1
|
Gule-Monroe MK, Calle S, Policeni B, Juliano AF, Agarwal M, Chow LQM, Dubey P, Friedman ER, Hagiwara M, Hanrahan KD, Jain V, Rath TJ, Smith RB, Subramaniam RM, Taheri MR, Yom SS, Zander D, Burns J. ACR Appropriateness Criteria® Staging and Post-Therapy Assessment of Head and Neck Cancer. J Am Coll Radiol 2023; 20:S521-S564. [PMID: 38040469 DOI: 10.1016/j.jacr.2023.08.008] [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: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Imaging of head and neck cancer at initial staging and as part of post-treatment surveillance is a key component of patient care as it guides treatment strategy and aids determination of prognosis. Head and neck cancer includes a heterogenous group of malignancies encompassing several anatomic sites and histologies, with squamous cell carcinoma the most common. Together this comprises the seventh most common cancer worldwide. At initial staging comprehensive imaging delineating the anatomic extent of the primary site, while also assessing the nodal involvement of the neck is necessary. The treatment of head and neck cancer often includes a combination of surgery, radiation, and chemotherapy. Post-treatment imaging is tailored for the evaluation of treatment response and early detection of local, locoregional, and distant recurrent tumor. Cross-sectional imaging with CT or MRI is recommended for the detailed anatomic delineation of the primary site. PET/CT provides complementary metabolic information and can map systemic involvement. 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.
Collapse
Affiliation(s)
| | - Susana Calle
- Research Author, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bruno Policeni
- Panel Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Amy F Juliano
- Panel Vice-Chair, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Mohit Agarwal
- Froedtert Memorial Lutheran Hospital Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laura Q M Chow
- University of Texas at Austin, Dell Medical School, Austin, Texas; American Society of Clinical Oncology
| | | | | | - Mari Hagiwara
- New York University Langone Health, New York, New York
| | | | - Vikas Jain
- MetroHealth Medical Center, Cleveland, Ohio
| | | | - Russell B Smith
- Baptist Medical Center, Jacksonville, Florida; American Academy of Otolaryngology-Head and Neck Surgery
| | - Rathan M Subramaniam
- University of Otago, Dunedin, Otepoti, New Zealand; Commission on Nuclear Medicine and Molecular Imaging
| | - M Reza Taheri
- George Washington University Hospital, Washington, District of Columbia
| | - Sue S Yom
- University of California, San Francisco, San Francisco, California
| | | | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
| |
Collapse
|
2
|
Müller M, Li J, Giger R, Elicin O. Head and neck cancer with synchronous nodules of the lung as a diagnostic and therapeutic challenge - A systematic review. Oral Oncol 2023; 145:106529. [PMID: 37506514 DOI: 10.1016/j.oraloncology.2023.106529] [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: 02/06/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023]
Abstract
Head and neck squamous cell carcinoma (HNSCC) often presents with synchronous nodules of the lung (sNL), which may be benign nodules, second primary malignancies or metastases of HNSCC. We sought to gain an insight into the incidence of sNL and synchronous second primary of the lung (sSPML) in HNSCC patients and current opinions on useful diagnostic and therapeutic approaches. We conducted a systematic search of the PubMed database for articles that reported the simultaneous detection of HNSCC and sNL/sPML, within the timeframe of diagnosis and staging. Only studies involving humans were included, without restrictions for sex, age, ethnicity, or smoking history. All articles were categorised according to the Oxford Centre of Evidence-Based Medicine levels and their data collected. Data from 24 studies were analysed. Amongst HNSCC, the mean overall incidence rate of sNL and sSPML was 11.4% (range: 1.3-27%) and 2.95% (range: 0.4-7.4%), respectively. The possibility of a sNL to be a sSPML cannot be ignored (mean: 35.2%). Studies investigating smoking habits showed that the majority (98-100%) of HNSCC patients with sSPML were previous or active smokers. Detection of human papillomavirus through DNA analysis, p16 immunohistochemistry, and identification of clonal evolution were useful in differentiating metastasis from sSPML. 18FDG-PET scan was the most reliable method to diagnose sSPML (sensitivity: 95%; specificity: 96%; positive predictive value: 80%). With early sSPML detection and curative treatment, the 5-year overall survival rate is 34-47%. However, the proposed advantage of early detection warrants further evidence-based justification.
Collapse
Affiliation(s)
- Marc Müller
- HMS Hospital, Ear Nose and Throat Department, Mirdif, Dubai, United Arab Emirates; Freie Universität Liechtenstein, Triesen, Liechtenstein
| | - Jinji Li
- HMS Hospital, Ear Nose and Throat Department, Mirdif, Dubai, United Arab Emirates
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| |
Collapse
|
3
|
Macmillan MT, Hopkins M, Gomati A, Subedi D, Reid H, Bruce L, Murchison JT, Nixon IJ. Analysis of the interactions between small pulmonary nodules, clinical factors and the risk of malignancy in the chest following diagnosis of head and neck cancer. Clin Otolaryngol 2022; 47:455-463. [PMID: 35212150 DOI: 10.1111/coa.13922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/18/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aims to investigate radiological and clinical factors which predict malignancy in indeterminate pulmonary nodules in patients with head and neck cancer (HNC). METHODS Prospective data was collected in 424 patients who were reviewed in the NHS Lothian HNC multi-disciplinary meeting from May 2016 to May 2018. Staging and follow up CT chest imaging was reviewed to identify and assess pulmonary nodules in all patients. RESULTS 61.8% of patients had at least one pulmonary nodule at staging CT. In total 25 patients developed malignancy in the chest. Metastatic disease in the chest was significantly associated with unknown or negative p16 status (p<0.0005). Pleural indentation and spiculation were associated with indeterminate nodules, subsequently being shown to represent metastatic disease (p>0.0005 and p=0.046 respectively). CONCLUSION Negative or unknown p16 status was associated with an increased propensity to develop metastatic disease in the chest in patients with HNC.
Collapse
Affiliation(s)
- Mark T Macmillan
- Department of Radiology Edinburgh Royal Infirmary, Edinburgh, UK.,Centre for Regenerative medicine, University of Edinburgh, Edinburgh, UK
| | - Michael Hopkins
- Edinburgh Ear, Nose, and Throat Department, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Anas Gomati
- Edinburgh Ear, Nose, and Throat Department, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Deepak Subedi
- Department of Radiology Western General Hospital, Edinburgh, UK
| | - Helen Reid
- Department of Radiology Western General Hospital, Edinburgh, UK
| | - Lorna Bruce
- South East Scotland Cancer Network (SCAN) Cancer Audit Edinburgh, Scotland, UK
| | - John T Murchison
- Department of Radiology Edinburgh Royal Infirmary, Edinburgh, UK
| | - Iain J Nixon
- Edinburgh Ear, Nose, and Throat Department, Edinburgh Royal Infirmary, Edinburgh, UK
| |
Collapse
|
4
|
Green R, Macmillan MT, Tikka T, Bruce L, Murchison JT, Nixon IJ. Analysis of the incidence and factors predictive of outcome in patients with head and neck cancer with pulmonary nodules. Head Neck 2017; 39:2241-2248. [PMID: 28741723 DOI: 10.1002/hed.24885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/17/2017] [Accepted: 06/15/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The management of pulmonary nodules is challenging; unfortunately, little is known about the incidence and significance of pulmonary nodules in patients with head and neck cancer. METHODS A review was conducted of 400 consecutive patients with head and neck cancer. Imaging was reviewed to identify the incidence of nodules and patient, tumor, and radiological factors associated with the risk of malignancy. RESULTS Nodules were found in 58% of patients, with a malignant rate of 6%. Age was the only predictor of having a nodule and advanced-stage III + IV was a predictor of malignancy (P = .023; odds ratio [OR] 10.64; confidence interval 1.33-84.98). CONCLUSION Patients presenting with head and neck cancer have a higher incidence of pulmonary nodules and a higher risk of malignancy. In contrast to the British Thoracic Society (BTS) guidelines, which use size to guide the need for serial scans, we would recommend follow-up imaging in all patients with head and neck cancer with nodules, irrespective of size.
Collapse
Affiliation(s)
- Richard Green
- Edinburgh Ear, Nose, and Throat Department, Edinburgh Royal Infirmary, Edinburgh, Scotland, UK
| | - Mark T Macmillan
- Radiology Department, Edinburgh Royal Infirmary, Edinburgh, Scotland, UK
| | - Theofano Tikka
- Glasgow Ear, Nose, and Throat Department, Glasgow, Scotland, UK.,School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Lorna Bruce
- South East Scotland Cancer Network (SCAN) Cancer Audit Edinburgh, Scotland, UK
| | - John T Murchison
- Radiology Department, Edinburgh Royal Infirmary, Edinburgh, Scotland, UK
| | - Iain J Nixon
- Edinburgh Ear, Nose, and Throat Department, Edinburgh Royal Infirmary, Edinburgh, Scotland, UK
| |
Collapse
|
5
|
Service delivery: subspecialisation, emergencies, sharps injuries, personality traits and the ENT surgeon. The Journal of Laryngology & Otology 2017; 130:511. [PMID: 27229873 DOI: 10.1017/s0022215116008045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
6
|
Shi Z, Wang Y, He X. Differential diagnosis of solitary pulmonary nodules with dual-source spiral computed tomography. Exp Ther Med 2016; 12:1750-1754. [PMID: 27588092 PMCID: PMC4997995 DOI: 10.3892/etm.2016.3528] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 07/15/2016] [Indexed: 01/20/2023] Open
Abstract
The aim of the present study was to analyze the value of applying dual-source 64-layer spiral computed tomography (CT) in the differential diagnosis of solitary pulmonary nodules (SPNs). Mediastinal windows from 45 cases were selected to study SPNs (maximum diameter, ≤3 cm), and the pathological nature of lesions was determined by clinical and pathological diagnosis. Conventional 64-layer spiral CT scanning, local enhancement and 3D recombination technologies were used to determine the occurrence rate, lesion diameter, degree of enhancement, lobular sign, spicule sign, pleural indentation sign, vessel convergence sign and bronchus sign. The final diagnoses indicated 34 cases of malignant SPNs (75.6%) and 11 benign cases (24.4%). When the nodule diameter in the malignant group was compared with that of the benign group, the difference was not statistically significant (P>0.05). Nodules in the malignant group showed inhomogeneous enhancement while nodules in the benign group showed homogeneous enhancement. The enhanced CT values in the malignant group were higher than those in the benign group, and the difference was statistically significant (P<0.05). The proportion of nodules with lobular sign in the malignant group was significantly higher than that in the benign group (P<0.05). The proportion of nodules with calcification, vessel convergence sign and bronchus sign in the malignant group were significantly higher than those in the benign group, and the differences were statistically significant (P<0.05). A comparison of vacuole sign, pleural indentation sign, spiculate protuberance and fat occurrence between the two groups yielded no statistically significant differences (P>0.05). The sensitivity of CT enhancement was 85.6%, specificity was 79.6%, positive predicated value was 92.3%, and the negative predicted value was 85.2%. In conclusion, SPNs diagnosed by CT enhancement manifested with enhancement degree, lobular sign, calcification, vessel convergence sign and bronchus sign with high diagnostic accuracy.
Collapse
Affiliation(s)
- Zhitao Shi
- CT Room, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, P.R. China
| | - Yanhui Wang
- CT Room, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, P.R. China
| | - Xueqi He
- Jining Medical University, Jining, Shandong 272029, P.R. China
| |
Collapse
|