Journal of Population Therapeutics

& Clinical Pharmacology

RESEARCH ARTICLE
DOI: 10.47750/jptcp.2023.30.06.024

Histological depth of invasion and its correlation in oral squamous cell

carcinoma- a retrospective study
Reenu Joshy1, Palati Sinduja2*, Priyadharshini3
1Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences,

Saveetha University, Chennai-600077.

2Senior Lecturer, Department of Oral and Maxillofacial Pathology, Saveetha Dental College and

Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University,Chennai-600077

3Senior Lecturer, Department of Oral and Maxillofacial Pathology, Saveetha Dental College and

Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University,Chennai-600077

*Corresponding author: Palati Sinduja, Senior Lecturer, Department of Oral and Maxillofacial
Pathology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical
Sciences, Saveetha University, Chennai-600077, Email: sindujap.sdc@saveetha.com

Submitted: 11 February 2023; Accepted: 14 March 2023; Published: 03 April 2023

ABSTRACT
Introduction: Oral squamous cell carcinoma is the most prevalent head and neck tumour, which is
also one of the main causes of cancer-specific mortality. The most often impacted area of OSCC is the
tongue. Occult nodal metastasis is the most significant indicator for prognosis of early-stage OSCC
with a clinically negative neck. It was discovered that depth of invasion was a highly accurate indicator
of occult nodal metastasis in OSCC, making it potentially a very valuable tool for predicting the
incidence of nodal dissemination and, consequently, prognosis.
Aim: To determine the correlation between depth of invasion and staging of cancer.
Materials and methods: Evaluated the records of OSCC patients retrospectively. Depth of invasion
for 30 excision specimens were measured using the magna software. The data was statistically
analysed using SPSS software.
Results: DOI less than 5mm can be considered as stage one of OSCC. Similarly DOI of 6-10 mm as
stage 2 and 11-15 mm as stage 3. Furthermore, depth of invasion above 16mm can be considered as
stage 4 which involves nodal metastasis.
Conclusion: The study concludes that there is correlation between depth of invasion and staging of
OSCC, thus DOI can be considered as an important prognosis factor.

Keywords: Depth of invasion, nodal metastasis, oral squamous cell carcinoma, prognosis, Good
health and well being

INTRODUCTION neoplasms. About 90% of all oral cancers are

Oral squamous cell carcinoma (OSCC) is a type OSCCs (1). Oral cancers that affect the salivary
of malignant oral epithelial neoplasia, which glands, pharynx, and oral cavity account for 2%
represents the most frequent of all oral to 4% of all cancer cases globally (2,3).

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Histological depth of invasion and its correlation in oral squamous cell carcinoma- a retrospective study

OSSC most commonly develops on the sites such studies have consistently shown a relationship
as lips, tongue and floor of the mouth, while some between a number of prognostic markers and
OSCCs arise in apparently normal mucosa and disease-specific survival, local and regional
some may be preceded by clinically obvious recurrence, and lymph node metastasis. The
premalignant lesions like leukoplakia and prognosticators are extranodal extension (ENE),
erythroplakia (4,5). Typically, OSCC often lymphovascular invasion (LVI), perineural
presents as an ulcer with prominent exophytic invasion (PNI), depth of invasion (DOI), and
margins or fissures(6). It can also develop as a pattern of invasion (POI)(1,3,5) .
lump, an enlarged, hard, or fixated cervical
DOI is regarded as an objective metric that has
lymph node, a white or mixed white and red
been examined by numerous researchers for the
lesion, an extraction socket that won't heal, or a
prognosis of OSCC. Although the majority of
red lesion (erythroplakia)(7,8). If any of these
writers mostly concur that DOI is a crucial factor
characteristics last for longer than two weeks,
in determining nodal metastasis and survival,
OSCC should be taken into consideration(9).
there is no set threshold for when neck dissection
The two biggest risk factors for oral cancer are should be performed because the outcomes in the
smoking and alcohol consumption. 75% of all research differ. The aim of the present is to
incidences of oral cancer are related to tobacco analyse the correlation between DOI and staging
use. Smokers are six times more likely to get oral of OSCC.
cancer than non-smokers.(10). Alcohol drinkers
are also six times more likely than non-drinkers
to acquire oral cancer. Users of cigarettes and MATERIALS AND METHODS
alcohol have an oral cancer risk that is fifteen The Department of Oral and Maxillofacial
times greater than non-users. While smoking and Pathology's archives provided access to 30
drinking are typically the biggest risk factors, it's formalin fixed paraffin embedded tissue blocks
vital to take into account other aspects as well, that represented the core specimens of excision
like betel quid chewing in some ethnic groups. specimens. The excision of oral squamous cell
Chewing betel nut is common among Indian and carcinoma and the removal of lymph nodes were
Taiwanese people, and it raises your risk of both inclusion criteria for the study.
mouth cancer substantially (11). Use of cannabis,
areca nuts, and opioids leads to a higher risk of
oral cancer. Older men, people from poorer Staining Protocol
socioeconomic backgrounds, and members of The sections were rehydrated with alcohol for 10
ethnic minorities are most likely to have OSCC. minutes after being deparaffinized with Xylene
There are additional considerations at play. These for 20 minutes. During the differentiation
consist of decreased capacity to repair mutagen- process the slides were dipped in acid alcohol and
induced DNA damage, an inability to digest ammonia each for one dip, and then washed in
cancer-causing substances, vitamins A, E, or C, running water for bluing. Harris's haematoxylin
or trace element deficiencies and immunity stain was used to stain the sections for 5 minutes
problems (12). after which it was rinsed in running tap water for
3-5 minutes. Slides were dehydrated using
Oropharyngeal and oral SCC are becoming more progressively stronger alcohol, after being
common. Globally, there are about 263,000 new dipped once in eosin. The slides were mounted
cases of oral cancer each year, and the illness with DPX after being cleaned in xylene.
claims 127,000 lives (13). It is the third most
prevalent malignancy in India and causes close to The slides were observed under a microscope and
40% of fatalities. In India it is the second most the DOI was recorded and tabulated. Magna
frequent site in men and the fourth in women. Software was used to measure the DOI. The
Male incidence rates were 10.1 per 100,000 in patient’s information was recorded using the
2012, while female incidence rates were 4.3 per patient data. Measurements were taken in
100,000 (14). Numerous single or multicenter millimetres by an experienced pathologist.

J Popul Ther Clin Pharmacol Vol 30(6):e183–e188; 03 April 2023.

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Histological depth of invasion and its correlation in oral squamous cell carcinoma- a retrospective study

Statistical analysis The SPSS software was used to analyse the data.
To summarise qualitative data, descriptive
statistics expressed as percentage was generated.

FIGURE 2: DOI analysis in invasive SCC

RESULTS OSCC. Similarly DOI of 6-10 mm as stage 2 and

The depth of invasion and staging of oral 11-15 mm as stage 3. Furthermore, depth of
squamous cell carcinoma is correlated. DOI less invasion above 16mm can be considered as stage
than 5mm can be considered as stage one of 4 which involves nodal metastasis.

FIGURE 3: Bar graph depicting the correlation between DOI and mean stagging. X axis represents
the depth of invasion in millimetres and Y axis represents mean staging of OSCC.

J Popul Ther Clin Pharmacol Vol 30(6):e183–e188; 03 April 2023.

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Histological depth of invasion and its correlation in oral squamous cell carcinoma- a retrospective study

Group Stagging
Group Pearson Correlation 1 .914**
Sig. (2- tailed) .000
N 40 40

Stagging PearsonCorrelation .914** 1

Correlation .000
Sig. (2- tailed) 40 40
N
**. Correlation is significant at the 0.01 level (2- tailed).

DISCUSSION tumours. Males are more likely to get cancer of

Radical neck dissections have been conducted the tongue, according to numerous research.
since the late 1800s to prevent cancer recurrences Indian men are exposed to both smokeless and
despite the fact that they resulted in serious smoked tobacco, which explains why this is the
postoperative problems such as shoulder case. But recently, some cases without any prior
dislocation. The lymph nodes that drained the history of habits that can contribute to the
tumour's initial site were removed during more emergence of oral cancers, including tongue
focused neck dissections in the 1980s. Even with cancer, have been identified.
conservative care, shoulder dysfunction might In our study we have found that depth of invasion
still occur occasionally(15). less than 5 mm can be considered as stage one of
The size of the primary tumour, the location, the OSCC. Similarly DOI of 6-10 mm as stage 2 and
T stage, the grade, the depth of invasion, the 11-15 mm as stage 3. Furthermore, depth of
biological tumour markers, the perineural invasion above 16mm can be considered as stage
invasion, and patient compliance are a few of the 4 which involves nodal metastasis.
variables that can influence the rate of cervical When the depth of invasion is greater than 5 mm,
metastasis and survival from oral cavity cancer it was found that the cutoff threshold is most
(16)(17). Since the tumour breadth and the site significantly associated with neck metastasis.
were once thought to be the key prognostic Therefore, predicting the occult cervical lymph
determinants, numerous prognostic models were node metastases using the depth of invasion may
developed to determine the amount of metastasis be helpful. Similar investigations have shown
dissemination. Recently, DOI has gained that in cases of carcinomas of the lateral border
importance as a prognostic factor for early of the tongue, level II nodes are the most
detection of OSCC. frequently involved site, followed by level III
The term "depth of invasion" refers to the extent nodes(6,18,19).
cancer penetrated into the tissue below an Depth of invasion also has its limitations; in some
epithelial surface. Some investigators restore a circumstances, particularly when there has been
surface line after the epithelium has been perineural invasion, it can be challenging to
damaged and measure along this line. However, ascertain the depth of invasion. The fundamental
rather than using precise millimetre issue with measuring tumour thickness in
measurements from a micrometre, the depth of mucosal tumours, when there is frequently no
invasion is frequently described in terms of the mucosal surface on the slide to utilise as a
microscopic, deep anatomical structures that are reference point, is the difference in complexity
reached. (20). This issue was also brought up by several
In the present study we have assessed the depth publications. Another drawback is that multiple
of invasion of 30 excisional specimens and the cutoff values have been used to determine
correlation with staging and nodal metastasis. elective neck dissection for clinically negative
The lateral margin of the tongue and buccal necks due to the lack of a consistent way of
mucosa are the two most frequent locations for assessing tumour thickness/depth of
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Histological depth of invasion and its correlation in oral squamous cell carcinoma- a retrospective study

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Commercial 4.0 International License. ©2021 Muslim OT et al.

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