ABSTRACT
Background:
The presence of cervical lymph node metastasis stands as a key element for predicting the prognosis of oral squamous cell carcinoma (OSCC) because it affects both management decisions and survival durations.
Materials and Methods:
This study evaluated 80 OSCC cases that received treatment at a tertiary care facility during the period from 2020 to 2024 by means of retrospective analysis. The study obtained data about the patient characteristics together with tumor site, size and histological grade, depth of invasion (DOI), perineural invasion (PNI) and lymphovascular invasion (LVI), and clinical nodal status. Surgical neck dissections occurred in every case, and the histopathological analyses received comparison with the clinical assessments. SPSS version 26.0 performed the statistical analysis through which results with P values below 0.05 emerged as significant statistical findings.
Results:
The tongue was the most affected site with 42.5% of cases, while buccal mucosa followed closely with 31.2% of patients. The histopathological analysis demonstrated that cervical lymph node metastasis existed in 38 patients (47.5%) among the study group. The evaluation revealed significant positive trends between deep invasion beyond 5 mm (P = 0.003) and the presence of PNI (P = 0.012) and LVI (P = 0.007) and nodal metastasis. Clinical palpation evaluation found nodal status correctly in 70% of patients, while it failed to identify the presence of hidden metastases in nine cases (11.2%).
Conclusion:
Multiple pathological features including deep invasion level and the presence of perineural invasion and lymphovascular invasion prove highly associated with cervical lymph node metastasis in patients with OSCC.
KEYWORDS: Cervical lymph node metastasis, depth of invasion, oral squamous cell carcinoma, perineural invasion
INTRODUCTION
OSCC represents the predominant head and neck malignancy since it constitutes more than 90% of all oral cancers. The disease occupies a leading position among mortality and morbidity causes linked to cancer worldwide who especially reside in Southeast Asia because tobacco and betel nut usage is common.[1,2] OSCC’s adverse clinical outcome mostly stems from regional lymph node metastasis because this factor determines both disease evolution and survival duration.[3,4]
The survival rate for patients with OSCC falls dramatically when lymph nodes in the cervical area show involvement, thus demonstrating the urgent need for early detection of metastasis.[5] Routinely performed examinations using ultrasonography, along with CT and MRI, help evaluate nodal status, yet they demonstrate poor ability to identify hidden metastases.[6,7] Pathologists use neck dissection tissue evaluation as the definitive method to diagnose lymph node metastasis.[8]
MATERIALS AND METHODS
The study included 80 patients diagnosed with oral squamous cell carcinoma (OSCC) after surgical treatment with neck dissection within a timeframe between January 2020 and December 2024. Medical experts excluded patients who experienced tumor return as well as those who received radiation or chemotherapy treatments combined with missing clinical reports.
The research collected demographic and clinical data points including patient age and sex and tumor location and neck condition status from medical records. All histological findings such as tumor size and grade and DOI and PNI and LVI and cervical lymph node metastasis results were obtained from reports of biopsy and surgical specimen.
The laboratory process involved formalin-fixed buffered 10% formaldehyde fixation, followed by paraffin embedding and subsequent hematoxylin and eosin staining of all surgical samples. Microscopic examination served as the method for diagnosing lymph node metastasis. The distance measurement for DOI began at the basement membrane area of normal adjacent mucosa and ended at the most invasive tumor point. The presence of PNI occurred when pathologists identified tumor cells present inside the perineural space, and LVI developed through tumor emboli located within endothelial-lined spaces.
Statistical analysis
Data were entered and analyzed using IBM SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA).
RESULTS
The research involved eighty patients who received an oral squamous cell carcinoma (OSCC) diagnosis through histological examination. The study participants included 52 males representing 65% of the cohort, along with 28 females making up 35%, while the mean age came to 54.3 ± 11.2 years. Tongue became the leading site of OSCC appearance among 80 patients, with 34 patients developing tumors (42.5%), while buccal mucosa followed with 25 cases (31.2%), floor of mouth with 11 cases (13.8%), and retromolar trigone with 10 cases (12.5%).
The reviews of total patients led to findings of cervical lymph node metastasis through histological analysis of 38 patients (47.5%). The investigation presents the link between nodal metastasis and different clinicopathologic parameters in Table 1. There were 46 patients with tumor invasion passing 5 mm depth, and among those, 30 patients (65.2%) showed positive lymph node metastasis results. The frequency of nodal involvement among 34 patients with DOI ≤5 mm was eight patients only (23.5%) (P = 0.003).
Table 1.
Association between clinicopathologic parameters and cervical lymph node metastasis (n=80)
| Parameter | Total (n) | Positive nodes (n) | % Positive | P |
|---|---|---|---|---|
| Depth of invasion >5 mm | 46 | 30 | 65.2% | 0.003* |
| Depth of invasion ≤5 mm | 34 | 8 | 23.5% | |
| Perineural invasion (+) | 29 | 22 | 75.9% | 0.012* |
| Perineural invasion (–) | 51 | 16 | 31.4% | |
| Lymphovascular invasion (+) | 26 | 20 | 76.9% | 0.007* |
| Lymphovascular invasion (–) | 54 | 18 | 33.3% |
*Statistically significant (P<0.05)
Perineural invasion was present in 29 cases, and 22 (75.9%) of those cases showed positive lymph nodes. Lymphovascular invasion was present in 26 cases, while 20 (76.9%) showed metastasis. Statistics showed both clinical variables strongly linked to nodal involvement as determined by P = 0.012 and P = 0.007.
In terms of clinical staging, 48 patients were classified as clinically node-negative (cN0) and 32 as clinically node-positive (cN+). However, histopathology revealed that nine cN0 cases (18.7%) had occult nodal metastasis, while five clinically suspected cases (15.6%) turned out to be node-negative upon microscopic evaluation [Table 2].
Table 2.
Comparison of clinical nodal assessment with histopathological findings (n=80)
| Clinical nodal status | Histologically positive | Histologically negative | Total (n) |
|---|---|---|---|
| cN+ (palpable nodes) | 27 | 5 | 32 |
| cN0 (no palpable nodes) | 11 | 37 | 48 |
As seen in Table 2, the sensitivity and specificity of clinical palpation for detecting nodal metastasis were 71.0% and 88.1%, respectively.
DISCUSSION
Cervical lymph node metastasis acts as a significant prognostic element for oral squamous cell carcinoma (OSCC) because it determines both survival expectations and necessary treatment approaches.
The pathological feature of depth of invasion (DOI) proved to be statistically significant for lymph node metastasis assessment (P = 0.003). DOI serves as a unique predictor of nodal spread according to the AJCC 8th edition, and the authors support its application for tumor staging.[4] Researchers have proven that cancers extending deeper than 4–5 mm contain a greater potential to spread, so doctors use this metric as an elective neck dissection determining tool.[5]
Research showed PNI and LVI factors directly correlated to the development of nodal metastasis. Such features signify aggressive tumor conduct and enable peritumoral spread because they allow tumor cells to reach nearby neural and vascular components.[6] Our study findings indicate that PNI and LVI appear as prime indicators for regional dissemination since they were present in 75.9% and 76.9% of node-positive cases, respectively. While other investigative studies confirm these relations, biomarkers require standard incorporation into biopsy and surgical specimen assessment.[7]
A significant percentage of 18.7% of cN0 patients tested positive for occult metastasis shows that clinical examinations alone are inadequate for proper nodal assessment. The reliability of palpation testing for staging purposes declines when metastasis develops early in the disease process. Our study suggests that medical professionals should employ risk-control methods when selecting cN0 patients for elective neck dissection, especially when high-risk histological features are present.[8,9]
CONCLUSION
In conclusion, clinicopathologic parameters, such as depth of invasion, perineural invasion, and lymphovascular invasion, serve as important predictors of cervical lymph node metastasis in OSCC. Incorporating these markers into routine diagnostic protocols may enhance early detection of nodal disease and guide surgical planning more effectively.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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