Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO 63110, USA.
Histopathology. 2012 Feb;60(3):427-36. doi: 10.1111/j.1365-2559.2011.04092.x. Epub 2011 Dec 23.
Nonkeratinizing morphology in oropharyngeal squamous cell carcinoma (NKSCC) strongly correlates with human papillomavirus and p16 status, but as a unique diagnostic entity is not widely recognized by pathologists. We sought to prospectively examine the performance of a new histological typing system during 1 year of routine clinical practice (Aim 1) and also its reproducibility amongst six head and neck pathologists using a 40 case test set (Aim 2).
The three histological types were: Type 1 (keratinizing), Type 2 (nonkeratinizing with maturation) and Type 3 (nonkeratinizing). For Aim 1, there were 85 cases. p16 immunohistochemistry was positive in five of the 18 (27.8%) cases classified as Type 1, 18 of the 19 (94.7%) as Type 2, and 47 of the 48 (97.9%) as Type 3. For Aim 2, agreement among pathologists on the test cases was best for types 1 and 3 (kappa values 0.62 and 0.56; P < 0.0001) and lowest for type 2 (kappa 0.35; P < 0.0001). All 21 cases classified as NK SCC (type 3) by any of the reviewers was p16 positive.
Pathologists can recognize NK SCC with good agreement, and when a pathologist classifies a tumour as NK SCC, this reliably predicts p16 positivity.
口咽鳞状细胞癌（NKSCC）中的非角化形态与人类乳头瘤病毒（HPV）和 p16 状态密切相关，但作为一种独特的诊断实体，尚未被病理学家广泛认可。我们旨在通过 1 年的常规临床实践（目的 1）前瞻性检查新的组织学分型系统的性能，并用 40 例测试集（目的 2）检查其在 6 位头颈部病理学家中的可重复性。
三种组织学类型分别为：1 型（角化型）、2 型（非角化型伴成熟）和 3 型（非角化型）。在目的 1 中，有 85 例。18 例 1 型中 5 例（27.8%）p16 免疫组化阳性，19 例 2 型中 18 例（94.7%）阳性，48 例 3 型中 47 例（97.9%）阳性。在目的 2 中，病理学家对测试病例的一致性最好的是 1 型和 3 型（kappa 值为 0.62 和 0.56；P<0.0001），2 型最低（kappa 值为 0.35；P<0.0001）。任何一位审阅者将 21 例归类为 NK SCC（3 型）的病例均为 p16 阳性。
病理学家可以很好地识别 NK SCC，且当病理学家将肿瘤归类为 NK SCC 时，这可可靠地预测 p16 阳性。
