A Prospective Observational Study to Determine the Correlation of Clinical, Ultrasonography, and Pathological Examination of Cervical Lymph Nodal Staging in Oral Squamous Cell Carcinoma

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Abstract
Oral cancer is one of the most common cancers in our population. These cancers are drained by the nodes located in the cervical region which are easily accessible for clinical examination. However, these cervical nodes may also be enlarged due to various other nonmalignant causes. Hence, accuracy of clinical examination and ultrasound screening for cervical lymph nodes is invaluable. The aims of this study are (1) to correlate the clinical, radiological, and pathological results of cervical lymph nodes in patients with oral malignancy and (2) to calculate the accuracy of clinical and radiological methods in detecting malignant cervical lymph nodes. A prospective observational study was undertaken from January 2016 to December 2016 amounting to a total of 76 patients. All patients diagnosed with squamous cell carcinoma of the oral cavity and having a palpable neck node(s), who were planned for surgery were included. Clinical examination, ultrasonographic (USG) screening of the neck, and the final histopathology reports were noted. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for radiological screening by ultrasound were 90.5%, 90.9%, 79.2%, and 96.2%, respectively, and that for clinical examination were 61.9%, 69.1%, 43.3%, and 82.6%, respectively. Area under the curve (AUC) for ultrasound screening was 0.907, and the AUC for clinical examination was 0.655. Ultrasonography is a reliable, cost-effective imaging method in the assessment of malignant cervical nodes in patients with oral cancer, which is to be used along with clinical palpation for improving the accuracy of clinical staging and surgical planning preoperatively.

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