Abstract
Jeyashanth Riju
Objectives The study was aimed to (1) evaluate the effectiveness of clinical examination, intraoperative
finding, and contrast-enhanced computed tomography (CECT) to detect extranodal extension
(ENE) in buccoalveolar complex squamous cell carcinoma (BAOSCC), (2) to know various
factors influencing ENE, and (3) to evaluate survival outcome in patients with ENE.
Materials and Methods This was a retrospective cohort study, which included 137 patients with BAOSCC who
underwent curative treatment between May 2019 and April 2021. Collaborative findings
suggestive of ENE were noted during preoperative clinical examination, CECT, and intraoperatively,
and their efficacy was compared with postoperative histopathology. Also, the various
factors associated with ENE were evaluated and compared.
Statistical Analysis Univariate and multivariate analysis of parameters was done using multiple logistic
regression analysis and significant correlation was determined using chi-square test
between ENE positive and negative categories. Analysis of prognosis and survival was
done by Kaplan–Meier curve plotting using regression analysis and its significance
was compared.
Results The overall prevalence of ENE was 18.98% and that of lymph node involvement was 40.88%.
CECT (73.1%) was found to be more sensitive in detecting ENE compared to intraoperative
examination (46.2%) and clinical examination (34.6%).In comparison with clinical examination
(91.9%) or CECT (78.38%), intraoperative examination (93.7%) showed the highest specificity
in detecting ENE. Clinical nodal size ≥ 3 cm (p ≤ 0.001), fixity (p ≤ 0.001), and clinical number of nodes (p ≤ 0.001) had significant association with ENE. The presence of thick nodal walls
on CECT increased the probability of predicting ENE 15 times (p = 0.180, confidence interval: 0.3–765.4). After a mean follow-up of 18 months, subjects
without nodal positivity had a survival advantage over patients with positive lymph
nodes (86.4% vs. 53.3%) and those with ENE (86.4% vs. 23.2%), respectively.
Conclusion The results demonstrated that clinical examination can be used as an adjuvant to
radiological imaging for prediction of ENE preoperatively. Clinical finding suggesting
size of node ≥ 3 cm and ≥ 2 nodes are strong predictor of ENE, in addition to other
known predictors. Patients with ENE had an unfavorable prognosis when compared with
subjects with metastatic nodes without ENE. Presence of ENE remains one of the strongest
factors predicting recurrence and thus poor prognosis.
Keywords
oral squamous cell carcinoma - extranodal extension - contrast-enhanced computed tomography
- prognosis - oral cancer - neck metastasis
