Cervical Lymph Node Metastases in Oral Squamous Cell Carcinoma-How Much Imaging Do We Need?

Nonmetastatic Lymph Node Histological Architecture Is Associated With Metastasis, Recurrence, and Survival in Oral Squamous Cell Carcinoma

INTRODUCTION

Oral squamous cell carcinoma (OSCC) is a common cancer, with a high propensity for regional lymph node metastasis (LnM), resulting in 5-year survival rates of only 40%-50%. The premetastatic niche (PMN), a modified lymph node microenvironment preparing for future metastasis, is poorly understood. This study analyzes the histomorphological features of nonmetastatic lymph nodes from OSCC patients, stratified by the presence or absence of regional cervical LnM.

METHODS

This cohort study examined 424 nonmetastatic lymph nodes, preserved in paraffin blocks, from 45 OSCC patients. Histological analysis was performed using hematoxylin and eosin staining to evaluate architectural features, specifically capsule and trabeculae thickness, subcapsular and medullary sinus ectasia, fibrosis, follicular organization, and hyperplasia. Logistic regression models were used to assess the relationships between these features and LnM, recurrence, and survival.

RESULTS

Our analysis revealed that intense medullary ectasia was associated with an increased risk of lymph node metastasis (LnM) (OR = 1.63; 95% CI: 0.99-2.67; p = 0.051), whereas follicular hyperplasia appeared protective (OR = 0.27; 95% CI: 0.15-0.5; p < 0.001). Nonvisible sinusoidal trabeculae suggested a higher risk of recurrence (OR = 2.18; 95% CI: 0.99-4.81; p = 0.05). Disorganized lymphoid follicles (OR = 1.91; 95% CI: 0.97-3.77; p = 0.059), focal subcapsular ectasia (OR = 4.4; 95% CI: 1.34-14.37; p = 0.014) and marked subcapsular ectasia (OR = 3.2; 95% CI: 1.06-9.63; p = 0.038) correlated with decreased survival. Conversely, follicular hyperplasia (OR = 0.38; 95% CI: 0.19-0.74; p = 0.005) and medullary fibrosis (OR = 0.13; 95% CI: 0.02-0.67; p = 0.015) were associated with improved survival.

CONCLUSION

These results highlight the potential clinical significance of follicular hyperplasia in lymph nodes. Patients exhibiting this feature may have a more favorable prognosis, characterized by increased survival and decreased risk of lymph node metastasis, regardless of concurrent alterations in other lymph node architecture.

Comparing the Efficacy of CT, MRI, PET-CT, and US in the Detection of Cervical Lymph Node Metastases in Head and Neck Squamous Cell Carcinoma with Clinically Negative Neck Lymph Node: A Systematic Review and Meta-Analysis

Background: Traditional imaging techniques have limited efficacy in detecting occult cervical lymph node (LN) metastases in head and neck squamous cell carcinoma (HNSCC). Positron emission tomography/computed tomography (PET-CT) has demonstrated potential for assessing HNSCC, but the literature on its efficacy for detecting cervical LN metastases is scarce and exhibits varied outcomes, hindering comparisons. Aim: To compare the efficacy of CT, MRI, PET-CT, and US for detecting LN metastasis in HNSCC with clinically negative neck lymph nodes. Methods: A systematic search was performed using Web of Science, PubMed, Scopus, Embase, and Cochrane databases. Studies comparing CT, MRI, PET-CT, or US to detect cervical metastases in HNSCC were identified. The quality of the studies was assessed using the QUADAS-2 instrument. The positive likelihood ratios (+LR) and negative likelihood ratios (-LR), sensitivity (SEN), specificity (SPE), and diagnostic odds ratio (DOR), with 95% confidence intervals (C.I.), were calculated. Analysis was stratified according to lymph node and patient basis. Results: Fifty-seven studies yielded 3791 patients. At the patient level, PET-CT exhibited the highest diagnostic performance, with a SEN of 74.5% (95% C.I.: 65.4-81.8%) and SPE of 83.6% (95% C.I.: 77.2-88.5%). PET-CT also demonstrated the highest +LR of 4.303 (95% C.I.: 3.082-6.008) and the lowest -LR of 0.249 (95% C.I.: 0.168-0.370), resulting in the highest DOR of 15.487 (95% C.I.: 8.973-26.730). In the evaluation of diagnostic parameters for various imaging modalities on node-based analysis results, MRI exhibited the highest SEN at 77.4%, and PET demonstrated the highest SPE at 96.6% (95% C.I.: 94.4-98%). PET-CT achieved the highest DOR at 24.353 (95% C.I.: 10.949-54.166). Conclusions: PET-CT outperformed other imaging modalities across the majority of studied metrics concerning LN metastasis detection in HNSCC.

Head and Neck Squamous Cell Carcinoma: Insights from Dual-Energy Computed Tomography (DECT)

Head and neck cancer represents the seventh most common neoplasm worldwide, with squamous cell carcinoma being the most represented histologic variant. The rising incidence of the neoplastic pathology of this district, coupled with the drastic changes in its epidemiology over the past decades, have posed significant challenges to physicians worldwide in terms of diagnosis, prognosis, and treatment. In order to meet these challenges, a considerable amount of effort has been spent by the authors of the recent literature to explore new technologies and their possible employment for the better diagnostic and prognostic definition of head and neck squamous cell carcinoma (HNSCC). Among these technologies, a growing interest has been gathering around the possible applications of dual-energy computed tomography (DECT) in head and neck pathology. Dual-energy computed tomography (DECT) utilizes two distinct X-ray energy spectra to obtain two datasets in a single scan, allowing for material differentiation based on unique attenuation profiles. DECT offers key benefits such as enhanced contrast resolution, reduced beam-hardening artifacts, and precise iodine quantification through monochromatic reconstructions. It also creates material decomposition images, like iodine maps, aiding in tumor characterization and therapy assessment. This paper aims to summarize recent findings on the use of DECT in HNSCC, providing a comprehensive overview to aid further research and exploration in the field.

Predictors of Occult Metastasis and Prognostic Factors in Patients with cN0 Oral Cancer Who Underwent Elective Neck Dissection

Elective neck dissection (END) is recommended for the management of patients with oral squamous cell carcinoma (OSCC) because of the risk of occult metastasis (OM). We hypothesized that some factors predict poor prognosis regardless of a cN0 END. This study aimed to investigate the predictors of OM and prognostic factors in patients with cN0 OSCC who underwent supraomohyoid neck dissection (SOHND). A retrospective cohort study design was created and implemented. The primary predictive variables in this study were OM and risk factors for poor prognosis after SOHND. A Cox proportional hazard model was used to adjust for the effects of potential confounders on the risk factors for poor prognoses. Among 86 patients with OSCC, OMs were observed in 9 (10.5%). The neutrophil-to-lymphocyte ratio (NLR) and vascular invasion are good markers for detecting OM. A Cox multivariable analysis identified two independent predictors of overall survival: pathologic node (pN) and laterality of END. An independent predictive factor for disease-free survival, the surgical margin, was also identified in this study. According to the pN classification, pN1 patients had a worse survival rate than pN2 patients. Therefore, in the case of pN1, regardless of being cN0, additional adjuvant therapy may be necessary.

Radiomics from dual-energy CT-derived iodine maps predict lymph node metastasis in head and neck squamous cell carcinoma

OBJECTIVE

To develop and validate an iodine maps-based radiomics nomogram for preoperatively predicting cervical lymph node metastasis (LNM) in head and neck squamous cell carcinoma (HNSCC).

MATERIALS AND METHODS

A total of 278 patients who pathologically confirmed as HNSCC were retrospectively recruited from two medical centers between June 2012 and July 2022. The training set (n = 152) and internal set (n = 67) were randomly selected from medical center A, and the patients from medical center B were enrolled as the external set (n = 69). The minority group in the training set was balanced by the adaptive synthetic sampling (ADASYN) approach. Radiomics features were extracted from dual-energy CT-derived iodine maps at arterial phase (AP) and venous phase (VP), respectively. Three radiomics signatures were constructed to predict the LNM by using a random forest algorithm. The independent clinical predictors for LNM were identified by multivariate analysis and combined with radiomics signatures to establish a radiomic-clinical nomogram. The performance of radiomic-clinical nomogram was evaluated with respect to its discrimination and clinical usefulness.

RESULTS

The AP-VP-incorporated radiomics model exhibited a great predictive performance for LNM prediction with an area under curve (AUC) of 0.885 (95% CI, 0.836-0.933) in ADASYN-training set and confirmed in all validation sets. The nomogram that incorporated AP-VP radiomics signatures, CT-reported LN status, and histological grades yielded AUCs of 0.920 (95% CI, 0.881-0.959) in ADASYN-training set, 0.858 (95% CI, 0.771-0.944) in internal validation, and 0.849 (95% CI, 0.752-0.946) in external validation, with good calibration in all cohorts (p > 0.05). Decision curve analyses indicated the nomogram was clinically useful. In addition, the predictive performance of clinical-radiomics nomogram was also validation in combing cohorts. Stratified analysis confirmed the stability of nomogram, particularly in group negative for CT-reported LNM.

CONCLUSION

Clinical-radiomics nomogram based on iodine maps exhibited promising performance in predicting LNM and providing valuable information for making individualized therapy decisions.

Comparing three-dimensional and two-dimensional deep-learning, radiomics, and fusion models for predicting occult lymph node metastasis in laryngeal squamous cell carcinoma based on CT imaging: a multicentre, retrospective, diagnostic study

Background

The occult lymph node metastasis (LNM) of laryngeal squamous cell carcinoma (LSCC) affects the treatment and prognosis of patients. This study aimed to comprehensively compare the performance of the three-dimensional and two-dimensional deep learning models, radiomics model, and the fusion models for predicting occult LNM in LSCC.

Methods

In this retrospective diagnostic study, a total of 553 patients with clinical N0 stage LSCC, who underwent surgical treatment without distant metastasis and multiple primary cancers, were consecutively enrolled from four Chinese medical centres between January 01, 2016 and December 30, 2020. The participant data were manually retrieved from medical records, imaging databases, and pathology reports. The study cohort was divided into a training set (n = 300), an internal test set (n = 89), and two external test sets (n = 120 and 44, respectively). The three-dimensional deep learning (3D DL), two-dimensional deep learning (2D DL), and radiomics model were developed using CT images of the primary tumor. The clinical model was constructed based on clinical and radiological features. Two fusion strategies were utilized to develop the fusion model: the feature-based DLRad_FB model and the decision-based DLRad_DB model. The discriminative ability and correlation of 3D DL, 2D DL and radiomics features were analysed comprehensively. The performances of the predictive models were evaluated based on the pathological diagnosis.

Findings

The 3D DL features had superior discriminative ability and lower internal redundancy compared to 2D DL and radiomics features. The DLRad_DB model achieved the highest AUC (0.89-0.90) among all the study sets, significantly outperforming the clinical model (AUC = 0.73-0.78, P = 0.0001-0.042, Delong test). Compared to the DLRad_DB model, the AUC values for the DLRad_FB, 3D DL, 2D DL, and radiomics models were 0.82-0.84 (P = 0.025-0.46), 0.86-0.89 (P = 0.75-0.97), 0.83-0.86 (P = 0.029-0.66), and 0.79-0.82 (P = 0.0072-0.10), respectively in the study sets. Additionally, the DLRad_DB model exhibited the best sensitivity (82-88%) and specificity (79-85%) in the test sets.

Interpretation

The decision-based fusion model DLRad_DB, which combines 3D DL, 2D DL, radiomics, and clinical data, can be utilized to predict occult LNM in LSCC. This has the potential to minimize unnecessary lymph node dissection and prophylactic radiotherapy in patients with cN0 disease.

Funding

National Natural Science Foundation of China, Natural Science Foundation of Shandong Province.

Diagnostic accuracy of contrast-enhanced computed tomography in assessing cervical lymph node status in patients with oral squamous cell carcinoma

OBJECTIVE

Accurate preoperative prediction of lymph node (LN) status plays a pivotal role in determining the extension of neck dissection (ND) required for patients with oral squamous cell carcinoma (OSCC). This study aims to evaluate the diagnostic accuracy of contrast-enhanced computed tomography (CT) in detecting LN metastases (LNMs) and to explore clinicopathological factors associated with its reliability.

METHODS

Data from 239 patients with primary OSCC who underwent preoperative CT and subsequent radical surgery involving ND were retrospectively reviewed. Suspicious LNs were categorized into three groups: accentuated (< 10 mm), enlarged (≥ 10 mm), and melted. Statistical analysis encompassing correlation and comparative analysis, and determination of sensitivity, specificity, PPV, and NPV were performed.

RESULTS

Overall, sensitivity was significantly higher in the accentuated LNs group (83.54%) compared to the melted LNs group (39.24%, p < 0.05, t test). Conversely, specificity was significantly higher in the melted LNs group (98.19%) compared to the accentuated LNs group (55.15%, p < 0.05, t test). Accentuated LNs exhibited a false negative rate of 13.00%. False positive rates were 51.80%, 30.26% and 8.82%, respectively. Diagnostic accuracy for detecting LNMs in level IIa and IIb exceeded that of level III. Patients with solely accentuated LNs were more likely to have a small, well-differentiated tumor. However, no distinctions emerged in terms of the occurrence of T4 tumors among the three groups.

CONCLUSION

CT proves sufficient to predict LNMs in patients with OSCC. Looking ahead, the potential integration of artificial intelligence and deep learning holds promise to further enhance the reliability of CT in LNMs detection. However, this prospect necessitates further investigation.

Diagnostic Accuracy of Up-Front PET/CT and MRI for Detecting Cervical Lymph Node Metastases in T1-T2 Oral Cavity Cancer-A Prospective Cohort Study

The diagnostic accuracy of up-front 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for detecting cervical lymph node metastases in patients with T1-T2 oral squamous cell carcinoma is reported with large discrepancies across the literature. We investigated the sensitivity, specificity, positive and negative predictive value, and accuracy of up-front PET/CT for detecting cervical lymph node metastases in this patient group and compared the performance to magnetic resonance imaging (MRI). In this prospective cohort study, 76 patients with T1-T2 oral squamous cell carcinoma underwent an up-front PET/CT and MRI at the Odense University Hospital from September 2013 to February 2016. Sentinel node biopsy and elective neck dissection were used for histopathological verification of the imaging modalities. Up-front PET/CT was significantly more sensitive than neck MRI (74% vs. 27%, p = 0.0001), but less specific (60% vs. 88%, p = 0.001). The accuracy of PET/CT and neck MRI was comparable (66% vs. 63%, p = 0.85), the PPV was slightly in favor of neck MRI (56% vs. 62%, p = 0.73), the NPV was slightly in favor of PET/CT (77% vs. 63%, p = 0.16). Neither PET/CT nor neck MRI should stand alone for N-staging T1-T2 oral cavity cancer.

A preoperative nomogram model for the prediction of lymph node metastasis in buccal mucosa cancer

OBJECTIVES

We sought to construct a nomogram model predicting lymph node metastasis (LNM) in patients with squamous cell carcinoma of the buccal mucosa based on preoperative clinical characteristics.

METHODS

Patients who underwent radical resection of a primary tumor in the buccal mucosa with neck dissection were enrolled. Clinical characteristics independently associated with LNM in multivariate analyses were adopted to build the model. Patients at low risk of LNM were defined by a predicted probability of LNM of less than 5%.

RESULTS

Patients who underwent surgery in an earlier period (January 2015-November 2019) were defined as the model development cohort (n = 325), and those who underwent surgery later (November 2019-March 2021) were defined as the validation cohort (n = 140). Age, tumor differentiation, tumor thickness, and clinical N stage assessed by computed tomography/magnetic resonance imaging (cN) were independent predictors of LNM. The nomogram model based on these four predictors showed good discrimination accuracy in both the model development and validation cohorts, with areas under the receiver-operating characteristic curve (AUC) of 0.814 and 0.828, respectively. LNM prediction by the nomogram model was superior to cN in AUC comparisons (0.815 vs. 0.753) and decision curve analysis of the whole cohort. Seventy-one patients were defined as having a low risk of LNM, among whom the actual metastasis rate was only 1.4%.

CONCLUSIONS

A robust nomogram model for preoperative LNM prediction is built.

The role of magnetic resonance imaging and computed tomography in oral squamous cell carcinoma patients' preoperative staging

INTRODUCTION

The aim of the study was to evaluate the accuracy of MRI and CT with regard to the detection of lymph node metastases based on the data of specific patients with OSCC who received bilateral neck dissection.

MATERIALS AND METHODS

In a retrospective analysis from 01/2014 to 12/2020 patients who underwent primary tumor resection and bilateral neck dissection were evaluated.

RESULTS

174 preoperative MRI (78.74%, N=137) and CT (21.26%, N=37) were correlated with the histopathological findings. CT had a sensitivity of 67% and specificity of 68% (p=0.76). MRI showed an overall sensitivity of 66% and a specificity of 68% (p=0.76). In 52.87% of all cases no differences between cN and pN were found. MRI is the method to overestimate lymph node involvement compared to CT (overestimation in 27% vs. 21.62%).

CONCLUSION

The current data indicate that MR and CT show poor efficacy in the detection of cervical metastases. Accordingly, attention must be paid to alternatives to correct local staging modalities. The application of structured bilateral neck dissection needs to be questioned.

Preoperative Prediction of the Aggressiveness of Oral Tongue Squamous Cell Carcinoma with Quantitative Parameters from Dual-Energy Computed Tomography

OBJECTIVES

To determine whether quantitative parameters derived from dual-energy computed tomography (DECT) were predictive of the aggressiveness of oral tongue squamous cell carcinoma (OTSCC) including the pathologic stages, histologic differentiation, lymph node status, and perineural invasion (PNI).

METHODS

Between August 2019 and March 2021, 93 patients (mean age, 54.6 ± 13.8 years; 66 men) with pathologically diagnosed OTSCC were enrolled in this prospective study. Preoperative DECT was performed and quantitative parameters (e.g., slope of the spectral Hounsfield unit curve [λHu], normalized iodine concentration [nIC], normalized effective atomic number [nZeff], and normalized electron density [nRho]) were measured on arterial phase (AP) and venous phase (VP) DECT imaging. Quantitative parameters from DECT were compared between patients with different pathologic stages, histologic differentiation, lymph node statuses, and perineural invasion statuses. Logistic regression analysis was utilized to assess independent parameters and the diagnostic performance was analyzed by the receiver operating characteristic curves (ROC).

RESULTS

λHu and nIC in AP and λHu, nZeff, and nIC in VP were significantly lower in stage III-IV lesions than in stage I-II lesions (p < 0.001 to 0.024). λHu in VP was an independent predictor of tumor stage with an odds ratio (OR) of 0.29, and area under the curve (AUC) of 0.80. λHu and nIC were higher in well-differentiated lesions than in poorly differentiated lesions (p < 0.001 to 0.021). The nIC in VP was an independent predictor of histologic differentiation with OR of 0.31, and AUC of 0.78. λHu and nIC in VP were lower in OTSCCs with lymph node metastasis than those without metastasis (p < 0.001 to 0.005). λHu in VP was the independent predictor of lymph node status with OR of 0.42, and AUC of 0.74. No significant difference was found between OTSCCs without PNI and those with PNI in terms of the quantitative DECT parameters.

CONCLUSION

DECT can be a complementary means for the preoperative prediction of the aggressiveness of OTSCC.

Extent of Neck Dissection and Cervical Lymph Node Involvement in Oral Squamous Cell Carcinoma

Introduction

Tumor resection combined with neck dissection (ND) or radiotherapy are established methods for the treatment of patients with oral squamous cell carcinoma (OSCC). However, the extent of ND can lead to postoperative complications. Therefore, for the first time, this study aims to identify lymph node involvement in OSCC performed in a bilateral systematic approach based on oncologic board meetings relying on presurgical magnetic resonance imaging (MRI) and computed tomography (CT).

Materials and Methods

In a retrospective single-center study, patients with primary OSCC resection and systematic ND performed in 4 different manners (MRND III bilateral, MRND III left and SND right, MRND III right, SND left, and SND bilateral) were examined. Lymph node involvement allocated to levels was evaluated depending on primary localization and T-stage.

Results

A total of 177 consecutive patients (mean age 63.64; 92 female, male 85) were enrolled in this study. A total of 38.98% showed cervical lymph node involvement, and metastases were found in levels 1–4. The distribution of positive lymph node metastases (n=190 LNs) was 39.47% in level 1, 38.95% in level 2, 10.53% in level 3, and 11.05% in level 4.

Discussion

In a cohort of OSCC patients with systematic bilateral ND, levels 1 and 2 had positive lymph node involvement, and no lymph node involvement was seen at level 5. Without any clinical or imaging suspicion, ND expanding 5-level MRND should be avoided regardless of the primary tumor localization, T-stage and intraoperative proof of cervical metastases.

Image Fusion Improves Interdisciplinary Communication in the Treatment of Head and Neck Cancer

INTRODUCTION

The diagnosis and therapy of oral squamous cell carcinoma (Osee) in Germany is according to guidelines and relies on interdisciplinary board meetings. Standard examination techniques are computed tomography (CT) and magnet resonance imaging (MRI). These technologies are used as objective tools for serial presentation in an oncologic board meeting. The presentation of multiple series at different time points can be time consuming and might not often depict a patients case clearly for all involved disciplinaries. A conclusive image fusion could improve the communication. Thus, this study aims to introduce a novel idea of image fusion into the field of craniomaxillofacial surgery in order to ease understanding and improve therapy in complex Osee patients' cases.

MATERIALS AND METHODS

Three key data sets of a patient with OSCC at the right tongue have been merged by image fusion of 3 MRi of head and neck with 3 CT thorax and abdomen using Syngo via (Siemens). Fused images were used as at a glance picture for presenting and discussion a patients case. Focus was on presenting a case of a primary manifestation of OSCC with the potential of a local relapse and distant metastases in an interdisciplinary oncol-ogic board meeting.

RESULTS

Image fusion enabled to visualize the primary tumor, local relapse as well as distant pulmonary metastasis and within the suprarenal gland, which have been occurred in a linear time line of 13 months.

DISCUSSION

Image fusion of different modalities that is CT and MRi, which were gathered at different time points, presents a new approach within the field of craniomaxillofacial surgery and helped to understand cancer localization and relapse at 1 glance. This new approach will enable a compact data set of patients oncological history as a more decisive tool for all involved disciplinaries.

CONCLUSIONS

Image fusion might have the potential to become a standard approach in order to ease multiple therapists to make therapy decisions in oncologic board meetings on basis of current three-dimensional ready CT imaging and MRI.

A robust and interpretable gene signature for predicting the lymph node status of primary T1/T2 oral cavity squamous cell carcinoma

Oral cavity squamous cell carcinoma (OSCC) affects more than 30 000 individuals in the United States annually, with smoking and alcohol consumption being the main risk factors. Management of early-stage tumors usually includes surgical resection followed by postoperative radiotherapy in certain cases. The cervical lymph nodes (LNs) are the most common site for local metastasis, and elective neck dissection is usually performed if the primary tumor thickness is greater than 3.5 mm. However, postoperative histological examination often reveals that many patients with early-stage disease are negative for neck nodal metastasis, posing a pressing need for improved risk stratification to either avoid overtreatment or prevent the disease progression. To this end, we aimed to identify a primary tumor gene signature that can accurately predict cervical LN metastasis in patients with early-stage OSCC. Using gene expression profiles from 189 samples, we trained K-top scoring pairs models and identified six gene pairs that can distinguish primary tumors with nodal metastasis from those without metastasis. The signature was further validated on an independent cohort of 35 patients using real-time polymerase chain reaction (PCR) in which it achieved an area under the receiver operating characteristic (ROC) curve and accuracy of 90% and 91%, respectively. These results indicate that such signature holds promise as a quick and cost effective method for detecting patients at high risk of developing cervical LN metastasis, and may be potentially used to guide the neck treatment regimen in early-stage OSCC.

Pretreatment Blood Markers in the Prediction of Occult Neck Metastasis: A 10-Year Retrospective Study

Introduction

The purpose of this study was to clarify the role of inflammatory blood markers in the management of early-stage (T1-T2) oral squamous cell carcinoma (OSCC) of the tongue in patients with a clinically negative neck. 

Materials and methods

We undertook a retrospective chart review of 102 patients with early-stage OSCC of the tongue, subjected to tumor resection and elective neck dissection. Based on postsurgical histopathological examination results, we divided our cohort into pN+ and pN0 groups. Afterwards, we analyzed the role of pretreatment inflammatory blood markers in predicting occult neck metastasis. We also evaluated neutrophil-lymphocyte ratio (NLR) association with the depth of invasion (DOI) of the primary tumor.

Results

We found a significant association of NLR (p=0.001) and monocyte-lymphocyte ratio (p=0.011) with neck status on univariate analysis. Multivariate analysis showed that only NLR (p=0.02) was an independent risk factor for occult metastasis among inflammatory blood markers. Receiver Operating Characteristic curve analysis and Younden’s Index determined the NLR value of 2.96 as the most adequate cut-off value for neck status prediction. NLR values of pretreatment workup also had a significant association with the DOI of the primary tumor (p=0.018).

Conclusion

Our study supports the role of pretreatment NLR in predicting occult neck metastasis in early-stage OSCC of the tongue. It also sheds some light over the potential of NLR as a predictor of the primary tumor’s DOI.