Correlating the depth of invasion at specific anatomic locations with the risk for regional metastatic disease to lymph nodes in the neck for oral squamous cell carcinoma (original) (raw)
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Ear, Nose & Throat Journal, 2012
Cervical lymph node metastasis is the most important prognostic factor in patients with head and neck carcinoma. We retrospectively analyzed the effects of three different variables—tumor size, degree of differentiation, and depth of invasion—on the risk of neck node metastasis in 50 adults who had been treated with surgery for primary squamous cell carcinoma of the oral cavity. Primary tumor depth and other pathologic features were determined by reviewing the pathology specimens. Preoperatively, 36 of the 50 patients were clinically N0; however, occult lymph node metastasis was found in 13 of these patients (36.1%). The prevalence of neck node metastasis in patients with T1/T2 and T3/T4 category tumors was 51.5 and 58.8%, respectively. The associations between the prevalence of neck node metastasis and both the degree of differentiation and the depth of invasion were statistically significant, but there was no significant association between neck node metastasis and tumor size. We ...
Frontiers in Oncology, 2021
ObjectiveThe depth of invasion (DOI) is considered an independent risk factor for occult lymph node metastasis in oral cavity squamous cell carcinoma (OCSCC). It is used to decide whether an elective neck dissection (END) is indicated in the case of a clinically negative neck for early stage carcinoma (pT1/pT2). However, there is no consensus on the cut-off value of the DOI for performing an END. The aim of this study was to determine a cut-off value for clinical decision making on END, by assessing the association of the DOI and the risk of occult lymph node metastasis in early OCSCC.MethodsA retrospective cohort study was conducted at the Erasmus MC, University Medical Centre Rotterdam, The Netherlands. Patients surgically treated for pT1/pT2 OCSCC between 2006 and 2012 were included. For all cases, the DOI was measured according to the 8th edition of the American Joint Committee on Cancer guideline. Patient characteristics, tumor characteristics (pTN, differentiation grade, perin...
International Journal of Research in Medical Sciences
Background: Squamous cell carcinomas of the oral cavity are relatively common among the head and neck cancers. The increasing depth of invasion (DOI) and the microvascular proliferation caused by neoplastic growth might determine proximity to blood vessels and lymphatics, thus facilitating the tumor’s ability to metastasize. The role of tumour DOI as a prognostic parameter for the development of nodal metastases and for the survival of patients with OSCC are important. Aim of the study was to determine the relationship of the DOI of tumor with the neck node metastasis in squamous cell carcinoma of the oral cavity.Methods: This study is conducted in the State cancer institute, Gauhati medical college over a period of 1 year from June 2021 to June 2022 among 100 patients. All patients underwent tumor resection with neck dissection, and the DOI is measured.Results: Out of 100 patients included in the study 66 were males and 34 were females. Maximum number of cases 30% were seen in the ...
International Journal of Otorhinolaryngology and Head and Neck Surgery
Background: The aims of the study were to know whether the increase in the depth of invasion in oral cavity carcinoma assessed histopathologically and radiologically co-relates with neck node metastasis and to accurately co-relate the radiological thickness at which neck dissection is required.Methods: A retrospective study has been conducted over thirty patients with oral cavity carcinoma (buccal mucosa and tongue) in the time period of April 2018 to December 2018 who were operated in our tertiary care hospital. Results: Depth of invasion is relatable histopathologically and radiologically, is directly proportional to neck node metastasis. Pre-operative radiology is a reliable modality to rule out the need of neck node dissection.Conclusions: Depth of invasion is directly proportional to the incidence of neck node metastasis and pre-operative radiology has been reliable to rule out the need of neck dissection and reduce its morbidity.
Cureus, 2021
Background and objective Cervical lymph node metastasis has a significant impact on the survival of patients with oral cavity tumors. The rate of occult neck node metastasis is reported to range from 20 to 40%. The depth of invasion (DOI) has been incorporated in the eighth edition of the American Joint Commission on Cancer (AJCC) staging manual and is an important predictor of cervical lymph node metastasis. In this study, we aimed to identify the occult neck node metastasis rate in early oral tongue squamous cell carcinoma (OTSCC) and correlate it with the DOI. Methods A retrospective review of all patients presenting to our facility with early-stage OTSCC was performed. Patients with tumor size of ≤4 cm and who underwent elective neck dissection at the time of surgery were included. The study outcomes were the rates of occult neck metastases in T1 and T2 OTSCC and their correlation with the DOI. Results There were 80 patients in total. Occult neck node metastases were seen in 29 (36.25%) patients. Patients with a DOI >5 mm were 1.41 times more likely to have occult neck node metastasis than those with a DOI ≤5 mm. Conclusion Occult neck node metastasis is significantly associated with the DOI. The risk of neck metastasis is higher in patients with a DOI >5 mm.
PloS one, 2018
The new AJCC staging system (8th edition) incorporates depth of invasion to stage oral cancers. It is a recognized predictor for neck nodal metastasis and local recurrence, the associated risk is not well defined. The aim of this study was to explore the risk of occult neck nodal metastasis and local recurrence in relation to depth in early stage squamous cell carcinoma of oral tongue. We have evaluated records of 179 patients with early tongue cancer treated in our unit from 2006-2015 with a mean age of 57.92 ± 11.93 years. Treatment modalities used were surgery (26%), surgery followed by radiotherapy (64%) and chemo-radiation (10%). Neck dissection was ipsilateral in 94% and bilateral in 6% of the patients. Patients were grouped according to the AJCC cut off points in 8th edition for depth; group A: 1-5 mm (35%), group B: 6-10 mm (47%) and group C: > 10 mm (18%). Risk of local recurrence and nodal metastasis for Group A was 15% (10/63) and 23% (15/63), group B 20% (17/84) and 3...
A Study on Secondary Neck Nodes from Squamous Cell Carcinoma of the Head and Neck Region
AIM: To find out the incidence of cervical node metastases on clinical examination in squamous cell carcinoma of the head and neck region. To find the incidence of cervical nodal metastases commonly involved according to the primary tumour at the time of presentation. To describe the distribution of cervical node metastases by the site of the primary tumour. To correlate individually the size of the tumour and cervical nodal metastases. To correlate individually the degree of histopathological differentiation of tumour and cervical nodal metastases. METHODS: The materials used in the study consisted of 60 cases of histologically proven squamous cell carcinoma in the head and neck region which were admitted in all surgical wards of Government Mohan Kumaramangalam Medical College and Hospital, Salem during June 2018-June 2020. RESULTS: Males are predominantly affected by squamous cell carcinoma of head and neck region. 75% of patients had nodal metastasis at the time of admission. Posteriorly situated tumours displayed greater propensity of nodal metastases than anteriorly situated tumours. Carcinoma arising in the buccal mucosa, alveolus, floor of mouth, hard palate and maxillary antrum predominantly metastasized to the submandibular nodes, whereas those arising in the tongue (both anterior 2/3rd and posterior 1/3rd), tonsils and soft palate predominantly metastasized to the upper deep cervical group. A progressive increase in the incidence of node metastases was observed with increasing tumour size. A progressive increase in the incidence of node metastasis was observed with increasing histological undifferentiation of the tumour. CONCLUSION: Males are predominantly affected by squamous cell carcinoma of head and neck region. 75% of patients had nodal metastasis at the time of admission Site of the primary appeared to influence the incidence of regional nodal metastases. Posteriorly situated tumours arising in the oropharynx (base of tongue, tonsils, soft palate) displayed a greater propensity for regional metastases(66% to 100%) as compared to anteriorly situated tumours arising in the oral cavity(33% to 83%). Amongst the posteriorly situated tumours, carcinoma of the tonsils showed the highest incidence of nodal metastases(100 percent). Amongst the anteriorly situated tumours, carcinoma of buccal mucosa showed the highest incidence of node metastases (83.33%). The large primaries (more than 4cm) and those with higher histologic grade (moderate to poorly differentiated) have a greater propensity for developing regional nodal metastasis.
Auris, nasus, larynx, 2017
To evaluate the incidence of level IIB and IV lymph node metastases in patients of oral carcinoma with N0 necks. This study will help to decide the extent and need of routine comprehensive removal of these specific lymph node groups in selective neck dissection. Prospective analytical study of 231 patients of oral carcinoma with N0 necks undergoing neck dissections were prospectively analyzed. The incidence of metastases at level IIB and IV were then observed. 71 (30.73%) out of 231 cases had microscopic metastatic lymphadenopathy. Lymph node metastases from oral cancers were seen predominantly at levels IB and IIA. Metastases at levels IIB and IV were very rare (0.86% and 0%, respectively). Metastases at level IIB was associated with metastases at the level IIA in both cases (100%) and with level IB in 1 case (50%). 27 (11.68%) out of 231 cases had positive IIA nodes and conversely, only 7.4% (2/27) of all level IIA metastases had positive nodes at level IIB. Selective neck dissect...
Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 2019
Objectives: Tumor thickness (TT) and tumor depth of invasion (DOI) correlate with the risk of regional lymph node metastases in early oral tongue squamous cell carcinoma (OTSCC). We aimed to determine optimal cut-points to guide elective nodal treatment in early OTSCC. Study Design: 145 patients treated between 1995 and 2012 for histologically proven, OTSCC (<4cm) were included in this retrospective study. The minimum p value method was used to calculate cut-point values of TT and DOI that predicted for nodal disease. The utility of the DOI cut-point value and the 5mm DOI currently used for staging were then compared. Results: Logistic regression analysis demonstrated DOI (p=0.00036) and TT (p=0.0001) were highly correlated with nodal disease and each other. The cut-points that best predicted for nodal disease were 4.5 for DOI and 8mm for TT. There was no difference in utility between DOI of 4.5mm and 5mm. Conclusion: TT and DOI were highly correlated with nodal risk but had different cut-points for prediction. Our findings highlight the need for these parameters to be recognized as discrete entities and reported appropriately. This study supports using the 5mm DOI, currently used for staging, as also the threshold value to guide elective nodal treatment.