A 3 dimensional assessment of the depth of tumor invasion in microinvasive tongue squamous cell carcinoma - A case series analysis

BACKGROUND: Accurate assessment of the depth of tumor invasion (DI) in microinvasive squamous cell carcinoma (MISCC) of the tongue is critical to prognosis. An arithmetic model is generated to determine a reliable method of measurement of DI and correlate this with the local recurrence. MATERIAL AND METHODS: Tumor thickness (TT) and DI were measured in tissue sections of 14 cases of MISCC of the tongue, by manual ocular micrometer and digital image analysis at four reference points (A, B, C, and D). The comparison of TT and DI with relevant clinicopathologic parameters was assessed using Mann Whitney U test. Reliability of these methods and the values obtained were compared and correlated with the recurrence of tumors by Wilcoxon Signed Ranks Test. 3D reconstruction of the lesion was done on a Cartesian coordinate system. X face was on the YZ plane and Z face was on the XY plane of the coordinate system. RESULTS: Computer generated 3D model of oral mucosa in four cases that recurred showed increased DI in the Z coordinate compared to the XY coordinate. The median DI measurements between XY and Z coordinates in these cases showed no significant difference (Wilcoxon Signed Ranks Test, p = 0.068). CONCLUSIONS: The assessment of DI in 3 dimensions is critical for accurate assessment of MISCC and precise DI allows complete removal of tumor. Key words:Depth of invasion, tumor thickness, microinvasive squamous cell carcinoma, tongue squamous cell carcinoma.