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. 2023 Jun;17(2):479-486.
doi: 10.1007/s12105-023-01533-1. Epub 2023 Feb 28.

WPOI-5: Accurately Identified at Intraoperative Consultation and Predictive of Occult Cervical Metastases

John E Beute  1 , Lily A Greenberg  1 , Lauren E Wein  1 , Danielle A Kapustin  2   3 , Jun Fan  4 , Eric M Dowling  5 , Shabnam Samankan  6 , Ammar Matloob  4 , Monica Xing  1 , Ippolito Modica  4 , Daniel Chung  4 , William Carroll  7 , Eben L Rosenthal  7   8 , Mohemmed Nazir Khan  5 , Raymond L Chai  5 , Margaret S Brandwein-Weber  4 , Mark L Urken  1   5
Affiliations

WPOI-5: Accurately Identified at Intraoperative Consultation and Predictive of Occult Cervical Metastases

John E Beute et al. Head Neck Pathol. 2023 Jun.

Abstract

Background: Frozen section analysis of oral cancer specimens is ideal for assessing margin distances and depth of invasion (DOI); the latter impacts intraoperative decisions regarding elective neck dissection (END). Here, we show that intraoperative determination of worst pattern of invasion (WPOI), specifically WPOI-5, has a high level of accuracy. This relates to our demonstration herein that WPOI-5 predicts occult cervical metastases (OCM) for pT1 oral squamous carcinoma (OSC).

Methods: The presence of OCM was correlated with WPOI in 228 patients with primary T1/T2/cN0 OSC undergoing resection and END. Concordance between intraoperative and final pathology WPOI determination was assessed on 51 cases of OSC.

Results: WPOI-5 predicts OCM in pT1 patients, compared with WPOI-4/WPOI-3 (p < 0.0001). Most pT1 WPOI-5 tumors had DOI of 4-5 mm (24/59 or 40.7%). Only two pT1 WPOI-5 tumors had DOI < 4 mm (3.0 and 3.5 mm). If END were performed in this pT1 cohort for all WPOI-5 OSC patients regardless of DOI, OR all OSC patients with DOI ≥ 4 mm regardless of WPOI, then no OCM would be missed (p = 0.017, 100% sensitivity, 29% specificity, 77% positive predictive value, 23% negative predictive value). With respect to intraoperative WPOI-5 determination, the accuracy, sensitivity, and specificity was 92.16, 73.33, and 100.0%, respectively.

Conclusions: DOI ≥ 4 mm is the dominant predictor of OCM. For the rare WPOI-5 OSC with DOI < 4 mm, it is reasonable to suggest that surgeons perform END. WPOI-5 may be accurately determined intraoperatively. As microscopic instruction is needed to accurately assess WPOI-5, a teaching link is included in this manuscript.

Keywords: Cervical occult metastases; Frozen section pathology; Oral cavity squamous cell carcinoma; Permanent section pathology; Worst pattern of invasion.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

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