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

Abstract

Context: Cumulative appraisal of tumor size, lymph node involvementand metastasis is essential for evaluating the prognosis of any cancer.Oral cancer being no exception to this rule also shows lymph nodemetastasis in advanced stages. Oral cancer boasts of certain peculiarmicroscopic features, among which nuclear morphometric changesform a key component. Accuracy in identifying these nuclear changeswill help in better prediction of the prognosis of oral cancer.Fractal measurement is an offshoot of the computer aided image analysiswhich aids in the accurate analysis of the structural properties ofhistopathology specimens.Aims: To evaluate the use of nuclear fractal dimensions (NFD) topredict lymph node metastasis in oral squamous cell carcinoma.Settings and Design: A cross-sectional comparative study was carriedout using archived histopathological tissue specimens of oral squamouscell carcinoma which were then subjected to morphometric analysis.Methods and Material: 30 H&E stained sections of OSCC with andwithout lymph node metastasis were taken for the analysis. The microscopicimages were captured from five representative high power fieldsfrom infiltrated dysplastic epithelial islands in the connective tissue andsubjected to image analysis using Image Pro Premiere software. Wellstained,well-defined and non-overlapping neoplastic nuclei were semimanuallyselected and subjected to fractal analysis.Statistical analysis used: Statistical analysis was done by applyingstudent’s unpaired t-test and ‘p’ value below 0.005 was consideredstatistically significant.Results: A mean Nuclear Fractal Dimension of 1.099 0.0068 forOSCCs with nodal metastasis as opposed to NFD of 1.0550.0047 forOSCCs devoid of lymph node involvement was observedConclusions: Nuclear fractal dimensions may prove to be a valuableindicator in the assessment of prognosis oral squamous cell carcinoma.Keywords: nuclear fractal dimensions, image analysis, nuclear morphometry