Grading of Oral Cancer: Comparison of Different Systems with Respect to Lymph Node Metastasis in Tongue SCC

Background-Histologic grading has been used as a prognostic factor and for clinical behavior evaluation of oral squamous cell carcinoma (SCC) for the past several decades. At the same time, the prognostic value of different grading classifications remains controversial. Methods-A retrospective study of 48 cases of tongue SCC was undertaken to compare different grading systems and their relation to lymph node metastasis. Surgical specimens of 22 non-metastasizing tumors were compared with 26 tumors which had metastasized. Each case was graded according to: Broders' classification in the whole thickness of tumor as well as deep invasive margins, multifactorial grading system (Anneroth et al. 1987), the Bryne et al. system (1989), and the new invasive margins grading method modified by Bryne et al. (1992). Results-New malignancy grading based on the deep invasive margins showed significant relation with lymph node metastasis (p=0.03). Other grading methods failed to show any relation with metastasis. Conclusion-Grading of the deep invasive margins in appropriate biopsy specimens would be of great value in predicting lymph node metastasis and treatment results of tongue SCC. Prospective studies with adequate follow ups are needed in order to obtain better evaluation of the role of this system in prognosis and survival.