Perinerural, lymphovascular and depths of invasion in extrapolating nodal metastasis in oral cancer

Density of CD3+ and CD8+ cells in gingivo-buccal oral squamous cell carcinoma is associated with lymph node metastases and survival

“…Our multivariate analysis showed significant association of Lympho-Vascular Invasion (LVI) and Perineural Invasion (PNI) with lymph node metastases. Similar results were reported in Oral Squamous Cell Carcinoma [55][56][57]. An established link between tumor infiltrating cells and lymph node metastasis has been reported in 78 cases of oral squamous cell carcinoma, where increased CD8 + cells was associated with absence of lymph node metastasis [33].…”

Is Perineural Invasion a Reasonable Indicator for Neck Dissection in cT1N0M0 Squamous Cell Carcinoma of the Oral Cavity?

“…6,8,19,21,23 Reports have also found a higher number of positive nodes in tumors with PNI. 8,19,23,24 A number of limitations exist in our study. The majority of the data is from a retrospective review, and therefore, the entire study suffers from all of the limitations associated with such scientific endeavors.…”

Oral cancer: changing the aim of the biopsy in the age of precision medicine. A review

“…In addition, several studies have highlighted tumour budding (BD) and tumour-stroma ratio (TSR), considered in other non-TNM-based staging systems, as predictive factors for lymphatic diffusion and disease-free survival (DFS) 15,[45][46][47] . Table I shows the definition and purpose of these markers 2,15,37,38,42,45,46,[48][49][50][51][52][53][54][55][56][57] . To plan personalised treatment, oncologists need to assess these markers, including DOI, on biopsy samples according to the AJCC TNM (8th edition) recommendations 38 .…”

“…A "plumb line" is dropped from this plane to the deepest point of tumour invasion 38,42 Included in T1-3 Categories for Oral Cavity Cancer, TNM Staging Manual 8th Edition 37 The T category increases with every interval of 5 mm Tumour Thickness (TT) TT is measured from the surface of the tumour to the deepest point of invasion. In exofitic and ulcerated lesions TT is measured from the imaginary line reconstructing the intact mucosa to the deepest point of invasion 42,48 TT1 is measured from the level of adjacent mucosa to the deepest point of tumour invasion 49 TT2 is the distance from the bottom of most adjacent dysplastic abnormal rete pegs to the deepest point of invasion 49 TT3 is measured as distance from the epithelial junction of the most adjacent dermal papillae to the deepest point of tumour invasion 49 As defined before publication of the 8 th TNM Edition 42,48 or defined as an alternative to the proposed classification 49 Rete pegs: epithelial extensions in the connective tissue underlying the mucosa 49 Radiological Depth of Invasion (rDOI) rDOI is measured by drawing a perpendicular line from the reference line to the deepest point of the tumour 50 Radiological definition of DOI is also reported in TNM 8 th Edition 37. The reference line connects the junction of the tumour surfaces and of the normal mucosa on both sides 50 Tumour Budding (TB)…”

“…PNI is defined as the tumour cell infiltration in any layer of the nerve sheath or tumour in close proximity involving more than one-third of the nerve circumference 49 PNI should be subclassified as either intratumoral or extratumoral, and as focal or multifocal. Extensive multifocal PNl is usually extratumoral and frequently associated with a "strand-like" tumour phenotype 37…”