title: Tumor budding is an independent prognostic factor for prediction of lymph node metastasis in oral squamous cell carcinoma.
abstract: OBJECTIVE
  Despite the enormous advances in diagnostic and management modalities of oral squamous cell carcinoma (OSCC), the mortality rates have remained stagnant with a 5-year survival rate of <50% challenging the available methods of prognostic assessment. Presence of tumor budding has been associated with aggressive behavior and is correlated with lymph node metastasis, recurrence, distant metastasis, and decreased survival in several cancers. However, the prognostic significance of this apparently simple to evaluate parameter is sparse in OSCC.
  
  
  METHODS
  A total of 75 cases of surgically excised OSCC were analyzed for tumor budding along with other clinicopathologic parameters. Tumor budding was graded as high and low intensity based on presence and absence of ≥10 or <10 budding foci in hematoxylin and eosin-stained sections. An association between the clinicopathological parameters, lymph node metastases with the budding index was examined using univariate and multivariate analyses.
  
  
  RESULTS
  Tumor budding was evident in 89% of cases with around 45.3% of the cases demonstrated high-intensity budding. High-intensity tumor budding was significantly associated with lymph node metastasis and depth of invasion. Multivariate analysis demonstrated that tumor budding and depth of invasion were significant independent predictors for lymph node metastasis.
  
  
  CONCLUSIONS
  Tumor budding is frequently encountered histologic marker in OSCC. High-intensity tumor budding is a strong independent prognostic factor for prediction of lymph node metastasis.
authors.affiliation: KLE University's VK Institute of Dental Sciences, Belgaum, Karnataka, India punnya_angadi@rediffmail.com.
authors.forename: Punnya V
authors.initials: PV
authors.lastname: Angadi
authors.affiliation: Mayo Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
authors.forename: Prakash V
authors.initials: PV
authors.lastname: Patil
authors.affiliation: SDM College of Dental Sciences and Hospital, Dhavalgiri, Dharwad, Karnataka, India.
authors.forename: Kaveri
authors.initials: K
authors.lastname: Hallikeri
authors.affiliation: KLE University's VK Institute of Dental Sciences, Belgaum, Karnataka, India Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
authors.forename: M D
authors.initials: MD
authors.lastname: Mallapur
authors.affiliation: KLE University's VK Institute of Dental Sciences, Belgaum, Karnataka, India.
authors.forename: Seema
authors.initials: S
authors.lastname: Hallikerimath
authors.affiliation: KLE University's VK Institute of Dental Sciences, Belgaum, Karnataka, India.
authors.forename: Alka D
authors.initials: AD
authors.lastname: Kale
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology*; D009361:Neoplasm Invasiveness; D011379:Prognosis; D055815:Young Adult
keywords: histopathologic marker; lymph node metastasis; oral squamous cell carcinoma; prognosis; tumor budding