title: Histopathological Parameters predicting Occult Nodal Metastases in Tongue Carcinoma Cases: An Indian Perspective.
abstract: BACKGROUND
  It is a well-established fact that in squamous cell carcinoma cases, the presence of lymph node metastases decreased the 5-year survival rate by 50% and also caused the recurrence of the primary tumor with development of distant metastases. Till date, the predictive factors for occult cervical lymph nodes metastases in cases of tongue squamous cell carcinoma remain inconclusive. Therefore, it is imperative to identify patients who are at the greatest risk for occult cervical metastases. This study was thus performed with the aim to identify various histopathologic parameters of the primary tumor that predict occult nodal metastases.
  
  
  METHODS
  The clinicopathologic features of 56 cases of lateral tongue squamous cell carcinoma with cT1NoMo/cT2NoMo as the stage and without prior radiotherapy or chemotherapy were considered. The surgical excision of primary tumor was followed by elective neck dissection. The glossectomy specimen along with the neck nodes were fixed in formalin and 5 urn thick sections were obtained. The hematoxylin & eosin stained sections were then subjected to microscopic examination. The primary tumor characteristics that were analyzed include tumor grade, invading front, depth of tumor, lymphovascular invasion, perineural invasion and inflammatory response. The nodes were examined for possible metastases using hematoxylin & eosin followed by cytokeratin immunohistochemistry.
  
  
  RESULTS
  A total of 12 cases were found with positive occult nodal metastases. On performing univariate analysis, the histopathologic parameters that were found to be statistically significant were lymphovascular invasion (p = 0.004) and perineural invasion (p = 0.003) along with a cut-off depth of infiltration more than 5 mm (p = 0.01).
  
  
  CONCLUSIONS
  Histopathologic assessment of the primary tumor specimen therefore continues to provide information that is central to guide clinical management, particularly in cases of occult nodal metastases. Clinical significance The study highlights the importance of extensive histopathological screening, which holds the key for establishing occult metastases. Pathological upgrading of tumors is possible following histopathological studies similar to the present one. Presence of occult metastases justify neck dissection in these clinically N0 cases. In an Indian setting, histopathological evaluation assumes a bigger role than other expensive and advanced techniques.
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Pathology, Bangalore Institute of Dental Sciences and Hospital, Hosur main road, Lakkasandra, Bengaluru 560029, Karnataka, India Phone: +919900984984, e-mail: drtinajaicob@yahoo.co.in.
authors.forename: Tina Elizabeth
authors.initials: TE
authors.lastname: Jacob
authors.affiliation: Department of Oral and Maxillofacial Pathology, Faculty of Dental Sciences, Sri Ramachandra University and Hospital Chennai, Tamil Nadu, India.
authors.forename: N
authors.initials: N
authors.lastname: Malathi
authors.affiliation: Department of Oral and Maxillofacial Pathology, Faculty of Dental Sciences, Sri Ramachandra University and Hospital Chennai, Tamil Nadu, India.
authors.forename: Sharada T
authors.initials: ST
authors.lastname: Rajan
authors.affiliation: Department of Oral and Maxillofacial Pathology, Faculty of Dental Sciences, MS Ramaiah University of Applied Sciences Gnanagangothri Campus, Bengaluru, Karnataka, India.
authors.forename: Dominic
authors.initials: D
authors.lastname: Augustine
authors.affiliation: Department of Oral Pathology and Microbiology, Bangalore Institute of Dental Sciences, Bengaluru, Karnataka, India.
authors.forename: N
authors.initials: N
authors.lastname: Manish
authors.affiliation: College of Dentistry, Jazan University, Jazan, Saudi Arabia.
authors.forename: Shankargouda
authors.initials: S
authors.lastname: Patil
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000556:secondary*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D014062:Tongue Neoplasms / Q000473:pathology*
keywords: Augustine D; Malathi N; Manish N; Metastases; Occult; Patil SG. Histopathological Parameters predicting Occult Nodal Metastases in Tongue Carcinoma Cases: An Indian Perspective. J Contemp Dent Pract 2016; 17(1):70-77. Source of support: Nil Conflict of interest: None.; Rajan ST; Tongue carcinoma. How to cite this article: Jacob TE