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Smits RWH, van Dis V, Datema FR. Large chondroid syringoma in the reconstructed nasal tip: Diagnostic dilemmas and surgical management. JAAD Case Rep 2021; 15:39-41. [PMID: 34401427 PMCID: PMC8355822 DOI: 10.1016/j.jdcr.2021.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Roeland W H Smits
- Department of Otolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Vera van Dis
- Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Frank R Datema
- Department of Otolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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Aaboubout Y, Barroso EM, Algoe M, Ewing-Graham PC, Ten Hove I, Mast H, Hardillo JA, Sewnaik A, Monserez DA, Keereweer S, Jonker BP, van Lanschot CGF, Smits RWH, Nunes Soares MR, Ottevanger L, Matlung SE, Seegers PA, van Dis V, Verdijk RM, Wolvius EB, Caspers PJ, Bakker Schut TC, Baatenburg de Jong RJ, Puppels GJ, Koljenović S. Intraoperative Assessment of Resection Margins in Oral Cavity Cancer: This is the Way. J Vis Exp 2021. [PMID: 34028453 DOI: 10.3791/62446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The goal of head and neck oncological surgery is complete tumor resection with adequate resection margins while preserving acceptable function and appearance. For oral cavity squamous cell carcinoma (OCSCC), different studies showed that only 15%-26% of all resections are adequate. A major reason for the low number of adequate resections is the lack of information during surgery; the margin status is only available after the final histopathologic assessment, days after surgery. The surgeons and pathologists at the Erasmus MC University Medical Center in Rotterdam started the implementation of specimen-driven intraoperative assessment of resection margins (IOARM) in 2013, which became the standard of care in 2015. This method enables the surgeon to turn an inadequate resection into an adequate resection by performing an additional resection during the initial surgery. Intraoperative assessment is supported by a relocation method procedure that allows accurate identification of inadequate margins (found on the specimen) in the wound bed. The implementation of this protocol resulted in an improvement of adequate resections from 15%-40%. However, the specimen-driven IOARM is not widely adopted because grossing fresh tissue is counter-intuitive for pathologists. The fear exists that grossing fresh tissue will deteriorate the anatomical orientation, shape, and size of the specimen and therefore will affect the final histopathologic assessment. These possible negative effects are countered by the described protocol. Here, the protocol for specimen-driven IOARM is presented in detail, as performed at the institute.
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Affiliation(s)
- Yassine Aaboubout
- Department of Pathology, Erasmus MC University Medical Center; Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC University Medical Center
| | - Elisa M Barroso
- Department of Pathology, Erasmus MC University Medical Center; Department of Oral and Maxillofacial Surgery, Erasmus MC University Medical Center; Department of Dermatology, Erasmus MC University Medical Center
| | - Mahesh Algoe
- Department of Pathology, Erasmus MC University Medical Center
| | | | - Ivo Ten Hove
- Department of Oral and Maxillofacial Surgery, Erasmus MC University Medical Center; Department of Oral and Maxillofacial Surgery, Leiden University Medical Center
| | - Hetty Mast
- Department of Oral and Maxillofacial Surgery, Erasmus MC University Medical Center
| | - José A Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC University Medical Center
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC University Medical Center
| | - Dominiek A Monserez
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC University Medical Center
| | - Stijn Keereweer
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC University Medical Center
| | - Brend P Jonker
- Department of Oral and Maxillofacial Surgery, Erasmus MC University Medical Center
| | | | - Roeland W H Smits
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC University Medical Center
| | - Maria R Nunes Soares
- Department of Pathology, Erasmus MC University Medical Center; Department of Dermatology, Erasmus MC University Medical Center
| | - Lars Ottevanger
- Department of Pathology, Erasmus MC University Medical Center
| | - Sanne E Matlung
- Department of Pathology, Erasmus MC University Medical Center
| | - Paul A Seegers
- PALGA foundation, The nationwide network and registry of histo- and cytopathology
| | - Vera van Dis
- Department of Pathology, Erasmus MC University Medical Center
| | | | - Eppo B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus MC University Medical Center
| | - Peter J Caspers
- Department of Dermatology, Erasmus MC University Medical Center
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Aaboubout Y, van der Toom QM, de Ridder MAJ, De Herdt MJ, van der Steen B, van Lanschot CGF, Barroso EM, Nunes Soares MR, Ten Hove I, Mast H, Smits RWH, Sewnaik A, Monserez DA, Keereweer S, Caspers PJ, Baatenburg de Jong RJ, Bakker Schut TC, Puppels GJ, Hardillo JA, Koljenović S. Is the Depth of Invasion a Marker for Elective Neck Dissection in Early Oral Squamous Cell Carcinoma? Front Oncol 2021; 11:628320. [PMID: 33777774 PMCID: PMC7996205 DOI: 10.3389/fonc.2021.628320] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/01/2021] [Indexed: 12/12/2022] Open
Abstract
Objective The depth of invasion (DOI) is considered an independent risk factor for occult lymph node metastasis in oral cavity squamous cell carcinoma (OCSCC). It is used to decide whether an elective neck dissection (END) is indicated in the case of a clinically negative neck for early stage carcinoma (pT1/pT2). However, there is no consensus on the cut-off value of the DOI for performing an END. The aim of this study was to determine a cut-off value for clinical decision making on END, by assessing the association of the DOI and the risk of occult lymph node metastasis in early OCSCC. Methods A retrospective cohort study was conducted at the Erasmus MC, University Medical Centre Rotterdam, The Netherlands. Patients surgically treated for pT1/pT2 OCSCC between 2006 and 2012 were included. For all cases, the DOI was measured according to the 8th edition of the American Joint Committee on Cancer guideline. Patient characteristics, tumor characteristics (pTN, differentiation grade, perineural invasion, and lymphovascular invasion), treatment modality (END or watchful waiting), and 5-year follow-up (local recurrence, regional recurrence, and distant metastasis) were obtained from patient files. Results A total of 222 patients were included, 117 pT1 and 105 pT2. Occult lymph node metastasis was found in 39 of the 166 patients who received END. Univariate logistic regression analysis showed DOI to be a significant predictor for occult lymph node metastasis (odds ratio (OR) = 1.3 per mm DOI; 95% CI: 1.1-1.5, p = 0.001). At a DOI of 4.3 mm the risk of occult lymph node metastasis was >20% (all subsites combined). Conclusion The DOI is a significant predictor for occult lymph node metastasis in early stage oral carcinoma. A NPV of 81% was found at a DOI cut-off value of 4 mm. Therefore, an END should be performed if the DOI is >4 mm.
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Affiliation(s)
- Yassine Aaboubout
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Quincy M van der Toom
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Maria A J de Ridder
- Department of Medical informatics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Maria J De Herdt
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Berdine van der Steen
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Cornelia G F van Lanschot
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Elisa M Barroso
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Maria R Nunes Soares
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Ivo Ten Hove
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Hetty Mast
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Roeland W H Smits
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Dominiek A Monserez
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Stijn Keereweer
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Peter J Caspers
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Tom C Bakker Schut
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Gerwin J Puppels
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - José A Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Senada Koljenović
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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Aaboubout Y, ten Hove I, Smits RWH, Hardillo JA, Puppels GJ, Koljenovic S. Specimen-driven intraoperative assessment of resection margins should be standard of care for oral cancer patients. Oral Dis 2021; 27:111-116. [PMID: 32816373 PMCID: PMC7821253 DOI: 10.1111/odi.13619] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 06/29/2020] [Accepted: 08/13/2020] [Indexed: 12/24/2022]
Abstract
With an incidence of 350.000 new cases per year, cancer of the oral cavity ranks among the 10 most common solid organ cancers. Most of these cancers are squamous cell carcinomas. Five-year survival is about 50%. It has been shown that clear resection margins (>5 mm healthy tissue surrounding the resected tumor) have a significant positive effect on locoregional control and survival. It is not uncommon that the resection margins of oral tumors are inadequate. However, when providing the surgeon with intraoperative feedback on the resection margin status, it is expected that obtaining adequate resection margins is improved. In this respect, it has been shown that specimen-driven intraoperative assessment of resection margins is superior to defect-driven intraoperative assessment of resection margins. In this concise report, it is described how a specimen-driven approach can increase the rate of adequate resections of oral cavity squamous cell carcinoma as well as that it is discussed how intraoperative assessment can be further improved with regard to the surgical treatment of oral cavity squamous cell carcinoma.
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Affiliation(s)
- Yassine Aaboubout
- Depatment of PathologyErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
- Department of Otorhinolaryngology and Head and Neck SurgeryErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Ivo ten Hove
- Department of Oral and Maxillofacial SurgeryErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
- Department of Oral and Maxillofacial SurgeryLUMCLeiden University Medical CenterRotterdamThe Netherlands
| | - Roeland W. H. Smits
- Department of Otorhinolaryngology and Head and Neck SurgeryErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Jose A. Hardillo
- Department of Otorhinolaryngology and Head and Neck SurgeryErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Gerwin J. Puppels
- Department of DermatologyErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Senada Koljenovic
- Depatment of PathologyErasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
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5
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Smits RWH, van Lanschot CGF, Aaboubout Y, de Ridder M, Hegt VN, Barroso EM, Meeuwis CA, Sewnaik A, Hardillo JA, Monserez D, Keereweer S, Mast H, Hove IT, Bakker Schut TC, Baatenburg de Jong RJ, Puppels GJ, Koljenović S. Intraoperative Assessment of the Resection Specimen Facilitates Achievement of Adequate Margins in Oral Carcinoma. Front Oncol 2020; 10:614593. [PMID: 33425769 PMCID: PMC7786304 DOI: 10.3389/fonc.2020.614593] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Received: 10/06/2020] [Accepted: 11/20/2020] [Indexed: 01/10/2023] Open
Abstract
Background Inadequate resection margins in oral cavity squamous cell carcinoma have an adverse effect on patient outcome. Intraoperative assessment provides immediate feedback enabling the surgeon to achieve adequate resection margins. The goal of this study was to evaluate the value of specimen-driven intraoperative assessment by comparing the margin status in the period before and the period after the introduction of specimen-driven assessment as a standard of care (period 2010-2012 vs period 2013-2017). Methods A cohort of patients surgically treated for oral squamous cell carcinoma at the Erasmus MC Cancer Institute, Rotterdam, between 2010-2012 was studied retrospectively and compared to results of a prospectively collected cohort between 2013-2017. The frequency, type and results of intraoperative assessment of resection margins were analyzed. Results One hundred seventy-four patients were included from 2010-2012, 241 patients were included from 2013-2017. An increase in the frequency of specimen-driven assessment was seen between the two periods, from 5% in 2010-2012 to 34% in 2013-2017. When performing specimen-driven assessment, 16% tumor-positive resection margins were found in 2013-2017, compared to 43% tumor-positive resection margins overall in 2010-2012. We found a significant reduction of inadequate resection margins for specimen-driven intraoperative assessment (p < 0.001). Also, tumor recurrence significantly decreased, and disease-specific survival improved when performing specimen-driven intraoperative assessment. Conclusions Specimen-driven intraoperative assessment improves resection margins and consequently, the outcome of oral cancer patients. We advocate this method as standard of care.
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Affiliation(s)
- Roeland W H Smits
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands.,Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Cornelia G F van Lanschot
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands.,Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Yassine Aaboubout
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Maria de Ridder
- Department of Medical Informatics, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Vincent Noordhoek Hegt
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Elisa M Barroso
- Department of Medical Informatics, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Oral and Maxillofacial surgery, Special Dental Care, and Orthodontics, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Cees A Meeuwis
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jose A Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Dominiek Monserez
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Stijn Keereweer
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Hetty Mast
- Department of Oral and Maxillofacial surgery, Special Dental Care, and Orthodontics, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Ivo Ten Hove
- Department of Oral and Maxillofacial surgery, Special Dental Care, and Orthodontics, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Tom C Bakker Schut
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Gerwin J Puppels
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Senada Koljenović
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
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6
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van Lanschot CGF, Mast H, Hardillo JA, Monserez D, Ten Hove I, Barroso EM, Cals FLJ, Smits RWH, van der Kamp MF, Meeuwis CA, Sewnaik A, Verdijk R, van Leenders GJLH, Noordhoek Hegt V, Bakker Schut TC, Baatenburg de Jong RJ, Puppels GJ, Koljenović S. Relocation of inadequate resection margins in the wound bed during oral cavity oncological surgery: A feasibility study. Head Neck 2019; 41:2159-2166. [PMID: 30706624 PMCID: PMC6618026 DOI: 10.1002/hed.25690] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 10/09/2017] [Revised: 12/31/2018] [Accepted: 01/10/2019] [Indexed: 11/10/2022] Open
Abstract
Background Specimen‐driven intraoperative assessment of the resection margins provides immediate feedback if an additional excision is needed. However, relocation of an inadequate margin in the wound bed has shown to be difficult. The objective of this study is to assess a reliable method for accurate relocation of inadequate tumor resection margins in the wound bed after intraoperative assessment of the specimen. Methods During oral cavity cancer surgery, the surgeon placed numbered tags on both sides of the resection line in a pair‐wise manner. After resection, one tag of each pair remained on the specimen and the other tag in the wound bed. Upon detection of an inadequate margin in the specimen, the tags were used to relocate this margin in the wound bed. Results The method was applied during 80 resections for oral cavity cancer. In 31 resections an inadequate margin was detected, and based on the paired tagging an accurate additional resection was achieved. Conclusion Paired tagging facilitates a reliable relocation of inadequate margins, enabling an accurate additional resection during the initial surgery.
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Affiliation(s)
- Cornelia G F van Lanschot
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hetty Mast
- Department of Oral and Maxillofacial surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jose A Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dominiek Monserez
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ivo Ten Hove
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Oral and Maxillofacial surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Elisa M Barroso
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Froukje L J Cals
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roeland W H Smits
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Martine F van der Kamp
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Cees A Meeuwis
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rob Verdijk
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Geert J L H van Leenders
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent Noordhoek Hegt
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tom C Bakker Schut
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gerwin J Puppels
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Senada Koljenović
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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7
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Santos IP, Barroso EM, Bakker Schut TC, Caspers PJ, van Lanschot CGF, Choi DH, van der Kamp MF, Smits RWH, van Doorn R, Verdijk RM, Noordhoek Hegt V, von der Thüsen JH, van Deurzen CHM, Koppert LB, van Leenders GJLH, Ewing-Graham PC, van Doorn HC, Dirven CMF, Busstra MB, Hardillo J, Sewnaik A, Ten Hove I, Mast H, Monserez DA, Meeuwis C, Nijsten T, Wolvius EB, Baatenburg de Jong RJ, Puppels GJ, Koljenović S. Raman spectroscopy for cancer detection and cancer surgery guidance: translation to the clinics. Analyst 2018; 142:3025-3047. [PMID: 28726868 DOI: 10.1039/c7an00957g] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Oncological applications of Raman spectroscopy have been contemplated, pursued, and developed at academic level for at least 25 years. Published studies aim to detect pre-malignant lesions, detect cancer in less invasive stages, reduce the number of unnecessary biopsies and guide surgery towards the complete removal of the tumour with adequate tumour resection margins. This review summarizes actual clinical needs in oncology that can be addressed by spontaneous Raman spectroscopy and it provides an overview over the results that have been published between 2007 and 2017. An analysis is made of the current status of translation of these results into clinical practice. Despite many promising results, most of the applications addressed in scientific studies are still far from clinical adoption and commercialization. The main hurdles are identified, which need to be overcome to ensure that in the near future we will see the first Raman spectroscopy-based solutions being used in routine oncologic diagnostic and surgical procedures.
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Affiliation(s)
- Inês P Santos
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Smits RWH, Ten Hove I, Dronkers EAC, Bakker Schut TC, Mast H, Baatenburg de Jong RJ, Wolvius EB, Puppels GJ, Koljenović S. Evaluation of bone resection margins of segmental mandibulectomy for oral squamous cell carcinoma. Int J Oral Maxillofac Surg 2018; 47:959-964. [PMID: 29605084 DOI: 10.1016/j.ijom.2018.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 01/15/2018] [Accepted: 03/09/2018] [Indexed: 12/01/2022]
Abstract
Resection margins are frequently studied in patients with oral squamous cell carcinoma and are accepted as a constant prognostic factor. While most evidence is based on soft tissue margins, reported data for bone resection margins are scarce. The aim of this retrospective study was to evaluate and determine the utility of surgical margins in bone resections for oral cavity squamous cell carcinoma (OCSCC). The status of bone resection margins and their impact on survival was investigated in patients who had undergone segmental mandibulectomy for OCSCC. Medical records were retrieved for the years 2000-2012; 127 patients were identified and included in the study. Tumour-positive bone resection margins were found in 21% of the patients. The 5-year overall survival was significantly lower in this group (P<0.005). Therefore, there is a need for intraoperative feedback on the status of bone resection margins to enable immediate additional resection where necessary. Although the lack of intraoperative methods for the evaluation of bone tissue has been addressed by many authors, there is still no reliable method for widespread use. Future research should focus on an objective, accurate, and rapid method of intraoperative assessment for the entire bone resection margin to optimize patient outcomes.
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Affiliation(s)
- R W H Smits
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands; Centre for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ivo Ten Hove
- Centre for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - E A C Dronkers
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - T C Bakker Schut
- Centre for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - H Mast
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - R J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - G J Puppels
- Centre for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - S Koljenović
- Department of Pathology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
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9
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Barroso EM, Ten Hove I, Bakker Schut TC, Mast H, van Lanschot CGF, Smits RWH, Caspers PJ, Verdijk R, Noordhoek Hegt V, Baatenburg de Jong RJ, Wolvius EB, Puppels GJ, Koljenović S. Raman spectroscopy for assessment of bone resection margins in mandibulectomy for oral cavity squamous cell carcinoma. Eur J Cancer 2018; 92:77-87. [PMID: 29428867 DOI: 10.1016/j.ejca.2018.01.068] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/22/2017] [Accepted: 01/07/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the potential of Raman spectroscopy for detection of oral cavity squamous cell carcinoma (OCSCC) in bone resection surfaces during mandibulectomy. MATERIALS & METHODS Raman mapping experiments were performed on fresh mandible resection specimens from patients treated with mandibulectomy for OCSCC. A tumour detection algorithm was created based on water concentration and the high-wavenumber range (2800 cm-1-3050 cm-1) of the Raman spectra. RESULTS Twenty-six ex vivo Raman mapping experiments were performed on 26 fresh mandible resection specimens obtained from 22 patients. The algorithm was applied on an independent test set and showed an accuracy of 95%, a sensitivity of 95%, and a specificity of 87%. CONCLUSION These results form the basis for further development of a Raman spectroscopy tool as an objective method for intraoperative assessment of bone resection margins.
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Affiliation(s)
- Elisa M Barroso
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Ivo Ten Hove
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Tom C Bakker Schut
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Hetty Mast
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Cornelia G F van Lanschot
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Roeland W H Smits
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Peter J Caspers
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Rob Verdijk
- Department of Pathology, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Vincent Noordhoek Hegt
- Department of Pathology, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Eppo B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Gerwin J Puppels
- Center for Optical Diagnostics and Therapy, Department of Dermatology, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Senada Koljenović
- Department of Pathology, Erasmus University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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10
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Barroso EM, Smits RWH, van Lanschot CGF, Caspers PJ, Ten Hove I, Mast H, Sewnaik A, Hardillo JA, Meeuwis CA, Verdijk R, Noordhoek Hegt V, Baatenburg de Jong RJ, Wolvius EB, Bakker Schut TC, Koljenović S, Puppels GJ. Water Concentration Analysis by Raman Spectroscopy to Determine the Location of the Tumor Border in Oral Cancer Surgery. Cancer Res 2016; 76:5945-5953. [PMID: 27530325 DOI: 10.1158/0008-5472.can-16-1227] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/06/2016] [Indexed: 11/16/2022]
Abstract
Adequate resection of oral cavity squamous cell carcinoma (OCSCC) means complete tumor removal with a clear margin of more than 5 mm. For OCSCC, 85% of the surgical resections appear inadequate. Raman spectroscopy is an objective and fast tool that can provide real-time information about the molecular composition of tissue and has the potential to provide an objective and fast intraoperative assessment of the entire resection surface. A previous study demonstrated that OCSCC can be discriminated from healthy surrounding tissue based on the higher water concentration in tumor. In this study, we investigated how the water concentration changes across the tumor border toward the healthy surrounding tissue on freshly excised specimens from the oral cavity. Experiments were performed on tissue sections from 20 patients undergoing surgery for OCSCC. A transition from a high to a lower water concentration, from tumor (76% ± 8% of water) toward healthy surrounding tissue (54% ± 24% of water), takes place over a distance of about 4 to 6 mm across the tumor border. This was accompanied by an increase of the heterogeneity of the water concentration in the surrounding healthy tissue. The water concentration distributions between the regions were significantly different (P < 0.0001). This new finding highlights the potential of Raman spectroscopy for objective intraoperative assessment of the resection margins. Cancer Res; 76(20); 5945-53. ©2016 AACR.
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Affiliation(s)
- Elisa M Barroso
- Department of Oral & Maxillofacial Surgery, Special Dental Care, and Orthodontics, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Roeland W H Smits
- Department of Otorhinolaryngology & Head and Neck Surgery, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Cornelia G F van Lanschot
- Department of Otorhinolaryngology & Head and Neck Surgery, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Peter J Caspers
- Center for Optical Diagnostics & Therapy, Department of Dermatology, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands. RiverD International BV, Rotterdam, The Netherlands
| | - Ivo Ten Hove
- Department of Oral & Maxillofacial Surgery, Special Dental Care, and Orthodontics, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Hetty Mast
- Department of Oral & Maxillofacial Surgery, Special Dental Care, and Orthodontics, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology & Head and Neck Surgery, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - José A Hardillo
- Department of Otorhinolaryngology & Head and Neck Surgery, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Cees A Meeuwis
- Department of Otorhinolaryngology & Head and Neck Surgery, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Rob Verdijk
- Department of Pathology, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | | | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology & Head and Neck Surgery, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Eppo B Wolvius
- Department of Oral & Maxillofacial Surgery, Special Dental Care, and Orthodontics, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Tom C Bakker Schut
- Center for Optical Diagnostics & Therapy, Department of Dermatology, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands. RiverD International BV, Rotterdam, The Netherlands.
| | - Senada Koljenović
- Department of Pathology, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Gerwin J Puppels
- Center for Optical Diagnostics & Therapy, Department of Dermatology, Cancer Institute, Erasmus MC, Rotterdam, The Netherlands. RiverD International BV, Rotterdam, The Netherlands
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11
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Barroso EM, Smits RWH, Bakker Schut TC, ten Hove I, Hardillo JA, Wolvius EB, Baatenburg de Jong RJ, Koljenović S, Puppels GJ. Discrimination between oral cancer and healthy tissue based on water content determined by Raman spectroscopy. Anal Chem 2015; 87:2419-26. [PMID: 25621527 DOI: 10.1021/ac504362y] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Tumor-positive resection margins are a major problem in oral cancer surgery. High-wavenumber Raman spectroscopy is a reliable technique to determine the water content of tissues, which may contribute to differentiate between tumor and healthy tissue. The aim of this study was to examine the use of Raman spectroscopy to differentiate tumor from surrounding healthy tissue in oral squamous cell carcinoma. From 14 patients undergoing tongue resection for squamous cell carcinoma, the water content was determined at 170 locations on freshly excised tongue specimens using the Raman bands of the OH-stretching vibrations (3350-3550 cm(-1)) and of the CH-stretching vibrations (2910-2965 cm(-1)). The results were correlated with histopathological assessment of hematoxylin and eosin stained thin tissue sections obtained from the Raman measurement locations. The water content values from squamous cell carcinoma measurements were significantly higher than from surrounding healthy tissue (p-value < 0.0001). Tumor tissue could be detected with a sensitivity of 99% and a specificity of 92% using a cutoff water content value of 69%. Because the Raman measurements are fast and can be carried out on freshly excised tissue without any tissue preparation, this finding signifies an important step toward the development of an intraoperative tool for tumor resection guidance with the aim of enabling oncological radical surgery and improvement of patient outcome.
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Affiliation(s)
- E M Barroso
- Department of Oral & Maxillofacial Surgery, Special Dental Care, and Orthodontics, ‡Department of Otorhinolaryngology & Head and Neck Surgery, §Center for Optical Diagnostics & Therapy, Department of Dermatology, ∥Department of Pathology, Erasmus MC, University Medical Center Rotterdam , 3015 CE Rotterdam, The Netherlands
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