Assessment of Clinically Occult Nodal Metastasis by Evaluation of Histological Parameters and Immunohistochemical Markers (Cyclin D1 and E-cadherin) in Early Stage Oral Squamous Cell Carcinoma: A Cross-sectional Study

Introduction: Oral Squamous Cell Carcinoma (OSCC) is a prevalent malignancy, particularly in South Central Asia and Melanesia. Despite advancements in diagnosis and treatment, the optimal approach for early stage OSCC (T1-T2, N0) remains debated. While Elective Neck Dissection (END) helps identify occult metastases, it may also contribute to unnecessary morbidity in patients without nodal involvement. Thus, accurate predictive markers for occult nodal metastasis are crucial. Aim: The present study aimed to assess clinically occult metastasis by evaluation of various histopathological parameters and Immunohistochemistry (IHC) markers (E-cadherin and cyclin D1) in early stage OSCC. Materials and Methods: The present prospective crosssectional observational study was conducted at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India. The study included 50 biopsy-confirmed early stage (T1/T2, N0) OSCC patients from June 2023 to May 2024. Histopathological examination followed College of American Pathologists (CAP) and American Joint Committee on Cancer (AJCC) 8th edition guidelines. Immunohistochemistry (IHC) was performed for E-cadherin and cyclin D1 expression. Statistical analysis (Student’s t-test and Chi-square test) was conducted to identify significant association between various histopathological parameters (Worst Pattern of Invasion (WPOI), tumour budding, Tumour-Infiltrating Lymphocytes (TIL)’s, tumour differentiation, T-stage, Lymphovascular Invasion (LVI) Perineural Invasion (PNI) and IHC markers (E-cadherin and cyclin D) in predicting occult nodal metastasis in early stage OSCC. Statistical analysis was conducted using the Statistical Package for Social Sciences (SPSS) statistics software windows version 22.0 released 2013. Results: Among the 50 patients, 24 were Lymph Node (LN)- positive, while 26 were LN-negative. Significant predictors of nodal metastasis included pT2 stage, Depth Of Invasion (DOI) exceeding 5 mm, WPOI grade 5, high tumour budding score, tumour differentiation, TIL’s and LVI (p