Role of Intratumoural Budding and Its Association with Tumour-Associated Macrophages in Preoperative Biopsies of Oral Squamous Cell Carcinoma

Abstract

Objectives: Intratumoural budding (ITB) is an emerging entity in oral squamous cell carcinoma (OSCC) and serves as a prime histopathological predictor of aggressive potential. This study aimed to investigate the incidence of ITB in OSCC due to its limited representation in the literature. Methods: This retrospective study was conducted in the Department of Oral Pathology and Microbiology, Post Graduate Institute of Dental Sciences, Rohtak, India, between 2017 and 2021. A total of 73 haematoxylin and eosin-stained sections of various grades of OSCC were examined for ITB and tumour-associated macrophages (TAMs), focusing on correlating these findings with clinicopathological parameters. Immunohistochemical analysis using a cluster of differentiation 68 (CD68) was performed. Additionally, the expression of CD68+ TAMs was studied in the centre of the tumour mass and correlated with ITB to ascertain the biological behaviour of OSCC. The data obtained were analysed using chi-square and Pearson correlation tests (P < 0.05). Results: ITB significantly increased in higher histopathological grades of OSCC (P = 0.000). Conversely, CD68+ TAMs in OSCC decreased significantly as the histopathological grades increased (P = 0.000), whereas on correlating with ITB, a non-significant difference was observed, revealing a negative correlation (r = −0.149; P = 0.208). Conclusions: The inverse association between ITB and TAMs with increasing histopathological grades may help identify ITB as a precise histopathological parameter for evaluating the aggressive biological potential in OSCC. Additionally, this relationship suggests the involvement of the anti-tumour immune response of TAMs within tumour mass. © 2025 Published by Sultan Qaboos University Sultan Qaboos University Medical Journal.