Cellular dissociation: a missing item in the pathology report and histologic grading of oral tongue cancer?

Excerpt

We read with interest the recent study by Xu and colleagues [1] that was published in the recent volume (volume 479; issue 3) of Virchows Arch. As reported in their study [1] and other recent studies published in Virchows Arch [2] or in other journals [3, 4], tumor budding and worst pattern of invasion have shown superior prognostic value compared with the conventional WHO grading system. Findings supporting this, especially on significance of tumor budding [4], have been reported in many studies of oral squamous cell carcinoma (OSCC) including specific analysis of oral tongue (OTSCC) and approved in a recent meta-analysis [5]. These two histopathologic features (i.e., tumor budding and worst pattern of invasion) describe cellular dissociation of the tumor and were promising prognosticators of survival in large cohorts [1, 2]. On the other hand, the routine histopathologic grading of OTSCC/OSCC that is currently included in pathology reports is based on assessment of cellular differentiation, and has shown low prognostic significance especially in early-stage cases [1, 2]. Furthermore, it has been clearly stated in the 4th edition (2017) of the World Health Organization (WHO) classification of head and neck tumors that “Grading alone does not correlate well with prognosis.” …