1
|
Geukens T, Maetens M, Hooper JE, Oesterreich S, Lee AV, Miller L, Atkinson JM, Rosenzweig M, Puhalla S, Thorne H, Devereux L, Bowtell D, Loi S, Bacon ER, Ihle K, Song M, Rodriguez-Rodriguez L, Welm AL, Gauchay L, Murali R, Chanda P, Karacay A, Naceur-Lombardelli C, Bridger H, Swanton C, Jamal-Hanjani M, Kollath L, True L, Morrissey C, Chambers M, Chinnaiyan AM, Wilson A, Mehra R, Reichert Z, Carey LA, Perou CM, Kelly E, Maeda D, Goto A, Kulka J, Székely B, Szasz AM, Tőkés AM, Van Den Bogaert W, Floris G, Desmedt C. Research autopsy programmes in oncology: shared experience from 14 centres across the world. J Pathol 2024; 263:150-165. [PMID: 38551513 DOI: 10.1002/path.6271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/22/2023] [Accepted: 02/09/2024] [Indexed: 05/12/2024]
Abstract
While there is a great clinical need to understand the biology of metastatic cancer in order to treat it more effectively, research is hampered by limited sample availability. Research autopsy programmes can crucially advance the field through synchronous, extensive, and high-volume sample collection. However, it remains an underused strategy in translational research. Via an extensive questionnaire, we collected information on the study design, enrolment strategy, study conduct, sample and data management, and challenges and opportunities of research autopsy programmes in oncology worldwide. Fourteen programmes participated in this study. Eight programmes operated 24 h/7 days, resulting in a lower median postmortem interval (time between death and start of the autopsy, 4 h) compared with those operating during working hours (9 h). Most programmes (n = 10) succeeded in collecting all samples within a median of 12 h after death. A large number of tumour sites were sampled during each autopsy (median 15.5 per patient). The median number of samples collected per patient was 58, including different processing methods for tumour samples but also non-tumour tissues and liquid biopsies. Unique biological insights derived from these samples included metastatic progression, treatment resistance, disease heterogeneity, tumour dormancy, interactions with the tumour micro-environment, and tumour representation in liquid biopsies. Tumour patient-derived xenograft (PDX) or organoid (PDO) models were additionally established, allowing for drug discovery and treatment sensitivity assays. Apart from the opportunities and achievements, we also present the challenges related with postmortem sample collections and strategies to overcome them, based on the shared experience of these 14 programmes. Through this work, we hope to increase the transparency of postmortem tissue donation, to encourage and aid the creation of new programmes, and to foster collaborations on these unique sample collections. © 2024 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
Collapse
Affiliation(s)
- Tatjana Geukens
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Marion Maetens
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Jody E Hooper
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Steffi Oesterreich
- University of Pittsburgh UPMC Hillman Cancer Center, and Magee Womens Research Institute, Pittsburgh, PA, USA
| | - Adrian V Lee
- University of Pittsburgh UPMC Hillman Cancer Center, and Magee Womens Research Institute, Pittsburgh, PA, USA
| | - Lori Miller
- University of Pittsburgh UPMC Hillman Cancer Center, and Magee Womens Research Institute, Pittsburgh, PA, USA
| | - Jenny M Atkinson
- University of Pittsburgh UPMC Hillman Cancer Center, and Magee Womens Research Institute, Pittsburgh, PA, USA
| | - Margaret Rosenzweig
- University of Pittsburgh UPMC Hillman Cancer Center, and Magee Womens Research Institute, Pittsburgh, PA, USA
| | - Shannon Puhalla
- University of Pittsburgh UPMC Hillman Cancer Center, and Magee Womens Research Institute, Pittsburgh, PA, USA
| | - Heather Thorne
- Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Lisa Devereux
- Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | | | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Eliza R Bacon
- Center for Precision Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | - Kena Ihle
- Center for Precision Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | - Mihae Song
- Center for Precision Medicine, City of Hope National Medical Center, Duarte, CA, USA
| | | | - Alana L Welm
- University of Utah Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Lisa Gauchay
- University of Utah Huntsman Cancer Institute, Salt Lake City, UT, USA
| | | | - Pharto Chanda
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ali Karacay
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Hayley Bridger
- Cancer Research UK, and UCL Cancer Trials Centre, University College London, London, UK
| | - Charles Swanton
- Cancer Evolution and Genome Instability Laboratory, The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, UCL Cancer Institute, London, UK
- Department of Medical Oncology, University College London Hospitals, London, UK
| | - Mariam Jamal-Hanjani
- Cancer Research UK Lung Cancer Centre of Excellence, UCL Cancer Institute, London, UK
- Department of Medical Oncology, University College London Hospitals, London, UK
- Cancer Metastasis Laboratory, University College London Cancer Institute, London, UK
| | | | | | | | | | | | | | | | | | - Lisa A Carey
- University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Charles M Perou
- University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Erin Kelly
- University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Daichi Maeda
- Department of Molecular and Cellular Pathology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Akiteru Goto
- Department of Cellular and Organ Pathology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Janina Kulka
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - Borbála Székely
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
- National Institute of Oncology, Budapest, Hungary
| | - A Marcell Szasz
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Anna-Mária Tőkés
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | | | - Giuseppe Floris
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Christine Desmedt
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| |
Collapse
|
2
|
Nishio T, Maeda T, Ishikawa K, Murao N, Fuyama K, Yamamoto Y, Hayashi T. Lymphatic drainage patterns of malignant skin tumors in the head and neck region: a single-center retrospective study. Int J Clin Oncol 2024; 29:582-591. [PMID: 38554214 DOI: 10.1007/s10147-024-02487-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/09/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND This study aimed to clarify the relationship between primary site and lymphatic drainage pattern for malignant skin tumors in the head and neck region. Malignant melanoma and squamous cell carcinoma in the head and neck region are known to have poor prognosis because of lymph node metastasis. Nevertheless, numerous aspects of lymphatic drainage patterns remain elusive. METHODS We statistically analyzed data of 47 patients with malignant skin tumors in the head and neck region. Information was collected on the patients' clinical characteristics, primary tumor site, and lymphatic drainage patterns. RESULTS The parotid lymph nodes drained the greatest amount of lymph from skin tumors of the head and neck. Important lymphatic drainage pathways were the superficial cervical nodes for primary tumors in the buccal/nasal region, level IA and level IB nodes for primary tumors in the lip region, the occipital nodes, posterior auricular nodes, and level VA nodes in the parietal/occipital region, and the preauricular nodes in the auricular region. CONCLUSION These findings have considerable significance in terms of understanding lymphatic drainage patterns for malignant skin tumors in the head and neck and may be useful for clinical decision-making and when planning treatment. Further research and clinical applications are expected to contribute to an improved prognosis in patients with cutaneous head and neck malignancies.
Collapse
Affiliation(s)
- Takuya Nishio
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Plastic and Reconstructive Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Taku Maeda
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kosuke Ishikawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Naoki Murao
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kanako Fuyama
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Yuhei Yamamoto
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshihiko Hayashi
- Department of Plastic and Reconstructive Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan.
| |
Collapse
|
3
|
Węgiel A, Zielinska N, Głowacka M, Olewnik Ł. Hypoglossal Nerve Neuropathies-Analysis of Causes and Anatomical Background. Biomedicines 2024; 12:864. [PMID: 38672218 PMCID: PMC11048189 DOI: 10.3390/biomedicines12040864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
The hypoglossal nerve is the last, and often neglected, cranial nerve. It is mainly responsible for motor innervation of the tongue and therefore the process of chewing and articulation. However, tumors, aneurysms, dissections, trauma, and various iatrogenic factors such as complications after surgeries, radiotherapy, or airway management can result in dysfunction. Correct differential diagnosis and suitable treatment require a thorough knowledge of the anatomical background of the region. This review presents the broad spectrum of hypoglossal neuropathies, paying particular attention to these with a compressive background. As many of these etiologies are not common and can be easily overlooked without prior preparation, it is important to have a comprehensive understanding of the special relations and characteristic traits of these medical conditions, as well as the most common concomitant disorders and morphological traits, influencing the clinical image. Due to the diverse etiology of hypoglossal neuropathies, specialists from many different medical branches might expect to encounter patients presenting such symptoms.
Collapse
Affiliation(s)
- Andrzej Węgiel
- Department of Anatomical Dissection and Donation, Medical University of Lodz, 90-647 Lodz, Poland; (A.W.); (N.Z.)
| | - Nicol Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, 90-647 Lodz, Poland; (A.W.); (N.Z.)
| | - Mariola Głowacka
- Nursing Department, Masovian Academy in Płock, 09-402 Płock, Poland;
| | - Łukasz Olewnik
- Department of Clinical Anatomy, Masovian Academy in Płock, 09-402 Płock, Poland
| |
Collapse
|
4
|
Carsuzaa F, Chabrillac E, Marcy PY, Mehanna H, Thariat J. Advances and residual knowledge gaps in the neck management of head and neck squamous cell carcinoma patients with advanced nodal disease undergoing definitive (chemo)radiotherapy for their primary. Strahlenther Onkol 2024:10.1007/s00066-024-02228-4. [PMID: 38600366 DOI: 10.1007/s00066-024-02228-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/03/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE Substantial changes have been made in the neck management of patients with head and neck squamous cell carcinomas (HNSCC) in the past century. These have been fostered by changes in cancer epidemiology and technological progress in imaging, surgery, or radiotherapy, as well as disruptive concepts in oncology. We aimed to review changes in nodal management, with a focus on HNSCC patients with nodal involvement (cN+) undergoing (chemo)radiotherapy. METHODS A narrative review was conducted to review current advances and address knowledge gaps in the multidisciplinary management of the cN+ neck in the context of (chemo)radiotherapy. RESULTS Metastatic neck nodes are associated with poorer prognosis and poorer response to radiotherapy, and have therefore been systematically treated by surgery. Radical neck dissection (ND) has gradually evolved toward more personalized and less morbid approaches, i.e., from functional to selective ND. Omission of ND has been made feasible by use of positron-emission tomography/computed tomography to monitor the radiation response in cN+ patients. Human papillomavirus-driven oropharyngeal cancers and their cystic nodes have shown dramatically better prognosis than tobacco-related cancers, justifying a specific prognostic classification (AJCC) creation. Finally, considering the role of lymph nodes in anti-tumor immunity, de-escalation of ND and prophylactic nodal irradiation in combination are intense areas of investigation. However, the management of bulky cN3 disease remains an issue, as aggressive multidisciplinary strategies or innovative combined treatments have not yet significantly improved their prognosis. CONCLUSION Personalized neck management is an increasingly important aspect of the overall therapeutic strategies in cN+ HNSCC.
Collapse
Affiliation(s)
- Florent Carsuzaa
- Department of Oto-Rhino-Laryngology & Head and Neck Surgery, Poitiers University Hospital, Poitiers, France
| | - Emilien Chabrillac
- Department of Surgery, University Cancer Institute of Toulouse-Oncopole, Toulouse, France
| | - Pierre Yves Marcy
- Department of Radiology, Clinique du Cap d'Or, La Seyne-sur-mer, France
| | - Hisham Mehanna
- Institute for Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - Juliette Thariat
- Department of radiotherapy, Centre François Baclesse, Caen, France.
- Laboratoire de physique Corpusculaire, IN2P3/ENSICAEN/CNRS, UMR 6534, Normandie Université, Caen, France.
| |
Collapse
|
5
|
Matos LL, Kowalski LP, Chaves ALF, de Oliveira TB, Marta GN, Curado MP, de Castro Junior G, Farias TP, Bardales GS, Cabrera MA, Capuzzo RDC, de Carvalho GB, Cernea CR, Dedivitis RA, Dias FL, Estefan AM, Falco AH, Ferraris GA, Gonzalez-Motta A, Gouveia AG, Jacinto AA, Kulcsar MAV, Leite AK, Lira RB, Mak MP, De Marchi P, de Mello ES, de Matos FCM, Montero PH, de Moraes ED, de Moraes FY, Morais DCR, Poenitz FM, Poitevin A, Riveros HO, Sanabria Á, Ticona-Castro M, Vartanian JG, Viani G, Vines EF, William Junior WN, Conway D, Virani S, Brennan P. Latin American Consensus on the Treatment of Head and Neck Cancer. JCO Glob Oncol 2024; 10:e2300343. [PMID: 38603656 DOI: 10.1200/go.23.00343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 04/13/2024] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is well known as a serious health problem worldwide, especially in low-income countries or those with limited resources, such as most countries in Latin America. International guidelines cannot always be applied to a population from a large region with specific conditions. This study established a Latin American guideline for care of patients with head and neck cancer and presented evidence of HNSCC management considering availability and oncologic benefit. A panel composed of 41 head and neck cancer experts systematically worked according to a modified Delphi process on (1) document compilation of evidence-based answers to different questions contextualized by resource availability and oncologic benefit regarding Latin America (region of limited resources and/or without access to all necessary health care system infrastructure), (2) revision of the answers and the classification of levels of evidence and degrees of recommendations of all recommendations, (3) validation of the consensus through two rounds of online surveys, and (4) manuscript composition. The consensus consists of 12 sections: Head and neck cancer staging, Histopathologic evaluation of head and neck cancer, Head and neck surgery-oral cavity, Clinical oncology-oral cavity, Head and neck surgery-oropharynx, Clinical oncology-oropharynx, Head and neck surgery-larynx, Head and neck surgery-larynx/hypopharynx, Clinical oncology-larynx/hypopharynx, Clinical oncology-recurrent and metastatic head and neck cancer, Head and neck surgery-reconstruction and rehabilitation, and Radiation therapy. The present consensus established 48 recommendations on HNSCC patient care considering the availability of resources and focusing on oncologic benefit. These recommendations could also be used to formulate strategies in other regions like Latin America countries.
Collapse
Affiliation(s)
- Leandro Luongo Matos
- Head and Neck Surgery, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
- Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
| | | | | | | | | | | | - Gilberto de Castro Junior
- Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Andrés Munyo Estefan
- Profesor Adjunto Catedra de Otorrinolaringologia del Hospital de Clínicas, Montevidéu, Uruguay
| | | | | | | | - Andre Guimarães Gouveia
- Juravinski Cancer Centre, Department of Oncology, Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | | | - Marco Aurelio Vamondes Kulcsar
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | - Ana Kober Leite
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | - Renan Bezerra Lira
- AC Camargo Cancer Center and Hospital Albert Einstein, São Paulo, Brazil
| | - Milena Perez Mak
- 3Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | | | | | | | - Pablo H Montero
- Department of Surgical Oncology and Head and Neck Surgery, Division of Surgery, P. Universidad Católica de Chile, Santiago, Chile
| | | | | | | | | | | | | | - Álvaro Sanabria
- 4Department of Surgery, Universidad de Antioquia, Hospital Alma Mater, Medellin, Colombia
| | - Miguel Ticona-Castro
- 5ESMO Member, Peruvian Society of Medical Oncology (S.P.O.M.) Member, La Molina, Peru
| | - José Guilherme Vartanian
- 6Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Gustavo Viani
- 7Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Eugenio F Vines
- Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | | | - Shama Virani
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
| | - Paul Brennan
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
| |
Collapse
|
6
|
Altawil M, Stanisz I, Van Den Berg NH, Sheahan P. Pattern of regional recurrence after selective neck dissection for clinically positive neck in mucosal squamous carcinoma. Head Neck 2024. [PMID: 38476090 DOI: 10.1002/hed.27727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 02/10/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Selective neck dissection (SND) has traditionally been applied to clinically negative (cN0) necks in mucosal squamous cell carcinoma (SCC). We aimed to examine the oncological safety and patterns of regional recurrence (RR) of SND in clinically positive (cN+) necks. METHODS Retrospective review of prospective cohort of 206 patients with mucosal SCC undergoing neck dissection. RR was classified as occurring within previously dissected levels, within ipsilateral undissected levels, within unusual locations of ipsilateral neck, or contralateral neck. RESULTS Seven of seventy-seven (9.1%) cN+ patients undergoing SND developed isolated RR, versus 16.2% after MRND, and 8.7% after SND for cN0 disease. RR was rarely seen within undissected levels of the ipsilateral neck. RR and survival rates were not associated with ND extent (SND vs. MRND) among either cN+ or pN+ patients. CONCLUSION SND can be safely performed in most patients with cN+ SCC, who do not have gross sternocleidomastoid infiltration or level V metastases.
Collapse
Affiliation(s)
- Mohammad Altawil
- Department of Otolaryngology - Head & Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Isabella Stanisz
- Department of Otolaryngology - Head & Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Nadia H Van Den Berg
- Department of Otolaryngology - Head & Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Patrick Sheahan
- Department of Otolaryngology - Head & Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
- ENTO Research Unit, College of Medicine and Health, University College, Cork, Ireland
| |
Collapse
|
7
|
Rullière A, Danion J, Fieux M, Tonnerre D, Faure JP, Legré M, Favier V, Oriot D, Dufour X, Carsuzaa F. SimLife®: A New Dynamic Model for Head and Neck Surgical Oncology Simulation. Otolaryngol Head Neck Surg 2024; 170:972-976. [PMID: 38111133 DOI: 10.1002/ohn.630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/20/2023] [Accepted: 12/02/2023] [Indexed: 12/20/2023]
Abstract
The SimLife® model consists in a human cadaver dynamized by pulsatile vascularization. The objective was to evaluate the face, contents, and constructs validity of the SimLife® model in head and neck surgical oncology simulation. Head and neck surgical oncology simulation sessions on SimLife® models were organized with lateral neck dissection and total laryngectomy. Face and contents validity were addressed by questionnaires. Constructs validity was assessed by objective structured assessment of technical skills (OSATS) score. High realism was demonstrated for consistency of tissues (7.1 ± 1.4), color of arteries and veins (7.3 ± 1.9, 8.5 ± 1.1, respectively), and vein consistency (8.5 ± 1.2). The mean OSATS score was 19.7 ± 5.4 for residents and 32.7 ± 1.9 for senior surgeon (P = .0022). SimLife® is a hyperrealistic model for head and neck surgical oncology simulation and it might become a core component of the surgical resident curriculum.
Collapse
Affiliation(s)
- Anne Rullière
- Service ORL et chirurgie cervico-faciale, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Jérôme Danion
- Service de chirurgie viscérale, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- ABS Lab, Université de Poitiers, Poitiers, France
| | - Maxime Fieux
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervico-faciale, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Denis Tonnerre
- Service ORL et chirurgie cervico-faciale, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Jean-Pierre Faure
- Service de chirurgie viscérale, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- ABS Lab, Université de Poitiers, Poitiers, France
| | - Margaux Legré
- Service ORL et chirurgie cervico-faciale, Institut Arthur Vernes, Paris, France
| | - Valentin Favier
- Département d'ORL, chirurgie cervico faciale et maxillo-faciale, Hôpital Gui de Chauliac, CHU de Montpellier, Montpellier, France
| | - Denis Oriot
- ABS Lab, Université de Poitiers, Poitiers, France
| | - Xavier Dufour
- Service ORL et chirurgie cervico-faciale, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Florent Carsuzaa
- Service ORL et chirurgie cervico-faciale, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| |
Collapse
|
8
|
Ruan J, Chen Z, Chen S, Xu Z, Wen L, Mao Z, Shen J, Liu J, Wang W. Lateral lymph node metastasis in papillary thyroid microcarcinoma: a study of 5241 follow-up patients. Endocrine 2024; 83:414-421. [PMID: 37596455 DOI: 10.1007/s12020-023-03486-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/07/2023] [Indexed: 08/20/2023]
Abstract
PURPOSE To investigate the impact of lateral lymph node metastasis in papillary thyroid microcarcinoma (PTMC). METHODS 5241 PTMC patients with follow-up information were enrolled in the current study. These patients underwent primary surgery in our situation from January 1997 to December 2016. Additionally, a validation cohort consisting of 274 PTMC patients who underwent primary surgery between January 2020 and December 2021 was also included. Univariable and multivariate logistic analyses were conducted to identify the association between clinicopathologic features and lateral lymph node metastasis (LLNM). Kaplan-Meier survival curve analysis was used to calculate the disease-free survival (DFS) rate. The fitting curve was generated to identify the quantitative relationship between central lymph node metastases (CLNM) and LLNM. RESULTS Of 5241 PTMC patients, cervical lymph node metastasis was detected in 1494 (28.5%) cases, including 1364 (26.0%) with CLNM only and 130 (2.5%) with LLNM. With a median follow-up time of 60 months (interquartile range [IQR], 44-81), recurrence was detected in 114 patients (2.2%). Multivariate Cox regression analyses showed that LNM was the only independent risk factor for recurrence, with HR values of 3.03 in CLNM and 11.14 in LLNM, respectively. Tumor diameter >0.5 cm (hazard ratio [HR]:1.80), multifocality (HR:2.59), bilaterality (HR:2.13), extrathyroidal invasion (HR:2.13), and CLNM (HR:5.11) were independent risk factors for LLNM. The prevalence of LLNM escalated significantly with increasing number of lymph node involvement in CLNM when stratified by the number of metastatic lymph nodes and trend was observed similarly in the validation cohort. The fitting curve showed that the incidence of LLNM could be as high as 20.7% when the number of CLNM ≥ 5. CONCLUSIONS By analyzing a large database with follow-up information, our study provides evidence that LLNM is significantly correlated with tumor recurrence in patients with PTMC. Tumor size (>0.5 cm), multifocality, bilaterality, extrathyroidal extension (ETE) and CLNM are independent risk factors for LLNM.
Collapse
Affiliation(s)
- Jiaying Ruan
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhendong Chen
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shitu Chen
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zehang Xu
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liping Wen
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhuochao Mao
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiejie Shen
- Community Health Service Center, Jingjiang Street, Xiaoshan District, Hangzhou, China
| | - Jian Liu
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Weibin Wang
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| |
Collapse
|
9
|
Eskander A, Dziegielewski PT, Patel MR, Jethwa AR, Pai PS, Silver NL, Sajisevi M, Sanabria A, Doweck I, Khariwala SS, St John M. Oral Cavity Cancer Surgical and Nodal Management: A Review From the American Head and Neck Society. JAMA Otolaryngol Head Neck Surg 2024; 150:172-178. [PMID: 38153725 DOI: 10.1001/jamaoto.2023.4049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Importance Lymph node metastases from oral cavity cancers are seen frequently, and there is still inconsistency, and occasional controversies, regarding the surgical management of the neck in patients with oral cancer. This review is intended to offer a surgically focused discussion of the current recommendations regarding management of the neck, focusing on the indications and extent of dissection required in patients with oral cavity squamous cell carcinoma while balancing surgical risk and oncologic outcome. Observations The surgical management of the neck for oral cavity cancer has been robustly studied, as evidenced by substantial existing literature surrounding the topic. Prior published investigations have provided a sound foundation on which data-driven treatment algorithms can generally be recommended. Conclusions Existing literature suggests that patients with oral cavity cancer should be fully staged preoperatively, and most patients should receive a neck dissection even when clinically N0. Quality standards supported by the literature include separation of each level during specimen handling and lymph node yield of 18 or more nodes. Sentinel lymph node biopsy can be considered in select tumors and within a well-trained multidisciplinary team.
Collapse
Affiliation(s)
- Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Peter T Dziegielewski
- Department of Otolaryngology, University of Florida College of Medicine, Gainesville
| | - Mihir R Patel
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia
| | - Ashok R Jethwa
- Department of Otolaryngology-Head and Neck, University of Minnesota Medical School, Minneapolis
| | - Prathamesh S Pai
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - Mirabelle Sajisevi
- Department of Otolaryngology, The University of Vermont Medical Center, Burlington
| | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Ilana Doweck
- Department of Otolaryngology, Head and Neck Surgery, Carmel Medical Center, Rappaport School of Medicine, Technion, Haifa, Israel
| | - Samir S Khariwala
- Department of Otolaryngology-Head and Neck, University of Minnesota Medical School, Minneapolis
| | - Maie St John
- Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, California
| |
Collapse
|
10
|
Pagedar NA, Hoffman HT. Anatomic Variability of the Accessory Nerve: Implications for Dissection of Level IIB. Laryngoscope 2024; 134:154-159. [PMID: 37289066 PMCID: PMC10703995 DOI: 10.1002/lary.30758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVES During neck dissection, level IIB lymphadenectomy necessitates manipulation of the spinal accessory nerve that might be avoided and might cause postoperative disability. Current literature does not describe the effect of variation in the spinal accessory nerve in the upper neck. We sought to measure the effect of the dimensions of level IIB on nodal yield in level IIB and on patient reported neck symptoms. METHODS We measured the boundaries of level IIB of 150 patients undergoing neck dissection. Level II was dissected and separated into levels IIA and IIB intraoperatively. Patient-reported symptoms were assessed in 50 patients using the Neck Dissection Impairment Inventory. We computed descriptive statistics, and sought to identify correlation with the number and proportion of level IIB nodes and the number of metastatic nodes. Level IIB dimensions were analyzed as predictors of postoperative symptoms. RESULTS We measured 184 sides, with 37.7% of level II nodes found in level IIB. Mean accessory nerve length across level II was 2.5 cm. Every additional 1 cm in accessory nerve length was associated with two more level IIB nodes. At all accessory nerve lengths, meaningful numbers of nodes were present in level IIB. Accessory nerve length and other factors did not correlate with NDII scores. CONCLUSIONS Longer lengths of accessory nerve across level IIB correlated with greater nodal yield. However, data did not point to an accessory nerve length cutoff below which level IIB dissection could be avoided. In addition, the dimensions of level IIB did not correlate with postoperative neck symptoms. LEVEL OF EVIDENCE 2 Laryngoscope, 134:154-159, 2024.
Collapse
Affiliation(s)
- Nitin A Pagedar
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa, Iowa City, Iowa, U.S.A
| | - Henry T Hoffman
- Department of Otolaryngology - Head and Neck Surgery, University of Iowa, Iowa City, Iowa, U.S.A
| |
Collapse
|
11
|
Burioka H, Yamamori U, Nagano N, Ue A, Tamaki Y. Radiation Therapy for Breast Cancer With Oligometastatic Cervical Lymph Nodes: A Case Report. Cureus 2024; 16:e51617. [PMID: 38313990 PMCID: PMC10837370 DOI: 10.7759/cureus.51617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 02/06/2024] Open
Abstract
Stage IV breast cancer is difficult to cure and is mainly treated with systemic therapy. However, when distant metastasis is oligometastatic, proactive treatment including local therapies for the primary lesion and distant metastases has been reported to improve prognosis. We encountered a patient who had left breast cancer with ipsilateral cervical lymph node metastases. The metastases were oligometastatic, and we treated them curatively. The patient was a female in her 50s who had been aware of a lump in the lower inner quadrant of the left breast for a few years. A biopsy was performed and left breast cancer was diagnosed pathologically. Radiological examination showed metastasis to ipsilateral axillary and cervical lymph nodes. The cervical lymph node metastases were oligometastatic, suggesting possible improvement in prognosis by multimodality treatment including local therapy. The multimodality treatment in this case comprised mastectomy with levels I and II axillary lymph node dissection, systemic therapy (including chemotherapy, endocrine therapy, and molecular targeted therapy), and postmastectomy radiation therapy. The left chest wall and left supraclavicular lymph node region were irradiated. Furthermore, following the postmastectomy radiation therapy, the cervical lymph node metastases were treated with radical radiation therapy. The cure was achieved, with recurrence-free status maintained for two years and four months after the completion of radiation therapy. This case suggests that, for breast cancer with oligometastatic involvement of cervical lymph nodes, locally treating these distant metastatic lesions with radical radiation therapy as part of multimodality treatment is beneficial.
Collapse
Affiliation(s)
- Hiroshi Burioka
- Radiation Oncology, Shimane University Faculty of Medicine, Izumo, JPN
| | - Unta Yamamori
- Radiation Oncology, Shimane University Faculty of Medicine, Izumo, JPN
| | - Natsuko Nagano
- Radiation Oncology, Shimane University Faculty of Medicine, Izumo, JPN
| | - Atsushi Ue
- Radiation Oncology, Shimane University Faculty of Medicine, Izumo, JPN
| | - Yukihisa Tamaki
- Radiation Oncology, Shimane University Faculty of Medicine, Izumo, JPN
| |
Collapse
|
12
|
Liokatis P, Obermeier KT, Trautner F, Kraus M, Smolka W, Troeltzsch M, Otto S, Haidari S. Comparison of alternative N-staging models in patients with oral cancer. Is nodal yield or burden the most critical parameter? JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101594. [PMID: 37562715 DOI: 10.1016/j.jormas.2023.101594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND There is increasing evidence in the literature that alternative N-classification systems offer a simpler and more precise risk stratification than the current N- classification in patients with oral squamous cell carcinoma. The purpose of this study is to compare three broadly proposed models incorporating lymph node ratio, log odds of positive lymph nodes and number of positive lymph nodes regarding disease-free and overall survival. METHODS This is a retrospective study of patients treated in a single center between 2013 and 2019. Cox proportional hazard models, Kaplan Meier curves, the long rank test and the area under the curve were implemented to compare the risk-stratification ability of the three models. Moreover, a hazard ratio plot was calculated to investigate the association between nodal yield and disease-free survival. RESULTS 231 patients were included. All three proposed N-models were significantly correlated to the patient's prognosis in the multivariate analysis. Pairwise comparisons between the groups showed that the current pN classification offers the worst stratification and that the model incorporating the number of positive lymph nodes had a better performance for predicting both endpoints. Finally, a decrease in hazard ratio was observed with each additional lymph node removed up to the number of 39 lymph nodes. CONCLUSIONS The model incorporating the nodal burden offered a better predictive ability. The current N-classification cannot adequately identify patients with different prognosis. A non-linear relationship was found between nodal yield and survival, which could be the disadvantage of the lymph node ratio and log odds models.
Collapse
Affiliation(s)
- Paris Liokatis
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Munich Germany
| | - Katharina Theresa Obermeier
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Munich Germany
| | - Fabienne Trautner
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Munich Germany.
| | - Moritz Kraus
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Munich Germany
| | - Wenko Smolka
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Munich Germany
| | - Matthias Troeltzsch
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Munich Germany
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Munich Germany
| | - Selgai Haidari
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Munich Germany
| |
Collapse
|
13
|
Valdés Olmos RA, Collarino A, Rietbergen DDD, Pereira Arias-Bouda L, Giammarile F, Vidal-Sicart S. Setting-up a training programme for intraoperative molecular imaging and sentinel node mapping: how to teach? How to learn? Eur J Nucl Med Mol Imaging 2023:10.1007/s00259-023-06496-7. [PMID: 38030743 DOI: 10.1007/s00259-023-06496-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND The current expansion of image-guided surgery is closely related to the role played by radio-guided surgery in supporting the sentinel node (SN) procedure during more than three decades. The so-called triple approach (lymphoscintigraphy, gamma probe detection and blue dye) was not only essential in the seminal validation of the SN procedure but also a first collective learning effort based on skill transfer and outcome-related evaluation which laid the fundaments to delineate the field of intraoperative molecular imaging (IMI) based on a similar multimodality approach and multidisciplinary practice. METHODS These elements are also becoming valid in the current incorporation of SPECT/CT and PET/CT to existing and new protocols of IMI procedures and SN mapping concerning other clinical applications. On the other hand, there is a growing tendency to combine novel modern technologies in an allied role with gamma guidance in the operating room following the development of hybrid tracers and multimodal detection approaches. Against this background, learning initiatives are required for professionals working in this area. RESULTS This objective has led to a group of European practitioners with large experience in SN mapping and IMI applications to give shape to a programme made up out of specific learning modules aimed to be used as a conductive thread in peripherical or centralised training instances concerning the topic. CONCLUSION The presented work, written as a tutorial review, is placed in an available prior-art context and is primarily aimed at medical and paramedical practitioners as well as at hardware and software developers.
Collapse
Affiliation(s)
- Renato A Valdés Olmos
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Angela Collarino
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daphne D D Rietbergen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Lenka Pereira Arias-Bouda
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Francesco Giammarile
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency (IAEA), Vienna, Austria
| | - Sergi Vidal-Sicart
- Department of Nuclear Medicine, Hospital Clinic Barcelona, Barcelona, Catalonia, Spain
| |
Collapse
|
14
|
McDonald C, Kent S, Schache A, Rogers S, Shaw R. Health-related quality of life, functional outcomes, and complications after sentinel lymph node biopsy and elective neck dissection in early oral cancer: A systematic review. Head Neck 2023; 45:2754-2779. [PMID: 37642334 DOI: 10.1002/hed.27495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Elective neck dissection improves survival in early oral cancer. Sentinel lymph node biopsy may also do this with less morbidity. This systematic review compared health-related quality of life, functional outcomes, and complications after sentinel lymph node biopsy and elective neck dissection in early oral cancer. METHODS PRISMA guidelines were followed. Thirteen studies met inclusion criteria. RESULTS Results favoring sentinel lymph node biopsy were found in complications, scar length and appearance, length of hospital stay, time to drain removal, and objective shoulder measures at timepoints up to 12 months. Where differences in health-related quality of life were found, methodological issues make their clinical significance questionable. CONCLUSIONS Sentinel lymph node biopsy was associated with fewer complications and statistically better outcomes in a number of physical measures. There is as yet no strong evidence to suggest it is associated with better health-related quality of life outcomes. While a number of health-related quality of life outcome measures show promise, their interpretation is hampered by methodological concerns. Further rigorous research is required to address this.
Collapse
Affiliation(s)
- Christopher McDonald
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
- Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Andrew Schache
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
- University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Simon Rogers
- Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK
| | - Richard Shaw
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
- University of Liverpool and Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
15
|
Abdel-Halim CN, O'Byrne TJ, Graves JP, Akpala CO, Moore EJ, Price DL, Tasche KT, Ma DJ, Neben-Wittich MA, Lester SC, Gamez M, Price KA, Bayne HEF, Rwigema JCM, Patel SH, McGee LA, Janus JR, Nagel TH, Hinni ML, Savvides PS, Van Abel KM, Routman DM. Patterns and distribution of regional nodal involvement and recurrence in a surgically treated oropharyngeal squamous cell carcinoma cohort at a tertiary center. Oral Oncol 2023; 146:106569. [PMID: 37734203 DOI: 10.1016/j.oraloncology.2023.106569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVES To investigate and describe the patterns of regional metastases and recurrences after surgical treatment of oropharyngeal squamous cell cancer (OPSCC). MATERIALS AND METHODS Retrospective study of patients diagnosed with OPSCC from 2006 to 2021 at a tertiary referral center. Only patients treated with surgery including a neck dissection were included. Patients with unknown human papillomavirus (HPV) status, prior head and neck cancer, distant metastases, or synchronous head and neck cancer were excluded. RESULTS A total of 928 patients were included. 89% were males, the average age was 58.6 years (range: 25.2-87.5), 874 (94%) were HPV(+), and 513 (55.3%) had a tonsil cancer. Among cN + patients, the most commonly involved levels at presentation were level II (85.2%), level III (33.3%), and level IV (9.4%). In cN0 patients, metastases were only observed in level II (16.2%) and level III (9.2%). Nodal recurrence occurred in 48 (5.2%) patients after a median time of 1.0 years (interquartile range: 0.6-2.0). Nodal recurrence incidence was similar in HPV(+) and HPV(-) patients (5.0% vs. 7.4%, p = 0.44). The most common levels for regional recurrence were ipsilateral level II (45.8%), contralateral level II (43.8%), and ipsilateral level V (25.0%). Multivariable analysis revealed that pN was a significant predictor for regional recurrence (p = 0.02). CONCLUSION There is no difference in the distribution of regional metastases and recurrences in HPV(+) and HPV(-) OPSCC patients. Our findings align with the established understanding that regional metastases predominantly manifest in the ipsilateral level II-IV at presentation. Moreover, the data support the clinical recommendation to restrict elective neck dissection in cN0 patients to ipsilateral levels IIa and III, excluding level IIb. Regional recurrence is significantly associated with pN status.
Collapse
Affiliation(s)
- Chadi N Abdel-Halim
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Thomas J O'Byrne
- Department of Quantitative Health Sciences, Rochester, MN, United States
| | - Jeffrey P Graves
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Christeebella O Akpala
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Eric J Moore
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Daniel L Price
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Kendall T Tasche
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | | | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Mauricio Gamez
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Katharine A Price
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Jeffrey R Janus
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Thomas H Nagel
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Scottsdale, AZ, United States
| | - Michael L Hinni
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Scottsdale, AZ, United States
| | | | - Kathryn M Van Abel
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States.
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
16
|
Boschin IM, Bertazza L, Scaroni C, Mian C, Pelizzo MR. Sentinel lymph node mapping: current applications and future perspectives in thyroid carcinoma. Front Med (Lausanne) 2023; 10:1231566. [PMID: 37942415 PMCID: PMC10629113 DOI: 10.3389/fmed.2023.1231566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/26/2023] [Indexed: 11/10/2023] Open
Abstract
Sentinel lymph node (SLN) mapping is a standard, minimally-invasive diagnostic method in the surgical treatment of many solid tumors, as for example melanoma and breast cancer, for detecting the presence of regional nodal metastases. A negative SLN accurately indicates the absence of metastases in the other regional lymph nodes (LN), thus avoiding unnecessary lymph nodal dissection. Papillary thyroid carcinoma (PTC) is the most common type of thyroid carcinoma (TC) with cervical LN metastases at diagnosis in 20-90%, and nodal involvement correlates with local persistence/recurrence. The SLN in PTC is an intraoperative method for staging preoperative N0 patients and for detecting metastatic LNs "in and outside" the cervical LN central compartment; it represents an alternative method to prophylactic central neck node dissection. In this review we summarize different methods and results of the use of SLN in TC. The SLN identification techniques currently used include the selective vital-dye (VD) method, 99mTc-nanocolloid planar lymphoscintigraphy with intraoperative use of a hand-held gamma probe (LS), the combination LS + VD, and the combination LS and preoperative SPECT-CT (LS + SPECT/CT). The application of the SLN procedure in TC has been described in many studies, however, the techniques are heterogeneous, and the role of SLN in TC, with indications, results, advantages and limits, is still debated.
Collapse
Affiliation(s)
- Isabella Merante Boschin
- UOC Endocrinology, Dipartimento di Scienze Chirurgiche Oncologiche e Gastroenterologiche (DiSCOG), Università degli Studi di Padova, Azienda Ospedale-Università di Padova, Padua, Italy
| | - Loris Bertazza
- UOC Endocrinology, Dipartimento di Medicina (DIMED), Università degli Studi di Padova, Azienda Ospedale-Università di Padova, Padua, Italy
| | - Carla Scaroni
- UOC Endocrinology, Dipartimento di Medicina (DIMED), Università degli Studi di Padova, Azienda Ospedale-Università di Padova, Padua, Italy
| | - Caterina Mian
- UOC Endocrinology, Dipartimento di Medicina (DIMED), Università degli Studi di Padova, Azienda Ospedale-Università di Padova, Padua, Italy
| | - Maria Rosa Pelizzo
- Dipartimento di Scienze Chirurgiche Oncologiche e Gastroenterologiche (DiSCOG), Università degli Studi di Padova, Padua, Italy
| |
Collapse
|
17
|
Ji H, Hu C, Yang X, Liu Y, Ji G, Ge S, Wang X, Wang M. Lymph node metastasis in cancer progression: molecular mechanisms, clinical significance and therapeutic interventions. Signal Transduct Target Ther 2023; 8:367. [PMID: 37752146 PMCID: PMC10522642 DOI: 10.1038/s41392-023-01576-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 07/04/2023] [Accepted: 07/26/2023] [Indexed: 09/28/2023] Open
Abstract
Lymph nodes (LNs) are important hubs for metastatic cell arrest and growth, immune modulation, and secondary dissemination to distant sites through a series of mechanisms, and it has been proved that lymph node metastasis (LNM) is an essential prognostic indicator in many different types of cancer. Therefore, it is important for oncologists to understand the mechanisms of tumor cells to metastasize to LNs, as well as how LNM affects the prognosis and therapy of patients with cancer in order to provide patients with accurate disease assessment and effective treatment strategies. In recent years, with the updates in both basic and clinical studies on LNM and the application of advanced medical technologies, much progress has been made in the understanding of the mechanisms of LNM and the strategies for diagnosis and treatment of LNM. In this review, current knowledge of the anatomical and physiological characteristics of LNs, as well as the molecular mechanisms of LNM, are described. The clinical significance of LNM in different anatomical sites is summarized, including the roles of LNM playing in staging, prognostic prediction, and treatment selection for patients with various types of cancers. And the novel exploration and academic disputes of strategies for recognition, diagnosis, and therapeutic interventions of metastatic LNs are also discussed.
Collapse
Affiliation(s)
- Haoran Ji
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Chuang Hu
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Xuhui Yang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yuanhao Liu
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Guangyu Ji
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Shengfang Ge
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiansong Wang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Mingsong Wang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| |
Collapse
|
18
|
Jansen F, Betz CS, Belau MH, Matnjani G, Clauditz TS, Dwertmann-Rico S, Stölzel K, Möckelmann N, Böttcher A. Outcomes following oropharyngeal squamous cell carcinoma resection and bilateral neck dissection with or without contralateral postoperative radiotherapy of the pathologically node-negative neck. Eur Arch Otorhinolaryngol 2023; 280:3843-3853. [PMID: 37133497 PMCID: PMC10313843 DOI: 10.1007/s00405-023-07972-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/06/2023] [Indexed: 05/04/2023]
Abstract
PURPOSE There are no consensus guidelines regarding the postoperative treatment of the contralateral pathologically node-negative neck in oropharyngeal squamous cell carcinoma. This study aimed to determine if omission of postoperative irradiation of the contralateral pathologically node-negative neck affects oncological outcomes. METHODS We retrospectively identified 84 patients with primary surgical treatment including bilateral neck dissection and postoperative (chemo-)radiotherapy (PO(C)RT). Survival was analyzed using the log-rank test and the Kaplan-Meier method. RESULTS Patients showed no decrease in tumor-free, cause-specific (CSS), or overall survival (OS) when PO(C)RT of the contralateral pathologically node-negative neck was omitted. Increased OS was found in patients with unilateral PO(C)RT and especially an increased OS and CSS was found in unilateral PO(C)RT and in tumors arising from lymphoepithelial tissue. CONCLUSIONS Omitting the contralateral pathologically node-negative neck appears to be safe in terms of survival and our retrospective study advocates further prospective randomized control de-escalation trials.
Collapse
Affiliation(s)
- Florian Jansen
- Department of Otorhinolaryngology, Head and Neuro Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Christian Stephan Betz
- Department of Otorhinolaryngology, Head and Neuro Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Matthias Hans Belau
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gesa Matnjani
- Department of Radiotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Katharina Stölzel
- Department of Otorhinolaryngology, Head and Neuro Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Nikolaus Möckelmann
- Department of Otorhinolaryngology, Head and Neuro Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- Department of Otorhinolaryngology, Kath. Marienkrankenhaus GmbH, Hamburg, Germany
| | - Arne Böttcher
- Department of Otorhinolaryngology, Head and Neuro Center, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| |
Collapse
|
19
|
Smith JD, Mentz G, Leis AM, Yuan Y, Stucken CL, Chinn SB, Casper KA, Malloy KM, Shuman AG, McLean SA, Rosko AJ, Prince MEP, Tremper KK, Spector ME, Schechtman SA. Use of neuromuscular blockade for neck dissection and association with iatrogenic nerve injury. BMC Anesthesiol 2023; 23:254. [PMID: 37507689 PMCID: PMC10375630 DOI: 10.1186/s12871-023-02217-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Cranial nerve injury is an uncommon but significant complication of neck dissection. We examined the association between the use of intraoperative neuromuscular blockade and iatrogenic cranial nerve injury during neck dissection. METHODS This was a single-center, retrospective, electronic health record review. Study inclusion criteria stipulated patients > 18 years who had ≥ 2 neck lymphatic levels dissected for malignancy under general anesthesia with a surgery date between 2008 - 2018. Use of neuromuscular blockade during neck dissection was the primary independent variable. This was defined as any use of rocuronium, cisatracurium, or vecuronium upon anesthesia induction without reversal with sugammadex prior to surgical incision. Univariate tests were used to compare variables between those patients with, and those without, iatrogenic cranial nerve injury. Multivariable logistic regression determined predictors of cranial nerve injury and was performed incorporating Firth's estimation given low prevalence of the primary outcome. RESULTS Our cohort consisted of 925 distinct neck dissections performed in 897 patients. Neuromuscular blockade was used during 285 (30.8%) neck dissections. Fourteen instances (1.5% of surgical cases) of nerve injury were identified. On univariate logistic regression, use of neuromuscular blockade was not associated with iatrogenic cranial nerve injury (OR: 1.73, 95% CI: 0.62 - 4.86, p = 0.30). There remained no significant association on multivariable logistic regression controlling for patient age, sex, weight, ASA class, paralytic dose, history of diabetes, stroke, coronary artery disease, carotid atherosclerosis, myocardial infarction, and cardiac arrythmia (OR: 1.87, 95% CI: 0.63 - 5.51, p = 0.26). CONCLUSIONS In this study, use of neuromuscular blockade intraoperatively during neck dissection was not associated with increased rates of iatrogenic cranial nerve injury. While this investigation provides early support for safe use of neuromuscular blockade during neck dissection, future investigation with greater power remains necessary.
Collapse
Affiliation(s)
- Joshua D Smith
- Department of Otolaryngology - Head and Neck Surgery, Michigan Medicine - University of Michigan, Ann Arbor, MI, 48109, USA
| | - Graciela Mentz
- Department of Anesthesiology, Michigan Medicine - University of Michigan, 1H247 UH, SPC 5048, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Aleda M Leis
- Department of Anesthesiology, Michigan Medicine - University of Michigan, 1H247 UH, SPC 5048, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Yuan Yuan
- Department of Anesthesiology, Michigan Medicine - University of Michigan, 1H247 UH, SPC 5048, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Chaz L Stucken
- Department of Otolaryngology - Head and Neck Surgery, Michigan Medicine - University of Michigan, Ann Arbor, MI, 48109, USA
| | - Steven B Chinn
- Department of Otolaryngology - Head and Neck Surgery, Michigan Medicine - University of Michigan, Ann Arbor, MI, 48109, USA
- Rogel Comprehensive Cancer Center, Michigan Medicine University of Michigan, Ann Arbor, MI, 48109, USA
| | - Keith A Casper
- Department of Otolaryngology - Head and Neck Surgery, Michigan Medicine - University of Michigan, Ann Arbor, MI, 48109, USA
- Rogel Comprehensive Cancer Center, Michigan Medicine University of Michigan, Ann Arbor, MI, 48109, USA
| | - Kelly M Malloy
- Department of Otolaryngology - Head and Neck Surgery, Michigan Medicine - University of Michigan, Ann Arbor, MI, 48109, USA
- Rogel Comprehensive Cancer Center, Michigan Medicine University of Michigan, Ann Arbor, MI, 48109, USA
| | - Andrew G Shuman
- Department of Otolaryngology - Head and Neck Surgery, Michigan Medicine - University of Michigan, Ann Arbor, MI, 48109, USA
- Rogel Comprehensive Cancer Center, Michigan Medicine University of Michigan, Ann Arbor, MI, 48109, USA
| | - Scott A McLean
- Department of Otolaryngology - Head and Neck Surgery, Michigan Medicine - University of Michigan, Ann Arbor, MI, 48109, USA
| | - Andrew J Rosko
- Department of Otolaryngology - Head and Neck Surgery, Michigan Medicine - University of Michigan, Ann Arbor, MI, 48109, USA
| | - Mark E P Prince
- Department of Otolaryngology - Head and Neck Surgery, Michigan Medicine - University of Michigan, Ann Arbor, MI, 48109, USA
- Rogel Comprehensive Cancer Center, Michigan Medicine University of Michigan, Ann Arbor, MI, 48109, USA
| | - Kevin K Tremper
- Department of Anesthesiology, Michigan Medicine - University of Michigan, 1H247 UH, SPC 5048, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, Michigan Medicine - University of Michigan, Ann Arbor, MI, 48109, USA
- Rogel Comprehensive Cancer Center, Michigan Medicine University of Michigan, Ann Arbor, MI, 48109, USA
| | - Samuel A Schechtman
- Department of Anesthesiology, Michigan Medicine - University of Michigan, 1H247 UH, SPC 5048, 1500 E. Medical Center Dr, Ann Arbor, MI, 48109, USA.
| |
Collapse
|
20
|
Marcy PY, Bauduer F, Thariat J, Gisserot O, Ghanassia E, Chetaille B, Boudin L, Morvan JB. Fast Track Management of Primary Thyroid Lymphoma in the Very Elderly Patient. Curr Oncol 2023; 30:5816-5827. [PMID: 37366918 DOI: 10.3390/curroncol30060435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023] Open
Abstract
A rapid growing cervical mass mobile while swallowing is the most common clinical presentation of severe thyroid malignancy. A 91-year-old female patient with a history of Hashimoto thyroiditis presented with clinical compressive neck symptoms. The patient had gastric Maltoma diagnosed that was surgically resected thirty years ago. A straightforward process was needed to reach full histological diagnosis and initiate prompt therapy. Ultrasound (US) showed a 67 mm hypoechoic left thyroid mass with reticulated pattern without signs of locoregional invasion. Percutaneous trans isthmic US-guided 18G core needle biopsy (CNB) disclosed diffuse large B cell lymphoma of the thyroid gland. FDG PET revealed two distinct thyroid and gastric foci (both SUVmax 39.1). Therapy was initiated rapidly to decrease clinical symptoms in this aggressive stage III primitive malignant thyroid lymphoma. The prognostic nomogram was calculated by using a seven-item scale, which disclosed a one-year overall survival rate of 52%. The patient underwent three R-CVP chemotherapy courses, then refused further treatment and died within five months. Real-time US-guided CNB approach led to rapid patient's management that was tailored to patient's characteristics. Transformation of Maltoma into diffuse large B cell lymphoma (DLBCL) into two body areas is deemed to be extremely rare.
Collapse
Affiliation(s)
- Pierre Yves Marcy
- Radiodiagnostics and Interventional Radiology Department, Polyclinics ELSAN Medipole Sud, Quartier Quiez, 83189 Ollioules, France
| | - Frederic Bauduer
- Department of Hematology, Centre Hospitalier de la côte Basque, College of Health Sciences, Bordeaux University, 64100 Bayonne, France
| | - Juliette Thariat
- Department of Radiation Therapy, Francois Baclesse Cancer Research Institute, Laboratoire de Physique Corpusculaire IN2P3/ENSI CAEN/CNRS UMR 6534, Normandy University, 3 Avenue General Harris, 14076 Caen, France
| | - Olivier Gisserot
- Department of Medical Oncology, CH Sainte Musse, 54 Rue Sainte-Claire Deville, 83100 Toulon, France
| | - Edouard Ghanassia
- Department of Endocrinology, PolyClinics Sainte Therese, 06 quai du mas Coulet, 33200 Sete, France
| | - Bruno Chetaille
- MEDIPATH Toulon, Pathology Center, 146 Avenue Foch, 83300 Toulon, France
| | - Laurys Boudin
- Department of Medical Oncology, University Military Hospital Sainte Anne, 2 Boulevard Sainte Anne, BP 600, 83300 Toulon, France
| | - Jean Baptiste Morvan
- Department of Head & Neck Surgery, University Military Hospital Sainte Anne, 2 Boulevard Sainte Anne, BP 600, 83000 Toulon, France
| |
Collapse
|
21
|
Battoo AJ, Sheikh ZA, Nisar J, Thankappan K, Kuriakose MA, Haji AG. Extended Level IV Neck Dissection for Limited Prophylactic Clearance of Level V in Node-Positive Papillary Thyroid Carcinoma: a Homogenous Study Population. Indian J Surg Oncol 2023; 14:345-353. [PMID: 37324295 PMCID: PMC10267089 DOI: 10.1007/s13193-020-01167-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/07/2020] [Indexed: 11/26/2022] Open
Abstract
There is near consensus that prophylactic lateral neck dissection has no role in the management of differentiated thyroid cancer, but the extent of lateral neck dissection in differentiated thyroid cancer remains controversial, especially whether level V should be addressed or not. There is lot of heterogeneity in reporting of the management of level V in papillary thyroid cancer. We at our Institute address the lateral neck positive papillary thyroid cancer with selective neck dissection involving levels II-IV, performing extended level IV dissection with inclusion of the triangular area delineated by the sternocleidomastoid muscle, the clavicle, and the perpendicular line drawn to the clavicle from the point where the horizontal line at the level of cricoid cuts the posterior border of sternocleidomastoid muscle. Retrospective analysis of the departmental data set related to thyroidectomy with lateral neck dissection from 2013 to mid-2019 for papillary thyroid cancer, was carried out. Patients with recurrent papillary thyroid cancer were excluded as were patients with involvement of level V. Data related to the demography of patients, histological diagnosis, and postoperative complications were compiled and summarized. Note was made of the incidence of ipsilateral neck recurrence and the neck level involved with recurrence noted. Data was analyzed for fifty-two patients of non-recurrent papillary thyroid cancer who had undergone total thyroidectomy and lateral neck dissection involving levels II-IV, with extended dissection at level IV. It should be noted that none of the patients had clinical involvement of level V. Only two patients had lateral neck recurrence, both the recurrences were in level III, one on the ipsilateral side and the other on the contralateral side. Recurrence in the central compartment was noted in two patients, with one of these patients also having ipsilateral level III recurrence. One of the patients had distal metastasis to the lungs. Transient paresis of the unilateral vocal cords was noted in seven patients which got resolved within 2 months in all of them. Transient hypocalcemia was noted in four patients. Although our series has a small sample size with limited follow-up, it is one of the few studies in which prophylactic level V dissection has been studied in a homogenous study population of non-recurrent papillary thyroid cancer. Our study has shown that prophylactic dissection of level V may have a limited role, but further large multi-institutional studies need to be carried out to come up with a definite answer.
Collapse
Affiliation(s)
- Azhar Jan Battoo
- Sher i Kashmir Institute of Medical Sciences, Srinagar, 190011 India
| | | | - Jasif Nisar
- Sher i Kashmir Institute of Medical Sciences, Srinagar, 190011 India
| | | | - Moni Abraham Kuriakose
- Cochin Cancer Research Centre, Kochi, Kerala 683503 India
- Roswell Park Cancer Institute, Elm & Carlton Streets Buffalo, Buffalo, NY 14263 USA
| | | |
Collapse
|
22
|
Farias T, Kowalski LP, Dias F, Barreira CSR, Vartanian JG, Tavares MR, Vaisman F, Momesso D, Oliveira AF, Pinheiro RN, de Castro Ribeiro HS. Guidelines from the Brazilian society of surgical oncology regarding indications and technical aspects of neck dissection in papillary, follicular, and medullary thyroid cancers. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:e000607. [PMID: 37252696 PMCID: PMC10665072 DOI: 10.20945/2359-3997000000607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 10/12/2022] [Indexed: 05/31/2023]
Abstract
Objective The purpose of these guidelines is to provide specific recommendations for the surgical treatment of neck metastases in patients with papillary, follicular, and medullary thyroid carcinomas. Materials and methods Recommendations were developed based on research of scientific articles (preferentially meta-analyses) and guidelines issued by international medical specialty societies. The American College of Physicians' Guideline Grading System was used to determine the levels of evidence and grades of recommendations. The following questions were answered: A) Is elective neck dissection indicated in the treatment of papillary, follicular, and medullary thyroid carcinoma? B) When should central, lateral, and modified radical neck dissection be performed? C) Could molecular tests guide the extent of the neck dissection? Results and conclusion Recommendation 1: Elective central neck dissection is not indicated in patients with cN0 well-differentiated thyroid carcinoma or in those with noninvasive T1 and T2 tumors but may be considered in T3-T4 tumors or in the presence of metastases in the lateral neck compartments. Recommendation 2: Elective central neck dissection is recommended in medullary thyroid carcinoma. Recommendation 3: Selective neck dissection of levels II-V should be indicated to treat neck metastases in papillary thyroid cancer, an approach that decreases the risk of recurrence and mortality. Recommendation 4: Compartmental neck dissection is indicated in the treatment of lymph node recurrence after elective or therapeutic neck dissection; "berry node picking" is not recommended. Recommendation 5: There are currently no recommendations regarding the use of molecular tests in guiding the extent of neck dissection in thyroid cancer.
Collapse
Affiliation(s)
- Terence Farias
- Instituto Nacional de Câncer, Ringgold Standard Institution, Cabeça e Pescoço, Rio de Janeiro, RJ, Brasil
- Pontifícia Universidade Católica do Rio de Janeiro, Ringgold Standard Institution, Pós-graduação em Cirurgia de Cabeça e Pescoço, Rio de Janeiro, RJ, Brasil
- Sociedade Brasileira de Cirurgia de Cabeça e Pescoço, Ringgold Standard Institution, São Paulo, SP, Brasil
- Sociedade Brasileira de Cirurgia Oncológica, Ringgold Standard Institution, Rio de Janeiro, RJ, Brasil
| | - Luiz Paulo Kowalski
- Sociedade Brasileira de Cirurgia de Cabeça e Pescoço, Ringgold Standard Institution, São Paulo, SP, Brasil
- Sociedade Brasileira de Cirurgia Oncológica, Ringgold Standard Institution, Rio de Janeiro, RJ, Brasil
- A.C.Camargo Cancer Center, Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, São Paulo, SP, Brasil
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Ringgold Standard Institution, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brasil
| | - Fernando Dias
- Instituto Nacional de Câncer, Ringgold Standard Institution, Cabeça e Pescoço, Rio de Janeiro, RJ, Brasil
- Pontifícia Universidade Católica do Rio de Janeiro, Ringgold Standard Institution, Pós-graduação em Cirurgia de Cabeça e Pescoço, Rio de Janeiro, RJ, Brasil
- Sociedade Brasileira de Cirurgia de Cabeça e Pescoço, Ringgold Standard Institution, São Paulo, SP, Brasil
- Sociedade Brasileira de Cirurgia Oncológica, Ringgold Standard Institution, Rio de Janeiro, RJ, Brasil
| | - Carlos S Ritta Barreira
- Sociedade Brasileira de Cirurgia de Cabeça e Pescoço, Ringgold Standard Institution, São Paulo, SP, Brasil
- Sociedade Brasileira de Cirurgia Oncológica, Ringgold Standard Institution, Rio de Janeiro, RJ, Brasil
- Hospital Dasa Brasília, Cirurgia de Cabeça e Pescoço, Brasília, DF, Brasil,
| | - José Guilherme Vartanian
- Sociedade Brasileira de Cirurgia de Cabeça e Pescoço, Ringgold Standard Institution, São Paulo, SP, Brasil
- Sociedade Brasileira de Cirurgia Oncológica, Ringgold Standard Institution, Rio de Janeiro, RJ, Brasil
- A.C.Camargo Cancer Center, Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, São Paulo, SP, Brasil
| | - Marcos Roberto Tavares
- Sociedade Brasileira de Cirurgia de Cabeça e Pescoço, Ringgold Standard Institution, São Paulo, SP, Brasil
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Ringgold Standard Institution, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brasil
| | - Fernanda Vaisman
- Instituto Nacional de Câncer, Ringgold Standard Institution, Seção de Cirurgia de Cabeça e Pescoço/Endocrinologia, Rio de Janeiro, RJ, Brasil
| | - Denise Momesso
- Universidade Federal do Rio de Janeiro, Endocrinologia, Rio de Janeiro, RJ, Brasil
| | - Alexandre Ferreira Oliveira
- Sociedade Brasileira de Cirurgia Oncológica, Ringgold Standard Institution, Rio de Janeiro, RJ, Brasil
- Universidade Federal de Juiz de Fora, Ringgold Standard Institution, Departamento de Oncologia, Juiz de Fora, MG, Brasil
| | - Rodrigo Nascimento Pinheiro
- Sociedade Brasileira de Cirurgia Oncológica, Ringgold Standard Institution, Rio de Janeiro, RJ, Brasil
- Hospital de Base do Distrito Federal, Ringgold Standard Institution, Cirurgia Oncológica, Brasília, DF, Brasil
| | - Heber Salvador de Castro Ribeiro
- Sociedade Brasileira de Cirurgia Oncológica, Ringgold Standard Institution, Rio de Janeiro, RJ, Brasil
- A.C.Camargo Cancer Center, Ringgold Standard Institution, Departamento de Cirurgia Abdominal, São Paulo, SP, Brasil
| |
Collapse
|
23
|
Gaujoux S, Gharios J, Avisse C, Renard Y, Hartl D. Extent of cervical lymph node dissection: Recommendations from the Francophone Association for Endocrine Surgery, the French Society of Endocrinology and the French Society of Nuclear Medicine. J Visc Surg 2023:S1878-7886(23)00078-4. [PMID: 37169713 DOI: 10.1016/j.jviscsurg.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
When metastatic ipsilateral central lymph nodes from thyroid cancer are identified pre- or intraoperatively (cN1a), ipsilateral central lymph node dissection should be performed concomitantly with thyroidectomy. When the patient is N1a on one side, contralateral prophylactic central lymph node dissection can also be considered. Prophylactic ipsilateral lymph dissection is not recommended. Ipsilateral compartment lymph node dissection is recommended in the corresponding sector for treatment of thyroid cancer with lymph node involvement (cN1b). Lymph node dissection can be limited to sectors III and IV when one of these sectors (or both) is involved and ultrasound does not demonstrate involvement of the other lateral sectors. Associated prophylactic lymph node dissection of sectors IIA and IIB is not recommended, while lymph node dissection of sector V (and exceptionally sector I) is indicated only when metastatic lymph nodes are proven. Prophylactic lymph node dissection of sector VB can be considered when positive lymph nodes are identified in sectors II, III and IV. When isolated metastatic lateral lymph nodes are identified (cN1b), prophylactic central (sector VI) lymph node dissection is recommended on the same side as the lateral compartment in addition to ipsilateral lateral lymph node compartment dissection. The level of evidence is insufficient to recommend prophylactic lateral lymph node dissection on the contralateral side for unilateral cN1b tumors. This type of lymph node dissection can be discussed for tumors that are at high risk of recurrence, bilateral tumors, in case of ipsilateral lateral lymph nodes > 3cm or in presence of > 4 metastatic lymph nodes in the central compartment.
Collapse
Affiliation(s)
- Sébastien Gaujoux
- Service de chirurgie générale, viscérale et endocrinienne, GH Pitié-Salpêtrière, AP-HP, Sorbonne université, 47-83, avenue de l'hôpital, 75013 Paris, France.
| | - Joseph Gharios
- Service de chirurgie générale, endocrinienne et métabolique, CHU La Conception, AP-HM, Aix Marseille université, Marseille, France
| | - Claude Avisse
- Service de chirurgie digestive et endocrinienne, hôpital Robert-Debré, université de Champagne Ardennes, Reims, France
| | - Yves Renard
- Service de chirurgie digestive et endocrinienne, hôpital Robert-Debré, université de Champagne Ardennes, Reims, France
| | - Dana Hartl
- Département d'anesthésie, de chirurgie et de radiologie interventionnelle, unité de chirurgie thyroïdienne, institut Gustave-Roussy, Villejuif, France
| |
Collapse
|
24
|
Wagner S, Langer C, Wuerdemann N, Reiser S, Abing H, Pons-Kühnemann J, Prigge ES, von Knebel Doeberitz M, Gattenlöhner S, Waterboer T, Schroeder L, Arens C, Klussmann JP, Wittekindt C. Predictors for Survival of Patients with Squamous Cell Carcinoma of Unknown Primary in the Head and Neck Region. Cancers (Basel) 2023; 15:cancers15072167. [PMID: 37046829 PMCID: PMC10093301 DOI: 10.3390/cancers15072167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/26/2023] [Accepted: 03/17/2023] [Indexed: 04/08/2023] Open
Abstract
Background: Human papillomavirus (HPV) status is the most important predictor of survival in oropharyngeal squamous cell carcinoma (OPSCC). In patients with cervical lymph node metastases of squamous cell carcinoma of unknown origin (CUPHNSCC), much less is known. Methods: We assessed a consecutive cohort of CUPHNSCC diagnosed from 2000–2018 for HPV DNA, mRNA, p16INK4a (p16) expression, and risk factors to identify prognostic classification markers. Results: In 32/103 (31%) CUPHNSCC, p16 was overexpressed, and high-risk HPV DNA was detected in 18/32 (56.3%). This was mostly consistent with mRNA detection. In recursive partitioning analysis, CUPHNSCC patients were classified into three risk groups according to performance status (ECOG) and p16. Principal component analysis suggests a negative correlation of p16, HPV DNA, and gender in relation to ECOG, as well as a correlation between N stage, extranodal extension, and tobacco/alcohol consumption. Conclusions: Despite obvious differences, CUPHNSCC shares similarities in risk profile with OPSCC. However, the detection of p16 alone appears to be more suitable for the classification of CUPHNSCC than for OPSCC and, in combination with ECOG, allows stratification into three risk groups. In the future, additional factors besides p16 and ECOG may become important in larger studies or cases with special risk profiles.
Collapse
Affiliation(s)
- Steffen Wagner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, 35392 Giessen, Germany
| | - Christine Langer
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, 35392 Giessen, Germany
| | - Nora Wuerdemann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, 35392 Giessen, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, 50937 Cologne, Germany
| | - Susanne Reiser
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, 35392 Giessen, Germany
| | - Helen Abing
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, 50937 Cologne, Germany
| | - Jörn Pons-Kühnemann
- Medical Statistics, Institute of Medical Informatics, University of Giessen, 35392 Giessen, Germany
| | - Elena-Sophie Prigge
- Department of Applied Tumor Biology, Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Applied Tumor Biology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Magnus von Knebel Doeberitz
- Department of Applied Tumor Biology, Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Applied Tumor Biology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | | | - Tim Waterboer
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Lea Schroeder
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, 35392 Giessen, Germany
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, 35392 Giessen, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, 50937 Cologne, Germany
| | - Claus Wittekindt
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, 35392 Giessen, Germany
- Department of Otorhinolaryngology, Klinikum Dortmund gGmbH, University Hospital Witten/Herdecke, 44137 Dortmund, Germany
| |
Collapse
|
25
|
Driessen DAJJ, Arens AIJ, Dijkema T, Weijs WLJ, Draaijer LC, van den Broek GB, Takes RP, Honings J, Kaanders JHAM. Sentinel node identification in laryngeal and pharyngeal carcinoma after flexible endoscopy-guided tracer injection under topical anesthesia: A feasibility study. Head Neck 2023; 45:1359-1366. [PMID: 36942817 DOI: 10.1002/hed.27347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/02/2023] [Accepted: 03/06/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the feasibility of flexible endoscopy-guided tracer injection for sentinel lymph node (SLN) identification in patients with laryngeal and pharyngeal carcinoma. METHODS Sixteen cT1-4N0-2M0 patients with laryngeal or pharyngeal carcinoma underwent intra- and peritumoral [99m Tc]Tc-nanocolloid injections after topical anesthesia under endoscopic guidance. SPECT-CT scans were performed at two time points. RESULTS Tracer injection and visualization of SLNs was successful in 15/16 (94%) patients. Median number of tracer injections was 1 intratumoral and 3 peritumoral. The median duration of the endoscopic procedure including tracer injection after biopsy taking was 7 min (range 4-16 min). A total of 28 SLNs were identified which were all visualized on the early and late SPECT-CT. Most SLNs were visualized in neck levels II and III. CONCLUSIONS Flexible endoscopy-guided tracer injection for SLN identification is a feasible and fast procedure in laryngeal and pharyngeal carcinoma patients.
Collapse
Affiliation(s)
- Daphne A J J Driessen
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anne I J Arens
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tim Dijkema
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Willem L J Weijs
- Department of Oral- and Maxillofacial Surgery and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lisette C Draaijer
- Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Johannes H A M Kaanders
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
26
|
Smith TO, Garrett A, Liu T, Morris A, Gallyer V, Fordham BA, Dutton SJ, Chester-Jones M, Lamb SE, Winter SC. Getting Recovery Right After Neck Dissection (GRRAND-F): Mixed-methods feasibility study to design a pragmatic randomised controlled trial. Front Oncol 2023; 13:1110500. [PMID: 37007098 PMCID: PMC10061058 DOI: 10.3389/fonc.2023.1110500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
ObjectiveTo determine the feasibility of a randomised controlled trial to estimate the effectiveness and cost-effectiveness of a rehabilitation intervention following neck dissection (ND) after head and neck cancer (HNC).DesignTwo-arm, open, pragmatic, parallel, multicentre, randomised controlled feasibility trial.SettingTwo UK NHS hospitals.ParticipantsPeople who had HNC in whom a ND was part of their care. We excluded those with a life expectancy of six months or less, pre-existing, long-term neurological disease affecting the shoulder and cognitive impairment.InterventionUsual care (standard care supplemented with a booklet on postoperative self-management) was received by all participants. The GRRAND intervention programme consisted of usual care plus up to six individual physiotherapy sessions including neck and shoulder range of motion and progressive resistance exercises, advice and education. Between sessions, participants were advised to complete a home exercise programme.Randomisation1:1 randomisation. Allocation was based on minimisation, stratified by hospital site and spinal accessory nerve sacrifice. It was not possible to mask treatment received.Main outcome measuresPrimary: Participant recruitment, retention and fidelity to the study protocol and interventions from study participants and staff at six months post-randomisation (and 12 months for those reaching that time-point). Secondary: clinical measures of pain, function, physical performance, health-related quality of life, health utilisation and adverse events.Results36 participants were recruited and enrolled. The study achieved five of its six feasibility targets. These included consent - 70% of eligible participants were consented; intervention fidelity - 78% participants discharged completed the intervention sessions; contamination - none - no participants in the control arm received the GRRAND-F intervention and retention - 8% of participants were lost to follow-up. The only feasibility target that was not achieved was the recruitment target where only 36 of the planned 60 participants were recruited over 18 months. This was principally due to the COVID-19 pandemic which caused all research activity to be paused or reduced, with a subsequent reduction in.ConclusionsBased on the findings a full-trial can now be designed to better understand whether this proposed intervention is effective.Clinical Trial Registrationhttps://www.isrctn.com/ISRCTN1197999, identifier ISRCTN11979997.
Collapse
Affiliation(s)
- Toby O. Smith
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Angela Garrett
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Tianshu Liu
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Alana Morris
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Victoria Gallyer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Bethany A. Fordham
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Susan J. Dutton
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Mae Chester-Jones
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Sarah E. Lamb
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Stuart Charles Winter
- Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
- Oxford Cancer Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- *Correspondence: Stuart Charles Winter,
| |
Collapse
|
27
|
Masuoka S, Hiyama T, Kuno H, Sekiya K, Sakashita S, Kobayashi T. Imaging Approach for Cervical Lymph Node Metastases from Unknown Primary Tumor. Radiographics 2023; 43:e220071. [PMID: 36795593 DOI: 10.1148/rg.220071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Neck swelling due to lymph node (LN) metastasis is one of the initial symptoms of head and neck cancer, and in some cases, the primary tumor is not clinically evident. The purpose of imaging for LN metastasis from an unknown primary site is to identify the primary tumor or detect its absence, which leads to the correct diagnosis and optimal treatment. The authors discuss diagnostic imaging approaches for identifying the primary tumor in cases of unknown primary cervical LN metastases. The distribution and characteristics of LN metastases may help locate the primary site. Unknown primary LN metastasis often occurs at nodal levels II and III, and in recent reports, these were mostly related to human papillomavirus (HPV)-positive squamous cell carcinoma of the oropharynx. Another characteristic imaging finding suggestive of metastasis from HPV-associated oropharyngeal cancer is a cystic change in LN metastases. Other characteristic imaging findings such as calcification may help predict the histologic type and locate the primary site. In cases of LN metastases at nodal levels IV and VB, a primary lesion located outside the head and neck region must also be considered. One clue for detecting the primary lesion at imaging is the disruption of anatomic structures, which can help in identifying small mucosal lesions or submucosal tumors at each subsite. Additionally, fluorine 18 fluorodeoxyglucose PET/CT may help identify a primary tumor. These imaging approaches for identifying primary tumors enable prompt identification of the primary site and assist clinicians in making the correct diagnosis. © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
Collapse
Affiliation(s)
- Sota Masuoka
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Takashi Hiyama
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Hirofumi Kuno
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Kotaro Sekiya
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Shingo Sakashita
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| | - Tatsushi Kobayashi
- From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan
| |
Collapse
|
28
|
Verde-Sánchez L, Capote AL, Sanz-García A, Brabyn P, Rodríguez-Campo FJ, Naval Gías L. Prognostic Involvement of Lymph Node Density in Oral Squamous Cell Carcinoma. A New Predictive Model. J Oral Maxillofac Surg 2023; 81:358-369. [PMID: 36502856 DOI: 10.1016/j.joms.2022.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 10/17/2022] [Accepted: 11/20/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Lymph node density (LND) has been reported to be a significant predictor of survival in oral squamous cell carcinoma (OSCC). The aim of this study was to analyze LND as a prognostic factor in OSCC and create a predictive model that determines the probability of death in these patients. METHODS A retrospective cohort study was carried out with a cohort of patients who underwent cervical dissection and primary resection of OSCC between 1980 and 2020. The primary predictor variable in this study was LND, which is defined as the number of positive lymph nodes divided by the total number of lymph nodes removed. The cutoff values for prediction of disease-specific survival (DSS) were calculated by receiver operating characteristic curve analysis, which determined the best cutoff value was 0.07. Patients were divided into binary subgroups (low and high risk) using the best cutoff value of LND. The outcome variable was DSS, defined as the duration from the date of diagnosis to death due to OSCC and not due to other causes or secondary tumors. Other variables were type of neck dissection, postsurgical treatment, surgical margin, pathological T category stage, pathological N category (pN) stage, extranodal extension, perineural invasion, bone invasion, and presence of recurrence. A predictive model (score) was generated by selecting variables using a log-rank test and by using the Cox proportional-hazards regression (multivariate analysis). RESULTS The sample consisted of 368 patients, 252 (68.5%) male and 116 (31.5%) female patients, with a mean age of 60.3 years. According to the LND cutoff value, there were 289 patients with a low LND (≤0.07) and 79 with a high LND (>0.07). The univariate analysis showed LND as a significant predictor of DSS at 5 years (67.1% in LND ≤ 0.07 vs 32.9% in LND > 0.07; P < .001). The Cox multivariate analysis identified LND (hazard ratio [HR] = 27.2; 95% confidence interval [CI], 3.18-231; P = .002), recurrence (HR = 4.45; 95% CI, 2.3-8.4; P < .001), and type of treatment (HR = 0.52; 95% CI, 0.34-0.81; P < .001) as independent predictive factors for DSS. In the predictive model, the presence of recurrence was the most important factor with 8 points, whereas LND >0.07 contributed only 1 point; however, the 2 categories resulting from this limit were statistically significant. CONCLUSIONS Our study demonstrates that LND is an additional prognostic factor in patients with a pN+ disease. In addition, our predictive model could be useful in the therapeutic algorithm of OSCC patients, as it can predict the probability of death in these patients.
Collapse
Affiliation(s)
- Laura Verde-Sánchez
- Resident, Oral and Maxillofacial Surgery Department, University Hospital ''La Princesa", Madrid, Spain.
| | - Ana-Laura Capote
- Consultant, Oral and Maxillofacial Surgery Department, University Hospital ''La Princesa", Madrid, Spain
| | - Ancor Sanz-García
- Research Associate, Data Analysis Unit, University Hospital ''La Princesa", Madrid, Spain
| | - Philip Brabyn
- Consultant, Oral and Maxillofacial Surgery Department, University Hospital ''La Princesa", Madrid, Spain
| | | | - Luis Naval Gías
- Department Head, Oral and Maxillofacial Surgery Department, University Hospital ''La Princesa", Madrid, Spain
| |
Collapse
|
29
|
Zhao J, Zeng W, Qiu C, Liu J, Li K, Huang J, Tong MCF, Zhang X. Protection of the marginal mandibular branches of the facial nerves by different surgical procedures in comprehensive cervical lymphadenectomy for locally advanced oral and oropharyngeal cancer: a multicenter experience. World J Surg Oncol 2023; 21:30. [PMID: 36721264 PMCID: PMC9887872 DOI: 10.1186/s12957-023-02913-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/12/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE According to the different characteristics of patients and cervical lymph node metastasis of oral and oropharyngeal cancer, the marginal mandibular branches of facial nerves were treated by different surgical procedures, and the safety and protective effects of different surgical procedures were investigated. METHODS One hundred ninety-seven patients with oral and oropharyngeal cancer satisfying the inclusion criteria were selected. According to the different characteristics of patients and cervical metastatic lymph nodes, three different surgical procedures were used to treat the marginal mandibular branches of the facial nerve: finding and exposing the marginal mandibular branches of the facial nerves at the mandibular angles of the platysma flaps, finding and exposing the marginal mandibular branches of facial nerves at the intersections of the distal ends of facial arteries and veins with the mandible, and not exposing the marginal mandibular branches of the facial nerves. The anatomical position, injury, and complications of the marginal mandibular branches of the facial nerves were observed. RESULTS The marginal mandibular branches of the facial nerves were found and exposed at the mandibular angles of the platysma flaps in 102 patients; the marginal mandibular branches of facial nerves were found and exposed at the intersections of the distal ends of the facial arteries and veins with the mandibles in 64 patients; the marginal mandibular branches of facial nerves were not exposed in 31 patients; among them, four patients had permanent injury of the marginal mandibular branches of the facial nerves, and temporary injury occurred in seven patients. There were statistically significant differences in the protection of the mandibular marginal branch of the facial nerve among the three different surgical methods (P = 0.0184). The best protective effect was to find and expose the mandibular marginal branch of the facial nerve at the mandibular angle of the platysma muscle flap, and the injury rate was only 2.94%. CONCLUSION The three different surgical procedures were all safe and effective in treating the marginal mandibular branches of the facial nerves, the best protective effect was to find and expose the mandibular marginal branch of the facial nerve at the mandibular angle of the platysma muscle flap.
Collapse
Affiliation(s)
- Jiuzhou Zhao
- Department of Otolaryngology, Longgang E.N.T Hospital & Shenzhen Key Laboratory of E.N.T, Institute of E.N.T Shenzhen, Guangdong Province, No.3004, Longgang Avenue, Shenzhen, People’s Republic of China
| | - Wen Zeng
- Department of Head and Neck, Tumor Hospital of Ganzhou, Ganzhou, Jiangxi Province People’s Republic of China
| | - Chengyu Qiu
- Department of Oral and Maxillofacial Surgery, First Hospital of Qiqihaer City, Heilongjiang Province, Qiqihaer, People’s Republic of China
| | - Jiafeng Liu
- grid.452437.3Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi Province People’s Republic of China
| | - Ke Li
- Department of Otolaryngology, Longgang E.N.T Hospital & Shenzhen Key Laboratory of E.N.T, Institute of E.N.T Shenzhen, Guangdong Province, No.3004, Longgang Avenue, Shenzhen, People’s Republic of China
| | - Jing Huang
- Department of Institute of Cancer Research, Tumor Hospital of Ganzhou, Ganzhou, Jiangxi Province People’s Republic of China
| | - Michael C. F. Tong
- grid.10784.3a0000 0004 1937 0482Department of Otorhinolaryngology, Head & Neck Surgery, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, People’s Republic of China
| | - Xiangmin Zhang
- Department of Otolaryngology, Longgang E.N.T Hospital & Shenzhen Key Laboratory of E.N.T, Institute of E.N.T Shenzhen, Guangdong Province, No.3004, Longgang Avenue, Shenzhen, People’s Republic of China
| |
Collapse
|
30
|
Central Compartment Neck Dissection in Laryngeal and Hypopharyngeal Squamous Cell Carcinoma: Clinical Considerations. Cancers (Basel) 2023; 15:cancers15030804. [PMID: 36765762 PMCID: PMC9913832 DOI: 10.3390/cancers15030804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 02/01/2023] Open
Abstract
Metastatic lymph node involvement represents the most relevant prognostic factor in head and neck squamous cell carcinomas (HNSCCs), invariably affecting overall survival, disease-specific survival, and relapse-free survival. Among HNSCCs, laryngeal and hypopharyngeal cancers are known to be at highest risk to metastasize to the central neck compartment (CNC). However, prevalence and prognostic implications related to the CNC involvement are not well defined yet, and controversies still exist regarding the occult metastasis rate. Guidelines for the management of CNC in laryngeal and hypopharyngeal cancers are vague, resulting in highly variable selection criteria for the central neck dissection among different surgeons and institutions. With this review, the authors intend to reappraise the existing data related to the involvement of CNC in laryngeal and hypopharyngeal malignancies, in the attempt to define the principles of management while highlighting the debated aspects that are lacking in evidence and consensus. Furthermore, as definition and boundaries of the CNC have changed over the years, an up-to-date anatomical-surgical description of the CNC is provided.
Collapse
|
31
|
Grasl S, Janik S, Faisal M, Grasl MC, Pammer J, Weinreb I, Fischer G, Kim J, Hosni A, de Almeida JR, Goldstein DP, Erovic BM. Influence of Grading on Management and Outcome in Mucoepidermoid Carcinoma of the Parotid-A Multi-institutional Analysis. Laryngoscope 2023; 133:124-132. [PMID: 35475580 DOI: 10.1002/lary.30135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate clinical outcome of low (G1), intermediate (G2), and high-(G3) grade mucoepidermoid carcinomas (MEC) of the parotid gland. STUDY DESIGN Retrospective chart review including 212 patients. Clinicopathological data was statistically analyzed regarding grading, overall survival (OS), disease-free survival (DFS) and disease-specific survival (DSS). RESULTS 105 (49.5%) G1, 73 (34.5%) G2, and 34 (16%) G3 MEC were included and 56 (26.4%) patients presented with neck node metastases. The risk of occult nodal metastases was significantly associated with grading and increased from 9.2% in G1 to 26.7% and 27.8% in G2 and G3 tumors, respectively (p = 0.008). Elective periparotid and cervical lymph node dissection was performed in 170 (80.2%) and 70 (33%) patients, respectively. All patients with positive periparotid nodes when subjected to an additional neck dissection had associated cervical neck node involvement (p < 0.001). Grading was an independent significant prognostic factor for OS (HR 4.05; 95%CI: 1.15-14.35; p = 0.030) and DSS (HR 17.35; 95%CI: 1.10-273.53; p = 0.043). In a subgroup analysis, elective neck dissection (END) was also significantly associated with a better DFS (p = 0.041) in neck node-negative G1 MECs. CONCLUSION The risk of occult nodal metastasis in intermediate-grade MEC is as high as in high-grade MEC and that END in G1 tumors is associated with a prolonged DFS. Additionally, periparotid node involvement seems to be a predictor for positive neck node involvement. This study presents some preliminary data to consider END in clinically neck node negative patients with parotid MEC; however, larger series are needed. LEVEL OF EVIDENCE 3 Laryngoscope, 133:124-132, 2023.
Collapse
Affiliation(s)
- Stefan Grasl
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Janik
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Muhammad Faisal
- Department of Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.,Institute of Head and Neck Diseases, Evangelical Hospital, Vienna, Austria
| | - Matthaeus C Grasl
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Johannes Pammer
- Clinical Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Ilan Weinreb
- Department of Pathology, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Gregor Fischer
- Department of Otolaryngology, Karl Landsteiner University Hospital, Krems, Austria
| | - John Kim
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Boban M Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital, Vienna, Austria
| |
Collapse
|
32
|
Van den Broeck J, Sealy MJ, Brussaard C, Kooijman J, Jager-Wittenaar H, Scafoglieri A. The correlation of muscle quantity and quality between all vertebra levels and level L3, measured with CT: An exploratory study. Front Nutr 2023; 10:1148809. [PMID: 36908909 PMCID: PMC9996002 DOI: 10.3389/fnut.2023.1148809] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/10/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction In patients with cancer, low muscle mass has been associated with a higher risk of fatigue, poorer treatment outcomes, and mortality. To determine body composition with computed tomography (CT), measuring the muscle quantity at the level of lumbar 3 (L3) is suggested. However, in patients with cancer, CT imaging of the L3 level is not always available. Thus far, little is known about the extent to which other vertebra levels could be useful for measuring muscle status. In this study, we aimed to assess the correlation of the muscle quantity and quality between any vertebra level and L3 level in patients with various tumor localizations. Methods Two hundred-twenty Positron Emission Tomography (PET)-CT images of patients with four different tumor localizations were included: 1. head and neck (n = 34), 2. esophagus (n = 45), 3. lung (n = 54), and 4. melanoma (n = 87). From the whole body scan, 24 slices were used, i.e., one for each vertebra level. Two examiners contoured the muscles independently. After contouring, muscle quantity was estimated by calculating skeletal muscle area (SMA) and skeletal muscle index (SMI). Muscle quality was assessed by calculating muscle radiation attenuation (MRA). Pearson correlation coefficient was used to determine whether the other vertebra levels correlate with L3 level. Results For SMA, strong correlations were found between C1-C3 and L3, and C7-L5 and L3 (r = 0.72-0.95). For SMI, strong correlations were found between the levels C1-C2, C7-T5, T7-L5, and L3 (r = 0.70-0.93), respectively. For MRA, strong correlations were found between T1-L5 and L3 (r = 0.71-0.95). Discussion For muscle quantity, the correlations between the cervical, thoracic, and lumbar levels are good, except for the cervical levels in patients with esophageal cancer. For muscle quality, the correlations between the other levels and L3 are good, except for the cervical levels in patients with melanoma. If visualization of L3 on the CT scan is absent, the other thoracic and lumbar vertebra levels could serve as a proxy to measure muscle quantity and quality in patients with head and neck, esophageal, lung cancer, and melanoma, whereas the cervical levels may be less reliable as a proxy in some patient groups.
Collapse
Affiliation(s)
- Jona Van den Broeck
- Experimental Anatomy Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Martine J Sealy
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Carola Brussaard
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jasmijn Kooijman
- Department of Medical Imaging and Radiation Therapy, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Harriët Jager-Wittenaar
- Experimental Anatomy Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands.,Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Aldo Scafoglieri
- Experimental Anatomy Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
33
|
Margin Free Resection Achieves Excellent Long Term Outcomes in Parathyroid Cancer. Cancers (Basel) 2022; 15:cancers15010199. [PMID: 36612195 PMCID: PMC9818355 DOI: 10.3390/cancers15010199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
Long-term outcomes of parathyroid cancer remain poorly documented and unsatisfactory. This cohort includes 25 consecutive parathyroid cancer patients with median follow-up of 10.7 years (range 4.1−26.5 years). Pre-operative work-up in the center identified a suspicion of parathyroid cancer in 17 patients. En bloc resection, including the recurrent laryngeal nerve in 4/17 (23.5%), achieved cancer-free resection margins (R0) in 82.4% and lasting loco-regional disease control in 94.1%. Including patients referred after initial surgery elsewhere, R0 resection was achieved in merely 17/25 (68.0%) of patients. Cancer-positive margins (R1) in 8 patients led to local recurrence in 50%. On multivariate analysis, only margin status prevailed as independent predictor of recurrence free survival (χ2 19.5, p < 0.001). Local excision alone carried a 3.5-fold higher risk of positive margins than en bloc resection (CI95: 1.1−11.3; p = 0.03), and a 6.4-fold higher risk of locoregional recurrence (CI95: 0.8−52.1; p = 0.08). R1-status was associated with an 18.0-fold higher risk of recurrence and redo surgery (CI95: 1.1−299.0; p = 0.04), and a 22.0-fold higher probability of radiation (CI95: 1.4−355.5; p = 0.03). In patients at risk, adjuvant radiation reduced the actuarial risk of locoregional recurrence (p = 0.05). When pre-operative scrutiny resulted in upfront oncological surgery achieving cancer free margins, it afforded 100% recurrence free survival at 5- and 10-year follow-up, whilst failure to achieve clear margins caused significant burden by outpatient admissions (176 vs. 4 days; χ2 980, p < 0.001) and exposure to causes for concern (1369 vs. 0 days; χ2 11.3, p = 0.003). Although limited by cohort size, our study emphasizes the paradigm of getting it right the first time as key to improve survivorship in a cancer with excellent long-term prognosis.
Collapse
|
34
|
Xu X, Xi L, Wei L, Wu L, Xu Y, Liu B, Li B, Liu K, Hou G, Lin H, Shao Z, Su K, Shang Z. Deep learning assisted contrast-enhanced CT-based diagnosis of cervical lymph node metastasis of oral cancer: a retrospective study of 1466 cases. Eur Radiol 2022; 33:4303-4312. [PMID: 36576543 PMCID: PMC9795159 DOI: 10.1007/s00330-022-09355-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/23/2022] [Accepted: 11/29/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Lymph node (LN) metastasis is a common cause of recurrence in oral cancer; however, the accuracy of distinguishing positive and negative LNs is not ideal. Here, we aimed to develop a deep learning model that can identify, locate, and distinguish LNs in contrast-enhanced CT (CECT) images with a higher accuracy. METHODS The preoperative CECT images and corresponding postoperative pathological diagnoses of 1466 patients with oral cancer from our hospital were retrospectively collected. In stage I, full-layer images (five common anatomical structures) were labeled; in stage II, negative and positive LNs were separately labeled. The stage I model was innovatively employed for stage II training to improve accuracy with the idea of transfer learning (TL). The Mask R-CNN instance segmentation framework was selected for model construction and training. The accuracy of the model was compared with that of human observers. RESULTS A total of 5412 images and 5601 images were labeled in stage I and II, respectively. The stage I model achieved an excellent segmentation effect in the test set (AP50-0.7249). The positive LN accuracy of the stage II TL model was similar to that of the radiologist and much higher than that of the surgeons and students (0.7042 vs. 0.7647 (p = 0.243), 0.4216 (p < 0.001), and 0.3629 (p < 0.001)). The clinical accuracy of the model was highest (0.8509 vs. 0.8000, 0.5500, 0.4500, and 0.6658 of the Radiology Department). CONCLUSIONS The model was constructed using a deep neural network and had high accuracy in LN localization and metastasis discrimination, which could contribute to accurate diagnosis and customized treatment planning. KEY POINTS • Lymph node metastasis is not well recognized with modern medical imaging tools. • Transfer learning can improve the accuracy of deep learning model prediction. • Deep learning can aid the accurate identification of lymph node metastasis.
Collapse
Affiliation(s)
- Xiaoshuai Xu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Linlin Xi
- School of Computer Science, Wuhan University, 299 Bayi Road, Wuhan, 430072, Hubei, China
| | - Lili Wei
- Department of Radiology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Luping Wu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yuming Xu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Bailve Liu
- School of Computer Science, Wuhan University, 299 Bayi Road, Wuhan, 430072, Hubei, China
| | - Bo Li
- Department of Radiology, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Ke Liu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Oral and Maxillofacial Head Neck Surgery, School & Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, Hubei, China
| | - Gaigai Hou
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Hao Lin
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Zhe Shao
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Department of Oral and Maxillofacial Head Neck Surgery, School & Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, Hubei, China.
| | - Kehua Su
- School of Computer Science, Wuhan University, 299 Bayi Road, Wuhan, 430072, Hubei, China.
| | - Zhengjun Shang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
- Department of Oral and Maxillofacial Head Neck Surgery, School & Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, 430079, Hubei, China.
| |
Collapse
|
35
|
Jovanovic N, Chinnery T, Mattonen SA, Palma DA, Doyle PC, Theurer JA. Sarcopenia in head and neck cancer: A scoping review. PLoS One 2022; 17:e0278135. [PMID: 36441690 PMCID: PMC9704631 DOI: 10.1371/journal.pone.0278135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES In those undergoing treatment for head and neck cancer (HNC), sarcopenia is a strong prognostic factor for outcomes and mortality. This review identified working definitions and methods used to objectively assess sarcopenia in HNC. METHOD The scoping review was performed in accordance with Arksey and O'Malley's five-stage methodology and the Joanna Briggs Institute guidelines. INFORMATION SOURCES Eligible studies were identified using MEDLINE, Embase, Scopus, Cochrane Library, and CINAHL databases. STUDY SELECTION Inclusion criteria represented studies of adult HNC patients in which sarcopenia was listed as an outcome, full-text articles written in English, and empirical research studies with a quantitative design. DATA EXTRACTION Eligible studies were assessed using a proprietary data extraction form. General information, article details and characteristics, and details related to the concept of the scoping review were extracted in an iterative process. RESULTS Seventy-six studies published internationally from 2016 to 2021 on sarcopenia in HNC were included. The majority were retrospective (n = 56; 74%) and the prevalence of sarcopenia ranged from 3.8% to 78.7%. Approximately two-thirds of studies used computed tomography (CT) to assess sarcopenia. Skeletal muscle index (SMI) at the third lumbar vertebra (L3) (n = 53; 70%) was the most prevalent metric used to identify sarcopenia, followed by SMI at the third cervical vertebra (C3) (n = 4; 5%). CONCLUSIONS Currently, the most effective strategy to assess sarcopenia in HNC depends on several factors, including access to resources, patient and treatment characteristics, and the prognostic significance of outcomes used to represent sarcopenia. Skeletal muscle mass (SMM) measured at C3 may represent a practical, precise, and cost-effective biomarker for the detection of sarcopenia. However, combining SMM measurements at C3 with other sarcopenic parameters-including muscle strength and physical performance-may provide a more accurate risk profile for sarcopenia assessment and allow for a greater understanding of this condition in HNC.
Collapse
Affiliation(s)
- Nedeljko Jovanovic
- Health and Rehabilitation Sciences, Western University, London, ON, Canada
- * E-mail:
| | - Tricia Chinnery
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Sarah A. Mattonen
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - David A. Palma
- London Health Sciences Centre, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Philip C. Doyle
- Division of Laryngology, Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Julie A. Theurer
- Health and Rehabilitation Sciences, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Department of Otolaryngology–Head and Neck Surgery, London, ON, Canada
- School of Communication Sciences and Disorders, Elborn College, Western University, London, ON, Canada
| |
Collapse
|
36
|
Muacevic A, Adler JR, Sayed Z. Perifacial Lymph Node Metastasis After Treatment of Oropharyngeal Primary Malignancy: A Case Report. Cureus 2022; 14:e31332. [PMID: 36514564 PMCID: PMC9741130 DOI: 10.7759/cureus.31332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 11/12/2022] Open
Abstract
With the rate of oropharyngeal cancer on the rise, appropriate surgical management is an increasingly important consideration. Much debate currently exists regarding the necessary extent of neck dissections when performing curative surgery for primary oropharyngeal malignancies. Here, we present the case of a 64-year-old patient with p16+ T1N1M0 squamous cell carcinoma (SCC) of the right tonsil. Approximately four years following transoral robotic surgery oropharyngectomy and ipsilateral level II-IV right selective neck dissection, metastatic SCC was discovered on fine-needle aspiration biopsy of a right perifacial lymph node (level Ib). The patient then underwent a revision right neck dissection at levels Ia and Ib. Adjuvant immunotherapy was recommended following revision neck dissection. Postoperative imaging and flexible laryngoscopy three months after surgery were not concerning for cervical lymphadenopathy or oropharyngeal lesions. Although rare, physicians must maintain a healthy level of suspicion for recurrence to level Ib in oropharyngeal primary malignancies.
Collapse
|
37
|
D'Aco LF, Cagnoni L, Murè C, Piazza A, Aresi G, Panciera DT. Surgical Use of Supraclavicular Artery Flap for Head and Neck Cancer Defects Repair: Personal Experience. Int Arch Otorhinolaryngol 2022; 27:e117-e122. [PMID: 36714897 PMCID: PMC9879638 DOI: 10.1055/s-0042-1744169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 01/26/2022] [Indexed: 02/01/2023] Open
Abstract
Introduction For a long time, major surgical defects after oncological surgery have always been challenging cases for surgeons in terms of wound healing and covering technique. Objectives To demonstrate the feasibility of supraclavicular artery flap (SCAF) in the reconstruction of surgical defects in those "fragile" patients undergoing oncological surgery who could not possibly have endured the timeframes involved in using microvascular free flaps. Methods Between January 2018 and January 2019, at the Azienda Socio Sanitaria Territoriale (ASST) Bergamo Est Hospital (Bergamo, Italy), we reported the cases of 11 patients in whom the SCAF was used for surgical reconstruction after oncological surgery in our Otolaryngology Department. The median age of the 11 patients was 68.7 years old. Results The SCAF has proved, in almost all 11 cases in which it was used, to be very reliable and, above all, easy and quick to make in those "fragile" patients without the need for further intervention. There was only one case in which the resection involved the auricle entirely and a small area of perimeatal bone exposure occurred, which, anyway, healed by secondary intention. Conclusion The SCAF is an extremely versatile flap for head and neck surgery to be considered especially for fragile and vulnerable patients who cannot undergo prolonged surgical time. Moreover, this technique has also shown high feasibility in small hospitals where there is not a plastic surgery department and the surgeon may face the difficulty of practicing surgical reconstruction after enlarged resection.
Collapse
Affiliation(s)
- Luigi Filippo D'Aco
- Department of Otorhinolaryngology, Azienda Socio Sanitaria Territoriale (ASST) Bergamo Est, Hospital Bolognini, Seriate (BG), Italy,Address for correspondence Laura Cagnoni medical doctor, Azienda Socio Sanitaria Territoriale (ASST) Bergamo est – Hospital “Bolognini,” Department of OtorhinolaryngologyVia Paderno 21, 24068, Seriate (BG)Italy
| | - Laura Cagnoni
- Department of Otorhinolaryngology, Azienda Socio Sanitaria Territoriale (ASST) Bergamo Est, Hospital Bolognini, Seriate (BG), Italy,Address for correspondence Laura Cagnoni medical doctor, Azienda Socio Sanitaria Territoriale (ASST) Bergamo est – Hospital “Bolognini,” Department of OtorhinolaryngologyVia Paderno 21, 24068, Seriate (BG)Italy
| | - Carmelo Murè
- Department of Otorhinolaryngology, Azienda Socio Sanitaria Territoriale (ASST) Bergamo Est, Hospital Bolognini, Seriate (BG), Italy,Address for correspondence Laura Cagnoni medical doctor, Azienda Socio Sanitaria Territoriale (ASST) Bergamo est – Hospital “Bolognini,” Department of OtorhinolaryngologyVia Paderno 21, 24068, Seriate (BG)Italy
| | - Alessandro Piazza
- Department of Otorhinolaryngology, Azienda Socio Sanitaria Territoriale (ASST) Bergamo Est, Hospital Bolognini, Seriate (BG), Italy,Address for correspondence Laura Cagnoni medical doctor, Azienda Socio Sanitaria Territoriale (ASST) Bergamo est – Hospital “Bolognini,” Department of OtorhinolaryngologyVia Paderno 21, 24068, Seriate (BG)Italy
| | - Giuseppe Aresi
- Department of Otorhinolaryngology, Azienda Socio Sanitaria Territoriale (ASST) Bergamo Est, Hospital Bolognini, Seriate (BG), Italy,Address for correspondence Laura Cagnoni medical doctor, Azienda Socio Sanitaria Territoriale (ASST) Bergamo est – Hospital “Bolognini,” Department of OtorhinolaryngologyVia Paderno 21, 24068, Seriate (BG)Italy
| | - Davide Thomas Panciera
- Department of Otorhinolaryngology, Azienda Socio Sanitaria Territoriale (ASST) Bergamo Est, Hospital Bolognini, Seriate (BG), Italy,Address for correspondence Laura Cagnoni medical doctor, Azienda Socio Sanitaria Territoriale (ASST) Bergamo est – Hospital “Bolognini,” Department of OtorhinolaryngologyVia Paderno 21, 24068, Seriate (BG)Italy
| |
Collapse
|
38
|
Marcuzzo AV, Sacchet E, Capriotti V, Gardenal N, Boscolo-Rizzo P, Chepeha DB, Tirelli G. Italian validation of the Neck Dissection Impairment Index questionnaire. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:230-236. [PMID: 35880363 PMCID: PMC9330753 DOI: 10.14639/0392-100x-n2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022]
|
39
|
Level IV neck dissection in cN0 HPV-negative oropharyngeal squamous cell carcinoma: a retrospective cohort study. BMC Cancer 2022; 22:535. [PMID: 35549914 PMCID: PMC9097444 DOI: 10.1186/s12885-022-09609-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As opposed to observation of the neck, elective neck dissection has a survival benefit for cN0 oropharyngeal squamous cell carcinoma (OPSCC). However, there are limited date on level IV neck dissection in human papillomavirus (HPV)-negative OPSCC because most earlier studies did not stratify by P16 or HPV status. Thus, whether to exclude level IV from selective dissection (SND) of cN0 HPV-negative OPSCC remains controversial. METHODS In this single-center retrospective cohort study, disease-free survival (DFS) was estimated as the primary endpoint for 124 cN0 HPV-negative OPSCC patients who received SND of levels I-III (Group A) and I-IV (Group B). Overall survival (OS) and disease-specific survival (DSS) were considered secondary endpoints. RESULTS For the entire cohort, the 5-year DFS rates of Groups A and B were 55.0% and 60.1%, respectively. Five-year OS rates were 58.9% and 61.5%, and 5-year DSS rates were 74.0% and 64.8%, respectively. Group B did not show higher 5-year DFS, OS, or DSS than Group A. CONCLUSIONS This retrospective cohort study validated that in cN0 HPV-negative OPSCC, SND including level IV does not have substantial benefits regarding DFS, OS or DSS.
Collapse
|
40
|
Papillary thyroid cancer: the value of bilateral diagnostic lymphadenectomy. Langenbecks Arch Surg 2022; 407:2059-2066. [PMID: 35301585 PMCID: PMC9399002 DOI: 10.1007/s00423-022-02493-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/09/2022] [Indexed: 11/04/2022]
Abstract
Purpose Papillary thyroid carcinoma (PTC) spreads early to lymph nodes (LN). However, prophylactic central (CND) and lateral neck dissection (LND) is controversially discussed in patients with clinically negative nodes (cN0). The preoperative prediction of LN metastasis is desirable as re-operation is associated with higher morbidity and poor prognosis. The study aims to analyse possible benefits of a systemic bilateral diagnostic lateral lymphadenectomy (DLL) for intraoperative LN staging. Methods Preoperative prediction of LN metastasis by conventional ultrasound (US) was correlated with the results of DLL and intra-/postoperative complications in 118 consecutive patients with PTC (cN0) undergoing initial thyroidectomy and bilateral CND and DLL. Results Lateral LNs (pN1b) were positive in 43/118 (36.4%) patients, including skip lesions (n = 6; 14.0%). Preoperative US and intraoperative DLL suspected lateral LN metastasis in 19/236 (TP: 8.1%) and 54/236 (TP: 22.9%) sides at risk, which were confirmed by histology. Sixty-seven out of 236 (FN: 28.4%) and 32/236 (FN: 13.6%) sides at risk with negative preoperative US and intraoperative DLL lateral LN metastasis were documented. DLL was significantly superior compared to US regarding sensitivity (62.8% vs 22.1%; p < 0.002), positive predictive value (100% vs 76.0%), negative predictive value (82.4% vs 68.2%), and accuracy (86.4% vs 69.1%), but not specificity (100% vs 96.0%; p = 0.039). DLL-related complications (haematoma) occurred in 6/236 [2.5%] sides at risk, including chylous fistula in 2/118 [1.7%] patients. Conclusion DLL can be recommended for LN staging during initial surgery in patients with PTC to detect occult lateral LN metastasis not suspected by US in order to plan lateral LN dissection.
Collapse
|
41
|
Level IIb neck dissection guided by fine-needle aspiration for N1b papillary thyroid carcinoma. Surg Oncol 2022; 40:101705. [DOI: 10.1016/j.suronc.2021.101705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/14/2021] [Accepted: 12/28/2021] [Indexed: 11/22/2022]
|
42
|
Factors Influencing Quality of Life in Survivors of Head and Neck Cancer: A Preliminary Study. Semin Oncol Nurs 2022; 38:151256. [DOI: 10.1016/j.soncn.2022.151256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 11/19/2022]
|
43
|
Liu S, Lu H, Liu L, Wu Y, Zhu Y, Xu W, Yang W, Zhang C. Carcinoma ex pleomorphic adenoma of the submandibular gland: a retrospective analysis of 86 patients. Oral Dis 2022; 29:1602-1612. [PMID: 35199423 DOI: 10.1111/odi.14168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 02/03/2022] [Accepted: 02/19/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the prognostic and locoregional metastatic features of carcinoma ex pleomorphic adenoma of submandibular gland (SMG-CXPA) and improve the understanding of this uncommon condition. PATIENTS AND METHODS We retrospectively reviewed patients who were diagnosed with SMG-CXPA. The survival data of SMG-CXPA patients were statistically analyzed using Cox regression and Kaplan-Meier method. The associations between cervical metastasis and clinicopathological parameters were evaluated using chi-squared test. Additionally, two different histological categories (histological grade and invasiveness) and their combination were evaluated with the Kaplan-Meier method and receiver operating characteristic curves. RESULTS In total, 86 patients were diagnosed: 38 clinically node-negative, 31 pathologically node-negative and 17 node-positive patients. Clinical tumor stage and histological grade were two independent prognostic factors for SMG-CXPA. There were significant correlations between sex, tumor size, clinical tumor stage, clinical lymph node stage, histological grade, invasiveness, malignant components, perineural invasion and no specific criteria exist for the clinical outcome. CONCLUSION SMG-CXPA is a high-grade malignancy with an unfavorable prognosis. Elective neck dissection should be performed in SMG-CXPA patients with a risk of locoregional metastasis. Histological grade seems to be a more valuable predictor of lymph node involvement than invasiveness.
Collapse
Affiliation(s)
- Shengwen Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Hao Lu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Limin Liu
- Department of Oral Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, 200011, China
| | - Yifan Wu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Yun Zhu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Wanlin Xu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Wenjun Yang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Chenping Zhang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, 200011, China
| |
Collapse
|
44
|
Witek ME, Woody NM, Musunuru HB, Hill PM, Yadav P, Burr AR, Ko HC, Ross RB, Kimple RJ, Harari PM. Defining high-risk elective contralateral neck radiation volumes for oropharynx cancer. Head Neck 2022; 44:317-324. [PMID: 34761832 PMCID: PMC9723806 DOI: 10.1002/hed.26924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/22/2021] [Accepted: 10/26/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND To define the location of the initial contralateral lymph node (LN) metastasis in patients with oropharynx cancer. METHODS The location of the LN centroids from patients with oropharynx cancer and a single radiographically positive contralateral LN was defined. A clinical target volume (CTV) inclusive of all LN centroids was created, and its impact on dose to organs at risk was assessed. RESULTS We identified 55 patients of which 49/55 had a single contralateral LN in level IIA, 4/55 in level III, 1/55 in level IIB, and 1/55 in the retropharynx. Mean radiation dose to the contralateral parotid gland was 15.1 and 21.0 Gy, (p <0.001) using the modeled high-risk elective CTV and a consensus CTV, respectively. CONCLUSIONS We present a systematic approach for identifying the contralateral nodal regions at highest risk of harboring subclinical disease in patients with oropharynx cancer that warrants prospective clinical study.
Collapse
Affiliation(s)
- Matthew E. Witek
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Carbone Cancer Center, Madison, WI,Department of Radiation Oncology, University of Maryland, School of Medicine, MD
| | - Neil M. Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland OH, USA
| | - Hima B. Musunuru
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Patrick M. Hill
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Carbone Cancer Center, Madison, WI
| | - Poonam Yadav
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Carbone Cancer Center, Madison, WI
| | - Adam R. Burr
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Carbone Cancer Center, Madison, WI
| | - Huaising C. Ko
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Carbone Cancer Center, Madison, WI
| | - Richard B. Ross
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Randall J. Kimple
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Carbone Cancer Center, Madison, WI
| | - Paul M. Harari
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Carbone Cancer Center, Madison, WI
| |
Collapse
|
45
|
Rago T, Vitti P. Risk Stratification of Thyroid Nodules: From Ultrasound Features to TIRADS. Cancers (Basel) 2022; 14:cancers14030717. [PMID: 35158985 PMCID: PMC8833686 DOI: 10.3390/cancers14030717] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Thyroid nodules are a frequent clinical issue. Their incidence has increased mainly due to the widespread use of neck ultrasound scans. Most thyroid nodules are asymptomatic, incidentally discovered, and benign at cytology. Thyroid ultrasound is the most sensitive diagnostic tool to evaluate patients with nodular thyroid disease. It is therefore important to use the ultrasound features to select nodules that require a fine-needle aspiration cytology. Abstract Thyroid nodules are common in iodine deficient areas, in females, and in patients undergoing neck irradiation. High-resolution ultrasonography (US) is important for detecting and evaluating thyroid nodules. US is used to determine the size and features of thyroid nodules, as well as the presence of neck lymph node metastasis. It also facilitates guided fine-needle aspiration (US-FNA). The most consistent US malignancy features of thyroid nodules are spiculated margins, microcalcifications, a taller-than-wide shape, and marked hypoechogenicity. Increased nodular vascularization is not identified as a predictor of malignancy. Thyroid elastosonography (USE) is also used to characterize thyroid nodules. In fact, a low elasticity of nodules at USE has been related to a higher risk of malignancy. According to their US features, thyroid nodules can be stratified into three categories: low-, intermediate-, and high-risk nodules. US-FNA is suggested for intermediate and high-risk nodules.
Collapse
|
46
|
Management of lateral neck nodes in common and aggressive variants of thyroid cancer. Curr Opin Otolaryngol Head Neck Surg 2022; 30:130-136. [DOI: 10.1097/moo.0000000000000790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
47
|
Zhai Y, Ruan L. The Necessity of Lymph Node Dissection Between Sternocleidomastoid and Sternohyoid Muscles in pN1b Papillary Thyroid Carcinoma. Front Endocrinol (Lausanne) 2022; 13:865621. [PMID: 35547002 PMCID: PMC9082312 DOI: 10.3389/fendo.2022.865621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the association between clinicopathologic variables and metastasis of the lymph node (LN) between the sternocleidomastoid and sternohyoid muscles (LNSS) to clarify the necessity of LNSS dissection in papillary thyroid carcinomas (PTCs). METHODS A total of 219 patients undergoing unilateral or bilateral neck dissection for PTCs were prospectively enrolled. The associations between clinicopathologic variables and LNSS metastasis were evaluated by univariate and multivariate analyses. RESULTS LNSS was present in 108 (40.1%) neck dissection samples and in 76 (34.7%) patients. Positive LNSS occurred in 40/269 (14.9%) neck dissection samples and in 20/219 (9.1%) patients. Univariate analysis showed that tumor stage, number of positive nodes in level III, and number of positive nodes in level IV were related to LNSS metastasis. Multivariate analysis confirmed that T3/4 stage tumors and >2 positive LNs in level IV independently increased the risk of LNSS metastasis. CONCLUSIONS The low rate of LNSS metastasis would deem routine dissection unnecessary; however, LNSS would require excision if advanced stage tumors or level IV LN metastasis were present.
Collapse
|
48
|
Grillo VTRDS, Jaldin RG, Bertanha M, Sobreira ML, Soares CSP, Camargo PABD. O que fazer quando o câncer de tireoide avançado invade a artéria carótida? Desafio terapêutico. J Vasc Bras 2022; 21:e20210220. [PMID: 36187221 PMCID: PMC9499725 DOI: 10.1590/1677-5449.202102201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022] Open
Abstract
Of all thyroid cancers, anaplastic thyroid carcinoma (ATC) has the lowest incidence and worst prognosis. In this report, we describe a 64-year-old female patient who underwent total thyroidectomy and level VI neck dissection for papillary thyroid carcinoma. During follow-up, she showed signs of regional recurrence and underwent extended neck dissection and cervical esophagectomy. Intraoperatively, there was no cleavage plane between the tumor and the common carotid artery (CCA), so a carotid shunt was implanted and en bloc resection, including the affected CCA and esophagus segments was performed followed by vascular bypass with interposition of a great saphenous vein graft. A pathology review found evidence of anaplastic carcinoma. The patient underwent adjuvant treatment and has no signs of locoregional recurrence. Presented with the possibility of carrying out curative surgery with en bloc resection, the vascular surgeon must be prepared for the surgical options.
Collapse
|
49
|
Wan SM. Gamma camera imaging of sentinel lymph nodes in early stage oral cancer. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00148-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
50
|
Grillo VTRDS, Jaldin RG, Bertanha M, Sobreira ML, Soares CSP, Camargo PABD. What to do when advanced thyroid cancer invades the carotid artery? Therapeutic challenge. J Vasc Bras 2022. [DOI: 10.1590/1677-5449.202102202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Of all thyroid cancers, anaplastic thyroid carcinoma (ATC) has the lowest incidence and worst prognosis. In this report, we describe a 64-year-old female patient who underwent total thyroidectomy and level VI neck dissection for papillary thyroid carcinoma. During follow-up, she showed signs of regional recurrence and underwent extended neck dissection and cervical esophagectomy. Intraoperatively, there was no cleavage plane between the tumor and the common carotid artery (CCA), so a carotid shunt was implanted and en bloc resection, including the affected CCA and esophagus segments was performed followed by vascular bypass with interposition of a great saphenous vein graft. A pathology review found evidence of anaplastic carcinoma. The patient underwent adjuvant treatment and has no signs of locoregional recurrence. Presented with the possibility of carrying out curative surgery with en bloc resection, the vascular surgeon must be prepared for the surgical options.
Collapse
|