Pattern of Lymphatic Metastasis in Relation to the Depth of Tumor in Oral Tongue Cancers: A Clinico Pathological Correlation

Abstract

Carcinoma of tongue is one of the most notorious cancers of oral cavity. Multivariate analysis have shown that the parameter with greatest influence on survival is tumor thickness especially in carcinoma tongue. To study the pattern of lymphatic metastasis in oral tongue in relation to the depth of tumor. This is a prospective study of 60 patients over a period of 4 years. Squamous cell carcinoma of anterior two-third (oral tongue) which were managed by upfront surgery were considered in the study. USG tongue was done in a few cases (25 out of 60) but was not a mandatory criteria for inclusion or exclusion of the case. The measurements for depth of invasion were made from surface of mucosa to maximal depth by an ocular micrometer. Frequency, proportions and percentages were used to analyse the data. Out of 15 patients who had tumor thickness less than 5 mm, two had nodal metastasis i.e. 13%, whereas 28 patients out of 45 patients with tumor thickness more than 5 mm had nodal disease i.e. 62%. Out of 60 patients enrolled, 13 (21.66%) lost to follow up by the end of 1 year. Of remaining 47 patients seven (14.89%) presented with recurrence (four nodal and three local), three out of which underwent second surgery and four were referred for palliative care. All the four patients referred for palliative care died within 1 year of surgery. As evident from above study only two patients had positive nodal disease when the depth of the tumor was less than 5 mm. There is no role of observation of neck in carcinoma tongue, however if observation is being planned then preoperative ultrasonography of tongue should be done and tumors more than 5 mm should at least be offered extended supraomohyoid neck dissection. Chance of level V involvement is negligible and can be omitted in N0 and N1 neck. © 2012 Association of Otolaryngologists of India.