Clinical And Pathological Analysis Between Primary Focuses In Squamous Cell Carcinoma Of Tongue And Cervical Lymph Node Metastasis

Objective:To explore the preoperative evaluation value of intraoral ultrasonography for tongue cancer and the relationship between tumor invasive depth and cervical lymph node metastasis as well as extracapsular spread in tongue cancer. To study the relationship between different patterns of invasion of the tongue tumor and lymph node metastasis as well as extracapsular spread.Methods:We collected 29 patients with tongue cancer treated by combined radical operation of jaw and neck in the Department of Stomatology ,the Second Xiangya Hospital of Central South University from Oct 2008 to Apr 2009.We selected 11 patients willing to do intraoral ultrasonography preoperation, to measure tumor invasive depth. We measured the tumor depth of resction of primary after operation by naked eye, collected lymph node according to the region of cervical part, and recorded the size following 5mm,5-10mm,≥10mm,then sent the specimen to the Department of Pathology. Pattern of invasion described by Anneroth was used to evaluate the malignance grade of tongue cancer and measure histological depth of the primarily tumor(Pointed fixedly by Ocular-micrometer,reconstructed normal mucosa,measured the distance from the surface of the tumor to the deepest point of invasion).Then compared tumor invasive depth measured by intraoral ultrasonography with histological depth and analysis their correlation.Results:1. Compared tumor invasive depth measured by intraoral ultrasonography with histological invasive depth, it was statistically significant (p<0.05),meanwhile,we found that there was correlation between them(r=0.693,p<0.05). Compared the tumor depth of resction of primary after operation by naked eye with histological invasive depth, it was statistically significant(p<0.001), their correlation was significant(r=0.925,p<0.001).2. The rate of neck lymph node metastasis was 41.4%(12/29). Patients with tumor depth in primary < 8 mm had 21.4% nodal metastasis, tumor depth≥8 mm had 60% nodal metastasis, there was statistically significant between them(p<0.05).3. The lymph nodes metastasis rate in the different group of patterns of invasion I ,II, III and IV were 0, 8.3%, 61.5%, 100% respectively. There were relationship between different patterns of invasion and cervical lymph nodes metastasis(P<0.05).4. The number of the diameter of cervical lymph nodes(the most diameter)≤5mm,5-10mm and≥10mm were 552, 451 and 100 respectively, the lymph nodes metastasis rate of them was 0.5%,3.8% and 16.0% respectively. There was statistically significant between them(p<0.001) .We found that 9 lymph nodes of the metastases were extracapsular spread, their diameters were all more than 5mm.We found that the diameter of lymph nodes and extracapsular spread was correlative(p<0.001).Conclusion:1 .It was important value of intraoral ultrasonography in measuring tumor depth before operation, which is helpful for operation plan.2. It was positive relationship between the tongue tumor invasive depth and cervical lymph node metastasis. To those histological invasive depth≥8mm,as the higher cervical lymph node metastasis,we should commomly resect the primary tumor extensively and carry out therapeutic neck dissection simultaneously.3. The patterns of invasion III and IV had the higher chances of cervical lymph node metastasis.4. It was positive relationship between the diameter of cervical lymph nodes and cervical lymph node metastasis, we considered it was an important parameter of evaluating cervical lymph node metastasis.