1
|
Pollastri F, Locatello LG, Bruno C, Maggiore G, Gallo O, Pecci R, Giannoni B. Otoendoscopy in the era of narrow-band imaging: a pictorial review. Eur Arch Otorhinolaryngol 2023; 280:1683-1693. [PMID: 36129549 PMCID: PMC9988719 DOI: 10.1007/s00405-022-07656-5] [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: 08/03/2022] [Accepted: 09/12/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Otoendoscopy represents the initial non-invasive diagnostic cornerstone for external and middle ear disorders. Recently, new techniques of enhanced imaging such as narrow-band imaging (NBI) have been introduced but their role as a potential aid in otological practice remains unproven. In this pictorial review, we want to present the potential application of this endoscopic method, highlight its limitations, and give some hints regarding its future implementation. METHODS Representative cases of external and/or middle ear pathologies were selected to illustrate the role of NBI in this regard. RESULTS NBI may represent a useful aid in the otological work-up, in the differential diagnosis of ear tumor-like masses, and, possibly, in the prognosis of tympanic perforations. For other ear disorders, instead, this technique does not seem to add anything to the standard clinical practice. CONCLUSIONS NBI might prove useful in the assessment of selected external and middle ear disorders but its role must be prospectively validated.
Collapse
Affiliation(s)
- Federica Pollastri
- Unit of Audiology, Oncological and Robotic Head and Neck Surgery, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy. .,Department of Neuroscience, Psychology, Drug's Area and Child's Health, University of Florence, Florence, Italy.
| | | | - Chiara Bruno
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | | | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | - Rudi Pecci
- Unit of Audiology, Oncological and Robotic Head and Neck Surgery, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Beatrice Giannoni
- Unit of Audiology, Oncological and Robotic Head and Neck Surgery, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.,Department of Neuroscience, Psychology, Drug's Area and Child's Health, University of Florence, Florence, Italy
| |
Collapse
|
2
|
Surgical Treatment for Advanced Oropharyngeal Cancer: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020304. [PMID: 36837506 PMCID: PMC9961866 DOI: 10.3390/medicina59020304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/30/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
Background and Objectives: to describe current scientific knowledge regarding the treatment options in advanced oropharyngeal cancer. The standard care for advanced oropharyngeal cancer (OPSCC) has been chemoradiotherapy, although surgical approaches followed by adjuvant treatment have been proposed. The best therapy for each patient should be decided by an interdisciplinary tumour-board. Different strategies should be considered for the specific patient's treatment: surgery, chemotherapy and radiation therapy or combinations of them. The treatment choice is influenced by tumour variability and prognostic factors, but it also depends on cancer extension, extranodal extension, nervous invasion, human papilloma virus (HPV) presence, making the decisional algorithm not always clear. HPV-related OPSCC is strongly associated with a favourable overall survival (OS) and disease-free survival rate (DSS); by contrast, HPV-negative OPSCC often flags a worse prognosis. Consequently, the American Joint Committee on Cancer (AJCC) differentiates OPSCC treatment and prognosis based on HPV status. Methods: we carried out a review of current scientific literature to analyze the different indications and limitations of surgical treatment options in OPSCC stage III and IV. Conclusion: robotic surgery or open approaches with reconstructive flaps can be considered in advanced stages, resulting in the de-intensification of subsequent systemic therapy and fewer related side effects. Furthermore, in the event of the primary failure of systemic therapy or disease recurrence, the surgical approach constitutes an additional therapeutic option which lengthens patient survival functions.
Collapse
|
3
|
Implementation of Routine Endoscopy with Narrow Band Imaging in the Evaluation of Oral and Upper Airways Lesions in Oral Chronic Graft-Versus-Host Disease: A Preliminary Study. J Pers Med 2022; 12:jpm12101628. [PMID: 36294767 PMCID: PMC9605591 DOI: 10.3390/jpm12101628] [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] [Received: 08/19/2022] [Revised: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 11/09/2022] Open
Abstract
(1) Background: The aim of our study is to investigate the main oral lesion patterns in patients with oral graft-versus-host disease and to describe and validate the use of endoscopy enhanced with narrow-band imaging (NBI) as a personalized, reliable and user-friendly tool for the early detection of oral potentially diseases. (2) Methods: We retrospectively evaluated the medical records of 20 patients with chronic GVHD and with oral manifestations, who were referred to our “Interdisciplinary Center for Oropharyngeal Pathology (CIPO)” from January 2017 to July 2022. (3) Results: Data on GVHD, oral localization and NBI endoscopic evaluation are collected. A total of six mucositis, one mucosal erythematous change, ten lichenoid-like changes, eight erosive lesions, one leukoplakia, two erythroplakia and two case of blisters were observed. Two vascular abnormalities were seen with NBI, leading to one excisional biopsy. The patient was diagnosed with squamous cell carcinoma. (4) Conclusion: Our study is the first to highlight the relevance of the routine use of endoscopy with NBI in patients with oral chronic GVHD. We highlighted its role as a reliable, reproducible, easy-to-use and tailor-made tool in the follow-up of those patients and to allow an earlier identification of aberrant neoangiogenesis related to oral potentially malignant disorders and oral cancer.
Collapse
|
4
|
Schuman A, Anderson KS, Day AT, Ferrell J, Sturgis EM, Dahlstrom KR. Is 2045 the best we can do? Mitigating the HPV-related oropharyngeal cancer epidemic. Expert Rev Anticancer Ther 2022; 22:751-761. [PMID: 35679626 DOI: 10.1080/14737140.2022.2088514] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Oropharyngeal cancer (OPC) will be among the most common cancers in men by 2045 due to a rapid rise in human papillomavirus (HPV)-related OPC. Those who survive their cancer often suffer life-long treatment effects and early death. HPV vaccination could prevent virtually all HPV-related cancers but is not an effective preventive strategy for those already exposed. Without a dramatic increase in vaccine uptake in the U.S., HPV vaccination will have a negligible effect on OPC incidence through 2045 and no substantial impact until 2060. Additionally, targeted screening for earlier diagnosis may soon be feasible for those inadequately protected by vaccination. AREAS COVERED PubMed search for English-language articles related to incidence, screening, and prevention of HPV-related malignancies, focused on OPC in the U.S. EXPERT OPINION HPV-related OPC incidence will continue to increase for the foreseeable future with prophylactic vaccination offering no substantial public health impact for decades. Consequently, we must rapidly increase vaccination rates and develop screening methods to identify high-risk individuals. Such individuals would be eligible for potential preventive treatments and screening to diagnose early-stage HPV-related OPC allowing less morbid treatments. These methods will bridge the population into an era of decreasing incidence after vaccination takes effect.
Collapse
Affiliation(s)
- Ari Schuman
- Department of Otolaryngology, Baylor College of Medicine, Houston, TX, USA
| | - Karen S Anderson
- Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ, USA
| | - Andrew T Day
- and Neck Surgery, University of Texas Southwestern Medical CenterDepartment of Otolaryngology-Head, Dallas, TX, USA
| | - Jay Ferrell
- and Neck Surgery, University of Texas Health Science CenterDepartment of Otolaryngology-Head, San Antonio, TX, USA
| | - Erich M Sturgis
- Department of Otolaryngology, Baylor College of Medicine, Houston, TX, USA
| | - Kristina R Dahlstrom
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
5
|
[Confocal laser endomicroscopy - first application and validation of malignancy criteria]. Laryngorhinootologie 2021; 100:818-823. [PMID: 33772483 DOI: 10.1055/a-1418-9175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Confocal laser endomicroscopy (CLE) is a method for real-time in vivo visualization of mucosal changes on a cellular level. First investigations on head and neck carcinoma described the oropharyngeal application. The aim of this investigation is to elucidate, based on the criteria validated in the oropharynx, whether these can be transferred to endonasal mucosa. METHODS CLE was performed with intravenous fluorescein staining in endoscopic sinus surgery in one patient with sinonasal inverted papilloma and another with squamous cell carcinoma. We compared cellular visualization of pathological changes to those of healthy mucosa in the same specimen as well to our former findings in the oropharynx. RESULTS Endonasal CLE proved to be well feasible in the surgical setting and the transfer of malignancy criteria in analogy to histological examination could be optically retraced. Furthermore, additional criteria for tissue dignity assessment were obtained. CONCLUSION Our results suggest that endonasal CLE represents a valuable extension of the diagnostic repertoire available to date by an additional real-time analysis of nasal mucosa. This is of particular value in surgically challenging anatomical areas such as the paranasal sinuses. Further investigation and validation will be necessary.
Collapse
|
6
|
Chabrillac E, Dupret-Bories A, Vairel B, Woisard V, De Bonnecaze G, Vergez S. Narrow-Band Imaging in oncologic otorhinolaryngology: State of the art. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:451-458. [PMID: 33722467 DOI: 10.1016/j.anorl.2021.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To describe the diagnostic performance of Narrow Band Imaging (NBI) combined with White Light Imaging (WLI) in the diagnosis of mucosal lesions at each location of the upper aerodigestive tract, for detection of primary tumor in case of carcinoma of unknown primary, for determination of intraoperative resection margins, and to describe its main diagnostic pitfalls. MATERIAL AND METHODS A PubMed search was carried out according to the PRISMA method. RESULTS Four hundred and seventy-seven articles published between 2007 and 2020 were identified, 133 of which met the study inclusion criteria and were assessed. CONCLUSION The current literature seems to support the use of NBI in diagnosis and/or follow-up of (pre-)malignant head & neck tumors, and in the determination of intraoperative resection margins.
Collapse
Affiliation(s)
- E Chabrillac
- Department of ENT-Head and Neck Surgery, University Cancer Institute Toulouse and Toulouse University Hospital, Hôpital Larrey, 24 Chemin de Pouvourville, 31059 Toulouse, France; Department of Surgery, University Cancer Institute Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - A Dupret-Bories
- Department of Surgery, University Cancer Institute Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - B Vairel
- Department of ENT-Head and Neck Surgery, University Cancer Institute Toulouse and Toulouse University Hospital, Hôpital Larrey, 24 Chemin de Pouvourville, 31059 Toulouse, France; Department of Surgery, University Cancer Institute Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - V Woisard
- Department of ENT-Head and Neck Surgery, University Cancer Institute Toulouse and Toulouse University Hospital, Hôpital Larrey, 24 Chemin de Pouvourville, 31059 Toulouse, France; Department of Surgery, University Cancer Institute Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France
| | - G De Bonnecaze
- Department of ENT-Head and Neck Surgery, University Cancer Institute Toulouse and Toulouse University Hospital, Hôpital Larrey, 24 Chemin de Pouvourville, 31059 Toulouse, France
| | - S Vergez
- Department of ENT-Head and Neck Surgery, University Cancer Institute Toulouse and Toulouse University Hospital, Hôpital Larrey, 24 Chemin de Pouvourville, 31059 Toulouse, France; Department of Surgery, University Cancer Institute Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse, France.
| |
Collapse
|
7
|
Boscolo Nata F, Tirelli G, Capriotti V, Marcuzzo AV, Sacchet E, Šuran-Brunelli AN, de Manzini N. NBI utility in oncologic surgery: An organ by organ review. Surg Oncol 2020; 36:65-75. [PMID: 33316681 DOI: 10.1016/j.suronc.2020.11.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/26/2020] [Indexed: 02/07/2023]
Abstract
The main aims of the oncologic surgeon should be an early tumor diagnosis, complete surgical resection, and a careful post-treatment follow-up to ensure a prompt diagnosis of recurrence. Radiologic and endoscopic methods have been traditionally used for these purposes, but their accuracy might sometimes be suboptimal. Technological improvements could help the clinician during the diagnostic and therapeutic management of tumors. Narrow band imaging (NBI) belongs to optical image techniques, and uses light characteristics to enhance tissue vascularization. Because neoangiogenesis is a fundamental step during carcinogenesis, NBI could be useful in the diagnostic and therapeutic workup of tumors. Since its introduction in 2001, NBI use has rapidly spread in different oncologic specialties with clear advantages. There is an active interest in this topic as demonstrated by the thriving literature. It is unavoidable for clinicians to gain in-depth knowledge about the application of NBI to their specific field, losing the overall view on the topic. However, by looking at other fields of application, clinicians could find ideas to improve NBI use in their own specialty. The aim of this review is to summarize the existing literature on NBI use in oncology, with the aim of providing the state of the art: we present an overview on NBI fields of application, results, and possible future improvements in the different specialties.
Collapse
Affiliation(s)
- Francesca Boscolo Nata
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy; Otorhinolaryngology Unit, Ospedali Riuniti Padova Sud "Madre Teresa di Calcutta", ULSS 6 Euganea, Via Albere 30, 35043, Monselice, PD, Italy.
| | - Giancarlo Tirelli
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Vincenzo Capriotti
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Alberto Vito Marcuzzo
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Erica Sacchet
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Azzurra Nicole Šuran-Brunelli
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Nicolò de Manzini
- General Surgery Unit, Department of Medical, Surgical and Health Sciences, Azienda Sanitaria Universitaria Giuliano Isontina, Strada di Fiume 447, 34149, Trieste, Italy.
| |
Collapse
|
8
|
Shenson JA, Liu GS, Farrell J, Blevins NH. Multispectral Imaging for Automated Tissue Identification of Normal Human Surgical Specimens. Otolaryngol Head Neck Surg 2020; 164:328-335. [PMID: 32838646 DOI: 10.1177/0194599820941013] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Safe surgery requires the accurate discrimination of tissue intraoperatively. We assess the feasibility of using multispectral imaging and deep learning to enhance surgical vision by automated identification of normal human head and neck tissues. STUDY DESIGN Construction and feasibility testing of novel multispectral imaging system for surgery. SETTING Academic university hospital. SUBJECTS AND METHODS Multispectral images of fresh-preserved human cadaveric tissues were captured with our adapted digital operating microscope. Eleven tissue types were sampled, each sequentially exposed to 6 lighting conditions. Two convolutional neural network machine learning models were developed to classify tissues based on multispectral and white-light color images (ARRInet-M and ARRInet-W, respectively). Blinded otolaryngology residents were asked to identify tissue specimens from white-light color images, and their performance was compared with that of the ARRInet models. RESULTS A novel multispectral imaging system was developed with minimal adaptation to an existing digital operating microscope. With 81.8% accuracy in tissue identification of full-size images, the multispectral ARRInet-M classifier outperformed the white-light-only ARRInet-W model (45.5%) and surgical residents (69.7%). Challenges with discrimination occurred with parotid vs fat and blood vessels vs nerve. CONCLUSIONS A deep learning model using multispectral imaging outperformed a similar model and surgical residents using traditional white-light imaging at the task of classifying normal human head and neck tissue ex vivo. These results suggest that multispectral imaging can enhance surgical vision and augment surgeons' ability to identify tissues during a procedure.
Collapse
Affiliation(s)
- Jared A Shenson
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - George S Liu
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Joyce Farrell
- Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Nikolas H Blevins
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| |
Collapse
|
9
|
Maghami E, Ismaila N, Alvarez A, Chernock R, Duvvuri U, Geiger J, Gross N, Haughey B, Paul D, Rodriguez C, Sher D, Stambuk HE, Waldron J, Witek M, Caudell J. Diagnosis and Management of Squamous Cell Carcinoma of Unknown Primary in the Head and Neck: ASCO Guideline. J Clin Oncol 2020; 38:2570-2596. [PMID: 32324430 DOI: 10.1200/jco.20.00275] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To provide evidence-based recommendations to practicing physicians and other health care providers on the diagnosis and management of squamous cell carcinoma of unknown primary in the head and neck (SCCUP). METHODS The American Society of Clinical Oncology convened an Expert Panel of medical oncology, surgery, radiation oncology, radiology, pathology, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2008 through 2019. Outcomes of interest included survival, local and regional disease control, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 100 relevant studies to inform the evidence base for this guideline. Four main clinical questions were addressed, which included subquestions on preoperative evaluations, surgical diagnostic and therapeutic procedures, appropriate pathology techniques, and adjuvant therapy. RECOMMENDATIONS Evidence-based recommendations were developed to address preoperative evaluation for patients with a neck mass, surgical diagnostic and therapeutic procedures, appropriate treatment options in unilateral versus bilateral SCCUP.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Bruce Haughey
- Advent Health Medical Group, Otolaryngology, Head and Neck Surgery, Celebration, FL, and University of South Florida, Tampa, FL
| | - Doru Paul
- Weill Cornell Medical College, New York, NY
| | | | - David Sher
- University of Texas Southwestern, Dallas, TX
| | | | - John Waldron
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Matt Witek
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | |
Collapse
|
10
|
Saeidi H, Ge J, Kam M, Opfermann JD, Leonard S, Joshi AS, Krieger A. Supervised Autonomous Electrosurgery via Biocompatible Near-Infrared Tissue Tracking Techniques. IEEE TRANSACTIONS ON MEDICAL ROBOTICS AND BIONICS 2019; 1:228-236. [PMID: 33458603 PMCID: PMC7810241 DOI: 10.1109/tmrb.2019.2949870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Autonomous robotic surgery systems aim to improve patient outcomes by leveraging the repeatability and consistency of automation and also reducing human induced errors. However, intraoperative autonomous soft tissue tracking and robot control still remains a challenge due to the lack of structure, and high deformability of such tissues. In this paper, we take advantage of biocompatible Near-Infrared (NIR) marking methods and develop a supervised autonomous 3D path planning, filtering, and control strategy for our Smart Tissue Autonomous Robot (STAR) to enable precise and consistent incisions on complex 3D soft tissues. Our experimental results on cadaver porcine tongue samples indicate that the proposed strategy reduces surface incision error and depth incision error by 40.03% and 51.5%, respectively, compared to a teleoperation strategy via da Vinci. Furthermore, compared to an autonomous path planning method with linear interpolation between the NIR markers, the proposed strategy reduces the incision depth error by 48.58% by taking advantage of 3D tissue surface information.
Collapse
Affiliation(s)
- H. Saeidi
- Mechanical Engineering Department, University of Maryland, College Park, MD 20742, USA., Fischell Institute for Biomedical Devices and the Marlene and Stewart Greenebaum Cancer Center
| | - J. Ge
- Mechanical Engineering Department, University of Maryland, College Park, MD 20742, USA., Fischell Institute for Biomedical Devices and the Marlene and Stewart Greenebaum Cancer Center
| | - M. Kam
- Mechanical Engineering Department, University of Maryland, College Park, MD 20742, USA., Fischell Institute for Biomedical Devices and the Marlene and Stewart Greenebaum Cancer Center
| | - J. D. Opfermann
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Childrens National Health System, 111 Michigan Ave. N.W., Washington, DC 20010
| | - S. Leonard
- Electrical and Computer Science Eng. Dept., Johns Hopkins University, Baltimore, MD 21211
| | - A. S. Joshi
- Division of Otolaryngology - Head & Neck Surgery at The George Washington University Medical Faculty Associates, 2300 M St. NW 4th Floor, Washington DC 20037
| | - A. Krieger
- Mechanical Engineering Department, University of Maryland, College Park, MD 20742, USA., Fischell Institute for Biomedical Devices and the Marlene and Stewart Greenebaum Cancer Center
| |
Collapse
|
11
|
Baj A, Fusco N, Bolzoni A, Carioli D, Mazzucato C, Faversani A, Bresciani L, Maggioni M, Capaccio P. A novel integrated platform for the identification of surgical margins in oral squamous cell carcinoma: results from a prospective single-institution series. BMC Cancer 2019; 19:467. [PMID: 31101023 PMCID: PMC6525414 DOI: 10.1186/s12885-019-5634-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/23/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The optimal surgical margins assessment is capital in oral squamous cell carcinoma (OSCC) management. We evaluated the clinical benefits of integrating intraoperative macroscopic margin (MM) assessment and narrow band imaging (NBI). METHODS Sixteen OSCC patients eligible for surgery were prospectively enrolled. For each patient, 2 to 6 bioptic samples of MM and NBI margins were obtained and histologically analyzed for the presence of dysplasia and lymphocytes. Microvessel density was investigated by CD34 immunohistochemistry. RESULTS Taken together, 104 specimens were analyzed, including 15% tumors, 33% MM, 33% NBI margins, and 19% MM-NBI overlapping margins. The NBI margins were closer to the lesion in 50% cases, while the same number of MM were more conservative than NBI, irrespective of the tumor site. The rate of histologically positive margins was similar among the two methods, akin to the microvessel density. CONCLUSIONS MM assessment should be integrated but not replaced with the NBI technology to allow for more conservative surgery.
Collapse
Affiliation(s)
- Alessandro Baj
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Fondazione IRCCS Ca’ Granda Policlinico, via Francesco Sforza, 35, 20122 Milan, Italy
- Maxillo-Facial Surgery and Odontostomatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Fusco
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Fondazione IRCCS Ca’ Granda Policlinico, via Francesco Sforza, 35, 20122 Milan, Italy
- Division of Pathology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Bolzoni
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Fondazione IRCCS Ca’ Granda Policlinico, via Francesco Sforza, 35, 20122 Milan, Italy
- Maxillo-Facial Surgery and Odontostomatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Carioli
- Otolaryngology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Camilla Mazzucato
- Maxillo-Facial Surgery and Odontostomatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alice Faversani
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Fondazione IRCCS Ca’ Granda Policlinico, via Francesco Sforza, 35, 20122 Milan, Italy
- Division of Pathology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Bresciani
- Maxillo-Facial Surgery and Odontostomatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Maggioni
- Division of Pathology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pasquale Capaccio
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Fondazione IRCCS Ca’ Granda Policlinico, via Francesco Sforza, 35, 20122 Milan, Italy
- Otolaryngology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
12
|
Tirelli G, Hinni ML, Fernández‐Fernández MM, Bussani R, Gatto A, Bonini P, Giudici F, Boscolo Nata F. Frozen sections and complete resection in oral cancer surgery. Oral Dis 2019; 25:1309-1317. [DOI: 10.1111/odi.13101] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/11/2019] [Accepted: 03/27/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Giancarlo Tirelli
- ENT Clinic, Head and Neck Department Azienda Sanitaria Universitaria Integrata di Trieste Trieste Italy
| | - Michael L. Hinni
- Department of Otolaryngology Mayo Clinic Phoenix Phoenix Arizona
| | | | - Rossana Bussani
- UCO Pathological Anatomy and Histopathology Unit Azienda Sanitaria Universitaria Integrata di Trieste Trieste Italy
| | - Annalisa Gatto
- ENT Clinic, Head and Neck Department Azienda Sanitaria Universitaria Integrata di Trieste Trieste Italy
| | - Pierluigi Bonini
- ENT Clinic, Head and Neck Department Azienda Sanitaria Universitaria Integrata di Trieste Trieste Italy
| | - Fabiola Giudici
- Biostatistics Unit‐Department of Medical, Surgical and Health Science Azienda Sanitaria Universitaria Integrata di Trieste Trieste Italy
| | - Francesca Boscolo Nata
- ENT Clinic, Head and Neck Department Azienda Sanitaria Universitaria Integrata di Trieste Trieste Italy
| |
Collapse
|
13
|
Upadhyay A, Saraswathi N, Mundra RK. Narrow Band Imaging: An Effective and Early Diagnostic Tool in Diagnosis of Oral Malignant Lesions. Indian J Otolaryngol Head Neck Surg 2019; 71:967-971. [PMID: 31742103 DOI: 10.1007/s12070-019-01650-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 04/05/2019] [Indexed: 11/26/2022] Open
Abstract
The management of oral carcinoma leads to both cosmetic and functional deficit to the patient and the confirmatory histopathology is a time consuming process which may be a reason for a reduced follow up and compliance of the patient. We hereby use this study as an opportunity to tell that narrow band imaging (NBI) serves both the above purposes in an earlier period and in a non-invasive manner and thereby improving the lifestyle of the patients. To find out a better non-invasive and time saving diagnostic tool in the management of premalignant and malignant oral lesions in its earlier period. A prospective cross sectional study of 38 patients presenting to the department of ENT, MGMMC, MYH, Indore was taken with suspicious lesions and subjected to endoscopic examination by both white light and NBI and samples were sent to histopathological examination for confirmation. The Intrapapillary Capillary Loop were identified through NBI with Type I (50%) and Type II (31%) to be the most common pattern both correlating with the histopathological squamous cell carcinoma. The sensitivity and specificity of White Light Endoscopy is to be 75.75% and 76.43% respectively and of NBI to be 93.93% and 80% respectively. Narrow band imaging is found to be an optical diagnostic tool in the diagnosis of the lesions at an earlier stage and preventing from further functional and structural deterioration by the disease progression.
Collapse
Affiliation(s)
| | - N Saraswathi
- Department of ENT, MGM Medical College and MY Hospital, Indore, MP India
| | - R K Mundra
- Department of ENT, MGM Medical College and MY Hospital, Indore, MP India
| |
Collapse
|
14
|
Tirelli G, Boscolo Nata F, Gatto A, Bussani R, Spinato G, Zacchigna S, Piovesana M. Intraoperative Margin Control in Transoral Approach for Oral and Oropharyngeal Cancer. Laryngoscope 2018; 129:1810-1815. [PMID: 30284261 DOI: 10.1002/lary.27567] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/06/2018] [Accepted: 08/17/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Piecemeal resection provides an innovative conceptual tool for margins surveillance because it entails the intraoperative evaluation of the whole resection margins and not just sample points, which should result in a better control of deep margins compared to en bloc resection. Although it is recognized that the intraoperative use of narrow band imaging (NBI) results in a better control of superficial margins, in this exploratory study we investigated whether NBI and piecemeal resection could be used in combination to improve margin control at both superficial and deep levels. Because piecemeal resection is based on frozen section analysis, we wanted to verify its reliability compared to definitive histological examination. METHODS The status of resection margins in a group of patients with oral and oropharyngeal cancers treated with NBI and laser CO2 piecemeal resection (group 1) was compared with that of an historical group of patients (group 2) treated with NBI and conventional en bloc resection. In group 1, sensitivity, specificity, and positive and negative predictive values were used to verify the rate of concordance between frozen section and definitive histology. RESULTS The difference between deep positive margins in the two groups was statistically significant (P = 0.042). The high sensitivity and specificity (94.6% and 94.7%, respectively) of frozen section analysis also demonstrated its reliability in the examination of larger samples corresponding to the whole margin. CONCLUSION Even if our findings are limited by the small number of patients, we are confident that the combined use of NBI and piecemeal resection could represent an attractive surgical strategy to improve margin control. LEVEL OF EVIDENCE 2b Laryngoscope, 129:1810-1815, 2019.
Collapse
Affiliation(s)
- Giancarlo Tirelli
- Department of Otorhinolaryngology and Head and Neck Surgery, Trieste
| | | | - Annalisa Gatto
- Department of Otorhinolaryngology and Head and Neck Surgery, Trieste
| | - Rossana Bussani
- Department of Pathological Anatomy and Histopathology, University of Trieste, Cattinara Hospital, Trieste
| | - Giacomo Spinato
- Ear, Nose and Throat Department, Rovigo Provincial Hospital, Rovigo, Italy
| | - Serena Zacchigna
- Department of Medical Sciences University of Trieste and Cardiovascular Biology, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste
| | - Marco Piovesana
- Department of Otorhinolaryngology and Head and Neck Surgery, Trieste
| |
Collapse
|
15
|
Transoral surgery (TOS) in oropharyngeal cancer: Different tools, a single mini-invasive philosophy. Surg Oncol 2018; 27:643-649. [PMID: 30449487 DOI: 10.1016/j.suronc.2018.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/21/2018] [Accepted: 08/16/2018] [Indexed: 12/13/2022]
Abstract
Surgery with or without adjuvant therapy and radiotherapy with or without chemotherapy have traditionally represented the possible treatment options for oropharyngeal cancer. The adverse effects of non-surgical treatments and recent technical innovations have prompted a new interest in the surgical approach. However, in parallel to the possibility of achieving radical cancer clearance, we should remember the impact that traditional open surgery has on the patient's cosmesis, functionality and quality of life. As a result, transoral surgery is an attractive option for oropharyngeal tumors. The term "transoral surgery" only indicates that the tumor is accessed and resected via the oral cavity, but the surgeon can choose among different resection methods, such as transoral laser microsurgery, transoral robotic surgery, transoral videolaryngoscopic surgery, endoscopic laryngo-pharyngeal surgery, and transoral ultrasound surgery. The aim of this paper is to review the recent literature on the transoral treatment of oropharyngeal cancer, to standardize the terminology of transoral procedures, analyzing the common aspects, main differences and future perspectives of the various forms of transoral surgery.
Collapse
|
16
|
Tirelli G, Piovesana M, Marcuzzo AV, Gatto A, Biasotto M, Bussani R, Zandonà L, Giudici F, Boscolo Nata F. Tailored resections in oral and oropharyngeal cancer using narrow band imaging. Am J Otolaryngol 2018; 39:197-203. [PMID: 29150027 DOI: 10.1016/j.amjoto.2017.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/28/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE In a previous pilot study we observed that intra-operative narrow-band imaging (NBI) helps achieve clear superficial resection margins. The aim of this study was to verify if the use of intra-operative NBI can help to obtain tailored resections and if it is influenced by the lesion site, aspects not investigated in our previous study. MATERIALS AND METHODS The resection margins of 39 oral and 22 oropharyngeal squamous cell carcinomas were first set at 1.5cm from the macroscopic lesion boundary (white light, WL, tattoo). Then, the superficial tumor extension was more precisely defined with NBI, giving rise to three possible situations: NBI tattoo larger than the WL tattoo, NBI tattoo coinciding with the WL tattoo, or NBI tattoo smaller than the WL tattoo. For each of these situations the space comprised between the NBI and WL tattoos was defined "NBI positive", "NBI null", and "NBI negative", respectively. Resections were performed following the outer tattoo. The number of clear superficial resection margins, and the pathological response on the "NBI-positive" and the "NBI-negative" areas were recorded. RESULTS We obtained 80.3% negative superficial resection margins. NBI provided a more precise definition of superficial tumor extension in 43 patients. Sensitivity, specificity, positive and negative predictive values were 94.4%, 64%, 79.1% and 88.9%, respectively; a test of proportions demonstrated they were not influenced by tumor site. CONCLUSIONS NBI could allow for real-time definition of superficial tumor extension with possible tailored resections and fewer positive superficial resection margins; it is not influenced by tumor site.
Collapse
|
17
|
Valls-Mateus M, Nogués-Sabaté A, Blanch JL, Bernal-Sprekelsen M, Avilés-Jurado FX, Vilaseca I. Narrow band imaging for head and neck malignancies: Lessons learned from mistakes. Head Neck 2018; 40:1164-1173. [PMID: 29385299 DOI: 10.1002/hed.25088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 09/17/2017] [Accepted: 12/20/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The accuracy of white light endoscopy in combination with narrow band imaging (WLE + NBI) for diagnosis of squamous cell carcinoma (SCC) does not reach 100%. We evaluated the characteristics of the false-negative and false-positive cases. METHODS Five hundred thirty lesions of the upper airways were evaluated. The WLE was followed by NBI examination before performing a biopsy. RESULTS The false-negative lesions (7.36%) were represented by submucosal and non-SCC tumors. Among the 25 non-SCC tumors, 72% did not show any suspicious vascular pattern under NBI. The false-positive lesions (6.04%) were mainly represented by postradiotherapy mucosal changes, ulcers, and infections. Regarding papillomas, NBI accuracy reached 95.32%, although cases with dysplasia were difficult to distinguish from SCC. CONCLUSION The WLE + NBI improved diagnostic accuracy, but not all lesions were ideally evaluated with current defined patterns. An accurate anamnesis is mandatory, because, in some cases, it may be more relevant than the NBI pattern.
Collapse
Affiliation(s)
- Meritxell Valls-Mateus
- Department of Otolaryngology, Hospital Clínic, Barcelona, Spain.,Ear, Nose, and Throat Surgical Oncology Section, Hospital Clínic, Barcelona, Spain
| | | | - Jose Luis Blanch
- Department of Otolaryngology, Hospital Clínic, Barcelona, Spain.,Ear, Nose, and Throat Surgical Oncology Section, Hospital Clínic, Barcelona, Spain
| | - Manuel Bernal-Sprekelsen
- Department of Otolaryngology, Hospital Clínic, Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | | | - Isabel Vilaseca
- Department of Otolaryngology, Hospital Clínic, Barcelona, Spain.,Ear, Nose, and Throat Surgical Oncology Section, Hospital Clínic, Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| |
Collapse
|
18
|
Tirelli G, Piovesana M, Gatto A, Boscolo Nata F. Narrow-band imaging with 4K technology in the head and neck: preliminary experience and technical settings. Br J Oral Maxillofac Surg 2017; 55:740-741. [PMID: 28712510 DOI: 10.1016/j.bjoms.2017.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 06/17/2017] [Indexed: 11/30/2022]
Affiliation(s)
- G Tirelli
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - M Piovesana
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - A Gatto
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - F Boscolo Nata
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Strada di Fiume 447, 34149, Trieste, Italy.
| |
Collapse
|