CAM WE DETECT OR PREDICT THE PRESENCE OF OCCULT NODAL METASTASES IN PATIENTS WITH SQUAMOUS CARCINOMA OF THE ORAL TONGUE

Background. When to do a neck dissection as part of the surgical treat ment for a patient with squamous carcinoma of the oral tongue is contr oversial, particularly when the primary can De resected without enteri ng the neck. if the patient who is al high risk for having occult noda l disease in the neck can De identified, node dissection with the glos sectomy could be justified. To better identify patients for this proce dure, we correlated various tumor and patient factors along with preop erative diagnostic studies with the presence or absence of pathologica lly positive nodes in a group of patients who underwent node dissectio n. Methods, Ninety-one previously untreated patients with biopsy-prove d squamous carcinoma of the oral tongue were prospectively studied, Al l patients had a glossectomy and neck dissection as their initial trea tment. The pathology findings (ie, lymph nodes with squamous cancer) w ere correlated with many preoperative and intraoperative factors, and a statistical analysis was made. Results. The use of computed tomograp hy and ultrasound was not better than the clinical examination in dete rmining the presence or absence of nodal metastases. The best predicto rs were depth of muscle invasion, double DNA aneuploidy, and histologi c differentiation of the tumor. Conclusions. All patients with stage T 2-T4 squamous cancers of the oral tongue should have an elective disse ction of the neck. Patients with T1NO cancer who have a double DNA-ane uploid tumor, depth of muscle invasion > 4 mm, or have a poorly differ entiated cancer should definitely undergo elective neck dissection. Ul trasound and computed tomography are of little value in predicting whi ch patients have positive nodes. (C) 1998 John Wiley & Sons, Inc.