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Tumour Thickness Can Predict Nodal Metastasis in Oral Carcinoma: Presented at IAOO By Louise Gagnon TORONTO -- July 13, 2009 -- Tumour thickness can predict nodal metastasis in oral carcinoma and guide surgeons' decisions to perform neck dissections on patients, according to a study presented here at the 2nd World Congress of the International Academy of Oral Oncology (IAOO). "Generally, the thicker the tumour, the higher the incidence of spread of the tumour into the neck," said Mark Taylor, MD, Department of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia. "That would necessitate treatment of the neck with a neck dissection." Dr. Taylor noted that previously published research found tumour thickness to be predictive of neck metastasis, prompting the researchers to prospectively examine the role of tumour thickness. "We don't really have any preoperative predictors of nodal metastases," he said in an interview following an oral presentation on July 10. "We have imaging, but if the cancer cells and lymph nodes are very small, they can't be picked up with conventional imaging, including the use of PET [positron emission tomography]." Dr. Taylor and colleagues prospectively studied 21 patients with biopsy-proven squamous cell carcinoma of the tongue or floor of the mouth. Patients received a preoperative ultrasound to evaluate the depth of the tumour and investigators compared the results of the ultrasound with histological measures. The same radiologist interpreted the ultrasound scans, and the same pathologist measured the thickness of the tumours, noted Dr. Taylor. Researchers discovered a statistically significant correlation between the ultrasound measurement and histological measures of tumour depth, with the correlation coefficient measuring 0.981 (P < .001). In addition, the overall rate of metastasis of the lymph nodes was 52%, and the rate of metastasis in N0 necks was 33%. They found 5 mm to be the threshold above which there was an elevated risk of metastasis: the neck metastatic rate was 0% in patients with tumours <5 mm in depth, and the rate was 65% in those who had tumour depth of >=5 mm. "If the thickness was 5 mm or greater, patients had much higher incidence of metastases and they would need treatment of their neck," said Dr. Taylor. Statistically, tumour depth and T stage were significant predictors of cervical metastasis, (P = .0351 and P = .0300, respectively). "We realise that the thickness of the tumour is more important than the diameter of the tumour [in predicting metastasis]," said Dr. Taylor. [Presentation title: A Preoperative Measure of Tumor Thickness as a Predictor of Cervical Nodal Metastasis in Oral Carcinoma. Abstract 086] E-mail this page to a friend or colleague! To print, use this version