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Zhi Y, Zhang Y, Zhang B. Transoral robotic surgery in the diagnosis and treatment of primary unknown head and neck squamous cell carcinoma: A preliminary single centre experience. Int J Med Robot 2024; 20:e2652. [PMID: 39031752 DOI: 10.1002/rcs.2652] [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: 01/09/2024] [Revised: 06/01/2024] [Accepted: 06/06/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Squamous cell carcinoma of unknown primary (CUP) in the head and neck is difficult to diagnose and treat. This report outlines 11 cases of CUP treated with transoral robotic surgery (TORS), aimed at investigating the diagnostic efficiency of primary tumour and radical resection effectiveness of TORS. METHODS 11 cases of CUP among 68 oropharyngeal cancer patients treated by TORS were analysed retrospectively. RESULTS All the 11 cases received TORS with cervical lymph node dissection. Primary tumours were found in 8 cases (72.7%), 4 cases in the palatine tonsil and 4 cases in the base of the tongue. The average diameter of the primary tumour was 1.65 cm. All patients resumed eating by mouth within 24 h, no tracheotomy, no pharyngeal fistula and no postoperative death. The 3-year disease-free survival rate was 91%. CONCLUSIONS TORS can improve the diagnostic efficiency of primary tumour of CUP and achieve good oncology and functional results.
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Affiliation(s)
- Yinghui Zhi
- Department of General Surgery, Beijing United Family Hospital and Clinics, Beijing, China
| | - Yabing Zhang
- Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Bin Zhang
- Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Beijing, China
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2
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Xu M, Gu B, Zhang J, Xu X, Qiao Y, Hu S, Song S. Differentiation of cancer of unknown primary and lymphoma in head and neck metastatic poorly differentiated cancer using 18 F-FDG PET/CT tumor metabolic heterogeneity index. Nucl Med Commun 2024; 45:148-154. [PMID: 38095143 DOI: 10.1097/mnm.0000000000001797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
OBJECTIVE To explore the value of 18 F-FDG PET/CT tumor metabolic heterogeneity index (HI) and establish and validate a nomogram model for distinguishing head and neck cancer of unknown primary (HNCUP) from lymphoma with head and neck metastatic poorly differentiated cancer. METHODS This retrospective analysis was conducted on 1242 patients with cervical metastatic poorly differentiated cancer. 108 patients, who were clinically and pathologically confirmed as HNCUP or lymphoma, were finally enrolled. Two independent sample t-tests and χ 2 test were used to compare the clinical and imaging features. Binary logistic regression was used to screen for independent predictive factors. RESULTS Among the 108 patients), 65 patients were diagnosed with HNCUP and 43 were lymphoma. Gender ( P = 0.001), SUV max ( P < 0.001), SUV mean ( P < 0.001), TLG ( P = 0.012), and HI ( P < 0.001) had statistical significance in distinguishing HNCUP and lymphoma. Female ( OR = 4.546, P = 0.003) and patients with HI ≥ 2.37 ( OR = 3.461, P = 0.047) were more likely to be diagnosed as lymphoma. CONCLUSION For patients with cervical metastatic poorly differentiated cancer, gender and HI were independent predictors of pathological type. For such patients, clinical attention should be paid to avoid misdiagnosing lymphoma as HNCUP, which may delay treatment.
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Affiliation(s)
- Mingzhen Xu
- Department of Nuclear Medicine, Shanghai Proton and Heavy Ion Center, Fudan University Shanghai Cancer Center
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000)
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Xuhui District, Shanghai, China
| | - Bingxin Gu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Xuhui District, Shanghai, China
| | - Jianping Zhang
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Xuhui District, Shanghai, China
| | - Xiaoping Xu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Xuhui District, Shanghai, China
| | - Ying Qiao
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Xuhui District, Shanghai, China
| | - Silong Hu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Xuhui District, Shanghai, China
| | - Shaoli Song
- Department of Nuclear Medicine, Shanghai Proton and Heavy Ion Center, Fudan University Shanghai Cancer Center
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000)
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Xuhui District, Shanghai, China
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3
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Madani G, Arain Z, Awad Z. The radiological unknown primary of the head and neck: Recommendations for imaging strategies based on a systematic review. Clin Otolaryngol 2024; 49:16-28. [PMID: 37846889 DOI: 10.1111/coa.14111] [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: 04/13/2023] [Revised: 09/24/2023] [Accepted: 09/30/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVES To develop recommendations for the radiological investigation of clinically occult primary cancer in the head and neck. DESIGN AND SETTING In accordance with PRISMA guidelines, a search was performed on Medline, Embase and Cochrane library databases to investigate the efficacy of ultrasound guided Fine Needle Aspiration (US FNAC), contrast enhanced CT (CECT), magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose PET-CT (18F-FDG PET-CT) in the investigation of head and neck squamous cell carcinoma from an unknown primary (HNSCCUP) presenting with a metastatic cervical lymph node (s). The Quality Assessment of Diagnostic Accuracy Studies Version 2 tool and SIGN 50 guidelines were used to assess the risk of bias and quality of the included studies. PARTICIPANTS Adult patients presenting with metastatic cervical lymph nodes from a HNSCCUP. MAIN OUTCOME MEASURES Utility of different imaging modalities (PET-CT, MRI, CE CT and US FNAC in the management of HNSCCUP). RESULTS Twenty-eight studies met inclusion criteria; these were meta-analyses, systematic reviews, prospective and retrospective studies. CONCLUSIONS The optimal imaging strategy involves utilisation of various imaging modalities. US FNAC can provide the initial diagnosis and HPV status of the occult primary tumour. CECT and MRI detect up to 44% of occult tumours and guide management. FDG PET-CT is the most sensitive imaging modality for the detection of CUP and should be performed prior to panendoscopy.
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Affiliation(s)
- Gitta Madani
- Imperial College Healthcare NHS Trust, London, UK
| | - Zoya Arain
- Imperial College Healthcare NHS Trust, London, UK
| | - Zaid Awad
- Imperial College Healthcare NHS Trust, London, UK
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Becker M, de Vito C, Dulguerov N, Zaidi H. PET/MR Imaging in Head and Neck Cancer. Magn Reson Imaging Clin N Am 2023; 31:539-564. [PMID: 37741640 DOI: 10.1016/j.mric.2023.08.001] [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] [Indexed: 09/25/2023]
Abstract
Head and neck squamous cell carcinoma (HNSCC) can either be examined with hybrid PET/MR imaging systems or sequentially, using PET/CT and MR imaging. Regardless of the acquisition technique, the superiority of MR imaging compared to CT lies in its potential to interrogate tumor and surrounding tissues with different sequences, including perfusion and diffusion. For this reason, PET/MR imaging is preferable for the detection and assessment of locoregional residual/recurrent HNSCC after therapy. In addition, MR imaging interpretation is facilitated when combined with PET. Nevertheless, distant metastases and distant second primary tumors are detected equally well with PET/MR imaging and PET/CT.
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Affiliation(s)
- Minerva Becker
- Diagnostic Department, Division of Radiology, Unit of Head and Neck and Maxillofacial Radiology, Geneva University Hospitals, University of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 14 1211, Switzerland.
| | - Claudio de Vito
- Diagnostic Department, Division of Clinical Pathology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 14 1211, Switzerland
| | - Nicolas Dulguerov
- Department of Clinical Neurosciences, Clinic of Otorhinolaryngology, Head and Neck Surgery, Unit of Cervicofacial Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 14 1211, Switzerland
| | - Habib Zaidi
- Diagnostic Department, Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, University of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva 14 1211, Switzerland; Geneva University Neurocenter, University of Geneva, Geneva, Switzerland; Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; Department of Nuclear Medicine, University of Southern Denmark, Odense, Denmark
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5
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Bicci E, Calamandrei L, Mungai F, Granata V, Fusco R, De Muzio F, Bonasera L, Miele V. Imaging of human papilloma virus (HPV) related oropharynx tumour: what we know to date. Infect Agent Cancer 2023; 18:58. [PMID: 37814320 PMCID: PMC10563217 DOI: 10.1186/s13027-023-00530-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/11/2023] [Indexed: 10/11/2023] Open
Abstract
The tumours of head and neck district are around 3% of all malignancies and squamous cell carcinoma is the most frequent histotype, with rapid increase during the last two decades because of the increment of the infection due to human papilloma virus (HPV). Even if the gold standard for the diagnosis is histological examination, including the detection of viral DNA and transcription products, imaging plays a fundamental role in the detection and staging of HPV + tumours, in order to assess the primary tumour, to establish the extent of disease and for follow-up. The main diagnostic tools are Computed Tomography (CT), Positron Emission Tomography-Computed Tomography (PET-CT) and Magnetic Resonance Imaging (MRI), but also Ultrasound (US) and the use of innovative techniques such as Radiomics have an important role. Aim of our review is to illustrate the main imaging features of HPV + tumours of the oropharynx, in US, CT and MRI imaging. In particular, we will outline the main limitations and strengths of the various imaging techniques, the main uses in the diagnosis, staging and follow-up of disease and the fundamental differential diagnoses of this type of tumour. Finally, we will focus on the innovative technique of texture analysis, which is increasingly gaining importance as a diagnostic tool in aid of the radiologist.
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Affiliation(s)
- Eleonora Bicci
- Department of Radiology, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Florence, 50134, Italy.
| | - Leonardo Calamandrei
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Florence, 50134, Italy
| | - Francesco Mungai
- Department of Radiology, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Florence, 50134, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, Naples, 80131, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, Naples, 80013, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, 20122, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, Campobasso, 86100, Italy
| | - Luigi Bonasera
- Department of Radiology, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Florence, 50134, Italy
| | - Vittorio Miele
- Department of Radiology, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Florence, 50134, Italy
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Righini CA, Gil H, Gallazzini-Crepin C, Fabre C. A cyst located in the parapharyngeal space. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:95-98. [PMID: 35811281 DOI: 10.1016/j.anorl.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- C-A Righini
- Service d'ORL et chirurgie cervico-faciale du CHU de Grenoble-Alpes (CHUGA), Grenoble, France; Faculté de médecine, universités des Alpes, Grenoble-Alpes (UGA), Grenoble, France.
| | - H Gil
- Laboratoire d'anatomopathologie, CHU de Grenoble-Alpes (CHUGA), Grenoble, France
| | - C Gallazzini-Crepin
- Service de médecine nucléaire, CHU de Grenoble-Alpes (CHUGA), Grenoble, France
| | - C Fabre
- Service d'ORL et chirurgie cervico-faciale du CHU de Grenoble-Alpes (CHUGA), Grenoble, France; Faculté de médecine, universités des Alpes, Grenoble-Alpes (UGA), Grenoble, France
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Marcus C, Sheikhbahaei S, Shivamurthy VKN, Avey G, Subramaniam RM. PET Imaging for Head and Neck Cancers. Radiol Clin North Am 2021; 59:773-788. [PMID: 34392918 DOI: 10.1016/j.rcl.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Head and neck cancers are commonly encountered cancers in clinical practice in the United States. Fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT has been clinically applied in staging, occult primary tumor detection, treatment planning, response assessment, follow-up, recurrent disease detection, and prognosis prediction in these patients. Alternative PET tracers remain investigational and can provide additional valuable information such as radioresistant tumor hypoxia. The recent introduction of 18F-FDG PET/MR imaging has provided the advantage of combining the superior soft tissue resolution of MR imaging with the functional information provided by 18F-FDG PET. This article is a concise review of recent advances in PET imaging in head and neck cancer.
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Affiliation(s)
- Charles Marcus
- Department of Nuclear Medicine and Molecular Imaging, Emory University Hospital, Atlanta, GA, USA.
| | - Sara Sheikhbahaei
- Department of Radiology, Johns Hopkins Medical Institutions, 601 N. Caroline Street, JHOC 3235, Baltimore, MD 21287, USA
| | - Veeresh Kumar N Shivamurthy
- Epilepsy Center, St. Francis Hospital and Medical Center, Trinity Health of New England, 114 Woodland Street, Hartford, CT 06105, USA
| | - Greg Avey
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave #3284, Madison, WI 53792, USA
| | - Rathan M Subramaniam
- Dean's Office, Otago Medical School, University of Otago, 201 Great King Street, Dunedin 9016, New Zealand
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Human Papillomavirus and Squamous Cell Carcinoma of Unknown Primary in the Head and Neck Region: A Comprehensive Review on Clinical Implications. Viruses 2021; 13:v13071297. [PMID: 34372502 PMCID: PMC8310239 DOI: 10.3390/v13071297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 01/02/2023] Open
Abstract
Squamous cell carcinoma of unknown primary (SCCUP) is a challenging diagnostic subgroup of oropharyngeal squamous cell carcinoma (OPSCC). The incidence of SCCUP is increasing in parallel with the well-documented increase in OPSCC and is likewise driven by the increase in human papillomavirus (HPV). The SCCUP patient often presents with a cystic lymph node metastasis and undergoes an aggressive diagnostic and treatment program. Detection of HPV in cytologic specimens indicates an oropharyngeal primary tumor origin and can guide the further diagnostic strategy. Advances in diagnostic modalities, e.g., transoral robotic surgery and transoral laser microsurgery, have increased the successful identification of the primary tumor site in HPV-induced SCCUP, and this harbors a potential for de-escalation treatment and increased survival. This review provides an overview of HPV-induced SCCUP, diagnostic modalities, and treatment options.
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Impact of Neck Dissection in Head and Neck Squamous Cell Carcinomas of Unknown Primary. Cancers (Basel) 2021; 13:cancers13102416. [PMID: 34067697 PMCID: PMC8156697 DOI: 10.3390/cancers13102416] [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: 04/12/2021] [Accepted: 05/06/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary A retrospective multicentric study of 322 patients with head and neck cancers of unknown primary (HNCUP) was performed testing the impact of neck dissection (ND) extent on nodal relapse, progression-free survival and survival. After 5 years, the incidence of nodal relapse was 13.4%, and progression-free survival (PFS) was 59.1%. In multivariate analysis after adjusting for nodal stage, the risk of nodal relapse or progression was reduced with lymphadenectomy, selective ND or radical/modified ND but survival rates were similar. Patients undergoing lymphadenectomy or ND had significantly better PFS and a lower nodal relapse incidence in the N1 + N2a group, but the improvement was not significant for the N2b or N2 + N3c patients. Severe toxicity rates exceeded 40% with radical ND. In HNCUP, ND improves PFS regardless of nodal stage but fails to improve survival. The magnitude of the benefit of ND did not appear to depend on ND extent and decreased with a more advanced nodal stage. Abstract Purpose: Management of head and neck cancers of unknown primary (HNCUP) combines neck dissection (ND) and radiotherapy, with or without chemotherapy. The prognostic value of ND has hardly been studied in HNCUP. Methods: A retrospective multicentric study assessed the impact of ND extent (adenectomy, selective ND, radical/radical-modified ND) on nodal relapse, progression-free survival (PFS) or survival, taking into account nodal stage. Results: 53 patients (16.5%) had no ND, 33 (10.2%) had lymphadenectomy, 116 (36.0%) underwent selective ND and 120 underwent radical/radical-modified ND (37.3%), 15 of which received radical ND (4.7%). With a 34-month median follow-up, the 3-year incidence of nodal relapse was 12.5% and progression-free survival (PFS) 69.1%. In multivariate analysis after adjusting for nodal stage, the risk of nodal relapse or progression was reduced with lymphadenectomy, selective or radical/modified ND, but survival rates were similar. Patients undergoing lymphadenectomy or ND had a better PFS and lowered nodal relapse incidence in the N1 + N2a group, but the improvement was not significant for the N2b or N2 + N3c patients. Severe toxicity rates exceeded 40% with radical ND. Conclusion: In HNCUP, ND improves PFS, regardless of nodal stage. The magnitude of the benefit of ND does not appear to depend on ND extent and decreases with a more advanced nodal stage.
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Huasong H, Shurui S, Shi G, Bin J. Performance of 18F-FDG-PET/CT as a next step in the search of occult primary tumors for patients with head and neck squamous cell carcinoma of unknown primary: a systematic review and meta-analysis. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00429-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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Chen B, Zhang H, Liu D, Wang X, Ji B, Gao S. Diagnostic performance of 18F-FDG PET/CT for the detection of occult primary tumors in squamous cell carcinoma of unknown primary in the head and neck: a single-center retrospective study. Nucl Med Commun 2021; 42:523-527. [PMID: 33481505 DOI: 10.1097/mnm.0000000000001365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigate the diagnostic performance of 18F-FDG PET/computed tomography (CT) for the detection of occult primary tumors in patients with squamous cell carcinoma of unknown primary (SCCUP) in the head and neck. PATIENTS From March 2016 to January 2020, 37 patients diagnosed as SCCUP before PET/CT were retrospectively reviewed. The diagnosis of SCCUP was made when an overt primary tumor location could not be found for histologically proven squamous cell cervical lymphadenopathy after a complete diagnostic workup which includes full medical history, physical examinations, flexible rhinolaryngoscopy and CT or MRI. The PET/CT images were visually assessed by two nuclear medicine radiologists. Histopathological investigations after the PET scan served as the reference standard. RESULTS The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT for SCCUP were 71.4, 43.8, 62.5, 53.9 and 59.5%, respectively. PET/CT allowed identification of previously undetected lesions in 40.5% of the SCCUP patients. A total of 24 PET/CT scans indicated a positive result. Among them, nine were categorized into false-positive because of negative results from subsequent targeted and random biopsies. There were 13 PET/CT scans with a negative result, six of which, however, were revealed to have a primary site by subsequent random biopsies. CONCLUSION 18F-FDG PET/CT was shown to be useful in detecting a primary tumor for SCCUP, but had limitations in terms of both false-positive cases and false-negative cases. Therefore, histopathological investigations such as targeted and random biopsy should be viewed as necessary practice irrespective of PET/CT results.
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Affiliation(s)
- Bin Chen
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University
- NHC Key Laboratory of Radiobiology, School of Public Health of Jilin University
| | - Haoran Zhang
- Department of Nuclear Medicine, Changchun Center Hospital
| | - Dezhi Liu
- Department of Radiation Oncology, Jilin Cancer Hospital
| | - Xueju Wang
- Department of Pathology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Bin Ji
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University
- NHC Key Laboratory of Radiobiology, School of Public Health of Jilin University
| | - Shi Gao
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University
- NHC Key Laboratory of Radiobiology, School of Public Health of Jilin University
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The Additional Value of Ultrafast DCE-MRI to DWI-MRI and 18F-FDG-PET to Detect Occult Primary Head and Neck Squamous Cell Carcinoma. Cancers (Basel) 2020; 12:cancers12102826. [PMID: 33007978 PMCID: PMC7600235 DOI: 10.3390/cancers12102826] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 12/27/2022] Open
Abstract
Simple Summary Patients with cervical lymph node metastasis from squamous cell carcinoma undergo extensive irradiation or surgery of the head and neck with higher treatment morbidity, recurrence rate and lower overall survival than patients with overt primary tumor. In order to enhance treatment efficiency and morbidity reduction, the primary tumor detection accuracy was evaluated by using Ultrafast-Dynamic Contrast-Enhancement (DCE-)MRI in addition to Diffusion-Weighted (DW-)MRI and 18F-FDG-PET/CT imaging. Ultrafast-DCE, with a temporal resolution of 4 s, enabled capturing lesions with increased neoangiogenesis or perfusion compared to normal tissue. The use of Ultra-fast DCE resulted in higher confidence for suspicious locations and high observer agreement. Ultrafast-DCE showed potential to improve detection of unknown primary tumors in addition to DWI and 18F-FDG-PET/CT in patients with cervical squamous cell carcinoma lymph node metastasis. The combined use of ultrafast-DCE, DWI and 18F-FDG-PET/CT yielded highest sensitivity. Abstract To evaluate diagnostic accuracy of qualitative analysis and interobserver agreement of single ultrafast-DCE, DWI or 18F-FDG-PET and the combination of modalities for the detection of unknown primary tumor (UPT) in patients presenting with cervical lymph node metastasis from squamous cell carcinoma (SCC). Between 2014–2019, patients with histologically proven cervical lymph node metastasis of UPT SCC were prospectively included and underwent DWI, ultrafast-DCE, and 18F-FDG-PET/CT. Qualitative assessment was performed by two observers per modality. Interobserver agreement was calculated using the proportion specific agreement. Diagnostic accuracy of combined use of DWI, ultrafast-DCE and 18F-FDG-PET/CT was assessed. Twenty-nine patients were included (20 males. [68%], median age 60 years). Nine (31%) primary tumors remained occult. Ultrafast-DCE added reader confidence for suspicious locations (one additional true positive (5%), 2 decisive true malignant (10%). The per-location analysis showed highest specific positive agreement for ultrafast-DCE (77.6%). The per-location rating showed highest sensitivity (95%, 95%CI = 75.1–99.9, YI = 0.814) when either one of all modalities was scored positive, and 97.4% (95%CI = 93.5–99.3, YI = 0.774) specificity when co-detected on all. The per-patient analysis showed highest sensitivity (100%) for 18F-FDG-PET/CT (YI = 0.222) and either DWI or PET (YI = 0.111). Despite highest trends, no significant differences were found. The per-patient analysis showed highest specific positive agreement when co-detected on all modalities (55.6%, 95%CI = 21.2–86.3, YI = 0.456). Ultrafast-DCE showed potential to improve detection of unknown primary tumors in addition to DWI and 18F-FDG-PET/CT in patients with cervical squamous cell carcinoma lymph node metastasis. The combined use of ultrafast-DCE, DWI and 18F-FDG-PET/CT yielded highest sensitivity.
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13
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de Almeida JR. Role of Transoral Robotic Surgery in the Work-up of the Unknown Primary. Otolaryngol Clin North Am 2020; 53:965-980. [PMID: 32951898 DOI: 10.1016/j.otc.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Unknown primary squamous cell carcinoma metastatic to cervical lymph nodes is a relatively rare tumor presentation, although the incidence may be increasing along with the rising incidence of human papilloma virus-mediated oropharyngeal cancers. Traditional diagnostic methods with palatine tonsillectomy and panendoscopy may identify the minority of primary tumors. The addition of a transoral lingual tonsillectomy may improve the diagnostic yield of identifying a primary tumor. Incorporation of transoral robotic surgery may be used for diagnostic purposes to identify a primary site and also for therapeutic purposes, whereby a primary tumor may be completely resected and combined with a neck dissection.
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Affiliation(s)
- John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto General Hospital, 200 Elizabeth Street, 8NU-883, Toronto, Ontario, Canada; Department of Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto General Hospital, 200 Elizabeth Street, 8NU-883, Toronto, Ontario, Canada.
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14
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Beier M, Sack I, Beck-Broichsitter B, Hamm B, Marticorena Garcia SR. Tomoelastography for non-invasive detection of ameloblastoma and metastatic neck lymph nodes. BMJ Case Rep 2020; 13:13/9/e235930. [PMID: 32912890 DOI: 10.1136/bcr-2020-235930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Ameloblastoma is a benign epithelial tumour and the most common odontogenic tumour, accounting for about 18% of cases. We present a patient to illustrate the first use of tomoelastography for quantitatively mapping tissue stiffness (shear wave speed) and fluidity (loss angle of the complex shear modulus) in a metastasised ameloblastoma of the left mandible. Tomoelastography maps clearly depicted the extent of the tumour by abnormally high values of stiffness and fluidity (1.73±0.23 m/s, 1.18±0.08 rad) compared with normal values in the contralateral mandible (1.04±0.09 m/s, 0.93±0.12 rad). Abnormal stiffness also revealed metastatic involvement of the neck lymph nodes (1.30±0.03 m/s vs 0.86±0.01 m/s). Taken together, stiffness and fluidity measured by tomoelastography can sensitively detect the presence and extent of bone tumours and metastatic spread to cervical lymph nodes.
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Affiliation(s)
- Marie Beier
- Department of Oral and Maxillofacial Surgery, Charité- - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ingolf Sack
- Department of Radiology, Charité- - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Benedicta Beck-Broichsitter
- Department of Oral and Maxillofacial Surgery, Charité- - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité- - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Stephan Rodrigo Marticorena Garcia
- Department of Radiology, Charité- - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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15
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Yoo SW, Chowdhury MSA, Jeon S, Kang SR, Lee C, Jabin Z, Kim J, Cho SG, Song HC, Bom HS, Min JJ, Kwon SY. Clinical Impact of F-18 FDG PET-CT on Biopsy Site Selection in Patients with Suspected Bone Metastasis of Unknown Primary Site. Nucl Med Mol Imaging 2020; 54:192-198. [PMID: 32831965 DOI: 10.1007/s13139-020-00649-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 06/10/2020] [Accepted: 06/26/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose We investigated the clinical role of F-18 fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) in the identification of the primary site and the selection of the optimal biopsy site in patients with suspected bone metastasis of unknown primary site. Methods The patients with suspected bone metastasis who underwent PET-CT for evaluation of primary site were enrolled in this study. The primary sites were identified by the histopathologic or imaging studies and were classified according to the FDG uptake positivity of the primary site. To evaluate the guiding capability of PET-CT in biopsy site selection, we statistically analyzed whether the biopsy site could be affected according to the presence of extra-skeletal FDG uptake. Results Among 74 enrolled patients, 51 patients had a metastatic bone disease. The primary site was identified in 48 of 51 patients (94.1%). Forty-six patients were eligible to test the association of clinical choice of biopsy site with PET positivity of extra-skeletal lesion. The extra-skeletal biopsies were done in 42 out of 43 patients with positive extra-skeletal uptake lesions. Bone biopsies were inevitably performed in the other three patients without extra-skeletal uptake lesions. The association came out to be significant (Fisher's exact test, P < 0.001). Conclusion F-18 FDG PET-CT significantly contributed not only to identify the primary site but also to suggest optimal biopsy sites in patients with suspected bone metastasis.
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Affiliation(s)
- Su Woong Yoo
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, 58128 Republic of Korea
| | - Md Sunny Anam Chowdhury
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, 58128 Republic of Korea.,Institute of Nuclear Medicine and Allied Sciences, Bangladesh Atomic Energy Commission, Bogra, Bangladesh
| | - Subin Jeon
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, 58128 Republic of Korea
| | - Sae-Ryung Kang
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, 58128 Republic of Korea
| | - Changho Lee
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, 58128 Republic of Korea.,Department of Nuclear Medicine, Chonnam National University Medical School, Jeollanam-do, Republic of Korea
| | - Zeenat Jabin
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, 58128 Republic of Korea.,National Institute of Nuclear Medicine and Allied Sciences, Bangladesh Atomic Energy Commission, Dhaka, Bangladesh
| | - Jahae Kim
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ho-Chun Song
- Department of Nuclear Medicine, Chonnam National University Medical School, Jeollanam-do, Republic of Korea.,Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, 58128 Republic of Korea.,Department of Nuclear Medicine, Chonnam National University Medical School, Jeollanam-do, Republic of Korea
| | - Jung-Joon Min
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, 58128 Republic of Korea.,Department of Nuclear Medicine, Chonnam National University Medical School, Jeollanam-do, Republic of Korea
| | - Seong Young Kwon
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeollanam-do, 58128 Republic of Korea.,Department of Nuclear Medicine, Chonnam National University Medical School, Jeollanam-do, Republic of Korea
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16
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van Weert S, Rijken JA, Plantone F, Bloemena E, Vergeer MR, Lissenberg-Witte BI, Leemans CR. A systematic review on Transoral robotic surgery (TORS) for carcinoma of unknown primary origin: Has tongue base mucosectomy become indispensable? Clin Otolaryngol 2020; 45:732-738. [PMID: 32369264 PMCID: PMC7496155 DOI: 10.1111/coa.13565] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 03/10/2020] [Accepted: 04/26/2020] [Indexed: 12/22/2022]
Abstract
Background Transoral robotic surgery (TORS) is increasingly used in head and neck surgery and in carcinoma of unknown primary (CUP) origin specifically. Due to the rising incidence of human papillomavirus (HPV)‐related oropharyngeal squamous cell carcinoma (OPSCC), there is a rationale for finding ways to de‐escalate treatment strategies. This review aims to test the hypothesis that TORS is a meaningful adjunct in the diagnostic (and therapeutic) pathway in CUP in head and neck. Methods A structured search of the literature was performed with the search terms ‘TORS’ and ‘Carcinoma of Unknown Primary’. Results Two hundred and seventy four cases of CUP in which TORS was used were identified for further analysis. Workup for CUP was comparable in all series with regard to physical examination, fine and/or gross needle examination of cervical nodes, fibre optic endoscopy, imaging and robot assisted mucosectomy of the base of tongue (BOT). Identification rate of the primary tumour was 72% on average (range 17%‐ 90%), and 55%‐ 96% were HPV positive. Clear margins were achieved in 60% (range 0%‐85%) of resected occult tumours. Complication rate of TORS BOT mucosectomy was low with mainly grade I‐III sequelae according to Clavien–Dindo. Conclusions Transoral robotic surgery seems to be a useful and safe adjunct in the diagnostic and therapeutic pathway in case of CUP in an era of increasing incidence of HPV‐positive OPSCC.
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Affiliation(s)
- Stijn van Weert
- Department of Otolaryngology/Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Johannes A Rijken
- Department of Otolaryngology/Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Elisabeth Bloemena
- Department of Pathology and Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marije R Vergeer
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C René Leemans
- Department of Otolaryngology/Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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17
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Giotakis E, Sakagiannis G, Delidis A, Maragkoudakis P, Economopoulou P, Zacharatou A, Kalkanis D, Psyrri A. Multiple synchronous squamous cell carcinomas of the head and neck: A case report. Oral Oncol 2020; 109:104717. [PMID: 32362358 DOI: 10.1016/j.oraloncology.2020.104717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 04/10/2020] [Indexed: 12/30/2022]
Abstract
Head and neck squamous cell carcinoma (HNSCC) of unknown primary represents a diagnostic and therapeutic challenge for treating physicians. Detection of the primary site requires appropriate diagnostic work up. During the past few years more cases of concurrent primaries are described posing significant therapeutic dilemmas. Herein, we describe the first case of a patient with three synchronous HNSCCs.
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18
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Samolyk-Kogaczewska N, Sierko E, Dziemianczyk-Pakiela D, Nowaszewska KB, Lukasik M, Reszec J. Usefulness of Hybrid PET/MRI in Clinical Evaluation of Head and Neck Cancer Patients. Cancers (Basel) 2020; 12:cancers12020511. [PMID: 32098356 PMCID: PMC7072319 DOI: 10.3390/cancers12020511] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/17/2020] [Accepted: 02/17/2020] [Indexed: 12/22/2022] Open
Abstract
(1) Background: The novel hybrid of positron emission tomography/magnetic resonance (PET/MR) examination has been introduced to clinical practice. The aim of our study was to evaluate PET/MR usefulness in preoperative staging of head and neck cancer (HNC) patients (pts); (2) Methods: Thirty eight pts underwent both computed tomography (CT) and PET/MR examination, of whom 21 pts underwent surgical treatment as first-line therapy and were further included in the present study. Postsurgical tissue material was subjected to routine histopathological (HP) examination with additional evaluation of p16, human papillomavirus (HPV), Epstein-Barr virus (EBV) and Ki67 status. Agreement of clinical and pathological T staging, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of CT and PET/MR in metastatic lymph nodes detection were defined. The verification of dependences between standardized uptake value (SUV value), tumor geometrical parameters, number of metastatic lymph nodes in PET/MR and CT, biochemical parameters, Ki67 index, p16, HPV and EBV status was made with statistical analysis of obtained results; (3) Results: PET/MR is characterized by better agreement in T staging, higher specificity, sensitivity, PPV and NPV of lymph nodes evaluation than CT imaging. Significant correlations were observed between SUVmax and maximal tumor diameter from PET/MR, between SUVmean and CT tumor volume, PET/MR tumor volume, maximal tumor diameter assessed in PET/MR. Other correlations were weak and insignificant; (4) Conclusions: Hybrid PET/MR imaging is useful in preoperative staging of HNC. Further studies are needed.
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Affiliation(s)
| | - Ewa Sierko
- Department of Radiotherapy, Comprehensive Cancer Center, 15-027 Bialystok, Poland;
- Department of Oncology, Medical University of Bialystok, 15-027 Bialystok, Poland
- Correspondence: ; Tel.: +48-85-6646827
| | - Dorota Dziemianczyk-Pakiela
- Department of Otolaryngology and Maxillofacial Surgery, Jedrzej Sniadecki Memorial Regional Hospital, 15-950 Bialystok, Poland;
| | - Klaudia Beata Nowaszewska
- Department of Maxillofacial and Plastic Surgery, Medical University of Bialystok, 15-276 Bialystok, Poland;
| | - Malgorzata Lukasik
- Department of Medical Pathology, Medical University of Bialystok, 15-089 Bialystok, Poland; (M.L.); (J.R.)
| | - Joanna Reszec
- Department of Medical Pathology, Medical University of Bialystok, 15-089 Bialystok, Poland; (M.L.); (J.R.)
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19
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Dulguerov P, Broglie MA, Henke G, Siano M, Putora PM, Simon C, Zwahlen D, Huber GF, Ballerini G, Beffa L, Giger R, Rothschild S, Negri SV, Elicin O. A Review of Controversial Issues in the Management of Head and Neck Cancer: A Swiss Multidisciplinary and Multi-Institutional Patterns of Care Study-Part 1 (Head and Neck Surgery). Front Oncol 2019; 9:1125. [PMID: 31709185 PMCID: PMC6822016 DOI: 10.3389/fonc.2019.01125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/09/2019] [Indexed: 11/23/2022] Open
Abstract
Background: The Head and Neck Cancer Working Group of Swiss Group for Clinical Cancer Research (SAKK) has investigated the level of consensus (LOC) and discrepancy in everyday practice of diagnosis and treatment in head and neck cancer. Materials and Methods: An online survey was iteratively generated with 10 Swiss university and teaching hospitals. LOC below 50% was defined as no agreement, while higher LOC were arbitrarily categorized as low (51-74%), moderate (75-84%), and high (≥85%). Results: Any LOC was achieved in 62% of topics (n = 60). High, moderate and low LOC were found in 18, 20, and 23%, respectively. Regarding Head and Neck Surgery, Radiation Oncology, Medical Oncology, and biomarkers, LOC was achieved in 50, 57, 83, and 43%, respectively. Conclusions: Consensus on clinical topics is rather low for surgeons and radiation oncologists. The questions discussed might highlight discrepancies, stimulate standardization of practice, and prioritize topics for future clinical research.
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Affiliation(s)
- Pavel Dulguerov
- Department of Otorhinolaryngology, Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Martina A. Broglie
- Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Guido Henke
- Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Marco Siano
- Department of Medical Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Medical Oncology, Hôpital Riviera-Chablais, Vevey, Switzerland
| | - Paul Martin Putora
- Department of Radiation Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Simon
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Daniel Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Graubünden, Chur, Switzerland
- Department of Radiation Oncology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Gerhard F. Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Giorgio Ballerini
- Department of Radiation Oncology, Clinica Luganese SA, Lugano, Switzerland
| | - Lorenza Beffa
- Department of Radiation Oncology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Sacha Rothschild
- Department of Medical Oncology, University Hospital of Basel, Basel, Switzerland
| | - Sandro V. Negri
- Department of Otorhinolaryngology, Lindenhofspital, Bern, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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20
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Albertson M, Chandra S, Sayed Z, Johnson C. PET/CT Evaluation of Head and Neck Cancer of Unknown Primary. Semin Ultrasound CT MR 2019; 40:414-423. [PMID: 31635768 DOI: 10.1053/j.sult.2019.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The diagnosis of carcinoma of unknown primary in the head and neck is made when there is a metastasis but no primary lesion is identified after physical exam and diagnostic CT or MR imaging. PET/CT is the first step in searching for a primary lesion, followed by more invasive techniques such as endoscopy and surgery. Knowledge of the different tumor histologic types, preferential locations of nodal spread, imaging pitfalls, and other special considerations such as cystic metastases can be helpful in the ultimate identification of primary tumors, which leads to improved overall patient survival.
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Affiliation(s)
- Megan Albertson
- Department of Radiology, University of Nebraska Medical Center, Omaha, NE.
| | - Srinivasa Chandra
- Division of Oral & Maxillofacial Surgery, Department of Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Zafar Sayed
- Department of Otolaryngology - Head and Neck Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Craig Johnson
- Department of Radiology, University of Nebraska Medical Center, Omaha, NE
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21
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Liu Y. FDG PET/CT for metastatic squamous cell carcinoma of unknown primary of the head and neck. Oral Oncol 2019; 92:46-51. [PMID: 31010622 DOI: 10.1016/j.oraloncology.2019.03.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/22/2019] [Accepted: 03/17/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The role of FDG PET/CT is uncertain in squamous cell carcinoma of unknown primary (SCCUP). Published data are limited by heterogeneity of pathology, varied diagnostic criteria, and small sample size. MATERIALS/METHODS This retrospective study was conducted in 40 patients who had FDG PET/CT for SCCUP. Prior to PET/CT, patients had underwent standard clinical evaluations including flexible rhinolaryngoscopy. The majority of the patients had anatomic imaging. All subjects had histopathological investigations, and follow-up data after PET/CT. RESULTS FDG PET/CT detected the primary in 16 of 40 patients (40%), and the most common locations of the primary were in the base of the tongue, palatine tonsil, and hypopharynx. There were 10 false positive and 6 false negative PET/CT scans. There was no difference in the mean SUVs of the suspected primary lesions between true and false positive groups. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy of FDG PET/CT for SCCUP in this patient cohort were 72.7% (16/22), 44.4% (8/18), 61.5% (16/26), 57.1% (8/14), and 60% (24/40), respectively. The tonsil was the site with the most false positive and false negative findings. CONCLUSIONS FDG PET/CT might be an effective single shot of whole-body imaging for detection of the primary in SCCUP. Low specificity remained the most notable weakness of FDG-PET in work-up for SCCUP. In addition to varied physiologic uptake or inflammatory related uptake in the common locations of the primary, the image indication bias might be another significant contributor of high false positive rate.
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Affiliation(s)
- Yiyan Liu
- Nuclear Medicine Service, Department of Radiology, New Jersey Medical School, Rutgers University, Newark, NJ, USA.
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