Neck involvement in early carcinoma of tongue. Is elective neck dissection warranted?

To evaluate need of elective neck dissection in patients with early oral tongue cancer, and to see the pattern of involvement of different lymph node levels.

Ninety four patients with T1-T2, N0 squamous cell carcinoma of the oral tongue were treated with a partial glossectomy and an elective modified radical neck dissection.

Thirty two patients had T1 and 62 patients had T2 lesion. In patients with T1 carcinoma, 9 out of 32 had metastases (28%), whereas in patients with T2 carcinoma, 21 out of 62 showed metastases(34%).Thus, the overall rate of occult lymph node metastases was high(32%). In our study skip metastases to level III was seen in only in 2 patients (6%) but there was no skip metastases seen involving level IV or V.

The overall micrometastases rate in our patients (32%) warrants elective neck dissection in early cases also. The incidence of metastases to level IV and V from T1-T2 oral tongue cancer is low so these lymph nodes should be removed only when there is intraoperative suspicion of extensive metastases in levels I, II or III., otherwise supraomohyoid neck dissection is sufficient.