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Tirelli G, Costariol L, Gardenal N, Tofanelli M, Sia E, Polesel J, Giudici F, Boscolo-Rizzo P, Marcuzzo AV. MRI and frozen section evaluation of mylohyoid muscle in determining surgical approach for T2-T3 floor of the mouth cancer. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08665-2. [PMID: 38691154 DOI: 10.1007/s00405-024-08665-2] [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: 03/27/2024] [Accepted: 04/06/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE The choice of surgical approach for floor of the mouth (FOM) cancer, particularly for intermediate-stage tumors (cT2-cT3), remains controversial. This study aims to evaluate a method considering mylohyoid muscle (MM) invasion as a determinant for surgical approach selection, utilizing magnetic resonance imaging (MRI) preoperatively and frozen section (FS) analysis intraoperatively. METHODS This observational retrospective cohort study analyzed patients undergoing surgical resection of cT2 and cT3 FOM squamous cell carcinoma (SCC) between January 2013 and June 2023. MM infiltration assessed by preoperative MRI determined the surgical approach: clear infiltration led to compartmental surgery (CS), while doubtful or absent infiltration led to transoral surgery (TOS). Conversion from TOS to CS occurred intraoperatively based on macroscopic evidence or positive FS. Data collected included demographic, clinical, surgical, and pathological variables. Survival analysis was conducted using Kaplan-Meier method. RESULTS Among 44 patients included, majority had cT2 tumors (59.1%). MM resection was necessary in 22.7% of cases. Overall survival (OS) and progression-free survival (PFS) did not significantly differ between TOS and CS groups. Radiological depth of invasion (rDOI) < 10 mm is correlated with MM preservation in 89% of cases, while rDOI > 10 mm is correlated with MM resection only in 23.8% of cases. Pathological depth of invasion (pDOI) discrepancies were observed in the two groups: in CS group is shown a higher pDOI (> 10 mm) confirmation (90%). Surgical complications and functional outcomes differed between TOS and CS groups. CONCLUSION Considering MM invasion for surgical approach selection in cT2-cT3 FOM tumors appears oncologically safe, with better functional outcomes in muscle preservation. Preoperative MRI for MM assessment combined with intraoperative FS analysis provides reliable guidance for surgical decision-making.
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Affiliation(s)
- Giancarlo Tirelli
- Otorhinolaryngology and Head and Neck Surgery Clinic, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Strada Di Fiume 447, 39149, Trieste, Italy
| | - Ludovica Costariol
- Otorhinolaryngology and Head and Neck Surgery Clinic, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Strada Di Fiume 447, 39149, Trieste, Italy
| | - Nicoletta Gardenal
- Otorhinolaryngology and Head and Neck Surgery Clinic, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Strada Di Fiume 447, 39149, Trieste, Italy
| | - Margherita Tofanelli
- Otorhinolaryngology and Head and Neck Surgery Clinic, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Strada Di Fiume 447, 39149, Trieste, Italy
| | - Egidio Sia
- Otorhinolaryngology and Head and Neck Surgery Clinic, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Strada Di Fiume 447, 39149, Trieste, Italy
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Fabiola Giudici
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Paolo Boscolo-Rizzo
- Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Alberto Vito Marcuzzo
- Otorhinolaryngology and Head and Neck Surgery Clinic, Azienda Sanitaria Universitaria Giuliano Isontina-ASUGI, Strada Di Fiume 447, 39149, Trieste, Italy.
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Divakar P, Kim SS, Kerr DA, Pettus JR, Paydarfar JA. The art of specimen orientation: Two-dimensional maps for oropharynx squamous cell carcinoma. Head Neck 2024; 46:702-707. [PMID: 38116698 DOI: 10.1002/hed.27613] [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: 07/23/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023] Open
Abstract
The goal of surgical treatment for oropharynx squamous cell carcinoma (SCCa) is resection to negative margins. Current methods of orienting resection specimens often do not give a comprehensive view, especially in oropharynx SCCa where specimens can lack anatomic landmarks. We created standardized two-dimensional maps of oropharynx anatomy drawn to scale to improve communication between surgeons and pathologists. Notes regarding surgery including anatomic landmarks, areas of concern, additional margins, and relevant clinical information were added to the map. The maps guided pathology work-up, and the pathologist could communicate details back to the surgeon on how the specimen was sectioned or locations of microscopic foci to direct future treatment and clinical monitoring. The use of two-dimensional maps for oropharynx SCCa specimens offers a standardized solution to address the challenges of anatomic orientation. These maps summarized key pathological information, preserved clinical details from the specimens, and guided multidisciplinary conferences when planning adjuvant treatment.
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Affiliation(s)
- Prashanthi Divakar
- Section of Otolaryngology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Stephanie S Kim
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Darcy A Kerr
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jason R Pettus
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Joseph A Paydarfar
- Section of Otolaryngology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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3
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Sorroche BP, Miranda KC, Beltrami CM, Arantes LMRB, Kowalski LP, Marchi FA, Rogatto SR, Almeida JD. HOXA1 3'UTR Methylation Is a Potential Prognostic Biomarker in Oral Squamous cell Carcinoma. Cancers (Basel) 2024; 16:874. [PMID: 38473236 DOI: 10.3390/cancers16050874] [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: 01/11/2024] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND HOXA1 is a prognostic marker and a potential predictive biomarker for radioresistance in head and neck tumors. Its overexpression has been associated with promoter methylation and a worse prognosis in oral squamous cell carcinoma (OSCC) patients. However, opposite outcomes are also described. The effect of the methylation of this gene on different gene regions, other than the promoter, remains uncertain. We investigated the methylation profile at different genomic regions of HOXA1 in OSCC and correlated differentially methylated CpG sites with clinicopathological data. METHODS The HOXA1 DNA methylation status was evaluated by analyzing data from The Cancer Genome Atlas and three Gene Expression Omnibus datasets. Significant differentially methylated CpG sites were considered with a |∆β| ≥ 0.10 and a Bonferroni-corrected p-value < 0.01. Differentially methylated CpGs were validated by pyrosequencing using two independent cohorts of 15 and 47 OSCC patients, respectively. RESULTS Compared to normal tissues, we found significantly higher DNA methylation levels in the 3'UTR region of HOXA1 in OSCC. Higher methylation levels in tumor samples were positively correlated with smoking habits and patients' overall survival. CONCLUSIONS Our findings suggest that HOXA1 gene body methylation is a promising prognostic biomarker for OSCC with potential clinical applications in patient monitoring.
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Affiliation(s)
- Bruna Pereira Sorroche
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos 14784-400, Brazil
| | - Keila Cristina Miranda
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), São José dos Campos 12224-300, Brazil
| | | | | | - Luiz Paulo Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, AC Camargo Cancer Center, Latin American Cooperative Oncology Group, São Paulo 01509-010, Brazil
- Head and Neck Surgery Department and LIM 28, University of São Paulo Medical School, São Paulo 01246-903, Brazil
| | - Fabio Albuquerque Marchi
- Center for Translational Research in Oncology, Cancer Institute of the State of São Paulo (ICESP), São Paulo 01246-000, Brazil
- Clinical Hospital of the University of Sao Paulo Medical School (HCFMUSP), São Paulo 05403-010, Brazil
| | - Silvia Regina Rogatto
- Department of Clinical Genetics, University Hospital of Southern Denmark, 7100 Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Janete Dias Almeida
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), São José dos Campos 12224-300, Brazil
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4
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Levy JJ, Davis MJ, Chacko RS, Davis MJ, Fu LJ, Goel T, Pamal A, Nafi I, Angirekula A, Suvarna A, Vempati R, Christensen BC, Hayden MS, Vaickus LJ, LeBoeuf MR. Intraoperative margin assessment for basal cell carcinoma with deep learning and histologic tumor mapping to surgical site. NPJ Precis Oncol 2024; 8:2. [PMID: 38172524 PMCID: PMC10764333 DOI: 10.1038/s41698-023-00477-7] [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: 09/12/2022] [Accepted: 11/14/2023] [Indexed: 01/05/2024] Open
Abstract
Successful treatment of solid cancers relies on complete surgical excision of the tumor either for definitive treatment or before adjuvant therapy. Intraoperative and postoperative radial sectioning, the most common form of margin assessment, can lead to incomplete excision and increase the risk of recurrence and repeat procedures. Mohs Micrographic Surgery is associated with complete removal of basal cell and squamous cell carcinoma through real-time margin assessment of 100% of the peripheral and deep margins. Real-time assessment in many tumor types is constrained by tissue size, complexity, and specimen processing / assessment time during general anesthesia. We developed an artificial intelligence platform to reduce the tissue preprocessing and histological assessment time through automated grossing recommendations, mapping and orientation of tumor to the surgical specimen. Using basal cell carcinoma as a model system, results demonstrate that this approach can address surgical laboratory efficiency bottlenecks for rapid and complete intraoperative margin assessment.
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Affiliation(s)
- Joshua J Levy
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA.
- Emerging Diagnostic and Investigative Technologies, Clinical Genomics and Advanced Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03756, USA.
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA.
- Program in Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA.
| | - Matthew J Davis
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
| | | | - Michael J Davis
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
| | - Lucy J Fu
- Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA
| | - Tarushii Goel
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
- Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Akash Pamal
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
- University of Virginia, Charlottesville, VA, 22903, USA
| | - Irfan Nafi
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
- Stanford University, Palo Alto, CA, 94305, USA
| | - Abhinav Angirekula
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
- University of Illinois Urbana-Champaign, Champaign, IL, 61820, USA
| | - Anish Suvarna
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
| | - Ram Vempati
- Thomas Jefferson High School for Science and Technology, Alexandria, VA, 22312, USA
| | - Brock C Christensen
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
| | - Matthew S Hayden
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
| | - Louis J Vaickus
- Emerging Diagnostic and Investigative Technologies, Clinical Genomics and Advanced Technologies, Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03756, USA
| | - Matthew R LeBoeuf
- Department of Dermatology, Geisel School of Medicine at Dartmouth, Hanover, NH, 03756, USA
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5
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Vlocskó M, Piffkó J, Janovszky Á. Intraoperative Assessment of Resection Margin in Oral Cancer: The Potential Role of Spectroscopy. Cancers (Basel) 2023; 16:121. [PMID: 38201548 PMCID: PMC10777979 DOI: 10.3390/cancers16010121] [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: 10/25/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
In parallel with the increasing number of oncological cases, the need for faster and more efficient diagnostic tools has also appeared. Different diagnostic approaches are available, such as radiological imaging or histological staining methods, but these do not provide adequate information regarding the resection margin, intraoperatively, or are time consuming. The purpose of this review is to summarize the current knowledge on spectrometric diagnostic modalities suitable for intraoperative use, with an emphasis on their relevance in the management of oral cancer. The literature agrees on the sensitivity, specificity, and accuracy of spectrometric diagnostic modalities, but further long-term prospective, multicentric clinical studies are needed, which may standardize the intraoperative assessment of the resection margin and the use of real-time spectroscopic approaches.
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Affiliation(s)
| | | | - Ágnes Janovszky
- Department of Oral and Maxillofacial Surgery, Albert Szent-Györgyi Medical School, University of Szeged, Kálvária 57, H-6725 Szeged, Hungary; (M.V.); (J.P.)
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6
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O’Meara CH, Nguyen TV, Jafri Z, Boyer M, Shonka DC, Khachigian LM. Personalised Medicine and the Potential Role of Electrospinning for Targeted Immunotherapeutics in Head and Neck Cancer. NANOMATERIALS (BASEL, SWITZERLAND) 2023; 14:6. [PMID: 38202461 PMCID: PMC10780990 DOI: 10.3390/nano14010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/03/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024]
Abstract
Advanced head and neck cancer (HNC) is functionally and aesthetically destructive, and despite significant advances in therapy, overall survival is poor, financial toxicity is high, and treatment commonly exacerbates tissue damage. Although response and durability concerns remain, antibody-based immunotherapies have heralded a paradigm shift in systemic treatment. To overcome limitations associated with antibody-based immunotherapies, exploration into de novo and repurposed small molecule immunotherapies is expanding at a rapid rate. Small molecule immunotherapies also have the capacity for chelation to biodegradable, bioadherent, electrospun scaffolds. This article focuses on the novel concept of targeted, sustained release immunotherapies and their potential to improve outcomes in poorly accessible and risk for positive margin HNC cases.
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Affiliation(s)
- Connor H. O’Meara
- Department of Otorhinolaryngology, Head & Neck Surgery, The Canberra Hospital, Garran, ACT 2605, Australia
- ANU School of Medicine, Australian National University, Canberra, ACT 0200, Australia
| | - Thanh Vinh Nguyen
- School of Chemistry, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Zuhayr Jafri
- Vascular Biology and Translational Research, Department of Pathology, School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia; (Z.J.)
| | - Michael Boyer
- Chris O’Brien Lifehouse, Camperdown, NSW 2050, Australia;
| | - David C. Shonka
- Department of Otolaryngology, Head & Neck Surgery, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - Levon M. Khachigian
- Vascular Biology and Translational Research, Department of Pathology, School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia; (Z.J.)
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7
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Sacco A, Battaglia AM, Santamaria G, Buffone C, Barone S, Procopio A, Lavecchia AM, Aversa I, Giorgio E, Petriaggi L, Cristofaro MG, Biamonte F, Giudice A. SOX2 promotes a cancer stem cell-like phenotype and local spreading in oral squamous cell carcinoma. PLoS One 2023; 18:e0293475. [PMID: 38096163 PMCID: PMC10721099 DOI: 10.1371/journal.pone.0293475] [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: 04/12/2023] [Accepted: 10/13/2023] [Indexed: 12/17/2023] Open
Abstract
Emerging evidence shows that oral squamous cell carcinoma (OSCC) invasiveness can be attributed to a small subpopulation of cancer stem cells (CSCs) in the bulk of the tumor. However, the presence of CSCs in the OSCC close resection margins is still poorly unexplored. Here, we found that BMI1, CD44, SOX2, OCT4, UBE2C, CXCR4 CSCs marker genes are significantly upregulated, while IGF1-R, KLF4, ALDH1A1, CD133, FAM3C are downregulated in the tumor core vs healthy mucosa of 24 patients with OSCC. Among these, SOX2 appears also upregulated in the tumor close margin vs healthy mucosa and this significantly correlates with tumor size and lymph node compromise. In vitro analyses in CAL27 and SCC15 tongue squamous cell carcinoma cell lines, show that SOX2 transient knockdown i) promotes the mesenchymal-to-epithelial transition, ii) smooths the invasiveness, iii) attenuates the 3D tumor sphere-forming capacity, and iv) partially increases the sensitivity to cisplatin treatment. Overall, our study highlights that the OSCC close margins can retain CSC-specific markers. Notably, SOX2 may represent a useful CSCs marker to predict a more aggressive phenotype and a suitable target to prevent local invasiveness.
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Affiliation(s)
- Alessandro Sacco
- Department of Experimental and Clinical Medicine, Biochemistry and Molecular Biology Laboratory, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Anna Martina Battaglia
- Department of Experimental and Clinical Medicine, Biochemistry and Molecular Biology Laboratory, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Gianluca Santamaria
- Department of Experimental and Clinical Medicine, Biochemistry and Molecular Biology Laboratory, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Caterina Buffone
- Department of Health Sciences, School of Dentistry, “Magna Graecia” University of Catanzaro, Catanzaro, Italy
| | - Selene Barone
- Department of Health Sciences, School of Dentistry, “Magna Graecia” University of Catanzaro, Catanzaro, Italy
| | - Anna Procopio
- Department of Experimental and Clinical Medicine, Biomechatronics Laboratory, “Magna Græcia” University of Catanzaro, Catanzaro, Italy
| | | | - Ilenia Aversa
- Department of Experimental and Clinical Medicine, Biochemistry and Molecular Biology Laboratory, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Emanuele Giorgio
- Department of Experimental and Clinical Medicine, Biochemistry and Molecular Biology Laboratory, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Lavinia Petriaggi
- Department of Experimental and Clinical Medicine, Biochemistry and Molecular Biology Laboratory, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Maria Giulia Cristofaro
- Department of Experimental and Clinical Medicine, Biochemistry and Molecular Biology Laboratory, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Flavia Biamonte
- Department of Experimental and Clinical Medicine, Biochemistry and Molecular Biology Laboratory, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
- Center of Interdepartmental Services (CIS), "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Amerigo Giudice
- Department of Health Sciences, School of Dentistry, “Magna Graecia” University of Catanzaro, Catanzaro, Italy
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Yun J, Su V, Kapustin D, Rubin SJ, Brandwein-Weber M, Khan MN, Chai R, Doyle S, Karasick M, Urken ML. Intraoperative three-dimensional scanning of head and neck surgical defects: Enhanced communication and documentation of harvested supplemental margins. Head Neck 2023; 45:2690-2699. [PMID: 37638591 DOI: 10.1002/hed.27498] [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: 02/16/2023] [Revised: 08/11/2023] [Accepted: 08/19/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND We have demonstrated the effectiveness of 3D resection specimen scanning for communicating margin results. We now address the corresponding surgical defect by debuting 3D defect models, which allow for accurate annotations of harvested supplemental margins. METHODS Surgical defects were rendered into 3D models, which were annotated to document the precise location of harvested supplemental margins. 3D defect scans were also compared with routine 2D photography and were analyzed for quality, clarity, and the time required to complete the scan. RESULTS Forty defects were scanned from procedures including segmental mandibulectomy, maxillectomy, and laryngopharyngectomy. Average duration of defect scan was 6 min, 45 s. In six of ten 2D photographs, the surgeon was unable to precisely annotate the extent of at least one supplemental margin. CONCLUSION 3D defect scanning offers advantages in that this technique enables documentation of the precise location and breadth of supplemental margins harvested to address margins at-risk.
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Affiliation(s)
- Jun Yun
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, USA
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vivian Su
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, USA
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Danielle Kapustin
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, USA
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samuel J Rubin
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, USA
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Mohemmed N Khan
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Raymond Chai
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Scott Doyle
- Department of Pathology and Anatomical Sciences, Jacobs School of Medicine & Biomedical Sciences, Buffalo, New York, USA
| | - Michael Karasick
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, USA
| | - Mark L Urken
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, New York, USA
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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9
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van Lanschot C, Schut TB, Barroso E, Sewnaik A, Hardillo J, Monserez D, Meeuwis C, Keereweer S, de Jong RB, Puppels G, Koljenović S. Raman spectroscopy to discriminate laryngeal squamous cell carcinoma from non-cancerous surrounding tissue. Lasers Med Sci 2023; 38:193. [PMID: 37624524 PMCID: PMC10457228 DOI: 10.1007/s10103-023-03849-4] [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: 05/09/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023]
Abstract
As for many solid cancers, laryngeal cancer is treated surgically, and adequate resection margins are critical for survival. Raman spectroscopy has the capacity to accurately differentiate between cancer and non-cancerous tissue based on their molecular composition, which has been proven in previous work. The aim of this study is to investigate whether Raman spectroscopy can be used to discriminate laryngeal cancer from surrounding non-cancerous tissue. Patients surgically treated for laryngeal cancer were included. Raman mapping experiments were performed ex vivo on resection specimens and correlated to histopathology. Water concentration analysis and CH-stretching region analysis were performed in the high wavenumber range of 2500-4000 cm-1. Thirty-four mapping experiments on 22 resection specimens were used for analysis. Both laryngeal cancer and all non-cancerous tissue structures showed high water concentrations of around 75%. Discriminative information was only found to be present in the CH-stretching region of the Raman spectra of the larynx (discriminative power of 0.87). High wavenumber region Raman spectroscopy can discriminate laryngeal cancer from non-cancerous tissue structures. Contrary to the findings for oral cavity cancer, water concentration is not a discriminating factor for laryngeal cancer.
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Affiliation(s)
- Cornelia van Lanschot
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Tom Bakker Schut
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Elisa Barroso
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Jose Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Dominiek Monserez
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Cees Meeuwis
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Stijn Keereweer
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Rob Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Gerwin Puppels
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Senada Koljenović
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Pathology, Antwerp University Hospital, 2650, Antwerp, Belgium
- Faculty of Medicine, University of Antwerp, 2610, Antwerp, Belgium
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Kowalski LP. Eugene Nicholas Myers' Lecture on Head and Neck Cancer, 2020: The Surgeon as a Prognostic Factor in Head and Neck Cancer Patients Undergoing Surgery. Int Arch Otorhinolaryngol 2023; 27:e536-e546. [PMID: 37564472 PMCID: PMC10411134 DOI: 10.1055/s-0043-1761170] [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: 08/23/2022] [Accepted: 09/26/2022] [Indexed: 08/12/2023] Open
Abstract
This paper is a transcript of the 29 th Eugene N. Myers, MD International Lecture on Head and Neck Cancer presented at the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) in 2020. By the end of the 19 th century, the survival rate in treated patients was 10%. With the improvements in surgical techniques, currently, about two thirds of patients survive for > 5 years. Teamwork and progress in surgical reconstruction have led to advancements in ablative surgery; the associated adjuvant treatments have further improved the prognosis in the last 30 years. However, prospective trials are lacking; most of the accumulated knowledge is based on retrospective series and some real-world data analyses. Current knowledge on prognostic factors plays a central role in an efficient treatment decision-making process. Although the influence of most tumor- and patient-related prognostic factors in head and neck cancer cannot be changed by medical interventions, some environmental factors-including treatment, decision-making, and quality-can be modified. Ideally, treatment strategy decisions should be taken in dedicated multidisciplinary team meetings. However, evidence suggests that surgeons and hospital volume and specialization play major roles in patient survival after initial or salvage head and neck cancer treatment. The metrics of surgical quality assurance (surgical margins and nodal yield) in neck dissection have a significant impact on survival in head and neck cancer patients and can be influenced by the surgeon's expertise. Strategies proposed to improve surgical quality include continuous performance measurement, feedback, and dissemination of best practice measures.
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Affiliation(s)
- Luiz P. Kowalski
- Head and Neck Surgery Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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11
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Urken ML, Yun J, Saturno MP, Greenberg LA, Chai RL, Sharif K, Brandwein-Weber M. Frozen Section Analysis in Head and Neck Surgical Pathology: A Narrative Review of the Past, Present, and Future of Intraoperative Pathologic Consultation. Oral Oncol 2023; 143:106445. [PMID: 37285683 DOI: 10.1016/j.oraloncology.2023.106445] [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: 02/24/2023] [Revised: 05/13/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Abstract
Frozen section has remained the diagnostic gold standard for intraoperative pathological evaluation of surgical margins for head and neck specimens. While achieving tumor-free margins is of utmost importance to all head and neck surgeons, in practice, there are numerous debates and a lack of standardization for the role and method of intraoperative pathologic consultation. This review serves as a summary guide to the historical and contemporary practice of frozen section analysis and margin mapping in head and neck cancer. In addition, this review discusses current challenges in head and neck surgical pathology, and introduces 3D scanning as a groundbreaking technology to bypass many of the pitfalls in the current frozen section workflow. The ultimate goal for all head and neck pathologists and surgeons should be to modernize practices and take advantage of new technology, such as virtual 3D specimen mapping techniques, that improves the workflow for intraoperative frozen section analysis.
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Affiliation(s)
- Mark L Urken
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, NY, USA; Dept. of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Jun Yun
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, NY, USA; Dept. of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, USA
| | | | - Lily A Greenberg
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, NY, USA
| | - Raymond L Chai
- Dept. of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Kayvon Sharif
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Margaret Brandwein-Weber
- THANC (Thyroid, Head & Neck Cancer) Foundation, New York, NY, USA; Dept. of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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12
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Carnicelli G, Disconzi L, Cerasuolo M, Casiraghi E, Costa G, De Virgilio A, Esposito AA, Ferreli F, Fici F, Lo Casto A, Marra S, Malvezzi L, Mercante G, Spriano G, Torzilli G, Francone M, Balzarini L, Giannitto C. Image-Guided Intraoperative Assessment of Surgical Margins in Oral Cavity Squamous Cell Cancer: A Diagnostic Test Accuracy Review. Diagnostics (Basel) 2023; 13:diagnostics13111846. [PMID: 37296701 DOI: 10.3390/diagnostics13111846] [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: 04/02/2023] [Revised: 05/12/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023] Open
Abstract
(1) Background: The assessment of resection margins during surgery of oral cavity squamous cell cancer (OCSCC) dramatically impacts the prognosis of the patient as well as the need for adjuvant treatment in the future. Currently there is an unmet need to improve OCSCC surgical margins which appear to be involved in around 45% cases. Intraoperative imaging techniques, magnetic resonance imaging (MRI) and intraoral ultrasound (ioUS), have emerged as promising tools in guiding surgical resection, although the number of studies available on this subject is still low. The aim of this diagnostic test accuracy (DTA) review is to investigate the accuracy of intraoperative imaging in the assessment of OCSCC margins. (2) Methods: By using the Cochrane-supported platform Review Manager version 5.4, a systematic search was performed on the online databases MEDLINE-EMBASE-CENTRAL using the keywords "oral cavity cancer, squamous cell carcinoma, tongue cancer, surgical margins, magnetic resonance imaging, intraoperative, intra-oral ultrasound". (3) Results: Ten papers were identified for full-text analysis. The negative predictive value (cutoff < 5 mm) for ioUS ranged from 0.55 to 0.91, that of MRI ranged from 0.5 to 0.91; accuracy analysis performed on four selected studies showed a sensitivity ranging from 0.07 to 0.75 and specificity ranging from 0.81 to 1. Image guidance allowed for a mean improvement in free margin resection of 35%. (4) Conclusions: IoUS shows comparable accuracy to that of ex vivo MRI for the assessment of close and involved surgical margins, and should be preferred as the more affordable and reproducible technique. Both techniques showed higher diagnostic yield if applied to early OCSCC (T1-T2 stages), and when histology is favorable.
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Affiliation(s)
- Giorgia Carnicelli
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Luca Disconzi
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Michele Cerasuolo
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Elena Casiraghi
- AnacletoLab, Department of Computer Science "Giovanni degli Antoni", Università degli Studi di Milano, Via Celoria 18, 20133 Milan, Italy
- Environmental Genomics and Systems Biology Division, Lawrence Berkeley National Laboratory, 717 Potter Street, Berkeley, CA 94710, USA
| | - Guido Costa
- Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | | | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Federica Fici
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Antonio Lo Casto
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University Hospital of Palermo, 90127 Palermo, Italy
| | - Silvia Marra
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Luca Malvezzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Guido Torzilli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Marco Francone
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Luca Balzarini
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
| | - Caterina Giannitto
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
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13
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Zhang L, Judd RT, Zhao S, Rygalski C, Li M, Briody A, Swendseid B, Blakaj DM, Agrawal A, Ozer E, Carrau RL, Teknos TN, VanKoevering K, Rocco JW, Old MO, Seim NB, Puram SV, Haring CT, Kang SY. Immediate resection of positive margins improves local control in oral tongue cancer. Oral Oncol 2023; 141:106402. [PMID: 37094500 DOI: 10.1016/j.oraloncology.2023.106402] [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: 11/07/2022] [Revised: 04/08/2023] [Accepted: 04/15/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVES This study investigates the impact of immediate resection of positive margins on local control of oral tongue cancer. MATERIALS AND METHODS We analyzed 273 consecutive oral tongue cancers resected from 2013 to 2018. Additional resection was performed in cases during the initial operation based on surgeon inspection of the specimen and/or frozen margins. Positive margins were defined as invasive carcinoma/high-grade dysplasia < 1 mm from the inked edge. Patients were grouped as follows: negative margin (Group 1); positive margin with immediate additional tissue resection (Group 2); and positive margin without additional tissue resection (Group 3). RESULTS Overall, the rate of local recurrence was 7.7 % (21/273), and the rate of positive main specimen margin was 17.9 %. Of these patients, 38.8 % (19/49) underwent immediate additional resection of the presumed positive margin. Group 3 had higher local recurrence rates than Group 1 after adjustment for T-stage (aHR 2.8 [95 % CI 1.0-7.7], p = 0.04). Group 2 had similar rates of local recurrence (aHR 0.45 [95 % CI 0.06-3.6], p = 0.45). Three year local recurrence free survival for Groups 1, 2, and 3 were 91 %, 92 % and 73 %, respectively. Compared to the main specimen margin, sensitivity of intraoperative frozen tumor bed margins was 17.4 %, and specificity was 95 %. CONCLUSION In patients with positive main specimen margins, anticipation and detection in real-time with immediate additional tissue resection reduced local recurrence to rates similar to those with negative main specimen margins. These findings support the use of technology to provide real-time intraoperative margin data and guide additional resection for improved local control.
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Affiliation(s)
- Lisa Zhang
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Ryan T Judd
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Songzhu Zhao
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Chandler Rygalski
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Michael Li
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | | | - Brian Swendseid
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Dukagjin M Blakaj
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Amit Agrawal
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Enver Ozer
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Ricardo L Carrau
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Theodoros N Teknos
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Kyle VanKoevering
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - James W Rocco
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Matthew O Old
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Nolan B Seim
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Sidharth V Puram
- Department of Otolaryngology, Division of Head and Neck Surgery, Washington University School of Medicine, USA
| | - Catherine T Haring
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA
| | - Stephen Y Kang
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, 4000 Eye and Ear Institute, 915 Olentangy River Rd, Columbus, OH 43212, USA.
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14
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Sivrice ME, Akın V, Erkılınç G, Yasan H, Tüz M, Okur E, Kumbul YÇ, Çiriş İM. Frozen Section Evaluation for Surgical Margins in Laryngeal Squamous Cell Carcinoma: Is it a Reliable Method for Partial and Total Laryngectomies? Head Neck Pathol 2023; 17:172-177. [PMID: 36171534 PMCID: PMC10063756 DOI: 10.1007/s12105-022-01485-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/24/2022] [Accepted: 08/02/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND In this study, we aimed to compare the accuracy of frozen section evaluation in partial and total laryngectomies performed to treat laryngeal squamous cell carcinoma . METHODS A retrospective study was conducted to evaluate the efficacy and accuracy of frozen section analysis for laryngeal squamous cell carcinoma of 65 patients, operated at a tertiary hospital. Two groups were recruited according to the surgical procedure. RESULTS The sensitivity and specificity of frozen section diagnosis in laryngeal cancer were 20% and 99.73%, respectively. For partial laryngectomy, the sensitivity was 16.66% and specificity was 100%. For total laryngectomy, sensitivity was 22.2% and specificity 99.13%. Discordances between the initial frozen section diagnosis and the subsequent permanent section diagnosis were found in 13 (3.35%) pairs (3.37% partial laryngectomy and 3.33% total laryngectomy). CONCLUSION Our study shows that the surgical method applied has no effect on discordances. However, sampling errors are likely to be more common in partial laryngectomy procedures. It should be kept in mind that the sensitivity of frozen section evaluation is low.
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Affiliation(s)
- Mehmet Emre Sivrice
- Department of Oto-Rhino-Laryngology and Head&Neck Surgery, Faculty of Medicine, Süleyman Demirel University, 32200 Isparta, Isparta Turkey
| | - Vural Akın
- Department of Oto-Rhino-Laryngology and Head&Neck Surgery, Faculty of Medicine, Süleyman Demirel University, 32200 Isparta, Isparta Turkey
| | - Gamze Erkılınç
- Department of Pathology, Urla State Hospital, İzmir, Turkey
| | - Hasan Yasan
- Department of Oto-Rhino-Laryngology and Head&Neck Surgery, Faculty of Medicine, Süleyman Demirel University, 32200 Isparta, Isparta Turkey
| | - Mustafa Tüz
- Department of Oto-Rhino-Laryngology and Head&Neck Surgery, Faculty of Medicine, Süleyman Demirel University, 32200 Isparta, Isparta Turkey
| | - Erdoğan Okur
- Department of Oto-Rhino-Laryngology and Head&Neck Surgery, Faculty of Medicine, Süleyman Demirel University, 32200 Isparta, Isparta Turkey
| | - Yusuf Çağdaş Kumbul
- Department of Oto-Rhino-Laryngology and Head&Neck Surgery, Faculty of Medicine, Süleyman Demirel University, 32200 Isparta, Isparta Turkey
| | - İbrahim Metin Çiriş
- Department of Pathology, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey
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15
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Intraoperative Imaging Techniques to Improve Surgical Resection Margins of Oropharyngeal Squamous Cell Cancer: A Comprehensive Review of Current Literature. Cancers (Basel) 2023; 15:cancers15030896. [PMID: 36765858 PMCID: PMC9913756 DOI: 10.3390/cancers15030896] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023] Open
Abstract
Inadequate resection margins in head and neck squamous cell carcinoma surgery necessitate adjuvant therapies such as re-resection and radiotherapy with or without chemotherapy and imply increasing morbidity and worse prognosis. On the other hand, taking larger margins by extending the resection also leads to avoidable increased morbidity. Oropharyngeal squamous cell carcinomas (OPSCCs) are often difficult to access; resections are limited by anatomy and functionality and thus carry an increased risk for close or positive margins. Therefore, there is a need to improve intraoperative assessment of resection margins. Several intraoperative techniques are available, but these often lead to prolonged operative time and are only suitable for a subgroup of patients. In recent years, new diagnostic tools have been the subject of investigation. This study reviews the available literature on intraoperative techniques to improve resection margins for OPSCCs. A literature search was performed in Embase, PubMed, and Cochrane. Narrow band imaging (NBI), high-resolution microendoscopic imaging, confocal laser endomicroscopy, frozen section analysis (FSA), ultrasound (US), computed tomography scan (CT), (auto) fluorescence imaging (FI), and augmented reality (AR) have all been used for OPSCC. NBI, FSA, and US are most commonly used and increase the rate of negative margins. Other techniques will become available in the future, of which fluorescence imaging has high potential for use with OPSCC.
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16
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Intraoperative Assessment of Tumor Margins in Tissue Sections with Hyperspectral Imaging and Machine Learning. Cancers (Basel) 2022; 15:cancers15010213. [PMID: 36612208 PMCID: PMC9818424 DOI: 10.3390/cancers15010213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/16/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
The intraoperative assessment of tumor margins of head and neck cancer is crucial for complete tumor resection and patient outcome. The current standard is to take tumor biopsies during surgery for frozen section analysis by a pathologist after H&E staining. This evaluation is time-consuming, subjective, methodologically limited and underlies a selection bias. Optical methods such as hyperspectral imaging (HSI) are therefore of high interest to overcome these limitations. We aimed to analyze the feasibility and accuracy of an intraoperative HSI assessment on unstained tissue sections taken from seven patients with oral squamous cell carcinoma. Afterwards, the tissue sections were subjected to standard histopathological processing and evaluation. We trained different machine learning models on the HSI data, including a supervised 3D convolutional neural network to perform tumor detection. The results were congruent with the histopathological annotations. Therefore, this approach enables the delineation of tumor margins with artificial HSI-based histopathological information during surgery with high speed and accuracy on par with traditional intraoperative tumor margin assessment (Accuracy: 0.76, Specificity: 0.89, Sensitivity: 0.48). With this, we introduce HSI in combination with ML hyperspectral imaging as a potential new tool for intraoperative tumor margin assessment.
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17
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Yu AC, Afework DD, Goldstein JD, Abemayor E, Mendelsohn AH. Association of Intraoperative Frozen Section Controls With Improved Margin Assessment During Transoral Robotic Surgery for Human Papillomavirus-Positive Oropharyngeal Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg 2022; 148:1029-1037. [PMID: 36136328 PMCID: PMC9501795 DOI: 10.1001/jamaoto.2022.2840] [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: 04/09/2022] [Accepted: 08/02/2022] [Indexed: 12/13/2022]
Abstract
Importance Intraoperative margin assessment is an important technique for ensuring complete tumor resection in malignant cancers. However, in patients undergoing transoral robotic surgery (TORS) for oropharyngeal carcinomas, tissue artifact may provide pathologic uncertainty. Objective To assess the benefit of providing frozen section control samples ("positive tumor biopsies") for use during intraoperative margin assessment for patients undergoing TORS for human papillomavirus (HPV)-16-positive oropharyngeal squamous cell carcinoma (OPSCC). Design, Setting, and Participants In this cohort study, patients receiving curative-intent TORS for biopsy-proven HPV-16-positive OPSCC performed by a single attending surgeon (A.H.M.) at Ronald Reagan UCLA Medical Center from 2017 to 2021 were included in a retrospective data analysis. Exclusion criteria included HPV-negative status, participation in clinical trials, and tumors of unknown primary origin. Main Outcomes and Measures Survival outcomes investigated included overall and disease-free survival. Adverse pathologic outcomes measured included occurrence of nondiagnostic margins and margin reversal from frozen to fixed pathology. Results Of the 170 patients included (mean [SD] age, 61.8 [9.9] years; 140 [82%] male), 50% of patients (n = 85) received a frozen section control. Use of a frozen section control was associated with statistically significantly improved sensitivity of intraoperative margin assessment, from 82.8% to 88.9% (difference, 6.1%; 95% CI, 3.9%-8.3%). Eleven percent (n = 18) of all tumors evaluated exhibited at least 1 nondiagnostic intraoperative margin, and 11% (n = 18) experienced margin reversal from frozen to fixed pathology. In patients with nondiagnostic margins, use of frozen section controls was associated with statistically significantly reduced time spent in the operating room (Cohen d, 1.14; 95% CI, 0.12-2.14). Conclusions and Relevance In this cohort study, frozen intraoperative margins assessed during TORS resections of HPV-16-positive OPSCC were diagnostically challenging. Adverse pathologic outcomes, such as margin status reversal from positive on frozen pathology to negative on formal analysis, were common. Providing intraoperative frozen section control biopsies may offer clarity in cases with nondiagnostic margins, reducing the need for additional sampling and time spent in the operating room.
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Affiliation(s)
- Alice C. Yu
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles
| | - David D. Afework
- Department of Pathology, David Geffen School of Medicine at University of California, Los Angeles
| | - Jeffrey D. Goldstein
- Department of Pathology, David Geffen School of Medicine at University of California, Los Angeles
| | - Elliot Abemayor
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles
| | - Abie H. Mendelsohn
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles
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18
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Wako BD, Dese K, Ulfata RE, Nigatu TA, Turunbedu SK, Kwa T. Squamous Cell Carcinoma of Skin Cancer Margin Classification From Digital Histopathology Images Using Deep Learning. Cancer Control 2022; 29:10732748221132528. [PMID: 36194624 PMCID: PMC9536105 DOI: 10.1177/10732748221132528] [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] [Indexed: 12/03/2022] Open
Abstract
Objectives Now a days, squamous cell carcinoma (SCC) margin assessment is done by examining histopathology images and inspection of whole slide images (WSI) using a conventional microscope. This is time-consuming, tedious, and depends on experts’ experience which may lead to misdiagnosis and mistreatment plans. This study aims to develop a system for the automatic diagnosis of skin cancer margin for squamous cell carcinoma from histopathology microscopic images by applying deep learning techniques. Methods The system was trained, validated, and tested using histopathology images of SCC cancer locally acquired from Jimma Medical Center Pathology Department from seven different skin sites using an Olympus digital microscope. All images were preprocessed and trained with transfer learning pre-trained models by fine-tuning the hyper-parameter of the selected models. Results The overall best training accuracy of the models become 95.3%, 97.1%, 89.8%, and 89.9% on EffecientNetB0, MobileNetv2, ResNet50, VGG16 respectively. In addition to this, the best validation accuracy of the models was 94.7%, 91.8%, 87.8%, and 86.7% respectively. The best testing accuracy of the models at the same epoch was 95.2%, 91.5%, 87%, and 85.5% respectively. From these models, EfficientNetB0 showed the best average training and testing accuracy than the other models. Conclusions The system assists the pathologist during the margin assessment of SCC by decreasing the diagnosis time from an average of 25 minutes to less than a minute.
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Affiliation(s)
- Beshatu Debela Wako
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia,Center of Biomedical Engineering, Jimma University Medical Center, Jimma, Ethiopia
| | - Kokeb Dese
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia,Artificial Intelligence and Biomedical Imaging Research Lab, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia,Kokeb Dese, Department of Biomedical Engineering, Jimma University, Jimma 378, Ethiopia. ,
| | - Roba Elala Ulfata
- Department of Pathology, Jimma Institute of Health, Jimma University, Jimma, Ethiopia,Department of Pathology, Adama General Hospital and Medical College, Adama, Ethiopia
| | - Tilahun Alemayehu Nigatu
- Department of Biomedical Sciences (Anatomy Course Unit), Jimma Institute of Health, Jimma University, Jimma, Ethiopia
| | | | - Timothy Kwa
- School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, Ethiopia,Department of Biomedical Engineering, University of California, 451 Health Sciences, Davis, CA, USA,Medtronic MiniMed, 18000 Devonshire St., Northridge, Los Angeles, CA, USA,Timothy Kwa, Department of Biomedical Engineering, Jimma University, Jimma 378, Ethiopia.
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19
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De Ravin E, Venkatesh S, Harmsen S, Delikatny EJ, Husson MA, Lee JYK, Newman JG, Rajasekaran K. Indocyanine green fluorescence-guided surgery in head and neck cancer: A systematic review. Am J Otolaryngol 2022; 43:103570. [PMID: 35939987 DOI: 10.1016/j.amjoto.2022.103570] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 07/31/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the feasibility and effectiveness of indocyanine green (ICG) for image-guided resection of head and neck cancer (HNC). DATA SOURCES PubMed, Embase, and Scopus databases. REVIEW METHODS Searches were conducted from database inception to February 2022. Patient and study characteristics, imaging parameters, and imaging efficacy data were extracted from each study. RESULTS Nine studies met inclusion criteria, representing 103 head and neck tumors. Weighted mean ICG dose and imaging time were 1.27 mg/kg and 11.77 h, respectively. Among the five studies that provided quantitative metrics of imaging efficacy, average ICG tumor-to-background ratio (TBR) was 1.56 and weighted mean ONM-100 TBR was 3.64. Pooled sensitivity and specificity across the five studies were 91.7 % and 71.9 %, respectively. CONCLUSION FGS with ICG may facilitate real-time tumor-margin delineation to improve margin clearance rates and progression-free survival. Future studies with validated, quantitative metrics of imaging success are necessary to further evaluate the prognostic benefit of these techniques.
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Affiliation(s)
- Emma De Ravin
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States of America; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Sanjena Venkatesh
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Stefan Harmsen
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Edward J Delikatny
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Michael A Husson
- Department of Pathology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - John Y K Lee
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Jason G Newman
- Department of Otolaryngology - Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, United States of America
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, United States of America.
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20
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Postoperative Examination of Laryngeal Malignant Tumor Based on Narrowband Imaging Resolution Enhancement Technology. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:7762622. [PMID: 35685659 PMCID: PMC9167113 DOI: 10.1155/2022/7762622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/25/2022]
Abstract
The application of endoscopic imaging in the biopsy of malignant laryngeal lesions is one of the current research hotspots in the medical field. Based on the narrowband imaging resolution enhancement technology, a model for postoperative examination of laryngeal malignant tumor was constructed in this paper. The article calculated the biopsy detection rate of malignant lesions and the correct biopsy detection rate of the two groups and made a statistical comparison. In the NBI mode group, the mucosal morphology and superficial mucosal microvascular morphology of the same lesion under two different modes of white light and NBI were compared, which solved the problem of data processing of cases. During the case comparison process, patients who needed biopsies to be sent for pathology were selected for inclusion in the study and were randomly divided into two groups. The coincidence rate of EUS combined with NBI diagnosis was significantly higher than that of ordinary white light gastroscopy (47.92%), and the difference was statistically significant (P=0.000 < 0.05). The experimental results compared the accuracy of the normal white light mode and the NBI mode to diagnose the nature of the lesions: according to the Kudo classification criteria, 23 cases of tumor lesions were to be diagnosed in the normal white light mode, with an accuracy rate of 69.70%, and the NBI mode was to be used to diagnose tumors. There were 81 cases of sexual lesions, with an accuracy rate of 93.94%. The NBI mode was more accurate in diagnosing the nature of the lesions under the Kudo classification standard (P < 0.05). In 64 cases, the accuracy rate was 63.63%. Under the NBI mode, 29 cases of tumor lesions were proposed to be diagnosed, and the accuracy rate was 87.88% to promote the application of NBI endoscopy in the biopsy of malignant laryngeal lesions.
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21
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Faur C, Falamas A, Chirila M, Roman R, Rotaru H, Moldovan M, Albu S, Baciut M, Robu I, Hedesiu M. Raman spectroscopy in oral cavity and oropharyngeal cancer: a systematic review. Int J Oral Maxillofac Surg 2022; 51:1373-1381. [DOI: 10.1016/j.ijom.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 12/24/2022]
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22
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Tran MH, Ma L, Litter JV, Chen AY, Fei B. Thyroid Carcinoma Detection on Whole Histologic Slides Using Hyperspectral Imaging and Deep Learning. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2022; 12039:120390H. [PMID: 36798939 PMCID: PMC9929647 DOI: 10.1117/12.2612963] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Hyperspectral imaging (HSI), a non-invasive imaging modality, has been successfully used in many different biological and medical applications. One such application is in the field of oncology, where hyperspectral imaging is being used on histologic samples. This study compares the performances of different image classifiers using different imaging modalities as training data. From a database of 33 fixed tissues from head and neck patients with follicular thyroid carcinoma, we produced three different datasets: an RGB image dataset that was acquired from a whole slide image scanner, a hyperspectral (HS) dataset that was acquired with a compact hyperspectral camera, and an HS-synthesized RGB image dataset. Three separate deep learning classifiers were trained using the three datasets. We show that the deep learning classifier trained on HSI data has an area under the receiver operator characteristic curve (AUC-ROC) of 0.966, higher than that of the classifiers trained on RGB and HSI-synthesized RGB data. This study demonstrates that hyperspectral images improve the performance of cancer classification on whole histologic slides. Hyperspectral imaging and deep learning provide an automatic tool for thyroid cancer detection on whole histologic slides.
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Affiliation(s)
- Minh Ha Tran
- Univ. of Texas at Dallas, Dept. of Bioengineering, Richardson, TX
- Univ. of Texas at Dallas, Center for Imaging and Surgical Innovation, Richardson, TX
| | - Ling Ma
- Univ. of Texas at Dallas, Dept. of Bioengineering, Richardson, TX
- Univ. of Texas at Dallas, Center for Imaging and Surgical Innovation, Richardson, TX
| | - James V. Litter
- Emory Univ. School of Medicine, Dept. of Pathology and Laboratory Medicine, Atlanta, GA
| | - Amy Y. Chen
- Emory Univ. School of Medicine, Dept. of Otolaryngology, Atlanta, GA
| | - Baowei Fei
- Univ. of Texas at Dallas, Dept. of Bioengineering, Richardson, TX
- Univ. of Texas at Dallas, Center for Imaging and Surgical Innovation, Richardson, TX
- Univ. of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX
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23
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van Munster MH, de Bree R, Breimer GE, Van Cann EM. Surgical margins in the resection of oral squamous cell carcinoma under local versus general anesthesia. Oral Oncol 2022; 125:105724. [DOI: 10.1016/j.oraloncology.2022.105724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/13/2021] [Accepted: 01/09/2022] [Indexed: 11/28/2022]
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24
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Zhang Y, Xie M, Xue R, Tang Q, Zhu X, Wang J, Yang H, Ma C. A Novel Cell Morphology Analyzer Application in Head and Neck Cancer. Int J Gen Med 2021; 14:9307-9314. [PMID: 34887678 PMCID: PMC8650834 DOI: 10.2147/ijgm.s341420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/23/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Rapid and accurate diagnosis of the pathological characteristics of head and neck cancer and tumor resection margins is important. The DiveScope cell morphology analyzer (DiveScope) is a new endomicroscope that can rapidly image living tissues and cells. In this study, we preliminarily examined the accuracy of the DiveScope for determining the malignancy of head and neck cancers and the positivity/negativity of tumor resection margins and determined the consistency between diagnostic results with the DiveScope and those of frozen section pathology to provide a foundation for further clinical trials in pathological diagnosis of head and neck cancers and tumor resection margins. Methods Head and neck cancer samples and resection margin samples were rapidly stained ex vivo before observation under the DiveScope cell morphology analyzer. Experienced pathologists distinguished the benignity and malignancy of the tumors based on images obtained by the DiveScope in a double-blind manner to validate the diagnostic performance of the analyzer. Results We found that the cell morphology, cell nucleus morphology, karyoplasmic ratio, and even the nucleolus could be clearly distinguished. The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) of benign and malignant head and neck cancer according to DiveScope results were 10.55 and 0.04, respectively. The PLR and NLR of the head and neck cancer resection margins according to the DiveScope were 19.01 and 0, respectively. Conclusion The DiveScope showed high accuracy in determining the benignity and malignancy of head and neck cancer and the positivity/negativity of resection margins, and its results were highly consistent with those of intraoperative frozen section pathology tests.
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Affiliation(s)
- Yongli Zhang
- Department of Otolaryngology, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, People's Republic of China.,Translational Medicine Center, Peking Union Medical College Hospital, Beijing, 100730, People's Republic of China
| | - Mengyao Xie
- Department of Otolaryngology, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, People's Republic of China.,Translational Medicine Center, Peking Union Medical College Hospital, Beijing, 100730, People's Republic of China
| | - Ruoyan Xue
- Department of Otolaryngology, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, People's Republic of China.,Translational Medicine Center, Peking Union Medical College Hospital, Beijing, 100730, People's Republic of China
| | - Qi Tang
- Department of Otolaryngology, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, People's Republic of China.,Translational Medicine Center, Peking Union Medical College Hospital, Beijing, 100730, People's Republic of China
| | - Xiaohui Zhu
- Department of Otolaryngology, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, People's Republic of China.,Translational Medicine Center, Peking Union Medical College Hospital, Beijing, 100730, People's Republic of China
| | - Jian Wang
- Department of Otolaryngology, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, People's Republic of China.,Translational Medicine Center, Peking Union Medical College Hospital, Beijing, 100730, People's Republic of China
| | - Hua Yang
- Department of Otolaryngology, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, 100730, People's Republic of China.,Translational Medicine Center, Peking Union Medical College Hospital, Beijing, 100730, People's Republic of China
| | - Chao Ma
- Institute of Basic Medical Sciences, Department of Human Anatomy, Histology and Embryology, Neuroscience Center, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, 100005, People's Republic of China.,Joint Laboratory of Anesthesia and Pain, Peking Union Medical College, Beijing, 100730, People's Republic of China.,Chinese Institute for Brain Research, Beijing, 102206, People's Republic of China
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25
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Maharaj D, Thaduri A, Jat B, Poonia D, Durgapal P, Rajkumar K. Performance and survival outcomes of defect-driven versus specimen-driven method of frozen section intraoperative margin assessment in oral cancers. Int J Oral Maxillofac Surg 2021; 51:1131-1137. [DOI: 10.1016/j.ijom.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 11/14/2021] [Accepted: 11/17/2021] [Indexed: 11/15/2022]
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26
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Head and Neck Cancers Are Not Alike When Tarred with the Same Brush: An Epigenetic Perspective from the Cancerization Field to Prognosis. Cancers (Basel) 2021; 13:cancers13225630. [PMID: 34830785 PMCID: PMC8616074 DOI: 10.3390/cancers13225630] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/30/2021] [Accepted: 11/02/2021] [Indexed: 12/26/2022] Open
Abstract
Simple Summary Squamous cell carcinomas affect different head and neck subsites and, although these tumors arise from the same epithelial lining and share risk factors, they differ in terms of clinical behavior and molecular carcinogenesis mechanisms. Differences between HPV-negative and HPV-positive tumors are those most frequently explored, but further data suggest that the molecular heterogeneity observed among head and neck subsites may go beyond HPV infection. In this review, we explore how alterations of DNA methylation and microRNA expression contribute to head and neck squamous cell carcinoma (HNSCC) development and progression. The association of these epigenetic alterations with risk factor exposure, early carcinogenesis steps, transformation risk, and prognosis are described. Finally, we discuss the potential application of the use of epigenetic biomarkers in HNSCC. Abstract Head and neck squamous cell carcinomas (HNSCC) are among the ten most frequent types of cancer worldwide and, despite all efforts, are still diagnosed at late stages and show poor overall survival. Furthermore, HNSCC patients often experience relapses and the development of second primary tumors, as a consequence of the field cancerization process. Therefore, a better comprehension of the molecular mechanisms involved in HNSCC development and progression may enable diagnosis anticipation and provide valuable tools for prediction of prognosis and response to therapy. However, the different biological behavior of these tumors depending on the affected anatomical site and risk factor exposure, as well as the high genetic heterogeneity observed in HNSCC are major obstacles in this pursue. In this context, epigenetic alterations have been shown to be common in HNSCC, to discriminate the tumor anatomical subsites, to be responsive to risk factor exposure, and show promising results in biomarker development. Based on this, this review brings together the current knowledge on alterations of DNA methylation and microRNA expression in HNSCC natural history, focusing on how they contribute to each step of the process and on their applicability as biomarkers of exposure, HNSCC development, progression, and response to therapy.
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A New Look into Cancer-A Review on the Contribution of Vibrational Spectroscopy on Early Diagnosis and Surgery Guidance. Cancers (Basel) 2021; 13:cancers13215336. [PMID: 34771500 PMCID: PMC8582426 DOI: 10.3390/cancers13215336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 02/05/2023] Open
Abstract
Simple Summary Cancer is a leading cause of death worldwide, with the detection of the disease in its early stages, as well as a correct assessment of the tumour margins, being paramount for a successful recovery. While breast cancer is one of most common types of cancer, head and neck cancer is one of the types of cancer with a lower prognosis and poor aesthetic results. Vibrational spectroscopy detects molecular vibrations, being sensitive to different sample compositions, even when the difference was slight. The use of spectroscopy in biomedicine has been extensively explored, since it allows a broader assessment of the biochemical fingerprint of several diseases. This literature review covers the most recent advances in breast and head and neck cancer early diagnosis and intraoperative margin assessment, through Raman and Fourier transform infrared spectroscopies. The rising field of spectral histopathology was also approached. The authors aimed at expounding in a more concise and simple way the challenges faced by clinicians and how vibrational spectroscopy has evolved to respond to those needs for the two types of cancer with the highest potential for improvement regarding an early diagnosis, surgical margin assessment and histopathology. Abstract In 2020, approximately 10 million people died of cancer, rendering this disease the second leading cause of death worldwide. Detecting cancer in its early stages is paramount for patients’ prognosis and survival. Hence, the scientific and medical communities are engaged in improving both therapeutic strategies and diagnostic methodologies, beyond prevention. Optical vibrational spectroscopy has been shown to be an ideal diagnostic method for early cancer diagnosis and surgical margins assessment, as a complement to histopathological analysis. Being highly sensitive, non-invasive and capable of real-time molecular imaging, Raman and Fourier transform infrared (FTIR) spectroscopies give information on the biochemical profile of the tissue under analysis, detecting the metabolic differences between healthy and cancerous portions of the same sample. This constitutes tremendous progress in the field, since the cancer-prompted morphological alterations often occur after the biochemical imbalances in the oncogenic process. Therefore, the early cancer-associated metabolic changes are unnoticed by the histopathologist. Additionally, Raman and FTIR spectroscopies significantly reduce the subjectivity linked to cancer diagnosis. This review focuses on breast and head and neck cancers, their clinical needs and the progress made to date using vibrational spectroscopy as a diagnostic technique prior to surgical intervention and intraoperative margin assessment.
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28
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Machine-Learning Assisted Discrimination of Precancerous and Cancerous from Healthy Oral Tissue Based on Multispectral Autofluorescence Lifetime Imaging Endoscopy. Cancers (Basel) 2021; 13:cancers13194751. [PMID: 34638237 PMCID: PMC8507537 DOI: 10.3390/cancers13194751] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 12/20/2022] Open
Abstract
Multispectral autofluorescence lifetime imaging (maFLIM) can be used to clinically image a plurality of metabolic and biochemical autofluorescence biomarkers of oral epithelial dysplasia and cancer. This study tested the hypothesis that maFLIM-derived autofluorescence biomarkers can be used in machine-learning (ML) models to discriminate dysplastic and cancerous from healthy oral tissue. Clinical widefield maFLIM endoscopy imaging of cancerous and dysplastic oral lesions was performed at two clinical centers. Endoscopic maFLIM images from 34 patients acquired at one of the clinical centers were used to optimize ML models for automated discrimination of dysplastic and cancerous from healthy oral tissue. A computer-aided detection system was developed and applied to a set of endoscopic maFLIM images from 23 patients acquired at the other clinical center, and its performance was quantified in terms of the area under the receiver operating characteristic curve (ROC-AUC). Discrimination of dysplastic and cancerous from healthy oral tissue was achieved with an ROC-AUC of 0.81. This study demonstrates the capabilities of widefield maFLIM endoscopy to clinically image autofluorescence biomarkers that can be used in ML models to discriminate dysplastic and cancerous from healthy oral tissue. Widefield maFLIM endoscopy thus holds potential for automated in situ detection of oral dysplasia and cancer.
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Hakim SG, von Bialy R, Falougy M, Steller D, Tharun L, Rades D, Sieg P, Alsharif U. Impact of stratified resection margin classification on local tumor control and survival in patients with oral squamous cell carcinoma. J Surg Oncol 2021; 124:1284-1295. [PMID: 34416792 DOI: 10.1002/jso.26655] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/29/2021] [Accepted: 08/12/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Guidelines recommended for resection of oral cancer define a free margin of ≥5 mm as clear and safe (R0). This statement was questioned recently based on the assumption that different surgical margins may hold different risk categories. The aim of this study was to investigate the impact of stratification of the surgical margins on the survival outcome of patients with oral cancer. METHODS In a cohort of 753 patients, the hazard ratio for local recurrence-free survival (LRFS), overall survival (OS), and oral cancer-specific survival (OCSS) were estimated for R0 resection, the close margin of 1-4 mm, involved resection borders but with free frozen sections. Competing risk factors were considered in the statistical regression model. RESULTS One hundred seventy-three (23%) patients developed local recurrence and 316 (42%) died in the 5 follow-up years. There was a gradual improvement in the LRFS, OCSS, OS with the increase of clear margin. OS showed a similar tendency. CONCLUSION Not all patients with an R0cm status carry the same risk for impaired LRFS, OCSS, and OS. Their risk to develop recurrence is higher than those patients with R0 ≥5 mm but stratified risk management can be recommended according to the presented results.
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Affiliation(s)
- Samer G Hakim
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein (Campus Lübeck), Lübeck, Germany
| | - Robert von Bialy
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein (Campus Lübeck), Lübeck, Germany
| | - Mohamed Falougy
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein (Campus Lübeck), Lübeck, Germany
| | - Daniel Steller
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein (Campus Lübeck), Lübeck, Germany
| | - Lars Tharun
- Institute of Pathology, University Hospital Schleswig-Holstein (Campus Lübeck), Lübeck, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University Hospital Schleswig-Holstein (Campus Lübeck), Lübeck, Germany
| | - Peter Sieg
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein (Campus Lübeck), Lübeck, Germany
| | - Ubai Alsharif
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein (Campus Lübeck), Lübeck, Germany.,Department of Oral and Maxillofacial Surgery, Dortmund General Hospital, Dortmund, Germany
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30
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Impact of Planning Method (Conventional versus Virtual) on Time to Therapy Initiation and Resection Margins: A Retrospective Analysis of 104 Immediate Jaw Reconstructions. Cancers (Basel) 2021; 13:cancers13123013. [PMID: 34208555 PMCID: PMC8235255 DOI: 10.3390/cancers13123013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/11/2021] [Accepted: 06/13/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Computer-aided design and manufacturing of osseous reconstructions are currently widely used in jaw reconstructive surgery, providing an improved surgical outcome and decreased procedural stumbling block. However, data on the influence of planning time on the time-to-surgery initiation and resection margin are missing in the literature. This retrospective, monocentric study compares process times from the first patient contact in hospital, time of in-house or out-of-house biopsy for tumor diagnosis and surgical therapy of tumor resection, and immediate reconstruction of the jaw with free fibula flaps (FFF). Two techniques for reconstruction are used: Virtual surgical planning (VSP) and non-VSP. A total of 104 patients who underwent FFF surgery for immediate jaw reconstruction from 2002 to 2020 are included. The study findings fill the gaps in the literature and obtain clear insights based on the investigated study subjects. Abstract Virtual surgical planning (VSP) and patient-specific implants are currently increasing for immediate jaw reconstruction after ablative oncologic surgery. This technique contributes to more accurate and efficient preoperative planning and shorter operation time. The present retrospective, single-center study analyzes the influence of time delay caused by VSP vs. conventional (non-VSP) reconstruction planning on the soft and hard tissue resection margins for necessary oncologic safety. A total number of 104 cases of immediate jaw reconstruction with free fibula flap are included in the present study. The selected method of reconstruction (conventionally, non-VSP: n = 63; digitally, VSP: n = 41) are analyzed in detail. The study reveals a statistically significant (p = 0.008) prolonged time to therapy initiation with a median of 42 days when the VSP method compared with non-VSP (31.0 days) is used. VSP did not significantly affect bony or soft tissue resection margin status. Apart from this observation, no significant differences concerning local tumor recurrence, lymph node, and distant metastases rates are found according to the reconstruction method, and affect soft or bone tissue resection margins. Thus, we conclude that VSP for immediate jaw reconstruction is safe for oncological purposes.
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31
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Pierik AS, Leemans CR, Brakenhoff RH. Resection Margins in Head and Neck Cancer Surgery: An Update of Residual Disease and Field Cancerization. Cancers (Basel) 2021; 13:2635. [PMID: 34071997 PMCID: PMC8198309 DOI: 10.3390/cancers13112635] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/13/2021] [Accepted: 05/21/2021] [Indexed: 12/16/2022] Open
Abstract
Surgery is one of the mainstays of head and neck cancer treatment, and aims at radical resection of the tumor with 1 cm tumor-free margins to obtain locoregional control. Surgical margins are evaluated by histopathological examination of the resection specimen. It has been long an enigma that approximately 10-30% of surgically treated head and neck cancer patients develop locoregional recurrences even though the resection margins were microscopically tumor-free. However, the origins of these recurrences have been elucidated by a variety of molecular studies. Recurrences arise either from minimal residual disease, cancer cells in the surgical margins that escape detection by the pathologist when examining the specimen, or from precancerous mucosal changes that may remain unnoticed. Head and neck tumors develop in mucosal precursor changes that are sometimes visible but mostly not, fueling research into imaging modalities such as autofluorescence, to improve visualization. Mostly unnoticed, these precancerous changes may stay behind when the tumor is resected, and subsequent malignant progression will cause a local relapse. This led to a clinical trial of autofluorescence-guided surgery, of which the results were reported in 2020. This review focuses on the most recent literature of the improved diagnosis of the resection margins of surgically treated head and neck cancer patients, the pathobiological origin of recurrent disease, and relevant biomarkers to predict local relapse. Directions for further research will be discussed, including potential options for improved and personalized treatment, based on the most recently published data.
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Affiliation(s)
| | | | - Ruud H. Brakenhoff
- Amsterdam UMC, Vrije Universiteit Amsterdam Tumor Biology and Immunology Section, Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam, 1081 HV Amsterdam, The Netherlands; (A.S.P.); (C.R.L.)
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32
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Current Intraoperative Imaging Techniques to Improve Surgical Resection of Laryngeal Cancer: A Systematic Review. Cancers (Basel) 2021; 13:cancers13081895. [PMID: 33920824 PMCID: PMC8071167 DOI: 10.3390/cancers13081895] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Laryngeal cancer is a prevalent head and neck malignancy, with poor prognosis and low survival rates for patients with advanced disease. The recurrence rate for advanced laryngeal cancer is between 25 and 50%. In order to improve surgical resection of laryngeal cancer and reduce local recurrence rates, various intraoperative optical imaging techniques have been investigated. In this systematic review we identify these technologies, evaluating the current state and future directions of optical imaging for this indication. Evidently, the investigated imaging modalities are generally unsuitable for deep margin assessment, and, therefore, inadequate to guide resection in advanced laryngeal disease. We discuss two optical imaging techniques that can overcome these limitations and suggest how they can be used to achieve adequate margins in laryngeal cancer at all stages. Abstract Laryngeal cancer is a prevalent head and neck malignancy, with poor prognosis and low survival rates for patients with advanced disease. Treatment consists of unimodal therapy through surgery or radiotherapy in early staged tumors, while advanced stage tumors are generally treated with multimodal chemoradiotherapy or (total) laryngectomy followed by radiotherapy. Still, the recurrence rate for advanced laryngeal cancer is between 25 and 50%. In order to improve surgical resection of laryngeal cancer and reduce local recurrence rates, various intraoperative optical imaging techniques have been investigated. In this systematic review, we identify these technologies, evaluating the current state and future directions of optical imaging for this indication. Narrow-band imaging (NBI) and autofluorescence (AF) are established tools for early detection of laryngeal cancer. Nonetheless, their intraoperative utility is limited by an intrinsic inability to image beyond the (sub-)mucosa. Likewise, contact endoscopy (CE) and optical coherence tomography (OCT) are technically cumbersome and only useful for mucosal margin assessment. Research on fluorescence imaging (FLI) for this application is sparse, dealing solely with nonspecific fluorescent agents. Evidently, the imaging modalities that have been investigated thus far are generally unsuitable for deep margin assessment. We discuss two optical imaging techniques that can overcome these limitations and suggest how they can be used to achieve adequate margins in laryngeal cancer at all stages.
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Merchant YP, Kudpaje A, Rao VUS. Looking beyond the lens of dysplasia at surgical margins. Oral Oncol 2021; 119:105219. [PMID: 33593631 DOI: 10.1016/j.oraloncology.2021.105219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/30/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Yash P Merchant
- Dept. Head and Neck Oncology, Health Care Global, Tower #8, P. Kalinga Rao Road, Sampangi Ram Nagar, Bangalore 560 027, India.
| | - Akshay Kudpaje
- Dept Head and Neck Oncology, Health Care Global, Bangalore, India.
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HPV/p16-positive oropharyngeal cancer treated with transoral robotic surgery: The roles of margins, extra-nodal extension and adjuvant treatment. Am J Otolaryngol 2021; 42:102793. [PMID: 33130532 DOI: 10.1016/j.amjoto.2020.102793] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Human papilloma virus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) treatment outcomes are re-defining management. Traditional margins, the role of extranodal extension (ENE) and adjuvant treatment intensity continue to be debated. This study aimed to determine the impact of margins, ENE and adjuvant therapy on survival following transoral robotic surgery (TORS). METHODS Patients treated with TORS at an academic center were retrospectively identified (2013-2019). Survival outcomes were evaluated using Kaplan-Meier curves. RESULTS 48 patients were included. 40 (83%) were male. Mean age was 61.2 years. 43 (90%) were stage I. 22 (45.8%) had ENE. 31 (65%) had margins >1 mm. 38 (79%) had indications for radiation therapy; 9 (24%) refused. Chemotherapy was recommended in 36 (75%) patients; 24 (67%) refused. Locoregional control was 98%, metastasis-free survival was 96%, and disease-specific survival was 100% at 5-years. Overall survival was 95%. CONCLUSIONS Given the high survival rate seen after TORS, it is likely that margins, ENE and adjuvant treatment may not significantly contribute to outcomes.
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Homma A, Nakamaru Y, Lund VJ, Hanna EY, Kowalski LP, Toledo RN, Mäkitie AA, Rodrigo JP, Rinaldo A, Snyderman CH, Ferlito A. Endonasal endoscopic surgery for sinonasal squamous cell carcinoma from an oncological perspective. Auris Nasus Larynx 2020; 48:41-49. [PMID: 33280972 DOI: 10.1016/j.anl.2020.11.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 12/20/2022]
Abstract
Endonasal endoscopic surgery (EES) has been applied to the management of sinonasal (SN) tumors based on recent advances in endoscopic surgical techniques and technologies over the past three decades. EES has been mainly indicated for benign tumors and less aggressive malignant tumors. Notwithstanding this, EES has been gradually adopted for squamous cell carcinoma (SCC), which is the most common histology among SN malignancies. However, an analysis of the outcomes of EES for patients with SCC is difficult because most articles included SCC a wide range of different tumor histologies. Therefore, we herein review and clarify the current status of EES focusing on SCC from an oncological perspective. The oncologic outcomes and the ability to achieve a histologically complete resection are similar between endoscopic and open approaches in highly selected patients with SN-SCC. Surgical complications associated with EES are likely similar for SN-SCC compared to other sinonasal malignancies. The indications for a minimally invasive approach such as EES in the management of patients with SN-SCC should be stricter than those for less aggressive malignant tumors because of the aggressive nature of SCC. Also, it is important to achieve negative surgical margins with EES in patients with SCC. We believe that the indications for EES for SN-SCC are widening due to advances in diagnostic imaging, and endoscopic surgical techniques and technologies. However, while expanding the indications for EES for SN-SCC we must carefully confirm that the outcomes support this strategy.
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Affiliation(s)
- Akihiro Homma
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Sapporo 060-8638, Japan.
| | - Yuji Nakamaru
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Sapporo 060-8638, Japan
| | - Valerie J Lund
- Royal National Throat Nose and Ear Hospital, UCLH Foundation Trust, London, United Kingdom
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luiz Paulo Kowalski
- Division of Head and Neck Surgery, University of São Paulo Medical School and Department of Head and Neck Surgery and Otolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil; Department of Head and Neck Surgery and Otolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Ronaldo Nunes Toledo
- Department of Head and Neck Surgery and Otolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Juan Pablo Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, ISPA, IUOPA, University of Oviedo, CIBERONC, Oviedo, Spain
| | | | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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Hashmi AA, Iftikhar SN, Haider R, Baig NN, Asif MG, Irfan M. Recurrence and Disease-Free Survival in Head and Neck Squamous Cell Carcinoma After Margin-Free Resection on Frozen Section: An Institutional Perspective. Cureus 2020; 12:e11385. [PMID: 33312786 PMCID: PMC7725211 DOI: 10.7759/cureus.11385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction The most important factor determining survival in patients with head and neck squamous cell carcinoma (HNSCC) is a disease recurrence. A high rate of recurrence was noted in previous studies conducted in Pakistan; however, these studies did not consider margin status as inadequate margin clearance leads to disease recurrence. In this study, we determined cancer recurrence in patients with HNSCC after nullifying this factor. Methods This cross-sectional observational study was conducted in Liaquat National Hospital (LNH) for a duration of three years. Data collection period was from January 2015 to December 2017. A total of 150 patients that underwent surgery at LNH for HNSCC with margin-free frozen sections were included in the study. Pathological tumor characteristics such as tumor type, size, depth of invasion and nodal status were determined. Results The mean age of the patients was 50.31±12.90 with mean tumor size of 3.38±1.76. Nodal metastases were present in 45.3% cases with 17.3% showing extranodal extension. Recurrence was observed in 66% of cases with median disease-free survival of 12 months and perineural invasion was noted in 12% cases. We found a significant association of disease recurrence with larger tumor size, depth of invasion and extranodal extension. Moreover, younger age (<30 years) and older age (>50 years) groups showed higher rates of recurrence than the middle age group (30-50 years). Similarly, univariate and multivariate analyses revealed that tumors with ≥1 cm depth of invasion and the presence of extranodal extension were more likely to have disease recurrence than tumors with <1 cm depth of invasion and without extranodal extension. Survival analysis using the Kaplan-Meier method for HNSCC revealed a significant difference in disease-free survival in patients with more than 2 cm tumor size and ≥1 cm depth of invasion than cases with ≤ 2cm tumor size and <1 cm depth of invasion. Conclusion A high rate of disease recurrence for HNSSC was noted in our study, despite margin-free primary tumor resection. Apart from tumor size and depth of invasion, extranodal extension was significantly associated with disease recurrence in HNSCC. This signifies a need for margin evaluation of neck dissection specimen in cases with extranodal extension.
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Affiliation(s)
- Atif A Hashmi
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Syeda N Iftikhar
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Rimsha Haider
- Internal Medicine, Liaquat National Hospital and Medical College, Karachi, PAK.,Emergency Medicine, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, PAK
| | - Nabeel N Baig
- Research and Development, College of Physicians and Surgeons, Karachi, PAK
| | | | - Muhammad Irfan
- Statistics, Liaquat National Hospital and Medical College, Karachi, PAK
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Demir B, Incaz S, Uckuyulu EI, Oysu C. Accuracy of Frozen Section Examination in Oral Cavity Cancers. EAR, NOSE & THROAT JOURNAL 2020; 101:NP354-NP357. [PMID: 33155855 DOI: 10.1177/0145561320967334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE This study aimed to compare the intraoperative frozen section with the surgical margin in the postoperative surgical margins of the postoperative pathology of oral squamous cell carcinomas in order to examine the reliability of the frozen section. METHODS A retrospective analysis was conducted for patients who underwent surgery for oral squamous cell carcinoma in a tertiary hospital between January 2018 and 2019. The intraoperative frozen section examinations, grade of the tumor, number of lymph nodes, number of affected lymph nodes, depth of invasion, perineural invasion, lymphovascular invasion, and extranodal extension were recorded from the pathological records. The concordance between the frozen section examination and postoperative pathology 2 methods was examined using the Cronbach α coefficient. Sensitivity, specificity, positive predictive value, negative predictive value regarding surgical margins, and accuracy were calculated and reported. RESULTS Overall, 181patients who underwent surgery for oral cavity cancers were included; 118 (65.2%) were males. The mean (± standard deviation) age of the included participants was 57.4 ± 16.1 years. The most common tumour subsite was the tongue (n = 71, 39.2%). There was concordancy between the frozen, positive intraoperative malignancy and the postoperative pathology malignancy. The frozen, negative intraoperative malignancy and postoperative safe surgical margin did not significantly differ. CONCLUSION As a result of intraoperative frozen examination, we found conformity between the postoperative pathology results of patients with positive and negative surgical margins. Frozen section examination could be used safely to examine intraoperative surgical margins of oral squamous cell carcinoma.
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Affiliation(s)
- Berat Demir
- Department of Otorhinolaryngology-Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University Medical Faculty, Istanbul, Turkey
| | - Sefa Incaz
- Department of Otorhinolaryngology-Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University Medical Faculty, Istanbul, Turkey
| | - Esin Irem Uckuyulu
- Department of Otorhinolaryngology-Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University Medical Faculty, Istanbul, Turkey
| | - Cagatay Oysu
- Department of Otorhinolaryngology-Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University Medical Faculty, Istanbul, Turkey
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Guna TP, Sathyanarayanan R, Madhu K, Bharathi S. Margin Analysis in Head and Neck Cancer: State of the Art and Future Directions. Ann Surg Oncol 2020; 28:3431. [PMID: 33151505 DOI: 10.1245/s10434-020-09294-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/03/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Thamizhp Pozhil Guna
- Department of Oral and Maxillofacial Surgery, Indira Gandhi Institute of Dental Sciences, Puducherry, India.
| | - R Sathyanarayanan
- Department of Oral and Maxillofacial Surgery, Indira Gandhi Institute of Dental Sciences, Puducherry, India
| | - K Madhu
- Oral and MaxilloFacial Surgeon, Trichy, Tamil Nadu, India
| | - S Bharathi
- Oral and MaxilloFacial Surgeon, Karaikudi, Tamil Nadu, India
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An Update on Surgical Margins in the Head Neck Squamous Cell Carcinoma: Assessment, Clinical Outcome, and Future Directions. Curr Oncol Rep 2020; 22:82. [PMID: 32601821 DOI: 10.1007/s11912-020-00942-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Failure to achieve tumor-free margins is the single largest cause of death for head neck cancer patients. At the same time, it is the only factor that is in complete control of the surgeon. This review summarizes evidence for the definition, clinical implications, and methods to achieve optimal margins. RECENT FINDINGS The previous universally followed definition of adequate margin (5 mm in final histopathology) has been disputed. Various biological, optical, and imaging adjuncts can aid in achieving optimal margins. Extent of resection and margins in human papilloma virus (HPV)-positive oropharyngeal cancers and following induction chemotherapy remain controversial. Though practiced widely, frozen section-guided margin revision has not conclusively shown improved local control rates. The role of molecular assessment of margins is promising but not established. The definition of adequate margin differs according to the site in the head neck region. Currently, the 5-mm margin at final histopathology is the most commonly accepted definition of an "adequate" margin.
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Singh R, Das S, Datta S, Mazumdar A, Biswas NK, Maitra A, Majumder PP, Ghose S, Roy B. Study of Caspase 8 mutation in oral cancer and adjacent precancer tissues and implication in progression. PLoS One 2020; 15:e0233058. [PMID: 32492030 PMCID: PMC7269231 DOI: 10.1371/journal.pone.0233058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/27/2020] [Indexed: 12/16/2022] Open
Abstract
It is hypothesized that same driver gene mutations should be present in both oral leukoplakia and cancer tissues. So, we attempted to find out mutations at one of the driver genes, CASP8, in cancer and adjacent leukoplakia tissues. Patients (n = 27), affected by both of cancer and adjacent leukoplakia, were recruited for the study. Blood and tissue DNA samples were used to identify somatic mutations at CASP8 by next generation sequencing method. In total, 56% (15 out of 27) cancer and 30% (8 out of 27) leukoplakia tissues had CASP8 somatic mutations. In 8 patients, both cancer and adjacent leukoplakia tissues, located within 2-5 cm of tumor sites, had identical somatic mutations. But, in 7 patients, cancer samples had somatic mutations but none of the leukoplakia tissues, located beyond 5cm of tumor sites, had somatic mutations. Mutated allele frequencies at CASP8 were found to be more in cancer compared to adjacent leukoplakia tissues. This study provides mutational evidence that oral cancer might have progressed from previously grown leukoplakia lesion. Leukoplakia tissues, located beyond 5cm of cancer sites, were free from mutation. The study implies that CASP8 mutation could be one of the signatures for some of the leukoplakia to progress to oral cancer.
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Affiliation(s)
- Richa Singh
- Human Genetics Unit, Indian Statistical Institute, Kolkata, India
| | - Shreya Das
- Dr. R. Ahmed Dental College and Hospital, Kolkata, India
| | - Sila Datta
- Dr. R. Ahmed Dental College and Hospital, Kolkata, India
| | | | - Nidhan K. Biswas
- National Institute of Biomedical Genomics, Kalyani, West Bengal, India
| | - Arindam Maitra
- National Institute of Biomedical Genomics, Kalyani, West Bengal, India
| | | | - Sandip Ghose
- Dr. R. Ahmed Dental College and Hospital, Kolkata, India
- * E-mail: (BR); (SG)
| | - Bidyut Roy
- Human Genetics Unit, Indian Statistical Institute, Kolkata, India
- * E-mail: (BR); (SG)
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Surgical resection of oral cancer: en-bloc versus discontinuous approach. Eur Arch Otorhinolaryngol 2020; 277:3127-3135. [PMID: 32367148 DOI: 10.1007/s00405-020-06016-5] [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: 01/07/2020] [Accepted: 04/26/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES In the past literature agreed on treating oral carcinomas, using an "en-bloc" resection (EBR) but recently minimally invasive transoral surgery has spread as the preferable treatment for selected cases. This latter technique, which is performed with a discontinuous resection (DR), allows for a satisfactory postoperative quality of life (QoL) maintaining good survival rates. MATERIALS AND METHODS In this study, we analyzed data about 147 surgically treated patients with oral cancer involving tongue and floor of the mouth. The sample was divided according to the surgical approach: EBR and DR group which were compared in terms of recurrence, overall survival, disease-free survival, and QoL. RESULTS In the DR group, survival analysis showed better results in term of survival, locoregional control, and postoperative anxiety, while the other QoL scores were similar in the two groups. CONCLUSION The more invasive approach does not correlate to a better outcome. In selected cases, DR is an oncologically safe technique; EBR is still a valid option to treat advanced oral cancers.
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Hubbard TJE, Shore A, Stone N. Raman spectroscopy for rapid intra-operative margin analysis of surgically excised tumour specimens. Analyst 2020; 144:6479-6496. [PMID: 31616885 DOI: 10.1039/c9an01163c] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Raman spectroscopy, a form of vibrational spectroscopy, has the ability to provide sensitive and specific biochemical analysis of tissue. This review article provides an in-depth analysis of the suitability of different Raman spectroscopy techniques in providing intra-operative margin analysis in a range of solid tumour pathologies. Surgical excision remains the primary treatment of a number of solid organ cancers. Incomplete excision of a tumour and positive margins on histopathological analysis is associated with a worse prognosis, the need for adjuvant therapies with significant side effects and a resulting financial burden. The provision of intra-operative margin analysis of surgically excised tumour specimens would be beneficial for a number of pathologies, as there are no widely adopted and accurate methods of margin analysis, beyond histopathology. The limitations of Raman spectroscopic studies to date are discussed and future work necessary to enable translation to clinical use is identified. We conclude that, although there remain a number of challenges in translating current techniques into a clinically effective tool, studies so far demonstrate that Raman Spectroscopy has the attributes to successfully perform highly accurate intra-operative margin analysis in a clinically relevant environment.
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Heidari AE, Pham TT, Ifegwu I, Burwell R, Armstrong WB, Tjoson T, Whyte S, Giorgioni C, Wang B, Wong BJ, Chen Z. The use of optical coherence tomography and convolutional neural networks to distinguish normal and abnormal oral mucosa. JOURNAL OF BIOPHOTONICS 2020; 13:e201900221. [PMID: 31710775 PMCID: PMC7250484 DOI: 10.1002/jbio.201900221] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 11/08/2019] [Accepted: 11/10/2019] [Indexed: 06/10/2023]
Abstract
Incomplete surgical resection of head and neck squamous cell carcinoma (HNSCC) is the most common cause of local HNSCC recurrence. Currently, surgeons rely on preoperative imaging, direct visualization, palpation and frozen section to determine the extent of tissue resection. It has been demonstrated that optical coherence tomography (OCT), a minimally invasive, nonionizing near infrared mesoscopic imaging modality can resolve subsurface differences between normal and abnormal head and neck mucosa. Previous work has utilized two-dimensional OCT imaging which is limited to the evaluation of small regions of interest generated frame by frame. OCT technology is capable of performing rapid volumetric imaging, but the capacity and expertise to analyze this massive amount of image data is lacking. In this study, we evaluate the ability of a retrained convolutional neural network to classify three-dimensional OCT images of head and neck mucosa to differentiate normal and abnormal tissues with sensitivity and specificity of 100% and 70%, respectively. This method has the potential to serve as a real-time analytic tool in the assessment of surgical margins.
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Affiliation(s)
- Andrew E. Heidari
- Beckman Laser Institute & Medical Clinic, Irvine, CA 92612, USA
- Department of Biomedical Engineering, University of California - Irvine, Irvine, CA 92697, USA
| | - Tiffany T. Pham
- Beckman Laser Institute & Medical Clinic, Irvine, CA 92612, USA
- University of California - Irvine, School of Medicine, Irvine, CA 92617, USA
| | - Ibe Ifegwu
- Department of Pathology, University of California – Irvine, Irvine, CA 92697, USA
| | - Ross Burwell
- Department of Pathology, University of California – Irvine, Irvine, CA 92697, USA
| | - William B. Armstrong
- Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine, School of Medicine, Orange, CA 92868, USA
| | - Tjoa Tjoson
- Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine, School of Medicine, Orange, CA 92868, USA
| | - Stephanie Whyte
- Department of Pathology, University of California – Irvine, Irvine, CA 92697, USA
| | - Carmen Giorgioni
- Department of Pathology, University of California – Irvine, Irvine, CA 92697, USA
| | - Beverly Wang
- Department of Pathology, University of California – Irvine, Irvine, CA 92697, USA
| | - Brian J.F. Wong
- Beckman Laser Institute & Medical Clinic, Irvine, CA 92612, USA
- Department of Biomedical Engineering, University of California - Irvine, Irvine, CA 92697, USA
- Department of Otolaryngology - Head and Neck Surgery, University of California - Irvine, School of Medicine, Orange, CA 92868, USA
| | - Zhongping Chen
- Beckman Laser Institute & Medical Clinic, Irvine, CA 92612, USA
- Department of Biomedical Engineering, University of California - Irvine, Irvine, CA 92697, USA
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De Leeuw F, Abbaci M, Casiraghi O, Ben Lakhdar A, Alfaro A, Breuskin I, Laplace-Builhé C. Value of Full-Field Optical Coherence Tomography Imaging for the Histological Assessment of Head and Neck Cancer. Lasers Surg Med 2020; 52:768-778. [PMID: 32072655 DOI: 10.1002/lsm.23223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND OBJECTIVES In head and neck surgery, intraoperative and postoperative evaluation of tumor margins is achieved by histopathological assessment, which is a multistep process. Intraoperative analysis of tumor margins to obtain a preliminary diagnosis is usually carried out on frozen sections. Analysis of frozen sections is challenging due to technical difficulties in processing. Full-field optical coherence tomography (FFOCT) provides ex vivo images of fresh tissue samples at a microscopic scale without tissue processing. The objectives of our study were to define the diagnostic criteria required to interpret head and neck FFOCT images and to evaluate the reliability of a histological diagnosis made on an "optical biopsy" produced by head and neck FFOCT imaging compared with conventional histology. STUDY DESIGN/MATERIALS AND METHODS First, we established an atlas of comparative images (FFOCT/standard histology) and defined the diagnostic criteria based on FFOCT images. Two pathologists subsequently performed a blinded review on 57 FFOCT images (32 patients). Specificity and sensitivity were measured by comparison with the standard histological diagnosis. The primary endpoint was major concordance, defined as two classifications leading to the same therapeutic decision (treatment/no treatment). RESULTS Pathologists identified four main criteria for tissue diagnosis on FFOCT images: heterogeneous cell distribution, stromal reaction, coiling, and keratinization abnormalities. The correlation study showed good results, with sensitivity from 88% to 90% and specificity from 81% to 87%, regardless of whether the FFOCT image review was performed by a pathologist with or without previous experience in optical imaging. CONCLUSIONS Our results demonstrate that FFOCT images can be used by pathologists for differential diagnosis, and that high-resolution FFOCT imaging can provide an assessment of microscopic architecture in head and neck tissues without tissue processing requirements. Lasers Surg. Med. © 2020 Wiley Periodicals, Inc.
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Affiliation(s)
- Frederic De Leeuw
- Gustave Roussy, Plate-forme Imagerie et Cytométrie, Université Paris-Saclay, UMS 23/3655, Villejuif, F-94805, France
| | - Muriel Abbaci
- Gustave Roussy, Plate-forme Imagerie et Cytométrie, Université Paris-Saclay, UMS 23/3655, Villejuif, F-94805, France.,UMR CNRS 8081-IR4M, Univ Paris-Sud, Université Paris-Saclay, Orsay, F-91401, France
| | - Odile Casiraghi
- Département de pathologie, Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Aïcha Ben Lakhdar
- Département de pathologie, Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Alexia Alfaro
- Gustave Roussy, Plate-forme Imagerie et Cytométrie, Université Paris-Saclay, UMS 23/3655, Villejuif, F-94805, France
| | - Ingrid Breuskin
- Département de chirurgie, Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Corinne Laplace-Builhé
- Gustave Roussy, Plate-forme Imagerie et Cytométrie, Université Paris-Saclay, UMS 23/3655, Villejuif, F-94805, France.,UMR CNRS 8081-IR4M, Univ Paris-Sud, Université Paris-Saclay, Orsay, F-91401, France
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Surgical margins in oral squamous cell cancer: intraoperative evaluation and prognostic impact. Curr Opin Otolaryngol Head Neck Surg 2019; 27:98-103. [PMID: 30844923 DOI: 10.1097/moo.0000000000000516] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW To summarize recent findings regarding surgical management of oral squamous cell cancer (OSCC) through analysis of different intraoperative techniques for assessment of margins, evaluate the pros and cons of each, and ensuing prognostic impact. RECENT FINDINGS 'En bloc' OSCC resection and histopathologic evaluation of margins on the formalin-fixed specimen remain the 'gold standard' for oral oncologic surgery, whereas assessment of intraoperative surgical margins and its overall clinical value are still questioned and debated in the literature. The commonly applied evaluation of frozen sections still raises concerns regarding its efficacy and reproducibility; therefore, several ancillary diagnostic methods have entered the field of head and neck oncology in the last decades, aiming to support the surgeon in achieving tumor-free margins during ablative procedures. SUMMARY Poor prognosis of OSCC is strongly associated with residual tumor after surgery. Negative surgical margins are one of the strongest prognosticators for disease-free survival and locoregional control, but their intraoperative determination seems still to be suboptimal and needs better refinement. The most studied techniques to assess intraoperative margins include fluorescence, Raman spectroscopy, narrow band imaging, optical coherence tomography, and cytological bone margins analysis; each has its unique characteristics that are described in detail herein.
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46
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van Keulen S, Nishio N, Birkeland A, Fakurnejad S, Martin B, Forouzanfar T, Cunanan K, Colevas AD, S van den Berg N, Rosenthal E. The Sentinel Margin: Intraoperative Ex Vivo Specimen Mapping Using Relative Fluorescence Intensity. Clin Cancer Res 2019; 25:4656-4662. [PMID: 31142505 DOI: 10.1158/1078-0432.ccr-19-0319] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/27/2019] [Accepted: 05/14/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Despite major advancements in surgical oncology, the positive margin rate for primary head and neck cancer resection remains around 15%-30%. In particular, the deep surface margin is the most challenging to adequately assess. Inadequate margins are directly correlated to poor survival, and as such, mitigation of these rates is critical to improve patient outcomes. We have developed an ex vivo imaging strategy that utilizes fluorescence intensity peaks (relative to background signal) of an injected anti-EGFR antibody conjugated to a fluorescent probe to locate potential close or positive margins on the deep surface of the resected tumor specimen. EXPERIMENTAL DESIGN Twelve patients with head and neck cancer scheduled for surgery received systemic administration of a tumor-specific contrast-agent (panitumumab-IRDye800CW). After surgical resection, the tumor specimen was imaged using a fluorescence imager. The three highest fluorescence intensity-peaks on the deep surface of the specimen were isolated and correlated to histology to determine the margin distance at these regions. RESULTS Relative fluorescence peak intensities identified the closest margin on the deep surface of the specimen within 2.5 minutes. The highest intensity peak consistently (100%) detected the closest margin to the tumor. The difference in tumor margin distance between the first and second highest fluorescence intensity peak averaged 2.1 ± 1.4 mm. The tumor-margin difference between the second and third highest peak averaged 1.6 ± 0.6 mm. CONCLUSIONS Fluorescence intensity peaks can identify the region on the specimen where tumor is closest to specimen's edge on the deep surface. This technique could have broad applications in obtaining adequate margins in oncological surgery.
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Affiliation(s)
- Stan van Keulen
- Department of Otolaryngology-Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.,Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands
| | - Naoki Nishio
- Department of Otolaryngology-Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Andrew Birkeland
- Department of Otolaryngology-Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Shayan Fakurnejad
- Department of Otolaryngology-Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Brock Martin
- Department of Clinical Pathology, Stanford University School of Medicine, Stanford, California
| | - Tim Forouzanfar
- Department of Oral and Maxillofacial Surgery/Oral Pathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands
| | - Kristen Cunanan
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
| | - A Dimitrios Colevas
- Department of Medicine, Division of Medical Oncology, Stanford University School of Medicine, Stanford, California
| | - Nynke S van den Berg
- Department of Otolaryngology-Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Eben Rosenthal
- Department of Otolaryngology-Division of Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.
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47
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Tirelli G, Hinni ML, Fernández‐Fernández MM, Bussani R, Gatto A, Bonini P, Giudici F, Boscolo Nata F. Frozen sections and complete resection in oral cancer surgery. Oral Dis 2019; 25:1309-1317. [DOI: 10.1111/odi.13101] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/11/2019] [Accepted: 03/27/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Giancarlo Tirelli
- ENT Clinic, Head and Neck Department Azienda Sanitaria Universitaria Integrata di Trieste Trieste Italy
| | - Michael L. Hinni
- Department of Otolaryngology Mayo Clinic Phoenix Phoenix Arizona
| | | | - Rossana Bussani
- UCO Pathological Anatomy and Histopathology Unit Azienda Sanitaria Universitaria Integrata di Trieste Trieste Italy
| | - Annalisa Gatto
- ENT Clinic, Head and Neck Department Azienda Sanitaria Universitaria Integrata di Trieste Trieste Italy
| | - Pierluigi Bonini
- ENT Clinic, Head and Neck Department Azienda Sanitaria Universitaria Integrata di Trieste Trieste Italy
| | - Fabiola Giudici
- Biostatistics Unit‐Department of Medical, Surgical and Health Science Azienda Sanitaria Universitaria Integrata di Trieste Trieste Italy
| | - Francesca Boscolo Nata
- ENT Clinic, Head and Neck Department Azienda Sanitaria Universitaria Integrata di Trieste Trieste Italy
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