{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T05:11:26Z","timestamp":1788757886511,"version":"build-2803163510"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cervical nodal metastasis critically influences prognosis in oral squamous cell carcinoma (OSCC), yet current staging does not quantify the degree of metastatic replacement within lymph nodes. This study evaluated morphometric index Node Deposit Size Index (NDSI) to assess their association with pathological aggressiveness and survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An ambispective cohort of 104 surgically treated, node-positive OSCC patients was analysed. Maximum metastatic deposit diameter and lymph node diameter were measured on routine H&amp;amp;E slides. NDSI correlated with clinicopathological variables, extranodal extension (ENE), lymph node density (LND), and survival using non-parametric tests, Spearman correlation, Kaplan\u2013Meier analysis, and ROC curves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      ENE-positive nodes demonstrated higher NDSI than ENE-negative nodes (86.9%\n                      <jats:italic>vs<\/jats:italic>\n                      43.8%;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001). NDSI increased across pathological nodal stage (pN), from 31.9% in pN1 to 87.8% in pN3b (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001), and across overall stage, reaching 87.9% in Stage IVB (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001). Higher NDSI was associated with lymphovascular invasion (LVI) (72.0%\n                      <jats:italic>vs<\/jats:italic>\n                      45.4%;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001) and perineural invasion (69.5%\n                      <jats:italic>vs<\/jats:italic>\n                      50.7%;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.024). NDSI correlated with LND (Spearman \u03c1=0.43,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001). ROC analysis identified an NDSI cutoff of 73.3% for predicting ENE (AUC\u00a0=\u00a00.854; not internally validated) and a cutoff of 60% for predicting 1-year mortality (AUC\u00a0=\u00a00.708; not internally validated). On multivariable linear regression (R\u00b2 = 0.524), LVI and pN (pN2a, pN2b, and pN3b) were independently associated with higher NDSI, whereas the remaining clinicopathological variables were not independently significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>NDSI correlate with adverse pathology and early mortality. However, the association between NDSI and ENE is not fully independent of pathological N-stage, and reproducibility, independent prognostic value, and cutoff stability require external validation before clinical use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1923931","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T04:22:59Z","timestamp":1788754979000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Node deposit size index as morphometric marker of intranodal tumour burden in node-positive oral cancer: a hypothesis-generating cohort study"],"prefix":"10.3389","volume":"16","author":[{"given":"Karthik N.","family":"Rao","sequence":"first","affiliation":[{"name":"Department of Head and Neck Surgery and Oncology, Sri Shankara Cancer Hospital","place":["Bangalore, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teertha","family":"Shetty","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery and Oncology, Sri Shankara Cancer Hospital","place":["Bangalore, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanthi","family":"Velusamy","sequence":"additional","affiliation":[{"name":"Department of Pathology, Sri Shankara Cancer Hospital","place":["Bangalore, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prajwal","family":"Dange","sequence":"additional","affiliation":[{"name":"Department of Pathology, Sri Shankara Cancer Hospital","place":["Bangalore, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sreeram","family":"MP","sequence":"additional","affiliation":[{"name":"Department of Pathology, Sri Shankara Cancer Hospital","place":["Bangalore, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. S.","family":"Srinath","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Sri Shankara Cancer Hospital","place":["Bangalore, Karnataka, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2019.104476","article-title":"Management of the neck in oral cancers","volume":"100","author":"Pantvaidya","year":"2020","journal-title":"Oral Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2020.104607","article-title":"New AJCC: How does it impact oral cancers","volume":"104","author":"Zanoni","year":"2020","journal-title":"Oral Oncol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-024-02861-6","article-title":"Primary management of operable locally advanced oral cavity squamous cell carcinoma: Current concepts and strategies","volume":"41","author":"Asarkar","year":"2024","journal-title":"Adv Ther"},{"key":"B4","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1038\/s41392-023-01576-4","article-title":"Lymph node metastasis in cancer progression: Molecular mechanisms, clinical significance and therapeutic interventions","volume":"8","author":"Ji","year":"2023","journal-title":"Signal Transduct Target Ther"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2025.107391","article-title":"Re-evaluating lymph node yield, lymph node ratio, and the number of metastatic nodes as prognostic factors in oral cavity squamous cell carcinoma","volume":"166","author":"Dudkiewicz","year":"2025","journal-title":"Oral Oncol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1007\/s12105-025-01839-2","article-title":"Micrometastasis and isolated tumour cells in oral squamous cell carcinoma: Refining nodal staging with emerging technologies","volume":"19","author":"MP","year":"2025","journal-title":"Head Neck Pathol"},{"key":"B7","doi-asserted-by":"crossref","first-page":"e227","DOI":"10.1002\/ctd2.227","article-title":"Lymph node metastasis in oral squamous cell carcinoma: Where we are and where we are going","volume":"3","author":"Cao","year":"2023","journal-title":"Clin. 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