Patho-Anatomic Spectrum of Branchial Cleft Anomalies: Proposal of Novel Classification System

Area of Science:

• Otolaryngology
• Developmental Biology
• Pathology

Background:

• Branchial cleft anomalies (BCAs) have complex histogenesis and classification, leading to ongoing debate.
• Current developmental theories for BCAs lack definitive accuracy in explaining their patho-anatomic characteristics.

Purpose of the Study:

• To evaluate the accuracy of existing developmental theories in defining the anatomic and histopathological features of branchial cleft anomalies.
• To investigate the utility of the hybrid branchial inclusion theory for BCA classification.

Main Methods:

• A retrospective cohort study of 90 patients who underwent surgical excision for BCAs.
• Analysis of histopathological findings and comparison with established developmental theories.

Main Results:

• Branchial cleft cysts were the most common BCA (85.87%), predominantly in the neck (95.65%).
• Lymphoepithelial tissue was found in 90.22% of BCAs.
• The hybrid branchial inclusion theory demonstrated significantly higher accuracy (90.22%) in defining BCA patho-anatomy compared to other theories.

Conclusions:

• The hybrid branchial inclusion theory provides a superior framework for understanding BCA patho-anatomy.
• A novel branchial node (BN) classification system, founded on the hybrid theory, is proposed as a more effective method for classifying BCAs.