Depth of invasion (DOI)
Depth of invasion is how far down a cancer has grown from the surface it started on, measured in millimetres on the pathology slide; in mouth cancer it now sets the T stage and a depth over 4 mm means the neck nodes are treated even when they look clean, and in early stomach cancer it decides whether an endoscopic removal was enough.
Overview
What is measured: the distance from the reconstructed basement membrane of the adjacent normal mucosa to the deepest point of invasion, measured perpendicular to the surface; unlike tumour thickness it excludes the exophytic part. How: microscopy of the resection or biopsy specimen. Thresholds by site: oral cavity (AJCC 8th edition) 5 mm or less, 5 to 10 and over 10 mm move the T stage, and elective neck dissection is recommended above 3 to 4 mm (the D'Cruz trial of elective against therapeutic neck dissection and the Huang meta-analysis); stomach and oesophagus distinguish mucosal from submucosal invasion (SM1 under 500 micrometres against SM2 and deeper) to judge whether endoscopic submucosal dissection was curative (the eCura system); cervix FIGO 2018 stage IA1 is under 3 mm and IA2 3 to 5 mm; endometrial cancer splits at half the myometrial thickness for the ESGO risk groups and adjuvant brachytherapy; cutaneous squamous cell carcinoma over 6 mm or beyond the subcutaneous fat is high risk (Brigham and Women's T2b); Breslow thickness in melanoma is the analogous measure. What a result changes: T stage, elective treatment of the neck, completion surgery after endoscopic resection, adjuvant radiotherapy and sentinel node thresholds. Where it matters: oral, tongue and buccal cancers, early gastric cancer, advanced cutaneous SCC, NSMP endometrial cancer and early cervical cancer.
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