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van Oorschot HD, de Jel DVC, Hardillo JA, Smeele LE, Baatenburg de Jong RJ. National Improvement of Waiting Times: First Results From the Dutch Head and Neck Audit. Otolaryngol Head Neck Surg 2024; 170:766-775. [PMID: 37747035 DOI: 10.1002/ohn.532] [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: 06/05/2023] [Revised: 08/21/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE Timely treatment initiation in head and neck cancer (HNC) care is of great importance regarding survival, oncological, functional, and psychological outcomes. Therefore, waiting times are assessed in the Dutch Head and Neck Audit (DHNA). This audit aims to assess and improve the quality of care through feedback and benchmarking. For this study, we examined how waiting times evolved since the start of the DHNA. STUDY DESIGN Prospective cohort study. SETTING National multicentre study. METHODS The DHNA was established in 2014 and reached national coverage of all patients treated for primary HNC in 2019. DHNA data on curative patients from 2015 to 2021 was extracted on national (benchmark) and hospital level. We determined 3 measures for waiting time: (1) the care pathway interval (CPI, first visit to start treatment), (2) the time to treatment interval (TTI, biopsy to start treatment), and (3) CPI-/TTI-indicators (percentage of patients starting treatment ≤30 days). The Dutch national quality norm for the CPI-indicator is 80%. RESULTS The benchmark median CPI and TTI improved between 2015 and 2021 from 37 to 26 days and 37 to 33 days, respectively. Correspondingly, the CPI- and TTI-indicators, respectively, increased from 39% to 64% and 35% to 40% in 2015 to 2021. Outcomes for all hospitals improved and dispersion between hospitals declined. Four hospitals exceeded the 80% quality norm in 2021. CONCLUSION Waiting times improved gradually over time, with 4 hospitals exceeding the quality standard in 2021. On the hospital-level, process improvement plans have been initiated. Systematic registration, auditing, and feedback of data support the improvement of quality of care.
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Affiliation(s)
- Hanneke Doremiek van Oorschot
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, Rotterdam, The Netherlands
| | | | - Jose Angelito Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, Rotterdam, The Netherlands
| | - Ludi E Smeele
- Department of Head and Neck Oncology and Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - Robert Jan Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, Rotterdam, The Netherlands
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Key S, Chia C, Magarey M, Dixon B. Risk of malignancy in incidental oropharyngeal lesions exhibiting fluorodeoxyglucose uptake which proceed to tissue biopsy. ANZ J Surg 2024; 94:122-127. [PMID: 38115646 DOI: 10.1111/ans.18839] [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: 08/07/2023] [Revised: 12/02/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Utilization of positron emission tomography/computed tomography (PET/CT) with fluorodeoxyglucose is increasing in use for a variety of indications, including surveillance of cancer patients. There is a paucity of evidence pertaining to the significance of incidental PET-avid oropharyngeal lesions. This study aims to examine the clinical and radiological features of these incidental oropharyngeal lesions in patients undergoing PET for indications other than head and neck cancer. METHODS Retrospective cohort study of three Australian tertiary hospitals, from 2015 to 2021, on adult patients undergoing biopsy of incidental PET-avid oropharyngeal lesions. Primary outcome of interest was the incidence of malignancy. Patients with a previous history of, or undergoing investigations for, head and neck cancer were excluded. RESULTS Thirty-one patients were included, wherein 21 patients had tonsillar uptake, and 13 patients had base of tongue uptake. Tonsillar disease was mostly asymmetrical (n = 15/21), bilateral (n = 11/21), and had median SUVmax 9.35 (n = 12, IQR 7.4-11.15). Base of tongue was mostly asymmetrical (n = 7/13, 54%), bilateral (n = 8/13, 62%), and had median SUVmax 8.2 (n = 10, IQR 6.9-12.65). Seven patients had malignancy confirmed on tissue biopsy: five biopsies confirmed the tissue diagnosis of suspected lymphoma, and two incidental findings of unexpected malignancies: one p16 positive tonsillar squamous cell carcinoma, and one metastatic breast cancer. CONCLUSION In 31 patients undergoing tissue biopsy for incidental PET-avid oropharyngeal lesions, there were two unexpected malignancies. Our study results indicate that although unexpected malignancies are uncommon, a malignant diagnosis cannot be excluded from clinical features alone.
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Affiliation(s)
- Seraphina Key
- Department of ENT, Head & Neck Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Clemente Chia
- Department of ENT, Head & Neck Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Matthew Magarey
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
- Pinnacle Surgery, Epworth Hospital, Richmond, Victoria, Australia
- Department of Medical Education, University of Melbourne, Parkville, Victoria, Australia
| | - Benjamin Dixon
- Department of ENT, Head & Neck Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Pinnacle Surgery, Epworth Hospital, Richmond, Victoria, Australia
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Lee YJ, van den Berg NS, Duan H, Azevedo EC, Ferri V, Hom M, Raymundo RC, Valencia A, Castillo J, Shen B, Zhou Q, Freeman L, Koran ME, Kaplan MJ, Colevas AD, Baik FM, Chin FT, Martin BA, Iagaru A, Rosenthal EL. 89Zr-panitumumab Combined With 18F-FDG PET Improves Detection and Staging of Head and Neck Squamous Cell Carcinoma. Clin Cancer Res 2022; 28:4425-4434. [PMID: 35929985 DOI: 10.1158/1078-0432.ccr-22-0094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/16/2022] [Accepted: 08/02/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Determine the safety and specificity of a tumor-targeted radiotracer (89Zr-pan) in combination with 18F-FDG PET/CT to improve diagnostic accuracy in head and neck squamous cell carcinoma (HNSCC). EXPERIMENTAL DESIGN Adult patients with biopsy-proven HNSCC scheduled for standard-of-care surgery were enrolled in a clinical trial and underwent systemic administration of 89Zirconium-panitumumab and panitumumab-IRDye800 followed by preoperative 89Zr-pan PET/CT and intraoperative fluorescence imaging. The sensitivity, specificity, and AUC were evaluated. RESULTS A total of fourteen patients were enrolled and completed the study. Four patients (28.5%) had areas of high 18F-FDG uptake outside the head and neck region with maximum standardized uptake values (SUVmax) greater than 2.0 that were not detected on 89Zr-pan PET/CT. These four patients with incidental findings underwent further workup and had no evidence of cancer on biopsy or clinical follow-up. Forty-eight lesions (primary tumor, LNs, incidental findings) with SUVmax ranging 2.0-23.6 were visualized on 18F-FDG PET/CT; 34 lesions on 89Zr-pan PET/CT with SUVmax ranging 0.9-10.5. The combined ability of 18F-FDG PET/CT and 89Zr-pan PET/CT to detect HNSCC in the whole body was improved with higher specificity of 96.3% [confidence interval (CI), 89.2%-100%] compared to 18F-FDG PET/CT alone with specificity of 74.1% (CI, 74.1%-90.6%). One possibly related grade 1 adverse event of prolonged QTc (460 ms) was reported but resolved in follow-up. CONCLUSIONS 89Zr-pan PET/CT imaging is safe and may be valuable in discriminating incidental findings identified on 18F-FDG PET/CT from true positive lesions and in localizing metastatic LNs.
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Affiliation(s)
- Yu-Jin Lee
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine. Stanford, California
| | | | - Heying Duan
- Department of Radiology, Stanford University School of Medicine. Stanford, California
| | - E Carmen Azevedo
- Department of Radiology, Stanford University School of Medicine. Stanford, California
| | - Valentina Ferri
- Department of Radiology, Stanford University School of Medicine. Stanford, California
| | - Marisa Hom
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center. Nashville, Tennessee
| | - Roan C Raymundo
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine. Stanford, California
| | - Alex Valencia
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine. Stanford, California
| | - Jessa Castillo
- Department of Radiology, Stanford University School of Medicine. Stanford, California
| | - Bin Shen
- Department of Radiology, Stanford University School of Medicine. Stanford, California
| | - Quan Zhou
- Department of Neurosurgery, Stanford University School of Medicine. Stanford, California
| | - Laura Freeman
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine. Stanford, California
| | - Mary Ellen Koran
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center. Nashville, Tennessee
| | - Michael J Kaplan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine. Stanford, California
| | - A Dimitrios Colevas
- Department of Medicine - Division of Medical Oncology, Stanford University School of Medicine. Stanford, California
| | - Fred M Baik
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine. Stanford, California
| | - Frederick T Chin
- Department of Radiology, Stanford University School of Medicine. Stanford, California
| | - Brock A Martin
- Department of Pathology, University of Louisville. Louisville, Kentucky
| | - Andrei Iagaru
- Department of Radiology, Stanford University School of Medicine. Stanford, California
| | - Eben L Rosenthal
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center. Nashville, Tennessee
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Cortés P, Ghoz HM, Stancampiano F, Omer M, Malviya B, Bowman AW, Palmer WC. Incidentalomas are associated with an increase in liver transplantation in patients with cirrhosis: a single-center retrospective study. BMC Gastroenterol 2022; 22:336. [PMID: 35818022 PMCID: PMC9275240 DOI: 10.1186/s12876-022-02379-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Incidentalomas, defined as incidental findings on imaging, are a growing concern. Our aim was to determine the impact and outcomes of extrahepatic incidentalomas on liver transplantation.
Methods Patients at a large liver transplant center, who had an initial MRI for hepatocellular carcinoma screening between January 2004 and March 2020 were identified. Clinical data were collected retrospectively. Survival analysis, utilizing Kaplan Meier estimates and Cox proportional hazards regression analysis, was utilized to determine factors associated with liver transplantation. Results 720 patients were included. NASH (24.9%), HCV (22.1%) and alcohol (20.6%) were the most common causes of cirrhosis. 79.7% of patients had an extrahepatic incidentaloma. Older age and having received a liver transplant by the end of the study were associated with an incidentaloma. MELD was not associated with the presence of an incidentaloma. On univariate Cox proportional hazards regression, male sex, history of moderate alcohol use, smoking history, MELD, and incidentalomas were predictors of liver transplantation. On multivariate analysis, only MELD and the presence of an incidentaloma were found to be significant. Discovery of an incidentaloma was associated with a 30% increase in the risk of liver transplantation. Median time to transplantation did not differ based on the presence on an incidentaloma. Patients with cirrhosis from alcohol or HCV had a significantly shorter median time to transplantation than those with NASH. Renal and pancreatic lesions comprised 91% of all incidentalomas. Conclusions In this single-center retrospective study, extrahepatic incidentalomas were common in patients with cirrhosis. The finding of an incidentaloma was associated with a higher risk of liver transplantation despite a similar median time to transplantation if no incidentaloma was discovered.
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Affiliation(s)
- Pedro Cortés
- Division of Community Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, 32224, USA
| | - Hassan M Ghoz
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Fernando Stancampiano
- Division of Community Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, 32224, USA
| | - Mohamed Omer
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Balkishan Malviya
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Andrew W Bowman
- Division of Hospital and Emergency Radiology, Mayo Clinic Florida, Jacksonville, FL, 32224, USA
| | - William C Palmer
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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