YIJOM-1517; No of Pages 8

Int. J. Oral Maxillofac. Surg. 2009; xxx: xxx–xxx

doi:10.1016/j.ijom.2009.01.004, available online at http://www.sciencedirect.com

Clinical Paper
Head and Neck Oncology

Significant invasion depth of J. Junga, N. H. Chob, J. Kimc,

E. C. Choia, S. Y. Leed,
H. K. Byeona, Y. M. Parka,
W. S. Yanga, S.-H. Kima
early oral tongue cancer a
Department of Otorhinolaryngology, Yonsei
University College of Medicine, Seoul, Korea;
b
Department of Pathology, Yonsei University

originated from the lateral College of Medicine, Seoul, Korea;

c
Department of Radiology, Yonsei University
College of Medicine, Seoul, Korea;

border to predict regional

d
Department of Otorhinolaryngology, Chung-
Ang University College of Medicine, Seoul,
Korea

metastases and prognosis

J. Jung, N. H. Cho, J. Kim, E. C. Choi, S. Y. Lee, H. K. Byeon, Y. M. Park, W. S. Yang,
S. -H. Kim: Significant invasion depth of early oral tongue cancer originated from the
lateral border to predict regional metastases and prognosis. Int. J. Oral Maxillofac.
Surg. 2009; xxx: xxx–xxx. # 2009 International Association of Oral and
Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Abstract. In oral tongue cancer, tumor depth is crucial for cervical lymph node
metastasis. There is no standardized method to predict tumor invasion or deciding
who should undergo selective neck dissection. In this study, calculated MRI
invasion depth was compared with histopathologic (HP) invasion depth to find a
correlation, and determine a cutoff value of invasion depth that predicts occult neck
node metastasis. 50 patients, diagnosed with T1 or T2 oral tongue cancer originating
from the lateral border of the tongue, underwent MRI screening and received
surgical excision as primary treatment. MRI and HP invasion depths were compared
and the cutoff value determined. The invasion depth to determine the presence of
nodal metastasis where summation of specificity and sensitivity was greatest was
8.5 mm HP, 10.5 mm in T1 weighted enhanced axial image, and 11.5 mm in T2
weighted MRI axial image. The relation coefficient of T2 weighted MRI invasion
depth and HP depth was 0.851, and accuracy 84%, all of which showed higher Keywords: tongue cancer; invasion; depth;
correlation compared with T1 weighted enhanced axial image. HP depth was regional metastases; prognosis.
significantly correlated with survival rate. The measurement of invasion depth using
MRI is a prerequisite for determining a surgical plan in early oral tongue cancer. Accepted for publication 19 January 2009

Apart from the lip, the most common site
of cancer development in the oral cavity is
the oral tongue. Oral tongue carcinomas
exhibit neck node metastasis more than
any other carcinomas3,5,21. It has been
reported that at the time of diagnosis,
40% of all tongue cancer patients have
neck metastasis and 40% of stage 2 lesions
show occult metastasis13. The cure rate
decreases by 50% if there is neck node
metastasis and the single most important
prognostic factor in oral tongue carcinoma
is neck node metastasis12.
For early tongue carcinoma at stages T1
or T2, the mainstay of treatment is surgical

0901-5027/000001+08 $30.00/0 # 2009 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Please cite this article in press as: J.. Jung, et al., Significant invasion depth of early oral tongue cancer originated from the lateral border
to predict regional metastases and prognosis, Int J Oral Maxillofac Surg (2009), doi:10.1016/j.ijom.2009.01.004
YIJOM-1517; No of Pages 8

2 Jung et al.

resection. This generally involves suprao-

mohyoid neck dissection (SOND) as
the elective neck dissection (END) in
stage I or II carcinoma, mainly because
there is a great chance of occult metastasis
and END may improve neck control and
the overall survival rate compared with
observation alone6,9. There is a strong
relationship between depth and lymph
node metastasis1,2,14,15,19,25.
It has been reported, that of the factors
influencing lymph node metastasis in oral
tongue carcinoma, tumor depth is more
important than tumor size1,16. YUEN et al.25
reported that of the factors such as
tumor width, diameter, area, volume and
depth, which affect lymph node metasta-
sis, local recurrence and survival rate, only
depth was significant. Controversies
remain about the parameters of histo-
pathologic (HP) depth in determining
the existence of occult metastasis and
the necessity of performing selective neck
dissection4,10.22,23.
A preoperative imaging method for
tumor depth that can indirectly show the Fig. 1. MRI depth was measured from deepest tumor invasion to the presumed original surface
possibility of occult metastasis is required level ignoring exophytic growth.
for oral tongue carcinoma. MRI is useful
for measuring tumor depth. According to
IWAI et al.7, there is a strong correlation archiving and communication system matrix 256  256. Invasion depth on MRI
between MRI depth and the HP depth of were excluded as were those at stage was defined as tumor thickness, measured
oral tongue carcinoma and it is possible to cM1. The male to female ratio was as follows. The reference line was deter-
predict nodal metastasis before surgery on 26:24 and the mean age was 52  12 mined as a horizontal line connecting the
the basis of tumor depth. LAM et al.11 years. In terms of TNM staging, 13 mucosal junction of the tumor and the
reported that T1-weighted MRI imaging patients were in stage I, 19 in stage II, 7 length perpendicular to this line towards
shows a strong correlation with HP depth. in stage III, and 11 in stage IV. In 16 the deepest point of tumor infiltration was
There is no uniform method to assess patients, the cancer was identified as measured (Fig. 1). If the tumor was ulcera-
the invasion depth of tongue cancer on pathologic stage T1 (pT1) and in 34 as tive, the reference line was determined in
MRI. The object of this study is to assess pathologic T2 (pT2). There were 18 the same way to be considered as the
the cutoff value of the MRI and HP inva- patients with positive pathologic node presumed original surface level, exophytic
sion depth that indicates the existence of (pN+) and 32 with negative pathologic lesions were ignored and length measure-
lymph node metastasis of tongue cancer node (pN0). Of the 18 patients with ment was simplified to represent invasion
and to calculate the disease-free survival pN+, 7 were pN1, 10 were pN2b and 1 ability. Invasion depth was assessed by the
and overall survival rate according to was pN2c. 46 patients with negative clin- same radiologist on gadolinium-enhanced
depth. The clinical significance of tumor ical node (cN0) or cN1 received partial T1 weighted image and T2 weighted
invasion depth on the MRI was investi- glossectomy with unilateral or bilateral image.
gated by evaluating the correlation and the SOND, and 4 patients who were cN2b The surgical specimen was fixed in
accuracy between MRI and HP depth of received partial glossectomy with radical formalin, embedded in paraffin, stained
oral tongue carcinoma. neck dissection or modified radical neck with hematoxylin-eosin, a 3-mm slice
dissection with contralateral SOND fol- was then made into a slide. Using a
lowed by postoperative radiotherapy. X12.5 microscope, maximal tumor depth
Materials and methods
Patients who received total glossectomy was measured in the same way as for MRI.
Retrospective analysis was carried out on due to midline extension of the tumor were The cutoff value of invasion depth that
50 patients who were diagnosed as having also excluded. The mean period of follow can best indicate the existence of nodal
T1 or T2 early oral tongue squamous cell up was 24 months. metastasis was determined as the highest
carcinoma originating from the lateral All MRI examinations were performed summation value of sensitivity and speci-
border of the tongue and who conse- using the 1.5-T system (Intera: Philips ficity on the basis of a receiver operation
quently received surgery as primary treat- Medical Systems, Best, the Netherlands) characteristic curve. With this value,
ment after having undergone preoperative with Synergy Head/Neck coils. Gadoli- tumor invasion depth was divided into
MRI from January 2002 to December nium-enhanced T1 weighted images were two groups and correlation with nodal
2005. Patients with ventral or floor of achieved with settings of TR (repetition metastasis was evaluated using X2. Cor-
the mouth tongue cancer were excluded time) 500 ms, TE (echo time) 12 ms at the relation between HP depth and MRI depth
from the study. Patients whose MRI coronal plane, section thickness 3 mm, was calculated by Pearson correlation test
images were not retrievable on the picture field of view (FOV) 23 cm and acquisition and applying the standards given by YUEN

Please cite this article in press as: J.. Jung, et al., Significant invasion depth of early oral tongue cancer originated from the lateral border
to predict regional metastases and prognosis, Int J Oral Maxillofac Surg (2009), doi:10.1016/j.ijom.2009.01.004
YIJOM-1517; No of Pages 8

Significant invasion depth of early oral tongue cancer originated 3

et al.25 the values of HP depth were cate-

gorized into three groups and the accuracy
of MRI depth measurement was evalu-
ated. To investigate factors affecting dis-
ease-specific recurrence and death,
disease-free survival rate and overall sur-
vival rate according to T stage, TNM
stage, node metastasis, MRI depth and
HP depth were calculated using the
Kaplan–Meier method.

Results
Of the 50 patients, 42 were in negative
clinical node (cN0). In 11 of the 42
patients, positive metastatic nodes were
reported, the occult metastasis rate was
26%. Of the 8 patients with a positive
clinical node (cN+), 1 had a negative
pathologic node.

Invasion depth and nodal metastasis

The mean values of HP depth were signifi-
cantly different between the 32 pN0 patients
and the 18 pN+ patients; 8.0  4.5 mm and
12.4  3.9 mm, respectively (p = 0.001)
(Fig. 2A). Gadolinium-enhanced T1
weighted MRI depths (T1WGd MRI depth)
were significantly different between pN0
and pN+ groups, the mean values of which
were 7.9  5.2 mm and 12.2  4.0 mm,
respectively (p = 0.005) (Fig. 2B). The
mean values of T2 weighted MRI depth
(T2W MRI depth) were also significantly
different between the two groups;
8.2  5.3 mm and 12.5  3.9 mm, respec-
tively (p = 0.005) (Fig. 2C).

Cutoff values for HP depth and MRI depth

The cutoff value of HP depth that could
determine the existence of nodal metas-
tasis was 8.5 mm. The cutoff values for
T1WGd MRI depth and T2W MRI depth
were 10.5 mm and 11.5 mm, respectively.
With the HP depth cutoff value of 8.5 mm
as a standard, groups were subdivided into
those >9 mm and those <9 mm; the nodal
metastasis rates for each group were 53%
and 10%, respectively (p = 0.002). As for
the T1WGd MRI depth with a cutoff value
of 10.5 mm, the nodal metastasis rate in
the group with values >11 mm was 52%,
and for those <11 mm was 24%, both of
which were significantly different
(p = 0.040). Similar results were observed
for the T2W MRI depth with a cutoff
value of 11.5 mm, the nodal metastasis
rate in the groups >12 mm and <12 mm
were 52% and 24%, respectively
Fig. 2. Tumor invasion depth according to nodal metastasis. (A) HP depth was significantly
(p = 0.040). There was no significant dif-
different according to nodal metastasis (p = 0.001) (B), (C) T1WGd MRI depth and T2W MRI ference in nodal metastasis rate between
depth were significantly different according to nodal metastasis (p = 0.005). the cT1 and cT2 groups, the values were

Please cite this article in press as: J.. Jung, et al., Significant invasion depth of early oral tongue cancer originated from the lateral border
to predict regional metastases and prognosis, Int J Oral Maxillofac Surg (2009), doi:10.1016/j.ijom.2009.01.004
YIJOM-1517; No of Pages 8

4 Jung et al.

Table 1. Nodal metastasis rate according to invasion depth. stage, TNM stage, node metastasis, HP
Results according to HP depth with cutoff 9 mm depth and MRI depth. Applying the
HP depth <9 mm HP depth 9 mm Kaplan–Meier method, disease-free survi-
val and overall survival were calculated
N0 18 14
with N = 50. There were no significant
N+ 2 16 *
* x2 test: p = 0.002 differences of disease-free survival for T
- HP depth <9 mm: nodal metastasis rate = 10% stage (p = 0.228), node metastasis
- HP depth 9 mm: nodal metastasis rate = 53% (p = 0.769), T1WGd MRI depth with cut-
off value 11 mm (p = 0.635) and T2W
Results according to T1WGd MRI depth with cutoff 11 mm MRI depth with cutoff value 12 mm
T1WGd depth <11 mm T1WGd depth 11 mm
(p = 0.233). Disease-free survival rate
N0 22 10 was significant only for HP depth with
N+ 7 11 * cutoff value 9 mm, where the group
* x2 test: p = 0.040 <9 mm was 82% and the group >9 mm
- T1WGd depth <11 mm: nodal metastasis rate = 24%
- T1WGd depth 11 mm: nodal metastasis rate = 52%
was 59% (p = 0.042) (Fig. 5). For the
overall survival rate, there were no sig-
Results according to T2W MRI depth with cutoff 12 mm
nificant differences for T stage
T2W depth <12 mm T2W depth 12 mm
(p = 0.105), node metastasis (p = 0.170),
N0 22 10 T1WGd MRI depth with cutoff value
N+ 7 11 * 11 cm (p = 0.645) and T2W MRI depth
* x2 test: p = 0.040
with cutoff value 12 cm (p = 0.080) but for
 T2W depth <12 mm: nodal metastasis rate = 24%
 T2W depth 12 mm: nodal metastasis rate = 52% HP depth the overall survival rate was
93% in the group <9 mm and 60% in
Results according to T stage the group >9 mm (p = 0.023) (Fig. 6).
T1 T2
N0 13 19
N+ 4 14 * Nodal staging considering invasion
depth
* x2 test: p = 0.187.
 T1: nodal metastasis rate = 24%. Occult node metastasis according to the
 T2: nodal metastasis rate = 42%. clinical N staging system that takes inva-
sion depth into account was evaluated
24% and 42%, respectively (p = 0.187) squares regression equation was (Table 3). Clinical N0 patients were
(Table 1). Y = 0.917X + 0.696 for T1WGd MRI divided into two groups; N0a: T1WGd
depth and Y = 0.883X + 1.304 for T2W depth <11 mm, N0b: T1WGd depth
MRI depth. HP depth was categorized into 11 mm. N0a patients were determined
Correlation between HP depth and MRI
three groups and MRI measurement accu- to be a clinically low risk group and N0b
depth
racy was examined for each, the results patients as a high risk group for nodal
Pearson correlation coefficient of HP were 84% for T1WGd image and 80% for metastasis.
depth and T1WGd MRI depth was T2W, showing that T1WGd was more Similar to the clinical N stage, patho-
0.851 (p < 0.001) and the Pearson corre- accurate than T2W (Table 2). logic N stage was further classified
lation coefficient of HP depth and T2W according to the HP depth cutoff value
MRI depth was 0.813 (p < 0.001) suggest- 9 mm; pN0a: HP depth <9 mm, pN0b: HP
Survival rate
ing that HP depth shows stronger correla- depth 9 mm. There was no difference
tion with T2W MRI depth than with Disease-free survival rate and overall sur- between N0 and N+ in overall survival
T1WGd MRI depth (Figs. 3, 4). The least vival rate were calculated according to T rate according to the original pathologic N

Fig. 3. Scatterplot shows tumor depth as determined from pathologic specimens compared with tumor depth as determined from contrast-
enhanced T1-weighted images (T1WGd images).

Please cite this article in press as: J.. Jung, et al., Significant invasion depth of early oral tongue cancer originated from the lateral border
to predict regional metastases and prognosis, Int J Oral Maxillofac Surg (2009), doi:10.1016/j.ijom.2009.01.004
YIJOM-1517; No of Pages 8

Significant invasion depth of early oral tongue cancer originated 5

Fig. 4. Scatterplot shows tumor depth as determined from pathologic specimens compared with tumor depth as determined from T2-weighted
images (T2W images).

Table 2. MRI invasion depth accuracy. staging system. In overall survival rate a
MRI invasion depth significant difference between pN0a and
Pathologic tumor Invasion depth pN0b plus pN was noted, of 92% versus
T1WGd T2W 62% (Fig. 7).
No. % No. %
3 mm (n = 10) 7 70 7 70 Discussion
>3 mm, but 9 mm (n = 14) 11 79 10 71
>9 mm (n = 26) 24 92 23 88 Nodal metastasis is the most important
prognostic factor in oral tongue carci-
Overall accuracy (%) 84 80 noma7,12. The most common cause of
HP depth was divided into three groups and MRI measurement accuracy was examined for each, surgical treatment failure in oral tongue
the results were 84% for T1WGd image and 80% for T2W, showing that T1WGd was more carcinoma is nodal recurrence25. In this
accurate than T2W. study, of the 14 patients with recurrence,
ipsilateral node recurrence was noted in 10
patients (71%). The most relevant factor in
nodal metastasis is the invasion depth of
tongue cancer, but there is controversy
about the standard value of depth that
distinguishes nodal metastasis. There is
no verified preoperative study to measure
tumor invasion depth exactly, therefore it
is difficult to apply tumor depth in the
AJCC (American Joint Committee on
Cancer) TNM staging system.
Tumor invasion depth is excluded in the
TNM staging system despite its impor-
tance in disease prognosis, therefore a
new revised staging system has been pro-
posed in the present study.
LAM et al.11 reported that preoperative
MRI is a good measurement for estimating
the invasion depth of oral tongue carci-
noma. In this study, the correlation
between T1WGd MRI depth and HP depth
was found to be strong with a Pearson
correlation coefficient of 0.851. Classify-
ing into three groups according to HP
depth (<3, 3–9, >9 mm), MRI depth
values showed accuracies over 80% in
T1WGd depth and T2W MRI depth
(Table 2). The correlation with HP depth
Fig. 5. Tongue cancer disease-free survival rate related to HP depth with cutoff value = 9 mm. was stronger and the values more accurate
Disease survival rate was 82% in HP depth <9 mm group and 59% in HP depth 9 mm group for T1WGd depth than for T2W MRI
(p = 0.042). depth, probably because of the tendency

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YIJOM-1517; No of Pages 8

6 Jung et al.

values of invasion depth that can discern

Fig. 6. Tongue cancer overall survival rate related to HP depth with cutoff value = 9 mm.
Overall survival rate was 93% in HP depth <9 mm group and 60% in HP depth 9 mm group
(p = 0.023).
to overestimation in T2W images due to
inflammation and edema.11
The methods of invasion depth mea-
surement proposed by LAM et al.11
included exophytic tumor growth, this
was excluded in the present study and only
the invasion depth from the original sur-
face was measured, mainly so that only the
invasion potency of the tumor was con-
sidered. The reason for using the original
surface as the baseline for ulcerative
tumors was to reflect the invasion potency
accurately, starting from the epithelial cell
lining of the tongue.
Significant differences were noted
according to the status of nodal metastasis
at all HP depths, T1WGd MRI depth and
T2W MRI depth (Fig. 2). This shows that
preoperative MRI is a valuable tool for
predicting nodal metastasis. The cutoff
nodal metastasis were 9 mm for HP depth,
11 mm for T1WGd MRI depth and 12 mm
for T2W depth. The fact that the cutoff
value of T1WGd depth is 2 mm larger than
the HP depth can be explained by the
difference made due to the shrinkage
and distortion of the surgical specimen8,20.
Significant differences in nodal metastasis
rate were observed according to each cut-
off values, but the difference between T1
and T2 stages was not statistically signifi-
cant. It can be speculated that the depth of
tumor is more important than the size as a
prognostic factor in nodal metastasis. Par-
ticularly in terms of HP depth, dividing the
group under the cutoff value of 9 mm, the
nodal metastasis rate was merely 10% in
the group <9 mm compared with over
50% in the group >9 mm.
The cutoff value of 9 mm in HP depth is
higher than the values reported in previous
studies. BYERS et al.3 reported that a mus-
cular invasion depth exceeding 4 mm had
more possibility to metastasize as a prog-
nostic factor in oral tongue cancer, and
SPIRO et al.23 set 2 mm as a cutoff value.
O’BRIEN et al.17 reported that difference in
the rate of survival and nodal metastasis
was present with 4 mm. It is difficult to
compare studies, because previous studies
have included tumors originating from
various anatomical lesions such as ventral
and dorsal tongue, base of tongue and floor
of mouth, the mean invasion depth in the
group with nodal metastasis could be
lower than the present study in which only
tongue cancer of lateral tongue origin was
included. The present study included only
those patients in whom nodal metastasis

Table 3. Occult cervical lymph node metastasis.

Clinical N0 patients were divided into two groups; N0a: T1WGd depth <11 mm, N0b: T1WGd depth 11 mm. N0a patients were determined as a
clinically low risk group and N0b patients as a high risk group for nodal metastasis.

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to predict regional metastases and prognosis, Int J Oral Maxillofac Surg (2009), doi:10.1016/j.ijom.2009.01.004
YIJOM-1517; No of Pages 8
Fig. 7. Overall survival rate in revised pathologic N staging system. (A) Overall survival rate in
original N staging system: no difference between N0 and N+. (B) Overall survival rate in revised
pathologic N staging system: significant difference between pN0a and pN0b plus pN+
(p = 0.039).
was confirmed pathologically using surgi-
cal specimen obtained after partial glos-
sectomy and selective neck dissection in
cN0 patients, whereas the studies of
O’BRIEN and SPIRO study included cases
of nodal recurrence after initial surgical
treatment, which can lead to a lower cutoff
value compared with the present study. It
Please cite this article in press as: J.. Jung, et al., Significant invasion depth of early oral tongue cancer originated from the lateral border
to predict regional metastases and prognosis, Int J Oral Maxillofac Surg (2009), doi:10.1016/j.ijom.2009.01.004
Significant invasion depth of early oral tongue cancer originated
can be considered that an HP depth of
9 mm is a clinically important cutoff value
in early oral tongue cancer originating
from the lateral border.
ODELL et al.18 reported that the pattern
of invasion was the closest correlation
with metastasis and recurrence in this type
of carcinoma. The present study showed
7
that the group in which the cancer had a
tentacular border (finger like invasion bor-
der) (N = 19) had a statistically significant
rise in the nodal metastasis rate compared
with a pushing border (N = 31), this was
related to the invasion pattern (p = 0.026).
Even if the invasion pattern is an impor-
tant factor in determining survival rate and
nodal metastasis rate, these pathologic
factors can not be evaluated preopera-
tively in the same way as MRI depth
measurements, and are not appropriate
for use as factors in determining treatment.
Investigating the possibility of occult
nodal metastasis before surgery is impor-
tant because it could be the cause of
surgical failure. KUROKAWA et al.10
reported that if the depth of tumor invasion
exceeds 5 mm, there would be a greater
chance of occult cervical lymph node
metastasis. The occult nodal metastasis
rate of oral tongue cancer in this study
was 26%. To decrease the occult nodal
metastasis rate, nodal staging taking into
account invasion depth was suggested in
this study. Occult nodal metastasis accord-
ing to the revised clinical N staging system
decreased to 7% compared with 26% in
the AJCC TNM staging system.
SPIRO et al.23 claimed that in oral tongue
carcinoma, the increase in tumor thickness
is related more to treatment failure and
low survival rate than the increase in
tumor size, and that disease-related death
is uncommon in patients with an invasion
depth <2 mm. Calculating the disease-
free survival and the overall survival rate,
the results revealed that only HP depth
was statistically significant. MRI depth
did not show a statistically significant
relationship with the survival rate. When
the authors divided the cases using a para-
meter of 11 mm in MRI T1Gd depth, the
overall survival rate of the group <11 mm
was 82%, compared with 70% observed in
the other group, though there was no
statistical significance (p = 0.170).
Similar to the result of SPIRO et al.23,
there was no significant difference in sur-
vival rate between T1 and T2 (disease free
survival rate: 82% versus 66%, p = 0.228;
overall survival rate 94% versus 72%,
p = 0.105). There was no difference in
survival rate according to the status of
nodal metastasis, although nodal metasta-
sis is one of the most important prognostic
factors of tongue cancer (disease free sur-
vival: 72% versus 72%, p = 0.769; overall
survival rate: 81% versus 67%, p = 0.170).
As a result of a pathologic review of nodal
metastasis of 18 pN+ patients, no extra-
capsular spread (ECS) was observed in
any of the 18 cases. Therefore, when
admitting that presence of ECS affects
YIJOM-1517; No of Pages 8
8 Jung et al.
the survival rate more than the simple
presence of nodal metastasis24, the fact
that there was no statistical difference in
survival rate between the pN+ group with-
out ECS and the pN0 group, can be
explained.
In pathologic N staging which considers
invasion depth, significant difference was
shown in survival rate according to the N
staging (Fig. 7). Classifying HP depth
according to 9 mm cutoff value, disease-
free survival rates were 82% versus 59%
and overall survival rates were 93% versus
60%. According to YUEN et al.25, disease-
free survival of tongue cancer when tumor
invasion depth was larger than 9 mm was
60%, which was similar to the results of
this study. SHAHA et al.22 reported that
when the invasion depth of floor of mouth
cancer was larger than 9 mm, the overall
survival rate was 65% which was slightly
higher than the overall survival rate of
tongue cancer in this study. From these
observations, it can be considered that
invasion depth, which greatly affects the
survival rate in oral tongue carcinoma, is a
vital factor to be included in the TNM
staging system.
In conclusion, estimation of invasion
depth using MRI as a preoperative study
in oral tongue carcinoma is essential in
planning surgical treatment strategies such
as the extent of elective neck dissection.
Invasion depth, which greatly affects
occult node metastasis rate, disease-free
survival rate and overall survival rate,
must be included in the TNM staging of
oral tongue carcinoma.
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Corresponding author
Address:
Se-Heon Kim
Department of Otorhinolaryngology
Yonsei University College of Medicine
134 Shinchon-Dong
Seodaemun-Gu
Seoul
120-752
Korea
Tel.: +82 2 2228 3622
fax: +82 2 393 0580
E-mail: shkimmd@yuhs.ac