Tumour Budding as a Predictive Factor for Lymph Node Metastases in Preoperative Oral Cancer Biopsies: A Retrospective Study

Abstract

Introduction: The enormous advancement in understanding of Oral Squamous Cell Carcinomas (OSCCs) has not been accompanied by a significant reduction in the high morbidity and mortality rates associated primarily with disease recurrence and lymph node metastases. Aim: To evaluate the tumour budding as an independent prognostic marker to predict lymph node metastasis in preoperative biopsies. Materials and Methods: The present retrospective study was conducted in the Department of Pathology, Guntur Medical College (tertiary care centre), Andhra Pradesh, India, from January 2018 to December 2021. Samples collected from 32 patients with preoperative diagnostic oral cavity biopsies, who also underwent resection with cervical lymph node dissection. The degree of differentiation, preoperative tumour budding, postoperative tumour budding, and intratumoural budding in preoperative biopsies were all assessed histologically in each case. The results were analysed using Chi-square test, KaplanMeier method and log-rank test. Results: Thirty two OSCC cases were examined by Haematoxylin and Eosin (H&E) stained slides. By using univariate analysis, the histological factors like depth of invasion (p-value=0.04), pattern of invasion (p-value=0.004), presence of preoperative tumour budding (p-value=0.008), postoperative tumour budding (p-value=0.004), intratumoural tumour budding (p-value=0.019), and sex (p-value=0.03) all significantly associated with risk of lymph node metastasis. Other clinical and histological factors, including age, the largest tumour size, histological grade, Lymphovascular Invasion (LVI), Perineural Invasion (PNI), and stromal response, did not significantly associate with the probability of lymph node metastasis. Conclusion: The potential of morphological features, such as Tumour Budding (TB) evaluated in OSCC diagnostic preoperative biopsies may aid in identifying patients who may benefit from more aggressive treatments.