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5005/jp-journals-10011-1105
Ankur
Aggarwal ARTICLE
et al
ORIGINAL
Junior Resident, Department of Oral Medicine and Radiology, Mahatma Gandhi Postgraduate Institute of
Dental Sciences, Puducherry, India
Professor and Head, Department of Oral Medicine and Radiology, Mahatma Gandhi Postgraduate Institute of
Dental Sciences, Puducherry, India
Associate Professor, Department of Oral Medicine and Radiology, Mahatma Gandhi Postgraduate Institute of
Dental Sciences, Puducherry, India
Specialist Grade II Radiologist, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry, India
Correspondence: Ankur Aggarwal, Junior Resident, Department of Oral Medicine and Radiology, Mahatma Gandhi Postgraduate
Institute of Dental Sciences, Puducherry-605006, India, e-mail: dr.ankuraggarwal@ymail.com
ABSTRACT
Objectives: The purpose of the study was to evaluate the role of grayscale ultrasound (US) in differentiation of benign from malignant lymph
nodes in oral cancer patients and to correlate the ultrasonographic features with TNM staging and FNAC findings of cervicofacial lymph
nodes.
Methods: In the study, 34 patients with histopathologically proved oral cancer presenting with enlarged superficial cervicofacial
lymphadenopathy were included. The clinical, ultrasonographic and fine needle aspiration cytology (FNAC) findings were compared in
these patients. Patients were assessed for presence of nodes, their size, ratio of maximum longitudinal diameter to maximum transverse
diameter (L/T) and echogenicity. All patients then underwent fine needle aspiration cytology of the lymph nodes and the slides were
examined for the presence of malignant cells.
Results: It was found that ultrasonography had assessed the status of 28 nodes positively out of 34 nodes for metastasis when compared
with results of FNAC. Thus, ultrasonography had a sensitivity of 75% and specificity of 86% in detecting the metastatic nodes when
compared with FNAC taken as standard in the detection of metastatic nodes.
Conclusion: The lymph node status can be assessed successfully by ultrasonography preoperatively for the presence of metastasis in
majority of cases. Therefore, ultrasonography was found to be efficient and cost-effective preoperatively, in planning appropriate management
in oral cancer patients.
Keywords: Ultrasonography, Lymph node, Fine needle aspiration cytology.
INTRODUCTION
Regional lymph node status in oral cancer patients is of
paramount prognostic significance. Patients who present with
tumors localized at the primary site without dissemination to
regional lymph nodes have excellent prognosis. On the other
hand, once dissemination to regional lymph nodes takes place,
the probability of 5-year survivorship, regardless of the
treatment rendered, reduces to nearly half of that seen in early
staged patients.1,5,6 The inadequacy of physical palpation in
examination of regional lymph nodes is well-documented and
other investigations, like computed tomography, magnetic
resonance imaging and newer positron emission tomography
are expensive for the average income patient in our country.
Ultrasonography being a noninvasive and radiation free
modality can be used as a powerful tool in assessment of regional
lymph nodes in oral cancer.4,7 Hence, the study was undertaken
with the following aim and objective: (1) To evaluate the role
of grayscale ultrasonography in differentiation of benign from
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JIAOMR
Grayscale Ultrasonography in the Assessment of Regional Lymph Nodes in Oral Cancer and its Correlation with TNM Staging and FNAC
RESULTS
Since the p-value is less than 0.05, so the difference between
the two groups was found to be statistically significant. This
test leads to the conclusion that the heterogeneous lymph nodes
tend to have greater nodal diameter than the homogeneous group
of lymph nodes (Table 1).
Although the values in Table 2 show that the heterogeneous
group of lymph nodes is having L/T value lesser than the
homogeneous group, the difference between the two groups
was not found to be statistically significant with p-value > 0.05
(0.2076) (Table 2).
There was significant correlation between the findings of
clinical and ultrasonographic examination as both have detected
the N1 and N2 status equally and it was found to be statistically
significant with p < 0.05 (Table 3).
There was significant correlation between the findings of
ultrasonographic examination and FNAC results for detection
of metastasis (M) and it was found to be statistically significant
with p-value less than 0.05 (0.0007) (Table 4). Ultrasonography
had a sensitivity of 75% and specificity of 86% in detecting the
metastatic nodes when compared with FNAC taken as standard
for detection of metastatic nodes.
DISCUSSION
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Ankur Aggarwal et al
Table. 1: Comparison of mean nodal diameter of cases with homogeneous and heterogeneous findings
Findings
Mean SD
Homogeneous
9.65 1.62
Heterogeneous
15.16 4.52
t-value
p-value
5.16
0.0001
Table. 2: Comparison of mean L/T of cases with homogeneous and heterogeneous findings
Findings
Mean SD
Homogeneous
1.69 0.43
Heterogeneous
1.48 0.43
t-value
p-value
1.29
0.2076
Ultrasound
N1
N2
N1
19
N2
15
t-value
p-value
33
0.0001
FNAC results
Non-metastatic
106
t-value
p-value
11.52
0.0007
Metastatic
Non-metastatic
20
Metastatic
JAYPEE
JIAOMR
Grayscale Ultrasonography in the Assessment of Regional Lymph Nodes in Oral Cancer and its Correlation with TNM Staging and FNAC
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