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

Aaboubout, Yassine; Toom, Quincy M van der; Ridder, Maria A. J. de; Herdt, Maria J. De; Steen, Berdine van der; Lanschot, Cornelia G.F. van; Barroso, Elisa M.; Soares, Maria R Nunes; Hove, Ivo ten; Mast, Hetty; Smits, Roeland W.H.; Sewnaik, Aniel; Monserez, Dominiek; Keereweer, Stijn; Jong, Robert J. Baatenburg de; Schut, Tom C. Bakker; Puppels, Gerwin J.; Hardillo, José A.; Koljenović, Senada

doi:10.3389/fonc.2021.628320

Cited by 33 publications

(20 citation statements)

References 42 publications

(66 reference statements)

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“…The DOI was found to be a good predictor for occult nodal metastases. Controversies remain about the proper pDOI threshold for a clinically relevant risk of occult nodal metastases; however, data from the literature suggest that an elective neck dissection should be performed with a pDOI ≥ 4 mm [ 12 , 13 , 14 ]. An accurate instrument to preoperatively measure the DOI may allow proposing concomitant tumor resection and elective neck dissection, reducing the rate of two-step procedures.…”

Section: Discussionmentioning

confidence: 99%

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High-Frequency Intraoral Ultrasound for Preoperative Assessment of Depth of Invasion for Early Tongue Squamous Cell Carcinoma: Radiological–Pathological Correlations

Caprioli

Casaleggio

Tagliafico

et al. 2022

IJERPH

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The eighth edition of the TNM classification officially introduced “depth of invasion” (DOI) as a criterion for determining the T stage in tongue squamous cell carcinoma. The DOI is a well-known independent risk factor for nodal metastases. In fact, several experts strongly suggest elective neck dissection for tongue cancer with a DOI > 4 mm due to the high risk of early and occult nodal metastases. Imaging plays a pivotal role in preoperative assessments of the DOI and, hence, in planning the surgical approach. Intraoral ultrasound (IOUS) has been proposed for early-stage SCC of the oral tongue as an alternative to magnetic resonance imaging (MRI) for local staging. The aim of this work is to investigate the accuracy of IOUS in the assessment of the DOI in early oral SCC (CIS, pT1, and pT2). A total of 41 patients with tongue SCCs (CIS-T2) underwent a preoperative high-frequency IOUS. An IOUS was performed using a small-size, high-frequency hockey-stick linear probe. The ultrasonographic DOI (usDOI) was retrospectively compared to the pathological DOI (pDOI) as the standard reference. In patients who underwent a preoperative MRI, their usDOI, magnetic resonance DOI (mriDOI), and pDOI were compared. Specificity and sensitivity for the IOUS to predict a pDOI > 4 mm and to differentiate invasive and noninvasive tumors were also evaluated. A high correlation was found between the pDOI and usDOI, pDOI and mriDOI, and usDOI and mriDOI (Spearman’s ρ = 0.84, p < 0.0001, Spearman’s ρ = 0.79, p < 0.0001, and Spearman’s ρ = 0.91, p < 0.0001, respectively). A Bland–Altman plot showed a high agreement between the usDOI and pDOI, even though a mean systematic error was found between the usDOI and pDOI (0.7 mm), mriDOI and pDOI (1.6 mm), and usDOI and mriDOI (−0.7 mm). The IOUS was accurate at determining the T stage (p < 0.0001). The sensitivity and specificity for the IOUS to predict a pDOI ≥4 mm were 92.31% and 82.14%, respectively, with an AUC of 0.87 (p < 0.0001). The specificity, sensitivity, negative predictive value (NPV), and positive predictive value (PPV) for the IOUS to predict an invasive cancer were 100%, 94.7%, 60%, and 100%, respectively. The AUC was 0.8 (95% CI 0.646–0.908, p < 0.0001). The IOUS was accurate in a preoperative assessment of a pDOI and T stage, and can be proposed as an alternative to MRI in the preoperative staging of tongue SCC.

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Section: Discussionmentioning

confidence: 99%

“…Notwithstanding, there is no global consensus for the threshold, with a range varying between 3 mm and 10 mm [ 3 , 10 , 11 ]. However, a DOI cut-off of 4 mm was recently proposed by several experts [ 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

High-Frequency Intraoral Ultrasound for Preoperative Assessment of Depth of Invasion for Early Tongue Squamous Cell Carcinoma: Radiological–Pathological Correlations

Caprioli

Casaleggio

Tagliafico

et al. 2022

IJERPH

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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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“…6,16 In the modification of the 8th edition of the American Joint Committee on Cancer (AJCC), 17 depth of invasion (DOI) was incorporated into the criteria for T classification. 17 Aaboubout et al 18 recommended elective neck dissection if the DOI is >4 mm, considering the possibility of occult lymph node metastasis in early-stage cancer. These results suggest that YK classification and the DOI values are closely correlated with the prognosis.…”

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confidence: 99%

Automatic discrimination of Yamamoto-Kohama classification by machine learning approach for invasive pattern of oral squamous cell carcinoma using digital microscopic images: a retrospective study

Yoshizawa¹,

Ando²,

Kimura³

et al. 2022

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

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

Cited by 33 publications

References 42 publications

High-Frequency Intraoral Ultrasound for Preoperative Assessment of Depth of Invasion for Early Tongue Squamous Cell Carcinoma: Radiological–Pathological Correlations

High-Frequency Intraoral Ultrasound for Preoperative Assessment of Depth of Invasion for Early Tongue Squamous Cell Carcinoma: Radiological–Pathological Correlations

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

Automatic discrimination of Yamamoto-Kohama classification by machine learning approach for invasive pattern of oral squamous cell carcinoma using digital microscopic images: a retrospective study

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