Lymph node metastasis in cT1/T2 buccal mucosa squamous cell carcinoma: A subsite-specific study

Abstract

Objectives: To analyze the incidence of cervical lymph node metastasis in cT1/T2 buccal mucosa cancers, correlate it with the depth of invasion and study the percentage of occult metastasis. Through this study, we also attempt to look into subsite-specific buccal mucosa data which are lacking in literature and will help us improve the understanding of the disease. Materials and Methods: Retrospective analysis of the prospectively collected data of 109 patients with cT1/T2 buccal mucosa cancer operated from January 2018 to August 2019 was done. Information regarding the pathological T stage, depth of invasion, presence or absence of cervical node metastasis, occult metastasis, size of the metastatic lymph nodes, and the presence of extracapsular extension was collected from the final histopathology reports. Results: Twenty-five out of 109 (22.94%) patients had cervical node metastasis. Nine out of 93 (9.68%) clinically N0 patients had occult metastasis. No metastasis was observed for the patients with depth of invasion <4 mm. Of these 25 patients, 17 were pathologically staged T2 (68%), whereas 8 were staged T1 (32%). P value obtained by the Fisher's exact test was 0.003 and validated the hypothesis generated by our results. Conclusion: Through this study, we can conclude that the possibility of cervical node metastasis in cT1/T2 buccal mucosa cancers with depth of invasion <4 mm is negligible and the percentage of occult metastasis stands low. Our study also reflects the lack of robust data in context to early-stage buccal mucosa cancers and offers an insight on the importance of subsite specific research.