The presence of metastatic cervical lymph nodes in oral squamous cell carcinoma is a crucial factor in the treatment plan and prognosis. The present study aimed to compare the clinical examination versus CT scan in the detection of neck lymphatic metastasis in patients with oral squamous cell carcinoma in comparison with postoperative histopathological findings.

To compare between the clinical examination, CT scan radiographic evaluation and histopathological assessment in detection and staging of cervical nodal metastasis.

A prospective comparative study on 60 Sudanese newly diagnosed patients (hospital based study) of OSCC in Sudan from Aug 2019–Feb 2021 comparing their nodal and extra nodal extension status depending on: clinical examination, CT scan assessment using the metastatic score, and postoperative histopathological findings.

Age, gender, habits, patient medical status, socioeconomic status, time duration between diagnoses till surgery.

Clinical TNM staging, site of the tumor, CT scan evaluation, Metastatic Score (MS), postoperative histopathological assessment.

Data were analyzed by using SPSS software program 25. Statistical analysis set at 95% confidence level, 0.2 as the width of the confidence interval and a level of significant alpha 0.05.

This study has included 60 patients diagnosed with OSCC, 33(55%) were males, while 27 (45%) were females. Regarding the clinical staging of OSCC, patients with stage IV constituted the majority of 52(86.6%). According to the metastatic score 23 (38%) patients scored between 6 and 10 (which indicates there is a 100% indication for neck dissection), 21(91.3%) of them had lymph nodes involvement in postoperative histopathological findings. An extra nodal extension was presented in 12 (20%) during clinical examination of nodal metastasis, 7 (11.6%) of them showed features of ENE in CT scan and 11 (18.3%) of them were confirmed for ENE in postoperative histopathology findings. Clinical examination of lymph nodes metastasis showed an accuracy of (55.3%), sensitivity of (100%) and specificity of (4%), compared to accuracy of (88.3%), sensitivity of (91.6%), specificity of (87.5%) in the clinical examination of ENE. While CT scan assessment showed an accuracy of (86.2%), sensitivity of (58%) and specificity of (93.4%) regarding features of ENE. The cross-tabulation revealed there is a relatively strong significant association between MS and lymph nodes metastasis (p value 0.046).

Clinical examination of metastatic lymph nodes is not considered a reliable method in the detection of nodal metastasis in comparison with CT scan assessment combined with MS according to this study. For ENE both methods are acceptable according to the literature, as they showed high accuracy. Additionally, the pathological TNM showed a significant role as it indicates the further need for concurrent chemoradiation therapy. We recommend in relation to this study findings: Using MS should be recommended, as it confirmed as a valid diagnostic tools. And the pathological TNM should be more included in oral cancer management protocol.