Abstract
A role for incisional biopsy in preoperative prognostication is increasingly being advocated in oral tongue squamous cell carcinomas (OTSCC). Biopsies at two locations were compared, and prognostic factors in biopsies and their corresponding resections were evaluated. A total of 138 OTSCC biopsy slides from Finland and Saudi Arabia were compared for size (horizontal and vertical) and invasive front. The Finnish cases were assessed for tumor stroma ratio (TSR) and tumor-infiltrating lymphocytes (TILs) using light microscopy and digital image analysis assessment and compared. Furthermore, TSR, TILs, and previously analyzed budding and depth of invasion (BD) score in biopsies were compared with their evaluation in the corresponding resections. Fifty-nine percent of Finnish and 42% of Saudi Arabian biopsies were≥5mm deep, while 98% of Saudi Arabian and 76% of Finnish biopsies were≥5mm wide. Assessment of invasion front was possible in 72% of Finnish in comparison with 40% of Saudi Arabian biopsies. There was 86.8% agreement between TSR and 75% agreement between TIL evaluation using light microscopy and digital assessment. Significant agreement was obtained on comparing the TSR (p=0.04) and BD (p<0.001) values in biopsies and resections. Biopsies of≥5mm depth from representative OTSCC areas are essential for prognostic information. Clinical pathologists are advised to assess BD score and TSR for prognostic features in such biopsies.
Highlights
Squamous cell carcinoma of the oral tongue (OTSCC) contributes the highest number of cases of oral squamous cell carcinoma (OSCC), and is associated with the lowest relative survival of the different subsites within the oral cavity [1, 2]
The study was approved by the local institutional review boards of the 3 participating institutions: Universities of Helsinki, Eastern Finland and King Saud, Saudi Arabia
Histological slides of biopsies of oral tongue squamous cell carcinomas (OTSCC) cases were randomly retrieved from the archives of two Finnish University hospitals; Helsinki (HUH) and Kuopio (KUH), and King Saud University Oral
Summary
Squamous cell carcinoma of the oral (mobile) tongue (OTSCC) contributes the highest number of cases of oral squamous cell carcinoma (OSCC), and is associated with the lowest relative survival of the different subsites within the oral cavity [1, 2]. Incisional biopsy remains an indispensable diagnostic tool for oral cancers. Cancer diagnosis is mandatorily followed by preoperative staging (usually by clinical and imaging modalities) in order to determine the risk category and the most appropriate treatment plan for the patient. The need for extending the role of the biopsy from being only diagnostic to include prognostication has recently been highlighted by some investigators [3, 4]. In OSCC (and OTSCC), tumor grade of differentiation has not been found to be useful in prognostication despite being the only universal routinely assessed histological feature in preoperative biopsies by pathologists [5,6,7]. Several tumor-related histological features such as depth of invasion (DOI), worst pattern of invasion (WPOI), tumor budding, budding and depth of invasion (BD) score, as well as some stromal features such as tumor stroma ratio (TSR) and tumor-infiltrating lymphocytes (TILs) have been identified in several studies as being of significant prognostic potential in OTSCC [8,9,10,11]
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