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Muscle Invasion in Oral Tongue Squamous Cell Carcinoma as a Predictor of Nodal Status and Local Recurrence: Just as Effective as Depth of Invasion?

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Abstract

Tumor depth of invasion (DOI) is a histologic feature that consistently correlates with lymph node metastasis; however, there are many difficulties with accurately assessing DOI. The aim of this study was to identify a simpler and more reproducible method of determining DOI, by using skeletal muscle invasion as a surrogate marker of depth. Oral tongue squamous cell carcinoma American Joint Committee on Cancer (AJCC) stage T1 cases were identified in the Emory University Department of Pathology database. 61 cases, with a minimum of 2 years of follow-up, were included in the study. Cases were examined histologically to assess muscle invasion and DOI. The two methods of measurement were analyzed to determine the positive predictive value (PPV) of DOI or muscle invasion for both nodal disease and local recurrence. Cases with muscle invasion had a 23.3% PPV of occult lymph node metastasis. Cases with DOI of greater than 3 mm had a 29.7% PPV of occult lymph node metastasis. Cases with muscle invasion had a 43.7% PPV of local tumor recurrence. Cases with maximum DOI of greater than 3 mm had a 40.4% PPV of tumor recurrence. Although the PPV of muscle invasion in regards to nodal status was slightly less than DOI, it represents a more easily reproducible parameter which could guide surgeons in determining if the case warrants an elective neck dissection in a cN0 (clinically negative) neck. Interestingly, the PPV of local recurrence was higher with muscle invasion than DOI, and may represent an important indicator for extent of resection.

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References

  1. Jemal A, et al. Global Cancer Statistics 2011. CA Cancer J Clin. 2011;61(2):69–90.

  2. Howlader N, Noone AM, Krapcho M, et al. (eds). SEER Cancer statistics review, 1975–2008. Bethesda, MD: National Cancer Institute; 2011.

  3. Ries LSGHB, Miller BS, Hartman AM, Edwards BK (eds). Cancer statistics review, 1973–1998. National Cancer Institute, NIH publication no. 91-2789; 1991.

  4. Silverman S. Jr. Demographics and occurrence of oral and pharyngeal cancers: the outcomes, the trends, and the challenge. J Am Dent Association. 132(Suppl):75–115.

  5. Kalnins IK, Leonard AG, Sako K, et al. Correlation between the prognosis and degree of lymph node involvement in carcinoma of the oral cavity. Am J Surg. 1977;134:450–4.

    Article  PubMed  CAS  Google Scholar 

  6. Schuller DE, McGuirt WF, McCabe BF, et al. The prognostic significance of metastatic cervical lymph nodes. Laryngoscope. 1980;90:557–70.

    PubMed  CAS  Google Scholar 

  7. Snow GB, Annyas AA, van Slooten EA, et al. Prognostic factors of neck node metastasis. Clinical Otolaryngol Allied Sci. 1982;7:185–92.

    Article  CAS  Google Scholar 

  8. Grandi C, Alloisio M, Moglia D, et al. Prognostic significance of lymphatic spread in head and neck carcinoma: therapeutic implications. Head Neck Surg. 1985;8:67–73.

    Article  PubMed  CAS  Google Scholar 

  9. 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;12:1080–91.

    Google Scholar 

  10. Spiro RH, Huvos AG, Wong GY, et al. Predictive value of tumor thickness in squamous carcinoma confined to the tongue and floor of mouth. Am J Surg. 1986;152:345–50.

    Article  PubMed  CAS  Google Scholar 

  11. Brown B, Barnes L, Mazariegos J, et al. Prognostic factors in mobile tongue and floor of mouth carcinoma. Cancer. 1989;64:1195–202.

    Article  PubMed  CAS  Google Scholar 

  12. Fakih AR, Rao RS, Borges AM, et al. Elective versus therapeutic neck dissection in early carcinoma of the oral tongue. Am J Surg. 1989;158:309–13.

    Article  PubMed  CAS  Google Scholar 

  13. 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;8:731–6.

    Google Scholar 

  14. Lim SC, Zhang S, Ishii G, et al. Predictive markers for late cervical metastasis in stage I and II invasive squamous cell carcinoma of the oral tongue. Clin Cancer Res. 2004;10:166–72.

    Article  PubMed  CAS  Google Scholar 

  15. Byers R, El-Naggar AK, Lee YY, et al. Can we detect or predict the presence of occult nodal metastases in patients with squamous cell carcinoma of the oral tongue? Head Neck. 1998;2:138–44.

    Google Scholar 

  16. Sparano A, Weinstein G, Chalian A, et al. Multivariate predictors of occult neck metastasis in early oral tongue cancer. Otolaryngol Head Neck Surg. 2004;131:472–6.

    Article  PubMed  Google Scholar 

  17. Alkureishi LWT, Ross G, Shoaib T, et al. Does tumor depth affect nodal upstaging in squamous cell carcinoma of the head and neck? Laryngoscope. 2008;118:629–34.

    Article  PubMed  Google Scholar 

  18. 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;19:205–10.

    Article  PubMed  CAS  Google Scholar 

  19. Hosal AS, Unal OF, Ayhan A. Possible prognostic value of histopathologic parameters in patients with carcinoma of the oral tongue. Eur Arch Otorhinolaryngol. 1998;255(4):216–9.

    Google Scholar 

  20. 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. EJSO. 2006;32:795–803.

    PubMed  CAS  Google Scholar 

  21. 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;39:386–90.

    Article  PubMed  CAS  Google Scholar 

  22. 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;180:139–43.

    Article  PubMed  CAS  Google Scholar 

  23. Yuen APW, Lam KY, Lam LK, et al. Prognostic factors of clinically stage I and II oral tongue carcinoma–A comparative study of stage, thickness, shape, growth pattern, invasive front malignancy grading, Martinez-Gimeno score, and pathologic features. Head Neck. 2002;24:513–20.

    Article  PubMed  Google Scholar 

  24. Shintani S, Matsuura H, Hasegawa Y, et al. The relationship of shape of tumor invasion to depth of invasion and cervical lymph node metastasis in squamous cell carcinoma of the tongue. Oncology. 1997;54(6):463–7.

    Google Scholar 

  25. Moore C, Kuhns JG, Greenberg R. Thickness as prognostic aid in upper aerodigestive tract cancer. Arch Surg. 1986;121:1410–4.

    PubMed  CAS  Google Scholar 

  26. American Joint Committee on Cancer. Cancer staging manual, 7th ed. Berlin: Springer; 2010.

  27. Weiss MH, Harrison LB, Isaacs RS. Use of decision analysis in planning a management strategy for the stage N0 neck. Arch Otolaryngol Head and Neck Surg. 1994;120:699–702.

    CAS  Google Scholar 

  28. Kowalski LP, Medina JE. Nodal metastases; predictive factors. Otolaryngol Clin North Am. 1998;31:621–37.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, Emory University, 1364 Clifton Road, NE, Atlanta, GA, 30322, USA

    Katherine Chandler, Courtney Vance, Steven Budnick & Susan Muller

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  1. Katherine Chandler
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  2. Courtney Vance
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  3. Steven Budnick
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  4. Susan Muller
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Correspondence to Katherine Chandler.

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This material was presented in part at the 2011 USCAP Meeting in San Antonio, Texas.

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Chandler, K., Vance, C., Budnick, S. et al. Muscle Invasion in Oral Tongue Squamous Cell Carcinoma as a Predictor of Nodal Status and Local Recurrence: Just as Effective as Depth of Invasion?. Head and Neck Pathol 5, 359–363 (2011). https://doi.org/10.1007/s12105-011-0296-5

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