Depth of invasion in early stage oral cavity squamous cell carcinoma: The optimal cut-off value for elective neck dissection

Lanschot, Cornelia G.F. van; Klazen, Yoram P.; Ridder, Maria A. J. de; Mast, Hetty; Hove, Ivo ten; Hardillo, José A.; Monserez, Dominiek; Sewnaik, Aniel; Meeuwis, Cees A.; Keereweer, Stijn; Aaboubout, Yassine; Barroso, Elisa M.; Toom, Quincy M van der; Schut, Tom C. Bakker; Wolvius, Eppo B.; Jong, Robert J. Baatenburg de; Puppels, Gerwin J.; Koljenović, Senada

doi:10.1016/j.oraloncology.2020.104940

Cited by 53 publications

(43 citation statements)

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“…Several studies report the DOI as a predictor of occult lymph node metastasis, and it is used as a criterion to decide on END in early OCSCC (19)(20)(21)(22)(23)(24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

“…For instance, Faisal et al showed 10 mm DOI cut-off value for decision making on END, Tam et al showed 7.25 mm, and Kozak et al did not specify another DOI cut-off value (23,24,31). On the other hand, van Lanschot et al confirmed the DOI cut-off value of 4 mm, and Brockhoff et al calculated DOI cut-off values for most subsites (i.e., tongue = 2mm, floor of mouth = 3mm, and Proc alv/hard palate = 4mm) (20,22).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, for the old cohort the reliable data for LVI, PNI, tumor diameter and margin status were missing and therefore not further analyzed and compared with the newer cohort. Finally, the patient outcome (locoregional recurrence and survival) in the previously published study may be influenced by the fact that our institute started with intra-operative assessment of resection margins in 2013 (22,37,38).…”

Section: Discussionmentioning

confidence: 99%

“…Most authors base their decision on END according to 20% (NPV 80%) risk of occult lymph node metastasis (19,20,(22)(23)(24)(25)(26). The origin of this risk cut-off value is the publication of Weiss et al in 1994 (7).…”

Section: Discussionmentioning

confidence: 99%

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Is the Depth of Invasion a Marker for Elective Neck Dissection in Early Oral Squamous Cell Carcinoma?

et al. 2021

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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, perineural invasion, and lymphovascular invasion), treatment modality (END or watchful waiting), and 5-year follow-up (local recurrence, regional recurrence, and distant metastasis) were obtained from patient files.ResultsA total of 222 patients were included, 117 pT1 and 105 pT2. Occult lymph node metastasis was found in 39 of the 166 patients who received END. Univariate logistic regression analysis showed DOI to be a significant predictor for occult lymph node metastasis (odds ratio (OR) = 1.3 per mm DOI; 95% CI: 1.1–1.5, p = 0.001). At a DOI of 4.3 mm the risk of occult lymph node metastasis was >20% (all subsites combined).ConclusionThe DOI is a significant predictor for occult lymph node metastasis in early stage oral carcinoma. A NPV of 81% was found at a DOI cut-off value of 4 mm. Therefore, an END should be performed if the DOI is >4 mm.

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“…Several studies report the DOI as a predictor of occult lymph node metastasis, and it is used as a criterion to decide on END in early OCSCC (19)(20)(21)(22)(23)(24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Is the Depth of Invasion a Marker for Elective Neck Dissection in Early Oral Squamous Cell Carcinoma?

et al. 2021

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“…Depth of invasion with a cut-off value (> 4 mm) is a strong predictor for occult LNM, this cutoff value is therefore used within the Erasmus MC in making decisions on END ( 1 , 3 , 4 ). The DOI however is determined during the final pathological evaluation, days after the excision of the primary tumor ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

The Potential of MET Immunoreactivity for Prediction of Lymph Node Metastasis in Early Oral Tongue Squamous Cell Carcinoma

et al. 2021

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ObjectiveMET positivity is independently associated with survival in oral squamous cell carcinoma (OSCC). Since MET is a known orchestrator of invasive tumor growth, we investigated its association with LNM in early oral tongue squamous cell carcinoma (OTSCC). As it is recommended by the NCCN to use tumor depth of invasion (DOI) in making decisions on elective neck dissection (END), the results obtained for MET positivity were aligned with those for DOI > 4 mm. The cutoff value used in our institution.MethodsTumor samples from patients who underwent primary tumor resection and neck dissection between 1995 and 2013, were collected from the archives of the Leiden and Erasmus University Medical Center. Immunohistochemistry with D1C2 was performed to identify MET negative (< 10% uniform positivity) and MET positive (≥ 10% uniform positivity) cancers. ROC curve analysis and the Chi-squared test were used to investigate the association of MET positivity with LNM (pN+ and occult). Binary logistic regression was used to investigate the association of MET positivity with LNM.ResultsForty-five (44.1%) of the 102 cancers were MET positive. Ninety were cN0 of which 20 were pN+ (occult metastasis). The remaining 12 cancers were cN+, of which 10 were proven pN+ and 2 were pN0. MET positivity was associated with LNM with a positive predictive value (PPV) of 44.4% and a negative predictive value (NPV) of 82.5% for pN+. For the occult group, the PPV was 36.8% and the NPV was 88.5%. Regression analysis showed that MET positivity is associated with pN+ and occult LNM (p-value < 0.05).ConclusionMET positivity is significantly associated with LNM in early OTSCC, outperforming DOI. The added value of MET positivity could be in the preoperative setting when END is being considered during the initial surgery. For cases with DOI ≤ 4 mm, MET positivity could aid in the clinical decision whether regular follow-up, watchful waiting, or END is more appropriate. Realizing that these preliminary results need to be independently validated in a larger patient cohort, we believe that MET positivity could be of added value in the decision making on END in early OTSCC.

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Role of sentinel lymph node biopsy for oral squamous cell carcinoma: Current evidence and future challenges

et al. 2022

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Sentinel lymph node biopsy (SLNB) has been used across oncological specialties for prognostication, staging, and identification of occult nodal metastasis. Recent studies demonstrated the potential clinical utility of SLNB in oral cavity squamous cell carcinoma (OCSCC). Elective neck dissection is the current standard of care in early management of OCSCC with depth of invasion greater than 2-4 mm; however, majority of patients ultimately do not have nodal disease on final pathology. SLNB is an alternative procedure widely adopted in early cancer management in many oncological subspecialities. Several considerations such as depth of invasion, nodal mapping, histopathology methods, operator variability, postoperative complications, and advancement in preoperative and intraoperative imaging technology can guide the appropriate application to SLNB in OCSCC. The aim of this review is to discuss the current evidence for SLNB in the treatment of early stage OCSCC, imaging technologies that support SLNB procedures, and studies that are currently underway.

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Depth of invasion in early stage oral cavity squamous cell carcinoma: The optimal cut-off value for elective neck dissection

Cited by 53 publications

References 49 publications

Is the Depth of Invasion a Marker for Elective Neck Dissection in Early Oral Squamous Cell Carcinoma?

Is the Depth of Invasion a Marker for Elective Neck Dissection in Early Oral Squamous Cell Carcinoma?

The Potential of MET Immunoreactivity for Prediction of Lymph Node Metastasis in Early Oral Tongue Squamous Cell Carcinoma

Role of sentinel lymph node biopsy for oral squamous cell carcinoma: Current evidence and future challenges

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