A Comparative Assessment of Clinical and Pathological Staging in Patients Undergoing Surgery for Oral Squamous Cell Carcinoma in Pakistan

Abstract

Objective: To compare the radiological and histopathological staging of Oral Squamous cell carcinoma and to measure the concordance between clinical and histopathological staging in patients visiting a tertiary care hospital in Pakistan.
Study Design: Retrospective cross-sectional study.
Place and Duration of Study: Foundation University College of Dentistry, September 2019-November 2023.
Materials and Methods: Thirty-two histopathologically confirmed cases of OSCC who underwent tumor resection with neck dissection were included. Clinical and radiological records were reviewed for clinical staging (cT, cN), and histopathological reports for pathological staging (pT, pN). Concordance was assessed using Chisquare, Kendall's tau-b, Cohen's Kappa, and Cramer's V, with p < 0.05 considered significant.
Results: Concordance between clinical tumor size (cT) and pathological tumor size (pT) was 46.9%, The Chisquare test was not significant (p = .232), but Kendall's tau-b showed a significant positive correlation, Cramer's V indicated a moderate effect size (V = 0.349), and Cohen's Kappa demonstrated fair agreement (κ = 0.271, p = .005). Nodal staging showed marked discordance (84.4%) between cN and pN, with no significant association (p > 0.05), weak correlation (τb = 0.124, p = .433), moderate but non-significant effect size (V = 0.408, p = .192), and negligible agreement (κ = 0.002, p = .968).
Conclusion: Assessment of OSCC staging showed fair agreement for tumor size but negligible correlation for nodal status. These findings highlight the limitations of clinical staging and stress the role of pathological confirmation in guiding treatment.