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Updated: Nov 10, 2025
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A Model for Perineural Invasion in Head and Neck Squamous Cell Carcinoma
Published on: January 5, 2017
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Interobserver Variation in Evaluating Perineural Invasion for Oral Squamous Cell Carcinoma: Phase 2 Survey Study.
Flora Yan1, Yi-Shing Lisa Cheng2, Nora Katabi3
1Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
Head and Neck Pathology
|March 31, 2021
Summary
Evaluating perineural invasion (PNI) in oral squamous cell carcinoma (OSCC) showed improved pathologist agreement when using the "tumor invading the perineurium" criterion. Further research is needed for more reproducible PNI assessment criteria.
Area of Science:
- Pathology
- Oncology
- Surgical Pathology
Background:
- Interobserver agreement for perineural invasion (PNI) in oral squamous cell carcinoma (OSCC) was previously found to be fair.
- Pathologists most commonly used criteria included "tumor invading the perineurium" and "tumor surrounding a nerve."
Purpose of the Study:
- To determine if applying the most common PNI criteria improves interobserver agreement among pathologists.
- To compare agreement levels using specific criteria versus standard practice.
Main Methods:
- A web-based survey was distributed to 512 pathologists.
- 84 board-certified pathologists evaluated OSCC photomicrographs using two predefined criteria for PNI.
- Interobserver agreement was assessed using kappa statistics.
Main Results:
- Moderate agreement (k=0.46) was achieved using the "tumor invading the perineurium" criterion.
- Fair agreement (k=0.24) was observed with the "tumor surrounding a nerve" criterion.
- Agreement using "tumor invading the perineurium" was significantly higher than standard practice (k=0.36) and the other criterion (p<0.001).
Conclusions:
- Applying the "tumor invading the perineurium" criterion improves interobserver agreement for PNI in OSCC compared to previous methods.
- Current criteria for histopathologic assessment of PNI require further refinement for objectivity and reproducibility.
