Archival, paraffin-embedded, pathology specimens representing pretreatment tissue biopsies from 73 patients with epidermoid carcinoma of the head and neck were analyzed for DNA Index and %S-phase cells by flow cytometry and were scored for quantitative histomorphology. The DNA fluorescencefiight scatter size patterns derived from paraffinembedded specimens were shown to be essentially the same as those from mechanically disaggregated, ethanol-fixed cells obtained from the same tissue specimen. Patterns ranged from lymphocyte-like to highly abnormal DNA Index cytokinetic patterns. The DNA Index values ranged from 0.70 to 3.50 (median 1.42), with an aneuploidy frequency of 63/73 (86%). DNA distribution %S ranged from 4% to 45% (mean 19), with the microscopic malignancy grading showing broad heterogeneity (mean 2.1, range 1.0-3.0, where 1.0-1.7 = well differentiated, 1.8-2.3 = moderately differentiated, 2.4-3.0 = poorly differentiated). Cross-comparison of these data showed that (1) the tumor %S was dependent on DNA Index (higher %S at higher ploidy), (2) low to high malignancy tumors were randomly distributed between diploidhear diploid tumors and high-degree DNA abnormality tumors, and (3) proliferative activity values broadly overlapped between low to high malignancy scored tumors. However, those carcinomas characterized by high DNA Index ( 2 1.50) and high %S-phase fractions ( 2 20) had a five fold higher incidence of high -degree malignancy, invasive tumors than diploidhear diploid (%S < 19) tumors.Key terms: Human head and neck carcinomas, DNA Index, cytokinetics, malignancy, grading, paraffin-embedded specimens Historically, microscopic-based morphology detection and classification of malignant disease has undergone a progressive development toward the use of more detailed tissue and cellular features in order to achieve improved diagnosis and subclassification of human neoplasms. Presently, however, uncertainty still exists as to the reliability of histomorphology as a predictor of in situ tumor biological behavior, such as the growth properties, propensity for metastasis, or therapy response of human solid tumors, and is not predictable based on pathology. This is considered due in large part to the subjective and qualitative nature of microscopic malignancy grading, in addition to the inherent uncertainties of tumor heterogeneity and sampling error.Static (1-3,10,46) and flow cytometry (5,8,12,16,34, 38,40,43) techniques provide more quantitative and objective measurements of tumor cytogenetic, cytokinetic, and phenotypic features, and this information has proved useful for supplementing clinical and pathology classification of malignant disease (6-9,29,31-34,40,45). Accumulating evidence supports the contention that (1) cytometric detection of abnormal GI DNA content in cells in most cases is a reliable marker of malignancy (2,3,5-9,31,34,45) and (2) that the degree of DNA abnormality andor proliferative activity expressed in in vivo, spontaneous tumor stemlines may reflect the degree of malignancy and b...