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Dettrick A, Foden N, Hogan D, Azer M, Blazak J, Atwell D, Buddle N, Min M, Livingston R, Banney L, Donkin R. The hidden Australian skin cancer epidemic, high-risk cutaneous squamous cell carcinoma: a narrative review. Pathology 2024; 56:619-632. [PMID: 38871593 DOI: 10.1016/j.pathol.2024.05.002] [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: 10/22/2023] [Revised: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 06/15/2024]
Abstract
Deaths from non-melanoma skin cancers (NMSCs) have almost doubled in Australia in recent years. Cutaneous squamous cell carcinoma (cSCC) constitutes approximately 20% of NMSCs, but is responsible for most of the deaths. Most skin cancers are easy to diagnose and treat and therefore cSCC are often trivialised; however, there is a high-risk subgroup of cSCC (HRcSCC) that is associated with a high risk of metastasis and death. The definition of early HRcSCC and our ability to identify them is evolving. Many significant prognostic factors have been identified, but a universally accepted prognostic index does not exist. Guidelines for workup, treatment, and follow-up leave many important decisions open to broad interpretation by the treating physician or multidisciplinary team. Some of the treatments used for metastatic cSCC are not supported by robust evidence and the prognosis of metastatic cSCC is guarded. In this review, we highlight the rapid rise in NMSC deaths and discuss some of the deficiencies in our knowledge of how to define, diagnose, stage, and manage HRcSCC.
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Affiliation(s)
- Andrew Dettrick
- Anatomical Pathology, Pathology Queensland, Sunshine Coast, Qld, Australia; School of Health, University of the Sunshine Coast, Qld, Australia.
| | - Neil Foden
- Ear, Nose and Throat, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - David Hogan
- Ear, Nose and Throat, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Mary Azer
- Medical Oncology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - John Blazak
- Radiology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Daisy Atwell
- Radiation Oncology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Nicole Buddle
- Radiation Oncology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Myo Min
- School of Health, University of the Sunshine Coast, Qld, Australia; Radiation Oncology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia; School of Medicine and Dentistry, Griffith University, Sunshine Coast, Qld, Australia
| | - Ryan Livingston
- Plastic Surgery, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Leith Banney
- Dermatology, Sunshine Coast University Hospital, Sunshine Coast, Qld, Australia
| | - Rebecca Donkin
- School of Health, University of the Sunshine Coast, Qld, Australia; School of Medicine and Dentistry, Griffith University, Sunshine Coast, Qld, Australia
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Ludwig R, Schubert AD, Barbatei D, Bauwens L, Hoffmann JM, Werlen S, Elicin O, Dettmer M, Zrounba P, Pouymayou B, Balermpas P, Grégoire V, Giger R, Unkelbach J. Modelling the lymphatic metastatic progression pathways of OPSCC from multi-institutional datasets. Sci Rep 2024; 14:15750. [PMID: 38977731 PMCID: PMC11231166 DOI: 10.1038/s41598-024-66012-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 06/26/2024] [Indexed: 07/10/2024] Open
Abstract
The elective clinical target volume (CTV-N) in oropharyngeal squamous cell carcinoma (OPSCC) is currently based mostly on the prevalence of lymph node metastases in different lymph node levels (LNLs) for a given primary tumor location. We present a probabilistic model for ipsilateral lymphatic spread that can quantify the microscopic nodal involvement risk based on an individual patient's T-category and clinical involvement of LNLs at diagnosis. We extend a previously published hidden Markov model (HMM), which models the LNLs (I, II, III, IV, V, and VII) as hidden binary random variables (RVs). Each represents a patient's true state of lymphatic involvement. Clinical involvement at diagnosis represents the observed binary RVs linked to the true state via sensitivity and specificity. The primary tumor and the hidden RVs are connected in a graph. Each edge represents the conditional probability of metastatic spread per abstract time-step, given disease at the edge's starting node. To learn these probabilities, we draw Markov chain Monte Carlo samples from the likelihood of a dataset (686 OPSCC patients) from three institutions. We compute the model evidence using thermodynamic integration for different graphs to determine which describes the data best.The graph maximizing the model evidence connects the tumor to each LNL and the LNLs I through V in order. It predicts the risk of occult disease in level IV is below 5% if level III is clinically negative, and that the risk of occult disease in level V is below 5% except for advanced T-category (T3 and T4) patients with clinical involvement of levels II, III, and IV. The provided statistical model of nodal involvement in OPSCC patients trained on multi-institutional data may guide the design of clinical trials on volume-deescalated treatment of OPSCC and contribute to more personal guidelines on elective nodal treatment.
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Affiliation(s)
- Roman Ludwig
- Dep. of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
- Dep. of Physics, University of Zurich, Rämistrasse 71, 8006, Zurich, Switzerland.
| | - Adrian Daniel Schubert
- Dep. of ENT, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
- Head and Neck Anticancer Center, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
- Dep. of ENT, Head & Neck Surgery, Réseau Hospitalier Neuchâtelois (RHNe), Neuchâtel, Switzerland
| | - Dorothea Barbatei
- Dep. of Radiation Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France
| | - Lauence Bauwens
- Dep. of Radiation Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France
| | - Jean-Marc Hoffmann
- Dep. of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Sandrine Werlen
- Dep. of ENT, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
- Head and Neck Anticancer Center, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Olgun Elicin
- Dep. of Radiation Oncology, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Matthias Dettmer
- Institute of Tissue Medicine and Pathology, Bern University Hospital, University of Bern, Murtenstrasse 31, 3008, Bern, Switzerland
- Institute of Pathology, Klinikum Stuttgart, Kriegsbergstr. 60c, 70174, Stuttgart, Germany
| | - Philippe Zrounba
- Dep. of Head and Neck surgery, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France
| | - Bertrand Pouymayou
- Dep. of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Panagiotis Balermpas
- Dep. of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Vincent Grégoire
- Dep. of Radiation Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France
| | - Roland Giger
- Dep. of ENT, Head & Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
- Head and Neck Anticancer Center, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Jan Unkelbach
- Dep. of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
- Dep. of Physics, University of Zurich, Rämistrasse 71, 8006, Zurich, Switzerland
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3
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Gang Q, Feng J, Kauczor HU, Zhang K. Predicting nodal metastasis progression of oral tongue cancer using a hidden Markov model in MRI. Front Oncol 2024; 14:1360253. [PMID: 38912064 PMCID: PMC11191577 DOI: 10.3389/fonc.2024.1360253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/16/2024] [Indexed: 06/25/2024] Open
Abstract
Objectives The presence of occult nodal metastases in patients with oral tongue squamous cell carcinomas (OTSCCs) has implications for treatment. More than 30% of patients will have occult nodal metastases, yet a considerable number of patients undergo unnecessary invasive neck dissection to confirm nodal status. In this work, we propose a probabilistic model for lymphatic metastatic spread that can quantify the risk of microscopic involvement at the lymph node level (LNL) given the location of macroscopic metastases and the tumor stage using the MRI method. Materials and methods A total of 108 patients of OTSCCs were included in the study. A hidden Markov model (HMM) was used to compute the probabilities of transitions between states over time based on MRI. Learning of the transition probabilities was performed via Markov chain Monte Carlo sampling and was based on a dataset of OTSCC patients for whom involvement of individual LNLs was reported. Results Our model found that the most common involvement was that of level I and level II, corresponding to a high probability of 𝑝b1 = 0.39 ± 0.05, 𝑝b2 = 0.53 ± 0.09; lymph node level I had metastasis, and the probability of metastasis in lymph node II was high (93.79%); lymph node level II had metastasis, and the probability of metastasis in lymph node III was small (7.88%). Lymph nodes progress faster in the early stage and slower in the late stage. Conclusion An HMM can produce an algorithm that is able to predict nodal metastasis evolution in patients with OTSCCs by analyzing the macroscopic metastases observed in the upstream levels, and tumor category.
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Affiliation(s)
- Qiangqiang Gang
- Department of Radiology, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Jie Feng
- Department of Radiology, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ke Zhang
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
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Morisada MV, Bewley AF, Broadhead K, Assadsangabi R, Paydar A, Birkeland AC, Abouyared M, Qi L, Ivanovic V. CT predictors of sub-centimeter occult lymph node metastases in oral cavity squamous cell carcinoma: A case-control study. Neuroradiol J 2024; 37:214-220. [PMID: 38148295 PMCID: PMC10973826 DOI: 10.1177/19714009231224447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND For patients with oral cavity squamous cell carcinoma (OCSCC) without evidence of nodal metastasis (cN0) on pre-operative evaluation, there are no clear guidelines who should undergo elective neck dissection (END) versus clinical surveillance. OBJECTIVE To identify CT imaging characteristics of sub-centimeter lymph nodes that would help predict the likelihood of nodal metastases on pathology. METHODS Retrospective review of cN0 OCSCC patients at a tertiary academic medical center was performed. Inclusion criteria included elective neck dissection, pre-operative CT imaging and presence of metastatic disease within lymph nodes. Control group consisted of patients without nodal metastases on pathology. CT features that were evaluated included asymmetric size, disrupted fatty hilum, asymmetric number, presence of cortical nodule, cortical nodule size, and round/oval shape. We evaluated the associations between CT LN features and the presence of metastases using multi-level mixed-effects logistic regression models. Model evaluation was performed using 5-fold cross-validation. The positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS 26 patients in each study and control groups were included. Three-level mixed-effects logistic regression models indicated round/oval shape (OR = 1.39, p = .01), asymmetric number (OR = 7.20, p = .005), and disrupted fatty hilum (OR = 3.31, p = .04) to be independently predictive in a 3-variable model with sensitivity = 38.0%, specificity = 92.0%, and PPV = 93.8%. CONCLUSIONS In cN0 OCSCC patients undergoing END, round/oval shape, asymmetric number, and disrupted fatty hilum of lymph nodes on pre-operative CT imaging are novel and highly predictive of occult nodal disease.
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Affiliation(s)
- Megan V Morisada
- Department of Otolaryngology, University of California Davis, USA
| | - Arnaud F Bewley
- Department of Otolaryngology, University of California Davis, USA
| | | | - Reza Assadsangabi
- Department of Radiology, Keck School of Medicine, University of Southern California, USA
| | - Alireza Paydar
- Department of Radiology, Cleveland Clinic Foundation, USA
| | | | | | - Lihong Qi
- Department of Public Health Sciences, School of Medicine, University of California Davis, USA
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Zhang W, Liu J, Jin W, Li R, Xie X, Zhao W, Xia S, Han D. Radiomics from dual-energy CT-derived iodine maps predict lymph node metastasis in head and neck squamous cell carcinoma. LA RADIOLOGIA MEDICA 2024; 129:252-267. [PMID: 38015363 DOI: 10.1007/s11547-023-01750-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 10/27/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To develop and validate an iodine maps-based radiomics nomogram for preoperatively predicting cervical lymph node metastasis (LNM) in head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS A total of 278 patients who pathologically confirmed as HNSCC were retrospectively recruited from two medical centers between June 2012 and July 2022. The training set (n = 152) and internal set (n = 67) were randomly selected from medical center A, and the patients from medical center B were enrolled as the external set (n = 69). The minority group in the training set was balanced by the adaptive synthetic sampling (ADASYN) approach. Radiomics features were extracted from dual-energy CT-derived iodine maps at arterial phase (AP) and venous phase (VP), respectively. Three radiomics signatures were constructed to predict the LNM by using a random forest algorithm. The independent clinical predictors for LNM were identified by multivariate analysis and combined with radiomics signatures to establish a radiomic-clinical nomogram. The performance of radiomic-clinical nomogram was evaluated with respect to its discrimination and clinical usefulness. RESULTS The AP-VP-incorporated radiomics model exhibited a great predictive performance for LNM prediction with an area under curve (AUC) of 0.885 (95% CI, 0.836-0.933) in ADASYN-training set and confirmed in all validation sets. The nomogram that incorporated AP-VP radiomics signatures, CT-reported LN status, and histological grades yielded AUCs of 0.920 (95% CI, 0.881-0.959) in ADASYN-training set, 0.858 (95% CI, 0.771-0.944) in internal validation, and 0.849 (95% CI, 0.752-0.946) in external validation, with good calibration in all cohorts (p > 0.05). Decision curve analyses indicated the nomogram was clinically useful. In addition, the predictive performance of clinical-radiomics nomogram was also validation in combing cohorts. Stratified analysis confirmed the stability of nomogram, particularly in group negative for CT-reported LNM. CONCLUSION Clinical-radiomics nomogram based on iodine maps exhibited promising performance in predicting LNM and providing valuable information for making individualized therapy decisions.
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Affiliation(s)
- Weiyuan Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Jin Liu
- Center of PET/CT, 920th Hospital of Joint Logistics Support Force, PLA, Kunming, 650032, China
| | - Wenfeng Jin
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Ruihong Li
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Xiaojie Xie
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Wen Zhao
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Shuang Xia
- Department of Radiology, The First Central Clinical School, Tianjin Medical University, Tianjin, 300192, China
| | - Dan Han
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China.
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Madani G, Arain Z, Awad Z. The radiological unknown primary of the head and neck: Recommendations for imaging strategies based on a systematic review. Clin Otolaryngol 2024; 49:16-28. [PMID: 37846889 DOI: 10.1111/coa.14111] [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: 04/13/2023] [Revised: 09/24/2023] [Accepted: 09/30/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVES To develop recommendations for the radiological investigation of clinically occult primary cancer in the head and neck. DESIGN AND SETTING In accordance with PRISMA guidelines, a search was performed on Medline, Embase and Cochrane library databases to investigate the efficacy of ultrasound guided Fine Needle Aspiration (US FNAC), contrast enhanced CT (CECT), magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose PET-CT (18F-FDG PET-CT) in the investigation of head and neck squamous cell carcinoma from an unknown primary (HNSCCUP) presenting with a metastatic cervical lymph node (s). The Quality Assessment of Diagnostic Accuracy Studies Version 2 tool and SIGN 50 guidelines were used to assess the risk of bias and quality of the included studies. PARTICIPANTS Adult patients presenting with metastatic cervical lymph nodes from a HNSCCUP. MAIN OUTCOME MEASURES Utility of different imaging modalities (PET-CT, MRI, CE CT and US FNAC in the management of HNSCCUP). RESULTS Twenty-eight studies met inclusion criteria; these were meta-analyses, systematic reviews, prospective and retrospective studies. CONCLUSIONS The optimal imaging strategy involves utilisation of various imaging modalities. US FNAC can provide the initial diagnosis and HPV status of the occult primary tumour. CECT and MRI detect up to 44% of occult tumours and guide management. FDG PET-CT is the most sensitive imaging modality for the detection of CUP and should be performed prior to panendoscopy.
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Affiliation(s)
- Gitta Madani
- Imperial College Healthcare NHS Trust, London, UK
| | - Zoya Arain
- Imperial College Healthcare NHS Trust, London, UK
| | - Zaid Awad
- Imperial College Healthcare NHS Trust, London, UK
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Mihulka O, Nisenbaum E, Nicolli E. Surgical Management of the Neck in Oral Cavity Squamous Cell Carcinoma. Crit Rev Oncog 2024; 29:25-31. [PMID: 38683152 DOI: 10.1615/critrevoncog.2023050817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Oral cavity cancer remains a significant cause of morbidity and mortality globally, with a poor prognosis once the disease has metastasized to cervical lymph nodes. The anatomy of lymphatic drainage in the neck gives us a roadmap to follow when assessing for metastasis, although the predictive factors are still not well understood. The mainstay of treatment continues to be neck dissection. However, there is much debate on the management of the clinically negative neck. The necessity of elective neck dissection has been questioned in recent years, with other options such as sentinel lymph node biopsy gaining popularity. This review will explore the aspects of surgical management of the neck in oral cavity cancer and highlights the further research that needs to be done.
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Affiliation(s)
| | - Eric Nisenbaum
- Department of Otolaryngology-Head and Neck Surgery, University of Miami, Miami, FL, USA
| | - Elizabeth Nicolli
- Department of Otolaryngology-Head and Neck Surgery, University of Miami, Miami, FL, USA
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Huang SY, Hsu WL, Liu DW, Wu EL, Peng YS, Liao ZT, Hsu RJ. Identifying Lymph Nodes and Their Statuses from Pretreatment Computer Tomography Images of Patients with Head and Neck Cancer Using a Clinical-Data-Driven Deep Learning Algorithm. Cancers (Basel) 2023; 15:5890. [PMID: 38136434 PMCID: PMC10741600 DOI: 10.3390/cancers15245890] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Head and neck cancer is highly prevalent in Taiwan. Its treatment mainly relies on clinical staging, usually diagnosed from images. A major part of the diagnosis is whether lymph nodes are involved in the tumor. We present an algorithm for analyzing clinical images that integrates a deep learning model with image processing and attempt to analyze the features it uses to classify lymph nodes. METHODS We retrospectively collected pretreatment computed tomography images and surgery pathological reports for 271 patients diagnosed with, and subsequently treated for, naïve oral cavity, oropharynx, hypopharynx, and larynx cancer between 2008 and 2018. We chose a 3D UNet model trained for semantic segmentation, which was evaluated for inference in a test dataset of 29 patients. RESULTS We annotated 2527 lymph nodes. The detection rate of all lymph nodes was 80%, and Dice score was 0.71. The model has a better detection rate at larger lymph nodes. For those identified lymph nodes, we found a trend where the shorter the short axis, the more negative the lymph nodes. This is consistent with clinical observations. CONCLUSIONS The model showed a convincible lymph node detection on clinical images. We will evaluate and further improve the model in collaboration with clinical physicians.
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Affiliation(s)
- Sheng-Yao Huang
- Institute of Medical Science, Tzu Chi University, Hualien 970374, Taiwan; (S.-Y.H.); (D.-W.L.)
- Department of Radiation Oncology, Hualien Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan;
| | - Wen-Lin Hsu
- Department of Radiation Oncology, Hualien Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan;
- Cancer Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Dai-Wei Liu
- Institute of Medical Science, Tzu Chi University, Hualien 970374, Taiwan; (S.-Y.H.); (D.-W.L.)
- Department of Radiation Oncology, Hualien Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan;
- Cancer Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Edzer L. Wu
- DeepQ Technology Corp, New Taipei City 242062, Taiwan; (E.L.W.); (Y.-S.P.); (Z.-T.L.)
| | - Yu-Shao Peng
- DeepQ Technology Corp, New Taipei City 242062, Taiwan; (E.L.W.); (Y.-S.P.); (Z.-T.L.)
| | - Zhe-Ting Liao
- DeepQ Technology Corp, New Taipei City 242062, Taiwan; (E.L.W.); (Y.-S.P.); (Z.-T.L.)
| | - Ren-Jun Hsu
- Institute of Medical Science, Tzu Chi University, Hualien 970374, Taiwan; (S.-Y.H.); (D.-W.L.)
- Cancer Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
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9
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Zwittag P, Asel C, Gabriel M, Rubicz N, Bauer B, Poier-Fabian N. MRI and PET/CT in the assessment of lymph node metastases in head and neck cancer. Sci Rep 2023; 13:19347. [PMID: 37935875 PMCID: PMC10630387 DOI: 10.1038/s41598-023-46845-y] [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: 09/12/2023] [Accepted: 11/06/2023] [Indexed: 11/09/2023] Open
Abstract
The aim of this study is to present the diagnostic accuracy of MRI and PET/CT in the evaluation of cervical lymph nodes in patients with head and neck cancer (HNC). Data of 114 patients who underwent MRI and PET/CT prior to surgery in the time period between January 2010 and September 2021 in our center is analyzed retrospectively. Histopathological results of surgical preparations serve as the gold standard. The mean time from MRI to surgery is 22.9 (± 18.7) days, and from PET/CT to surgery 21.7 (± 19.9) days. Sensitivities of 80.4% and 80.4%, specificities of 85.7% and 87.3%, PPVs of 82.0% and 83.7% and NPVs of 84.4% and 84.6% are registered for MRI and PET/CT, respectively. 37 false results are further analyzed with respect to side and level of the affected lymph node, as well as intersections of the two imaging modalities. In 29 patients (25.4%), additional findings are described in PET/CT, 7 (6.1%) of which were histologically confirmed to be further malignancies. A combination of both MRI and PET/CT imaging modalities could improve diagnostic accuracy, especially with regard to sensitivity. A notable number of additional findings in whole body acquisition leads to the potential diagnosis of further malignancies.
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Affiliation(s)
- Paul Zwittag
- Department of Otorhinolaryngology, Head and Neck Surgery, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Christian Asel
- Department of Radiology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Michael Gabriel
- Institute of Nuclear Medicine and Endocrinology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Nina Rubicz
- Department of Otorhinolaryngology, Head and Neck Surgery, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Belinda Bauer
- Department of Otorhinolaryngology, Head and Neck Surgery, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4021, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Nikolaus Poier-Fabian
- Department of Otorhinolaryngology, Head and Neck Surgery, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4021, Linz, Austria.
- Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria.
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10
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Stratigos AJ, Garbe C, Dessinioti C, Lebbe C, van Akkooi A, Bataille V, Bastholt L, Dreno B, Dummer R, Fargnoli MC, Forsea AM, Harwood CA, Hauschild A, Hoeller C, Kandolf-Sekulovic L, Kaufmann R, Kelleners-Smeets NW, Lallas A, Leiter U, Malvehy J, Del Marmol V, Moreno-Ramirez D, Pellacani G, Peris K, Saiag P, Tagliaferri L, Trakatelli M, Ioannides D, Vieira R, Zalaudek I, Arenberger P, Eggermont AMM, Röcken M, Grob JJ, Lorigan P. European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma. Part 1: Diagnostics and prevention-Update 2023. Eur J Cancer 2023; 193:113251. [PMID: 37717283 DOI: 10.1016/j.ejca.2023.113251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 09/19/2023]
Abstract
Invasive cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers in white populations, accounting for 20% of all cutaneous malignancies. Overall, cSCC mostly has very good prognosis after treatment, with 5-year cure rates greater than 90%. Despite the overall favourable prognosis and the proportionally rare deaths, cSCC is associated with a high total number of deaths due to its high incidence. A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF), the European Society for Radiotherapy and Oncology (ESTRO), the European Union of Medical Specialists (UEMS), the European Academy of Dermatology and Venereology (EADV) and the European Organization of Research and Treatment of Cancer (EORTC), was formed to update recommendations on cSCC, based on current literature and expert consensus. Part 1 of the guidelines addresses the updates on classification, epidemiology, diagnosis, risk stratification, staging and prevention in immunocompetent as well as immunosuppressed patients.
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Affiliation(s)
- Alexander J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece.
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Clio Dessinioti
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Celeste Lebbe
- Université Paris Cite, Dermato-Oncology AP-HP Hôpital Saint Louis, Cancer Institute APHP. Nord-Université Paris Cite, INSERM U976, Paris, France
| | - Alexander van Akkooi
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Melanoma Institute Australia, Sydney, New South Wales, Australia
| | | | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Brigitte Dreno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Reinhard Dummer
- Skin Cancer Centre at University Hospital Zurich, Zurich, Switzerland
| | - Maria Concetta Fargnoli
- Dermatology Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana Maria Forsea
- Carol Davila University of Medicine and Pharmacy Bucharest, Department of Oncologic Dermatology, Elias University Hospital Bucharest, Bucharest, Romania
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | - Christoph Hoeller
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Wj Kelleners-Smeets
- GROW-School for Oncology and Reproduction, Maastricht, the Netherlands; Department of Dermatology, Maastricht University Medical Centre+, Maastricht University, Maastricht, the Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBER de enfermedades raras, Instituto Carlos III, Barcelona Spain
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - David Moreno-Ramirez
- Department of Medical and Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise-Paré hospital, APHP, and EA 4340 'Biomarkers in Cancerology and Hemato-oncology', UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Luca Tagliaferri
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Myrto Trakatelli
- Department of Dermatology, Papageorgiou Hospital, Aristotle University Department of Medicine, Thessaloniki, Greece
| | | | - Ricardo Vieira
- Department of Dermatology Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Iris Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alexander M M Eggermont
- University Medical Center Utrecht and Princess Máxima Center, Utrecht, the Netherlands; Comprehensive Cancer Center Munich, Technical University Munich and Ludwig Maximilian University, Munich, Germany
| | - Martin Röcken
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | | | - Paul Lorigan
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Department of Medical Oncology, Christie NHS Foundation Trust, Manchester, UK
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11
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Vartak A, Malhotra M, Jaiswal P, Talwar R, Tyagi A, Kishore B. Role of 18F-FDG PET/CT in Guiding Surgical Management of Clinically Node Negative Neck (cN0) in Carcinoma Oral Cavity. Indian J Otolaryngol Head Neck Surg 2023; 75:1799-1805. [PMID: 37636652 PMCID: PMC10447354 DOI: 10.1007/s12070-023-03744-y] [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: 03/15/2022] [Accepted: 03/27/2023] [Indexed: 08/29/2023] Open
Abstract
Conventional staging paradigm with clinical examination or imaging invariably leads to underestimation of occult metastatic neck disease in oral cavity carcinoma. The advantage of 18F-FDG PET/CT is in its ability to identify lymph nodes without morphological changes yet harboring occult metastases. We present findings of our study to evaluate diagnostic accuracy of 18F-FDG PET/CT, in detecting occult cervical lymph node metastasis in carcinoma oral cavity. In a single institution prospective study, 51 consecutive patients with histologically proven (cT1/T2) oral cavity carcinoma and clinically node negative neck (cNo), underwent 18F-FDG PET/CT before elective neck dissection of 58 neck sides. 18F-FDG PET/CT findings were compared with histopathology of dissected nodes, to calculate diagnostic accuracy. 18F-FDG PET/CT correctly characterized the occult lymph node metastasis status (true positive + true negative) in 51 of 58 neck sides, yielding diagnostic accuracy of 87.93%. Sensitivity of 18F-FDG PET/CT was 90% and specificity was 87.5%. While a positive 18F-FDG PET/CT accurately predicted the disease in only 60% (positive predictive value), a negative 18F-FDG PET/CT reasonably ruled out occult metastases in 97.67% (negative predictive value). If a decision regarding the need for neck dissection had been based solely on 18F-FDG PET/CT, the number of neck dissections would have been reduced by 74.13%. Based on diagnostic accuracy and high negative predictive value, incorporating 18F-FDG PET/CT in preoperative staging paradigm of cT1/T2 carcinoma oral cavity will guide in selection of patients in which cN0 neck can be safely observed.
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Affiliation(s)
- Anushree Vartak
- Department of Surgical Oncology, Army Hospital Research and Referral, Delhi Cantt, New Delhi, 110010 India
| | - Munish Malhotra
- Department of Surgical Oncology, INHS Asvini, Mumbai, 40005 India
| | - Pradeep Jaiswal
- Department of Surgical Oncology, Army Hospital Research and Referral, Delhi Cantt, New Delhi, 110010 India
| | - Rajnish Talwar
- Department of Surgical Oncology, Fortis Mohali, Sahibzada Ajit Singh Nagar, Punjab 160062 India
| | - Arvind Tyagi
- Department of Surgical Oncology, Yashoda Super Speciality Hospital and Cancer Institute, Ghaziabad, Uttar Pradesh 201002 India
| | - Brij Kishore
- Department of Nuclear Medicine, INHS Asvini, Mumbai, 40005 India
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12
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Civantos F, Helmen ZM, Bradley PJ, Coca-Pelaz A, De Bree R, Guntinas-Lichius O, Kowalski LP, López F, Mäkitie AA, Rinaldo A, Robbins KT, Rodrigo JP, Takes RP, Ferlito A. Lymph Node Metastases from Non-Melanoma Skin Cancer of the Head and Neck. Cancers (Basel) 2023; 15:4201. [PMID: 37686478 PMCID: PMC10486745 DOI: 10.3390/cancers15174201] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 09/10/2023] Open
Abstract
Non-melanoma skin cancer (NMSC) represents the most common malignancy in the world, comprising exceedingly common lesions such as basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) and rare lesions such as Merkel cell carcinoma. Risk factors are widely recognized and include ultraviolet (UV) light exposure, radiation exposure, immunosuppression, and many others. As a whole, survival and functional outcomes are favorable, but each histopathological subtype of NMSC behaves differently. Treatment regimens for the primary site usually include wide surgical excision and neck dissection in cases of clinically involved metastatic lymph nodes. The elective management of draining nodal basins, however, is a contested topic. Nearly all subtypes, excluding BCC, have a significant risk of lymphatic metastases, and have been studied with regard to sentinel lymph node biopsy (SLNB) and elective neck dissection. To date, no studies have definitively established a true single standard of care, as exists for melanoma, for any of the NMSCs. As a result, the authors have sought to summarize the current literature and identify indications and management options for the management of the cervical lymphatics for each major subtype of NMSC. Further research remains critically necessary in order to develop complete treatment algorithms.
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Affiliation(s)
- Francisco Civantos
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (F.C.); (Z.M.H.)
| | - Zachary M. Helmen
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (F.C.); (Z.M.H.)
| | - Patrick J. Bradley
- Department of Otorhinolaryngology-Head and Neck Surgery, Nottingham University Hospitals, Queens Medical Centre Campus, Nottingham NG7 2UH, UK
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain; (A.C.-P.); (F.L.)
| | - Remco De Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, 07747 Jena, Germany
| | - Luiz P. Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paolo 01509-900, Brazil
- Head and Neck Surgery Department, University of São Paulo Medical School, Sao Paulo 05403-000, Brazil
| | - Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain; (A.C.-P.); (F.L.)
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, FI-00029 HUS Helsinki, Finland;
| | | | - K. Thomas Robbins
- Department of Otolaryngology Head and Neck Surgery, School of Medicine, Southern Illinois University Carbondale, Carbondale, IL 62901, USA
| | - Juan P. Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain; (A.C.-P.); (F.L.)
| | - Robert P. Takes
- Department of Otorhinolaryngology-Head and Neck Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35100 Padua, Italy
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13
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Carobbio ALC, Cheng Z, Gianiorio T, Missale F, Africano S, Ascoli A, Fragale M, Filauro M, Marchi F, Guastini L, Mora F, Parrinello G, Canevari FRM, Peretti G, Mattos LS. Electric Bioimpedance Sensing for the Detection of Head and Neck Squamous Cell Carcinoma. Diagnostics (Basel) 2023; 13:2453. [PMID: 37510197 PMCID: PMC10377945 DOI: 10.3390/diagnostics13142453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/09/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
The early detection of head and neck squamous cell carcinoma (HNSCC) is essential to improve patient prognosis and enable organ and function preservation treatments. The objective of this study is to assess the feasibility of using electrical bioimpedance (EBI) sensing technology to detect HNSCC tissue. A prospective study was carried out analyzing tissue from 46 patients undergoing surgery for HNSCC. The goal was the correct identification of pathologic tissue using a novel needle-based EBI sensing device and AI-based classifiers. Considering the data from the overall patient cohort, the system achieved accuracies between 0.67 and 0.93 when tested on tissues from the mucosa, skin, muscle, lymph node, and cartilage. Furthermore, when considering a patient-specific setting, the accuracy range increased to values between 0.82 and 0.95. This indicates that more reliable results may be achieved when considering a tissue-specific and patient-specific tissue assessment approach. Overall, this study shows that EBI sensing may be a reliable technology to distinguish pathologic from healthy tissue in the head and neck region. This observation supports the continuation of this research on the clinical use of EBI-based devices for early detection and margin assessment of HNSCC.
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Affiliation(s)
- Andrea Luigi Camillo Carobbio
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-"Azienda Ospedaliera di Padova", 35128 Padua, Italy
| | - Zhuoqi Cheng
- Maersk Mc-Kinney Moller Institute, University of Southern Denmark, 5230 Odense, Denmark
| | - Tomaso Gianiorio
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, 16163 Genova, Italy
| | - Francesco Missale
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Molecular and Translational Medicine, University of Brescia, 25125 Brescia, Italy
- Department of Head & Neck Oncology & Surgery, Antoni Van Leeuwenhoek, Nederlands Kanker Instituut, 1066 Amsterdam, The Netherlands
| | - Stefano Africano
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Alessandro Ascoli
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Marco Fragale
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Marta Filauro
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Experimental Medicine (DIMES), University of Genoa, 16132 Genoa, Italy
| | - Filippo Marchi
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Luca Guastini
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Francesco Mora
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | | | - Frank Rikki Mauritz Canevari
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Giorgio Peretti
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Leonardo S Mattos
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, 16163 Genova, Italy
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14
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Singh G, Tolkachjov SN, Farberg AS. Incorporation of the 40-Gene Expression Profile (40-GEP) Test to Improve Treatment Decisions in High-Risk Cutaneous Squamous Cell Carcinoma (cSCC) Patients: Case Series and Algorithm. Clin Cosmet Investig Dermatol 2023; 16:925-935. [PMID: 37051586 PMCID: PMC10083143 DOI: 10.2147/ccid.s403330] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/25/2023] [Indexed: 04/08/2023]
Abstract
Cutaneous squamous cell carcinoma (cSCC) has become a significant public health issue due to its rapidly rising incidence and an estimated 1.8 million newly diagnosed cases annually. As with other cancers, treatment decisions for patients with cSCC are based primarily on a patient's risk for poor outcomes. There has been improvement in clinicopathologic factor-based risk assessment approaches, either through informal methods or ever evolving staging approaches. However, these approaches misidentify patients who will eventually have disease progression as low-risk and conversely, over classify patients as high-risk who do not experience relapse. To improve the accuracy of risk assessment for patients with cSCC, the 40-gene expression profile (40-GEP) test has been validated to show statistically significant stratification of a high-risk cSCC patient's risk of nodal or distant metastasis, independent of currently available risk-assessment methods. The 40-GEP test allows for a more accurate classification of metastatic risk for high-risk cSCC patients, with the aim to influence appropriate allocation of clinician time and therapeutic resources to those patients who will most benefit. The objective of this article is to present a treatment algorithm in which clinicians can easily integrate the results of the 40-GEP test into their current treatment approaches to tailor patient care based on individual tumor biology. The following modalities were considered: surveillance imaging, sentinel lymph node biopsy (SLNB), adjuvant radiation therapy (ART), and clinical follow-up. The authors have contributed their own cases for discussion as to how they have seen the beneficial impact of 40-GEP test results in their own practice. Overall, clinicians can identify risk-aligned treatment pathway improvements with the use of the 40-GEP test for challenging to manage, high-risk cSCC patients.
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Affiliation(s)
| | - Stanislav N Tolkachjov
- Epiphany Dermatology, Dallas, TX, USA
- University of Texas at Southwestern, Dallas, TX, USA
- Baylor University Medical Center, Dallas, TX, USA
- Texas A&M College of Medicine, Dallas, TX, USA
| | - Aaron S Farberg
- Texas A&M College of Medicine, Dallas, TX, USA
- Bare Dermatology, Dallas, TX, USA
- Baylor Scott & White Health System, Dallas, TX, USA
- Correspondence: Aaron S Farberg, Bare Dermatology, 2110 Research Row, Dallas, TX, 75235, USA, Tel +1 847-721-2725, Email
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15
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Driessen DAJJ, Arens AIJ, Dijkema T, Weijs WLJ, Draaijer LC, van den Broek GB, Takes RP, Honings J, Kaanders JHAM. Sentinel node identification in laryngeal and pharyngeal carcinoma after flexible endoscopy-guided tracer injection under topical anesthesia: A feasibility study. Head Neck 2023; 45:1359-1366. [PMID: 36942817 DOI: 10.1002/hed.27347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/02/2023] [Accepted: 03/06/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the feasibility of flexible endoscopy-guided tracer injection for sentinel lymph node (SLN) identification in patients with laryngeal and pharyngeal carcinoma. METHODS Sixteen cT1-4N0-2M0 patients with laryngeal or pharyngeal carcinoma underwent intra- and peritumoral [99m Tc]Tc-nanocolloid injections after topical anesthesia under endoscopic guidance. SPECT-CT scans were performed at two time points. RESULTS Tracer injection and visualization of SLNs was successful in 15/16 (94%) patients. Median number of tracer injections was 1 intratumoral and 3 peritumoral. The median duration of the endoscopic procedure including tracer injection after biopsy taking was 7 min (range 4-16 min). A total of 28 SLNs were identified which were all visualized on the early and late SPECT-CT. Most SLNs were visualized in neck levels II and III. CONCLUSIONS Flexible endoscopy-guided tracer injection for SLN identification is a feasible and fast procedure in laryngeal and pharyngeal carcinoma patients.
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Affiliation(s)
- Daphne A J J Driessen
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anne I J Arens
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tim Dijkema
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Willem L J Weijs
- Department of Oral- and Maxillofacial Surgery and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lisette C Draaijer
- Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jimmie Honings
- Department of Otorhinolaryngology - Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Johannes H A M Kaanders
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
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16
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Giannitto C, Mercante G, Ammirabile A, Cerri L, De Giorgi T, Lofino L, Vatteroni G, Casiraghi E, Marra S, Esposito AA, De Virgilio A, Costantino A, Ferreli F, Savevski V, Spriano G, Balzarini L. Radiomics-based machine learning for the diagnosis of lymph node metastases in patients with head and neck cancer: Systematic review. Head Neck 2023; 45:482-491. [PMID: 36349545 DOI: 10.1002/hed.27239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/11/2022] [Accepted: 10/25/2022] [Indexed: 11/10/2022] Open
Abstract
Machine learning (ML) is increasingly used to detect lymph node (LN) metastases in head and neck (H&N) carcinoma. We systematically reviewed the literature on radiomic-based ML for the detection of pathological LNs in H&N cancer. A systematic review was conducted in PubMed, EMBASE, and the Cochrane Library. Baseline study characteristics and methodological quality items (modeling, performance evaluation, clinical utility, and transparency items) were extracted and evaluated. The qualitative synthesis is presented using descriptive statistics. Seven studies were included in this study. Overall, the methodological quality items were generally favorable for modeling (57% of studies). The studies were mostly unsuccessful in terms of transparency (85.7%), evaluation of clinical utility (71.3%), and assessment of generalizability employing independent or external validation (72.5%). ML may be able to predict LN metastases in H&N cancer. Further studies are warranted to improve the generalizability assessment, clinical utility evaluation, and transparency items.
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Affiliation(s)
- Caterina Giannitto
- Department of Diagnostic Radiology, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Angela Ammirabile
- Department of Diagnostic Radiology, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Luca Cerri
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Teresa De Giorgi
- Department of Diagnostic Radiology, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ludovica Lofino
- Department of Diagnostic Radiology, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giulia Vatteroni
- Department of Diagnostic Radiology, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Elena Casiraghi
- Department of Computer Science (DI), University of Milan, Milan, Italy
| | - Silvia Marra
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Fabio Ferreli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Victor Savevski
- Humanitas AI Center, Humanitas Research Hospital, Rozzano, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Luca Balzarini
- Department of Diagnostic Radiology, IRCCS Humanitas Research Hospital, Milan, Italy
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17
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Zhao X, Li W, Zhang J, Tian S, Zhou Y, Xu X, Hu H, Lei D, Wu F. Radiomics analysis of CT imaging improves preoperative prediction of cervical lymph node metastasis in laryngeal squamous cell carcinoma. Eur Radiol 2023; 33:1121-1131. [PMID: 35984515 DOI: 10.1007/s00330-022-09051-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/16/2022] [Accepted: 07/23/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To investigate the role of CT radiomics for preoperative prediction of lymph node metastasis (LNM) in laryngeal squamous cell carcinoma (LSCC). METHODS LSCC patients who received open surgery and lymphadenectomy were enrolled and randomized into primary and validation cohorts at a ratio of 7:3 (325 vs. 139). In the primary cohort, we extracted radiomics features from whole intratumoral regions on venous-phase CT images and constructed a radiomics signature by least absolute shrinkage and selection operator (LASSO) regression. A radiomics model incorporating the radiomic signature and independent clinical factors was established via multivariable logistic regression and presented as a nomogram. Nomogram performance was compared with a clinical model and traditional CT report with respect to its discrimination and clinical usefulness. The radiomics nomogram was internally tested in an independent validation cohort. RESULTS The radiomics signature, composed of 9 stable features, was associated with LNM in both the primary and validation cohorts (both p < .001). A radiomics model incorporating independent predictors of LNM (the radiomics signature, tumor subsite, and CT report) showed significantly better discrimination of nodal status than either the clinical model or the CT report in the primary cohort (AUC 0.91 vs. 0.84 vs. 0.68) and validation cohort (AUC 0.89 vs. 0.83 vs. 0.70). Decision curve analysis confirmed that the radiomics nomogram was superior to the clinical model and traditional CT report. CONCLUSIONS The CT-based radiomics nomogram may improve preoperative identification of nodal status and help in clinical decision-making in LSCC. KEY POINTS • The radiomics model showed favorable performance for predicting LN metastasis in LSCC patients. • The radiomics model may help in clinical decision-making and define patient subsets benefiting most from neck treatment.
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Affiliation(s)
- Xingguo Zhao
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Wenming Li
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, 250012, Shandong, China
| | - Jiulou Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Shui Tian
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yang Zhou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Xiaoquan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Dapeng Lei
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, 250012, Shandong, China.
| | - Feiyun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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18
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Scott-Wittenborn N, D'Souza G, Aygun N, Tewari SR, Azadi J, Vosler P, Gooi Z, Mehta V, Mydlarz W, Nance M, Mlot S, Patel MR, Tan M, Miles BA, Troy T, Fakhry C. Feasibility of clinical evaluation of individuals with increased risk for HPV-associated oropharynx cancer. Head Neck 2023; 45:95-102. [PMID: 36200696 DOI: 10.1002/hed.27212] [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: 01/24/2022] [Revised: 07/13/2022] [Accepted: 09/21/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Human papillomavirus-associated oropharynx squamous cell carcinoma (HPV-OPSCC) has no known pre-malignant lesion. While vaccination offers future primary prevention, there is current interest in secondary prevention. The feasibility of clinical evaluation of individuals at increased risk for HPV-OPSCC is unclear. METHODS Individuals with risk factors for HPV-OPSCC were enrolled in a prospective study (MOUTH). Participants positive for biomarkers associated with HPV-OPSCC were eligible for a clinical evaluation which comprised a head and neck examination and imaging with ultrasound and/or magnetic resonance imaging (MRI). This study was designed to evaluate feasibility of clinical evaluation in a screening study. RESULTS Three hundred and eighty-four participants were eligible for clinical evaluation. Of the 384, 204 (53%) completed a head and neck examination or imaging. Of these, 66 (32%) completed MRI (n = 51) and/or ultrasound (n = 64) studies. CONCLUSIONS Clinical evaluations, including head and neck examination and imaging, are feasible in the context of a screening study for HPV-OPSCC.
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Affiliation(s)
- Nicholas Scott-Wittenborn
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nafi Aygun
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Sakshi R Tewari
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Javad Azadi
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Peter Vosler
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Zhen Gooi
- Section of Otolaryngology-Head and Neck Surgery, Biological Sciences Division, Department of Surgery, University of Chicago Medicine, Chicago, Illinois, USA
| | - Vikas Mehta
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Wojciech Mydlarz
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Melonie Nance
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Stefan Mlot
- ENT and Allergy Associates LLP, White Plains, New York, USA
| | - Mihir R Patel
- Department of Otolaryngology Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Marietta Tan
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Tanya Troy
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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19
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Ai QYH, So TY, Hung KF, King AD. Normal size of benign upper neck nodes on MRI: parotid, submandibular, occipital, facial, retroauricular and level IIb nodal groups. Cancer Imaging 2022; 22:66. [PMID: 36482491 PMCID: PMC9730594 DOI: 10.1186/s40644-022-00504-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/10/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Nodal size is an important imaging criterion for differentiating benign from malignant nodes in the head and neck cancer staging. This study evaluated the size of normal nodes in less well-documented nodal groups in the upper head and neck on magnetic resonance imaging (MRI). METHODS Analysis was performed on 289 upper head and neck MRIs of patients without head and neck cancer. The short axial diameters (SAD) of the largest node in the parotid, submandibular, occipital, facial, retroauricular and Level IIb of the upper internal jugular nodal groups were documented and compared to the commonly used threshold of ≥ 10 mm for diagnosis of a malignant node. RESULTS Normal nodes in the parotid, occipital, retroauricular and Level IIb groups were small with a mean SAD ranging from 3.8 to 4.4 mm, nodes in the submandibular group were larger with a mean SAD of 5.5 mm and facial nodes were not identified. A size ≥ 10 mm was found in 0.8% of submandibular nodes. Less than 10% of the other nodal group had a SAD of ≥ 6 mm and none of them had a SAD ≥ 8 mm. CONCLUSION To identify malignant neck nodes in these groups there is scope to reduce the size threshold of ≥ 10 mm to improve sensitivity without substantial loss of specificity.
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Affiliation(s)
- Qi Yong H. Ai
- grid.16890.360000 0004 1764 6123Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong S.A.R, P.R. China ,grid.415197.f0000 0004 1764 7206Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong S.A.R, P.R. China
| | - Tiffany Y. So
- grid.415197.f0000 0004 1764 7206Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong S.A.R, P.R. China
| | - Kuo Feng Hung
- grid.194645.b0000000121742757Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong, Hong Kong S.A.R, P.R. China
| | - Ann D. King
- grid.415197.f0000 0004 1764 7206Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong S.A.R, P.R. China
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20
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Tapia M, Manji J, Dhillon K, Kleid S, Flatman S, Prasad J, Cardin A, Fua T, Rischin D, Dixon B, J.R Magarey M. The negative predictive value of FDG PET/CT staging in early oropharyngeal squamous cell carcinoma and implications to transoral robotic surgery patient selection. Oral Oncol 2022; 135:106213. [DOI: 10.1016/j.oraloncology.2022.106213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/12/2022] [Accepted: 10/10/2022] [Indexed: 11/22/2022]
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21
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Hallur N, Sathar R, Siddiqua A, Zakaullah S, Kothari C. Evaluation of Metastatic Lymph Nodes in Oral Squamous Cell Carcinoma: A Comparative Study of Clinical, FNAC, Ultra Sonography and Computed Tomography with Post Operative Histopathology. Indian J Otolaryngol Head Neck Surg 2022; 74:5921-5926. [PMID: 36742803 PMCID: PMC9895754 DOI: 10.1007/s12070-021-02495-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/01/2021] [Indexed: 02/07/2023] Open
Abstract
All the head and neck tumours, more than 90% are squamous cell carcinomas (SCC). The presence of metastatic cervical lymph nodes histologically positive for SCC provides one of the simplest and most important prognostic factor in patients with head and neck cancer. In this study, all patients were examined clinically for, location, number, size, shape, consistency and fixation of cervical neck nodes to the underlying structure, and the same was carried out by FNAC, USG and CT. Findings of these modalities and histopathological results were compared for the overall metastases of lymph nodes in the neck. The accuracy of clinical examination was 87.77% and sensitivity only 41.66%. FNAC has the greatest specificity, 98.71% and least sensitivity, 33.33%. The accuracy of FNAC was 90%. The positive predictive value and negative predictive value of FNAC were 80.0% and 90.58% respectively. USG revealed 50% of sensitivity. Specificity of USG was 93.58% and accuracy 87.77%. CT scan have the highest sensitivity among all other tests, 66.66%.The negative predictive value for CT scan was also the highest, 94.59%. Specificity and accuracy of CT scan was 89.74% and 86.66% respectively. This study concludes that USG with FNAC is the most accurate in evaluating metastatic lymph nodes in oral squamous cell carcinoma patients along with other investigations like CT scan for staging of the oral squamous cell carcinoma.
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Affiliation(s)
- Neelakamal Hallur
- Al-Badar Rural Dental College and Hospital, Sy. No. 12, GDA Layout, Dariyapur, Naganhalli Road, Kalaburagi, Karnataka 585102 India
| | - Reju Sathar
- Al-Badar Rural Dental College and Hospital, Sy. No. 12, GDA Layout, Dariyapur, Naganhalli Road, Kalaburagi, Karnataka 585102 India
| | - Aaisha Siddiqua
- Al-Badar Rural Dental College and Hospital, Sy. No. 12, GDA Layout, Dariyapur, Naganhalli Road, Kalaburagi, Karnataka 585102 India
| | - Syed Zakaullah
- Al-Badar Rural Dental College and Hospital, Sy. No. 12, GDA Layout, Dariyapur, Naganhalli Road, Kalaburagi, Karnataka 585102 India
| | - Chaitanya Kothari
- Al-Badar Rural Dental College and Hospital, Sy. No. 12, GDA Layout, Dariyapur, Naganhalli Road, Kalaburagi, Karnataka 585102 India
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22
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Perineural invasion and perineural spread in periocular squamous cell carcinoma. Eye (Lond) 2022; 37:875-884. [PMID: 36400852 PMCID: PMC10050156 DOI: 10.1038/s41433-022-02306-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/14/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
AbstractPerineural invasion (PNI) in cutaneous squamous cell carcinoma (SCC) of the periocular region is a prognostic marker of adverse tumour outcomes. PNI carries a well-established risk of tumour recurrence, regional metastasis and higher likelihood of mortality. This review will explore and stratify the risks conferred by histological PNI parameters. The radiological features of perineural spread (PNS) and the imaging sequences that delineate these findings will also be highlighted. Surgical excision with en face margin control is the preferred technique for achieving histological clearance. Adjuvant radiotherapy improves treatment outcomes in the setting of concomitant high-risk features. For locally advanced or metastatic cutaneous SCC, immunotherapy represents a novel treatment alternative. This review will provide an algorithm for the diagnosis and management of periocular SCC with PNI and PNS.
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23
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de Koekkoek-Doll PK, Roberti S, Smit L, Vogel WV, Beets-Tan R, van den Brekel MW, Castelijns J. ADC Values of Cytologically Benign and Cytologically Malignant 18 F-FDG PET-Positive Lymph Nodes of Head and Neck Squamous Cell Carcinoma. Cancers (Basel) 2022; 14:cancers14164019. [PMID: 36011013 PMCID: PMC9406365 DOI: 10.3390/cancers14164019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
Simple Summary In squamous cell carcinoma of the head and neck, 18F-fluordeoxyglucose positron emission tomography (FDG-PET), diffusion-weighted magnetic resonance imaging (DW-MRI) and ultrasound-guided fine needle aspiration are commonly used imaging tools for nodal staging (N-staging). Although FDG-PET has good performance in nodal detection, it is still difficult to distinguish between PET-positive reactive and malignant nodes for the purpose of selecting nodes to be aspirated. DW-MRI can help to detect small lymph node metastases, and an inverse correlation with FDG uptake is expected. We found a mild negative correlation between SUVmax and ADC. Comparing the apparent diffusion coefficient (ADC) values between PET-positive and PET-negative nodes, ADC was significantly higher in PET-negative nodes. Whereas no significantly lower ADC value of cytological malignant nodes could be found overall, in the subgroup of non-HPV-related nodes, the ADC values of cytologically malignant PET-positive nodes were significantly lower than in cytologically benign nodes. This finding might be helpful in selecting nodes for puncture. Abstract Nodal staging (N-staging) in head and neck squamous cell carcinoma (HNSCC) is essential for treatment planning and prognosis. 18F-fluordeoxyglucose positron emission tomography (FDG-PET) has high performance for N-staging, although the distinction between cytologically malignant and reactive PET-positive nodes, and consequently, the selection of nodes for ultrasound-guided fine needle aspiration cytology (USgFNAC), is challenging. Diffusion-weighted magnetic resonance imaging (DW-MRI) can help to detect nodal metastases. We aim to investigate the potential of the apparent diffusion coefficient (ADC) as a metric to distinguish between cytologically reactive and malignant PET-positive nodes in order to improve node selection criteria for USgFNAC. PET-CT, real-time image-fused USgFNAC and DW-MRI to calculate ADC were available for 78 patients offered for routine N-staging. For 167 FDG-positive nodes, differences in the ADC between cytologically benign and malignant PET-positive nodes were evaluated, and both were compared to the ADC values of PET-negative reference nodes. Analyses were also performed in subsets of nodes regarding HPV status. A mild negative correlation between SUVmax and ADC was found. No significant differences in ADC values were observed between cytologically malignant and benign PET-positive nodes overall. Within the subset of non-HPV-related nodes, ADCb0-200-1000 was significantly lower in cytologically malignant PET-positive nodes when compared to benign PET-positive nodes. ADCb0-1000 and ADCb0-200-1000 were significantly lower (p = 0.018, 0.016, resp.) in PET-negative reference nodes than in PET-positive nodes. ADC was significantly higher in PET-negative reference nodes than in PET-positive nodes. The non-HPV-related subgroup showed significantly (p = 0.03) lower ADC values in cytologically malignant than in cytologically benign PET-positive nodes, which should help inform the node selection procedure for puncture.
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Affiliation(s)
- Petra K. de Koekkoek-Doll
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- Correspondence:
| | - Sander Roberti
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Laura Smit
- Department of Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Wouter V. Vogel
- Department of Nuclear Medicine, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Regina Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | - Michiel W. van den Brekel
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
- Department of Maxillofacial Surgery, Amsterdam University Medical Center, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | - Jonas Castelijns
- Department of Radiology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
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24
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Vonk J, Kukačka J, Steinkamp P, de Wit J, Voskuil F, Hooghiemstra W, Bader M, Jüstel D, Ntziachristos V, van Dam G, Witjes M. Multispectral optoacoustic tomography for in vivo detection of lymph node metastases in oral cancer patients using an EGFR-targeted contrast agent and intrinsic tissue contrast: A proof-of-concept study. PHOTOACOUSTICS 2022; 26:100362. [PMID: 35541024 PMCID: PMC9079001 DOI: 10.1016/j.pacs.2022.100362] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/07/2022] [Accepted: 04/27/2022] [Indexed: 05/09/2023]
Abstract
Oral cancer patients undergo diagnostic surgeries to detect occult lymph node metastases missed by preoperative structural imaging techniques. Reducing these invasive procedures that are associated with considerable morbidity, requires better preoperative detection. Multispectral optoacoustic tomography (MSOT) is a rapidly evolving imaging technique that may improve preoperative detection of (early-stage) lymph node metastases, enabling the identification of molecular changes that often precede structural changes in tumorigenesis. Here, we characterize the optoacoustic properties of cetuximab-800CW, a tumor-specific fluorescent tracer showing several photophysical properties that benefit optoacoustic signal generation. In this first clinical proof-of-concept study, we explore its use as optoacoustic to differentiate between malignant and benign lymph nodes. We characterize the appearance of malignant lymph nodes and show differences in the distribution of intrinsic chromophores compared to benign lymph nodes. In addition, we suggest several approaches to improve the efficiency of follow-up studies.
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Affiliation(s)
- J. Vonk
- Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, the Netherlands
| | - J. Kukačka
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - P.J. Steinkamp
- Department of Surgery, University of Groningen, University Medical Center Groningen, the Netherlands
| | - J.G. de Wit
- Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, the Netherlands
| | - F.J. Voskuil
- Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, the Netherlands
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - W.T.R. Hooghiemstra
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - M. Bader
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - D. Jüstel
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - V. Ntziachristos
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - G.M. van Dam
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- AxelaRx / TRACER B.V., Groningen, the Netherlands
| | - M.J.H. Witjes
- Department of Oral & Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, the Netherlands
- Correspondence to: Department of Oral & Maxillofacial Surgery, University Medical Center Groningen, the Netherlands.
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25
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Pham N, Ju C, Kong T, Mukherji SK. Artificial Intelligence in Head and Neck Imaging. Semin Ultrasound CT MR 2022; 43:170-175. [PMID: 35339257 DOI: 10.1053/j.sult.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Artificial intelligence (AI) can be applied to head and neck imaging to augment image quality and various clinical tasks including segmentation of tumor volumes, tumor characterization, tumor prognostication and treatment response, and prediction of metastatic lymph node disease. Head and neck oncology care is well positioned for the application of AI since treatment is guided by a wealth of information derived from CT, MRI, and PET imaging data. AI-based methods can integrate complex imaging, histologic, molecular, and clinical data to model tumor biology and behavior, and potentially identify associations, far beyond what conventional qualitative imaging can provide alone.
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Affiliation(s)
- Nancy Pham
- Neuroradiology, Radiology Department, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA; Neuroradiology, Radiology Department, University of Illinois.
| | - Connie Ju
- Neuroradiology, Radiology Department, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA
| | - Tracie Kong
- Neuroradiology, Radiology Department, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA
| | - Suresh K Mukherji
- Neuroradiology, Radiology Department, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA
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26
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Kejner AE, Harris BN, Patel R, McMullen C, Weir J, Dahshan BA, Carroll WR, Gillespie MB. Management of the parotid for high-risk cutaneous squamous cell carcinoma: A review from the salivary section of the American Head and Neck Society. Am J Otolaryngol 2022; 43:103374. [PMID: 35158264 DOI: 10.1016/j.amjoto.2022.103374] [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: 11/10/2021] [Accepted: 01/22/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Metastases to the parotid nodal basin in patients with high-risk cutaneous squamous cell carcinoma (HRcSCC) impact disease specific survival (DSS) and overall survival (OS). METHODS A writing group convened by the Salivary Section of the American Head and Neck Society (AHNS) developed contemporary, evidence-based recommendations regarding management of the parotid nodal basin in HRcSCC based on available literature, expert consultation, and collective experience. The statements and recommendations were then submitted and approved by the AHNS Salivary Committee. RESULTS These recommendations were developed given the wide variation of practitioners who treat HRcSCC in order to streamline management of the parotid nodal basin including indications for imaging, surgery, radiation, and systemic treatment options as well. CONCLUSIONS This clinical update represents contemporary optimal management of the parotid nodal basin in HRcSCC and is endorsed by the Salivary Section of the AHNS.
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Huang J, Wu SS, Zheng S, Gao H, Wu ZY, Xu JW. Trans-lymphatic contrast-enhanced ultrasound with sentinel lymph node biopsy for detecting cervical skip metastasis to lymph nodes in early-stage oral tongue squamous cell carcinoma. Dentomaxillofac Radiol 2022; 51:20210107. [PMID: 34613749 PMCID: PMC8802708 DOI: 10.1259/dmfr.20210107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The purpose of this study was to assess whether trans-lymphatic contrast-enhanced ultrasound (CEUS) combined with sentinel lymph node biopsy can be used to assess the status of cervical lymph nodes and skip metastasis in patients with early squamous cell carcinoma (SCC) of the oral tongue. METHODS This study included 21 subjects with early oral tongue SCC who received multiple intramucosal peritumoral injections of Sonazoid. CEUS examinations were performed immediately after Sonazoid injection to identify sentinel lymph nodes (SLNs). The SLNs were excised for histological examination to determine if the lymph nodes has metastases. RESULTS Thirty-five SLNs were detected by CEUS after Sonazoid injection in the subjects. SLNs were identified in 20 of the total 21 subjects. Four participants had metastasis to lymph nodes, and one had skip metastasis in level Ⅲ. In one subject, SLNs were successfully detected in level Ⅳ without skip metastasis. CONCLUSIONS Trans-lymphatic CEUS combined with sentinel lymph node biopsy showed high accuracy for evaluating cervical lymph node status. This could be a reliable approach for detecting cervical skip metastases of lymph nodes in early-stage oral cancer patients.
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Affiliation(s)
- Jian Huang
- Department of Oral and Maxillofacial Surgery, Fujian Provincial Hospital, 134 Dongjie, Fuzhou, China
| | - Song-song Wu
- Department of Ultrasonography, Fujian Provincial Hospital, 134 Dongjie, Fuzhou, China
| | - Song Zheng
- Department of Oral and Maxillofacial Surgery, Fujian Provincial Hospital, 134 Dongjie, Fuzhou, China
| | - Hong Gao
- Department of Oral and Maxillofacial Surgery, Fujian Provincial Hospital, 134 Dongjie, Fuzhou, China
| | - Zhi-yuan Wu
- Department of Oral and Maxillofacial Surgery, Fujian Provincial Hospital, 134 Dongjie, Fuzhou, China
| | - Jun-wu Xu
- Department of Oral and Maxillofacial Surgery, Fujian Provincial Hospital, 134 Dongjie, Fuzhou, China
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28
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Tokez S, Koekelkoren FHJ, Baatenburg de Jong RJ, Grünhagen DJ, Mooyaart AL, Nijsten T, van der Lugt A, Wakkee M. Assessment of the Diagnostic Accuracy of Baseline Clinical Examination and Ultrasonographic Imaging for the Detection of Lymph Node Metastasis in Patients With High-risk Cutaneous Squamous Cell Carcinoma of the Head and Neck. JAMA Dermatol 2022; 158:151-159. [PMID: 34964807 PMCID: PMC8717207 DOI: 10.1001/jamadermatol.2021.4990] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Patients with cutaneous squamous cell carcinoma (SCC) of the head and neck may develop lymph node metastasis; therefore, additional workup of the regional lymph nodes in these patients should be considered. However, there is uncertainty regarding the value of baseline ultrasonographic imaging in addition to clinical examination for the detection of metastasis. OBJECTIVE To assess the diagnostic accuracy of clinical examination and baseline ultrasonography for the detection of metastasis among patients with high-risk cutaneous SCC of the head and neck and to assess the accuracy of ultrasonography when baseline clinical examination produces negative results. DESIGN, SETTING, AND PARTICIPANTS This diagnostic study was conducted among a retrospective cohort of 233 patients with 246 high-risk cutaneous SCC tumors of the head and neck. The study included all patients with high-risk cutaneous SCC of the head and neck who received clinical examination and baseline ultrasonographic imaging of their lymph nodes at the Erasmus Medical Center Cancer Institute, a tertiary referral hospital for patients with skin cancer in Rotterdam, the Netherlands, between January 1, 2015, and December 31, 2017. Data were analyzed from October 13, 2020, to September 29, 2021. MAIN OUTCOMES AND MEASURES Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Fine-needle aspiration cytologic biopsy and 6 months of follow-up per patient were used as the reference standards. RESULTS Among 233 patients (176 men [75.5%]; median age, 79.1 years [IQR, 71.5-83.7 years]; data on race and ethnicity were not collected) with 246 high-risk cutaneous SCC tumors of the head and neck, 20 metastases were cytologically confirmed at baseline, and 2 metastases were detected during 6 months of follow-up, yielding a 9% metastasis rate. The sensitivity of clinical examination was 50% (95% CI, 28%-72%), and the specificity was 96% (95% CI, 93%-98%). The PPV and NPV were 55% (95% CI, 36%-72%) and 95% (95% CI, 93%-97%), respectively. In the total cohort, ultrasonography had a sensitivity of 91% (95% CI, 71%-99%) and a specificity of 78% (95% CI, 72%-83%), with a PPV of 29% (95% CI, 23%-35%) and an NPV of 99% (95% CI, 96%-100%). In the group of patients with negative results at baseline clinical examination, 9 of 11 metastases were detected by ultrasonography, with 82% sensitivity (95% CI, 48%-98%); specificity was 79% (95% CI, 73%-84%), PPV was 17% (95% CI, 12%-23%), and NPV was 99% (95% CI, 96%-100%). CONCLUSIONS AND RELEVANCE In this diagnostic study, among a cohort of patients with high-risk cutaneous SCC of the head and neck, baseline ultrasonography was more sensitive than clinical examination alone for the detection of lymph node metastasis. In the setting of a negative result at baseline clinical examination, ultrasonography had high sensitivity for detecting nodal metastases, but this sensitivity should be evaluated against the high rate of false-positive findings.
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Affiliation(s)
- Selin Tokez
- Department of Dermatology, Erasmus Medical Center Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Fabiënne H. J. Koekelkoren
- Department of Dermatology, Erasmus Medical Center Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Robert J. Baatenburg de Jong
- Department of Otolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, Rotterdam, the Netherlands
| | - Dirk J. Grünhagen
- Department of Surgical Oncology, Erasmus Medical Center Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Antien L. Mooyaart
- Department of Pathology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Tamar Nijsten
- Department of Dermatology, Erasmus Medical Center Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marlies Wakkee
- Department of Dermatology, Erasmus Medical Center Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Wang F, Tan R, Feng K, Hu J, Zhuang Z, Wang C, Hou J, Liu X. Magnetic Resonance Imaging-Based Radiomics Features Associated with Depth of Invasion Predicted Lymph Node Metastasis and Prognosis in Tongue Cancer. J Magn Reson Imaging 2021; 56:196-209. [PMID: 34888985 PMCID: PMC9299921 DOI: 10.1002/jmri.28019] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 12/18/2022] Open
Abstract
Background Adequate safe margin in tongue cancer radical surgery is one of the most important prognostic factors. However, the role of peritumoral tissues in predicting lymph node metastasis (LNM) and prognosis using radiomics analysis remains unclear. Purpose To investigate whether magnetic resonance imaging (MRI)‐based radiomics analysis with peritumoral extensions contributes toward the prediction of LNM and prognosis in tongue cancer. Study type Retrospective. Population Two hundred and thirty‐six patients (38.56% female) with tongue cancer (training set, N = 157; testing set, N = 79; 37.58% and 40.51% female for each). Field Strength/Sequence 1.5 T; T2‐weighted turbo spin‐echo images. Assessment Radiomics models (Rprim, Rprim+3, Rprim+5, Rprim+10, Rprim+15) were developed with features extracted from the primary tumor without or with peritumoral extensions (3, 5, 10, and 15 mm, respectively). Clinicopathological characteristics selected from univariate analysis, including MRI‐reported LN status, radiological extrinsic lingual muscle invasion, and pathological depth of invasion (DOI) were further incorporated into radiomics models to develop combined radiomics models (CRprim, CRprim+3, CRprim+5, CRprim+10, CRprim+15). Finally, the model performance was validated in the testing set. DOI was measured from the adjacent normal mucosa to the deepest point of tumor invasion. Statistical Tests Chi‐square test, regression analysis, receiver operating characteristic curve (ROC) analysis, decision analysis, spearman correlation analysis. The Delong test was used to compare area under the ROC (AUC). P < 0.05 was considered statistically significant. Results Of all the models, the CRprim+10 reached the highest AUC of 0.995 in the training set and 0.872 in the testing set. Radiomics features were significantly correlated with pathological DOI (correlation coefficients, −0.157 to −0.336). The CRprim+10 was an independent indicator for poor disease‐free survival (hazard ratio, 5.250) and overall survival (hazard ratio, 17.464) in the testing set. Data Conclusion Radiomics analysis with a 10‐mm peritumoral extension had excellent power to predict LNM and prognosis in tongue cancer.
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Affiliation(s)
- Fei Wang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Rukeng Tan
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Kun Feng
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Jing Hu
- Department of Oral and Maxillofacial Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zehang Zhuang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Cheng Wang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Jinsong Hou
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Xiqiang Liu
- Department of Oral and Maxillofacial Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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张 浩, 胡 国. [Risk and prognostic analysis of cervical lymph node metastasis in cN+ laryngeal squamous cell carcinoma]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:1115-1123. [PMID: 34886627 PMCID: PMC10127652 DOI: 10.13201/j.issn.2096-7993.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Indexed: 06/13/2023]
Abstract
Objective:To analyze the clinical, pathological features and metastatic regularity of cervical lymph node metastasis in cN+ laryngeal squamous cell carcinoma, and to explore its diagnosis and management. Methods:Among 1030 patients with laryngeal squamous cell carcinoma who underwent surgery in the Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University from March 2011 to January 2021, 83 patients with cN+ were included in the retrospective analysis of clinical data and follow-up data. Results:Among the 83 cases of cN+ laryngeal carcinoma, there were pN+65 cases and pN-18 cases. The false positive rate of cN+ was 21.7%. cN+ cervical lymph node metastasis was related to classification and staging, and the difference was statistically significant(P<0.05).The false positive rate of cN+ in different types of laryngeal carcinoma was 57.7% (16/27) in glottic type and 3.9% (2/55) in supraglottic type. With the increase of T stage, the false positive rate decreased.The false positive rates of different CT imaging features were as follows:①Size:the critical lymph nodes of more than 2 sizes were 27.3% (3/11), the 1~3 cm of lymph nodes was 29.4% (15/51), and the lymph nodes > 3 cm were not false positive (0/21);②The enhancement types of uniform enhancement, non-uniform enhancement and circular enhancement were 34.3% (12/35), 31.6% (6/19) and 0% (0/29) respectively. ③The proportion of unclear shape and boundary of lymph nodes was 0(0/24).The neck recurrence rate was 2.4% in the selective neck dissection (SND) and 20.0% in the non-SND. The 3-year neck area control rates of SND and non-SND group were 93.7% and 81.1% respectively, and the difference was statistically significant (P < 0.05). The 3-year cumulative survival rates of pN+ group and pN- group were 75.5% and 87.5%, respectively, and there was no significant difference between the two groups (P > 0.05). The 3-year cumulative survival rates of lymph node extranodal extension ENE+ group and ENE- group were 50.6% and 79.3%, respectively, and the difference was statistically significant (P < 0.05). Conclusion: There is false positive in cN+ laryngeal carcinoma, which is related to tumor classification and staging. Preoperative imaging diagnosis of cN+ should not be over-dependent on size, but should be combined with the specific manifestations of lymph node metastasis such as circular enhancement and unclear boundaries. Proper use of SND in the treatment of cN+ laryngeal carcinoma is safe and effective, and reduces the risk of overtreatment. In patients with pN+ laryngeal carcinoma, postoperative supplementary treatment can improve the neck control rate and survival rate. However, even if postoperative treatment is performed in patients with ENE+, it is still an unfavorable factor affecting the prognosis.
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Affiliation(s)
- 浩 张
- 重庆医科大学附属第一医院耳鼻咽喉科(重庆,400016)Department of Otorhinolaryngology, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - 国华 胡
- 重庆医科大学附属第一医院耳鼻咽喉科(重庆,400016)Department of Otorhinolaryngology, First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
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Lobo R, Turk S, Bapuraj JR, Srinivasan A. Advanced CT and MR Imaging of the Posttreatment Head and Neck. Neuroimaging Clin N Am 2021; 32:133-144. [PMID: 34809834 DOI: 10.1016/j.nic.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Advances in MR and computed tomography (CT) techniques have resulted in greater fidelity in the assessment of treatment response and residual tumor on one hand and the assessment of recurrent head and neck malignancies on the other hand. The advances in MR techniques primarily are related to diffusion and perfusion imaging which rely on the intrinsic architecture of the tissues and organ systems. The techniques exploit the density of the cellular architecture; and the vascularity of benign and malignant lesions which in turn affect the changes in the passage of contrast through the vascular bed. Dual-energy CT and CT perfusion are the major advances in CT techniques that have found significant applications in the assessment of treatment response and tumor recurrence.
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Affiliation(s)
- Remy Lobo
- Neuroradiology Division, Radiology, Michigan Medicine, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Sevcan Turk
- Neuroradiology Division, Radiology, Michigan Medicine, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA
| | - J Rajiv Bapuraj
- Neuroradiology Division, Radiology, Michigan Medicine, 1500 E Medical Center Drive, B2A209, Ann Arbor, MI 48109, USA
| | - Ashok Srinivasan
- Neuroradiology Division, Radiology, Michigan Medicine, 1500 E Medical Center Drive, B2A209, Ann Arbor, MI 48109, USA.
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Novikov SN, Krzhivitskii PI, Radgabova ZA, Kotov MA, Girshovich MM, Artemyeva AS, Melnik YS, Kanaev SV. Single photon emission computed tomography-computed tomography visualization of sentinel lymph nodes for lymph flow guided nodal irradiation in oral tongue cancer. Radiat Oncol J 2021; 39:193-201. [PMID: 34610658 PMCID: PMC8497868 DOI: 10.3857/roj.2021.00395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/09/2021] [Indexed: 11/03/2022] Open
Abstract
PURPOSE To evaluate correlation of single photon emission computed tomography-computed tomography (SPECT-CT) data on lymph flow (LF) from oral tongue cancer (OC) and the topography of lymph nodes (LN) metastases; to determine the clinical value of lymph flow guided radiotherapy (LFGRT). MATERIALS AND METHODS SPECT-CT visualization of LF from the OC lesions was performed after peritumoral injection of 99mTc-phytate in 26 primary patients with clinical stage cT1-2N0M0 disease. We determined the individual drainage (unilateral/bilateral) from the tumor, and localization of sentinel LNs according to the neck levels. Metastases in LNs were verified with histology and a 2-year follow-up. RESULTS SPECT-CT detected bilateral LF in 10 (38.5%) of 26 patients; in 16 (61.5%) cases the drainage was unilateral. Histology revealed LNs metastases in three cases; regional recurrences were diagnosed in other four patients. In all seven observations metastases were located at the same site and level as the sentinel LNs. In eight (30.8%) of 26 patients sentinel LNs were visualized unilaterally at levels Ib-IIa; in five cases, unilaterally at levels I-IIa-III. In these patients, LFGRT demonstrated 59%-70% reduction of irradiated volume, and 26%-42% and 51%-70% decrease of the mean dose to the spinal cord and the contralateral parotid gland. In patients with a bilateral drainage the reduction of doses absorbed by the spinal cord and contralateral parotid gland was 19% and 6%, respectively. CONCLUSION Localization of sentinel LNs determined by SPECT-CT corresponds to the localization of metastatic LNs in terms of side and levels.
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Affiliation(s)
- Sergey Nikolaevich Novikov
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Pavel Ivanovich Krzhivitskii
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Zamira Achmedovna Radgabova
- Department of Head and Neck Surgery, N.N. Petrov National Medical Research Center of Oncology, St Petersburg, Russia
| | - Maxim Andreevitch Kotov
- Department of Head and Neck Surgery, N.N. Petrov National Medical Research Center of Oncology, St Petersburg, Russia
| | - Mikhail Markovich Girshovich
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Anna Sergeevna Artemyeva
- Department of Pathology, N.N. Petrov National Medical Research Center of Oncology, St Petersburg, Russia
| | - Yulia Sergeevna Melnik
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
| | - Sergey Vasilevich Kanaev
- Department of Radiation Oncology & Nuclear Medicine, N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, Russia
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Zhong YW, Jiang Y, Dong S, Wu WJ, Wang LX, Zhang J, Huang MW. Tumor radiomics signature for artificial neural network-assisted detection of neck metastasis in patient with tongue cancer. J Neuroradiol 2021; 49:213-218. [PMID: 34358534 DOI: 10.1016/j.neurad.2021.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE To determine the neck management of tongue cancer, this study attempted to construct an artificial neural network (ANN)-assisted model based on computed tomography (CT) radiomics of primary tumors to predict neck lymph node (LN) status in patients with tongue squamous cell carcinoma (SCC). MATERIALS AND METHODS Three hundred thirteen patients with tongue SCC were retrospectively included and randomly divided into training (60%), validation (20%) and internally independent test (20%) sets. In total, 1673 feature values were extracted after the semiautomatic segmentation of primary tumors and set as input layers of a classical 3-layer ANN incorporated with or without clinical LN (cN) status after dimension reduction. The receiver operating characteristic (ROC) curve, accuracy (ACC), sensitivity (SEN), specificity (SPE), area under curve (AUC) and Net Reclassification Index (NRI), were used to evaluate and compare the models. RESULTS Four models with different settings were constructed. The ACC, SEN, SPE and AUC reached 84.1%, 93.1%, 76.5% and 0.943 (95% confidence interval: 0.891-0.996, p<.001), respectively, in the test set. The NRI of models compared with radiologists reached 40% (p<.001). The occult nodal metastasis rate was reduced from 30.9% to a minimum of 12.7% in the T1-2 group. CONCLUSION ANN-based models that incorporated CT radiomics of primary tumors with traditional LN evaluation were constructed and validated to more precisely predict neck LN metastasis in patients with tongue SCC than with naked eyes, especially in early-stage cancer.
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Affiliation(s)
- Yi-Wei Zhong
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - Yin Jiang
- Department of Physics, Beihang University, Beijing, PR China; Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Beihang University, Beijing, PR China
| | - Shuang Dong
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - Wen-Jie Wu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China.
| | - Ling-Xiao Wang
- Department of Physics, Tsinghua University, Beijing, PR China; Frankfurt Institute for Advanced Studies, Frankfurt am Main, Germany
| | - Jie Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - Ming-Wei Huang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China
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New Developments in the Management of Cutaneous Squamous Cell Carcinoma. Plast Reconstr Surg 2021; 147:492-504. [PMID: 33620947 DOI: 10.1097/prs.0000000000007678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. List important prognostic features that affect cutaneous squamous cell carcinoma risk. 2. Summarize the changes to the AJCC Cancer Staging Manual, Eighth Edition, staging system for cutaneous squamous cell carcinoma. 3. Evaluate the draining nodal basin with appropriate imaging modalities. 4. Recommend adjuvant radiation therapy in the correct clinical setting for high-risk tumors. 5. Recognize the currently available treatments for advanced cutaneous squamous cell carcinoma. SUMMARY This continuing medical education article reviews the features, management, and prognosis of cutaneous squamous cell carcinoma with an emphasis on high-risk squamous cell carcinoma and data from the past 3 years. This review will discuss the primary tumor management, high-risk features of a squamous cell carcinoma, changes to the American Joint Committee on Cancer staging system, and the utility of sentinel lymph node biopsy, and critically review the evidence regarding adjuvant therapy.
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Lassau N, Bousaid I, Chouzenoux E, Verdon A, Balleyguier C, Bidault F, Mousseaux E, Harguem-Zayani S, Gaillandre L, Bensalah Z, Doutriaux-Dumoulin I, Monroc M, Haquin A, Ceugnart L, Bachelle F, Charlot M, Thomassin-Naggara I, Fourquet T, Dapvril H, Orabona J, Chamming's F, El Haik M, Zhang-Yin J, Guillot MS, Ohana M, Caramella T, Diascorn Y, Airaud JY, Cuingnet P, Gencer U, Lawrance L, Luciani A, Cotten A, Meder JF. Three artificial intelligence data challenges based on CT and ultrasound. Diagn Interv Imaging 2021; 102:669-674. [PMID: 34312111 DOI: 10.1016/j.diii.2021.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE The 2020 edition of these Data Challenges was organized by the French Society of Radiology (SFR), from September 28 to September 30, 2020. The goals were to propose innovative artificial intelligence solutions for the current relevant problems in radiology and to build a large database of multimodal medical images of ultrasound and computed tomography (CT) on these subjects from several French radiology centers. MATERIALS AND METHODS This year the attempt was to create data challenge objectives in line with the clinical routine of radiologists, with less preprocessing of data and annotation, leaving a large part of the preprocessing task to the participating teams. The objectives were proposed by the different organizations depending on their core areas of expertise. A dedicated platform was used to upload the medical image data, to automatically anonymize the uploaded data. RESULTS Three challenges were proposed including classification of benign or malignant breast nodules on ultrasound examinations, detection and contouring of pathological neck lymph nodes from cervical CT examinations and classification of calcium score on coronary calcifications from thoracic CT examinations. A total of 2076 medical examinations were included in the database for the three challenges, in three months, by 18 different centers, of which 12% were excluded. The 39 participants were divided into six multidisciplinary teams among which the coronary calcification score challenge was solved with a concordance index > 95%, and the other two with scores of 67% (breast nodule classification) and 63% (neck lymph node calcifications).
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Affiliation(s)
- Nathalie Lassau
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay. BIOMAPS, UMR 1281. Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France.
| | - Imad Bousaid
- Direction de la Transformation Numérique et des Systèmes d'Information, Institut Gustave Roussy, 94800 Villejuif, France
| | | | - Antoine Verdon
- Direction de la Transformation Numérique et des Systèmes d'Information, Institut Gustave Roussy, 94800 Villejuif, France
| | - Corinne Balleyguier
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay. BIOMAPS, UMR 1281. Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France
| | - François Bidault
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay. BIOMAPS, UMR 1281. Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France
| | - Elie Mousseaux
- Unité Fonctionnelle d'Imagerie Cardiovasculaire Non Invasive, Hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - Sana Harguem-Zayani
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay. BIOMAPS, UMR 1281. Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France
| | - Loic Gaillandre
- Centre Libéral d'Imagerie Médicale Agglomération Lille, 59800 Lille, France
| | - Zoubir Bensalah
- Department of Radiology, Centre Hospitalier St Jean, 66000 Perpignan, France
| | | | - Michèle Monroc
- Department of Radiology, Clinique Saint Antoine, 76230 Bois-Guillaume, France
| | - Audrey Haquin
- Department of Radiology, Hôpital de la Croix-Rousse - HCL, 69004 Lyon, France
| | - Luc Ceugnart
- Department of Radiology, Centre Oscar Lambret, 59000 Lille, France
| | | | - Mathilde Charlot
- Department of Radiology, Hôpital Lyon Sud - HCL, 69310 Pierre-Bénite, France
| | | | - Tiphaine Fourquet
- Department of Radiology, Centre Hospitalier Universitaire de Lille, 59000 Lille, France
| | - Héloise Dapvril
- Service d'Imagerie de la Femme, Centre Hospitalier de Valenciennes, 59300 Valenciennes, France
| | - Joseph Orabona
- Department of Radiology, Centre Hospitalier de Bastia, 20600 Bastia, France
| | | | - Mickael El Haik
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay. BIOMAPS, UMR 1281. Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France; Department of Imaging, Institut Gustave Roussy, 94800 Villejuif, France
| | - Jules Zhang-Yin
- Department of Radiology, Hôpital Tenon, AP-HP, 75020 Paris, France
| | - Marc-Samir Guillot
- Unité Fonctionnelle d'Imagerie Cardiovasculaire Non Invasive, Hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - Mickaël Ohana
- Department of Radiology, Centre Hospitalier Universitaire de Strasbourg, 67200 Strasbourg, France
| | - Thomas Caramella
- Department of Radiology, Institut Arnault Tzanck, 06700 Saint-Laurent du Var, France
| | - Yann Diascorn
- Department of Radiology, Institut Arnault Tzanck, 06700 Saint-Laurent du Var, France
| | | | - Philippe Cuingnet
- Department of Radiology, Centre Hospitalier de Douai, 59507 Douai, France
| | - Umit Gencer
- Unité Fonctionnelle d'Imagerie Cardiovasculaire Non Invasive, Hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France
| | - Littisha Lawrance
- Laboratoire d'Imagerie Biomédicale Multimodale Paris-Saclay. BIOMAPS, UMR 1281. Université Paris-Saclay, Inserm, CNRS, CEA, 94800 Villejuif, France
| | - Alain Luciani
- Collège des Enseignants de Radiologie de France, 75013 Paris, France; Department of Radiology, Centre Hospitalier Henri Mondor, 94000 Créteil, France
| | - Anne Cotten
- Musculoskeletal Imaging Department, Lille Regional University Hospital, 59000 Lille, France
| | - Jean-François Meder
- Department of Neuroradiology, Centre Hospitalier Sainte-Anne, 75014 Paris, France; Université de Paris, Faculté de Médecine, 75006 Paris, France
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Wilkie MD, Lancaster J, Roland NJ, Jones TM. Elective management of regional nodal basins in cutaneous squamous cell carcinoma of the head and neck: Controversies and contemporary perspectives. Oral Oncol 2021; 120:105432. [PMID: 34218060 DOI: 10.1016/j.oraloncology.2021.105432] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/04/2021] [Accepted: 06/22/2021] [Indexed: 10/21/2022]
Abstract
Non-melanoma skin cancer (NMSC) is among the most common cancers worldwide, with an incidence that continues to rise. Although cutaneous squamous cell carcinoma (cSCC) constitutes only approximately 20% of such cases, it represents the most common cause of NMSC mortality, owing largely to the propensity for development of regional lymph node metastases (LNM), which, when present, carry a dismal prognosis. Whilst overall rates of LNM are low, there are a number of patient and tumour factors that likely confer considerably higher risks, which has led several investigators to propose more proactive elective management of regional nodal basins in selected high-risk cases. Current international guidelines, however, do not recommend any elective treatment or sampling of regional nodal basins in the absence of clinically apparent disease. The purpose of this review is to explore in detail the fundamental issues underlying this controversy, focusing specifically on cSCC of the head and neck (cSCCHN). In particular the rationale for more a proactive elective approach to regional nodal basins, including the evidence-base underlying identification of potentially high-risk factors for development of LNM is discussed, along with oncological outcomes for those patients that do go onto suffer LNM. We also provide contemporary perspectives and evidence for approaches to electively managing regional nodal basins, and offer insight into how these may develop both in the clinical and research arenas.
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Affiliation(s)
- Mark D Wilkie
- Liverpool Head and Neck Centre, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, United Kingdom.
| | - Jeffrey Lancaster
- Liverpool Head and Neck Centre, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, United Kingdom
| | - Nicholas J Roland
- Liverpool Head and Neck Centre, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, United Kingdom
| | - Terence M Jones
- Liverpool Head and Neck Centre, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, United Kingdom
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A hidden Markov model for lymphatic tumor progression in the head and neck. Sci Rep 2021; 11:12261. [PMID: 34112849 PMCID: PMC8192955 DOI: 10.1038/s41598-021-91544-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/27/2021] [Indexed: 11/08/2022] Open
Abstract
Currently, elective clinical target volume (CTV-N) definition for head and neck squamous cell carcinoma (HNSCC) is mostly based on the prevalence of nodal involvement for a given tumor location. In this work, we propose a probabilistic model for lymphatic metastatic spread that can quantify the risk of microscopic involvement in lymph node levels (LNL) given the location of macroscopic metastases and T-category. This may allow for further personalized CTV-N definition based on an individual patient's state of disease. We model the patient's state of metastatic lymphatic progression as a collection of hidden binary random variables that indicate the involvement of LNLs. In addition, each LNL is associated with observed binary random variables that indicate whether macroscopic metastases are detected. A hidden Markov model (HMM) is used to compute the probabilities of transitions between states over time. The underlying graph of the HMM represents the anatomy of the lymphatic drainage system. Learning of the transition probabilities is done via Markov chain Monte Carlo sampling and is based on a dataset of HNSCC patients in whom involvement of individual LNLs was reported. The model is demonstrated for ipsilateral metastatic spread in oropharyngeal HNSCC patients. We demonstrate the model's capability to quantify the risk of microscopic involvement in levels III and IV, depending on whether macroscopic metastases are observed in the upstream levels II and III, and depending on T-category. In conclusion, the statistical model of lymphatic progression may inform future, more personalized, guidelines on which LNL to include in the elective CTV. However, larger multi-institutional datasets for model parameter learning are required for that.
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Sinha NK, Kohli PS, Nagarajan K, Gochhait D, Ganapathy S, Swamiappan E, Ganesan S, Penumadu P. A nomogram for predicting the risk of neck node metastasis in oral cavity carcinoma using acoustic radiation force impulse imaging (ARFI). Oral Oncol 2021; 118:105311. [PMID: 33932875 DOI: 10.1016/j.oraloncology.2021.105311] [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: 12/17/2020] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The study was conducted to assess the accuracy power of Acoustic radiation force impulse imaging (ARFI) and generate a nomogram using ultrasound and ARFI to predict malignant cervical lymph nodes in head and neck squamous cell carcinoma. MATERIAL AND METHODS 374 cervical lymph nodes from 67 patients were evaluated. The B-mode ultrasonography and the elastography findings were compared with the final histopathological diagnosis. Radiological variables were used to construct nomogram and clinical utility of the nomogram was cross-validated. RESULTS In univariate analysis, status of the hilum, Long Axis Diameter, Short axis diameter, colour virtual touch imaging grade (VTI) and shear wave velocity were significant in predicting metastasis in the cervical lymph nodes. In multivariable analysis, it was found that predominance of red over yellow area on colour VTI was significantly associated with lymph node metastasis. A multiple logistic regression performed to ascertain the effects of on the likelihood that patients had lymph node metastasis on histopathology was statistically significant, χ2(10) = 44.96, p < 0.001. The model was able to correctly classify 93.28% of cases and the concordance index (c-index) was estimated to be 0.8773. A nomogram was thus established to predict metastasis in cervical lymph nodes. CONCLUSIONS ARFI increases the diagnostic accuracy of conventional USG in predicting metastatic lymph nodes in HNSCC. Adding the constructed nomogram to the conventional diagnostic pathway can provide an alternative option to frozen section and FNAC.
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Affiliation(s)
- Neetesh Kumar Sinha
- Department of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Pavneet Singh Kohli
- Department of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Krishnan Nagarajan
- Additional Professor and Head, Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Debasis Gochhait
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sachit Ganapathy
- Department of Biostatistics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Elango Swamiappan
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sivaraman Ganesan
- Department of ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Prasanth Penumadu
- Department of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
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Fernández-Ferreira R, De la Peña-López IR, Zamudio-Coronado KW, Delgado-Soler LA, Torres-Pérez ME, Bourlón-de Los Ríos C, Cortés-González R. Calcitonin-Negative Neuroendocrine Carcinoma of the Thyroid Gland: Case Report and Literature Review. Case Rep Oncol 2021; 14:112-122. [PMID: 33776692 PMCID: PMC7983544 DOI: 10.1159/000510807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 11/24/2022] Open
Abstract
Calcitonin-negative neuroendocrine tumor (CNNET) of the thyroid is an extremely rare entity. In some of the previously reported cases within the literature, the terms “atypical medullary thyroid carcinoma,” “calcitonin-free oat cell carcinoma,” and “a distinct clinical entity” were applied to NETs without definitive evidence of calcitonin production. In the English-language literature, not only are there only few reported cases of CNNET, but the criteria for diagnosis in these cases are also controversial. Most of the current published cases were also treated surgically for local disease. We describe a case of NET of the thyroid with calcitonin, chromogranin A and thyroglobulin negativity, synaptophysin and TTF-1 positivity, and a high Ki-67 proliferation index with metastases in the cervical region as well as mediastinal adenopathies. This case was considered an unresectable thyroid carcinoma, and chemotherapy including cisplatin and etoposide was started as neoadjuvant treatment at the department of medical oncology. Total thyroidectomy plus bilateral and central cervical dissection was performed, and the patient underwent 2 cycles of adjuvant radiotherapy. Currently, the patient's <sup>18</sup>F-FDG-PET/CT findings show a complete response 17 months after diagnosis. In conclusion, CNNET of the thyroid is very rare and there is limited evidence regarding treatment in patients with metastases. Chemotherapy including cisplatin and etoposide as well as early aggressive surgical resection appears to positively impact patients' survival.
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Affiliation(s)
- Ricardo Fernández-Ferreira
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic & Foundation, Mexico, Mexico
| | - Ildefonso Roberto De la Peña-López
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic & Foundation, Mexico, Mexico
| | - Karla Walkiria Zamudio-Coronado
- Department of Endocrinology, Diabetology and Thyroid, National Institute of Medical Sciences and Nutrition "Salvador Zubiran", Mexico, Mexico
| | | | | | - Christianne Bourlón-de Los Ríos
- Department of Oncology Medicine, Comprehensive Oncology Center "Diana Laura Riojas de Colosio," Medica Sur Clinic & Foundation, Mexico, Mexico
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Huang S, Zhao Y, Jiang X, Lin N, Zhang M, Wang H, Zheng A, Ma X. Clinical Utility of Contrast-enhanced Ultrasound for the Diagnosis of Lymphadenopathy. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:869-879. [PMID: 33487474 DOI: 10.1016/j.ultrasmedbio.2020.12.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 02/05/2023]
Abstract
This meta-analysis aimed to evaluate the diagnostic accuracy of contrast-enhanced ultrasonography (CEUS) in identifying lymphazdenopathy. PubMed, Web of Science, Embase and the Cochrane Library were searched for relevant articles through September 2020. A total of 16 articles, which included 1787 participants, were analyzed. The summary sensitivity, specificity, positive likelihood ratio (LR), negative LR and diagnostic odds ratio of CEUS for diagnosing lymphadenopathy were 0.88 (0.86-0.90), 0.90 (0.88-0.92), 6.04 (3.67-9.95), 0.15 (0.10-0.21) and 47.38 (23.45-95.66), respectively. The summary receiver operating characteristic (SROC) area under the curve (AUC) was 0.9405. After omitting outliers identified in a bivariate box plot and forest plot, heterogeneity was decreased, and the pooled sensitivity and specificity were 0.87 (0.84-0.90) and 0.87 (0.84-0.90), respectively. Furthermore, the SROC AUC was 0.9327. In conclusion, CEUS has the potential to be a valuable tool for characterizing lymphadenopathy and could provide clinical decision support.
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Affiliation(s)
- Siyang Huang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Tumor Targeted and Immune Therapy, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan, Chengdu, China
| | - Yunuo Zhao
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xian Jiang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Tumor Targeted and Immune Therapy, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, West China Hospital, Sichuan, Chengdu, China
| | - Nan Lin
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Mingxuan Zhang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Hang Wang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Aiping Zheng
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelei Ma
- Department of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
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41
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Iqbal MS, Kelly C, Kovarik J, McQueen A. Rapid recurrence in postoperative head and neck cancer: Underappreciated or overcalled problem? Head Neck 2021; 43:1380-1381. [PMID: 33495998 DOI: 10.1002/hed.26615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/14/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Muhammad Shahid Iqbal
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Charles Kelly
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Josef Kovarik
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew McQueen
- Department of Radiology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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42
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Crimì F, Borsetto D, Stramare R, Di Carlo R, Emauelli E, Nicolai P, Lacognata C, Zucchetta P, Oliveri G, Merola A, Bodanza V, Albertoni L, Campi C, Cecchin D. [ 18F]FDG PET/MRI versus contrast-enhanced MRI in detecting regional HNSCC metastases. Ann Nucl Med 2021; 35:260-269. [PMID: 33454923 DOI: 10.1007/s12149-020-01565-5] [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: 10/12/2020] [Accepted: 12/04/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare the accuracy of contrast-enhanced MRI using established dimensional and morphological criteria versus integrated [18F]FDG PET/MRI in identifying regional lymph node metastases in patients with newly diagnosed head and neck squamous cell carcinoma (HNSCC). For this purpose, we compare MRI and PET/MRI using the histopathological findings in dissected lymph nodes as the gold standard. METHODS We retrospectively reviewed 26 patients with histologically proven HNSCC who underwent gadolinium-enhanced [18F]FDG PET/MRI as part of their staging. All neck lymph nodes were classified on MRI using dimensional and/or morphological criteria. Then, they were jointly assessed by a nuclear medicine physician and a radiologist using integrated [18F]PET/MR images. ROC curves were obtained to compare the techniques. Lymph node histopathology was considered as the reference standard. RESULTS Out of 865 lymph nodes, 35 were malignant at histopathology (3 with micro-metastases). Sensitivity and specificity were 48.6% and 99.5% for MRI using dimensional criteria; 60.0% and 99.6% for MRI using morphological criteria; 60.0% and 99.4% for MRI using both; and 74.3% and 97.6% for PET using MR as anatomic localization. The area under the ROC curve was higher for PET and MRI localization (0.859) than for MRI using dimensional (0.740; p < 0.05), or morphological (0.798; p < 0.05), or both criteria (0.797; p < 0.05). PET/MR using a PET SUVmax cutoff of 5.7 combined with MRI using dimensional and/or morphological criteria reached high values for accuracy (98.2%), NPV (98.2%), and PPV (95.2%). CONCLUSIONS Compared with traditional contrast-enhanced MRI or PET alone, integrated PET/MRI could improve diagnostic accuracy in detecting metastatic lymph nodes in patients with HNSCC.
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Affiliation(s)
- Filippo Crimì
- Department of Medicine DIMED, Institute of Radiology, Padova University Hospital, Padua, Italy
| | - Daniele Borsetto
- Guy's and St Thomas NHS Trust, Great Maze Pond, London, SE1 9RT, UK.
| | - Roberto Stramare
- Department of Medicine DIMED, Institute of Radiology, Padova University Hospital, Padua, Italy
| | - Roberto Di Carlo
- Otolaryngology Unit, Department of Neurosciences DNS, Padova University Hospital, Padua, Italy
| | - Enzo Emauelli
- Otolaryngology Unit, Department of Neurosciences DNS, Padova University Hospital, Padua, Italy
| | - Piero Nicolai
- Otolaryngology Unit, Department of Neurosciences DNS, Padova University Hospital, Padua, Italy
| | | | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine DIMED, Padova University Hospital, Padua, Italy
| | - Giulia Oliveri
- Otolaryngology Unit, Department of Neurosciences DNS, Padova University Hospital, Padua, Italy
| | - Arcangelo Merola
- Department of Medicine DIMED, Institute of Radiology, Padova University Hospital, Padua, Italy
| | - Valentina Bodanza
- Nuclear Medicine Unit, Department of Medicine DIMED, Padova University Hospital, Padua, Italy
| | - Laura Albertoni
- Surgical Pathology and Cytopathology Unit, Department of Medicine DIMED, Padova University Hospital, Padua, Italy
| | - Cristina Campi
- Department of Mathematics "Tullio Levi-Civita", University of Padova, Padua, Italy
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine DIMED, Padova University Hospital, Padua, Italy
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43
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Bozzato A, Pillong L, Schick B, Lell MM. [Current diagnostic imaging and treatment planning for laryngeal cancer]. Radiologe 2021; 60:1026-1037. [PMID: 33057744 DOI: 10.1007/s00117-020-00757-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CLINICAL/METHODICAL ISSUE Laryngeal cancer is the third most common malignancy in the head and neck region. Endoscopic laryngoscopy with assessment of vocal fold function, microlaryngoscopy with biopsy and computed tomography (CT)/magnetic resonance imaging (MRI) remain the cornerstones of diagnostic workup. Thus, in the context of therapy planning, consideration of individual functional and socioeconomic aspects is of major importance. STANDARD RADIOLOGICAL METHODS Due to the short acquisition time and the possibility to perform functional maneuvers, CT is the tool of choice. MRI allows better soft tissue differentiation, but is more susceptible to movement artifacts and is complicated by disease-specific symptoms. The choice of examination method therefore depends on the patient's physical resilience. PERFORMANCE Depending on the study, the information on the sensitivity of CT with regard to the question of cartilage infiltration varies between 62 and 87% with a specificity between 75 and 98%. For MRI, sensitivity between 64 and 95% and specificity between 56 and 88% are stated. ACHIEVEMENTS The synthesis of the findings from endoscopy, biopsy and imaging is prerequisite for initiation of stage-appropriate treatment. For image interpretation, knowledge of the anatomical landmarks is essential. However, the assessment of posttherapeutic changes also poses a challenge for the radiologist. PRACTICAL RECOMMENDATIONS Regular interdisciplinary dialogue between radiologists, otorhinolaryngologists and radiotherapists in the context of primary diagnostics, therapy planning and aftercare is essential.
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Affiliation(s)
- A Bozzato
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum des Saarlandes, Kirrbergerstraße Gebäude 6, 66421, Homburg, Deutschland
| | - L Pillong
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum des Saarlandes, Kirrbergerstraße Gebäude 6, 66421, Homburg, Deutschland.
| | - B Schick
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum des Saarlandes, Kirrbergerstraße Gebäude 6, 66421, Homburg, Deutschland
| | - M M Lell
- Institut für Radiologie und Nuklearmedizin, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg, Deutschland
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Sharafeldin M, Chen T, Ozkaya GU, Choudhary D, Molinolo AA, Gutkind JS, Rusling JF. Detecting cancer metastasis and accompanying protein biomarkers at single cell levels using a 3D-printed microfluidic immunoarray. Biosens Bioelectron 2021; 171:112681. [PMID: 33096435 PMCID: PMC7666000 DOI: 10.1016/j.bios.2020.112681] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 12/18/2022]
Abstract
A low-cost microfluidic microarray capable of lysing cells and quantifying proteins released after lysis was designed and 3D-printed. The array lyses cells on-chip in lysis buffer augmented with a 2s pulse of a sonic cell disruptor. Detection of desmoglein 3 (DSG3), a metastatic biomarker for head and neck squamous cell carcinoma (HNSCC), along with two accompanying HNSCC biomarkers from a single cell lysate of oral cancer cell cultures was demonstrated. A lysis chamber and reagent compartments deliver sample and reagents into detection chambers decorated with capture antibodies immobilized onto inner walls coated with a highly swollen 3D chitosan hydrogel film. Sandwich immunoassays are achieved when captured analytes labeled with biotinylated secondary antibodies, which then capture streptavidin-poly [horse radish peroxidase] (Poly-HRP). Subsequent delivery of super-bright femto-luminol with H2O2 generates chemiluminescence captured with a CCD camera. DSG3 is membrane-bound protein in HNSCC cells of invaded lymph nodes, vascular endothelial growth factor-A (VEGF-A), vascular endothelial growth factor-C (VEGF-C) were positive controls overexpressed into the HNSCC culture medium. Beta-tubulin (β-Tub) was used as a loading control to estimate the number of cells in analyzed samples. Limits of detection (LOD) were 0.10 fg/mL for DSG3, and 0.20 fg/mL for VEGF-A, VEGF-C and β-Tub. Three orders of magnitude semilogarithmic dynamic ranges were achieved. VEGF-A showed high in-cell expression, but VEGF-C had low levels inside cells. The very low LODs enabled quantifying these proteins released from single cells. Strong correlation between results from on-chip cell lysis, conventional off-line lysis and ELISA confirmed accuracy.
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Affiliation(s)
| | - Tianqi Chen
- Department of Chemistry, University of Connecticut, Storrs, CT, 06269, USA
| | - Gulsum Ucak Ozkaya
- Department of Food Engineering, Chemical and Metallurgical Engineering Faculty, Yildiz Technical University, Istanbul, 34210, Turkey
| | | | - Alfredo A Molinolo
- Department of Pathology and Moores Cancer Center, Univ. of Calif. San Diego, La Jolla, CA, 92093-0012, USA
| | - J Silvio Gutkind
- Department of Pharmacology and Moores Cancer Center, Univ. Calif. San Diego, UC San Diego, La Jolla, CA, 92093-0012, USA
| | - James F Rusling
- Department of Chemistry, University of Connecticut, Storrs, CT, 06269, USA; Department of Surgery, UConn Health, Farmington, CT, 06032, USA; Institute of Material Science, Storrs, CT, 06269, USA; School of Chemistry, National University of Ireland at Galway, Ireland; Neag Cancer Center, UConn Health, Farmington, CT, 06032, USA.
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Chen J, Hagiwara M, Givi B, Schmidt B, Liu C, Chen Q, Logan J, Mikheev A, Rusinek H, Kim SG. Assessment of metastatic lymph nodes in head and neck squamous cell carcinomas using simultaneous 18F-FDG-PET and MRI. Sci Rep 2020; 10:20764. [PMID: 33247166 PMCID: PMC7695736 DOI: 10.1038/s41598-020-77740-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/02/2020] [Indexed: 11/09/2022] Open
Abstract
In this study, we investigate the feasibility of using dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), diffusion weighted imaging (DWI), and dynamic positron emission tomography (PET) for detection of metastatic lymph nodes in head and neck squamous cell carcinoma (HNSCC) cases. Twenty HNSCC patients scheduled for lymph node dissection underwent DCE-MRI, dynamic PET, and DWI using a PET-MR scanner within one week prior to their planned surgery. During surgery, resected nodes were labeled to identify their nodal levels and sent for routine clinical pathology evaluation. Quantitative parameters of metastatic and normal nodes were calculated from DCE-MRI (ve, vp, PS, Fp, Ktrans), DWI (ADC) and PET (Ki, K1, k2, k3) to assess if an individual or a combination of parameters can classify normal and metastatic lymph nodes accurately. There were 38 normal and 11 metastatic nodes covered by all three imaging methods and confirmed by pathology. 34% of all normal nodes had volumes greater than or equal to the smallest metastatic node while 4 normal nodes had SUV > 4.5. Among the MRI parameters, the median vp, Fp, PS, and Ktrans values of the metastatic lymph nodes were significantly lower (p = <0.05) than those of normal nodes. ve and ADC did not show any statistical significance. For the dynamic PET parameters, the metastatic nodes had significantly higher k3 (p value = 8.8 × 10-8) and Ki (p value = 5.3 × 10-8) than normal nodes. K1 and k2 did not show any statistically significant difference. Ki had the best separation with accuracy = 0.96 (sensitivity = 1, specificity = 0.95) using a cutoff of Ki = 5.3 × 10-3 mL/cm3/min, while k3 and volume had accuracy of 0.94 (sensitivity = 0.82, specificity = 0.97) and 0.90 (sensitivity = 0.64, specificity = 0.97) respectively. 100% accuracy can be achieved using a multivariate logistic regression model of MRI parameters after thresholding the data with Ki < 5.3 × 10-3 mL/cm3/min. The results of this preliminary study suggest that quantitative MRI may provide additional value in distinguishing metastatic nodes, particularly among small nodes, when used together with FDG-PET.
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Affiliation(s)
- Jenny Chen
- grid.137628.90000 0004 1936 8753Department of Radiology, Center for Biomedical Imaging (CBI), Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, 660 First Avenue, New York, NY 10016 USA
| | - Mari Hagiwara
- grid.137628.90000 0004 1936 8753Department of Radiology, Center for Biomedical Imaging (CBI), Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, 660 First Avenue, New York, NY 10016 USA
| | - Babak Givi
- grid.137628.90000 0004 1936 8753Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY USA
| | - Brian Schmidt
- grid.137628.90000 0004 1936 8753Department of Oral and Maxillofacial Surgery, Bluestone Center for Clinical Research, New York University College of Dentistry, New York, NY USA
| | - Cheng Liu
- grid.137628.90000 0004 1936 8753Department of Pathology, New York University School of Medicine, New York, NY USA
| | - Qi Chen
- grid.137628.90000 0004 1936 8753Department of Radiology, Center for Biomedical Imaging (CBI), Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, 660 First Avenue, New York, NY 10016 USA
| | - Jean Logan
- grid.137628.90000 0004 1936 8753Department of Radiology, Center for Biomedical Imaging (CBI), Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, 660 First Avenue, New York, NY 10016 USA
| | - Artem Mikheev
- grid.137628.90000 0004 1936 8753Department of Radiology, Center for Biomedical Imaging (CBI), Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, 660 First Avenue, New York, NY 10016 USA
| | - Henry Rusinek
- grid.137628.90000 0004 1936 8753Department of Radiology, Center for Biomedical Imaging (CBI), Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, 660 First Avenue, New York, NY 10016 USA
| | - Sungheon Gene Kim
- Department of Radiology, Center for Biomedical Imaging (CBI), Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, 660 First Avenue, New York, NY, 10016, USA. .,Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
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Abstract
FDG PET-CT is one the main investigations for squamous cell (Sq) head and neck (H&N) cancer patients. FDG PET-CT has a key role for the staging of patients with T4 cancer of the hypopharynx and nasopharynx and patients with N3 nodal disease. It is effective in detecting recurrent disease accurately. In addition, it has an emerging role in the surveillance of Sq H&N cancer survivors. In patients with advanced neck nodal disease treated with chemoradiotherapy, there is compelling evidence that patients with no FDG uptake in the neck 12 weeks following completion of treatment do not require neck dissection. There is considerable interest in using FDG PET-CT for develop more effective clinical pathways for the surveillance of Sq H&N cancer. Currently, the detection rate of recurrence in patients who attend regular clinical follow-up is poor, less than 1% in asymptomatic patients. FDG PET-CT may enable survivors to be stratified into groups based on the likelihood of having recurrent disease. Optimal surveillance pathways can be developed, reserving most intense imaging regimes and most frequent follow-up for survivors at high risk of recurrence. FDG PET CT is sometimes considered for patients with non Sq H&N cancer. If used in this context, a baseline FDG PET-CT should be done to ensure that the tumour is avid. Most H&N malignant tumours are avid. However, salivary gland cancers, and tumours with muco-epidermoid, adenoid cystic and clear cell histology show paucity of FDG avidity, especially when they recur. In addition, peri-neural invasion cannot be detected reliably with FDG PET-CT.
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Affiliation(s)
- Wai Lup Wong
- Consultant Radiologist (Nuclear Medicine) Mount Vernon Hospital, Northwood, UK; PET-CT Clinical Lead Strickland Scanner Centre, Northwood, UK.
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Mahieu R, de Maar JS, Nieuwenhuis ER, Deckers R, Moonen C, Alic L, ten Haken B, de Keizer B, de Bree R. New Developments in Imaging for Sentinel Lymph Node Biopsy in Early-Stage Oral Cavity Squamous Cell Carcinoma. Cancers (Basel) 2020; 12:cancers12103055. [PMID: 33092093 PMCID: PMC7589685 DOI: 10.3390/cancers12103055] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/03/2020] [Accepted: 10/15/2020] [Indexed: 12/18/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) is a diagnostic staging procedure that aims to identify the first draining lymph node(s) from the primary tumor, the sentinel lymph nodes (SLN), as their histopathological status reflects the histopathological status of the rest of the nodal basin. The routine SLNB procedure consists of peritumoral injections with a technetium-99m [99mTc]-labelled radiotracer followed by lymphoscintigraphy and SPECT-CT imaging. Based on these imaging results, the identified SLNs are marked for surgical extirpation and are subjected to histopathological assessment. The routine SLNB procedure has proven to reliably stage the clinically negative neck in early-stage oral squamous cell carcinoma (OSCC). However, an infamous limitation arises in situations where SLNs are located in close vicinity of the tracer injection site. In these cases, the hotspot of the injection site can hide adjacent SLNs and hamper the discrimination between tracer injection site and SLNs (shine-through phenomenon). Therefore, technical developments are needed to bring the diagnostic accuracy of SLNB for early-stage OSCC to a higher level. This review evaluates novel SLNB imaging techniques for early-stage OSCC: MR lymphography, CT lymphography, PET lymphoscintigraphy and contrast-enhanced lymphosonography. Furthermore, their reported diagnostic accuracy is described and their relative merits, disadvantages and potential applications are outlined.
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Affiliation(s)
- Rutger Mahieu
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Josanne S. de Maar
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands; (J.S.d.M.); (R.D.); (C.M.)
| | - Eliane R. Nieuwenhuis
- Department of Magnetic Detection & Imaging, University of Twente, 7522 NB Enschede, The Netherlands; (E.R.N.); (L.A.); (B.t.H.)
| | - Roel Deckers
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands; (J.S.d.M.); (R.D.); (C.M.)
| | - Chrit Moonen
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands; (J.S.d.M.); (R.D.); (C.M.)
| | - Lejla Alic
- Department of Magnetic Detection & Imaging, University of Twente, 7522 NB Enschede, The Netherlands; (E.R.N.); (L.A.); (B.t.H.)
| | - Bennie ten Haken
- Department of Magnetic Detection & Imaging, University of Twente, 7522 NB Enschede, The Netherlands; (E.R.N.); (L.A.); (B.t.H.)
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands;
- Correspondence: ; Tel.: +31-88-7550819
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48
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Evaluation of primary lateral neck mass in adults: Cross sectional study. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.703630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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49
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Horváth A, Prekopp P, Polony G, Székely E, Tamás L, Dános K. Accuracy of the preoperative diagnostic workup in patients with head and neck cancers undergoing neck dissection in terms of nodal metastases. Eur Arch Otorhinolaryngol 2020; 278:2041-2046. [PMID: 32860560 PMCID: PMC8131330 DOI: 10.1007/s00405-020-06324-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022]
Abstract
Purpose The presence of cervical lymph node metastases is one of the most influential prognostic factors in head and neck squamous cell carcinomas. The management of clinically N0 neck in patients with head and neck cancer remains controversial: elective neck dissection has relatively high morbidity, adversely affecting the quality of life, however, abandoning elective neck dissection is known to compromise overall survival in numerous primaries. The purpose of this study was to evaluate the accuracy of the conventional imaging modalities (CT, MRI, US) and fine-needle aspiration cytology (FNAC) in the detection of lymph node metastases in the neck. Methods Sixty two patients were included in the study, who underwent primary tumor resection and neck dissection. Preoperative nodal status was compared with postoperative histopathology nodal status. In our retrospective study, we reviewed the patient documentation. Statistical analysis of the data—with descriptive statistics and correlation analysis—was performed with Chi-square test. Results The sensitivity of conventional imaging modalities and FNAC were 82.8% and 81.8%, respectively, while specificity were 73.9% and 100%, respectively. Positive predictive value calculated for imaging modalities and FNAC were 82.8%, 100%, respectively, while negative predictive values were 73.9% and 66.6%, respectively. Conclusion Neither the sensitivity of imaging modalities (CT, MRI, US) nor FNAC reached 100%, none of these methods can definitively exclude the presence of regional tumor metastasis. According to these data, no permissive alteration should be allowed from the current guidelines (e.g. NCCN) based on imaging/FNAC examinations regarding the need for elective neck dissection.
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Affiliation(s)
- Angéla Horváth
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Szigony Str. 36, Budapest, 1083, Hungary
| | - Péter Prekopp
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Szigony Str. 36, Budapest, 1083, Hungary
| | - Gábor Polony
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Szigony Str. 36, Budapest, 1083, Hungary
| | - Eszter Székely
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - László Tamás
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Szigony Str. 36, Budapest, 1083, Hungary
| | - Kornél Dános
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Szigony Str. 36, Budapest, 1083, Hungary.
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Soumya, Whitehorn A, Ooi EH, Lockwood C. Accuracy of core needle biopsy compared to fine needle biopsy for the diagnosis of neoplasm in patients with suspected head and neck cancers: a systematic review protocol of diagnostic test accuracy. JBI Evid Synth 2020; 18:1602-1608. [PMID: 32813401 DOI: 10.11124/jbisrir-d-19-00225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The objective of this review is to determine the difference in diagnostic accuracy of core needle biopsy and fine needle aspiration for patients with a head and neck mass using surgical histopathology as a reference test. The risks and adverse events associated with each technique will also be compared. INTRODUCTION Tissue diagnosis is critical in evaluation of head and neck lesions to guide management. Options for tissue biopsy include surgical biopsy, fine needle aspiration and core needle biopsy. INCLUSION CRITERIA Studies that compare ultrasound-guided core needle biopsy and/or fine needle aspiration to investigate lumps in the thyroid, cervical lymph nodes, or salivary glands for malignancy in adult patients will be included. The comparator test will be definitive histology in form of surgical biopsy/excision. METHODS MEDLINE, Emcare, Embase, Web of Science and Cochrane Register of Diagnostic Accuracy Studies will be searched. Studies will be critically appraised by two independent reviewers for methodological quality, using the modified critical appraisal instrument QUADAS-2 and JBI SUMARI software. Two independent reviewers will extract data from papers included in the review using the standardized data extraction tool available in the JBI Reviewer's Manual. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020140005.
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Affiliation(s)
- Soumya
- 1Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Australia 2JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia 3Department of Otolaryngology and Head and Neck Surgery, Flinders Medical Centre, Bedford Park, Australia 4Department of Surgery, Flinders University, Bedford Park, Australia
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