Evaluation of Occult Lymph Node Metastases in Cases of T1 and T2 Tongue Squamous Cell Carcinoma

Background: Squamous cell carcinoma (SCC) is associated with a high risk for lymph node (LN) metastases even for T1 and
T2 patients even in clinically and radiologically negative neck. However, little data are provided in the literature about each
type separately.
Objectives: therefore, the current study tries to present more specific data about the level of LN metastases for each stage.
Material and methods: This is a retrospective study that was conducted on 67 patients diagnosed with tongue SCC. Patients’
records were reviewed who were previously untreated T1 or T2 patients and were operated by radical resection of the primary
tumour and neck dissection (level I-IV). cases woth multiple tumours or recurrent or with distant metastases were excluded.
The level of LN metastases was evaluated and compared to clinical and histopathological data.
Results: T1 patients showed positive cLN up to level IB with occult LN metastases up to level III, T2 patients had clinically
positive LN metastases up to level II, but occult metastases up to level IV. In T1 and T2 patients with cLN0, the occult
involvement extended to level II. (not statistically significant). However, primary tumours with more than 3mm depth of
penetration were associated with pathologically positive LN metastases.
Conclusion: The distal-most level for occult LN metastases can be at least two levels ahead of the last clinically detectable
evidence of the disease, however not statistically significant. Nevertheless, the depth of invasion is more important predictor
for LN metastases rather than the size of the primary lesion.