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Cellular and Molecular Biology

Tumour budding in head and neck cancer: what have we learnt and the next steps towards clinical implementation

British Journal of Cancer volume 130, pages 1–2 (2024)Cite this article

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It is of utmost importance to take into account that head and neck squamous cell carcinomas (HNSCCs) are heterogeneous tumours with variations in risk factors, treatment planning, and survival. Thus, it is necessary to report the clinical significance of tumour budding for each subsite of HNSCC separately. This should include the identification of the optimal cutoff point for risk stratification and the clinical scenarios in each subsite. Furthermore, a standardised method for the assessment of tumour budding in HNSCC still requires research efforts to identify the best method of assessment, although several methods have been introduced previously. Towards generalisability of assessing tumour budding and strengthening the evidence of risk stratification and clinical decision-making, it is necessary to validate the cutoff point (of 6 buds) introduced by Stögbauer et al. [1] and to find out if its prognostic value differs from the cutoff point of 5 buds that has been widely used in previous studies of HNSCC [7]. In addition, automated assessment of tumour budding in HNSCC is not yet well established and requires further studies.

In challenging cases (e.g., heavy inflammation that often obscures the evaluation of buds) and if the pathologist is inexperienced in the assessment of tumour budding, pan-cytokeratin staining can aid in the counting of the buds [8]. Assessment of tumour budding in preoperative biopsies has been reported previously in HNSCC [3, 9]. In such small samples, it is important to encourage the clinicians to take multiple deep biopsies (whenever possible) to allow for a reliable counting of the highest number of tumour buds at the invasive front area of the tumour. In most of the published studies in HNSCC, peritumoural budding (i.e., at the invasive front) was evaluated [7]. The prognostic impact of intratumoural budding and how it differs from peritumoural budding needs to be analysed separately in the various sites of HNSCC. In preoperative biopsies, evaluating intratumoural budding can be more accurate than peritumoural budding, particularly in cases where the invasive front is not fully included in a partially superficial biopsy. This requires comparative studies on intratumoural and peritumoural budding in preoperative biopsies of HNSCC. Of note, in preoperative biopsies of rectal cancer, intratumoural budding predicted lymph node and distant metastasis [10].

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Fig. 1: Tumour budding in head and neck squamous cell carcinomas.

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Authors and Affiliations

  1. Department of Pathology, University of Helsinki, P.O. Box 21, FI-00014, Helsinki, Finland

    Alhadi Almangush

  2. Institute of Biomedicine, Pathology, University of Turku, Turku, Finland

    Alhadi Almangush

  3. Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland

    Alhadi Almangush & Antti A. Mäkitie

  4. Faculty of Dentistry, Misurata University, Misurata, Libya

    Alhadi Almangush

  5. Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, FI-00029 HUS, Helsinki, Finland

    Antti A. Mäkitie

  6. Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden

    Antti A. Mäkitie

  7. Institute of Biomedicine, Pathology, University of Turku, Kiinamyllynkatu 10 D 5035, 20520, Turku, Finland

    Ilmo Leivo

  8. Turku University Central Hospital, 20521, Turku, Finland

    Ilmo Leivo

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The three authors have contributed to the writing of the manuscript and have approved the final version for submission to the British Journal of Cancer.

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Correspondence to Alhadi Almangush.

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Almangush, A., Mäkitie, A.A. & Leivo, I. Tumour budding in head and neck cancer: what have we learnt and the next steps towards clinical implementation. Br J Cancer 130, 1–2 (2024). https://doi.org/10.1038/s41416-023-02531-4

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