar
• 24 Maxwell JH, Ferris RL, Gooding W. et al. Extracapsular spread in head and neck carcinoma: impact of site and human papillomavirus status. Cancer 2013; 119 (18) 3302-3308
  CrossrefPubMedGoogle Scholar
• 25 Woolgar JA, Rogers SN, Lowe D, Brown JS, Vaughan ED. Cervical lymph node metastasis in oral cancer: the importance of even microscopic extracapsular spread. Oral Oncol 2003; 39 (02) 130-137
  CrossrefPubMedGoogle Scholar
• 26 Brasilino de Carvalho M. Quantitative analysis of the extent of extracapsular invasion and its prognostic significance: a prospective study of 170 cases of carcinoma of the larynx and hypopharynx. Head Neck 1998; 20 (01) 16-21
  CrossrefPubMedGoogle Scholar
• 27 Wreesmann VB, Katabi N, Palmer FL. et al. Influence of extracapsular nodal spread extent on prognosis of oral squamous cell carcinoma. Head Neck 2016; 38 (Suppl. 01) E1192-E1199
  CrossrefPubMedGoogle Scholar