Is neck ultrasound necessary for early stage oral tongue carcinoma with clinically N0 neck?

Background: Oral tongue is one of the common site for carcinoma. 22% to 39% of oral cancer develops at this site. The high incidence of cervical lymph node metastasis, occult cervical metastasis, Provide a logical basis for treatment of the neck. The aim of this is study was to find out the importance of selective neck dissection in primary T1, T2, N0 Neck Oral Tongue Carcinoma. Methods: This cross-sectional study was conducted in the Department of Otolaryngology- Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College Hospital and National Institute of ENT, Dhaka. Thirty cases of primary T1, T2, N0 Neck Oral Tongue Carcinoma with inclusion criteria was enrolled as a study sample. Patients were evaluated by a complete clinical head and neck examination as well as Imaging (MRI) of the primary tumor and neck. All the data were compiled and sorted properly and the numerical data were analyzed statistically. The results were expressed as percentage and mean ± SD. Chi-square (x2) test or Fisher’s Exact test was done for comparison of data presented in categorical value and p value <0.05 was considered as the level of significance. Among the patients 23(76.7%) were T1 lesion and remaining 7(23.33%) were T2 lesion. Extended Supraomohyoid Selective Neck Dissection (SOSD) (I-IV) was done in all patients. Following histopathological examination, 8(26.67%) patients of N0 neck became positive for nodal metastasis. Results: The study showed that most commonly (50%) involved group of occult metastasis was upper deep cervical lymph node in submandibular area (level-I). Occult nodal metastasis was significantly common 87.5% among male patients than females (p=0.039) and also common 87.5% among <50 years age group (p=0.023). Neck node positive was significantly more 62.5% in T2 lesion (p=0.002) of oral tongue carcinoma. Conclusion: In this study, we found that a number of patients had been histopathologicallly detected micro-metastases in regional neck nodes in clinically N0 patients.So, Extended Supraomohyoid Selective neck dissection (I-IV) was appropriate in T1,T2, N0 Neck Oral Tongue Carcinoma. Bangladesh J Otorhinolaryngol 2021; 27(2): 130-138

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Prediction of lymphatic metastasis based on gene expression profile analysis after brachytherapy for early-stage oral tongue carcinoma

Radiotherapy and Oncology ◽

10.1016/j.radonc.2007.12.027 ◽

2008 ◽

Vol 87 (2) ◽

pp. 237-242 ◽

Cited By ~ 16

Author(s):

Hiroshi Watanabe ◽

Kaoru Mogushi ◽

Masahiko Miura ◽

Ryo-ichi Yoshimura ◽

Tohru Kurabayashi ◽

...

Keyword(s):

Gene Expression ◽

Gene Expression Profile ◽

Expression Profile ◽

Lymphatic Metastasis ◽

Profile Analysis ◽

Early Stage ◽

Tongue Carcinoma ◽

Oral Tongue ◽

Expression Profile Analysis

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Predictive factors for regional metastases in oral tongue squamous cell carcinoma

Oncology Reviews ◽

10.4081/oncol.2011.13 ◽

2011 ◽

pp. 21-30 ◽

Cited By ~ 1

Author(s):

Anastasios Kanatas ◽

Amy Marschall ◽

Craig D. S. T. Needs ◽

Thomas Mucke ◽

James McCaul

Keyword(s):

Decision Making ◽

Squamous Cell Carcinoma ◽

Predictive Factors ◽

Decision Making Process ◽

Tongue Carcinoma ◽

Nodal Metastases ◽

Oral Tongue ◽

N0 Neck ◽

Neck Disease ◽

Regional Metastases

The process of deciding to treat or not to treat the clinically N0 neck in early oral tongue carcinoma whether surgically or with radiotherapy remains difficult and open to discussion. This is due to the minority of patients who will have occult nodal metastases and the reduced outcome for those patients whose neck disease is not treated primarily. Studies which have looked at factors which may predict for nodal metastases both at the histological and immunohistochemical level and therefore help with this decision making process are reviewed.

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Should early cancers of the oral tongue be kept under surveillance after wide excision alone? A prospective study

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.5541 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 5541-5541

Author(s):

T. Gupta ◽

J. Agarwal ◽

A. D’Cruz ◽

S. Ghosh-Laskar ◽

R. Malde ◽

...

Keyword(s):

Tongue Cancer ◽

Early Stage ◽

Wide Excision ◽

Elective Neck Dissection ◽

Oral Tongue ◽

N0 Neck ◽

Increased Risk ◽

Oral Tongue Cancer ◽

A Prospective Study ◽

The Impact

5541 Background: The treatment of the clinically N0 neck in early stage oral tongue cancer remains controversial. Several clinico-pathologic criteria that can reliably identify an increased risk of occult metastases in the neck have been proposed. Our aim was to assess the impact of elective neck dissection (END) on outcome and correlate it with clinico-pathologic criteria for patient selection for surveillance. Methods: Patients with early stage cancer of the oral tongue (T1–2, N0) after undergoing wide excision with or without END were prospectively kept under observation. Patients having adverse histological features necessitating adjuvant radiotherapy were excluded. All patients gave informed consent and were closely followed. Relapsers were offered appropriate salvage therapy. The primary end-point for our prospective phase II study was the impact of END on relapse-free survival (RFS) with an estimated sample size of 50 patients. Overall survival (OS) was a secondary endpoint. Results: Fifty three eligible patients were consecutively accrued on the trial after surgery. Forty eight patients underwent per oral wide excision, with only 5 requiring a neck approach. Twenty two patients underwent upfront END. Twenty four patients relapsed (23 of which had some loco-regional component). The risk of neck recurrence in patients whose necks were not dissected electively was significantly higher than in patients treated with END (55% vs 9% respectively, p = 0.0016). The 3-year RFS (69.1% vs 40.9%, p = 0.008) and OS (87.2% vs 42.6%, p = 0.0228) was significantly better for patients treated with END. Conclusions: Regional recurrences are the most important cause of failure after wide excision alone. END which achieves excellent disease control in the neck and significantly improves RFS and OS should be considered routine for early stage oral tongue cancer. No significant financial relationships to disclose.

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PO-068 Locoregional Relapse Impact on Survival for Resected Early Stage Oral Tongue Carcinoma

Radiotherapy and Oncology ◽

10.1016/s0167-8140(19)30234-8 ◽

2019 ◽

Vol 132 ◽

pp. 36

Author(s):

M. Labareda ◽

E. Netto ◽

J. Filipe ◽

R. Pocinho ◽

A. Mota ◽

...

Keyword(s):

Early Stage ◽

Tongue Carcinoma ◽

Oral Tongue ◽

Locoregional Relapse ◽

Impact On Survival

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Role of Sampling Neck Dissection in Early Oral Tongue Carcinoma

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v26i2.50643 ◽

2020 ◽

Vol 26 (2) ◽

pp. 147-152

Author(s):

Md Shoukat Ali ◽

SM Masudul Alam ◽

Md Mahbubul Alam ◽

Md Abdus Sattar ◽

Md Mosleh Uddin ◽

...

Keyword(s):

Neck Dissection ◽

Early Stage ◽

Tertiary Care ◽

Cross Sectional Study ◽

Nodal Metastasis ◽

Stage Migration ◽

Tongue Carcinoma ◽

Oral Tongue ◽

Cross Sectional ◽

Male Patients

Background: Carcinoma of oral tongue has a great potential for metastatic spread to neck nodes, which may not be clinically detected in early stage. To detect frequency of occult neck metastasis in clinically No patients with early oral tongue carcinoma (stage I & II) the study has done. Methods: It was a 2 years cross sectional study among fifty patients in three tertiary care hospitals of Dhaka from 2016 to 2018. Results: Majority of the patients were male (M:F=3:2) with age ranged 25 to 80 years. Among these patients 38(76%) were in T1 and remaining 12(24%) in T2 stage. Tongue ulceration was most common(84%) presenting feature followed by dysphagia(64%) and pain(52%).Only 32(64%) patients revealed no histopathological proved metastasis(true N0). Occult nodal metastasis was significantly common(83.33%) among male patients than females(p<0.01) and also common(72.22%) among < 50 years age group(p<0.01).Sampling node positive was significantly more(66.67%) in T2 stage(p<0.01). Conclusion: Regarding clinical, radiological and histopathological stages and stage migration of early carcinoma in oral tongue this study revealed significant differentiation among these methods. This study implies sampling neck dissection of sentinel neck nodes in early oral tongue carcinoma for management. Bangladesh J Otorhinolaryngol; October 2020; 26(2): 147-152

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Recurrence Pattern of Early Stage- Node Negative Oral Tongue Carcinoma Post Operative - A Retrospective Study

Journal of Medical Science And clinical Research ◽

10.18535/jmscr/v7i3.20 ◽

2019 ◽

Vol 7 (3) ◽

Author(s):

Dr R. Giridharan ◽

Keyword(s):

Retrospective Study ◽

Early Stage ◽

Tongue Carcinoma ◽

Recurrence Pattern ◽

Oral Tongue ◽

Node Negative

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Improving Risk Stratification of Early Oral Tongue Cancer with TNM-Immune (TNM-I) Staging System

Cancers ◽

10.3390/cancers13133235 ◽

2021 ◽

Vol 13 (13) ◽

pp. 3235

Author(s):

Alhadi Almangush ◽

Ibrahim O. Bello ◽

Ilkka Heikkinen ◽

Jaana Hagström ◽

Caj Haglund ◽

...

Keyword(s):

Overall Survival ◽

Tongue Cancer ◽

Early Stage ◽

Disease Free Survival ◽

Tumor Infiltrating Lymphocytes ◽

Staging System ◽

Oral Tongue ◽

Oral Tongue Cancer ◽

Important Player ◽

Infiltrating Lymphocytes

Although patients with early-stage oral tongue squamous cell carcinoma (OTSCC) show better survival than those with advanced disease, there is still a number of early-stage cases who will suffer from recurrence, cancer-related mortality and worse overall survival. Incorporation of an immune descriptive factor in the staging system can aid in improving risk assessment of early OTSCC. A total of 290 cases of early-stage OTSCC re-classified according to the American Joint Committee on Cancer (AJCC 8) staging were included in this study. Scores of tumor-infiltrating lymphocytes (TILs) were divided as low or high and incorporated in TNM AJCC 8 to form our proposed TNM-Immune system. Using AJCC 8, there were no significant differences in survival between T1 and T2 tumors (p > 0.05). Our proposed TNM-Immune staging system allowed for significant discrimination in risk between tumors of T1N0M0-Immune vs. T2N0M0-Immune. The latter associated with a worse overall survival with hazard ratio (HR) of 2.87 (95% CI 1.92–4.28; p < 0.001); HR of 2.41 (95% CI 1.26–4.60; p = 0.008) for disease-specific survival; and HR of 1.97 (95% CI 1.13–3.43; p = 0.017) for disease-free survival. The TNM-Immune staging system showed a powerful ability to identify cases with worse survival. The immune response is an important player which can be assessed by evaluating TILs, and it can be implemented in the staging criteria of early OTSCC. TNM-Immune staging forms a step towards a more personalized classification of early OTSCC.

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