Citation Information :
Shah AH, Parikh RP. Clinicopathological Correlation between Depth of Tumor and Neck Node Metastasis in Oral (Tongue and Buccal Mucosa) Carcinoma. Int J Head Neck Surg 2021; 12 (1):6-10.
Aims and objectives: (1) To study the depth of tumor invasion in an oral (tongue and buccal mucosa) carcinoma and its correlation with neck metastasis. (2) To know whether the increase in depth of tumor (depth of invasion) increases the chances of cervical nodal metastasis in the oral tongue and buccal mucosa carcinoma and derive cutoff value of depth of invasion at which the metastasis occurs.
Materials and methods: The study was carried out on 14 tongue and 22 buccal mucosa cases to know the correlation between the depth of tumor and neck node metastasis in the oral (tongue and buccal mucosa) carcinoma.
Results: Among 36 cases, 10 cases were pN+. Out of 10 cases, 7 (70%) were having depth ≥12 mm and 30% cases (pN+) having depth between 8 and <10. We found it statistically significant and so as the depth of tumor increases the chances of nodal metastasis increases. We found the cutoff for a depth of invasion in both tongue and buccal mucosa carcinomas as 8 out of 22 patients had DOI >10 mm and among them 4 were pN+ and among 14 tongue cases, 3 cases had DOI >8 mm and all of them were pN+.
Conclusion: For tongue 8 mm and for buccal mucosa, 10 mm of the depth of tumor invasion was calculated as the cutoff depth, above which the incidence of nodal metastasis increases to 75% and 66.66%, respectively.
Clinical significance: Depth of tumor is an important prognostic indicator in the tongue and buccal mucosa carcinoma to know the cervical nodal metastasis. Hence for an increase in depth of tumor cases, neck must be addressed along with primary tumor excision. Radiological investigations [ultrasonography (USG), magnetic resonance imaging (MRI), computed tomography (CT) scan] play an important role in nodal metastasis detection hence should be considered in carcinoma of the oral tongue and buccal mucosa especially in clinically N0 neck.
Parkin DM, Bray F, Ferlay J, et al. Global cancer statistics, 2002. CA: a cancer. J Clinici 2005;55(2):74–108. DOI: 10.3322/canjclin.55.2.74.
Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11.Lyon, France: International Agency for Research on Cancer, 2013 http://globocan.iarc.fr (accessed Dec 23, 2013).
Incidence And Prevalence [Internet]. Available from: http://ocf.org.in/professional/IncidenceAndPrevalence.aspx.
National Cancer Registry Programme. Three year report of the population based cancer registries: 2009-2011. Indian Council of Medical Research, India.
Sessions DG, Spector GJ, Lenox J, et al. Analysis of treatment results for oral tongue cancer. Laryngoscope 2002;112(4):616–625. DOI: 10.1097/00005537-200204000-00005.
Le Tourneau C, Velten M, Jung GM, et al. Prognostic indicators for survival in head and neck squamous cell carcinomas: analysis of a series of 621 cases. Head Neck 2005;27(9):801–808. DOI: 10.1002/hed.20254.
De Zinis LO, Bolzoni A, Piazza C, et al. Prevalence and localization of nodal metastases in squamous cell carcinoma of the oral cavity: role and extension of neck dissection. Eur Arch OtorhinolaryngoI 2006;263(12):1131–1135. DOI: 10.1007/s00405-006-0128-5.
Ferlito A, Rinaldo A, Devaney KO, et al. Detection of lymph node micrometastases in patients with squamous carcinoma ofthe head and neck. Eur Arch Otorhinolaryngol 2008;265(10):1147–1153. DOI: 10.1007/s00405-008-0715-8.
Pfister DG, Ang K, Briezel D. NCCN clinical practice guidelines in oncology – head and neck cancer. J Natl Compr Canc Netw 2011;9(6):596–650. DOI: 10.6004/jnccn.2011.0053.
Close LG, Burns DK, Reisch J, et al. Microvascular invasion in cancer of the oral cavity and oropharynx. Arch Otolaryngol Head Neck Surg 1987;113(11):1191–1195. DOI: 10.1001/archotol.1987.01860110057008.
Fakih AR, Rao RS, Borges AM, et al. Elective versus therapeutic neck dissection in early carcinoma of the oral tongue. Am J Surg 1989;158(4):309–313. DOI: 10.1016/0002-9610(89)90122-0.
Fukano H, Matsuura H, Hasegawa Y, et al. Depth of invasion as a predictive factor for cervical lymph node metastasis in tongue carcinoma. Head Neck 1997;19(3):205–210. DOI: 10.1002/(SICI)1097-0347(199705)19:3<205::AID-HED7>3.0.CO;2-6.
Jones KR, Lodge-Rigal RD, Reddick RL, et al. Prognostic factors in the recurrence of stage I and II squamous cell cancer of the oral cavity. Arch Otolaryngol Head Neck Surg 1992;118(5):483–485. DOI: 10.1001/archotol.1992.01880050029006.
Kurokawa H, Yamashita Y, Takeda S, et al. Risk factors for late cervical lymph node metastases in patients with stage I or II carcinoma of the tongue. Head Neck 2002;24(8):731–736. DOI: 10.1002/hed.10130.
O-charoenrat P, Pillai G, Patel S, et al. Tumour thickness predicts cervical nodal metastases and survival in early oral tongue cancer. Oral Oncol 2003;39(4):386–390. DOI: 10.1016/S1368-8375(02) 00142-2.
Moore C, Kuhns JG, Greenberg RA. Thickness as prognostic aid in upper aerodigestive tract cancer. Arch Surg 1986.
Pentenero M, Gandolfo S, Carrozzo M. Importance of tumor thickness and depth of invasion in nodal involvement and prognosis of oral squamous cell carcinoma: a review of the literature. Head Neck 2005;27(12):1080–1091. DOI: 10.1002/hed.20275.
Kane SV, Gupta M, Kakade AC, et al. Depth of invasion is the most significant histological predictor of subclinical cervical lymph node metastasis in early squamous carcinomas of the oral cavity. Eur I Surg Oncol 2006;32(7):795–803. DOI: 10.1016/j.ejso.2006.05.004.
Giacomarra V, Tirelli G, Papanikolla L, et al. Predictive factors of nodal metastases in oral cavity and oropharynx carcinomas. Laryngoscope 1999;109:795–799.
Breslow A. Prognostic factors in the treatment of cutaneous melanoma. J Cutan Pathol 1979;6:208–212.
Woolgar JA, Scott J. Prediction of cervical lymph node metastasis in squamous cell carcinoma of the tongue/floor of mouth. Head Neck 1995;17:463–472.
Hoçal AS, Unal OF, Ayhan A. Possible prognostic value of histopathologic parameters in patients with carcinoma ofthe oral tongue. Eur Arch Otorhinolaryngol 1998;255(4):216–219. DOI: 10.1007/s004050050046.
Ambrosch P, Kron M, Fischer G, et al. Micrometastases in carcinoma of the upper aerodigestive tract: detection, risk of metastasizing, and prognostic value of depth of invasion. Head Neck 1995;17(6):473–479. DOI: 10.1002/hed.2880170604.
Shah AR, Spiro RH, Shah JP, et al. Squamous carcinoma of the floor of the mouth. Am J Surg 1984;148(4):455–459. DOI: 10.1016/0002-9610(84)90369-6.
Yuen APW, Lam KY, Wei WI, et al. A comparison of the prognostic significance of tumor diameter, length, width, thickness, area, volume, and clinicopathological features of oral tongue carcinoma. Am J Surg 2000;80(2):139–143. DOI: 10.1016/S0002-9610(00) 00433-5.
Samanta DR, Senapati SN, Upadhyaya A. Histopathology correlation between depth of invasion and cervical lymph node metastasis in post operative patients of carcinoma buccal mucosa and tongue. In ASCO Annual Meeting Proceedings 2016 May 20 (vol. 34, No. 15_suppl, p. e17542).