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Contralateral Nodal Metastasis from Tongue Malignancy.

Konduru Vidya1, Jeyashanth Riju1, Janakiraman Rajinikanth1

  • 1Department of Head and Neck Surgery, Christian Medical College, Vellore, India.

Indian Journal of Otolaryngology and Head and Neck Surgery : Official Publication of the Association of Otolaryngologists of India
|December 1, 2022
PubMed
Summary

Contralateral neck node metastasis in tongue cancer is linked to advanced stage, floor of mouth involvement, and lesions crossing the midline. Extranodal extension significantly increases the risk of contralateral metastasis.

Keywords:
Contralateral neck nodeNeck dissectionOral cancerSquammous cell cancerTongue

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Area of Science:

  • Oncology
  • Head and Neck Surgery
  • Cancer Research

Background:

  • Oral cavity cancers, particularly tongue cancer, are prevalent in India.
  • Neck node involvement is a critical prognostic factor in tongue cancer survival.
  • Occult nodal metastasis necessitates elective neck dissection when metastasis risk exceeds 15-20%.

Purpose of the Study:

  • To identify factors influencing contralateral nodal metastasis (CLNM) in carcinoma of the tongue.
  • To evaluate the significance of tumor characteristics and extranodal extension in predicting CLNM.
  • To inform surgical decision-making regarding neck dissection in tongue cancer patients.

Main Methods:

  • Retrospective analysis of 149 patients with curative intent surgery for carcinoma of the tongue (April 2017 - March 2019).
  • Statistical analysis to determine factors associated with CLNM, including tumor stage, site, midline crossing, extranodal extension (ENE), and lymph node ratio.
  • Multivariate analysis to identify independent predictors of CLNM.

Main Results:

  • Thirteen patients (8.7%) presented with CLNM.
  • Advanced stage, floor of mouth involvement, and lesion crossing midline were associated with increased CLNM risk (p < 0.001).
  • Extranodal extension (p < 0.001) and ipsilateral lymph node ratio (p = 0.002) influenced CLNM. Multivariate analysis confirmed lesion crossing midline (p = 0.03) and ENE (p < 0.001) as significant predictors, with ENE increasing risk 12.8-fold.

Conclusions:

  • Contralateral nodal metastasis in tongue cancer is significantly influenced by the lesion crossing the midline and extranodal extension.
  • Clinical or radiological suspicion of nodal involvement, along with identified risk factors, warrants consideration for contralateral neck dissection.
  • These findings aid in optimizing surgical management and improving outcomes for tongue cancer patients.