Aim: To compare radiological [Computed Tomography (CT)] tumour and nodal dimensions in head and neck and oral cancer with post-operative pathological status and explore the ramifications associated with disparity.

Materials and Methods: This prospective analytical study was conducted on a cohort of 90 patients with operable oral and head and neck cancer. Forty patients with head and neck cancer and 50 oral cancer patients were radiologically evaluated pre-operatively and assigned a clinical tumour, node and metastasis (TNM) staging, which was subsequently compared with the corresponding pathological TNM components.

Results: A significant comparative disparity was seen in 38 [42%] patients with relation to T category. Pathologically larger tumour dimensions were evidenced in both categories. Sixteen oral cancer patients and 16 patients with head and neck cancer had greater than 30% increase in tumour dimensions in the post-operative pathological staging. This did achieve statistical significance [p= 0.00]. The specificity of CT scan in defining low-risk nodal volumes [cNo Neck] was 76% for oral cancers and 53.8% in head and neck cancer subjects. The rate of false positives for both categories was fairly high, i.e., 48% and 37.9%, respectively.

Conclusion: By theoretically extrapolating the inferences of this study to situations where radiotherapy would be the primary treatment, our findingswould draw caution towards considering overtly conservative/uniform clinical tumour dimensions and estimating intermediate nodal target volumes at risk solely on the basis of CT-based evaluation.

Keywords: Advanced Head and Neck cancer, Computed tomography, Clinical target volumes, IMRT, TNM. 

1. Tuljapurkar V, Dhar H, Mishra A, Chakraborti S, Chaturvedi P, Pai PS. The Indian scenario of head and neck oncology–Challenging the dogmas. South Asian journal of cancer. 2016 Jul;5(3):105
2. Kidwai Memorial Institute of Oncology Department of Epidemiology & Biostatistics Hospital Based Cancer Registry Annual Report 2013 Pg 23-25
3. Grégoire V, Evans M, Le QT, Bourhis J, Budach V, Chen A, Eisbruch A, Feng M, Giralt J, Gupta T, Hamoir M. Delineation of the primary tumour Clinical Target Volumes (CTV-P) in laryngeal, hypopharyngeal, oropharyngeal and oral cavity squamous cell carcinoma: AIRO, CACA, DAHANCA, EORTC, GEORCC, GORTEC, HKNPCSG, HNCIG, IAG-KHT, LPRHHT, NCIC CTG, NCRI, NRG Oncology, PHNS, SBRT, SOMERA, SRO, SSHNO, TROG consensus guidelines. Radiotherapy and Oncology. 2018 Jan 1;126(1):3-24.
4. Paulson ES, Erickson B, Schultz C, Allen Li X. Comprehensive MRI simulation methodology using a dedicated MRI scanner in radiation oncology for external beam radiation treatment planning. Medical physics. 2015 Jan 1;42(1):28-39.
5. Hatt M, Lee JA, Schmidtlein CR, Naqa IE, Caldwell C, De Bernardi E, Lu W, Das S, Geets X, Gregoire V, Jeraj R. Classification and evaluation strategies of auto‐segmentation approaches for PET: report of AAPM Task Group No. 211. Medical physics. 2017 Jun 1;44(6).
6. Ligtenberg H, Jager EA, Caldas-Magalhaes J, Schakel T, Pameijer FA, Kasperts N, Willems SM, Terhaard CH, Raaijmakers CP, Philippens ME. Modality-specific target definition for laryngeal and hypopharyngeal cancer on FDG-PET, CT and MRI. Radiotherapy and Oncology. 2017 Apr 1;123(1):63-70.
7. Di Martino E, Nowak B, Hassan HA, Hausmann R, Adam G, Buell U et al. Diagnosis and staging of head and neck cancer: a comparison of modern imaging modalities (positron emission tomography, computed tomography, color-coded duplex sonography) with panendoscopic and histopathologic findings. Archives of Otolaryngology–Head & Neck Surgery. 2000 Dec 1;126(12):1457-61.
8. Mohamad R Chaaban “Management of the N0 Neck Workup”; https://emedicine.medscape.com/article/850469-workup accessed on 26th December 2017
9. Liao LJ, Lo WC, Hsu WL, Wang CT, Lai MS. Detection of cervical lymph node metastasis in head and neck cancer patients with clinically N0 neck—a meta-analysis comparing different imaging modalities. BMC cancer. 2012 Dec;12(1):236.
10. Koch WM, Ridge JA, Forastiere A, Manola J. Comparison of clinical and pathological staging in head and neck squamous cell carcinoma: results from Intergroup Study ECOG 4393/RTOG 9614. Archives of Otolaryngology–Head & Neck Surgery. 2009 Sep 1;135(9):851-8.
11. Biron VL, O’Connell DA, Seikaly H. The impact of clinical versus pathological staging in oral cavity carcinoma–a multi-institutional analysis of survival. Journal of Otolaryngology-Head & Neck Surgery. 2013 Apr 11;42(1):28.
12. Uribe S, Rojas LA, Rosas CF. Accuracy of imaging methods for detection of bone tissue invasion in patients with oral squamous cell carcinoma. Dentomaxillofacial Radiology. 2013 Apr 30;42(6):20120346.

Dr Bindhu Joseph, MD

Associate Professor, Department of Radiotherapy, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India

Phone Number: +919845280651, Email: This email address is being protected from spambots. You need JavaScript enabled to view it., This email address is being protected from spambots. You need JavaScript enabled to view it.