# Beyond the T: Volumetric MRI Predicts Lymphatic Spread in Oral Squamous Cell Carcinoma

## TL;DR

This study shows that 3D MRI scans can better predict how oral cancer spreads to lymph nodes compared to traditional staging methods.

## Contribution

The study introduces MRI-based volumetric analysis as a more accurate predictor of lymph node metastasis spread in oral cancer.

## Key findings

- Tumor volume is more strongly associated with lymph node metastasis distance than traditional T-stage classification.
- Larger tumors are linked to greater distances to metastatic lymph nodes and increased bilateral nodal involvement.
- Quantitative MRI analysis could improve individualized treatment planning for oral squamous cell carcinoma.

## Abstract

In this retrospective study, we investigate the relationship between primary tumor volume, the spatial distribution of cervical lymph node metastases, and TNM staging in patients with oral squamous cell carcinoma. Using high-resolution MRI-based 3D volumetric analysis and center-to-center distance measurements, we quantitatively assessed metastatic spread patterns in a cohort of 116 patients treated with either primary surgery and neck dissection or definitive chemoradiation. Our results demonstrate that tumor volume shows a significantly stronger association with the spatial extent of lymph node metastases than T-stage alone. Larger primary tumors were associated with greater distances to metastatic lymph nodes and a higher likelihood of bilateral nodal involvement. The significance of this work lies in its potential to improve individualized surgical and radiotherapeutic planning in OSCC.

Purpose: To assess the relationship between primary tumor volume, the spatial distribution of cervical lymph node metastases, and TNM (Tumor, node, metastasis) staging in patients with oral squamous cell carcinoma (OSCC) based on high-resolution MRI. Methods: This retrospective analysis evaluated 116 predominantly male (62.9%) patients (age 67.7 ± 11.5 years) with histologically confirmed OSCC who underwent surgical resection with neck dissection or definitive chemoradiation. MRI-based volumetry and center-to-center distance measurements between primary tumor and cervical lymph node metastases were performed using 3D postprocessing software. Results: Tumor-to-lymph node center-to-center distances ranged from 11.7 to 117.3 mm (median: 44.8 mm; interquartile range [IQR]: 32.1–59.6 mm). Primary tumor volume ranged from 0.5 to 87.2 cm3 (median: 13.3 cm3; IQR: 6.4–21.5 cm3) and was higher in male patients. A significant association was observed between tumor volume and both lymph node distance and pT-stage (p < 0.0001). The association between tumor volume and tumor–node distance was stronger (Spearman’s r = 0.4541, p < 0.0001) than that between pT-stage (TNM classification) and nodal distance (Spearman’s r coefficient =0.2682, p = 0.0036). Conclusion: MRI-based assessment indicated that tumor volume has a stronger association with the spatial extent of lymph node metastases compared with T-stage alone. Larger tumors were associated with greater distances to metastatic lymph nodes. These findings highlight the value of quantitative 3D MRI-based volume and distance analyses in potentially improving surgical and radiotherapeutic planning.