Prognostic Efficacy of Nuclear Morphometry at Invasive Front of Oral Squamous Cell Carcinoma: An Image Analysis Microscopic Study

BACKGROUND Oral cancer is revisited on a pathologist perspective with advanced imaging technique. OBJECTIVE The present study assessed the new malignancy grading system at tumor proper (TP) and Bryne's grading system at invasive tumor front (ITF), morphometric features using software, to clarify their associations with prognosis of oral cancers. METHODS Histologically confirmed oral squamous cell carcinoma (OSCC) with 5-year follow-up was assessed morphometrically using image analysis at TP and ITF, correlated with the prognosis of patient. RESULTS On comparison of grading systems, a moderate agreement between both (Bryne and Anneroth) was seen. Among all histological parameters, we noted inverse correlation between degree of mitosis at invasive front and decrease in lymphoplasmacytic infiltrate at ITF with increase rate of recurrence and event of death. An increase in nuclear area, diameter, and perimeter along with decrease circularity in advancing OSCC was seen. Correlation of parameters showed higher values for maximum nuclear diameter, perimeter, and circularity at TP and ITF with recurrence. CONCLUSION This study, while limited in sample size, concluded that a combined assessment of clinical TNM staging, histopathological grading system {excluding the parameter "mitotic activity" (due to its inverse relation)}, and nuclear morphometry at the ITF are better prognosticators. This combination proved to be an accurate predictive factor in eliciting the varied molecular characteristics of tumor heterogeneity.