Small and Thin Oral Squamous Cell Carcinomas may Exhibit Adverse Pathologic Prognostic Features

Area of Science:

• Oncology
• Pathology
• Head and Neck Surgery

Background:

• Early oral squamous cell carcinoma (OSCC) management can be influenced by perceived tumor size and depth.
• Small and thin OSCCs may be incorrectly assumed to have a less aggressive behavior.
• Accurate assessment of adverse pathologic features is crucial for appropriate treatment planning.

Purpose of the Study:

• To determine the frequency of adverse pathologic features in early OSCC, particularly in small and thin tumors.
• To correlate these features with the presence of neck disease (nodal status).
• To evaluate the impact of biopsy site on the assessment of the worst pattern of invasion (WPOI) in small tumors.

Main Methods:

• Retrospective review of 95 early OSCC cases (≤20 mm size, ≤10 mm depth) over a 5-year period.
• Recorded tumor dimensions, depth, perineural invasion (PNI), lymphovascular invasion (LVI), WPOI, and nodal status.
• Analyzed the influence of depth and WPOI on predicting nodal disease and assessed biopsy site interference with WPOI5 evaluation.

Main Results:

• 46.3% of tumors were small and 82.1% were thin; 43.2% were both small and thin.
• Tumor depth and WPOI were significant predictors of nodal disease.
• Small and thin OSCCs showed similar rates of PNI and nodal disease compared to other early OSCCs, with 61% exhibiting WPOI 4 or 5.
• Biopsy site scarring rarely affected WPOI5 assessment (2/38 cases).

Conclusions:

• Depth and WPOI are critical factors for predicting nodal metastasis in early OSCC.
• Small and thin early OSCCs exhibit aggressive features and nodal disease rates comparable to other early OSCCs.
• Despite their size, small and thin OSCCs should be managed similarly to all early OSCCs, avoiding de-escalation of treatment.
• Biopsy-induced scarring minimally impacts the assessment of WPOI5 in very small tumors.