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Wamasing N, Nakamura S, Watanabe H, Kuribayashi A, Miura M. Potential of preoperative fluorodeoxyglucose-positron emission tomography/computed tomography to diagnose contralateral lymph node metastases in patients with oral cancer. Nucl Med Commun 2023; 44:1168-1175. [PMID: 37706262 DOI: 10.1097/mnm.0000000000001765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To establish a decision tree using preoperative PET/computed tomography (CT) parameters for detecting contralateral lymph node metastasis (CLNM) in oral cancer patients. METHODS In total, 140 patients with a confirmed histopathological diagnosis of oral carcinoma showed fluorodeoxyglucose accumulation of contralateral lymph nodes in PET images. Of 260 lymph nodes, eight were metastatic. We compared metastatic and non-metastatic nodes using Fisher-Freeman-Halton exact and Fisher's exact and Mann-Whitney U tests. The diagnostic performance was analyzed using receiver operating characteristic curves. We established a decision tree using exhaustive chi-squared automatic interaction detection algorithm. RESULTS Five PET/CT parameters were significantly different between metastatic and non-metastatic nodes: the longest ( P = 0.015) and shortest ( P = 0.023) diameter, and the maximum standardized uptake values (SUVmax) of the contralateral node ( P = 0.030), primary tumor ( P < 0.001), and ipsilateral node ( P < 0.001). The area under the curves of SUVmax of the primary tumor (0.887), ipsilateral node (0.886), and longest diameter (0.752) were the largest and these three parameters were used as predictive criteria in the decision tree. The accuracy of the decision tree was 97.7% with 100% sensitivity and 97.6% specificity. CONCLUSION Preoperative PET/CT imaging with a decision tree has the potential to diagnose CLNM in patients with oral cancer.
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Affiliation(s)
- Natnicha Wamasing
- Department of Dental Radiology and Radiation Oncology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
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2
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Kowalski LP. Eugene Nicholas Myers' Lecture on Head and Neck Cancer, 2020: The Surgeon as a Prognostic Factor in Head and Neck Cancer Patients Undergoing Surgery. Int Arch Otorhinolaryngol 2023; 27:e536-e546. [PMID: 37564472 PMCID: PMC10411134 DOI: 10.1055/s-0043-1761170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/26/2022] [Indexed: 08/12/2023] Open
Abstract
This paper is a transcript of the 29 th Eugene N. Myers, MD International Lecture on Head and Neck Cancer presented at the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) in 2020. By the end of the 19 th century, the survival rate in treated patients was 10%. With the improvements in surgical techniques, currently, about two thirds of patients survive for > 5 years. Teamwork and progress in surgical reconstruction have led to advancements in ablative surgery; the associated adjuvant treatments have further improved the prognosis in the last 30 years. However, prospective trials are lacking; most of the accumulated knowledge is based on retrospective series and some real-world data analyses. Current knowledge on prognostic factors plays a central role in an efficient treatment decision-making process. Although the influence of most tumor- and patient-related prognostic factors in head and neck cancer cannot be changed by medical interventions, some environmental factors-including treatment, decision-making, and quality-can be modified. Ideally, treatment strategy decisions should be taken in dedicated multidisciplinary team meetings. However, evidence suggests that surgeons and hospital volume and specialization play major roles in patient survival after initial or salvage head and neck cancer treatment. The metrics of surgical quality assurance (surgical margins and nodal yield) in neck dissection have a significant impact on survival in head and neck cancer patients and can be influenced by the surgeon's expertise. Strategies proposed to improve surgical quality include continuous performance measurement, feedback, and dissemination of best practice measures.
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Affiliation(s)
- Luiz P. Kowalski
- Head and Neck Surgery Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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3
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Fox H, Robson A, Cocks H, Meikle D, Kelly C, Goranova R, Kovarik J, Shaikh G, Paleri V, O'Hara J. Contralateral neck metastases in lateralised, resectable advanced stage oropharyngeal squamous cell carcinoma-Results of 57 patients undergoing bilateral selective neck dissection. Clin Otolaryngol 2017; 43:739-741. [DOI: 10.1111/coa.13040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2017] [Indexed: 12/01/2022]
Affiliation(s)
| | | | - H. Cocks
- Sunderland Royal Hospital; Sunderland UK
| | | | - C. Kelly
- Northern Centre for Cancer Care; Freeman Hospital; Newcastle UK
| | - R. Goranova
- Northern Centre for Cancer Care; Freeman Hospital; Newcastle UK
| | - J. Kovarik
- Northern Centre for Cancer Care; Freeman Hospital; Newcastle UK
| | - G. Shaikh
- Northern Centre for Cancer Care; Freeman Hospital; Newcastle UK
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4
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Colecchia D, Nicolato E, Ravagli C, Faraoni P, Strambi A, Rossi M, Doumett S, Mosconi E, Locatelli E, Comes Franchini M, Balzi M, Baldi G, Marzola P, Chiariello M. EGFR-Targeted Magnetic Nanovectors Recognize, in Vivo, Head and Neck Squamous Cells Carcinoma-Derived Tumors. ACS Med Chem Lett 2017; 8:1230-1235. [PMID: 29259739 DOI: 10.1021/acsmedchemlett.7b00278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/07/2017] [Indexed: 01/07/2023] Open
Abstract
Head and neck squamous cell carcinomas (HNSCC) are a diverse group of tumors with high morbidity and mortality that have remained mostly unchanged over the past decades. The epidermal growth factor receptor (EGFR) is often overexpressed and activated in these tumors and strongly contributes to their pathogenesis. Still, EGFR-targeted therapies such as monoclonal antibodies and kinase inhibitors have demonstrated only limited improvements in the clinical outcome of this disease. Here, we take advantage of the extraordinary affinity of EGF for its cognate receptor to specifically target magnetite-containing nanoparticles to HNSCC cells and mediate, in vitro, their cellular upload. On the basis of this, we show efficient accumulation, in vivo, of such nanoparticles in subcutaneous xenograft tumor tissues in sufficient amounts to be able to mediate visualization by magnetic resonance imaging. Overall, our EGF-coated nanosystem may warrant, in the near future, novel and very efficient theranostic approaches to HNSCC.
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Affiliation(s)
- David Colecchia
- Consiglio
Nazionale delle Ricerche, Istituto di Fisiologia Clinica and Istituto Toscano Tumori-AOU Senese, Core Research Laboratory, Via Fiorentina 1, 53100 Siena, Italy
| | | | - Costanza Ravagli
- Dipartimento
di Nanobiotecnologie, Colorobbia Consulting-Cericol, Via Pietramarina 53, 50053 Sovigliana Vinci, Italy
| | - Paola Faraoni
- Dipartimento
di Scienze Biomediche, Sperimentali e Cliniche “Mario Serio”, Università di Firenze, Viale Morgagni 50, 50134 Firenze, Italy
| | - Angela Strambi
- Consiglio
Nazionale delle Ricerche, Istituto di Fisiologia Clinica and Istituto Toscano Tumori-AOU Senese, Core Research Laboratory, Via Fiorentina 1, 53100 Siena, Italy
| | - Matteo Rossi
- Consiglio
Nazionale delle Ricerche, Istituto di Fisiologia Clinica and Istituto Toscano Tumori-AOU Senese, Core Research Laboratory, Via Fiorentina 1, 53100 Siena, Italy
| | - Saer Doumett
- Dipartimento
di Nanobiotecnologie, Colorobbia Consulting-Cericol, Via Pietramarina 53, 50053 Sovigliana Vinci, Italy
| | | | - Erica Locatelli
- Dipartimento
di Chimica Industriale “Toso Montanari”, Università di Bologna, Viale Risorgimento 4, 40136 Bologna, Italy
| | - Mauro Comes Franchini
- Dipartimento
di Chimica Industriale “Toso Montanari”, Università di Bologna, Viale Risorgimento 4, 40136 Bologna, Italy
| | - Manuela Balzi
- Dipartimento
di Scienze Biomediche, Sperimentali e Cliniche “Mario Serio”, Università di Firenze, Viale Morgagni 50, 50134 Firenze, Italy
| | - Giovanni Baldi
- Dipartimento
di Nanobiotecnologie, Colorobbia Consulting-Cericol, Via Pietramarina 53, 50053 Sovigliana Vinci, Italy
| | | | - Mario Chiariello
- Consiglio
Nazionale delle Ricerche, Istituto di Fisiologia Clinica and Istituto Toscano Tumori-AOU Senese, Core Research Laboratory, Via Fiorentina 1, 53100 Siena, Italy
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5
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Kawaguchi M, Kato H, Kito Y, Mizuta K, Aoki M, Kato K, Goshima S, Matsuo M. Imaging findings of primary immunoglobulin G4-related cervical lymphadenopathy. Neuroradiology 2017; 59:1111-1119. [PMID: 28918513 DOI: 10.1007/s00234-017-1921-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 09/06/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE The purpose of the present study was to assess imaging findings of primary immunoglobulin G4 (IgG4)-related cervical lymphadenopathy. METHODS Five consecutive patients with clinically, serologically, and histopathologically confirmed primary IgG4-related cervical lymphadenopathy without any other organ involvement were included. All patients underwent contrast-enhanced computed tomography (CT), and four underwent 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT. We retrospectively reviewed the images and assessed the number, size, location, central necrosis, perinodal infiltration, penetrating vessels, and maximum standardized uptake values (SUVmax) of the enlarged cervical nodes. RESULTS Thirteen enlarged cervical nodes measuring larger than 10 mm in minimum diameter were identified. The maximum and minimum diameter of enlarged nodes ranged from 1.2 to 3.2 cm (median, 1.8 cm) and from 1.0 to 1.9 cm (median, 1.2 cm), respectively. Lymphadenopathy was unilateral in all patients, and eight enlarged nodes were located at level IB (62%), one at level II (8%), three at level IV (23%), and one at level V (8%). Central necrosis was not seen in any nodes. Perinodal infiltration was seen in only one node (8%), and penetrating vessels were seen in seven nodes (54%). The median SUVmax of nine nodes was 4.45 (range, 2.08-12.44). CONCLUSION Eight enlarged nodes (62%) were located in the submandibular region. Central necrosis was not observed in any nodes and perinodal infiltration was observed in one node (8%).
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Affiliation(s)
- Masaya Kawaguchi
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Hiroki Kato
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Yusuke Kito
- Department of Pathology and Translational Research, Gifu University School of Medicine, Gifu, Japan
| | - Keisuke Mizuta
- Department of Otolaryngology, Gifu University School of Medicine, Gifu, Japan
| | - Mitsuhiro Aoki
- Department of Otolaryngology, Gifu University School of Medicine, Gifu, Japan
| | - Keizo Kato
- Department of Oral and Maxillofacial Sciences, Gifu University School of Medicine, Gifu, Japan
| | - Satoshi Goshima
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
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Cho JK, Ow TJ, Lee AY, Smith RV, Schlecht NF, Schiff BA, Tassler AB, Lin J, Moadel RM, Valdivia A, Abraham T, Gulko E, Neimark M, Ustun B, Bello JA, Shifteh K. Preoperative 18F-FDG-PET/CT vs Contrast-Enhanced CT to Identify Regional Nodal Metastasis among Patients with Head and Neck Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2017; 157:439-447. [PMID: 28608737 DOI: 10.1177/0194599817703927] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective Our objective was to compare the accuracy of preoperative positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced CT (CECT) in detecting cervical nodal metastases in patients treated with neck dissection and to scrutinize the ability of each modality to determine nodal stage. Study Design Case series with chart review. Setting Montefiore Medical Center, Bronx, New York. Subjects and Methods Patients who underwent neck dissection at our institution for primary treatment of head and neck squamous cell carcinoma (HNSCC) and had received preoperative PET/CT and CECT were included in this study. Imaging studies were reinterpreted by 3 specialists within the field and compared for interreader agreement. Concordance between radiology and histopathology was measured using neck levels and sides, along with patient nodal stage. Sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and agreement coefficients were calculated. Results Seventy-three patients were included in the study. Sensitivity was 0.69 and 0.94 (level and side) for PET/CT vs 0.53 and 0.66 for CECT ( P = .056, P = .001). Specificity was 0.86 and 0.56 for PET/CT vs 0.91 and 0.76 for CECT ( P = .014, P = .024). No significant difference was found in overall accuracy ( P = .33, P = .88). The overall agreement percentages between N stage called by imaging modality and pathology were 52% and 55% for PET/CT and CECT, respectively. Conclusion No significant difference in sensitivity was found between PET/CT and CECT. CECT was found to have superior specificity compared with PET/CT. The information gleaned from each modality in the pretreatment evaluation of HNSCC appears to be complementary.
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Affiliation(s)
- Joshua K Cho
- 1 Albert Einstein College of Medicine, Bronx, New York, USA
| | - Thomas J Ow
- 2 Montefiore Medical Center, Department of Otorhinolaryngology-Head and Neck Surgery, Bronx, New York, USA
| | - Andrew Y Lee
- 2 Montefiore Medical Center, Department of Otorhinolaryngology-Head and Neck Surgery, Bronx, New York, USA
| | - Richard V Smith
- 2 Montefiore Medical Center, Department of Otorhinolaryngology-Head and Neck Surgery, Bronx, New York, USA
| | - Nicolas F Schlecht
- 1 Albert Einstein College of Medicine, Bronx, New York, USA.,3 Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Bradley A Schiff
- 2 Montefiore Medical Center, Department of Otorhinolaryngology-Head and Neck Surgery, Bronx, New York, USA
| | - Andrew B Tassler
- 4 Weill Cornell Medical College, Department of Otolaryngology-Head and Neck Surgery, New York, New York, USA
| | - Juan Lin
- 1 Albert Einstein College of Medicine, Bronx, New York, USA
| | - Renee M Moadel
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Ana Valdivia
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Tony Abraham
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Edwin Gulko
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Matthew Neimark
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Berrin Ustun
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Jacqueline A Bello
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Keivan Shifteh
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
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A novel classification scheme for advanced laryngeal cancer midline involvement: implications for the contralateral neck. J Cancer Res Clin Oncol 2017; 143:1605-1612. [DOI: 10.1007/s00432-017-2419-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 04/06/2017] [Indexed: 12/19/2022]
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8
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Park JT, Roh JL, Kim JS, Lee JH, Cho KJ, Choi SH, Nam SY, Kim SY. 18F FDG PET/CT versus CT/MR Imaging and the Prognostic Value of Contralateral Neck Metastases in Patients with Head and Neck Squamous Cell Carcinoma. Radiology 2016; 279:481-91. [DOI: 10.1148/radiol.2015150959] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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9
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Langner S. Optimized imaging of the midface and orbits. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2016; 14:Doc05. [PMID: 26770279 PMCID: PMC4702054 DOI: 10.3205/cto000120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A variety of imaging techniques are available for imaging the midface and orbits. This review article describes the different imaging techniques based on the recent literature and discusses their impact on clinical routine imaging. Imaging protocols are presented for different diseases and the different imaging modalities.
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Affiliation(s)
- Sönke Langner
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Germany
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10
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[18F]-FDG PET/CT imaging for detection of nodal metastases in patients with squamous cell carcinoma of the pharynx and larynx: comparison with CT. Jpn J Radiol 2015; 34:203-10. [DOI: 10.1007/s11604-015-0510-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 11/29/2015] [Indexed: 10/22/2022]
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11
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Present and future role of FDG-PET/CT imaging in the management of head and neck carcinoma. Jpn J Radiol 2015; 33:776-89. [DOI: 10.1007/s11604-015-0495-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 10/16/2015] [Indexed: 01/09/2023]
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12
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Mabray MC, Behr SC, Naeger DM, Flavell RR, Glastonbury CM. Predictors of pathologic outcome of focal FDG uptake in the parotid gland identified on whole-body FDG PET imaging. Clin Imaging 2015; 39:1073-9. [PMID: 26324219 DOI: 10.1016/j.clinimag.2015.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/23/2015] [Accepted: 07/06/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose was to test whether patient's primary malignancy type and presence of F-18-fluorodeoxyglucose (FDG)-avid cervical lymph node(s) are predictors of pathologic outcome of incidental focal FDG-avid parotid lesions. BASIC PROCEDURES A retrospective cohort study of pathologically proven incidental cases was performed. MAIN FINDINGS Focal parotid FDG uptake in the setting of head and neck cancer/melanoma [odds ratio (OR)=24.6, P<.01], lymphoma (OR=7.2, P=.02), or FDG-avid cervical lymph node(s) (OR=3.6, P=.07) has a higher odds of representing metastases. No malignant primary parotid tumors were incidentally discovered. PRINCIPAL CONCLUSIONS In patients with head and neck cancer/melanoma, lymphoma, or FDG-avid cervical lymph node(s), there were higher odds that focal parotid FDG uptake was a metastasis.
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Affiliation(s)
- Marc C Mabray
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco CA 94143.
| | - Spencer C Behr
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco CA 94143
| | - David M Naeger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco CA 94143
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco CA 94143
| | - Christine M Glastonbury
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, San Francisco CA 94143
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Sun R, Tang X, Yang Y, Zhang C. (18)FDG-PET/CT for the detection of regional nodal metastasis in patients with head and neck cancer: a meta-analysis. Oral Oncol 2015; 51:314-20. [PMID: 25619735 DOI: 10.1016/j.oraloncology.2015.01.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 01/03/2015] [Accepted: 01/05/2015] [Indexed: 11/28/2022]
Abstract
We performed a meta-analysis to evaluate the role of (18)FDG-PET/CT for detection of regional nodal metastasis in patients with head and neck cancer (HNC). Studies about (18)FDG-PET/CT were systematically searched in the MEDLINE and EMBASE databases. The Stata software was used to obtain pooled estimates of sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for (18)FDG-PET/CT. We also compared the performance of (18)FDG-PET/CT with that of conventional imaging (CT, MRI, and CT/MRI) by analyzing studies that had also used conventional imaging on the same patients. 24 articles bulled all inclusion criteria (1270 patients). The pooled per-patient, per-neck-side, and per-neck-level sensitivities/specificities for (18)FDG-PET/CT were 0.91/0.87, 0.84/0.83, and 0.80/0.96, respectively. Across 13 studies (3460 neck levels) with per-neck-level data, the sensitivity and specificity of PET-CT were 0.84 and 0.96, and of conventional imaging were 0.63 and 0.96, respectively. (18)FDG-PET/CT has good diagnostic performance for the detection of regional nodal metastasis in HNC patients. Compared with conventional imaging, (18)FDG-PET/CT may have higher per-neck-level sensitivity.
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Affiliation(s)
- Rong Sun
- Department of Physical Examination, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xinye Tang
- Departments of Otolaryngology, Children's Hospital of Chongqing Medical University, Chongqing 400016, China; Pediatric Research Institute of Chongqing Medical University, Chongqing 400016, China; National Key Disciplinary Areas of Pediatrics, Ministry of Education, Chongqing 400016, China.
| | - Yang Yang
- Departments of Otolaryngology, Children's Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Cheng Zhang
- Departments of Otolaryngology, Children's Hospital of Chongqing Medical University, Chongqing 400016, China
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