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Urology/Head & Neck

E177: Depth of Invasion as a predictor of Cervical Nodal Disease in T1-3, clinically Node negative Squamous Cell Carcinoma Oral Tongue- A Retrospective Analysis of 545 patients at a tertiary cancer care centre in India

Introduction: Squamous Cell Carcinoma (SCC) Oral Tongue (a part of Oral Cavity CA) is well known for its notoriety in terms of high Recurrence rates and occult Cervical Nodal Disease. The aim of the study is to note the concordance between DOI and Nodal positivity in clinically N0 Patients. This in turn translates into need for END (Elective Neck Dissection) in this subset of patients

Methods: We present here a Retrospective, Observational study of 545 SCC Tongue who were T1-3 and clinically N0 (Node Negative). The study included patients over a time period of 5 years (2018 – 2023). All cases included in the study had Oral Tongue as the primary disease site without the involvement of other oral cavity subsites or secondary sites. Clinical Node Negative status was given after independent examinations by 2 different clinicians. HPE was reported by a consultant of the same team of Pathologists and was verified by second consultant. DOI was noted for each case from final HPE report. DOI Intervals were taken as per the latest AJCC TNM staging for Oral Cavity SCC (at intervals of 5 mm). Patients with Nodal disease were identified from final HPE report. Statistical Analysis was done, and Correlation Coefficient calculated

Results: Results demonstrated that there is a Strong Linear Relation between DOI (on HPE) and Positive Pathological Cervical Nodes (pN). With DOI upto 5 mm, a 14 % (31 out of 229) incidence of positive pathological nodes was noted which rose to 87 %(26 out of 30) with DOI more than 15 mm. r2 value was calculated as 0.9866 i.e DOI is highly predictive of presence of pN and 98.66 % of the variability in the percentage of pN can be explained by variations in DOI

Conclusions: Increasing DOI translates into Increased risk of Cervical Nodal disease in SCC Tongue. Caution is to be practised while snubbing END (Elective Neck Dissection) in Early-Stage CA Tongue and DOI can be a useful guide to such decisions

Learning Objectives:

  • appreciate the bearing of depth of invasion on cervical nodal disease
  • decipher the warning sign of depth of invasion in clinically node negative patients
  • make an informed decision in pre-operative setting regarding the possible need of elective neck dissection in clinically node negative patients