Analysis of metastatic lymph nodes in oral squamous cell carcinoma patients and its correlation with treatment outcome and nodal recurrence / Vethanayaki Kanagaraja

Vethanayaki , Kanagaraja (2024) Analysis of metastatic lymph nodes in oral squamous cell carcinoma patients and its correlation with treatment outcome and nodal recurrence / Vethanayaki Kanagaraja. Masters thesis, Universiti Malaya.

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Abstract

Introduction: Oral squamous cell carcinoma (OSCC) frequently metastasizes to cervical lymph nodes with recurrence rate of approximately 30%. Understanding the dynamics of lymph node metastasis in OSCC is essential for improving prognostic accuracy and developing targeted therapies. Objectives: To analyse the clinicopathological features of lymph nodes in OSCC patients having metastatic and non-metastatic lymph nodes and correlate these findings with treatment modalities and post-operative outcome, specifically nodal recurrence. Materials and Methods: This is a retrospective cohort study, 52 cases diagnosed with OSCC and surgically treated with neck dissection in the Oral Surgery Clinic, Department of Oral and Maxillofacial Clinical Science, Faculty of Dentistry, Universiti Malaya, between 2009 and 2018. The haematoxylin and eosin (H & E) slides were retrieved from departmental archives. In cases of missing or faded slides, new sections are obtained from existing paraffin blocks and stained using standard H&E staining procedures. The sociodemographic, clinical, and histopathological features of metastatic and non-metastatic lymph nodes as well as treatment modalities and nodal recurrence were analysed. Results: A total of 52 OSCC patients with a mean age of 55.63 with a female gender predilection were observed in this study. A total of 104 lymph nodes were histologically evaluated. Out of all, 52 lymph nodes were positive for metastasis, and 52 were non-metastatic nodes. The most frequently encountered lymph node pattern was of lymphocytes predominant (32.7%), followed by germinal centre predominance (23.7%), vascular transformation of sinuses (23.1%), sinus histiocytosis (9.6%), lymphocyte depletion (9.0%), and giant cell response (1.9%). Germinal centre predominance and vascular transformation of sinuses demonstrated notable correlations with metastatic lymph nodes. Nodal recurrence occurred in only 3 out of 52 patients. The recurrence was predominantly observed at neck levels II and V. Conclusion: This study reveals key histopathological features of metastatic and non-metastatic lymph nodes in OSCC patients, including features such as germinal centre predominance, vascular transformation of sinuses, lymphocyte depletion, and giant cell response. There is a potential correlation between the levels of neck dissection and the occurrence of metastatic lymph nodes, with bilateral level I-III dissections showing a higher number of metastatic nodes compared to unilateral level I-III dissections. The findings also suggest a possible association between metastatic lymph node levels and the grade of tumour deposits within the nodes. Notably, well-differentiated and moderately differentiated tumour deposits were more commonly found in levels I-III compared to levels IV-V.

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