DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20185306

Correlation between histological grading, LVI and PNI of carcinoma oral tongue to lymph node metastasis

Sumana C. Viswanatha, Naveen Hedne, Suhel Hasan

Abstract


Background: Squamous cell carcinoma (SCC) of oral tongue has a higher predisposition to lymph node metastasis which reduces survival by 50%. In clinical practice, TNM classification is used for treatment planning which does not provide information on the biological characteristics of the tumor.

Methods: This prospective cross sectional observational study included 30 patients with T1 to T3, N0/+ oral tongue SCC from 1st March 2014 to 30th April 2015. Incisional biopsy was taken from the primary tumour, pathological evaluation for differentiation of the tumour and assessment of lymphovascular (LVI) and perineural invasion(PNI) was carried out. Post operative histopathological examination included differentiation, LVI and PNI. The pathological findings were correlated using chi square test.  

Results: Majority presented with T2 stage. 27% had nodal metastasis. There was higher incidence of lymph node metastasis in moderately differentiated (MD) and poorly differentiated (PD) SCC which was not statistically significant. Significant correlation was seen between LVI and PNI to lymph node metastasis (p≤0.001).

Conclusions: There is a higher incidence of lymph node metastasis seen in moderately and poorly differentiated SCC of oral tongue, which can be assessed on the preoperative biopsy, guiding us to be more aggressive in the management of cervical nodes in early tongue cancer. LVI and PNI are good predictors of nodal metastasis, help in assessing aggressiveness and prognosis of the disease, and are soft indicators for considering adjuvant / concurrent RT.


Keywords


Carcinoma oral tongue, Cervical lymph node metastasis, Histologic grade, Lymphovascular-perineural invasion

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References


Chaturvedi P. Head and Neck Surgery. J Can Res Ther. 2009;5:143.

National Cancer Registry Programme (NCRP, ICMR). Consolidated report of population based cancer registries 2004-2005. Bangalore: NCRP; 2008.

Tumuluri VR. A retrospective analysis of cell proliferation in human oral squamous cell carcinoma. Queen Elizabeth Research Institute for Mothers and Infants: University of Sydney; 1998.

Dantas DDL, Ramos CCF, Costa ALL, Souza LB, Pinto LP. Clinical-pathological parameters in squamous cell carcinoma of the tongue. Braz Dent J. 2003;14(1):22-5.

Grandi C, Alloisio M, Moglia D, Podrecca S, Sala L, Salatori P, et al. Prognostic significance of lymphatic spread in head and neck carcinomas: therapeutic implications. Head Neck Surg. 1985;8:67–73.

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

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

Snow GB, Annyas AA, van Slooten EA, Bartelink H, Hart AA. Prognostic factors of neck node metastasis. Clin Otolaryngol. 1982;7:185–92.

Dib LL, Sabba LMB, Marques LA, Araújo NS. Fatores prognósticos em carcinoma de borda de língua: análise clínica e histopatológica. Acta Oncol Bras. 1994;14:88-93.

Hiratsuka H, Miykawa A, Nakamori K, Kido Y, Sunakawa H, Kohama G. Multivariate analysis of occult lymph node metastasis as a prognostic indicator for patients with squamous cell carcinoma of the oral cavity. Cancer.1997;80:351-6.

American Cancer Society. Cancer Facts and Figures 2005. Atlanta: American Cancer Society; 2005.

Rikardsen OG, Bjerkli IH, Uhlin-Hansen L, Hadler-Olsen E, Steigen SE. Clinicopathological characteristics of oral squamous cell carcinoma in Northern Norway: a retrospective study. BMC Oral Health. 2014;14:103.

Akhter M, Hossain S, Rahman QB, Molla MR. A study on histological grading of oral squamous cell carcinoma and its co-relationship with regional metastasis. J Oral Maxillofac Pathol. 2011;15(2):168–76.

Kurokawa H, Yamashita Y, Takeda S, Zhang M, Fukuyama H, Takahashi T. Risk factors for late cervical lymph node metastases in patients with stage I or II carcinoma of the tongue. Head Neck. 2002;24(8):731–6.

Woolgar JA. Histopathological prognosticators in oral and oropharyngeal squamous cell carcinoma. Oral Oncol. 2006;42(3):229-39.

Binmadi NO, Basile JR. Perineural invasion in oral squamous cell carcinoma: a discussion of significance and review of the literature. Oral Oncol. 2011;47:1005–10.

Jones HB, Sykes A, Bayman N, Sloan P, Swindell R, Patel M, Musgrove B. The impact of lymphovascular invasion on survival in oral carcinoma. Oral Oncol. 2009;45(1):10-5.

Sharma P, Shah SV, Taneja C, Patel AM, Patel MD. A prospective study of prognostic factors for recurrence in early oral tongue cancer J Clin Diagn Res. 2013;7(11):2559–62.

Jardim JF, Franciso ALN, Gondak R, Damascena A, Kowalski LP. Prognostic impact of perineural invasion and lymphovascular invasion in advanced stage oral squamous cell carcinoma. Inter. J Oral Maxillo Facial Surg. 2015;44(1):23–8.

Michikawa C, Uzawa N, Kayamori K, Sonoda I, Ohyama Y, Okada N, et al. Clinical significance of lymphatic and blood vessel invasion in oral tongue squamous cell carcinomas. Oral Oncol. 2012;48(4):320-4.

Lim SC, Zhang S, Ishii G, Endoh Y, Kodama K, Miyamoto S, 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.