Almangush, Alhadi

Leivo, Ilmo

Mäkitie, Antti A.

English

Helsingin yliopiston digitaalinen arkisto

https://helda.helsinki.fiBack to basics : Hematoxylin and eosin staining is the principaltool for histopathological risk assessment of oral cancerAlmangush, Alhadi2021-04Almangush , A , Mäkitie , A A & Leivo , I 2021 , ' Back to basics : Hematoxylin and eosinstaining is the principal tool for histopathological risk assessment of oral cancer ' , OralOncology , vol. 115 , 105134 . https://doi.org/10.1016/j.oraloncology.2020.105134http://hdl.handle.net/10138/342194https://doi.org/10.1016/j.oraloncology.2020.105134cc_by_nc_nddraftDownloaded from Helda, University of Helsinki institutional repository.This is an electronic reprint of the original article.This reprint may differ from the original in pagination and typographic detail.Please cite the original version.Oral Oncology xxx (xxxx) xxxPlease cite this article as: Alhadi Almangush, Oral Oncology, https://doi.org/10.1016/j.oraloncology.2020.1051341368-8375/© 2020 Elsevier Ltd. All rights reserved.Letter to the editor Back to basics: Hematoxylin and eosin staining is the principal tool for histopathological risk assessment of oral cancer Despite the discovery of several biomarkers that have been intro-duced for risk assessment of oral squamous cell carcinoma (OSCC) [1], daily practice still depends on morphological assessment of histopath-ologic parameters/prognosticators. Parameters that are identified using routine hematoxylin and eosin (HE) staining include, for example, depth of invasion, perineural and lymphovascular invasion among others. Of note, in the recent issue (December 2020) of Oral Oncology, two inter-esting studies [2,3] focused on such prognosticators and confirmed their clinical significance and underlined some important methodological considerations such as the optimal cutoff point for risk stratification based on depth of invasion. Also in mind, the traditional WHO grading system which is routinely included in pathology reports is evaluated using HE staining and is the cornerstone for histopathologic classifica-tion of OSCC [4]. Moreover, the eighth edition of the American Joint Committee on Cancer (AJCC 8) incorporated depth of invasion as a modifier of T stage, typically assessed using HE staining in daily prac-tice. In addition, evidence from recent research has highlighted many other promising prognosticators that can be identified by HE staining. Such emerging histologic markers include tumor budding, tumor-stroma ratio and infiltrating lymphocytes, and all have been discussed in a recent article published in Oral Oncology [5]. Furthermore, cannibalistic activity presented as cell-in-cell invasion has also been evaluated using HE staining and it has shown a valuable risk stratification in many cancers including OSCC [6]. Again, the assessment of these newly introduced histopathologic markers of OSCC is cost-effective and can be easily included in pathology reports. In addition, the above-mentioned markers reveal tumor-related features (e.g. tumor budding reveals tumor dissociation and active invasion) and also stroma-related features (e.g. estimation of lymphocytes reveals the status of stromal immune response). It is well documented that deeper invasion of OSCC tumors is asso-ciated with worse survival compared with superficial invasion. In a recent attempt to recognize the optimal cutoff point for the depth of invasion in early OSCC, van Lanschot et al. [2] recommended elective neck dissection for tumors with invasion depth of 4 mm or more. In another recent study, Noorlag et al. [7] reported that intraoral ultra-sound can be used accurately in cases with depth up to 10 mm; and magnetic resonance imaging was a better tool for tumors more than 10 mm in depth. Such assessment of depth using preoperative imaging tools can guide clinicians during treatment planning and therefore require further confirmatory studies. Lymphatic and vascular invasion of OSCC were recently confirmed by Spoerl et al. [3] as promising prognosticators in a large population- based cohort. Similarly, multifocal perineural invasion showed a promising value in risk assessment of OSCC in a recent study [8]. In-vasion of cancer cells in vital structures such as lymphatic vessels, blood vessels and nerves is associated with worse survival in many other cancers as well. Indeed, the possibility of assessing such invasion using HE staining is well documented and therefore it is ready for routine assessment in daily practice. HE is the gold standard in histopathologic diagnosis of solid tumors including the OSCC. As a routine staining, it has many advantages (including easy and simple protocol, cheap costs and fast processing) that makes it the staining of choice for risk assessment. Notably, recent research efforts have successfully used machine learning techniques for automated microscopic image analysis of some markers and this can assist in reducing variability among pathologists during the evaluation of HE-related markers (e.g. estimation of the infiltrating lymphocytes [9]). In addition, machine learning was used recently to analyze clini-copathologic data allowing clinicians to consider all markers together in risk stratification by a web-based tool [10]. Altogether, existing recent literature strongly supports the utility of conventional HE staining in prognostication of OSCC helping in decision making and treatment planning. For those histologic prognosticators that are not yet estab-lished in daily practice of OSCC (e.g. tumor budding and stroma ratio), it is necessary to consider multi-institutional studies and prospective studies. Indeed, that will warrant collaborative efforts. We support such initiatives and recommend to benefit from experience gained in studies [11] that established tumor budding for daily practice of colorectal cancer. Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. References [1] Rivera C, Oliveira AK, Costa RAP, De Rossi T, Paes Leme AF. Prognostic biomarkers in oral squamous cell carcinoma: A systematic review. Oral Oncol 2017;72:38–47. [2] van Lanschot CGF, Klazen YP, de Ridder MAJ, Mast H, Ten Hove I, Hardillo JA, et al. Depth of invasion in early stage oral cavity squamous cell carcinoma: The optimal cut-off value for elective neck dissection. Oral Oncol 2020;111:104940. [3] Spoerl S, Gerken M, Fischer R, Mamilos A, Spoerl S, Wolf S, et al. Lymphatic and vascular invasion in oral squamous cell carcinoma: Implications for recurrence and survival in a population-based cohort study. Oral Oncol 2020;111:105009. [4] Chuang ST, Chen CC, Yang SF, Chan LP, Kao YH, Huang MY, et al. Tumor histologic grade as a risk factor for neck recurrence in patients with T1–2N0 early tongue cancer. Oral Oncol 2020;106:104706. [5] Almangush A, Makitie AA, Triantafyllou A, de Bree R, Strojan P, Rinaldo A, et al. Staging and grading of oral squamous cell carcinoma: An update. Oral Oncol 2020; 107:104799. [6] Fais S, Overholtzer M. Cell-in-cell phenomena in cancer. Nat Rev Cancer 2018;18: 758–66. Contents lists available at ScienceDirect Oral Oncology journal homepage: www.elsevier.com/locate/oraloncology https://doi.org/10.1016/j.oraloncology.2020.105134 Received 26 November 2020; Accepted 1 December 2020   Oral Oncology xxx (xxxx) xxx2[7] Noorlag R, Klein Nulent TJW, Delwel VEJ, Pameijer FA, Willems SM, de Bree R, et al. Assessment of tumour depth in early tongue cancer: Accuracy of MRI and intraoral ultrasound. Oral Oncol 2020;110:104895. [8] Hasmat S, Ebrahimi A, Gao K, Low TH, Palme C, Gupta R, et al. Multifocal peri-neural invasion is a better prognosticator than depth of invasion in oral squamous cell carcinoma. Head Neck 2019;41:3992–9. [9] Shaban M, Khurram SA, Fraz MM, Alsubaie N, Masood I, Mushtaq S, et al. A novel digital score for abundance of tumour infiltrating lymphocytes predicts disease free survival in oral squamous cell carcinoma. Sci Rep 2019;9:13341. [10] Alabi RO, Elmusrati M, Sawazaki-Calone I, Kowalski LP, Haglund C, Coletta RD, et al. Machine learning application for prediction of locoregional recurrences in early oral tongue cancer: a Web-based prognostic tool. Virchows Arch 2019;475: 489–97. [11] Lugli A, Zlobec I, Berger MD, Kirsch R, Nagtegaal ID. Tumour budding in solid cancers. Nat Rev Clin Oncol 2020. Alhadi Almangush* Department of Pathology, University of Helsinki, Helsinki, Finland Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland Institute of Biomedicine, Pathology, University of Turku, Turku, Finland Faculty of Dentistry, University of Misurata, Misurata, Libya Antti A. Mäkitie Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Finland Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden E-mail address: antti.makitie@helsinki.fi. Ilmo Leivo Institute of Biomedicine, Pathology, University of Turku, Turku, Finland E-mail address: ilmo.leivo@utu.fi. * Corresponding author at: Department of Pathology, University of Helsinki, Haartmaninkatu 3 (P.O. Box 21), FIN-00014 University of Helsinki, Helsinki, Finland. E-mail address: alhadi.almangush@helsinki.fi (A. Almangush). Letter to the editor                                                                                                                                                                                                                              

Back to basics : Hematoxylin and eosin staining is the principal tool for histopathological risk assessment of oral cancer

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Back to basics : Hematoxylin and eosin staining is the principal tool for histopathological risk assessment of oral cancer

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