CT staging of oral cavity malignancy with histopathological correlation

Abstract

Author(s): Beena Devi Agarwal*, Soumya Ranjan Nayak and Satya Sundar Mohapatra

Background: Oral cavity malignancy is the third most common tumour in India. While clinical examination allows direct lesion visualization and cervical lymph node evaluation, a deeper extension of primary disease and its relation to adjacent structures (which help in deciding resectability), sub-centimetre cervical lymph node evaluation is limited by clinical examination. Cross-section imaging has become the mainstay in the pre-treatment evaluation of oral cavity malignancy for appropriate management and prognostication.

Objective: Assess the role of multi-detector CT in T & N staging of squamous cell carcinoma of oral cavity subsites and correlate the CT staging with histopathological staging.

Materials and Methods: This prospective study was carried out in a tertiary care hospital. Patients with biopsy proven squamous cell carcinoma of oral cavity were evaluated with multi-detector computed tomography and appropriate gross histopathological examination. Puffed cheek manoeuvre was used to detect buccal mucosa and GBS lesions.

Results: The study focuses on CT staging (T & N stage) of various subsites of the oral cavity malignancy with histopathological correlation. The most common subsites in our study was buccal mucosa i.e., 26 out of 75 patients. RMT, alveolus, and GBS were the second most common subsites. CT scan of the oral cavity provides a better assessment of loco regional spread especially cortical bone involvement and morphological analysis of cervical lymph nodes.

Conclusion: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CT in staging oral cavity squamous cell carcinoma is statistically significant compared to the gold standard, i.e. post-op histopathological staging. CT was most sensitive in detecting maxillary sinus infiltration and bone infiltration.

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