ULTRASOUND GUIDED FINE NEEDLE ASPIRATION CYTOLOGY IN EVALUATION OF CERVICAL LYMPHNODE METASTASIS IN ORAL SQUAMOUS CELL CARCINOMA

DR. ARGHA BARUAH; DR.TN SURESH; DR.SM AZEEM MOHIYUDDIN; DR. ANIL KUMAR SAKALECHA

Volume : VIII, Issue : III, March - 2019

ULTRASOUND GUIDED FINE NEEDLE ASPIRATION CYTOLOGY IN EVALUATION OF CERVICAL LYMPHNODE METASTASIS IN ORAL SQUAMOUS CELL CARCINOMA

Dr. Argha Baruah, Dr. Tn Suresh, Dr. Sm Azeem Mohiyuddin, Dr. Anil Kumar Sakalecha

Abstract :

INTRODUCTION: Oral cancer is the most frequent malignancy of head and neck region.The presence of metastatic lymph nodes greatly affects the outcome . The 5–year survival for a patient is halved if a single ipsilateral neck node is involved, and is reduced by three–quarters if bilateral nodes are present. 5 One of the most important problems in selecting patients for elective neck dissection is lack of confirmatory diagnostic tests to classify a patient as neck positive or negative.The biggest challenge of FNAC is getting representative sample which can be minimized by ultrasound guidance. 7 Role of ultrasound guided FNAC in staging of cervical lymph node status in Oral Squamous Cell carcinoma not yet a standard preoperative evaluation.8 MATERIALS AND METHODS : All biopsy proven oral squamous cell carcinoma patients with palpable lymph nodes who had undergone neck dissection during the period of January 2016 to June 2017 were included. Cervical lymph node with ultrasonographic features such as round shape, absence of echogenic hilum, sharp nodal borders, presence of intranodal necrosis and peripheral vascularity suggestive of metastatic cervical lymph nodes were aspirated. Smears were stained with H&E,PAP and Giemsa stain. The FNAC diagnosis was correlated with the histopathological findings. Results: Most of the cases belonged to the age group of 40 to 70 years with a male to female ratio of 1:2.1. The common site of carcinoma of oral cavity was Buccal mucosa (70%) .Most of the cases presented clinically at a late stage ie. TNM Stage IV (65.8%). There was significant correlation between cytology and HPE findings. ( p value <0.001).Sensitivity of USG guided FNAC was 93.55%,specificity was 100%,positive predictive value was 100% ,negative predictive value was 95.12% and diagnostic accuracy was 97.14%. False negative results on USG guided FNAC seen in 2 cases(6.5%). Conclusion: High diagnostic accuracy of FNAC combined with advantage of ultrasound guidance helps in accurate diagnosis of cervical lymphnode metastasis in oral cancers. Ultrasound guided FNAC should be recommended in the preoperative assessment of cervical lymphnode metastasis in Oral squamous cell carcinoma.