الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background: Lymph node metastases of HNSCC is frequent up to 50% at initial presentation and considered one of the most important negative prognostic factors, resulting in decreased survival by at least 50%. The successful management of the neck is one of the main pillars in the treatment of HNSCC. Biological behavior of oral squamous cell carcinoma (OSCC) is uncertain and may be aggressive even in early stages because of high lymphatic drainage of oral cavity. So, neck management either by elective neck dissection (END) or elective radiotherapy is recommended in early stages OSCC. Aim of the work: The aim of the study is to detect the rate of nodal micro metastasis, predictors of nodal metastasis and its impact on tumor recurrence Patients and Methods: This is a prospective descriptive study where 33 patients of early HNSCC from the Oncology Center Mansoura University underwent elective neck dissection after excision of primary tumor. Results: Initial pathological assessment by hematoxylin & eosin of dissected nodes detected macro metastasis in 7 cases. Further evaluation by IHC and micro slicing detected 5 cases of nodal micro metastasis. All cases with micro metastasis were initially pathologically N0. On the other hand, reassessment by IHC for patients with macro metastasis did not reveal any further micro metastatic deposits. Correlation between nodal metastasis and patients/tumor characteristics including all patients with macro and micro metastasis (n=12) revealed that the only significant predictor of nodal metastasis is depth of invasion while there is no statistically significant association between other risk factors and occurrence of nodal metastasis results among studied cases. Conclusions: Elective neck dissection limited the under staged cases; however, there are still a group of accurately staged patients whom overall behavior and disease-free survival (DFS) are not clearly understood. Depth of invasion and tumor thickness both till now are the best predictor for lymph node metastasis; however, this is not correlated to overall survival and outcome, further studies are needed for comprehensive multivariant assessment on larger multicenter study groups to explain this unpredictable pattern of behavior for this peculiar group of patients.