ABSTRACT
Histological grading is a crucial diagnostic technique for forecasting the molecular and clinical characteristics of cancer. A bad prognosis for mouth cancer is indicated by cervical lymph node metastases. There is a correlation between lymph node metastases and TNM staging, Broder’s grading system, and Anneroth grading system. The purpose of this study is to examine how histological malignancy is graded in connection to metastases in the cervical lymph nodes using Broder’s classification and the Anneroth grading system of biopsy specimens.
Materials and Procedures:
The study comprised 50 participants with oral squamous cell carcinoma (OSCC). Fifteen metastatic cases and 35 nonmetastatic tumor specimens were compared. Every patient was graded using the Anneroth grading method, Broder’s system, and TNM. There was no discernible difference between metastasis and Broder’s grading system. There was a statistically significant difference between metastasis and the Anneroth grading system. In conclusion, Anneroth’s categorization of OSCC’s multifactorial grading system may be a useful diagnostic and prognostic indicator for lymph node metastases.
KEYWORDS: Anneroth grading, Broder’s classification, oral cancer
INTRODUCTION
The WHO anticipates that the number of patients with oral cancer will continue to rise globally, making it a serious issue. Oral cancer is the most prevalent malignancy in South East Asia, per a WHO report from 1983. In India, between 30% and 50% of all body tumors are mouth cancers. The mucosal epithelium is where mouth cancer begins. Oral squamous cell carcinoma (OSCC) accounts for about 94% of all mouth cancers. It is caused by environmental differences, lifestyle choices, or habits of a particular group, such as chewing betel quid, dipping snuff, or the cancer-causing behavior of reverse smoking. Men in their sixth to eighth decades of life are typically affected, with individuals under 40 years old experiencing relatively fewer cases. Because more men than women engage in unhealthy behaviors like abusing alcohol and tobacco, it is more common in men than in women (M: F =1.5:1). Although the tongue, floor of the mouth, and lower lip are the most often reported sites, this cancer affects every part of the oral cavity.
OSCC of the oral tongue is more likely than other oral cancers to spread to lymph nodes, with an incidence ranging from 15% to 75%, depending on how far the initial lesion extends.[1,2,3,4,5,6,7,8]
Based on an evaluation, OSCC’s biological activity is descriptively classified as highly, moderately, and poorly differentiated. This quantitative cancer grading system was mostly created by Broder in 1920. First proposed the new grading system for head and neck OSCC. Recently modified it and suggested a system based on the degree of keratinization, nuclear polymorphism, invasion pattern, host response, and mitotic activity.[1,9,10] Comparisons between the histology and metastatic grading systems of the patients who took part in our investigation were also included.
MATERIAL AND METHOD
The clinical and pathological analysis of data from 50 patients with biopsy-confirmed oral cavity OSCC served as the foundation for the current prospective investigation. The primary source of data was the archives of the Gujarat Cancer Research Institute’s Radiology and Surgical Oncology department in Ahmedabad. After obtaining a certificate of institutional ethical clearance, the study was carried out.
Included were lesions with a primary intraoral tumor. The pharyngeal complexes and tumors originating from the vermillion edge of the lip were not included. Patients with recurring tumors and those undergoing chemotherapy or radiation therapy were not allowed to participate in the trial. After obtaining informed consent, a thorough history and intraoral examination were performed on each patient. Age, gender, lesion type, etiology, diameter, duration, and assessment of regional metastasis if a palpable lymph node was present were among the details. The TNM classification was used when performing the clinical stage. The TNM system is predicated on the evaluation of three key elements.
The size of the lesion, the size and involvement of the node, and the metastasis were among the CT scan reports that were examined to help with clinical TNM staging. The main lesion was removed by incision and preserved in 10% formalin. Hematoxylin and eosin were used to cut and stain 4–6 um sections for histological diagnosis and grading in accordance with Anneroth’s and Broder’s classification. After reviewing the cases, they were divided into two groups: metastatic and nonmetastatic, depending on the lymph node metastases. Broder’s (1920) categorization and multifactorial grading system were used to grade the cases in both groups, and the outcomes were compared between the metastasizing and nonmetastasizing groups.
In instances when the two writers’ opinions diverged, the third author assessed the work after it had been jointly reviewed using a multiheaded microscope. Logistic regression was used to examine the outcomes of the two grading schemes in each of the two groups (metastatic and nonmetastatic). An attempt was made to examine the relationship between histopathological staging and the presence of lymph node metastases.
RESULTS
Anneroth gave all of the study participants an I in the topics using Well Broder’s grading method. In the moderate Broder’s grading system, the majority of the study participants had Anneroth grades of III. Every study participant in the topics using Poor Broder’s grading system had an Anneroth grade of III. There was a statistically significant difference between the Anneroth and Broder grading systems. According to Well Broder’s grading method, metastases were present in 23.1% of the individuals. Metastases were present in 34.4% of the individuals using the Moderate Broder’s grading scale. Around 80% of the individuals using Poor Broder’s grading system had metastases. According to statistics, there was no discernible difference between metastasis and Broder’s grading system [Table 1].
Table 1.
Correlation of conventional malignancy grading with Anneroth grading system and lymph node metastasis
| Broder’s | Total no of patients n (%) | Anneroth grading system | Histological Lymph node metastasis | |||
|---|---|---|---|---|---|---|
|
|
|
|||||
| I n (%) | II n (%) | III n (%) | Absent n (%) | Present n (%) | ||
| Well | 13 (26%) | 13 (100%) | 0 (0%) | 0 (0%) | 10 (76.9%) | 3 (23.1%) |
| Moderate | 32 (64%) | 8 (25%) | 11 (34.4%) | 13 (40.6%) | 21 (65.6%) | 11 (34.4%) |
| Poor | 5 (10%) | 0 (0%) | 0 (0%) | 5 (100%) | 1 (20%) | 4 (80%) |
| Total | 50 (100%) | 21 (42%) | 11 (22%) | 18 (36%) | 32 (64%) | 18 (36%) |
| P | 0.000* | 0.075* | ||||
| Pearson Chi-square value | 31.461 | 5.180 | ||||
Thirty-three percent of the individuals with Anneroth grade I had metastases. The percentage of individuals with metastases in those with Anneroth grading II was 36.4%. Of the individuals who had an Anneroth grading of III, 54.2% had metastases. A statistically significant difference was found between metastasis and the Anneroth grading system [Table 2].
Table 2.
Correlation of Anneroth grading system with lymph node metastasis
| Anneroth | Total no of patients n (%) | Histological Lymph node metastasis | |
|---|---|---|---|
|
| |||
| Absent n (%) | Present n (%) | ||
| I | 21 (43.8%) | 14 (66.7%) | 7 (33.3%) |
| II | 11 (21.9%) | 7 (63.6%) | 4 (36.4%) |
| III | 18 (34.4%) | 11 (45.8%) | 13 (54.2%) |
| Total | 50 (100%) | 32 (64%) | 18 (36%) |
| P | 0.011* | ||
| Pearson Chi-square value | 9.040 | ||
Chi-square test *P≤0.05 statistically significant
DISCUSSION
One of the difficulties faced by oral and maxillofacial surgeons is OSCC. It may become clearer through additional research using more advanced statistical techniques as well as more thorough and uniform materials whether OSCC grading has any greater significance in reflecting the tumor’s growth potential and malignancy and in early disease outcome prediction. The various histological characteristics listed in the definitions of the six morphologic factors, such as an evaluation of the tumor cell population and the tumor–host relationship, were shown to be suitable for classifying malignancy in oral OSCC.[1,8]
We discovered in our study that there was a correlation between palpable lymph nodes and Anneroth’s grading system (P = 0.002). A correlation between palpable lymph nodes and Broder’s grading system was also seen (P = 0.012). Based on statistical analysis, the Anneroth grading system is more significant than the Broder grading system. In this work, M. Akhter and colleagues (1), the size and location of the main tumor, involvement of regional lymph nodes, and the existence of distant metastases are some of the characteristics that some studies suggest may affect the prognosis and survival of patients with OSCC.
Comparing our study to the traditional method of grading OSCC, such as Broder’s, which did not correlate well with the initial clinical staging but did correlate with Annoreth’s and cervical lymph node metastasis, we discovered a stronger correlation between the grading score and clinical stage and cervical lymph node metastasis.[1,9,10]
CONCLUSION
In summary, we believe that the multifactorial OSCC grading system based on Anneroth’s classification may be a useful diagnostic and lymph node metastatic prediction tool.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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