Treatment strategy for cervical lymph node metastases from early-stage tongue and floor of the mouth squamous cell carcinoma using tumour budding and depth of invasion as predictors

Masaru Ogawa ¹, Satoshi Yokoo ², Takahiro Yamaguchi ²

⁰Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, 3-39-15, Showa-machi, Maebashi-city, Gunma, 370-8511, Japan. masaru0523@gunma-u.ac.jp.

Clinical Oral Investigations +

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October 8, 2024

View abstract on PubMed

Summary

Pathological depth of invasion (pDOI) and budding score (BS) ≥5 in biopsy specimens are key predictors of cervical lymph node metastasis (CLM) in early-stage tongue and floor SCC. These factors help determine initial surgical treatment for improved patient outcomes.

Area Of Science

Oncology
Head and Neck Surgery
Pathology

Background

Early-stage tongue and floor squamous cell carcinoma (SCC) prognosis is significantly influenced by cervical lymph node metastasis (CLM).
Elective neck dissection is a common treatment, but identifying patients who will benefit requires accurate prediction of CLM.

Purpose Of The Study

To statistically analyze biopsy specimen data to predict CLM incidence and prognosis in early-stage tongue and floor SCC.
To determine if specific pathological features can guide the need for elective neck dissection during initial surgery.

Main Methods

Analysis of biopsy specimens from 103 patients with early cT1-T2 tongue and floor of the mouth cancer.
Multivariate and univariate statistical analyses to identify correlations between biopsy parameters and CLM.

Main Results

Pathological depth of invasion (pDOI) ≥5 mm and budding score (BS) ≥5 were identified as independent risk factors for CLM.
Significant differences in 5-year disease-specific survival were observed based on BS and pDOI thresholds.
The budding and depth of invasion (BD) score model demonstrated high specificity for CLM prediction.

Conclusions

Preoperative criteria including pDOI ≥5 mm or BS ≥5 in biopsy specimens, and imaging-based DOI ≥8 mm, can help manage occult CLM in initial surgery for early-stage tumors (≤20 mm).
The BD model is a valuable tool for predicting CLM in these patients.
Identifying high-risk patients for CLM allows for tailored surgical management, potentially improving survival outcomes.

Keywords:

Biopsy Cervical lymph node metastasis Depth of invasion Early tongue and floor of the mouth squamous cell carcinoma Tumour budding