Anders Högmo

Human papillomavirus is more common in base of tongue than in mobile tongue cancer and is a favorable prognostic factor in base of tongue cancer patients

The frequency of human papilloma virus (HPV) and its influence on clinical outcome was analyzed retrospectively in pre‐treatment paraffin embedded biopsies from 110 patients with tongue cancer. The presence of HPV DNA was examined in 85 mobile tongue tumors and 25 base of tongue tumors by a polymerase chain reaction (PCR) with 2 general primer pairs, GP5+/6+ and CPI/IIG. When HPV‐DNA was found, HPV‐type specific primers and direct sequencing were used for HPV sub‐type verification. Twelve of 110 (10.9%) samples were HPV‐positive; 9 for HPV‐16, 1 for HPV‐33, 1 for HPV‐35 and 1 could not be analyzed because of shortage of DNA. HPV was significantly more common in base of tongue tumors (10/25, 40.0%) compared to tumors of the mobile tongue (2/85, 2.3%). The influence of HPV on clinical outcome in mobile tongue cancer could not be studied, due to that HPV was present in too few cases. Of the 19 patients with base of tongue cancer that were included in the survival analysis, however, 7 patients with HPV‐positive base of tongue cancer had a significantly favorable 5‐year survival rate compared to the 12 HPV‐negative patients. In conclusion, HPV is significantly more common in base of tongue cancer than in mobile tongue cancer, and has a positive impact on disease‐specific survival in patients with base of tongue cancer.

Predictive value of malignancy grading systems, DNA content, p53, and angiogenesis for stage I tongue carcinomas.

AIM: To assess the clinical value of malignancy grading systems compared with nuclear DNA content, protein p53, and angiogenesis for predicting recurrence of stage I (UICC, 1987) tongue carcinomas. METHODS: Histopathological malignancy grading according to Jakobsson and tumour front grading according to Bryne et al were performed on haematoxylin and eosin slides. DNA analysis was performed by image cytometry. Protein p53 and angiogenesis were evaluated by immunohistochemical analysis using antibody CM1 and antibody against factor VIII related antigen, respectively. RESULTS: 49 patients with stage I carcinomas of the mobile tongue were included, all treated by local surgical excision alone. Eight patients (16%) suffered from local recurrence during follow up, and 13 (27%) had regional recurrence. Both Jakobssons malignancy grading system and p53 immunoreactivity proved to be useful predictors of regional recurrence in a Cox multivariate regression analysis. CONCLUSIONS: Histopathological malignancy grading systems provide valuable prognostic information and can still compete with current biological markers in this respect.

The Clinical Value of Image Cytometry DNA Analysis in Distinguishing Branchial Cleft Cysts From Cystic Metastases of Head and Neck Cancer

Objectives/Hypothesis A branchial cleft cyst presents as a lump in the neck that, generally, is easily cured by surgical excision. The preoperative diagnosis is based on clinical examination and, especially in the Scandinavian countries, fine‐needle aspiration cytology. However, at times, the histopathological analysis of the excised cyst reveals a cystic metastasis of squamous cell carcinoma of the head and neck. If adequate diagnosis could be obtained preoperatively, patients would most likely fare better. The study was performed to investigate whether the diagnostic accuracy for these lesions could be improved preoperatively by image cytometry DNA analysis of the fine‐needle aspiration cytology specimen.

Nuclear DNA content and p53 immunostaining in metachronous preneoplastic lesions and subsequent carcinomas of the oral cavity.

Clinical evaluation of preneoplastic lesions of the oral cavity is difficult. Histopathologic grading of dysplasias shows large variability and does not give reliable information concerning the risk for progression to cancer.

Image Cytometry DNA-Analysis of Fine Needle Aspiration Cytology to Aid Cytomorphology in the Distinction of Branchial Cleft Cyst from Cystic Metastasis of Squamous Cell Carcinoma: A Prospective Study†

Objective: Frequently, the distinction between branchial cleft cyst and cystic metastases from squamous cell carcinoma is difficult by cytomorphology. In a prospective study, we investigated the need for, and the value of, image cytometry DNA‐analysis as a complement to cytologic evaluation of cystic lesions in the neck.

Radiological imaging of the neck for initial decision-making in oral squamous cell carcinomas-A questionnaire survey in the Nordic countries

Background. Fast and accurate work-up is crucial to ensure the best possible treatment and prognosis for patients with head and neck cancer. The presence or absence of neck lymph node metastases is important for the prognosis and the choice of treatment. Clinical lymph node (N)-staging is done by palpation and diagnostic imaging of the neck. We investigated the current practice of the initial radiological work-up of patients with oral squamous cell carcinomas (OSCC) in the Nordic countries. Methods. A questionnaire regarding the availability and use of guidelines and imaging modalities for radiological N-staging in OSCC was distributed to 21 Head and Neck centres in Denmark (n = 4), Finland (n = 5), Iceland (n = 1), Norway (n = 4) and Sweden (n = 7). We also asked for a description of the radiological criteria for determining the lymph nodes as clinical positive (cN+) or negative (cN0). Results. All 21 Head and Neck centres responded to the questionnaire. Denmark and Finland have national guidelines, while Norway and Sweden have local or regional guidelines. Seventeen of the 19 centres with available guidelines recommended computed tomography (CT) of the cN0 neck. The waiting time may influence the imaging modalities used. Lymph node size was the most commonly used criteria for radiological cN+, but the cut-off measures vary from 0.8 to 2.0 cm. Conclusion. Overall, CT is the most commonly recommended and used imaging modality for OSCC. Despite availability of national guidelines the type and number of radiological examinations vary between centres within a country, but the implementation of a fast-track programme may facilitate fast access to imaging. The absence of uniform criteria for determining the lymph nodes of the neck as cN+ complicates the comparison of the accuracy of the imaging modalities. Well-defined radiological strategies and criteria are needed to optimise the radiological work-up in OSCC.

Results from the Swedish Head and Neck Cancer Register for Oral Cancer

Objective: The Swedish Head and Neck Cancer Register (SweHNCR) started in 2008. The purpose was to register all new patients with head and neck cancer and collect data about tumor stage, planned and received treatment, relapse and survival. Data for oral cancer from the first 3 years will be presented. Method: The SweHNCR is covering more than 95% of all HN cancers in Sweden. Between 2008 and 2010, 3701 new cases were registered including 1029 of oral cancers (28%). The most common location was tongue (42%), followed by gingival (21%), buccal mucosa (19%), floor of the mouth (14%), and hard palate (3%). Less than 10% were treated with palliative intent. Results: Sixty percent of all gingival cancers were diagnosed as T4 while 70% of the tongue cancers were diagnosed as T1-T2. A total of 25% had lymphnode metastasis, range 27% (tongue) to 12% (hard palate). Surgery was the most common treatment (38%), followed by combinations of surgery and radiotherapy (36%), 19% were treated with radiotherapy alone or combined with chemotherapy, and 7% did not receive any treatment. The 2-year survival was 69% (hard palate 83%, buccal mucosa 74%, gingival 70%, tongue 69%, and floor of the mouth 63%). Data regarding treatment and stage of the disease will be further analyzed together with survival data. Conclusion: Oral cancer is the most common HN cancer location in Sweden. Almost all patients are given curative treatment (90%) consisting of surgery alone or in combination with radiotherapy (70%). The 2-year survival rate varied between 63% to 83%. Different treatment policies and survival rate was found within the country.