Reliability of Incision Biopsy for Diagnosis of Oral Verrucous Carcinoma: A Multivariate Clinicopathological Study

Abstract

Introduction Studies have reported 20 % of conventional squamous cell carcinoma in patients with verrucous carcinoma (VC), later these cancers were termed as hybrid VC. It is important to distinguish both while planning treatment since hybrid VC requires addressing regional lymphatics in addition to respective surgery. Information on odds of missing the foci of invasion on routine incision biopsy might be useful in this regard. Patients and MethodsRecords of all the patients surgically treated for oral cancer from Jan 2010 to Oct 2013 in a Tertiary Cancer Centre was analyzed. Patients diagnosed with primary VC or Verrucous Hyperplasia on incision biopsy were included in the study. Proportion of patients undiagnosed for invasive component on incision biopsy was calculated, multivariate analysis of the sample was performed to find associated cofounders. Results Fifty-five patients who reported with the diagnosis of VC (n = 53) or Verrucous Hyperplasia (n = 2) on incision biopsy were included in the study. Twenty-seven were diagnosed as VC and 28 as hybrid VC after excision. This corresponded to 51 % (n = 28) of cases missing invasive component on incision biopsy. VC was significantly more commonly seen in lip and in buccal mucosa, hybrid VC was more commonly seen in tongue and gingiva and this association was statistically significant (p = 0.031) in our study. Conclusion Incision biopsy is extremely unreliable to diagnose and differentiate oral Hybrid VC from VC or Verrucous Hyperplasia. Caution is required while planning treatment of these patients regarding possibility of presence of conventional squamous cell carcinoma within these tumors.

A population‐based analysis of verrucous carcinoma of the oral cavity

“…Shear and Pindborg similarly described deep epithelial projections into subcutaneous tissue without invasion in VC as compared with superficial projections in VH . To complicate the diagnostic pursuit, recent studies have demonstrated the poor reliability of incisional biopsy to reach a diagnosis of VC and the notable possibility of hybrid neoplasms within lesions . Nevertheless, our analysis of this cohort adds an important contribution to the understanding of prognostic factors in oral cavity VC.…”

“…28 To complicate the diagnostic pursuit, recent studies have demonstrated the poor reliability of incisional biopsy to reach a diagnosis of VC and the notable possibility of hybrid neoplasms within lesions. 29 Nevertheless, our analysis of this cohort adds an important contribution to the understanding of prognostic factors in oral cavity VC. To our knowledge, this report is the first population-based analysis of prognostic factors affecting survival outcomes in patients with oral cavity VC.…”

Oral verrucous carcinoma: Ten year experience from a Tertiary Care Hospital in India

“…[ 6 7 ] They are slow growing tumors known to have low metastatic potential with good prognosis. [ 8 ]…”

Oral verrucous carcinoma: From multifactorial etiology to diverse treatment regimens (Review)

“…however, the proportion of conventional OVC component may vary and the prognosis of hybrid VC with high proportion of OVC may have better prognosis than OSCC. Due to high similarity in staging and grading, incision biopsy is extremely unreliable to diagnose and differentiate oral hybrid VC from OVC (86). For diagnosis of this hybrid tumor, it is necessary to examine an adequate biopsy sample extending to the underlying bone for examination of the periosteum and the mucosa-connective tissue interface.…”