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Eskander A, Khariwala SS, St John M. Sentinel Node Biopsy in Oral Cancer-Indications, Analysis, and Outcomes-Reply. JAMA Otolaryngol Head Neck Surg 2024; 150:634-635. [PMID: 38842842 DOI: 10.1001/jamaoto.2024.1328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Affiliation(s)
- Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Samir S Khariwala
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota Twin Cities, Minneapolis
| | - Maie St John
- Division of Head and Neck Surgery-Otolaryngology Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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White HW, Naveed AB, Campbell BR, Lee YJ, Baik FM, Topf M, Rosenthal EL, Hom ME. Infrared Fluorescence-guided Surgery for Tumor and Metastatic Lymph Node Detection in Head and Neck Cancer. Radiol Imaging Cancer 2024; 6:e230178. [PMID: 38940689 DOI: 10.1148/rycan.230178] [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] [Indexed: 06/29/2024]
Abstract
In patients with head and neck cancer (HNC), surgical removal of cancerous tissue presents the best overall survival rate. However, failure to obtain negative margins during resection has remained a steady concern over the past 3 decades. The need for improved tumor removal and margin assessment presents an ongoing concern for the field. While near-infrared agents have long been used in imaging, investigation of these agents for use in HNC imaging has dramatically expanded in the past decade. Targeted tracers for use in primary and metastatic lymph node detection are of particular interest, with panitumumab-IRDye800 as a major candidate in current studies. This review aims to provide an overview of intraoperative near-infrared fluorescence-guided surgery techniques used in the clinical detection of malignant tissue and sentinel lymph nodes in HNC, highlighting current applications, limitations, and future directions for use of this technology within the field. Keywords: Molecular Imaging-Cancer, Fluorescence © RSNA, 2024.
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Affiliation(s)
- Haley W White
- From the University of Michigan School of Medicine, Ann Arbor, Mich (H.W.W.); Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 754, Nashville, TN 37232 (A.B.N., B.R.C., M.T., E.L.R., M.E.H.); and Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, Calif (Y.J.L., F.M.B.)
| | - Abdullah Bin Naveed
- From the University of Michigan School of Medicine, Ann Arbor, Mich (H.W.W.); Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 754, Nashville, TN 37232 (A.B.N., B.R.C., M.T., E.L.R., M.E.H.); and Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, Calif (Y.J.L., F.M.B.)
| | - Benjamin R Campbell
- From the University of Michigan School of Medicine, Ann Arbor, Mich (H.W.W.); Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 754, Nashville, TN 37232 (A.B.N., B.R.C., M.T., E.L.R., M.E.H.); and Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, Calif (Y.J.L., F.M.B.)
| | - Yu-Jin Lee
- From the University of Michigan School of Medicine, Ann Arbor, Mich (H.W.W.); Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 754, Nashville, TN 37232 (A.B.N., B.R.C., M.T., E.L.R., M.E.H.); and Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, Calif (Y.J.L., F.M.B.)
| | - Fred M Baik
- From the University of Michigan School of Medicine, Ann Arbor, Mich (H.W.W.); Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 754, Nashville, TN 37232 (A.B.N., B.R.C., M.T., E.L.R., M.E.H.); and Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, Calif (Y.J.L., F.M.B.)
| | - Michael Topf
- From the University of Michigan School of Medicine, Ann Arbor, Mich (H.W.W.); Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 754, Nashville, TN 37232 (A.B.N., B.R.C., M.T., E.L.R., M.E.H.); and Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, Calif (Y.J.L., F.M.B.)
| | - Eben L Rosenthal
- From the University of Michigan School of Medicine, Ann Arbor, Mich (H.W.W.); Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 754, Nashville, TN 37232 (A.B.N., B.R.C., M.T., E.L.R., M.E.H.); and Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, Calif (Y.J.L., F.M.B.)
| | - Marisa E Hom
- From the University of Michigan School of Medicine, Ann Arbor, Mich (H.W.W.); Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 754, Nashville, TN 37232 (A.B.N., B.R.C., M.T., E.L.R., M.E.H.); and Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, Calif (Y.J.L., F.M.B.)
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Wang B, Ma X, Zhang X, Zhang X, Guan S, Xiao T, Li X. Application value of a hybrid tracer during sentinel lymph node biopsy for head and neck malignancies: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108340. [PMID: 38653162 DOI: 10.1016/j.ejso.2024.108340] [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: 01/05/2024] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
To address the limitations of conventional sentinel lymph node biopsy (SLNB), a novel hybrid tracer (indocyanine green [ICG]-99mTc-nanocolloid) has been developed. This meta-analysis aimed to compare the differences between the novel hybrid tracer and conventional methods using ICG or radioisotope (RI) for SLNB in head and neck malignancies. This study was registered in the International Prospective Register of Systematic Reviews (CRD42023409127). PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched. This study included raw data on the number of sentinel lymph nodes (SLNs) identified using different modalities during surgery for head and neck malignancies. The identification rate of SLNs was the main outcome of interest. Prognostic data and complication rate cannot be deduced from this article. The heterogeneity test (I2) determined the use of a fixed- or random-effects model for the pooled risk ratio (RR). Overall, 1275 studies were screened, of which 11 met the inclusion criteria for the meta-analysis. In SLN identification of head and neck malignancies, ICG-99mTc-nanocolloid was superior to ICG or RI. In the subgroup analyses, the detection rates of ICG and RI tracers in SLNB were comparable, regardless of the device, tumor type, or tumor stage. In conclusion, in SLN identification of head and neck malignancies, the use of ICG-99mTc-nanocolloid is superior to the single technique of ICG or RI. This study suggests that Hospitals using ICG or RI may find it beneficial to change their practice to ICG-99mTc-nanocolloid, especially in the head and neck area, owing to its superior effectiveness.
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Affiliation(s)
- Bowen Wang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Hebei Medical University& Hebei Key Laboratory of Stomatology& Hebei Clinical Research Center for Oral Diseases& Hebei Technology Innovation Center of Oral Health, Shijiazhuang, 050017, China
| | - Xingyue Ma
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Hebei Medical University& Hebei Key Laboratory of Stomatology& Hebei Clinical Research Center for Oral Diseases& Hebei Technology Innovation Center of Oral Health, Shijiazhuang, 050017, China
| | - Xiao Zhang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Hebei Medical University& Hebei Key Laboratory of Stomatology& Hebei Clinical Research Center for Oral Diseases& Hebei Technology Innovation Center of Oral Health, Shijiazhuang, 050017, China
| | - Xiaoyan Zhang
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Hebei Medical University& Hebei Key Laboratory of Stomatology& Hebei Clinical Research Center for Oral Diseases& Hebei Technology Innovation Center of Oral Health, Shijiazhuang, 050017, China
| | - Shuai Guan
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Hebei Medical University& Hebei Key Laboratory of Stomatology& Hebei Clinical Research Center for Oral Diseases& Hebei Technology Innovation Center of Oral Health, Shijiazhuang, 050017, China
| | - Tiepeng Xiao
- Department of Orthodontics, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, China
| | - Xiangjun Li
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Hebei Medical University& Hebei Key Laboratory of Stomatology& Hebei Clinical Research Center for Oral Diseases& Hebei Technology Innovation Center of Oral Health, Shijiazhuang, 050017, China.
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Haraguchi K, Habu M, Takahashi O, Tominaga K, Yoshioka I, Sasaguri M. Association between lymph node ratio and survival outcomes in patients with oral squamous cell carcinoma. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101816. [PMID: 38458548 DOI: 10.1016/j.jormas.2024.101816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Recent reports have shown that the Lymph node ratio (LNR) is useful for predicting the prognosis in some cancers, however there are few reports on the usefulness of LNR in predicting the prognosis of oral squamous cell carcinoma (OSCC). The predictive value of LNR for prognosis of OSCC was investigated. MATERIALS AND METHODS The study included 152 patients with OSCC and histologically confirmed cervical lymph node metastasis who underwent neck dissection. We analyzed the relationship between LNR and overall survival (OS) and recurrence-free survival (RFS) retrospectively in these cases, with the relationship between prognosis and clinicopathological findings also examined. RESULTS Using a receiver operating characteristics curve, the LNR cutoff value was set at 0.095, categorizing 64 and 88 cases into high LNR (≥ 0.095) and low LNR (< 0.095) groups, respectively. Regarding OS and RFS, the prognosis was significantly worse in the high LNR group compared with the low LNR group. In multivariate analysis, sex, postoperative nodal stage, and LNR merged as independent prognostic factors. CONCLUSION This study's findings suggest that LNR may represent a prognostic indicator in OSCC with cervical lymph node metastasis.
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Affiliation(s)
- Kazuya Haraguchi
- Department of Science of Physical Functions, Division of Oral and Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan.
| | - Manabu Habu
- Department of Science of Physical Functions, Division of Oral and Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - Osamu Takahashi
- Department of Science of Physical Functions, Division of Oral and Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
| | - Kazuhiro Tominaga
- Department of Oral and Maxillofacial Surgery, Tobata Kyoritsu Hospital, Kitakyushu, Japan
| | - Izumi Yoshioka
- Department of Science of Physical Functions, Division of Oral Medicine, Kyushu Dental University, Kitakyushu, Japan
| | - Masaaki Sasaguri
- Department of Science of Physical Functions, Division of Oral and Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Japan
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5
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Nishio T, Maeda T, Ishikawa K, Murao N, Fuyama K, Yamamoto Y, Hayashi T. Lymphatic drainage patterns of malignant skin tumors in the head and neck region: a single-center retrospective study. Int J Clin Oncol 2024; 29:582-591. [PMID: 38554214 DOI: 10.1007/s10147-024-02487-2] [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: 08/31/2023] [Accepted: 02/09/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND This study aimed to clarify the relationship between primary site and lymphatic drainage pattern for malignant skin tumors in the head and neck region. Malignant melanoma and squamous cell carcinoma in the head and neck region are known to have poor prognosis because of lymph node metastasis. Nevertheless, numerous aspects of lymphatic drainage patterns remain elusive. METHODS We statistically analyzed data of 47 patients with malignant skin tumors in the head and neck region. Information was collected on the patients' clinical characteristics, primary tumor site, and lymphatic drainage patterns. RESULTS The parotid lymph nodes drained the greatest amount of lymph from skin tumors of the head and neck. Important lymphatic drainage pathways were the superficial cervical nodes for primary tumors in the buccal/nasal region, level IA and level IB nodes for primary tumors in the lip region, the occipital nodes, posterior auricular nodes, and level VA nodes in the parietal/occipital region, and the preauricular nodes in the auricular region. CONCLUSION These findings have considerable significance in terms of understanding lymphatic drainage patterns for malignant skin tumors in the head and neck and may be useful for clinical decision-making and when planning treatment. Further research and clinical applications are expected to contribute to an improved prognosis in patients with cutaneous head and neck malignancies.
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Affiliation(s)
- Takuya Nishio
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Plastic and Reconstructive Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Taku Maeda
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kosuke Ishikawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Naoki Murao
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kanako Fuyama
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Yuhei Yamamoto
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshihiko Hayashi
- Department of Plastic and Reconstructive Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan.
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Nicholson OA, Van Lanschot CGF, McDowell L, Iseli T, Koljenovic S, Baatenburg de Jong RJ, Keereweer S, Wiesenfeld D. In Reply. Int J Oral Maxillofac Surg 2024; 53:445-447. [PMID: 38182476 DOI: 10.1016/j.ijom.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/20/2023] [Indexed: 01/07/2024]
Affiliation(s)
- O A Nicholson
- Head and Neck Tumour Stream, Department of Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - C G F Van Lanschot
- Department of Otorhinolaryngology Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - L McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University Melbourne, Parkville, Victoria, Australia
| | - T Iseli
- Head and Neck Tumour Stream, Department of Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - S Koljenovic
- Department of Pathology, Erasmus Medical Centre Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Pathology, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - R J Baatenburg de Jong
- Department of Otorhinolaryngology Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - S Keereweer
- Department of Otorhinolaryngology Head and Neck Surgery, Erasmus Medical Centre Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - D Wiesenfeld
- Head and Neck Tumour Stream, Department of Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia
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7
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Kansara S, Oral E, Sarkar I, Sandulache V, Mualla R, Walvekar RR, Ryan W, Ha P. Rate of occult metastasis in lip squamous cell carcinoma: A systematic review and meta-analysis. Head Neck 2024. [PMID: 38497534 DOI: 10.1002/hed.27747] [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: 12/05/2023] [Revised: 02/12/2024] [Accepted: 03/12/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVES The rate of occult metastasis in lip cancer is poorly studied. Management of the regional nodal basin in lip cancer is thus controversial. This study sought to understand the true rate of micrometastasis in lip cancer. MATERIALS AND METHODS Systematic review and meta-analysis was conducted of English language studies reporting lip cancer sentinel node biopsy results. Studies were obtained from the PubMed database between the years 2000 and 2023 using the search terms "sentinel node biopsy" and "squamous cell carcinoma." Random effect and fixed effect meta-analyses were performed. RESULTS Thirteen studies met inclusion criteria. Low heterogeneity was noted among the studies, as indicated by the I2 inconsistency test (I2 = 0%). The rate of occult metastasis ranged between 0 and 33% (mean 9%). A total of 189 lip sentinel node biopsies had been performed. Of these, 21 revealed occult nodal metastasis (11.1%, 95% CI 7.36%-16.44%). One step, generalized linear mixed modeling revealed the true rate of occult nodal metastasis to be 10% (95% CI (0.0504, 0.1746), p < 0.0001). CONCLUSION The rate of occult metastasis in lip cancer approaches the threshold for elective management of the regional nodal basin. Sentinel node biopsy is optimally suited for management of high-risk early T stage lip cancer.
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Affiliation(s)
- Sagar Kansara
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Evrim Oral
- School of Public Health, Biostatistics and Data Science Program, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Indrani Sarkar
- School of Public Health, Biostatistics and Data Science Program, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Vlad Sandulache
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Rula Mualla
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Rohan R Walvekar
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - William Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Patrick Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA
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Ionna F, Pavone E, Aversa C, Maffia F, Spinelli R, Carraturo E, Salzano G, Maglitto F, Sarcinella M, Fusco R, Granata V, Lastoria S, Del Prato F, Maglione MG. Sentinel Lymph Node Biopsy (SLNB) for Early-Stage Head and Neck Squamous-Cell Carcinoma of the Tongue: Twenty Years of Experience at I.N.T. "G.Pascale". Cancers (Basel) 2024; 16:1153. [PMID: 38539488 PMCID: PMC10969103 DOI: 10.3390/cancers16061153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 07/28/2024] Open
Abstract
Oral tongue squamous-cell carcinoma (OTSCC) is the most prevalent malignancy in the head and neck region. Lymphatic spread, particularly to cervical lymph nodes, significantly impacts 5-year survival rates, emphasizing the criticality of precise staging. Metastatic cervical lymph nodes can decrease survival rates by 50%. Yet, elective neck dissection (END) in T1-2 cN0 patients proves to be an overtreatment in around 80% of cases. To address this, sentinel lymph node biopsy (SLNB) was introduced, aiming to minimize postoperative morbidity. This study, conducted at the ENT and Maxillofacial Surgery department of the Istituto Nazionale Tumori in Naples, explores SLNB's efficacy in early-stage oral tongue squamous-cell carcinoma (OTSCC). From January 2020 to January 2022, 122 T1/T2 cN0 HNSCC patients were enrolled. Radioactive tracers and lymphoscintigraphy identified sentinel lymph nodes, aided by a gamma probe during surgery. Results revealed 24.6% SLN biopsy positivity, with 169 SLNs resected and a 21.9% positivity ratio. The study suggests SLNB's reliability for T1-2 cN0 OTSCC patient staging and early micrometastasis detection.
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Affiliation(s)
- Franco Ionna
- Istituto Nazionale Tumori—IRCCS—Fondazione “G.Pascale”, 80131 Naples, Italy; (F.I.); (E.P.); (C.A.); (R.F.); (V.G.); (S.L.); (F.D.P.); (M.G.M.)
| | - Ettore Pavone
- Istituto Nazionale Tumori—IRCCS—Fondazione “G.Pascale”, 80131 Naples, Italy; (F.I.); (E.P.); (C.A.); (R.F.); (V.G.); (S.L.); (F.D.P.); (M.G.M.)
| | - Corrado Aversa
- Istituto Nazionale Tumori—IRCCS—Fondazione “G.Pascale”, 80131 Naples, Italy; (F.I.); (E.P.); (C.A.); (R.F.); (V.G.); (S.L.); (F.D.P.); (M.G.M.)
| | - Francesco Maffia
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy; (R.S.); (E.C.); (G.S.); (M.S.)
| | - Raffaele Spinelli
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy; (R.S.); (E.C.); (G.S.); (M.S.)
| | - Emanuele Carraturo
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy; (R.S.); (E.C.); (G.S.); (M.S.)
| | - Giovanni Salzano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy; (R.S.); (E.C.); (G.S.); (M.S.)
| | - Fabio Maglitto
- Maxillofacial Surgery Operative Unit, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, 70120 Bari, Italy;
| | - Marco Sarcinella
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, 80131 Naples, Italy; (R.S.); (E.C.); (G.S.); (M.S.)
| | - Roberta Fusco
- Istituto Nazionale Tumori—IRCCS—Fondazione “G.Pascale”, 80131 Naples, Italy; (F.I.); (E.P.); (C.A.); (R.F.); (V.G.); (S.L.); (F.D.P.); (M.G.M.)
| | - Vincenza Granata
- Istituto Nazionale Tumori—IRCCS—Fondazione “G.Pascale”, 80131 Naples, Italy; (F.I.); (E.P.); (C.A.); (R.F.); (V.G.); (S.L.); (F.D.P.); (M.G.M.)
| | - Secondo Lastoria
- Istituto Nazionale Tumori—IRCCS—Fondazione “G.Pascale”, 80131 Naples, Italy; (F.I.); (E.P.); (C.A.); (R.F.); (V.G.); (S.L.); (F.D.P.); (M.G.M.)
| | - Francesco Del Prato
- Istituto Nazionale Tumori—IRCCS—Fondazione “G.Pascale”, 80131 Naples, Italy; (F.I.); (E.P.); (C.A.); (R.F.); (V.G.); (S.L.); (F.D.P.); (M.G.M.)
| | - Maria Grazia Maglione
- Istituto Nazionale Tumori—IRCCS—Fondazione “G.Pascale”, 80131 Naples, Italy; (F.I.); (E.P.); (C.A.); (R.F.); (V.G.); (S.L.); (F.D.P.); (M.G.M.)
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9
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Al-Moraissi EA, Alkhutari AS, de Bree R, Kaur A, Al-Tairi NH, Pérez-Sayáns M. Management of clinically node-negative early-stage oral cancer: network meta-analysis of randomized clinical trials. Int J Oral Maxillofac Surg 2024; 53:179-190. [PMID: 37661515 DOI: 10.1016/j.ijom.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023]
Abstract
The best treatments for the clinically node-negative (cN0) neck in early-stage oral squamous cell carcinoma (OSCC) patients are a subject of ongoing debate and there is no consensus. A network meta-analysis (NMA) of randomized clinical trials (RCTs) was conducted to determine the most effective treatment and to rank treatments based on their effectiveness. A systematic search was performed in accordance with the PRISMA guidelines to retrieve RCTs that compared therapeutic neck dissection (TND), sentinel lymph node biopsy (SLNB), and elective neck dissection (END). The outcomes analysed were overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), and nodal recurrence. Hazard ratios and risk ratios were calculated by direct meta-analysis and NMA. Ten RCTs with a total of 1858 patients were eligible for inclusion. Direct meta-analysis showed END to be superior to TND and comparable to SLNB. The NMA revealed no statistically significant difference between END and SLNB (very low quality evidence) regarding OS, DSS, DFS, and nodal recurrence. However, END was found to significantly improve OS and DFS, and reduce nodal recurrence when compared to TND (moderate quality evidence). END ranked as probably the top treatment option for maximizing OS and DSS, and reducing nodal recurrence in early-stage OSCC, followed by SLNB and TND. There was very low quality evidence supporting SLNB as non-inferior to END for patients with early-stage OSCC. This NMA yielded favourable results for the use of END (with moderate quality evidence) in early-stage OSCC patients, although excellent results have also been obtained with SLNB. However, data in the literature for SLNB are scarce, as this technique has not yet been formalized in many countries. There is a need to further explore SLNB for early-stage OSCC patients, as well as its value in detecting occult lymph node metastases on the contralateral side. More studies comparing morbidity, quality of life, and costs between the different management strategies for the clinically negative neck in early-stage OSCC patients are needed.
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Affiliation(s)
- E A Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Thamar University, Thamar, Yemen.
| | - A S Alkhutari
- Department of Oral and Maxillofacial Surgery, Thamar University, Thamar, Yemen
| | - R de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A Kaur
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Vijaypur, Jammu and Kashmir, India
| | - N H Al-Tairi
- Department of Oral and Maxillofacial Surgery, Thamar University, Thamar, Yemen
| | - M Pérez-Sayáns
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Instituto de Investigación Sanitaria de Santiago (IDIS), ORALRES Group, Santiago de Compostela, Spain
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10
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Homma A, Ando M, Hanai N, Harada H, Honma Y, Kanda T, Kano S, Kawakita D, Kiyota N, Kizawa Y, Nakagawa M, Ogawa T, Shinomiya H, Shinozaki T, Suzuki M, Tsuji T, Yasuda K, Zenda S, Kodaira T, Kirita T, Nibu KI. Summary of Japanese clinical practice guidelines for head and neck cancer - 2022 update edited by the Japan society for head and neck cancer. Auris Nasus Larynx 2024; 51:174-188. [PMID: 37482431 DOI: 10.1016/j.anl.2023.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/25/2023]
Abstract
The aim of the "Japanese Clinical Practice Guidelines for Head and Neck Cancer - 2022 Update" is to review the latest evidence regarding head and neck cancer and to present the current standard approaches for diagnosis and treatment. These evidence-based recommendations were created with the consensus of the Guideline Committee, which is composed of otorhinolaryngologists and head and neck surgeons, together with radiologists, radiation oncologists, medical oncologists, plastic surgeons, dentists, palliative care physicians, and rehabilitation physicians. These guidelines were created by the Clinical Practice Guideline Committee of the Japan Society for Head and Neck Cancer based on the "Head and Neck Cancer Treatment Guidelines 2018 Edition," and the revised draft was compiled after evaluation by the Assessment Committee and public comments. The 'Clinical questions and recommendations' section consists of 13 categories, and 59 clinical questions are described in total. Here we describe 6 clinical questions specific to other sets of guidelines with recommendations and comments.
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Affiliation(s)
- Akihiro Homma
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15, W7, Kita-ku, Sapporo 060-8638, Japan.
| | - Mizuo Ando
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hiroyuki Harada
- Department of Oral and Maxillofacial Surgical Oncology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshitaka Honma
- Department of Head and Neck, Esophageal Medical Oncology. National Cancer Center Hospital, Tokyo, Japan
| | - Tomonori Kanda
- Department of Radiology, Kobe University School of Medicine, Kobe, Japan
| | - Satoshi Kano
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15, W7, Kita-ku, Sapporo 060-8638, Japan
| | - Daisuke Kawakita
- Department of Otorhinolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative and Supportive Care, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masahiro Nakagawa
- Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takenori Ogawa
- Department of Otolaryngology-Head and Neck Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hirotaka Shinomiya
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
| | - Takeshi Shinozaki
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Motoyuki Suzuki
- Department of Otolaryngology - Head & Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Yasuda
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan
| | - Sadamoto Zenda
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Nara-Kashihara, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital and Graduate School of Medicine, Kobe, Japan
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11
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Eskander A, Dziegielewski PT, Patel MR, Jethwa AR, Pai PS, Silver NL, Sajisevi M, Sanabria A, Doweck I, Khariwala SS, St John M. Oral Cavity Cancer Surgical and Nodal Management: A Review From the American Head and Neck Society. JAMA Otolaryngol Head Neck Surg 2024; 150:172-178. [PMID: 38153725 DOI: 10.1001/jamaoto.2023.4049] [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: 12/29/2023]
Abstract
Importance Lymph node metastases from oral cavity cancers are seen frequently, and there is still inconsistency, and occasional controversies, regarding the surgical management of the neck in patients with oral cancer. This review is intended to offer a surgically focused discussion of the current recommendations regarding management of the neck, focusing on the indications and extent of dissection required in patients with oral cavity squamous cell carcinoma while balancing surgical risk and oncologic outcome. Observations The surgical management of the neck for oral cavity cancer has been robustly studied, as evidenced by substantial existing literature surrounding the topic. Prior published investigations have provided a sound foundation on which data-driven treatment algorithms can generally be recommended. Conclusions Existing literature suggests that patients with oral cavity cancer should be fully staged preoperatively, and most patients should receive a neck dissection even when clinically N0. Quality standards supported by the literature include separation of each level during specimen handling and lymph node yield of 18 or more nodes. Sentinel lymph node biopsy can be considered in select tumors and within a well-trained multidisciplinary team.
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Affiliation(s)
- Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Peter T Dziegielewski
- Department of Otolaryngology, University of Florida College of Medicine, Gainesville
| | - Mihir R Patel
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia
| | - Ashok R Jethwa
- Department of Otolaryngology-Head and Neck, University of Minnesota Medical School, Minneapolis
| | - Prathamesh S Pai
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - Mirabelle Sajisevi
- Department of Otolaryngology, The University of Vermont Medical Center, Burlington
| | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia, Medellín, Antioquia, Colombia
| | - Ilana Doweck
- Department of Otolaryngology, Head and Neck Surgery, Carmel Medical Center, Rappaport School of Medicine, Technion, Haifa, Israel
| | - Samir S Khariwala
- Department of Otolaryngology-Head and Neck, University of Minnesota Medical School, Minneapolis
| | - Maie St John
- Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, California
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12
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Rich BJ, Samuels SE, Azzam GA, Kubicek G, Freedman L. Oral Cavity Squamous Cell Carcinoma: Review of Pathology, Diagnosis, and Management. Crit Rev Oncog 2024; 29:5-24. [PMID: 38683151 DOI: 10.1615/critrevoncog.2023050055] [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: 05/01/2024]
Abstract
Squamous cell carcinoma of the oral cavity presents a significant global health burden, primarily due to risk factors such as tobacco smoking, smokeless tobacco use, heavy alcohol consumption, and betel quid chewing. Common clinical manifestations of oral cavity cancer include visible lesions and sores, often accompanied by pain in advanced stages. Diagnosis relies on a comprehensive assessment involving detailed history, physical examination, and biopsy. Ancillary imaging studies and functional evaluations aid in accurate staging and facilitate treatment planning. Prognostic information is obtained from histopathological factors, such as tumor grade, depth of invasion, lymphovascular invasion, and perineural invasion. Notably, lymph node metastasis, found in approximately half of the patients, carries significant prognostic implications. Effective management necessitates a multidisciplinary approach to optimize patient outcomes. Surgical resection is the backbone of treatment, aimed at complete tumor removal while preserving functional outcomes. Adjuvant therapies, including radiation and chemotherapy, are tailored according to pathological factors. Further work in risk stratification and treatment is necessary to optimize outcomes in squamous cell carcinoma of the oral cavity.
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Affiliation(s)
| | | | - Gregory A Azzam
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine
| | - Gregory Kubicek
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine
| | - Laura Freedman
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine
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13
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Mihulka O, Nisenbaum E, Nicolli E. Surgical Management of the Neck in Oral Cavity Squamous Cell Carcinoma. Crit Rev Oncog 2024; 29:25-31. [PMID: 38683152 DOI: 10.1615/critrevoncog.2023050817] [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: 05/01/2024]
Abstract
Oral cavity cancer remains a significant cause of morbidity and mortality globally, with a poor prognosis once the disease has metastasized to cervical lymph nodes. The anatomy of lymphatic drainage in the neck gives us a roadmap to follow when assessing for metastasis, although the predictive factors are still not well understood. The mainstay of treatment continues to be neck dissection. However, there is much debate on the management of the clinically negative neck. The necessity of elective neck dissection has been questioned in recent years, with other options such as sentinel lymph node biopsy gaining popularity. This review will explore the aspects of surgical management of the neck in oral cavity cancer and highlights the further research that needs to be done.
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Affiliation(s)
| | - Eric Nisenbaum
- Department of Otolaryngology-Head and Neck Surgery, University of Miami, Miami, FL, USA
| | - Elizabeth Nicolli
- Department of Otolaryngology-Head and Neck Surgery, University of Miami, Miami, FL, USA
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14
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Uchida K, Ueyama Y, Nonaka R, Noda K, Misumi J, Mishima K. Prognostic study of sentinel lymph node biopsy in early-stage oral squamous cell carcinoma with computed tomography lymphography. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 125:101723. [PMID: 38048906 DOI: 10.1016/j.jormas.2023.101723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 12/06/2023]
Abstract
PURPOSE Occult metastasis is a prognostic factor for early-stage oral squamous cell carcinoma (OSCC). Sentinel lymph node (SLN) biopsy (SLNB) is a promising method to detect such metastases. The present study aimed to evaluate the diagnostic reliability of SLNB with computed tomography lymphography (CTL) for early-stage OSCC and to clarify patient outcomes after SLNB. METHODS The medical records of 42 patients with T1 or T2 cN0 OSCC who had undergone CTL the day before surgery were retrospectively collected and statistically analyzed. RESULTS SLNs were identified on CTL in 41 of 42 OSCC patients (97.6 %). Micrometastases were detected in 10 of 41 cases (24.4 %) and 11 of 65 SLNs (16.9 %) by intraoperative pathological diagnosis. Three cases showed occult metastasis within a year after the primary operation. Specificity and negative predictive value were 76.9 % and 90.3 %, respectively. The cumulative 5-year regional recurrence-free rate was 89.7 % in 31 SLNB-negative patients. Five-year overall and disease-free survival rates were 86.9 % and 70.1 %, respectively, in the 41 cases with identified SLNs. CONCLUSION CTL offers acceptable results and appears likely to be effective in treating early-stage OSCC patients with low-invasive surgery. Further investigation is necessary to compare radioisotope-based methods.
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Affiliation(s)
- Kenichiro Uchida
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan.
| | - Yoshiya Ueyama
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - Ryo Nonaka
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - Kento Noda
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - Jyunichi Misumi
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - Katsuaki Mishima
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
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15
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Choi KY, Hao Q, Carlisle K, Hollenbeak CS, Lai SY. Cost-Effectiveness of [ 99mTc]Tilmanocept Relative to [ 99mTc]Sulfur Colloid for Sentinel Lymph Node Biopsy in Early Stage Oral Cavity Cancer. Ann Surg Oncol 2023; 30:7689-7698. [PMID: 37556007 PMCID: PMC10562505 DOI: 10.1245/s10434-023-13937-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 06/29/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Several studies have demonstrated varying rates of efficacy, reliability, and sensitivity of sentinel lymph node biopsy (SLNB) in identifying occult nodal disease for early stage oral cavity squamous cell carcinoma (OCSCC) depending on the radionuclide agent utilized. No head-to-head comparison of cost or clinical outcomes of SLNB when utilizing [99mTc]tilmanocept versus [99mTc]sulfur colloid has been performed. The goal of this study was to develop a decision model to compare the cost-effectiveness of [99mTc]tilmanocept versus [99mTc]sulfur colloid in early stage OCSCC. PATIENTS AND METHODS A decision model of disease and treatment as a function of SLNB was created. Patients with a negative SLNB entered a Markov model of the natural history of OCSCC parameterized with published data to simulate five states of health and iterated over a 30-year time horizon. Treatment costs and quality-adjusted life-years (QALYs) for each health state were included. The incremental cost-effectiveness ratio (ICER) was then estimated using $100,000 per additional QALY as the threshold for determining cost-effectiveness. RESULTS The base case cost-effectiveness analysis suggested [99mTc]tilmanocept was more effective than [99mTc]sulfur colloid by 0.12 QALYs (7.06 versus 6.94 QALYs). [99mTc]Tilmanocept was more costly, with a lifetime cost of $84,961 in comparison with $84,264 for sulfur colloid, however, the overall base case ICER was $5859 per additional QALY, well under the threshold for cost-effectiveness. Multiple one-way sensitivity analyses were performed, and demonstrated the model was robust to alternative parameter values. CONCLUSION Our analysis showed that while [99mTc]tilmanocept is more costly upfront, these costs are worth the additional QALYs gained by the use of [99mTc]tilmanocept.
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Affiliation(s)
- Karen Y Choi
- Penn State College of Medicine, Hershey Medical Center, Hershey, PA, USA.
- Department of Otolaryngology Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, PA, USA.
| | - Qiang Hao
- Department of Health Policy and Administration, Penn State University, University Park, PA, USA
| | - Kathryn Carlisle
- Penn State College of Medicine, Hershey Medical Center, Hershey, PA, USA
| | | | - Stephen Y Lai
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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16
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Vartak A, Malhotra M, Jaiswal P, Talwar R, Tyagi A, Kishore B. Role of 18F-FDG PET/CT in Guiding Surgical Management of Clinically Node Negative Neck (cN0) in Carcinoma Oral Cavity. Indian J Otolaryngol Head Neck Surg 2023; 75:1799-1805. [PMID: 37636652 PMCID: PMC10447354 DOI: 10.1007/s12070-023-03744-y] [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: 03/15/2022] [Accepted: 03/27/2023] [Indexed: 08/29/2023] Open
Abstract
Conventional staging paradigm with clinical examination or imaging invariably leads to underestimation of occult metastatic neck disease in oral cavity carcinoma. The advantage of 18F-FDG PET/CT is in its ability to identify lymph nodes without morphological changes yet harboring occult metastases. We present findings of our study to evaluate diagnostic accuracy of 18F-FDG PET/CT, in detecting occult cervical lymph node metastasis in carcinoma oral cavity. In a single institution prospective study, 51 consecutive patients with histologically proven (cT1/T2) oral cavity carcinoma and clinically node negative neck (cNo), underwent 18F-FDG PET/CT before elective neck dissection of 58 neck sides. 18F-FDG PET/CT findings were compared with histopathology of dissected nodes, to calculate diagnostic accuracy. 18F-FDG PET/CT correctly characterized the occult lymph node metastasis status (true positive + true negative) in 51 of 58 neck sides, yielding diagnostic accuracy of 87.93%. Sensitivity of 18F-FDG PET/CT was 90% and specificity was 87.5%. While a positive 18F-FDG PET/CT accurately predicted the disease in only 60% (positive predictive value), a negative 18F-FDG PET/CT reasonably ruled out occult metastases in 97.67% (negative predictive value). If a decision regarding the need for neck dissection had been based solely on 18F-FDG PET/CT, the number of neck dissections would have been reduced by 74.13%. Based on diagnostic accuracy and high negative predictive value, incorporating 18F-FDG PET/CT in preoperative staging paradigm of cT1/T2 carcinoma oral cavity will guide in selection of patients in which cN0 neck can be safely observed.
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Affiliation(s)
- Anushree Vartak
- Department of Surgical Oncology, Army Hospital Research and Referral, Delhi Cantt, New Delhi, 110010 India
| | - Munish Malhotra
- Department of Surgical Oncology, INHS Asvini, Mumbai, 40005 India
| | - Pradeep Jaiswal
- Department of Surgical Oncology, Army Hospital Research and Referral, Delhi Cantt, New Delhi, 110010 India
| | - Rajnish Talwar
- Department of Surgical Oncology, Fortis Mohali, Sahibzada Ajit Singh Nagar, Punjab 160062 India
| | - Arvind Tyagi
- Department of Surgical Oncology, Yashoda Super Speciality Hospital and Cancer Institute, Ghaziabad, Uttar Pradesh 201002 India
| | - Brij Kishore
- Department of Nuclear Medicine, INHS Asvini, Mumbai, 40005 India
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17
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Mohamad I, Glaun MDE, Prabhash K, Busheri A, Lai SY, Noronha V, Hosni A. Current Treatment Strategies and Risk Stratification for Oral Carcinoma. Am Soc Clin Oncol Educ Book 2023; 43:e389810. [PMID: 37200591 DOI: 10.1200/edbk_389810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Management of oral cavity squamous cell carcinoma (OSCC) involves a multidisciplinary team approach. Surgery is ideally the primary treatment option for nonmetastatic OSCC, and less invasive curative surgical approaches are preferred in early-stage disease to minimize surgical-related morbidity. For patients at high risk of recurrence, adjuvant treatment using radiation therapy or chemoradiation is often used. Systemic therapy may also be used in the neoadjuvant setting (for advanced-stage disease with the intent of mandibular preservation) or in the palliative setting (for nonsalvageable locoregional recurrence and/or distant metastases). Patient involvement in treatment decision is the key for patient-driven management, particularly in clinical situation with poor prognosis, for example, early postoperative recurrence before planned adjuvant therapy.
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Affiliation(s)
- Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Mica D E Glaun
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Homi Bhabha National Institute, Mumbai, India
| | - Ahmed Busheri
- Department of Radiation Oncology, Kuwait Cancer Control Center, Kuwait
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Homi Bhabha National Institute, Mumbai, India
| | - Ali Hosni
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
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18
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Christensen A, Wessel I, Charabi BW, Juhl K, Kiss K, Lelkaitis G, Mortensen J, Kjaer A, von Buchwald C, Tvedskov JF. Diagnostic accuracy of combined optical- and radio-guided SNB for neck staging of oral squamous cell carcinoma lesions in the anterior oral cavity. Eur Arch Otorhinolaryngol 2023; 280:3393-3403. [PMID: 37010601 DOI: 10.1007/s00405-023-07939-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/21/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE The purpose was to investigate the diagnostic performance of bimodal optical and radio-guided sentinel node biopsy (SNB) for oral squamous cell carcinoma (OSCC) sub-sites in the anterior oral cavity. METHODS Prospective study of 50 consecutive patients with cN0 OSCC scheduled for SNB was injected with the tracer complex Tc99m:ICG:Nacocoll. A near-infrared camera was applied for optical SN detection. Endpoints were modality for intraoperative SN detection and false omission rate at follow-up. RESULTS In all patients, a SN could be detected. In 12/50 (24%) of cases, the SPECT/CT showed no focus in level 1, but intraoperatively a SN in level 1 was optically detected. In 22/50 cases (44%), an additional SN was identified only due to the optical imaging. At follow-up, the false omission rate was 0%. CONCLUSION Optical imaging appears to be an effective tool to allow real-time SN identification comprising level 1 unaffected by possible interference of radiation site from the injection.
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Affiliation(s)
- Anders Christensen
- Department of Otolaryngology, Head & Neck Surgery and Audiology, 6033, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Irene Wessel
- Department of Otolaryngology, Head & Neck Surgery and Audiology, 6033, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Birgitte Wittenborg Charabi
- Department of Otolaryngology, Head & Neck Surgery and Audiology, 6033, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Karina Juhl
- Department of Clinical Physiology and Nuclear Medicine & Cluster for Molecular Imaging & Department of Biomedical Sciences, Copenhagen University Hospital, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Katalin Kiss
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Giedrius Lelkaitis
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jann Mortensen
- Department of Clinical Physiology and Nuclear Medicine & Cluster for Molecular Imaging & Department of Biomedical Sciences, Copenhagen University Hospital, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology and Nuclear Medicine & Cluster for Molecular Imaging & Department of Biomedical Sciences, Copenhagen University Hospital, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otolaryngology, Head & Neck Surgery and Audiology, 6033, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Jesper Filtenborg Tvedskov
- Department of Otolaryngology, Head & Neck Surgery and Audiology, 6033, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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19
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Garau LM, Di Gregorio F, Nonne G, Volterrani D, Manca G. Measures of performance for sentinel lymph node biopsy in oro-oropharyngeal squamous cell carcinoma: a systematic review and meta-analysis. Clin Transl Imaging 2023. [DOI: 10.1007/s40336-023-00552-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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20
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Peng B, Hao Y, Si C, Wang B, Luo C, Chen M, Luo C, Gong B, Li Z. Tween-20-Modified BiVO 4 Nanorods for CT Imaging-Guided Radiotherapy of Tumor. ACS OMEGA 2023; 8:4736-4746. [PMID: 36777573 PMCID: PMC9910094 DOI: 10.1021/acsomega.2c06714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
Oral cancer is the most common malignant tumor in the oral and maxillofacial region, which seriously threatens the health of patients. At present, radiotherapy is one of the commonly used methods for oral cancer treatment. However, the resistance of cancerous tissues to ionizing radiation, as well as the side effects of X-rays on healthy tissues, still limit the application of radiotherapy. Therefore, how to effectively solve the above problems is still a challenge at present. Generally speaking, elements with high atomic numbers, such as bismuth, tungsten, and iodine, have a high X-ray attenuation capacity. Using nanomaterials containing these elements as radiosensitizers can greatly improve the radiotherapy effect. At the same time, the modification of nanomaterials based on the above elements with the biocompatible polymer can effectively reduce the side effects of radiosensitizers, providing a new method for the realization of efficient and safe radiotherapy for oral cancer. In this work, we prepared Tween-20-modified BiVO4 nanorods (Tw20-BiVO4 NRs) and further used them in the radiotherapy of human tongue squamous cell carcinoma. Tw20-BiVO4 NRs are promising radiosensitizers, which can generate a large number of free radicals under X-rays, leading to the damage of cancer cells and thus playing a role in tumor therapy. In cell experiments, radiotherapy sensitization of Tw20-BiVO4 NRs significantly enhanced the production of free radicals in oral cancer cells, aggravated the destruction of chromosomes, and improved the therapeutic effect of radiotherapy. In animal experiments, the strong X-ray absorption ability of Tw20-BiVO4 NRs makes them effective contrast agents in computed tomography (CT) imaging. After the tumors are located by CT imaging, it helps to apply precise radiotherapy; the growth of subcutaneous tumors in nude mice was significantly inhibited, confirming the remarkable effect of CT imaging-guided radiotherapy.
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Affiliation(s)
- Bo Peng
- Department
of Oral Radiology, School of Stomatology, China Medical University, Shenyang 110002, P. R. China
| | - Yifan Hao
- Department
of Oral Radiology, Hospital of Stomatology, Jilin University, Changchun 130021, P. R. China
| | - Chao Si
- Department
of Oral Radiology, Hospital of Stomatology, Jilin University, Changchun 130021, P. R. China
| | - Bo Wang
- Department
of Oral Radiology, School of Stomatology, China Medical University, Shenyang 110002, P. R. China
| | - Chengfeng Luo
- Department
of Oral Radiology, School of Stomatology, China Medical University, Shenyang 110002, P. R. China
| | - Menghao Chen
- Department
of Oral Radiology, School of Stomatology, China Medical University, Shenyang 110002, P. R. China
| | - Cheng Luo
- Department
of Orthodontics, School of Stomatology, China Medical University, Shenyang 110002, P. R. China
| | - Baijuan Gong
- Department
of Orthodontics, School of Stomatology, China Medical University, Shenyang 110002, P. R. China
| | - Zhimin Li
- Department
of Oral Radiology, School of Stomatology, China Medical University, Shenyang 110002, P. R. China
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21
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Malik A, Dhar H, Vaidya A, Fatehi K, Mair M, Chidambaranathan N, Thiagarajan S. Sentinel lymph node biopsy in early oral cancers: are we ready for it yet? Results from a survey among Indian surgeons treating oral cancers. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:204-210. [PMID: 36229367 DOI: 10.1016/j.oooo.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/09/2022] [Accepted: 06/05/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Emerging evidence has shown that sentinel node biopsy (SNB) is an oncologically safe option in patients with early oral cancer compared with elective neck dissection (END). However, its use on a routine basis could be associated with many challenges. STUDY DESIGN This online survey was conducted among the Indian surgeons treating patients with oral cancer to understand and comprehend the incidence and patterns of usage of SNB in their practice, their approach toward the use of SNB, and the possible challenges they face or perceive in its routine use in patients with early oral cancer. RESULTS We received 352 responses with a response rate of 47.63%. Most of the respondents (82.6%) were managing N-zero necks with END, only 15.1% (n = 53) respondents practiced SNB currently. Most respondents believed that SNB offered the advantage of better shoulder function compared with END (76.4% [n = 269]). The deterrents considered for routine use of SNB in early oral cancer were additional costs (71.9% [n = 253]), the unavailability of necessary expertise and infrastructure (87.2% [n = 307]), SLNB being a more time-consuming treatment (58.8% [n = 207]), a higher false negative rate (74.1% [n = 261]), and the possible need of a second surgery (82.4% [n = 290]). CONCLUSIONS Though SNB presently could be considered as an alternative treatment option, there seem to be various issues that need to be addressed before it can be adopted as a standard of care across centers.
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Affiliation(s)
- Akshat Malik
- Department of Head & Neck Surgical Oncology, Max Superspeciality Hospital, Saket, New Delhi, India
| | - Harsh Dhar
- Department of Head & Neck Surgical Oncology, Medica Cancer Center, Kolkata, India
| | - Abhishek Vaidya
- Department of Head & Neck Surgical Oncology, National Cancer Institute, Nagpur, India
| | - Khuzema Fatehi
- Department of Head & Neck Surgical Oncology, Bombay Hospital, Mumbai, India
| | - Manish Mair
- Department of Head & Neck Surgical Oncology, John Hunter Hospital, NSW, Australia
| | - Nithyanand Chidambaranathan
- Department of Head & Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, Mumbai 400012, Maharashtra, India
| | - Shivakumar Thiagarajan
- Department of Head & Neck Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, Mumbai 400012, Maharashtra, India.
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22
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Jang SS, Davis ME, Vera DR, Lai SY, Guo TW. Role of sentinel lymph node biopsy for oral squamous cell carcinoma: Current evidence and future challenges. Head Neck 2023; 45:251-265. [PMID: 36193862 PMCID: PMC11081060 DOI: 10.1002/hed.27207] [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: 06/01/2022] [Revised: 08/24/2022] [Accepted: 09/19/2022] [Indexed: 12/14/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) has been used across oncological specialties for prognostication, staging, and identification of occult nodal metastasis. Recent studies demonstrated the potential clinical utility of SLNB in oral cavity squamous cell carcinoma (OCSCC). Elective neck dissection is the current standard of care in early management of OCSCC with depth of invasion greater than 2-4 mm; however, majority of patients ultimately do not have nodal disease on final pathology. SLNB is an alternative procedure widely adopted in early cancer management in many oncological subspecialities. Several considerations such as depth of invasion, nodal mapping, histopathology methods, operator variability, postoperative complications, and advancement in preoperative and intraoperative imaging technology can guide the appropriate application to SLNB in OCSCC. The aim of this review is to discuss the current evidence for SLNB in the treatment of early stage OCSCC, imaging technologies that support SLNB procedures, and studies that are currently underway.
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Affiliation(s)
- Sophie S Jang
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Diego, La Jolla, California, USA
| | - Morgan E Davis
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Diego, La Jolla, California, USA
| | - David R Vera
- Department of Radiology, University of California, San Diego, La Jolla, California, USA
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Theresa W Guo
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Diego, La Jolla, California, USA
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23
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Surgical Extent for Oral Cancer: Emphasis on a Cut-Off Value for the Resection Margin Status: A Narrative Literature Review. Cancers (Basel) 2022; 14:cancers14225702. [PMID: 36428794 PMCID: PMC9688090 DOI: 10.3390/cancers14225702] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
The optimal cut-off point of the resection margin was recently debated in oral cancer. To evaluate the current evidence of the dynamic criteria of the resection margin, a review of the available literature was performed. Studies were sourced from PubMed and EMBASE by searching for the keywords "mouth neoplasm", "oral cancer", "oral cavity cancer", "oral squamous cell carcinoma", "tongue cancer", "margins of excision", "surgical margin" and "resection margin". We found approximately 998 articles on PubMed and 2227 articles on EMBASE. A total of 3225 articles was identified, and 2763 of those were left after removing the duplicates. By applying advanced filters about the relevance of the subjects, these were narrowed down to 111 articles. After the final exclusion, 42 full-text articles were reviewed. The universal cut-off criteria of 5 mm used for determining the resection margin status has been debated due to recent studies evaluating the impact of different margin criteria on patient prognosis. Of note, the degree of the microscopic extension from the gross tumor border correlates with tumor dimensions. Therefore, a relatively narrow safety margin can be justified in early-stage oral cancer without the additional risk of recurrence, while a wide safety margin might be required for advanced-stage oral cancer. This review suggests a surgical strategy to adjust the criteria for risk grouping and adjuvant treatments, according to individual tumor dimensions or characteristics. In the future, it might be possible to establish individual tumor-specific surgical margins and risk stratification during or after surgery. However, the results should be interpreted with caution because there is no strong evidence (e.g., prospective randomized controlled studies) yet to support the conclusions. Our study is meaningful in suggesting future research directions and discussions.
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24
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Identification and Analysis of Senescence-Related Genes in Head and Neck Squamous Cell Carcinoma by a Comprehensive Bioinformatics Approach. Mediators Inflamm 2022; 2022:4007469. [PMID: 36299414 PMCID: PMC9592240 DOI: 10.1155/2022/4007469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/10/2022] [Indexed: 12/24/2022] Open
Abstract
Head and neck cancer is the sixth most frequent cancer all over the world, with the majority of subtypes of head and neck squamous cell carcinoma (HNSCC). Cellular senescence-associated genes have been confirmed to play a critical role in cancer and have the potential to be prognostic biomarkers for cancer. Clinical information of HNSCC samples and expression data were acquired from public databases. Expression profiles of genes related to cellular senescence were used to identify molecular subtypes by consensus clustering. To screen differentially expressed genes (DEGs) between different subtypes, differential analysis was performed. We used the univariate Cox regression to identify prognostic DEGs and performed least absolute shrinkage and selection operator (LASSO) to optimize and construct a prognostic model. CIBERSORT, ESTIMATE, and TIDE tools were applied to estimate immune characteristics. Four molecular subtypes were established based on cellular senescence-associated genes. Differential prognosis was observed among different subtypes with C4 having the longest overall survival and C1 having the worst prognosis. C4 subtype also showed the highest immune infiltration. We screened a total of eight cellular senescence prognosis-related genes and established a cellular senescence-related signature score (CSRS.Score) that could stratify samples into high-CSRS.Score and low-CSRS.Score groups. The high-CSRS.Score group had worse prognosis, lower immune infiltration, and lower response to immunotherapy. We further improved the prognostic model and survival prediction by combining CSRS.Score with clinicopathological features using a decision tree model, which had high predictive accuracy and survival prediction. This study demonstrated an important role of cellular senescence in HNSCC. The identified eight cellular senescence-associated genes have the potential to provide ideas for adjuvant treatment and personalized treatment of HNSCC patients.
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25
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Mwagiru D, Shivashankar P, Wong E, Farlow D, Cambden B, Abdul‐Razak M. Tilmanocept as a novel tracer for lymphatic mapping and sentinel lymph node biopsy in melanoma and oral cancer. ANZ J Surg 2022; 92:2607-2612. [PMID: 35848587 PMCID: PMC9796895 DOI: 10.1111/ans.17868] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/28/2022] [Accepted: 06/14/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) has been pivotal for pathological assessment of nodal status in cutaneous melanoma (CM) and oral cavity squamous cell carcinoma (OCSCC) thus crucial for staging. An ideal agent for lymphatic mapping should have a standardized preparation, appropriate accumulation in first-echelon nodes and no side effects. Tilmanocept, a CD206-receptor targeted novel radiotracer fulfils these properties. This study investigated Tilmanocept for lymphoscintigraphy and intraoperative identification of sentinel lymph nodes (SLN) in CM and OCSCC. METHODS This prospective cross sectional study examined patients who presented to Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney. Patients had biopsy proven tumours with clinically and radiologically negative regional lymph nodes. Tilmanocept guided lymphoscintigraphy was followed by intraoperative SLNs identification via handheld gamma probe. Primary endpoints were detection and retrieval rate of SLNs while secondary endpoints included pathological status of SLNs. RESULTS Thirty-five patients were included (26 with CM and 9 with OCSCC) with the most common primary tumour site for CM on the extremities (33.3%). Lymphoscintigraphy with Tilmanocept identified at least 1 SLN (sensitivity 100%) in all patients. SLNs were retrieved in all of patients intraoperatively (100% retrieval rate) with positive nodes found in 20% of patients. Tilmanocept also demonstrated 100% tissue specificity, with lymph nodal tissue confirmed histologically, with no false positives. CONCLUSION Tilmanocept is a reliable radiotracer for assessing the nodal status in patients with CM and OCSCC. Our group is the first to evaluate the use of Tilmanocept in the Australian setting, adding to the limited studies worldwide.
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Affiliation(s)
- Derek Mwagiru
- Department of Surgical Oncology and Head and Neck SurgeryCrown Princess Mary Cancer CentreSydneyNew South WalesAustralia
| | - Pranav Shivashankar
- Department of Surgical Oncology and Head and Neck SurgeryCrown Princess Mary Cancer CentreSydneyNew South WalesAustralia
| | - Eva Wong
- Department of Surgical Oncology and Head and Neck SurgeryCrown Princess Mary Cancer CentreSydneyNew South WalesAustralia
| | - David Farlow
- Department of Nuclear MedicineWestmead HospitalSydneyNew South WalesAustralia
| | - Brad Cambden
- Department of Nuclear MedicineWestmead HospitalSydneyNew South WalesAustralia
| | - Muzib Abdul‐Razak
- Faculty of Medicine, Department of Surgical Oncology and Head and Neck SurgeryCrown Princess Mary Cancer Centre, University of SydneySydneyNew South WalesAustralia
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26
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Anderson EM, Luu M, Lu DJ, Chung EM, Gay C, Scher KS, Mita AC, Mallen‐St. Clair J, Ho AS, Zumsteg ZS. Predicting Pathologic Lymph Node Positivity in
cN0
Pharynx and Larynx Cancers. Laryngoscope 2022. [DOI: 10.1002/lary.30358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/23/2022] [Accepted: 03/30/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Eric M. Anderson
- Department of Radiation Oncology Cedars‐Sinai Medical Center Los Angeles California U.S.A
- Samuel Oschin Comprehensive Cancer Institute Cedars‐Sinai Medical Center Los Angeles California U.S.A
| | - Michael Luu
- Department of Biostatistics and Bioinformatics Cedars‐Sinai Medical Center Los Angeles California U.S.A
| | - Diana J. Lu
- Department of Radiation Oncology Cedars‐Sinai Medical Center Los Angeles California U.S.A
- Samuel Oschin Comprehensive Cancer Institute Cedars‐Sinai Medical Center Los Angeles California U.S.A
| | - Eric M. Chung
- Department of Radiation Oncology Cedars‐Sinai Medical Center Los Angeles California U.S.A
- Samuel Oschin Comprehensive Cancer Institute Cedars‐Sinai Medical Center Los Angeles California U.S.A
| | - Christopher Gay
- Department of Radiation Oncology Cedars‐Sinai Medical Center Los Angeles California U.S.A
- Samuel Oschin Comprehensive Cancer Institute Cedars‐Sinai Medical Center Los Angeles California U.S.A
| | - Kevin S. Scher
- Samuel Oschin Comprehensive Cancer Institute Cedars‐Sinai Medical Center Los Angeles California U.S.A
- Department of Medical Oncology Cedars‐Sinai Medical Center Los Angeles California U.S.A
- Tower Hematology Oncology Los Angeles California U.S.A
| | - Alain C. Mita
- Samuel Oschin Comprehensive Cancer Institute Cedars‐Sinai Medical Center Los Angeles California U.S.A
- Department of Medical Oncology Cedars‐Sinai Medical Center Los Angeles California U.S.A
| | - Jon Mallen‐St. Clair
- Samuel Oschin Comprehensive Cancer Institute Cedars‐Sinai Medical Center Los Angeles California U.S.A
- Department of Surgery, Division of Otolaryngology‐Head and Neck Surgery Cedars‐Sinai Medical Center Los Angeles California U.S.A
| | - Allen S. Ho
- Samuel Oschin Comprehensive Cancer Institute Cedars‐Sinai Medical Center Los Angeles California U.S.A
- Department of Surgery, Division of Otolaryngology‐Head and Neck Surgery Cedars‐Sinai Medical Center Los Angeles California U.S.A
| | - Zachary S. Zumsteg
- Department of Radiation Oncology Cedars‐Sinai Medical Center Los Angeles California U.S.A
- Samuel Oschin Comprehensive Cancer Institute Cedars‐Sinai Medical Center Los Angeles California U.S.A
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27
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Vaish R, Mittal N, Mahajan A, Rane SU, Agrawal A, D'Cruz AK. Sentinel node biopsy in node negative early oral cancers: Solution to the conundrum! Oral Oncol 2022; 134:106070. [PMID: 35988294 DOI: 10.1016/j.oraloncology.2022.106070] [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: 05/12/2022] [Revised: 07/21/2022] [Accepted: 08/07/2022] [Indexed: 11/25/2022]
Abstract
Ideal management of the node-negative neck in early oral cancers is a debated issue. Elective neck dissection (END) is recommended in these patients as it offers a survival benefit. However, about 50-70% of patients who do not harbor occult metastasis are overtreated with this approach. Surgery is associated with morbidity, predominantly shoulder dysfunction. Numerous attempts have been made to identify true node-negative patients through imaging and prediction models but none have high diagnostic accuracy to safely spare the neck dissection. The recent publications of 2 large randomized controlled trials comparing the outcomes of sentinel node biopsy (SNB) and END have spurred interest in SNB. Both the trials reported SNB to be an oncologically safe procedure and spared unnecessary neck dissections. The functional outcomes of the trials showed that SNB limits the morbidity compared to END, which albeit evens out at the end of one-year post-surgery. Despite its benefits, SNB has failed to gain widespread acceptability due to various limitations including the need for infrastructure, equipment costs, staff, and multidisciplinary collaboration of nuclear medicine, surgical, and pathology fraternity. The labor-intensive pathology protocol with serial step sectioning and immunohistochemistry poses a challenge to the feasibility at a high-volume center. This perspective discusses these limitations and propose plausible solutions to the conundrum. To make it widely applicable and feasible across the globe efforts should be directed to understand biology better, find novel solutions, and implement the lessons learned over decades from other sites.
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Affiliation(s)
- Richa Vaish
- Department of Head and Neck Oncology, Tata Memorial Hospital, Mumbai 400012, Maharashtra, India; Homi Bhabha National Institute, Mumbai 400094, Maharashtra, India.
| | - Neha Mittal
- Homi Bhabha National Institute, Mumbai 400094, Maharashtra, India; Department of Pathology, Tata Memorial Hospital, Mumbai 400012, Maharashtra, India.
| | - Abhishek Mahajan
- Consultant Radiologist, Department of Radiology, The Clatterbridge Cancer Centre NHS Foundation Trust, Pembroke Place, Liverpool L7 8YA, UK.
| | - Swapnil U Rane
- Homi Bhabha National Institute, Mumbai 400094, Maharashtra, India; Department of Pathology, Tata Memorial Hospital, Mumbai 400012, Maharashtra, India.
| | - Archi Agrawal
- Homi Bhabha National Institute, Mumbai 400094, Maharashtra, India; Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai 400012, Maharashtra, India.
| | - Anil K D'Cruz
- Director Oncology-Apollo Group of Hospitals, Dept. of Oncology, Apollo Hospital, Navi Mumbai, President Union International Cancer Control (UICC) Geneva, 400614 Maharashtra, India.
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28
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Huang W, Wang K, Huang W, He Z, Zhang J, Zhang B, Xiong Z, Gillen KM, Li W, Chen F, Yang X, Zhang S, Tian J. Carbonic anhydrase IX stratifies patient prognosis and identifies nodal status in animal models of nasopharyngeal carcinoma using a targeted imaging strategy. Eur J Nucl Med Mol Imaging 2022; 49:4427-4439. [PMID: 35925443 DOI: 10.1007/s00259-022-05922-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/12/2022] [Indexed: 12/16/2022]
Abstract
PURPOSE Accurate identification of nodal status enables adequate neck irradiation for nasopharyngeal carcinoma (NPC). However, most conventional techniques are unable to pick up occult metastases, leading to underestimation of tumor extensions. Here we investigate the clinical significance of carbonic anhydrase IX (CAIX) in human NPC samples, and develop a CAIX-targeted imaging strategy to identify occult lymph node metastases (LNMs) and extranodal extension (ENE) in animal studies. METHODS A total of 211 NPC samples are performed CAIX staining, and clinical outcomes are analyzed. The metastatic murine models are generated by foot pad injection of NPC cells, and a CAIX-targeted imaging agent (CAIX-800) is intravenously administered. We adopt fluorescence molecular tomography and ultrasonography (US)-guided spectroscopic photoacoustic (sPA) imaging to perform in vivo studies. Histological and immunohistochemical characterization are carried out via node-by-node analysis. RESULTS For clinical samples, 90.1% (91/101) primary tumors, 73.3% (66/90) metastases, and 100% (20/20) local recurrences are CAIX positive. In metastases group, 84.7% (61/72) nodal metastases and 22.2% (4/18) organ metastases are CAIX positive. CAIX expression in primary tumors is significantly associated with NPC stage and prognosis. For animal studies, CAIX-800-based fluorescence imaging achieves 81.3% sensitivity and 93.8% specificity in detecting occult LNMs in vivo, with a minimum detectable diameter of 1.7 mm. Coupled with CAIX-800, US-guided sPA imaging could not only detect subcapsular deposits of metastatic cancer cells 2 weeks earlier than conventional techniques, but also successfully track pathological ENE. CONCLUSION CAIX remarkably expresses in human NPCs and stratifies patient prognosis. In preclinical studies, CAIX-800-based imaging successfully identifies occult LNMs and tracks early stage of pathological ENE. This attractive method shows potential in clinic, allowing medical workers to longitudinally monitor nodal status and helping to reduce unnecessary nodal biopsy for patients with NPC. The schematic diagram for the study. CAIX, carbonic anhydrase IX; NPC, nasopharyngeal carcinoma; US, ultrasonography; sPA, spectroscopic photoacoustic.
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Affiliation(s)
- Wenhui Huang
- College of Medicine and Biological Information Engineering, Northeastern University, 110057, Shenyang, China.,CAS Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, No. 95 Zhongguancun East Road, Haidian District, Beijing, 100190, China.,Medical Imaging Center, the First Affiliated Hospital, Jinan University, No. 613, Huangpu West Road, Tianhe District, 510632, Guangzhou, China
| | - Kun Wang
- CAS Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, No. 95 Zhongguancun East Road, Haidian District, Beijing, 100190, China
| | - Weiyuan Huang
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), 570311, Haikou, China
| | - Zicong He
- Medical Imaging Center, the First Affiliated Hospital, Jinan University, No. 613, Huangpu West Road, Tianhe District, 510632, Guangzhou, China
| | - Jingming Zhang
- Department of Nuclear Medicine, Peking University First Hospital, No. 8, Xishiku Road, Xicheng District, Beijing, 100034, China
| | - Bin Zhang
- Medical Imaging Center, the First Affiliated Hospital, Jinan University, No. 613, Huangpu West Road, Tianhe District, 510632, Guangzhou, China
| | - Zhiyuan Xiong
- Department of Chemical and Bio-Molecular Engineering, The University of Melbourne, Victoria 3010, Melbourne, Australia
| | - Kelly McCabe Gillen
- Department of Radiology, Weill Medical College of Cornell University, 407 E 61st Street, New York, NY, USA
| | - Wenzhe Li
- State Key Laboratory of Natural and Biomimetic Drugs, Peking University, 100191, Beijing, China
| | - Feng Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), 570311, Haikou, China
| | - Xing Yang
- Department of Nuclear Medicine, Peking University First Hospital, No. 8, Xishiku Road, Xicheng District, Beijing, 100034, China.
| | - Shuixing Zhang
- Medical Imaging Center, the First Affiliated Hospital, Jinan University, No. 613, Huangpu West Road, Tianhe District, 510632, Guangzhou, China.
| | - Jie Tian
- College of Medicine and Biological Information Engineering, Northeastern University, 110057, Shenyang, China. .,CAS Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, No. 95 Zhongguancun East Road, Haidian District, Beijing, 100190, China. .,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Engineering Medicine, Beihang University, 100191, Beijing, China.
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29
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Patel HN, Bowe C, Garg M, Tighe D, Gulati A, Norris P, Kerawala C, McGurk M, Bisase B, Thavaraj S, Schilling C. Centralised pathology service for sentinel node biopsy in oral cavity cancer: The Southeast England Consortium experience. J Oral Pathol Med 2022; 51:315-321. [PMID: 35218247 DOI: 10.1111/jop.13291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/07/2022] [Accepted: 02/22/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy is an increasingly recognised option for accurate staging and subsequent management of the clinically negative neck in early stage oral cavity squamous cell carcinoma. However, the technique is currently underused due to several logistic constraints including increased burden on pathology services. Here, we describe the feasibility of an outsourced centralised pathology processing and reporting service for sentinel lymph node biopsies in oral cavity squamous cell carcinoma. PATIENTS AND METHODS The Southeast England Consortium comprises four surgical centres utilising a central pathology service. Consecutive cases between January 2016 and February 2020 were retrospectively evaluated for survival outcomes and laboratory turnaround times. RESULTS Twenty-eight per cent from a cohort of 139 patients had positive sentinel nodes. There was a trend towards greater overall, disease-free and disease-specific survival (OS, DFS and DSS, respectively) in sentinel node negative compared to sentinel node positive patients, but these differences were not statistically significant. The sensitivity, negative predictive value and false negative rate were 92.8%, 97.0% and 6.8%, respectively. The mean and mode laboratory TAT were 5 and 4 working days, respectively. CONCLUSION An outsourced centralised pathology service is a feasible option to widen the availability of sentinel node biopsy in oral cavity squamous cell carcinoma.
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Affiliation(s)
- Helina N Patel
- Head and Neck Academic Centre, University College London, London, UK
| | - Conor Bowe
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Montey Garg
- Department of Oral & Maxillofacial Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David Tighe
- Department of Oral & Maxillofacial Surgery, East Kent Hospitals NHS Foundation Trust, Kent, UK
| | - Aakshay Gulati
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Paul Norris
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Cyrus Kerawala
- Head and Neck Unit, Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Mark McGurk
- Head and Neck Academic Centre, University College London, London, UK.,Head & Neck Surgery, University College London Hospital, London, UK
| | - Brian Bisase
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Selvam Thavaraj
- Faculty of Dentistry, Oral & Craniofacial Science, King's College London, London, UK.,Head and Neck Pathology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Clare Schilling
- Head and Neck Academic Centre, University College London, London, UK.,Head & Neck Surgery, University College London Hospital, London, UK
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30
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Yang G, Wei L, Thong BKS, Fu Y, Cheong IH, Kozlakidis Z, Li X, Wang H, Li X. A Systematic Review of Oral Biopsies, Sample Types, and Detection Techniques Applied in Relation to Oral Cancer Detection. BIOTECH 2022; 11:5. [PMID: 35822813 PMCID: PMC9245907 DOI: 10.3390/biotech11010005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/18/2022] [Accepted: 02/24/2022] [Indexed: 12/11/2022] Open
Abstract
Background: Early identification of the stage of oral cancer development can lead to better treatment outcomes and avoid malignant transformation. Therefore, this review aims to provide a comprehensive overview that describes the development of standardized procedures for oral sample collection, characterization, and molecular risk assessment. This can help investigators to choose the appropriate sampling method and downstream analyses for different purposes. Methods: This systematic review was conducted according to the PRISMA guidelines. Using both PubMed and Web of Science databases, four independent authors conducted a literature search between 15 and 21 June 2021. We used key search terms to broaden the search for studies. Non-conforming articles were removed using an EndNote-based and manual approach. Reviewers used a designed form to extract data. Results: This review included a total of 3574 records, after eliminating duplicate articles and excluding papers that did not meet the inclusion criteria. Finally, 202 articles were included in this review. We summarized the sampling methods, biopsy samples, and downstream analysis. The biopsy techniques were classified into tissue and liquid biopsy. The common sequential analysis of tissue biopsy includes histopathological examination such as H&E or IHC to identify various pathogenic features. Meanwhile, liquid samples such as saliva, blood, and urine are analyzed for the purpose of screening to detect mutations in cancer. Commonly used technologies are PCR, RT-PCR, high-throughput sequencing, and metabolomic analysis. Conclusions: Currently, tissue biopsies provide increased diagnostic value compared to liquid biopsy. However, the minimal invasiveness and convenience of liquid biopsy make it a suitable method for mass screening and eventual clinical adoption. The analysis of samples includes histological and molecular analysis. Metabolite analysis is rising but remains scarce.
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Affiliation(s)
- Guanghuan Yang
- State Key Laboratory of Oncogenes and Related Genes, Centre for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (G.Y.); (L.W.); (B.K.S.T.); (Y.F.); (I.H.C.); (X.L.)
| | - Luqi Wei
- State Key Laboratory of Oncogenes and Related Genes, Centre for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (G.Y.); (L.W.); (B.K.S.T.); (Y.F.); (I.H.C.); (X.L.)
| | - Benjamin K. S. Thong
- State Key Laboratory of Oncogenes and Related Genes, Centre for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (G.Y.); (L.W.); (B.K.S.T.); (Y.F.); (I.H.C.); (X.L.)
| | - Yuanyuan Fu
- State Key Laboratory of Oncogenes and Related Genes, Centre for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (G.Y.); (L.W.); (B.K.S.T.); (Y.F.); (I.H.C.); (X.L.)
| | - Io Hong Cheong
- State Key Laboratory of Oncogenes and Related Genes, Centre for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (G.Y.); (L.W.); (B.K.S.T.); (Y.F.); (I.H.C.); (X.L.)
| | - Zisis Kozlakidis
- International Agency for Research on Cancer, World Health Organization, 69372 Lyon, France;
| | - Xue Li
- State Key Laboratory of Oncogenes and Related Genes, Centre for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (G.Y.); (L.W.); (B.K.S.T.); (Y.F.); (I.H.C.); (X.L.)
| | - Hui Wang
- State Key Laboratory of Oncogenes and Related Genes, Centre for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (G.Y.); (L.W.); (B.K.S.T.); (Y.F.); (I.H.C.); (X.L.)
| | - Xiaoguang Li
- State Key Laboratory of Oncogenes and Related Genes, Centre for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; (G.Y.); (L.W.); (B.K.S.T.); (Y.F.); (I.H.C.); (X.L.)
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Detection of sentinel lymph nodes by tilmanocept in oral squamous cell carcinoma. Clin Exp Metastasis 2022; 39:417-419. [PMID: 35192090 DOI: 10.1007/s10585-022-10159-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/14/2022] [Indexed: 11/03/2022]
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Vaish R. Shifting Paradigm of the Management of Node-Negative Neck in Early Oral Cancers: Where do we Stand Today? Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1742637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Richa Vaish
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Does sentinel lymph node biopsy accurately stage the clinically negative neck in early oral cavity squamous cell carcinoma? J Oral Maxillofac Surg 2022; 80:1134-1142. [DOI: 10.1016/j.joms.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 11/21/2022]
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34
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Methods for sentinel lymph node mapping in oral cancer: a literature review. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2022-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Oral cancers, excluding non-melanoma skin cancer, are the most common cancers of the head and neck. Of these, 90% are squamous cell carcinomas (SCC). Surgery, which consists of dissection of the primary tumor and lymphadenectomy, is considered a radical method of treatment. There are several ranges of cervical lymphadenectomy: selective neck dissection (SND), modified radical neck dissection (MRND), and radical neck dissection (RND). The extension of surgery depends on the stage of clinical advancement, which can be determined by TNM classification, among other methods. The greatest controversy is related to SND in patients with cN0 (no evidence of regional lymph node metastasis), which is currently standard procedure. This approach is dictated by the possibility of hidden or subclinical metastases. The use of the sentinel lymph node (SLN) concept in patients with early stage of oral cancer and appropriate methods of its mapping may lead to a reduction in the extent of the lymphadenectomy procedure, thus reducing postoperative mortality and maintaining the patient’s function and quality of life, with correct oncological results. So far, available methods for SLN mapping are based on use of markers: methylene blue dye (MBD), metastable radioactive isotope Technetium (99mTc), or the fluorescent substance indocyanine green (ICG).
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35
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Detection of melanoma, breast cancer and head and neck squamous cell cancer sentinel lymph nodes by Tc-99m Tilmanocept (Lymphoseek®). Clin Exp Metastasis 2021; 39:39-50. [PMID: 34962630 PMCID: PMC8967737 DOI: 10.1007/s10585-021-10137-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023]
Abstract
Technetium-99m-labeled Tilmanocept or Lymphoseek® (Cardinal Health, Dublin, Ohio) is a soluble, synthetic molecule with a small diameter (7 nm), which is comprised of technetium-99m chelated to a dextran backbone containing multiple units of mannose ligands with a high affinity for CD206, a receptor located on the surface of macrophages and dendritic cells that are found in high concentration in lymph nodes. It enables quick transit from the injection site and rapid lymph node accumulation. The binding of mannose ligand and CD206 results in the internalization of the ligand and receptor into the cell. Once the Technetium-99m-labeled Tilmanocept (Lymphoseek®) reaches the lymph node, it is readily internalized by the macrophages and dendritic cells within the draining lymph nodes. Technetium-99m-labeled Tilmanocept (Lymphoseek®) has been extensively studied as a radioisotope for detection of sentinel lymph nodes in melanoma, breast cancer and head and neck squamous cell carcinoma in clinical trials. Based on its safety and ability to detect sentinel lymph nodes satisfactorily, it has been approved by the FDA to use as a radioisotope for preoperative lymphoscintigraphy for identification of sentinel lymph nodes in these types of cancer. Further, the FDA has expanded approval of Technetium-99m-labeled for sentinel lymph node mapping of all solid tumors as well as in pediatric patients.
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Analysis of the Efficiency and Prognostic Value of the Sentinel Node Technique in Oral Squamous Cell Carcinoma after Seven Years. ACTA ACUST UNITED AC 2021; 57:medicina57101092. [PMID: 34684129 PMCID: PMC8540189 DOI: 10.3390/medicina57101092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/07/2021] [Accepted: 10/10/2021] [Indexed: 11/16/2022]
Abstract
Background and objectives: The purpose of this study was to analyse the diagnostic and prognostic efficiency of the sentinel lymph node biopsy technique (SLNB). Materials and Methods: This is a prospective observational study performed by the Hospital Complex in Santiago de Compostela (CHUS) in Spain, between February 2013 and June 2020. The study included 60 patients, who had been diagnosed with OSCC in stage T1/T2N0M0. Results: 10 patients (16.7%) presented with SN+ (sentinel node positive). The majority (80%) only presented subcapsular affection, however one case also presented with extracapsular affection. Using the Kaplan–Meier curves, we determined that the average survival estimation for SN− patients was 74.0 months (CI95% 67.6–80.5) and it was 45.4 months (CI95% 10.9–24.0) for SN+ patients (p = 0.002). SN+ patients presented an OR = 11.000 (CI95% 2.393–50.589, p = 0.002) for cancer-related mortality. In terms of the diagnostic performance of the SN (sentinel node) test, a 55% sensitivity, a 100% specificity, 100% PPV and a 84% NPV were obtained. The analysis using ROC (receiver operating characteristic) curves revealed an AUC = 0.671 (CI95% 0.492–0.850, p = 0.046). Conclusions: SLNB seems to be an adequate technique for the detection of hidden metastases.
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37
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Treating the N0 neck in early stage oral cancer: a pause for re-assessment? Br J Oral Maxillofac Surg 2021; 59:1308-1312. [PMID: 34688501 DOI: 10.1016/j.bjoms.2021.07.024] [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: 04/13/2021] [Accepted: 07/09/2021] [Indexed: 11/22/2022]
Abstract
The incidence of metastases following neck dissection in the apparent lymph node negative neck in oral cancer is between 7% and 33%; early resection of cervical metastases may well increase survival. Modern imaging techniques can reduce the yield of previously undiagnosed metastatic nodes in elective neck dissection (END). An audit of 112 consecutive cases was conducted to determine the proportion of undiagnosed nodal metastases, after END. There were neck metastases in 10 cases (9%), which were mainly (but not all) micrometastic. The 20% likelihood of nodal metastases was only apparent in primary tumours greater than 6 mm thick. The length of inpatient stay was increased from 3.7 to 16.5 days with free vascularised transfer. There were complications including cranial nerve damage. There were two peri-operative deaths. No ipsilateral neck failures occurred, median follow up was 937 days. To reduce unnecessary END, resection can be undertaken as a prior procedure, subsequently only carrying out END on tumours greater than 6 mm, or with unfavourable tumour characteristics.
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38
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Panula E, Hirvonen J, Vahlberg T, Schrey A, Irjala H. Practical aspects of sentinel node biopsy in oral cavity cancer: all nodes that emit a signal are important. Acta Otolaryngol 2021; 141:820-824. [PMID: 34275432 DOI: 10.1080/00016489.2021.1945681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Sentinel node biopsy (SNB) is a safe and effective way to examine an N0 neck in early-stage oral cavity cancer (OCC). In this study, we evaluated the variables of SNB detection, surgery, and outcome. MATERIAL AND METHODS Ninety-two patients with N0 OCC examined with SNB were included. Number and brightness of nodes detected on preoperative imaging and during surgery were analyzed and compared with histological findings. Patients with recurrent disease were evaluated separately and the effect of smoking and alcohol consumption was analyzed. RESULTS Eighteen patients had at least malignant cells in the sentinel lymph node (SLN); 18 patients had recurrent disease and nine patients died from the cancer. The negative predictive value of SNB was 95%. Six patients did not have metastases in the node with the strongest signal, but metastases were found in an SLN with a weaker signal. Smoking and alcohol consumption did not affect disease-specific or overall survival. CONCLUSION AND SIGNIFICANCE SNB has been confirmed to be safe and effective in early stage N0 OCC. However, it is important to carefully harvest up to four hottest SLNs that emit a signal. Treatment of patients with only isolated tumor cells (ITC) in the SLN appears to be necessary.
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Affiliation(s)
- Elina Panula
- Department of Otorhinolaryngology – Head and Neck Surgery, University Hospital of Turku and Turku University, Turku, Finland
| | - Jussi Hirvonen
- Department of Radiology, University Hospital of Turku and Turku University, Turku, Finland
| | - Tero Vahlberg
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Aleksi Schrey
- Department of Otorhinolaryngology – Head and Neck Surgery, University Hospital of Turku and Turku University, Turku, Finland
| | - Heikki Irjala
- Department of Otorhinolaryngology – Head and Neck Surgery, University Hospital of Turku and Turku University, Turku, Finland
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39
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Nieuwenhuis ER, Kolenaar B, van Bemmel AJM, Hof JJ, van Baarlen J, Christenhusz A, Pouw JJ, Ten Haken B, Alic L, de Bree R. A complete magnetic sentinel lymph node biopsy procedure in oral cancer patients: A pilot study. Oral Oncol 2021; 121:105464. [PMID: 34329868 DOI: 10.1016/j.oraloncology.2021.105464] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/25/2021] [Accepted: 07/12/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To assess the feasibility and merits of a complete magnetic approach for a sentinel lymph node biopsy (SLNB) procedure in oral cancer patients. MATERIALS AND METHODS This study included ten oral cancer patients (stage cT1-T2N0M0) scheduled for elective neck dissection (END). Superparamagnetic iron oxide nanoparticles (SPIO) were administered peritumorally prior to surgery. A preoperative MRI was acquired to identify lymph nodes (LNs) with iron uptake. A magnetic detector was used to identify magnetic hotspots prior, during, and after the SLNB procedure. The resected sentinel LNs (SLNs) were evaluated using step-serial sectioning, and the neck dissection specimen was assessed by routine histopathological examination. A postoperative MRI was acquired to observe any residual iron. RESULTS Of ten primary tumors, eight were located in the tongue, one floor-of-mouth (FOM), and one tongue-FOM transition. SPIO injections were experienced as painful by nine patients, two of whom developed a tongue swelling. In eight patients, magnetic SLNs were successfully detected and excised during the magnetic SLNB procedure. During the END procedure, additional magnetic SLNs were identified in three patients. Histopathology confirmed iron deposits in sinuses of excised SLNs. Three SLNs were harboring metastases, of which one was identified only during the END procedure. The END specimens revealed no further metastases. CONCLUSION A complete magnetic SLNB procedure was successfully performed in eight of ten patients (80% success rate), therefore the procedure seems feasible. Recommendations for further investigation are made including: use of anesthetics, magnetic tracer volume, planning preoperative MRI, comparison to conventional technique and follow-up.
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Affiliation(s)
- Eliane R Nieuwenhuis
- Magnetic Detection and Imaging Group, Technical Medical Centre, University of Twente, Enschede, the Netherlands; Department of Maxillofacial Surgery - Head and Neck Surgical Oncology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Barry Kolenaar
- Department of Maxillofacial Surgery - Head and Neck Surgical Oncology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Alexander J M van Bemmel
- Department of Otorhinolaryngology - Head and Neck Surgical Oncology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Jurrit J Hof
- Department of Radiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Joop van Baarlen
- Laboratorium Pathologie Oost Nederland, Hengelo, the Netherlands
| | - Anke Christenhusz
- Magnetic Detection and Imaging Group, Technical Medical Centre, University of Twente, Enschede, the Netherlands; Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Joost J Pouw
- Magnetic Detection and Imaging Group, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Bernard Ten Haken
- Magnetic Detection and Imaging Group, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Lejla Alic
- Magnetic Detection and Imaging Group, Technical Medical Centre, University of Twente, Enschede, the Netherlands.
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
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40
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Sentinel Lymph Node Biopsy in Early Stages of Oral Squamous Cell Carcinoma Using the Receptor-Targeted Radiotracer 99mTc-Tilmanocept. Diagnostics (Basel) 2021; 11:diagnostics11071231. [PMID: 34359314 PMCID: PMC8303850 DOI: 10.3390/diagnostics11071231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 06/27/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023] Open
Abstract
Neck management in patients with early-stage, clinically node-negative oral squamous cell carcinoma (OSCC) remains a matter of discussion. Sentinel lymph node biopsy (SLNB) represents a treatment alternative to avoid elective neck dissection (END) in this cohort and different protocols and tracers exist. Here we present the clinical outcome of SLNB using 99mTc-tilmanocept in a two-day protocol in patients suffering from early-stage OSCC. A total of 13 patients (males: 6; females: 7; mean age: 65.7 years, ranging from 47 to 89 years) were included in this study. Most of the patients suffered from an OSCC of the floor of mouth (n = 6), followed by tongue (n = 5) and upper alveolar crest/hard palate (n = 2). Sentinel lymph nodes (SLNs) were successfully identified in all cases (range: 1–7). The average length of hospital stay was 4.7 days (range: 3–8 days) and mean duration of surgical intervention was 121 min (range: 74–233 min). One patient who suffered from an OSCC of the tongue was sentinel lymph node positive (SLN+). The mean follow-up for all sentinel lymph node negative (SLN-) patients (n = 12) was 20.3 months (range: 10–28 months). No local or nodal recurrences were observed within the observation period. In our patient cohort, SLNB using 99mTc-tilmanocept in a two-day protocol proved to be a reliable and safe staging method for patients suffering from early-stage, clinically node-negative OSCC. These results and their possible superiority to colloid tracers have to be confirmed in a prospective randomized controlled study.
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41
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Süslü NS, Katar O, Tuncel M. Role of indocyanine green combined with radiotracer-Technetium 99 m in neck surgery for primary and recurrent head and neck cancer: preliminary results of a tertiary cancer center. Eur Arch Otorhinolaryngol 2021; 279:1549-1560. [PMID: 34146148 DOI: 10.1007/s00405-021-06931-1] [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: 04/25/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Neck dissection (ND), whether therapeutic or elective, is an essential component of the treatment of head and neck squamous cell carcinoma (HNSCC). Due to altered anatomy and fibrosis caused by initial treatments, surgeons face challenges during salvage ND. A combination of Technetium-99 m and indocyanine green (ICG) previously used in the sentinel lymph node (SLN) biopsy for oral cavity cancers, may be useful in different types of neck surgeries. We aimed to show the additional advantage of this combination in detecting HNSCC and thyroid cancer recurrences, as well as individual lymphatic drainage in elective ND. METHODS We retrospectively reviewed medical records of patients, underwent neck surgery guided with ICG and Tc-99 m, in Hacettepe University Hospital between June 2018 and December 2020. In a total of 28 patients, intraoperative gamma probes were paired with near infrared (NIR) cameras. Patients are divided into two groups: neck surgery with recurrent occult lesion localization (NS- ROLL) (n: 14) and ND with SLN screening (ND-SLNS) (n: 14). RESULTS Among all 14 patients in NS-ROLL group, recurrent diseases, hidden behind tissues were 100% successfully localized. In ND-SLNS group, 238 lymph nodes were harvested, metastasis rate was 31.3% (10/32) in sentinel nodes. SLNS revealed 100% accuracy in detecting metastasis in clinically N0 neck (10/238). Contralateral lymphatic drainage was observed in three patients (lateral-sided oral cavity SCC). In two patients (floor of mouth), three sentinel nodes were detected by NIR only. CONCLUSION The use of ICG-radiotracer provides additional value in disease removal for both primary and recurrent tumors of the head and neck.
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Affiliation(s)
- Nilda Sütay Süslü
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey.
| | - Oğuzhan Katar
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
| | - Murat Tuncel
- Department of Nuclear Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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42
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King C, Elsherif N, Kirwan R, Schilling C, Hall G, Morgan P, Collins L, Sandison A, Odell E, Thavaraj S. Serial step sections at narrow intervals with immunohistochemistry are required for accurate histological assessment of sentinel lymph node biopsy in oral squamous cell carcinoma. Head Neck 2021; 43:2985-2993. [PMID: 34128276 DOI: 10.1002/hed.26784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/21/2021] [Accepted: 06/07/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy is an accurate staging modality in early oral squamous cell carcinoma (OSCC), but its accuracy relies on labor-intensive histopathology protocols. We sought to determine whether serial step sections with immunohistochemistry (SSSIHC) at narrow intervals of the entire SLN are required to accurately exclude metastasis. METHODS Consecutive SLN biopsies over a 13-year period were retrospectively evaluated. If the index section was negative for carcinoma, the entire SLN was subjected to SSSIHC at 150 μm intervals. The first section level and total number of section levels to contain carcinoma were recorded. RESULTS One hundred and eighteen SLN+ from 90 patients were included. SSSIHC upstaged the nodal status in 19.5% of patients. Metastasis was identified in 16.7% and 10.2% beyond section levels 4 and 6, respectively. Among SLNs requiring SSSIHC, 47.5% contained carcinoma in a single section level. CONCLUSION SSSIHC of the entire SLN at 150 μm intervals are required to identify occult metastasis in OSCC.
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Affiliation(s)
- Claire King
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nusaybah Elsherif
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ruaidhrí Kirwan
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Clare Schilling
- Head & Neck Surgery, University College London Hospital, London, UK.,Head and Neck Academic Centre, University College London, London, UK
| | - Gillian Hall
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Peter Morgan
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Oral, Dental and Craniofacial Science, King's College London, London, UK
| | - Lisette Collins
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ann Sandison
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Edward Odell
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Oral, Dental and Craniofacial Science, King's College London, London, UK
| | - Selvam Thavaraj
- Head & Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Oral, Dental and Craniofacial Science, King's College London, London, UK
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43
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Pugh SL, Torres-Saavedra PA. Fundamental Statistical Concepts in Clinical Trials and Diagnostic Testing. J Nucl Med 2021; 62:757-764. [PMID: 33608427 DOI: 10.2967/jnumed.120.245654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/27/2021] [Indexed: 11/16/2022] Open
Abstract
This article explores basic statistical concepts of clinical trial design and diagnostic testing, or how one starts with a question, formulates it into a hypothesis on which a clinical trial is then built, and integrates it with statistics and probability, such as determining the probability of rejecting the null hypothesis when it is actually true (type I error) and the probability of failing to reject the null hypothesis when it is false (type II error). There are a variety of tests for different types of data, and the appropriate test must be chosen for which the sample data meet the assumptions. Correcting type I error in the presence of multiple testing is needed to control the error's inflation. Within diagnostic testing, identifying false-positive and false-negative results is critical to understanding the performance of a test. These are used to determine the sensitivity and specificity of a test along with the test's negative predictive value and positive predictive value. These quantities, specifically sensitivity and specificity, are used to determine the accuracy of a diagnostic test using receiver-operating-characteristic curves. These concepts are briefly introduced to provide a basic understanding of clinical trial design and analysis, with references to allow the reader to explore various concepts at a more detailed level if desired.
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Affiliation(s)
- Stephanie L Pugh
- NRG Oncology Statistical and Data Management Center, American College of Radiology, Philadelphia, Pennsylvania
| | - Pedro A Torres-Saavedra
- NRG Oncology Statistical and Data Management Center, American College of Radiology, Philadelphia, Pennsylvania
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44
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De Herdt MJ, van der Steen B, van der Toom QM, Aaboubout Y, Willems SM, Wieringa MH, Baatenburg de Jong RJ, Looijenga LHJ, Koljenović S, Hardillo JA. The Potential of MET Immunoreactivity for Prediction of Lymph Node Metastasis in Early Oral Tongue Squamous Cell Carcinoma. Front Oncol 2021; 11:638048. [PMID: 33996551 PMCID: PMC8117234 DOI: 10.3389/fonc.2021.638048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/06/2021] [Indexed: 01/19/2023] Open
Abstract
Objective MET positivity is independently associated with survival in oral squamous cell carcinoma (OSCC). Since MET is a known orchestrator of invasive tumor growth, we investigated its association with LNM in early oral tongue squamous cell carcinoma (OTSCC). As it is recommended by the NCCN to use tumor depth of invasion (DOI) in making decisions on elective neck dissection (END), the results obtained for MET positivity were aligned with those for DOI > 4 mm. The cutoff value used in our institution. Methods Tumor samples from patients who underwent primary tumor resection and neck dissection between 1995 and 2013, were collected from the archives of the Leiden and Erasmus University Medical Center. Immunohistochemistry with D1C2 was performed to identify MET negative (< 10% uniform positivity) and MET positive (≥ 10% uniform positivity) cancers. ROC curve analysis and the Chi-squared test were used to investigate the association of MET positivity with LNM (pN+ and occult). Binary logistic regression was used to investigate the association of MET positivity with LNM. Results Forty-five (44.1%) of the 102 cancers were MET positive. Ninety were cN0 of which 20 were pN+ (occult metastasis). The remaining 12 cancers were cN+, of which 10 were proven pN+ and 2 were pN0. MET positivity was associated with LNM with a positive predictive value (PPV) of 44.4% and a negative predictive value (NPV) of 82.5% for pN+. For the occult group, the PPV was 36.8% and the NPV was 88.5%. Regression analysis showed that MET positivity is associated with pN+ and occult LNM (p-value < 0.05). Conclusion MET positivity is significantly associated with LNM in early OTSCC, outperforming DOI. The added value of MET positivity could be in the preoperative setting when END is being considered during the initial surgery. For cases with DOI ≤ 4 mm, MET positivity could aid in the clinical decision whether regular follow-up, watchful waiting, or END is more appropriate. Realizing that these preliminary results need to be independently validated in a larger patient cohort, we believe that MET positivity could be of added value in the decision making on END in early OTSCC.
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Affiliation(s)
- Maria J De Herdt
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Cancer Institute, Rotterdam, Netherlands
| | - Berdine van der Steen
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Cancer Institute, Rotterdam, Netherlands
| | - Quincy M van der Toom
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Cancer Institute, Rotterdam, Netherlands
| | - Yassine Aaboubout
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Cancer Institute, Rotterdam, Netherlands.,Department of Pathology and Medical Biology, Erasmus MC, University Medical Center Rotterdam, Cancer Institute, Rotterdam, Netherlands
| | - Stefan M Willems
- Department of Pathology, University Medical Center Groningen, Groningen, Netherlands
| | - Marjan H Wieringa
- Department of Education, Office of Science, Elisabeth TweeSteden, Ziekenhuis, Tilburg, Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Cancer Institute, Rotterdam, Netherlands
| | - Leendert H J Looijenga
- Department of Pathology and Medical Biology, Erasmus MC, University Medical Center Rotterdam, Cancer Institute, Rotterdam, Netherlands.,Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Senada Koljenović
- Department of Pathology and Medical Biology, Erasmus MC, University Medical Center Rotterdam, Cancer Institute, Rotterdam, Netherlands
| | - Jose A Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Cancer Institute, Rotterdam, Netherlands
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Nuyts S, Bollen H, Eisbruch A, Corry J, Strojan P, Mäkitie AA, Langendijk JA, Mendenhall WM, Smee R, DeBree R, Lee AWM, Rinaldo A, Ferlito A. Unilateral versus bilateral nodal irradiation: Current evidence in the treatment of squamous cell carcinoma of the head and neck. Head Neck 2021; 43:2807-2821. [PMID: 33871090 DOI: 10.1002/hed.26713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 12/21/2022] Open
Abstract
Cancers of the head and neck region often present with nodal involvement. There is a long-standing convention within the community of head and neck radiation oncology to irradiate both sides of the neck electively in almost all cases to include both macroscopic and microscopic disease extension (so called elective nodal volume). International guidelines for the selection and delineation of the elective lymph nodes were published in the early 2000s and were updated recently. However, diagnostic imaging techniques have improved the accuracy and reliability of nodal staging and as a result, small metastases that used to remain undetected and were thus in the past included in the elective nodal volume, will now be included in high-dose volumes. Furthermore, the elective nodal areas are situated close to the parotid glands, the submandibular glands and the swallowing muscles. Therefore, irradiation of a smaller, more selected volume of the elective nodes could reduce treatment-related toxicity. Several researchers consider the current bilateral elective neck irradiation strategies an overtreatment and show growing interest in a unilateral nodal irradiation in selected patients. The aim of this article is to give an overview of the current evidence about the indications and benefits of unilateral nodal irradiation and the use of SPECT/CT-guided nodal irradiation in squamous cell carcinomas of the head and neck.
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Affiliation(s)
- Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, Leuven, Belgium
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Heleen Bollen
- Laboratory of Experimental Radiotherapy, Department of Oncology, Leuven, Belgium
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Avrahram Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - June Corry
- Division of Medicine, Department of Radiation Oncology, St. Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Primoz Strojan
- Department of Radiation Oncology, Institute of Oncology, University of Ljubljana, Ljubljana, Slovenia
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, HUS Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - William M Mendenhall
- Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, New South Wales, Australia
| | - Remco DeBree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Anne W M Lee
- Department of Clinical Oncology, University of Hong Kong, Hong Kong, China
| | - Alessandra Rinaldo
- Department of Otolaryngology, University of Udine School of Medicine, Udine, Italy
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Udine, Italy
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46
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Park W, Jin H, Heo Y, Jeong HS, Son YI, Chung MK, Baek CH. Sentinel lymph node biopsy versus elective neck dissection: long-term oncologic outcomes in clinically node-negative tongue cancer. Clin Exp Otorhinolaryngol 2021; 15:107-114. [PMID: 33781056 PMCID: PMC8901953 DOI: 10.21053/ceo.2020.02411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/26/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives The aim of this study was to compare the long-term oncologic outcomes of sentinel lymph node biopsy (SLNB) versus elective neck dissection (END) in clinically node-negative (cN0) tongue cancer. Methods This was a retrospective cohort study of patients with cN0 tongue cancer from a single institution, including 91 patients in the SLNB group and 120 patients in the END group. Results The overall recurrence rate showed no significant difference between the two groups. The regional control rate was also comparable between the two groups (P=0.490). The 5-year recurrence-free survival (RFS) was slightly better in the SLNB group than in the END group (P=0.427). The 5-year overall survival (OS) rate was 89.9% in the SLNB group versus 91.9% in the END group (P=0.737). In a propensity-matched subgroup analysis, the type of neck management did not affect RFS or OS. Conclusion SLNB showed non-inferior oncologic outcomes compared to END in patients with cN0 tongue squamous cell carcinoma.
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Affiliation(s)
- Woori Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Hokyung Jin
- Department of Otorhinolaryngology-Head & Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Yujin Heo
- Department of Otorhinolaryngology-Head & Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head & Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Young-Ik Son
- Department of Otorhinolaryngology-Head & Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology-Head & Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Chung-Hwan Baek
- Department of Otorhinolaryngology-Head & Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
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Aaboubout Y, van der Toom QM, de Ridder MAJ, De Herdt MJ, van der Steen B, van Lanschot CGF, Barroso EM, Nunes Soares MR, Ten Hove I, Mast H, Smits RWH, Sewnaik A, Monserez DA, Keereweer S, Caspers PJ, Baatenburg de Jong RJ, Bakker Schut TC, Puppels GJ, Hardillo JA, Koljenović S. Is the Depth of Invasion a Marker for Elective Neck Dissection in Early Oral Squamous Cell Carcinoma? Front Oncol 2021; 11:628320. [PMID: 33777774 PMCID: PMC7996205 DOI: 10.3389/fonc.2021.628320] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/01/2021] [Indexed: 12/12/2022] Open
Abstract
Objective The depth of invasion (DOI) is considered an independent risk factor for occult lymph node metastasis in oral cavity squamous cell carcinoma (OCSCC). It is used to decide whether an elective neck dissection (END) is indicated in the case of a clinically negative neck for early stage carcinoma (pT1/pT2). However, there is no consensus on the cut-off value of the DOI for performing an END. The aim of this study was to determine a cut-off value for clinical decision making on END, by assessing the association of the DOI and the risk of occult lymph node metastasis in early OCSCC. Methods A retrospective cohort study was conducted at the Erasmus MC, University Medical Centre Rotterdam, The Netherlands. Patients surgically treated for pT1/pT2 OCSCC between 2006 and 2012 were included. For all cases, the DOI was measured according to the 8th edition of the American Joint Committee on Cancer guideline. Patient characteristics, tumor characteristics (pTN, differentiation grade, perineural invasion, and lymphovascular invasion), treatment modality (END or watchful waiting), and 5-year follow-up (local recurrence, regional recurrence, and distant metastasis) were obtained from patient files. Results A total of 222 patients were included, 117 pT1 and 105 pT2. Occult lymph node metastasis was found in 39 of the 166 patients who received END. Univariate logistic regression analysis showed DOI to be a significant predictor for occult lymph node metastasis (odds ratio (OR) = 1.3 per mm DOI; 95% CI: 1.1-1.5, p = 0.001). At a DOI of 4.3 mm the risk of occult lymph node metastasis was >20% (all subsites combined). Conclusion The DOI is a significant predictor for occult lymph node metastasis in early stage oral carcinoma. A NPV of 81% was found at a DOI cut-off value of 4 mm. Therefore, an END should be performed if the DOI is >4 mm.
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Affiliation(s)
- Yassine Aaboubout
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Quincy M van der Toom
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Maria A J de Ridder
- Department of Medical informatics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Maria J De Herdt
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Berdine van der Steen
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Cornelia G F van Lanschot
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Elisa M Barroso
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Maria R Nunes Soares
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Ivo Ten Hove
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Hetty Mast
- Department of Oral and Maxillofacial Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Roeland W H Smits
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Dominiek A Monserez
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Stijn Keereweer
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Peter J Caspers
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Tom C Bakker Schut
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Gerwin J Puppels
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - José A Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Senada Koljenović
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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Diagnostic yield of sentinel lymph node biopsy in oral squamous cell carcinoma T1/T2-N0: systematic review and meta-analysis. Int J Oral Maxillofac Surg 2021; 50:1271-1279. [PMID: 33602650 DOI: 10.1016/j.ijom.2021.01.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 01/24/2021] [Accepted: 01/27/2021] [Indexed: 12/24/2022]
Abstract
The objective of this study was to conduct a systematic review and meta-analysis on the efficacy of sentinel lymph node biopsy (SLNB) in T1/T2-N0 oral squamous cell carcinoma (OSCC). A systematic review of the literature on SLNB until March 2019 was conducted. The review was organized according to the PRISMA protocol, considering the following PICO (population, intervention, comparison, outcome) question: What is the sensitivity of sentinel lymph node biopsy in OSCC? 'P' was patients with head and neck squamous cell carcinoma T1/2-N0; 'I' was SLNB; 'C' was neck treated with elective neck dissection and haematoxylin-eosin histopathology; 'O' was sensitivity and specificity. A meta-analysis and meta-regression were performed on the selected studies. The sensitivity of SLNB was up to 88% (95% confidence interval (CI) 72-96%) and specificity was up to 99% (95% CI 96-100%). The area under the summary receiver operating characteristic curve was 0.99 (95% CI 0.98-1.00). In the four studies where immunohistochemistry was performed, both the sensitivity and specificity were higher than in the studies without immunohistochemistry: 93% (95% CI 88-97%) and 98% (95% CI 96-100%), respectively. In conclusion, SLNB is an effective technique for treating patients with some types of stage T1/2-N0 OSCC. Some parameters such as immunohistochemistry could determine the level of diagnostic accuracy.
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Driessen DAJJ, Dijkema T, Weijs WLJ, Takes RP, Pegge SAH, Zámecnik P, van Engen-van Grunsven ACH, Scheenen TWJ, Kaanders JHAM. Novel Diagnostic Approaches for Assessment of the Clinically Negative Neck in Head and Neck Cancer Patients. Front Oncol 2021; 10:637513. [PMID: 33634033 PMCID: PMC7901951 DOI: 10.3389/fonc.2020.637513] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023] Open
Abstract
In head and neck cancer, the presence of nodal disease is a strong determinant of prognosis and treatment. Despite the use of modern multimodality diagnostic imaging, the prevalence of occult nodal metastases is relatively high. This is why in clinically node negative head and neck cancer the lymphatics are treated “electively” to eradicate subclinical tumor deposits. As a consequence, many true node negative patients undergo surgery or irradiation of the neck and suffer from the associated and unnecessary early and long-term morbidity. Safely tailoring head and neck cancer treatment to individual patients requires a more accurate pre-treatment assessment of nodal status. In this review, we discuss the potential of several innovative diagnostic approaches to guide customized management of the clinically negative neck in head and neck cancer patients.
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Affiliation(s)
- Daphne A J J Driessen
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Tim Dijkema
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Willem L J Weijs
- Department of Oral- and Maxillofacial Surgery and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Sjoert A H Pegge
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | - Patrik Zámecnik
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Tom W J Scheenen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, Netherlands
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50
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Abstract
Well executed multicenter clinical trials often provide significant evidence and support for, or against, foundational aspects of clinical procedures perceived to improve clinical management of a medical condition. In this review, discussed are reports of multicenter clinical trials designed to investigate sentinel lymph node biopsy procedures in seven types of cancer: breast, melanoma, head and neck, gastric, colon, uterine, and vulvar-with focus on the most recent reports of the hypotheses, objectives, parameters, data, results, implications, and impacts of the included trials. Such trials generally enroll more subjects, in shorter time periods, than do single-center studies. Such studies generally also have greater diversities among investigator practitioners and investigative environments than do single-center studies. The greater number of subjects provides more power to statistical analyses performed in such studies. The more rapid accrual usually results in data being more consistently acquired. The diversities of practitioners and environments may produce results that are more conservative than might be obtained from more "focused" studies; however, diversities in a study often identify implicitly results that are more robust-that is results applicable by more practitioners and applicable in more environments.
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Affiliation(s)
- Valeria M Moncayo
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Erin E Grady
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Naomi P Alazraki
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA; Nuclear Medicine Service, Atlanta Veterans Affairs Healthcare System, Decatur, GA
| | - John N Aarsvold
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA; Nuclear Medicine Service, Atlanta Veterans Affairs Healthcare System, Decatur, GA.
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