Histologic grading in the clinical evaluation of laryngeal carcinoma

Exploring Radiomics for Classification of Supraglottic Tumors: A Pilot Study in a Tertiary Care Center

Accurate classification of laryngeal cancer is a critical step for diagnosis and appropriate treatment. Radiomics is a rapidly advancing field in medical image processing that uses various algorithms to extract many quantitative features from radiological images. The high dimensional features extracted tend to cause overfitting and increase the complexity of the classification model. Thereby, feature selection plays an integral part in selecting relevant features for the classification problem. In this study, we explore the predictive capabilities of radiomics on Computed Tomography (CT) images with the incidence of laryngeal cancer to predict the histopathological grade and T stage of the tumour. Working with a pilot dataset of 20 images, an experienced radiologist carefully annotated the supraglottic lesions in the three-dimensional plane. Over 280 radiomic features that quantify the shape, intensity and texture were extracted from each image. Machine learning classifiers were built and tested to predict the stage and grade of the malignant tumour based on the calculated radiomic features. To investigate if radiomic features extracted from CT images can be used for the classification of laryngeal tumours. Out of 280 features extracted from every image in the dataset, it was found that 24 features are potential classifiers of laryngeal tumour stage and 12 radiomic features are good classifiers of histopathological grade of the laryngeal tumor. The novelty of this paper lies in the ability to create these classifiers before the surgical biopsy procedure, giving the clinician valuable, timely information.

Localization and Level of Expression of β-Catenin in Human Laryngeal Squamous Cell Carcinoma

OBJECTIVE: We studied the participation of β-catenin in the histologic differentiation of laryngeal squamous cell carcinomas.

STUDY DESIGN AND SETTING: At the National Institute of Respiratory Diseases, a tertiary referral center, localization and level of expression of β-catenin were compared between normal epithelium (15 cases) and primary tumors in different degrees of differentiation (38 cases), using an immunohistochemical procedure.

RESULTS: Cell membrane staining of β-catenin was observed in normal epithelium and in well and moderately differentiated carcinomas. Cytoplasmic redistribution was observed in poorly differentiated carcinomas. Loss of β-catenin correlated with tumor dedifferentiation.

CONCLUSION: Reduction of cell membrane β-catenin expression correlated with tumor dedifferentiation.

SIGNIFICANCE: Loss of β-catenin may lead to diminishing the strength of the intercellular adhesion system, thereby promoting the invasive phenotype of the squamous cell carcinoma of the larynx.

Histopathological grading of laryngectomy specimens

A material comprising 118 laryngectomy specimens, prepared by whole organ serial sectioning, was analyzed to determine the prognostic significance of histopathological tumor grading. No statistically significant association could be demonstrated between grading and a number of clinical and histopathological variables, including pathological staging, lymph node metastases or recurrence rate. The study supports the contention that the prognostic value of histopathological grading of laryngeal squamous cell carcinoma remains uncertain and unproven. Serial sections of the whole organ, processed by routine laboratory techniques, remain important for studying tumor extension but do not contribute to establishing histopathological grading as a significant prognostic parameter.

Lymph node histology in head and neck cancer: impact of immunotherapy with IRX-2

OBJECTIVE

To determine if lymph nodes (LN) of patients receiving IRX-2 immunotherapy reflect changes in histology.

SETTING

National Cancer Institute, Mexico City, Mexico.

PATIENTS

Thirty patients with advanced squamous cell carcinoma of the head and neck (H and N SCC) and 10 non-cancer controls.

INTERVENTION

A 21-day cycle of preoperative immunotherapy, including a single intravenous infusion of low-dose cyclophosphamide (300 mg/M(2)), 10 or 20 daily perilymphatic injections of a natural cytokine mixture (IRX-2) (approximately 200 U interleukin-2 equivalence by enzyme-linked immunosorbent assay), daily oral indomethacin, and daily oral zinc with multivitamins, followed by surgery (20 patients); surgery only (10 patients); LN biopsy controls (10).

OUTCOME MEASURES

Pretreatment biopsies were performed to confirm the diagnosis. Clinical responses were assessed at surgery, and the specimen and a sample of lymph node were analyzed with respect to changes in morphology and lymphoid and inflammatory infiltration (T and B lymphocytes, plasma cells, macrophages, granulocytes, and giant cells). The postsurgical characteristics were ascribed percentages based on a representative section and compared.

RESULTS

All 20 H and N SCC patients treated with IRX-2 showed the changes of immune regression of their tumors, previously characterized [Arch. Pathol. Lab. Med. 122 (1998) 447]. The 10 H and N SCC controls showed no such changes. Lymph node histology of the 10 H and N SCC controls showed, compared to non-cancer controls, reduced size, decreased T cell area and density and increased sinus histiocytosis. The lymph nodes of IRX-2-treated H and N SCC patients showed increased size (over both control groups), increased T cell area and density and decreased follicles and sinus histiocytosis. The T cell and/or B cell areas of LN of IRX-2-treated patients showed a high correlation with T and/or B cell infiltration into these tumors (p<0.001).

CONCLUSION

The lymph nodes of patients with H and N SCC are distinguished by T cell depletion and sinus histiocytosis (SH). Immunotherapy reverses these changes and induces nodal expansion and lymphoid infiltration into the tumor that correlates with LN changes. The correlation of nodal expansion with tumor lymphoid infiltration and regression implies an effective immunization to host tumor antigens occurring at the level of the regional lymph node. The reversal of sinus histiocytosis, by IRX-2 treatment, in association with nodal expansion suggests that tumor antigen processing via dendritic cells is defective in cancer-bearing patients and that it is corrected by the treatment.

The spectrum of laryngeal neoplasia: the pathologist's view

Several types of neoplastic change with different prognostic implications typically involve the laryngeal squamous epithelium. The purpose of this review is to examine the spectrum of these changes, as well as their relationship to benign squamous epithelial proliferative states. Since these pathological changes are apt to occur in regions where the epithelial lining is typically squamous, it is important to recognize that the epithelium of the larynx varies from stratified squamous to respiratory-type, depending on the location. The lingual (anterior) surface of the epiglottis is lined by a stratified squamous type, while the laryngeal (posterior) surface is stratified squamous merging into respiratory-type. In the larynx, the supraglottic and infraglottic portions are a respiratory-type, which contrasts with the stratified squamous epithelium of the glottis. This typical distribution does show some degree of variability in those patches of squamous epithelium and is frequently seen within the respiratory-type epithelial regions. The junction between the two epithelial types may be abrupt or separated by a transitional zone.

Relation between lymphatic vessel diameter and clinicopathologic parameters in squamous cell carcinomas of the oral region

BACKGROUND

In an attempt to determine the mechanism of cervical lymph node metastases, the authors studied the relation between lymphatic vessels in or around tumor tissue and lymph node metastases in patients with primary squamous cell carcinoma (SCC) of the oral region by enzyme histochemistry using 5'nucleotidase-alkaline phosphatase.

METHODS

The subjects were 23 patients who had biopsy proven oral SCC. After enzyme histochemical staining, the cross-sectional dimension (referred to as diameter) of the lymphatic vessels were measured and analyzed in relation to the T classification of the tumor, degree of tumor differentiation, and mode of invasion.

RESULTS

The average diameter of the lymphatic vessels in or around tumor tissue was significantly greater than that in tumor free tissue (P < 0.01). The mode of invasion correlated significantly with the lymphatic vessel diameter (P < 0.01). The diameter did not correlate significantly with the T classification (P range, 0.135-0.254) or tumor differentiation (P = 0.274). The following relation was found between the incidence of cervical lymph node metastases and the mode of invasion: 40.0% of Grade 2 tumors were positive for metastases, 71.4% of Grade 3 tumors were positive, and 75.0% of Grade 4 tumors were positive (grading was according to Jakobsson's classification).

CONCLUSIONS

Of the factors evaluated in this study, only the mode of invasion correlated significantly with the diameter of the lymphatic vessels. Although other studies have shown that tumor thickness and perhaps even perineural and blood vessel invasion may be equally important, the findings of the current study suggest that both lymphatic vessel diameter and the mode of invasion may be important factors in the prediction of cervical lymph node metastases.

Quantitative pathology of the intraepithelial laryngeal neoplasia

A clinical-histologic and morphometric study on 32 patients with precancerous laryngeal lesions was carried out. Two biopsies taken at different times were studied, and the cases in which carcinoma developed were compared with those cases in which it did not. The only clinical-histologic variable with prognostic value, related with evolution to carcinoma, was severe dysplasia. The Malignancy Grading System, which grouped together 13 clinical-histologic variables, had both high sensitivity and high specificity. On the other hand, quantitative microscopy was a more sensitive and objective method. Through the relationship between the parameters of orientation/nuclearity and Histometric Progression Index, we could separate those cases in which invasive carcinoma developed from those cases in which it did not with a sensitivity of 100% and a specificity of 82%.

Evaluation of histopathologic parameters in predicting cervical lymph node metastasis of oral and oropharyngeal carcinomas

A retrospective study of 53 patients with squamous cell carcinomas of the oral cavity and oropharynx was undertaken to evaluate histopathologic parameters in predicting cervical lymph node metastasis. Biopsy and surgical specimens were examined for degree of differentiation, pattern and depth of stromal invasion, lymphatic-vascular invasion, and lymphoplasmacytic response in relation to metastasis. The incidence of lymph node metastasis in tumors showing grade III type diffuse invasion (71.4%) and with stromal invasion of more than 8 mm in depth (83.3%) was significantly higher than that of tumors with well-demarcated boundaries (44.4% to 5.2%) and superficial invasion (35.3% to 8.3%). Lymph node metastasis also increased in the presence of lymphatic-vascular invasion by tumor cells, whereas the degree of differentiation and lymphoplasmacytic response was not related to metastasis. Thus, the pattern and the depth of stromal invasion and the presence of lymphatic-vascular invasion were important indicators in prediction of cervical lymph node metastasis. Prophylactic neck dissection is advocated when grade III type diffuse invasion, invasion exceeding 8 mm in depth, or grade II type invasion accompanied by a 4 mm to 8 mm depth of invasion is observed in a biopsy specimen.

Prognostic parameters in metastatic spread of laryngeal cancer: clinico-histopathological correlations

The authors present a series of 130 patients with laryngeal tumours submitted to total or horizontal laryngectomy and to neck dissection. The possible correlations between the staging and histology of the primary lesion, tumour marker (LASA) and the incidence of lymph node metastases are examined. The information provided by clinical and histopathological parameters is no doubt useful, but the margin of clinical error is high. On the contrary, the tumour marker concentration (LASA) was significantly higher in the patients whose lymph nodes were found to be histologically invaded, than in those without metastatic spread. Consequently, the LASA test may assume clinical importance before surgical therapy and in the follow-up of treated patients.

The influence of field size, treatment modality, commissure involvement and histology in the treatment of early vocal cord cancer with irradiation

One hundred and thirty-seven patients with TNM staged T1 glottic cancer were treated from 1966 to 1980. The patient characteristics were no different from those noted in previous studies. Patients were treated either with 60Co teletherapy units or 4 MeV linear accelerators with different daily (180-225) and weekly (4 times vs. 5 times) fractionation schemes. A recurrent-free survival was attained in 80% of the patients 2 years after primary treatment with radiation therapy. There were 27 local recurrences, of which 82% were salvaged with surgery for an overall adjusted survival of 95%. Patients treated on 60Co units with field sizes less than or equal to 30 sq. cm had a 15% increase in local recurrence compared with field size greater than 30 sq. cm, which could not be attributed to lower doses. Poorly differentiated tumors and those involving the anterior commissure were more likely to develop a local recurrence. Doses above 1900 ret were associated with a decrease in local recurrence in patients having anterior commissure involvement. Salvage with limited surgery for failure was effective in selected cases.