Role of Selective Neck Dissection in Primary T1, T2, N0 Neck Oral Tongue Carcinoma

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

RADIOLOGIC- PATHOLOGIC CORRELATION OF DEPTH OF INVASION IN TONGUE CARCINOMA

Introduction: th In tongue carcinoma according to AJCC 8 guidelines depth of invasion is included in staging, therefore there is need of imaging which can accurately assess the pretreatment stage of tumor. The objective of this study was to correlate the depth of invasion reporting by MRI and postoperative HPR. Methods: In MRI DOI was measured by drawing perpendicular lines from the reference line to the point of maximal tumor projection in the tongue medially, histologically DOI was measured from the level of the basement membrane of the closest adjacent normal mucosa. Results: Paired t test was done on the DOI of MRI and HPR. The two tailed P value is less than 0.0001. This difference is considered to be extremely statistically signicant. The mean of group one (DOI-MRI) minus Group 2 (DOI-HPR) equals 6.860. 95% condence interval of this difference is from 5.200 to 8.520. Conclusion: In our study we nd there is statiscally signicant difference between DOI reports in MRI and postoperative HPR.

MRI Before Biopsy Correlates With Depth of Invasion Corrected for Shrinkage Rate of the Histopathological Specimen in Tongue Carcinoma

The purpose of this study was to evaluate which radiological depth of invasion (r-DOI) measurement is the most concordant to clinical DOI (c-DOI) derived from correction for the shrinkage rate of the histopathological specimens.We retrospectively reviewed 128 patients with tongue carcinoma who had undergone glossectomy between 2006 and 2019. At first, the width shrinkage rate during formalin fixation and preparation process of histopathological specimens was evaluated. From the shrinking rates, a formula to calculate c-DOI from pathological DOI (p-DOI) was developed. The correlation between c-DOI and r-DOI was evaluated.The specimen shrinkage rate during the histopathological specimen preparation process was 10.3%. Based on that, we yielded the correct formula for c-DOI based on p-DOI and preparation shrinkage rate: c-DOI = p-DOI × 100/89.7. The regression equations for the association of c-DOI with r-DOI measured by ultrasound (n = 128), MRI before biopsy (n = 18), and MRI after biopsy (n = 110) were y = 1.12 * x + 0.21, y = 0.89 * x − 0.26, and y = 0.52 * x + 2.63, respectively, while the coefficients of determination were 0.664, 0.891, and 0.422, respectively. In conclusion, r-DOI using MRI before biopsy most strongly correlated with c-DOI.

Relationship between Thickness of Early Oral Tongue Carcinoma (T1, T2) with Cervical Lymph Node Metastasis

Background: Carcinoma of oral tongue is the most common oral cancer and because of its structure and function is prone for early local and regional spread of cancer. The final outcome of a primary tongue carcinoma patient depends upon various prognostic factors like thickness of tumor, depth of invasion, size of lesion and neck node 67metastasis. Risk of metastasis and spread to neck nodes increases with increase in tumor thickness Methods: This prospective observational study was carried out in the Department of Otolayngology- Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka for 18 months. Thirty patients with early oral tongue carcinoma i.e.T1 & T2 as per UICC and AJC criteria were included in this study by purposive non-randomized sampling technique. Result of the study were expressed as mean, standard deviation (+SD), frequency and percentages. Unpaired Student’s t-test and Pearson’s correlation co-efficient (r) test were performed. Results: Result of the study showed the mean (+SD) thickness of the tumor was 3.62 (+1.46) mm. Minimum thickness 1.1mm and maximum thickness 7.8mm. Only 21 (70%) subjects neck node were metastasized from tongue and mean (+SD) tumor thickness of the positive neck node metastasis was 5.54 (+1.07) mm and negative neck node metastasis was 2.87 (+0.75) mm. This indicated a significant difference between the groups. Pearson’s correlation co-efficient r (+0.981) which indicated tumor thickness was positively correlated with neck node metastasis. Conclusion: Tumor thickness of the early oral carcinoma positively correlated with neck node metastasis. Correlation between thickness and metastatic lymph node can help planning the treatment regimen and indicate the disease prognosis. Bangladesh J Otorhinolaryngol; April 2021; 27(1): 25-35