Clinical, Radiological and Histological Features and Their Association with Extranodal Extension in Buccoalveolar...

Area of Science:

• Oncology
• Radiology
• Head and Neck Surgery

Background:

• Extranodal extension (ENE) is a critical prognostic factor in head and neck cancers, significantly impacting patient survival.
• Accurate preoperative detection of ENE in buccoalveolar complex squamous cell carcinoma (BAOSCC) remains challenging, influencing treatment decisions and outcomes.

Purpose of the Study:

• To evaluate the diagnostic efficacy of clinical examination, intraoperative findings, and contrast-enhanced computed tomography (CECT) for detecting ENE in BAOSCC.
• To identify factors associated with ENE and assess their impact on survival outcomes in BAOSCC patients.

Main Methods:

• A retrospective cohort study involving 137 BAOSCC patients treated between May 2019 and April 2021.
• Comparison of preoperative clinical examination, CECT, and intraoperative findings against postoperative histopathology for ENE detection.
• Statistical analysis using logistic regression and chi-square tests to evaluate factors influencing ENE and Kaplan-Meier curves for survival analysis.

Main Results:

• The overall prevalence of ENE was 18.98%. CECT demonstrated higher sensitivity (73.1%) than clinical (34.6%) or intraoperative (46.2%) examination for ENE detection.
• Intraoperative examination showed the highest specificity (93.7%) for ENE. Clinical factors like nodal size ≥ 3 cm, fixity, and number of nodes were significantly associated with ENE.
• Patients with ENE had significantly poorer survival rates (23.2%) compared to those with metastatic nodes without ENE (53.3%) and node-negative patients (86.4%) after an 18-month follow-up.

Conclusions:

• Clinical examination, particularly nodal size ≥ 3 cm and ≥ 2 nodes, can serve as an adjunct to radiological imaging for preoperative ENE prediction.
• CECT is a valuable tool for detecting ENE, while intraoperative findings offer high specificity.
• ENE is a strong predictor of recurrence and poor prognosis in BAOSCC, underscoring the need for accurate preoperative assessment.