Depth of Invasion as a Predictor of Cervical Nodal Metastasis of Oral Tongue Squamous Cell Carcinoma: Findings From a Tertiary Care Center in Pakistan

Abstract

Background and objectiveCervical 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. MethodsA 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. ResultsThere 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. ConclusionOccult neck node metastasis is significantly associated with the DOI. The risk of neck metastasis is higher in patients with a DOI >5 mm.

Frequency and Pattern of presentation of Oral Squamous Cell Carcinoma and its predisposing Factors in patients presented to Nishtar Institute of Dentistry

“…One of the key factor affecting overall survival rate among oral squamous cell carcinoma patients is involvement of neck lymph nodes. The risk of occult neck nodal metastasis on presentation is about 40% as reported in literature 6 .…”

“…Elective neck dissection to remove involved lymph nodes is necessary once more than 15% lymph nodes involvement is present 6 . Also prognostic factor which affect the overall survival rate are depth of invasion, lymphovascular invasion and perineural invasion.…”

“…In Asian population buccal cancer is more common 1 and in Pakistan buccal cancer is common in males due to betel nuts use and tobacco smoking 5 . The risk factors include tobacco chewing, alcohol consumption, betel nuts usage and viral infections like human papilloma virus 6 . Oral squamous cell carcinoma has got very high mortality due to high degree of invasiveness and 5 years survival rate is 50 % with half of patients dyeing in first 2-3 years of diagnosis 7,8 .…”

The Applications and Potential Developments of Ultrasound in Oral Cancer Management

“…Tumor thickness (TT), depth of invasion (DOI), and ultrasound (US) with/without US-guided fine needle aspiration (FNA) are parameters that have been studied for the prediction of nodal metastasis and correlate with locoregional recurrence. 8 – 14 …”

“…Tumor thickness (TT), depth of invasion (DOI), and ultrasound (US) with/without US-guided fine needle aspiration (FNA) are parameters that have been studied for the prediction of nodal metastasis and correlate with locoregional recurrence. [8][9][10][11][12][13][14] US is a simple, noninvasive, time-saving, and low-cost image modality. It illustrates cervical soft tissues very clearly and bears no risk of radiation exposure.…”