Comparative analysis of clinical and pathological lymph node staging data in HNSCC patients treated at the General Hospital Vienna with results from the literature

Objective : Results from publications evaluating discrepancies between clinical staging data in relation to pathological findings demonstrate that a significant number of head and neck squamous cell carcinoma (HNSCC) patients are not correctly staged. The aim of this retrospective study was to analyze potential discrepancies of radiological assessment versus pathological data of regional lymph node involvement and to compare the results with data published in the literature. Study design: In a retrospective analysis we focused on patients with HNSCC routinely treated by surgery plus PORT between 2002 and 2012. Setting: For inclusion, complete pre-operative clinical staging information with lymph node status and patho-histological information on involved lymph node regions as well as survival outcome data were mandatory. Subjects and Methods: We included 87 patients (UICC stage III-IV 90.8%) for which the aforementioned criteria obtained by CT or MRI were available.Overall survival rates were estimated by the Kaplan–Meier method. The Pearson correlation coefficient and Spearman`s rank correlation coefficient (non-linear relationship) was calculated. Results: Discrepancies at the level of overall tumor stage assessment were noticed in 27.5% of all cases. Thereof, 5.7% were assigned to patho-histological up-staging or down-staging of the primary tumor. At the lymph node level, 11.5 % of the patients were downstaged, and 10.3% were upstaged. Conclusion: Our results show that in approximately one-fifth (21.8%) of the patients, lymph node assessment by CT or MRI differs from the pathologic staging, an outcome that corresponds well with those published by several other groups in this field.