Mori et al developed the DIAGS Index (differentiation, invasion mode, adhesion molecules, glycosaminoglycan, sugar chain) for describing the potential of a squamous cell carcinoma of the oral cavity to metastasize to regional lymph nodes. This can help identify patients who should be evaluated more carefully for occult metastases. The authors are from Tohoku University School of Dentistry and Ehime School of Medicine in Japan.
Parameters:
(1) histologic tumor differentiation
(2) histologic pattern of invasion (after Yamamoto et al)
(3) immunostaining for the adhesion molecule CD44
(4) immunostaining for the adhesion molecule E-cadherin
(5) immunostaining for the glycosaminoglycan HS-GAG (heparin sulfate glycosaminoglycan)
(6) staining with biotinylated L-PHA to detect L-PHA binding oligosaccharides (L for leukoagglutinin, PHA for phytohemagglutinin, from Phaseolus vulgaris)
|
Histologic Pattern of Invasion |
Grade |
|---|---|
|
well-defined tumor margin |
1 |
|
less obvious margin |
2 |
|
groups of cells with no obvious margin |
3 |
|
diffuse invasion with cords of cells |
4C |
|
diffuse invasion with diffuse infiltration of cells |
4D |
|
Parameters |
Finding |
Points |
|---|---|---|
|
tumor differentiation |
well-differentiated |
0 |
|
|
moderately differentiated |
1 |
|
|
poorly differentiated |
2 |
|
pattern of invasion |
Grade 1, 2 or 3 |
0 |
|
|
Grade 4C |
1 |
|
|
Grade 4D |
2 |
|
immunostains for CD44 |
negative (0) |
0 |
|
|
weak (+) |
1 |
|
|
moderate to strong (++) |
2 |
|
immunostains for E-Cadherin |
moderate to strong (++) |
2 |
|
|
weak (+) |
1 |
|
|
negative (0) |
0 |
|
immunostains for HS-GAG |
negative (0) |
0 |
|
|
weak (+) |
1 |
|
|
moderate to strong (++) |
2 |
|
staining with L-PHA |
negative (0) |
0 |
|
|
weak (+) |
1 |
|
|
moderate to strong (++) |
2 |
from Table 3, page 554
where:
• Staining intensity refers to staining of the tumor and not staining of lymphocytes, stroma or other tissues.
DIAGS index =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 12
• The higher the score the greater the potential for lymph node metastases.
|
DIAGS Index |
Percent Metastases |
|---|---|
|
0 |
0 |
|
1 |
0 |
|
2 |
0 |
|
3 |
0 |
|
4 |
6% |
|
5 |
18% |
|
6 |
50% |
|
7 |
62% |
|
8 |
75% |
|
9 |
100% |
|
>= 10 |
100% |
from Figure 5, page 555
where:
• In the implementation I gave 9 points a probability of 80-100%. There were only 3 patients with an index of 9, and only 1 patient with an index of 10. There may not have been enough tumors with high scores to give accurate percentages.
Purpose: To determine the potential for lymph node metastases of a squamous cell carcinoma arising in the oral cavity using the DIAGS index of Mori et al.
Specialty: Hematology Oncology, Surgery, general, Otolaryngology
Objective: risk factors, severity, prognosis, stage, complications, selection
ICD-10: C01, C02, C03, C04, C05, C06,
