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Chmiel P, Krotewicz M, Szumera-Ciećkiewicz A, Bartnik E, Czarnecka AM, Rutkowski P. Review on Lymph Node Metastases, Sentinel Lymph Node Biopsy, and Lymphadenectomy in Sarcoma. Curr Oncol 2024; 31:307-323. [PMID: 38248105 PMCID: PMC10814427 DOI: 10.3390/curroncol31010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/17/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Soft tissue sarcomas (STS) originating from connective tissue rarely affect the lymph nodes. However, involvement of lymph nodes in STS is an important aspect of prognosis and treatment. Currently, there is no consensus on the diagnosis and management of lymph node metastases in STS. The key risk factor for nodal involvement is the histological subtype of sarcoma. Radiological and pathological evaluation seems to be the most effective method of assessing lymph nodes in these neoplasms. Thus, sentinel lymph node biopsy (SLNB), which has been shown to be valuable in the management of melanoma or breast cancer, may also be a beneficial diagnostic option in some high-risk STS subtypes. This review summarizes data on the risk factors and clinical characteristics of lymph node involvement in STS. Possible management and therapeutic options are also discussed.
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Affiliation(s)
- Paulina Chmiel
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.C.); (M.K.); (P.R.)
| | - Maria Krotewicz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.C.); (M.K.); (P.R.)
| | - Anna Szumera-Ciećkiewicz
- Department of Pathology, Maria Sklodowska Curie National Research Institute of Oncology, 02-781 Warsaw, Poland;
| | - Ewa Bartnik
- Institute of Genetics and Biotechnology, Faculty of Biology, University of Warsaw, 02-106 Warsaw, Poland;
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, 02-106 Warsaw, Poland
| | - Anna M. Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.C.); (M.K.); (P.R.)
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (P.C.); (M.K.); (P.R.)
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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.
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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
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Mee-Inta O, Hsieh CF, Chen DQ, Fan CH, Chiang YY, Liu CC, Sze CI, Gean PW, Wu PC, Yang MS, Huang PS, Chieh Wu P, Kuo YM, Huang CC. High-frequency ultrasound imaging for monitoring the function of meningeal lymphatic system in mice. ULTRASONICS 2023; 131:106949. [PMID: 36773481 DOI: 10.1016/j.ultras.2023.106949] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/30/2022] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
The meningeal lymphatic system drains the cerebrospinal fluid from the subarachnoid space to the cervical lymphatic system, primarily to the deep cervical lymph nodes. Perturbations of the meningeal lymphatic system have been linked to various neurologic disorders. A method to specifically monitor the flow of meningeal lymphatic system in real time is unavailable. In the present study, we adopted the high-frequency ultrasound (HFUS) with 1,1'diocatadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (DiI)-loaded microbubble and FePt@PLGA nanoparticle contrast agents to evaluate the flow of the meningeal lymphatic system in 2-month-old mice. Statistical analysis was performed to identify changes of HFUS signals among the microbubbles, FePt@PLGA nanoparticles, and saline control groups. Approximately 15 min from the start of intracerebroventricular injection of contrast agents, their signals were evident at the deep cervical lymph nodes and lasted for at least 60 min. These signals were validated on the basis of the presence of DiI and Fe signals in the deep cervical lymph nodes. Ligation of afferent lymphatic vessels to the deep cervical lymph nodes eliminated the HFUS signals. Moreover, ablation of lymphatic vessels near the confluence of sinuses decreased the HFUS signals in the deep cervical lymph nodes. Glioma-bearing mice that exhibited reduced lymphatic vessel immunostaining signals near the confluence of sinuses had lowered HFUS signals in the deep cervical lymph nodes within 60 min. The proposed method provides a minimally invasive approach to monitor the qualities of the meningeal lymphatic system in real time as well as the progression of the meningeal lymphatic system in various brain disease animal models.
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Affiliation(s)
- Onanong Mee-Inta
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chin-Fang Hsieh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - De-Quan Chen
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Hsiang Fan
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Yi Chiang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chan-Chuan Liu
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Chun-I Sze
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Wu Gean
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ping-Ching Wu
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan; Institute of Oral Medicine and Department of Stomatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University Tainan, Taiwan; Center of Applied Nanomedicine, National Cheng Kung University, Tainan, Taiwan
| | - Mon-Shieh Yang
- College of Science, National Cheng Kung University, Tainan, Taiwan
| | - Po-Sheng Huang
- Department of Photonics, National Cheng Kung University, Tainan, Taiwan
| | - Pin Chieh Wu
- Department of Photonics, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Min Kuo
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Chih-Chung Huang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.
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Tan W, Mao M, He H, Chen M, Deng Q, Yang Y, Li Y, Sheng H, He L, Li J. Endonasopharyngeal ultrasound and magnetic resonance imaging features of recurrent retropharyngeal nodes in nasopharyngeal carcinoma patients: A radiologic-histopathologic study. Radiother Oncol 2023; 183:109579. [PMID: 36842662 DOI: 10.1016/j.radonc.2023.109579] [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: 07/04/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND The imaging criteria of malignant retropharyngeal lymph node (RLN) in nasopharyngeal cancer (NPC) have yet to be fully elucidated. This study aimed to establish predictive models based on ultrasound (US) and magnetic resonance (MR) characteristics for identifying malignant RLN in NPC patients after radiotherapy. METHODS 81 post-radiotherapy NPC patients with abnormal enlargement of RLN underwent endonasopharyngeal ultrasound-guided fine-needle aspirations (EPUS-FNA) to access the nature of RLN. The following features were assessed on US and MR: size, margin, vascular signal, echogenicity, enhancement signal and accompany with suspicious cervical nodes or not. A multivariate analysis was performed to screen out high-risk imaging features for recurrent RLN (RRLN), and models for the diagnosis of RRLN was constructed and tested with internal verification. We evaluated the clinical usefulness of the models through comparison of C-index and decision curve analysis. RESULTS High-risk features of RRLN were heterogeneous echo (p < 0.01), vascular signal (p < 0.01) on EPUS, heterogeneous enhancement (p < 0.01) and minimum axis diameter > 10 mm (p < 0.01) on MR. The models based on the US and MR features showed good discrimination (AUC of 0.76 in the US model, 0.74 in the MR model and 0.77 in the US + MR model) and good net benefit in the validation group. CONCLUSION Prediction models based on the US and MR features show good diagnostic performance for RRLN after radiotherapy in NPC patients. The combination of EPUS and MR may be constructed to provide prompt and reliable guidance to manage RLN.
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Affiliation(s)
- Wencheng Tan
- Department of Endoscopy, Sun Yat-Sen University Cancer Center, China; 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
| | - Minjie Mao
- Department of Laboratory Medicine, Sun Yat-Sen University Cancer Center, China; 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
| | - Haoqiang He
- Department of Medical imaging, Sun Yat-Sen University Cancer Center, China; 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
| | - Mingshi Chen
- Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, China; 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
| | - Qiwen Deng
- Department of Anesthesiology, the First Affiliated Hospital, Sun Yet-sen University, Guangzhou 510080, China
| | - Youzhuo Yang
- Department of Endoscopy, Sun Yat-Sen University Cancer Center, China; 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
| | - Yin Li
- Department of Endoscopy, Sun Yat-Sen University Cancer Center, China; 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
| | - Hui Sheng
- Department of Experimental Research, Sun Yat-Sen University Cancer Center, China; 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.
| | - Longjun He
- Department of Endoscopy, Sun Yat-Sen University Cancer Center, China; 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.
| | - Jianjun Li
- Department of Endoscopy, Sun Yat-Sen University Cancer Center, China; 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.
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Hua S, Hu X, Zhao X, Mao J. The diagnostic value and safety of modified needle aspiration biopsy for superficial lymphadenectasis. Front Surg 2022; 9:968706. [DOI: 10.3389/fsurg.2022.968706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
ObjectiveTo explore the safety and diagnostic value of modified needle aspiration biopsy for superficial enlarged lymph nodes.MethodsA total of 88 patients with unknown diagnosis of superficial lymphadenopathy in our hospital (Wuxi Fifth People's Hospital) from January 2018 to July 2021 were recruited and then divided into two groups using the simple random grouping method. The study group included 48 patients who were punctured via modified needle aspiration biopsy, while the control group included 40 patients who were punctured via core needle biopsy (CNB) and had a better clinical evaluation. A BARD® automatic biopsy gun with a 18 G needle was used to puncture any enlarged lymph nodes, and specimens were obtained for pathological examination. The diagnostic positive rate of the two puncture methods was then compared and the complications involved in the two methods were observed.ResultsThe positive rate of definite pathological diagnosis was 79.2% (38/48) in the study group and 82.5% (33/40) in the control group. Both groups had similar diagnostic positive rates regarding tuberculosis and metastatic tumours in the lymph nodes (P > 0.05). Only slight bleeding was observed during the operations using the two puncture methods, with the bleeding rate of the study group 20.8% and that of the control group 15.0%, and the difference was not statistically significant (P > 0.05). No other complications were observed across both groups. Among the 48 patients with enlarged lymph nodes in the study group, there was no difference in the positive rate of diagnosis between enlarged lymph nodes larger than 20 mm and those smaller than 20 mm in the pathological, bacterial culture and cytology examinations (P > 0.05). The sensitivity, specificity, positive predictive values and negative prediction values of the improved lymph node lesions were 83.3%, 100%, 100% and 90.9%, respectively.ConclusionThe diagnostic efficacy and safety of modified needle aspiration biopsy in superficial swollen lymph nodes are equivalent to those of CNB, but the former is a more economical, simple and practical method for clinical settings and one that could be popularised in primary hospitals.
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Lo WC, Chang CM, Cheng PC, Wen MH, Wang CT, Cheng PW, Liao LJ. The Applications and Potential Developments of Ultrasound in Oral Cancer Management. Technol Cancer Res Treat 2022; 21:15330338221133216. [PMID: 36254559 PMCID: PMC9580086 DOI: 10.1177/15330338221133216] [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] [Indexed: 11/23/2022] Open
Abstract
Oral cancer is endemic and causes a great burden in Southern Asia. It is preferably treated by surgery with/without adjuvant radiotherapy (RT) or chemoradiation therapy, depending on the stage of the disease. Close or positive resection margin and cervical lymph node (LN) metastasis are important prognostic factors that have been presented to be related to undesirable locoregional recurrence and poor survival. Ultrasound (US) is a simple, noninvasive, time-saving, and inexpensive diagnostic modality. It can depict soft tissues very clearly without the risk of radiation exposure. Additionally, it is real-time and continuous image is demonstrated during the exam. Furthermore, the clinician can perform US-guided fine needle aspiration (FNA) or core needle biopsy (CNB) at the same time. US with/without US-guided FNA/CNB is reported to be of value in determining tumor thickness (TT), depth of invasion (DOI), and cervical LN metastasis, and in aiding the staging of oral cancer. DOI has a relevant prognostic value as reported in the eighth edition of the American Joint Committee on Cancer staging of oral cancer. In the present review, we describe the clinical applications of US in oral cancer management in different phases and potential applications in the future. In the pretreatment and surgical phase, US can be used to evaluate TT/DOI and surgical margins of oral cancer in vivo and ex vivo. The prediction of a malignant cervical LN (nodal metastasis) by the US-based prediction model can guide the necessity of FNA/CNB and elective neck dissection in clinical early-stage oral cancer. In the posttreatment surveillance phase, US with/without US-guided FNA or CNB is helpful in the detection of nodal persistence or LN recurrence, and can assess the possibility and extent of carotid artery stenosis after irradiation therapy. Both US elastography and US swallowing assessment are potentially helpful to the management of oral cancer.
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Affiliation(s)
- Wu-Chia Lo
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei,Graduate Institute of Medicine, Yuan Ze University, Taoyuan,Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City
| | - Chih-Ming Chang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei,Department of Biomedical Engineering, National Yang-Ming University, Taipei
| | - Ping-Chia Cheng
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei,Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City,Department of Biomedical Engineering, National Yang-Ming University, Taipei,Department of Communication Engineering, Asia Eastern University of Science and Technology, New Taipei City
| | - Ming-Hsun Wen
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei
| | - Chi-Te Wang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei,Department of Electrical Engineering, Yuan Ze University, Taoyuan
| | - Po-Wen Cheng
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei
| | - Li-Jen Liao
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei,Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City,Department of Electrical Engineering, Yuan Ze University, Taoyuan,Li-Jen Liao, MD, PhD, Department of Otolaryngology, Far Eastern Memorial Hospital, 21, Section 2, Nan-Ya South Road, Banqiao, New Taipei 22061.
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Yang J, Guo W, Huang R, Xu Z, Zhou C, Lu M. Ultrasound-guided microwave ablation in the treatment of early-stage tongue cancer. Front Oncol 2022; 12:950228. [PMID: 36110931 PMCID: PMC9468925 DOI: 10.3389/fonc.2022.950228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/08/2022] [Indexed: 12/07/2022] Open
Abstract
Background Tongue cancer is a common malignant tumor of the head and neck. Its treatment methods include surgery, radiotherapy, and chemotherapy. However, these treatments have serious side effects and poor cosmetic effect, so it is urgent to find new treatment methods. We pioneered the use of microwave ablation (MWA) in the treatment of early tongue cancer and achieved good results. Case Presentation A 67-year-old woman (Han nationality) was admitted to the hospital because of progressive aggravation of tongue pain. She had a history of tongue pain of more than 1 year. Pathological biopsy showed squamous cell carcinoma; following this, radical operation of the tongue cancer was planned. The preoperative examination showed thyroid occupation in the upper mediastinum region compressing the airway; hence, the risk of general anesthesia was high. Consent was obtained from the patient and her family. Ultrasound-guided MWA was successfully performed under the lingual nerve block. The patient was followed for 1 year. She recovered well with no dysphagia and unclear articulation symptoms, and the cosmetic effect was excellent. Conclusion To our knowledge, this is the first case of using MWA for the treatment of early-stage tongue cancer (ESTC). Ultrasound-guided MWA may be used for ESTC that can completely ablate the tumor and retain the function of the tongue, further improving the quality of life of the patient. However, it is only a case report and needs more research to verify the use of MWA in ESTC.
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Affiliation(s)
- Jianquan Yang
- The School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wen Guo
- Institute of Materia Medica, North Sichuan Medical College, Nanchong, China
| | - Rong Huang
- Institute of Materia Medica, North Sichuan Medical College, Nanchong, China
| | - Zhengmin Xu
- Institute of Materia Medica, North Sichuan Medical College, Nanchong, China
| | - Chunyang Zhou
- Institute of Materia Medica, North Sichuan Medical College, Nanchong, China
- *Correspondence: Chunyang Zhou, ; Man Lu,
| | - Man Lu
- The School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Ultrasound Medical Center, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- *Correspondence: Chunyang Zhou, ; Man Lu,
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Alphandéry E. Ultrasound and nanomaterial: an efficient pair to fight cancer. J Nanobiotechnology 2022; 20:139. [PMID: 35300712 PMCID: PMC8930287 DOI: 10.1186/s12951-022-01243-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/02/2022] [Indexed: 01/12/2023] Open
Abstract
Ultrasounds are often used in cancer treatment protocols, e.g. to collect tumor tissues in the right location using ultrasound-guided biopsy, to image the region of the tumor using more affordable and easier to use apparatus than MRI and CT, or to ablate tumor tissues using HIFU. The efficacy of these methods can be further improved by combining them with various nano-systems, thus enabling: (i) a better resolution of ultrasound imaging, allowing for example the visualization of angiogenic blood vessels, (ii) the specific tumor targeting of anti-tumor chemotherapeutic drugs or gases attached to or encapsulated in nano-systems and released in a controlled manner in the tumor under ultrasound application, (iii) tumor treatment at tumor site using more moderate heating temperatures than with HIFU. Furthermore, some nano-systems display adjustable sizes, i.e. nanobubbles can grow into micro-bubbles. Such dual size is advantageous since it enables gathering within the same unit the targeting properties of nano bubbles via EPR effect and the enhanced ultrasound contrasting properties of micro bubbles. Interestingly, the way in which nano-systems act against a tumor could in principle also be adjusted by accurately selecting the nano-system among a large choice and by tuning the values of the ultrasound parameters, which can lead, due to their mechanical nature, to specific effects such as cavitation that are usually not observed with purely electromagnetic waves and can potentially help destroying the tumor. This review highlights the clinical potential of these combined treatments that can improve the benefit/risk ratio of current cancer treatments.
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Affiliation(s)
- Edouard Alphandéry
- Sorbonne Université, Muséum National d'Histoire Naturelle, UMR CNRS, 7590, IRD, Institut de Minéralogie, de Physique des Matériaux et de. Cosmochimie, IMPMC, 75005, Paris, France. .,Nanobacterie SARL, 36 boulevard Flandrin, 75116, Paris, France. .,Institute of Anatomy, UZH University of Zurich, Instiute of Anatomy, Winterthurerstrasse 190, 8057, Zurich, Switzerland.
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Lo TH, Wang CP, Chen CN, Yang TL, Lou PJ, Ko JY, Chang YL, Chen TC. Diagnostic performance of core needle biopsy for nodal recurrences in patients with head and neck squamous cell carcinoma. Sci Rep 2022; 12:2048. [PMID: 35132145 PMCID: PMC8821564 DOI: 10.1038/s41598-022-06102-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/24/2022] [Indexed: 11/25/2022] Open
Abstract
This study investigated the diagnostic accuracy and affecting factors of ultrasound (US)-guided core-needle biopsy (CNB) in patients with treated head and neck squamous cell carcinoma (HNSCC). We retrospectively reviewed patients with treated HNSCC who received US-guided CNB from January 2011 to December 2018 with corresponding imaging. Pathological necrosis and fibrosis of targeted lymph nodes (LNs) were evaluated. We analyzed the correlation between CNB accuracy and clinical and pathological characteristics. In total, 260 patients were included. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of CNB for nodal recurrence were 84.47%, 100%, 100%, 54.67%, and 86.92%, respectively. CNB of fibrotic LNs had significantly worse sensitivity, NPV, and accuracy than that of non-fibrotic LNs. Similarly, CNB of necrotic LNs had significantly worse sensitivity, NPV, and accuracy than non-necrotic LNs. Multivariate regression revealed that fibrotic LN was the only independent factor for a true positive rate, whereas both necrotic LN and fibrotic LN were independent factors for a false negative rate. The diagnostic accuracy of CNB in treated HNSCC patients is affected by LN necrosis and fibrosis. Therefore, CNB results, particularly for necrotic or fibrotic LNs, should be interpreted carefully.
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Chang CW, Wang C, Lu CJ, Wang CW, Wu CT, Wang CP, Yang TL, Lou PJ, Ko JY, Chang YL, Chen TC. Incidence and prognostic significance of extranodal extension in isolated nodal recurrence of oral squamous cell carcinoma. Radiother Oncol 2021; 167:81-88. [PMID: 34902369 DOI: 10.1016/j.radonc.2021.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/23/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Extranodal extension (ENE) is a crucial prognostic factor of oral squamous cell carcinoma (OSCC). However, the role of ENE in regional recurrence (rENE) remains unclear. The purpose of our study is to assess the salvage outcome according to the presence of rENE in oral cancer patients with isolated nodal recurrence. METHODS Oral cancer patients diagnosed with isolated nodal recurrence at the National Taiwan University Hospital between January 2010 and December 2015 were reviewed. All patients were classified into two groups: with and without rENE. The treatment included salvage neck dissection (ND) ± metronomic chemotherapy, salvage ND and radiation (RT)/concurrent chemoradiation (CCRT), Salvage RT/CCRT alone, metronomic chemotherapy, or supportive care. RESULTS We analyzed 198 patients, 156 with rENE and 42 without rENE. rENE presented more frequently in patients with initial ENE+ (OR = 3.17, p = 0.04), prior RT+ (OR = 2.96, p = 0.02), initial N2/N3 (OR = 2.76, p = 0.01), and recurrent LN size >1.5 cm (OR = 2.33, p = 0.03). The extent of rENE were also significantly different in these patients. The 2-year disease-free survival for patients with and without rENE were 15.7% and 31.7%, respectively (p = 0.002). The 2-year overall survival for patients with and without rENE were 19.6% and 43.9%, respectively (p = 0.004). For patients without rENE, those received salvage ND had better survival outcome (p < 0.001). By contrast, for patients with rENE, those received salvage RT/CCRT had better survival outcome (p < 0.001). CONCLUSION The rENE is frequently present (78.79%) in OSCC patients with isolated nodal recurrence. Individualized treatment modalities based on the presence of rENE should be recommended to achieve better salvage outcomes.
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Affiliation(s)
- Chun-Wei Chang
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chi Wang
- Department of Otolaryngology, National Taiwan University BioMedical Park Hospital, Hsin-Chu, Taiwan
| | - Chi-Ju Lu
- Department of Radiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chun-Wei Wang
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chen-Tu Wu
- Department of Pathology, National Taiwan University Hospital, National Taiwan University Cancer Center and National Taiwan University College of Medicine Taipei, Taiwan; Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Ping Wang
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tsung-Lin Yang
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jenq-Yuh Ko
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yih-Leong Chang
- Department of Pathology, National Taiwan University Hospital, National Taiwan University Cancer Center and National Taiwan University College of Medicine Taipei, Taiwan; Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tseng-Cheng Chen
- Department of Otolaryngology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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11
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Assessment of clinical radiosensitivity in patients with head-neck squamous cell carcinoma from pre-treatment quantitative ultrasound radiomics. Sci Rep 2021; 11:6117. [PMID: 33731738 PMCID: PMC7969626 DOI: 10.1038/s41598-021-85221-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/23/2021] [Indexed: 12/24/2022] Open
Abstract
To investigate the role of quantitative ultrasound (QUS) radiomics to predict treatment response in patients with head and neck squamous cell carcinoma (HNSCC) treated with radical radiotherapy (RT). Five spectral parameters, 20 texture, and 80 texture-derivative features were extracted from the index lymph node before treatment. Response was assessed initially at 3 months with complete responders labelled as early responders (ER). Patients with residual disease were followed to classify them as either late responders (LR) or patients with persistent/progressive disease (PD). Machine learning classifiers with leave-one-out cross-validation was used for the development of a binary response-prediction radiomics model. A total of 59 patients were included in the study (22 ER, 29 LR, and 8 PD). A support vector machine (SVM) classifier led to the best performance with accuracy and area under curve (AUC) of 92% and 0.91, responsively to define the response at 3 months (ER vs. LR/PD). The 2-year recurrence-free survival for predicted-ER, LR, PD using an SVM-model was 91%, 78%, and 27%, respectively (p < 0.01). Pretreatment QUS-radiomics using texture derivatives in HNSCC can predict the response to RT with an accuracy of more than 90% with a strong influence on the survival. Clinical trial registration: clinicaltrials.gov.in identifier NCT03908684.
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12
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Zhou Y, Yu T, Rui X, Jin T, Huang Z, Huang Z. Effectiveness of diffusion-weighted imaging in predicting cervical lymph node metastasis in head and neck malignancies. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 131:122-129.e2. [DOI: 10.1016/j.oooo.2020.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 06/11/2020] [Accepted: 06/28/2020] [Indexed: 01/18/2023]
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13
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Dasgupta A, Fatima K, DiCenzo D, Bhardwaj D, Quiaoit K, Saifuddin M, Karam I, Poon I, Husain Z, Tran WT, Sannachi L, Czarnota GJ. Quantitative ultrasound radiomics in predicting recurrence for patients with node-positive head-neck squamous cell carcinoma treated with radical radiotherapy. Cancer Med 2020; 10:2579-2589. [PMID: 33314716 PMCID: PMC8026932 DOI: 10.1002/cam4.3634] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/05/2020] [Accepted: 11/05/2020] [Indexed: 12/24/2022] Open
Abstract
This prospective study was conducted to investigate the role of quantitative ultrasound (QUS) radiomics in predicting recurrence for patients with node‐positive head‐neck squamous cell carcinoma (HNSCC) treated with radical radiotherapy (RT). The most prominent cervical lymph node (LN) was scanned with a clinical ultrasound device having central frequency of 6.5 MHz. Ultrasound radiofrequency data were processed to obtain 7 QUS parameters. Color‐coded parametric maps were generated based on individual QUS spectral features corresponding to each of the smaller units. A total of 31 (7 primary QUS and 24 texture) features were obtained before treatment. All patients were treated with radical RT and followed according to standard institutional practice. Recurrence (local, regional, or distant) served as an endpoint. Three different machine learning classifiers with a set of maximally three features were used for model development and tested with leave‐one‐out cross‐validation for nonrecurrence and recurrence groups. Fifty‐one patients were included, with a median follow up of 38 months (range 7–64 months). Recurrence was observed in 17 patients. The best results were obtained using a k‐nearest neighbor (KNN) classifier with a sensitivity, specificity, accuracy, and an area under curve of 76%, 71%, 75%, and 0.74, respectively. All the three features selected for the KNN model were texture features. The KNN‐model‐predicted 3‐year recurrence‐free survival was 81% and 40% in the predicted no‐recurrence and predicted‐recurrence groups, respectively. (p = 0.001). The pilot study demonstrates pretreatment QUS‐radiomics can predict the recurrence group with an accuracy of 75% in patients with node‐positive HNSCC. Clinical trial registration: clinicaltrials.gov.in identifier NCT03908684.
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Affiliation(s)
- Archya Dasgupta
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada.,Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Kashuf Fatima
- Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Daniel DiCenzo
- Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Divya Bhardwaj
- Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Karina Quiaoit
- Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | | | - Irene Karam
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Ian Poon
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Zain Husain
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - William T Tran
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Canada.,Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | | | - Gregory J Czarnota
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada.,Physical Sciences, Sunnybrook Research Institute, Toronto, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Canada
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14
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Gao Y, Wu WJ, Zheng L, Huang MW, Liu SM, Zhang JG. Diagnostic value of navigation-guided core needle biopsy in deep regions of the head and neck with focal FDG uptake on 18F-FDG PET/CT. J Craniomaxillofac Surg 2020; 48:508-513. [PMID: 32143863 DOI: 10.1016/j.jcms.2020.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 01/29/2020] [Accepted: 02/14/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the feasibility and diagnostic accuracy of core needle biopsy (CNB) in patients with focal fluorodeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT) in deep regions of the head and neck, with the guidance of infrared navigation integrated with PET. MATERIALS AND METHODS Patients with suspected primary or recurrent malignancies of the head and neck on PET/CT, from June 2016 to December 2018, were included. Before CNB, the region of interest was delineated and the ideal needle entry points, target sites, and a number of trajectories were designed on iPlan CMF 3.0. CNB was performed with the guidance of infrared navigation integrated with PET, according to the pre-plan. Sensitivity and diagnostic accuracy were analyzed by comparing the biopsy results with the final diagnosis. RESULTS Thirty-one consecutive patients were included. Among the 31 lesions, 18 were skull base, six were infratemporal fossa, and seven were maxillary region. The median values for SUVmax, SUVmean, and MTV were 6.09 (range: 1.43-24.67), 3.41 (range: 0.38-20.96), and 25.83 (range: 3.54-361.94) for the 31 lesions, respectively. Combined needle approaches were employed, including temporal (nine), subzygomatic (19), paramaxillary (11), and retromandibular (16) approaches. The depths of the 31 deep-region lesions, measured from the needle entry site on the skin to the target point, ranged from 1.33 cm to 7.82 cm (median 4.25 cm). There were three non-diagnostic lesions resulting from CNB, and these were all skull base. The diagnostic accuracy was 90.3%, while the sensitivity was 88%. According to the binary logistic regression for the final diagnosis, the only significant parameter was SUVmax. CONCLUSION With the guidance of navigation integrated with PET, CNB is a feasible and accurate diagnostic modality, which is also an alternative to open biopsy in patients with suspected primary or recurrent malignancies in deep regions of the head and neck on PET/CT.
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Affiliation(s)
- Ya Gao
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Wen-Jie Wu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Lei Zheng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
| | - Ming-Wei Huang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Shu-Ming Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jian-Guo Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
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15
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Li Y, Liu K, Ke Y, Zeng Y, Chen M, Li W, Liu W, Hua X, Li Z, Zhong Y, Xie C, Yu H. Risk Factors Analysis of Pathologically Confirmed Cervical Lymph Nodes Metastasis in Oral Squamous Cell Carcinoma Patients with Clinically Negative Cervical Lymph Node: Results from a Cancer Center of Central China. J Cancer 2019; 10:3062-3069. [PMID: 31281484 PMCID: PMC6590044 DOI: 10.7150/jca.30502] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 04/27/2019] [Indexed: 12/30/2022] Open
Abstract
Objective: To explore the risk factors of cervical lymph node metastasis in oral squamous cell carcinoma (OSCC) patients with clinical negative cervical lymph nodes(cN0) and provide a reference for clinical treatment. Methods: The clinical data of 161 OSCC patients with cN0 were retrospectively analyzed. All patients underwent extended primary resection combined with cervical lymph node dissection. The level and number of cervical lymph node metastasis were confirmed by postoperative pathology. The risk factors of cervical lymph node metastasis in patients were analyzed by univariate and multivariate Logistic regression analysis. Results: Thirty-one out of 161 cases (19%) were confirmed cervical lymph node metastasis. Among them, there were 28 cases of lymph node metastasis in one cervical level and 3 cases in two cervical levels. A total of 42 positive lymph nodes were detected in 34 cervical levels. The level number of positive areas in the IA, IB, IIA, IIB, III, IV and V levels was 2, 15, 12, 1, 4,0, and 0, respectively. The corresponding regional metastasis rates were 5.9%, 44.1%, 35.3%, 2.9%, 11.8%, 0% and 0%, respectively. The number of positive lymph node metastases in the corresponding levels were 2, 17, 17, 1, 5, 0, and 0 respectively. Univariate analysis showed that gender, age, lesion location, T stage, and perineural invasion/lymphvascular invasion (PNI/PVI) had no significant effect on cervical lymph node metastasis (P>0.05). The growth pattern, degree of differentiation, depth of invasion, neutrophil/lymphocyte ratio (NLR) and the short/long axis diameter ratio (S/L ratio) of lymph nodes were important factors influencing the cervical lymph node metastasis in cN0 OSCC patients (P<0.05). Multivariate Logistic regression analysis indicated that the growth pattern, degree of differentiation, depth of invasion, NLR, and the S/L ratio of lymph nodes were independent risk factors for cervical lymph node metastasis (P<0.05). Conclusion: The growth pattern, degree of differentiation, depth of invasion, neutrophil/lymphocyte ratio, and the short/long axis diameter ratio of lymph nodes were the independent risk factors for pathological cervical lymph node metastasis in oral squamous cell carcinoma patients with cN0. If patients with the above risk factors receive nonstandard radical neck dissection or no dissection, it may be necessary for them to receive the corresponding regional postoperative radiotherapy.
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Affiliation(s)
- Yonghong Li
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China.,Department of Oncology and Surgery, The First Hospital of Tianmen City of Hubei Province, Tianmen, Hubei, China
| | - Ke Liu
- Department of Oromaxillofacial and Head Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yuan Ke
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Yifei Zeng
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Mengge Chen
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Wei Li
- Department of Oncology and Surgery, The First Hospital of Tianmen City of Hubei Province, Tianmen, Hubei, China
| | - Wenming Liu
- Department of Oncology and Surgery, The First Hospital of Tianmen City of Hubei Province, Tianmen, Hubei, China
| | - Xinying Hua
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Zheng Li
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Yahua Zhong
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Conghua Xie
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
| | - Haijun Yu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University; Hubei Cancer Clinical Study Center, Hubei Key Laboratory of Tumor Biological Behaviors, Wuhan, China
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