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Lan T, Kuang S, Liang P, Ning C, Li Q, Wang L, Wang Y, Lin Z, Hu H, Yang L, Li J, Liu J, Li Y, Wu F, Chai H, Song X, Huang Y, Duan X, Zeng D, Li J, Cao H. MRI-based deep learning and radiomics for prediction of occult cervical lymph node metastasis and prognosis in early-stage oral and oropharyngeal squamous cell carcinoma: a diagnostic study. Int J Surg 2024; 110:4648-4659. [PMID: 38729119 PMCID: PMC11325978 DOI: 10.1097/js9.0000000000001578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/25/2024] [Indexed: 05/12/2024]
Abstract
INTRODUCTION The incidence of occult cervical lymph node metastases (OCLNM) is reported to be 20-30% in early-stage oral cancer and oropharyngeal cancer. There is a lack of an accurate diagnostic method to predict occult lymph node metastasis and to help surgeons make precise treatment decisions. AIM To construct and evaluate a preoperative diagnostic method to predict OCLNM in early-stage oral and oropharyngeal squamous cell carcinoma (OC and OP SCC) based on deep learning features (DLFs) and radiomics features. METHODS A total of 319 patients diagnosed with early-stage OC or OP SCC were retrospectively enrolled and divided into training, test and external validation sets. Traditional radiomics features and DLFs were extracted from their MRI images. The least absolute shrinkage and selection operator (LASSO) analysis was employed to identify the most valuable features. Prediction models for OCLNM were developed using radiomics features and DLFs. The effectiveness of the models and their clinical applicability were evaluated using the area under the curve (AUC), decision curve analysis (DCA), and survival analysis. RESULTS Seventeen prediction models were constructed. The Resnet50 deep learning (DL) model based on the combination of radiomics and DL features achieves the optimal performance, with AUC values of 0.928 (95% CI: 0.881-0.975), 0.878 (95% CI: 0.766-0.990), 0.796 (95% CI: 0.666-0.927), and 0.834 (95% CI: 0.721-0.947) in the training, test, external validation set1, and external validation set2, respectively. Moreover, the Resnet50 model has great prediction value of prognosis in patients with early-stage OC and OP SCC. CONCLUSION The proposed MRI-based Resnet50 DL model demonstrated high capability in diagnosis of OCLNM and prognosis prediction in the early-stage OC and OP SCC. The Resnet50 model could help refine the clinical diagnosis and treatment of the early-stage OC and OP SCC.
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Affiliation(s)
- Tianjun Lan
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-Sen Memorial Hospital, Guangzhou
| | - Shijia Kuang
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-Sen Memorial Hospital, Guangzhou
| | - Peisheng Liang
- Guanghua School of Stomatology, Hospital of Stomatology, Guangdong Province Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou
| | - Chenglin Ning
- School of Biomedical Engineering, Southern Medical University, Guangzhou
| | - Qunxing Li
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-Sen Memorial Hospital, Guangzhou
| | - Liansheng Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-Sen Memorial Hospital, Guangzhou
| | - Youyuan Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-Sen Memorial Hospital, Guangzhou
| | - Zhaoyu Lin
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-Sen Memorial Hospital, Guangzhou
| | - Huijun Hu
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou
| | - Lingjie Yang
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou
| | - Jintao Li
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-Sen Memorial Hospital, Guangzhou
| | - Jingkang Liu
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-Sen Memorial Hospital, Guangzhou
| | - Yanyan Li
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-Sen Memorial Hospital, Guangzhou
| | - Fan Wu
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-Sen Memorial Hospital, Guangzhou
| | - Hua Chai
- School of Mathematics and Big Data, Foshan University, Foshan, Guangdong
| | - Xinpeng Song
- School of Mathematics and Big Data, Foshan University, Foshan, Guangdong
| | - Yiqian Huang
- School of Mathematics and Big Data, Foshan University, Foshan, Guangdong
| | - Xiaohui Duan
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou
| | - Dong Zeng
- School of Biomedical Engineering, Southern Medical University, Guangzhou
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Jinsong Li
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-Sen Memorial Hospital, Guangzhou
| | - Haotian Cao
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-Sen Memorial Hospital, Guangzhou
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Song JM, Mo N, Lv YQ, Huang LL, Wen YJ, Liu T, Li ZR, Wang RS, Zhang TT. Effects of concurrent chemoradiotherapy with or without Endostar on the regression of retropharyngeal lymph node and prognosis of patients with locally advanced nasopharyngeal carcinoma: a retrospective study. J Cancer Res Clin Oncol 2024; 150:232. [PMID: 38703186 PMCID: PMC11069474 DOI: 10.1007/s00432-024-05762-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/23/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND AND PURPOSE To investigate the effect of combining Endostar with concurrent chemoradiotherapy (ECCRT) compared to concurrent chemoradiotherapy (CCRT) on the regression rate of retropharyngeal lymph nodes (RLNs) and the relationship between regression rate of RLNs and prognosis of patients with locally advanced nasopharyngeal carcinoma (LANPC). METHODS A total of 122 LANPC patients with RLNs metastasis were included. Metastatic RLNs were delineated both before and after treatment slice by slice on the magnetic resonance images cross-section. The regression rate of RLNs, adverse effects (AE) were evaluated. The median regression rate of RLNs was taken as the cut-off value, and the patients were furtherly divided into high regression rate (HRR) group and low regression rate (LRR) group, then survival times were evaluated. RESULTS The median regression rates of RLNs in the ECCRT and CCRT groups were 81% and 50%, respectively (P < 0.001). There was no statistically significant difference in the incidence of grade 3/4 AEs between the two groups, except for oral mucositis (ECCRT 26.23% vs. CCRT 44.26%, P = 0.037). The 3-year overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS) and locoregional failure-free survival (LRFFS) rates in the HRR and LRR groups were 85.48% and 86.67% (P = 0.983), 80.65% and 68.33% (P = 0.037), 83.87% and 85% (P = 0.704), 93.55% and 81.67% (P = 0.033), respectively. CONCLUSIONS Patients in the ECCRT group had higher regression rates of RLNs and lower incidence of severe oral mucositis. Furthermore, patients in the HRR group had a better 3-year PFS and LRFFS rate than those in the LRR group.
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Affiliation(s)
- Jun-Mei Song
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Oncology Department, Nanchong Central Hospital, The Second Clinical Institute of North Sichuan Medical College, Nanchong, 637000, Sichuan, China
- Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, China
| | - Ning Mo
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, China
| | - Yu-Qing Lv
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, China
| | - Lu-Lu Huang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, China
| | - Ya-Jing Wen
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Ting Liu
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, China
| | - Zhi-Ru Li
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
- Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor (Guangxi Medical University), Ministry of Education, Nanning, 530021, China
| | - Ren-Sheng Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China.
| | - Ting-Ting Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China.
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Hingsammer L, Schönegg D, Gander T, Lanzer M. Radioactive nanosized colloids and indocyanine green identify the same sentinel lymph nodes in oral squamous cell carcinoma. J Cancer Res Clin Oncol 2023; 149:17223-17229. [PMID: 37801136 PMCID: PMC10657288 DOI: 10.1007/s00432-023-05427-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/13/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE Near-infrared fluorescence imaging using indocyanine green (ICG) combined with radioactive markers has the potential to improve sentinel lymph-node (SLN) mapping in oral squamous cell carcinoma (OSCC). This study aimed to evaluate the ability of 99mTc and ICG in identifying the sentinel lymph nodes in patients with early stage OSCC. METHODS Data were collected prospectively, and a retrospective analysis of 15 patients with early stage OSCC and a cN0 neck was performed. All patients received peritumoral injection of 99mTc the day before surgery and ICG was administered intraoperatively. Intentionally, the application of the two different tracers were done by two different physicians with varying degrees of experience. The number of identified lymph nodes positive for 99mTc and ICG, the overlap or possible discrepancies of both methods, and the time until fluorescence signals of ICG were detected were noted. RESULTS In all patients, a 100% agreement in sentinel lymph-node identification was achieved, regardless of both the exact location of the peritumoral injection and the experience of the injecting surgeon. Time until ICG accumulation in the sentinel lymph node was consistently found to be between 1 and 3 min. CONCLUSION ICG constitutes a viable and useful addition to 99mTc for intraoperative sentinel lymph-node detection in this study.
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Affiliation(s)
- Lukas Hingsammer
- Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
- Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Daphne Schönegg
- Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Thomas Gander
- Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Martin Lanzer
- Department of Cranio-Maxillo-Facial and Oral Surgery, University Hospital of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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Takamura M, Nikkuni Y, Hayashi T, Katsura K, Nishiyama H, Yamazaki M, Maruyama S, Tanuma JI. Comparing the Diagnostic Accuracy of Ultrasonography, CT, MRI, and PET/CT in Cervical Lymph Node Metastasis of Oral Squamous Cell Carcinoma. Biomedicines 2023; 11:3119. [PMID: 38137340 PMCID: PMC10740725 DOI: 10.3390/biomedicines11123119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: In oral cancer staging, ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and 2-deoxy-2-[fluorine-18]fluoro-D-glucose (FDG) with positron emission tomography/computed tomography (PET/CT) are routinely used in clinical practice. The present study is a retrospective examination of the diagnostic accuracy of cervical lymph node metastasis using US, CT, MRI, and PET/CT, with histopathological diagnosis as a reference, to compare the different diagnostic imaging modalities. (2) Methods: The participants included 16 patients with oral squamous cell carcinoma who underwent US-, CT-, MRI-, and PET/CT-based preoperative diagnostic imaging and simultaneous primary lesion resection and neck dissection, including 82 level regions and 424 lymph nodes. We compared the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of each imaging modality based on the imaging results and the pathology results of metastasis. (3) Results: Of the four diagnostic imaging modalities, PET/CT exhibited the highest sensitivity but the lowest specificity and accuracy. US, CT, and MRI had high specificities. Comparing each level region and lymph node showed that differences were observed in PET/CT. (4) Conclusions: PET/CT to diagnose lymph node metastasis requires a comprehensive evaluation because it produces more false positives than other diagnostic imaging modalities. Using US, CT, and MRI, which have excellent spatial resolution, improves diagnostic accuracy at the lymph node level.
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Affiliation(s)
- Masaki Takamura
- Division of Oral and Maxillofacial Radiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, 2-5274 Gakkocho-dori, Chuo-ku, Niigata 951-8514, Japan
| | - Yutaka Nikkuni
- Division of Oral and Maxillofacial Radiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, 2-5274 Gakkocho-dori, Chuo-ku, Niigata 951-8514, Japan
| | - Takafumi Hayashi
- Division of Oral and Maxillofacial Radiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, 2-5274 Gakkocho-dori, Chuo-ku, Niigata 951-8514, Japan
| | - Kouji Katsura
- Division of Oral and Maxillofacial Radiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, 2-5274 Gakkocho-dori, Chuo-ku, Niigata 951-8514, Japan
| | - Hideyoshi Nishiyama
- Division of Oral and Maxillofacial Radiology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, 2-5274 Gakkocho-dori, Chuo-ku, Niigata 951-8514, Japan
| | - Manabu Yamazaki
- Division of Oral Pathology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, 2-5274 Gakkocho-dori, Chuo-ku, Niigata 951-8514, Japan
| | - Satoshi Maruyama
- Division of Oral Pathology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, 2-5274 Gakkocho-dori, Chuo-ku, Niigata 951-8514, Japan
| | - Jun-ichi Tanuma
- Division of Oral Pathology, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, 2-5274 Gakkocho-dori, Chuo-ku, Niigata 951-8514, Japan
- Oral Pathology Section, Department of Surgical Pathology, Niigata University Medical & Dental Hospital, 1-754 Asahimachi-dori, Chuo-ku, Niigata 951-8520, Japan
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Li G, Yang S, Wang S, Jiang R, Xu X. Diagnostic Value of Dynamic 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography ( 18F-FDG PET-CT) in Cervical Lymph Node Metastasis of Nasopharyngeal Cancer. Diagnostics (Basel) 2023; 13:2530. [PMID: 37568893 PMCID: PMC10417831 DOI: 10.3390/diagnostics13152530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND AND PURPOSE Dynamic 18F-FDG PET-CT scanning can accurately quantify 18F-FDG uptake and has been successfully applied in diagnosing and evaluating therapeutic effects in various malignant tumors. There is no conclusion as to whether it can accurately distinguish benign and malignant lymph nodes in nasopharyngeal cancer. The main purpose of this study is to reveal the diagnostic value of dynamic PET-CT in cervical lymph node metastasis of nasopharyngeal cancer through analysis. METHOD We first searched for cervical lymph nodes interested in static PET-CT, measured their SUV-Max values, and found the corresponding lymph nodes in magnetic resonance images before and after treatment. The valid or invalid groups were included according to the changes in lymph node size before and after treatment. If the change in the product of the maximum diameter and maximum vertical transverse diameter of the lymph node before and after treatment was greater than or equal to 50%, they would be included in the valid group. If the change was less than 50%, they would be included in the invalid group. Their Ki values were measured on dynamic PET-CT and compared under different conditions. Then, we conducted a correlation analysis between various factors and Ki values. Finally, diagnostic tests were conducted to compare the sensitivity and specificity of Ki and SUV-Max. RESULT We included 67 cervical lymph nodes from different regions of 51 nasopharyngeal cancer patients and divided them into valid and invalid groups based on changes before treatment. The valid group included 50 lymph nodes, while the invalid group included 17. There wer significant differences (p < 0.001) between the valid and the invalid groups in SUV-Max, Ki-Mean, and Ki-Max values. When the SUV-Max was ≤4.5, there was no significant difference in the Ki-Mean and Ki-Max between the two groups (p > 0.05). When the SUV-Max was ≤4.5 and pre-treatment lymph nodes were <1.0 cm, the valid group had significantly higher Ki-Mean (0.00910) and Ki-Maximum (0.01004) values than the invalid group (Ki-Mean = 0.00716, Ki-Max = 0.00767) (p < 0.05). When the SUV-Max was ≤4.5, the pre-treatment lymph nodes < 1.0 cm, and the EBV DNA replication normal, Ki-Mean (0.01060) and Ki-Max (0.01149) in the valid group were still significantly higher than the invalid group (Ki-Mean = 0.00670, Ki-Max = 0.00719) (p < 0.05). The correlation analysis between different factors (SUV-Max, T-stage, normal EB virus DNA replication, age, and pre-treatment lymph node < 1.0 cm) and the Ki value showed that SUV-Max and a pre-treatment lymph node < 1.0 cm were related to Ki-Mean and Ki-Max. Diagnostic testing was conducted; the AUC value of the SUV-Max value was 0.8259 (95% confidence interval: 0.7296-0.9222), the AUC value of the Ki-Mean was 0.8759 (95% confidence interval: 0.7950-0.9567), and the AUC value of the Ki-Max was 0.8859 (95% confidence interval: 0.8089-0.9629). After comparison, it was found that there was no significant difference in AUC values between Ki-Mean and SUV-Max (p = 0.220 > 0.05), and there was also no significant difference in AUC values between Ki max and SUV-Max (p = 0.159 > 0.05). By calculating the Youden index, we identified the optimal cut-off value. It was found that the sensitivity of SUV-Max was 100% and the specificity was 66%, the sensitivity of Ki-Mean was 100% and the specificity was 70%, and the sensitivity of Ki-Max was 100% and the specificity was 72%. After Chi-Square analysis, it was found that there was no significant difference in specificity between Ki-Mean and SUV-Max (p = 0.712), and there was also no significant difference in specificity between Ki-Max and SUV-Max (p = 0.755). CONCLUSION Dynamic PET-CT has shown a significant diagnostic value in diagnosing cervical lymph node metastasis of nasopharyngeal cancer, especially for the small SUV value, and lymph nodes do not meet the metastasis criteria before treatment, and EBV DNA replication is normal. Although the diagnostic accuracy, sensitivity, and specificity of dynamic PET-CT were not significantly different from traditional static PET-CT, the dynamic PET-CT had a more accurate tendency.
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Affiliation(s)
- Guanglie Li
- Department of Head and Neck Oncology, The Fifth Hospital of Sun Yat-sen University, Zhuhai 519000, China; (G.L.); (S.W.)
| | - Shuai Yang
- Department of Radiotherapy Physics, The Fifth Hospital of Sun Yat-sen University, Zhuhai 519000, China;
| | - Siyang Wang
- Department of Head and Neck Oncology, The Fifth Hospital of Sun Yat-sen University, Zhuhai 519000, China; (G.L.); (S.W.)
| | - Renwei Jiang
- Department of Radiotherapy Physics, The Fifth Hospital of Sun Yat-sen University, Zhuhai 519000, China;
| | - Xiwei Xu
- Department of Head and Neck Oncology, The Fifth Hospital of Sun Yat-sen University, Zhuhai 519000, China; (G.L.); (S.W.)
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Chen Q, Wei R, Li S. A preoperative nomogram model for the prediction of lymph node metastasis in buccal mucosa cancer. Cancer Med 2023. [PMID: 37184116 DOI: 10.1002/cam4.6076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 03/27/2023] [Accepted: 05/03/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVES We sought to construct a nomogram model predicting lymph node metastasis (LNM) in patients with squamous cell carcinoma of the buccal mucosa based on preoperative clinical characteristics. METHODS Patients who underwent radical resection of a primary tumor in the buccal mucosa with neck dissection were enrolled. Clinical characteristics independently associated with LNM in multivariate analyses were adopted to build the model. Patients at low risk of LNM were defined by a predicted probability of LNM of less than 5%. RESULTS Patients who underwent surgery in an earlier period (January 2015-November 2019) were defined as the model development cohort (n = 325), and those who underwent surgery later (November 2019-March 2021) were defined as the validation cohort (n = 140). Age, tumor differentiation, tumor thickness, and clinical N stage assessed by computed tomography/magnetic resonance imaging (cN) were independent predictors of LNM. The nomogram model based on these four predictors showed good discrimination accuracy in both the model development and validation cohorts, with areas under the receiver-operating characteristic curve (AUC) of 0.814 and 0.828, respectively. LNM prediction by the nomogram model was superior to cN in AUC comparisons (0.815 vs. 0.753) and decision curve analysis of the whole cohort. Seventy-one patients were defined as having a low risk of LNM, among whom the actual metastasis rate was only 1.4%. CONCLUSIONS A robust nomogram model for preoperative LNM prediction is built.
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Affiliation(s)
- Qian Chen
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Rui Wei
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
| | - Shan Li
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, China
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7
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Kojima I, Takanami K, Ogawa T, Ishikawa K, Morishita Y, Ishii R, Ohkoshi A, Nakanome A, Odagiri H, Iikubo M. High diagnostic accuracy for lymph node metastasis of oral squamous cell carcinoma using PET/CT with a silicon photomultiplier. Oral Radiol 2022; 38:540-549. [PMID: 35061164 DOI: 10.1007/s11282-022-00588-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The higher sensitivity of the new-generation positron emission tomography/computed tomography (PET/CT) with silicon photomultiplier (SiPM) may increase false-positive rates in detecting metastatic lymph nodes (LNs). This study aimed to clarify the usefulness of the SiPM PET scanner in diagnosing LN metastasis of oral squamous cell carcinoma (SCC). METHODS We retrospectively reviewed consecutive F-18 fluorodeoxyglucose PET/CT images of 39 SCC patients using SiPM PET and 31 SCC patients using non-SiPM PET. We measured the maximum standardized uptake value (SUVmax) of the LNs on PET images and maximum short-axis diameter on transverse CT images. RESULTS The sensitivity and specificity of SiPM PET were 86.2% and 95.6%, respectively (cut-off SUVmax, 4.6). The area under the curve (AUC) of SiPM PET (0.977; 95% confidence interval [CI], 0.958-0.995) was significantly higher than that of non-SiPM PET (0.825; 95% CI 0.717-0.934) (P < 0.01). In a size-limited analysis of diameter, the AUC of SiPM PET (≥ 0.96 for all diameters) was significantly higher than that of non-SiPM PET (tended to decrease as the LN diameter decreased) for the diagnosis of LN metastasis by SUVmax. CONCLUSION SiPM PET had higher diagnostic accuracy for LN metastasis of oral SCC than non-SiPM PET, even for small LN metastasis without increasing false-positives.
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Affiliation(s)
- Ikuho Kojima
- Department of Dental Informatics and Radiology, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan. .,Head and Neck Cancer Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Kentaro Takanami
- Department of Diagnostic Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takenori Ogawa
- Head and Neck Cancer Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.,Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.,Department of Otolaryngology, Gifu University Hospital, 1-1 Yanagido, Gifu city, 501-1194, Japan
| | - Kenichiro Ishikawa
- Head and Neck Cancer Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.,Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Yohei Morishita
- Head and Neck Cancer Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.,Department of Diagnostic Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Ryo Ishii
- Head and Neck Cancer Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.,Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Akira Ohkoshi
- Head and Neck Cancer Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.,Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Ayako Nakanome
- Head and Neck Cancer Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.,Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hayato Odagiri
- Department of Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Masahiro Iikubo
- Department of Dental Informatics and Radiology, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.,Head and Neck Cancer Center, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
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8
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Dai Y, Wang Z, Yan E, Li J, Ge H, Xiao N, Cheng J, Diao P. Development of a novel signature derived from single cell RNA-sequencing for preoperative prediction of lymph node metastasis in head and neck squamous cell carcinoma. Head Neck 2022; 44:2171-2180. [PMID: 35726502 DOI: 10.1002/hed.27126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/11/2022] [Accepted: 06/07/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Lymph node metastasis (LNM) is considered as an adverse prognostic indicator for cancer patients. Preoperative knowledge of LNM is valuable for pretreatment decision making. Here, we sought to develop and validate an LNM signature for preoperative prediction of LNM in patients with head and neck squamous cell carcinoma (HNSCC). METHODS By studying single cell RNA-sequencing data (scRNA-seq), differentially expressed mRNA were selected and analyzed through univariate logistic regression and least absolute shrinkage and selection operator (LASSO) to identify an LNM signature. Multivariate logistic regression was utilized to establish an LNM nomogram incorporating LNM signature and T-classification. RESULTS The LNM signature was significantly associated with lymph node status and prognosis. The LNM signature and LNM nomogram displayed a robust predictive effect. CONCLUSION Our study reveals that LNM signature is a powerful biomarker for preoperative prediction of LNM in patients with HNSCC, which may be effective to realize individualized outcome prediction.
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Affiliation(s)
- Yibin Dai
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, China
| | - Ziyu Wang
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Jiangsu, China
| | - Enshi Yan
- Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Jiangsu, China
| | - Jin Li
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, China.,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing Medical University, Jiangsu, China
| | - Han Ge
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, China.,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing Medical University, Jiangsu, China
| | - Na Xiao
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, China.,Jiangsu Province Engineering Research Center of Stomatological Translational Medicine, Nanjing Medical University, Jiangsu, China
| | - Jie Cheng
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, China.,Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Jiangsu, China
| | - Pengfei Diao
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatological Hospital, Nanjing Medical University, Nanjing, China.,Jiangsu Key Laboratory of Oral Disease, Nanjing Medical University, Jiangsu, China
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9
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Chen S, Chen Z, Zou G, Zheng S, Zheng K, Zhang J, Huang C, Yao S, Miao W. Accurate preoperative staging with [ 68Ga]Ga-FAPI PET/CT for patients with oral squamous cell carcinoma: a comparison to 2-[ 18F]FDG PET/CT. Eur Radiol 2022; 32:6070-6079. [PMID: 35352157 DOI: 10.1007/s00330-022-08686-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the potential value of [68Ga]Ga-labelled fibroblast activation protein inhibitor ([68Ga]Ga-FAPI) positron emission tomography/computed tomography (PET/CT) in preoperative staging for patients with oral squamous cell carcinoma (OSCC) as compared to 2-[18F]fluoro-2-deoxy-D-glucose (2-[18F]FDG) PET/CT. METHODS Thirty-six treatment-naïve patients with OSCC who underwent 2-[18F]FDG and [68Ga]Ga-FAPI PET/CT for preoperative staging were enrolled. The maximum standardised uptake value (SUVmax) of the primary tumour and suspected cervical metastatic lymph nodes, and the tumour-to-background ratio (TBR) of the primary tumour, were measured. The accuracy of two imaging modalities for preoperative diagnosis of metastatic lymph nodes was analysed. Histopathology served as the standard of reference. RESULTS Thirty-seven primary lesions of 36 patients were accurately detected by both [68Ga]Ga-FAPI and 2-[18F]FDG PET/CT. Regarding primary tumours, the SUVmax and TBR of the two imaging modalities in stage T3-T4 were significantly higher than those of stage T1-T2 (all p < 0.05). On the patient analysis, the accuracy for the evaluation of N1-N3 neck status was 52.6% (10/19) for [68Ga]Ga-FAPI PET/CT and 57.9% (11/19) for 2-[18F]FDG PET/CT. Notably, the accuracy for the evaluation of the N0 neck status between [68Ga]Ga-FAPI and 2-[18F]FDG PET/CT was 100% (17/17) and 29% (5/17), respectively. Based on the patient, neck side and neck level, [68Ga]Ga-FAPI PET/CT resulted in higher specificity and accuracy in diagnosing metastatic neck lymph nodes than 2-[18F]FDG PET/CT (all p < 0.05). CONCLUSION [68Ga]Ga-FAPI PET/CT is a promising tool for preoperative staging of OSCC, and appears to reduce the false positivity seen with 2-[18F]FDG PET/CT for the detection of neck lymph node metastases. KEY POINTS • [68Ga]Ga-FAPI PET/CT is a promising tool targeting cancer-associated fibroblasts with comparable diagnostic performance to 2-[18F]FDG PET/CT for identifying the primary lesions of OSCC. • [68Ga]Ga-FAPI PET/CT showed higher specificity and accuracy for the evaluation of neck lymph node metastases of OSCC than 2-[18F]FDG PET/CT, especially for N0 neck status.
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Affiliation(s)
- Shaoming Chen
- Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350005, China
| | - Zhenying Chen
- Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350005, China
| | - Gengsen Zou
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian Province, China
| | - Shan Zheng
- Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350005, China
| | - Ke Zheng
- Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian Province, China
| | - Jiaying Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350005, China
| | - Chao Huang
- Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350005, China
| | - Shaobo Yao
- Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350005, China.
- Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, Fujian Province, China.
| | - Weibing Miao
- Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, No. 20 Chazhong Road, Taijiang District, Fuzhou, 350005, China.
- Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, Fujian Province, China.
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10
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Tomita H, Yamashiro T, Heianna J, Nakasone T, Kimura Y, Mimura H, Murayama S. Nodal-based radiomics analysis for identifying cervical lymph node metastasis at levels I and II in patients with oral squamous cell carcinoma using contrast-enhanced computed tomography. Eur Radiol 2021; 31:7440-7449. [PMID: 33787970 DOI: 10.1007/s00330-021-07758-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 01/11/2021] [Accepted: 02/05/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Discriminating metastatic from benign cervical lymph nodes (LNs) in oral squamous cell carcinoma (OSCC) patients using pretreatment computed tomography (CT) has been controversial. This study aimed to investigate whether CT-based texture analysis with machine learning can accurately identify cervical lymph node metastasis in OSCC patients. METHODS Twenty-three patients (with 201 cervical LNs [150 benign, 51 metastatic] at levels I-V) who underwent preoperative contrast-enhanced CT and subsequent cervical neck dissection were enrolled. Histopathologically proven LNs were randomly divided into the training cohort (70%; n = 141, at levels I-V) and validation cohort (30%; n = 60, at level I/II). Twenty-five texture features and the nodal size of targeted LNs were analyzed on the CT scans. The nodal-based sensitivities, specificities, diagnostic accuracy rates, and the area under the curves (AUCs) of the receiver operating characteristic curves of combined features using a support vector machine (SVM) at levels I/II, I, and II were evaluated and compared with two radiologists and a dentist (readers). RESULTS In the validation cohort, the AUCs (0.820 at level I/II, 0.820 at level I, and 0.930 at level II, respectively) of the radiomics approach were superior to three readers (0.798-0.816, 0.773-0.798, and 0.825-0.865, respectively). The best models were more specific at levels I/II and I and accurate at each level than each of the readers (p < .05). CONCLUSIONS Machine learning-based analysis with contrast-enhanced CT can be used to noninvasively differentiate between benign and metastatic cervical LNs in OSCC patients. KEY POINTS • The best algorithm in the validation cohort can noninvasively differentiate between benign and metastatic cervical LNs at levels I/II, I, and II. • The AUCs of the model at each level were superior to those of multireaders. • Significant differences in the specificities at level I/II and I and diagnostic accuracy rates at each level between the model and multireaders were found.
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Affiliation(s)
- Hayato Tomita
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
| | - Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Joichi Heianna
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Toshiyuki Nakasone
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Yusuke Kimura
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Hidefumi Mimura
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
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11
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Bowe CM, Shastri M, Gulati A, Norris P, Corrigan A, Barrett AW, Bisase B. Challenges and outcomes in establishing a sentinel lymph node biopsy service for oral squamous cell carcinoma in a regional district specialist hospital. Br J Oral Maxillofac Surg 2020; 59:217-221. [PMID: 33131801 DOI: 10.1016/j.bjoms.2020.08.057] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/11/2020] [Indexed: 01/19/2023]
Abstract
UK national guidelines in 2016 recommended that sentinel lymph node biopsy (SLNB) should be offered to patients with early oral squamous cell carcinoma (OSCC). We review the establishment of an OSCC SLNB service with specific consideration to resources, service implications and patient outcomes. A review of processes was performed to identify key stages in establishing the service, and subsequently a retrospective cohort study consisting of 46 consecutive patients with T1/T2 N0 OSCC was undertaken. The key stages identified were: coordinating a nuclear medicine pathway and reliable cost-appropriate pathology service, constructing a Trust business case, and gaining approval of a new interventional service policy. A median (range) of 3.3 (1-8) sentinel nodes (SLN) were removed, with 17 patients having a positive SLN. The negative predictive value of SLNB was 100%, with 12 having a SLN outside the field if elective neck dissection (END) was planned. There was a significantly increased risk of a positive SLN with increasing depth of invasion (DOI) (p=0.007) and increased diameter (p=0.036). We also identified a longer-than-ideal time to completion neck dissection and inadequate ultrasound follow up of negative SLNB patients. Establishment of a service requires careful planning. Our results were in keeping with those reported in the literature, and showed that SLNB for OSCC has a high negative predictive value and can identify at-risk SLN outside the traditional END levels, even in well-lateralised tumours. Our findings show that DOI and size of SLN were significantly associated with a positive SLN, and also identified areas requiring improvement.
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Affiliation(s)
- C M Bowe
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead.
| | - M Shastri
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead
| | - A Gulati
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead
| | - P Norris
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead
| | - A Corrigan
- Department of Nuclear Medicine, Maidstone and Tunbridge Wells NHS FT
| | - A W Barrett
- Department of Pathology, Queen Victoria Hospital NHS Foundation Trust, East Grinstead
| | - B Bisase
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead
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12
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Ding Z, Deng C, Wang Z, Liu L, Ma X, Huang J, Wang X, Xuan M, Xie H. Comparison of contrast-enhanced ultrasound and contrast-enhanced computed tomography for the diagnosis of cervical lymph node metastasis in squamous cell carcinoma of the oral cavity. Int J Oral Maxillofac Surg 2020; 50:294-301. [PMID: 32739248 DOI: 10.1016/j.ijom.2020.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/29/2020] [Accepted: 07/09/2020] [Indexed: 02/08/2023]
Abstract
Early detection of cervical lymph node metastasis (CLNM) from squamous cell carcinoma (SCC) of the oral cavity remains challenging. This prospective study was performed to evaluate the ability of contrast-enhanced ultrasound (CEUS) to detect CLNM from oral cavity SCC. Additionally, its diagnostic value was compared with that of contrast-enhanced computed tomography (CECT). Forty-eight consecutive patients with SCC of the oral cavity were enrolled. All subjects were examined preoperatively with both CEUS and CECT. Subsequently, neck dissections were performed for these patients, and cervical lymph nodes separated from the surgical specimens were assessed histologically. The diagnostic performance of these two examinations was compared based on the results of histopathology. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Youden index for CEUS and CECT were 69.39% vs. 44.90%, 94.71% vs. 97.12%, 89.88%% vs. 87.16%, 75.56% vs. 78.57%, 92.92% vs. 88.21%, and 64.10% vs. 42.02%, respectively. A significant difference was observed in terms of sensitivity (P=0.024) and Youden index (rate difference 22.08%, 95% confidence interval 2.72-41.44%). Therefore, CEUS appears to be a promising diagnostic tool that is superior to CECT for detecting CLNM from SCC of the oral cavity, with a higher sensitivity.
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Affiliation(s)
- Z Ding
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - C Deng
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Z Wang
- Department of Ultrasound, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - L Liu
- Department of Radiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - X Ma
- Department of Biotherapy, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - J Huang
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - X Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - M Xuan
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - H Xie
- State Key Laboratory of Oral Diseases, National Clinical Research Centre for Oral Diseases, Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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13
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Lee J, Emmett L, Tang R, Ho B, Earls P, Matthews T, Gallagher R. Prospective evaluation of the impact of human papilloma virus status and small node size on the diagnostic accuracy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography for primary head and neck squamous cell carcinoma. ANZ J Surg 2020; 90:1396-1401. [PMID: 32564498 DOI: 10.1111/ans.16093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 05/30/2020] [Accepted: 05/31/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is well validated in the staging of pre-treatment head and neck squamous cell carcinoma (HNSCC), although the impact of human papilloma virus (HPV) status and node size on accuracy remains unclear. The aim of this study was to assess the diagnostic accuracy of PET/CT based on HPV status and node size and determine the effects of maximum standardized uptake value thresholds on sensitivity, specificity and positive predictive value. METHODS A total of 38 patients with primary HNSCC were recruited. All patients underwent primary tumour resection and cervical node dissection following FDG-PET/CT. RESULTS A total of 38 patients including 68 dissected necks, representing 353 nodal levels and a total of 2701 lymph nodes were included. Histopathological analysis revealed lymph node metastases in 4.3% (116/2701) of dissected lymph nodes. Forty-four percent of patients had HPV-positive tumours. Sixty-four percent of involved lymph nodes were <1 cm. The sensitivity and specificity for HPV-positive nodes were 67.2% and 99.3% versus 35.6% and 98.2% in HPV-negative nodes, respectively (P < 0.001). Mean maximum standardized uptake value in HPV-positive nodes was 6.3 versus 3.5 in HPV-negative nodes (P < 0.001). Sensitivity and specificity were 30.7% and 99.2% in <1 cm nodes versus 90.2% and 84.8% in ≥1 cm nodes, respectively (P < 0.001). CONCLUSION FDG-PET/CT has significantly higher diagnostic accuracy in determining nodal metastases in HPV-positive HNSCC versus HPV-negative disease. Accuracy was lower in <1 versus ≥1 cm nodes.
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Affiliation(s)
- Jonathan Lee
- Department of Nuclear Medicine and Theranostics, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Louise Emmett
- Department of Nuclear Medicine and Theranostics, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Reuben Tang
- Department of Nuclear Medicine and Theranostics, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Bao Ho
- Department of Nuclear Medicine and Theranostics, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Peter Earls
- Department of Pathology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Tim Matthews
- Department of Otolaryngology-Head and Neck Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Richard Gallagher
- Department of Otolaryngology-Head and Neck Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
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14
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Sağlampınar Karyağar S, Karyağar S, Güven O, Üstün O, Atar Y, Uyar Y. The Predictive Value of Proportional Evaluation Based on the Metabolic Activity of Cervical Lymph Nodes on PET/CT Imaging in Patients with Larynx Cancer. Mol Imaging Radionucl Ther 2020; 29:59-64. [PMID: 32368876 PMCID: PMC7201430 DOI: 10.4274/mirt.galenos.2019.92300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives We aimed to evaluate the proportional values of maximum standardized uptake value (SUVmax) for cervical lymph nodes on 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for prediction of the presence of metastasis in patients with larynx squamous cell cancer (LSCC). Methods This retrospective study involved 43 patients with LSCC. All patients underwent resection of the primary tumor and neck dissection within 4 weeks after undergoing 18F-FDG PET/CT examinations. Receiver operating characteristic (ROC) analysis was performed to evaluate the lymph node SUVmax/primary tumor SUVmax (SUVmaxLN/SUVmaxPT), lymph node SUVmax/aortic SUVmax (SUVmaxLN/SUVmaxA), and lymph node SUVmax/ liver SUVmax (SUVmaxLN/SUVmaxL) ratios for diagnosis of lymph node metastasis. Results SUVmaxLN/SUVmaxA, SUVmaxLN/SUVmaxL, and SUVmaxLN/SUVmaxPT rates were significantly higher in metastatic lymph nodes compared to non-metastatic nodes. ROC analysis for metastasis showed that the cut-off thresholds were 3.87 for SUVmaxLN; 1.78 for SUVmaxLN /SUVmaxA; 1.08 for SUVmaxLN/SUVmaxL; and 0.36 for SUVmaxLN/SUVmaxPT. The diagnostic sensitivity, specificity and AUC were 83.7%, 77%, 0.856 for SUVmaxLN; 79.7%, 84%, 1.78 for SUVmaxLN/SUVmaxA; 84.1%, 76%, 0.833 for SUVmaxLN/SUVmaxL; and 53.6%, 76%, 0.666 for SUVmaxLN/SUVmaxPT, respectively. Conclusion SUVmaxLN/SUVmaxA, SUVmaxLN/SUVmaxL, and SUVmaxLN/SUVmaxPT ratios can be safely used for diagnosis of cervical lymph node metastasis in patients with LSCC.
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Affiliation(s)
- Sevda Sağlampınar Karyağar
- University of Health Sciences Turkey, İstanbul Okmeydanı Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Savaş Karyağar
- University of Health Sciences Turkey, İstanbul Okmeydanı Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Osman Güven
- University of Health Sciences Turkey, İstanbul Okmeydanı Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Onur Üstün
- University of Health Sciences Turkey, İstanbul Okmeydanı Training and Research Hospital, Clinic of Otorhinolaryngology, İstanbul, Turkey
| | - Yavuz Atar
- University of Health Sciences Turkey, İstanbul Okmeydanı Training and Research Hospital, Clinic of Otorhinolaryngology, İstanbul, Turkey
| | - Yavuz Uyar
- University of Health Sciences Turkey, İstanbul Okmeydanı Training and Research Hospital, Clinic of Otorhinolaryngology, İstanbul, Turkey
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15
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Retropharyngeal Lymph Node Involvement in Oropharyngeal Carcinoma: Impact upon Risk of Distant Metastases and Survival Outcomes. Cancers (Basel) 2019; 12:cancers12010083. [PMID: 31905773 PMCID: PMC7016660 DOI: 10.3390/cancers12010083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/09/2019] [Accepted: 12/23/2019] [Indexed: 12/28/2022] Open
Abstract
The influence of retropharyngeal lymph node (RPLN) involvement on prognosis in oropharyngeal carcinoma remains poorly defined. The aim of this study was to assess the impact of RPLN involvement upon outcomes. A single-centre retrospective analysis of 402 patients with oropharyngeal carcinoma treated nonsurgically between 2010 and 2017 was performed. All had a baseline 2-[fluorine-18]-fluoro-2-deoxy-d-glucose (FDG) PET-CT and contrast-enhanced MRI and/or CT. RPLN status was determined by radiology review of cases with reported abnormal RPLN. Multivariate backwards logistic regression was used to examine impact on outcomes of factors. Abnormal RPLNs were identified in 40/402 (10%) of patients. Median follow up was 42.9 months. RPLN involvement was associated with inferior 3 year outcomes for overall survival (OS) (67.1% vs. 79.1%, p = 0.006) and distant metastases-free survival (DMFS) (73.9% versus 88.0%, p = 0.011), with no significant difference in local control (81.6% vs. 87.7%, p = 0.154) or regional control (80.7% vs. 85.4%, p = 0.252). On multivariate analysis abnormal RPLN, no concurrent chemotherapy and ongoing smoking were associated with inferior DMFS and OS, while advanced T stage was also associated with inferior OS. In summary, RPLN involvement, present in 10% of patients, was an independent prognostic factor for the development of distant disease failure translating into inferior OS. These findings need confirmation in future studies.
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16
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Iyizoba-Ebozue Z, Murray LJ, Arunsingh M, Vaidyanathan S, Scarsbrook AF, Prestwich RJD. Incidence and patterns of retropharyngeal lymph node involvement in oropharyngeal carcinoma. Radiother Oncol 2019; 142:92-99. [PMID: 31431388 DOI: 10.1016/j.radonc.2019.07.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/27/2019] [Accepted: 07/17/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The aim was to evaluate in oropharyngeal carcinoma the: (1) incidence and predictors of retropharyngeal (RP) lymph node (LN) involvement, (2) pattern of ipsilateral/bilateral/contralateral-only RP LNs (3) location of RP LNs in relation to contouring guidelines. METHODS Single centre retrospective analysis of 402 patients with oropharyngeal carcinoma treated non-surgically between 2010 and 2017. All patients had a baseline FDG PET-CT and contrast-enhanced MRI and/or CT. All cases with reported abnormal RP LNs underwent radiology review. RESULTS Abnormal RP LNs were identified in 40/402 (10%) of patients. On multivariate analysis, RP LN involvement was associated with posterior pharyngeal wall/soft palate primaries (OR 10.13 (95% CI 2.29-19.08), p = 0.002) and contralateral cervical LN involvement (OR 2.26 (95% CI 1.05-4.86), p = 0.036). T stage, largest LN size, levels of ipsilateral LN level involvement, HPV and smoking status did not predict risk. 5/402 (1.2%) patients had bilateral RP involvement. 3/402 patients (0.7%) had contralateral-only RP LNs. All patients with contralateral RP LNs had contralateral neck nodes or primary cancers extending across midline. In 5/40 (12.5%) cases with involved RP LNs, the RP LNs were superior to hard palate/upper edge of body of C1 vertebra. CONCLUSIONS RP LNs were identified in 10% of oropharyngeal carcinoma patients, and were associated with contralateral neck disease and/or posterior pharyngeal wall/soft palate primary. Contralateral RP LN involvement was rare and associated with contralateral neck disease and/or primary crossing midline, suggesting potential for omission from target volumes for selected patients. Involvement of RP LNs close to the skull base highlights the need for generous elective outlining.
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Affiliation(s)
| | - Louise J Murray
- Department of Clinical Oncology, Leeds Cancer Centre, UK; Leeds Institute of Medical Research at St James's, University of Leeds, UK
| | | | | | - Andrew F Scarsbrook
- Leeds Institute of Medical Research at St James's, University of Leeds, UK; Department of Nuclear Medicine and Radiology, Leeds Cancer Centre, UK
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17
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Murakami R, Shiraishi S, Yoshida R, Sakata J, Yamana K, Hirosue A, Uchiyama Y, Nakayama H, Yamashita Y. Reliability of MRI-Derived Depth of Invasion of Oral Tongue Cancer. Acad Radiol 2019; 26:e180-e186. [PMID: 30268718 DOI: 10.1016/j.acra.2018.08.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/06/2018] [Accepted: 08/14/2018] [Indexed: 12/17/2022]
Abstract
RATIONALE AND OBJECTIVE To evaluate the inter-rater reliability of the magnetic resonance imaging (MRI)-derived depth of invasion (DOI) and the agreement between MRI and pathological measurements of oral tongue cancer. MATERIALS AND METHODS The institutional review board approved this retrospective study. The study population consisted of 29 patients with clinical T2N0 oral tongue cancer treated by surgery. Routine pretreatment MRI was performed on a 3T superconducting imager. Two raters with 23 and 18 years of head-and-neck MRI experience, respectively, independently chosen MRI sequences for each patient, then delineate the tumor, and then used three protocols to measure the MRI-derived DOI: the axial reconstructed thickness (method 1), the axial invasive portion (method 2), and the coronal invasive portion (method 3). Then they consensually selected the optimal among the three methods for each patient; it was designated method 4. The Bland-Altman plots, intraclass correlation coefficients (ICCs), and the paired samples test were used. According to the median follow-up of 41 months, the relationship between the MRI-derived DOI and nodal recurrence was also investigated. RESULTS The inter-rater reliability of methods 2 and 4 was excellent (ICC of 0.829 and 0.807, respectively). The correlation between MRI and pathological measurements was good for method 4 (ICC of 0.611), however, all measurements recorded on MRI were 2-3 mm larger than on pathology. No patients whose MRI-derived DOI was less than 5 mm suffered nodal recurrence. CONCLUSION The MRI-derived DOI was valuable for the preoperative staging. The optimal measurement method should be selected on a case-by-case basis.
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Affiliation(s)
- Ryuji Murakami
- Department of Medical Imaging, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
| | - Shinya Shiraishi
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Ryoji Yoshida
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Junki Sakata
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Keisuke Yamana
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Akiyuki Hirosue
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshikazu Uchiyama
- Department of Medical Physics, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideki Nakayama
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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18
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Choi WR, Oh JS, Roh J, Kim JS, Oh I, Choi S, Nam SY, Kim SY. Metabolic tumor volume and total lesion glycolysis predict tumor progression and survival after salvage surgery for recurrent oral cavity squamous cell carcinoma. Head Neck 2019; 41:1846-1853. [DOI: 10.1002/hed.25622] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 11/13/2018] [Accepted: 12/12/2018] [Indexed: 12/17/2022] Open
Affiliation(s)
- Woo Ri Choi
- Department of OtolaryngologyUniversity of Ulsan College of Medicine Seoul Republic of Korea
| | - Jungsu S. Oh
- Department of Nuclear Medicine, Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Republic of Korea
| | - Jong‐Lyel Roh
- Department of OtolaryngologyUniversity of Ulsan College of Medicine Seoul Republic of Korea
| | - Jae Seung Kim
- Department of Nuclear Medicine, Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Republic of Korea
| | - Inhye Oh
- Department of Nuclear Medicine, Asan Medical CenterUniversity of Ulsan College of Medicine Seoul Republic of Korea
| | - Seung‐Ho Choi
- Department of OtolaryngologyUniversity of Ulsan College of Medicine Seoul Republic of Korea
| | - Soon Yuhl Nam
- Department of OtolaryngologyUniversity of Ulsan College of Medicine Seoul Republic of Korea
| | - Sang Yoon Kim
- Department of OtolaryngologyUniversity of Ulsan College of Medicine Seoul Republic of Korea
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19
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Lin TA, Garden AS, Elhalawani H, Elgohari B, Jethanandani A, Ng SP, Mohamed AS, Frank SJ, Glisson BS, Debnam JM, Sturgis EM, Phan J, Reddy JP, Fuller CD, Morrison WH, Skinner HD, Rosenthal DI, Gunn GB. Radiographic retropharyngeal lymph node involvement in HPV-associated oropharyngeal carcinoma: Patterns of involvement and impact on patient outcomes. Cancer 2019; 125:1536-1546. [PMID: 30620385 DOI: 10.1002/cncr.31944] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND The objective of the current study was to characterize the incidence, pattern, and impact on oncologic outcomes of retropharyngeal lymph node (RPLN) involvement in HPV-associated oropharyngeal cancer (OPC). METHODS Data regarding patients with HPV-associated OPC who were treated at The University of Texas MD Anderson Cancer Center with intensity-modulated radiotherapy from 2004 through 2013 were analyzed retrospectively. RPLN status was determined by reviewing pretreatment imaging and/or reports. Outcomes analysis was restricted to patients with lymph node-positive (+) disease. Kaplan-Meier survival estimates were generated and survival curves were compared using the log-rank test. Bayesian information criterion assessed model performance changes with the addition of RPLN status to current American Joint Committee on Cancer staging. Competing risk analysis compared modes of disease recurrence. RESULTS The incidence of radiographic RPLN involvement was 9% (73 of 796 patients) and was found to vary by primary tumor site. The 5-year rates of freedom from distant metastases (FDM) and overall survival were lower in patients with RPLN(+) status compared with those with RPLN-negative (-) status (84% vs 93% [P = .0327] and 74% vs 87% [P = .0078], respectively). RPLN(+) status was not found to be associated with outcomes on multivariate analysis. Bayesian information criterion analysis demonstrated that current American Joint Committee on Cancer staging was not improved with the inclusion of RPLN. Locoregional and distant disease recurrence probabilities for those patients with RPLN(+) status were 8% and 13%, respectively, compared with 10% and 6%, respectively, for those with RPLN(-) status. RPLN(+) status portended worse 5-year FDM in the low-risk subgroup (smoking history of <10 pack-years) and among patients who received concurrent chemotherapy but not induction chemotherapy. CONCLUSIONS RPLN(+) status was associated with worse overall survival and FDM on univariate but not multivariate analysis. In subgroup analyses, RPLN(+) status was associated with poorer FDM in both patients with a smoking history of <10 pack-years and those who received concurrent chemotherapy, suggesting that RPLN(+) status could be considered an exclusion criteria in treatment deintensification efforts seeking to omit chemotherapy.
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Affiliation(s)
- Timothy A Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hesham Elhalawani
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Baher Elgohari
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amit Jethanandani
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sweet P Ng
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Abdallah S Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bonnie S Glisson
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J Matthew Debnam
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Erich M Sturgis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jay P Reddy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William H Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Heath D Skinner
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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20
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Peltenburg B, de Keizer B, Dankbaar JW, de Boer M, Willems SM, Philippens MEP, Terhaard CHJ, de Bree R. Prediction of ultrasound guided fine needle aspiration cytology results by FDG PET-CT for lymph node metastases in head and neck squamous cell carcinoma patients. Acta Oncol 2018; 57:1687-1692. [PMID: 30489180 DOI: 10.1080/0284186x.2018.1529426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Accurate assessment of cervical lymph node status is essential in patients with head and neck squamous cell carcinoma (HNSCC) as it influences prognosis and treatment decisions. During patient workup, lymph node status is often examined by ultrasound guided fine needle aspiration cytology (USgFNAC). 18F-Fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG PET-CT) is frequently used to assess primary tumor and distant metastases but provides information on lymph node status as well. It is possible that FDG PET-CT (if already made for abovementioned indications) can predict the results of USgFNAC in subgroups of lymph nodes based on FDG-uptake and size. The objective of this study is to identify maximum standardized uptake (SUVmax) and short axis diameter cutoff values of lymph nodes at which FDG PET-CT can reliably predict USgFNAC results. METHODS One hundred and seventeen patients with HNSCC were retrospectively analyzed. Patients were included when FDG PET-CT and USgFNAC were available. SUVmax measurements were performed and compared to the USgFNAC results. RESULTS Using USgFNAC as a reference standard, the area under the curve of the receiver operating curve was 0.91. At an SUVmax cutoff value of 4.9, the accuracy of FDG PET-CT was the highest (85%). Lymph nodes with short axis diameter ≥1.0 cm and SUVmax ≥4.9 were in 91% positive on USgFNAC. If SUVmax was below 2.2, no nodes were positive on USgFNAC. Of all lymph nodes 52% either had a short axis diameter ≥1.0 cm and SUVmax ≥4.9 or an SUVmax <2.2. FDG PET-CT and USgFNAC results were very similar in these nodes. CONCLUSIONS By measuring SUVmax values and minimal axial diameters of lymph nodes and using appropriate cutoff values, FDG PET-CT can predict the results of USgFNAC examinations in half of the examined lymph nodes. This information may lead to a reduction of USgFNAC examinations in HNSCC patients if FDG PET-CT is already performed for other indications.
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Affiliation(s)
- Boris Peltenburg
- Department of Head and Neck Surgical Oncology, University Medical Center, University Utrecht, Utrecht, The Netherlands
- Department of Radiotherapy, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Mirthe de Boer
- Department of Pathology, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Stefan M. Willems
- Department of Pathology, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Marielle E. P. Philippens
- Department of Radiotherapy, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Chris H. J. Terhaard
- Department of Radiotherapy, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center, University Utrecht, Utrecht, The Netherlands
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21
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Hingsammer L, Seier T, Zweifel D, Huber G, Rücker M, Bredell M, Lanzer M. Sentinel lymph node biopsy for early stage tongue cancer-a 14-year single-centre experience. Int J Oral Maxillofac Surg 2018; 48:437-442. [PMID: 30389112 DOI: 10.1016/j.ijom.2018.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 02/05/2023]
Abstract
This study was performed to report the usage of sentinel lymph node biopsy (SLNB) in clinical stage I or II tongue cancer patients with cN0 necks seen over a 14-year period. Data were collected prospectively, and a retrospective analysis was performed of 41 patients with early stage oral squamous cell carcinoma of the tongue and a cN0 neck. Sentinel lymph node (SLN)-positive patients underwent elective neck dissection, whereas SLN-negative patients were kept under careful observation. Seven of the 41 (17%) patients enrolled in the study were found to have occult metastases. The patients were followed up for a mean duration of 92 months (range 60-144 months). The neck recurrence rate for SLN-positive patients was 0% and for SLN-negative patients was 3%. The authors recommend the routine use of SLNB in patients with early stage oral squamous cell carcinoma of the tongue and a cN0 neck. Furthermore, special focus should be placed on isolated tumour cells, as their presence is of high clinical relevance.
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Affiliation(s)
- L Hingsammer
- Department of Oral and Maxillofacial Surgery, University Clinic of Zurich, Zurich, Switzerland.
| | - T Seier
- Department of Oral and Maxillofacial Surgery, University Clinic of Zurich, Zurich, Switzerland
| | - D Zweifel
- Department of Oral and Maxillofacial Surgery, University Clinic of Zurich, Zurich, Switzerland
| | - G Huber
- Department of Ear, Nose and Throat, University Clinic of Zurich, Zurich, Switzerland
| | - M Rücker
- Department of Oral and Maxillofacial Surgery, University Clinic of Zurich, Zurich, Switzerland
| | - M Bredell
- Department of Oral and Maxillofacial Surgery, University Clinic of Zurich, Zurich, Switzerland
| | - M Lanzer
- Department of Oral and Maxillofacial Surgery, University Clinic of Zurich, Zurich, Switzerland
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22
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Fujiwara M, Suzuki T, Senoo A, Fukamizu H, Tokura Y. Evaluation of positron emission tomography imaging to detect lymph node metastases in patients with extramammary Paget's disease. J Dermatol 2017; 44:939-943. [DOI: 10.1111/1346-8138.13833] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 02/06/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Masao Fujiwara
- Department of Plastic and Reconstructive Surgery; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Takahiro Suzuki
- Department of Dermatology; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Ayumi Senoo
- Department of Plastic and Reconstructive Surgery; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Hidekazu Fukamizu
- Department of Plastic and Reconstructive Surgery; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Yoshiki Tokura
- Department of Dermatology; Hamamatsu University School of Medicine; Hamamatsu Japan
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23
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Lim RSM, Ramdave S, Beech P, Billah B, Karim MN, Smith JA, Safdar A, Sigston E. Utility of SUV max on 18 F-FDG PET in detecting cervical nodal metastases. Cancer Imaging 2016; 16:39. [PMID: 27821180 PMCID: PMC5100181 DOI: 10.1186/s40644-016-0095-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 10/25/2016] [Indexed: 11/25/2022] Open
Abstract
Background The presence of cervical lymph node metastasis is an important prognostic factor for patients with head and neck squamous cell carcinomas (HNSCC). Accurate assessment of lymph node metastasis in these patients is essential for appropriate prognostic and management purposes. Here, we evaluated the effectiveness of the maximum standardized uptake value (SUVmax) on positron emission tomography (PET) in assessing lymph node metastasis in HNSCC prior to surgery. Methods A retrospective review of 74 patients with HNSCC who underwent PET/CT prior to neck dissection were examined. Pre-operative PET/CT scans were reviewed by two experienced nuclear medicine physicians and SUVmax of the largest node in each nodal basin documented. These were compared with the histology results of the neck dissection. Results A total of 359 nodal basins including 86 basins with metastatic nodes were evaluated. A nodal SUVmax ≥3.16 yielded a sensitivity of 74.4 % and specificity of 84.9 % in detecting metastatic nodes. The nodal SUVmax/Liver SUVmax ratio was found on receiver operating characteristic (ROC) to be effective in detecting metastatic nodes with an area under ROC curve of 0.90. A nodal SUVmax/Liver SUVmax ratio ≥0.90 yielded a sensitivity of 74.1 % and specificity of 93.4 %. By comparison, visual inspection yielded sensitivities of 66.3 and 61.6 % in observers 1 and 2 respectively. The corresponding specificities were 77.7 and 86.5 %. Conclusions Nodal SUVmax and nodal SUVmax/liver SUVmax are both useful in the pre-operative detection of metastatic nodes with the latter being superior to visual inspection. The ratio is likely to be more useful as it corrects for inter-scanner variability.
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Affiliation(s)
- Rebecca S M Lim
- Department of Otolaryngology and Head & Neck Surgery, Monash Medical Centre, 823-865 Centre Rd, Bentleigh East, VIC, 3165, Australia. .,Department of Surgery, School of Clinical Sciences, Monash University, 246 Clayton Rd, Clayton, VIC, 3168, Australia. .,Department of Radiology, Westmead Hospital, Cnr Hawkesbury Road and Darcy Road, Westmead, NSW, 2145, Australia.
| | - Shakher Ramdave
- Department of Nuclear Medicine & PET, Monash Medical Centre, 823-865 Centre Rd, Bentleigh East, VIC, 3165, Australia
| | - Paul Beech
- Department of Nuclear Medicine & PET, Monash Medical Centre, 823-865 Centre Rd, Bentleigh East, VIC, 3165, Australia.,Department of Nuclear Medicine, The Alfred, First Floor, East Block, Commercial Road, Melbourne, VIC, 3004, Australia
| | - Baki Billah
- School of Public Health, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Md Nazmul Karim
- School of Public Health, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Julian A Smith
- Department of Surgery, School of Clinical Sciences, Monash University, 246 Clayton Rd, Clayton, VIC, 3168, Australia
| | - Adnan Safdar
- Department of Otolaryngology and Head & Neck Surgery, Monash Medical Centre, 823-865 Centre Rd, Bentleigh East, VIC, 3165, Australia.,Department of Surgery, School of Clinical Sciences, Monash University, 246 Clayton Rd, Clayton, VIC, 3168, Australia
| | - Elizabeth Sigston
- Department of Otolaryngology and Head & Neck Surgery, Monash Medical Centre, 823-865 Centre Rd, Bentleigh East, VIC, 3165, Australia.,Department of Surgery, School of Clinical Sciences, Monash University, 246 Clayton Rd, Clayton, VIC, 3168, Australia
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Cacicedo J, Navarro A, Del Hoyo O, Gomez-Iturriaga A, Alongi F, Medina JA, Elicin O, Skanjeti A, Giammarile F, Bilbao P, Casquero F, de Bari B, Dal Pra A. Role of fluorine-18 fluorodeoxyglucose PET/CT in head and neck oncology: the point of view of the radiation oncologist. Br J Radiol 2016; 89:20160217. [PMID: 27416996 DOI: 10.1259/bjr.20160217] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Squamous cell carcinoma is the most common malignant tumour of the head and neck. The initial TNM staging, the evaluation of the tumour response during treatment, and the long-term surveillance are crucial moments in the approach to head and neck squamous cell carcinoma (HNSCC). Thus, at each of these moments, the choice of the best diagnostic tool providing the more precise and larger information is crucial. Positron emission tomography with fluorine-18 fludeoxyglucose integrated with CT (18F-FDG-PET/CT) rapidly gained clinical acceptance, and it has become an important imaging tool in routine clinical oncology. However, controversial data are currently available, for example, on the role of 18F-FDG-PET/CT imaging during radiotherapy planning, the prognostic value or its real clinical impact on treatment decisions. In this article, the role of 18F-FDG-PET/CT imaging in HNSCC during pre-treatment staging, radiotherapy planning, treatment response assessment, prognosis and follow-up is reviewed focusing on current evidence and controversial issues. A proposal on how to integrate 18F-FDG-PET/CT in daily clinical practice is also described.
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Affiliation(s)
- Jon Cacicedo
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain.,2 Grupo Español de Oncología Radioterápica en Cabeza y Cuello (GEORCC)
| | - Arturo Navarro
- 3 Radiation Oncology Department, Hospital Duran i Reynals (ICO) Avda, Gran Via de L´Hospitalet, Hospitalet de Llobregat, Barcelona, Spain
| | - Olga Del Hoyo
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - Alfonso Gomez-Iturriaga
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - Filippo Alongi
- 4 Radiation Oncology Department, Sacro Cuore-Don Calabria Hospital, Verona, Italy
| | - Jose A Medina
- 2 Grupo Español de Oncología Radioterápica en Cabeza y Cuello (GEORCC).,5 Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Olgun Elicin
- 6 Radiation Oncology Department, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Andrea Skanjeti
- 7 Nuclear Medicine Department, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Francesco Giammarile
- 7 Nuclear Medicine Department, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Pedro Bilbao
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - Francisco Casquero
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - Berardino de Bari
- 8 fESTRO Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Alan Dal Pra
- 6 Radiation Oncology Department, Inselspital, Bern University Hospital, Bern, Switzerland
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Cammaroto G, Quartuccio N, Sindoni A, Di Mauro F, Caobelli F. The role of PET/CT in the management of patients affected by head and neck tumors: a review of the literature. Eur Arch Otorhinolaryngol 2016; 273:1961-73. [PMID: 25971995 DOI: 10.1007/s00405-015-3651-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/06/2015] [Indexed: 02/07/2023]
Abstract
The management of head and neck tumor (HNSCC) has been changing over the years, especially due to the aid of imaging techniques that help physicians to attain a correct diagnosis. These techniques represent a valuable tool to help tailor treatment and during follow-up of patients affected by malignancies. The aim of this review is to summarize the results of the most recent and relevant studies about the use of PET imaging in HNSCCs. This review is divided into six chapters: (1) The role of PET/CT in the pre-treatment phase; (2) PET/CT and radiotherapy planning; (3) PET/CT in the post-treatment setting; (4) PET/CT and SUVmax for prediction of prognosis; (5) miscellanea on the utility of PET in specific HNSCCs; (6) non-FDG PET tracers used in HNSCC. Promising results have been obtained so far. Despite the encouraging outcomes, more investigations are needed to warrant the value of this technique, especially in the pre-treatment setting.
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Affiliation(s)
- Giovanni Cammaroto
- Department of Otorhinolaryngology, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy.
| | - Natale Quartuccio
- Nuclear Medicine Unit, Department of Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Alessandro Sindoni
- Nuclear Medicine Unit, Department of Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Francesca Di Mauro
- Nuclear Medicine Unit, Department of Biomedical Sciences and Morphologic and Functional Images, University of Messina, Messina, Italy
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Fujiwara M, Suzuki T, Takiguchi T, Fukamizu H, Tokura Y. Evaluation of positron emission tomography imaging to detect lymph node metastases in patients with high-risk cutaneous squamous cell carcinoma. J Dermatol 2016; 43:1314-1320. [DOI: 10.1111/1346-8138.13403] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 02/29/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Masao Fujiwara
- Department of Plastic and Reconstructive Surgery; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Takahiro Suzuki
- Department of Dermatology; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Tetsuya Takiguchi
- Department of Plastic and Reconstructive Surgery; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Hidekazu Fukamizu
- Department of Plastic and Reconstructive Surgery; Hamamatsu University School of Medicine; Hamamatsu Japan
| | - Yoshiki Tokura
- Department of Dermatology; Hamamatsu University School of Medicine; Hamamatsu Japan
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[18F]-FDG PET/CT imaging for detection of nodal metastases in patients with squamous cell carcinoma of the pharynx and larynx: comparison with CT. Jpn J Radiol 2015; 34:203-10. [DOI: 10.1007/s11604-015-0510-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 11/29/2015] [Indexed: 10/22/2022]
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Kitajima K, Suenaga Y, Minamikawa T, Komori T, Otsuki N, Nibu KI, Sasaki R, Itoh T, Sugimura K. Clinical significance of SUVmax in (18)F-FDG PET/CT scan for detecting nodal metastases in patients with oral squamous cell carcinoma. SPRINGERPLUS 2015; 4:718. [PMID: 26636006 PMCID: PMC4656255 DOI: 10.1186/s40064-015-1521-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 11/10/2015] [Indexed: 11/10/2022]
Abstract
To retrospectively investigate the diagnostic accuracy of FDG-PET/CT relative to CT for detection of cervical node metastases in patients with oral squamous cell carcinoma (OSCC), using histologic evaluation of dissected cervical nodes as the reference standard. Thirty-six patients with OSCC who underwent neck dissection (4 bilateral, 32 unilateral; 250 nodal levels) after FDG-PET/CT. Two observers consensually determined the lesion size and SUVmax of visible cervical nodes and compared the results with pathologic findings at the nodal level. Histopathology revealed nodal metastases in 13 (36.1 %) of 36 patients and 28 (11.2 %) of 250 nodal levels. Using a best discriminative SUVmax cut-off of 3.5 for the node, the sensitivity, specificity and accuracy of FDG-PET/CT for identification of nodal metastases on a level-by-level basis were 67.9, 94.6, and 91.6 %, respectively. The corresponding figures for CT were 42.9, 96.8, and 90.8 %, respectively. The sensitivity of FDG-PET/CT was significantly better than CT (p = 0.023). Moreover, using the level-based modified SUVmax cut-off, the respective figures for FDG-PET/CT were 71.4, 95.9, and 93.2 %, with significantly higher sensitivity (p = 0.013) and accuracy (p = 0.041) than CT. FDG PET/CT with SUVmax is a useful modality for preoperative evaluation of cervical neck lymph node metastases in patients with OSCC.
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Affiliation(s)
- Kazuhiro Kitajima
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Yuko Suenaga
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Tsutomu Minamikawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Takahide Komori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Naoki Otsuki
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Ryohei Sasaki
- Department of Radiology, Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
| | - Kazuro Sugimura
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan
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Present and future role of FDG-PET/CT imaging in the management of head and neck carcinoma. Jpn J Radiol 2015; 33:776-89. [DOI: 10.1007/s11604-015-0495-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 10/16/2015] [Indexed: 01/09/2023]
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FDG PET/CT for Management and Assessing Outcomes of Squamous Cell Cancer of the Oral Cavity. AJR Am J Roentgenol 2015; 205:W150-61. [DOI: 10.2214/ajr.14.13830] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Chung MK, Lee GJ, Choi N, Cho JK, Jeong HS, Baek CH. Comparative study of sentinel lymph node biopsy in clinically N0 oral tongue squamous cell carcinoma: Long-term oncologic outcomes between validation and application phases. Oral Oncol 2015; 51:914-20. [PMID: 26231920 DOI: 10.1016/j.oraloncology.2015.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 07/14/2015] [Accepted: 07/17/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study tested the long-term outcomes of sentinel lymph node biopsy (SLNB) for oral tongue squamous cell carcinoma (SCC) during the transition from validation to application phase. MATERIALS AND METHODS Sensitivity, negative predictive value (NPV), neck control rate, disease-specific survival (DSS), disease-free survival (DFS), and overall survival (OS) were compared in cN0 oral tongue SCC patients from different phases. RESULTS A total of 133 SLNs from 61 patients (21 in the validation phase, 40 in the application phase) were harvested. Fourteen SLNs of 12 patients (6 in each phase) were positive for metastasis (occult metastasis rate, 19.6%). Regional recurrences developed from 5 negative SLNs (one in the validation phase, 4 in the application phase), of whom 3 patients were successfully salvaged. Sensitivity and NPV of the validation phase were both 100%, with 60.0% and 88.2% in the application phase. False omission rates were 6.6% (1/15) in the validation group, and 11.7% (4/34) in the application group, respectively. The neck control rate was 95.2% in the validation phase and 97.5% in the application phase (p=0.52). No differences were evident in DSS, DFS, and OS between the two phases (DSS: 92.5% vs 95.2%, p=0.69; DFS: 85.0% vs 90.4%, p=0.40; OS: 90% vs 85.5%, p=0.62). Subgroup analyses between negative- and positive-SLNs within each phase revealed no significant differences in all endpoints. CONCLUSION Given higher false negative cases in the application phase, stringent strategy of follow-up and salvage treatment is mandatory to maintain acceptable outcomes.
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Affiliation(s)
- Man Ki Chung
- Department of Otorhinolaryngology -Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Gil Joon Lee
- Department of Otorhinolaryngology -Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Nayeon Choi
- Department of Otorhinolaryngology -Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology - Head and Neck Surgery, Pusan National University Yansan Hospital, Puasn National University, Busan, South Korea
| | - Han-Sin Jeong
- Department of Otorhinolaryngology -Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Chung-Hwan Baek
- Department of Otorhinolaryngology -Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea.
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Loeffelbein DJ, Eiber M, Mayr P, Souvatzoglou M, Mücke T, von Bomhard A, Kesting MR, Wolff KD. Loco-regional recurrence after surgical treatment of oral squamous cell carcinoma: Proposals for follow-up imaging based on literature, national guidelines and institutional experience. J Craniomaxillofac Surg 2015; 43:1546-52. [PMID: 26189143 DOI: 10.1016/j.jcms.2015.06.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 05/29/2015] [Accepted: 06/17/2015] [Indexed: 12/17/2022] Open
Abstract
The recurrence rate following the treatment of oral squamous cell carcinoma (OSCC) by primary surgery is about 10%-26%. The earliest possible diagnosis of residual tumour, recurrence of local tumour disease, and subsequent metastasis is essential for an improvement of the overall survival and of the survival period for affected patients. No international consensus exists for a post-therapeutic surveillance schedule for OSCCs. Based on a review of the literature, existing guidelines, and our institutional experience, we have established an algorithm for the follow-up of these patients regarding the timing and techniques of postoperative imaging. We recommend a follow-up interval of 6 weeks during the first half-year after discharge from hospital by single clinical and alternating clinical check-ups combined with computed tomography (CT) or magnetic resonance imaging (MRI), followed by an interval of 3 months in the second half-year, with clinical and radiological check-ups. In year 2, we recommend a follow-up interval of 3 months with single clinical and alternating clinical check-ups combined with CT or MRI. In year 3, we recommend screening every 6 months, both clinically and via imaging, because of the decreased risk of recurrence. From year 5 onwards, our recommendation is a clinical and imaging-based examination every 6-12 months, depending on patient risk factors and disease progression. Four standard imaging techniques, namely positron emission tomography (PET), CT, MRI, and ultrasound (US), are discussed concerning their range of application, sensitivity, and specificity. Furthermore, the technical aspects of our institutional protocols are described in detail. In highly frequented head and neck cancer centres, PET and US are of secondary importance, since CT and MRI are nowadays highly efficient tools in primary diagnostic and post-therapeutic surveillance.
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Affiliation(s)
- D J Loeffelbein
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Ismaninger Str. 22, D-81675 München, Germany.
| | - M Eiber
- Department of Radiology, Technische Universität München, Ismaninger Str. 22, D-81675 München, Germany
| | - P Mayr
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Ismaninger Str. 22, D-81675 München, Germany
| | - M Souvatzoglou
- Department of Nuclear Medicine, Technische Universität München, Ismaninger Str. 22, D-81675 München, Germany
| | - T Mücke
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Ismaninger Str. 22, D-81675 München, Germany
| | - A von Bomhard
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Ismaninger Str. 22, D-81675 München, Germany
| | - M R Kesting
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Ismaninger Str. 22, D-81675 München, Germany
| | - K-D Wolff
- Department of Oral and Maxillofacial Surgery, Technische Universität München, Ismaninger Str. 22, D-81675 München, Germany
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Chikui T, Kitamoto E, Kami Y, Kawano S, Kobayashi K, Kamitani T, Obara M, Yoshiura K. Dynamic contrast-enhanced MRI of oral squamous cell carcinoma: a preliminary study of the correlations between quantitative parameters and the clinical stage. Br J Radiol 2015; 88:20140814. [PMID: 25906295 DOI: 10.1259/bjr.20140814] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To probe the utility of dynamic contrast-enhanced MRI (DCE-MRI) parameters in assessing the clinical characteristics of oral squamous cell carcinoma. METHODS A total of 85 tumours were included. We applied the Tofts and Kermode model for the DCE-MRI data and obtained three dependent parameters: the influx forward volume transfer constant into the extravascular extracellular space (EES) from the plasma (K(trans)), the fractional volume of EES per unit volume of tissue (ve) and the fractional volume of plasma (vp). We evaluated the correlations between these parameters and the clinical stages. RESULTS The T stage showed a negative correlation with the K(trans) (r = -0.2272; p = 0.0365), but it did not show a significant correlation with the other parameters. The N stage showed a negative correlation with K(trans) (r = -0.1948; p = 0.0404), and there were significant differences between N1 and N2+3 (0.119 ± 0.027 vs 0.096 ± 0.023 min(-1); p = 0.0198) and between N0 and N2+3 (0.114 ± 0.29 vs 0.096 ± 0.023 min(-1); p = 0.0288). CONCLUSION A decrease in the K(trans) at the primary site was found in advanced N stage cases, which might indicate that the hypoxic status cause a high possibility of the metastasis. ADVANCES IN KNOWLEDGE A decrease in the K(trans) at the primary site suggested the high possibility of an advanced N stage.
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Affiliation(s)
- T Chikui
- 1 Department of Oral and Maxillofacial Radiology, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
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Choi HJ, Lee KH, Kim NH, Kim JH, Hyun IY, Ryu JS. The usefulness of combined axial and coronal computed tomography for the evaluation of metastatic supraclavicular lymph nodes. Clin Imaging 2015; 39:608-12. [PMID: 25940644 DOI: 10.1016/j.clinimag.2015.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 04/10/2015] [Indexed: 12/18/2022]
Abstract
The purpose is to assess the value of adding coronal images for the identification of metastatic supraclavicular lymph nodes (LNs). Two radiologists reviewed axial images and combined axial and coronal images using thoracic computed tomography (CT) of 386 patients whose maximum standardized uptake value measured in a supraclavicular LN was ≥2.0 on a positron emission tomography. We compared sensitivity and agreement between readers before and after the addition of coronal images. For combined images, agreement was almost perfect (κ=0.982), and sensitivity was significantly higher (90.4%, P<.001). Interpreting both axial and coronal images improves the diagnostic accuracy for supraclavicular metastasis.
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Affiliation(s)
- Hyun Jin Choi
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Inhang-ro 27, Jung-gu, Incheon, Korea
| | - Kyung Hee Lee
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Inhang-ro 27, Jung-gu, Incheon, Korea
| | - Na Hee Kim
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Inhang-ro 27, Jung-gu, Incheon, Korea
| | - Jun Ho Kim
- Department of Radiology, Inha University Hospital, Inha University School of Medicine, Inhang-ro 27, Jung-gu, Incheon, Korea.
| | - In Young Hyun
- Department of Nuclear Medicine, Inha University Hospital, Inha University School of Medicine, Inhang-ro 27, Jung-gu, Incheon, Korea
| | - Jeong-Seon Ryu
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Inhang-ro 27, Jung-gu, Incheon, Korea
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Burusapat C, Jarungroongruangchai W, Charoenpitakchai M. Prognostic factors of cervical node status in head and neck squamous cell carcinoma. World J Surg Oncol 2015; 13:51. [PMID: 25889704 PMCID: PMC4336753 DOI: 10.1186/s12957-015-0460-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 01/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical nodal status is one of prognostic factors in head and neck squamous cell carcinoma (HNSCC). The objective of this study was to identify prognostic factors of cervical node status including site and size of primary tumors, presence of lymphovascular invasion, and size of cervical node for appropriate further treatment in HNSCC. METHODS A 5-year retrospective review of patients with HNSCC in Phramongkutklao Hospital from 2009 to 2013 was conducted. Histopathologic data on primary tumors and cervical nodes were reviewed. Cervical nodes were divided into five groups: 1-3, 4-6, 7-9, 10-30, and >30 mm. Numbers of positive and negative nodes were compared in different sizes and sites and the presence of extracapsular extension. RESULTS In all, 165 patients and 1,472 nodes were reviewed. The mean age was 52.6 years and 77.58% were male. The most frequent primary site was oral tongue (50.91%). In sum, 52.72% showed lymphovascular invasion. Thirty-five patients (81.40%) in therapeutic neck dissections and 18 patients (69.23%) in prophylactic neck dissections showed nodal metastasis. The mean size of metastatic nodes was 3.89 mm (range, 2-45 mm) and 3.53 mm (range, 2-23 mm), respectively. Significant associations were found between the size of cervical nodes and the site of primary tumor of the oral tongue, lip, base of the tongue, and floor of the mouth (p < 0.05). Metastatic lymph nodes showed extracapsular extension 69.55%. No significance was found between extracapsular extension and clinical staging, size of primary tumor, pathologic differentiation, and size of cervical nodes. Sizes of cervical lymph node of squamous cell carcinoma (SCC) of the oral tongue and lip were statistically significant with the size of tumor and tumor grading (p < 0.05). CONCLUSIONS A statistical significance was found between the size of cervical nodes and the site of primary tumor of the oral tongue and lip. Herein, we recommended performing neck dissection in all cases of SCC of the base of the tongue, floor of the mouth, buccal mucosa, and retromolar trigone.
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Affiliation(s)
- Chairat Burusapat
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Thung Phayathai, Ratchathewi, Bangkok, 10400, Thailand.
| | - Weerawut Jarungroongruangchai
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi Road, Thung Phayathai, Ratchathewi, Bangkok, 10400, Thailand.
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The method and efficacy of support vector machine classifiers based on texture features and multi-resolution histogram from (18)F-FDG PET-CT images for the evaluation of mediastinal lymph nodes in patients with lung cancer. Eur J Radiol 2014; 84:312-7. [PMID: 25487819 DOI: 10.1016/j.ejrad.2014.11.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 10/27/2014] [Accepted: 11/01/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVES In clinical practice, image analysis is dependent on simply visual perception and the diagnostic efficacy of this analysis pattern is limited for mediastinal lymph nodes in patients with lung cancer. In order to improve diagnostic efficacy, we developed a new computer-based algorithm and tested its diagnostic efficacy. METHODS 132 consecutive patients with lung cancer underwent (18)F-FDG PET/CT examination before treatment. After all data were imported into the database of an on-line medical image analysis platform, the diagnostic efficacy of visual analysis was first evaluated without knowing pathological results, and the maximum short diameter and maximum standardized uptake value (SUVmax) were measured. Then lymph nodes were segmented manually. Three classifiers based on support vector machine (SVM) were constructed from CT, PET, and combined PET-CT images, respectively. The diagnostic efficacy of SVM classifiers was obtained and evaluated. RESULTS According to ROC curves, the areas under curves for maximum short diameter and SUVmax were 0.684 and 0.652, respectively. The areas under the ROC curve for SVM1, SVM2, and SVM3 were 0.689, 0.579, and 0.685, respectively. CONCLUSION The algorithm based on SVM was potential in the diagnosis of mediastinal lymph nodes.
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The Value of F-18 FDG PET for Planning Treatment and Detecting Recurrence in Malignant Salivary Gland Tumors: Comparison with Conventional Imaging Studies. Nucl Med Mol Imaging 2013; 47:242-8. [PMID: 24900119 DOI: 10.1007/s13139-013-0222-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/21/2013] [Accepted: 07/28/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To assess the value of F-18 FDG PET/CT for detecting cervical lymph node (LN) metastasis and recurrence, as well as planning treatment, and to compare the accuracy of PET/CT with conventional imaging studies (CIS) in patients with malignant salivary gland tumor (SGT). METHODS Staging and follow-up PET/CT for SGT were retrospectively reviewed. Enhanced CT and/or MRI of the neck were performed within 1 month of PET/CT. Final diagnosis was based on histology from cervical LN dissection and biopsy or a minimum 6 months of clinical and imaging follow-up. We compared the performance of PET/CT in initial cervical LN staging and recurrence detection with that of CIS. RESULTS A total of 184 PET/CT exams of 66 patients were included, and 34 initial staging and 150 surveillance PET/CT exams were performed. The initial cervical LN detection sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 60.9 %, 89.2 %, 84.0 %, 56.0 %, and 91.0 % for visual analysis on PET/CT, 39.1 %, 95.0 %, 84.8 %, 64.3 %, and 87.4 % for semiquantitative analysis on PET/CT, and and 43.5 %, 94.1 %, 84.8 %, 62.5 %, and 88.1 % for CIS. The sensitivity of visual analysis on PET/CT was significantly higher than that of semiquantitative analysis on PET/CT and CIS (p = 0.0009 and 0.0086). In 5 of 34 initial staging patients (14.7 %), the treatment plan was changed from curative surgery to palliative therapy. The performance of follow-up PET/CT showed no significant difference compared with CIS. CONCLUSION PET/CT showed comparable performance with CIS for cervical LNs staging. Initial PET/CT changed treatment plans in 14.7 % of patients. However, PET/CT offered no additional advantage for detecting locoregional recurrence.
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Gunn GB, Debnam JM, Fuller CD, Morrison WH, Frank SJ, Beadle BM, Sturgis EM, Glisson BS, Phan J, Rosenthal DI, Garden AS. The impact of radiographic retropharyngeal adenopathy in oropharyngeal cancer. Cancer 2013; 119:3162-9. [PMID: 23733178 DOI: 10.1002/cncr.28195] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 04/24/2013] [Accepted: 04/26/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND We performed this study to define the incidence of radiographic retropharyngeal lymph node (RPLN) involvement in oropharyngeal cancer (OPC) and its impact on clinical outcomes, neither of which has been well established to date. METHODS Our departmental database was queried for patients irradiated for OPC between 2001 and 2007. Analyzable patients were those with imaging data available for review to determine radiographic RPLN status. Demographic, clinical, and outcome data were retrieved and analyzed. RESULTS The cohort consisted of 981 patients. The median follow-up was 69 months. The base of the tongue (47%) and the tonsil (46%) were the most common primary sites. The majority of patients had stage T1 to T2 primary tumors (64%), and 94% had stage 3 to 4B disease. Intensity-modulated radiation therapy was used in 77% of patients, and systemic therapy was administered in 58% of patients. The incidence of radiographic RPLN involvement was 10% and was highest for the pharyngeal wall (23%) and lowest for the base of the tongue (6%). RPLN adenopathy correlated with several patient and tumor factors. RPLN involvement was associated with poorer 5-year outcomes on univariate analysis (P<.001 for all) for local control (79% vs 92%), nodal control (80% vs 93%), recurrence-free survival (51% vs 81%), distant metastases-free survival (66% vs 89%), and overall survival (52% vs 82%) and maintained significance on multivariate analysis for local control (P = .023), recurrence-free survival (P = .001), distant metastases-free survival (P = .003), and overall survival (P = .001). CONCLUSIONS In this cohort of nearly 1000 patients investigating [corrected] radiographic RPLN adenopathy in OPC, RPLN involvement was observed in 10% of patients and portends [corrected] a negative influence on disease recurrence, distant relapse, and survival. In this cohort of nearly 1000 patients investigating radiographic RPLN adenopathy in OPC, RPLN involvement was observed in 10% of patients and portends a negative influence on disease recurrence, distant relapse, and survival.
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Affiliation(s)
- G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Alemayehu D, Zou KH. Applications of ROC analysis in medical research: recent developments and future directions. Acad Radiol 2012; 19:1457-64. [PMID: 23122565 DOI: 10.1016/j.acra.2012.09.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 09/17/2012] [Accepted: 09/18/2012] [Indexed: 12/14/2022]
Abstract
With the growing focus on comparative effectiveness research and personalized medicine, receiver-operating characteristic analysis can continue to play an important role in health care decision making. Specific applications of receiver-operating characteristic analysis include predictive model assessment and validation, biomarker diagnostics, responder analysis in patient-reported outcomes, and comparison of alternative treatment options. The authors present a survey of the potential applications of the method and briefly review several relevant extensions. Given the level of attention paid to biomarker validation, personalized medicine and comparative effectiveness research, it is highly likely that the receiver-operating characteristic analysis will remain an important visual and analytic tool for medical research and evidence-based medicine in the foreseeable future.
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