Agarwal, Shweta

Abstract Background: Perineural invasion (PNI) is a key prognostic factor in oral squamous cell carcinoma (OSCC). Recent studies have proposed the importance of subcategorizing PNI based on location in relation to the tumor. However, current gaps in definition of PNI subcategories limit its integration into staging system and treatment planning. This study evaluates the prognostic value of the presence of PNI and its location, in correlation with other tumor characteristics, and examines their relationship with survival and recurrence. Design: A total of 159 patients with histologically confirmed OSCC from February 2022–May 2025 were included in the study. PNI was subclassified into intratumoral, peripheral and extratumoral. Association of PNI metrics with other prognostic factors (margin status, lymph node metastasis [LN mets], and lymphovascular invasion [LVI]) were assessed using a Fisher’s exact test (categorical variables). Comparisons of disease-free survival (DFS) and overall survival (OS) between the PNI subgroups were made with a logrank test. Cox proportional hazards regression models were used to find univariate predictors of death and the composite outcome of recurrence or death. A p value <0.05 was considered statistically significant. Statistical analyses were performed using R Statistical Software (version 4.4.1; R Foundation for Statistical Computing, Vienna, Austria). Results: 49/159 cases were PNI positive. Median age: 69 years and male predominance (58.5%). Floor of mouth was the most common site. Presence of PNI correlated significantly with positive margins and positive LVI (p = 0.013 and 0.048 respectively). However, only peripheral PNI showed significant correlation with LN mets (p = 0.004). On univariate analysis, the strongest predictors of recurrence or death were larger tumor size (p <0.001); presence of PNI (p = 0.014), especially intratumoral (p = 0.003); positive LN mets (p = 0.024); and non-white race (p = 0.023). Both DFS and OS were significantly worse in patients with PNI compared with those without (DFS: p = 0.012, OS: p = 0.018). Subclassification of PNI showed a significantly poorer DFS and OS in cases with intratumoral PNI (DFS: p = 0.002, OS: p = 0.012), but not with extratumoral or peripheral PNI.

ABSTRACTBackgroundThe Milan System for Reporting Salivary Gland Cytopathology is an effective reporting system for salivary gland fine needle aspirations with well‐established risks of malignancy. Salivary gland neoplasm of uncertain malignant potential (SUMP) comprises a heterogenous group of lesions which have features that can be recognized as at least neoplastic but preclude further classification into benign or malignant. In this study, we reviewed the cytomorphologic features of salivary gland fine needle aspirations diagnosed as SUMP at our institution (over the past 6 years) and correlated those with the final diagnosis on surgical follow up.DesignA retrospective search was performed to identify cases classified as SUMP at our institution from January 2018 to February 2024. Cytology slides were reviewed, and cases were subclassified based on key cytomorphologic features into the following categories: (1) basaloid, (2) oncocytic, (3) with clear cell features and (4) mixed features (myoepithelial/oncocytoid/squamoid features). Histologic diagnosis was recorded if available.ResultsA total of 36 cases of SUMP were identified; 31/36 had surgical follow up; final diagnosis included 22 benign lesions (2 non‐neoplastic and 20 benign neoplasms), and nine malignant lesions. The overall risk of neoplasm and risk of malignancy were 93.5% and 29% respectively, with the oncocytic sub‐category recording the highest ROM (42.8%). Mucoepidermoid carcinoma was the most common malignant diagnosis and pleomorphic adenoma the most common benign diagnoses.ConclusionsOur study supports the subclassification of SUMP lesions based on key cytomorphologic features, thereby aiding in refining this ambiguous entity and providing a precise risk assessment.