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VOLUME 17 , ISSUE 1 ( January, 2016 ) > List of Articles

RESEARCH ARTICLE

Histopathological Parameters predicting Occult Nodal Metastases in Tongue Carcinoma Cases: An Indian Perspective

N Malathi, Tina Elizabeth Jacob, Sharada T Rajan, N Manish

Citation Information : Malathi N, Jacob TE, Rajan ST, Manish N. Histopathological Parameters predicting Occult Nodal Metastases in Tongue Carcinoma Cases: An Indian Perspective. J Contemp Dent Pract 2016; 17 (1):70-77.

DOI: 10.5005/jp-journals-10024-1805

Published Online: 01-01-2016

Copyright Statement:  Copyright © 2016; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background

It is a well-established fact that in squamous cell carcinoma cases, the presence of lymph node metastases decreased the 5-year survival rate by 50% and also caused the recurrence of the primary tumor with development of distant metastases. Till date, the predictive factors for occult cervical lymph nodes metastases in cases of tongue squamous cell carcinoma remain inconclusive. Therefore, it is imperative to identify patients who are at the greatest risk for occult cervical metastases. This study was thus performed with the aim to identify various histopathologic parameters of the primary tumor that predict occult nodal metastases.

Materials and methods

The clinicopathologic features of 56 cases of lateral tongue squamous cell carcinoma with cT1NoMo/cT2NoMo as the stage and without prior radiotherapy or chemotherapy were considered. The surgical excision of primary tumor was followed by elective neck dissection. The glossectomy specimen along with the neck nodes were fixed in formalin and 5 ìm thick sections were obtained. The hematoxylin & eosin stained sections were then subjected to microscopic examination. The primary tumor characteristics that were analyzed include tumor grade, invading front, depth of tumor, lymphovascular invasion, perineural invasion and inflammatory response. The nodes were examined for possible metastases using hematoxylin & eosin followed by cytokeratin immunohistochemistry.

Result

A total of 12 cases were found with positive occult nodal metastases. On performing univariate analysis, the histopathologic parameters that were found to be statistically significant were lymphovascular invasion (p = 0.004) and perineural invasion (p = 0.003) along with a cut-off depth of infiltration more than 5 mm (p = 0.01).

Conclusion

Histopathologic assessment of the primary tumor specimen therefore continues to provide information that is central to guide clinical management, particularly in cases of occult nodal metastases.

Clinical significance

The study highlights the importance of extensive histopathological screening, which holds the key for establishing occult metastases. Pathological upgrading of tumors is possible following histopathological studies similar to the present one. Presence of occult metastases justify neck dissection in these clinically N0 cases. In an Indian setting, histopathological evaluation assumes a bigger role than other expensive and advanced techniques.

How to cite this article

Jacob TE, Malathi N, Rajan ST, Augustine D, Manish N, Patil SG. Histopathological Parameters predicting Occult Nodal Metastases in Tongue Carcinoma Cases: An Indian Perspective. J Contemp Dent Pract 2016; 17(1):70-77.


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  1. Robbins basic pathology. 8th ed. Philadelphia, PA: Saunders/Elsevier; 2007.
  2. Improved staging of cervical metastases in clinically node-negative patients with head and neck squamous cell carcinoma. Ann Surg Oncol 2004 Feb;11(2):213-218.
  3. Histopathologic validation of sentinel node concept in oral and oropharyngeal squamous cell carcinoma. Head Neck 2005 Feb;27(2):150-158.
  4. Oral & maxillofacial pathology. 3rd ed. St. Louis; 2009.
  5. Management of radiation-induced head and neck injury. Cancer Treat Res 2006;128:23-41.
  6. Detection and significance of occult axillary node metastases in patients with invasive breast cancer. Cancer 1978 Oct;42(4):2025-2031.
  7. Regional metastasis and its significance in developing distant metastases in head and neck carcinoma. Cancer 1993;71:452-456.
  8. Detailed topography of cervical lymph-node metastases from oral squamous cell carcinoma. Int J Oral Maxillofac Surg 1997 Feb;26(1):3-9.
  9. Effectiveness of selective neck dissection for management of the clinically negative neck. Arch Otolaryngology Head Neck Surg 1997 Sep;123(9):917-922.
  10. Diagnosis and treatment of the N0 neck of carcinomas of the upper aerodigestive tract. Report of an international symposium, Gottingen, Germany, 1992. Eur Arch Otorhinolaryngol 1993;250(8):450-456.
  11. Grading of oral cancer: comparison of different systems with respect to lymph node metastasis in tongue squamous cell carcinoma. Arch Iran Med 1999;2:87-92.
  12. Occult cervical lymph node metastases in 100 consecutive patients with cN0 tongue cancer. Chin Med J (Engl) 2008 Oct 5;121(19):1871-1874.
  13. Depth of invasion as a predictive factor for cervical lymph node metastasis in tongue carcinoma. Head Neck 1997 May;19(3):205-210.
  14. Established prognostic variables in N0 oral carcinoma. Otolaryngol Head Neck Surg 2006 Nov;135(5):748-753.
  15. Tumour thickness predicts cervical nodal metastases and survival in early oral tongue cancer. Oral Oncol 2003 Jun;39(4):386-390.
  16. Histopathological factors affecting nodal metastasis in tongue cancer: analysis of 94 patients in Taiwan. Int J Oral Maxillofac Surg 2008 Oct;37(10):912-916.
  17. Predictive factors of occult metastasis and prognosis of clinical stages I and II squamous cell carcinoma of the tongue and floor of the mouth. Oral Oncol 2004 Sep;40(8):780-786.
  18. Risk factors for late cervical lymph node metastases in patients with stage I or II carcinoma of the tongue. Head Neck 2002 Aug;24(8):731-736.
  19. Perineural invasion in squamous cell carcinoma of head & neck. Arch Otolaryngol Head Neck Surg 1998 Jun;124(6):637-640.
  20. Multivariate analysis of occult lymph node metastasis as a prognostic indicator for patients with squamous cell carcinoma of the oral cavity. Cancer 1997 Aug 1;80(3):351-356.
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