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Durrant FG, Gutierrez JA, Nguyen SA, Nathan CAO, Newman JG. Sexual history of patients with human papillomavirus positive and negative oropharyngeal cancer: A systematic review and meta-analysis. Head Neck 2024. [PMID: 38477218 DOI: 10.1002/hed.27733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 02/25/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Increased sexual activity is associated with higher human papillomavirus (HPV) rates; however, there is a lack of analysis comparing the sexual history of patients with HPV positive and HPV negative oropharyngeal cancer (OPC). METHODS In this meta-analysis, PubMed, Scopus, and CINAHL were searched for articles that included patients with OPC and reported information regarding HPV status and either history of oral sex, number of sexual partners, or sexually transmitted infections (STI). RESULTS A total of 11 studies were included with 3296 patients with OPC. Patients with HPV positive OPC were more likely than patients with HPV negative OPC to report a history of oral sex (92%, 95% CI: 87.0-97.0 vs. 74.5%, 95% CI: 50.6-98.4, p < 0.0001), higher mean number of sexual partners (18.4 partners, 95% CI: 1.5-35.4 vs. 7.2 partners, 95% CI: 1.0-13.4, p < 0.0001), and more frequent history of STI (23.7%, 95% CI: 18.4-29.0 vs. 8.8%, 95% CI: 4.7-12.8, p = 0.0001). CONCLUSIONS Compared to patients with HPV negative OPC, our analysis shows a larger proportion of patients with HPV positive OPC had participated in oral sex, had a higher number of sexual partners, and had a higher proportion of STI history.
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Affiliation(s)
- Frederick G Durrant
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jorge A Gutierrez
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cherie-Ann O Nathan
- Department of Otolaryngology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Jason G Newman
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Garset-Zamani M, Norling R, Hahn CH, Agander TK, von Buchwald C, Todsen T. Transoral Ultrasound in the Outpatient Clinic for the Diagnostic Work-Up of Oropharyngeal Cancer: A Feasibility Study. Cancers (Basel) 2023; 15:5292. [PMID: 37958465 PMCID: PMC10649062 DOI: 10.3390/cancers15215292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
Magnetic resonance imaging (MRI) is the preferred imaging modality for oropharyngeal cancers (OPCs), but it has difficulties distinguishing between small OPCs and unilateral tonsil hypertrophy. We hypothesized that surgeon-performed transoral ultrasound (US) could be used to accurately detect T-stage OPCs. We performed a single-center prospective diagnostic accuracy study including patients with suspected or biopsy-verified OPCs during outpatient appointments. All patients were offered transoral US and MRI. If transoral US could not be tolerated by the patient, transcervical US was performed. The primary outcome was the diagnostic accuracy of detecting OPCs with US compared to MRI, using histopathology as the reference standard. The secondary outcome was comparing the primary tumor diameters between US and MRI blinded to each other. Out of the 26 patients included in the study, 21 (81%) had OPCs. Transoral US could be performed in 21/21 and 1/5 patients with suspected palatine and lingual tonsil OPCs, respectively. Overall, US diagnostic accuracy was 92%, compared to 81% with MRI (p = 0.37). US and MRI had a high correlation between tumor diameters in the anteroposterior diameter (R = 0.80, p < 0.001), corresponding to the depth axis on US. In conclusion, this small study showed the promise and feasibility of transoral US to improve the initial clinical evaluations of patients with suspected OPCs.
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Affiliation(s)
- Martin Garset-Zamani
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen, Denmark
| | - Rikke Norling
- Department of Radiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Christoffer Holst Hahn
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen, Denmark
| | - Tina Klitmøller Agander
- Department of Pathology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen, Denmark
| | - Tobias Todsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, 2100 Copenhagen, Denmark
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Bicci E, Calamandrei L, Mungai F, Granata V, Fusco R, De Muzio F, Bonasera L, Miele V. Imaging of human papilloma virus (HPV) related oropharynx tumour: what we know to date. Infect Agent Cancer 2023; 18:58. [PMID: 37814320 PMCID: PMC10563217 DOI: 10.1186/s13027-023-00530-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/11/2023] [Indexed: 10/11/2023] Open
Abstract
The tumours of head and neck district are around 3% of all malignancies and squamous cell carcinoma is the most frequent histotype, with rapid increase during the last two decades because of the increment of the infection due to human papilloma virus (HPV). Even if the gold standard for the diagnosis is histological examination, including the detection of viral DNA and transcription products, imaging plays a fundamental role in the detection and staging of HPV + tumours, in order to assess the primary tumour, to establish the extent of disease and for follow-up. The main diagnostic tools are Computed Tomography (CT), Positron Emission Tomography-Computed Tomography (PET-CT) and Magnetic Resonance Imaging (MRI), but also Ultrasound (US) and the use of innovative techniques such as Radiomics have an important role. Aim of our review is to illustrate the main imaging features of HPV + tumours of the oropharynx, in US, CT and MRI imaging. In particular, we will outline the main limitations and strengths of the various imaging techniques, the main uses in the diagnosis, staging and follow-up of disease and the fundamental differential diagnoses of this type of tumour. Finally, we will focus on the innovative technique of texture analysis, which is increasingly gaining importance as a diagnostic tool in aid of the radiologist.
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Affiliation(s)
- Eleonora Bicci
- Department of Radiology, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Florence, 50134, Italy.
| | - Leonardo Calamandrei
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Florence, 50134, Italy
| | - Francesco Mungai
- Department of Radiology, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Florence, 50134, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Naples, 80131, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, Naples, 80013, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, 20122, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, Campobasso, 86100, Italy
| | - Luigi Bonasera
- Department of Radiology, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Florence, 50134, Italy
| | - Vittorio Miele
- Department of Radiology, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Florence, 50134, Italy
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Tofanelli M, Rigo S, Polesel J, Zanconati F, Bonazza D, Vito Marcuzzo A, Gardenal N, Boscolo-Rizzo P, Tirelli G. Accuracy of fine-needle aspiration and frozen section for the detection of squamous metastasis in cystic masses of the lateral neck. Br J Oral Maxillofac Surg 2022; 60:1261-1265. [DOI: 10.1016/j.bjoms.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/07/2022] [Accepted: 07/22/2022] [Indexed: 10/16/2022]
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Schuman A, Anderson KS, Day AT, Ferrell J, Sturgis EM, Dahlstrom KR. Is 2045 the best we can do? Mitigating the HPV-related oropharyngeal cancer epidemic. Expert Rev Anticancer Ther 2022; 22:751-761. [PMID: 35679626 DOI: 10.1080/14737140.2022.2088514] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Oropharyngeal cancer (OPC) will be among the most common cancers in men by 2045 due to a rapid rise in human papillomavirus (HPV)-related OPC. Those who survive their cancer often suffer life-long treatment effects and early death. HPV vaccination could prevent virtually all HPV-related cancers but is not an effective preventive strategy for those already exposed. Without a dramatic increase in vaccine uptake in the U.S., HPV vaccination will have a negligible effect on OPC incidence through 2045 and no substantial impact until 2060. Additionally, targeted screening for earlier diagnosis may soon be feasible for those inadequately protected by vaccination. AREAS COVERED PubMed search for English-language articles related to incidence, screening, and prevention of HPV-related malignancies, focused on OPC in the U.S. EXPERT OPINION HPV-related OPC incidence will continue to increase for the foreseeable future with prophylactic vaccination offering no substantial public health impact for decades. Consequently, we must rapidly increase vaccination rates and develop screening methods to identify high-risk individuals. Such individuals would be eligible for potential preventive treatments and screening to diagnose early-stage HPV-related OPC allowing less morbid treatments. These methods will bridge the population into an era of decreasing incidence after vaccination takes effect.
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Affiliation(s)
- Ari Schuman
- Department of Otolaryngology, Baylor College of Medicine, Houston, TX, USA
| | - Karen S Anderson
- Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ, USA
| | - Andrew T Day
- and Neck Surgery, University of Texas Southwestern Medical CenterDepartment of Otolaryngology-Head, Dallas, TX, USA
| | - Jay Ferrell
- and Neck Surgery, University of Texas Health Science CenterDepartment of Otolaryngology-Head, San Antonio, TX, USA
| | - Erich M Sturgis
- Department of Otolaryngology, Baylor College of Medicine, Houston, TX, USA
| | - Kristina R Dahlstrom
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Romano A, Di Stasio D, Petruzzi M, Fiori F, Lajolo C, Santarelli A, Lucchese A, Serpico R, Contaldo M. Noninvasive Imaging Methods to Improve the Diagnosis of Oral Carcinoma and Its Precursors: State of the Art and Proposal of a Three-Step Diagnostic Process. Cancers (Basel) 2021; 13:cancers13122864. [PMID: 34201237 PMCID: PMC8228647 DOI: 10.3390/cancers13122864] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Oral squamous cell carcinoma (OSCC) accounts for 90–95% of malignant tumors of the lip and oral cavity and is associated with high mortality in the advanced stages. Early diagnosis is a challenge for oral pathologists and dentists, due to the ambiguous appearance of early OSCC, which is often misdiagnosed, mistreated, and associated with diagnostic delay. The gold standards for OSCC diagnosis are biopsy and histopathological assessment, but these procedures are invasive and time-consuming. Adjunctive noninvasive techniques allow the definition of the malignant features of a suspicious lesion in real time and noninvasively, thus improving the diagnostic procedure. The present review aimed to focus on some of the main promising noninvasive imaging techniques, to highlight their perspective adoption in a three-step diagnosis, which is idealistically faster and better, as well as enables the patient’s compliance. Abstract Oral squamous cell carcinoma (OSCC) is the most prevalent form of cancer of lips and oral cavity, and its diagnostic delay, caused by misdiagnosis at the early stages, is responsible for high mortality ratios. Biopsy and histopathological assessment are the gold standards for OSCC diagnosis, but they are time-consuming, invasive, and do not always enable the patient’s compliance, mainly in cases of follow-up with the need for more biopsies. The use of adjunctive noninvasive imaging techniques improves the diagnostic approach, making it faster and better accepted by patients. The present review aims to focus on the most consolidated diagnostic techniques, such as vital staining and tissue autofluorescence, and to report the potential role of some of the most promising innovative techniques, such as narrow-band imaging, high-frequency ultrasounds, optical coherence tomography, and in vivo confocal microscopy. According to their contribution to OSCC diagnosis, an ideal three-step diagnostic procedure is proposed, to make the diagnostic path faster, better, and more accurate.
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Affiliation(s)
- Antonio Romano
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Via Luigi de Crecchio, 6, 80138 Naples, Italy; (A.R.); (D.D.S.); (F.F.); (A.L.); (R.S.)
| | - Dario Di Stasio
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Via Luigi de Crecchio, 6, 80138 Naples, Italy; (A.R.); (D.D.S.); (F.F.); (A.L.); (R.S.)
| | - Massimo Petruzzi
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Fausto Fiori
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Via Luigi de Crecchio, 6, 80138 Naples, Italy; (A.R.); (D.D.S.); (F.F.); (A.L.); (R.S.)
| | - Carlo Lajolo
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli–IRCCS, School of Dentistry, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, Italy;
| | - Andrea Santarelli
- Department of Clinical Specialist and Dental Sciences, Marche Polytechnic University, Via Tronto 10, 60126 Ancona, Italy;
| | - Alberta Lucchese
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Via Luigi de Crecchio, 6, 80138 Naples, Italy; (A.R.); (D.D.S.); (F.F.); (A.L.); (R.S.)
| | - Rosario Serpico
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Via Luigi de Crecchio, 6, 80138 Naples, Italy; (A.R.); (D.D.S.); (F.F.); (A.L.); (R.S.)
| | - Maria Contaldo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Via Luigi de Crecchio, 6, 80138 Naples, Italy; (A.R.); (D.D.S.); (F.F.); (A.L.); (R.S.)
- Correspondence: ; Tel.: +39-3204876058
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Künzel J, Bozzato A, Arens C. [Sonography of the head and neck area - Part 1: Endosonography]. Laryngorhinootologie 2021; 100:483-98. [PMID: 34062579 DOI: 10.1055/a-1353-7859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Sonography of the head and neck area plays a major role in both outpatient and inpatient ear, nose and throat medicine. Transcervical ultrasound is an important imaging method, especially in lymph node and tumor diagnostics. Its advantage is the ubiquitous availability and the excellent combinability with endoscopy and palpation. Despite decades of experience with sonography in the head and neck area, in contrast to the transcutaneous application, the transoral or endosonographic approach has so far not been widely used. Here it is often not due to the technical capabilities of the examiner, but rather to the unusual approach within the scope of the investigation. In this context, endosonography may be used primarily in tumor diagnostics in order to establish a complete sonographic examination from in- and outside.
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Ye W, Arnaud EH, Langerman A, Mannion K, Topf MC. Diagnostic approaches to carcinoma of unknown primary of the head and neck. Eur J Cancer Care (Engl) 2021; 30:e13459. [PMID: 33932056 DOI: 10.1111/ecc.13459] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 11/27/2022]
Abstract
Squamous cell carcinoma in cervical lymph nodes arising from an undetected primary tumour, termed carcinoma of unknown primary (SCCUP), is a well-recognized clinical presentation within head and neck oncology. SCCUP is a common presentation for patients with human papillomavirus-mediated oropharyngeal cancer (HPV + OPSCC), as patients with HPV + OPSCC often present with smaller primary tumours and early nodal metastasis. Meticulous work-up of the SCCUP patient is central to the management of these patients as identification of the primary site improves overall survival and allows for definitive oncologic resection or more focused radiation when indicated. This review summarizes the comprehensive diagnostic approach to the SCCUP patient, including history and physical examination, methods of biopsy of the cervical lymph node, imaging modalities and intraoperative methods to localize the unknown primary. Novel techniques such as transcervical ultrasound of the oropharynx, narrow band imaging and diagnostic transoral robotic surgery are also discussed.
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Affiliation(s)
- Wenda Ye
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ethan H Arnaud
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alexander Langerman
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kyle Mannion
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael C Topf
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Pandya K, Pradeep S, Jayakumar NK, Vidhyadharan S, Hedne N. Feasibility of Use of the 8 th Edition of the American Joint Committee on Cancer Staging for Head and Neck Cancers in Indian Scenario: An Evaluative Study. Ann Maxillofac Surg 2021; 11:27-31. [PMID: 34522650 PMCID: PMC8407616 DOI: 10.4103/ams.ams_125_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 01/21/2021] [Accepted: 02/03/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Inclusion of depth of invasion (DOI) and a separate classification for human papillomavirus (HPV)-associated Oropharyngeal Cancers (OPCs) are two of the many major changes in the 8th edition of the American Joint Committee on Cancer staging system. After more than 2 years of implementation, the authors found the need to evaluate if the Indian clinicians found it feasible to apply the system in their practice and if the same has influenced their decision-making. METHODS The survey was done in the form of a questionnaire which was distributed personally and via the internet to 100 clinicians. Seventy-two clinicians responded to the questionnaire. The results were analyzed and frequency distribution was computed. RESULTS Eighty-three percent of the clinicians experienced that palpation of the tumour was not a reliable method to determine the DOI. The common issues stated by the clinicians were difficulty in assessing DOI in certain subsites of the oral cavity (most commonly retromolar trigone-83%), inability to determine DOI in patients with trismus, and inability to correlate pathological and clinical DOI. Thirteen percent of the clinicians did not rely on radiological tools for measuring the DOI. Seventy percent of the clinicians did not perform a P16 assay for patients with oropharyngeal cancers. Fifty percent of the clinicians preferred chemoradiotherapy for early HPV positive oropharyngeal cancers. DISCUSSION Based on the results of the survey, the authors recommend a need for more interpretative guidelines and methods for determining the DOI. The authors also emphasize the need for determining HPV status for all oropharyngeal carcinomas.
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Affiliation(s)
- Kalpa Pandya
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sivakumar Pradeep
- Department of Head and Neck Surgical Oncology, Apollo Proton Cancer Center, Chennai, Tamil Nadu, India
| | - Naveen Kumar Jayakumar
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sivakumar Vidhyadharan
- Department of Head and Neck Surgical Oncology, Apollo Proton Cancer Center, Chennai, Tamil Nadu, India
| | - Naveen Hedne
- Department of Head and Neck Surgical Oncology, Apollo Proton Cancer Center, Chennai, Tamil Nadu, India
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Abstract
Unknown primary squamous cell carcinoma metastatic to cervical lymph nodes is a relatively rare tumor presentation, although the incidence may be increasing along with the rising incidence of human papilloma virus-mediated oropharyngeal cancers. Traditional diagnostic methods with palatine tonsillectomy and panendoscopy may identify the minority of primary tumors. The addition of a transoral lingual tonsillectomy may improve the diagnostic yield of identifying a primary tumor. Incorporation of transoral robotic surgery may be used for diagnostic purposes to identify a primary site and also for therapeutic purposes, whereby a primary tumor may be completely resected and combined with a neck dissection.
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Affiliation(s)
- John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto General Hospital, 200 Elizabeth Street, 8NU-883, Toronto, Ontario, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto General Hospital, 200 Elizabeth Street, 8NU-883, Toronto, Ontario, Canada.
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Aulino JM, Kirsch CFE, Burns J, Busse PM, Chakraborty S, Choudhri AF, Conley DB, Jones CU, Lee RK, Luttrull MD, Moritani T, Policeni B, Ryan ME, Shah LM, Sharma A, Shih RY, Subramaniam RM, Symko SC, Bykowski J. ACR Appropriateness Criteria ® Neck Mass-Adenopathy. J Am Coll Radiol 2020; 16:S150-S160. [PMID: 31054741 DOI: 10.1016/j.jacr.2019.02.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 11/26/2022]
Abstract
A palpable neck mass may be the result of neoplastic, congenital, or inflammatory disease. Older age suggests neoplasia, and a congenital etiology is more prevalent in the pediatric population. The imaging approach is based on the patient age, mass location, and clinical pulsatility. Underlying human papillomavirus-related malignancy should be considered in all age groups. Although the imaging appearance of some processes in the head and neck overlap, choosing the appropriate imaging examination may allow a specific diagnosis, or a limited differential diagnosis. Tissue sampling is indicated to confirm suspected malignancy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Claudia F E Kirsch
- Panel Chair, Northwell Health, Zucker Hofstra School of Medicine at Northwell, Manhasset, New York
| | | | - Paul M Busse
- Massachusetts General Hospital, Boston, Massachusetts
| | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada, Canadian Association of Radiologists
| | - Asim F Choudhri
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - David B Conley
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, American Academy of Otolaryngology-Head and Neck Surgery
| | | | - Ryan K Lee
- Einstein Healthcare Network, Philadelphia, Pennsylvania
| | | | | | - Bruno Policeni
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Maura E Ryan
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Aseem Sharma
- Mallinckrodt Institute of Radiology, Saint Louis, Missouri
| | - Robert Y Shih
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | - Julie Bykowski
- Specialty Chair, UC San Diego Health Center, San Diego, California
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Day AT, Fakhry C, Tiro JA, Dahlstrom KR, Sturgis EM. Considerations in Human Papillomavirus-Associated Oropharyngeal Cancer Screening: A Review. JAMA Otolaryngol Head Neck Surg 2020; 146:656-664. [PMID: 32379293 DOI: 10.1001/jamaoto.2019.4811] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The incidence of human papillomavirus (HPV)-positive oropharyngeal cancer (OPC) is anticipated to rise over the next few decades until the effects of prophylactic vaccination are realized, which highlights the potential importance of secondary prevention. The objective of this review is to evaluate the evidence associated with screening for HPV-positive OPC. Observations Evaluation of a potential clinical preventive screening service requires characterization of the disease burden, the at-risk target screening population, screening tests, treatment, and screening benefits and harms. The lifetime risk of OPC is 0.7% for men and 0.2% for women and is expected to increase. The disease burden of HPV-positive OPC is substantial; most patients undergo morbid multimodality treatment and incur high costs in the process. Middle-aged and older adult men with elevated number of lifetime vaginal or oral sex partners are at highest risk. Patients may benefit from early detection of the disease-the 4-year overall survival of patients with stage I HPV-positive OPC is 87%, a considerable portion of whom are eligible for less morbid single-modality therapy. However, available screening tests are insufficiently sensitive and specific considering the current HPV-positive OPC incidence rates in the most at-risk patients. Further, the benefits and harms of screening for HPV-positive OPC are unknown. Conclusions and Relevance The current and projected future population-level burden of HPV-positive OPC supports further exploration of secondary preventive interventions. However, screening for HPV-positive OPC is not currently justified. Advances in biomarker discovery and improved characterization of (1) a highly at-risk, target screening population and (2) the benefits and harms of screening will be necessary. Large-scale clinical trials and rigorous evaluation of how to best implement this service into clinical practice will also be needed.
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Affiliation(s)
- Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jasmin A Tiro
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas
| | - Kristina R Dahlstrom
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Erich M Sturgis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
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14
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Maghami E, Ismaila N, Alvarez A, Chernock R, Duvvuri U, Geiger J, Gross N, Haughey B, Paul D, Rodriguez C, Sher D, Stambuk HE, Waldron J, Witek M, Caudell J. Diagnosis and Management of Squamous Cell Carcinoma of Unknown Primary in the Head and Neck: ASCO Guideline. J Clin Oncol 2020; 38:2570-2596. [PMID: 32324430 DOI: 10.1200/jco.20.00275] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To provide evidence-based recommendations to practicing physicians and other health care providers on the diagnosis and management of squamous cell carcinoma of unknown primary in the head and neck (SCCUP). METHODS The American Society of Clinical Oncology convened an Expert Panel of medical oncology, surgery, radiation oncology, radiology, pathology, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2008 through 2019. Outcomes of interest included survival, local and regional disease control, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 100 relevant studies to inform the evidence base for this guideline. Four main clinical questions were addressed, which included subquestions on preoperative evaluations, surgical diagnostic and therapeutic procedures, appropriate pathology techniques, and adjuvant therapy. RECOMMENDATIONS Evidence-based recommendations were developed to address preoperative evaluation for patients with a neck mass, surgical diagnostic and therapeutic procedures, appropriate treatment options in unilateral versus bilateral SCCUP.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
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Affiliation(s)
| | | | | | | | | | | | | | - Bruce Haughey
- Advent Health Medical Group, Otolaryngology, Head and Neck Surgery, Celebration, FL, and University of South Florida, Tampa, FL
| | - Doru Paul
- Weill Cornell Medical College, New York, NY
| | | | - David Sher
- University of Texas Southwestern, Dallas, TX
| | | | - John Waldron
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Matt Witek
- University of Wisconsin School of Medicine and Public Health, Madison, WI
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15
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Lang Kuhs KA, Wood CB, Wiggleton J, Aulino JM, Latimer B, Smith DK, Bender N, Rohde S, Mannion K, Kim Y, Sinard R, Langerman A, Fleischer A, Fakhry C, Waterboer T, Netterville JL. Transcervical sonography and human papillomavirus 16 E6 antibodies are sensitive for the detection of oropharyngeal cancer. Cancer 2020; 126:2658-2665. [PMID: 32129894 DOI: 10.1002/cncr.32799] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/06/2020] [Accepted: 01/14/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Human papillomavirus 16 (HPV-16) E6 seropositivity is a promising early marker of human papillomavirus-driven oropharyngeal cancer (HPV-OPC), yet more sensitive imaging modalities are needed before screening is considered. The objective of this study was to determine the sensitivity of transcervical sonography (TCS) for detecting clinically apparent HPV-OPC in comparison with computed tomography (CT) and positron emission tomography (PET)/CT. METHODS Fifty-one patients with known or suspected HPV-OPC without prior treatment underwent oropharyngeal TCS and blood collection (for HPV multiplex serology testing). Eight standard sonographic images were collected; primary-site tumors were measured in 3 dimensions if identified. Each patient underwent a full diagnostic workup as part of standard clinical care. The pathologic details, HPV status, final staging, and imaging findings were abstracted from the medical record. The sensitivity of each imaging modality was compared with the final clinical diagnosis (the gold standard). RESULTS Twenty-four base of tongue cancers (47%), 22 tonsillar cancers (43%), and 2 unknown primary cancers (4%) were diagnosed; 3 patients (6%) had no tumors. All p16-tested patients were positive (n = 47). Primary-site tumors were correctly identified in 90.2% (95% confidence interval [CI], 78.6%-96.7%) with TCS, in 69.4% (95% CI, 54.6%-81.7%) with CT, and in 83.3% (95% CI, 68.6%-93.0%) with PET/CT. TCS identified tumors in 10 of 14 cases missed by CT and recognized the absence of tumors in 3 cases for which CT or PET/CT was falsely positive. The smallest sonographically identified primary-site tumor was 0.5 cm in its greatest dimension; the average size was 2.3 cm. Among p16-positive patients, 76.1% (95% CI, 61.2%-87.4%) were seropositive for HPV-16 E6. CONCLUSIONS TCS and HPV-16 E6 antibodies are sensitive for the diagnosis of HPV-OPC.
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Affiliation(s)
| | - C Burton Wood
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Brian Latimer
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Derek K Smith
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Noemi Bender
- German Cancer Research Center, Heidelberg, Germany
| | - Sarah Rohde
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kyle Mannion
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Young Kim
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert Sinard
- Vanderbilt University Medical Center, Nashville, Tennessee
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16
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Abstract
The diagnosis of carcinoma of unknown primary in the head and neck is made when there is a metastasis but no primary lesion is identified after physical exam and diagnostic CT or MR imaging. PET/CT is the first step in searching for a primary lesion, followed by more invasive techniques such as endoscopy and surgery. Knowledge of the different tumor histologic types, preferential locations of nodal spread, imaging pitfalls, and other special considerations such as cystic metastases can be helpful in the ultimate identification of primary tumors, which leads to improved overall patient survival.
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Affiliation(s)
- Megan Albertson
- Department of Radiology, University of Nebraska Medical Center, Omaha, NE.
| | - Srinivasa Chandra
- Division of Oral & Maxillofacial Surgery, Department of Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Zafar Sayed
- Department of Otolaryngology - Head and Neck Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Craig Johnson
- Department of Radiology, University of Nebraska Medical Center, Omaha, NE
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17
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Qiao X, Liu W, Cao Y, Miao C, Yang W, Su N, Ye L, Li L, Li C. Performance of different imaging techniques in the diagnosis of head and neck cancer mandibular invasion: A systematic review and meta-analysis. Oral Oncol 2018; 86:150-164. [PMID: 30409295 DOI: 10.1016/j.oraloncology.2018.09.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/06/2018] [Accepted: 09/16/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND To assess diagnostic efficacy of imaging techniques for mandibular invasion by head and neck cancer. METHODS Thirteen databases were searched. Study inclusion, data-extraction and quality assessment were performed independently. STATA 14.0 were mainly used for meta-analysis. RESULTS Forty-nine studies were included. For mandibular invasion (cortex and marrow), CBCT, SPECT, CT, MRI, orthopantomography, PET-CT and bone-scintigraphy showed pooled sensitivities of 90%, 97%, 73%, 88%, 75%, 90%, 92%, specificities of 85%, 69% 91%, 90%, 83%, 89%, 79%, AUC of 0.9461, 0.9434, 0.8995, 0.9296, 0.8761, 0.9290, 0.9207, respectively. The combined SROC curves indicated CBCT and SPECT were superior to other techniques. For mandibular medullary invasion (marrow), CT and MRI showed pooled sensitivities of 85% and 93%, specificities of 86% and 84%. CONCLUSIONS CBCT was top-priority choice for bone invasion diagnosis. SPECT was recommended for exclusion, CT and MRI were suitable for conformation. Further investigations are needed for mandibular medullary involvement.
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Affiliation(s)
- Xianghe Qiao
- Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Wei Liu
- Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Yubin Cao
- Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Cheng Miao
- Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Wenbin Yang
- Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Naichuan Su
- Department of Prosthodontics, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Li Ye
- Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Longjiang Li
- Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China.
| | - Chunjie Li
- Department of Head and Neck Oncology, Department of Evidence-based Dentistry, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China.
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18
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Suk R, Mahale P, Sonawane K, Sikora AG, Chhatwal J, Schmeler KM, Sigel K, Cantor SB, Chiao EY, Deshmukh AA. Trends in Risks for Second Primary Cancers Associated With Index Human Papillomavirus-Associated Cancers. JAMA Netw Open 2018; 1:e181999. [PMID: 30646145 PMCID: PMC6324459 DOI: 10.1001/jamanetworkopen.2018.1999] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE In the last 4 decades, survival among patients with human papillomavirus (HPV)-associated cancers has improved, while the incidence of these cancers has increased among younger cohorts. Among survivors of HPV-associated cancers, persistent HPV infection may remain a risk factor for preventable HPV-associated second primary cancers (HPV-SPCs). OBJECTIVES To investigate the risk of HPV-SPCs among survivors of HPV-associated index cancers and to test the hypothesis that the HPV-SPC risk among these persons has increased over the last 4 decades. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of 9 cancer registries of the Surveillance, Epidemiology, and End Results (SEER) database was conducted to identify patients with HPV-associated (cervical, vaginal, vulvar, oropharyngeal, anal, and penile) cancers diagnosed from January 1, 1973, through December 31, 2014. The dates of analysis were July 1, 2017, to January 31, 2018. MAIN OUTCOMES AND MEASURES The HPV-SPC risk was quantified by calculating standard incidence ratios (SIRs) and excess absolute risks (EARs) per 10 000 person-years at risk (PYR). The HPV-SPC risk by time was estimated using Poisson regression. RESULTS From 113 272 (73 085 female and 40 187 male) survivors of HPV-associated cancers, 1397 women and 1098 men developed HPV-SPCs. The SIRs for HPV-SPCs were 6.2 (95% CI, 5.9-6.6) among women and 15.8 (95% CI, 14.9-16.8) among men. The EARs were 18.2 per 10 000 PYR for women and 53.5 per 10 000 PYR for men. Among both women and men, those who had index oropharyngeal cancers had the highest HPV-SPC risk (SIR, 19.8 [95% CI, 18.4-21.4] and EAR, 80.6 per 10 000 PYR among women; SIR, 18.0 [95% CI, 16.9-19.1] and EAR, 61.5 per 10 000 PYR among men). Women who had index cervical cancers and men who had index anal cancers had the lowest HPV-SPC risk (SIR, 2.4 [95% CI, 2.2-2.7] and EAR, 4.5 per 10 000 PYR among women; SIR, 6.5 [95% CI, 4.7-8.8] and EAR, 18.5 per 10 000 PYR among men). Both women and men who had index HPV-associated cancers of any kind had a significantly higher risk of oropharyngeal HPV-SPCs. Over the last 4 decades, the risk of developing most types of HPV-SPCs after index cervical, vaginal, and vulvar cancers increased. CONCLUSIONS AND RELEVANCE According to this study, the HPV-SPC risk among survivors of HPV-associated cancers is significant, implying that persistent HPV infection at multiple sites may be associated with HPV-SPCs. These findings have the potential to inform surveillance recommendations for survivors of HPV-associated cancers.
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Affiliation(s)
- Ryan Suk
- Department of Management Policy and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston
| | - Parag Mahale
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Kalyani Sonawane
- Department of Management Policy and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston
| | - Andrew G. Sikora
- Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Jagpreet Chhatwal
- Massachusetts General Hospital Institute for Technology Assessment, Harvard Medical School, Boston
| | - Kathleen M. Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Keith Sigel
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Scott B. Cantor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Elizabeth Y. Chiao
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ashish A. Deshmukh
- Department of Management Policy and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, Houston
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19
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Izzetti R, Vitali S, Gabriele M, Caramella D. Feasibility of a combination of intraoral UHFUS and CBCT in the study of peri-implantitis. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:e89-e94. [PMID: 30249536 DOI: 10.1016/j.oooo.2018.08.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/17/2018] [Accepted: 08/21/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the combination of intraoral ultra-high-frequency ultrasonography (UHFUS) and cone beam computed tomography (CBCT) in the evaluation of hard and soft tissues in a case of peri-implantitis. STUDY DESIGN A 57-year-old patient was referred for pain and numbness of the chin after implant placement and the subsequent guided bone regeneration (GBR) procedure. Clinical examination revealed hard tumefaction of the mandibular mucosa, with mild mobility of the implants. Assessment with UHFUS was undertaken for the study of the width, degree of tissue alteration, and vascularity of the swollen mucosa, and CBCT was used to evaluate the bone surrounding the implants and the possible impingement of the inferior alveolar nerve. RESULTS A combination of CBCT and UHFUS was effective in the evaluation of GBR complications in peri-implantitis, revealing alterations in the periosteum secondary to suboptimal GBR treatment. This was the first study to use UHFUS to evaluate the characteristics of oral soft tissues. CONCLUSIONS UHFUS is a promising tool for the diagnosis of complicated soft tissue diseases. When used with CBCT, it can provide useful information on oral and maxillofacial diseases involving hard and soft tissue in a noninvasive way, with reduced radiation dose exposure.
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Affiliation(s)
- Rossana Izzetti
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy.
| | - Saverio Vitali
- Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
| | - Mario Gabriele
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Davide Caramella
- Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
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20
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Kreimer AR, Shiels MS, Fakhry C, Johansson M, Pawlita M, Brennan P, Hildesheim A, Waterboer T. Screening for human papillomavirus-driven oropharyngeal cancer: Considerations for feasibility and strategies for research. Cancer 2018; 124:1859-1866. [PMID: 29499070 DOI: 10.1002/cncr.31256] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/20/2017] [Accepted: 12/22/2017] [Indexed: 01/04/2023]
Abstract
The incidence and burden of human papillomavirus (HPV)‐driven oropharyngeal cancer is expected to increase for decades, thus motivating discussions regarding possibilities for screening. This article addresses issues related to the validity and timeliness of screening for HPV‐driven oropharyngeal cancer, and raises important questions, highlights deficits and confusion in the existing literature, and proposes needed steps in the research agenda.
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Affiliation(s)
- Aimée R Kreimer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Carole Fakhry
- Head and Neck Surgery, Department of Otolaryngology, Johns Hopkins University, Baltimore, Maryland
| | | | - Michael Pawlita
- Division of Molecular Diagnostics of Oncogenic Infections, Infection, Inflammation and Cancer Program, German Cancer Research Center, Heidelberg, Germany
| | - Paul Brennan
- International Agency for Research on Cancer, Lyon, France
| | - Allan Hildesheim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Tim Waterboer
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center, Heidelberg, Germany
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21
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Faraji F, Coquia SF, Wenderoth MB, Padilla ES, Blitz D, DeJong MR, Aygun N, Hamper UM, Fakhry C. Evaluating oropharyngeal carcinoma with transcervical ultrasound, CT, and MRI. Oral Oncol 2018; 78:177-185. [DOI: 10.1016/j.oraloncology.2018.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 01/15/2018] [Accepted: 01/22/2018] [Indexed: 01/06/2023]
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22
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Faraji F, Padilla ES, Blitz D, Wenderoth MB, Blanco RG, Kawamoto S, Sheth S, Hamper UM, Fakhry C. Reader performance in the ultrasonographic evaluation of oropharyngeal carcinoma. Oral Oncol 2018; 77:105-110. [PMID: 29362115 DOI: 10.1016/j.oraloncology.2017.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 12/11/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine reader performance in evaluating oropharyngeal anatomy on ultrasonography. MATERIALS AND METHODS Ultrasound images of the oropharynx comprising normal and malignant anatomic variants were organized into slideshows. Slideshows were administered to 6 readers blinded to participant tumor status and with varying experience reading oropharyngeal sonograms. A training slideshow oriented readers to images of the oropharynx with and without malignant lesions. Readers then evaluated images in a test slideshow for tumor presence and marked orthogonal long and short dimensions of the tumor. Results were analyzed for accuracy, sensitivity, specificity, inter-reader agreement, and measurement error relative to prospectively-identified reference measurements. RESULTS Eighty-seven percent of base of tongue (BOT) sonograms were identified correctly by a majority of readers. In identifying BOT tumors, median accuracy, sensitivity, specificity, and Fleiss's kappa were 79%, 73%, 85%, and 0.51, respectively. Median measurement error in the long and short axes for BOT tumors was -2.6% (range: -40% to 29%) and -2.6% (range: -56% to 156%), respectively. Eighty-four percent of palatine tonsil sonograms were identified correctly by a majority of readers. In identifying tonsil tumors, median accuracy, sensitivity, specificity, and Fleiss's kappa were 77%, 74%, 78%, and 0.41, respectively. Median measurement error in the long and short axes for tonsil tumors was 3.8% (range: -45% to 32%) and -6.5% (range: -83% to 42%), respectively. CONCLUSIONS Overall, US has clinically useful sensitivity for identification of oropharyngeal carcinoma among readers of diverse clinical backgrounds and experience. US may be useful for the evaluation of features such as tumor dimensions.
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Affiliation(s)
- Farhoud Faraji
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States.
| | - Ericka S Padilla
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, United States.
| | - Dana Blitz
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, United States.
| | - Meghan B Wenderoth
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, United States.
| | - Ray G Blanco
- Department of Surgery, Greater Baltimore Medical Center, Baltimore, MD, United States.
| | - Satomi Kawamoto
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, United States.
| | - Sheila Sheth
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, United States.
| | - Ulrike M Hamper
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD, United States.
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States.
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23
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Troussier I, Klausner G, Morinière S, Blais E, Jean-Christophe Faivre, Champion A, Geoffrois L, Pflumio C, Babin E, Maingon P, Thariat J. [Advances in the management of cervical lymphadenopathies of unknown primary: advances in diagnostic imaging and surgical modalities and new international staging system]. Bull Cancer 2017; 105:181-192. [PMID: 29275831 DOI: 10.1016/j.bulcan.2017.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/10/2017] [Accepted: 11/15/2017] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Cervical lymphadenopathies of unknown primary represent 3 % of head and neck cancers. Their diagnostic work up has largely changed in recent years. This review provides an update on diagnostic developments and their potential therapeutic impact. MATERIALS AND METHODS This is a systematic review of the literature. RESULTS In recent years, changes in epidemiology-based prognostic factors such as human papilloma virus (HPV) cancers, advances in imaging and minimally invasive surgery have been integrated in the management of cervical lymphadenopathies of unknown primary. In particular, systematic use of PET scanner and increasing practice of robotic or laser surgery have contributed to increasing detection rate of primary cancers. These allow more adapted and personalized treatments. The impact of changes in the eighth TNM staging system is discussed. CONCLUSION The management of cervical lymphadenopathies of unknown primary cancer has changed significantly in the last 10 years. On the other hand, practice changes will have to be assessed.
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Affiliation(s)
- Idriss Troussier
- CHRU Pitié-Salpêtrière, radiothérapie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Guillaume Klausner
- Institut Gustave-Roussy, radiothérapie, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - Sylvain Morinière
- CHRU de Tours, carcinologie cervicofaciale, 2, boulevard Tonnellé, 37000 Tours, France
| | - Eivind Blais
- Centre Bergonié, radiothérapie, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Jean-Christophe Faivre
- Institut de cancérologie de Lorraine, oncologie médicale, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Ambroise Champion
- Hôpitaux universitaires Genève, radiothérapie, rue Gabrielle-Perret-Gentil, 4, 1205 Genève, Suisse
| | - Lionnel Geoffrois
- CHRU de Tours, carcinologie cervicofaciale, 2, boulevard Tonnellé, 37000 Tours, France
| | - Carole Pflumio
- CHRU de Tours, carcinologie cervicofaciale, 2, boulevard Tonnellé, 37000 Tours, France
| | - Emmanuel Babin
- CHRU de Caen, carcinologie cervicofaciale, avenue de la Côte-de-Nacre, 14033 Caen, France
| | - Philippe Maingon
- CHRU Pitié-Salpêtrière, radiothérapie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Juliette Thariat
- ARCHADE centre François-Baclesse, radiothérapie, 3, avenue du Général-Harris, 14000 Caen, France.
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Fukuhara T, Matsuda E, Hattori Y, Donishi R, Ehara H, Fujiwara K, Takeuchi H. Usefulness of ultrasound for assessing the primary tumor of hypopharyngeal carcinoma. Laryngoscope Investig Otolaryngol 2017; 2:390-394. [PMID: 29299513 PMCID: PMC5743166 DOI: 10.1002/lio2.126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/02/2017] [Accepted: 10/24/2017] [Indexed: 11/30/2022] Open
Abstract
Objectives To clarify the usefulness of ultrasonography for detecting hypopharyngeal cancer. Study Design Cross‐sectional study. Methods The study included 95 patients who underwent pre‐treatment ultrasonography. We evaluated the usefulness of ultrasonography for detecting primary hypopharyngeal carcinoma of each T stage and subsite, and for assessing extrahypopharyngeal invasion. Additionally, we determined the efficacy of color Doppler for evaluating primary hypopharyngeal carcinoma. Results The patients comprised 93 men and 2 women with a mean age of 67.5 years. The T stage (primary tumors) was T1 in 29 patients, T2 in 22, T3 in 9, and T4 in 35. Primary sites with a T stage over T3 were detected using ultrasonography in 17 patients. Regarding primary subsites, postcricoid tumors were assessed most easily (64%), while posterior wall tumors were the most difficult to assess (25%). In 15 of 17 patients, the evaluation of extrahypopharyngeal invasion by ultrasonography matched up precisely with computed tomography findings. In addition, abnormally increased blood flow in primary hypopharyngeal cancers was recognized by color Doppler, and could be used to predict subsites. Conclusions Cancers at T3 and T4 hypopharyngeal primary tumors and their extrahypopharyngeal invasion were detectable using ultrasonography. Furthermore, ultrasonography was useful for assessing postcricoid tumors that were difficult to observe by flexible laryngoscopy. Level of Evidence 4
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Affiliation(s)
- Takahiro Fukuhara
- Department of Otolaryngology, Head and Neck Surgery Tottori University Faculty of Medicine Yonago Tottori Japan
| | - Eriko Matsuda
- Department of Otolaryngology, Head and Neck Surgery Tottori University Faculty of Medicine Yonago Tottori Japan
| | - Yuiko Hattori
- Department of Otolaryngology, Head and Neck Surgery Tottori University Faculty of Medicine Yonago Tottori Japan
| | - Ryohei Donishi
- Department of Otolaryngology, Head and Neck Surgery Tottori University Faculty of Medicine Yonago Tottori Japan
| | - Hiroaki Ehara
- Department of Otolaryngology, Head and Neck Surgery Tottori University Faculty of Medicine Yonago Tottori Japan
| | - Kazunori Fujiwara
- Department of Otolaryngology, Head and Neck Surgery Tottori University Faculty of Medicine Yonago Tottori Japan
| | - Hiromi Takeuchi
- Department of Otolaryngology, Head and Neck Surgery Tottori University Faculty of Medicine Yonago Tottori Japan
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Izzetti R, Fantoni G, Gelli F, Faggioni L, Vitali S, Gabriele M, Caramella D. Feasibility of intraoral ultrasonography in the diagnosis of oral soft tissue lesions: a preclinical assessment on an ex vivo specimen. Radiol Med 2017; 123:135-142. [PMID: 28948476 DOI: 10.1007/s11547-017-0817-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 09/14/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The early detection of oral soft tissue lesions is an important prognostic factor, and the possibility of using ultrasonography (US) as a diagnostic tool may improve the diagnosis and characterization of tissue alterations at an early stage. This study aims to evaluate the feasibility of intraoral US by performing a preclinical assessment of an ex vivo specimen in which focal lesions were simulated. MATERIALS AND METHODS Fourteen lesions were simulated on a freshly extracted calf tongue, by introducing in the tongue different materials mimicking the appearance of various focal lesions. The specimen was scanned with a 8 MHz US probe and computed tomography (CT) was performed to compare the two imaging techniques. Later, the specimen was dissected to set a benchmark for size assessment. RESULTS US was able to identify all the simulated lesions within the tongue, resulting in one case more accurate than CT. Statistical analysis demonstrated high correlation between the measurements of the simulated lesions performed on the US images and the real size of the materials introduced in the tongue (p < 0.05). CONCLUSIONS This preclinical study proves that US performs well in the detection and characterization of simulated lesions of the tongue. These findings suggest that US could be effectively used in clinical applications. However, further research is mandatory to assess the reliability of in vivo US in the detection and characterization of tongue lesions as well as of other oral soft tissue alterations.
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Affiliation(s)
- Rossana Izzetti
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
| | - Gualtiero Fantoni
- Department of Civil and Industrial Engineering, University of Pisa, Pisa, Italy
| | | | - Lorenzo Faggioni
- Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy
| | - Saverio Vitali
- Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy
| | - Mario Gabriele
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Davide Caramella
- Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy
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Kreimer AR, Johansson M, Yanik EL, Katki HA, Check DP, Lang Kuhs KA, Willhauck-Fleckenstein M, Holzinger D, Hildesheim A, Pfeiffer R, Williams C, Freedman ND, Huang WY, Purdue MP, Michel A, Pawlita M, Brennan P, Waterboer T. Kinetics of the Human Papillomavirus Type 16 E6 Antibody Response Prior to Oropharyngeal Cancer. J Natl Cancer Inst 2017; 109:3078532. [PMID: 28376197 PMCID: PMC5967352 DOI: 10.1093/jnci/djx005] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/02/2016] [Accepted: 01/09/2017] [Indexed: 12/27/2022] Open
Abstract
Background In a European cohort, it was previously reported that 35% of oropharyngeal cancer (OPC) patients were human papillomavirus type-16 (HPV16) seropositive up to 10 years before diagnosis vs 0.6% of cancer-free controls. Here, we describe the kinetics of HPV16-E6 antibodies prior to OPC diagnosis. Methods We used annual serial prediagnostic blood samples from the PLCO Cancer Screening Trial. Antibodies to HPV were initially assessed in prediagnostic blood drawn at study enrollment from 198 incident head and neck cancer patients (median years to cancer diagnosis = 6.6) and 924 matched control subjects using multiplex serology, and subsequently in serial samples (median = 5/individual). Available tumor samples were identified and tested for HPV16 RNA to define HPV-driven OPC. Results HPV16-E6 antibodies were present at baseline in 42.3% of 52 OPC patients and 0.5% of 924 control subjects. HPV16-E6 antibody levels were highly elevated and stable across serial blood samples for 21 OPC patients who were seropositive at baseline, as well as for one OPC patient who seroconverted closer to diagnosis. All five subjects with HPV16-driven OPC tumors were HPV16-E6-seropositive, and the four subjects with HPV16-negative OPC tumors were seronegative. The estimated 10-year cumulative risk of OPC was 6.2% (95% confidence interval [CI] = 1.8% to 21.5%) for HPV16-E6-seropositive men, 1.3% (95% CI = 0.1% to 15.3%) for HPV16-E6-seropositive women, and 0.04% (95% CI = 0.03% to 0.06%) among HPV16-E6-seronegative individuals. Conclusions Forty-two percent of subjects diagnosed with OPC between 1994 and 2009 in a US cohort were HPV16-E6 seropositive, with stable antibody levels during annual follow-up for up to 13 years prior to diagnosis. Tumor analysis indicated that the sensitivity and specificity of HPV16-E6 antibodies were exceptionally high in predicting HPV-driven OPC.
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Affiliation(s)
- Aimée R. Kreimer
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (ARK, EY, HAK, DPC, KALK, AH, RP, NDF, WYH, MPP); International Agency for Research on Cancer (IARC), Lyon, France (MJ, PB); Division of Molecular Diagnostics of Oncogenic Infections (F020), Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany (MWF, DH, AM, MP, TW); Information Management Systems, Rockville, MD (CW)
| | - Mattias Johansson
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (ARK, EY, HAK, DPC, KALK, AH, RP, NDF, WYH, MPP); International Agency for Research on Cancer (IARC), Lyon, France (MJ, PB); Division of Molecular Diagnostics of Oncogenic Infections (F020), Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany (MWF, DH, AM, MP, TW); Information Management Systems, Rockville, MD (CW)
| | - Elizabeth L. Yanik
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (ARK, EY, HAK, DPC, KALK, AH, RP, NDF, WYH, MPP); International Agency for Research on Cancer (IARC), Lyon, France (MJ, PB); Division of Molecular Diagnostics of Oncogenic Infections (F020), Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany (MWF, DH, AM, MP, TW); Information Management Systems, Rockville, MD (CW)
| | - Hormuzd A. Katki
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (ARK, EY, HAK, DPC, KALK, AH, RP, NDF, WYH, MPP); International Agency for Research on Cancer (IARC), Lyon, France (MJ, PB); Division of Molecular Diagnostics of Oncogenic Infections (F020), Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany (MWF, DH, AM, MP, TW); Information Management Systems, Rockville, MD (CW)
| | - David P. Check
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (ARK, EY, HAK, DPC, KALK, AH, RP, NDF, WYH, MPP); International Agency for Research on Cancer (IARC), Lyon, France (MJ, PB); Division of Molecular Diagnostics of Oncogenic Infections (F020), Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany (MWF, DH, AM, MP, TW); Information Management Systems, Rockville, MD (CW)
| | - Krystle A. Lang Kuhs
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (ARK, EY, HAK, DPC, KALK, AH, RP, NDF, WYH, MPP); International Agency for Research on Cancer (IARC), Lyon, France (MJ, PB); Division of Molecular Diagnostics of Oncogenic Infections (F020), Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany (MWF, DH, AM, MP, TW); Information Management Systems, Rockville, MD (CW)
| | - Martina Willhauck-Fleckenstein
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (ARK, EY, HAK, DPC, KALK, AH, RP, NDF, WYH, MPP); International Agency for Research on Cancer (IARC), Lyon, France (MJ, PB); Division of Molecular Diagnostics of Oncogenic Infections (F020), Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany (MWF, DH, AM, MP, TW); Information Management Systems, Rockville, MD (CW)
| | - Dana Holzinger
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (ARK, EY, HAK, DPC, KALK, AH, RP, NDF, WYH, MPP); International Agency for Research on Cancer (IARC), Lyon, France (MJ, PB); Division of Molecular Diagnostics of Oncogenic Infections (F020), Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany (MWF, DH, AM, MP, TW); Information Management Systems, Rockville, MD (CW)
| | - Allan Hildesheim
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (ARK, EY, HAK, DPC, KALK, AH, RP, NDF, WYH, MPP); International Agency for Research on Cancer (IARC), Lyon, France (MJ, PB); Division of Molecular Diagnostics of Oncogenic Infections (F020), Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany (MWF, DH, AM, MP, TW); Information Management Systems, Rockville, MD (CW)
| | - Ruth Pfeiffer
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (ARK, EY, HAK, DPC, KALK, AH, RP, NDF, WYH, MPP); International Agency for Research on Cancer (IARC), Lyon, France (MJ, PB); Division of Molecular Diagnostics of Oncogenic Infections (F020), Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany (MWF, DH, AM, MP, TW); Information Management Systems, Rockville, MD (CW)
| | - Craig Williams
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (ARK, EY, HAK, DPC, KALK, AH, RP, NDF, WYH, MPP); International Agency for Research on Cancer (IARC), Lyon, France (MJ, PB); Division of Molecular Diagnostics of Oncogenic Infections (F020), Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany (MWF, DH, AM, MP, TW); Information Management Systems, Rockville, MD (CW)
| | - Neal D. Freedman
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (ARK, EY, HAK, DPC, KALK, AH, RP, NDF, WYH, MPP); International Agency for Research on Cancer (IARC), Lyon, France (MJ, PB); Division of Molecular Diagnostics of Oncogenic Infections (F020), Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany (MWF, DH, AM, MP, TW); Information Management Systems, Rockville, MD (CW)
| | - Wen-Yi Huang
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (ARK, EY, HAK, DPC, KALK, AH, RP, NDF, WYH, MPP); International Agency for Research on Cancer (IARC), Lyon, France (MJ, PB); Division of Molecular Diagnostics of Oncogenic Infections (F020), Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany (MWF, DH, AM, MP, TW); Information Management Systems, Rockville, MD (CW)
| | - Mark P. Purdue
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (ARK, EY, HAK, DPC, KALK, AH, RP, NDF, WYH, MPP); International Agency for Research on Cancer (IARC), Lyon, France (MJ, PB); Division of Molecular Diagnostics of Oncogenic Infections (F020), Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany (MWF, DH, AM, MP, TW); Information Management Systems, Rockville, MD (CW)
| | - Angelika Michel
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (ARK, EY, HAK, DPC, KALK, AH, RP, NDF, WYH, MPP); International Agency for Research on Cancer (IARC), Lyon, France (MJ, PB); Division of Molecular Diagnostics of Oncogenic Infections (F020), Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany (MWF, DH, AM, MP, TW); Information Management Systems, Rockville, MD (CW)
| | - Michael Pawlita
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (ARK, EY, HAK, DPC, KALK, AH, RP, NDF, WYH, MPP); International Agency for Research on Cancer (IARC), Lyon, France (MJ, PB); Division of Molecular Diagnostics of Oncogenic Infections (F020), Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany (MWF, DH, AM, MP, TW); Information Management Systems, Rockville, MD (CW)
| | - Paul Brennan
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (ARK, EY, HAK, DPC, KALK, AH, RP, NDF, WYH, MPP); International Agency for Research on Cancer (IARC), Lyon, France (MJ, PB); Division of Molecular Diagnostics of Oncogenic Infections (F020), Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany (MWF, DH, AM, MP, TW); Information Management Systems, Rockville, MD (CW)
| | - Tim Waterboer
- Affiliations of authors: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (ARK, EY, HAK, DPC, KALK, AH, RP, NDF, WYH, MPP); International Agency for Research on Cancer (IARC), Lyon, France (MJ, PB); Division of Molecular Diagnostics of Oncogenic Infections (F020), Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany (MWF, DH, AM, MP, TW); Information Management Systems, Rockville, MD (CW)
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Mirghani H, Jung AC, Fakhry C. Primary, secondary and tertiary prevention of human papillomavirus-driven head and neck cancers. Eur J Cancer 2017; 78:105-115. [PMID: 28437708 DOI: 10.1016/j.ejca.2017.03.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/13/2017] [Accepted: 03/20/2017] [Indexed: 01/03/2023]
Abstract
Human papillomavirus (HPV)-driven oropharyngeal cancers (OPCs) represent an increasing proportion of head and neck cancers that could become, in the next few decades, a public health problem in certain western countries. This significant epidemiological change strongly calls for preventive measures. Prophylactic HPV vaccination and screening programmes for early identification and treatment of premalignant lesions are currently being used to reduce the incidence of uterine cervical cancer, which is the paradigm of HPV-driven malignancy. These strategies have proven to be efficient as the incidence of cervical cancer has dramatically dropped since the 1960s in most countries where they are properly applied. The success of cervical cancer prevention encourages the development of similar approaches to prevent HPV-driven OPCs. However, a number of important limitations impede their application to HPV-driven OPCs, and the development of innovative and specific strategies dedicated to this disease are urgently needed. This article provides an overview on primary, secondary and tertiary prevention of HPV-driven OPC and discusses some directions for future research.
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Affiliation(s)
- Haïtham Mirghani
- Department of Otolaryngology - Head and Neck Surgery, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif, France.
| | - Alain C Jung
- Laboratoire de Biologie Tumorale, EA 3430 Université de Strasbourg, CLCC Paul Strauss, Strasbourg, France
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Kojcev R, Khakzar A, Fuerst B, Zettinig O, Fahkry C, Dejong R, Richmon J, Taylor R, Sinibaldi E, Navab N. On the reproducibility of expert-operated and robotic ultrasound acquisitions. Int J Comput Assist Radiol Surg 2017; 12:1003-11. [DOI: 10.1007/s11548-017-1561-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/07/2017] [Indexed: 10/19/2022]
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Tsao AS, Papadimitrakopoulou V, Lin H, Guo M, Lee JJ, Holsinger FC, Hong WK, Sturgis EM. Concordance of oral HPV prevalence between patients with oropharyngeal cancer and their partners. Infect Agent Cancer 2016; 11:21. [PMID: 27123042 PMCID: PMC4847345 DOI: 10.1186/s13027-016-0066-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 03/30/2016] [Indexed: 11/21/2022] Open
Abstract
Background Human papilloma virus (HPV) is a known causative factor in oropharyngeal squamous cell cancer (OPC). In this prospective study, we sought to define the risk of HPV transmission between OPC patients and their sexual partners by performing HPV genotyping on oral cytology brushings. Methods Newly diagnosed OPC patients and their sexual partners underwent oral mouth swabs and answered a risk factor questionnaire. Patient tumor samples and oral swabs from both the patient and partner were assessed for HPV status and genotyped using Easy-Chip HPV Blot PCR. Results We enrolled 227 patient-partner pairs and obtained sufficient analyzable DNA from both members in 198 pairs. Of 144 patients with available OPC tumor tissue, 128 (89 %) had HPV-positive tumors by either in situ hybridization or p16 immunohistochemical analysis (104 or 121, respectively). In total, there were 28 patients and 30 partners who were HPV positive by oral swab. The prevalence rate of oral HPV in partners was 15 %. There were 39 patient-partner pairs who had one or both members returning positive for HPV in the oral swab, and 49 % of these pairs were concordant for their HPV-genotype. Female partners had a higher oral HPV prevalence (16 %) than did male partners (11 %). Patients who were non-white were also found to have a higher oral prevalence of HPV (p = 0.032) by mouth swab. Conclusions Partners of OPC patients may have a higher prevalence of oral HPV and should be studied prospectively to understand their OPC risk. Additional future research is needed to identify oral HPV persistence in partners to OPC patients and to determine the optimal sampling methods and technologies to screen patients at high risk for HPV-related disease. Electronic supplementary material The online version of this article (doi:10.1186/s13027-016-0066-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne S Tsao
- Departments of Thoracic & Head and Neck Medical Oncology, Unit 432, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030 USA
| | - Vassiliki Papadimitrakopoulou
- Departments of Thoracic & Head and Neck Medical Oncology, Unit 432, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030 USA
| | - Heather Lin
- Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Ming Guo
- Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - J Jack Lee
- Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - F Christopher Holsinger
- Department of Otolaryngology Head/Neck Surgery, The Cancer Center and School of Medicine Stanford University, Stanford, CA 94305 USA
| | - Waun Ki Hong
- Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
| | - Erich M Sturgis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030 USA
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Coquia SF, Hamper UM, Holman ME, DeJong MR, Subramaniam RM, Aygun N, Fakhry C. Visualization of the Oropharynx With Transcervical Ultrasound. AJR Am J Roentgenol. 2015;205:1288-1294. [PMID: 26587936 DOI: 10.2214/AJR.15.14299] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The purposes of this article are to illustrate the sonographic appearance of the oropharynx and to discuss the potential role of ultrasound in evaluation of the oropharynx. CONCLUSION Ultrasound is not currently used in the standard clinical evaluation of the oropharynx, but it is a promising imaging modality for evaluating the base of the tongue and the palatine tonsils. Ultrasound is comparable and complementary to CT and MRI, which have recognized limitations.
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31
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Mani N, George MM, Nash L, Anwar B, Homer JJ. Role of 18-Fludeoxyglucose positron emission tomography-computed tomography and subsequent panendoscopy in head and neck squamous cell carcinoma of unknown primary. Laryngoscope 2015; 126:1354-8. [PMID: 26671043 DOI: 10.1002/lary.25783] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Head and neck squamous cell carcinomas of unknown primary (HNSCCUP) accounts for up to 10% of presenting head and neck squamous cell carcinomas. Identification of the primary site allows for directed therapy. Where initial investigations have failed to locate the primary site, 18-fludeoxyglucose positron emission tomography-computed tomography (PET/CT) has emerged as a useful tool with improved sensitivity over positron emission tomography alone. Following PET/CT scan, the role of subsequent panendoscopy ± biopsy has not been fully assessed. We aim to evaluate and quantify the role of PET/CT and subsequent panendoscopy in HNSCCUP. STUDY DESIGN Retrospective cohort study. METHODS Patients with HNSCCUP presenting between January 2005 and December 2010 at a regional oncology referral center were studied. All patients who presented with a metastatic neck node and unknown primary who had undergone PET/CT prior to panendoscopy were included. The accuracy of PET/CT was calculated and compared with panendoscopy and histopathological findings. RESULTS Fifty-two patients were included. Twenty-seven PET/CT scans suggested a primary site. Calculated diagnostic parameters were 83% sensitivity, 87% specificity, positive predictive value 89%, and negative predictive value 80%. Three false-positive PET/CT scans were noted after panendoscopy and normal histology. Importantly, three confirmed tongue base tumors were found on panendoscopy, which were undetected on PET/CT. CONCLUSIONS PET/CT is a valuable resource for locating tumors in HNSCCUP. It helps direct biopsy and aids in the detection of local and distant metastases along with synchronous primary tumors. Importantly, due to both false-positive and false-negative PET/CT rates, panendoscopy and biopsy remains an essential adjunct investigation irrespective of PET/CT results. LEVEL OF EVIDENCE 4 Laryngoscope, 126:1354-1358, 2016.
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Affiliation(s)
- Navin Mani
- Head and Neck Oncology Department, The Christie NHS Trust, Manchester, United Kingdom
| | - Manish M George
- Head and Neck Oncology Department, The Christie NHS Trust, Manchester, United Kingdom
| | - Laura Nash
- Head and Neck Oncology Department, The Christie NHS Trust, Manchester, United Kingdom
| | - Bilal Anwar
- Head and Neck Oncology Department, The Christie NHS Trust, Manchester, United Kingdom
| | - Jarrod J Homer
- Head and Neck Oncology Department, The Christie NHS Trust, Manchester, United Kingdom
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Abstract
Human papillomavirus (HPV) is now established as the principal cause of an increase in incidence of a subset of head and neck squamous cell cancers (HNCs) in numerous geographic regions around the world. Further study of the epidemiology of HPV-positive HNC will be critical to the development and implementation of public health interventions to reverse these global incidence trends. Here, recent data are reviewed to provide insight into several topics, including incidence trends and projections for HPV-positive HNC; the worldwide HPV-attributable fraction; sex disparities in cancer risk; the epidemiology of oral HPV infection; the latency period between infection and cancer; the potential impact of prophylactic HPV vaccination; and prospects for secondary prevention through screening for oral HPV infection or seroreactivity to viral antigens. The identification of a single necessary cause for any cancer provides a rare and perhaps extraordinary opportunity for cancer prevention.
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Affiliation(s)
- Maura L Gillison
- Maura L. Gillison, The Ohio State University Wexner Medical Center, Columbus, OH; Anil K. Chaturvedi and William F. Anderson, National Cancer Institute, National Institutes of Health, Rockville; and Carole Fakhry, Johns Hopkins Hospital, Baltimore, MD.
| | - Anil K Chaturvedi
- Maura L. Gillison, The Ohio State University Wexner Medical Center, Columbus, OH; Anil K. Chaturvedi and William F. Anderson, National Cancer Institute, National Institutes of Health, Rockville; and Carole Fakhry, Johns Hopkins Hospital, Baltimore, MD
| | - William F Anderson
- Maura L. Gillison, The Ohio State University Wexner Medical Center, Columbus, OH; Anil K. Chaturvedi and William F. Anderson, National Cancer Institute, National Institutes of Health, Rockville; and Carole Fakhry, Johns Hopkins Hospital, Baltimore, MD
| | - Carole Fakhry
- Maura L. Gillison, The Ohio State University Wexner Medical Center, Columbus, OH; Anil K. Chaturvedi and William F. Anderson, National Cancer Institute, National Institutes of Health, Rockville; and Carole Fakhry, Johns Hopkins Hospital, Baltimore, MD
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Abstract
Oral cavity squamous cell carcinoma (OC-SCC) is the most common malignancy of the head and neck (excluding nonmelanoma skin cancer). Recent trends have shown a dramatic rise in the incidence of oropharyngeal squamous cell carcinoma (OP-SCC), with a marked increase in lesions related to human papillomavirus infection. This update presents the latest evidence regarding OC-SCC and OP-SCC. In particular, the authors compare and contrast tumors at these two sites with respect to epidemiology, etiopathogenesis, clinicopathologic presentation, clinical assessment, imaging, management, and prognosis. It is important for clinicians to be aware of differences between OC-SCC and OP-SCC so that appropriate patient education and multidisciplinary care can be provided to optimize outcomes.
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Affiliation(s)
- Angela C Chi
- Professor, Division of Oral Pathology, Medical University of South Carolina, Charleston, SC
| | - Terry A Day
- Professor, Wendy and Keith Wellin Endowed Chair for Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Brad W Neville
- Distinguished University Professor, Division of Oral Pathology, Medical University of South Carolina, Charleston, SC
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Fakhry C, Andersen KK, Christensen J, Agrawal N, Eisele DW. The Impact of Tonsillectomy upon the Risk of Oropharyngeal Carcinoma Diagnosis and Prognosis in the Danish Cancer Registry. Cancer Prev Res (Phila) 2015; 8:583-9. [PMID: 25896236 DOI: 10.1158/1940-6207.capr-15-0101] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 03/31/2015] [Indexed: 12/22/2022]
Abstract
The incidence of oropharyngeal carcinoma, involving palatine and lingual tonsils, is increasing globally. This significant rise is driven by human papillomavirus. Whether palatine tonsillectomy affects risk of diagnosis with oropharyngeal carcinoma is unknown. The association between tonsillectomy and incidence of oropharyngeal carcinoma was explored in the Danish Cancer Registry. The association between tonsillectomy and oropharyngeal carcinoma was analyzed by time since first registration of tonsillectomy. Tonsillectomy was a time-dependent variable. Individuals were censored for death, emigration, or tonsillectomy within incident year of diagnosis. Incidence rate ratios (RR) were estimated by Poisson regression models and adjusted for confounders. Kaplan-Meier survival analyses were compared by the log-rank test, and HRs were estimated by Cox proportional hazards models. From 1977 to 2012, the incidence of tonsillectomies significantly decreased, whereas the incidence of oropharyngeal carcinoma significantly increased. Tonsillectomy was not associated with risk of oropharyngeal carcinoma or malignancies of other anatomic sites, including base of tongue. However, tonsillectomy significantly reduced risk of diagnosis with tonsil carcinoma [RR, 0.40; 95% confidence interval (CI), 0.22-0.70]. The risk of diagnosis with tonsil carcinoma at age <60 years was significantly decreased (RRadj, 0.15; 95% CI, 0.06-0.41) after tonsillectomy. Tonsillectomy within 1 year of diagnosis with tonsil carcinoma was associated with significantly improved overall survival (HR, 0.53; 95% CI, 0.38-0.74). In conclusion, remote history of tonsillectomy reduces the risk of diagnosis with tonsil carcinoma. These data inform risk and benefit of tonsillectomy, a common procedure and design of secondary prevention trials.
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Affiliation(s)
- Carole Fakhry
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland. Milton J. Dance Jr. Head and Neck Center, Baltimore, Maryland.
| | - Klaus K Andersen
- Danish Cancer Society Research Center, Statistics, Bioinformatics and Registry Unit, Copenhagen, Denmark
| | - Jane Christensen
- Danish Cancer Society Research Center, Statistics, Bioinformatics and Registry Unit, Copenhagen, Denmark
| | - Nishant Agrawal
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - David W Eisele
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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35
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Pahlevaninezhad H, Lee AMD, Rosin M, Sun I, Zhang L, Hakimi M, MacAulay C, Lane PM. Optical coherence tomography and autofluorescence imaging of human tonsil. PLoS One 2014; 9:e115889. [PMID: 25542010 PMCID: PMC4277424 DOI: 10.1371/journal.pone.0115889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 11/27/2014] [Indexed: 01/17/2023] Open
Abstract
For the first time, we present co-registered autofluorescence imaging and optical coherence tomography (AF/OCT) of excised human palatine tonsils to evaluate the capabilities of OCT to visualize tonsil tissue components. Despite limited penetration depth, OCT can provide detailed structural information about tonsil tissue with much higher resolution than that of computed tomography, magnetic resonance imaging, and Ultrasound. Different tonsil tissue components such as epithelium, dense connective tissue, lymphoid nodules, and crypts can be visualized by OCT. The co-registered AF imaging can provide matching biochemical information. AF/OCT scans may provide a non-invasive tool for detecting tonsillar cancers and for studying the natural history of their development.
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Affiliation(s)
- Hamid Pahlevaninezhad
- Department of Integrative Oncology, British Columbia Cancer Research Center, Vancouver, British Columbia, Canada
| | - Anthony M. D. Lee
- Department of Integrative Oncology, British Columbia Cancer Research Center, Vancouver, British Columbia, Canada
| | - Miriam Rosin
- Department of Integrative Oncology, British Columbia Cancer Research Center, Vancouver, British Columbia, Canada
| | - Ivan Sun
- Department of Integrative Oncology, British Columbia Cancer Research Center, Vancouver, British Columbia, Canada
| | - Lewei Zhang
- Department of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mehrnoush Hakimi
- Department of Integrative Oncology, British Columbia Cancer Research Center, Vancouver, British Columbia, Canada
| | - Calum MacAulay
- Department of Integrative Oncology, British Columbia Cancer Research Center, Vancouver, British Columbia, Canada
| | - Pierre M. Lane
- Department of Integrative Oncology, British Columbia Cancer Research Center, Vancouver, British Columbia, Canada
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36
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Mydlarz WK, Liu J, Blanco R, Fakhry C. Transcervical ultrasound identifies primary tumor site of unknown primary head and neck squamous cell carcinoma. Otolaryngol Head Neck Surg 2014; 151:1090-2. [PMID: 25193515 DOI: 10.1177/0194599814549181] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Wojciech K Mydlarz
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Jia Liu
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Ray Blanco
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA Milton J. Dance Jr Head and Neck Cancer Center, Greater Baltimore Medical Center, Baltimore, Maryland, USA
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA Milton J. Dance Jr Head and Neck Cancer Center, Greater Baltimore Medical Center, Baltimore, Maryland, USA Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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