Sandhya K N, Girija K L, Venugopal M, Thomas Valsa, Ramachandran Sunu, Asish R
Amrita School of Dentistry, Amrita Viswavidyapeetham University, Edapilly, Kochi, India.
Department of Oral Medicine and Radiology, Government Dental College, Trivandrum, India.
Contemp Clin Dent. 2020 Jul-Sep;11(3):256-260. doi: 10.4103/ccd.ccd_444_19. Epub 2020 Nov 26.
Oral cancer is the most frequent type of cancer of the head and neck area, with squamous cell carcinoma (SCC) being the most common single entity. Worldwide, oral cancer accounts for 2%-4% of all cancer cases, the prevalence being highest in India. Lymph node metastases occur in about 40% of patients with oral cancer. Clinically, their manifestations are hidden in rates of 15% to 34%. More accurate imaging techniques can reduce the risk of undiagnosed metastasis. Ultrasonography has gained wide acceptance as a diagnostic aid in the evaluation of reactive and metastatic lymph nodes. The present study is an attempt to assess the earliest evaluation of the cervical lymph nodes by ultrasound-guided fine-needle aspiration cytology (FNAC).
A descriptive diagnostic evaluation study was carried out to find out the sensitivity and specificity of ultrasound-guided FNAC in detecting metastasis to cervical lymph nodes from oral SCC in the Department of Oral Medicine and Radiology, Government Dental College, Thiruvananthapuram, in collaboration with the Department of Imageology, Regional Cancer Centre, Thiruvananthapuram during the time period from July 2015 to September 2016.
A total of 112 patients with histologically proven oral SCC having palpable lymph nodes were evaluated clinically and ultrasonographically. In this study, sensitivity and specificity of >90% were obtained for ultrasonographic criteria such as the long axis to short axis ratio <2, the absence of hilum, heterogeneous architecture, and altered vascularity in the evaluation of metastatic lymph nodes. The diagnostic yield in the detection of metastatic lymph nodes was much higher in the ultrasonographic examination.
Ultrasound-guided FNAC offers an opportunity to enhance patient prognosis through early detection and a specific diagnosis (92.5%) when compared to clinical examination (78.6%) in the current study.
口腔癌是头颈部最常见的癌症类型，其中鳞状细胞癌（SCC）是最常见的单一类型。在全球范围内，口腔癌占所有癌症病例的2%-4%，印度的患病率最高。约40%的口腔癌患者会发生淋巴结转移。临床上，其转移表现隐匿，隐匿率为15%至34%。更精确的成像技术可降低未诊断出转移的风险。超声检查作为评估反应性和转移性淋巴结的诊断辅助手段已被广泛接受。本研究旨在通过超声引导下细针穿刺抽吸细胞学检查（FNAC）评估颈部淋巴结的早期情况。
在2015年7月至2016年9月期间，在特里凡得琅政府牙科学院口腔医学与放射科与特里凡得琅地区癌症中心影像科合作，开展了一项描述性诊断评估研究，以确定超声引导下FNAC检测口腔SCC颈部淋巴结转移的敏感性和特异性。
对112例经组织学证实为口腔SCC且可触及淋巴结的患者进行了临床和超声检查评估。在本研究中，对于转移性淋巴结评估的超声标准，如长轴与短轴比值<2、无门部、结构不均一和血管改变等，敏感性和特异性均>90%。超声检查在检测转移性淋巴结方面的诊断率更高。
与本研究中的临床检查（78.6%）相比，超声引导下FNAC通过早期检测和特异性诊断（92.5%）为改善患者预后提供了机会。
