Recommendations for the reporting of specimens containing oral cavity and oropharynx neoplasms. Association of Directors of Anatomic and Surgical Pathology

CT Accuracy of Extrinsic Tongue Muscle Invasion in Oral Cavity Cancer

BACKGROUND AND PURPOSE

Extrinsic tongue muscle invasion in oral cavity cancer upstages the primary tumor to a T4a. Despite this American Joint Committee on Cancer staging criterion, no studies have investigated the accuracy or prognostic importance of radiologic extrinsic tongue muscle invasion, the feasibility of standardizing extrinsic tongue muscle invasion reporting, or the degree of agreement across different disciplines: radiology, surgery, and pathology. The purpose of this study was to assess the agreement among radiology, surgery, and pathology for extrinsic tongue muscle invasion and to determine the imaging features most predictive of extrinsic tongue muscle invasion with surgical/pathologic confirmation.

MATERIALS AND METHODS

Thirty-three patients with untreated primary oral cavity cancer were included. Two head and neck radiologists, 3 otolaryngologists, and 1 pathologist prospectively evaluated extrinsic tongue muscle invasion.

RESULTS

Fourteen of 33 patients had radiologic extrinsic tongue muscle invasion; however, only 8 extrinsic tongue muscle invasions were confirmed intraoperatively. Pathologists were unable to determine extrinsic tongue muscle invasion in post-formalin-fixed samples. Radiologic extrinsic tongue muscle invasion had 100% sensitivity, 76% specificity, 57% positive predictive value, and 100% negative predictive value with concurrent surgical-pathologic evaluation of extrinsic tongue muscle invasion as the criterion standard. On further evaluation, the imaging characteristic most consistent with surgical-pathologic evaluation positive for extrinsic tongue muscle invasion was masslike enhancement.

CONCLUSIONS

Evaluation of extrinsic tongue muscle invasion is a subjective finding for all 3 disciplines. For radiology, masslike enhancement of extrinsic tongue muscle invasion most consistently corresponded to concurrent surgery/pathology evaluation positive for extrinsic tongue muscle invasion. Intraoperative surgical and pathologic evaluation should be encouraged to verify radiologic extrinsic tongue muscle invasion to minimize unnecessary upstaging. Because this process is not routine, imaging can add value by identifying those cases most suspicious for extrinsic tongue muscle invasion, thereby prompting this more detailed evaluation by surgeons and pathologists.

The mitochondrial DNA Northeast Asia CZD haplogroup is associated with good disease-free survival among male oral squamous cell carcinoma patients

Reprogramming of energy metabolism in cancer cells has been directly/indirectly linked to mitochondria and mitochondrial functional defects and these changes seem to contribute to the development and progression of cancer. Studies have indicated that mitochondrial DNA haplogroups are associated with risk in relation to various diseases including cancer. However, few studies have examined the effect of haplogroups on cancer prognosis outcome. In order to explore the role of haplogroups on oral squamous cell carcinoma (OSCC) prognosis, the mitochondrial genomes of 300 male OSCC patients were comprehensively analyzed by direct sequencing. They were then haplotyped and grouped into four major geographic haplogroups, namely the East Asia AN, Southeast Asia RBF, East Asia MGE and Northeast Asia CZD groups. The Kaplan-Meier plot analysis indicated that individuals who were members of the CZD haplogroup showed a significant association with better disease-free survival (DFS) than the other three haplogroups and this phenomenon still existed after adjusting for tumor stage, differentiation and age at diagnosis (hazard ratio=0.55; 95% CI=0.36-0.84). In addition, an interaction between membership of the RBF haplogroup and radiotherapy/chemo-radiotherapy in DFS was also identified. The results strongly support the hypothesis that an individual's haplogroup, by defining their genomic background, plays an important role in tumor behavior and mitochondrially-targeted anticancer drugs are promising future therapeutic approaches.

Invasion characteristics of oral tongue cancer: frequency of reporting and effect on survival in a population-based study

BACKGROUND

The 2000 College of American Pathologists (CAP) guidelines recommend that a characterization of carcinomas of the upper aerodigestive tract, including tongue cancer, should include depth of invasion (DI) and the presence of lymphovascular invasion (LVI) or perineural invasion (PNI).

METHODS

This study included patients who were diagnosed with cancer of the oral tongue, who underwent tumor resection, and who were reported to either the Metropolitan Atlanta and Rural Georgia Surveillance, Epidemiology, and End Results (SEER) registry or the Los Angeles SEER registry. The authors assessed the completeness of pathology reporting with respect to the documentation of PNI or LVI and DI. Generalized estimating equations were used to examine factors that influenced reporting while taking into consideration clustering of observations within the hospitals. Univariate and multivariate survival analyses were conducted to examine the impact of tumor invasion characteristics on mortality while controlling for other prognostic factors.

RESULTS

DI reporting increased from 13% between 1997 and 1999 to 23% between 2000 and 2004 after the CAP issued its recommendations; whereas mode of invasion (the presence of LVI and/or PNI) reporting for the same period increased from 13% to 38%. The observed increase in reporting was most pronounced in the first 2 years (2000 and 2001) and appeared to decline again afterward. Tumor invasion >3 mm in depth and the presence of PNI were among the strongest predictors of survival in multivariate analyses.

CONCLUSIONS

The current results indicated the importance of reporting tumor invasion characteristics for patients diagnosed with cancer of the oral tongue. The findings also underscore the need for continuous monitoring of adherence to the CAP protocol.

[Head and neck squamous cell carcinoma: What's new in 2009]

Classical epidermoid carcinoma is the most frequent head and neck malignant neoplasm. Some particular variants are nevertheless of interest as they harbor a different prognosis, require specific care management and may arise from an alternate oncogenesis path. Best examples are verrucous carcinoma, basal-like or spindle cell carcinoma. Recent studies pointed out the critical role of infection with oncogenic HPV strains in the development of these carcinomas, especially in the oropharynx. In addition, HPV infection is changing the epidemiological profile of these cancers seems to have a prognostic value. New targeted therapies and prognostic markers will be discussed as they may dramatically improve the outcome of these tumors.

Variability of practice in anatomic pathology and its effect on patient outcomes

Variability in the delivery of medical care negatively affects patient outcomes and contributes to escalating health care costs. Such heterogeneity exists on geographic, provider-related, institutional, and financial levels. Efforts to reduce it have resulted in the development of evidence-based clinical practice guidelines that have been only inconsistently adopted. Testing patterns in anatomic pathology (AP) also manifest considerable inconsistency, further contributing to suboptimal health outcomes and increased costs. Test variability in AP can be identified in its clinician-dependent preanalytic aspect and in the analytic phase as well, including the gross prosection of specimens, their processing, and reporting formats. To address selected facets of these issues, pathologists have developed practice guidelines that generally are based on "expert" opinion, representing the weakest form of evidence. Interpretative variability in AP has been investigated in numerous published studies that have measuring the "kappa statistic." Few of those analyses have addressed the impact of diagnostic disagreement on patient care; in addition, proposed and effective methods to reduce interpretative variability have only rarely been included.