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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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2
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Cai ZM, Li ZZ, Zhong NN, Cao LM, Xiao Y, Li JQ, Huo FY, Liu B, Xu C, Zhao Y, Rao L, Bu LL. Revolutionizing lymph node metastasis imaging: the role of drug delivery systems and future perspectives. J Nanobiotechnology 2024; 22:135. [PMID: 38553735 PMCID: PMC10979629 DOI: 10.1186/s12951-024-02408-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/18/2024] [Indexed: 04/02/2024] Open
Abstract
The deployment of imaging examinations has evolved into a robust approach for the diagnosis of lymph node metastasis (LNM). The advancement of technology, coupled with the introduction of innovative imaging drugs, has led to the incorporation of an increasingly diverse array of imaging techniques into clinical practice. Nonetheless, conventional methods of administering imaging agents persist in presenting certain drawbacks and side effects. The employment of controlled drug delivery systems (DDSs) as a conduit for transporting imaging agents offers a promising solution to ameliorate these limitations intrinsic to metastatic lymph node (LN) imaging, thereby augmenting diagnostic precision. Within the scope of this review, we elucidate the historical context of LN imaging and encapsulate the frequently employed DDSs in conjunction with a variety of imaging techniques, specifically for metastatic LN imaging. Moreover, we engage in a discourse on the conceptualization and practical application of fusing diagnosis and treatment by employing DDSs. Finally, we venture into prospective applications of DDSs in the realm of LNM imaging and share our perspective on the potential trajectory of DDS development.
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Affiliation(s)
- Ze-Min Cai
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430072, China
| | - Zi-Zhan Li
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430072, China
| | - Nian-Nian Zhong
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430072, China
| | - Lei-Ming Cao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430072, China
| | - Yao Xiao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430072, China
| | - Jia-Qi Li
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430072, China
| | - Fang-Yi Huo
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430072, China
| | - Bing Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430072, China
- Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, Hubei, China
| | - Chun Xu
- School of Dentistry, The University of Queensland, Brisbane, QLD, 4066, Australia
| | - Yi Zhao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430072, China
- Department of Prosthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Lang Rao
- Institute of Biomedical Health Technology and Engineering, Shenzhen Bay Laboratory, Shenzhen, 518132, China.
| | - Lin-Lin Bu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430072, China.
- Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, Hubei, China.
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3
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Zhang R, Xu Y, Gao S, Jing Y, Li W. Observer- and radiomics model-based computed tomography classification of suppurative versus tuberculous lymphadenitis complicated with nodal necrosis of the neck in children. Pediatr Radiol 2023; 53:2586-2596. [PMID: 37806973 DOI: 10.1007/s00247-023-05761-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Computed tomography (CT) can be used for the early detection of lymphadenitis. Radiomics is able to identify a large amount of hidden information from images. However, few CT-based radiomics studies on cervical lymphadenitis in children have been published. OBJECTIVE This study aimed to investigate the role of visual CT analysis and CT radiomics in differentiating cervical suppurative node necrosis from tuberculous node necrosis in pediatric patients. MATERIALS AND METHODS A total of 101 patients with cervical suppurative lymphadenitis (n=52) or cervical tuberculous lymphadenitis (n=49) were included. Clinical data and CT images were retrieved for analysis. For visual observation, 11 major CT features were identified for univariate and multivariate analyses. For radiomics analysis, image segmentation, feature value extraction, and dimension reduction, feature selection and the construction of radiomics-based models were performed through the RadCloud platform. RESULTS For the visual observation, significant differences were found between the two groups, including the short diameter of the largest necrotic lymph node (P=0.03), sharp border of the node (P=0.02), fusion of nodes (P=0.02), regular silhouette of the necrotic area (P=0.001), multilocular necrotic area (P=0.02), node calcification (P=0.004), and enhancement degree of the nodal nonnecrotic area (P=0.01). No feature was found to be an independent predictor for suppurative or tuberculous lymphadenitis (P>0.05 for all features). Concerning the radiomics analysis, after feature value extraction and dimension reduction, nine related features were selected. The support vector machine classifier achieved high diagnostic performance in distinguishing suppurative from tuberculous lymphadenitis. The area under the curve, accuracy, sensitivity, and specificity of the support vector machine model test set were 0.89 (95% confidence interval: 0.72-1.00), 0.88, 0.78, and 0.90, respectively. CONCLUSION Compared to observer-based CT image analyses, radiomics model-based CT image analyses exhibit better performance in the differential diagnosis of cervical suppurative and tuberculous lymphadenitis complicated with nodal necrosis in children.
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Affiliation(s)
- Rui Zhang
- Department of Radiology, Children's Hospital of Chongqing Medical University, The Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, 136 Zhongshan Er Lu, Yuzhong District, Chongqing, 400000, China
| | - Ye Xu
- Department of Radiology, Children's Hospital of Chongqing Medical University, The Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, 136 Zhongshan Er Lu, Yuzhong District, Chongqing, 400000, China
| | - Sijie Gao
- Department of Radiology, Children's Hospital of Chongqing Medical University, The Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, 136 Zhongshan Er Lu, Yuzhong District, Chongqing, 400000, China
| | - Yang Jing
- Huiying Medical Technology Co., Ltd., Haidian District, Beijing, 100192, China
| | - Wei Li
- Department of Radiology, Children's Hospital of Chongqing Medical University, The Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, 136 Zhongshan Er Lu, Yuzhong District, Chongqing, 400000, China.
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4
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Mahale AR, Mahale NA. Diagnostic dilemma of the supraclavicular lymph node in oncology. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:1596-1597. [PMID: 37941502 DOI: 10.1002/jcu.23595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Ajit R Mahale
- Kasturba Medical College Mangalore, Mangalore, India
- Manipal Academy of Higher Education Manipal, Manipal, India
| | - Nina Ajit Mahale
- Kasturba Medical College Mangalore, Mangalore, India
- Manipal Academy of Higher Education Manipal, Manipal, India
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5
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Patel J, Maymeskul V, Kim J. Infections of the Oral Cavity and Suprahyoid Neck. Oral Maxillofac Surg Clin North Am 2023:S1042-3699(23)00001-8. [PMID: 37032180 DOI: 10.1016/j.coms.2023.01.001] [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: 04/11/2023]
Abstract
Acute infections of the oral cavity and suprahyoid neck range from simple superficial conditions that can be treated as an outpatient to complex multispatial processes that require surgical intervention and inpatient admission. This article provides an imaging overview of the range of infections in this region that may be encountered by oral and maxillofacial surgeons, emergency physicians, and primary care providers.
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Affiliation(s)
- Jeet Patel
- Department of Radiology, University of Florida College of Medicine - Jacksonville, 655 West 8th Street C90, Clinical Center 2nd Floor, Jacksonville, FL 32209, USA.
| | - Volodymyr Maymeskul
- Department of Radiology, University of Florida College of Medicine - Jacksonville, 655 West 8th Street C90, Clinical Center 2nd Floor, Jacksonville, FL 32209, USA
| | - John Kim
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive B2A205, Ann Arbor, MI 48109, USA
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6
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Wu Y, Yu H, Tang T, Li L, Tian Y. Difference after radiotherapy observed in patients with nasopharyngeal carcinoma. Bull Cancer 2023; 110:487-495. [PMID: 36966055 DOI: 10.1016/j.bulcan.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/17/2023] [Accepted: 02/05/2023] [Indexed: 03/27/2023]
Abstract
To evaluate the shrinkage rate of small cervical lymph nodes (SCLNs) at different levels in patients with nasopharyngeal carcinoma (NPC) treated with radiotherapy retrospectively. 96 adult patients with NPC who underwent intensity-modulated radiotherapy (IMRT) at our institution were analyzed and followed-up. Evaluation of the response (shrinking rate) of SCLNs was determined by the bidimensional tumor area. Binary logistic regression was conducted to explore the risk factors associated with the shrinking rate of SCLNs. Of the 96 patients included in this study, 1,194 SCLNs were identified. Among the SCLNs, 28.6% were level IIb and 21.3% were level IIa. SCLNs at level IIa (96.1%), tended to have a response effect of no change (NC) with shrinking rate <50% (odds ratio [OR]=0.007; 95% CI: 0.003-0.021, P=5.287×10-25). Conversely, the most proportionate share of SCLNs for shrinking rate ≥50% (complete response (CR) or partial response (PR)) was observed at level IIb (67.2%) (OR=6.104; 95% CI: 3.267-11.407, P=1.420×10-8). There was no significant difference of shrinking rate between irradiation doses of 60Gy and 63Gy. Most SCLNs at level IIa were not shrunk after radiotherapy. The irradiation dose of SCLNs at level IIa should be not more than 60Gy to reduce side effects.
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Affiliation(s)
- Yang Wu
- The Second Affiliated Hospital of Soochow University, Department of Radiotherapy & Oncology, 215004 Suzhou, Jiangsu, PR China
| | - Hongmin Yu
- School of Public Health, Xuzhou Medical University, 221004 Xuzhou, Jiangsu, PR China; Center for Medical Statistics and Data Analysis, Xuzhou Medical University, 221004 Jiangsu, PR China
| | - Tianyou Tang
- Xuzhou Medical University Affiliated Hospital, Department of Radiation Oncology, Xuzhou, 221004 Jiangsu, PR China
| | - Liantao Li
- Xuzhou Medical University Affiliated Hospital, Department of Radiation Oncology, Xuzhou, 221004 Jiangsu, PR China
| | - Ye Tian
- The Second Affiliated Hospital of Soochow University, Department of Radiotherapy & Oncology, 215004 Suzhou, Jiangsu, PR China; Institution of Radiotherapy & Oncology, Soochow University, 215004 Jiangsu, PR China.
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7
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Application of an Interpretable Machine Learning Model to Predict Lymph Node Metastasis in Patients with Laryngeal Carcinoma. JOURNAL OF ONCOLOGY 2022; 2022:6356399. [PMID: 36411795 PMCID: PMC9675609 DOI: 10.1155/2022/6356399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/01/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022]
Abstract
Objectives A more accurate preoperative prediction of lymph node metastasis (LNM) plays a decisive role in the selection of treatment in patients with laryngeal carcinoma (LC). This study aimed to develop a machine learning (ML) prediction model for predicting LNM in patients with LC. Methods We collected and retrospectively analysed 4887 LC patients with detailed demographical characteristics including age at diagnosis, race, sex, primary site, histology, number of tumours, T-stage, grade, and tumour size in the National Institutes of Health (NIH) Surveillance, Epidemiology, and End Results (SEER) database from 2005 to 2015. A correlation analysis of all variables was evaluated by the Pearson correlation. Independent risk factors for LC patients with LNM were identified by univariate and multivariate logistic regression analyses. Afterward, patients were randomly divided into training and test sets in a ratio of 8 to 2. On this basis, we established logistic regression (LR), k-nearest neighbor (KNN), support vector machine (SVM), extreme gradient boosting (XGBoost), random forest (RF), and light gradient boosting machine (LightGBM) algorithm models based on ML. The area under the receiver operating characteristic curve (AUC) value, accuracy, precision, recall rate, F1-score, specificity, and Brier score was adopted to evaluate and compare the prediction performance of the models. Finally, the Shapley additive explanation (SHAP) method was used to interpret the association between each feature variable and target variables based on the best model. Results Of the 4887 total LC patients, 3409 were without LNM (69.76%), and 1478 had LNM (30.24%). The result of the Pearson correlation showed that variables were weakly correlated with each other. The independent risk factors for LC patients with LNM were age at diagnosis, race, primary site, number of tumours, tumour size, grade, and T-stage. Among six models, XGBoost displayed a better performance for predicting LNM, with five performance metrics outperforming other models in the training set (AUC: 0.791 (95% CI: 0.776–0.806), accuracy: 0.739, recall rate: 0.638, F1-score: 0.663, and Brier score: 0.165), and similar results were observed in the test set. Moreover, the SHAP value of XGBoost was calculated, and the result showed that the three features, T-stage, primary site, and grade, had the greatest impact on predicting the outcomes. Conclusions The XGBoost model performed better and can be applied to forecast the LNM of LC, offering a valuable and significant reference for clinicians in advanced decision-making.
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8
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Pabst A, Thiem DGE, Goetze E, Bartella AK, Neuhaus MT, Hoffmann J, Zeller AN. How is neck dissection performed in Oral and Maxillofacial Surgery? Results of a representative nationwide survey among university and non-university hospitals in Germany. Clin Oral Investig 2021; 25:3007-3019. [PMID: 33779814 PMCID: PMC8113132 DOI: 10.1007/s00784-020-03622-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/01/2020] [Indexed: 11/30/2022]
Abstract
Introduction Neck dissection (ND) is a surgical procedure addressing cervical lymph nodes and metastases in patients with oral squamous cell carcinoma (OSCC). The aim of this study was to analyze clinical decisions regarding indications and variations of ND in Oral and Maxillofacial Surgery (OMFS) in Germany. Material and methods A nationwide survey of the German Association of Oral and Maxillofacial Surgery was performed using dynamic online questionnaires including 38 questions. Data about oncological centers, case numbers, and staging procedures were collected. Relevant aspects, such as inclusion of level IIb and levels IV and V to ND, uni- vs. bilateral ND, and the influence of extra-nodal extension (ENE) of metastases on extension of ND were evaluated. Results Eighty-four OMFS of university and non-university hospitals participated in the study (responding rate 21.4%). Sixty-six (78.57%) stated to work at certified cancer centers and 53.57% of the hospitals treated between 50 and 100 OSCC cases per year. CT and/or MRI of the head and neck was performed in most of the staging procedures. Level IIb was included by 71 (93.42%) of the participants in selective ND. Levels IV and V were included by 53 (69.74%) in node-positive neck. In solitary ipsilateral metastases (ENE−), 49 participants (62.82%) stated to perform exclusively an ipsilateral ND and 40 (51.95%) stated to perform only an ipsilateral ND in ENE+. Conclusion This study demonstrated a high rate of certified cancer centers in Germany showing differences regarding staging procedures, indications, and extension of ND, especially in increasingly complex cases. Clinical relevance Clinical decisions regarding ND are dependent on case-individual aspects and must be decided individually.
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Affiliation(s)
- Andreas Pabst
- Department of Oral and Maxillofacial Surgery, Federal Armed Forces Hospital, Rübenacherstr. 170, 56072, Koblenz, Germany.
| | - Daniel G E Thiem
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Elisabeth Goetze
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glückstr. 11, 91054, Erlangen, Germany
| | - Alexander K Bartella
- Department of Oral- and Maxillofacial Surgery, University Hospital Leipzig, Liebigstr. 12, 04103, Leipzig, Germany
| | - Michael T Neuhaus
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Alexander-N Zeller
- Department of Oral and Maxillofacial Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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9
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Aulino JM, Kirsch CFE, Burns J, Busse PM, Chakraborty S, Choudhri AF, Conley DB, Jones CU, Lee RK, Luttrull MD, Moritani T, Policeni B, Ryan ME, Shah LM, Sharma A, Shih RY, Subramaniam RM, Symko SC, Bykowski J. ACR Appropriateness Criteria ® Neck Mass-Adenopathy. J Am Coll Radiol 2020; 16:S150-S160. [PMID: 31054741 DOI: 10.1016/j.jacr.2019.02.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 11/26/2022]
Abstract
A palpable neck mass may be the result of neoplastic, congenital, or inflammatory disease. Older age suggests neoplasia, and a congenital etiology is more prevalent in the pediatric population. The imaging approach is based on the patient age, mass location, and clinical pulsatility. Underlying human papillomavirus-related malignancy should be considered in all age groups. Although the imaging appearance of some processes in the head and neck overlap, choosing the appropriate imaging examination may allow a specific diagnosis, or a limited differential diagnosis. Tissue sampling is indicated to confirm suspected malignancy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Claudia F E Kirsch
- Panel Chair, Northwell Health, Zucker Hofstra School of Medicine at Northwell, Manhasset, New York
| | | | - Paul M Busse
- Massachusetts General Hospital, Boston, Massachusetts
| | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada, Canadian Association of Radiologists
| | - Asim F Choudhri
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - David B Conley
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, American Academy of Otolaryngology-Head and Neck Surgery
| | | | - Ryan K Lee
- Einstein Healthcare Network, Philadelphia, Pennsylvania
| | | | | | - Bruno Policeni
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Maura E Ryan
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Aseem Sharma
- Mallinckrodt Institute of Radiology, Saint Louis, Missouri
| | - Robert Y Shih
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | - Julie Bykowski
- Specialty Chair, UC San Diego Health Center, San Diego, California
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10
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Distinguin L, Ammar A, Lechien JR, Chetrit A, Idrissi YC, Circiu M, Saussez S, Berradja N, Edjlali M, Carlier R, Hans S. MRI of Patients Infected With COVID-19 Revealed Cervical Lymphadenopathy. EAR, NOSE & THROAT JOURNAL 2020; 100:26-28. [PMID: 32703030 DOI: 10.1177/0145561320940117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Lea Distinguin
- Department of Otolaryngology-Head Neck Surgery, 37918Foch Hospital, Paris Saclay University, Paris, France
| | - Amine Ammar
- Department of Radiology, APHP, 55059Hôpitaux R. Poincaré-Ambroise Paré, DMU Smart Imaging, GH Université Paris-Saclay, U 1179 UVSQ/Paris-Saclay, Paris, France
| | - Jerome R Lechien
- Department of Otolaryngology-Head Neck Surgery, 37918Foch Hospital, Paris Saclay University, Paris, France.,Department of Anatomy, University of Mons (54521UMons), Mons, Belgium.,Department of Otolaryngology-Head Neck Surgery, 81880CHU de Bruxelles (Saint-Pierre), Université Libre de Bruxelles, Brussels, Belgium
| | - Annaelle Chetrit
- Department of Radiology, APHP, 55059Hôpitaux R. Poincaré-Ambroise Paré, DMU Smart Imaging, GH Université Paris-Saclay, U 1179 UVSQ/Paris-Saclay, Paris, France
| | - Younes Chekkoury Idrissi
- Department of Otolaryngology-Head Neck Surgery, 37918Foch Hospital, Paris Saclay University, Paris, France
| | - Marta Circiu
- Department of Otolaryngology-Head Neck Surgery, 37918Foch Hospital, Paris Saclay University, Paris, France
| | - Sven Saussez
- Department of Anatomy, University of Mons (54521UMons), Mons, Belgium.,Department of Otolaryngology-Head Neck Surgery, 81880CHU de Bruxelles (Saint-Pierre), Université Libre de Bruxelles, Brussels, Belgium
| | - Najete Berradja
- Department of Radiology, APHP, 55059Hôpitaux R. Poincaré-Ambroise Paré, DMU Smart Imaging, GH Université Paris-Saclay, U 1179 UVSQ/Paris-Saclay, Paris, France
| | - Myriam Edjlali
- Department of Radiology, APHP, 55059Hôpitaux R. Poincaré-Ambroise Paré, DMU Smart Imaging, GH Université Paris-Saclay, U 1179 UVSQ/Paris-Saclay, Paris, France.,Department of Neuroradiology, Centre Hospitalier Sainte-Anne, Paris, France
| | - Robert Carlier
- Department of Radiology, APHP, 55059Hôpitaux R. Poincaré-Ambroise Paré, DMU Smart Imaging, GH Université Paris-Saclay, U 1179 UVSQ/Paris-Saclay, Paris, France
| | - Stephane Hans
- Department of Otolaryngology-Head Neck Surgery, 37918Foch Hospital, Paris Saclay University, Paris, France
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González Moreno I, Torres del Río S, Vázquez Olmos C. Seguimiento del cáncer de cabeza y cuello tratado. Lo que el radiólogo debe conocer. RADIOLOGIA 2020; 62:13-27. [DOI: 10.1016/j.rx.2019.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 05/27/2019] [Accepted: 07/29/2019] [Indexed: 11/25/2022]
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Cervical necrotic lymphadenopathy: a diagnostic tree analysis model based on CT and clinical findings. Eur Radiol 2019; 29:5635-5645. [PMID: 30915564 DOI: 10.1007/s00330-019-06155-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/22/2019] [Accepted: 03/11/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To establish a diagnostic tree analysis (DTA) model based on computed tomography (CT) findings and clinical information for differential diagnosis of cervical necrotic lymphadenopathy, especially in regions where tuberculous lymphadenitis and Kikuchi disease are common. METHODS A total of 290 patients (147 men and 143 women; mean age (years), 46.2 ± 19.5; range, 3-91) with pathologically confirmed metastasis (n = 110), tuberculous lymphadenitis (n = 73), Kikuchi disease (n = 71), and lymphoma (n = 36) who underwent contrast-enhanced neck CT were included. The patients were randomly divided into training (86%, 248/290) and validation (14%, 42/290) datasets to assess diagnostic performance of the DTA model. Two sorts of DTA models were created using a classification and regression tree algorithm on the basis of CT findings alone and that combined with clinical findings. RESULTS In the DTA model based on CT findings alone, perinodal infiltration, number of the necrotic foci, percentage of necrotic lymph node (LN), degree of necrosis, margin and shape of the necrotic portion, shape of the LN, and enhancement ratio (cutoff value, 1.93) were significant predictors for differential diagnosis of cervical necrotic lymphadenopathy. The overall accuracy was 80.6% and 73.8% in training and validation datasets. In the model based on imaging and clinical findings, tenderness, history of underlying malignancy, percentage of necrotic LN, degree of necrosis, and number of necrotic foci were significant predictors. The overall accuracy was 87.1% and 88.1% in training and external validation datasets. CONCLUSIONS The DTA model based on CT imaging and clinical findings may be helpful for the diagnosis of cervical necrotic lymphadenopathy. KEY POINTS • The diagnostic tree analysis model based on CT may be useful for differential diagnosis of cervical necrotic lymphadenopathy. • Perinodal infiltration, number of necrotic foci, percentage of necrotic lymph nodes, degree of necrosis, margin and shape of necrotic portion, lymph node shape, and enhancement ratio were the most significant predictors.
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Rahimi-Nedjat RK, Al-Nawas B, Tuettenberg A, Sagheb K, Grabbe S, Walter C. Sentinel lymph node biopsy in malignant melanoma of the head and neck. J Craniomaxillofac Surg 2018; 46:1027-1031. [PMID: 29735384 DOI: 10.1016/j.jcms.2018.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/15/2018] [Accepted: 04/04/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of this retrospective study was to investigate sentinel lymph node biopsy in patients with head and neck melanoma. MATERIALS AND METHODS Patients who underwent SLNB between 2010 and 2016 were comprised. Epidemiological, radiological, and surgical data were collected and compared to histological findings. Patients who underwent primary complete lymph node dissection were excluded. RESULTS 74 patients underwent SLNB during this period. The most common tumor localizations were the cheek (20.4%) and ears (20.4%). Overall, 256 sentinel lymph nodes (SLN) were detected and removed, most frequently in Robbins-levels IIA and IIB as well as in the surrounding of the parotid gland. 12.3% of the SLN showed a microscopic or macroscopic metastasis. In preoperative imaging all lymph nodes with macroscopic metastasis were described as suspect but only 4 of 11 lymph nodes with microscopic metastases were described as such. CONCLUSIONS SLNB is an especially good procedure for the diagnosis of microscopically metastases as disease status is an important diagnostic and prognostic factor in early-stage melanoma patients. However, due to the complex lymphatic system in head and neck melanoma, a short follow-up interval is necessary in order to prevent delayed diagnosis of a nodal recurrence due to a false-negative SLN.
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Affiliation(s)
- Roman Kia Rahimi-Nedjat
- Department of Oral and Maxillofacial Surgery of the University Medical Center of the Johannes Gutenberg-University, Augustusplatz 2, 55131, Mainz, Germany.
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery of the University Medical Center of the Johannes Gutenberg-University, Augustusplatz 2, 55131, Mainz, Germany
| | - Andrea Tuettenberg
- Department of Dermatology of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Keyvan Sagheb
- Department of Oral and Maxillofacial Surgery of the University Medical Center of the Johannes Gutenberg-University, Augustusplatz 2, 55131, Mainz, Germany
| | - Stephan Grabbe
- Department of Dermatology of the Johannes Gutenberg-University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Christian Walter
- Department of Oral and Maxillofacial Surgery of the University Medical Center of the Johannes Gutenberg-University, Augustusplatz 2, 55131, Mainz, Germany
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Dual-Energy Computed Tomography Applications for the Evaluation of Cervical Lymphadenopathy. Neuroimaging Clin N Am 2017; 27:461-468. [PMID: 28711205 DOI: 10.1016/j.nic.2017.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There is recent interest in the use of dual-energy computed tomography (CT) in head and neck imaging, and the results are encouraging. This article reviews dual-energy CT applications as complementary tools to conventional CT scanning in the evaluation of cervical lymphadenopathy. The article cites the most relevant studies and highlights their results. Single-source and dual-source dual-energy applications including virtual noncontrast images, linear and nonlinear image blending, monochromatic images, iodine quantification, and spectral Hounsfield unit attenuation curve analysis are reviewed. Future directions and research suggestions are discussed in brief.
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Sjogren PP, Arnold RW, Skirko JR, Grimmer JF. Anatomic distribution of cervicofacial lymphatic malformations based on lymph node groups. Int J Pediatr Otorhinolaryngol 2017; 97:72-75. [PMID: 28483255 DOI: 10.1016/j.ijporl.2017.02.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/17/2017] [Accepted: 02/26/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate radiographic characteristics and to identify locations of cervicofacial lymphatic malformations in children based on known lymph node groupings. METHODS Retrospective chart review of pediatric patients with cervicofacial lymphatic malformations who underwent imaging with magnetic resonance imaging (MRI), computed tomography (CT) or ultrasonography (US). Ninety charts were reviewed from November 2005 to June 2015. Demographic information and imaging characteristics were evaluated. RESULTS Ninety children were included. The average age at presentation was 52 months (range, 1 day to 170 months). Imaging modalities were MRI in 73 (81%), CT in 7 (8%), US in 6 (7%), and multimodality imaging in 4 (4%) cases. Nearly half (49%) of lesions were found in the parotid and submandibular nodal group, 32% in the cervical group, and 19% in the midline face and oral cavity group. The lymphatic malformations were found on the left in 39 (43%) of cases, on the right in 30 (33%) of cases, and were bilateral in 21 (23%) cases. Nineteen (21%) lesions were macrocystic, twenty-two (24%) were microcystic, and forty-nine (49%) had mixed features. Mixed lesions were more likely to be extensive and involve multiple lymph node groups (P = 0.0005). Adjacent lymphadenopathy was present in 20 (22%) among all subjects, with an average size of 1.22 (± 1.92) cm in the short-axis. CONCLUSION The results of this study demonstrate three lymph node groupings in which LM are commonly identified. The midline face and oral cavity lesions are predominantly microcystic, the parotid and submandibular lesions are predominately of mixed morphology, and the cervical lesions are predominately macrocystic and mixed. Further studies are needed to determine if such a classification system demonstrates clinically significant difference in disease progression and response to therapy.
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Affiliation(s)
- Phayvanh P Sjogren
- Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ryan W Arnold
- Pediatric Radiology, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Jonathan R Skirko
- Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Johannes F Grimmer
- Division of Otolaryngology - Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Sturgeon C, Yang A, Elaraj D. Surgical Management of Lymph Node Compartments in Papillary Thyroid Cancer. Surg Oncol Clin N Am 2016; 25:17-40. [PMID: 26610772 DOI: 10.1016/j.soc.2015.08.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Although papillary thyroid cancer (PTC) commonly metastasizes to cervical lymph nodes, prophylactic central neck dissection is controversial. The primary treatment for lymph node metastases is surgical resection. Patients diagnosed with PTC should be assessed preoperatively by cervical ultrasound to evaluate central and lateral neck lymph node compartments. Sonographically suspicious lymph nodes in the lateral neck should be biopsied for cytology or thyroglobulin levels. Any compartment (central or lateral) that has definitive proof of nodal metastases should be formally dissected at the time of thyroidectomy.
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Affiliation(s)
- Cord Sturgeon
- Division of Endocrine Surgery, Department of Surgery, Northwestern University, 676 North Saint Clair Street, Suite 650, Chicago, IL 60611, USA.
| | - Anthony Yang
- Division of Endocrine Surgery, Department of Surgery, Northwestern University, 676 North Saint Clair Street, Suite 650, Chicago, IL 60611, USA
| | - Dina Elaraj
- Division of Endocrine Surgery, Department of Surgery, Northwestern University, 676 North Saint Clair Street, Suite 650, Chicago, IL 60611, USA
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Yang L, Luo D, Li L, Zhao Y, Lin M, Guo W, Zhou C. Differentiation of malignant cervical lymphadenopathy by dual-energy CT: a preliminary analysis. Sci Rep 2016; 6:31020. [PMID: 27498560 PMCID: PMC4976355 DOI: 10.1038/srep31020] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/12/2016] [Indexed: 12/19/2022] Open
Abstract
The accurate diagnosis of malignant cervical lymphadenopathy remains challenging. In this study, we determined the value of quantitative parameters derived from dual-energy computed tomography (DECT) for differentiating malignant cervical lymphadenopathy caused by thyroid carcinoma (TC), salivary gland carcinoma (SC), squamous cell carcinoma (SCC) and lymphoma. We retrospectively analysed 92 patients with pathologically confirmed cervical lymphadenopathy due to TC, SC, SCC and lymphoma. All patients received a DECT scan before therapy. Using GSI (gemstone spectral imaging) Volume Viewer software, we analysed the enhanced monochromatic data, and the quantitative parameters we acquired included the iodine concentration (IC), water concentration (WC) and the slope of the spectral HU curve (λHU). One-way ANOVA showed significant differences in the IC and λHU among different groups (P < 0.05). Post-hoc pairwise comparisons demonstrated the IC and λHU of TC group were significantly higher than those of SC, SCC and lymphoma groups (P < 0.05). In addition, the IC and λHU of SC group were significantly higher than those of the SCC and lymphoma groups (P < 0.05). Other comparisons of IC and λHU values showed no significant differences (P > 0.05). The quantitative parameters derived from DECT were useful supplements to conventional computed tomography images and were helpful for distinguishing different malignant cervical lymphadenopathies.
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Affiliation(s)
- Liang Yang
- Radiology Department, Cancer Hospital, Chinese Academy of Medical Sciences &Peking Union Medical College, Beijing, 100021, China
| | - Dehong Luo
- Radiology Department, Cancer Hospital, Chinese Academy of Medical Sciences &Peking Union Medical College, Beijing, 100021, China
| | - Lin Li
- Radiology Department, Cancer Hospital, Chinese Academy of Medical Sciences &Peking Union Medical College, Beijing, 100021, China
| | - Yanfeng Zhao
- Radiology Department, Cancer Hospital, Chinese Academy of Medical Sciences &Peking Union Medical College, Beijing, 100021, China
| | - Meng Lin
- Radiology Department, Cancer Hospital, Chinese Academy of Medical Sciences &Peking Union Medical College, Beijing, 100021, China
| | - Wei Guo
- Radiology Department, Cancer Hospital, Chinese Academy of Medical Sciences &Peking Union Medical College, Beijing, 100021, China
| | - Chunwu Zhou
- Radiology Department, Cancer Hospital, Chinese Academy of Medical Sciences &Peking Union Medical College, Beijing, 100021, China
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Deb S, Iseli TA, Wong T, Phal PM. Imaging characteristics of nodal metastases in paraganglioma, ameloblastoma and olfactory neuroblastoma: case reports and literature review. BJR Case Rep 2016; 2:20150096. [PMID: 30459963 PMCID: PMC6243361 DOI: 10.1259/bjrcr.20150096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 02/19/2016] [Accepted: 02/23/2016] [Indexed: 12/17/2022] Open
Abstract
Paraganglioma, ameloblastoma and olfactory neuroblastoma are uncommon primary head and neck tumours. When nodal metastases from these tumours occur, they may present later than and with different imaging characteristics compared with squamous cell carcinoma (SCC), demonstrating appearances similar to the primary tumour type rather than features typical of metastatic nodal SCC. We present three cases in which imaging characteristics of nodal metastases in paraganglioma, ameloblastoma and olfactory neuroblastoma mimicked the primary tumour and discuss their implications for clinicoradiological follow-up.
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Affiliation(s)
- Smita Deb
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Tim Anton Iseli
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Timothy Wong
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Pramit M Phal
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
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