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Qiu W, Zhong X, Jiang J, Huang L, Li J, Zheng R, Cai Z, Yuan Y. Prognostic significance of cervical radiologic carotid artery invasion by lymph node on magnetic resonance imaging in nasopharyngeal carcinoma. Cancer Imaging 2023; 23:26. [PMID: 36915156 PMCID: PMC10009921 DOI: 10.1186/s40644-023-00544-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
PURPOSE Carotid artery invasion (CAI) has been demonstrated to be an important prognosticator in some head and neck cancers. This study aimed to examine the prognostic value of radiologic CAI (rCAI) by cervical lymphadenopathy in nasopharyngeal carcinoma (NPC). METHODS NPC patients treated between January 2013 and December 2016 were included. Pre-treatment MRIs were reviewed for cervical rCAI according to the radiologic criteria. Univariate and multivariate models were constructed to assess the association between cervical rCAI and clinical outcomes. A new N classification system was proposed and compared to the 8th AJCC system. RESULTS The percentage of patients with MRI-positive lymph nodes was 84.7% (494/583), of whom cervical rCAI cases accounted for 42.3% (209/494). Cervical rCAI was associated with significantly poorer OS, DFS, DFFS and RFFS compared to non-rCAI (P < 0.05). Multivariate analyses confirmed that cervical rCAI was an independent prognosticator for DFS and DFFS, surpassing other nodal features, such as laterality, size, cervical node necrosis (CNN) and radiologic extranodal extension (rENE), while location of positive LNs remained independently associated with OS, DFS and DFFS. We propose a refined N classification: New_N1: upper neck LNs only without cervical rCAI; New_N2: upper neck LNs only with cervical rCAI; New_N3: upper and lower LNs. The proposed classification broadened the differences in OS, DFS and DFFS between N1 and N2 disease, and achieved a higher c-index for DFS and DFFS. CONCLUSIONS Cervical rCAI was an independent unfavorable indicator of NPC. Compared to the AJCC system, the proposed N category showed satisfactory stratification between N1 and N2 disease, and better prediction of distant metastasis and disease failure.
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Affiliation(s)
- Wenze Qiu
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, Guangdong, China
| | - Xi Zhong
- Department of Radiology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, Guangdong, China
| | - Jiali Jiang
- Health Ward, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, Guangdong, China
| | - Laiji Huang
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, Guangdong, China
| | - Jiansheng Li
- Department of Radiology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, Guangdong, China
| | - Ronghui Zheng
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, Guangdong, China.
| | - Zhuochen Cai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong, China. .,Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong, China.
| | - Yawei Yuan
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510095, Guangdong, China.
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Zhao Y, Bao D, Wang X, Lin M, Li L, Zhu Z, Zhao X, Luo D. Prediction model based on preoperative CT findings for carotid artery invasion in patients with head and neck masses. Front Oncol 2022; 12:987031. [PMID: 36276062 PMCID: PMC9582344 DOI: 10.3389/fonc.2022.987031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/22/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesTo investigate the performance of a model in predicting carotid artery (CA) invasion in patients with head and neck masses using computed tomography (CT).MethodsThis retrospective study included patients with head and neck masses who underwent CT and surgery between January 2013 and July 2021. Patient characteristics and ten CT features were assessed by two radiologists. The patients were randomly allocated to a training cohort (n=106) and a validation cohort (n=109). Independent risk factors for CA invasion were assessed by univariate and multivariate logistic regression analyses. The predictive model was established as a nomogram using the training cohort. In addition, the calibration, discrimination, reclassification, and clinical application of the model were assessed in the validation cohort.ResultsA total of 215 patients were evaluated, including 54 patients with CA invasion. Vascular wall deformation (odds ratio [OR], 7.17; p=0.02) and the extent of encasement to the CA (OR, 1.02; p<0.001) were independent predictors of CA invasion in the multivariable analysis in the training cohort. The performance of the model was similar between the training and validation cohort, with an area under the receiver operating characteristic curve of 0.93 (95% confidence intervals [CI], 0.88-0.98) and 0.88 (95% CI, 0.80-0.96) (p=0.07), respectively. The calibration curve showed a good agreement between the predicted and actual probabilities.ConclusionA predictive model for carotid artery invasion can be defined based on features that come from patient characteristics and CT data to help in improve surgical planning and invasion evaluation.
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Affiliation(s)
- Yanfeng Zhao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dan Bao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyi Wang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Lin
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Li
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Zhu
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinming Zhao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dehong Luo
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
- *Correspondence: Dehong Luo,
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3
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Mikoshiba T, Sakamoto K, Shinden S, Shimanuki M, Nakayama R, Okada T, Ozawa H. Utility of computed tomography findings as a predictor of carotid artery invasion by metastatic lymph nodes in head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol 2022; 279:4561-4568. [PMID: 35486174 DOI: 10.1007/s00405-022-07393-9] [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: 01/11/2022] [Accepted: 04/05/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Carotid artery invasion by metastatic lymph nodes in head and neck squamous cell carcinoma (HNSCC) is one of the diagnostic criteria for unresectable tumors. However, to date, the diagnostic criteria for carotid artery invasion have not been well documented. This study investigated the utility of computed tomography (CT) findings as a predictor of carotid artery invasion by metastatic lymph nodes in HNSCC. METHODS Twenty-eight patients who had metastatic lymph nodes of HNSCC attached to the carotid artery as seen on CT images before neck dissection from January 2011 to November 2017 were included. Five imaging parameters (angle of contact [AC], length of contact [LC], haziness of the carotid artery wall [HW], size of the lymph node, and involvement of the bifurcation of the carotid artery [IB]) were assessed using CT to predict carotid artery invasion. Furthermore, the utility of the combination of these five parameters was evaluated. RESULTS There were significant differences in AC, LC, and IB between patients with and without carotid artery invasion. There were significant differences in all combinations of the two image findings between patients with and without carotid artery invasion. In particular, the combinations of LC and HW, and LC and IB could clearly predict carotid artery invasion. CONCLUSION AC, LC, and IB were useful predictors of carotid artery invasion of metastatic lymph nodes in HNSCC. This study is the first to report that IB is a useful predictor of carotid artery invasion in HNSCC.
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Affiliation(s)
- Takuya Mikoshiba
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.,Department of Otorhinolaryngology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashimachi, Utsunomiya, Tochigi, Japan
| | - Koji Sakamoto
- Department of Otorhinolaryngology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashimachi, Utsunomiya, Tochigi, Japan.
| | - Seiichi Shinden
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.,Department of Otorhinolaryngology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashimachi, Utsunomiya, Tochigi, Japan
| | - Marie Shimanuki
- Department of Otorhinolaryngology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashimachi, Utsunomiya, Tochigi, Japan
| | - Rie Nakayama
- Department of Otorhinolaryngology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashimachi, Utsunomiya, Tochigi, Japan
| | - Takashi Okada
- Department of Otorhinolaryngology, Saiseikai Utsunomiya Hospital, 911-1 Takebayashimachi, Utsunomiya, Tochigi, Japan
| | - Hiroyuki Ozawa
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
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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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5
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Orlandi E, Ferrari M, Lafe E, Preda L, Benazzo M, Vischioni B, Bonora M, Rampinelli V, Schreiber A, Licitra L, Nicolai P. When Everything Revolves Around Internal Carotid Artery: Analysis of Different Management Strategies in Patients With Very Advanced Cancer Involving the Skull Base. Front Oncol 2021; 11:781205. [PMID: 34869033 PMCID: PMC8636461 DOI: 10.3389/fonc.2021.781205] [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: 09/22/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Internal or common carotid artery encasement (CAE) is observed in almost 2-7% of head and neck cancers (HNC) and designates the tumor with the T4b category. This clinical scenario is associated with a dismal prognosis, owing to the risk for thrombosis and bleeding that usually characterizes such an advanced cancer. Standardized radiological criteria to infer invasion of the carotid artery are lacking. Complete surgical resection in the context of a multimodality treatment is supposed to offer the greatest chances of cure. Surgery can either be carotid-sparing or include carotidectomy. Data on probability of cerebrovascular and non-cerebrovascular complications, risk of carotid blowout, poor oncologic outcomes, and less-than-certain efficacy of diagnostic and interventional preventive procedures against cerebral infarction make it difficult to define surgery as the recommended option among other therapeutic strategies. Non-surgical therapies based on radiation therapy possibly combined with chemotherapy are more frequently employed in HNC with CAE. In this context, carotid blowout is the most feared complication, and its probability increases with tumor stage and cumulative radiation dose received by the vessel. The use of highly conformal radiotherapies such as intensity-modulated particle therapy might substantially improve the manageability of HNC with CAE by possibly reducing the risk of late sequalae. Despite evidence is frail, it appears logical that a case-by-case evaluation through multidisciplinary decision making between head and neck surgeons, radiation oncologists, medical oncologists, diagnostic and interventional radiologists, and vascular surgeons are of paramount value to offer the best therapeutic solution to patients affected by HNC with CAE.
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Affiliation(s)
- Ester Orlandi
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy ("Fondazione CNAO"), Pavia, Italy
| | - Marco Ferrari
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy.,University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, UHN, Toronto, ON, Canada.,Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Elvis Lafe
- Department of Diagnostic Radiology and Interventional Radiology and Neuroradiology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Lorenzo Preda
- Department of Diagnostic Radiology and Interventional Radiology and Neuroradiology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Marco Benazzo
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Barbara Vischioni
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy ("Fondazione CNAO"), Pavia, Italy
| | - Maria Bonora
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy ("Fondazione CNAO"), Pavia, Italy
| | - Vittorio Rampinelli
- Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy.,Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Alberto Schreiber
- Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia - "ASST Spedali Civili di Brescia", Brescia, Italy
| | - Lisa Licitra
- Department of Oncology and Hematology-Oncology, University of Milan, IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head and Neck Surgery, Department of Neurosciences, University of Padua - "Azienda Ospedaliera di Padova", Padua, Italy
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6
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Abdel Razek AAK, Elsebaie NA, Gamaleldin OA, AbdelKhalek A, Mukherji SK. Role of MR Imaging in Head and Neck Squamous Cell Carcinoma. Magn Reson Imaging Clin N Am 2021; 30:1-18. [PMID: 34802573 DOI: 10.1016/j.mric.2021.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Routine and advanced MR imaging sequences are used for locoregional spread, nodal, and distant staging of head and neck squamous cell carcinoma, aids treatment planning, predicts treatment response, differentiates recurrence for postradiation changes, and monitors patients after chemoradiotherapy.
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Affiliation(s)
| | - Nermeen A Elsebaie
- Department of Radiology, Alexandria Faculty of Medicine, Champollion Street, El-Khartoum Square, El Azareeta Medical Campus, Alexandria 21131, Egypt
| | - Omneya A Gamaleldin
- Department of Radiology, Alexandria Faculty of Medicine, Champollion Street, El-Khartoum Square, El Azareeta Medical Campus, Alexandria 21131, Egypt
| | - Amro AbdelKhalek
- Internship at Mansoura University Hospital, Mansoura Faculty of Medicine, 60 Elgomheryia Street, Mansoura 35512, Egypt
| | - Suresh K Mukherji
- Marian University, Head and Neck Radiology, ProScan Imaging, Carmel, IN, USA.
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7
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Carsuzaa F, Gorphe P, Vergez S, Malard O, Fakhry N, Righini C, Philouze P, Lasne-Cardon A, Gallet P, Tonnerre D, Bozec A, de Mones E, Baujat B, Laccourreye L, Babin E, Dufour X, Thariat J. Consensus on resectability in N3 head and neck squamous cell carcinomas: GETTEC recommendations. Oral Oncol 2020; 106:104733. [PMID: 32335323 DOI: 10.1016/j.oraloncology.2020.104733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Among patients with T0-2 N3 head and neck squamous cell carcinomas (HNSCC), those undergoing upfront neck dissection have better oncological outcomes. However, there is no consensual definition of disease resectability of N3 nodes, leading to major treatment attrition and interpretation biases between studies. We established a Delphi method-based consensus to define resectability and impact on decision-making for upfront neck dissection in N3 patients. METHODS The Delphi method was designed as recommended by the French Haute Autorite de Sante among head and neck surgeons from university hospitals and cancer centers, using a 24-item questionnaire. Strong and relative agreements were subsequently established, and recommendations were written. The resulting recommendations were assessed by 30 independent surgeons. RESULTS N3 nodes with intraparenchymal brain invasion, foramen invasion, skull base erosion, nodes requiring bilateral XIIth cranial nerve sacrifice, retropharyngeal N3 node or a node above the plan of soft palate are major contraindications to neck dissection. When neck dissection requires unilateral sacrifice of the IXth or Xth or XIIth cranial nerves or cervical nerve roots, upfront neck dissection may be performed, based on a case-by-case assessment of other patient and tumor estimates. CONCLUSION Consensual contraindications to neck dissection in patients with T0-2 N3 HNSCC were defined among French head and neck surgeons as concerns skull base invasion, retropharyngeal nodes and bilateral XIIth cranial nerve sacrifice. This consensus should allow more reliable comparisons between surgical and non-surgical strategies in N3 patients.
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Affiliation(s)
| | - Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Sébastien Vergez
- Institut Universitaire du Cancer de Toulouse Oncopole, University Hospital of Toulouse, France
| | - Olivier Malard
- Head and Neck Surgery, University Hospital of Nantes, France
| | - Nicolas Fakhry
- Head and Neck Surgery, APHM, La Conception University Hospital, Marseille, France
| | | | - Pierre Philouze
- Head and Neck Surgery, Croix Rousse Hospital, Hospices Civils de Lyon (Hospital Group of Lyon), France
| | | | - Patrice Gallet
- Head and Neck Surgery, University Hospital of Nancy, France
| | - Denis Tonnerre
- Head and Neck Surgery, University Hospital of Poitiers, France
| | - Alexandre Bozec
- Head and Neck Surgery, Institut Universitaire de la Face et du Cou, Nice, France
| | - Erwan de Mones
- Head and Neck Surgery, University Hospital of Bordeaux, France
| | | | | | - Emmanuel Babin
- Head and Neck Surgery, Centre François Baclesse, Caen, France
| | - Xavier Dufour
- Head and Neck Surgery, University Hospital of Poitiers, France
| | - Juliette Thariat
- Radiation Oncology, Centre François Baclesse/ARCHADE, Caen, France.
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8
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Mahajan A, Ahuja A, Sable N, Stambuk HE. Imaging in oral cancers: A comprehensive review. Oral Oncol 2020; 104:104658. [PMID: 32208340 DOI: 10.1016/j.oraloncology.2020.104658] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/11/2020] [Accepted: 03/17/2020] [Indexed: 02/08/2023]
Abstract
This review aims at simplifying the relevant imaging anatomy, guiding the optimal imaging method and highlighting the key imaging findings that influence prognosis and management of oral cavity squamous cell carcinoma (OSCC). Early OSCC can be treated with either surgery alone while advanced cancers are treated with a combination of surgery, radiotherapy and/or chemotherapy. Considering the complex anatomy of the oral cavity and its surrounding structures, imaging plays an indispensable role not only in locoregional staging but also in the distant metastatic work-up and post treatment follow-up. Knowledge of the anatomy with understanding of common routes of spread of cancer, allows the radiologist to accurately determine disease extent and augment clinical findings to plan appropriate therapy. This review aims at simplifying the relevant imaging anatomy, guiding the optimal imaging method and highlighting the key imaging findings that influence prognosis and management.
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Affiliation(s)
- Abhishek Mahajan
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai 400012, India.
| | - Ankita Ahuja
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai 400012, India
| | - Nilesh Sable
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai 400012, India
| | - Hilda E Stambuk
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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Ampil F, Takalkar A, Sangster G, Richards T. Outcome in radiographic complete regression of unresectable head and neck cancer with carotid artery encasement from induction chemotherapy followed by concurrent chemoradiotherapy: Case reports. PRECISION RADIATION ONCOLOGY 2019. [DOI: 10.1002/pro6.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Federico Ampil
- Department of RadiologyLouisiana State University Health Sciences Center Shreveport Louisiana USA
| | - Amol Takalkar
- Department of RadiologyLouisiana State University Health Sciences Center Shreveport Louisiana USA
- Positron Emission Tomography Imaging CenterBiomedical Research Foundation of Northwest LouisianaLouisiana State University Health Sciences Center Shreveport Louisiana USA
| | - Guillermo Sangster
- Department of RadiologyLouisiana State University Health Sciences Center Shreveport Louisiana USA
| | - Troy Richards
- Department of RadiologyLouisiana State University Health Sciences Center Shreveport Louisiana USA
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10
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Xu MS, Li J, Wiseman SM. Major vessel invasion by thyroid cancer: a comprehensive review. Expert Rev Anticancer Ther 2018; 19:191-203. [DOI: 10.1080/14737140.2019.1559059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Michael S. Xu
- Department of Surgery, St. Paul’s Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer Li
- Department of Surgery, St. Paul’s Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Sam M. Wiseman
- Department of Surgery, St. Paul’s Hospital & University of British Columbia, Vancouver, British Columbia, Canada
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11
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Histological Assessment of the Carotid Sheath in Patients With Oral Squamous Cell Carcinoma. J Oral Maxillofac Surg 2017; 75:2465-2476. [PMID: 28453950 DOI: 10.1016/j.joms.2017.03.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/25/2017] [Accepted: 03/27/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE During surgical management of the neck using various types of neck dissection, the carotid sheath is removed, in particular, the part adjacent to the jugular lymph node chain, with the intention of preventing recurrence from the lymphatics present within it. The role of the carotid sheath as a potential origin for nodal recurrence has not been proved thus far. Working in a tissue plane between the carotid sheath and the neurovascular structures of the neck can lead to a greater chance of damage to these structures. Also, the carotid sheath is a strong fibroelastic tissue barrier that shields the internal jugular vein and carotid artery from saliva and local infection during the postoperative period. Thus, this study investigated the histopathology of the carotid sheath in patients with oral squamous cell carcinoma (OSCC) and assessed the pathologic infiltration of the carotid sheath when grossly uninvolved. PATIENTS AND METHODS Pathologic infiltration and histopathologic characteristics of the entire length of the carotid sheath were assessed in 30 biopsy-proved cases of OSCC; these patients underwent surgical excision of the lesion in addition to neck dissection from 2013 to 2015 in the craniofacial unit of the authors' institution. RESULTS The carotid sheath consisted of fibrofatty tissue and interspersed nerve bundles. Neutrophilic infiltration and dilated lymphatic channels were seen in all 30 cases. Miniature lymph nodes adherent to the carotid sheath were seen in 5 cases and some lymphoid aggregates were seen in 15 cases. The carotid sheath in all 30 cases (metastatic and nonmetastatic) was free from tumor deposit and lymphatic tumor emboli, which are indicators of tumor cell infiltration. CONCLUSION Indicators of tumor cell infiltration were not found in any of the 30 cases. The result did not vary with the age or gender of the patient, tumor size, location, staging or grading of the tumor, or even when there were metastatic lymph nodes in the gross specimen. Hence, the role of the carotid sheath as a potential origin for nodal recurrence is questionable and its removal needs reconsideration.
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12
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Teymoortash A, Rassow S, Bohne F, Wilhelm T, Hoch S. Clinical impact of radiographic carotid artery involvement in neck metastases from head and neck cancer. Int J Oral Maxillofac Surg 2016; 45:422-6. [PMID: 26723499 DOI: 10.1016/j.ijom.2015.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 10/02/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
Abstract
The treatment of lymph node metastases involving the carotid artery is controversial. The aim of the present study was to determine the outcomes of head and neck cancer patients with radiographic carotid artery involvement in neck metastases. A total of 27 patients with head and neck cancer and radiologically diagnosed advanced metastases involving the common carotid artery or internal carotid artery were enrolled. All patients underwent a primary or salvage neck dissection and surgical carotid peeling. The oncological outcome and survival of all patients were analyzed. Loco-regional control was observed in 13 of the 27 patients (48.1%). During follow-up, five patients (18.5%) developed second primaries and 11 (40.7%) developed distant metastases. The survival time was poor independent of regional control. The median overall survival was 1.55 years and disease-free survival was 0.71 year. Radiographic carotid artery involvement in neck metastases in head and neck cancer appears to correlate with a poor long-term prognosis, with a high rate of distant metastases despite loco-regional control.
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Affiliation(s)
- A Teymoortash
- Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany.
| | - S Rassow
- Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany
| | - F Bohne
- Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany
| | - T Wilhelm
- Department of Otolaryngology, Head/Neck and Facial Plastic Surgery, Sana Kliniken Leipziger Land, Borna, Germany
| | - S Hoch
- Department of Otolaryngology, Head and Neck Surgery, Philipp University, Marburg, Germany
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13
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Tumour–node–metastasis staging of human papillomavirus negative upper aerodigestive tract cancers: a critical appraisal. J Laryngol Otol 2015; 129:1148-55. [DOI: 10.1017/s0022215115002686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:The tumour–node–metastasis staging system has a dynamic structure that is continuously being updated as scientific data develops. This review discusses some suggested revisions on tumour–node–metastasis staging of human papillomavirus negative upper aerodigestive tract cancers.Methods:The seventh edition of The American Joint Committee on Cancer Staging Manual was reviewed and important issues that could be considered for revision were identified and discussed.Results:According to our assessment of the oncological outcomes of previous studies, the following factors should be considered for revision: anterior commissure involvement and subglottic extension in laryngeal cancers; underlying bone involvement in hard palate and upper alveolar ridge cancers; tumour thickness in oral cancers; and extracapsular spread and carotid artery involvement in neck metastases.Conclusion:Sufficient data on the prognostic importance of these issues have been reported. Suggested revisions in line with current knowledge on the clinical behaviour of upper aerodigestive tract cancers would improve the relevancy of staging.
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Chung EJ, Kwon KH, Yoon DY, Cho SW, Kim EJ, Rho YS. Clinical outcome analysis of 47 patients with advanced head and neck cancer with preoperative suspicion of carotid artery invasion. Head Neck 2015; 38 Suppl 1:E287-92. [DOI: 10.1002/hed.23987] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University, College of Medicine; Seoul Korea
| | - Kee-Hwan Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery; Ilsong Memorial Institute of Head and Neck Cancer, Hallym University, College of Medicine; Seoul Korea
| | - Dae-Young Yoon
- Department of Radiology; Hallym University, College of Medicine; Seoul Korea
| | - Sung-Woo Cho
- Department of Thoracic and Cardiovascular Surgery; Hallym University, College of Medicine; Seoul Korea
| | - Eung-Joong Kim
- Department of Thoracic and Cardiovascular Surgery; Hallym University, College of Medicine; Seoul Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology-Head and Neck Surgery; Ilsong Memorial Institute of Head and Neck Cancer, Hallym University, College of Medicine; Seoul Korea
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Ljøkjel B, Haave H, Lybak S, Aarstad HH, Karlsdottir A, Vintermyr OK, Aarstad HJ. The impact of HPV infection, smoking history, age and operability of the patient on disease-specific survival in a geographically defined cohort of patients with oropharyngeal squamous cell carcinoma. Acta Otolaryngol 2014; 134:964-73. [PMID: 24963968 DOI: 10.3109/00016489.2014.927590] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS Patients with human papillomavirus (HPV)-positive tumours had better 5-year disease-specific survival (DSS) than HPV-negative patients. TNM score only predicted prognosis among HPV-negative patients. A previous history of smoking and age at diagnosis predicted DSS among HPV-positive patients whereas operability at diagnosis predicted DSS among both HPV-positive and HPV-negative patients. OBJECTIVES HPV is a risk factor for oropharyngeal squamous cell carcinoma (OPSCC). The extent to which smoking, age and operability could play a role in HPV-positive surgically treated head and neck SCCs has not been extensively addressed previously and this study aimed to evaluate these factors. METHODS We identified 232 patients with OPSCC, of which 186 from the tonsil or base of the tongue region were treated in the period 1992-2008 in Western Norway. The 5-year DSS was recorded. Details on smoking history and whether the lesion was operable or not, as well as clinical information, were obtained retrospectively from the hospital records. RESULTS TNM stage predicted survival only among HPV-negative patients. A previous smoking affected prognosis only among HPV-positive patients (relative risk (RR) = 2.5; confidence interval (CI) = 1.0-6.2; p = 0.05). Increasing age of the patient had a negative effect on survival in HPV-positive patients only, especially among the oldest quartile (RR = 4.4; CI = 2.0-9.0; p < 0.001). Whether the tumour was operable or not uniquely predicted DSS both among HPV-positive (RR = 0.34; CI = 0.13-0.93; p < 0.05) and HPV-negative (RR = 0.25; CI = 0.10-0.66; p < 0.01) patients with tonsil/base of the tongue SCC.
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Affiliation(s)
- Borghild Ljøkjel
- Department of Otolaryngology/Head & Neck Surgery, Haukeland University Hospital
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Value of MR and CT Imaging for Assessment of Internal Carotid Artery Encasement in Head and Neck Squamous Cell Carcinoma. Int J Surg Oncol 2013; 2013:968758. [PMID: 23431430 PMCID: PMC3569906 DOI: 10.1155/2013/968758] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 01/04/2013] [Indexed: 11/18/2022] Open
Abstract
Objective. This study was conducted to assess the value of CT and MR imaging in the preoperative evaluation of ICA encasement. Methods. Based upon three patient groups this study was performed. Retrospective analysis of 260 neck dissection reports from 2001 to 2010 was performed to determine unexpected peroperative-diagnosed encasement. Two experienced head and neck radiologists reviewed 12 scans for encasement. Results. In four out of 260 (1.5%) patients undergoing neck dissection, preoperative imaging was false negative as there was peroperative encasement of the ICA. Of 380 patients undergoing preoperative imaging, the radiologist reported encasement of the ICA in 25 cases. In 342 cases no encasement was described, 125 of these underwent neck dissection, and 2 had encasement peroperatively. The interobserver variation kappa varied from 0.273 to 1 for the different characteristics studied. Conclusion. These retrospectively studied cohorts demonstrate that preoperative assessment of encasement of the ICA using MRI and/or CT was of value in evaluation of ICA encasement and therefore contributively in selecting operable patients (without ICA encasement), since in only 1.5% encasement was missed. However, observer variation affects the reliability of this feature.
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Wu LM, Xu JR, Liu MJ, Zhang XF, Hua J, Zheng J, Hu JN. Value of magnetic resonance imaging for nodal staging in patients with head and neck squamous cell carcinoma: a meta-analysis. Acad Radiol 2012; 19:331-40. [PMID: 22153656 DOI: 10.1016/j.acra.2011.10.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 10/26/2011] [Accepted: 10/26/2011] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting lymph node metastases in patients with head and neck squamous cell carcinoma (HNSCC). METHODS MEDLINE, EMBASE, the CBM disc databases, and other databases were searched for relevant original articles published between January 1990 and January 2011. Meta-analysis methods were used to pool sensitivity and specificity and to construct summary receiver-operating characteristic, and to calculate positive and negative likelihood ratios (LR+ and LR-). We also compared the performance of MRI with other diagnostic methods (positron emission tomography, computed tomography, and ultrasound) by analyzing studies that had also used these diagnostic methods on the same patients. RESULTS Across 16 studies, there was no evidence of publication bias (P = .15). Sensitivity and specificity of MRI for cervical lymph node status in patients with HNSCC across all studies were 76% (95% CI: 70%-82%) and 86% (95% CI: 73%-93%), respectively. Overall, Positive likelihood ratios was 5.47 (95% CI: 2.69-11.11) and positive negative likelihood ratios was 0.28 (95% CI: 0.21-0.36), respectively. The comparison of MRI performance with that of other diagnostic tools (positron emission tomography, computed tomography, and ultrasound) suggested no major differences against any of these methods. The Subgroup by using diffusion-weighted imaging had higher pooled sensitivity (0.86, 95% CI 0.78-0.92) than the subgroup without diffusion-weighted imaging. CONCLUSION MRI has good diagnostic performance in the overall pretreatment evaluation of node staging with HNSCC. A limited number of small studies suggest DWI is superior to conventional imaging for nodal staging of HNSCC.
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Affiliation(s)
- Lian-Ming Wu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pudong, Shanghai, China
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Current management of advanced resectable oral cavity squamous cell carcinoma. Clin Exp Otorhinolaryngol 2011; 4:1-10. [PMID: 21461056 PMCID: PMC3062220 DOI: 10.3342/ceo.2011.4.1.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 12/06/2010] [Indexed: 01/03/2023] Open
Abstract
The oral cavity is the most common site of head and neck squamous cell carcinoma, a disease which results in significant morbidity and mortality worldwide. Though the primary modality of treatment for patients with oral cavity cancer remains surgical resection, many patients present with advanced disease and are thus treated using a multi-disciplinary approach. Patients with extracapsular spread of lymphatic metastasis and surgical margins that remain positive have been found to be at high risk for local-regional recurrence and death from disease, and are most often recommended to receive both post-operative radiation as well as systemic chemotherapy. The basis for this approach, as well as scientific developments that underly future trials of novels treatments for patients with high-risk oral cavity cancer are reviewed.
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