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Jimmy J. Brown, MD, DDS; Gerald J. Berry, MD; John Moretto, MD; William F. Keating, MD; Willard E. Fee, Jr, MD

Arch Otolaryngol Head Neck Surg. 1997;123(9):950-955.

Abstract
Objective
To evaluate nasopharyngeal carcinoma resection specimens for heterogeneity of histologic patterns to determine if preoperative histologic characteristics of the clinic biopsy specimen are representative of the entire lesion. The null hypothesis is that clinic biopsy specimens are not necessarily representative.

Design
Preoperative clinic biopsy specimens were measured to calculate their average size. Resection specimens were then sectioned and evaluated in increments corresponding to this size. Each of these increments was then histologically classified according to the World Health Organization (WHO) criteria. This classification of the preoperative biopsy specimens was compared with that of the resection specimen as a whole.

Setting
University referral center.

Patients
Twenty-six consecutive patients with recurrent nasopharyngeal carcinoma who underwent surgical resection. Radiation therapy failed in all patients.

Main Outcome Measure
The presence or absence of WHO histologic heterogeneity in the nasopharyngectomy specimen was recorded. Disparity between preoperative clinic biopsy and resection specimens was recorded.

Results
The mean clinic biopsy specimen size was 13.9 mm² or less than 1% of the available surface area of the nasopharynx. Of 26 resection specimens classified in 5 increments of this size, 15 (57.7%) were a single WHO type, and 11(42.3%) were found to be mixtures of WHO types I, II, and III. Of 16 cases with preoperative biopsy specimens available, 4 (25%) were a different WHO classification than their corresponding resection specimen.

Conclusions
Most clinic biopsy specimens were representative of their corresponding tumor resection specimens in their entirety; however, tumor heterogeneity is such that some biopsy specimens will not be representative. This finding may interfere with WHO classification data determined on the basis of clinic biopsy specimens and hence confound any meaningful data on treatment outcomes. It is recommended then that multiple nasopharyngeal biopsy specimens be obtained from disparate areas of the lesion and each subjected to independent histopathologic review.

Arch Otolaryngol Head Neck Surg. 1997;123:950-955

Author Affiliations
From the Division of Otolaryngology—Head and Neck Surgery (Drs Brown, Keating, and Fee) and the Department of Pathology (Drs Berry and Moretto), Stanford University Medical Center, Stanford, Calif.

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