Nuclear fractal dimensions - an indicator of nodal metastasis in Oral Squamous Cell Carcinoma

Abstract

Context: Cumulative appraisal of tumor size, lymph node involvement and metastasis is essential for evaluating the prognosis of any cancer. Oral cancer being no exception to this rule also shows lymph node metastasis in advanced stages. Oral cancer boasts of certain peculiar microscopic features, among which nuclear morphometric changes form a key component. Accuracy in identifying these nuclear changes will help in better prediction of the prognosis of oral cancer. Fractal measurement is an offshoot of the computer aided image anal-ysis which aids in the accurate analysis of the structural properties of histopathology specimens. Aims: To evaluate the use of nuclear fractal dimensions (NFD) to predict lymph node metastasis in oral squamous cell carcinoma. Settings and Design: A cross-sectional comparative study was carried out using archived histopathological tissue specimens of oral squamous cell carcinoma which were then subjected to morphometric analysis. Methods and Material: 30 H&E stained sections of OSCC with and without lymph node metastasis were taken for the analysis. The micro-scopic images were captured from five representative high power fields from infiltrated dysplastic epithelial islands in the connective tissue and subjected to image analysis using Image Pro Premiere software. Well-stained, well-defined and non-overlapping neoplastic nuclei were semi-manually selected and subjected to fractal analysis. Statistical analysis used: Statistical analysis was done by applying student’s unpaired t-test and ‘p’ value below 0.005 was considered statistically significant. Results: A mean Nuclear Fractal Dimension of 1.099± 0.0068 for OSCCs with nodal metastasis as opposed to NFD of 1.055±0.0047 for OSCCs devoid of lymph node involvement was observed Conclusions: Nuclear fractal dimensions may prove to be a valuable indicator in the assessment of prognosis oral squamous cell carcinoma.