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Bugter O, Aaboubout Y, Algoe M, de Bruijn HS, Keereweer S, Sewnaik A, Monserez DA, Koljenović S, Hardillo JAU, Robinson DJ, Baatenburg de Jong RJ. Detecting head and neck lymph node metastases with white light reflectance spectroscopy; a pilot study. Oral Oncol 2021; 123:105627. [PMID: 34826688 DOI: 10.1016/j.oraloncology.2021.105627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/08/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION A challenge in the treatment of patients with head and neck cancer is the management of occult cervical lymph node (LN) metastases. Single-fiber reflectance (SFR) spectroscopy has the potential to detect physiological tissue changes that occur in a positive LN. This pilot study aimed to investigate whether SFR spectroscopy could serve as an alternative or additional technique to detect cervical lymph node metastases. MATERIALS AND METHODS We performed intraoperative SFR spectroscopy measurements of LNs with and without malignancies. We analyzed if physiological and scattering parameters were significantly altered in positive LNs. RESULTS Nine patients with a total of nineteen LNs were included. Three parameters, blood volume fraction (BVF), microvascular saturation (StO2), and Rayleigh amplitude, were significantly lower in positive LNs. They were combined into one optical parameter 'delta', using discriminant analysis. Delta was significantly decreased in positive LNs, p = 0,0006. It had a high diagnostic accuracy where the sensitivity, specificity, PPV, and NPV were 90,0%, 88.9%, 90,0%, and 88.9%, respectively. The area under the ROC curve was 96.7% (95% confidence interval 89.7-100.0%). CONCLUSION This proof of principle study is a first step in the development of an SFR spectroscopy technique to detect LN metastases in real time. A next step towards this goal is replicating these results in LNs with smaller metastases and in a larger cohort of patients. This future study will combine SFR spectroscopy with fine-needle aspiration, using the same needle, to perform preoperative in vivo measurements.
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Affiliation(s)
- Oisín Bugter
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Otorhinolaryngology and Head and Neck Surgery, Rotterdam, the Netherlands; Erasmus MC Cancer Institute, University Medical Center Rotterdam, Center for Optical Diagnostics and Therapy, Rotterdam, the Netherlands
| | - Yassine Aaboubout
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Otorhinolaryngology and Head and Neck Surgery, Rotterdam, the Netherlands; Erasmus MC Cancer Institute, University Medical Center Rotterdam, Center for Optical Diagnostics and Therapy, Rotterdam, the Netherlands; Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Pathology, Rotterdam, the Netherlands
| | - Mahesh Algoe
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Pathology, Rotterdam, the Netherlands
| | - Henriëtte S de Bruijn
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Otorhinolaryngology and Head and Neck Surgery, Rotterdam, the Netherlands; Erasmus MC Cancer Institute, University Medical Center Rotterdam, Center for Optical Diagnostics and Therapy, Rotterdam, the Netherlands
| | - Stijn Keereweer
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Otorhinolaryngology and Head and Neck Surgery, Rotterdam, the Netherlands
| | - Aniel Sewnaik
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Otorhinolaryngology and Head and Neck Surgery, Rotterdam, the Netherlands
| | - Dominiek A Monserez
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Otorhinolaryngology and Head and Neck Surgery, Rotterdam, the Netherlands
| | - Senada Koljenović
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Pathology, Rotterdam, the Netherlands
| | - Jose A U Hardillo
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Otorhinolaryngology and Head and Neck Surgery, Rotterdam, the Netherlands.
| | - Dominic J Robinson
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Otorhinolaryngology and Head and Neck Surgery, Rotterdam, the Netherlands; Erasmus MC Cancer Institute, University Medical Center Rotterdam, Center for Optical Diagnostics and Therapy, Rotterdam, the Netherlands
| | - Robert J Baatenburg de Jong
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Otorhinolaryngology and Head and Neck Surgery, Rotterdam, the Netherlands
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Vowles RH, Ghiacy S, Jefferis AF. A clinic for the rapid processing of patients with neck masses. J Laryngol Otol 1998; 112:1061-4. [PMID: 10197145 DOI: 10.1017/s002221510014246x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Neck masses are common and may have serious underlying pathology. There is much anxiety and confusion in primary care as to which hospital department will provide the patient with the best service and the swiftest diagnosis. A clinic was set up at Wexham Park hospital to enable patients with neck masses to be seen early, and to undergo a one-stop specialist evaluation, ultrasound scan and fine needle aspiration biopsy. The clinic has yielded a wide variety of benign and malignant pathology. The first 100 patients are discussed and evaluated.
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Affiliation(s)
- R H Vowles
- Department of Otolaryngology, Wexham Park Hospital, Slough, UK.
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Toriyabe Y, Nishimura T, Kita S, Saito Y, Miyokawa N. Differentiation between benign and metastatic cervical lymph nodes with ultrasound. Clin Radiol 1997; 52:927-32. [PMID: 9413967 DOI: 10.1016/s0009-9260(97)80226-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The differentiation between benign and metastatic lymph nodes with ultrasound (US) is based primarily on the evaluation of size, shape, margin and internal echo structure. The aim of this study is to determine whether these parameters are reliable indicators and to correlate internal echo structure and histopathological findings. MATERIALS AND METHODS Seventy-one nodes in 21 patients with pathologically proven oral squamous cell carcinoma were examined. The shortest diameter, the short/long diameter ratio (S/L ratio), margins and internal echo structure of the lymph node were evaluated by US. The internal echo structure was divided into six patterns: homogeneous hypoechoic, homogeneous hyperechoic, heterogeneous, eccentric hyperechoic, centric hyperechoic and anechoic pattern. In addition, internal echo structure was correlated with histopathological findings. RESULTS In 71.4% of the metastatic nodes, the shortest diameter was more than 10 mm and the S/L ratio was higher than that of benign nodes (average 0.71). Eleven (84.6%) of the 13 lymph nodes with irregular margins were metastatic. Heterogeneous and anechoic patterns were observed in metastatic nodes, whereas homogeneous hypoechoic and eccentric hyperechoic patterns were present in benign nodes. On ultrasonography with the corresponding histopathological findings, echogenic areas in the homogeneous hyperechoic, heterogeneous and centric hyperechoic patterns of metastatic nodes proved to be necrosis or fibrosis. Eccentric hyperechoic areas in benign nodes corresponded to the hilus and surrounding fatty tissue. CONCLUSIONS The shortest diameter, S/L ratio, margin and internal echo structure were considered to be critical indicators to differentiate between benign and metastatic nodes. Secondary changes caused by tumour infiltration, necrosis, or fibrosis should be assessed when metastatic lymph nodes are differentiated from benign ones by internal echo structure.
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Affiliation(s)
- Y Toriyabe
- Department of Oral and Maxillofacial Surgery, Asahikawa Medical College, Japan
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