1. CORRELATION OF PHYSICAL EVALUATION AND MRI OF CERVICAL LYMPH NODE WITH HISTOPATHOLOGICAL FINDINGS IN ORAL SQUAMOUS CELL CARCINOMA: AN AMBIDIRECTIONAL STUDY OF 125 NECK LEVELS IN 101 CASES
Dr. Aviral Verma
I.D.-33
Introduction: Squamous Cell Carcinoma accounts for more than 90% of all oral cancers. The assessment of neck remains a difficult challenge. The aim of this study was to evaluate cervical lymph node enlargement in patients with a biopsy diagnosis of Oral Squamous Cell Carcinoma using pre-operative physical evaluation and MRI findings and its correlation with post-operative histopathological data.
Methods: An Ambidirectional Observational study of 125 neck levels in 101 cases with biopsy proven Oral Squamous Cell Carcinoma were evaluated through physical examination for regional lymph node enlargement, radiological examination using MRI which included assessment of: short axis diameter, grouping and central nodal necrosis of cervical lymph nodes and were correlated with histopathological data.
Results: The diagnostic validity of cervical lymph nodes on physical evaluation was 65% sensitivity, 70.59% specificity, 50.98% PPV, 81% NPV, 68.80% accuracy and on MRI evaluation was 56.63% sensitivity, 90.47% specificity, 92.15% PPV, 51.35% NPV and 68% accuracy.
Conclusion: This study concluded that the cervical lymph nodes less than 20mm in the long axial diameter on clinical evaluation, with the absence of central nodal necrosis on MRI evaluation, with short axial diameter of less than 23mm on MRI and with the absence of grouping around the drainage area of the primary site of the tumor on MRI had a probability of 89.58% being benign. A diagnostic criteria was also developed.
HISTOPATHOLOGICAL
DIAGNOSIS
PHYSICAL EVALUATION
MRI

2. Lymph Node evaluation on MRI
Firm to Hard Node
Fixed Node
≥10mm in Diameter
(Minimal axial diameter greater than 11 mm in the subdigastric area or greater than 10 mm in other areas) 
Lymph Node evaluation on MRI
Short Axial Diameter
Grouping
Central Nodal Necrosis
Palpation
(A central area of low “water” attenuation necrosis with intermediate signal intensity on T2-weighted MRI images)
(A group of 3 of more nodes of 8~10 mm in the drainage area of the tumor)
Physical Evaluation
Short Axial Diameter
Grouping
Central Nodal Necrosis

3. DIAGNOSTIC CRITERIA CONCLUSION
Biopsy Diagnosed OSCC
Palpation- Size of node>20mm
Metastatic
MRI- Presence of Central Nodal Necrosis
MRI- Short Axial Diameter >23mm
MRI- Presence of Grouping
40% Metastatic
60% Benign
89.58% Benign
10.42% Metastatic
Palpation
CNN
Short Axial Diameter
Grouping
YES NO
YES NO
YES NO
CONCLUSION
With the help of this study, we developed a diagnostic criteria through which could accurately categorize the presence of metastatic disease in the cervical lymph nodes at various levels of diagnostic parameters .
With further advancement in diagnostic techniques, the improvement in the accuracy of diagnosis will occur which will be useful for the surgeons to differentiate benign from metastatic disease thus reducing the morbidity rate.
YES NO