Small and Thin Oral Squamous Cell Carcinomas may Exhibit Adverse Pathologic Prognostic Features
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ORIGINAL PAPER
Small and Thin Oral Squamous Cell Carcinomas may Exhibit Adverse Pathologic Prognostic Features Mutaz Mohammed Nur1 · Maimuna Al Saadi1 · Esther M. O’Regan1,2,3 · Maria Van Harten3 · Mary Toner1,2,3 Received: 17 May 2020 / Accepted: 27 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract We set out to record the frequency of recognised adverse pathologic features in early oral squamous cell carcinoma (OSCC) and correlate with neck disease, in particular in small and thin carcinomas, a group that might be assumed to behave less aggressively. We also examined the possibility of a biopsy site interfering with assessment of WPOI5 in small tumors. We reviewed all OSCCs ≤ 20 mm size and ≤ 10 mm depth reported at our institution over a 5-year period. Tumor maximum dimension, depth, perineural invasion (PNI), lymphovascular invasion (LVI), worst pattern of invasion (WPOI), and nodal status were recorded. Out of 95 cases, there were 44 (46.3%) small and 78 (82.1%) thin OSCCs. Depth and WPOI were significant factors in predicting nodal disease. There were 41 (43.2%) OSCC that were small and thin, of which 9.8% had PNI, none had LVI, and 61% had WPOI 4 or 5. Their rate of PNI and of nodal disease was similar to the other early OSCC. Assessment of WPOI5 at a biopsy site was only a problem in 2/38 cases. In early OSCC, depth and WPOI are important factors in predicting nodal disease. The very earliest OSCC (small and thin) have a similar rate of PNI and of nodal disease to other early OSCC, suggesting that while there may be a tendency to de-escalate treatment, these small tumours should be managed in the same way as for all early OSCC. In addition, the presence of scarring due to a biopsy in very small carcinomas rarely affects assessment of WPOI5. Keywords Oral squamous cell carcinoma · Adverse pathologic features · Lymph node metastasis · Worst pattern of invasion · Prognosis · pT1
Introduction Oral cancer represents a major health problem in many parts of the world [1]. Approximately 95% of oral malignancies are squamous cell carcinomas [2]. Many studies on oral squamous cell carcinoma (OSCC) have demonstrated an adverse prognosis associated with certain pathologic features and more recently refinements of these have been found to be useful in predicting outcome, including weighting of these features by scoring [3–7]. While many such studies * Mutaz Mohammed Nur [email protected] 1
Department of Histopathology, St. James’s Hospital, Dublin, Ireland
2
Department of Oral and Maxillofacial Surgery, Medicine and Pathology, Dublin Dental University Hospital, Dublin, Ireland
3
School of Dental Science, Trinity College Dublin, Dublin, Ireland
have included all stages of OSCC, there has been recent interest in prognostic variables in lower stage tumors, some of which spread to the lymph nodes and behave aggressively [3, 8–11]. Recently there have been changes to the TNM staging to incorporate depth of invasion [12, 13]. Tumors that would have been previousl
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