Molecular assessment of histopathological staging in squamous-cell carcinoma of the head and neck

Background: Surgical oncologists rely heavily on the histopathological assessment of surgical margins to ensure total excision of the tumor in patients with head and neck cancer. However, current techniques may not detect small numbers of cancer cells at the margins of resection or in cervical lymph nodes. Methods: We used molecular techniques to determine whether clonal populations of infiltrating tumor cells harboring mutations of the p53 gene could be detected in histopathologically negative surgical margins and cervical lymph nodes of patients with squamous-cell carcinoma of the head and neck. Results: We identified 25 patients with primary squamous-cell carcinoma of the head and neck containing a p53 mutation who appeared to have had complete tumor resection on the basis of a negative histopathological assessment. In 13 of these 25 patients, molecular analysis was positive for a p53 mutation in at least one tumor margin. In 5 of 13 patients with positive margins by this method (38 percent), the carcinoma has recurred locally, as compared with none of 12 patients with negative margins (P = 0.02 by the log-rank test). Furthermore, molecular analysis identified neoplastic cells in 6 of 28 lymph nodes (21 percent) that were initially negative by histopathological assessment. Conclusions: Among specimens initially believed to be negative on light microscopy, a substantial percentage of the surgical margins and lymph nodes from patients with squamous-cell carcinoma of the head and neck contained p53 mutations specific for the primary tumor. Patients with these positive margins appear to have a substantially increased risk of local recurrence. Molecular analysis of surgical margins and lymph nodes can augment standard histopathological assessment and may improve the prediction of local tumor recurrence., Squamous-cell carcinoma of the head and neck is one of the most common cancers, with a global incidence of 500,000 cases per year.¹ Surgical resection is the principal treatment for the majority of advanced-stage carcinomas of the upper aerodigestive tract and a frequent choice in treating early lesions as well. The single most important prognostic factor for squamous-cell carcinoma of the head and neck is complete surgical removal of the neoplasm, because it is generally believed that failure to eradicate the primary tumor is the leading cause of death from this type of cancer.²–⁵ When gross tumor remains, local…