Analysis of Tumor Buds & Worst Pattern of Invasion as Emerging Factor in Determining Lymph Node Metastasis in Oral Squamous Cell Carcinoma

  • Parth Rajendragiri Goswami Government Medical College, Bhavnagar (Gujarat)
  • Alpeshpuri P Goswami Government Medical College, Bhavnagar (Gujarat)
Keywords: Tumor Buds, Oral squamous cell carcinoma, Histopathological parameters, Worst pattern of invasion


Introduction Lymph node metastasis is associated with poor prognosis in oral squamous cell carcinoma. So, it’s important to identify most influencing histological parameter in association with lymph node metastasis. Aim Of Study: The aim of this study is to analyze various histological parameter including tumor buds and worst pattern of invasion to check its association with lymph node metastasis positive cases. Materials & Methods The study done on 100 oral squamous cell carcinoma patients. The various histopathological parameters like Nuclear Pleomorphism, Number of mitosis, Lymphoplasmacytic inflammation along with tumor buds and WPOI analyzed to check association with node metastasis. The data was tabulated and Fischer’s exact & chi square test applied to calculate p value. Result Invasive tumor buds more than 5 and worst pattern of invasion (WPOI) were strongly associated with positive lymph node metastasis cases. The p value for both has been lowest among all other parameter. Conclusion The tumor buds and Pattern of invasion are most important emerging influencing factor having strong association with nodal metastasis and thus high risk patient can be identified in biopsy specimen.

Author Biographies

Parth Rajendragiri Goswami, Government Medical College, Bhavnagar (Gujarat)
Department of Pathology
Alpeshpuri P Goswami, Government Medical College, Bhavnagar (Gujarat)
Department of Pathology


1. Shield KD, Ferlay J, Jemal A, Sankaranarayanan R, Chaturvedi AK, Bray F, et al. The global incidence of lip, oral cavity, and pharyngeal cancers by subsite in 2012. CA Cancer J Clin 2017;67(1):51–64.
2. Layland MK, Sessions DG, Lenox J. The influence of lymph node metastasis in the treatment of squamous cell carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx: N0 versus N+. Laryngoscope 2005;115(4):629–639.
3. Pereira MC, Oliveira DT, Landman G, Kowalski LP. Histologic subtypes of oral squamous cell carcinoma: Prognostic relevance. J Can Dent Assoc 2007;73:339-44
4. Byers RM, Wolf PF, Ballantyne AJ. Rationale for elective modified neck dissection. Head Neck Surg 1988;10:160-7.
5. Jesse RH, Barkley HT Jr., Lindberg RD, Fletcher GH. Cancer of the oral cavity. Is elective neck dissection beneficial? Am J Surg 1970;120:505-8.
6. van den Brekel MW, Stel HV, Castelijns JA, Nauta JJ, van der Waal I, Valk J, et al. Cervical lymph node metastasis: Assessment of radiologic criteria. Radiology 1990;177:379-84
7. Screaton NJ, Berman LH, Grant JW. Head and neck lymphadenopathy: Evaluation with US-guided cutting-needle biopsy. Radiology 2002;224:75-81
8. Almangush A, Pirinen M, Heikkinen I, Mäkitie AA, Salo T, Leivo I. Tumour budding in oral squamous cell carcinoma: a meta-analysis. Br J Cancer. 2017. November 30
9. Li Y, Bai S, Carroll W, Dayan D, Dort JC, Heller K, et al. Validation of the risk model: high-risk classification and tumor pattern of invasion predict outcome for patients with low-stage oral cavity squamous cell carcinoma. Head Neck Pathol 2013;7(3):211–223
10. Sherwin RP, Zovickian A. Squamous carcinoma of the oral cavity and throat. Its clinicopathologic correlation. Am J Surg. 1961;102:823–829
11. Bryne M, Koppang HS, Lilleng R, Kjaerheim A. Malignancy grading of the deep invasive margins of oral squamous cell carcinomas has high prognostic value. J Pathol 1992;166(4):375–381
12. Khwaja T,Tayaar AS, Acharya S,Bhushan J, Muddapur MV.Pattern of invasion as a factor in determining lymph node metastasis in oral squamous cell carcinoma.J can Res Ther2018:14:382-387.
13. Chatterjee D, Bansal V, Malik V.Tumor Budding and Worse Pattern of Invasion Can Predict Nodal Metastasis in Oral Cancers and Associated With Poor Survival in Early-Stage Tumors Ear, Nose & Throat Journal 2019, Vol. 98(7) 112–119
14. Kirita T, Yamakawa N, Ueda N, Yagyuu T (2018) Tumor Budding as a Useful Prognostic Indicator in Early Oral Squamous Cell Carcinoma. J Cancer Sci Ther 10: 162-167. DOI: 10.4172/1948-5956.1000536
15. Wu, K., Wei, J., Liu, Z. et al. Can pattern and depth of invasion predict lymph node relapse and prognosis in tongue squamous cell carcinoma. BMC Cancer 19, 714 (2019) doi:10.1186/s12885-019-5859-y
Original Article