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Ansley W, Kamyab A, Noden L, Odutoye B, Williamson P, Wong KH, Dent P, Sharma A, Weller A, Pitiyage G, Ofo E. Does the extent of neck surgery based on preoperative calcitonin level influence survival in medullary thyroid carcinoma: a retrospective tertiary centre experience. Ann R Coll Surg Engl 2024. [PMID: 38661438 DOI: 10.1308/rcsann.2024.0033] [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] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Medullary thyroid carcinoma (MTC) is a rare thyroid cancer arising from the calcitonin-secreting parafollicular cells. Previous studies suggested a preoperative calcitonin level >200ng/l is an indication for prophylactic lateral neck dissection (LND) to remove micrometastases and improve survival outcomes. METHODS This retrospective single-centre study assessed the efficacy of preoperative calcitonin levels as a marker for determining need for prophylactic LND in MTC. Data were obtained on demographics, preoperative calcitonin levels, size and laterality of index tumour, type of neck dissection (central neck dissection (CND), LND), nodes removed, levels with involved nodes, number of nodes histologically involved, mortality, adjuvant therapy and locoregional recurrence. RESULTS A total of 33 patients were identified from St George's University Hospitals NHS Foundation Trust between 1 January 2001 and 19 August 2021; 8 were excluded for data quality issues. Of the 18 classified with a high preoperative calcitonin level (>200ng/l), 10 (56%) had a LND and 8 (44%) had a CND. In the low-calcitonin group, three (43%) patients had a CND only and four (57%) had a LND. There was no difference in absolute or disease-free survival between the low and high groups (p=0.960, p=0.817), or between those who had a CND and LND in the high-calcitonin group (p=0.607, hazard ratio (HR) 0.55; p=0.129, HR 8.78). CONCLUSION There was no statistically significant difference in outcomes between high and low calcitonin groups. A selective approach to performing LND in MTC patients based on clinical and imaging findings suggesting disease presence in the lateral neck should be explored further.
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Affiliation(s)
- W Ansley
- St George's University Hospitals NHS Foundation Trust, UK
- St George's University of London, UK
| | - A Kamyab
- St George's University Hospitals NHS Foundation Trust, UK
- St George's University of London, UK
| | | | - B Odutoye
- St George's University Hospitals NHS Foundation Trust, UK
| | - P Williamson
- St George's University Hospitals NHS Foundation Trust, UK
| | - K H Wong
- Royal Marsden NHS Foundation Trust, UK
| | - P Dent
- St George's University Hospitals NHS Foundation Trust, UK
| | - A Sharma
- St George's University Hospitals NHS Foundation Trust, UK
| | - A Weller
- St George's University Hospitals NHS Foundation Trust, UK
| | - G Pitiyage
- St George's University Hospitals NHS Foundation Trust, UK
| | - E Ofo
- St George's University Hospitals NHS Foundation Trust, UK
- St George's University of London, UK
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2
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Schuster-Bruce J, Sargent P, Madden B, Ofo E, Allin D. A systematic-review of endotracheal stenting in patients with locally advanced thyroid cancer. Clin Otolaryngol 2022; 47:414-423. [PMID: 35218682 DOI: 10.1111/coa.13923] [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: 10/02/2021] [Accepted: 02/13/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Locally aggressive thyroid cancer can result in airway obstruction secondary to tracheal compression or vocal cord palsy. A tracheal stent provides an alternative to surgical resection, tracheostomy or conservative management in patients with compressive symptoms. This systematic review synthesises the current evidence associated with tracheal stenting in locally advanced thyroid cancer. DESIGN, SETTING AND PARTICIPANTS We conducted a systematic review of tracheal stenting in locally advanced thyroid cancers. We searched MEDLINE, Embase and Web of Science for studies until September 22nd 2020. Inclusion criteria were studies involving patients who had received tracheal stents to treat laryngo-tracheal stenosis secondary to locally advanced thyroid cancer. Single case reports or single cases were not included. MAIN OUTCOME MEASURES We assessed studies for data on the performance of tracheal stenting; defined as symptomatic relief, spirometry data, complication rates and mortality. We also extracted data pertaining to the use of different types of stent. RESULTS We identified 8 full-text articles from 325 titles found in our search. These were all single-centre retrospective studies that lacked homogeneity of thyroid cancer histotypes. The number of patients in each study ranged from 4 to 35 patients. Stenting improved performance status (2 of 2 studies), symptoms (5 of 5 studies) and spirometry (2 of 3 studies). The most common complications were tracheal granulation, tumor overgrowth, stent migration and sputum retention. CONCLUSION There is a lack of evidence in the literature of tracheal stents in locally advanced Thyroid cancer. However, the evidence available suggests tracheal stenting may be a useful treatment adjunct in advanced thyroid cancer causing symptomatic airway obstruction.
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Affiliation(s)
- James Schuster-Bruce
- Dept. of Ear, Nose and Throat, Head and Neck Surgery, St Georges University Hospitals NHS Trust, London, SW17 0QT
| | - Pippa Sargent
- Dept. of Medicine, St Georges University Hospitals NHS Trust, London, SW17 0QT
| | - Brendan Madden
- Dept. of Medicine, St Georges University Hospitals NHS Trust, London, SW17 0QT
| | - Enyinnaya Ofo
- Dept. of Ear, Nose and Throat, Head and Neck Surgery, St Georges University Hospitals NHS Trust, London, SW17 0QT
| | - David Allin
- Dept. of Ear, Nose and Throat, Head and Neck Surgery, Imperial College NHS Healthcare Trust, London, W6 8RF
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Salem J, Shamil E, Ffolkes L, Ofo E. Sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid: demonstrating the natural progression of a rare and misunderstood disease. BMJ Case Rep 2021; 14:14/7/e241086. [PMID: 34312124 PMCID: PMC8314697 DOI: 10.1136/bcr-2020-241086] [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] [Indexed: 11/04/2022] Open
Abstract
Sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid in a 46-year-old woman.
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Affiliation(s)
- Joseph Salem
- Ear, Nose and Throat Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Eamon Shamil
- Ear, Nose and Throat Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Lorrette Ffolkes
- Ear, Nose and Throat Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Enyinnaya Ofo
- Ear, Nose and Throat Department, St George's University Hospitals NHS Foundation Trust, London, UK
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Schuster-Bruce J, Ali A, Van M, Rogel-Salazar J, Ofo E, Shamil E. 36 A Randomised Trial to Compare How Undergraduates Diagnose Common Ear Pathology Using A Smartphone Otoscope and Standard Otoscope in A Simulated Setting. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
Abstract
Introduction
Competent otoscopy is a key otolaryngology skill for a broad range of medical careers, yet undergraduate’s confidence to perform otoscopy is reported as low. This study aimed to evaluate whether a smartphone-otoscope could enhance medical undergraduates recognition of common ear pathology.
Method
52 medical students were randomised into a standard group (traditional otoscope) and an intervention group (smartphone-otoscope). Following a short didactic presentation, participants were asked to diagnose four simulated pathologies. Force response items and 5-point Likert scales loaded on an electronic platform recorded their diagnosis and their perceptions towards the otoscope.
Results
The smartphone-group (n = 20) had higher overall rates of correct diagnosis compared to control (n = 22) (84% vs 39%, p = <0.001). Only the grommet station did not show a significant improvement between the two groups (100% vs 91%, p = 0.49). 90% (n = 20) of participants felt the smartphone-otoscope was preferential for their learning. The same number expressed they want to use it in future learning. The remainder were indifferent.
Conclusions
The smart-phone otoscope enabled learners to better observe and recognise middle ear pathology. This popular learning tool has the potential to accelerate the learning curve of otoscopy and therefore improve the proficiency of future doctors at recognising middle ear diseases.
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Affiliation(s)
| | - A Ali
- St George's Hospital, London, United Kingdom
| | - M Van
- St George's University of London, London, United Kingdom
| | | | - E Ofo
- St George's Hospital, London, United Kingdom
| | - E Shamil
- St George's Hospital, London, United Kingdom
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Garside G, Jaikaransingh D, Pitiyage G, Ofo E. Non-sebaceous lymphadenoma of the submandibular gland: diagnostic challenges in the head and neck cancer pathway. BMJ Case Rep 2020; 13:13/11/e238099. [PMID: 33257384 DOI: 10.1136/bcr-2020-238099] [Citation(s) in RCA: 1] [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] [Indexed: 11/04/2022] Open
Abstract
Non-sebaceous lymphadenoma (NSLA) is a rare benign salivary gland tumour with lymphoid and epithelial components and without sebaceous differentiation. The large majority of the reported cases arise within the parotid gland. We present an NSLA arising from the submandibular gland. The tumour presented as a painless longstanding neck lump. Ultrasound, fine needle aspiration, MRI and positron emission tomography found features supportive of squamous cell carcinoma. The patient was treated with surgery for oropharyngeal carcinoma of unknown origin, in accordance with local and national guidelines. The final histological assessment revealed the level Ib neck lesion to be NSLA. Although a rare occurrence, these lesions may pose a diagnostic challenge in the head and neck cancer pathway.
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Affiliation(s)
| | | | - Gayani Pitiyage
- Pathology, St George's University Hospital NHS Foundation Trust, London, London, UK
| | - Enyinnaya Ofo
- ENT-Head & Neck Surgery, St George's University Hospital NHS Foundation Trust, London, London, UK
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Abstract
BACKGROUND This study investigated whether the single-use rhinolaryngoscope is clinically and economically comparable to the conventional reusable rhinolaryngoscope within a tertiary otolaryngology centre in the UK. METHODS A non-blinded, prospective and single-arm evaluation was carried out over a 5-day period, in which micro-costing was used to compare single-use rhinolaryngoscopes with reusable rhinolaryngoscopes. RESULTS Overall, 68 per cent of the investigators perceived the single-use rhinolaryngoscope to be 'good' or 'very good', while 85 per cent believed the single-use rhinolaryngoscope could replace the reusable rhinolaryngoscope (n = 59). The incremental costs of reusable rhinolaryngoscope eyepieces and videoscopes in the out-patient clinic, when compared to single-use rhinolaryngoscopes, were £30 and £11, respectively. The incremental costs of reusable rhinolaryngoscope eyepieces and videoscopes in the acute surgical assessment unit, when compared to single-use rhinolaryngoscopes, were -£4 and -£73, respectively. CONCLUSION The single-use rhinolaryngoscope provides a clinically comparable, and potentially cost-minimising, alternative to the reusable rhinolaryngoscope for use in the acute surgical assessment unit of our hospital.
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Affiliation(s)
- R Mistry
- Department of Otolaryngology, St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - N Walker
- Department of Otolaryngology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - E Ofo
- Department of Otolaryngology, St George's University Hospitals NHS Foundation Trust, London, UK
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7
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Schuster-Bruce JR, Ali A, Van M, Rogel-Salazar J, Ofo E, Shamil E. A randomised trial to assess the educational benefit of a smartphone otoscope in undergraduate medical training. Eur Arch Otorhinolaryngol 2020; 278:1799-1804. [PMID: 32960350 DOI: 10.1007/s00405-020-06373-1] [Citation(s) in RCA: 4] [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] [Received: 05/08/2020] [Accepted: 07/27/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Competent otoscopy is a key otolaryngology skill for a broad range of medical careers, yet undergraduate's confidence to perform otoscopy is reported as low. Smartphone otoscopes have been suggested to improve undergraduates learning of normal eardrum anatomy because unlike the traditional otoscope, the learner and educator share the same image. This study aimed to evaluate whether a smartphone otoscope could enhance medical undergraduates recognition of common ear pathology. METHODS 52 medical students were randomised into a standard group that used a traditional otoscope and an intervention group that used a smartphone otoscope. Both groups received a short didactic presentation on the recognition of common ear pathologies and were asked to diagnose four simulated pathologies. Both groups received feedback and guidance on how to better visualise the tympanic membrane. Force response items and 5-point Likert scales loaded on an electronic platform recorded their diagnosis and their perceptions towards the otoscope. RESULTS The smartphone-group (n = 20) had higher overall rates of correct diagnosis compared to control (n = 22) (84% vs. 39%, p = < 0.001). Only the grommet station did not show a significant improvement between the two groups (100% vs. 91%, p = 0.49). 90% (n = 20) of participants felt the smartphone otoscope was preferential for their learning. The same number expressed that they want to use it in future learning. The remainder were indifferent. CONCLUSIONS The smartphone otoscope enabled learners to better observe and recognise middle ear pathology. This popular learning tool has the potential to accelerate the learning curve of otoscopy and therefore improve the proficiency of future doctors at recognising middle ear diseases.
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Affiliation(s)
- James R Schuster-Bruce
- Department of Ear, Nose and Throat, Head and Neck surgery, St George's University Hospitals Foundation Trust, London, UK.
| | - Asha Ali
- Department of Ear, Nose and Throat, Head and Neck surgery, St George's University Hospitals Foundation Trust, London, UK
| | - Minh Van
- St George's University, London, UK
| | - Jesus Rogel-Salazar
- Blackett Laboratory, Department of Physics, Imperial College London, London, UK
| | - Enyinnaya Ofo
- Department of Ear, Nose and Throat, Head and Neck surgery, St George's University Hospitals Foundation Trust, London, UK
| | - Eamon Shamil
- Department of Ear, Nose and Throat, Head and Neck surgery, St George's University Hospitals Foundation Trust, London, UK
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Mistry R, Walker A, Walker N, Ofo E. Royal Society of Medicine Surgical Innovation Day Adrian Tanner Prize Winner 2019: Multidisciplinary care and surgical innovation for the benefit of the patient with head and neck cancer of unknown primary. JRSM Open 2020; 11:2054270420921066. [PMID: 32685179 PMCID: PMC7346693 DOI: 10.1177/2054270420921066] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Head and neck carcinoma of unknown primary accounts for approximately 1–5% of all head and neck cancers and presents a genuine diagnostic and therapeutic dilemma. Despite advanced investigations, the primary tumour location remains unknown in up to 40% of these cases. Transoral robotic surgery presents a viable diagnostic and therapeutic option in these patients. This surgical innovation alongside advances in the understanding of head and neck cancer biology means that a multidisciplinary approach in the management of these complex patients is of utmost importance to ensure optimal therapeutic outcomes.
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Affiliation(s)
- Rakesh Mistry
- Department of ENT Surgery, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Abigail Walker
- Department of ENT Surgery, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Nathan Walker
- Department of ENT Surgery, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Enyinnaya Ofo
- Department of ENT Surgery, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK
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9
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Mistry R, Walker A, Kim D, Ofo E. Transoral robotic surgery for the benefit of patients with head and neck cancer of unknown primary: our experience at St George's University Hospital, London. Ann R Coll Surg Engl 2020; 102:442-450. [PMID: 32347742 PMCID: PMC7388938 DOI: 10.1308/rcsann.2020.0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Accepted: 03/23/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Head and neck carcinoma of unknown primary represents 1-5% of all head and neck cancers and presents a diagnostic and therapeutic dilemma. In approximately 40% of cases, a primary tumour location remains unknown despite investigation. With advancements in our understanding of the role of high-risk human papilloma virus in head and neck cancer, transoral robotic surgery presents an option for diagnosis and therapy. MATERIALS AND METHODS This is a retrospective case series from a single centre. Case notes were reviewed for 28 patients who had transoral robotic surgery for head and neck carcinoma of unknown primary between May 2015 and July 2019. RESULTS Transoral robotic surgery identified an oropharyngeal primary tumour in 19 of 28 (67.8%) patients. All oropharyngeal primaries were p16 positive. The base of tongue identification rate was 63.2%. Median length of inpatient stay postoperatively was 1.0 day. Normal oral intake resumed within 48 hours in 96% (27/28) of patients. Three patients (10.3%) suffered minor postoperative bleeds that were all managed conservatively. DISCUSSION The base of tongue primary identification rate (63.2%) in this series is consistent with that previously reported (43-63%; 95% confidence interval). Primary tumour identification rate if a patient is p16 positive is 86.3% (19/22), with 100% of these being oropharyngeal. We suggest future investigation into p16 status as a means of stratifying patients with head and neck carcinoma of unknown primary for transoral robotic surgery. CONCLUSION Transoral robotic base of tongue mucosectomy (or lingual tonsillectomy) is a promising technique that offers a high yield of positive identification for the primary tumour. It is well tolerated with minimal associated morbidity. Our findings are comparable with those in the current literature.
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Affiliation(s)
- R Mistry
- St George’s University Hospitals NHS Foundation Trust, Tooting, London, UK
| | - A Walker
- St George’s University Hospitals NHS Foundation Trust, Tooting, London, UK
| | - D Kim
- St George’s University Hospitals NHS Foundation Trust, Tooting, London, UK
| | - E Ofo
- St George’s University Hospitals NHS Foundation Trust, Tooting, London, UK
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10
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Meccariello G, Cammaroto G, Ofo E, Calpona S, Parisi E, D'Agostino G, Gobbi R, Firinu E, Bellini C, De Vito A, Montevecchi F, Costantini M, Amadori E, Nuzzo S, Pelucchi S, Vicini C. The emerging role of trans-oral robotic surgery for the detection of the primary tumour site in patients with head-neck unknown primary cancers: A meta-analysis. Auris Nasus Larynx 2019; 46:663-671. [PMID: 31064689 DOI: 10.1016/j.anl.2019.04.007] [Citation(s) in RCA: 10] [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: 02/02/2019] [Revised: 04/16/2019] [Accepted: 04/23/2019] [Indexed: 12/29/2022]
Abstract
The identification of the site in head neck unknown primary (HNUP) tumour is of utmost importance to help select best treatment while decreasing treatment-related morbidity and mortality. The primary purpose of this study is to demonstrate that TORS may be a valuable tool in detecting primary tumour. Studies were systematically searched in the PubMed, EMBASE, the Cochrane Library and CENTRAL electronic databases. A total of 12 selected studies (349 patients) were analyzed. The primary tumour detection and positive surgical margins rates were 70.8% and 19.4%, respectively. The rate of HPV-related tumour was 71.3%. The primary tumour was mainly in base of tongue (64%). In conclusion, TORS seems to be an effective surgical approach both in terms of detection of primary tumour site and in terms of therapeutic perspective for HNUP. In particular, a subset of HPV-related tumours might benefits all advantages from this surgical modality.
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Affiliation(s)
- Giuseppe Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy.
| | - Giovanni Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy; Department of Otolaryngology and Head-Neck Surgery, University of Messina, Italy
| | - Enyinnaya Ofo
- St George's University Hospital, Kingston Hospital NHS Foundation Trusts, London, UK
| | - Sebastiano Calpona
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori(IRST), IRCCS, Meldola, Italy
| | - Elisabetta Parisi
- Radiotherapy Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori(IRST), IRCCS, Meldola, Italy
| | - Giovanni D'Agostino
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Riccardo Gobbi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Elisabetta Firinu
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Chiara Bellini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Andrea De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Filippo Montevecchi
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Matteo Costantini
- Department of Surgical Pathology, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
| | - Elena Amadori
- Radiology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori(IRST), IRCCS, Meldola, Italy
| | - Simona Nuzzo
- Department of Biostatistics, Azienda USL della Romagna, Forlì, Italy
| | | | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Azienda USL della Romagna, Forlì, Italy
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Abstract
Carcinoma of unknown primary (CUP) comprises approximately 1%-5% of all head and neck malignancies. Primary site detection rates for metastatic cervical squamous cell carcinoma (SCC) remain variable, with current diagnostic imaging unable to identify all tumours. Prevailing evidence suggests that most head and neck CUP are located in the oropharynx. Diagnostic surgical efforts have been directed at sampling the entire oropharynx. Present techniques that make this possible include transoral robotic surgery (TORS). TORS Lingual tonsillectomy or tongue base mucosectomy performed in the setting of head and neck CUP increases the detection rate of occult tumour. The indication, surgical technique, evidence base, and controversies of performing TORS in the context of the unknown primary are presented.
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Affiliation(s)
- Enyinnaya Ofo
- St George's University Hospital and Kingston Hospital NHS Foundation Trusts, London, United Kingdom,
| | - Harry Spiers
- St George's University of London Medical School, London, United Kingdom
| | - Dae Kim
- St George's University Hospital NHS Foundation Trust, London, United Kingdom
| | - Umamaheswar Duvvuri
- University of Pittsburgh, Department of Otolaryngology, Eye & Ear Institute, Veterans Affairs Pittsburgh Health System, Pittsburgh, Pennsylvania, USA
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12
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Winter SC, Ofo E, Meikle D, Silva P, Fraser L, O'Hara J, Kim D, Robinson M, Paleri V. Trans-oral robotic assisted tongue base mucosectomy for investigation of cancer of unknown primary in the head and neck region. The UK experience. Clin Otolaryngol 2017; 42:1247-1251. [PMID: 28258624 DOI: 10.1111/coa.12860] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The diagnosis of cancer of unknown primary (CUP) in head and neck occurs when the treating clinicians have utilised all available diagnostic tests and failed to identify the origin of the disease. There is no agreed consensus on which diagnostic investigations to use, or the order in which to use them in, although broad recommendations exist. Small tumours arising in the tongue base can be below the limits of resolution of conventional diagnostic techniques. Given the difficulty in targeting the tongue base, current practice involves blind random biopsies, which leads to a variable detection rate. Robotically assisted surgical removal of the tongue base, tongue base mucosectomy (TBM) has been shown to improve diagnostic yield. This study reports the diagnostic hit rate for tongue base primaries using this technique. DESIGN Retrospective case review. SETTING UK Head and Neck Centres. PARTICIPANTS Patients presenting as an unknown primary, investigated with clinical examination, PET-CT and palatine tonsillectomy. MAIN OUTCOME MEASURES The detection of a primary site of head and neck cancer in the otherwise unknown primary tumour. RESULTS The primary tumour site was identified in the tongue base in 53% (n=17) of patients. In 15 patients the tumour was in the ipsliateral tongue base (88%) while in two cases (12%) the tumour was located in contra lateral tongue base. CONCLUSIONS Trans-oral robotic assisted TBM raises the possibility of identifying over 50% of tumours that would otherwise be classified as CUP. Identifying these in the contralateral tongue base has implications for treatment planning and outcome.
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Affiliation(s)
- S C Winter
- Oxford University NHS Trusts, Oxford, UK
| | - E Ofo
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - D Meikle
- Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - P Silva
- Oxford University NHS Trusts, Oxford, UK
| | - L Fraser
- Oxford University NHS Trusts, Oxford, UK
| | - J O'Hara
- Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - D Kim
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - M Robinson
- Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - V Paleri
- Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
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Hone RWA, Rahman E, Wong G, Annan Y, Alexander V, Al-Lami A, Varadharajan K, Parker M, Simo R, Pitkin L, Mace A, Ofo E, Balfour A, Nixon IJ. Do salivary bypass tubes lower the incidence of pharyngocutaneous fistula following total laryngectomy? A retrospective analysis of predictive factors using multivariate analysis. Eur Arch Otorhinolaryngol 2016; 274:1983-1991. [PMID: 28011997 PMCID: PMC5340845 DOI: 10.1007/s00405-016-4391-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/11/2016] [Indexed: 01/12/2023]
Abstract
Salivary bypass tubes (SBT) are increasingly used to prevent pharyngocutaneous fistula (PCF) following laryngectomy and pharyngolaryngectomy. There is minimal evidence as to their efficacy and literature is limited. The aim of the study was to determine if SBT prevent PCF. The study was a multicentre retrospective case control series (level of evidence 3b). Patients who underwent laryngectomy or pharyngolaryngectomy for cancer or following cancer treatment between 2011 and 2014 were included in the study. The primary outcome was development of a PCF. Other variables recorded were age, sex, prior radiotherapy or chemoradiotherapy, prior tracheostomy, type of procedure, concurrent neck dissection, use of flap reconstruction, use of prophylactic antibiotics, the suture material used for the anastomosis, tumour T stage, histological margins, day one post-operative haemoglobin and whether a salivary bypass tube was used. Univariate and multivariate analysis were performed. A total of 199 patients were included and 24 received salivary bypass tubes. Fistula rates were 8.3% in the SBT group (2/24) and 24.6% in the control group (43/175). This was not statistically significant on univariate (p value 0.115) or multivariate analysis (p value 0.076). In addition, no other co-variables were found to be significant. No group has proven a benefit of salivary bypass tubes on multivariate analysis. The study was limited by a small case group, variations in tube duration and subjects given a tube may have been identified as high risk of fistula. Further prospective studies are warranted prior to recommendation of salivary bypass tubes following laryngectomy.
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Affiliation(s)
- Robert W A Hone
- Faculty of Medical Science, Post Graduate Medical Institute, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, Essex, UK.
- Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY, UK.
| | - Eqramur Rahman
- Faculty of Medical Science, Post Graduate Medical Institute, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, Essex, UK
| | - Gentle Wong
- Ear, Nose and Throat Department, Brighton and Sussex University Hospital, 177 Preston Rd, Brighton, UK
| | - Yvette Annan
- Ear, Nose and Throat Department, Charing Cross Hospital, Fulham Palace Rd, London, UK
| | - Victoria Alexander
- Ear, Nose and Throat Department, Guy's Hospital, Great Maze Pond, London, UK
| | - Ali Al-Lami
- Ear, Nose and Throat Department, St Georges Hospital, Blackshaw Rd, London, UK
| | - Kiran Varadharajan
- Ear, Nose and Throat Department, William Harvey Hospital, Kennington Road, Willesborough, Ashford, Kent, UK
| | - Michael Parker
- Faculty of Medical Science, Post Graduate Medical Institute, Anglia Ruskin University, Bishop Hall Lane, Chelmsford, Essex, UK
| | - Ricard Simo
- Ear, Nose and Throat Department, Guy's Hospital, Great Maze Pond, London, UK
| | - Lisa Pitkin
- Ear, Nose and Throat Department, Royal Surrey County Hospital, Egerton Rd, Guildford, Surrey, UK
| | - Alasdair Mace
- Ear, Nose and Throat Department, Charing Cross Hospital, Fulham Palace Rd, London, UK
| | - Enyinnaya Ofo
- Ear, Nose and Throat Department, William Harvey Hospital, Kennington Road, Willesborough, Ashford, Kent, UK
| | - Alistair Balfour
- Ear, Nose and Throat Department, St Georges Hospital, Blackshaw Rd, London, UK
| | - Iain J Nixon
- Ear, Nose and Throat Department, St Georges Hospital, Blackshaw Rd, London, UK
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Krishnan S, Connell J, Ofo E. Transoral robotic surgery base of tongue mucosectomy for head and neck cancer of unknown primary. ANZ J Surg 2016; 87:E281-E284. [PMID: 27860242 DOI: 10.1111/ans.13741] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 05/06/2016] [Accepted: 07/18/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Head and neck cancer of unknown primary (HNCUP) is a source of diagnostic uncertainty. Patients presenting with cytologically positive neck lumps without a clinically identifiable primary, require extensive investigation including imaging, tonsillectomy, panendoscopy and tissue biopsy. Treatment typically involves neck dissection, wide field radiotherapy and chemotherapy. Transoral robotic surgery (TORS) has emerged as an expanding surgical technique for resecting tumours of the oropharynx. Its role in base of tongue (BOT) mucosectomy for HNCUP can alleviate diagnostic uncertainty and provide an adjunct treatment modality with few complications. METHODS We conducted a 7-year chart review of consecutive patients presenting with HNCUP that were treated with TORS BOT mucosectomy. We examined the efficacy, diagnostic rates and complications associated with TORS BOT mucosectomy when used for treating HNCUP. RESULTS TORS BOT mucosectomy was performed in seven cases of squamous cell carcinoma of unknown primary. Robotic mucosectomy diagnosed BOT as the primary tumour site in five cases (71.4%). All five cases were p16 positive. Average time before return to normal swallowing function was 2.7 days. There were no major surgical complications. CONCLUSION TORS BOT mucosectomy is an expanding surgical technique with a key role in head and neck surgery. It can be utilized to good effect where head and neck cancer is diagnosed without an identifiable primary. Incorporating robotic surgery in the diagnostic and treatment pathway offers low complication rates, reduced morbidity and improved tumour identification.
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Affiliation(s)
- Suren Krishnan
- Department of Otolaryngology Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - James Connell
- Department of Otolaryngology Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Enyinnaya Ofo
- Department of Otolaryngology Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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15
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Ofo E, Thavaraj S, Cope D, Barr J, Kapoor K, Jeannon JP, Oakley R, Lock C, Odell E, Simo R. Quantification of lymph nodes in the central compartment of the neck: a cadaveric study. Eur Arch Otorhinolaryngol 2015; 273:2773-8. [PMID: 26589898 DOI: 10.1007/s00405-015-3827-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 08/02/2015] [Accepted: 10/29/2015] [Indexed: 12/18/2022]
Abstract
Differentiated thyroid cancer (DTC) accounts for over 90 % of thyroid malignancies, and is frequently associated with central neck compartment nodal metastasis that requires a therapeutic central compartment neck dissection (CCND) for clinically evident nodes. Current knowledge on the expected lymph node yield from a CCND is limited, compared with data on the lateral neck. The aim of our study was to accurately quantify nodal yield from the cadaveric central neck compartment. Twenty-eight cadaveric necks were dissected and the central neck compartment was subdivided into four regions: pre-laryngeal (delphian), pre-tracheal, right and left para-tracheal regions. Each cadaver had a thyroid gland, which was also removed, and the CCND tissue in each compartment was processed and examined by a consultant histopathologist. Only lymphoid tissue with a defined microscopic fibrous capsule and subcapsular sinus was included in the node count. The median total lymph node count per cadaver was four (range 1-16), with a median of one node detectable in each para-tracheal region (range 0-7) and the pre-tracheal region (range 0-8). The median pre-laryngeal node count was 0 (range 0- 2). The average lymph node size across all compartments was 2.9 mm. This is the first European study to assess cadaveric central neck lymph nodes and establish baseline counts for nodal yield. If a prophylactic or therapeutic CCND is required during thyroid surgery, those involved in DTC management must recognise that there is a wide range, and low median yield of central neck compartment lymph nodes.
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Affiliation(s)
- Enyinnaya Ofo
- Department of Otolaryngology, Head & Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, United Kingdom.
| | - Selvam Thavaraj
- Department of Head and Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Daron Cope
- Department of Otolaryngology, Head & Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - James Barr
- Department of Otolaryngology, Head & Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Karan Kapoor
- Department of Otolaryngology, Head & Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Jean-Pierre Jeannon
- Department of Otolaryngology, Head & Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Richard Oakley
- Department of Otolaryngology, Head & Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Claire Lock
- Department of Head and Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Edward Odell
- Department of Head and Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Ricard Simo
- Department of Otolaryngology, Head & Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, United Kingdom
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16
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Ofo E, Yokoyama J. Rapidly Increasing Trends in Oropharyngeal Carcinoma Assessed by Worldwide Epidemiologic Analysis. CCTR 2015. [DOI: 10.2174/1573394711666150428003039] [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] [Indexed: 11/22/2022]
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17
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Warner E, Ofo E, Connor S, Odell E, Jeannon JP. Mucoepidermoid carcinoma in a thyroglossal duct remnant. Int J Surg Case Rep 2015; 13:43-7. [PMID: 26101054 PMCID: PMC4529606 DOI: 10.1016/j.ijscr.2015.04.028] [Citation(s) in RCA: 9] [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: 02/10/2015] [Revised: 04/20/2015] [Accepted: 04/26/2015] [Indexed: 11/30/2022] Open
Abstract
Thyroglossal duct remnants should be surgically excised, if possible due to the risk of malignant transformation. Mucoepidermoid carcinomas can present in diverse locations outside of salivary glands. A high index of suspicion for malignancy is required with neck masses in adults, especially following a period of rapid growth. If aggressively treated, patients with mucoepidermoid carcinoma outside of salivary glands may still have a favourable prognosis.
Introduction Thyroglossal duct cysts (TDC) are common midline neck swellings resulting from embryological remnants of the thyroglossal duct. They often contain ectopic thyroid tissue and malignant transformation has been reported, most commonly to papillary thyroid carcinoma. Mucoepidermoid carcinoma (MEC) usually occurs in the salivary glands and only rarely in the thyroid. This is the first case of a MEC occurring within a thyroglossal duct remnant. Presentation of a case A 73 year old lady presented with a thyroglossal duct cyst. She declined surgical excision, as she was adamant she wanted to avoid surgery. The neck mass rapidly enlarged at two years following initial diagnosis. Fine needle aspiration cytology was suspicious for carcinoma. She underwent total thyroidectomy and selective central compartment neck dissection with adjuvant radiotherapy. She remains alive and well two years post treatment. Discussion Mucoepidermoid carcinoma is the most common malignant neoplasm of salivary glands, although it has rarely been reported in diverse locations including the thyroid, lung and pancreas. To the best of our knowledge, this is the first reported case of mucoepidermoid carcinoma arising from a thyroglossal duct remnant. Conclusion This case adds weight to the literature favouring surgical excision of thyroglossal duct remnants due to the risk of malignant transformation.
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Affiliation(s)
- E Warner
- Department of Otolaryngology and Head and Neck Surgery, Guy's Hospital, Great Maze Pond, London, SE1 9RT England, UK.
| | - E Ofo
- Department of Otolaryngology and Head and Neck Surgery, Guy's Hospital, Great Maze Pond, London, SE1 9RT England, UK
| | - S Connor
- Head and Neck Radiology, Guy's Hospital, Great Maze Pond, London, SE1 9RT England, UK
| | - E Odell
- Head and Neck Pathology, Guy's Hospital, Great Maze Pond, London, SE1 9RT England, UK
| | - J P Jeannon
- Department of Otolaryngology and Head and Neck Surgery, Guy's Hospital, Great Maze Pond, London, SE1 9RT England, UK
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18
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Weitsman G, Lawler K, Kelleher MT, Barrett JE, Barber PR, Shamil E, Festy F, Patel G, Fruhwirth GO, Huang L, Tullis ID, Woodman N, Ofo E, Ameer-Beg SM, Irshad S, Condeelis J, Gillett CE, Ellis PA, Vojnovic B, Coolen AC, Ng T. Imaging tumour heterogeneity of the consequences of a PKCα-substrate interaction in breast cancer patients. Biochem Soc Trans 2014; 42:1498-505. [PMID: 25399560 PMCID: PMC4259014 DOI: 10.1042/bst20140165] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Breast cancer heterogeneity demands that prognostic models must be biologically driven and recent clinical evidence indicates that future prognostic signatures need evaluation in the context of early compared with late metastatic risk prediction. In pre-clinical studies, we and others have shown that various protein-protein interactions, pertaining to the actin microfilament-associated proteins, ezrin and cofilin, mediate breast cancer cell migration, a prerequisite for cancer metastasis. Moreover, as a direct substrate for protein kinase Cα, ezrin has been shown to be a determinant of cancer metastasis for a variety of tumour types, besides breast cancer; and has been described as a pivotal regulator of metastasis by linking the plasma membrane to the actin cytoskeleton. In the present article, we demonstrate that our tissue imaging-derived parameters that pertain to or are a consequence of the PKC-ezrin interaction can be used for breast cancer prognostication, with inter-cohort reproducibility. The application of fluorescence lifetime imaging microscopy (FLIM) in formalin-fixed paraffin-embedded patient samples to probe protein proximity within the typically <10 nm range to address the oncological challenge of tumour heterogeneity, is discussed.
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Affiliation(s)
- Gregory Weitsman
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, Guy’s Medical School Campus, London SE1 1UL, U.K
| | - Katherine Lawler
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, Guy’s Medical School Campus, London SE1 1UL, U.K
- Department of Mathematics, King’s College London, Strand Campus, London WC2R 2LS, U.K
| | - Muireann T. Kelleher
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, Guy’s Medical School Campus, London SE1 1UL, U.K
- Department of Medical Oncology, St George’s NHS Trust, London SW17 0QT, U.K
| | - James E. Barrett
- Department of Mathematics, King’s College London, Strand Campus, London WC2R 2LS, U.K
| | - Paul R. Barber
- Gray Institute for Radiation Oncology & Biology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford OX3 7DQ, U.K
| | - Eamon Shamil
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, Guy’s Medical School Campus, London SE1 1UL, U.K
| | - Frederic Festy
- Biomaterials, Biomimetics and Biophotonics Division, King’s College London Dental Institute, London SE1 9RT, U.K
| | - Gargi Patel
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, Guy’s Medical School Campus, London SE1 1UL, U.K
- Department of Medical Oncology, Guy’s and St. Thomas Foundation Trust, London SE1 9RT, U.K
| | - Gilbert O. Fruhwirth
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, Guy’s Medical School Campus, London SE1 1UL, U.K
- Division of Imaging Science and Biomedical Engineering, King’s College London, London SE1 7EH, U.K
| | - Lufei Huang
- Gray Institute for Radiation Oncology & Biology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford OX3 7DQ, U.K
| | - Iain D.C. Tullis
- Gray Institute for Radiation Oncology & Biology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford OX3 7DQ, U.K
| | - Natalie Woodman
- Guy’s & St. Thomas’ Breast Tissue & Data Bank, King’s College London, Guy’s Hospital, London SE1 9RT, U.K
| | - Enyinnaya Ofo
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, Guy’s Medical School Campus, London SE1 1UL, U.K
| | - Simon M. Ameer-Beg
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, Guy’s Medical School Campus, London SE1 1UL, U.K
| | - Sheeba Irshad
- Breakthrough Breast Cancer Research Unit, Department of Research Oncology, Guy’s Hospital King’s College London School of Medicine, London, SE1 9RT, U.K
| | - John Condeelis
- Tumor Microenvironment and Metastasis Program, Albert Einstein Cancer Center, New York, NY 10461, U.S.A
| | - Cheryl E. Gillett
- Guy’s & St. Thomas’ Breast Tissue & Data Bank, King’s College London, Guy’s Hospital, London SE1 9RT, U.K
| | - Paul A. Ellis
- Department of Medical Oncology, Guy’s and St. Thomas Foundation Trust, London SE1 9RT, U.K
| | - Borivoj Vojnovic
- Gray Institute for Radiation Oncology & Biology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford OX3 7DQ, U.K
- Randall Division of Cell & Molecular Biophysics, King’s College London, London, U.K
| | - Anthony C.C. Coolen
- Department of Mathematics, King’s College London, Strand Campus, London WC2R 2LS, U.K
| | - Tony Ng
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, Guy’s Medical School Campus, London SE1 1UL, U.K
- Breakthrough Breast Cancer Research Unit, Department of Research Oncology, Guy’s Hospital King’s College London School of Medicine, London, SE1 9RT, U.K
- UCL Cancer Institute, Paul O’Gorman Building, University College London, London WC1E 6DD, U.K
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Ofo E, Mandavia R, Jeannon JP, Odell E, Simo R. Renal cell carcinoma metastasis to the parathyroid gland: A very rare occurrence. Int J Surg Case Rep 2014; 5:378-80. [PMID: 24862026 PMCID: PMC4064424 DOI: 10.1016/j.ijscr.2014.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 08/28/2013] [Revised: 04/08/2014] [Accepted: 04/08/2014] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Metastases to the parathyroid gland are very uncommon. Although renal cell carcinoma metastasis to the head and neck region is well recognised, with a predilection for unpredictable metastasis to unusual sites such as the thyroid gland, nose, paranasal sinuses, and cranial bones, there are no reports of parathyroid gland involvement. PRESENTATION OF CASE We describe an unusual case of renal cell carcinoma metastasis to a parathyroid gland in a 69-year-old male who had been treated 8 years previously for a pT3b N0 M1 clear cell carcinoma of the right kidney with a right nephrectomy, and interferon immunotherapy for 18 months. The patient had originally presented to the plastic surgeons with a rapidly enlarging 3 cm superficial lesion on the ventral aspect of the left forearm, which was excised with histology revealing metastatic renal (clear) cell carcinoma. DISCUSSION Renal cell carcinoma has a reputation for unpredictable patterns of metastasis, and our case highlights this, with the first description in the literature of parathyroid gland metastasis. Despite the poor prognosis associated with metastatic renal cell carcinoma, our patient is still alive 10 years following original presentation, despite having metastasis to two different extra-renal sites and a shortened course of initial adjuvant systemic therapy. CONCLUSION In parathyroid gland metastasis, metastectomy can offer excellent local long term local control.
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Affiliation(s)
- Enyinnaya Ofo
- Department of Otolaryngology-Head & Neck Surgery, Guy's & St Thomas' NHS Foundation Trust, Great Maze Pond, SE1 9RT London, United Kingdom
| | - Rishi Mandavia
- Academic Section of Vascular Surgery, Imperial College London, 4 North Charing Cross Hospital, Fulham Palace Road, W6 8RF London, United Kingdom.
| | - Jean-Pierre Jeannon
- Department of Otolaryngology-Head & Neck Surgery, Guy's & St Thomas' NHS Foundation Trust, Great Maze Pond, SE1 9RT London, United Kingdom
| | - Edward Odell
- Head and Neck/Oral Pathology, King's College London and Guy's & St Thomas' NHS Foundation Trust, Great Maze Pond, SE1 9RT London, United Kingdom
| | - Ricard Simo
- Department of Otolaryngology-Head & Neck Surgery, Guy's & St Thomas' NHS Foundation Trust, Great Maze Pond, SE1 9RT London, United Kingdom
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20
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Sheeba I, Kelleher M, Lawler K, Festy F, Barber P, Shamill E, Gargi P, Weitsman G, Barrett J, Fruhwirth G, Huang L, Tullis I, Woodman N, Pinder S, Ofo E, Fernandes L, Beutler M, Ameer-Beg S, Holmberg L, Purushotham A, Fraternali F, Condeelis J, Hanby A, Gillett C, Ellis P, Vojnovic B, Coolen A, Ng T. Abstract P2-10-29: Time dependent breast cancer metastasis prediction using novel biological imaging, clinico-pathological and genomic data combined with Bayesian modeling to reduce over-fitting and improve on inter-cohort reproducibility. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p2-10-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Breast cancer heterogeneity demands that prognostic models must be biologically driven and recent clinical evidence indicates that future prognostic signatures need evaluation in the context of early versus late metastatic risk prediction. The aim of our work was to identify biologically validated quantitative imaging parameters with improved correlation to clinical outcome, and to address some of the remaining obstacles for a truly robust prognostic model in clinical use.
Method: We identified 4 seed proteins (ezrin/radixin/moesin-cofilin), along with several kinases as biologically relevant subnetwork of proteins that control tumor cell motility and metastasis. Patient-derived breast cancer tumour samples were used to perform a combination of imaging methods such as Fluoresecence lifetime imaging microscopy, automated segmentation and co-localisation intensity analysis. A complexity optimized Bayesian proportional hazard regression model was performed on a total of 419 breast cancer patients to validate time dependent predictions using traditional clinicopathological, genomic and our novel optical imaging-derived parameters. An independent dataset of 300 patient samples from the Leeds Institute of Molecular Medicine is currently being evaluated, representing a large cross centre validation of our integrated model.
Results: We demonstrate that the traditional gold standard clinico-pathological variables are poor predictors for patients that survive long periods, and that their predictive significance (in terms of hazard ratios) varies significantly between two temporal cohorts where the adjuvant treatments are vastly different. Moreover, we investigate the predictive accuracy of a combined imaging/clinicopathological model compared with genomic/clinicopathological models. We demonstrate how to reduce over-fitting to help improve the performance of prognostic models. Results of an integrated model combining genomic and imaging parameters are still awaited.
Discussion: We have produced the first optical imaging-derived multivariate tumour metastatic signature, which measures underlying key biological variables involved in regulating cancer cell motility. Using Bayesian proportional hazards regression in a time-dependent manner, we highlight the inadequacies of existing prediction tools and present a model combining the clinicopathological parameters with our imaging-based metastatic signature, as an integrative reproducible prognostic tool across different temporal cohorts.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-10-29.
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Affiliation(s)
- I Sheeba
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - M Kelleher
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - K Lawler
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - F Festy
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - P Barber
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - E Shamill
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - P Gargi
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - G Weitsman
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - J Barrett
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - G Fruhwirth
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - L Huang
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - I Tullis
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - N Woodman
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - S Pinder
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - E Ofo
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - L Fernandes
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - M Beutler
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - S Ameer-Beg
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - L Holmberg
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - A Purushotham
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - F Fraternali
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - J Condeelis
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - A Hanby
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - C Gillett
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - P Ellis
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - B Vojnovic
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - A Coolen
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
| | - T Ng
- Kings College London, Guy's Medical School Campus, London, England, United Kingdom; King's College London, Strand Campus, London, England, United Kingdom; Guy's and St Thomas Foundation Trust, London, England, United Kingdom; Gray Institute for Radiation Oncology & Biology, University of Oxford, England, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, England, United Kingdom
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21
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Matthews DR, Fruhwirth GO, Weitsman G, Carlin LM, Ofo E, Keppler M, Barber PR, Tullis IDC, Vojnovic B, Ng T, Ameer-Beg SM. A multi-functional imaging approach to high-content protein interaction screening. PLoS One 2012; 7:e33231. [PMID: 22506000 PMCID: PMC3323588 DOI: 10.1371/journal.pone.0033231] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 02/06/2012] [Indexed: 12/20/2022] Open
Abstract
Functional imaging can provide a level of quantification that is not possible in what might be termed traditional high-content screening. This is due to the fact that the current state-of-the-art high-content screening systems take the approach of scaling-up single cell assays, and are therefore based on essentially pictorial measures as assay indicators. Such phenotypic analyses have become extremely sophisticated, advancing screening enormously, but this approach can still be somewhat subjective. We describe the development, and validation, of a prototype high-content screening platform that combines steady-state fluorescence anisotropy imaging with fluorescence lifetime imaging (FLIM). This functional approach allows objective, quantitative screening of small molecule libraries in protein-protein interaction assays. We discuss the development of the instrumentation, the process by which information on fluorescence resonance energy transfer (FRET) can be extracted from wide-field, acceptor fluorescence anisotropy imaging and cross-checking of this modality using lifetime imaging by time-correlated single-photon counting. Imaging of cells expressing protein constructs where eGFP and mRFP1 are linked with amino-acid chains of various lengths (7, 19 and 32 amino acids) shows the two methodologies to be highly correlated. We validate our approach using a small-scale inhibitor screen of a Cdc42 FRET biosensor probe expressed in epidermoid cancer cells (A431) in a 96 microwell-plate format. We also show that acceptor fluorescence anisotropy can be used to measure variations in hetero-FRET in protein-protein interactions. We demonstrate this using a screen of inhibitors of internalization of the transmembrane receptor, CXCR4. These assays enable us to demonstrate all the capabilities of the instrument, image processing and analytical techniques that have been developed. Direct correlation between acceptor anisotropy and donor FLIM is observed for FRET assays, providing an opportunity to rapidly screen proteins, interacting on the nano-meter scale, using wide-field imaging.
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Affiliation(s)
- Daniel R. Matthews
- Division of Cancer Studies, Randall Division of Cell and Molecular Biophysics, King’s College London, London, United Kingdom
| | - Gilbert O. Fruhwirth
- Division of Cancer Studies, Randall Division of Cell and Molecular Biophysics, King’s College London, London, United Kingdom
| | - Gregory Weitsman
- Division of Cancer Studies, Randall Division of Cell and Molecular Biophysics, King’s College London, London, United Kingdom
| | - Leo M. Carlin
- Division of Cancer Studies, Randall Division of Cell and Molecular Biophysics, King’s College London, London, United Kingdom
| | - Enyinnaya Ofo
- Division of Cancer Studies, Randall Division of Cell and Molecular Biophysics, King’s College London, London, United Kingdom
| | - Melanie Keppler
- Division of Cancer Studies, Randall Division of Cell and Molecular Biophysics, King’s College London, London, United Kingdom
| | - Paul R. Barber
- Division of Cancer Studies, Randall Division of Cell and Molecular Biophysics, King’s College London, London, United Kingdom
- Gray Institute for Radiation Oncology and Biology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Iain D. C. Tullis
- Gray Institute for Radiation Oncology and Biology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Borivoj Vojnovic
- Division of Cancer Studies, Randall Division of Cell and Molecular Biophysics, King’s College London, London, United Kingdom
- Gray Institute for Radiation Oncology and Biology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | - Tony Ng
- Division of Cancer Studies, Randall Division of Cell and Molecular Biophysics, King’s College London, London, United Kingdom
| | - Simon M. Ameer-Beg
- Division of Cancer Studies, Randall Division of Cell and Molecular Biophysics, King’s College London, London, United Kingdom
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22
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Patel GS, Kiuchi T, Lawler K, Ofo E, Fruhwirth GO, Kelleher M, Shamil E, Zhang R, Selvin PR, Santis G, Spicer J, Woodman N, Gillett CE, Barber PR, Vojnovic B, Kéri G, Schaeffter T, Goh V, O'Doherty MJ, Ellis PA, Ng T. The challenges of integrating molecular imaging into the optimization of cancer therapy. Integr Biol (Camb) 2011; 3:603-31. [PMID: 21541433 DOI: 10.1039/c0ib00131g] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We review novel, in vivo and tissue-based imaging technologies that monitor and optimize cancer therapeutics. Recent advances in cancer treatment centre around the development of targeted therapies and personalisation of treatment regimes to individual tumour characteristics. However, clinical outcomes have not improved as expected. Further development of the use of molecular imaging to predict or assess treatment response must address spatial heterogeneity of cancer within the body. A combination of different imaging modalities should be used to relate the effect of the drug to dosing regimen or effective drug concentration at the local site of action. Molecular imaging provides a functional and dynamic read-out of cancer therapeutics, from nanometre to whole body scale. At the whole body scale, an increase in the sensitivity and specificity of the imaging probe is required to localise (micro)metastatic foci and/or residual disease that are currently below the limit of detection. The use of image-guided endoscopic biopsy can produce tumour cells or tissues for nanoscopic analysis in a relatively patient-compliant manner, thereby linking clinical imaging to a more precise assessment of molecular mechanisms. This multimodality imaging approach (in combination with genetics/genomic information) could be used to bridge the gap between our knowledge of mechanisms underlying the processes of metastasis, tumour dormancy and routine clinical practice. Treatment regimes could therefore be individually tailored both at diagnosis and throughout treatment, through monitoring of drug pharmacodynamics providing an early read-out of response or resistance.
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Affiliation(s)
- G S Patel
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, King's College London, Guy's Medical School Campus, London, SE1 1UL, UK.
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23
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Abstract
We present recent data on dynamic imaging of Rac1 activity in live T-cells. Förster resonance energy transfer between enhanced green and monomeric red fluorescent protein pairs which form part of a biosensor molecule provides a metric of this activity. Microscopy is performed using a multi-functional high-content screening instrument using fluorescence anisotropy to provide a means of monitoring protein-protein activity with high temporal resolution. Specifically, the response of T-cells upon interaction of a cell surface receptor with an antibody coated multi-well chamber was measured. We observed dynamic changes in the activity of the biosensor molecules with a time resolution that is difficult to achieve with traditional methodologies for observing Förster resonance energy transfer (fluorescence lifetime imaging using single photon counting or frequency domain techniques) and without spectral corrections that are normally required for intensity based methodologies.
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Affiliation(s)
- D R Matthews
- Richard Dimbleby Department of Cancer Research, New Hunts House, Kings College London, Guy's Medical School Campus, SE11UL, UK.
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24
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Kelleher MT, Fruhwirth G, Patel G, Ofo E, Festy F, Barber PR, Ameer-Beg SM, Vojnovic B, Gillett C, Coolen A, Kéri G, Ellis PA, Ng T. The potential of optical proteomic technologies to individualize prognosis and guide rational treatment for cancer patients. Target Oncol 2009; 4:235-52. [PMID: 19756916 PMCID: PMC2778706 DOI: 10.1007/s11523-009-0116-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 08/28/2009] [Indexed: 12/21/2022]
Abstract
Genomics and proteomics will improve outcome prediction in cancer and have great potential to help in the discovery of unknown mechanisms of metastasis, ripe for therapeutic exploitation. Current methods of prognosis estimation rely on clinical data, anatomical staging and histopathological features. It is hoped that translational genomic and proteomic research will discriminate more accurately than is possible at present between patients with a good prognosis and those who carry a high risk of recurrence. Rational treatments, targeted to the specific molecular pathways of an individual's high-risk tumor, are at the core of tailored therapy. The aim of targeted oncology is to select the right patient for the right drug at precisely the right point in their cancer journey. Optical proteomics uses advanced optical imaging technologies to quantify the activity states of and associations between signaling proteins by measuring energy transfer between fluorophores attached to specific proteins. Förster resonance energy transfer (FRET) and fluorescence lifetime imaging microscopy (FLIM) assays are suitable for use in cell line models of cancer, fresh human tissues and formalin-fixed paraffin-embedded tissue (FFPE). In animal models, dynamic deep tissue FLIM/FRET imaging of cancer cells in vivo is now also feasible. Analysis of protein expression and post-translational modifications such as phosphorylation and ubiquitination can be performed in cell lines and are remarkably efficiently in cancer tissue samples using tissue microarrays (TMAs). FRET assays can be performed to quantify protein-protein interactions within FFPE tissue, far beyond the spatial resolution conventionally associated with light or confocal laser microscopy. Multivariate optical parameters can be correlated with disease relapse for individual patients. FRET-FLIM assays allow rapid screening of target modifiers using high content drug screens. Specific protein-protein interactions conferring a poor prognosis identified by high content tissue screening will be perturbed with targeted therapeutics. Future targeted drugs will be identified using high content/throughput drug screens that are based on multivariate proteomic assays. Response to therapy at a molecular level can be monitored using these assays while the patient receives treatment: utilizing re-biopsy tumor tissue samples in the neoadjuvant setting or by examining surrogate tissues. These technologies will prove to be both prognostic of risk for individuals when applied to tumor tissue at first diagnosis and predictive of response to specifically selected targeted anticancer drugs. Advanced optical assays have great potential to be translated into real-life benefit for cancer patients.
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Affiliation(s)
- Muireann T. Kelleher
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, 2nd Floor, New Hunt House, Guy’s Medical School Campus, London, SE1 1UL UK
- Department Medical Oncology, Guy’s Hospital, London, SE1 9RT UK
| | - Gilbert Fruhwirth
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, 2nd Floor, New Hunt House, Guy’s Medical School Campus, London, SE1 1UL UK
| | - Gargi Patel
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, 2nd Floor, New Hunt House, Guy’s Medical School Campus, London, SE1 1UL UK
| | - Enyinnaya Ofo
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, 2nd Floor, New Hunt House, Guy’s Medical School Campus, London, SE1 1UL UK
| | - Frederic Festy
- Biomaterial, Biomimetics & Biophotonics Research Group, King’s College London, London, UK
| | - Paul R. Barber
- Gray Institute for Radiation Oncology & Biology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford, OX3 7DQ UK
| | - Simon M. Ameer-Beg
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, 2nd Floor, New Hunt House, Guy’s Medical School Campus, London, SE1 1UL UK
| | - Borivoj Vojnovic
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, 2nd Floor, New Hunt House, Guy’s Medical School Campus, London, SE1 1UL UK
- Gray Institute for Radiation Oncology & Biology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford, OX3 7DQ UK
| | - Cheryl Gillett
- Guy’s & St Thomas’ Breast Tissue & Data Bank, King’s College London, Guy’s Hospital, London, SE1 9RT UK
| | - Anthony Coolen
- Department of Mathematics, King’s College London, Strand Campus, London, WC2R 2LS UK
| | - György Kéri
- Vichem Chemie Research Ltd., Herman Ottó utca 15, Budapest, Hungary
- Pathobiochemistry Research Group of Hungarian Academy of Science, Semmelweis University, Budapest, 1444 Bp 8. POB 260, Hungary
| | - Paul A. Ellis
- Department Medical Oncology, Guy’s Hospital, London, SE1 9RT UK
| | - Tony Ng
- Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, Kings College London, 2nd Floor, New Hunt House, Guy’s Medical School Campus, London, SE1 1UL UK
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25
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Kelleher MT, Festy F, Barber PR, Gillett C, Ofo E, Coolen A, Pinder S, Patel G, Vojnovic B, Ng T, Ellis PA. Use of novel optical proteomics to profile breast cancer patients leading to individualised prognosis and tailored treatment. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e22090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22090 Background: Optical proteomics quantifies interactions between proteins and post-translational modifications by measuring Förster resonance energy transfer (FRET) quantified by fluorescence lifetime imaging microscopy (FLIM). This project aims to derive multiple high throughput optical proteomic markers, to predict metastatic risk at first diagnosis, and to perturb ‘high risk' protein-protein interactions using targeted therapeutics. This initial step develops robust FRET/FLIM assays, suitable for use in formalin fixed paraffin embedded (FFPE) tissue to be correlated with patient outcome. Methods: Fluorophore-conjugated antibodies to proteins involved in cell migration and survival, were applied to tissue microarrays (TMA), created from archived FFPE invasive ductal breast carcinoma samples. Where fluorophores are located within nanometer proximity, FRET occurs, thus allowing quantification of protein-protein interaction. Ezrin and PKCα phosphorylation, distribution, and interaction were imaged on four TMAs (patients diagnosed with early breast cancer 1984 -1987: 20 years follow-up data). Results: 71 patient samples were optically imaged. Patients were clustered based on the pairwise distances between 18 optical variables ‘input data'. Data are represented on self organising maps and dendrograms and correlated with clinical outcome ‘output data', displaying a heatmap distribution. Conclusions: Ezrin and PKCα phosphorylation, distribution, and interaction imaged optically within FFPE contain prognostic information regarding metastatic outcome in breast cancer, thus stepping ever closer to individualising prognosis. These advanced optics-based parameters informing on metastatic potential will be validated in prospective studies in conjunction with FRET/FLIM assays measuring HER2/HER3 dimerisation, and EGFR and HER2 ubiquitination in order to improve patient selection for targeted therapy. No significant financial relationships to disclose.
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Affiliation(s)
- M. T. Kelleher
- KCL and GKT Cancer Centre, London, United Kingdom; King's College London, London, United Kingdom; University of Oxford, Oxford, United Kingdom; Guy's and St Thomas' Hospitals and KCL, London, United Kingdom; Guy's Kings and St Thomas Cancer Centre, London, United Kingdom
| | - F. Festy
- KCL and GKT Cancer Centre, London, United Kingdom; King's College London, London, United Kingdom; University of Oxford, Oxford, United Kingdom; Guy's and St Thomas' Hospitals and KCL, London, United Kingdom; Guy's Kings and St Thomas Cancer Centre, London, United Kingdom
| | - P. R. Barber
- KCL and GKT Cancer Centre, London, United Kingdom; King's College London, London, United Kingdom; University of Oxford, Oxford, United Kingdom; Guy's and St Thomas' Hospitals and KCL, London, United Kingdom; Guy's Kings and St Thomas Cancer Centre, London, United Kingdom
| | - C. Gillett
- KCL and GKT Cancer Centre, London, United Kingdom; King's College London, London, United Kingdom; University of Oxford, Oxford, United Kingdom; Guy's and St Thomas' Hospitals and KCL, London, United Kingdom; Guy's Kings and St Thomas Cancer Centre, London, United Kingdom
| | - E. Ofo
- KCL and GKT Cancer Centre, London, United Kingdom; King's College London, London, United Kingdom; University of Oxford, Oxford, United Kingdom; Guy's and St Thomas' Hospitals and KCL, London, United Kingdom; Guy's Kings and St Thomas Cancer Centre, London, United Kingdom
| | - A. Coolen
- KCL and GKT Cancer Centre, London, United Kingdom; King's College London, London, United Kingdom; University of Oxford, Oxford, United Kingdom; Guy's and St Thomas' Hospitals and KCL, London, United Kingdom; Guy's Kings and St Thomas Cancer Centre, London, United Kingdom
| | - S. Pinder
- KCL and GKT Cancer Centre, London, United Kingdom; King's College London, London, United Kingdom; University of Oxford, Oxford, United Kingdom; Guy's and St Thomas' Hospitals and KCL, London, United Kingdom; Guy's Kings and St Thomas Cancer Centre, London, United Kingdom
| | - G. Patel
- KCL and GKT Cancer Centre, London, United Kingdom; King's College London, London, United Kingdom; University of Oxford, Oxford, United Kingdom; Guy's and St Thomas' Hospitals and KCL, London, United Kingdom; Guy's Kings and St Thomas Cancer Centre, London, United Kingdom
| | - B. Vojnovic
- KCL and GKT Cancer Centre, London, United Kingdom; King's College London, London, United Kingdom; University of Oxford, Oxford, United Kingdom; Guy's and St Thomas' Hospitals and KCL, London, United Kingdom; Guy's Kings and St Thomas Cancer Centre, London, United Kingdom
| | - T. Ng
- KCL and GKT Cancer Centre, London, United Kingdom; King's College London, London, United Kingdom; University of Oxford, Oxford, United Kingdom; Guy's and St Thomas' Hospitals and KCL, London, United Kingdom; Guy's Kings and St Thomas Cancer Centre, London, United Kingdom
| | - P. A. Ellis
- KCL and GKT Cancer Centre, London, United Kingdom; King's College London, London, United Kingdom; University of Oxford, Oxford, United Kingdom; Guy's and St Thomas' Hospitals and KCL, London, United Kingdom; Guy's Kings and St Thomas Cancer Centre, London, United Kingdom
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26
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Affiliation(s)
| | | | - A Kalan
- Northwick Park Hospital, Harrow Departments of Otolaryngology
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27
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Affiliation(s)
- E Ofo
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Nethermayne, Basildon SS16 5NL.
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28
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Abstract
The use of steroids during rhinoplasty to reduce post-operative periorbital oedema and ecchymosis has been advocated. A number of randomized controlled trials have demonstrated the benefit of steroids in rhinoplasty. The aim of this study was to determine current UK practice in the use of steroids during rhinoplasty performed by otolaryngologists.A postal survey of consultant otolaryngologists in the UK was conducted. We received 203 responses, with 115 consultants performing 12 or more rhinoplasties per year. Only 28 consultants (24 per cent) used steroids routinely in patients undergoing rhinoplasty and of these 11 used a protocol, although this was unpublished. Dexamethasone was the most common steroid used (82 per cent), being administered as a single intravenous dose of 8 mg in the majority of cases (54 per cent). There was no correlation between the use of steroids and the number of rhinoplasties performed by individual consultants.Despite the evidence supporting the use of steroids to reduce post-operative sequelae following rhinoplasty, only a minority of consultants in the UK appear to use them as part of their practice.
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Affiliation(s)
- E Ofo
- Department of Otolaryngology, Head & Neck Surgery and Audiological Medicine, Northwick Park & St Mark's Hospital, Harrow, UK.
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