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Prediction of Metastases to Cervical Lymph Nodes from Squamous Cell Carcinoma of the Tongue and Floor of the Mouth Based on the Histologic Malignancy Score and Vascular Invasion

Purpose: To predict the probability of metastasis to cervical lymph nodes in a patient with squamous cell carcinoma of the tongue or floor of the mouth.

Description

Woolgar et al were able to predict metastases to cervical lymph nodes from squamous cell carcinomas of the tongue or floor of the mouth. This was based on a histologic score termed the histologic malignancy score (HMS) and the status of vascular invasion.


Parameters for histologic malignancy score (HMS):

(1) degree of keratinization

(2) nuclear differentiation

(3) mitotic rate

(4) inflammatory response

(5) stage of invasion

(6) pattern of invasion

 

Histologic Parameter

Finding

Points

cytoplasmic keratinization

highly degree, with well-formed pearls

1

 

moderate attempts at pearl formation

2

 

poor, occurring only in single cells

3

 

no evidence of keratinization

4

nuclear polymorphism

slight

1

 

moderate

2

 

abundant

3

 

extreme (anaplastic)

4

number of mitoses in 10 high power field

0 - 15

1

 

16 - 35

2

 

36 - 55

3

 

> 55

4

lymphoplasmacytic infiltrate

continuous rim

1

 

patchy rim

2

 

occasional patch

3

 

none

4

stage of invasion

borderline invasion

1

 

invasion into lamina propria

2

 

invasion into submucosa

3

 

invasion into muscle

4

pattern of invasion

pushing border

1

 

bands

2

 

cords or islands with more than 15 cells

3

 

cords and islands with less than 15 cells

4

 

single cells

4

 

where:

• The parameters are similar to that of Crissman et al (previous section) except that "stage of invasion" replaces "vascular-lymphatic invasion."

• Mitoses are scored based on the number in 10 high power fields, rather than an average number per field.

• Nuclear polymorphism replaces nuclear differentiation, with different descriptors.

• Pattern of invasion uses different criteria than the score in Crissman et al.

 

histologic malignancy score =

= (points for keratinization) + (points for nuclear polymorphism) + (points for mitotic activity) + (points for lymphoplasmacytic response)+ (points for stage of invasion) + (points for invasion pattern)

 

Interpretation

• minimum histologic malignancy score: 6

• maximum histologic malignancy score: 24

 

Logistic Regression Analysis

 

q =

= (-10.73) + (1.95 if vascular invasion present, else 0) + (0.64 * (histologic malignancy score))

 

probability of metastasis =

= (1 / (1 + EXP (-q)))

 

The regression equation correctly classified 87% of cases in the study set.


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Specialty

Objective

ICD-10