Morphological changes in normal, premalignant and malignant oropharyngeal epithelial tissues

There is a marked rise in the incidence of oropharyngeal cancer associated with human papilloma virus (HPV) infections. While HPV positive oropharyngeal cancers have better outcomes, the outlook for HPV negative oropharyngeal cancers remains grim. Premalignant lesions precede some oropharyngeal cancers, however, means for predicting malignant transformation in these lesions are lacking with many of the histopathological features used to diagnose these lesions being highly subjective. Here, we assessed a range of morphological parameters at the tissue, cell and nucleus levels in normal, premalignant and HPV positive and negative malignant tissues from the oropharynx. Our findings showed significant changes from normal through premalignant to malignant oropharyngeal samples when assessing the complexity of the epithelial connective tissue interface and various parameters that describe the shape and size of cells and nuclei. Furthermore, we observed significant differences in the morphological features between HPV positive and negative cancers which align with the reported difference in their clinical outcome. The results of our study suggest the potential use of image analysis to objectively and reproducibly describe morphological parameters which could improve diagnosis and aid in predicting disease progression.