Depth of invasion as a predictive factor for cervical lymph node metastasis in tongue carcinoma

Abstract

Background Many histopathologic parameters in head and neck squamous cell carcinoma have been identified as predictive factors for cervical metastasis. Several studies focused on tumor thickness, and the depth of invasion was suggested to have a relationship to the occurrence of cervical metastasis. Nonetheless, the criterium for elective neck therapy in terms of tumor depth is still inconclusive. Therefore, a retrospective study was undertaken to substantiate the differing results in the literature with our own findings concerning the interrelationship between tumor thickness and clinically suspicious neck, as well as occult neck disease. In addition, the study attempted to identify further predictive factors for cervical metastasis in squamous cell carcinoma of the tongue. Methods The medical records of 34 primarily tongue carcinomas operated without any preoperative therapy between 1980 and 1991 were reviewed. Each patient's tumor type, tumor location, tumor size, invasion mode, depth of invasion, intralymphatic tumor emboli, and perineural invasion were evaluated. Chi‐square contingency tables were used to correlate clinical or histopathologic parameters with metasis in the neck. Results The overall cervical metastasic rate was 35.3% (n = 12/34). In univariate analysis, invasion mode and depth of invasion were statistically significant predictors of regional metastasis at p = 0.0019 and p = 0.0003, respectively. In the group in which tumor depth exceeded 5 mm, the metastatic rate was 64.7% (11/17). In contrast, when the depth of invasion was less than 5 mm, the incidence of cervical metastasis was 5.9% (1/17). Clinically negative necks turned out pathologically positive in 30.0% (n = 9/30). The tumor depth exceeded 5 mm in 43.4% (13/30) of the N0 necks. In the conversion (N0 → N1) group, tumor depth exceeding 5 mm was noted in 88.9% (n = 8/9). Conclusions We suggest that there is a discerning point at 5 mm of tumor depth at which cervical metastasis is probable. Electric neck therapy (surgery or irradiation) is strongly indicated for tumors exceeding 5 mm invasion. Tumor invasion mode and tumor size also bear an impact on the indication for therapy. © 1997 John Wiley & Sons, Inc. Head Neck 19: 205–210, 1997.

A meta-analysis of the randomized controlled trials on elective neck dissection versus therapeutic neck dissection in oral cavity cancers with clinically node-negative neck

“…Histopathologic factors like tumor thickness, perineural and microvascular invasions, lymphocytic inflammatory infiltration, pattern of tumor invasion and differentiation, and molecular tumor markers have been advocated to be reliable metastastic potential parameters [45,58,97,150,166]. A report on a multivariable clinicopathologic scoring system in which points were allotted to each individual variable or predictor has been document [135].…”

“…Neck node status is the single most important prognostic factor in oral cancers and other head and neck cancers [26]. The incidence of lymph node metastases of these cancers depends largely on histo-pathologic factors like tumor thickness, perineural and microvascular invasions, lymphocytic inflammatory infiltration, pattern of tumor invasion and differentiation, and molecular tumor markers [45,58,140,150].…”

“…The benefits of neck dissection as advocated by this group include successful reduction of regional recurrence, pathological staging of neck, avoidance of unnecessary neck irradiation and indication of cases where adjunct therapy should be employed [45,58,71,97,99,140,150,169].…”

Prognostic Indicators in Head and Neck Oncology Including the New 7th Edition of the AJCC Staging System

“…This may be due to the inclusion of more T2 patients (66%) as compared to Yuen's randomized trial (39%). Fukano [4] studied 34 patients with tongue SCC, all stages, but separated out the data for cN0 patients . No occult metastases were associated with depth of invasion \3 mm.…”

Cervical node metastasis in T1 squamous cell carcinoma of oral tongue- pattern and the predictive factors

“…Many studies subsequently have shown a strong correlation between the thickness of tumor and lymph node metastasis. Using <3 mm as a cutoff value Yuen et al [22,23].…”