Background. Oral cancer is revisited on a pathologist perspective with advanced imaging technique. Objective. The present study assessed the new malignancy grading system at tumor proper (TP) and Bryne’s grading system at invasive tumor front (ITF), morphometric features using software, to clarify their associations with prognosis of oral cancers. Methods. Histologically confirmed oral squamous cell carcinoma (OSCC) with 5-year follow-up was assessed morphometrically using image analysis at TP and ITF, correlated with the prognosis of patient. Results. On comparison of grading systems, a moderate agreement between both (Bryne and Anneroth) was seen. Among all histological parameters, we noted inverse correlation between degree of mitosis at invasive front and decrease in lymphoplasmacytic infiltrate at ITF with increase rate of recurrence and event of death. An increase in nuclear area, diameter, and perimeter along with decrease circularity in advancing OSCC was seen. Correlation of parameters showed higher values for maximum nuclear diameter, perimeter, and circularity at TP and ITF with recurrence. Conclusion. This study, while limited in sample size, concluded that a combined assessment of clinical TNM staging, histopathological grading system excluding the parameter “mitotic activity” (due to its inverse relation), and nuclear morphometry at the ITF are better prognosticators. This combination proved to be an accurate predictive factor in eliciting the varied molecular characteristics of tumor heterogeneity. 1. Introduction Head and neck squamous cell carcinoma (HNSCC) is an important cause of morbidity and mortality in addition to being one of the ten most common cancers occurring worldwide exhibiting marked geographic differences in occurrences [1]. Estimates based on the crude incidence rates under the National Cancer Registry Project revealed oral cancer to constitute 12% of all cancers in metropolitan cities and a frequency of 15–20% of all cancers reported from various cancer hospitals in India. Clinically, available data suggests that 60–80% of patients diagnosed with OSCC showed lymph node involvement at the time of presentation and only 10–15% of patients with OSCC presented with “localized” (T1 and T2) stages. Thus, OSCC is known to exhibit early metastasis and high degree of locoregional recurrence. This aggressive head and neck malignancy is associated with severe morbidity and lesser five-year survival rate, 32% (radiotherapy), 48% (surgery), and 54% (combined surgery and radiotherapy), despite advances in treatment [1]. OSCC
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