Histopathologic Score of Nason et al for Squamous Cell Carcinoma of the Floor of the Mouth

Description

Nason et al reported a histopathologic score for evaluating a patient with an early squamous cell carcinoma involving the floor of the mouth. This was based on the score of Jakobsson et al and can help to identify a patient at risk for metastases to cervical lymph nodes. The authors are from Roswell Park Memorial Institute in Buffalo.

Patient selection: early squamous cell carcinoma of the floor of the mouth (Stage I or II)

Parameters:

(1) cytoplasmic squamous differentiation

(2) nuclear pleomorphism

(3) mitotic activity

(4) mode of invasion

(5) inflammatory cell reaction

(6) desmoplasia

(7) vascular/lymphatic invasion

(8) level of invasion

Parameter	Finding	Points
cytoplasmic squamous differentiation	abundant keratinization	1
	some keratinization	2
	none to focal keratinization	3
nuclear pleomorphism	none to mild	1
	moderate	2
	marked	3
mitotic activity	< 10 per 10 hpf	1
	10 to 19 per 10 hpf	2
	>= 20 per 10 hpf	3
mode of invasion	sharply defined, pushing border	1
	sharply defined, infiltrating cords	2
	irregular, infiltrating cords	3
inflammatory cell reaction	marked	1
	moderate	2
	none to mild	3
desmoplasia	none to mild	1
	moderate	2
	marked	3
vascular/lymphatic invasion	absent	1
	probable	2
	definite	3
level of invasion	submucosa	1
	superficial muscle	2
	deep muscle or beyond	3

total score =

= SUM(points for all 8 parameters)

Interpretation:

• minimum score: 8

• maximum score: 24

• The higher the score the greater the risk for lymph node metastases.

Total Score	Risk Group	Lymph Node Metastases
8 to 13	low	13%
14 to 16	moderate	35%
17 to 24	high	90%

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Histopathologic Score of Nason et al for Squamous Cell Carcinoma of the Floor of the Mouth

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