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Cheng PC, Chang CM, Liao LJ, Hsieh CH, Shueng PW, Cheng PW, Lo WC. Ultrasound Is Beneficial to Determine Lymphadenopathy in Oral Cancer Patients after Radiotherapy. Diagnostics (Basel) 2023; 13:2409. [PMID: 37510156 PMCID: PMC10378444 DOI: 10.3390/diagnostics13142409] [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: 07/03/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
The present study aimed to investigate whether the addition of ultrasound (US) +/- fine needle aspiration (FNA) to magnetic resonance imaging (MRI) or computed tomography (CT) improves the diagnostic accuracy in assessing neck lymphadenopathy in oral cancer patients after neck irradiation. We retrospectively reviewed oral cancer patients who had neck lymphadenopathy after radiotherapy (RT) or chemoradiation therapy (CRT) from February 2008 to November 2019. The following diagnostic modalities were assessed: (1) MRI/CT, (2) MRI/CT with a post-RT US predictive model, and (3) MRI/CT with US + FNA. The receiver operating characteristic (ROC) curves were used to assess the diagnostic performance. A total of 104 irradiation-treated oral cancer patients who subsequently had neck lymphadenopathy were recruited and analyzed. Finally, there were 68 (65%) malignant and 36 (35%) benign lymphadenopathies. In terms of the diagnostic performance, the area under the ROC curves (C-statistics) was 0.983, 0.920, and 0.828 for MRI/CT with US + FNA, MRI/CT with a post-RT US predictive model, and MRI/CT, respectively. The addition of US to MRI/CT to evaluate cervical lymphadenopathy could achieve a better diagnostic accuracy than MRI/CT alone in oral cancer patients after neck irradiation.
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Affiliation(s)
- Ping-Chia Cheng
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Department of Communication Engineering, Asia Eastern University of Science and Technology, New Taipei City 22061, Taiwan
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Chih-Ming Chang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Li-Jen Liao
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan 32003, Taiwan
- Medical Engineering Office, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
| | - Chen-Hsi Hsieh
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
| | - Pei-Wei Shueng
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
| | - Po-Wen Cheng
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
| | - Wu-Chia Lo
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan 32003, Taiwan
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Rink M, Jung EM, Künzel J. The Use of Contrast-Enhanced Sonography for Therapy Monitoring of Metastatic Lymph Nodes: A Systematic Review. Curr Oncol 2023; 30:6734-6743. [PMID: 37504354 PMCID: PMC10378161 DOI: 10.3390/curroncol30070494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/06/2023] [Accepted: 07/13/2023] [Indexed: 07/29/2023] Open
Abstract
Metastatic cervical lymph nodes are a frequent finding in head and neck squamous cell carcinoma (HNSCC). If a non-surgical approach is primarily chosen, a therapy response evaluation of the primary tumor and the affected lymph nodes is necessary in the follow-up. Supplementary contrast-enhanced ultrasound (CEUS) can be used to precisely visualize the microcirculation of the target lesion in the neck, whereby malignant and benign findings differ in their uptake behavior. The same applies to many other solid tumors. For various tumor entities, it has already been shown that therapy monitoring is possible through regular contrast-enhanced sonography of the primary tumor or the affected lymph nodes. Thus, in some cases, maybe in the future, a change in therapy strategy can be achieved at an early stage in the case of non-response or, in the case of therapy success, a de-escalation of subsequent (surgical) measures can be achieved. In this paper, a systematic review of the available studies and a discussion of the potential of therapy monitoring by means of CEUS in HNSCC are presented.
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Affiliation(s)
- Maximilian Rink
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg, 93053 Regensburg, Germany
| | - Ernst-Michael Jung
- Department of Radiology, University Hospital of Regensburg, 93053 Regensburg, Germany
| | - Julian Künzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Regensburg, 93053 Regensburg, Germany
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Tan W, Mao M, He H, Chen M, Deng Q, Yang Y, Li Y, Sheng H, He L, Li J. Endonasopharyngeal ultrasound and magnetic resonance imaging features of recurrent retropharyngeal nodes in nasopharyngeal carcinoma patients: A radiologic-histopathologic study. Radiother Oncol 2023; 183:109579. [PMID: 36842662 DOI: 10.1016/j.radonc.2023.109579] [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: 07/04/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND The imaging criteria of malignant retropharyngeal lymph node (RLN) in nasopharyngeal cancer (NPC) have yet to be fully elucidated. This study aimed to establish predictive models based on ultrasound (US) and magnetic resonance (MR) characteristics for identifying malignant RLN in NPC patients after radiotherapy. METHODS 81 post-radiotherapy NPC patients with abnormal enlargement of RLN underwent endonasopharyngeal ultrasound-guided fine-needle aspirations (EPUS-FNA) to access the nature of RLN. The following features were assessed on US and MR: size, margin, vascular signal, echogenicity, enhancement signal and accompany with suspicious cervical nodes or not. A multivariate analysis was performed to screen out high-risk imaging features for recurrent RLN (RRLN), and models for the diagnosis of RRLN was constructed and tested with internal verification. We evaluated the clinical usefulness of the models through comparison of C-index and decision curve analysis. RESULTS High-risk features of RRLN were heterogeneous echo (p < 0.01), vascular signal (p < 0.01) on EPUS, heterogeneous enhancement (p < 0.01) and minimum axis diameter > 10 mm (p < 0.01) on MR. The models based on the US and MR features showed good discrimination (AUC of 0.76 in the US model, 0.74 in the MR model and 0.77 in the US + MR model) and good net benefit in the validation group. CONCLUSION Prediction models based on the US and MR features show good diagnostic performance for RRLN after radiotherapy in NPC patients. The combination of EPUS and MR may be constructed to provide prompt and reliable guidance to manage RLN.
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Affiliation(s)
- Wencheng Tan
- Department of Endoscopy, Sun Yat-Sen University Cancer Center, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong, China
| | - Minjie Mao
- Department of Laboratory Medicine, Sun Yat-Sen University Cancer Center, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong, China
| | - Haoqiang He
- Department of Medical imaging, Sun Yat-Sen University Cancer Center, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong, China
| | - Mingshi Chen
- Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong, China
| | - Qiwen Deng
- Department of Anesthesiology, the First Affiliated Hospital, Sun Yet-sen University, Guangzhou 510080, China
| | - Youzhuo Yang
- Department of Endoscopy, Sun Yat-Sen University Cancer Center, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong, China
| | - Yin Li
- Department of Endoscopy, Sun Yat-Sen University Cancer Center, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong, China
| | - Hui Sheng
- Department of Experimental Research, Sun Yat-Sen University Cancer Center, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong, China.
| | - Longjun He
- Department of Endoscopy, Sun Yat-Sen University Cancer Center, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong, China.
| | - Jianjun Li
- Department of Endoscopy, Sun Yat-Sen University Cancer Center, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou 510060, Guangdong, China.
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Cheng PC, Chang CM, Liao LJ, Hsieh CH, Shueng PW, Cheng PW, Lo WC. Ultrasound examination supporting CT or MRI in the evaluation of cervical lymphadenopathy in patients with irradiation-treated head and neck cancer. Open Med (Wars) 2023; 18:20230682. [PMID: 37069937 PMCID: PMC10105548 DOI: 10.1515/med-2023-0682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 02/11/2023] [Accepted: 03/01/2023] [Indexed: 04/19/2023] Open
Abstract
In this study, we determined the diagnostic performance of adding ultrasound (US) with/without fine-needle aspiration cytology (FNAC) to computed tomography (CT)/magnetic resonance imaging (MRI) in evaluating neck lymphadenopathy (LAP) in patients with head and neck cancer treated with irradiation. We included 269 patients who had neck LAP after radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) resulting from cancers of the head and neck region between October 2008 and September 2018. The diagnostic methods consisted of the following: 1) CT/MRI alone, 2) CT/MRI combined with a post-RT US predictive model, and 3) CT/MRI combined with US + FNAC. We compared their diagnostic performance using receiver operating characteristic (ROC) curves. In total, 141 (52%) malignant and 128 (48%) benign LAPs were observed. Regarding the diagnostic accuracy, the area under the ROC curves was highest for the combined CT/MRI and US + FNAC (0.965), followed by the combined CT/MRI and post-RT US predictive model (0.906) and CT/MRI alone (0.836). Our data suggest that the addition of a US examination to CT/MRI resulted in higher diagnostic performance than CT/MRI alone in terms of diagnosing recurrent or persistent nodal disease during the evaluation of LAP in patients with irradiation-treated head and neck cancer.
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Affiliation(s)
- Ping-Chia Cheng
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan (R.O.C.)
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C.)
- Department of Communication Engineering, Asia Eastern University of Science and Technology, New Taipei City, Taiwan (R.O.C.)
| | - Chih-Ming Chang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan (R.O.C.)
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan (R.O.C.)
| | - Li-Jen Liao
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan (R.O.C.)
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C.)
- Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan (R.O.C.)
- Medical Engineering Office, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C.)
| | - Chen-Hsi Hsieh
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan (R.O.C.)
| | - Pei-Wei Shueng
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan (R.O.C.)
| | - Po-Wen Cheng
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C.)
| | - Wu-Chia Lo
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan (R.O.C.)
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan, Taiwan (R.O.C.)
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banqiao Dist., New Taipei City 220, Taiwan (R.O.C.)
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Lo WC, Chang CM, Cheng PC, Wen MH, Wang CT, Cheng PW, Liao LJ. The Applications and Potential Developments of Ultrasound in Oral Cancer Management. Technol Cancer Res Treat 2022; 21:15330338221133216. [PMID: 36254559 PMCID: PMC9580086 DOI: 10.1177/15330338221133216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Oral cancer is endemic and causes a great burden in Southern Asia. It is preferably treated by surgery with/without adjuvant radiotherapy (RT) or chemoradiation therapy, depending on the stage of the disease. Close or positive resection margin and cervical lymph node (LN) metastasis are important prognostic factors that have been presented to be related to undesirable locoregional recurrence and poor survival. Ultrasound (US) is a simple, noninvasive, time-saving, and inexpensive diagnostic modality. It can depict soft tissues very clearly without the risk of radiation exposure. Additionally, it is real-time and continuous image is demonstrated during the exam. Furthermore, the clinician can perform US-guided fine needle aspiration (FNA) or core needle biopsy (CNB) at the same time. US with/without US-guided FNA/CNB is reported to be of value in determining tumor thickness (TT), depth of invasion (DOI), and cervical LN metastasis, and in aiding the staging of oral cancer. DOI has a relevant prognostic value as reported in the eighth edition of the American Joint Committee on Cancer staging of oral cancer. In the present review, we describe the clinical applications of US in oral cancer management in different phases and potential applications in the future. In the pretreatment and surgical phase, US can be used to evaluate TT/DOI and surgical margins of oral cancer in vivo and ex vivo. The prediction of a malignant cervical LN (nodal metastasis) by the US-based prediction model can guide the necessity of FNA/CNB and elective neck dissection in clinical early-stage oral cancer. In the posttreatment surveillance phase, US with/without US-guided FNA or CNB is helpful in the detection of nodal persistence or LN recurrence, and can assess the possibility and extent of carotid artery stenosis after irradiation therapy. Both US elastography and US swallowing assessment are potentially helpful to the management of oral cancer.
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Affiliation(s)
- Wu-Chia Lo
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei,Graduate Institute of Medicine, Yuan Ze University, Taoyuan,Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City
| | - Chih-Ming Chang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei,Department of Biomedical Engineering, National Yang-Ming University, Taipei
| | - Ping-Chia Cheng
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei,Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City,Department of Biomedical Engineering, National Yang-Ming University, Taipei,Department of Communication Engineering, Asia Eastern University of Science and Technology, New Taipei City
| | - Ming-Hsun Wen
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei
| | - Chi-Te Wang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei,Department of Electrical Engineering, Yuan Ze University, Taoyuan
| | - Po-Wen Cheng
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei
| | - Li-Jen Liao
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei,Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City,Department of Electrical Engineering, Yuan Ze University, Taoyuan,Li-Jen Liao, MD, PhD, Department of Otolaryngology, Far Eastern Memorial Hospital, 21, Section 2, Nan-Ya South Road, Banqiao, New Taipei 22061.
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Lo TH, Wang CP, Chen CN, Yang TL, Lou PJ, Ko JY, Chang YL, Chen TC. Diagnostic performance of core needle biopsy for nodal recurrences in patients with head and neck squamous cell carcinoma. Sci Rep 2022; 12:2048. [PMID: 35132145 PMCID: PMC8821564 DOI: 10.1038/s41598-022-06102-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/24/2022] [Indexed: 11/25/2022] Open
Abstract
This study investigated the diagnostic accuracy and affecting factors of ultrasound (US)-guided core-needle biopsy (CNB) in patients with treated head and neck squamous cell carcinoma (HNSCC). We retrospectively reviewed patients with treated HNSCC who received US-guided CNB from January 2011 to December 2018 with corresponding imaging. Pathological necrosis and fibrosis of targeted lymph nodes (LNs) were evaluated. We analyzed the correlation between CNB accuracy and clinical and pathological characteristics. In total, 260 patients were included. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of CNB for nodal recurrence were 84.47%, 100%, 100%, 54.67%, and 86.92%, respectively. CNB of fibrotic LNs had significantly worse sensitivity, NPV, and accuracy than that of non-fibrotic LNs. Similarly, CNB of necrotic LNs had significantly worse sensitivity, NPV, and accuracy than non-necrotic LNs. Multivariate regression revealed that fibrotic LN was the only independent factor for a true positive rate, whereas both necrotic LN and fibrotic LN were independent factors for a false negative rate. The diagnostic accuracy of CNB in treated HNSCC patients is affected by LN necrosis and fibrosis. Therefore, CNB results, particularly for necrotic or fibrotic LNs, should be interpreted carefully.
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7
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Wagner JM, Monfore N, McCullough AJ, Zhao L, Conrad RD, Krempl GA, Alleman AM. Ultrasound-Guided Fine-Needle Aspiration With Optional Core Needle Biopsy of Head and Neck Lymph Nodes and Masses: Comparison of Diagnostic Performance in Treated Squamous Cell Cancer Versus All Other Lesions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2275-2284. [PMID: 30593702 DOI: 10.1002/jum.14918] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/01/2018] [Accepted: 10/29/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate the diagnostic performance of ultrasound (US)-guided fine-needle aspiration with optional core needle biopsy of head and neck lymph nodes and masses, with attention to differences between biopsy of treated squamous cell carcinoma (SCC) and biopsy of other lesions. METHODS Institutional Review Board approval was obtained, and the need for consent was waived for this retrospective study. All 861 US-guided biopsies of head and neck lymph nodes and masses performed between March 1, 2012, and May 16, 2016, were reviewed. RESULTS Of the 861 biopsies, 53 targeted SCC with residual masses after treatment. The biopsy procedures yielded benign or malignant pathologic results in 71.7% (38 of 53) of treated SCC and 90.7% (733 of 808) of all other lesions (P < .001). A reference standard based on subsequent pathologic results or clinical and imaging follow-up was established in 68.4% of procedures. In cases with benign or malignant biopsy results and a subsequent reference standard, the sensitivity values for malignancy were 87.5% (95% confidence interval, 64.0%-96.5%) in treated SCC and 98.3% (95% confidence interval, 96.0%-99.3%) in all other cases (P = .047), and the specificity values were 63.6% (95% confidence interval, 35.4%-84.8%) in treated SCC and 99.5% (95% confidence interval, 97.3%-99.9%) in all other cases (P < .001). There were no major complications related to the biopsy procedures. CONCLUSIONS Excluding treated SCC, US-guided fine-needle aspiration with optional core needle biopsy of head and neck lymph nodes and masses has excellent diagnostic performance. Needle biopsy of head and neck SCC with a residual mass after therapy has a high rate of nondiagnostic samples, suboptimal sensitivity, and poor specificity.
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Affiliation(s)
- Jason M Wagner
- Departments of Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Natosha Monfore
- Departments of Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Austin J McCullough
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Lichao Zhao
- Departments of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Dr Zhao is now affiliated with Pathology and Laboratory Medicine Services, Central Texas Veterans Health Care System, Temple, Texas, USA
| | - Rachel D Conrad
- Departments of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Greg A Krempl
- Departments of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Anthony M Alleman
- Departments of Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Kotowski U, Brkic FF, Koperek O, Nemec SF, Perisanidis C, Altorjai G, Grasl MC, Erovic BM. Accuracy of fine‐needle aspiration cytology in suspicious neck nodes after radiotherapy: Retrospective analysis of 100 patients. Clin Otolaryngol 2019; 44:384-388. [DOI: 10.1111/coa.13271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/29/2018] [Accepted: 12/05/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Ulana Kotowski
- Department of Otolaryngology, Head and Neck Surgery Medical University of Vienna Vienna Austria
| | - Faris F. Brkic
- Department of Otolaryngology, Head and Neck Surgery Medical University of Vienna Vienna Austria
| | - Oskar Koperek
- Department of Clinical Pathology Medical University of Vienna Vienna Austria
| | - Stefan F. Nemec
- Department of Biomedical Imaging and Image‐guided therapy Medical University of Vienna Vienna Austria
| | - Christos Perisanidis
- Department of Maxillofacial Surgery and Medical University of Vienna Vienna Austria
| | - Gabriela Altorjai
- Department of Radiation Oncology Medical University of Vienna Vienna Austria
| | - Matthaeus Ch. Grasl
- Department of Otolaryngology, Head and Neck Surgery Medical University of Vienna Vienna Austria
| | - Boban M. Erovic
- Institute of Head and Neck Diseases Evangelical Hospital Vienna Vienna Austria
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Lo WC, Cheng PW, Shueng PW, Hsieh CH, Chang YL, Liao LJ. A real-time prediction model for post-irradiation malignant cervical lymph nodes. Clin Otolaryngol 2017; 43:477-482. [PMID: 28981204 DOI: 10.1111/coa.12998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To establish a real-time predictive scoring model based on sonographic characteristics for identifying malignant cervical lymph nodes (LNs) in cancer patients after neck irradiation. METHODS One-hundred forty-four irradiation-treated patients underwent ultrasonography and ultrasound-guided fine-needle aspirations (USgFNAs), and the resultant data were used to construct a real-time and computerised predictive scoring model. This scoring system was further compared with our previously proposed prediction model. RESULTS A predictive scoring model, 1.35 × (L axis) + 2.03 × (S axis) + 2.27 × (margin) + 1.48 × (echogenic hilum) + 3.7, was generated by stepwise multivariate logistic regression analysis. Neck LNs were considered to be malignant when the score was ≥ 7, corresponding to a sensitivity of 85.5%, specificity of 79.4%, positive predictive value (PPV) of 82.3%, negative predictive value (NPV) of 83.1%, and overall accuracy of 82.6%. When this new model and the original model were compared, the areas under the receiver operating characteristic curve (c-statistic) were 0.89 and 0.81, respectively (P < .05). CONCLUSIONS A real-time sonographic predictive scoring model was constructed to provide prompt and reliable guidance for USgFNA biopsies to manage cervical LNs after neck irradiation.
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Affiliation(s)
- W-C Lo
- Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - P-W Cheng
- Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - P-W Shueng
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan.,Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - C-H Hsieh
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan.,Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Y-L Chang
- Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - L-J Liao
- Department of Otolaryngology, Far Eastern Memorial Hospital, Taipei, Taiwan
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The application of ultrasound in detecting lymph nodal recurrence in the treated neck of head and neck cancer patients. Sci Rep 2017. [PMID: 28638103 PMCID: PMC5479791 DOI: 10.1038/s41598-017-04039-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Early detection of neck lymph node (LN) recurrence is paramount in improving the prognosis of treated head and neck cancer patients. Ultrasound (US) with US-guided fine needle aspiration (FNA) and core needle biopsy (CNB) have been shown to have great accuracy for LN diagnoses in the untreated neck. However, in the treated neck with fibrosis, their roles are not clarified. Here, we retrospectively review 153 treated head and neck cancer patients who had received US and US-guided FNA/CNB. In multivariate logistic regression analyses, size (short-axis diameter >0.8 cm) (odds ratio (OR) 4.19, P = 0.007), round shape (short/long axis ratio >0.5) (OR 3.44, P = 0.03), heterogeneous internal echo (OR 3.92, P = 0.009) and irregular margin (OR 7.32, P < 0.001) are effective US features in predicting recurrent LNs in the treated neck. However, hypoechogenicity (OR 2.38, P = 0.289) and chaotic/absent vascular pattern (OR 3.04, P = 0.33) are ineffective. US-guided FNA (sensitivity/specificity: 95.24%/97.92%) is effective in the treated neck, though with high non-diagnostic rate (29.69%). US-guided CNB (sensitivity/specificity: 84.62%/100%) is also effective, though with low negative predictive value (62.5%). Overall, US with US-guided FNA/CNB are still effective diagnostic tools for neck nodal recurrence surveillance.
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Pałasz P, Adamski Ł, Górska-Chrząstek M, Starzyńska A, Studniarek M. Contemporary Diagnostic Imaging of Oral Squamous Cell Carcinoma - A Review of Literature. Pol J Radiol 2017; 82:193-202. [PMID: 28439324 PMCID: PMC5391802 DOI: 10.12659/pjr.900892] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 08/10/2016] [Indexed: 01/18/2023] Open
Abstract
Oral squamous cell carcinoma (OSCC) is the most common cancer of the oral cavity and constitutes 95% of all cancers of this area. Men are affected twice as commonly as women, primarily if they are over 50 years of age. Forty percent of the lesions are localized in the tongue and 30% in the floor of the oral cavity. OSCC often affects upper and lower gingiva, buccal mucous membrane, the retromolar triangle and the palate. The prognosis is poor and the five-year survival rate ranges from 20% (OSCC in the floor of the mouth) to 60% (OSCC in the alveolar part of the mandible). Treatment is difficult, because of the localization and the invasiveness of the available methods. The diagnosis is made based on a histopathological examination of a biopsy sample. The low detection rate of early oral SCC is a considerable clinical issue. Although the oral cavity can be easily examined, in the majority of cases oral SCC is diagnosed in its late stages. It is difficult to diagnose metastases in local lymph nodes and distant organs, which is important for planning the scope of resection and further treatment, graft implantation, and differentiation between reactive and metastatic lymph nodes as well as between disease recurrence and scars or adverse reactions after surgery or radiation therapy. Imaging studies are performed as part of the routine work-up in oral SCC. However, it is difficult to interpret the results at the early stages of the disease. The following imaging methods are used – dental radiographs, panoramic radiographs, magnetic resonance imaging with diffusion-weighted and dynamic sequences, perfusion computed tomography, cone beam computed tomography, single-photon emission computed tomography, hybrid methods (PET/CT, PET/MRI, SPECT/CT) and ultrasound. Some important clinical problems can be resolved with the use of novel modalities such as MRI with ADC sequences and PET. The aim of this article is to describe oral squamous cell carcinoma as it appears in different imaging methods considering both their advantages and limitations.
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Affiliation(s)
- Paulina Pałasz
- Department of Stomatology, Medical University of Gdańsk, Gdańsk, Poland.,Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Łukasz Adamski
- Department of Stomatology, Medical University of Gdańsk, Gdańsk, Poland.,Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Anna Starzyńska
- Department of Maxillofacial and Oral Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Michał Studniarek
- Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland.,Department of Diagnostic Imaging, Medical University of Warsaw, Warsaw, Poland
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