HN-CLEAR: Head and Neck Consensus Language for Ease and Reproducibility, a Multidisciplinary Consensus Mechanism for Head and Neck Pathology

Head and Neck Pathology https://doi.org/10.1007/s12105-023-01570-w CORRESPONDENCE HN‑CLEAR: Head and Neck Consensus Language for Ease and Reproducibility, a Multidisciplinary Consensus Mechanism for Head and Neck Pathology Ruta Gupta1 · Munita Bal2 · Justin A. Bishop3 · Keith D. Hunter4 · Kelly Magliocca5 · Raja R. Seethala6 · Lester D. R. Thompson7 · Ilan Weinreb8 · Peter Angelos9 · Beth Beadle10 · R. Bryan Bell11 · Jonathan R. Clark12 · Robert Ferris13 · Shao Hui Huang14 · D. Neil Hayes15 · Rahul Ladwa16 · Jean Yang17 · Nicole A. Cipriani18 · Brenda L. Nelson19 · Peter M. Sadow20 · James S. Lewis21 Received: 28 May 2023 / Accepted: 1 July 2023 © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023 Background The head and neck region harbors a diverse range of tissue types and pathologies in close anatomical proximity. It also includes some of the most common human malignancies such as squamous cell carcinoma of the skin and aerodigestive tract while also including infections, inflammatory disorders, and many rare entities such as salivary gland and * Ruta Gupta odontogenic neoplasms. The head and neck brings together pathologists with diverse training and sub-specialty backgrounds including head and neck, maxillofacial, endocrine pathology, dermatopathology, cytopathology, and other subspecialists as well as general surgical pathologists. The broad range of diagnostic terminologies and prognostic issues that influence patient management in head and neck pathology are further confounded by overlapping and confusing terminology and lack of robust evidence in many areas. Uniform 12 Head and Neck Surgery, Chris O’Brien Lifehouse, Royal Prince Alfred Institute of Academic Surgery, The University of Sydney, Sydney, Australia 13 Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA 14 Radiation Oncology, Princess Margaret Cancer Center, Toronto, ON, Canada 15 Health Science CenterCenter for Medical Research Memphis, University of Tennessee, Memphis, TN, USA 1 Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, The University of Sydney, Sydney, Australia 2 Department of Pathology, Tata Memorial Center, Homi Bhabha, National Institute, Mumbai, Maharashtra, India 3 UT Southwestern Medical Center, Houston, TX, USA 4 Liverpool Head and Neck Center, University of Liverpool, Liverpool, UK 16 5 Department of Pathology and Laboratory Medicine, Winship Cancer Institute, Emory University, Atlanta, GA, USA Medical Oncology, Princess Alexandra Hospital, Brisbane, QLD, Australia 17 6 Pathology and Laboratory Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA Department of Mathematics and Statistics, University of Sydney, Sydney, Australia 18 7 Head and Neck Pathology Consultations, Woodland Hills, CA, USA Department of Surgical Pathology, University of Chicago, Illinois, USA 19 Scripps Oral Pathology Service, San Diego, CA, USA 20 Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA 21 Department of Pathology, Microbiology and Immunology, Department of Otolaryngology and Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA 8 Anatomic Pathology, University Health Network and University of Toronto Laboratory Medicine Program, Toronto, ON, Canada 9 Endocrine Surgery, University of Chicago, Chicago, IL, USA 10 Radiation Oncology, Stanford University, Palo Alto, CA, USA 11 Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR, USA 13 Vol.:(0123456789) Head and Neck Pathology and evidence-based diagnostic and prognostic terminologies are needed to inform the treatment of patients and support the design of clinical trials, epidemiological and fundamental research, cancer registries for education and preventive strategies, and assist policy makers in the allocation of health care resources. The World Health Organization (WHO) Classification of Tumours [1], the American Joint Commission on Cancer (AJCC) [2], the Union of International Cancer Control (UICC) [3], and the International Collaboration on Cancer Reporting (ICCR) [4, 5], through their periodic iterations, provide diagnostic, prognostic, and pathology reporting guidelines for all organ systems including the head and neck and attempt to inform equitable patient care across geopolitical boundaries. These bodies require level III National Health and Medical Research Council (NHMRC) [6] evidence for including and updating diagnostic entities and prognostic parameters. Such evidence may not be available within the time frame of an edition, thus, hampering progressive inclusions. Also, the developments in pathology, largely fuelled by the advances in molecular diagnostic techniques, are fast outpacing the WHO, AJCC, UICC, and ICCR updates. These problems are certainly not unique to head and neck pathology. Indeed, co-operative groups such as the International Society of Urologic Pathology (ISUP) [7], International Association for the Study of Lung Cancer (IASLC) [8], and the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy (cIMPACT) [9], have been working to develop consensus recommendations for practicing pathologists that also intend to inform upcoming WHO diagnostic and AJCC staging iterations. A co-operative group within head and neck pathology community is needed to refine the quality of diagnostic and prognostic information with the ultimate goal of improving patient outcomes and quality of life. To address this need, Head and Neck Consensus Language for Ease And Reproducibility (HN-CLEAR) is a global initiative to unify and strengthen the diagnostic and prognostic parameters in head and neck pathology through collection and analyses of high-quality data when available and the generation of new data when required. HN-CLEAR is sponsored by the North American Society of Head and Neck Pathology (NASHNP) and will have broad representation of pathologists across the globe supported by an international clinical advisory group to ensure relevance and facilitate implementation. The primary goal of HN-CLEAR is to provide consensus guidelines for currently ambiguous diagnostic or prognostic concepts through stringent collation and analyses of high level data. HN-CLEAR will evaluate the rapidly evolving immunohistochemistry and molecular information in the diagnosis, prognosis, and prediction for head and neck neoplasms. Similar to cIMPACT, IASLC, and ISUP, HN-CLEAR will complement (not supersede) the workings of WHO, AJCC, 13 and ICCR by providing robust evidence and terminology in a timely manner and drafting recommendations that can be included in upcoming iterations. Structure HN-CLEAR will conduct its work through three types of committees, a Steering Committee, a Clinical Advisory Panel, and the Working Groups. (...truncated)