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Correlation between brush cytology results and histopathological examination in diagnostic evaluation of precancerous conditions and laryngeal cancer: A prospective study. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2022-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Introduction
The aim of the paper was to demonstrate that brush cytology can be useful in diagnostic evaluation of precancerous states and laryngeal cancer.
Materials and Methods
Ninety-two patients were analyzed. The control group included patients with benign laryngeal lesions, while the study group was composed of patients in whom a precancerous condition or laryngeal cancer was suspected. Material for histopathological and cytological examination was collected during a laryngeal microsurgery. The authors analyzed the consistency of the results of cytological and histopathological examination in the diagnostic evaluation of precancerous conditions and laryngeal cancer.
Results
Comparing diagnoses based on cytological examination with the results of histopathological examinations, the authors observed that there was a strong and statistically significant (p<0.001) correlation between the results. The accuracy of brush cytology in the conducted study indicates that the sensitivity and specificity of the test reaches 90.09% and 93.5% with 4 false negative and 3 false positive results. Positive prediction reached 93% and negative prediction reached 91.5%.
Conclusions
Brush cytology of the larynx may be useful in screening and as an auxiliary test in diagnostic evaluation of precancerous conditions and laryngeal cancer.
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The combination of brush cytology with the results of histopathological examination in laryngeal cancer diagnosis. POSTEP HIG MED DOSW 2021. [DOI: 10.2478/ahem-2021-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Recently, the incidence rate of head and neck cancer (HNC) has been increasing significantly. It is estimated that there are over 550,000 new cases per year, of which over 130,000 are laryngeal cancers. It is assumed that in more than 60% of patients the disease is diagnosed late, at stages III–IV, which is associated with unfavorable prognoses: the average survival ranges from 15% to 45%. The mainstay of successful tumor therapy is the early detection of neoplastic tissue. The laryngological examination with the use of traditional instruments should be expanded with an endoscopic examination of the larynx using optics in the outpatient clinics. This procedure is sufficient to select patients who need a direct laryngoscopy with a surgical biopsy, usually under general anesthesia in operating room conditions. However, it may bear potential complications. In 1941, Papanicolaou and Traut showed that brush cytology could be useful in detecting precancerous conditions and cervical cancers. For decades, research on the usefulness of brush cytology in diagnosing precancerous conditions and laryngeal cancers has been conducted. This paper aims to enable the reader to understand the issues related to laryngeal cancer and present the results of the previous use of brush cytology in the diagnostic process.
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Boscolo Nata F, Gardenal N, Giudici F, Tirelli G. The role of NBI with flexible video-endoscope in the follow-up of head and neck cancer patients: a prospective study. Eur Arch Otorhinolaryngol 2021; 279:2133-2141. [PMID: 34304298 DOI: 10.1007/s00405-021-07016-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/21/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE Narrow band imaging (NBI) enhances mucosal vasculature and could help in the identification of recurrences. We assessed the effectiveness of NBI with flexible video-endoscope in the early detection of recurrence after treatment of head and neck squamous cell carcinoma, its diagnostic advantage over high-definition white-light (HD WL) endoscopy, also in relation to recurrence site, and the influence of previous radiotherapy (RT) or chemotherapy (CT). Moreover, we investigated the association between index tumor site and the risk of developing recurrence, and the relation between index tumor site and recurrence site. METHODS From January 2018 to November 2020, 160 patients previously treated with surgery and/or RT ± CT were evaluated using NBI with flexible video-endoscope. Sensitivity, specificity, positive/negative predictive value, and accuracy were calculated for NBI and HD WL, and compared using the McNemar test. The Fisher exact test was used to compare the other associations investigated. RESULTS The difference between NBI and HD WL sensitivity was statistically significant (p < 0.001). The NBI diagnostic advantage was 62.5%, highest in the hypopharynx (p = 0.05), and was not influenced by previous RT or CT (p = 0.49). Index tumor site statistically related with recurrence site (p < 0.001), but not with the risk of developing recurrence (p = 0.81). CONCLUSION NBI with flexible video-endoscope could represent a valid option to detect recurrence early during the follow-up, especially in a difficult-to-visualize site such as the hypopharynx.
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Affiliation(s)
- Francesca Boscolo Nata
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Nicoletta Gardenal
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy
| | - Fabiola Giudici
- Unit of Biostatistics, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giancarlo Tirelli
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy
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Tirelli G, Piovesana M, Marcuzzo AV, Gatto A, Biasotto M, Bussani R, Zandonà L, Giudici F, Boscolo Nata F. Tailored resections in oral and oropharyngeal cancer using narrow band imaging. Am J Otolaryngol 2018; 39:197-203. [PMID: 29150027 DOI: 10.1016/j.amjoto.2017.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/28/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE In a previous pilot study we observed that intra-operative narrow-band imaging (NBI) helps achieve clear superficial resection margins. The aim of this study was to verify if the use of intra-operative NBI can help to obtain tailored resections and if it is influenced by the lesion site, aspects not investigated in our previous study. MATERIALS AND METHODS The resection margins of 39 oral and 22 oropharyngeal squamous cell carcinomas were first set at 1.5cm from the macroscopic lesion boundary (white light, WL, tattoo). Then, the superficial tumor extension was more precisely defined with NBI, giving rise to three possible situations: NBI tattoo larger than the WL tattoo, NBI tattoo coinciding with the WL tattoo, or NBI tattoo smaller than the WL tattoo. For each of these situations the space comprised between the NBI and WL tattoos was defined "NBI positive", "NBI null", and "NBI negative", respectively. Resections were performed following the outer tattoo. The number of clear superficial resection margins, and the pathological response on the "NBI-positive" and the "NBI-negative" areas were recorded. RESULTS We obtained 80.3% negative superficial resection margins. NBI provided a more precise definition of superficial tumor extension in 43 patients. Sensitivity, specificity, positive and negative predictive values were 94.4%, 64%, 79.1% and 88.9%, respectively; a test of proportions demonstrated they were not influenced by tumor site. CONCLUSIONS NBI could allow for real-time definition of superficial tumor extension with possible tailored resections and fewer positive superficial resection margins; it is not influenced by tumor site.
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Tirelli G, Gatto A, Bonini P, Tofanelli M, Arnež ZM, Piccinato A. Prognostic indicators of improved survival and quality of life in surgically treated oral cancer. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:S2212-4403(18)30052-X. [PMID: 29506918 DOI: 10.1016/j.oooo.2018.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 01/10/2018] [Accepted: 01/23/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE No published study has analyzed the prognostic factors of surgically treated oral squamous cell carcinoma (OSCC) in relation to both survival and quality of life (QoL). The aim of this study was to analyze postoperative QoL in relation to survival to identify which parameters can predict the long-term outcome allowing the best QoL. STUDY DESIGN This retrospective cohort study considered 167 patients affected by OSCC treated surgically at the Otolaryngology Department of Cattinara Hospital (Trieste, Italy) by a single surgeon. We collected data about the main prognostic factors and the postoperative QoL 12 month after surgery. RESULTS The 5-year overall survival rate was equal to 68.1%, and the 5-year disease-specific survival was 77.8%. In this sample, 32% of patients also underwent adjuvant chemoradiotherapy. On stepwise Cox regression, the best predictors of disease-specific survival were the N stage (P < .001) and tumor depth of invasion (P < .001). QoL was affected by N stage, depth of invasion, invasive surgical approach, radiotherapy, and neck dissection (P < .05). CONCLUSION The prognostic factors that affect both survival rates and residual QoL are the surgical approach, the neck stage, and the depth of invasion, all of which can be minimized by early diagnosis.
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Affiliation(s)
- Giancarlo Tirelli
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
| | - Annalisa Gatto
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
| | - Pierluigi Bonini
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
| | - Margherita Tofanelli
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
| | - Zoran M Arnež
- Department of Plastic and Reconstructive Surgery, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Alice Piccinato
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Italy.
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Cao M, Zheng L, Liu J, Dobleman T, Hu S, Go VLW, Gao G, Xiao GG. MicroRNAs as effective surrogate biomarkers for early diagnosis of oral cancer. Clin Oral Investig 2018; 22:571-581. [PMID: 29299731 DOI: 10.1007/s00784-017-2317-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/12/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Oral squamous cell carcinomas (OC) are life-threatening diseases emerging as major international health concerns. OBJECTIVE Development of an efficient clinical strategy for early diagnosis of the disease is a key for reducing the death rate. Biomarkers are proven to be an effective approach for clinical diagnosis of cancer. Although mechanisms underlying regulation of oral malignancy are still unclear, microRNAs (miRNAs) as a group of small non-coded RNAs may be developed as the effective biomarkers used for early detection of oral cancer. METHODS A literature search was conducted using the databases of PubMed, Web of Science, and the Cochrane Library. The following search terms were used: miRNAs and oral cancer or oral carcinoma. A critical appraisal of the included studies was performed with upregulated miRNAs and downregulated miRNAs in oral cancer. RESULTS In this review, we summarize the research progress made in miRNAs for diagnosis of oral cancer. The involvement of miRNAs identified in signal transduction pathways in OC, including Ras/MAPK signaling, PI3K/AKT signaling, JAK/STAT signaling, Wnt/β-catenin signaling, Notch signaling, and TGF-β/SMAD signaling pathway. CONCLUSIONS A number of studies demonstrated that miRNAs may be developed as an ideal set of biomarkers used for early diagnosis and prognosis of cancers because of the stability in human peripheral blood and body fluids and availability of non-invasive approaches being developed for clinical utility. CLINICAL RELEVANCE These findings suggest that miRNAs as biomarkers may be useful for diagnosis of OC.
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Affiliation(s)
- Min Cao
- School of Pharmaceutical Science and Technology, Dalian University of Technology, Dalian, 116024, China
| | - Lijuan Zheng
- Geriatric Department of Stomatology, Dalian Stomatology Hospital, Dalian, 116021, China
| | - Jianzhou Liu
- School of Pharmaceutical Science and Technology, Dalian University of Technology, Dalian, 116024, China
| | - Thomas Dobleman
- Genomics and Functional Proteomics Laboratories, Creighton University Medical Center, Omaha, NE, 68131, USA
| | - Shen Hu
- School of Dentistry, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Vay Liang W Go
- UCLA Agi Hirshberg Center for Pancreatic Diseases, David Geffen School of Medicine at University of California Los Angeles, 900 Veteran Avenue, Warren Hall 13-146, Los Angeles, CA, 90095-1786, USA
| | - Ge Gao
- Faculty of Laboratory Medicine, Xiangya Medical College of Central South University, Changsha, 410013, China
| | - Gary Guishan Xiao
- School of Pharmaceutical Science and Technology, Dalian University of Technology, Dalian, 116024, China. .,Genomics and Functional Proteomics Laboratories, Creighton University Medical Center, Omaha, NE, 68131, USA. .,UCLA Agi Hirshberg Center for Pancreatic Diseases, David Geffen School of Medicine at University of California Los Angeles, 900 Veteran Avenue, Warren Hall 13-146, Los Angeles, CA, 90095-1786, USA.
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Nooij LS, van der Slot MA, Dekkers OM, Stijnen T, Gaarenstroom KN, Creutzberg CL, Smit VTHBM, Bosse T, van Poelgeest MIE. Tumour-free margins in vulvar squamous cell carcinoma: Does distance really matter? Eur J Cancer 2016; 65:139-49. [PMID: 27497345 DOI: 10.1016/j.ejca.2016.07.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/29/2016] [Accepted: 07/04/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is no consensus on the width of tumour-free margins after surgery for vulvar squamous cell carcinoma (VSCC). Most current guidelines recommend tumour-free margins of ≥8 mm. The aim of this study was to investigate whether a margin of <8 mm is associated with an increased risk of local recurrence in VSCC. METHODS A meta-analysis of the available literature and a cohort study of 148 VSCC patients seen at a referral centre from 2000 to 2012 was performed. The primary end-point of the cohort study was a histologically confirmed ipsilateral local recurrence within 2 years after primary treatment in relation to the margin distance. RESULTS Based on 10 studies, the meta-analysis showed that a tumour-free margin of <8 mm is associated with a higher risk of local recurrence compared to a tumour-free margin of ≥8 mm (pooled risk ratio, 1.99 [95% confidence interval {CI}: 1.13-3.51], p = 0.02). In the cohort study, we found no clear difference in the risk of local recurrence in the <8 versus ≥8 mm group; however, 40% of the patients in the <8 mm group received additional treatment. Tumour-positive margin was the only independent risk factor for local recurrence in the multivariable analysis (hazard ratio, 0.21 [95% CI: 0.08-0.55]). CONCLUSIONS This work provides important data to question the commonly used 8-mm margin as a prognosticator for local recurrence. More research is needed to address the question of whether additional treatment improves the prognosis in patients with a tumour-free margin of <8 mm.
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Affiliation(s)
- L S Nooij
- Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M A van der Slot
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - O M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - T Stijnen
- Department of Medical Statistics, Leiden University Medical Centre, Leiden, The Netherlands
| | - K N Gaarenstroom
- Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - C L Creutzberg
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - V T H B M Smit
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - T Bosse
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M I E van Poelgeest
- Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands.
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Tirelli G, Piovesana M, Gatto A, Torelli L, Boscolo Nata F. Is NBI-Guided Resection a Breakthrough for Achieving Adequate Resection Margins in Oral and Oropharyngeal Squamous Cell Carcinoma? Ann Otol Rhinol Laryngol 2016; 125:596-601. [PMID: 27056557 DOI: 10.1177/0003489416641428] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Obtaining free resection margins is the main goal of oncological surgeons. Narrow-band imaging (NBI) has been recently used to help define resection margins in transoral laser microsurgery for laryngeal carcinoma. The aim of this study was to evaluate the effect of intraoperative NBI in defining the surgical resection margins of oral and oropharyngeal cancers. METHODS Between January 2014 and March 2015, NBI was used intraoperatively after an initial definition of resection margins with white light in 26 patients (group A). The rate of superficial positive margins at definitive histology was compared with that of a historical cohort of 44 patients (group B) previously managed without the use of intraoperative NBI. RESULTS A statistically significant reduction in the rate of positive superficial margins was observed at definitive histology in group A (P = .028). NBI helped to identify the presence of dysplasia and cancer around the visible tumor not otherwise detectable with visual examination alone. CONCLUSIONS NBI could be a useful tool for obtaining free resection margins in oral and oropharyngeal carcinoma.
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Affiliation(s)
| | - Marco Piovesana
- ENT Clinic, Head and Neck Department, University of Trieste, Italy
| | - Annalisa Gatto
- ENT Clinic, Head and Neck Department, University of Trieste, Italy
| | - Lucio Torelli
- Department of Mathematics and Earth Science, University of Trieste, Italy
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