JOURNAL OF PATHOLOGY, VOL.
166: 375-38 1 (1 992)
MALIGNANCY GRADING OF THE DEEP INVASIVE MARGINS OF ORAL SQUAMOUS CELL CARCINOMAS HAS HIGH PROGNOSTIC VALUE MAGNE BRYNE*, HANNA
s. KOPPANG*,
RUNE L I L L E N C ~AND
ASMUND
KJERHEIM*
*Department of Oral Pathology, University of Oslo, Oslo, Norway; ?Department of Patholog??. The Norwegian Radium Hospital, Oslo. Norway Received 9 September 1991 Accepted26 November 1991
SUMMARY Several recent studies have indicated that cells at the invasive tumour margins often are different from cells within other parts of various human cancers. In this work, we have studied all squamous cell carcinomas of the floor of the mouth registered in Norway during the years 1963-1972 (N=96). Borderline cases and cases given no treatment were excluded. Of the remaining 79 cases, biopsy specimens acceptable for histological grading were obtained from 6 1 patients. Only the most invasive margins of the tumours were histologically graded independently by two pathologists according to a multifactorial grading system. The results confirmed our previous findings that grading of invasive tumour margins is an independent prognostic factor in Cox’s multivariate survival analysis ( P < 0.01). Inter-observer agreement was calculated by kappa statistics, and good agreement was obtained (kappa = 0.63). Neither agreement nor prognostic value was improved after calibration of the pathologists. Conventional Broders’ grading of the whole biopsy had no prognostic value (P 75% mature cells)
Moderately abundant nuclear polymorphism (50-75% mature cells)
Abundant nuclear polymorphism (2550% mature cells)
Extreme nuclear polymorphism (025% mature cells)
Number of mitoses (high power field)*
0-1
2-3
4-5
>5
Pattern of invasion
Pushing, welldelineated infiltrating borders
Infiltrating, solid cords, bands and/ or strands
Small groups or cords of infiltrating cells (n > 15)
Marked and widespread cellular dissociation in small groups and/ or in single cells ( n < 15)
Lymphoplasmacytic infiltration
Marked
Moderate
Slight
None
~~~~
~
*This parameter may be excluded from the grading (see Discussion).
increased (kappa =0.63). Overall agreement was 83 per cent and agreement by chance 55 per cent. One of us (HSK) had a slightly higher average total malignancy score (1 1.1) than the other (MB) (10.4). These results are shown in Figs 2 and 3, and Table 3. Cox multivariate survival analysis showed that ICG (total malignancy score, range 5-16) for both pathologists (P
166: 375-38 1 (1 992)
MALIGNANCY GRADING OF THE DEEP INVASIVE MARGINS OF ORAL SQUAMOUS CELL CARCINOMAS HAS HIGH PROGNOSTIC VALUE MAGNE BRYNE*, HANNA
s. KOPPANG*,
RUNE L I L L E N C ~AND
ASMUND
KJERHEIM*
*Department of Oral Pathology, University of Oslo, Oslo, Norway; ?Department of Patholog??. The Norwegian Radium Hospital, Oslo. Norway Received 9 September 1991 Accepted26 November 1991
SUMMARY Several recent studies have indicated that cells at the invasive tumour margins often are different from cells within other parts of various human cancers. In this work, we have studied all squamous cell carcinomas of the floor of the mouth registered in Norway during the years 1963-1972 (N=96). Borderline cases and cases given no treatment were excluded. Of the remaining 79 cases, biopsy specimens acceptable for histological grading were obtained from 6 1 patients. Only the most invasive margins of the tumours were histologically graded independently by two pathologists according to a multifactorial grading system. The results confirmed our previous findings that grading of invasive tumour margins is an independent prognostic factor in Cox’s multivariate survival analysis ( P < 0.01). Inter-observer agreement was calculated by kappa statistics, and good agreement was obtained (kappa = 0.63). Neither agreement nor prognostic value was improved after calibration of the pathologists. Conventional Broders’ grading of the whole biopsy had no prognostic value (P 75% mature cells)
Moderately abundant nuclear polymorphism (50-75% mature cells)
Abundant nuclear polymorphism (2550% mature cells)
Extreme nuclear polymorphism (025% mature cells)
Number of mitoses (high power field)*
0-1
2-3
4-5
>5
Pattern of invasion
Pushing, welldelineated infiltrating borders
Infiltrating, solid cords, bands and/ or strands
Small groups or cords of infiltrating cells (n > 15)
Marked and widespread cellular dissociation in small groups and/ or in single cells ( n < 15)
Lymphoplasmacytic infiltration
Marked
Moderate
Slight
None
~~~~
~
*This parameter may be excluded from the grading (see Discussion).
increased (kappa =0.63). Overall agreement was 83 per cent and agreement by chance 55 per cent. One of us (HSK) had a slightly higher average total malignancy score (1 1.1) than the other (MB) (10.4). These results are shown in Figs 2 and 3, and Table 3. Cox multivariate survival analysis showed that ICG (total malignancy score, range 5-16) for both pathologists (P
