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Chan TG, Wicks J, Sethi I, Becker J, Brandon D, Schmitt NC, Kaka A, Boyce B, Baddour HM, El-Deiry MW, Patel MR, Gross JH. Radiologic findings of occult nodal metastasis during clinically-N0 salvage total laryngectomy. Head Neck 2024. [PMID: 39092682 DOI: 10.1002/hed.27889] [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: 02/18/2024] [Revised: 07/01/2024] [Accepted: 07/12/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Occult nodal disease (OND) during clinically-N0 salvage total laryngectomy (TL) can be detected with the Neck-Imaging-Reporting-and-Data-Systems (NI-RADS). However, some patients will still have OND revealed on final pathology. METHODS A retrospective study on all patients who had OND during salvage TL with elective neck dissection (END) between 2009 and 2021 was performed. Repeat CT and PET scan interpretation was performed to evaluate their preoperative imaging for suspicious features. RESULTS Among 81 salvage TL patients undergoing END, 12 (16%) had OND and a total of 26 occult nodes were identified. On pathology, the average node length [SD] was 0.6 cm [0.3]. On CT, 31% (8 of 26) had rounded morphology. On PET, most had SUVmax below blood pool. One patient scored NI-RADS 2; the rest scored 1. CONCLUSIONS On re-review of preoperative imaging, occult nodes were subtle and challenging to identify. Despite no clear impact on survival, performing an END may provide prognostic information.
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Affiliation(s)
- Tyler G Chan
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jaime Wicks
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Ila Sethi
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Jennifer Becker
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - David Brandon
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia, USA
| | - Nicole C Schmitt
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Azeem Kaka
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Brian Boyce
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Harry Michael Baddour
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Mark W El-Deiry
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Mihir R Patel
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Jennifer H Gross
- Department of Otolaryngology - Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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Ling X, Alexander GS, Molitoris J, Choi J, Schumaker L, Tran P, Mehra R, Gaykalova D, Ren L. Radiomic biomarkers of locoregional recurrence: prognostic insights from oral cavity squamous cell carcinoma preoperative CT scans. Front Oncol 2024; 14:1380599. [PMID: 38715772 PMCID: PMC11074368 DOI: 10.3389/fonc.2024.1380599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/04/2024] [Indexed: 05/15/2024] Open
Abstract
Introduction This study aimed to identify CT-based imaging biomarkers for locoregional recurrence (LR) in Oral Cavity Squamous Cell Carcinoma (OSCC) patients. Methods Computed tomography scans were collected from 78 patients with OSCC who underwent surgical treatment at a single medical center. We extracted 1,092 radiomic features from gross tumor volume in each patient's pre-treatment CT. Clinical characteristics were also obtained, including race, sex, age, tobacco and alcohol use, tumor staging, and treatment modality. A feature selection algorithm was used to eliminate the most redundant features, followed by a selection of the best subset of the Logistic regression model (LRM). The best LRM model was determined based on the best prediction accuracy in terms of the area under Receiver operating characteristic curve. Finally, significant radiomic features in the final LRM model were identified as imaging biomarkers. Results and discussion Two radiomics biomarkers, Large Dependence Emphasis (LDE) of the Gray Level Dependence Matrix (GLDM) and Long Run Emphasis (LRE) of the Gray Level Run Length Matrix (GLRLM) of the 3D Laplacian of Gaussian (LoG σ=3), have demonstrated the capability to preoperatively distinguish patients with and without LR, exhibiting exceptional testing specificity (1.00) and sensitivity (0.82). The group with LRE > 2.99 showed a 3-year recurrence-free survival rate of 0.81, in contrast to 0.49 for the group with LRE ≤ 2.99. Similarly, the group with LDE > 120 showed a rate of 0.82, compared to 0.49 for the group with LDE ≤ 120. These biomarkers broaden our understanding of using radiomics to predict OSCC progression, enabling personalized treatment plans to enhance patient survival.
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Affiliation(s)
- Xiao Ling
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Gregory S. Alexander
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jason Molitoris
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jinhyuk Choi
- Department of Breast Surgery, Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Lisa Schumaker
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Phuoc Tran
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Ranee Mehra
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Daria Gaykalova
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Otorhinolaryngology-Head and Neck Surgery, Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland Medical Center, Baltimore, MD, United States
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, United States
| | - Lei Ren
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, United States
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Hiyama T, Miyasaka Y, Kuno H, Sekiya K, Sakashita S, Shinozaki T, Kobayashi T. Posttreatment Head and Neck Cancer Imaging: Anatomic Considerations Based on Cancer Subsites. Radiographics 2024; 44:e230099. [PMID: 38386602 DOI: 10.1148/rg.230099] [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: 02/24/2024]
Abstract
Posttreatment imaging surveillance of head and neck cancer is challenging owing to complex anatomic subsites and diverse treatment modalities. Early detection of residual disease or recurrence through surveillance imaging is crucial for devising optimal treatment strategies. Posttreatment imaging surveillance is performed using CT, fluorine 18-fluorodeoxyglucose PET/CT, and MRI. Radiologists should be familiar with postoperative imaging findings that can vary depending on surgical procedures and reconstruction methods that are used, which is dictated by the primary subsite and extent of the tumor. Morphologic changes in normal structures or denervation of muscles within the musculocutaneous flap may mimic recurrent tumors. Recurrence is more likely to occur at the resection margin, margin of the reconstructed flap, and deep sites that are difficult to access surgically. Radiation therapy also has a varying dose distribution depending on the primary site, resulting in various posttreatment changes. Normal tissues are affected by radiation, with edema and inflammation occurring in the early stages and fibrosis in the late stages. Distinguishing scar tissue from residual tumor becomes necessary, as radiation therapy may leave behind residual scar tissue. Local recurrence should be carefully evaluated within areas where these postradiation changes occur. Head and Neck Imaging Reporting and Data System (NI-RADS) is a standardized reporting and risk classification system with guidance for subsequent management. Familiarity with NI-RADS has implications for establishing surveillance protocols, interpreting posttreatment images, and management decisions. Knowledge of posttreatment imaging characteristics of each subsite of head and neck cancers and the areas prone to recurrence empowers radiologists to detect recurrences at early stages. ©RSNA, 2024 Test Your Knowledge questions in the supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.
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Affiliation(s)
- Takashi Hiyama
- From the Departments of Diagnostic Radiology (T.H., Y.M., H.K., K.S., T.K.), Pathology and Clinical Laboratories (S.S.), and Head and Neck Surgery (T.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Yusuke Miyasaka
- From the Departments of Diagnostic Radiology (T.H., Y.M., H.K., K.S., T.K.), Pathology and Clinical Laboratories (S.S.), and Head and Neck Surgery (T.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Hirofumi Kuno
- From the Departments of Diagnostic Radiology (T.H., Y.M., H.K., K.S., T.K.), Pathology and Clinical Laboratories (S.S.), and Head and Neck Surgery (T.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Kotaro Sekiya
- From the Departments of Diagnostic Radiology (T.H., Y.M., H.K., K.S., T.K.), Pathology and Clinical Laboratories (S.S.), and Head and Neck Surgery (T.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Shingo Sakashita
- From the Departments of Diagnostic Radiology (T.H., Y.M., H.K., K.S., T.K.), Pathology and Clinical Laboratories (S.S.), and Head and Neck Surgery (T.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Takeshi Shinozaki
- From the Departments of Diagnostic Radiology (T.H., Y.M., H.K., K.S., T.K.), Pathology and Clinical Laboratories (S.S.), and Head and Neck Surgery (T.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
| | - Tatsushi Kobayashi
- From the Departments of Diagnostic Radiology (T.H., Y.M., H.K., K.S., T.K.), Pathology and Clinical Laboratories (S.S.), and Head and Neck Surgery (T.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
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Fujimoto K, Shiinoki T, Kawazoe Y, Yuasa Y, Mukaidani W, Manabe Y, Kajima M, Tanaka H. Biomechanical imaging biomarker during chemoradiotherapy predicts treatment response in head and neck squamous cell carcinoma. Phys Med Biol 2024; 69:055033. [PMID: 38359451 DOI: 10.1088/1361-6560/ad29b9] [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: 06/23/2023] [Accepted: 02/15/2024] [Indexed: 02/17/2024]
Abstract
Objective. For response-adapted adaptive radiotherapy (R-ART), promising biomarkers are needed to predict post-radiotherapy (post-RT) responses using routine clinical information obtained during RT. In this study, a patient-specific biomechanical model (BM) of the head and neck squamous cell carcinoma (HNSCC) was proposed using the pre-RT maximum standardized uptake value (SUVmax) of18F-fluorodeoxyglucose (FDG) and tumor structural changes during RT as evaluated using computed tomography (CT). In addition, we evaluated the predictive performance of BM-driven imaging biomarkers for the treatment response of patients with HNSCC who underwent concurrent chemoradiotherapy (CCRT).Approach. Patients with histologically confirmed HNSCC treated with definitive CCRT were enrolled in this study. All patients underwent CT two times as follows: before the start of RT (pre-RT) and 3 weeks after the start of RT (mid-RT). Among these patients, 67 patients who underwent positron emission tomography/CT during the pre-RT period were included in the final analysis. The locoregional control (LC), progression-free survival (PFS), and overall survival (OS) prediction performances of whole tumor stress change (TS) between pre- and mid-RT computed using BM were assessed using univariate, multivariate, and Kaplan-Meier survival curve analyses, respectively. Furthermore, performance was compared with the pre and post-RT SUVmax, tumor volume reduction rate (TVRR) during RT, and other clinical prognostic factors.Main results. For both univariate, multivariate, and survival curve analyses, the significant prognostic factors were as follows (p< 0.05): TS and TVRR for LC; TS and pre-RT FDG-SUVmaxfor PFS; and TS only for OS. In addition, for 2 year LC, PFS, and OS prediction, TS showed a comparable predictive performance to post-RT FDG-SUVmax.Significance. BM-driven TS is an effective prognostic factor for tumor treatment response after CCRT. The proposed method can be a feasible functional imaging biomarker that can be acquired during RT using only routine clinical data and may provide useful information for decision-making during R-ART.
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Affiliation(s)
- Koya Fujimoto
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Takehiro Shiinoki
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Yusuke Kawazoe
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
- Department of Radiological Technology, Yamaguchi University Hospital, Ube, Japan
| | - Yuki Yuasa
- Department of Radiological Technology, Yamaguchi University Hospital, Ube, Japan
| | - Wataru Mukaidani
- Department of Radiological Technology, Yamaguchi University Hospital, Ube, Japan
| | - Yuki Manabe
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Miki Kajima
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Hidekazu Tanaka
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
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Van Hoe S, Hermans R. Post-treatment surveillance imaging in head and neck cancer: a systematic review. Insights Imaging 2024; 15:32. [PMID: 38315325 PMCID: PMC10844183 DOI: 10.1186/s13244-023-01578-4] [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: 09/13/2023] [Accepted: 11/29/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND In patients treated for head and neck cancer, imaging studies are usually obtained within 3-6 months after treatment for assessment of treatment response. After 6 months, most guidelines advocate clinical follow-up, with imaging reserved for patients with clinically suspect or equivocal findings. However, some guidelines do recommend systematic imaging surveillance, and many clinicians tend to include some type of imaging in their follow-up schemes. OBJECTIVES This systematic review focuses on the usefulness of routine (systematic) post-treatment imaging surveillance of head and neck cancer beyond the first 3-6-month baseline imaging study. METHODS A systematic literature search was conducted using PubMed and Google Scholar. Additional studies were identified by reviewing reference lists. Only original studies and review papers were considered. Results obtained with systematic post-treatment surveillance imaging were compared to symptom-directed imaging and/or clinical finding-directed imaging. RESULTS Five hundred twenty-one records were identified through the database search, and 44 additional records were identified through other sources. Forty-eight articles were selected for the final review. Analysis of these records showed that almost half of cases of locoregional recurrences and/or metastases were only detected by imaging (40.9%), and the mean time of detection of recurrent or metastatic disease (11.5 months) was well beyond the period of the first post-treatment scan. Most authors reported superior results with PET-CT when compared to other imaging techniques. CONCLUSION Strong arguments were found in favor of systematic imaging surveillance in locoregional advanced head and neck cancer during at least one and preferably 2 years after treatment. CRITICAL RELEVANCE STATEMENT Analysis of the selected records showed that almost half of cases of locoregional recurrences and/or metastases were only detected by imaging. This systematic review suggests that imaging may currently be underused in the post-treatment surveillance of patients with head and neck cancer. KEY POINTS • This systematic review focuses on the usefulness of long-term systematic imaging surveillance in patients treated for head and neck cancer. • Analysis of 521 articles revealed that systematic imaging allowed the initial detection of locoregional recurrences and/or metastases in more than 40% of patients. • Imaging may currently be underused in the post-treatment surveillance of patients with advanced head and neck cancer.
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Affiliation(s)
| | - Robert Hermans
- Department of Radiology, University Hospitals Leuven, Herestraat 49, Leuven, 3000, Belgium.
- Department of Imaging and Pathology, KU Leuven-University of Leuven, Leuven, Belgium.
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Parillo M, Mallio CA, Van der Molen AJ, Rovira À, Dekkers IA, Karst U, Stroomberg G, Clement O, Gianolio E, Nederveen AJ, Radbruch A, Quattrocchi CC. The role of gadolinium-based contrast agents in magnetic resonance imaging structured reporting and data systems (RADS). MAGMA (NEW YORK, N.Y.) 2024; 37:15-25. [PMID: 37702845 PMCID: PMC10876744 DOI: 10.1007/s10334-023-01113-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/22/2023] [Accepted: 07/13/2023] [Indexed: 09/14/2023]
Abstract
Among the 28 reporting and data systems (RADS) available in the literature, we identified 15 RADS that can be used in Magnetic Resonance Imaging (MRI). Performing examinations without using gadolinium-based contrast agents (GBCA) has benefits, but GBCA administration is often required to achieve an early and accurate diagnosis. The aim of the present review is to summarize the current role of GBCA in MRI RADS. This overview suggests that GBCA are today required in most of the current RADS and are expected to be used in most MRIs performed in patients with cancer. Dynamic contrast enhancement is required for correct scores calculation in PI-RADS and VI-RADS, although scientific evidence may lead in the future to avoid the GBCA administration in these two RADS. In Bone-RADS, contrast enhancement can be required to classify an aggressive lesion. In RADS scoring on whole body-MRI datasets (MET-RADS-P, MY-RADS and ONCO-RADS), in NS-RADS and in Node-RADS, GBCA administration is optional thanks to the intrinsic high contrast resolution of MRI. Future studies are needed to evaluate the impact of the high T1 relaxivity GBCA on the assignment of RADS scores.
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Affiliation(s)
- Marco Parillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Carlo Augusto Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Aart J Van der Molen
- Department of Radiology, C-2S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ilona A Dekkers
- Department of Radiology, C-2S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Uwe Karst
- Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstr. 48, 48149, Münster, Germany
| | - Gerard Stroomberg
- RIWA-Rijn-Association of River Water Works, Groenendael 6, 3439 LV, Nieuwegein, The Netherlands
| | - Olivier Clement
- Service de Radiologie, Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, DMU Imagina, 20 Rue LeBlanc, 75015, Paris, France
| | - Eliana Gianolio
- Department of Molecular Biotechnologies and Health Science, University of Turin, Via Nizza 52, 10125, Turin, Italy
| | - Aart J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127, Bonn, Germany
| | - Carlo Cosimo Quattrocchi
- Centre for Medical Sciences-CISMed, University of Trento, Via S. Maria Maddalena 1, 38122, Trento, Italy.
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Ren L, Ling X, Alexander G, Molitoris J, Choi J, Schumaker L, Mehra R, Gaykalova D. Radiomic Biomarkers of Locoregional Recurrence: Prognostic Insights from Oral Cavity Squamous Cell Carcinoma preoperative CT scans. RESEARCH SQUARE 2024:rs.3.rs-3857391. [PMID: 38343846 PMCID: PMC10854303 DOI: 10.21203/rs.3.rs-3857391/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
This study aimed to identify CT-based imaging biomarkers for locoregional recurrence (LR) in Oral Cavity Squamous Cell Carcinoma (OSCC) patients. Our study involved a retrospective review of 78 patients with OSCC who underwent surgical treatment at a single medical center. An approach involving feature selection and statistical model diagnostics was utilized to identify biomarkers. Two radiomics biomarkers, Large Dependence Emphasis (LDE) of the Gray Level Dependence Matrix (GLDM) and Long Run Emphasis (LRE) of the Gray Level Run Length Matrix (GLRLM) of the 3D Laplacian of Gaussian (LoG σ = 3), have demonstrated the capability to preoperatively distinguish patients with and without LR, exhibiting exceptional testing specificity (1.00) and sensitivity (0.82). The group with LRE > 2.99 showed a 3-year recurrence-free survival rate of 0.81, in contrast to 0.49 for the group with LRE ≤ 2.99. Similarly, the group with LDE > 120 showed a rate of 0.82, compared to 0.49 for the group with LDE ≤ 120. These biomarkers broaden our understanding of using radiomics to predict OSCC progression, enabling personalized treatment plans to enhance patient survival.
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Affiliation(s)
- Lei Ren
- University of Maryland School of Medicine
| | - Xiao Ling
- University of Maryland School of Medicine
| | | | | | | | | | | | - Daria Gaykalova
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University; Marlene & Stewart Greenebaum Comprehensive Cancer Center, University of Maryland Medical Center; Institute for Genome Sciences, U
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Vaish R, Mahajan A, Ghosh Laskar S, Prabhash K, Noronha V, D’Cruz AK. Editorial: Site specific imaging guidelines in head & neck, and skull base cancers. Front Oncol 2024; 14:1357215. [PMID: 38304872 PMCID: PMC10830622 DOI: 10.3389/fonc.2024.1357215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/04/2024] [Indexed: 02/03/2024] Open
Affiliation(s)
- Richa Vaish
- Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Abhishek Mahajan
- Radiology, The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Kumar Prabhash
- Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vanita Noronha
- Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Anil K. D’Cruz
- Oncology-Apollo Group of Hospitals, Department of Oncology, Apollo Hospital, Navi Mumbai, India
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Varoquaux A, Fakhry N, Baujat B, Verillaud B, Jegoux F, Barry B, Chabrillac E, Vergez S, Terroir-Cassou-Mounat M. Diagnostic imaging of salivary gland cancers: REFCOR recommendations by the formal consensus method. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:27-31. [PMID: 38036312 DOI: 10.1016/j.anorl.2023.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To define the indications for each imaging modality in the screening, characterization, extension and follow-up of salivary gland tumors. MATERIAL AND METHODS The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group who drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group, according to the formal consensus method. RESULTS If a swelling of a salivary gland is palpable for 3 weeks, an ultrasound scan is recommended to confirm a tumoral lesion and rule out differential diagnoses. For a salivary gland tumor, MRI is recommended with diffusion-weighted and dynamic contrast-enhanced techniques. In the case of histologically proven malignancy or a highly suspicious lesion, a CT scan of the neck and chest is recommended to assess the tumor, lymph nodes and metastases. FDG-PET is not currently recommended in routine clinical practice for initial diagnosis, assessment of extension, evaluation of response to treatment, staging of recurrence, or follow-up of salivary gland tumors. CONCLUSION Assessing salivary tumors is based on MRI. Extension assessment is based on neck and chest CT.
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Affiliation(s)
- A Varoquaux
- Département d'Imagerie Médicale, Hôpital La Conception, AP-HM, Aix-Marseille Univ, Marseille, France
| | - N Fakhry
- Département d'ORL et Chirurgie Cervico-Faciale, Hôpital La Conception, AP-HM, Aix-Marseille Univ, Marseille, France.
| | - B Baujat
- Département d'ORL et Chirurgie Cervico-Faciale, Hôpital Tenon, AP-HP, Sorbonne Université, Paris, France
| | - B Verillaud
- Département d'ORL et de Chirurgie Cervico-Faciale, Hôpital Lariboisière, AP-HP, Inserm U1141, Université Paris Cité, Paris, France
| | - F Jegoux
- Département d'ORL et Chirurgie Cervico-Faciale, CHU de Rennes, Rennes, France
| | - B Barry
- Département d'ORL et Chirurgie Cervico-Faciale, Hôpital Bichat, AP-HP, Paris, France
| | - E Chabrillac
- Département de Chirurgie, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
| | - S Vergez
- Département de Chirurgie, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France; Département de Chirurgie ORL et Cervico-Faciale, CHU de Toulouse-Larrey, Université Toulouse III Paul Sabatier, Toulouse, France
| | - M Terroir-Cassou-Mounat
- Département de Médecine Nucléaire, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
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Li W, Sun Y, Shang W, Xu H, Zhang H, Lu F. Diagnostic accuracy of NI-RADS for prediction of head and neck squamous cell carcinoma: a systematic review and meta-analysis. LA RADIOLOGIA MEDICA 2024; 129:70-79. [PMID: 37904037 DOI: 10.1007/s11547-023-01742-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/05/2023] [Indexed: 11/01/2023]
Abstract
OBJECTIVES This study aimed to assess the diagnostic performance of NI-RADS for the prediction of recurrence in patients treated for Head and Neck Squamous Cell Carcinoma (HNSCC). METHODS A literature search was conducted using various databases to identify relevant articles published from June 2016 onwards. We included studies reporting the diagnostic accuracy of NI-RADS in distinguishing recurrence in patients undergoing imaging surveillance, with pathologic results and/or follow-up as the reference standard. Summary estimates of diagnostic accuracy in terms of sensitivity, specificity, positive likelihood ratio (LR +), negative likelihood ratio (LR -), and diagnostic odds ratio (DOR) were calculated with the hierarchical summary receiver operating characteristic (HSROC) model. Meta-regression and subgroup analyses were conducted to investigate different clinical settings. Study quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. RESULTS A total of 12 studies were included in the current meta-analysis. The pooled sensitivity and specificity were 0.69 (95% CI 0.59-0.79) and 0.94 (95% CI 0.89-0.97), respectively. For the primary site, the pooled summary estimates were 0.67 (95% CI 0.53-0.78) and 0.95 (95% CI 0.90-0.97), for the nodal sites were 0.64 (95% CI 0.44-0.80) and 0.99 (95% CI 0.98-0.99), respectively. The recurrence rate for NI-RADS categories 1-3 was 0.03 (95% CI 0.02-0.05), 0.13 (95% CI 0.10-0.15), and 0.77 (95% CI 0.73-0.81). Meta-regression revealed that the type of analysis (per person vs. per site) and number of sites (≤ 200 vs. > 200) were significant factors associated with heterogeneity. CONCLUSIONS NI-RADS demonstrated high specificity but moderate sensitivity in patients after treatment for HNSCC. Summary estimates showed a significantly higher malignancy rate for NI-RADS category 3 compared to category 2.
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Affiliation(s)
- Wei Li
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
| | - Yuan Sun
- Department of Burn and Plastic Surgery, Affiliate Huaihai Hospital of Xuzhou Medical University, Xuzhou, China
| | - Wenwen Shang
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
| | - Haibing Xu
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China
| | - Hui Zhang
- Department of Medical Imaging, Jiangsu Vocational College of Medicine, Yancheng, China.
| | - Feng Lu
- Department of Radiology, Wuxi No. 2 People's Hospital, Wuxi, China.
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Chabrillac E, Vergez S, Barry B, Jegoux F, Verillaud B, Pham Dang N, Baujat B, Fakhry N. Post-treatment monitoring of salivary gland cancer: REFCOR recommendations by the formal consensus method. Eur Ann Otorhinolaryngol Head Neck Dis 2023:S1879-7296(23)00155-2. [PMID: 38030444 DOI: 10.1016/j.anorl.2023.11.003] [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] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To determine the frequency and modality of post-treatment monitoring of primary salivary gland cancer. MATERIAL AND METHODS The French Network of Rare Head and Neck Tumors (REFCOR) formed a steering group who drafted a narrative review of the literature published on Medline and proposed recommendations. The level of adherence to the recommendations was then assessed by a rating group, according to the formal consensus method. RESULTS Clinical monitoring should be adapted to the risk of recurrence: initially every 3 months and progressively spaced out, becoming annual after 5 years. Post-treatment head and neck and chest imaging is recommended at 3 months. Local and regional monitoring can then be carried out yearly or twice yearly with contrast-enhanced head and neck imaging. An annual chest CT scan is recommended for high-grade tumors. For lesions at high risk of late recurrence, very prolonged annual surveillance (up to 15 years) is recommended, including screening for pulmonary metastases. CONCLUSION Given the wide range of malignant salivary gland tumors, the modalities and frequency of post-treatment monitoring must be adapted to the expected course of the disease.
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Affiliation(s)
- E Chabrillac
- Département de chirurgie, institut universitaire du cancer Toulouse - Oncopole, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France.
| | - S Vergez
- Département de chirurgie, institut universitaire du cancer Toulouse - Oncopole, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France; Département de chirurgie ORL et cervico-faciale, CHU de Toulouse-Larrey, université Toulouse III Paul-Sabatier, Toulouse, France
| | - B Barry
- Département d'ORL et chirurgie cervico-faciale, hôpital Bichat, AP-HP, Paris, France
| | - F Jegoux
- Département d'ORL et chirurgie cervico-faciale, CHU de Rennes, Rennes, France
| | - B Verillaud
- Département d'ORL et de chirurgie cervico-faciale, hôpital Lariboisière, AP-HP, Inserm U1141, université Paris Cité, Paris, France
| | - N Pham Dang
- Service de chirurgie maxillo-faciale, université Clermont-Auvergne, CHU de Clermont-Ferrand, Inserm, Neuro-Dol, 63000 Clermont-Ferrand, France
| | - B Baujat
- Département d'ORL et chirurgie cervico-faciale, Sorbonne université, hôpital Tenon, AP-HP, Paris, France
| | - N Fakhry
- Département d'ORL et chirurgie cervico-faciale, hôpital La Conception, AP-HM, Marseille, France
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12
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Baba A, Kurokawa R, Kurokawa M, Yanagisawa T, Srinivasan A. Performance of Neck Imaging Reporting and Data System (NI-RADS) for Diagnosis of Recurrence of Head and Neck Squamous Cell Carcinoma: A Systematic Review and Meta-analysis. AJNR Am J Neuroradiol 2023; 44:1184-1190. [PMID: 37709352 PMCID: PMC10549942 DOI: 10.3174/ajnr.a7992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/12/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The Neck Imaging Reporting and Data System (NI-RADS) is a reporting template used in head and neck cancer posttreatment follow-up imaging. PURPOSE Our aim was to evaluate the pooled detection rates of the recurrence of head and neck squamous cell carcinoma based on each NI-RADS category and to compare the diagnostic accuracy between NI-RADS 2 and 3 cutoffs. DATA SOURCES The MEDLINE, Scopus, and EMBASE databases were searched. STUDY SELECTION This systematic review identified 7 studies with a total of 694 patients (1233 lesions) that were eligible for the meta-analysis. DATA ANALYSIS The meta-analysis of pooled recurrence detection rate estimates for each NI-RADS category and the diagnostic accuracy of recurrence with NI-RADS 3 or 2 as the cutoff was performed. DATA SYNTHESIS The estimated recurrence rates in each category for primary lesions were 74.4% for NI-RADS 3, 29.0% for NI-RADS 2, and 4.2% for NI-RADS 1. The estimated recurrence rates in each category for cervical lymph nodes were 73.3% for NI-RADS 3, 14.3% for NI-RADS 2, and 3.5% for NI-RADS 1. The area under the curve of the summary receiver operating characteristic for recurrence detection with NI-RADS 3 as the cutoff was 0.887 and 0.983, respectively, higher than 0.869 and 0.919 for the primary sites and cervical lymph nodes, respectively, with NI-RADS 2 as the cutoff. LIMITATIONS Given the heterogeneity of the data of the studies, the conclusions should be interpreted with caution. CONCLUSIONS This meta-analysis revealed estimated recurrence rates for each NI-RADS category for primary lesions and cervical lymph nodes and showed that NI-RADS 3 has a high diagnostic performance for detecting recurrence.
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Affiliation(s)
- Akira Baba
- From the Division of Neuroradiology (A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
- Department of Radiology (A.B.), The Jikei University School of Medicine, Tokyo, Japan
| | - Ryo Kurokawa
- From the Division of Neuroradiology (A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
- Department of Radiology (R.K., M.K.), The University of Tokyo, Tokyo, Japan
| | - Mariko Kurokawa
- From the Division of Neuroradiology (A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
- Department of Radiology (R.K., M.K.), The University of Tokyo, Tokyo, Japan
| | - Takafumi Yanagisawa
- Department of Urology (T.Y.), The Jikei University School of Medicine, Tokyo, Japan
| | - Ashok Srinivasan
- From the Division of Neuroradiology (A.B., R.K., M.K., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
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13
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Gupta M, Jajodia A, Ahlawat P, Gairola M, Agarwal M, Goyal S, Mehta P, Choudhury PS. Effectiveness of Head-and-Neck Molecular Imaging Reporting and Data System Criterion in Head-and-Neck Squamous Cell Carcinoma PostConcurrent Chemoradiotherapy. Indian J Nucl Med 2023; 38:334-339. [PMID: 38390552 PMCID: PMC10880860 DOI: 10.4103/ijnm.ijnm_23_23] [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: 03/01/2023] [Revised: 06/02/2023] [Accepted: 08/09/2023] [Indexed: 02/24/2024] Open
Abstract
Purpose Postconcurrent chemoradiotherapy (CRT) response assessment has been challenging in locally advanced head-and-neck squamous cell carcinoma (LA-HNSCC) due to prevailing postradiation changes. Molecular response methods have been encouraging, although further clarifications and validations were needed. We tested the effectiveness of a proposed semi-quantitative molecular response criterion in these patients. Materials and Methods Two subspecialty-trained physicians evaluated 18F-fluorodeoxyglucose positron emission tomography/computed tomography of LA-HNSCC patients (n = 83) post 3 months CRT using a five points Head and Neck Molecular Imaging-Reporting and Data System (HAN-MI-RADS) criterion. Where available, histopathology examination with clinical and imaging interpretation was taken as a reference for the disease. A diagnostic accuracy comparison was done with the existing Hopkins score. Further effectiveness was analyzed with disease-free survival (DFI) and overall survival (OS). Results Metastasis was developed in 11/83 patients at 3 months of evaluation. Of 72 patients, 39, 2, and 31 patients had a complete response, equivocal response, and partial response as per HAN-MI-RADS. Per patient sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for predicting loco-regional disease up to 1 and 2 years was 93.3%, 92.5%, 90.3%, 94.9%, 92.9%, and 84.9%, 91.9%, 90.3%, 87.2%, and 88.6% respectively. One year and two years DFI for each HAN-MI-RADS score showed a statistically significant difference while it was not for OS. The receiver operating characteristic curve analysis showed significantly better outcome predictability of HAN-MI-RADS (area under the curve [AUC] 0.884) than Hopkins (AUC 0.699). Conclusions A five points HAN-MI-RADS criterion was found promising for response assessment with less equivocal results and statistically significant higher AUC than Hopkins for loco-regional recurrence prediction.
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Affiliation(s)
- Manoj Gupta
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Ankush Jajodia
- Department of Radiology, Juravinski Hospital, McMaster University, Hamilton, Canada
| | - Parveen Ahlawat
- Department of Radiotherapy, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Munish Gairola
- Department of Radiotherapy, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Mudit Agarwal
- Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sumit Goyal
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Parv Mehta
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Partha Sarathi Choudhury
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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14
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Paul S, Gupta T, Purandare N, Joshi K, Ghosh-Laskar S, Budrukkar A, Swain M, Sinha S, Kumar A, Joshi A, Prabhash K, Nair S, Rangarajan V, Agarwal JP. Diagnostic Performance of Response Assessment FDG-PET/CECT in HNSCC Treated With Definitive Radio(chemo)therapy Using NI-RADS. Otolaryngol Head Neck Surg 2023; 169:938-947. [PMID: 36856038 DOI: 10.1002/ohn.305] [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: 10/18/2022] [Revised: 01/12/2023] [Accepted: 01/30/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To assess the diagnostic performance of response assessment 18F-fluorodeoxyglucose positron emission tomography/contrast-enhanced computed tomography (FDG-PET/CECT) following definitive radio(chemo)therapy in head and neck squamous cell carcinoma (HNSCC) using Neck Imaging Reporting and Data System (NI-RADS). STUDY DESIGN A retrospective analysis from a prospectively maintained dataset. SETTING Tertiary-care comprehensive cancer center in a low-middle-income country. METHODS Adults with newly diagnosed, biopsy-proven, nonmetastatic HNSCC treated with definitive radio(chemo)therapy were included. Posttreatment response assessment FDG-PET/CECT scans were retrospectively assigned NI-RADS categories (1-3) for the primary site, neck, and both sites combined. Locoregional recurrence occurring within 2-years was defined as the event of interest. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy were calculated. Locoregional control stratified by NI-RADS categories was computed with the Kaplan-Meier method and compared using the log-rank test. RESULTS Posttreatment FDG-PET/CECT scans were available in 190 patients constituting the present study cohort. Sensitivity, specificity, PPV, NPV, and overall accuracy of the NI-RADS template for the primary site was 73.5%, 81.4%, 46.3%, 93.4%, and 80.0%, respectively. Similar metrics for the neck were 72.7%, 87.5%, 43.2%, 96.1%, and 85.8%, respectively. Combining primary site and neck, the corresponding metrics of diagnostic accuracy were 84.4%, 69.7%, 46.3%, 93.5%, and 73.2%, respectively. At a median follow-up of 40 months, Kaplan-Meier estimates of 2-year locoregional control were significantly higher for NI-RADS category 1 (94.2%) compared to NI-RADS category 2 (69.4%) and category 3 (20.4%), respectively (stratified log-rank p < .0001). CONCLUSION FDG-PET/CECT using the NI-RADS template is associated with good diagnostic performance and prognostic utility in HNSCC treated with definitive radio(chemo)therapy.
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Affiliation(s)
- Sonz Paul
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nilendu Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kishore Joshi
- Department of Medical Physics, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sarbani Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Monali Swain
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shwetabh Sinha
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Anuj Kumar
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Surgery, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital (TMH)/Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
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15
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Mahajan A, Unde H, Sable NP, Shukla S, Vaish R, Patil V, Agarwal U, Agrawal A, Noronha V, Joshi A, Kapoor A, Menon N, Agarwal JP, Laskar SG, Dcruz AK, Chaturvedi P, Pai P, Rane SU, Bal M, Patil A, Prabhash K. Response assessment of post-treatment head and neck cancers to determine further management using NI-RADS (Neck Imaging Reporting and Data System): a subgroup analysis of a randomized controlled trial. Front Oncol 2023; 13:1200366. [PMID: 37810970 PMCID: PMC10552531 DOI: 10.3389/fonc.2023.1200366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/03/2023] [Indexed: 10/10/2023] Open
Abstract
Objective Interpreting complex post-treatment changes in head and neck cancer (HNC) is challenging with further added perplexity due to variable interobserver interpretation and hence evolved the NI-RADS lexicon. We evaluated the accuracy of NI-RADS in predicting disease status on 1st post-treatment follow-up CECT in a homogenous cohort of those who received only chemoradiation. Methods Retrospective analysis of imaging was done for LASHNC patients who received radical chemoradiation in an open-label, investigator-initiated, phase 3 randomized trial (2012-2018) randomly assigned to either radical radiotherapy with concurrent weekly cisplatin (CRT) or CRT with the same schedule plus weekly nimotuzumab (NCRT). 536 patients were accrued, and 74 patients who did not undergo PET/CECT after 8 weeks post-CRT were excluded. After assessing 462 patients for eligibility to allocate NI-RADS at primary and node sites, 435 cases fell in the Primary disease cohort and 412 cases in the Node disease cohort. We evaluated sensitivity, disease prevalence, the positive and negative predictive value of the NI-RADS lexicon, and accuracy, which were expressed as percentages. We also prepared flow charts to determine concordance with allocated NI-RADS category and established accuracy with which it can identify disease status. Results Out of 435 primary disease cohort, 92%, 55%, 48%,70% were concordant and had 100%, 72%, 70%, 82% accuracy in NI-RADS1 (n=12), NI-RADS2 (n=261), NIRADS3 (n=105), and NI-RADS 4 (n=60) respectively. Out of 412 nodes disease cohort, 95%, 90%, 48%, 70%were concordant and had 92%, 97%, 90%, 67% accuracy in NI-RADS1 (n=57), NI-RADS2 (n=255), NI-RADS3 (n=105) and NI-RADS4 (n=60) respectively. % concordance of PET/CT and CECT across all primary and node disease cohorts revealed that PET/CT was 91% concordant in primary NI-RADS2 as compared to 55% concordance of CECT whereas concordance of CECT was better with 57% in primary NI-RADS3 cohort as compared to PET/CT concordance of 41%. Conclusion The accuracy with which the NI-RADS lexicon performed in our study at node sites was better than that at the primary site. There is a great scope of research to understand if CECT performs better over clinical disease status in NI-RADS 3 and 4 categories. Further research should be carried out to understand if PET/CECT can be used for close interval follow-up in stage III/IV NI-RADS 2 cases.
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Affiliation(s)
- Abhishek Mahajan
- Department of Radiodiagnosis, The Clatterbridge Cancer Centre, University of Liverpool, Liverpool, United Kingdom
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Himangi Unde
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Nilesh P. Sable
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Shreya Shukla
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Richa Vaish
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Ujjwal Agarwal
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Archi Agrawal
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Akhil Kapoor
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Anil Keith Dcruz
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Prathamesh Pai
- Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Swapnil Ulhas Rane
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Munita Bal
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Asawari Patil
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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16
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Bhattacharya K, Mahajan A, Vaish R, Rane S, Shukla S, D'Cruz AK. Imaging of Neck Nodes in Head and Neck Cancers - a Comprehensive Update. Clin Oncol (R Coll Radiol) 2023; 35:429-445. [PMID: 37061456 DOI: 10.1016/j.clon.2023.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/08/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
Cervical lymph node metastases from head and neck squamous cell cancers significantly reduce disease-free survival and worsen overall prognosis and, hence, deserve more aggressive management and follow-up. As per the eighth edition of the American Joint Committee on Cancer staging manual, extranodal extension, especially in human papillomavirus-negative cancers, has been incorporated in staging as it is important in deciding management and significantly impacts the outcome of head and neck squamous cell cancer. Lymph node imaging with various radiological modalities, including ultrasound, computed tomography and magnetic resonance imaging, has been widely used, not only to demonstrate nodal involvement but also for guided histopathological evaluation and therapeutic intervention. Computed tomography and magnetic resonance imaging, together with positron emission tomography, are used widely for the follow-up of treated patients. Finally, there is an emerging role for artificial intelligence in neck node imaging that has shown promising results, increasing the accuracy of detection of nodal involvement, especially normal-appearing nodes. The aim of this review is to provide a comprehensive overview of the diagnosis and management of involved neck nodes with a focus on sentinel node anatomy, pathogenesis, imaging correlates (including radiogenomics and artificial intelligence) and the role of image-guided interventions.
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Affiliation(s)
- K Bhattacharya
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - A Mahajan
- The Clatterbridge Cancer Centre, NHS Foundation Trust, Liverpool, UK.
| | - R Vaish
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - S Rane
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - S Shukla
- Homi Bhabha Cancer Hospital, Varanasi, Uttar Pradesh, India
| | - A K D'Cruz
- Apollo Hospitals, India; Union International Cancer Control (UICC), Geneva, Switzerland; Foundation of Head Neck Oncology, India
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17
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Baba A, Kurokawa R, Rivera-de Choudens R, Kurokawa M, Ota Y, Srinivasan A. Diffusion and Perfusion Imaging in Post-Treatment Evaluation of the Head and Neck. Semin Roentgenol 2023; 58:347-354. [PMID: 37507174 DOI: 10.1053/j.ro.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/27/2023] [Accepted: 02/25/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Akira Baba
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, MI, 48109
| | - Ryo Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, MI, 48109
| | | | - Mariko Kurokawa
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, MI, 48109
| | - Yoshiaki Ota
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, MI, 48109
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, MI, 48109.
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18
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Tran NA, Gorolay VV, Wu X. Differentiating Post-treatment Changes from Tumor Recurrence in the Oral Cavity and Oropharynx. Semin Roentgenol 2023; 58:272-289. [PMID: 37507169 DOI: 10.1053/j.ro.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/17/2023] [Accepted: 04/02/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Ngoc-Anh Tran
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Vineet V Gorolay
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Xin Wu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA.
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19
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Sistonen HJ, Ilmarinen T, Atula T, Aro K, Schildt J, Markkola A. PET-CT detection of local residual laryngeal carcinoma after definitive (chemo)radiotherapy. BMC Cancer 2023; 23:358. [PMID: 37072716 PMCID: PMC10111680 DOI: 10.1186/s12885-023-10834-1] [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: 01/20/2023] [Accepted: 04/11/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Positron emission tomography and computed tomography (PET-CT) is currently recommended in evaluating the treatment response after (chemo)radiotherapy ([C]RT). In the larynx, post-treatment changes and physiological uptake make image interpretation more challenging compared to other head and neck sites. Previous research has not addressed imaging factors specifically in the larynx that would help in distinguishing the residual disease and explain the unique challenges of that anatomic area. The study cohorts are small and heterogenous. Our objective was to investigate the ability of PET-CT in diagnosing local residual laryngeal carcinoma, and to uncover imaging factors that could be used in differentiating the residual disease from post-treatment and physiological changes. In the same study cohort, we also aimed to uncover prognostic factors for local residual or recurrent disease. METHODS Our retrospective study cohort included 73 patients with T2-T4 laryngeal carcinoma undergoing (C)RT with curative intention, and post-treatment non-contrast-enhanced PET-CT at 2-6 months. Findings were compared between local residual and non-residual disease. Local residual disease was defined as a persistent tumor growth with no evidence of remission in between, confirmed by biopsy, and evident within 6 months from the end of RT. PET-CT was evaluated using a 3-step scale: negative, equivocal, and positive. RESULTS Nine (12%) had a local residual tumor and 11 (15%) developed local recurrence, based on the biopsy. The median follow-up of surviving patients was 64 months (range, 28-174). In univariate analysis, primary tumor diameter greater than 2.4 cm (median value), and vocal cord fixation were prognostic for local residual or recurrent disease. Sensitivity, specificity, PPV, and NPV were 100%, 75%, 36%, and 100%, respectively, when the equivocal interpretation was grouped with the positive interpretation. All local residuals, and 28% (18/64) non-residuals, had a primary tumor area SUVmax of over 4.0 (p < 0.001). CT showed a persistent mass at the primary tumor area in 56% of residuals, and in 23% of non-residuals (p > 0.05). By combining SUVmax>4.0 and mass, specificity improved to 91%. CONCLUSIONS NPV of post-treatment PET-CT in laryngeal carcinoma is high, but equivocal and positive results have low PPV and require further diagnostics. All local residuals had SUVmax over 4.0. The combination of SUVmax over 4.0 and mass on CT increased specificity, but the sensitivity was low.
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Affiliation(s)
- Heli J Sistonen
- Department of Radiology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Helsinki, 00029 HUS, Finland.
| | - Taru Ilmarinen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Kasarmikatu 11-13, Helsinki, 00029 HUS, Finland
| | - Timo Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Kasarmikatu 11-13, Helsinki, 00029 HUS, Finland
| | - Katri Aro
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Kasarmikatu 11-13, Helsinki, 00029 HUS, Finland
| | - Jukka Schildt
- Department of Nuclear Medicine, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Helsinki, 00029 HUS, Finland
| | - Antti Markkola
- Department of Radiology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Helsinki, 00029 HUS, Finland
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20
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Branstetter BF. Surveillance Imaging for Head and Neck Cancer: Some Much-needed Proof of Effectiveness. Radiology 2023; 307:e222560. [PMID: 36625751 DOI: 10.1148/radiol.222560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Barton F Branstetter
- From the Department of Radiology, Division of Neuroradiology, University of Pittsburgh School of Medicine, 200 Lothrop St, Pittsburgh, PA 15213
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21
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Beyond the AJR: Standardized Reporting in Head and Neck Squamous Cell Carcinoma PET/CT Reports Improves Communication Between Radiologists and Referring Clinicians. AJR Am J Roentgenol 2023; 220:906. [PMID: 36287621 DOI: 10.2214/ajr.22.28629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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22
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Mali SB. Surveillance of head neck cancer: Case for personalized and standardized surveillance. Oral Oncol 2023; 139:106354. [PMID: 36878144 DOI: 10.1016/j.oraloncology.2023.106354] [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: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
Although surgery, radiotherapy, chemotherapy, or combined treatment often elicits an initial satisfactory response, relapses are frequently observed within two years. Current surveillance methods, including clinical exams and imaging evaluations, have not unambiguously demonstrated a survival benefit, most probably due to a lack of sensitivity in detecting very early recurrence. Current guidelines advise post-treatment surveillance of head and neck cancer (HNC) patients should involve scheduled appointments with a variety of practitioners. The benefits of prolonged routine follow-up on survival have not been proven. Increasing numbers of HNC survivors raise the burden to provide efficient and effective care.
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Affiliation(s)
- Shrikant B Mali
- Mahatma Gandhi Vidya Mandir's Dental College and Hospital Nashik, India.
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23
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Contemporary Imaging and Reporting Strategies for Head and Neck Cancer: MRI, FDG PET/MRI, NI-RADS, and Carcinoma of Unknown Primary- AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 220:160-172. [PMID: 36069482 DOI: 10.2214/ajr.22.28120] [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] [Indexed: 01/25/2023]
Abstract
CT, MRI, and FDG PET/CT play major roles in the diagnosis, staging, treatment planning, and surveillance of head and neck cancers. Nonetheless, an evolving understanding of head and neck cancer pathogenesis, advances in imaging techniques, changing treatment regimens, and a lack of standardized guidelines have led to areas of uncertainty in the imaging of head and neck cancer. This narrative review aims to address four issues in the contemporary imaging of head and neck cancer. The first issue relates to the standard and advanced sequences that should be included in MRI protocols for head and neck cancer imaging. The second issue relates to approaches to surveillance imaging after treatment of head and neck cancer, including the choice of imaging modality, the frequency of surveillance imaging, and the role of standardized reporting through the Neck Imaging Reporting and Data System. The third issue relates to the role of imaging in the setting of neck carcinoma of unknown primary. The fourth issue relates to the role of simultaneous PET/MRI in head and neck cancer evaluation. The authors of this review provide consensus opinions for each issue.
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24
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Hanna GJ, Patel N, Tedla SG, Baugnon KL, Aiken A, Agrawal N. Personalizing Surveillance in Head and Neck Cancer. Am Soc Clin Oncol Educ Book 2023; 43:e389718. [PMID: 37079869 DOI: 10.1200/edbk_389718] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Head and neck squamous cell carcinoma (HNSCC) encompasses a spectrum of heterogeneous diseases originating in the oral cavity, pharynx, and larynx. Within the United States, head and neck cancer (HNC) accounts for 66,470 new cases, or 3% of all malignancies, annually.1 The incidence of HNC is rising, largely driven by increases in oropharyngeal cancer.2-4 Recent molecular and clinical advancements, particularly with regard to molecular and tumor biology, reflect the heterogeneity of the subsites contained within the head and neck. Despite this, existing guidelines for post-treatment surveillance remain broad without much consideration given to different anatomic subsites and etiologic factors (such as human papillomavirus [HPV] status or tobacco exposure).5 Surveillance incorporating the physical examination, imaging, and emerging molecular biomarkers is an essential part of care for patients treated for HNC and allows for the detection of locoregional recurrence, distant metastases, and second primary malignancies aiming for better functional and survival outcomes. Additionally, it allows for evaluation and management of post-treatment complications.
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Affiliation(s)
- Glenn J Hanna
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Nirali Patel
- Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, IL
| | - Sara G Tedla
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Kristen L Baugnon
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Ashley Aiken
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Nishant Agrawal
- Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, IL
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25
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Subramaniam RM, Duan FM, Romanoff J, Yu JQ, Bartel T, Dehdashti F, Intenzo CM, Solnes L, Sicks J, Stack BC, Lowe VJ. 18F-FDG PET/CT Staging of Head and Neck Cancer: Interobserver Agreement and Accuracy-Results from Multicenter ACRIN 6685 Clinical Trial. J Nucl Med 2022; 63:1887-1890. [PMID: 35552246 PMCID: PMC9730921 DOI: 10.2967/jnumed.122.263902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/27/2022] [Indexed: 01/11/2023] Open
Abstract
To our knowledge, no prior multicenter clinical trial has reported interobserver agreement of 18F-FDG PET/CT scans for staging of clinical N0 neck in head and neck cancer. Methods: A total of 287 participants were recruited. For visual analysis, positive nodal uptake of 18F-FDG was defined as uptake visually greater than activity seen in the blood pool. Results: The negative predictive value of the 18F-FDG PET/CT for N0 clinical neck was 86% or above for visual assessment (95% CI, 86%-88%) for the 2 central readers and above 90% (95% CI, 90%-95%) for SUVmax for central reads and site reads dichotomized at the optimal cutoff value of 1.8 and the prespecified cutoff value of 3.5, respectively. The κ coefficients between the 2 expert readers and between central reads and site reads varied between 0.53 and 0.78. Conclusion: The NPV of the 18F-FDG PET/CT for N0 clinical neck was 86% or above for visual assessment and above 90% for SUVmax cut points of 1.8 and 3.5 with moderate to substantial agreements.
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Affiliation(s)
- Rathan M Subramaniam
- Otago Medical School, University of Otago, Otago, Dunedin, New Zealand;
- Duke University, Durham, North Carolina
| | - Fenghai M Duan
- School of Public Health, Brown University, Providence, Rhode Island
| | - Justin Romanoff
- School of Public Health, Brown University, Providence, Rhode Island
| | - Jian Qin Yu
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | | | | | - Lilja Solnes
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - JoRean Sicks
- School of Public Health, Brown University, Providence, Rhode Island
| | - Brendan C Stack
- Southern Illinois School of Medicine, Springfield, Illinois; and
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26
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Patel Z, Schroeder JA, Bunch PM, Evans JK, Steber CR, Johnson AG, Farris JC, Hughes RT. Discordance Between Oncology Clinician-Perceived and Radiologist-Intended Meaning of the Postradiotherapy Positron Emission Tomography/Computed Tomography Freeform Report for Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2022; 148:927-934. [PMID: 35980655 PMCID: PMC9389438 DOI: 10.1001/jamaoto.2022.2290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/29/2022] [Indexed: 02/01/2023]
Abstract
Importance Assessment of response after radiotherapy (RT) using 18F-fluorodeoxyglucose positron emission tomography (PET) with computed tomography (CT) is routine in managing head and neck squamous cell carcinoma (HNSCC). Freeform reporting may contribute to a clinician's misunderstanding of the nuclear medicine (NM) physician's image interpretation, with important clinical implications. Objective To assess clinician-perceived freeform report meaning and discordance with NM interpretation using the modified Deauville score (MDS). Design, Setting, and Participants In this retrospective cohort study that was conducted at an academic referral center and National Cancer Institute-designated Comprehensive Cancer Center and included patients with HNSCC treated with RT between January 2014 and December 2019 with a posttreatment PET/CT and 1 year or longer of follow-up, 4 masked clinicians independently reviewed freeform PET/CT reports and assigned perceived MDS responses. Interrater reliability was determined. Clinician consensus-perceived MDS was then compared with the criterion standard NM MDS response derived from image review. Data analysis was conducted between December 2021 and February 2022. Exposures Patients were treated with RT in either the definitive or adjuvant setting, with or without concurrent chemotherapy. They then underwent posttreatment PET/CT response assessment. Main Outcomes and Measures Clinician-perceived (based on the freeform PET/CT report) and NM-defined response categories were assigned according to MDS. Clinical outcomes included locoregional control, progression-free survival, and overall survival. Results A total of 171 patients were included (45 women [26.3%]; median [IQR] age, 61 [54-65] years), with 149 (87%) with stage III to IV disease. Of these patients, 52 (30%) received postoperative RT and 153 (89%) received concurrent chemotherapy. Interrater reliability was moderate (κ = 0.68) among oncology clinicians and minimal (κ = 0.36) between clinician consensus and NM. Exact agreement between clinician consensus and the NM was 64%. The NM-rated MDS was significantly associated with locoregional control, progression-free survival, and overall survival. Conclusions and Relevance The results of this cohort study suggest that considerable variation in perceived meaning exists among oncology clinicians reading freeform HNSCC post-RT PET/CT reports, with only minimal agreement between MDS derived from clinician perception and NM image interpretation. The NM use of a standardized reporting system, such as MDS, may improve clinician-NM communication and increase the value of HNSCC post-RT PET/CT reports.
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Affiliation(s)
- Zachary Patel
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jennifer A. Schroeder
- Department of Nuclear Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Paul M. Bunch
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Joni K. Evans
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Cole R. Steber
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Adam G. Johnson
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Joshua C. Farris
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ryan T. Hughes
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Rhyner PA, Bhatt AA, Baugnon KL, Aiken AH. Neck Imaging Reporting and Data System: More Than Just a Template. AJNR Am J Neuroradiol 2022; 43:1400-1402. [PMID: 36574331 PMCID: PMC9575526 DOI: 10.3174/ajnr.a7627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/05/2022] [Indexed: 02/01/2023]
Abstract
The Neck Imaging Reporting and Data System (NI-RADS) is a guide developed and introduced in 2017 by head and neck radiologists who worked in an academic radiology department. Based on the Breast Imaging Reporting and Data System, the initial goals of NI-RADS were to make posttreatment head and neck cancer imaging dictations more succinct and efficient, guide treating physicians in the next appropriate steps when recurrence was suspected, and encourage institutional and national research. NI-RADS is more than a dictation template, and it is best instituted after a head and neck imaging practice is established. We support the use of NI-RADS once a radiologist understands the nuances of head and neck cancer, including the biology, common subsites involved, essentials of tumor staging, common posttreatment benign imaging appearances, and subtleties of recurrent disease.
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Affiliation(s)
- P A Rhyner
- From the Department of Radiology (P.A.R., A.A.B.), Mayo Clinic, Jacksonville, Florida
| | - A A Bhatt
- From the Department of Radiology (P.A.R., A.A.B.), Mayo Clinic, Jacksonville, Florida
| | - K L Baugnon
- Department of Radiology and Imaging Sciences (K.L.B., A.H.A.), Emory University School of Medicine, Atlanta, Georgia
| | - A H Aiken
- Department of Radiology and Imaging Sciences (K.L.B., A.H.A.), Emory University School of Medicine, Atlanta, Georgia
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28
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Fiori T, Lisewski D, Flukes S, Wood C, Gibson D. Lessons learnt from the global iodinated contrast media shortage in head and neck imaging. J Med Imaging Radiat Oncol 2022; 66:1073-1083. [PMID: 36125131 DOI: 10.1111/1754-9485.13472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/05/2022] [Indexed: 11/27/2022]
Abstract
A recent shortage in the global supply of iodinated contrast media (ICM) has required health service providers to review their contrast administration policies and implement strategies to conserve inventory. This article will review the current best practices in head and neck imaging for a variety of common presentations and provide examples where alternative imaging can be considered due to the recent ICM shortage. Ultrasound and MRI techniques can feature heavily in many diagnostic processes in head and neck pathology, and a variety of common presentations can be appropriately investigated through clinical evaluation or naso-endoscopy. In many instances, for the routine assessment of non-acute adult and paediatric head and neck presentations, the use of contrast-enhanced CT can be safely minimised to conserve ICM if required.
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Affiliation(s)
- Timothy Fiori
- Department of Medical Imaging, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Dean Lisewski
- Department of General Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Stephanie Flukes
- Department of Otolaryngology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Chris Wood
- Department of Medical Imaging, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Daren Gibson
- Department of Medical Imaging, Fiona Stanley Hospital, Perth, Western Australia, Australia
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29
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Baba A, Kurokawa R, Rawie E, Kurokawa M, Ota Y, Srinivasan A. Normalized Parameters of Dynamic Contrast-Enhanced Perfusion MRI and DWI-ADC for Differentiation between Posttreatment Changes and Recurrence in Head and Neck Cancer. AJNR Am J Neuroradiol 2022; 43:1184-1189. [PMID: 35835592 PMCID: PMC9575415 DOI: 10.3174/ajnr.a7567] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/22/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Differentiating recurrence from benign posttreatment changes has clinical importance in the imaging follow-up of head and neck cancer. This study aimed to investigate the utility of normalized dynamic contrast-enhanced MR imaging and ADC for their differentiation. MATERIALS AND METHODS This study included 51 patients with a history of head and neck cancer who underwent follow-up dynamic contrast-enhanced MR imaging with DWI-ADC, of whom 25 had recurrences and 26 had benign posttreatment changes. Quantitative and semiquantitative dynamic contrast-enhanced MR imaging parameters and ADC of the ROI and reference region were analyzed. Normalized dynamic contrast-enhanced MR imaging parameters and normalized DWI-ADC parameters were calculated by dividing the ROI by the reference region. RESULTS Normalized plasma volume, volume transfer constant between extravascular extracellular space and blood plasma per minute (K trans), area under the curve, and wash-in were significantly higher in patients with recurrence than in those with benign posttreatment change (P = .003 to <.001). The normalized mean ADC was significantly lower in patients with recurrence than in those with benign posttreatment change (P < .001). The area under the receiver operating characteristic curve of the combination of normalized dynamic contrast-enhanced MR imaging parameters with significance (normalized plasma volume, normalized extravascular extracellular space volume per unit tissue volume, normalized K trans, normalized area under the curve, and normalized wash-in) and normalized mean ADC was 0.97 (95% CI, 0.93-1). CONCLUSIONS Normalized dynamic contrast-enhanced MR imaging parameters, normalized mean ADC, and their combination were effective in differentiating recurrence and benign posttreatment changes in head and neck cancer.
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Affiliation(s)
- A Baba
- From the Division of Neuroradiology (A.B., R.K., M.K., Y.O., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - R Kurokawa
- From the Division of Neuroradiology (A.B., R.K., M.K., Y.O., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - E Rawie
- Department of Radiology (E.R.), Brooke Army Medical Center, San Antonio, Texas
| | - M Kurokawa
- From the Division of Neuroradiology (A.B., R.K., M.K., Y.O., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Y Ota
- From the Division of Neuroradiology (A.B., R.K., M.K., Y.O., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - A Srinivasan
- From the Division of Neuroradiology (A.B., R.K., M.K., Y.O., A.S.), Department of Radiology, University of Michigan, Ann Arbor, Michigan
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Landin D, Näsman A, Jara SJ, Hammarstedt-Nordenvall L, Munck-Wikland E, Dalianis T, Marklund L. Post-Treatment Neck Dissection of Tonsillar and Base of Tongue Squamous Cell Carcinoma in the Era of PET-CT, HPV, and p16. Viruses 2022; 14:v14081693. [PMID: 36016315 PMCID: PMC9413897 DOI: 10.3390/v14081693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
Human-papillomavirus (HPV)-positive tonsillar and base of tongue carcinomas (TSCC/BOTSCC) are rising in incidence and treatments with radiotherapy, chemoradiotherapy (RT/CRT), and neck dissections (NDs) have several side effects. Therefore, an improved selection of patients needing salvage NDs would be beneficial. We examined the prevalence and localisations of viable tumour cells in neck lymph nodes in patients post-RT/CRT, identified by fluorodeoxyglucose positron-emission tomography with computer-tomography (FDG PET-CT), with a focus on HPV-associated tumours. Patients with 217 TSCC/BOTSCC with tumours assessed for HPV-DNA and p16INK4a undergoing FDG PET-CT 12 weeks after treatment and/or an ND were included. The FDG PET-CT data were compared with the findings in the pathology report after the ND. In total, 36/217 (17%) patients were selected for an ND due to positive findings in post-treatment FDG PET-CT. Of these, 35/36 were HPV-associated, 10/36 (28%) had viable tumour cells in the pathology reports of the neck specimen, and 8/10 (80%) were consistent with the FDG PET-CT findings, while 2/36 (5%) were missed by FDG PET-CT. We conclude that FDG PET-CT 12 weeks after RT/CRT is useful, but not completely reliable for finding all the metastases of HPV-associated TSCC/BOTSCC. Nonetheless, our data indicate that an ND could be more selectively guided by FDG PET-CT.
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Affiliation(s)
- David Landin
- Department of Clinical Science, Intervention and Technology, Department of Oto-Rhinolaryngology, Head and Neck Surgery, Karolinska University Hospital, Karolinska Institute, 17164 Stockholm, Sweden; (D.L.); (L.H.-N.); (E.M.-W.)
- Medical Unit Head Neck, Lung and Skin Cancer, Karolinska University Hospital, 17164 Stockholm, Sweden
| | - Anders Näsman
- Department of Oncology, Pathology, Karolinska Institute, 17164 Stockholm, Sweden;
- Department of Clinical Pathology, Karolinska University Hospital, 17164 Stockholm, Sweden
| | - Sara Jonmarker Jara
- Department of Neuroradiology, Karolinska University Hospital, 17164 Stockholm, Sweden;
| | - Lalle Hammarstedt-Nordenvall
- Department of Clinical Science, Intervention and Technology, Department of Oto-Rhinolaryngology, Head and Neck Surgery, Karolinska University Hospital, Karolinska Institute, 17164 Stockholm, Sweden; (D.L.); (L.H.-N.); (E.M.-W.)
- Medical Unit Head Neck, Lung and Skin Cancer, Karolinska University Hospital, 17164 Stockholm, Sweden
| | - Eva Munck-Wikland
- Department of Clinical Science, Intervention and Technology, Department of Oto-Rhinolaryngology, Head and Neck Surgery, Karolinska University Hospital, Karolinska Institute, 17164 Stockholm, Sweden; (D.L.); (L.H.-N.); (E.M.-W.)
- Medical Unit Head Neck, Lung and Skin Cancer, Karolinska University Hospital, 17164 Stockholm, Sweden
| | - Tina Dalianis
- Department of Oncology, Pathology, Karolinska Institute, 17164 Stockholm, Sweden;
- Correspondence: (T.D.); (L.M.)
| | - Linda Marklund
- Department of Clinical Science, Intervention and Technology, Department of Oto-Rhinolaryngology, Head and Neck Surgery, Karolinska University Hospital, Karolinska Institute, 17164 Stockholm, Sweden; (D.L.); (L.H.-N.); (E.M.-W.)
- Medical Unit Head Neck, Lung and Skin Cancer, Karolinska University Hospital, 17164 Stockholm, Sweden
- Department of Surgical Sciences, Section of Otolaryngology and Head and Neck Surgery, Uppsala University, 75105 Uppsala, Sweden
- Correspondence: (T.D.); (L.M.)
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31
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Lee J, Kaht D, Ali S, Johnson S, Bullen J, Karakasis C, Lamarre E, Geiger J, Koyfman S, Stock S. Performance of the Neck Imaging Reporting and Data System as applied by general neuroradiologists to predict recurrence of head and neck cancers. Head Neck 2022; 44:2257-2264. [PMID: 35801334 DOI: 10.1002/hed.27138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/04/2022] [Accepted: 06/16/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The Neck Imaging Reporting and Data System (NI-RADS) is used to assess imaging after head and neck cancer treatment. We evaluated NI-RADS with general neuroradiologists rather than with head and neck subspecialists. METHODS Computed tomography and magnetic resonance imaging examinations with/without positron emission tomography from May 2018 to September 2020 were retrospectively identified. NI-RADS scores at the primary site and lymph nodes were provided by 21 neuroradiologists. Recurrence status was based on clinical and imaging findings. Area under the curve (AUC) was used to assess accuracy. RESULTS We assessed 608 scans from 464 patients. For NI-RADS categories 1, 2, and 3, primary site recurrence rates were 5%, 29%, and 65% with AUC of 0.765, while lymph node recurrence rates were 3%, 10%, and 80% with AUC of 0.820. CONCLUSIONS NI-RADS as used by general neuroradiologists is effective in separating head and neck cancers into discrete categories for predicting recurrent disease.
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Affiliation(s)
- Jonathan Lee
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Dagan Kaht
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Syed Ali
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Scott Johnson
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jennifer Bullen
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Eric Lamarre
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jessica Geiger
- Hematology and Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shlomo Koyfman
- Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sarah Stock
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Jajodia A, Mandal G, Yadav V, Khoda J, Goyal J, Pasricha S, Puri S, Dewan A. Adding MR Diffusion Imaging and T2 Signal Intensity to Neck Imaging Reporting and Data System Categories 2 and 3 in Primary Sites of Postsurgical Oral Cavity Carcinoma Provides Incremental Diagnostic Value. AJNR Am J Neuroradiol 2022; 43:1018-1023. [PMID: 35738671 DOI: 10.3174/ajnr.a7553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/03/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The NI-RADS lexicon doesn't use ADC parameters and T2 weighted signal for ascribing categories. We explored ADC, DWI, and T2WI to examine the diagnostic accuracy in primary sites of postsurgical oral cavity carcinoma in the Neck Imaging Reporting and Data System (NI-RADS) categories 2 and 3. MATERIALS AND METHODS We performed a retrospective analysis in clinically asymptomatic post-surgically treated patients with oral cavity squamous cell carcinoma who underwent contrast-enhanced MRI between January 2013 and January 2016. Histopathology and follow-up imaging were used to ascertain the presence or absence of malignancy in subjects with "new enhancing lesions," which were interpreted according to the NI-RADS lexicon by experienced readers, including NI-RADS 2 and 3 lesions in the primary site. NI-RADS that included T2WI and DWI (referred to as NI-RADS A) and ADC (using the best cutoff from receiver operating characteristic curve analysis, NI-RADS B) was documented in an Excel sheet to up- or downgrade existing classic American College of Radiology NI-RADS and calculate diagnostic accuracy. RESULTS Sixty-one malignant and 23 benign lesions included in the study were assigned American College of Radiology NI-RADS 2 (n = 33) and NI-RADS 3 (n = 51) categories. The recurrence rate was 90% (46/51) for NI-RADS three, 45% (15/33) for NI-RADS 2, and 73% (61/84) overall. T2WI signal morphology was intermediate in 45 subjects (53.5%) and restricted DWI in 54 (64.2%). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the American College of Radiology NI-RADS were the following: NI-RADS (75.4%, 78.3%, 90.1%, 54.5%, and 76.1%); NI-RADS A (79.1%, 81.2%, 91.9%, 59.1%, and 79.6%); and NI-RADS B (88.9%, 72.7%, 91.4%, 66.7%, and 85.1%), respectively. CONCLUSIONS Adding MR imaging diagnostic characteristics like T2WI, DWI, and ADC to the American College of Radiology NI-RADS improved diagnostic accuracy and sensitivity.
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Affiliation(s)
- A Jajodia
- From the Departments of Radiology (A.J., J.K., J.G., S.Puri.)
| | - G Mandal
- Surgical Oncology (G.M., V.Y., A.D.)
| | - V Yadav
- Surgical Oncology (G.M., V.Y., A.D.)
| | - J Khoda
- From the Departments of Radiology (A.J., J.K., J.G., S.Puri.)
| | - J Goyal
- From the Departments of Radiology (A.J., J.K., J.G., S.Puri.)
| | - S Pasricha
- Laboratory & Histopathology (S.Pasricha.), Rajiv Gandhi Cancer Institute, Delhi, India
| | - S Puri
- From the Departments of Radiology (A.J., J.K., J.G., S.Puri.)
| | - A Dewan
- Surgical Oncology (G.M., V.Y., A.D.)
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Wiggins RH, Hoffman JM, Fine GC, Covington MF, Salem AE, Koppula BR, Morton KA. PET-CT in Clinical Adult Oncology-V. Head and Neck and Neuro Oncology. Cancers (Basel) 2022; 14:cancers14112726. [PMID: 35681709 PMCID: PMC9179458 DOI: 10.3390/cancers14112726] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Positron emission tomography (PET), typically combined with computed tomography (CT) has become a critical advanced imaging technique in oncology. With PET-CT, a radioactive molecule (radiotracer) is injected in the bloodstream and localizes to sites of tumor because of specific cellular features of the tumor that accumulate the targeting radiotracer. The CT scan, performed at the same time, provides information to facilitate attenuation correction, so that radioactivity from deep or dense structures can be better visualized, but with head and neck malignancies it is critical to provide correlating detailed anatomic imaging. PET-CT has a variety of applications in oncology, including staging, therapeutic response assessment, restaging, and surveillance. This series of six review articles provides an overview of the value, applications, and imaging and interpretive strategies of PET-CT in the more common adult malignancies. The fifth report in this series provides a review of PET-CT imaging in head and neck and neuro oncology. Abstract PET-CT is an advanced imaging modality with many oncologic applications, including staging, assessment of response to therapy, restaging, and longitudinal surveillance for recurrence. The goal of this series of six review articles is to provide practical information to providers and imaging professionals regarding the best use of PET-CT for specific oncologic indications, and the potential pitfalls and nuances that characterize these applications. In addition, key tumor-specific clinical information and representative PET-CT images are provided to outline the role that PET-CT plays in the management of oncology patients. Hundreds of different types of tumors exist, both pediatric and adult. A discussion of the role of FDG PET for all of these is beyond the scope of this review. Rather, this series of articles focuses on the most common adult malignancies that may be encountered in clinical practice. It also focuses on FDA-approved and clinically available radiopharmaceuticals, rather than research tracers or those requiring a local cyclotron. The fifth review article in this series focuses on PET-CT imaging in head and neck tumors, as well as brain tumors. Common normal variants, key anatomic features, and benign mimics of these tumors are reviewed. The goal of this review article is to provide the imaging professional with guidance in the interpretation of PET-CT for the more common head and neck malignancies and neuro oncology, and to inform the referring providers so that they can have realistic expectations of the value and limitations of PET-CT for the specific type of tumor being addressed.
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Affiliation(s)
- Richard H. Wiggins
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (R.H.W.); (J.M.H.); (G.C.F.); (M.F.C.); (A.E.S.); (B.R.K.)
| | - John M. Hoffman
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (R.H.W.); (J.M.H.); (G.C.F.); (M.F.C.); (A.E.S.); (B.R.K.)
| | - Gabriel C. Fine
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (R.H.W.); (J.M.H.); (G.C.F.); (M.F.C.); (A.E.S.); (B.R.K.)
| | - Matthew F. Covington
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (R.H.W.); (J.M.H.); (G.C.F.); (M.F.C.); (A.E.S.); (B.R.K.)
| | - Ahmed Ebada Salem
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (R.H.W.); (J.M.H.); (G.C.F.); (M.F.C.); (A.E.S.); (B.R.K.)
- Department of Radiodiagnosis and Intervention, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt
| | - Bhasker R. Koppula
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (R.H.W.); (J.M.H.); (G.C.F.); (M.F.C.); (A.E.S.); (B.R.K.)
| | - Kathryn A. Morton
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (R.H.W.); (J.M.H.); (G.C.F.); (M.F.C.); (A.E.S.); (B.R.K.)
- Intermountain Healthcare Hospitals, Summit Physician Specialists, Murray, UT 84123, USA
- Correspondence: ; Tel.: +1-801-581-7553
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Sheikhbahaei S, Subramaniam RM, Solnes LB. 2-Deoxy-2-[18F] Fluoro-d-Glucose PET/Computed Tomography. PET Clin 2022; 17:307-317. [DOI: 10.1016/j.cpet.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Patel L, Bridgham K, Ciriello J, Almardawi R, Leon J, Hostetter J, Yazbek S, Raghavan P. PET/MR Imaging in Evaluating Treatment Failure of Head and Neck Malignancies: A Neck Imaging Reporting and Data System-Based Study. AJNR Am J Neuroradiol 2022; 43:435-441. [PMID: 35177543 PMCID: PMC8910793 DOI: 10.3174/ajnr.a7427] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/19/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE PET/MR imaging is a relatively new hybrid technology that holds great promise for the evaluation of head and neck cancer. The aim of this study was to assess the performance of simultaneous PET/MR imaging versus MR imaging in the evaluation of posttreatment head and neck malignancies, as determined by its ability to predict locoregional recurrence or progression after imaging. MATERIALS AND METHODS The electronic medical records of patients who had posttreatment PET/MR imaging studies were reviewed, and after applying the exclusion criteria, we retrospectively included 46 studies. PET/MR imaging studies were independently reviewed by 2 neuroradiologists, who recorded scores based on the Neck Imaging Reporting and Data System (using CT/PET-CT criteria) for the diagnostic MR imaging sequences alone and the combined PET/MR imaging. Treatment failure was determined with either biopsy pathology or initiation of new treatment. Statistical analyses including univariate association, interobserver agreement, and receiver operating characteristic analysis were performed. RESULTS There was substantial interreader agreement among PET/MR imaging scores (κ = 0.634; 95% CI, 0.605-0.663). PET/MR imaging scores showed a strong association with treatment failure by univariate association analysis, with P < .001 for the primary site, neck lymph nodes, and combined sites. Receiver operating characteristic curves of PET/MR imaging scores versus treatment failure indicated statistically significant diagnostic accuracy (area under curve range, 0.864-0.987; P < .001). CONCLUSIONS Simultaneous PET/MR imaging has excellent discriminatory performance for treatment outcomes of head and neck malignancy when the Neck Imaging Reporting and Data System is applied. PET/MR imaging could play an important role in surveillance imaging for head and neck cancer.
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Affiliation(s)
- L.D. Patel
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
| | - K. Bridgham
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
| | - J. Ciriello
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
| | - R. Almardawi
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
| | - J. Leon
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
| | - J. Hostetter
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
| | - S. Yazbek
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
| | - P. Raghavan
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
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Baba A, Kurokawa R, Kurokawa M, Hassan O, Ota Y, Srinivasan A. ADC for Differentiation between Posttreatment Changes and Recurrence in Head and Neck Cancer: A Systematic Review and Meta-analysis. AJNR Am J Neuroradiol 2022; 43:442-447. [PMID: 35210272 PMCID: PMC8910821 DOI: 10.3174/ajnr.a7431] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/31/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Previous studies reported that the ADC values of recurrent head and neck cancer lesions are lower than those of posttreatment changes, however, the utility of ADC to differentiate them has not been definitively summarized and established. PURPOSE Our aim was to evaluate the diagnostic benefit of ADC calculated from diffusion-weighted imaging in differentiating recurrent lesions from posttreatment changes in head and neck cancer. DATA SOURCES MEDLINE, Scopus, and EMBASE data bases were searched for studies. STUDY SELECTION The review identified 6 prospective studies with a total of 365 patients (402 lesions) who were eligible for the meta-analysis. DATA ANALYSIS Forest plots were used to assess the mean difference in ADC values. Heterogeneity among the studies was evaluated using the Cochrane Q test and the I2 statistic. DATA SYNTHESIS Among included studies, the overall mean of ADC values of recurrent lesions was 1.03 × 10-3mm2/s and that of the posttreatment changes was 1.51 × 10-3mm2/s. The ADC value of recurrence was significantly less than that of posttreatment changes in head and neck cancer (pooled mean difference: -0.45; 95% CI, -0.59-0.32, P < .0001) with heterogeneity among studies. The threshold of ADC values between recurrent lesions and posttreatment changes was suggested to be 1.10 × 10-3mm2/s. LIMITATIONS Given the heterogeneity of the data of the study, the conclusions should be interpreted with caution. CONCLUSIONS The ADC values in recurrent head and neck cancers are lower than those of posttreatment changes, and the threshold of ADC values between them was suggested.
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Affiliation(s)
- A. Baba
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - R. Kurokawa
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - M. Kurokawa
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - O. Hassan
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Y. Ota
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - A. Srinivasan
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan
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Janopaul-Naylor JR, Aiken AH, Saba NF, El-Deiry M, Kaka A, Stokes WA. To scan or not to scan: the dilemma of post-treatment imaging surveillance of head and neck cancer. Pract Radiat Oncol 2022; 12:210-214. [PMID: 35150898 DOI: 10.1016/j.prro.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/24/2022] [Accepted: 01/31/2022] [Indexed: 11/15/2022]
Abstract
Locoregional recurrence remains common after treatment of head and neck cancer, warranting careful surveillance in follow-up. While randomized data support an initial PET/CT several months after treatment, evidence supporting subsequent imaging is limited, and most recurrences ultimately manifest clinically. Cooperative group studies and consensus guidelines vary widely in their recommendations regarding surveillance imaging. Patients with indeterminate findings, new symptoms, or areas difficult to examine in clinic may avoid invasive and potentially morbid interventions with judicious use of subsequent imaging. For any patient undergoing post-treatment imaging, standardized reporting criteria provide a framework for risk-stratification that can enhance communication and potentially guide management.
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Affiliation(s)
| | - Ashley H Aiken
- Department of Radiology and Imaging Services, Winship Cancer Institute at Emory University; Department of Otolaryngology, Winship Cancer Institute at Emory University
| | - Nabil F Saba
- Department of Otolaryngology, Winship Cancer Institute at Emory University; Department of Hematology and Medical Oncology, Winship Cancer Institute at Emory University
| | - Mark El-Deiry
- Department of Otolaryngology, Winship Cancer Institute at Emory University
| | - Azeem Kaka
- Department of Otolaryngology, Winship Cancer Institute at Emory University
| | - William A Stokes
- Department of Radiation Oncology, Winship Cancer Institute at Emory University.
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Johansson ED, Hughes RT, Meegalla NT, Porosnicu M, Patwa HS, Lack CM, Bunch PM. Neck Imaging Reporting and Data System Category 3 on Surveillance Computed Tomography: Incidence, Biopsy Rate, and Predictive Performance in Head and Neck Squamous Cell Carcinoma. Laryngoscope 2022; 132:1792-1797. [PMID: 35043989 DOI: 10.1002/lary.30025] [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: 09/25/2021] [Revised: 12/07/2021] [Accepted: 12/29/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Neck Imaging Reporting and Data System (NI-RADS) is a radiology reporting system for head and neck cancer surveillance. Imaging findings of high suspicion for recurrence are assigned Category 3 and recommended for "Biopsy, if clinically indicated." After implementing NI-RADS for surveillance neck computed tomography (CT), our objectives are to determine the incidence of squamous cell carcinoma (SCC) Category 3 lesions in the year post-implementation, the associated biopsy rate, and the positive predictive value of NI-RADS 3 for SCC recurrence. STUDY DESIGN Retrospective cohort study. METHODS Neck CTs reported with NI-RADS between February 2020 and February 2021 were reviewed to identify patients undergoing surveillance for SCC assigned NI-RADS 3. Cancer recurrence, defined as positive biopsy result or treatment of clinically determined recurrence, was determined by electronic medical record review. RESULTS During the study period, 580 neck CTs were reported with NI-RADS, of which 39 (7%) CTs obtained in 37 unique patients (28 male, 9 female, mean age 66.6 years) formed the study cohort. Biopsies were obtained in 23 lesions (45%), of which 17 (74%) were positive for recurrent SCC. One nondiagnostic biopsy was clinically determined to represent recurrence. Of 28 (55%) lesions not biopsied, 18 (64%) were ultimately treated as clinically determined recurrence. Thus, among 51 individual NI-RADS 3 lesions (32 primary, 19 neck), 36 (71%) represented recurrence. CONCLUSION The incidence of NI-RADS 3 lesions in our cohort was 7%. The biopsy rate was 45%, and the overall positive predictive value of NI-RADS 3 for recurrent SCC was 71%. Category 3 lesions are associated with substantial SCC recurrence risk and should be managed accordingly. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Erik D Johansson
- Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Ryan T Hughes
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Nuwan T Meegalla
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Mercedes Porosnicu
- Department of Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Hafiz S Patwa
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Christopher M Lack
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Paul M Bunch
- Department of Radiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, U.S.A
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Chin O, Alshafai L, O'Sullivan B, Su J, Hope A, Bartlett E, Hansen AR, Waldron J, Chepeha D, Xu W, Huang SH, Yu E. Inter-rater concordance and operating definitions of radiologic nodal feature assessment in human papillomavirus-positive oropharyngeal carcinoma. Oral Oncol 2022; 125:105716. [PMID: 35038657 DOI: 10.1016/j.oraloncology.2022.105716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/21/2021] [Accepted: 01/06/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE This study aims to evaluate the reliability of radiologic nodal feature assessment in clinical node-positive human papillomavirus-positive oropharyngeal carcinoma. MATERIALS AND METHODS Baseline CTs or MRIs of clinical node-positive human papillomavirus-positive oropharyngeal carcinoma diagnosed between 2012 and 2015 were reviewed independently by two neuroradiologists for seven nodal features: radiologic nodal involvement, cystic change, presence of necrosis, clustering, conglomeration, coalescence, and extranodal extension. Consensus operating definitions were derived after discussion. The features were re-reviewed in a randomly selected cohort. Levels of certainty (probability of presence: <25%, ∼50%, ∼75%, and >90%) were recorded. Interrater concordance was calculated using Cohen's kappa coefficient. RESULTS A total of 413 patients (826 necks) were eligible. At initial review, the inter-rater kappa values for: radiologic nodal involvement, cystic change, necrosis, clustering, conglomeration, coalescence, and extranodal extension were 0.92, 0.64, 0.48, 0.32, 0.32, 0.62, and 0.56, respectively. A re-review of 94 randomly selected cases (188 necks) after consolidation of operating definitions for nodal features showed that the inter-rater kappa values of these features were 0.83, 0.62, 0.58, 0.32, 0.18, 0.68, and 0.74 when considering ≥50% certainty as positive, and improved to 0.94, 0.66, 0.59, 0.33, 0.19, 0.76, and 0.86 when considering ≥75% certainty as positive. CONCLUSION Clearly defined nomenclature results in improved interrater reliability when assessing radiologic nodal features, especially for coalescent adenopathy and extranodal extension. Higher levels of certainty are associated with higher inter-rater agreement. Radiology reporting should include clear definitions of clinically relevant nodal features as well as levels of certainty to serve various needs in clinical care and research.
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Affiliation(s)
- Olivia Chin
- Department of Neuroradiology, University of Toronto, Toronto, Canada
| | - Laila Alshafai
- Department of Neuroradiology, University of Toronto, Toronto, Canada; Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Jie Su
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Andrew Hope
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Eric Bartlett
- Department of Neuroradiology, University of Toronto, Toronto, Canada; Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Aaron R Hansen
- Division of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - John Waldron
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Douglas Chepeha
- Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Toronto, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
| | - Eugene Yu
- Department of Neuroradiology, University of Toronto, Toronto, Canada; Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada.
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Mahajan A, Agarwal U, Gupta A, Shukla S, Ashtekar R, Shah P, Sable N, Ankathi S, Ahuja A, Noronha V, Prabhash K, Menon N, Patil V, Vaish R, D' CRUZ A. Synoptic reporting in head and neck cancers— Head and Neck Cancer Imaging Reporting and Data Systems (HN-CIRADS): The journey ahead for standardization of imaging in head and neck cancer staging. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_304_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Elsholtz FHJ, Ro SR, Shnayien S, Dinkelborg P, Hamm B, Schaafs LA. Impact of double reading on NI-RADS diagnostic accuracy in reporting oral squamous cell carcinoma surveillance imaging - a single-center study. Dentomaxillofac Radiol 2022; 51:20210168. [PMID: 34233509 PMCID: PMC8693328 DOI: 10.1259/dmfr.20210168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The Neck Imaging Reporting and Data System (NI-RADS) is an increasingly utilized risk stratification tool for imaging surveillance after treatment for head and neck cancer. This study aims to measure the impact of supervision by subspecialized radiologists on diagnostic accuracy of NI-RADS when initial reading is performed by residents. METHODS 150 CT and MRI datasets were initially read by two trained residents, and then supervised by two subspecialized radiologists. Recurrence rates by NI-RADS category were calculated, and receiver operating characteristic (ROC) curves were plotted. After dichotomization of the NI-RADS system (category 1 vs categories 2 + 3+4 and categories 1 + 2 vs 3 + 4), sensitivity, specificity, positive and negative predictive value were calculated. RESULTS 26% of the reports were modified by the supervising radiologists. Area under the curve of ROC plots values of the supervision session were higher than those of the initial reading session for both the primary site (0.89 vs 0.86) and the neck (0.94 vs 0.91), but the difference was not statistically significant. For dichotomized NI-RADS category assignments, differences between the initial reading and the supervision session were statistically significant regarding specificity and PPV for the primary site (1 + 2 vs 3 + 4 and 1 vs 2 + 3+4) or even for both sites combined (1 vs 2 + 3+4). CONCLUSION NI-RADS enables trained resident radiologists to report surveillance imaging in patients with treated oral squamous cell carcinoma with high discriminatory power. Additional supervision by a subspecialized head and neck radiologist particularly improves specificity of radiological reports.
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Affiliation(s)
- Fabian Henry Jürgen Elsholtz
- Department of Radiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Sa-Ra Ro
- Department of Radiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Seyd Shnayien
- Department of Radiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Patrick Dinkelborg
- Department of Oral and Maxillofacial Surgery, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, 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, Campus Benjamin Franklin, Berlin, Germany
| | - Lars-Arne Schaafs
- Department of Radiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
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18F FDG imaging - response criteria in tumors. Eur J Radiol 2021; 147:110054. [PMID: 34933213 DOI: 10.1016/j.ejrad.2021.110054] [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: 01/15/2021] [Revised: 11/07/2021] [Accepted: 11/15/2021] [Indexed: 11/22/2022]
Abstract
With the progress of medical oncology, it became apparent that anatomical imaging is oftentimes insufficient for therapy response evaluation. Hybrid imaging, namely 18F-FDG PET/CT has helped to overcome these limitations. The aim of this paper is to emphasize the utility and impact in clinical use of 18F-FDG PET/CT, and to give an overview of the most important 18F-FDG PET/CT tumor response criteria. We also focus on standardization of hybrid imaging techniques as this is of outmost importance to provide reliable imaging evaluation.
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Joyner D, Rizvi T, Kalelioglu T, Jameson MJ, Mukherjee S. Lymph Node Dissection: Principles and Postoperative Imaging. Neuroimaging Clin N Am 2021; 32:19-36. [PMID: 34809838 DOI: 10.1016/j.nic.2021.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The management of neck nodes in head and neck cancer is critical, given a markedly increased poor prognosis in patients with nodal metastasis. The surgical management of neck nodes has undergone radical changes secondary to a paradigm shift from curative surgery to nonsurgical organ and function-preserving options, such as radiation therapy. In the neck after treatment, radiologists should be familiar with imaging findings in various types of neck dissections and post-chemoradiation changes, along with signs of residual or recurrent disease. A multidisciplinary approach is essential with well-designed evidence-based surveillance imaging protocols and standardized reporting.
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Affiliation(s)
- David Joyner
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA 22903, USA
| | - Tanvir Rizvi
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA 22903, USA
| | - Tuba Kalelioglu
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA 22903, USA
| | - Mark J Jameson
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA 22903, USA
| | - Sugoto Mukherjee
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA 22903, USA.
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Raghavan P, Vakharia K, Morales RE, Mukherjee S. Surgical Free Flaps and Grafts in Head and Neck Reconstruction: Principles and Postoperative Imaging. Neuroimaging Clin N Am 2021; 32:75-91. [PMID: 34809845 DOI: 10.1016/j.nic.2021.09.002] [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: 11/17/2022]
Abstract
This review article discusses the basic principles behind the use of flaps and grafts for reconstructive surgery in the head and neck, with a special emphasis on the types of commonly used free flaps, their imaging appearance as well as some frequently encountered postoperative complications. Given the ubiquity and complexity of these reconstructive techniques, it is essential that head and neck radiologists be familiar in distinguishing between the expected evolving findings, complications, and tumor recurrence.
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Affiliation(s)
- Prashant Raghavan
- Neuroradiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
| | - Kalpesh Vakharia
- Department of Otorhinolaryngology-Head and Neck Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 419 West Redwood Street, Suite 370, Baltimore, MD 21201, USA
| | - Robert E Morales
- Neuroradiology, Diagnostic Neuroradiology Fellowship, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Sugoto Mukherjee
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, 1215 Lee Street, Charlottesville, VA 22908-1070, USA
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Baugnon KL. NI-RADS to Predict Residual or Recurrent Head and Neck Squamous Cell Carcinoma. Neuroimaging Clin N Am 2021; 32:1-18. [PMID: 34809832 DOI: 10.1016/j.nic.2021.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
American College of Radiology NI-RADS is a surveillance imaging template used to predict residual or recurrent tumor in the setting of head and neck cancer. The lexicon and imaging template provides a framework to standardize the interpretations and communications with referring physicians and provides linked management recommendations, which add value in patient care. Studies have shown reasonable interreader agreement and excellent discriminatory power among the different NI-RADS categories. This article reviews the literature associated with NI-RADS and serves as a practical guide for radiologists interested in using the NI-RADS surveillance template at their institution, highlighting frequently encountered pearls and pitfalls.
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Affiliation(s)
- Kristen L Baugnon
- Department of Radiology and Imaging Sciences, Division of Neuroradiology, Head and Neck Imaging, Emory University, 1364 Clifton Road, Atlanta, GA 30322, USA.
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Hostetter J, Yazbek S. Postoperative Pharynx and Larynx. Neuroimaging Clin N Am 2021; 32:37-53. [PMID: 34809843 DOI: 10.1016/j.nic.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Cancers of the pharynx and larynx are treated using a combination of chemotherapeutic, radiation, and surgical techniques, depending on the cancer type, biology, location, and stage, as well as patient and other factors. When imaging in the postsurgical setting, the knowledge of the type of tumor, preoperative appearance, and type of surgery performed is essential for accurate interpretation. Surgical anatomic changes, surgical implants/devices, and potential postsurgical complications must be differentiated from suspected recurrent tumors.
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Affiliation(s)
- Jason Hostetter
- Department of Radiology, University of Maryland School of Medicine, 655 W Baltimore St S, Baltimore, MD 21201, USA.
| | - Sandrine Yazbek
- Department of Radiology, University of Maryland School of Medicine, 655 W Baltimore St S, Baltimore, MD 21201, USA
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Guzmán Pérez-Carrillo GJ, Ivanidze J. PET/CT and PET/MR Imaging of the Post-treatment Head and Neck: Traps and Tips. Neuroimaging Clin N Am 2021; 32:111-132. [PMID: 34809833 DOI: 10.1016/j.nic.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PET/computed tomography and PET/MR imaging are used to evaluate the post-treatment neck. Although 18F-FDG is helpful in the staging and treatment response assessment of head and neck cancer, recently developed PET radiotracers targeting specific surface markers are promising for applications of diagnostic problem solving and improved extent delineation. Diffusion-weighted MR imaging is helpful in the differential diagnosis of head and neck neoplasms, and improves the sensitivity and specificity for the detection of certain pathologies. Following standardized imaging parameters for PET/computed tomography and diffusion-weighted imaging in PET/MR imaging improves diagnostic accuracy and allows for future research data mining.
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Affiliation(s)
- Gloria J Guzmán Pérez-Carrillo
- Neuroradiology Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway, Campus Box 8131, St Louis, MO 63110, USA.
| | - Jana Ivanidze
- Division of Molecular Imaging & Therapeutics, Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Starr Building, 2nd Floor, New York, NY 10065, USA; Division of Neuroradiology, Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Starr Building, 2nd Floor, New York, NY 10065, USA
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Posttreatment Magnetic Resonance Imaging Surveillance of Head and Neck Cancers. Magn Reson Imaging Clin N Am 2021; 30:109-120. [PMID: 34802574 DOI: 10.1016/j.mric.2021.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Treatment strategies and recommended surveillance imaging differ for head and neck cancers depending on subsite and neoplasm type, and pose confusion for referring physicians and interpreting radiologists. The superior soft tissue resolution offered by magnetic resonance imaging is most useful in the surveillance of cancers with high propensities for intraorbital, intracranial, or perineural disease spread, which most commonly include those arising from the sinonasal cavities, nasopharynx, orbits, salivary glands, and the skin. This article discusses recommended surveillance protocoling and reviews treatment approaches, common posttreatment changes, and pearls for identifying disease recurrence in a subsite-based approach.
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Cramer JD, Grauer J, Sukari A, Nagasaka M. Incidence of Second Primary Lung Cancer After Low-Dose Computed Tomography vs Chest Radiography Screening in Survivors of Head and Neck Cancer: A Secondary Analysis of a Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2021; 147:1071-1078. [PMID: 34709369 DOI: 10.1001/jamaoto.2021.2776] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance In head and neck cancer survivors, lung cancer screening may aid in detecting a second primary lung cancer or metastatic head and neck cancer earlier in the course of disease, which may improve treatment outcomes. However, no randomized data exist to assess the value of lung cancer screening in this population. Objective To evaluate the incidence of second primary lung cancer in survivors of head and neck cancer survivors with screening low-dose computed tomography (CT) vs chest radiography (CXR). Design, Setting and Participants For this ad hoc secondary analysis of a randomized clinical trial, head and neck cancer survivors were identified from the National Lung Screening Trial, which enrolled participants from August 2002 to April 2004. This randomized clinical trial compared screening using low-dose CT chest vs CXR in patients aged 55 to 74 years with at least a 30 pack-year history of cigarette smoking and who were current smokers or had quit within the past 15 years and who were at high risk for lung cancer. The incidences of second primary lung cancer and second primary head and neck cancer were compared with screening using low-dose CT vs CXR. Data were analyzed from December 1, 2020, to June 30, 2021. Interventions Screening low-dose CT of the chest vs CXR. Main Outcomes and Measures The primary outcome was the incidence of a second primary lung cancer. Results Among 53 452 enrolled participants, we identified 171 survivors of head and neck cancer, of whom 82 were screened with low-dose CT of the chest and 89 with CXR. Participants' mean (SD) age was 61 (5) years, and 132 were men (77.2%). The incidence of lung cancer was higher among head and neck cancer survivors compared with participants without head and neck cancer (2080 per 100 000 person-years [2.1%] vs 609 per 100 000 person-years [0.6%]; adjusted rate ratio, 2.54; 95% CI, 1.63-3.95). In head and neck cancer survivors, the incidence of second primary lung cancer was 2610 cases per 100 000 person-years in the low-dose CT group vs 1594 cases per 100 000 person-years in the CXR group (rate ratio, 1.55; 95% CI, 0.59-3.63). In head and neck cancer survivors, overall survival was 7.07 years with low-dose CT vs 6.66 years with CXR (log-rank P = .48). Conclusions and Relevance The results of this ad hoc secondary analysis of a randomized clinical trial suggest that head and neck cancer survivors are at especially high risk for a second primary lung cancer. These findings underscore the importance of low-dose CT screening in head and neck cancer survivors with significant cigarette smoking history who are fit to undergo treatment with curative intent.
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Affiliation(s)
- John D Cramer
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Karmanos Cancer Institute, Detroit, Michigan
| | - Jordan Grauer
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Karmanos Cancer Institute, Detroit, Michigan
| | - Ammar Sukari
- Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Misako Nagasaka
- Division of Hematology and Oncology, University of California Irvine School of Medicine, Orange.,Division of Neurology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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Bunch PM, Meegalla NT, Abualruz AR, Frizzell BA, Patwa HS, Porosnicu M, Williams DW, Aiken AH, Hughes RT. Initial Referring Physician and Radiologist Experience with Neck Imaging Reporting and Data System. Laryngoscope 2021; 132:349-355. [PMID: 34272871 DOI: 10.1002/lary.29765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Neck Imaging Reporting and Data System (NI-RADS) is a radiology reporting system developed for head and neck cancer surveillance imaging, using standardized terminology, numeric levels of suspicion, and linked management recommendations. Through a multidisciplinary, interdepartmental quality improvement initiative, we implemented NI-RADS for the reporting of head and neck cancer surveillance CT. Our objective is to summarize our initial experience from the standpoints of head and neck cancer providers and radiologists. STUDY DESIGN Quality improvement study. METHODS Before and 3 months post-implementation, surveys were offered to referring physicians (n = 21 pre-adoption; 22 post-adoption) and radiologists (n = 17 pre- and post-adoption). NI-RADS utilization was assessed over time. RESULTS Survey response rates were 62% (13/21) and 73% (16/22) for referring physicians pre- and post-adoption, respectively, and 94% (16/17) for radiologists pre- and post-adoption. Among post-adoption provider respondents, 100% (16/16) strongly agreed or agreed with "I want our radiologists to continue using NI-RADS," "The NI-RADS numerical rating of radiologic suspicion is helpful," and "The language and style of NI-RADS neck CT reports are clear and understandable." Among radiologist respondents, 88% (14/16) strongly agreed or agreed with "NI-RADS improves consistency among our radiologists in the reporting of surveillance neck CTs." Radiologist NI-RADS utilization increased over time (46% month 1; 72% month 3). CONCLUSIONS Most referring physicians and radiologists preferred NI-RADS. Head and neck cancer providers indicated that NI-RADS reports are clear, understandable, direct, and helpful in guiding clinical management. Radiologists indicated that NI-RADS improves radiologist consistency in the reporting of surveillance neck CT, and radiologists increasingly used NI-RADS over time. LEVEL OF EVIDENCE Level 4 Laryngoscope, 2021.
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Affiliation(s)
- Paul M Bunch
- Department of Radiology, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, North Carolina, U.S.A
| | - Nuwan T Meegalla
- Department of Surgery, Wake Forest School of Medicine, Winston Salem, North Carolina, U.S.A
| | - Abdul-Rahman Abualruz
- Department of Radiology, Wake Forest School of Medicine, Winston Salem, North Carolina, U.S.A
| | - Bart A Frizzell
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina, U.S.A
| | - Hafiz S Patwa
- Department of Otolaryngology - Head and Neck Surgery, Wake Forest School of Medicine, Winston Salem, North Carolina, U.S.A
| | - Mercedes Porosnicu
- Department of Hematology and Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina, U.S.A
| | - Daniel W Williams
- Department of Radiology, Wake Forest School of Medicine, Winston Salem, North Carolina, U.S.A
| | - Ashley H Aiken
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Ryan T Hughes
- Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina, U.S.A
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