Patterns of Discordance Between Clinical and Pathologic Stage in Head and Neck Cancer

Objective: To enhance understanding in patterns of discordance between clinical and pathological T and N staging in multiple sites of head and neck squamous cell cancer. Methods: A retrospective cohort of 580 newly diagnosed and surgically treated head and neck squamous cell carcinoma patients from a single institution over a 10-year period are presented. Clinical and pathologic staging are compared. Results: Notably, 33% of cases had staging discordance. Overall Cohen's kappa agreement was kappa = 0.55 (moderate agreement). Highly discordant site stages with kappa < 0.45 included: T2 oral cavity, T2 oropharynx, T3 larynx, and N1 lymph node. T2-4 oral cavity cancers were often overstaged, and more than one-third of T3 larynx cancers were understaged. Highly concordant site stages with kappa>0.65 included: T1 larynx, T4 oropharynx, N0 lymph node, and N3 lymph node. Conclusion: There exists a quantifiable and, in certain sites, clinically relevant pattern of discordance between clinical and pathologic staging. Tumor board multidisciplinary evaluation can highlight these discrepancies and aide in limiting effects on treatment decisions. However, discordant staging can affect the interpretation and application of prognostication, treatment, and data accuracy. Further investigation is warranted to improve clinical staging accuracy in areas of highest discordance. Level of Evidence: 3 Laryngoscope, 2024