1
|
Tanaka H, Koyasu S, Kikuchi M, Iima M, Omori K, Nakamoto Y. Utility of Diffusion-weighted MR Imaging for Evaluating the Depth of Invasion in Oral Tongue Squamous Cell Carcinoma. Magn Reson Med Sci 2024:mp.2023-0137. [PMID: 38447989 DOI: 10.2463/mrms.mp.2023-0137] [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: 03/08/2024] Open
Abstract
PURPOSE The 8th edition of the American Joint Committee on Cancer staging system included the depth of invasion (DOI) for the T classification of oral cancer. However, no standardized method has been established to clinically measure the DOI. This study aimed to investigate the accuracy of MRI-based DOI for oral tongue squamous cell carcinoma (OTSCC) in each MRI sequence. METHODS We enrolled 49 patients with histologically proven OTSCC, treated surgically between April 2017 and February 2021. We divided the DOI into three groups using 5 and 10 mm, the thresholds for determining the T stage, and retrospectively evaluated the agreement between MRI-based DOI and pathological DOI (pDOI) for each MRI sequence, axial T1-weighted imaging (T1WI), T2-weighted imaging with fat suppression (FS-T2WI), contrast-enhanced T1WI with fat suppression (CE-T1WI), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) maps. We also divided the DOI into two groups using 3 mm, the threshold for considering elective neck dissection, and evaluated the overestimation rate of MRI-based DOI in lesions with pDOI ≤ 3 mm. RESULTS With 5-mm and 10-mm divisions, the accuracy of the DOI assessment was highest on DWI (0.82, weighted kappa = 0.85). With a 3-mm division, the accuracy was also highest on DWI (0.87, kappa = 0.73). The overestimation rate of the MRI-based DOI in lesions with pDOI ≤ 3 mm was lowest on DWI (27.8%). CONCLUSION DOI on DWI exhibits a comparatively higher rate of concordance with pDOI. DWI may be more useful than other MRI sequences in evaluating the DOI of OTSCC.
Collapse
Affiliation(s)
- Hiroki Tanaka
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Sho Koyasu
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Masahiro Kikuchi
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
- Department of Otolaryngology, Head and Neck Surgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Mami Iima
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
- Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Kyoto, Japan
| | - Koichi Omori
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| |
Collapse
|
2
|
Filauro M, Caprioli S, Lovino Camerino P, Sampieri C, Conforti C, Iandelli A, Benzi P, Gabella G, Bellini E, Mora F, Cittadini G, Peretti G, Marchi F. Depth of Invasion Assessment in Laryngeal Glottic Carcinoma: A Preoperative Imaging Approach for Prognostication. Laryngoscope 2024. [PMID: 38407326 DOI: 10.1002/lary.31369] [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: 10/30/2023] [Revised: 01/26/2024] [Accepted: 02/12/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE The prognostic value of depth of invasion (DOI) in oral squamous cell cancer carcinoma and cutaneous melanoma is well established, while there is a lack of reports investigating the role of DOI in laryngeal cancer. This study aims to explore the association of glottic cancer DOI with other established pathological risk factors and nodal metastasis and evaluate the feasibility of measuring DOI preoperatively using tomographic imaging. METHODS The medical records of glottic cancer patients treated between 2015 and 2020 in a single tertiary referral center were screened retrospectively. Pathologically measured DOI (pDOI) value was also reviewed and registered. Preoperative computer tomography (CT) was used to obtain the radiological DOI (rDOI) measured by two dedicated radiologists. Their inter-rated agreement was assessed and the correlation between pDOI and rDOI was calculated. pDOI association with the main pathology report features was assessed with univariable analysis. Cox univariable and multivariable models were used to explore the role of pDOI on survival. RESULTS Ninety-one patients had pDOI data available, of which 59 also had rDOI data. A strong concordance between the two radiologists was found (concordance correlation coefficient = 0.96); rDOI and pDOI were highly and significantly correlated (R = 0.85; p < 0.001). pDOI was significantly higher in patients with perineural invasion (PNI; p < 0.001), lymphovascular invasion (LVI; p < 0.001), and nodal metastasis (p < 0.001). pDOI was associated with disease-free survival at univariable analysis (p = 0.04) while it did not show a significant impact (p = 0.10) at multivariable analysis. CONCLUSION Glottic carcinoma DOI correlates with PNI, LVI, and nodal metastasis and it can be reliably assessed in a preoperative setting using CT imaging. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
Collapse
Affiliation(s)
- Marta Filauro
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Simone Caprioli
- Unit of Oncological and Interventional Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine (DIMI), University of Genova, Genoa, Italy
| | - Paola Lovino Camerino
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
- Department of Otorhinolaryngology, Ospedale S. Paolo, Savona, Italy
| | - Claudio Sampieri
- Department of Experimental Medicine (DIMES), University of Genova, Genoa, Italy
- Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain
- Functional Unit of Head and Neck Tumors, Hospital Clínic, Barcelona, Spain
| | - Cristina Conforti
- Unit of Oncological and Interventional Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Iandelli
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Pietro Benzi
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Giulia Gabella
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Elisa Bellini
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Francesco Mora
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Giuseppe Cittadini
- Unit of Oncological and Interventional Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giorgio Peretti
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| | - Filippo Marchi
- Unit of Otolaryngology Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
| |
Collapse
|
3
|
Pires Duarte LC, Teixeira K, Dias BMF, Fonseca FP, Travassos DV, Smit C, Castro MAAD, Sampaio AA. Ultrasonography use for tongue cancer management: A scoping review. J Oral Pathol Med 2024; 53:107-113. [PMID: 38355113 DOI: 10.1111/jop.13515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/27/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Tongue cancer is associated with debilitating diseases and poor prognostic outcomes. The use of imaging techniques like ultrasonography to assist in the clinical management of affected patients is desirable, but its reliability remains debatable. Therefore, the aim of this study is to investigate the importance of ultrasound use for the clinicopathological management of tongue cancer. METHODS A scoping review was carried out using specific search strategies in the following electronic databases: PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar. Collected data included bibliographical information, study design, ultrasound equipment, the aim of the ultrasonography use, the timing of ultrasound use during oncological treatment (pre-, trans-, and/or post-operatively), and the advantages and disadvantages of the use of the ultrasound. RESULTS A total of 47 studies were included in this review after following the selection process. The majority of the studies investigated the use of ultrasound pre-operatively for the investigation of lymph node metastases or to determine the tumor thickness and depth of invasion. The sensitivity, specificity, and accuracy of ultrasound to determine clinical lymph node metastases ranged from 47% to 87.2%, from 84.3% to 95.8%, and from 70% to 86.2%, respectively. The sensitivity and specificity to determine the microscopic depth of invasion were 92.3% and from 70.6% to 82.1%, respectively. CONCLUSION Ultrasonography seems to be a reliable imaging technique for the investigation of important prognostic parameters for tongue cancer, including depth of invasion and lymph node metastases.
Collapse
Affiliation(s)
- Luiz Cláudio Pires Duarte
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Karlayle Teixeira
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Felipe Paiva Fonseca
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Denise Vieira Travassos
- Department of Public Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Chané Smit
- Department of Oral and Maxillofacial Pathology, University of Pretoria, Pretoria, South Africa
| | | | - Aline Araujo Sampaio
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
4
|
Kaltoft M, Hahn CH, Wessman M, Hansen ML, Agander TK, Makouei F, Wessel I, Todsen T. Intraoral Ultrasound versus MRI for Depth of Invasion Measurement in Oral Tongue Squamous Cell Carcinoma: A Prospective Diagnostic Accuracy Study. Cancers (Basel) 2024; 16:637. [PMID: 38339388 PMCID: PMC10854529 DOI: 10.3390/cancers16030637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Oral squamous cell carcinoma (OSCC) of the tongue is the most common type of oral cavity cancer, and tumor depth of invasion (DOI) is an important prognostic factor. In this study, we investigated the accuracy of intraoral ultrasound and magnetic resonance imaging (MRI) for assessing DOI in patients with OSCC. Histopathological measurement of DOI was used as a reference standard. We conducted a prospective study including patients planned for surgical treatment of OSCC in the tongue. The DOI was measured in an outpatient setting by intraoral ultrasound and MRI, and was compared to the histopathological DOI measurements. Bland-Altman analysis compared the mean difference and 95% limits of agreement (LOA) for ultrasound and MRI, and the Wilcoxon signed-rank test was used to test for significance. The correlation was evaluated using Pearson's correlation coefficient. We included 30 patients: 26 with T1 or T2 tumors, and 4 with T3 tumors. The mean difference from histopathology DOI was significantly lower for ultrasound compared to MRI (0.95 mm [95% LOA -4.15 mm to 6.06 mm] vs. 1.90 mm [95% LOA -9.02 mm and 12.81 mm], p = 0.023). Ultrasound also led to significantly more correct T-stage classifications in 86.7% (26) of patients compared to 56.7% (17) for MRI, p = 0.015. The Pearson correlation between MRI and histopathology was 0.57 (p < 0.001) and the correlation between ultrasound and histopathology was 0.86 (p < 0.001). This prospective study found that intraoral ultrasound is more accurate than MRI in assessing DOI and for the T-staging of oral tongue cancers. Clinical practice and guidelines should implement intraoral ultrasound accordingly.
Collapse
Affiliation(s)
- Mikkel Kaltoft
- Department of Oto-Rhino-Laryngology, Head- and Neck Surgery and Audiology Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.H.H.); (F.M.); (I.W.); (T.T.)
| | - Christoffer Holst Hahn
- Department of Oto-Rhino-Laryngology, Head- and Neck Surgery and Audiology Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.H.H.); (F.M.); (I.W.); (T.T.)
- Institute of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, 2200 Copenhagen, Denmark
| | - Marcus Wessman
- Department of Oto-Rhino-Laryngology, Head- and Neck Surgery and Audiology Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.H.H.); (F.M.); (I.W.); (T.T.)
| | - Martin Lundsgaard Hansen
- Department of Radiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Tina Klitmøller Agander
- Department of Pathology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Fatemeh Makouei
- Department of Oto-Rhino-Laryngology, Head- and Neck Surgery and Audiology Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.H.H.); (F.M.); (I.W.); (T.T.)
- Institute of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, 2200 Copenhagen, Denmark
| | - Irene Wessel
- Department of Oto-Rhino-Laryngology, Head- and Neck Surgery and Audiology Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.H.H.); (F.M.); (I.W.); (T.T.)
- Institute of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, 2200 Copenhagen, Denmark
| | - Tobias Todsen
- Department of Oto-Rhino-Laryngology, Head- and Neck Surgery and Audiology Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (C.H.H.); (F.M.); (I.W.); (T.T.)
- Institute of Clinical Medicine, Faculty of Health Sciences, Copenhagen University, 2200 Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation, Capital Region, 2100 Copenhagen, Denmark
| |
Collapse
|
5
|
Kumar R, Sherif MP, Manchanda S, Barwad A, Sagar P, Khan MA, Bhalla AS, Singh CA, Kumar R. Depth of Invasion in Carcinoma Tongue: Evaluation of Clinical and Imaging Techniques. Laryngoscope 2024; 134:215-221. [PMID: 37249203 DOI: 10.1002/lary.30791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 05/10/2023] [Accepted: 05/19/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND "Depth of invasion" is an additional index incorporated in 8th AJCC staging system for oral cavity squamous cell carcinoma based on its prognostic significance. Pre-operative assessment by clinical palpation and imaging modalities has been used with limitations. The aim of the study is to compare different techniques including clinical palpation, ultrasound, and magnetic resonance imaging with histopathology for assessment of depth of tumor invasion. MATERIALS Fifty patients of carcinoma tongue (T1-T3) were enrolled. Clinical palpation, Ultrasound tongue, and Magnetic resonance imaging were used to assess depth of tumor invasion. Microscopic depth of invasion was considered as reference. Statistical analysis was done to assess the level of agreement, reliability, and internal consistency. ROC analysis was done to find the "Area Under Curve" for microscopic depth versus ultrasound, MRI, and gross histopathological "depth of invasion". RESULTS Ultrasound tongue showed highest "area under curve", Intra class correlation (ICC:0.786) with a good consistency (Cronbach's Alpha:0.880) with histological reference compared to MRI(ICC:0.689;CA:0.816). Clinical palpation showed weak agreement (Kappa:0.43) for assessing depth. To observe the concordance between ultrasound and microscopic depth, Lin's Concordance Correlation Coefficient (CCC = 0.782) was calculated with 95% limits of agreement. Lin's concordance correlation between ultrasound and microscopic depth showed a good agreement. CONCLUSIONS Ultrasound tongue is a reliable imaging modality for pre-operative T staging by assessing tumor "depth of invasion" in carcinoma tongue patients with good internal consistency as per 8th AJCC staging system. LEVEL OF EVIDENCE 2 (CEBM-Level of Evidence-2.1) Laryngoscope, 134:215-221, 2024.
Collapse
Affiliation(s)
- Rajeev Kumar
- Department of Otolaryngology Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mohammad Ponneth Sherif
- Department of Otolaryngology Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Adarsh Barwad
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Prem Sagar
- Department of Otolaryngology Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Maroof Ahmad Khan
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Chirom Amit Singh
- Department of Otolaryngology Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Otolaryngology Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
6
|
Yoshii H, Izumi H, Fujino R, Kurata M, Inomoto C, Sugiyama T, Nakagohri T, Nomura E, Mukai M, Tajiri T. Subserosal Layer and/or Pancreatic Invasion Based on Anatomical Features as a Novel Prognostic Indicator in Patients with Distal Cholangiocarcinoma. Diagnostics (Basel) 2023; 13:3406. [PMID: 37998542 PMCID: PMC10670817 DOI: 10.3390/diagnostics13223406] [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: 10/05/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023] Open
Abstract
The American Joint Committee on Cancer (AJCC) 8th edition T-staging system for distal cholangiocarcinoma (DCC) proposes classification according to the depth of invasion (DOI); nevertheless, DOI measurement is complex and irreproducible. This study focused on the fibromuscular layer and evaluated whether the presence or absence of penetrating fibromuscular invasion of DCC contributes to recurrence and prognosis. In total, 55 patients pathologically diagnosed with DCC who underwent surgical resection from 2002 to 2022 were clinicopathologically examined. Subserosal layer and/or pancreatic (SS/Panc) invasion, defined as penetration of the fibromuscular layer and invasion of the subserosal layer or pancreas by the cancer, was assessed with other clinicopathological prognostic factors to investigate recurrence and prognostic factors. According to the AJCC 8th edition, there were 11 T1, 28 T2, and 16 T3 cases, with 44 (80%) cases of SS/Panc invasion. The DOI was not significantly different for both recurrence and prognostic factors. In the multivariate analysis, only SS/Panc was identified as an independent factor for prognosis (hazard ratio: 16.1; 95% confidence interval: 2.1-118.8, p = 0.006). In conclusion, while the determination of DOI in DCC does not accurately reflect recurrence and prognosis, the presence of SS/Panc invasion may contribute to the T-staging system.
Collapse
Affiliation(s)
- Hisamichi Yoshii
- Department of Gastroenterological Surgery, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan
| | - Hideki Izumi
- Department of Gastroenterological Surgery, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan
| | - Rika Fujino
- Department of Gastroenterological Surgery, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan
| | - Makiko Kurata
- Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan (T.S.); (T.T.)
| | - Chie Inomoto
- Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan (T.S.); (T.T.)
| | - Tomoko Sugiyama
- Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan (T.S.); (T.T.)
| | - Toshio Nakagohri
- Department of Gastroenterological Surgery, Tokai University Hospital, Isehara 259-1193, Japan
| | - Eiji Nomura
- Department of Gastroenterological Surgery, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan
| | - Masaya Mukai
- Department of Gastroenterological Surgery, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan
| | - Takuma Tajiri
- Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Tokyo 192-0032, Japan (T.S.); (T.T.)
| |
Collapse
|
7
|
Gilja S, Barlow J, Kumar A, Berger MH, Khan MN, Kirke DN, Roof SA. Evaluating depth of invasion across oral cavity subsites as part of the AJCC 8th edition T staging criteria for oral cavity squamous cell carcinoma. Head Neck 2023; 45:2780-2788. [PMID: 37698539 DOI: 10.1002/hed.27497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND The prognostic impact of depth of invasion (DOI) in American Joint Committee on Cancer 8th edition TNM staging for oral cavity squamous cell carcinoma (OCSCCa) across oral cavity subsites is unknown. METHODS Overall survival of patients with pT1-4a OCSCCa in the National Cancer Database (2010-2017), stratified by tumor size and DOI across eight oral cavity subsites, was evaluated using multivariable-adjusted Cox proportional hazards modeling. RESULTS When stratified by tumor size ≤2 cm and >2 cm, DOI >5 mm and DOI >10 mm were only associated with worse overall survival, respectively, for tumors of the oral tongue (Tumor size ≤2 cm, DOI >5 mm v DOI ≤5 mm: HR: 1.31, 95% CI: 1.12-1.53, p < 0.001; Tumor size >2 cm, DOI >10 mm v DOI ≤10 mm: HR: 1.15, 95% CI: 1.01-1.30, p = 0.03). DOI >5 mm and DOI >10 mm was not prognostic for any other tumor location. CONCLUSIONS These findings suggest that the current staging schema for DOI in OCSCCa may not be prognostic across all oral cavity subsites.
Collapse
Affiliation(s)
- Shivee Gilja
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joshua Barlow
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Arvind Kumar
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael H Berger
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mohemmed N Khan
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Diana N Kirke
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Scott A Roof
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
8
|
Au VH, Miller LE, Deschler DG, Lin DT, Richmon JD, Varvares MA. Comparison of Preoperative DOI Estimation in Oral Tongue Cancer With cN0 Disease. Otolaryngol Head Neck Surg 2023; 169:948-953. [PMID: 36861847 DOI: 10.1002/ohn.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/12/2023] [Accepted: 02/15/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To understand the accuracy of pre- and intraoperative estimation of tumor depth of invasion (DOI). STUDY DESIGN A retrospective case-control study. SETTING Patients who presented at 1 institution with oral tongue squamous cell carcinoma that underwent oncologic resection between 2017 and 2019 were identified. METHODS Patients that met the inclusion criteria were included. Patients with nodal, distant, or recurrent disease, prior history of head and neck cancer, or preoperative tumor assessment and/or final histopathology that did not include DOI were excluded. Preoperative DOI estimation and technique and pathology reports were obtained. Our primary outcome was the sensitivity and specificity of DOI estimation modalities including full-thickness biopsy (FTB), manual palpation (MP), punch biopsy (PB), and intraoperative ultrasound (IOUS). RESULTS Tumor DOI was assessed quantitatively preoperatively in 40 patients by FTB (n = 19, 48%), MP (n = 17, 42%), or PB (n = 4, 10%). Additionally, 19 patients underwent IOUS to assess DOI. The sensitivities of FTB, MP, and IOUS for DOI ≥ 4 mm were 83% (confidence interval [CI]: 44%-97%), 83% (CI: 55%-95%), and 90% (CI: 60%-98%), respectively, and the specificities were 85% (CI: 58%-96%), 60% (CI: 23%-88%), and 78% (CI: 45%-94%). CONCLUSION Our study demonstrated that DOI assessment tools measured had similar sensitivity and specificity in stratifying patients with DOI ≥4 mm, with no statistically superior diagnostic test. Our results support the need for additional research into nodal disease prediction and continued refinement of ND decisions with respect to DOI.
Collapse
Affiliation(s)
- Vivienne H Au
- SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Lauren E Miller
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel G Deschler
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Derrick T Lin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeremy D Richmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark A Varvares
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
9
|
Gupta R, Selinger CI, Ashford B, Chua MST, Clark JR, Damian DL, Jackett LA, James C, Johnson S, Ladwa R, Lambie D, McKenzie C, Tan ST, Scolyer RA. Implementing structured pathology reporting protocol for non-melanocytic skin cancers: practical considerations. Pathology 2023; 55:743-759. [PMID: 37573165 DOI: 10.1016/j.pathol.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/14/2023]
Abstract
Non-melanocytic skin cancers (NMSCs) account for five times the incidence of all other cancers combined and cost US $6 billion annually. These are the most frequent specimens encountered in community pathology practice in many Western countries. Lack of standardised structured pathology reporting protocols (SPRPs) can result in omission of critical information or miscommunication leading to suboptimal patient management. The lack of standardised data has significant downstream public health implications, including insufficient data for reliable development of prognostic tools and health-economy planning. The Royal College of Pathologists of Australasia has developed an NMSC SPRP. A multidisciplinary expert committee including pathologists, surgeons, dermatologists, and radiation and medical oncologists from high volume cancer centres was convened. A systematic literature review was performed to identify evidence for including elements as mandatory standards or best practice guidelines. The SPRP and accompanying commentary of evidence, definitions and criteria was peer reviewed by external stakeholders. Finally, the protocol was revised following feedback and trialled in multiple centres prior to implementation. Some parameters utilised clinically for determining management and prognosis including tumour depth, lymphovascular invasion or distance to the margins lack high level evidence in NMSC. Dermatologists, surgeons, and radiation oncologists welcomed the SPRP. Pathologists indicated that the variety of NMSC specimens ranging from curettes to radical resections as well as significant differences in the biological behaviour of different tumours covered by the NMSC umbrella made use of a single protocol difficult. The feedback included that using a SPRP for low risk NMSC was neither clinically justified nor compensated adequately by the Australian Medicare Reimbursement Schedule. Following stakeholder feedback, the SPRP implementation was restricted to excision specimens of head and neck NMSC; and low-risk NMSC, such as superficial basal cell carcinoma, were excluded. Implementing NMSC SPRP fulfils an unmet clinical need. Unlike other cancers, NMSCs generate a range of specimen types and are reported in a wide range of pathology practices. Limiting use of SPRP to NMSC at higher risk of progression and providing formatted templates for easy incorporation into laboratory information systems were essential to successful deployment. In the future, further consideration should be given to implementing the SPRP to include all relevant specimens, including non-head and neck and low-risk NMSC specimens.
Collapse
Affiliation(s)
- Ruta Gupta
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia.
| | | | - Bruce Ashford
- Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia; Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia; Illawarra and Shoalhaven Local Health District, Wollongong, NSW, Australia; School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Margaret S T Chua
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia; The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Vic, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW, Australia; Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Diona L Damian
- Discipline of Dermatology, Bosch Institute, University of Sydney, and Royal Prince Alfred Hospital Sydney, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Louise A Jackett
- Department of Pathology, Austin Health, Melbourne, Vic, Australia
| | | | | | - Rahul Ladwa
- Department of Cancer Care Services, Princess Alexandra Hospital, Woolloongabba, Qld, Australia; Faculty of Medicine, University of Queensland, Herston, Qld, Australia
| | - Duncan Lambie
- Princess Alexandra Hospital, Pathology Queensland, Brisbane, Qld, Australia; Frazer Institute, University of Queensland, Brisbane, Qld, Australia
| | - Catriona McKenzie
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia
| | - Swee T Tan
- Gillies McIndoe Research Institute, Wellington, New Zealand; Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand; Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Vic, Australia
| | - Richard A Scolyer
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia; Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
10
|
Michcik A, Polcyn A, Sikora M, Wach T, Garbacewicz Ł, Drogoszewska B. Oral squamous cell carcinoma - do we always need elective neck dissection? evaluation of clinicopathological factors of greatest prognostic significance: a cross-sectional observational study. Front Oncol 2023; 13:1203439. [PMID: 37781178 PMCID: PMC10539602 DOI: 10.3389/fonc.2023.1203439] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
The aim of the study was to find clinical and pathological factors with the greatest prognostic significance in patients with OSCC. The analysis included 125 patients grouped according to the tumor primary site (TPS): the floor of the mouth (FOM), tongue (TC) and retromolar triangle (RMT). Grading (G), tumor size (pT), nodal metastases (NM), local recurrence (LR), nodal recurrence (NR), perineural invasion (PNI), lymphovascular invasion (LVI), extranodal extension (pENE), and nodal yield (NY) were evaluated in each group. Results With regard to TPS, FOM appeared to be the most metastatic. However, the recurrence rate was similar to TC tumors, which were characterized by higher G than those in other locations. When analyzing G, the highest percentage of LR (40.5%) and NM (34.5%) was observed among patients with G2. As G increased, so did the number of pENE G1 - 7.4%; G2 - 31%; G3 - 35.7%; LVI: G1 - 25.9%; G2 - 50%; G3 - 57.1%; PNI: G1 - 29.6%; G2 - 47.6%; G3 - 92.9%; NR G1 - 14.8%; G2 - 32.1%; G3 - 21.4%. Grading did not affect the type of growth and did not directly affect the occurrence of NR. pT and DOI increased the frequency of NM but we did not observe any effect of pT and DOI on LR, PNI, and LVI. NY in the study group did not increase the risk of NR. Conclusion Tumor primary sites within the FOM, TC, and pT classification are the factors that increase the risk of NM and LR. However, apart from the primary site predisposing to the occurrence of NM, the histological structure of the tumor turned out to be the most important feature affecting the patient's prognosis. The number of cases of pENE+, LVI+, PNI+, NM+, and NR+ increased with the increase in G. Although the pT, DOI increased the frequency of NM, we did not observe the effect of the pT and DOI on LR, PNI and LVI. Thus, even in the case of a small tumor of the FOM and TC with at least G2, elective neck dissection should be performed each time.
Collapse
Affiliation(s)
- Adam Michcik
- Department of Maxillofacial Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Adam Polcyn
- Department of Maxillofacial Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Maciej Sikora
- Department of Maxillofacial Surgery, Hospital of the Ministry Interior, Kielce, Poland
| | - Tomasz Wach
- Department of Maxillofacial Surgery, Medical University of Łódź, Łódź, Poland
| | - Łukasz Garbacewicz
- Department of Maxillofacial Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Barbara Drogoszewska
- Department of Maxillofacial Surgery, Medical University of Gdansk, Gdańsk, Poland
| |
Collapse
|
11
|
Cui M, Sadri N, Awadallah A, Zhou L, Xin W. Late Recurrence of Colorectal Carcinoma in Patients with Malignant Polyp and Risk Factors. Int J Surg Pathol 2023; 31:967-974. [PMID: 35929107 DOI: 10.1177/10668969221113498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Malignant polyps are polypoid lesions that appear benign endoscopically but harbor invasive adenocarcinoma microscopically. Patient with diagnosis of malignant polyp can be managed by surgical resection or endoscopic surveillance. Current literature on long term recurrence is sparse. A total of 76 patients with malignant polyp and follow-up period of over one year are included. Of these, 28 patients underwent endoscopic polypectomy followed by surveillance (group 1). Forty-eight patients underwent segmental colectomy (group 2). In group 1, three patients developed local recurrent pT3 adenocarcinoma (5.9 to 9.7 years) and one patient developed liver metastasis (7.3 years). One patient presented with malignant polyp in another segment of colon (4.0 years). Two of the malignant polyps with local recurrence do not have commonly reported high-risk features, including tumor ≤ 1 mm from resection margin, presence of lymphovascular invasion and high grade tumor, they had invasion depth of >4 mm and harbored a TP53 missense mutation. In group 2, during the follow-up period (1.0-21.8 years, median 9.3 years), none of the patients developed local recurrence. In this study, surveillance group had a local late recurrence rate of 10.7% versus no local recurrence in surgical resection group (0%). Our study shows that depth of invasion of over 4 mm in malignant polyp is a risk factor for late local recurrence if managed by endoscopic surveillance. Further study is needed to explore whether certain molecular alterations, such as TP53 mutation, is a risk factor for late recurrence.
Collapse
Affiliation(s)
- Min Cui
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
| | - Navid Sadri
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
| | - Amad Awadallah
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
| | - Lan Zhou
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
| | - Wei Xin
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
12
|
Yumii K, Ueda T, Urabe Y, Fukuhara M, Chikuie N, Taruya T, Kono T, Hamamoto T, Hattori M, Takumida M, Ishino T, Takeno S. Determining Invasion Depth in Superficial Pharyngeal Carcinoma by Transoral Ultrasonography. Laryngoscope 2023; 133:2192-2197. [PMID: 36440626 DOI: 10.1002/lary.30483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/24/2022] [Accepted: 10/31/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the clinical usefulness of transoral ultrasonography (US) in determining the invasion depth of superficial pharyngeal carcinoma (SPC). Determining the invasion depth of SPC is crucial for transoral surgery including determining treatment strategy. This study aimed to examine the usefulness of transoral US in determining the invasion depth of SPC. METHODS Forty-six patients with 51 lesions who underwent both magnifying endoscopy with narrow-band imaging (ME-NBI) and transoral US were included. The primary outcomes were the sensitivity, specificity, positive (PPV), and negative predictive values (NPV) of ME-NBI and transoral US findings for pathological tumor depth in SPCs. RESULTS The accuracy (82.4%), sensitivity (85.2%), PPV (82.1%), and NPV (82.6%) rates of US for subepithelial propria (SEP) were higher than those of ME-NBI and macroscopic classification, indicating that transoral US is superior to ME-NBI in determining the invasion depth. All cases where the SEP was clearly invaded (SEP deep) could be diagnosed as SEP by transoral US. CONCLUSIONS Transoral US may be useful in determining the invasion depth of SPCs. LEVEL OF EVIDENCE 3 Laryngoscope, 133:2192-2197, 2023.
Collapse
Affiliation(s)
- Kouhei Yumii
- Department of Otorhinolaryngology, Head and Neck Surgery Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tsutomu Ueda
- Department of Otorhinolaryngology, Head and Neck Surgery Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Urabe
- Department of Gastrointestinal Endoscopy and Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Motomitsu Fukuhara
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Nobuyuki Chikuie
- Department of Otorhinolaryngology, Head and Neck Surgery Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takayuki Taruya
- Department of Otorhinolaryngology, Head and Neck Surgery Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takashi Kono
- Department of Otorhinolaryngology, Head and Neck Surgery Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takao Hamamoto
- Department of Otorhinolaryngology, Head and Neck Surgery Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Minoru Hattori
- Center for Medical Education Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masaya Takumida
- Department of Otorhinolaryngology, Head and Neck Surgery Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takashi Ishino
- Department of Otorhinolaryngology, Head and Neck Surgery Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Sachio Takeno
- Department of Otorhinolaryngology, Head and Neck Surgery Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
13
|
Yamauchi M, Ishida T, Minesaki A, Kuratomi Y. WPOI-4/5 Correlates With Lymph Node Recurrence and Poor Prognosis in Early-stage Tongue Squamous Cell Carcinoma. Cancer Diagn Progn 2023; 3:457-462. [PMID: 37405220 PMCID: PMC10316060 DOI: 10.21873/cdp.10239] [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] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/05/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND/AIM Neck management in patients with early-stage tongue cancer remains controversial. The worst pattern of invasion (WPOI) of the primary tumor has been associated with the incidence of regional metastasis. We investigated the prognostic role of WPOI, especially in relation to regional lymph node recurrence and disease-specific survival (DSS). PATIENTS AND METHODS We retrospectively reviewed medical records and evaluated tumor specimens of 38 patients with early-stage tongue cancer who underwent primary tumor resection without elective neck dissection. RESULTS Regional lymph node recurrence rates were significantly higher in patients with WPOI-4/5 compared with WPOI-1 to -3. The 5-year DSS rates were significantly higher for WPOI-1 to -3 than for WPOI-4/5. Notably, patients with WPOI-1 to -3 achieved a 100% 5-year DSS rate with salvage neck dissection and postoperative treatment, even those with cervical lymph node recurrence, whereas patients with WPOI-4/5 had a poorer prognosis. CONCLUSION Patients with WPOI-1 to -3 tumors can be followed up without neck dissection until regional lymph node recurrence is detected, with a good course after salvage treatment. In contrast, patients with WPOI-4/5 tumors who are followed up until the appearance of regional lymph node recurrence have a poor prognosis, even with adequate treatment for recurrent disease.
Collapse
Affiliation(s)
- Moriyasu Yamauchi
- Department of Otolaryngology - Head and Neck Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Tomoya Ishida
- Department of Otolaryngology - Head and Neck Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Akimichi Minesaki
- Department of Otolaryngology - Head and Neck Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
- Department of Pathology and Microbiology, Saga University Faculty of Medicine, Nabeshima, Japan
| | - Yuichiro Kuratomi
- Department of Otolaryngology - Head and Neck Surgery, Saga University Faculty of Medicine, Nabeshima, Japan
| |
Collapse
|
14
|
Naha K, Biedermann G, Nada A, Cousins J, Layfield L, Schnabel J. Preoperative Determination of Depth of Invasion in Oral Cavity Squamous Cell Carcinoma by Standard Cross-Sectional Imaging With Computed Tomography and Positron Emission Tomography/Computed Tomography. Cureus 2023; 15:e40794. [PMID: 37485126 PMCID: PMC10362784 DOI: 10.7759/cureus.40794] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
Background Depth of invasion (DOI) is a known indicator of metastatic potential in oral cavity squamous cell carcinoma (SCC). Our purpose was to investigate the accuracy of preoperative determination of DOI in oral cavity SCC by computed tomography (CT) and positron emission tomography/computed tomography (PET/CT). Methodology A retrospective study was performed using consecutive patients with histologically proven oral cavity SCC presenting to our otorhinolaryngology department between January 2014 and July 2019 who underwent preoperative contrast-enhanced CT and/or PET/CT. Pathological assessment of DOI was determined by a review of pathology reports. The degree of DOI determined by radiographic studies was correlated to pathology results. Results A total of 79 patients were screened of whom appropriate radiographic studies were available for 63 patients. The mean DOI by pathological assessment was 12.3 ± 9.1 mm. CT and PET/CT determined depth both correlated with pathological DOI (r = 0.710; p < 0.001, r = 0.798; p < 0.001). No significant correlation was seen for CT-determined depth (r = 0.136; p = 0.709) or PET-determined depth (r = 0.234; p = 0.707) with pathologically confirmed superficial tumors (<5 mm). For patients with pathological tumor depth >10 mm, CT and PET determined depth both correlated with pathological depth (r = 0.577; p = 0.002, r = 0.668; p = 0.001). The sensitivity and specificity of CT and PET for the identification of deep invasion were 88.2% and 41.7% and 52.9% and 50%, respectively. Conclusions DOI measurement is feasible with routine preoperative CT and PET/CT images and is comparable to pathological measurement in patients with oral cavity SCC.
Collapse
Affiliation(s)
- Kushal Naha
- Hematology and Medical Oncology, University of Missouri, Columbia, USA
| | | | - Ayman Nada
- Radiology, University of Missouri, Columbia, USA
| | | | - Lester Layfield
- Pathology and Laboratory Medicine, University of Missouri, Columbia, USA
| | | |
Collapse
|
15
|
Hashmi AA, Tola R, Rashid K, Ali AH, Dowlah T, Malik UA, Zia S, Saleem M, Anjali F, Irfan M. Clinicopathological Parameters Predicting Nodal Metastasis in Head and Neck Squamous Cell Carcinoma. Cureus 2023; 15:e40744. [PMID: 37485190 PMCID: PMC10361629 DOI: 10.7759/cureus.40744] [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] [Accepted: 06/21/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Squamous cell carcinoma (SCC) is the most common type of malignancy of the head and neck region arising from the mucosal epithelium of the oral cavity and oropharynx. It is a multifactorial disease with a high rate of mortality. Lymph node metastasis is an important prognostic parameter associated with adverse prognosis. This study was conducted to establish a relationship between various clinicopathological characteristics and nodal metastasis in head and neck squamous cell carcinoma (HNSCC). Methods This retrospective study was conducted at Liaquat National Hospital, Karachi, Pakistan. A total of 306 biopsy-proven cases of HNSCC were included in the study. Clinical data, which included age, sex, and site of the lesion, were obtained from the clinical referral forms. Resections of the lesions were performed, and the specimens collected were sent to the laboratory for histological evaluation. The histological subtype, perineural invasion (PNI), depth of invasion (DOI), nodal metastasis, and extranodal extension were assessed, and the association of clinicopathological parameters with nodal metastasis was sought. Results The mean age at diagnosis was 50.26 ± 12.86 years with a female predominance (55.27%), and the mean tumor size was 3.37 ± 1.75 cm. The mean DOI was 1.08 ± 0.67 cm. The most common site of tumor was found to be the oral cavity (68.6%), followed by the tongue (24.2%). Keratinizing SCC (59.5%) was found to be the most prevalent histological subtype. At the time of diagnosis, the majority of the tumors were grade 2 (62.4%). PNI was present in 12.1% of the cases. Nodal metastasis was present in 44.8%, and extranodal extension was present in 17% of the cases. A significant association of nodal metastasis was noted with age, gender, tumor site, tumor size, and DOI. Male patients with HNSCC showed a higher frequency of nodal metastasis than female patients. Patients between the ages of 31 and 50 years with a tumor size of above 4 cm and a DOI of more than 1 cm had a higher frequency of nodal metastasis. Similarly, tumors arising in the oral cavity and the keratinizing subtype were more likely to possess nodal metastasis. Conclusion We found that HNSCCs were more prevalent among the female population, with the most common site being the oral cavity. Nodal metastasis was significantly associated with the keratinizing subtype of SCC, oral cavity location, male gender, and middle age group. Similarly, the tumor size and DOI were important predictors of nodal metastasis in HNSCC in our study.
Collapse
Affiliation(s)
- Atif A Hashmi
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Rutaba Tola
- Internal Medicine, Karachi Medical and Dental College, Karachi, PAK
| | - Khushbakht Rashid
- Internal Medicine, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Abrahim H Ali
- Internal Medicine, Bangladesh Medical College, Dhaka, BGD
| | - Tanim Dowlah
- Internal Medicine, Bangladesh Medical College, Dhaka, BGD
| | | | - Shamail Zia
- Pathology, Jinnah Sindh Medical University, Karachi, PAK
| | | | - Fnu Anjali
- Internal Medicine, Sakhi Baba General Hospital, Sukkur, PAK
| | - Muhammad Irfan
- Statistics, Liaquat National Hospital and Medical College, Karachi, PAK
| |
Collapse
|
16
|
Manchanda S, Bhalla AS, Ponneth MS, Kumar R. Intraoral Ultrasound in Early Stage Tongue Carcinoma. J Ultrasound Med 2023; 42:791-795. [PMID: 36129071 DOI: 10.1002/jum.16101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 06/15/2023]
Abstract
Preoperative assessment of depth of invasion (DOI) is critical in the surgical management of early stage carcinoma tongue. Intraoral ultrasound (IOUS) has been recently described as a cost-effective alternative to MRI in the accurate measurement of DOI. We describe the technique of IOUS in different types of lesions (surface, ulcerative, and exophytic); and provide key imaging pearls for the routine use of this novel ultrasound application.
Collapse
Affiliation(s)
- Smita Manchanda
- Department of Radiodiagnosis and Interventional Radiology, AIIMS, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis and Interventional Radiology, AIIMS, New Delhi, India
| | | | - Rajeev Kumar
- Department of Otorhinolaryngology & Head-Neck Surgery, AIIMS, New Delhi, India
| |
Collapse
|
17
|
Dang RR, Kim J, Qureshi MM, Fazeli SR, Zhao Q, Noonan VL, Sundararajan D, Salama A, Truong MT. Impact of depth of invasion on local recurrence in R0 resected node-negative oral tongue squamous cell carcinoma. Head Neck 2023; 45:561-566. [PMID: 36513522 DOI: 10.1002/hed.27264] [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: 07/07/2022] [Revised: 11/04/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This study evaluates the impact of depth of invasion (DOI) on local recurrence (LR) in node-negative oral tongue squamous cell carcinoma (SCC). METHODS Fifty-one patients were retrospectively reviewed from an institutional database. Patients were evaluated for local control (LC). Cox-proportional hazards modeling was used to calculate hazard ratios. RESULTS There were 84.3% T1/2 and 15.7% T3/4 classification tumors. The 3-year overall survival rate was 97.9%. Local failure rate was 5.7% with a 3-year LC of 93.6%. On Univariate analysis, increased hazard of LR was noted with each unit increase in DOI (HR 1.40, 95% CI 1.07-1.83, p = 0.014). Age, sex, T classification, margins ≥5 mm, lymphovascular invasion (LVI) and perineural invasion (PNI), and adjuvant treatment were not associated with LR. On Multivariate analysis, adjusting for age and adjuvant treatment, results for DOI remained significant (aHR 1.46, 95% CI 1.08-1.98, p = 0.013). CONCLUSION On evaluation of our institutional dataset increasing DOI was associated with increased hazard of local recurrence with oral tongue SCC.
Collapse
Affiliation(s)
- Rushil R Dang
- Division of Maxillofacial Oncology and Reconstructive Surgery, Department of Oral and Maxillofacial Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Jaegak Kim
- Department of Oral and Maxillofacial Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Muhammad M Qureshi
- Department of Radiation Oncology, Boston Medical center, Boston, Massachusetts, USA
| | - Shoreh Roghayeh Fazeli
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Qing Zhao
- Department of Anatomic Pathology, Boston Medical Center, Boston, Massachusetts, USA
| | - Vikki L Noonan
- Division of Oral and Maxillofacial Pathology, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
| | - Devaki Sundararajan
- Division of Oral and Maxillofacial Pathology, Boston University Henry M. Goldman School of Dental Medicine, Boston, Massachusetts, USA
| | - Andrew Salama
- Department of Oral and Maxillofacial Surgery, Long Island Jewish Medical Center, New York, New York, USA
| | - Minh Tam Truong
- Department of Radiation Oncology, Boston University School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
18
|
Iandelli A, Sampieri C, Marchi F, Pennacchi A, Carobbio ALC, Lovino Camerino P, Filauro M, Parrinello G, Peretti G. The Role of Peritumoral Depapillation and Its Impact on Narrow-Band Imaging in Oral Tongue Squamous Cell Carcinoma. Cancers (Basel) 2023; 15. [PMID: 36831538 DOI: 10.3390/cancers15041196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
A recent study reported that the occurrence of depapillated mucosa surrounding oral tongue squamous cell carcinomas (OTSCC) is associated with perineural invasion (PNI). The present study evaluates the reliability of depapillation as a PNI predictor and how it could affect narrow-band imaging (NBI) performance. This is thus a retrospective study on patients affected by OTSCC submitted to radical surgery. The preoperative endoscopy was evaluated to identify the presence of depapillation. Differences in distribution between depapillation and clinicopathological variables were analyzed. NBI vascular patterns were reported, and the impact of depapillation on those was studied. We enrolled seventy-six patients. After evaluation of the preoperative endoscopies, 40 (53%) patients had peritumoral depapillation, while 59 (78%) had a positive NBI pattern. Depapillation was strongly correlated to PNI, 54% vs. 28% (p = 0.022). Regarding the NBI pattern, there was no particular association with depapillation-associated tumors. The presence of depapillation did not affect the intralesional pattern detected by the NBI, while no NBI-positive pattern was found in the depapillation area. Finally, the NBI-guided resection margins were not affected by depapillation. Peritumoral depapillation is a reliable feature for PNI in OTSCC. NBI margin detection is not impaired by depapillation.
Collapse
|
19
|
Hamada M, Ebihara Y, Yoshida S, Saito N, Enoki Y, Inoue H, Matsumura S, Nakahira M, Yasuda M, Sugasawa M. Prediction Formula for Pathological Depth of Invasion From Clinical Depth of Invasion in Tongue Squamous Cell Carcinoma (SCC) Stage I/II Cases. Cureus 2023; 15:e34516. [PMID: 36879709 PMCID: PMC9984280 DOI: 10.7759/cureus.34516] [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] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The depth of invasion (DOI) of tongue squamous cell carcinoma (SCC) is an important prognostic factor. The definition is clear for pathological DOI (pDOI), but the treatment strategy is determined by the preoperative clinical DOI (cDOI). Few studies have investigated the difference between these DOIs. The purpose of this study was to obtain the correlation equation between cDOI and pDOI for Stage I/II tongue SCC and to consider the points to be noted in actual clinical practice. METHODS In this retrospective study, 58 patients with clinical stage I/II tongue SCC were included. Correlations between cDOI and pDOI were obtained for all 58 cases, as well as for 39 cases which excluded superficial and exophytic lesions. RESULTS The overall cDOI and pDOI median values were 8.0 and 5.5 mm, respectively; the 2.5 mm reduction was significant (p < 0.01). The correlation equation was pDOI = 0.81 × cDOI-0.23 (r = 0.73). Furthermore, re-analysis of the 39 cases revealed that pDOI = 0.84 × cDOI-0.37 (r = 0.62). Hence, a derived equation pDOI = 0.84 × (cDOI-0.44) was obtained to predict pDOI from cDOI. CONCLUSIONS This study indicated that it is necessary to consider contraction due to specimen fixation by subtracting the thickness of the mucosal epithelium. Clinical T1 cases with a cDOI of 5 mm or less had a pDOI of 4 mm or less, and it would be expected to have low positive rate of neck lymph node metastasis.
Collapse
Affiliation(s)
- Mei Hamada
- Pathology, Saitama Medical University International Medical Center, Saitama, JPN.,Pathology, Saitama Medical University, Saitama, JPN
| | - Yasuhiro Ebihara
- Head and Neck Surgery and Otolaryngology, Saitama Medical University International Medical Center, Saitama, JPN
| | - Saori Yoshida
- Preliminary Examination Room, Okayama University Hospital, Okayama, JPN.,Pathology, Saitama Medical University International Medical Center, Saitama, JPN
| | - Naoko Saito
- Radiology, Juntendo University School of Medicine, Tokyo, JPN.,Radiology, Saitama Medical University International Medical Center, Saitama, JPN
| | - Yuichro Enoki
- Head and Neck Surgery and Otolaryngology, Saitama Medical University International Medical Center, Saitama, JPN
| | - Hitoshi Inoue
- Head and Neck Surgery and Otolaryngology, Saitama Medical University International Medical Center, Saitama, JPN
| | - Satoko Matsumura
- Head and Neck Surgery and Otolaryngology, Saitama Medical University International Medical Center, Saitama, JPN
| | - Mitsuhiko Nakahira
- Head and Neck Surgery and Otolaryngology, Saitama Medical University International Medical Center, Saitama, JPN
| | - Masanori Yasuda
- Pathology, Saitama Medical University International Medical Center, Saitama, JPN
| | - Masashi Sugasawa
- Head and Neck Surgery and Otolaryngology, Saitama Medical University International Medical Center, Saitama, JPN
| |
Collapse
|
20
|
Ye C, Ling L, Li S, Zhang Z, Zhang X. Comparisons of the diagnostic accuracy of the ultrasonic sign-score method and MRI for PA, PI and PP in high-risk gravid women: a retrospective study. Ann Transl Med 2023; 11:81. [PMID: 36819564 PMCID: PMC9929761 DOI: 10.21037/atm-22-6508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Abstract
Background The diagnosis and management of placenta accrete spectrum (PAS) is a great challenge to obstetricians. Ultrasound (US) and magnetic resonance imaging (MRI) are two main methods to detect PAS. MRI has high resolution, but the examination fee is expensive. US machine and examination fee is cheap, but the resolution is relatively low. Balancing the cost and accuracy for PAS diagnosis is very important. Methods The ultrasonic sign-score method and MRI findings for 49 pregnant women at high risk of placental implantation were retrospectively analyzed. Inclusion criteria: (I) at high risk for PA as described in the Guidelines to Placenta Accreta Spectrum Disorders issued by the American College of Obstetricians and Gynecologists (ACOG) in 2018; (II) complete records of ultrasonic sign-scoring method and MRI data; (III) cesarean section; (IV) definite surgical and/or pathological findings. The results were validated by the gold-standard surgical or postoperative pathological findings, and the efficacy of the 2 imaging approaches in diagnosing placenta PAS was compared. Kappa test was used to analyze the consistency. Receiver operating characteristic (ROC) curves were used to compare the sensitivity and specificity. Results The mean maternal age was 32.6±4.4 years. The mean gestational week was 35.9±2.0 weeks. The mean gravidity was 3.3±1.1. The surgical or histopathological findings revealed PA in 26, placenta increta (PI) in 19 and placenta percreta (PP) in 4 of the 49 women. The diagnosis accuracy of PA, PI, and PP was higher using the ultrasonic sign-scoring method than MRI (75.51%, 73.47%, and 97.96% vs. 61.22%, 57.14% and 91.84%, respectively). The areas under the ROC curve for the sensitivity and specificity of the ultrasonic sign-scoring method and MRI in the diagnosis of PA, PI, and PP were 0.757 [95% confidence interval (CI): 0.613, 0.868], 0.725 (95% CI: 0.579, 0.843), 0.989 (95% CI: 0.907, 1.000), and 0.607 (95% CI: 0.457, 0.743), 0.544 (95% CI: 0.395, 0.687), 0.614 (95% CI: 0.464, 0.749), respectively. Conclusions Although the sensitivity and specificity were lower than 0.8, the ultrasonic sign-scoring method was still superior to MRI in the detection of PI and PP. US can be used to help identify high-risk gravid women.
Collapse
Affiliation(s)
- Caihong Ye
- Department of Ultrasound, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Li Ling
- Department of Obstetrics, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Shuo Li
- Department of Obstetrics, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Zhengrong Zhang
- Medical Imaging Center, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Xia Zhang
- Department of Ultrasound, Yijishan Hospital, Wannan Medical College, Wuhu, China
| |
Collapse
|
21
|
Cheng A, Wang Z, Yuan X, Liu H, Cao W, Wei W, Chang S, Han Z, Guo C, Feng Z. Development and validation of a nomogram for the prediction of lymph node metastasis within 2-year postoperatively in cT1-T2N0 oral squamous cell carcinoma. Head Neck 2023; 45:103-114. [PMID: 36226586 DOI: 10.1002/hed.27215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 08/14/2022] [Accepted: 09/22/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The current neck management for early oral squamous cell carcinoma (OSCC) has always been a controversial issue. A comprehensive model is necessary for predicting an individual's metastasis risk and appropriate patient counseling. METHODS A nomogram for predicting 2-year LNM in patients with cT1-2N0 OSCC was developed and validated using clinicopathological data from 642 patients from 2000 to 2018 in four hospitals, China. RESULTS Three variables (pathology grade, depth of invasion, tumor-infiltrating lymphocytes) were included in nomogram. C-indices were 0.826 (95% CI: 0.786-0.866) and 0.726 (95% CI: 0.653-0.780) in the internal and external validation. Kaplan-Meier method found the 2-year LNM rate of high-risk group (35.8%) was much higher than that of the low-risk group (14.5%). The nomogram model has an advantage over the 8th AJCC TNM stage in predicting the individual 2-year LNM probability for early OSCC. CONCLUSION Patients with low-risk nomogram score may receive neck observation; those with high-risk score should receive END.
Collapse
Affiliation(s)
- Aoming Cheng
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Zhen Wang
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaohong Yuan
- Department of Pathology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Huan Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Wei Cao
- Department of Oral and Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Wei
- Clinical Epidemiology and EBM Unit, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shimin Chang
- Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhengxue Han
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Chuanbin Guo
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Zhien Feng
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
22
|
Salzano G, Togo G, Maffia F, Vaira LA, Maglitto F, Committeri U, Fusco R, Maglione MG, Nocini R, De Luca P, Guida A, Di Stadio A, Ferrara G, Califano L, Ionna F. Early-Stage Oral Tongue Squamous Cell Carcinoma and a Positive Sentinel Lymph Node Biopsy: Description of a Prognostic Correlation between Pre-Treatment Inflammatory Biomarkers, the Depth of Invasion and the Worst Pattern of Invasion. J Pers Med 2022; 12:jpm12111931. [PMID: 36422107 PMCID: PMC9692700 DOI: 10.3390/jpm12111931] [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: 09/18/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to investigate the correlation between pre-treatment inflammatory biomarkers and the post-operative depth of invasion (DOI) and worst pattern of invasion (WPOI) in early-stage oral tongue squamous cell carcinoma (OTSCC) by means of positive sentinel lymph node biopsy (SLNB). A retrospective analysis of patients affected by cN0 T1-T2 OTSCC who had undergone an SLNB at the National Cancer Institute of Naples was performed. The patients were studied using an evaluation of the pre-treatment neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammatory index (SII), and a histopathological analysis of the DOI and WPOI. The statistical analysis showed that among the prognostic biomarkers, the NLR was a significant predictor of high WPOI values (p = 0.002). The cut-off NLR value was 2.52 with a probability of developing a positive sentinel lymph node biopsy (SLNB) of 30.3%. In contrast, the DOI value was 5.20 with a probability of developing a positive SLNB of 31.82%. Regarding the WPOI, increasing the WPOI class increased the likelihood of a positive SLNB occurrence, and a positive significant correlation was found between the WPOI and SLNB (Csp = 0.342; p < 0.001). Pre-treatment NLR, together with post-surgical DOI and WPOI, can be a reliable predictor of occult neck metastasis in patients affected by early-stage OTSCC with a clinically negative neck. Further prospective studies with a larger series will be needed to confirm the results obtained and to better define the NLR, WPOI and DOI cut-off values in order for elective neck dissection to be recommended in relation to a clinically negative neck.
Collapse
Affiliation(s)
- Giovanni Salzano
- Maxillo-Facial and ENT Surgery Unit, INT—IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Giulia Togo
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy
| | - Francesco Maffia
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Operative Unit, Department of Medicine, Surgery and Pharmacology, University of Sassari, 07100 Sassari, Italy
- Biomedical Science Department, PhD School of Biomedical Science, University of Sassari, 07100 Sassari, Italy
- Correspondence: ; Tel.: +39-3401846168
| | - Fabio Maglitto
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy
| | - Umberto Committeri
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy
| | - Roberta Fusco
- Oncology Medical and Research Development Division, Igea SpA, 80131 Naples, Italy
| | - Maria Grazia Maglione
- Maxillo-Facial and ENT Surgery Unit, INT—IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Riccardo Nocini
- Unit of Otolaryngology, Head and Neck Department, University of Verona, 37134 Verona, Italy
| | - Pietro De Luca
- Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy
| | - Agostino Guida
- U.O.C. Odontostomatologia, AORN A. Cardarelli Hospital, 80131 Naples, Italy
| | - Arianna Di Stadio
- Otolaryngology Department, University of Catania, 95123 Catania, Italy
| | - Gerardo Ferrara
- Department of Pathology, INT—IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| | - Luigi Califano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy
| | - Franco Ionna
- Maxillo-Facial and ENT Surgery Unit, INT—IRCCS “Fondazione G. Pascale”, 80131 Naples, Italy
| |
Collapse
|
23
|
Caprioli S, Casaleggio A, Tagliafico AS, Conforti C, Borda F, Fiannacca M, Filauro M, Iandelli A, Marchi F, Parrinello G, Peretti G, Cittadini G. High-Frequency Intraoral Ultrasound for Preoperative Assessment of Depth of Invasion for Early Tongue Squamous Cell Carcinoma: Radiological-Pathological Correlations. Int J Environ Res Public Health 2022; 19:ijerph192214900. [PMID: 36429617 PMCID: PMC9690087 DOI: 10.3390/ijerph192214900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 06/12/2023]
Abstract
The eighth edition of the TNM classification officially introduced "depth of invasion" (DOI) as a criterion for determining the T stage in tongue squamous cell carcinoma. The DOI is a well-known independent risk factor for nodal metastases. In fact, several experts strongly suggest elective neck dissection for tongue cancer with a DOI > 4 mm due to the high risk of early and occult nodal metastases. Imaging plays a pivotal role in preoperative assessments of the DOI and, hence, in planning the surgical approach. Intraoral ultrasound (IOUS) has been proposed for early-stage SCC of the oral tongue as an alternative to magnetic resonance imaging (MRI) for local staging. The aim of this work is to investigate the accuracy of IOUS in the assessment of the DOI in early oral SCC (CIS, pT1, and pT2). A total of 41 patients with tongue SCCs (CIS-T2) underwent a preoperative high-frequency IOUS. An IOUS was performed using a small-size, high-frequency hockey-stick linear probe. The ultrasonographic DOI (usDOI) was retrospectively compared to the pathological DOI (pDOI) as the standard reference. In patients who underwent a preoperative MRI, their usDOI, magnetic resonance DOI (mriDOI), and pDOI were compared. Specificity and sensitivity for the IOUS to predict a pDOI > 4 mm and to differentiate invasive and noninvasive tumors were also evaluated. A high correlation was found between the pDOI and usDOI, pDOI and mriDOI, and usDOI and mriDOI (Spearman's ρ = 0.84, p < 0.0001, Spearman's ρ = 0.79, p < 0.0001, and Spearman's ρ = 0.91, p < 0.0001, respectively). A Bland-Altman plot showed a high agreement between the usDOI and pDOI, even though a mean systematic error was found between the usDOI and pDOI (0.7 mm), mriDOI and pDOI (1.6 mm), and usDOI and mriDOI (-0.7 mm). The IOUS was accurate at determining the T stage (p < 0.0001). The sensitivity and specificity for the IOUS to predict a pDOI ≥4 mm were 92.31% and 82.14%, respectively, with an AUC of 0.87 (p < 0.0001). The specificity, sensitivity, negative predictive value (NPV), and positive predictive value (PPV) for the IOUS to predict an invasive cancer were 100%, 94.7%, 60%, and 100%, respectively. The AUC was 0.8 (95% CI 0.646-0.908, p < 0.0001). The IOUS was accurate in a preoperative assessment of a pDOI and T stage, and can be proposed as an alternative to MRI in the preoperative staging of tongue SCC.
Collapse
Affiliation(s)
- Simone Caprioli
- Department of Internal Medicine (DIMI), University of Genova, Viale Benedetto XV 6, 16132 Genoa, Italy
| | - Alessandro Casaleggio
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - Alberto Stefano Tagliafico
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genova, Via Pastore 1, 16132 Genoa, Italy
| | - Cristina Conforti
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| | - Fabio Borda
- Department of Health Sciences (DISSAL), University of Genova, Via Pastore 1, 16132 Genoa, Italy
| | - Martina Fiannacca
- Department of Health Sciences (DISSAL), University of Genova, Via Pastore 1, 16132 Genoa, Italy
| | - Marta Filauro
- Department of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
- Department of Experimental Medicine (DIMES), University of Genoa, 16132 Genoa, Italy
| | - Andrea Iandelli
- Department of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy
| | - Filippo Marchi
- Department of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Giampiero Parrinello
- Department of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16121 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Giuseppe Cittadini
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genoa, Italy
| |
Collapse
|
24
|
Nan M, Ye W, Liu Y, Zhang Z. Diagnostic accuracy of gastric filling ultrasonography in preoperative invasion depth (T stage) of gastric cancer: Meta-analysis. Medicine (Baltimore) 2022; 101:e31066. [PMID: 36281081 PMCID: PMC9592522 DOI: 10.1097/md.0000000000031066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the diagnostic value of gastric filling ultrasonography in the preoperative invasion depth (T staging) of gastric cancer. METHODS We systematically searched several online electronic databases including CNKI, Wanfang Medical Database, VIP, CBM, Pubmed, Embase, Cochrane Library, and Web of Science from January 2010 to December 2021, identifying the study about gastric filling ultrasonography for diagnostic of invasion depth of gastric cancer. Using bivariate mixed effect model to calculate the sensitivity (Sen), specificity (spe), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) with 95% confidence interval (CI). Draw the summary receiver operating characteristic (sROC) curve, likelihood ratio matrix and fagan diagram to evaluate the diagnostic value of gastric filling ultrasonography in the preoperative invasion depth of gastric cancer. Sen analysis and Publication bias tests were performed. RESULTS This study obtained 21 literatures and the quality were good. The pooled Sen and spe of gastric filling ultrasonography was: T1: 0.63 (95% CI:0.51-0.73), 0.96 (95% CI:0.94-0.98); T2: 0.67 (95% CI:0.62-0.71), 0.90 (95% CI:0.88-0.93); T3: 0.79 (95% CI:0.75-0.82), 0.83 (95% CI:0.80-0.86); T4: 0.80 (95% CI:0.73-0.86), 0.96 (95% CI:0.94-0.97), respectively. In addition, the PLR and NLR of gastric filling ultrasonography was: T1: 16.74 (95% CI:9.98-28.09), 0.39 (95% CI:0.29-0.52); T2: 6.98 (95% CI:5.20-9.38), 0.36 (95% CI:0.31-0.42); T3: 4.65 (95% CI:3.78-5.73), 0.26 (95% CI:0.21-0.31); T4: 18.51 (95% CI:12.77-26.83), 0.20 (95% CI: 0.15-0.29), respectively. The DOR of gastric filling ultrasonography in T1-T4 was: 43.17 (95% CI:20.62-90.41),19.13 (95% CI:12.61-29.03), 18.15 (95% CI:12.86-25.62), 90.63 (95% CI:47.36-173.41), respectively. The sROC curve revealed that the area under the curve (AUC) of T1-T4 was: 0.93, 0.82, 0.87, 0.97, respectively. Sen analysis indicated that the study was steadily. And there is no publication bias in this study. But the study has some heterogeneity. CONCLUSION Gastric filling ultrasonography is useful for clinical preoperative T staging of gastric cancer, and the result indicate that the accuracy of gastric filling ultrasonography in discriminating T1-T4 is higher than that in discriminating T2 - T3. It can be used as an imaging diagnostic method for preoperative T staging of gastric cancer.
Collapse
Affiliation(s)
- Mengmeng Nan
- Department of Ultrasonic, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Weihua Ye
- Department of Ultrasonic, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- * Correspondence: Weihua Ye, Department of Ultrasonic, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China (e-mail: )
| | - Yu Liu
- Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zibo Zhang
- Department of General Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| |
Collapse
|
25
|
George R, Prakasan A, Anila KR, Jagathnath Krishna KM, Iype EM, Jayasree K, Ramadas K. Stage migration and treatment outcome in carcinoma tongue - A comparison of seventh and eighth AJCC pathological staging systems. Indian J Cancer 2022; 59:584-590. [PMID: 36861529 DOI: 10.4103/ijc.ijc_752_21] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Background The eighth edition of the American Joint Committee on Cancer (AJCC) for oral cancer has incorporated additional pathological features like depth of invasion (DOI) and extranodal extension (ENE) into T and N staging. The incorporation of these two factors will impact the staging and, hence, the treatment decisions. The aim of the study was to clinically validate the new staging system in predicting the outcome in patients treated for carcinoma oral tongue. The study also examined the correlation of pathological risk factors with survival. Methods We studied 70 patients with squamous cell carcinoma of the oral tongue who underwent primary surgical treatment at a tertiary care center in the year 2012. All these patients were restaged pathologically according to the new AJCC eighth staging system. The 5-year overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method. Akaike information criterion and concordance index were calculated between both staging systems to identify a better predictive model. Log-rank test and univariate Cox regression analysis were conducted to find out the significance of different pathological factors on outcome. Results Incorporation of DOI and ENE resulted in 47.2% and 12.8% stage migration, respectively. DOI less than 5 mm was associated with a 5-year OS and DFS of 100% and 92.9%, respectively, compared to 88.7% and 85.1%, respectively, when the DOI was more than 5 mm. Presence of lymph node involvement, ENE, and perineural invasion (PNI) were associated with inferior survival. The eighth edition had lower Akaike information criterion and improved concordance index values compared with the seventh edition. Conclusion The eighth edition of AJCC allows better risk stratification. Restaging of cases based on the eighth edition AJCC staging manual resulted in significant upstaging with difference in survival.
Collapse
Affiliation(s)
- Rebecca George
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Aparna Prakasan
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - K R Anila
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - K M Jagathnath Krishna
- Department of Cancer Epidemiology and Biostatistics, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Elizabeth Mathew Iype
- Department of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - K Jayasree
- Department of Pathology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Kunnambath Ramadas
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| |
Collapse
|
26
|
Ghantous Y, Nashef A, Sidransky D, Abdelraziq M, Alkeesh K, Araidy S, Koch W, Brait M, Abu El-Naaj I. Clinical and Prognostic Significance of the Eighth Edition Oral Cancer Staging System. Cancers (Basel) 2022; 14:cancers14194632. [PMID: 36230555 PMCID: PMC9562893 DOI: 10.3390/cancers14194632] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: The most notable changes in the eighth edition of the AJCC Cancer Staging System include incorporating the depth of invasion (DOI) into T staging and extranodal extension (ENE) into N staging. In this study, we retrospectively assessed the prognostic and clinical implications of the eighth TNM staging system. Materials and Methods: Patients with Oral Squamous Cell Carcinoma (OSCC) who were treated surgically between 2010 and 2017 were retrospectively reviewed. Tumors were first staged according to the seventh edition and restaged using the eighth edition. The prognostic value of the resultant upstaging was evaluated. Results: Integrating the DOI into the T classification resulted in the upstaging of 65 patients, whereas incorporating ENE into the N staging resulted in the upstaging of 18 patients (p < 0.001). Upstaging due to DOI integration had no significant effect on OS or DSS (p > 0.05). Conclusion: Our results demonstrate the importance of incorporating ENE into nodal staging and considering adjuvant therapy when ENE is present.
Collapse
Affiliation(s)
- Yasmin Ghantous
- Department of Oral and Maxillofacial Surgery, Baruch Padeh Medical Center, Faculty of Medicine, Bar Ilan University, Ramat Gan 15208, Israel
- Correspondence: ; Tel.: +972-522404014
| | - Aysar Nashef
- Department of Oral and Maxillofacial Surgery, Baruch Padeh Medical Center, Faculty of Medicine, Bar Ilan University, Ramat Gan 15208, Israel
| | - David Sidransky
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Otolaryngology and Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Murad Abdelraziq
- Department of Oral and Maxillofacial Surgery, Baruch Padeh Medical Center, Faculty of Medicine, Bar Ilan University, Ramat Gan 15208, Israel
| | - Kutaiba Alkeesh
- Department of Oral and Maxillofacial Surgery, Baruch Padeh Medical Center, Faculty of Medicine, Bar Ilan University, Ramat Gan 15208, Israel
| | - Shareef Araidy
- Department of Oral and Maxillofacial Surgery, Baruch Padeh Medical Center, Faculty of Medicine, Bar Ilan University, Ramat Gan 15208, Israel
| | - Wayne Koch
- Department of Otolaryngology and Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Mariana Brait
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Otolaryngology and Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Imad Abu El-Naaj
- Department of Oral and Maxillofacial Surgery, Baruch Padeh Medical Center, Faculty of Medicine, Bar Ilan University, Ramat Gan 15208, Israel
| |
Collapse
|
27
|
Kallarakkal TG, Siriwardena BSMS, Samaranayaka A, De Silva R, Tilakaratne WM. A validated predictive model for risk of nodal metastasis in node negative oral squamous cell carcinoma of the buccal mucosa and tongue. J Oral Pathol Med 2022; 51:436-443. [PMID: 35315944 DOI: 10.1111/jop.13294] [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: 11/21/2021] [Revised: 01/25/2022] [Accepted: 03/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Lymph node metastasis in oral squamous cell carcinoma (OSCC) is influenced by clinical and histopathological variables. The aim of this study was to develop a simple model to predict nodal metastasis of OSCC in clinically negative necks (cN0). METHODS Data from patients who underwent surgery for treatment of OSCC of the tongue or buccal mucosa with neck dissection were used for model development and validation. RESULTS Nodal metastasis was significantly associated with gender, age, tumor size, site, pattern of invasion and depth of invasion on univariate analysis. All the five variables except age were retained at the variable selection step of the model development and were used in the final model because it was not significant at 0.10 significance level after adjusting for other variables. Regression coefficients of the model were used to estimate risks of nodal metastases for each combination of clinicopathological characteristics. A 10-fold cross-validation was used to assess the model. The average of the resultant 10 AUCs (along with its 95% confidence interval estimated using bootstrap) was used as the overall validated measure of the model. A risk chart was produced using probability of nodal metastasis predicted by the model for each combination of five characteristics. The model's ability to identify patients with nodal metastases as assessed by the area under the ROC curve (AUC) was 0.752. CONCLUSION The model based on established clinicopathological variables has been internally validated on a large cohort of patients and offers practicability for use in OSCCs of the tongue and buccal mucosa.
Collapse
Affiliation(s)
- Thomas George Kallarakkal
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia.,Oral Cancer Research and Coordinating Centre, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Ariyapala Samaranayaka
- Biostatistics Centre, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Rohana De Silva
- Oral and Maxillofacial Surgery, Department of Oral Diagnostic and Surgical Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Wanninayake M Tilakaratne
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia.,Oral Cancer Research and Coordinating Centre, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
28
|
Demir B, Abuzaid G. Association Between Mean Platelet Volume, Platelet Count, and Distribution Width With Depth of Invasion in Oral Cancers. Ear Nose Throat J 2022:1455613211032532. [PMID: 35411813 DOI: 10.1177/01455613211032532] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION To examine the potential predictive roles of the preoperative mean platelet volume (MPV), platelet count (PC), and platelet distribution width (PDW) in patients with oral cancer and their association with the depth of invasion (DOI). METHODS This retrospective study included 122 patients (66 males, 56 females) diagnosed with oral cancer between January 2009 and January 2015 by our Otolaryngology Department. At diagnosis, the mean age was 64.6 ± 13.9 years. The average follow-up period was 39.2 ± 23.9 months. RESULTS We found significant differences in all parameters (PDW, MPV, PC) based on the positivity of the lymph node and the tumor stage. The mean PDW, MPV, and PC were significantly higher in the exitus group than in the survivor group (P = .010, .036, and .047, respectively). In patients with high PDW, we observed a lower progression-free survival. We observed that PDW had a significant impact on the recurrence of the disease. Platelet distribution width, MPV, and PC were significant prognostic factors. A high PDW increased fatality 4.1 times, and a high MPV increased fatality 4.7 times (P = .040 and .032, respectively). We found in a univariate analysis that tumor grade, PDW, MPV, and PC were predictive factors for fatality. On multivariate analysis, we found that MPV, PC, and predictors were independent of tumor grade. We observed an association between MPV and DOI. CONCLUSION High PC, MPV, and PDW could be meaningful prognostic predictors for low survival rates. Mean platelet volume appears to be a more effective marker because it is associated with the DOI and prognosis. However, further research is required to confirm our findings.
Collapse
Affiliation(s)
- Berat Demir
- Department of Otorhinolaryngology-Head and Neck Surgery, Marmara University Medical Faculty, Pendik Training and Research Hospital, Istanbul, Turkey
| | - Ghazi Abuzaid
- Department of Otorhinolaryngology-Head and Neck Surgery, Marmara University Medical Faculty, Pendik Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
29
|
Yu S, Yu ZL, Ye ZW, Jia J. Comparative study on Classifications of AJCC 8th and 7th in the patients with tongue squamous cell carcinoma. Oral Dis 2022; 29:1542-1549. [PMID: 35247026 DOI: 10.1111/odi.14178] [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: 01/08/2022] [Revised: 02/07/2022] [Accepted: 03/01/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Depth of invasion (DOI) is the most important predictor for lymph node metastasis in early-stage oral cancer. This study aims to investigate the effects of the different classifications of AJCC 7th and 8th on predicting lymph node metastasis and the optimal cutoff point for DOI predicting the lymph node metastasis in patients with tongue squamous cell carcinoma (TSCC). MATERIALS AND METHODS We performed a retrospective study in 208 TSCC patients in early T-stage without clinical or radiological signs of lymph node metastasis. Those patients were treated with elective neck dissection (END) between April 2019 and December 2020. And the relation between DOI and lymph node metastasis was analyzed. RESULTS Metastases were found in 58 of 208 patients (27.88%). Of those 58 patients, the mean DOI was 8.311 mm compared to 5.425 mm in patients without metastases (P < 0.0001). The receiver operating characteristic curve (ROC-curve) showed an area under the curve of 0.7066 with the most optimal cutoff point on a DOI of 4.050 mm (sensitivity 86.21%, specificity 52%). Linear regression analysis (1 mm≤DOI≤6 mm) revealed that a DOI ≥ 3.211 mm predicated an incidence of occult lymph node metastasis greater than 20%. Regional metastases were found in 12.82% of patients with DOI ≤ 4.0 mm. Within the entire cohort, 60 cases (28.85%) got upgraded with respect to T-stage. No tumor underwent downstaging. CONCLUSION The 8th edition provides better lymph node metastasis prediction for TSCC than the 7th. And DOI is a poor predictor for regional metastasis in patients with early T-stage clinically node-negative TSCC. END in patients with early-stage TSCC should be performed in patients with DOI ≥ 3.211 mm.
Collapse
Affiliation(s)
- Shun Yu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Zi Li Yu
- Department of Oral Maxillofacial-Head Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Zi Wu Ye
- Department of Oral Maxillofacial-Head Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Jun Jia
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China.,Department of Oral Maxillofacial-Head Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| |
Collapse
|
30
|
Liu Y, Li Z, Qi Y, Wen X, Zhang L. Metagenomic Analysis Reveals a Changing Microbiome Associated With the Depth of Invasion of Oral Squamous Cell Carcinoma. Front Microbiol 2022; 13:795777. [PMID: 35222330 PMCID: PMC8863607 DOI: 10.3389/fmicb.2022.795777] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 12/10/2021] [Accepted: 01/17/2022] [Indexed: 12/15/2022] Open
Abstract
The relationship between oral squamous cell carcinoma (OSCC) development and the microbiome has attracted increasing attention. The depth of invasion (DOI) is an important indicator of tumor progression, staging and prognosis, and the change in the oral microbiome based on the DOI is unclear. This report describes the use of metagenomic analyses to investigate the relationship between the oral microbiome and the DOI. Forty patients in different DOI categories were recruited; 10 healthy people served as the control group. Swab samples collected from the participants were subjected to metagenomic analyses, and the oral microbial communities and their functions were investigated. The abundances of Fusobacterium nucleatum, Capnocytophaga sputigena, Porphyromonas endodontalis, and Gemella haemolysans were significantly increased in the patients compared with the controls. The abundances of some bacteria exhibited a stage-related trend. The abundances of P. endodontalis, Gemella morbillorum and G. haemolysans increased with increasing DOI. In contrast, the abundances of Prevotella melaninogenica, Haemophilus parainfluenzae and Neisseria flavescens decreased with increasing DOI. Based on receiver operating characteristic (ROC) curve analysis, eight species were found to have predictive value: Rothia mucilaginosa, P. melaninogenica, H. parainfluenzae, and N. flavescens in the healthy control group and P. endodontalis, G. morbillorum, G. haemolysans and Fusobacterium periodonticum in the high DOI group. In the functional analysis, several metabolic pathways were decreased, whereas flagellar assembly and bacterial chemotaxis showed an increasing trend as the disease progressed. Biofilm formation, flagella, lipopolysaccharide (LPS) and other virulence factors exhibited staging-related changes. These pathogenic pathways and factors had a clear correlation with specific pathogens. In particular, when OSCC progressed to the late stage, microbial diversity and functional potential changed greatly.
Collapse
Affiliation(s)
- Yuan Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology & National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Zhengrui Li
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology & National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yanxu Qi
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University, Shandong, China.,Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Shandong University, Shandong, China
| | - Xutao Wen
- Department of Oral and Maxillofacial Surgery, College and Hospital of Stomatology, Guangxi Medical University, Nanning, Guangxi, China
| | - Ling Zhang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.,National Center for Stomatology & National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology, Shanghai, China
| |
Collapse
|
31
|
Erfani H, Salmanian B, Fox KA, Coburn M, Meshinchiasl N, Shamshirsaz AA, Kopkin R, Gogia S, Patel K, Jackson J, Cadena M, Aalipour S, Sukumar S, Nassr AA, Espinoza J, Clark SL, Belfort MA, Shamshirsaz AA. Urologic morbidity associated with placenta accreta spectrum surgeries: single-center experience with a multidisciplinary team. Am J Obstet Gynecol 2022; 226:245.e1-245.e5. [PMID: 34391750 DOI: 10.1016/j.ajog.2021.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/15/2021] [Accepted: 08/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hysterectomy for placenta accreta spectrum may be associated with urologic morbidity, including intentional or unintentional cystostomy, ureteral injury, and bladder fistula. Although previous retrospective studies have shown an association between placenta accreta spectrum and urologic morbidities, there is still a paucity of literature addressing these urologic complications. OBJECTIVE We sought to report a systematic description of such morbidity and associated factors. STUDY DESIGN This was a retrospective study of all histology-proven placenta accreta spectrum deliveries in an academic center between 2011 and 2020. Urologic morbidity was defined as the presence of at least one of the following: cystotomy, ureteral injury, or bladder fistula. Variables were reported as median (interquartile range) or number (percentage). Analyses were made using appropriate parametric and nonparametric tests. Multinomial regression analysis was performed to assess the association of adverse urologic events with the depth of placental invasion. RESULTS In this study, 58 of 292 patients (19.9%) experienced urologic morbidity. Patients with urologic morbidity had a higher rate of placenta percreta (compared with placenta accreta and placenta increta) than those without such injuries. Preoperative ureteral stents were placed in 54 patients (93.1%) with and 146 patients (62.4%) without urologic injury (P=.003). After adjusting for confounding variables, multinomial regression analysis revealed that the odds of having adverse urologic events was 6.5 times higher in patients with placenta percreta than in patients with placenta accreta. CONCLUSION Greater depth of invasion in placenta accreta spectrum was associated with more frequent and severe adverse urologic events. Whether stent placement confers any protective benefit requires further investigation.
Collapse
Affiliation(s)
- Hadi Erfani
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Bahram Salmanian
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Karin A Fox
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Michael Coburn
- Department of Urology, Baylor College of Medicine, Houston, TX
| | | | - Amir A Shamshirsaz
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
| | - Rachel Kopkin
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Soumya Gogia
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Kunal Patel
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Josef Jackson
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Max Cadena
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Soroush Aalipour
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | | | - Ahmed A Nassr
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Jimmy Espinoza
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Steven L Clark
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Michael A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | | |
Collapse
|
32
|
Wang F, Tan R, Feng K, Hu J, Zhuang Z, Wang C, Hou J, Liu X. Magnetic Resonance Imaging-Based Radiomics Features Associated with Depth of Invasion Predicted Lymph Node Metastasis and Prognosis in Tongue Cancer. J Magn Reson Imaging 2021; 56:196-209. [PMID: 34888985 PMCID: PMC9299921 DOI: 10.1002/jmri.28019] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 10/06/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 12/18/2022] Open
Abstract
Background Adequate safe margin in tongue cancer radical surgery is one of the most important prognostic factors. However, the role of peritumoral tissues in predicting lymph node metastasis (LNM) and prognosis using radiomics analysis remains unclear. Purpose To investigate whether magnetic resonance imaging (MRI)‐based radiomics analysis with peritumoral extensions contributes toward the prediction of LNM and prognosis in tongue cancer. Study type Retrospective. Population Two hundred and thirty‐six patients (38.56% female) with tongue cancer (training set, N = 157; testing set, N = 79; 37.58% and 40.51% female for each). Field Strength/Sequence 1.5 T; T2‐weighted turbo spin‐echo images. Assessment Radiomics models (Rprim, Rprim+3, Rprim+5, Rprim+10, Rprim+15) were developed with features extracted from the primary tumor without or with peritumoral extensions (3, 5, 10, and 15 mm, respectively). Clinicopathological characteristics selected from univariate analysis, including MRI‐reported LN status, radiological extrinsic lingual muscle invasion, and pathological depth of invasion (DOI) were further incorporated into radiomics models to develop combined radiomics models (CRprim, CRprim+3, CRprim+5, CRprim+10, CRprim+15). Finally, the model performance was validated in the testing set. DOI was measured from the adjacent normal mucosa to the deepest point of tumor invasion. Statistical Tests Chi‐square test, regression analysis, receiver operating characteristic curve (ROC) analysis, decision analysis, spearman correlation analysis. The Delong test was used to compare area under the ROC (AUC). P < 0.05 was considered statistically significant. Results Of all the models, the CRprim+10 reached the highest AUC of 0.995 in the training set and 0.872 in the testing set. Radiomics features were significantly correlated with pathological DOI (correlation coefficients, −0.157 to −0.336). The CRprim+10 was an independent indicator for poor disease‐free survival (hazard ratio, 5.250) and overall survival (hazard ratio, 17.464) in the testing set. Data Conclusion Radiomics analysis with a 10‐mm peritumoral extension had excellent power to predict LNM and prognosis in tongue cancer.
Collapse
Affiliation(s)
- Fei Wang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Rukeng Tan
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Kun Feng
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Jing Hu
- Department of Oral and Maxillofacial Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zehang Zhuang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Cheng Wang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Jinsong Hou
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Xiqiang Liu
- Department of Oral and Maxillofacial Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
33
|
Muhammad AY, Dhanani R, Salman S, Shaikh Z, Ghaloo SK, Ikram M. Depth of Invasion as a Predictor of Cervical Nodal Metastasis of Oral Tongue Squamous Cell Carcinoma: Findings From a Tertiary Care Center in Pakistan. Cureus 2021; 13:e18976. [PMID: 34820231 PMCID: PMC8606179 DOI: 10.7759/cureus.18976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background and objective Cervical lymph node metastasis has a significant impact on the survival of patients with oral cavity tumors. The rate of occult neck node metastasis is reported to range from 20 to 40%. The depth of invasion (DOI) has been incorporated in the eighth edition of the American Joint Commission on Cancer (AJCC) staging manual and is an important predictor of cervical lymph node metastasis. In this study, we aimed to identify the occult neck node metastasis rate in early oral tongue squamous cell carcinoma (OTSCC) and correlate it with the DOI. Methods A retrospective review of all patients presenting to our facility with early-stage OTSCC was performed. Patients with tumor size of ≤4 cm and who underwent elective neck dissection at the time of surgery were included. The study outcomes were the rates of occult neck metastases in T1 and T2 OTSCC and their correlation with the DOI. Results There were 80 patients in total. Occult neck node metastases were seen in 29 (36.25%) patients. Patients with a DOI >5 mm were 1.41 times more likely to have occult neck node metastasis than those with a DOI ≤5 mm. Conclusion Occult neck node metastasis is significantly associated with the DOI. The risk of neck metastasis is higher in patients with a DOI >5 mm.
Collapse
Affiliation(s)
- Adnan Y Muhammad
- ENT and Head & Neck Surgery, Hayatabad Medical Complex, Peshawar, PAK
| | - Rahim Dhanani
- Otolaryngology - Head and Neck Surgery, Dr. Ziauddin University & Hospital, Karachi, PAK
| | - Summaiya Salman
- Otolaryngology - Head and Neck Surgery, Dr. Ziauddin University & Hospital, Karachi, PAK
| | | | | | - Mubasher Ikram
- Otolaryngology - Head and Neck Surgery, Dr. Ziauddin University & Hospital, Karachi, PAK
| |
Collapse
|
34
|
Wang J, Wang L, Li S, Bai F, Xie H, Shan H, Liu Z, Ma T, Tang X, Tang H, Qin A, Lei S, Zuo C. Risk Factors of Lymph Node Metastasis and Its Prognostic Significance in Early Gastric Cancer: A Multicenter Study. Front Oncol 2021; 11:649035. [PMID: 34722232 PMCID: PMC8548692 DOI: 10.3389/fonc.2021.649035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/03/2021] [Accepted: 09/23/2021] [Indexed: 01/14/2023] Open
Abstract
Background Early gastric cancer (EGC) is invasive gastric cancer that invades no deeper than the submucosa, regardless of lymph node metastasis (LNM). It is mainly treated by surgery. Recently, the resection range of EGC has been minimized, but cancer recurrence and overall survival in some patients should be given high status. LNM is an important indicator of prognosis and treatment in gastric cancer. The law of the number and location of metastatic lymph nodes in EGC is not yet clear. Therefore, we aimed to identify the risk factors of LNM in radically resected EGC and guide treatment. Methods The clinicopathological factors of 611 patients with EGC were retrospectively analyzed in six hospitals between January 2010 and December 2016. The relationship between clinicopathological factors and LNM, as well as their prognostic significance, were analyzed by univariate and multivariate analyses. Results The rate of LNM was 20.0% in the 611 EGC patients. The depth of invasion, differentiation type, tumor diameter, morphological ulceration, and lymphovascular invasion were independent risk factors for LNM (P<0.05) by logistic regression analysis. Tumor location in the proximal third of the stomach and morphological ulceration were significant factors for group 2 LNM. Moreover, the 5-year survival rate was 94.9% for patients with no positive nodes, 88.5% for patients with 1-2 positive nodes, 64.3% for patients with 3-6 positive nodes, and 41.8% for patients with >6 metastatic nodes. Interestingly, the 7-year risk of relapse diminished for patients with no LNM or retrieved no less than 15 lymph nodes. Conclusions Fifteen lymph node dissection and D2 radical operation are the surgical options in case of high risk factors for LNM. Extended lymph node dissection (D2+) is recommended for morphological ulceration or disease located in the proximal third of the stomach due to their high rate of group 2 LNM. Furthermore, LNM is a significant prognostic factor of EGC. Moreover, lymph nodes can also play a significant role in the chemotherapeutic and radiotherapy approach for non-surgical patients with EGC.
Collapse
Affiliation(s)
- Jinfeng Wang
- Department of Gastroduodenal and Pancreatic Surgery, Translational Medicine Research Center of Liver Cancer, Laboratory of Digestive Oncology, The Affiliated Cancer Hospital of Xiangya School of Medicine and Hunan Cancer Hospital (Hunan Cancer Institute), Central South University, Hunan Province Key Laboratory of Virology (Tumor Immunity), Changsha, China
| | - Liang Wang
- Graduates School, University of South China, Hengyang, China
| | - Sha Li
- Department of Gastroduodenal and Pancreatic Surgery, Translational Medicine Research Center of Liver Cancer, Laboratory of Digestive Oncology, The Affiliated Cancer Hospital of Xiangya School of Medicine and Hunan Cancer Hospital (Hunan Cancer Institute), Central South University, Hunan Province Key Laboratory of Virology (Tumor Immunity), Changsha, China
| | - Fei Bai
- Department of Gastroduodenal and Pancreatic Surgery, Translational Medicine Research Center of Liver Cancer, Laboratory of Digestive Oncology, The Affiliated Cancer Hospital of Xiangya School of Medicine and Hunan Cancer Hospital (Hunan Cancer Institute), Central South University, Hunan Province Key Laboratory of Virology (Tumor Immunity), Changsha, China
| | - Hailong Xie
- Graduates School, Department of Gastrointestinal Surgery of Second Affiliated Hospital, Cancer Research Institute, University of South China, Hengyang, China
| | - Hanguo Shan
- Graduates School, Department of Gastrointestinal Surgery of Second Affiliated Hospital, Cancer Research Institute, University of South China, Hengyang, China
| | - Zhuo Liu
- The Third Department of General Surgery, The Central Hospital of Xiangtan City, Xiangtan, China
| | - Tiexiang Ma
- The Third Department of General Surgery, The Central Hospital of Xiangtan City, Xiangtan, China
| | - Xiayu Tang
- Department of General Surgery, Yongzhou Central Hospital, Yongzhou, China
| | - Haibing Tang
- Department of General Surgery, People Hospital of Qiyang County, Yongzhou, China
| | - Ang Qin
- Department of Gastroduodenal and Pancreatic Surgery, Translational Medicine Research Center of Liver Cancer, Laboratory of Digestive Oncology, The Affiliated Cancer Hospital of Xiangya School of Medicine and Hunan Cancer Hospital (Hunan Cancer Institute), Central South University, Hunan Province Key Laboratory of Virology (Tumor Immunity), Changsha, China
| | - Sanlin Lei
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chaohui Zuo
- Department of Gastroduodenal and Pancreatic Surgery, Translational Medicine Research Center of Liver Cancer, Laboratory of Digestive Oncology, The Affiliated Cancer Hospital of Xiangya School of Medicine and Hunan Cancer Hospital (Hunan Cancer Institute), Central South University, Hunan Province Key Laboratory of Virology (Tumor Immunity), Changsha, China.,Graduates School, University of South China, Hengyang, China
| |
Collapse
|
35
|
Ventura E, Barros J, Salgado I, Millán A, Vilares M, Zagalo C, Gomes P. Pretreatment Blood Markers in the Prediction of Occult Neck Metastasis: A 10-Year Retrospective Study. Cureus 2021; 13:e16641. [PMID: 34458043 PMCID: PMC8384393 DOI: 10.7759/cureus.16641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction The purpose of this study was to clarify the role of inflammatory blood markers in the management of early-stage (T1-T2) oral squamous cell carcinoma (OSCC) of the tongue in patients with a clinically negative neck. Materials and methods We undertook a retrospective chart review of 102 patients with early-stage OSCC of the tongue, subjected to tumor resection and elective neck dissection. Based on postsurgical histopathological examination results, we divided our cohort into pN+ and pN0 groups. Afterwards, we analyzed the role of pretreatment inflammatory blood markers in predicting occult neck metastasis. We also evaluated neutrophil-lymphocyte ratio (NLR) association with the depth of invasion (DOI) of the primary tumor. Results We found a significant association of NLR (p=0.001) and monocyte-lymphocyte ratio (p=0.011) with neck status on univariate analysis. Multivariate analysis showed that only NLR (p=0.02) was an independent risk factor for occult metastasis among inflammatory blood markers. Receiver Operating Characteristic curve analysis and Younden’s Index determined the NLR value of 2.96 as the most adequate cut-off value for neck status prediction. NLR values of pretreatment workup also had a significant association with the DOI of the primary tumor (p=0.018). Conclusion Our study supports the role of pretreatment NLR in predicting occult neck metastasis in early-stage OSCC of the tongue. It also sheds some light over the potential of NLR as a predictor of the primary tumor’s DOI.
Collapse
Affiliation(s)
- Eduardo Ventura
- Oral and Maxillofacial Surgery Unit, Centro Hospitalar e Universitário do Porto, Porto, PRT
| | - João Barros
- Oral and Maxillofacial Surgery Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - Inês Salgado
- Department of Head and Neck Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, PRT
| | - Ana Millán
- Department of Head and Neck Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, PRT
| | - Miguel Vilares
- Department of Head and Neck Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, PRT
| | - Carlos Zagalo
- Department of Head and Neck Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, PRT.,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz - Cooperativa de Ensino Superior, CRL, Monte da Caparica, PRT
| | - Pedro Gomes
- Department of Head and Neck Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, PRT
| |
Collapse
|
36
|
Bruschini R, Maffini F, Chiesa F, Lepanto D, De Berardinis R, Chu F, Tagliabue M, Giugliano G, Ansarin M. Oral cancer: changing the aim of the biopsy in the age of precision medicine. A review. ACTA ACUST UNITED AC 2021; 41:108-119. [PMID: 34028455 PMCID: PMC8142729 DOI: 10.14639/0392-100x-n1056] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/03/2021] [Indexed: 01/15/2023]
Abstract
Oral cancer is a heterogeneous disease that develops through a complex, multi-step process. Precision medicine should help to better understand its molecular basis, integrate traditional classifications and have a positive impact on cancer management. To apply this information in clinical practice, we need to define its histology and identify biomarkers expressed by the tumour that provide useful information for planning tailored treatment. The most reliable information currently derives from evaluation of biomarkers on post-operative samples. To plan personalised treatment, oncologists need to assess these markers on biopsy samples. We reviewed the recent literature and identified 6 of 184 publications that compared markers measured on biopsy and post-operative samples or assessed their predictivity for the development of lymph node metastases. Data from these studies suggest that markers measured on biopsy samples can provide useful indications for tailoring treatments. However, due to their heterogeneity and low level of evidence, these results need to be confirmed by clinical studies on a large population to standardise and validate biomarkers in biopsies and to assess their reliability in other diagnostic mini-invasive procedures such as radiomics and liquid biopsy.
Collapse
Affiliation(s)
- Roberto Bruschini
- Division of Otolaryngology and Head & Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Fausto Maffini
- Division of Pathology, European Institute of Oncology IRCCS, Milan, Italy
| | - Fausto Chiesa
- Division of Otolaryngology and Head & Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Daniela Lepanto
- Division of Pathology, European Institute of Oncology IRCCS, Milan, Italy
| | - Rita De Berardinis
- Division of Otolaryngology and Head & Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Chu
- Division of Otolaryngology and Head & Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Marta Tagliabue
- Division of Otolaryngology and Head & Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Gioacchino Giugliano
- Division of Otolaryngology and Head & Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Mohssen Ansarin
- Division of Otolaryngology and Head & Neck Surgery, European Institute of Oncology IRCCS, Milan, Italy
| |
Collapse
|
37
|
De Herdt MJ, van der Steen B, van der Toom QM, Aaboubout Y, Willems SM, Wieringa MH, Baatenburg de Jong RJ, Looijenga LHJ, Koljenović S, Hardillo JA. The Potential of MET Immunoreactivity for Prediction of Lymph Node Metastasis in Early Oral Tongue Squamous Cell Carcinoma. Front Oncol 2021; 11:638048. [PMID: 33996551 PMCID: PMC8117234 DOI: 10.3389/fonc.2021.638048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/04/2020] [Accepted: 04/06/2021] [Indexed: 01/19/2023] Open
Abstract
Objective MET positivity is independently associated with survival in oral squamous cell carcinoma (OSCC). Since MET is a known orchestrator of invasive tumor growth, we investigated its association with LNM in early oral tongue squamous cell carcinoma (OTSCC). As it is recommended by the NCCN to use tumor depth of invasion (DOI) in making decisions on elective neck dissection (END), the results obtained for MET positivity were aligned with those for DOI > 4 mm. The cutoff value used in our institution. Methods Tumor samples from patients who underwent primary tumor resection and neck dissection between 1995 and 2013, were collected from the archives of the Leiden and Erasmus University Medical Center. Immunohistochemistry with D1C2 was performed to identify MET negative (< 10% uniform positivity) and MET positive (≥ 10% uniform positivity) cancers. ROC curve analysis and the Chi-squared test were used to investigate the association of MET positivity with LNM (pN+ and occult). Binary logistic regression was used to investigate the association of MET positivity with LNM. Results Forty-five (44.1%) of the 102 cancers were MET positive. Ninety were cN0 of which 20 were pN+ (occult metastasis). The remaining 12 cancers were cN+, of which 10 were proven pN+ and 2 were pN0. MET positivity was associated with LNM with a positive predictive value (PPV) of 44.4% and a negative predictive value (NPV) of 82.5% for pN+. For the occult group, the PPV was 36.8% and the NPV was 88.5%. Regression analysis showed that MET positivity is associated with pN+ and occult LNM (p-value < 0.05). Conclusion MET positivity is significantly associated with LNM in early OTSCC, outperforming DOI. The added value of MET positivity could be in the preoperative setting when END is being considered during the initial surgery. For cases with DOI ≤ 4 mm, MET positivity could aid in the clinical decision whether regular follow-up, watchful waiting, or END is more appropriate. Realizing that these preliminary results need to be independently validated in a larger patient cohort, we believe that MET positivity could be of added value in the decision making on END in early OTSCC.
Collapse
Affiliation(s)
- Maria J De Herdt
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Cancer Institute, Rotterdam, Netherlands
| | - Berdine van der Steen
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Cancer Institute, Rotterdam, Netherlands
| | - Quincy M van der Toom
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Cancer Institute, Rotterdam, Netherlands
| | - Yassine Aaboubout
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Cancer Institute, Rotterdam, Netherlands.,Department of Pathology and Medical Biology, Erasmus MC, University Medical Center Rotterdam, Cancer Institute, Rotterdam, Netherlands
| | - Stefan M Willems
- Department of Pathology, University Medical Center Groningen, Groningen, Netherlands
| | - Marjan H Wieringa
- Department of Education, Office of Science, Elisabeth TweeSteden, Ziekenhuis, Tilburg, Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Cancer Institute, Rotterdam, Netherlands
| | - Leendert H J Looijenga
- Department of Pathology and Medical Biology, Erasmus MC, University Medical Center Rotterdam, Cancer Institute, Rotterdam, Netherlands.,Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Senada Koljenović
- Department of Pathology and Medical Biology, Erasmus MC, University Medical Center Rotterdam, Cancer Institute, Rotterdam, Netherlands
| | - Jose A Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Cancer Institute, Rotterdam, Netherlands
| |
Collapse
|
38
|
Tang D, Zhou J, Wang L, Ni M, Chen M, Hassan S, Luo R, Chen X, He X, Zhang L, Ding X, Yu H, Xu G, Zou X. A Novel Model Based on Deep Convolutional Neural Network Improves Diagnostic Accuracy of Intramucosal Gastric Cancer (With Video). Front Oncol 2021; 11:622827. [PMID: 33959495 PMCID: PMC8095170 DOI: 10.3389/fonc.2021.622827] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 10/29/2020] [Accepted: 03/23/2021] [Indexed: 12/15/2022] Open
Abstract
Background and Aims Prediction of intramucosal gastric cancer (GC) is a big challenge. It is not clear whether artificial intelligence could assist endoscopists in the diagnosis. Methods A deep convolutional neural networks (DCNN) model was developed via retrospectively collected 3407 endoscopic images from 666 gastric cancer patients from two Endoscopy Centers (training dataset). The DCNN model’s performance was tested with 228 images from 62 independent patients (testing dataset). The endoscopists evaluated the image and video testing dataset with or without the DCNN model’s assistance, respectively. Endoscopists’ diagnostic performance was compared with or without the DCNN model’s assistance and investigated the effects of assistance using correlations and linear regression analyses. Results The DCNN model discriminated intramucosal GC from advanced GC with an AUC of 0.942 (95% CI, 0.915–0.970), a sensitivity of 90.5% (95% CI, 84.1%–95.4%), and a specificity of 85.3% (95% CI, 77.1%–90.9%) in the testing dataset. The diagnostic performance of novice endoscopists was comparable to those of expert endoscopists with the DCNN model’s assistance (accuracy: 84.6% vs. 85.5%, sensitivity: 85.7% vs. 87.4%, specificity: 83.3% vs. 83.0%). The mean pairwise kappa value of endoscopists was increased significantly with the DCNN model’s assistance (0.430–0.629 vs. 0.660–0.861). The diagnostic duration reduced considerably with the assistance of the DCNN model from 4.35s to 3.01s. The correlation between the perseverance of effort and diagnostic accuracy of endoscopists was diminished using the DCNN model (r: 0.470 vs. 0.076). Conclusions An AI-assisted system was established and found useful for novice endoscopists to achieve comparable diagnostic performance with experts.
Collapse
Affiliation(s)
- Dehua Tang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jie Zhou
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lei Wang
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Muhan Ni
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Min Chen
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shahzeb Hassan
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Renquan Luo
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xi Chen
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xinqi He
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lihui Zhang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiwei Ding
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Honggang Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Guifang Xu
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xiaoping Zou
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| |
Collapse
|
39
|
Abstract
OBJECTIVES The purpose of this study was to compare magnetic resonance imaging (MRI) maximum tumor diameter and depth of invasion with histopathology in oral tongue squamous cell carcinoma (OTSCC) patients in our Institute. Another objective was to compare recorded nodal status between MRI and histology. MATERIAL AND METHODS MRI and pathological records of 45 patients diagnosed with T1-T3 OTSCC were reviewed retrospectively. Maximum tumor diameter and depth of invasion were measured and rechecked by oral radiologist and pathologist. Nodal status was recorded from both MRI and histopathology. Correlation analyses were performed using Pearson's correlation. RESULTS Both maximum tumor diameter and depth of invasion correlated significantly between MRI and histology (ρ = 0.874, p < .001; ρ = 0.898, p < .001). Significant correlation was found between MRI and pathological dimensions in the MRI-based T-staged subgroups of T2 and T3 but not in T1. MRI sensitivity for detecting pathologically positive nodes was 60%. MRI specificity for detecting pathologically negative nodes was 83%. Moderate correlation was found between MRI and histological nodal status (ρ = 0.44, p = .003). CONCLUSIONS MRI tumor dimensions correlate with histopathological data in OTSCC. Based on our Finnish patient material and results, MRI serves as an accurate tool in supporting OTSCC patient treatment in our Institute.
Collapse
Affiliation(s)
- Piia Huopainen
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lauri Jouhi
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana Hagstrom
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Programs Unit, Translational Cancer Biology, University of Helsinki, Helsinki, Finland
- Department of Oral Pathology and Radiology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Satu Apajalahti
- HUS Medical Imaging Center, Department of Radiology, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
40
|
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.
Collapse
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
| |
Collapse
|
41
|
Gipsyianti N, Aziz A, Hernowo BS, Usman HA. High Expression of COX-2 Associated with the Depth of Invasion on Acral Melanoma by Increasing TGF-β1. Clin Cosmet Investig Dermatol 2021; 14:209-216. [PMID: 33688233 PMCID: PMC7937396 DOI: 10.2147/ccid.s285564] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/26/2020] [Indexed: 11/23/2022]
Abstract
Introduction Acral melanoma (AM) has a poor prognosis since it is easily metastatic and resistant to chemo and immunotherapy. Cyclooxygenase-2 (COX-2) is an enzyme that plays a role in the carcinogenesis process. The increased expression of COX-2 has an impact on increasing levels of Myeloid-Derived Suppressor Cell (MDSC), which is a key regulator of immune. The increase in MDSC produces Transforming Growth Factor β1 (TGF-β1), which will suppress Natural Killer (NK) cells and Dendritic Cells (DC) function so that tumor cells are spared from the immune systems and are easier to invade surrounding tissues. Purpose This study aimed to determine the role of COX-2 and TGF-β1 on the depth of invasion on AM. Materials and Methods This study was a cross-sectional observational study on 40 paraffin blocks of AM cases during 2014-2019 in the Department of Pathology Anatomy, Faculty of Medicine, Dr. Hasan Sadikin General Hospital, Bandung. The depth of invasion of all samples was measured by dotSlide imaging software and the immunohistochemical staining of COX-2 and TGF-β1 was performed. The association between COX-2 and TGF-β1 expression and AM depth of invasion were analyzed using Mann Whitney. Results The result showed a significant association between COX-2 and TGF-β1 expression and depth of invasion on AM. COX-2 expression had a significant association with TGF-β1 expression (0.0001). Through multivariate analysis, it was found that COX-2 had the greatest association with the depth of invasion (p=0.0001). Conclusion The findings showed that increasing expression of COX-2 in AM is associated with the depth of invasion by increasing TGF-β1 and it might play important roles during the invasion process of AM.
Collapse
Affiliation(s)
- Nastassa Gipsyianti
- Department of Pathology Anatomy, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Afiati Aziz
- Department of Pathology Anatomy, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Bethy S Hernowo
- Department of Pathology Anatomy, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Hermin A Usman
- Department of Pathology Anatomy, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| |
Collapse
|
42
|
Acharya S, Raj M, Hallikeri K, Desai A. Histological assessment of budding and depth of invasion (BD) model in biopsies of oral squamous cell carcinoma. J Oral Maxillofac Pathol 2021; 24:581. [PMID: 33967509 PMCID: PMC8083408 DOI: 10.4103/jomfp.jomfp_236_19] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/11/2020] [Accepted: 10/07/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives: Recognizing precise prognosticators from preoperative biopsies that aids in treatment is of immense clinical importance. Thus, the aim of this study was to assess and compare the tumor budding (B), depth of invasion (D) and combined scores (BD) model in the preoperative biopsies and subsequent postoperative specimens of oral squamous cell carcinoma (OSCC). Material and Methods: B and D were assessed in the pre- and postoperative specimens of 65 OSCC cases treated in the institution. Relationship between pre- and postoperative assessments was subjected to McNemar's, Chi-square, Fisher's exact, sensitivity and specificity statistics. Results: There was an agreement between the pre- and postoperative B scores in 54 cases with accuracy of 83% (95% confidence interval 71.73%–91.24%). The preoperative scores showed a good sensitivity of 67.86% and a high specificity of 94.59% in predicting the postoperative score of the same. The difference in assessing intensity B as low and high between preoperative and postoperative biopsies was not statistically different. There was an agreement between the pre- and postoperative scores of the BD model in 72%. The difference in BD scoring as low intermediate and high between preoperative and postoperative biopsies were significantly different statistically. Postoperative BD scoring showed a significant association with stage and lymph node metastasis. Conclusions: The findings validate the prognostic value of BD model in the postoperative specimens. Its value in preoperative biopsies is questionable. A judicious representative biopsy may increase the accuracy and reliability in the assessment of preoperative B and precision in BD model evaluation.
Collapse
Affiliation(s)
- Swetha Acharya
- Department of Oral Pathology and Microbiology, S.D.M College of Dental Sciences and Hospital, Unit of Shri Dharmasthala Manjunatheswara University, Dharwad, Karnataka, India
| | - Monica Raj
- Department of Oral Pathology and Microbiology, S.D.M College of Dental Sciences and Hospital, Unit of Shri Dharmasthala Manjunatheswara University, Dharwad, Karnataka, India
| | - Kaveri Hallikeri
- Department of Oral Pathology and Microbiology, S.D.M College of Dental Sciences and Hospital, Unit of Shri Dharmasthala Manjunatheswara University, Dharwad, Karnataka, India
| | - Anil Desai
- Department of Oral and Maxillofacial Surgery, S.D.M College of Dental Sciences and Hospital, Unit of Shri Dharmasthala Manjunatheswara University, Dharwad, Karnataka, India
| |
Collapse
|
43
|
Joshi P, Pol J, Chougule M, Jadhav K, Patil S, Patil S. Tumor budding - A promising prognostic histopathological parameter in oral squamous cell carcinoma - A comparative immunohistochemical study. J Oral Maxillofac Pathol 2021; 24:587. [PMID: 33967517 PMCID: PMC8083399 DOI: 10.4103/jomfp.jomfp_74_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 10/08/2020] [Accepted: 11/03/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction: The majority of the head and neck squamous cell carcinomas (HNSCC) occur in the oral cavity. Even with advances in cancer therapy only minor improvements in the survival of HNSCC patients have taken place and approximately 350,000 patients die annually of HNSCC worldwide. Tumor budding (TB) is a novel and promising histo-morphological parameter that has been studied in many cancers. The presence of TB is associated with lymph node and distant metastasis as well as poor survival, independently of the applied scoring system. The depth of tumor invasion (D) measured from the surface of the tumor to the deepest point of invasion is also an important prognostic parameter for oral squamous cell carcinoma (OSCC) with a cutoff point of 4 mm. Both taken together constitute BD model and it has also been found to be an independent prognostic factor for patients with OSCC. Therefore, it would be highly beneficial to evaluate TB and BD model in routine histopathological reporting. Aims and Objectives: This study aims to compare the detection of TB in hematoxylin-eosin and pan-cytokeratin stained immune-histochemical sections of OSCC and also to evaluate whether BD score can serve as a reliable prognostic indicator for OSCC. Methodology: A total of 30 formalin-fixed, paraffin-embedded tissue blocks of clinically and histopathologically diagnosed cases of OSCC were retrieved. One section was stained with hematoxylin and eosin and the other was processed for pancytokeratin immunohistochemistry to evaluate tumor buds. Depth of invasion (D) was also evaluated to achieve the BD score. Results: Statistical significance (P < 0.001) was noted between TB score evaluated in hematoxylin and eosin (H&E) and pancytokeratin stained sections. There was no statistical significance between age, gender, site of lesion, clinical staging, survival and BD score. Conclusion: Immunohistochemical analysis of TB is superior to H&E staining in detection of tumor buds at the tumor invasive front.
Collapse
Affiliation(s)
- Priya Joshi
- Department of Oral Pathology and Microbiology, Vasantdada Patil Dental College and Hospital, Sangli, Maharashtra, India
| | - Jaydeep Pol
- Department of Oncopathology, Mahatma Gandhi Cancer Hospital, Miraj, Maharashtra, India
| | - Madhuri Chougule
- Department of Oral Pathology and Microbiology, Vasantdada Patil Dental College and Hospital, Sangli, Maharashtra, India
| | - Kiran Jadhav
- Department of Oral Pathology and Microbiology, Vasantdada Patil Dental College and Hospital, Sangli, Maharashtra, India
| | - Sangeeta Patil
- Department of Oral Pathology and Microbiology, Vasantdada Patil Dental College and Hospital, Sangli, Maharashtra, India
| | - Swapnita Patil
- Department of Oral Pathology and Microbiology, Vasantdada Patil Dental College and Hospital, Sangli, Maharashtra, India
| |
Collapse
|
44
|
Salama AM, Valero C, Katabi N, Khimraj A, Yuan A, Zanoni DK, Ganly I, Patel SG, Ghossein R, Xu B. Depth of invasion versus tumour thickness in early oral tongue squamous cell carcinoma: which measurement is the most practical and predictive of outcome? Histopathology 2020; 79:325-337. [PMID: 33112422 DOI: 10.1111/his.14291] [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] [Received: 09/10/2020] [Revised: 10/15/2020] [Accepted: 10/26/2020] [Indexed: 12/24/2022]
Abstract
AIMS The 8th edition of the American Joint Committee on Cancer (AJCC) Staging introduced depth of invasion (DOI) into the pT category of oral cavity squamous cell carcinoma. However, we noted multiple practical obstacles in accurately measuring DOI histologically in our daily practice. METHODS AND RESULTS To compare the prognostic effects of DOI and tumour thickness (TT), a meticulous pathology review was conducted in a retrospective cohort of 293 patients with AJCC 7th edition pT1/T2 oral tongue squamous cell carcinoma. Overall survival (OS) and nodal metastasis rate at initial resection were the primary and secondary outcomes, respectively. We found that TT and DOI were highly correlated with a correlation coefficient of 0.984. The upstage rate was only 6% (18 of 293 patients) when using TT in the pT stage compared with using DOI. More importantly, DOI and TT, as well as pT stage using DOI and pT stage using TT, performed identically in predicting risk of nodal metastasis and OS. CONCLUSIONS We therefore propose to replace DOI, a complicated measurement with many challenges, with TT in the pT staging system.
Collapse
Affiliation(s)
- Abeer M Salama
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cristina Valero
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nora Katabi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anjanie Khimraj
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Avery Yuan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniella K Zanoni
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ian Ganly
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Snehal G Patel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ronald Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
45
|
Wahab A, Onkamo O, Pirinen M, Almangush A, Salo T. The budding and depth of invasion model in oral cancer: A systematic review and meta-analysis. Oral Dis 2020; 28:275-283. [PMID: 33031610 DOI: 10.1111/odi.13671] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/21/2020] [Accepted: 09/26/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Tumour budding (B) and depth of invasion (D) have both been reported as promising prognostic markers in oral squamous cell carcinoma (OSCC). This meta-analysis assessed the prognostic value of the tumour budding and depth of invasion combination (BD model) in OSCC. METHODS Databases including Ovid MEDLINE, PubMed, Scopus and Web of Science were searched for articles that studied the BD model as a prognosticator in OSCC. PICO search strategy was "In OSCC patients, does BD model have a prognostic power?" We used the reporting recommendations for tumour marker prognostic studies (REMARK) criteria to evaluate the quality of studies eligible for systematic review and meta-analysis. RESULTS Nine studies were relevant as they analysed the BD model for prognostication of OSCC. These studies used either haematoxylin and eosin (HE) or pan-cytokeratin (PCK)-stained resected sections of OSCC. Our meta-analysis showed a significant association of BD model with OSCC disease-free survival (hazard ratio = 2.02; 95% confidence interval = 1.44-2.85). CONCLUSIONS The BD model is a simple and reliable prognostic indicator for OSCC. Evaluation of the BD model from HE- or PCK-stained sections could facilitate individualized treatment planning for OSCC patients.
Collapse
Affiliation(s)
- Awais Wahab
- Department of Pathology, University of Helsinki, Helsinki, Finland.,Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Oona Onkamo
- Cancer Research and Translational Medicine Research Unit, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Matti Pirinen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | - Alhadi Almangush
- Department of Pathology, University of Helsinki, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Institute of Biomedicine, Pathology, University of Turku, Turku, Finland.,Faculty of Dentistry, University of Misurata, Misurata, Libya
| | - Tuula Salo
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland.,Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| |
Collapse
|
46
|
Domingueti CB, Miwa KYM, Dourado MR, Sawazaki-Calone Í, Salo TA, Paranaíba LMR, Coletta RD. Prognostication for oral carcinomas based on two histological scoring systems (BD and iBD models). Oral Dis 2020; 27:894-899. [PMID: 32772480 DOI: 10.1111/odi.13595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/26/2020] [Accepted: 08/02/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Catherine Bueno Domingueti
- Department of Pathology and Parasitology, Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, Brazil.,University José do Rosário Vellano, Biomedicine, Varginha, Brazil
| | | | - Mauricio Rocha Dourado
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Íris Sawazaki-Calone
- Department of Oral Pathology and Oral Medicine, Dentistry School, Western Paraná State University, Cascavel, Brazil
| | - Tuula A Salo
- Cancer and Translational Medicine Research Unit, Faculty of Medicine and Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.,Department of Pathology, Institute of Oral and Maxillofacial Disease, Helsinki University Hospital, University of Helsinki and HUSLAB, Helsinki, Finland
| | - Lívia Máris Ribeiro Paranaíba
- Department of Pathology and Parasitology, Institute of Biomedical Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Ricardo D Coletta
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| |
Collapse
|
47
|
Fu JY, Zhu L, Li J, Chen PQ, Shi WT, Shen SK, Zhang CP, Zhang ZY. Assessing the magnetic resonance imaging in determining the depth of invasion of tongue cancer. Oral Dis 2020; 27:457-463. [PMID: 32731298 DOI: 10.1111/odi.13579] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To assess the magnetic resonance imaging (MRI) in predicting tumour's depth of invasion (DOI) of tongue cancer by comparing to pathology and to determine the cut-off value of MRI-derived DOI for lymph node metastasis. PATIENTS AND METHODS In a retrospective analysis, 156 patients with newly diagnosed tongue cancer were included. Tumour's DOI was compared between MRI measurement and pathology by Pearson correlation coefficient and paired t test. The accuracy of MRI-derived DOI was compared to the pathological DOI. The relationship between MRI-derived DOI and cervical lymph node metastasis was calculated by receiver operating characteristic curve. RESULTS Tumour's DOI was well correlated between MRI measurement and pathology with correlation coefficients of 0.77. MRI-derived DOI was 3.4 mm (28%) larger than pathology. The accuracy of MRI in deciding pathological DOI was 67.9%. The cut-off value of MRI-derived DOI was 10.5 mm for lymph node metastasis of tongue cancer. CONCLUSION Magnetic resonance imaging can be used as a reference to determine tumour's DOI of tongue cancer. Tumour with MRI-derived DOI larger than 10.5 mm deserves simultaneous neck dissection at initial surgery.
Collapse
Affiliation(s)
- Jin-Ye Fu
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ling Zhu
- Department of Radiology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiang Li
- Department of Oral Pathology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Pei-Qian Chen
- Department of Radiology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen-Tao Shi
- Department of Biostatistics, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shu-Kun Shen
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chen-Ping Zhang
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi-Yuan Zhang
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
48
|
Terada H, Sasaki E, Suzuki H, Nishikawa D, Beppu S, Hanai N. An examination of the cutoff value of the depth of invasion for prophylactic neck dissection in stage I/II tongue cancer. Acta Otolaryngol 2020; 140:422-426. [PMID: 32022616 DOI: 10.1080/00016489.2020.1717606] [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] [Indexed: 10/25/2022]
Abstract
Background: In stage-I/stage-II oral tongue cancer, the cutoff value of depth of invasion (DOI) for prophylactic neck dissection is controversial.Objectives: To examine the relationship between the DOI and the rate of occult lymph node metastasis. In addition, to examine the relationship between the DOI evaluated by magnetic resonance imaging (MRI) and pathological DOI.Materials and methods: In this retrospective study, 95 patients with clinical T1-2/N0M0 oral tongue cancer were enrolled. The rate of occult lymph node metastasis per DOI between 2 and 11 mm was calculated from the total pathological lymph node metastasis and delayed neck metastasis cases. We measured DOI using MRI and compared DOI obtained from pathology.Results: The total rate of occult lymph node metastasis was 23.9%. In the rate of occult lymph node metastasis per DOI, there were two peaks at point of 5 to 6 mm and 9 to 10 mm. And there was a significant correlation between the DOI evaluated by MRI and the pathological DOI (Pearson's correlation coefficient was 0.87).Conclusions and significance: There was no consistent increase in the rate of occult lymph node metastasis per DOI. MRI was a useful modality to measure the DOI.
Collapse
Affiliation(s)
- Hoshino Terada
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Eiichi Sasaki
- Departments of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hidenori Suzuki
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Daisuke Nishikawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shintaro Beppu
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| |
Collapse
|
49
|
Vidiri A, Panfili M, Boellis A, Cristalli G, Gangemi E, Pellini R, Marzi S, Covello R. The role of MRI-derived depth of invasion in staging oral tongue squamous cell carcinoma: inter-reader and radiological-pathological agreement. Acta Radiol 2020; 61:344-352. [PMID: 31319692 DOI: 10.1177/0284185119862946] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The 8th edition of tumor, node, metastasis (TNM) classification incorporates depth of invasion evaluation in the staging of oral cavity squamous cell carcinoma, since it is a predictor of nodal metastasis and an independent prognostic factor. Although the histopathological definition of depth of invasion is clear, an accurate method for its radiological assessment has not yet been validated. Purpose To investigate the role of MRI-derived depth of invasion evaluation in staging oral tongue squamous cell carcinoma and to assess the inter-reader agreement and the radiological–pathological correlation. Material and Methods We retrospectively reviewed 43 patients with oral tongue squamous cell carcinoma who underwent preoperative MRI. The MRI-derived depth of invasion was measured by two radiologists, each with a different degree of experience in head and neck imaging. The pathological depth of invasion was recorded from histopathological reports. The inter-reader and the radiological–histopathological correlations for the depth of invasion were evaluated with Bland–Altman plots, the intraclass correlation coefficients (ICC), and the paired samples test; agreements for T staging were assessed using the Kappa coefficient. Results Inter-reader reliability was excellent for the MRI-derived depth of invasion (ICC = 0.91), very good between MRI-derived depth of invasion and pathological depth of invasion (ICC = 0.89 for the experienced reader, 0.86 for the inexperienced reader). Both readers reached a good agreement regarding T staging (kappa value = 0.70). Furthermore, the agreement between radiological and pathological T staging was good (kappa value = 0.74 for the experienced reader, 0.60 for the inexperienced reader). Conclusion MRI-derived depth of invasion should be measured in the pretreatment assessment of oral tongue squamous cell carcinoma as it has an excellent inter-reader reliability and nearly excellent radiological–pathological correlation.
Collapse
Affiliation(s)
- Antonello Vidiri
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marco Panfili
- Department of Radiological Science, Radiotherapy and Hematology, Institute of Radiology, Fondazione Policlinico A. Gemelli IRCCS – Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Boellis
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giovanni Cristalli
- Department of Otolaryngology & Head and Neck Surgery, Regina Elena National Cancer Institute, Rome, Italy
| | - Emma Gangemi
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Raul Pellini
- Department of Otolaryngology & Head and Neck Surgery, Regina Elena National Cancer Institute, Rome, Italy
| | - Simona Marzi
- Medical Physics Laboratory, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Renato Covello
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| |
Collapse
|
50
|
Oishi K, Ito T, Sakonishi D, Uchida K, Sekine M, Negi M, Kobayashi D, Miura K, Akashi T, Eishi Y. Cancer gland rupture as a potential risk factor for lymph node metastasis in early colorectal adenocarcinoma with deep submucosal invasion. Histopathology 2019; 76:603-612. [PMID: 31643099 PMCID: PMC7064972 DOI: 10.1111/his.14022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/22/2019] [Indexed: 12/27/2022]
Abstract
Aims Lymph node metastasis (LNM) has not been found in more than 85% of patients with early invasive colorectal adenocarcinoma (T1‐CRAC) who undergo surgery after therapeutic endoscopy due to the risk for LNM. Better histological risk assessment for LNM of endoscopically resected T1‐CRAC is important to avoid unnecessary additional surgery. Methods and results We evaluated cancer gland rupture (CGR), i.e. cancer glands with a discontinuous epithelial lining, at the invasive front, as a potential risk factor for LNM by histological examination of differentiated T1‐CRAC from 217 patients who underwent surgery with or without therapeutic endoscopy. CGR was represented by C‐shaped neoplastic glands with a variable inflammatory or stromal reaction, and was occasionally accompanied by mucus lake or abscess formation. CGR was observed in 168 (77%) cases, including all 20 cases with LNM, and the odds ratio of LNM was higher for CGR than for deep invasion (depth of submucosal invasion ≥1000 μm). All cases with LNM were found among 148 cases with deep invasion and positive CGR, whereas no LNM was detected in 29 cases with deep invasion and negative CGR, regardless of vascular invasion or tumour budding. In the 148 cases, LNM was detected in 18 (19%) of 93 cases with positive vascular invasion or high‐grade tumour budding, and in two (4%) of 55 cases without either. Conclusions Our findings suggest that CGR is an easily applied and objective histological finding for predicting LNM that could be useful for assessing the risk for LNM of endoscopically resected T1‐CRAC with deep invasion.
Collapse
Affiliation(s)
- Katsumi Oishi
- Department of Human Pathology, Graduate School and Faculty of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Ito
- Department of Human Pathology, Graduate School and Faculty of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Daisuke Sakonishi
- Division of Clinical Laboratory, Keio University Hospital, Tokyo, Japan
| | - Keisuke Uchida
- Division of Surgical Pathology, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Masaki Sekine
- Division of Surgical Pathology, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Mariko Negi
- Department of Human Pathology, Graduate School and Faculty of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Daisuke Kobayashi
- Department of Human Pathology, Graduate School and Faculty of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiko Miura
- Division of Surgical Pathology, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Takumi Akashi
- Division of Surgical Pathology, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Yoshinobu Eishi
- Department of Human Pathology, Graduate School and Faculty of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|