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Background <p>Oral squamous cell carcinoma (OSCC) is a globally prevalent malignancy marked by aggressive behaviour and varied clinical outcomes. Intratumoral budding (ITB) has emerged as a marker of OSCC aggressiveness. This study aimed to compare the prognostic accuracy of traditional (ITB-T) and refined (ITB-N) grading systems, along with 5-bud (ITB-5) and 10-bud (ITB-10) cutoffs, in pre-operative OSCC biopsies.</p> Materials and methods <p>This retrospective study analyzed 381 pre-operative OSCC biopsy cases. ITB was graded using both the traditional ITB-T (TB1: 0–4, TB2: 5–9, TB3: ≥10 buds) and refined ITB-N systems (TB0: 0, TB1: 1–4, TB2: 5–9, TB3: ≥10 buds), with additional 5-bud (ITB-5) and 10-bud (ITB-10) cutoffs. Statistical tests included Kruskal-Wallis, nominal, and logistic regression analyses.</p> Results <p>ITB grades varied significantly across OSCC differentiation, with poorly differentiated OSCC showing highest ITB grades. The refined ITB-N and ITB-10 demonstrated superior sensitivity in distinguishing WDSCC from MDSCC and MDSCC from PDSCC. Nominal regression indicated higher predictive accuracy for ITB-N and ITB-10 compared to ITB-T and ITB-5, with the highest classification accuracy at 62.2%. Logistic regression further confirmed a significant association between higher ITB grades in ITB-N and ITB-10 and increased mortality risk, underscoring their prognostic value.</p> Conclusion <p>The refined ITB-N grading system, incorporating a zero-budding category (TB-0) and a ten-bud cutoff (ITB-10), has emerged as a remarkably potent prognostic indicator across diverse grades of OSCC. This highlights the potential for adopting ITB-N grading system and ITB-10 cutoff to enhance risk stratification and tailor treatment plans for OSCC patients.</p>

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Refining Tumor Grading: an Enhanced Method for Evaluating Intratumoral Budding in Pre-Operative Biopsies of Oral Squamous Cell Carcinoma

  • 期刊论文

  • 发表日期：

    2025年6月6日

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  • R Keerthika,
  • Akhilesh Chandra,
  • Rahul Agarwal

摘要

Background

Oral squamous cell carcinoma (OSCC) is a globally prevalent malignancy marked by aggressive behaviour and varied clinical outcomes. Intratumoral budding (ITB) has emerged as a marker of OSCC aggressiveness. This study aimed to compare the prognostic accuracy of traditional (ITB-T) and refined (ITB-N) grading systems, along with 5-bud (ITB-5) and 10-bud (ITB-10) cutoffs, in pre-operative OSCC biopsies.

Materials and methods

This retrospective study analyzed 381 pre-operative OSCC biopsy cases. ITB was graded using both the traditional ITB-T (TB1: 0–4, TB2: 5–9, TB3: ≥10 buds) and refined ITB-N systems (TB0: 0, TB1: 1–4, TB2: 5–9, TB3: ≥10 buds), with additional 5-bud (ITB-5) and 10-bud (ITB-10) cutoffs. Statistical tests included Kruskal-Wallis, nominal, and logistic regression analyses.

Results

ITB grades varied significantly across OSCC differentiation, with poorly differentiated OSCC showing highest ITB grades. The refined ITB-N and ITB-10 demonstrated superior sensitivity in distinguishing WDSCC from MDSCC and MDSCC from PDSCC. Nominal regression indicated higher predictive accuracy for ITB-N and ITB-10 compared to ITB-T and ITB-5, with the highest classification accuracy at 62.2%. Logistic regression further confirmed a significant association between higher ITB grades in ITB-N and ITB-10 and increased mortality risk, underscoring their prognostic value.

Conclusion

The refined ITB-N grading system, incorporating a zero-budding category (TB-0) and a ten-bud cutoff (ITB-10), has emerged as a remarkably potent prognostic indicator across diverse grades of OSCC. This highlights the potential for adopting ITB-N grading system and ITB-10 cutoff to enhance risk stratification and tailor treatment plans for OSCC patients.