Akhtar Shabbir, Ikram Mubasher, Ghaffar Shehzad
Department of Otolaryngology, Aga Khan University Hospital, Karachi.
J Pak Med Assoc. 2007 Jun;57(6):305-7.
To evaluate need of elective neck dissection in patients with early oral tongue cancer, and to see the pattern of involvement of different lymph node levels.
Ninety four patients with T1-T2, N0 squamous cell carcinoma of the oral tongue were treated with a partial glossectomy and an elective modified radical neck dissection.
Thirty two patients had T1 and 62 patients had T2 lesion. In patients with T1 carcinoma, 9 out of 32 had metastases (28%), whereas in patients with T2 carcinoma, 21 out of 62 showed metastases(34%).Thus, the overall rate of occult lymph node metastases was high(32%). In our study skip metastases to level III was seen in only in 2 patients (6%) but there was no skip metastases seen involving level IV or V.
The overall micrometastases rate in our patients (32%) warrants elective neck dissection in early cases also. The incidence of metastases to level IV and V from T1-T2 oral tongue cancer is low so these lymph nodes should be removed only when there is intraoperative suspicion of extensive metastases in levels I, II or III., otherwise supraomohyoid neck dissection is sufficient.
评估早期舌癌患者选择性颈清扫术的必要性，并观察不同淋巴结水平的受累模式。
94例T1-T2、N0期舌鳞状细胞癌患者接受了部分舌切除术和选择性改良根治性颈清扫术。
32例患者为T1期病变，62例患者为T2期病变。T1期癌患者中，32例中有9例发生转移（28%），而T2期癌患者中，62例中有21例发生转移（34%）。因此，隐匿性淋巴结转移的总体发生率较高（32%）。在我们的研究中，仅2例患者（6%）出现跳跃性转移至Ⅲ区，但未发现涉及Ⅳ区或Ⅴ区的跳跃性转移。
我们患者的总体微转移率（32%）表明早期病例也有必要进行选择性颈清扫术。T1-T2期舌癌转移至Ⅳ区和Ⅴ区的发生率较低，因此仅在术中怀疑Ⅰ、Ⅱ或Ⅲ区有广泛转移时才应切除这些淋巴结，否则肩胛舌骨上颈清扫术就足够了。
