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

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.

Porphyromonas gingivalispromotes invasion of oral squamous cell carcinoma through induction of proMMP9 and its activation

“…In the present study, PAR2 activation induced by P. gingivalis promoted phosphorylation of IkB and nuclear translocation of NF‐kB leading to proMMP9 overexpression. Previous studies have also demonstrated that P. gingivalis RgpB stimulated PAR2, which then activated p38 and ERK1/2, as well as the AP‐1 pathway (Chandler et al ., ), whereas NF‐kB was not activated by PAR2 in another study (Fyfe et al ., ). In the current study, PAR2 activation in SAS cells did not lead to activation of p38 and ERK1/2.…”

“…OSCC often shows active invasion and lymph node metastasis (Chandler et al, 2011). OSCC cell lines are classified into 2 types based on invasiveness, with highly invasive SAS cells and low invasive for which Ca9-22 cells are representative (Shindoh et al, 1996).…”

Epidemiologic Trends in Head and Neck Cancer and Aids in Diagnosis

“…Similarly a tumor thickness of > 1.5 mm in the floor of mouth region portends a higher risk for occult nodal metastases favoring prophylactic neck dissection (TABLE 7) 57 . Invasion of the tumor into muscle shows similar correlation with increased risk for regional metastases 58 . Other histologic factors including tumor invasive patterns and associated tumor inflammation may also allow for future risk-classification and is currently undergoing prospective validation 59 .…”

Verrucous Carcinoma with Dysplasia or Minimal Invasion: A Variant of Verrucous Carcinoma with Extremely Favorable Prognosis

“…Epithelial dysplasia was defined in our cases as tumors having one or more of the following features: expansion of the basal layer by enlarged or hyperchromatic cells, cytologic atypia or pleomorphism, decreased maturation with enlarged or hyperchromatic nuclei above the basal layers, cells with high nuclear to cytoplasmic ratio above the suprabasal layer, or multiple or atypical mitoses above the basal or suprabasal layers. The cut off value of 2 mm was chosen somewhat arbitrarily based on published data on oral cavity SCC, where less than 2-4 mm of invasion means the likelihood of nodal metastases is quite low [13][14][15]. Depth of invasion was measured as the distance from the deepest point of invasion of the conventional invasive SCC component from the nearest focus of pure VC.…”