The relationship between primary tumour thicknesses in cancers of the oral cavity to subsequent lymph node metastasis


  • Ahmed Fawzy Department of General Surgery, Faculty of Medicine, Menoufia University, Egypt
  • Waleed Ali Al zaqri Department of Oral and maxillofacial Surgery, Faculity of Dentistry, Yemen
  • Mohamed Sabry Department of General Surgery, Faculty of Medicine, Menoufia University, Egypt
  • Ahmed Sabry Department of General Surgery, Faculty of Medicine, Menoufia University, Egypt
  • Hosam El Fol Department of General Surgery, Faculty of Medicine, Menoufia University, Egypt
  • Ahmed El Kased Department of General Surgery, Faculty of Medicine, Menoufia University, Egypt



Oral cavity cancer, Tumor thickness, Cervical node metastasis


Background: Elective dissection of cervical lymph nodes in oral cavity cancers gives very precious data on its pathological state, judge for adjuvant therapy requirement plus its therapeutic effect but it has its morbidities that cannot be condoned. Tumor thickness (TT) in oral cavity cancers show an increasing value to be one of the most important and reliable factors that have a great relationship to regional node involvement.

Methods: Forty-three patients with T1, T2 oral cavity squamous cell carcinoma with clinically and radiologically negative cervical L.Ns underwent elective neck dissection and the relation between the tumor thickness and the nodal metastasis was monitored. Tumor thickness was estimated preoperatively by using the intra-oral ultrasound and confirmed by histopathology postoperatively.

Results: Only 12 out of 43 neck dissections (27.9%) showed positive L.Ns metastasis of primary tumor. The excised number of L.Ns ranged from 15 to 31 with mean±SD (21.58±3.59) L.Ns. The (TT) ranged from 1.4 mm to 7.8 mm. Our statistical results showed that there is a cutoff point which was 4 mm where (TT) > 4 mm showed significant results with histologically found positive cervical node metastasis compared to (TT) ≤4 mm specimens.

Conclusions: Relationship of tumor thickness to lymph node metastasis was found to be significant as shown by this study. Our results clearly demonstrate that conservative elective neck dissection is indicated in patients with stage I/II oral cavity carcinoma whose tumors are > 4 mm in thickness as they mostly have latent metastasis.


Author Biography

Ahmed El Kased, Department of General Surgery, Faculty of Medicine, Menoufia University, Egypt

vice presedent of al Menoufia university


Sano D, Myers JN. Metastasis of squamous cell carcinoma of the oral tongue. Cancer and Metastasis Reviews. 2007;26:645-62.

ÖNerci M, Yilmaz T, Gedikoğlu G. Tumor thickness as a predictor of cervical lymph node metastasis in squamous cell carcinoma of the lower lip. Otolaryngol Head Neck Surg. 2000;122:139-42.

Lodder WL, Teertstra HJ, Tan B, Pameijer FA, Smeele EL, van Velthuysen MLF, et al. Tumour thickness in oral cancer using an intra-oral ultrasound probe. European Radiol. 2011;21:98-106.

Scully C, Bagan J. Oral squamous cell carcinoma overview. Oral Oncol. 2009;45:301-8.

Sharma P, Shah S, Taneja C, Patel AM, Patel MD. A prospective study of prognostic factors for recurrence in early oral tongue cancer. J Clin Diagnos Res. JCDR. 2013;7:2559.

DiTroia J. Nodal metastases and prognosis in carcinoma of the oral cavity. Otolaryngol Clin North Am. 1972;5:333-42.

Fagan JJ, Collins B, Barnes L, D'Amico F, Myers EN, Johnson JT. Perineural invasion in squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surge. 1998;124:637-40.

Pentenero M, Gandolfo S, Carrozzo M. Importance of tumor thickness and depth of invasion in nodal involvement and prognosis of oral squamous cell carcinoma: a review of the literature. Head Neck 2005;27:1080-91.

Woolgar JA. Histopathological prognosticators in oral and oropharyngeal squamous cell carcinoma. Oral Oncol. 2006;42:229-39.

Huang SH, Hwang D, Lockwood G, Goldstein DP, O'sullivan B. Predictive value of tumor thickness for cervical lymph‐node involvement in squamous cell carcinoma of the oral cavity. Cancer. 2009;115:1489-97.

Curtin HD, Ishwaran H, Mancuso AA, Dalley RW, Caudry DJ, McNeil BJ. Comparison of CT and MR imaging in staging of neck metastases. Radiol. 1998;207:123-30.

Brekel MW, Castelijns JA, Stel HV, Golding RP, Meyer CJ, Snow GB. Modern imaging techniques and ultrasound-guided aspiration cytology for the assessment of neck node metastases: a prospective comparative study. 1993;250:11-7.

Law CP, Chandra RV, Hoang JK, Phal PM. Imaging the oral cavity: key concepts for the radiologist. Br J Radiol. 2011;84:944-57.

Sureshkannan P, Vijayprabhu, John R. Role of ultrasound in detection of metastatic neck nodes in patients with oral cancer. Indian J Dent Res. 2011;22:419-23.

Rodrigues V, Moss S, Touraine H. Oral cancer in the UK: to screen or not to screen. Oral Oncol. 1998;34:454-65.

Fakih AR, Rao RS, Borges AM, Patel AR. Elective versus therapeutic neck dissection in early carcinoma of the oral tongue. Am J Surg. 1989;158: 309-313.

Sparano A, Weinstein G, Chalian A, Yodul M, Weber R. Multivariate predictors of occult neck metastasis in early oral tongue cancer. Otolaryngol Head Neck Surg. 2004;131:472-6.

Spiro RH, Huvos AG, Wong GY, Spiro JD, Gnecco CA, Strong EW. Predictive value of tumor thickness in squamous carcinoma confined to the tongue and floor of the mouth. Am J Surg. 1986;152:345-50.

Asakage T, Yokose T, Mukai K, Tsugane S, Tsubono Y, Asai M, et al. Tumor thickness predicts cervical metastasis in patients with stage I/II carcinoma of the tongue. Cancer. 1998;82:1443-8.

Iro H, Nitsche N. Intra-oral sonography in neoplasms of the mouth and base of the tongue. HNO. 1989;37:329-32.

Shintani S, Yoshihama Y, Ueyama Y, Terakado N, Kamei S, Fijimoto Y, et al. The usefulness of intraoral ultrasonography in the evaluation of oral cancer. Int J Oral Maxil Surg. 2001;30:139-43.

Fukano H, Matsuura H, Nakamura HYS. Depth of invasion as a predictive factor for cervical lymph node metastasis in tongue carcinoma. Head Neck. 1997;19:205-10.

Yuen PWA, Lam KY, Lam LK, Ho CM, Wong A, Chow TL, et al. Prognostic factors of clinically stage I and II oral tongue carcinoma - a comparative study of stage, thickness, shape, growth pattern, invasive front malignancy grading, Martinez‐gimeno score, and pathologic features. Head Neck. 2002;24:513-20.

van den Brekel, Stel HV, Castelijns JA, Croll GJ, Snow GB. Lymph node staging in patients with clinically negative neck examinations by ultrasound and ultrasound-guided aspiration cytology. Am J Surg. 1991;162:362-6.

Van den Brekel MW. US-guided fine-needle aspiration cytology of neck nodes in patients with N0 disease. Radiol. 1996;201:580.

Mücke T, Kanatas A, Ritschl LM, Koerdt S, Tannapfel A, Wolff KD, et al. Tumor thickness and risk of lymph node metastasis in patients with squamous cell carcinoma of the tongue. Oral Oncol. 2016;53:80-4.

Hu H, Cheng XQ, Xu, Wu FY, Tyan YS, Tsai CH, et al. Predicting the prognosis of oral tongue carcinoma using a simple quantitative measurement based on preoperative MR imaging: tumor thickness versus tumor volume. AJNR Am J Neuroradiol. 2015:2.

Woolgar JA. T2 carcinoma of the tongue. The histopathologist's perspective. Br J Oral Maxillofac Surg. 1999;37:187-93.

Kurokawa H, Yamashita Y, Takeda S, Zhang M, Fukuyama H, Takahashi T. Risk factors for late cervical lymph-node metastases in patients with stage I or II carcinoma of the tongue. Head Neck. 2002;24(73):1-6.

O-Charoenrat P, Pillai G, Patel S, Fisher C, Archer D, Eccles S, et al. Tumour thickness predicts cervical nodal metastases and survival in early oral tongue cancer. Oral Oncol. 2003;39:386-90.

Lim SC, Zhang S, Ishii G, Endoh Y, Kodama K, Miyamoto S, et al. Predictive markers for late cervical metastasis in stage I and II invasive squamous cell carcinoma of the oral tongue. Clin Cancer Res. 2004;10:166-72.

Kane SV, Gupta M, Kakade AC, Cruz AD. Depth of invasion is the most significant histological predictor of subclinical cervical lymph-node metastasis in early squamous carcinomas of the oral cavity. Eur J Surg Oncol. 2006;32:795-803.

Tai SK, Li WY, Chu PY, Chang SY, Tsai TL, Wang YF et al. Risks and clinical implications of perineural invasion in T1-2 oral tongue squamous cell carcinoma. Head Neck. 2012;34:994-1001.

Tai SK, Li WY, Yang MH, Chu PY, Chang SY, Tasi LT, et al. Perineural invasion as a major determinant for the aggressiveness associated with increased tumor thickness in T1-2 oral tongue and buccal squamous cell carcinoma. Ann Surg Oncol. 2013;20:3568-74.

Luongo de Matos L, Manfro G, Vieira dos Santos R, Stabenow E, Sobroza de Mello E, Alves VAF, et al. Tumor thickness as a predictive factor of lymph node metastasis and disease recurrence in T1N0 and T2N0 squamous cell carcinoma of the oral tongue. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;118:209-17.

Wang K, Veivers D. Tumour thickness as a determinant of nodal metastasis in oral tongue carcinoma. ANZ J Surg. 2016.

Khan SA, Zia S, Naqvi SU, Hatem A, Adil SO, Hussain M. Relationship of oral tumor thickness with the rate of lymph node metastasis in Neck based on CT Scan. Pak J Med Sci. 2017:353-7.






Original Research Articles