Computed tomographic features of adenoid cystic carcinoma in the palate

THE USE OF DENTAL PATIENT-REPORTED OUTCOMES (dPROs) IN PREDICTION MODELING STUDIES IN ORAL HEALTH: A METHODOLOGICAL REVIEW

OBJECTIVE

Dental patient-reported outcomes (dPROs) are critical indicators of shared decision-making in oral healthcare. This study aimed to assess the frequency of use of dPROs and dPRO-related factors being used as predictors or predicted outcomes in clinical prediction models (CPMs) in oral health, and to identify variables associated with the use of dPROs and/or dPRO-related factors in CPMs.

METHODS

A PubMed search was conducted on 17th May, 2024, to identify eligible studies. The studies which aimed to develop CPMs in oral health using traditional statistical techniques (e.g. logistic or Cox regression) and were published from 2018 onwards were included. The dPROs and dPRO-related factors used as potential predictors, final predictors, and predicted outcomes in the CPMs were extracted and summarized. Logistic regression analyses were performed to assess the associations between various variables and the use of dPROs and dPRO-related factors.

RESULTS

A total of 144 studies were included, of which 88.2% were retrospective studies and 73.6% were on oral oncology. dPROs and/or dPRO-related factors were used as potential predictors, final predictors, and predicted outcomes in 28 (19.4%), 21 (14.6%), and 7 (4.9%) studies, respectively. The most frequently used dPRO as both potential and final predictors was self-reported orofacial pain, while the most frequently used dPRO-related factor was self-reported toothbrushing. The most frequently used dPRO as a predicted outcome was self-reported xerostomia, while no studies used dPRO-related factors as outcomes. The study topic was statistically significantly associated with the use of dPROs and/or dPRO-related factors (Odds Ratio [OR]: 9.98; 95% confidence interval [CI]: 3.36 29.67; P < .01).

CONCLUSIONS

dPROs and dPRO-related factors were infrequently used as predictors or predicted outcomes in prediction modeling studies in oral health. Studies in dental fields other than oral oncology, such as cariology and periodontology, were more likely to use dPROs and/or dPRO-related factors compared to those in oral oncology.

Adenoid Cystic Carcinoma of Salivary Glands: A Ten-Year Review and an Assessment of the Current Management, Surgery, Radiotherapy, and Chemotherapy

Adenoid cystic carcinoma (ACC) is a rare cancer that arises from the salivary glands and other sites in the body, such as the lung and breast. Although the tumor accounts for 10% of all salivary gland malignancies, it only accounts for 1% of head and neck malignancies. It can affect both major and minor salivary glands; here, it is called salivary gland adenoid cystic carcinoma or SACC, with a slight predilection to the latter, and commonly manifests between the 6_th and 7_th decades of life. The disease also shows a slight female predilection, with a reported female to male ratio of 3 : 2. Lesions of SACC are often insidious and slow-growing, and symptoms such as pain and altered sensation are frequently associated with advanced stages of the disease. Salivary adenoid cystic carcinoma is characterized by perineural invasion (PNI), a distinctive feature that potentially plays a significant role in the tumor's relapse and recurrence, which is approximately 50%. The disease is not prevalent, and its etiopathogenesis is poorly understood, although several genetic patterns and biomarkers have been linked to its initiation and/or progression. The discovery of these mutations and biomarkers has encouraged several clinical studies to use therapeutic agents to target the specific receptors on the cancer cells to potentially prevent further proliferation of the tumor cells and metastasis of the disease. Diagnosis of SACC is often challenging and frequently requires a combination of clinical examination, imaging, and histopathology. Management of SACC is primarily surgical excision, while radiotherapy has shown to be effective in improving local control in cases with microscopic residual disease. However, treatment of recurrent or metastatic tumors by radiotherapy with or without chemotherapy has so far shown limited success. The aim of this thesis is to provide an update of literature on SACC with a particular focus on the latest management approaches and future trends.

Current opinions on diagnosis and treatment of adenoid cystic carcinoma

Adenoid cystic carcinoma (ACC) is a rare malignant tumor derived mainly from the salivary glands, representing approximately 1% of all headandneck carcinomasand 10% of all salivary gland neoplasms. ACC displays a paradoxical behavioral combination of an indolent growth pattern but an aggressive progression, with local recurrence and distant metastasis. The propensity of ACC of the head and neck (ACCHN) for perineural invasion and its anatomical location, especially if it extends to the nasal cavity and paranasal sinuses, facilitates tumor involvement in the surrounding structures, such as the orbit, pterygopalatine fossa, Meckel'scave, and cavernous sinus, which can lead to skull base involvement and intracranial extension. Despite advances in molecular mechanisms and diagnostic imaging, ACC treatment remainschallenging due to the lack ofconsensuson treatment patterns. In this review, we aimed toprovideanupdatedinsight intothe understanding of ACCHN by focusing on clinical behavior, imaging diagnosis, pathological features, and therapeutic strategies. We reviewed the molecular mechanisms, especially in ACCHN with perineural invasion, and elaborated on treatment options, including chemotherapy, targeted therapies, and immunotherapy, to establish a comprehensive understanding of ACC to arrive at a policy for proper diagnosis, preoperative evaluation, and therapeutic strategies.

Management of Salivary Gland Malignancy: ASCO Guideline

PURPOSE

To provide evidence-based recommendations for practicing physicians and other healthcare providers on the management of salivary gland malignancy.

METHODS

ASCO convened an Expert Panel of medical oncology, surgical oncology, radiation oncology, neuroradiology, pathology, and patient advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 2000 through 2020. Outcomes of interest included survival, diagnostic accuracy, disease recurrence, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations.

RESULTS

The literature search identified 293 relevant studies to inform the evidence base for this guideline. Six main clinical questions were addressed, which included subquestions on preoperative evaluations, surgical diagnostic and therapeutic procedures, appropriate radiotherapy techniques, the role of systemic therapy, and follow-up evaluations.

RECOMMENDATIONS

When possible, evidence-based recommendations were developed to address the diagnosis and appropriate preoperative evaluations for patients with a salivary gland malignancy, therapeutic procedures, and appropriate treatment options in various salivary gland histologies.Additional information is available at www.asco.org/head-neck-cancer-guidelines.

Strain elastography of palatal tumors in conjunction with intraoral ultrasonography, computed tomography, and magnetic resonance imaging: 2 case reports

Computed tomography (CT) and magnetic resonance imaging (MRI) can be useful for the evaluation of palatal lesions, and strain elastography (performed together with intraoral ultrasonography) is a relatively new sonographic imaging modality. This report describes 2 clinical cases in which strain elastography was used to assess palatal tumors in conjunction with intraoral ultrasonography, CT, and MRI. In the first case, diagnosed as a myoepithelioma, the strain was determined to be 0.000% (strain of normal tissue, 0.556%). In the second case, diagnosed as an adenoid cystic carcinoma, the determined strain was 0.000% (strain of normal tissue, 1.077%). Therefore, we conclude that intraoral strain elastography can be useful for evaluating palatal lesions.