Histologic Diagnosis Of Dysplasia Research Articles

Proceedings of the North American Society of Head and Neck Pathology Companion Meeting, New Orleans, LA, March 12, 2023: Oral Cavity Dysplasia: Why Does Histologic Grading Continue to be Contentious?

Head and neck squamous cell carcinoma (HNSCC) is the world's 6th most common malignancy. Oral cavity SCC (OCSCC) represents approximately one third of the HNSCC cases diagnosed annually in the United States. Despite therapeutic advances, OCSCC is frequently lethal, with a modest 5-year survival. Because OCSCC is often preceded by premalignant lesions, it is an ideal disease for screening initiatives. The conventional visual and tactile exam (CVTE), coupled with a tissue biopsy, remains the gold standard. However, CVTE alone cannot reliably differentiate between reactive/inflammatory and dysplastic lesions. Further, the histologic diagnosis of dysplasia is subjective in nature and a highly imperfect predictor of malignant transformation. This prognostic uncertainty creates a significant clinical management dilemma-watchful waiting with increased patient psychological and economic burdens versus unnecessary aggressive treatment. As such, the development and validation of novel diagnostic platforms such as Artificial Intelligence (AI) and prognostic molecular biomarkers may help address these critical unmet clinical needs.

ID: 3524488 UTILIZATION OF A DEEP LEARNING ARTIFICIAL INTELLIGENCE MODEL IN THE HISTOLOGIC DIAGNOSIS OF DYSPLASIA IN BARRETT’S ESOPHAGUS

The risk of malignant transformation to esophageal adenocarcinoma (EAC) in Barrett’s esophagus (BE) increases with development of dysplasia. However, the histologic diagnosis of dysplasia, particularly low-grade dysplasia (LGD), is challenging leading to lack of interobserver agreement amongst pathologists with upto 85% of all community diagnosed LGD being downstaged upon expert GI pathologist review. This may result in unnecessary therapeutic procedures with associated adverse effects. Hence, there is a critical need to improve diagnostic capabilities to identify dysplastic BE. We aimed to leverage artificial intelligence techniques and utilize a deep learning model to diagnose dysplasia in BE histologic slides.

Barrett-Ösophagus

Barrett's esophagus (BE), a well-known complication of gastroesophageal reflux disease (GERD), constitutes a precancerous condition for adenocarcinoma of the distal esophagus. The so-called Barrett's carcinoma shows increasing incidences in countries of the western hemisphere; new data, however, indicate that the rise in incidence is not quite as dramatic as previously assumed. The definition of BE is currently changing: despite good reasons for a purely endoscopic definition of BE, goblet cells are still mandatory for this diagnosis in Germany and the USA. Dysplastic changes in the epithelium are the most important risk factor for the development of Barrett's adenocarcinoma and recently dysplasia was subclassified into a more frequent adenomatous (intestinal) and a non-adenomatous (gastric-foveolar) types. The gold standard for diagnosing dysplasia is still H&E staining. The histological diagnosis of dysplasia is still encumbered by a significant interobserver variability, especially regarding the differentiation between low grade dysplasia and inflammatory/reactive changes and the discrimination between high grade dysplasia and adenocarcinoma. Current data, however, show much higher interobserver agreement in endoscopic resection specimens than in biopsies. Nevertheless, the histological diagnosis of dysplasia should be corroborated by an external second opinion because of its clinical consequences. In endoscopic resections of early Barrett's adenocarcinoma, the pathological report has to include a risk stratification for the likelihood of lymphogenic metastases.

Exciting new advances in oral cancer diagnosis: avenues to early detection.

The prognosis for patients with oral squamous cell carcinoma remains poor in spite of advances in therapy of many other malignancies. Early diagnosis and treatment remains the key to improved patient survival. Because the scalpel biopsy for diagnosis is invasive and has potential morbidity, it is reserved for evaluating highly suspicious lesions and not for the majority of oral lesions which are clinically not suspicious. Furthermore, scalpel biopsy has significant interobserver and intraobserver variability in the histologic diagnosis of dysplasia. There is an urgent need to devise critical diagnostic tools for early detection of oral dysplasia and malignancy that are practical, noninvasive and can be easily performed in an out-patient set-up. Diagnostic tests for early detection include brush biopsy, toluidine blue staining, autofluorescence, salivary proteomics, DNA analysis, biomarkers and spectroscopy. This state of the art review critically examines these tests and assesses their value in identifying oral squamous cell carcinoma and its precursor lesions.

Genetics/epigenetics of oral premalignancy: current status and future research*

Squamous cell carcinoma (SCC) of the oral and oropharyngeal region is the sixth most common malignancy in the world today. Despite numerous advances in treatment, long-term survival from this disease remains poor. Early detection can decrease both morbidity and mortality associated with this neoplasm. However, screening for potentially malignant disease is typically confounded by difficulty in discriminating between reactive/inflammatory lesions vs those lesions that are premalignant in nature. Furthermore, the histologic diagnosis of dysplasia can be subjective and is thus prone to a considerable range of interpretation. Similarly, no definitive, validated criteria exist for predicting which dysplastic lesions are most likely to progress to cancer over time. Given this state of science, the presence of dysplasia can only be used to indicate that an oral lesion may have an increased risk of malignant transformation. Molecular biomarkers capable of identifying the subset of lesions likely to progress to cancer are required to eliminate this clinical diagnostic dilemma. The purpose of this review is to assess the current state of knowledge regarding genetic/epigenetic alterations observed in oral mucosal premalignancy. In addition, recommendations for future research studies directed at defining the predictive capacity of specific biomarkers in this modeling are presented.

Autofluorescence bronchoscopy to identify pre-cancerous bronchial lesions

This study aimed to assess the diagnostic yield of autofluorescence bronchoscopy (AFB) in the detection of pre-cancerous bronchial lesions in a non-selected sample of patients. Both fiberoptic white-light bronchoscopy (WLB) and AFB using the Storz D-light system were performed on 166 consecutive patients. Biopsy specimens were taken in areas of the tracheobronchial tree judged as abnormal or suspicious at WLB and/or AFB. The bronchoscopic procedures were randomly performed by two operators. A total of 93 patients had a positive biopsy specimen: 80 for cancer and 13 for dysplasia. AFB was abnormal or suspicious in 85 of the 93 patients with a sensitivity of 91.4%. Specificity was 50.7%. In 16 patients with normal WLB examination, AFB identified abnormal or suspicious areas which had a positive biopsy. Thus AFB significantly improved sensitivity of WLB (100% vs 82.8%, respectively, p<0.001) in the entire sample of patients studied. Data was further analysed separately for patients with dysplasia and those with cancer. Indeed, 13 of 16 patients recognized only by AFB had a histological diagnosis of dysplasia. The remaining three patients had a diagnosis of cancer (small intraepithelial neoplastic lesions). Since no other patient with dysplasia was found, AFB had a sensitivity of 100% in diagnosing dysplasia. On the other hand, excluding the 13 patients with dysplasia, WLB had a high sensitivity in diagnosing cancer (93.7%). The AFB Storz system showed a high sensitivity. The increase in diagnostic yield of AFB in comparison with WLB was related to the power of AFB to identify pre-cancerous bronchial lesions so showing its usefulness in the early diagnosis of lung cancer.

The histologic diagnosis of dysplasia, dysplasia-associated lesion or mass, and adenoma: a pathologist's perspective.

Patients with ulcerative colitis are at an increased risk of developing dysplasia and carcinoma. The histologic recognition of dysplasia arising in this setting, particularly when patients have active colitis, can be challenging. However, even if it is clear that the patient has dysplasia, further challenges include the distinction of low-grade dysplasia from high-grade dysplasia and the distinction of an inflammatory bowel disease-related dysplastic lesion from a sporadic adenoma. This review article will summarize some of these issues from the gastrointestinal pathologist's perspective.

Histologic Correlations with the Clinical Diagnosis of Dysplastic Nevus

In melanoma kindreds the presence of dysplastic nevi correlates with greatly increased melanoma risk. The relative importance of sporadic, nonfamilial dysplastic nevi as a risk factor for melanoma is less certain. Although the clinical features of dysplastic nevi have been well described, the histologic basis for the diagnosis is not as firmly established. This study examines the degree of correspondence between the clinical and histopathologic diagnosis of dysplastic nevus. Histologic review of nevi with clinical features of dysplasia from 1,000 individuals demonstrated classic histologic features of dysplasia (as previously demonstrated in melanoma kindreds) in 54.7%. In 20.4% of patients, nevi displayed less convincing or only partially developed features of dysplasia. The remaining patients (24.9%) had nevi of other types. Correspondence between the clinical and histologic diagnosis of dysplasia was best for lesions from the trunk and in individuals beyond the age of 20 years. This study supports the validity of the dysplastic nevus as a clinical and pathologic entity.

The cytological and histological diagnosis of dysplasia, carcinoma in situ and early invasive carcinoma of the cervix.

The cytological and histological diagnosis of dysplasia, carcinoma in situ and early invasive carcinoma of the cervix.