Cervical Lymph Nodes Assessment in Oral Cancer Patients Using the Helical CT Scan

Introduction: Over 90% of all head and neck cancers are squamous cell carcinomas. Accurate evaluation of cervical lymph node status is a corner stone in treating patients with head and neck malignancy. Objectives: The aim of this study was to assess the cervical lymph nodes status in oral cancer patients using helical CT scan. Methods: Twenty-five oral cancer patients underwent preoperative Helical CT imaging followed by neck dissection. The cervical lymph nodes features on CT scan namely the size, the presence of necrosis, the shape and their number were studied.  The findings were analyzed and related to each other and to the histopathology report of the lymph nodes. This relationship between the different parameters was put in a form of a Metastatic Score (MS). Results: All Cases of nodal sizes >3cm were histopathologicaly positive, 82% Cases of nodal sizes between 2.1-3cm were histopathologically positive, 40% cases with nodal sizes between 1-2cm were histopathologically positive and all cases of lymph nodes sizes <1cm were histopathologicaly negative. 77% of cases which had a group of lymph nodes (>3 nodes/region) were  histopathologicaly positive 79% of cases with rounded nodes were histopathologicaly positive and all cases with necrotic lymph nodes were positive for malignancy. The CT showed a sensitivity of 93%, a specificity of 91% and an accuracy of 92% in the determination of cervical lymph nodes metastases. Cases with Metastatic Scores (MS) > 6 were 100% histopathologicaly positive. Cases with Metastatic Scores (MS) < 3 were 100% histopathologicaly negative Conclusion: CT scan can be used to predict the histopathological status of lymph nodes in oral cancer patients.