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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 PMCID: PMC11287229 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] [Received: 10/09/2023] [Revised: 05/13/2024] [Accepted: 05/24/2024] [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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Kashani F, Weiss BG, Bartenstein P, Canis M, Haubner F. Lymphatic drainage of sinonasal malignancies and the role of sentinel node biopsies. Orphanet J Rare Dis 2024; 19:120. [PMID: 38481240 PMCID: PMC10938691 DOI: 10.1186/s13023-024-03127-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Locoregional recurrence is a critical factor in the prognosis of sinonasal malignancies. Due to the rarity of these tumours, as well as the heterogeneity of histologies and anatomical subsites, there is little evidence regarding the rate and location of regional metastases in sinonasal malignancies. Elective regional lymph node dissection in the therapy of sinonasal malignancies has become controversial. On the one hand, elective regional lymph node dissection is considered to be an overtreatment in the cN0 cases. On the other hand, undetected occult lymphatic metastases are associated with a poor prognosis. In this study, we discuss the role of sentinel lymph node biopsy as a minimally invasive procedure in the treatment of sinonasal malignancies based on our two years of practical experience and the currently available data. RESULTS This is a descriptive, monocentric, retrospective study, including 20 cases of cN0 malignant sinonasal neoplasm, that underwent a surgical therapy between 2020 and 2022. The following aspects were investigated: tumour entity, localisation of the primary tumour, tumoral stage, localisation of the sentinel lymph nodes, and postoperative complications. Squamous cell carcinoma was the most frequently diagnosed tumour entity (50%), followed by adenocarcinoma (20%) and malignant melanoma (15%), adenoid cystic carcinoma and mucoepidermoid carcinoma. Sentinel lymph nodes were most frequently found in the ipsilateral neck region I (45%), followed by the ipsilateral neck region II (40%). In all cases, the removed lymph nodes were free of malignancy. There were no postoperative complications due to lymph node biopsy. There were no recurrences during the study period. CONCLUSION Sentinel node biopsy could add more safety to the management of cN0 sinonasal malignancies due to its low morbidity. Whether SNB could provide an alternative to elective neck dissection in the management of SNM should be investigated in further studies.
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Affiliation(s)
- Fatemeh Kashani
- Department of Otorhinolarnygology, Head and Neck Surgery, Ludwig-Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany.
| | - B G Weiss
- Department of Otorhinolarnygology, Head and Neck Surgery, Ludwig-Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany
| | - P Bartenstein
- Department of Nuclear Medicine, Ludwig-Maximilians University, Munich, Germany
| | - M Canis
- Department of Otorhinolarnygology, Head and Neck Surgery, Ludwig-Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany
| | - F Haubner
- Department of Otorhinolarnygology, Head and Neck Surgery, Ludwig-Maximilians University, Marchioninistrasse 15, 81377, Munich, Germany
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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: 2] [Impact Index Per Article: 2.0] [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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Al-Moraissi EA, Marwan H, Elayah SA, Traxler-Weidenauer D, Paraskevopoulos K, Amir Rais M, Zimmermann M. Sentinel lymph node biopsy versus elective neck dissection in management of the clinically negative (cN0) neck in patients with oral squamous cell carcinoma: A systematic review and meta-analysis. J Craniomaxillofac Surg 2024; 52:141-150. [PMID: 38195297 DOI: 10.1016/j.jcms.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/11/2023] [Accepted: 12/30/2023] [Indexed: 01/11/2024] Open
Abstract
Oral squamous cell carcinoma (OSCC) is the most prevalent type of head and neck cancer, and lymph node metastasis is a crucial prognostic factor that has a direct correlation with the survival rate. The standard procedure for managing clinically negative (cN0) neck in OSCC patients is elective neck dissection (END), but it can lead to various complications that affect the patient's quality of life. Therefore, medical professionals are exploring the use of the sentinel lymph node biopsy (SLNB) to manage cN0 neck in OSCC patients. The aim of this systematic review and meta-analysis was to compare the overall survival (OS) and disease-free survival (DFS) of patients undergoing SLNB and END in the surgical management of early cN0 neck in OSCC patients. To conduct this study, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to report the systematic reviews. The study included all comparative clinical studies, including randomized clinical trials (RCTs), clinical perspective studies, and retrospective studies that compared END to SLNB for early cN0 neck in OSCC patients. The hazard ratio (HR) and risk ratio (RR) with 95% confidence interval (CI) were calculated using comprehensive meta-analysis. The primary outcome variables were OS, DFS, and disease-specific survival (DSS). The secondary outcome variable was the nodal recurrence rate without local or distant metastasis. The GRADE system was used to assess the evidence's certainty. The meta-analysis included 12 clinical studies, comprising three RCTs and seven non-RCTs. The results showed no statistically significant difference between END and SLNB concerning OS (HR = 0.993, CI: 0.814 to 1.211, P = 0.947, low-quality evidence), DFS (HR = 0.705, CI: 0.408 to 1.29, P = 0.21, low-quality evidence), and nodal recurrence (RR = 1.028, CI: 0.969 to 1.090, P = 0.907, low-quality evidence). Additionally, SLNB was non-inferior to END regarding DSS (RR = 1.028, CI: 0.969 to 1.090, P = 0.907, low-quality evidence). In conclusion, this research affirms the safety and precision of SLNB as a means to stage cN0 OSCC patients, with outcomes that are comparable to END in terms of survival and nodal recurrence. Nevertheless, it's crucial to acknowledge that the quality of evidence in this study was relatively low. Therefore, additional RCTs comparing END to SLNB are warranted to validate these results and offer more robust guidance for managing cN0 OSCC patients.
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Affiliation(s)
| | - Hisham Marwan
- University of Texas Medical Branch at Galveston, USA; King Abdulaiz University, Jeddah, Saudi Arabia.
| | - Sadam Ahmed Elayah
- Department of Oral and Maxillofacial Surgery, Jiblah University For Medical and Health Sciences, Ibb, Yemen
| | | | | | | | - Matthias Zimmermann
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Vienna, Austria
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Zhou M, Liu P, Yin X, Deng C, Xiao Y, Lei M, Hu S, An F, Zhao M. A SPECT/NIR Fluorescence Dual-Modality Imaging Agent Composed of Drugs and Hospital Available Isotope for Preoperative Sentinel Lymph Node Mapping and Intraoperative Biopsy. Int J Nanomedicine 2023; 18:7637-7646. [PMID: 38106445 PMCID: PMC10725784 DOI: 10.2147/ijn.s430502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023] Open
Abstract
Background Sentinel lymph node (SLN) mapping-guided biopsy is crucial for cancer staging and treatment. Optical/nuclide dual-modality imaging agents for mapping SLN are ideal for preoperative planning and intraoperative biopsy, which are enabled by penetration-depth unlimited nuclide imaging and dynamic real-time optical imaging, respectively. However, commonly reported dual-modality imaging agents are composed of novel but safety-unproven materials, making their quick clinical translation challenging. Herein, we report a novel nanoparticle composed of facile hospital-available drugs and isotope for single-photon emission computed tomography (SPECT)/near-infrared (NIR) fluorescence imaging to detect SLNs. Methods Indocyanine green-human serum albumin (ICG-HSA) nanoparticles (NPs) were synthesized by ICG-induced HSA self-assembly and further 99mTc-labeling via a one-step, facile hospital-available method. After injecting 99mTc-ICG-HSA into the rats' forepaw pads, the rats' draining axillary lymph nodes were visualized by preoperative mapping with SPECT/CT and intraoperative biopsy with NIR fluorescence. The axillary lymph nodes of rats were identified by pathology and fluorescent staining after execution. Additionally, its toxicity testing and comparison with 99mTc-sulfur colloid imaging were also explored. Results The study reported a self-assembled 99mTc-ICG-HSA with a high radiochemical yield (85.6 ± 3.8%). Compared with conventional 99mTc-sulfur colloid, 99mTc-ICG-HSA NPs showed faster SLN identification, higher renal clearance, and lower hepatic retention. Furthermore, NIRF imaging allowed for the accurate visualization of the SLN and guided SLN biopsy intraoperatively. Notably, the 99mTc-ICG-HSA NPs were composed of hospital-available drugs and isotope, which are safe for acute toxicity evaluation by a certified institute. Conclusion The proposed 99mTc-ICG-HSA NPs are safe and capable of noninvasive SLN identification and biopsy guidance with multi-modal imaging strategies and could be a promising tool for clinically assisted SLN biopsy.
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Affiliation(s)
- Ming Zhou
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Key Laboratory of Biological, Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Peng Liu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Key Laboratory of Biological, Nanotechnology of National Health Commission, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Xiaoqin Yin
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Caiting Deng
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, People’s Republic of China
- Institute of Medical Engineering, Department of Biophysics, School of Basic Medical Science, Health Science Center, Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Yi Xiao
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Meng Lei
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Shuo Hu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Feifei An
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Min Zhao
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- Department of Nuclear Medicine, Third Xiangya Hospital, Central South University, Changsha, People’s Republic of China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China
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Nieuwenhuis ER, Mir N, Horstman-van de Loosdrecht MM, Meeuwis APW, de Bakker MGJ, Scheenen TWJ, Alic L. Performance of a Nonlinear Magnetic Handheld Probe for Intraoperative Sentinel Lymph Node Detection: A Phantom Study. Ann Surg Oncol 2023; 30:8735-8742. [PMID: 37661223 PMCID: PMC10625952 DOI: 10.1245/s10434-023-14166-z] [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: 02/03/2023] [Accepted: 07/09/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE This study investigates the performance of the DiffMag handheld probe (nonlinear magnetometry), to be used for sentinel lymph node detection. Furthermore, the performance of DiffMag is compared with a gamma probe and a first-order magnetometer (Sentimag®, linear magnetometry). METHODS The performance of all three probes was evaluated based on longitudinal distance, transverse distance, and resolving power for two tracer volumes. A phantom was developed to investigate the performance of the probes for a clinically relevant situation in the floor of the mouth (FOM). RESULTS Considering the longitudinal distance, both DiffMag handheld and Sentimag® probe had comparable performance, while the gamma probe was able to detect at least a factor of 10 deeper. Transverse distances of 13, 11, and 51 mm were measured for the small tracer volume by the DiffMag handheld, Sentimag®, and the gamma probe, respectively. For the large tracer volume this was 21, 18, and 55 mm, respectively. The full width at half maximum, at 7 mm probe height from the phantom surface, was 14, 12, and 18 mm for the small tracer volume and 15, 18, and 25 mm for the large tracer volume with the DiffMag handheld, Sentimag®, and gamma probe, respectively. CONCLUSIONS With a high resolving power but limited longitudinal distance, the DiffMag handheld probe seems suitable for detecting SLNs which are in close proximity to the primary tumor. In this study, comparable results were shown using linear magnetometry. The gamma probe reached 10 times deeper, but has a lower resolving power compared with the DiffMag handheld probe.
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Affiliation(s)
- Eliane R Nieuwenhuis
- Magnetic Detection and Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Nida Mir
- Magnetic Detection and Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | | | - Antoi P W Meeuwis
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maarten G J de Bakker
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom W J Scheenen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lejla Alic
- Magnetic Detection and Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
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Carey RM, Anagnos VJ, Prasad A, Sangal NR, Rajasekaran K, Shanti RM, Cannady SB, Newman JG, Brant JA, Brody RM. Nodal Metastasis in Surgically Treated Oral Cavity Squamous Cell Carcinoma. ORL J Otorhinolaryngol Relat Spec 2023; 85:348-359. [PMID: 37967536 PMCID: PMC10652645 DOI: 10.1159/000534491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 09/11/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION Management of the neck in oral cavity squamous cell carcinoma (OCSCC) is essential to oncologic control and survival. The rates of lymph node metastasis (LNM) vary based on oral cavity tumor site and stage and influence treatment decisions. The aim of this paper was to describe clinical LNM for different tumor subsites and stages of surgically managed OCSCC. METHODS We conducted a retrospective analysis of 25,846 surgically managed OCSCC patients from the National Cancer Database (NCDB) stratified by tumor subsite and clinical T-stage. For cN + patients, rates of pathologic LNM and absence of pathologic LNM were determined. For cN0 patients, outcomes included the rates of elective neck dissection (END) and occult LNM and predictors of occult LNM determined by a multivariable logistic regression model. RESULTS A total of 25,846 patients (59.1% male, mean age 61.9 years) met inclusion criteria with primary tumor sites including oral tongue (50.8%), floor of mouth (21.2%), lower alveolus (7.6%), buccal mucosa (6.7%), retromolar area (4.9%), upper alveolus (3.6%), hard palate (2.7%), and mucosal lip (2.5%). Among all sites, clinical N+ rates increased with T-stage (8.9% T1, 28.0% T2, 51.6% T3, 52.5% T4); these trends were preserved across subsites. Among patients with cN + disease, the overall rate of concordant positive pathologic LNM was 80.1% and the rate of discordant negative pathologic LNM was 19.6%, which varied based on tumor site and stage. In the overall cohort of cN0 patients, 59.9% received END, and the percentage of patients receiving END increased with higher tumor stage. Occult LNM among those cN0 was found in 25.1% of END cases, with the highest rates in retromolar (28.8%) and oral tongue (27.5%) tumors. Multivariable regression demonstrated significantly increased rates of occult LNM for higher T stage (T2 OR: 2.1 [1.9-2.4]; T3 OR: 3.0 [2.5-3.7]; T4 OR: 2.7 [2.2-3.2]), positive margins (OR: 1.4 [1.2-1.7]), and positive lymphovascular invasion (OR: 5.1 [4.4-5.8]). CONCLUSIONS Management of the neck in OCSCC should be tailored based on primary tumor factors and considered for early-stage tumors.
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Affiliation(s)
- Ryan M Carey
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Vincent J Anagnos
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aman Prasad
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA,
| | - Neel R Sangal
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rabie M Shanti
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Oral and Maxillofacial Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Steven B Cannady
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason G Newman
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jason A Brant
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Robert M Brody
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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Battaglia S, Crimi S, Piombino E, Villari L, Maugeri C, Minervini G, Cicciù M, Bianchi A. Nodal frozen section + elective neck dissection as an alternative to sentinel lymph node biopsy for the management of cT1-2N0 oral squamous cell carcinoma patients: a viability and accuracy study. J Cancer Res Clin Oncol 2023; 149:10465-10471. [PMID: 37278829 PMCID: PMC10423153 DOI: 10.1007/s00432-023-04941-6] [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: 03/31/2023] [Accepted: 05/24/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE Oral Squamous Cell Carcinoma (OSCC) is characterized by a high aggressiveness and a tendency to metastasize. The management of the neck in cT1-2N0 patients c follows three strategies: watchful waiting, elective neck dissection (END) or sentinel lymph node biopsy (SLNB). The aim was to assess the viability of intraoperative frozen sections of the nodes of cT1-2N0 to spot occult metastases as an alternative to SLNB, performing a modified radical neck dissection (MRND) in intraoperatively positive patients. METHODS The patients were treated at the Maxillo-Facial Surgery Unit of Policlinico San Marco of Catania between 2020 and 2022. END was performed in all patients, including frozen section examination of at least one clinically suspicious node per level. In case of positivity after frozen section examination, neck dissection was extended to levels IV and V. RESULTS All frozen sections were compared with a definitive test after paraffin inclusion. During surgery, 70 END were performed, and 210 nodes were analyzed with frozen sections. Among the 70 END, 52 were negative after frozen Sects. (156 negative nodes), and surgery was ended. Five of the 52 negative ENDs resulted in pN + after paraffin inclusion (9.6%), which underwent postoperative adjuvant treatment. The sensibility of our END + frozen section method was 75%, while the specificity of our test was 94%. The negative predictive value was 90,4%. CONCLUSIONS Elective neck dissection + intraoperative frozen section could be an alternative to SLNB to spot occult nodal metastases in cT1-2N0 OSCC due to the opportunity to perform a one-step diagnostic/therapeutic procedure.
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Affiliation(s)
- Salvatore Battaglia
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, CT Italy
| | - Salvatore Crimi
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, CT Italy
| | - Eliana Piombino
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, CT Italy
- Pathology Unit San Marco Hospital, San Marco Hospital, Catania, Italy
| | - Loredana Villari
- Pathology Unit San Marco Hospital, San Marco Hospital, Catania, Italy
| | - Claudia Maugeri
- Division of Maxillofacial Surgery Surgical Science dpt., Città Della Salute e Delle Scienze Hospital, University of Turin, Turin, Italy
| | - Giuseppe Minervini
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, CT Italy
| | - Alberto Bianchi
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, CT Italy
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9
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Stögbauer F, Beck S, Ourailidis I, Hess J, Poremba C, Lauterbach M, Wollenberg B, Buchberger AMS, Jesinghaus M, Schirmacher P, Stenzinger A, Weichert W, Boxberg M, Budczies J. Tumour budding-based grading as independent prognostic biomarker in HPV-positive and HPV-negative head and neck cancer. Br J Cancer 2023; 128:2295-2306. [PMID: 37045906 PMCID: PMC10241901 DOI: 10.1038/s41416-023-02240-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The prognostic significance of tumour budding (TB) and minimal cell nest size (MCNS) was shown in human papillomavirus (HPV)-negative head and neck squamous cell carcinomas (HNSCC). However, the optimisation of cutpoints, the prognostic impact in HPV-positive HNSCC, and the comparison with other histopathological grading systems are insufficiently investigated. METHODS TB and MCNS were analysed digitally in 1 and 10 high-power fields (HPF) of 331 HPV-positive and HPV-negative cases from TCGA. Optimising the cutpoints a new cellular dissociation grading (CDG) system was defined and compared to the WHO grading and the Brandwein-Gensler (BG) risk model. RESULTS The two-tiered CDG system based solely on TB yielded optimal prognostic stratification with shortened overall survival for CDG-high cases. Optimal cut-offs were two buds (1 HPF) and six buds (10 HPF), respectively. Analysing MCNS did not add prognostic significance to quantifying TB. CDG was a significant prognostic marker in HPV-negative and HPV-positive tumours and prognostically superior to the WHO and BG systems. High CDG was associated with clinically occult lymph-node metastases. CONCLUSIONS The most comprehensive study of TB in HNSCC so far confirmed its prognostic impact in HPV-negative tumours and for the first time in HPV-positive tumours. Further studies are warranted to evaluate its applicability for therapy guidance in HNSCC.
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Grants
- Speaker’s fees: AstraZeneca, Incyte, Janssen. Advisory Boards: BMS, MSD, AstraZeneca, Roche. Funding for research: Roche, Chugai, BMS, Novartis.
- Advisory Board/Speaker’s Bureau: Astra Zeneca, AGCT, Bayer, BMS, Eli Lilly, Illumina, Janssen, MSD, Novartis, Pfizer, Roche, Seattle Genetics, Takeda, Thermo Fisher. Grants: Bayer, BMS, Chugai, Incyte.
- Advisory Boards and speaker’s fees: Roche, MSD, BMS, AstraZeneca, Pfizer, Merck, Lilly, Boehringer, Novartis, Takeda, Bayer, Amgen, Astellas, Eisai, Illumina, Siemens, Agilent, ADC, GSK and Molecular Health. Funding for research: Roche, MSD, BMS and AstraZeneca.
- Deutsche Krebshilfe (German Cancer Aid)
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Affiliation(s)
- Fabian Stögbauer
- Institute of Pathology, School of Medicine, Technical University of Munich (TUM), 81675, Munich, Germany
| | - Susanne Beck
- University of Heidelberg, Institute of Pathology, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - Iordanis Ourailidis
- University of Heidelberg, Institute of Pathology, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - Jochen Hess
- Section Experimental and Translational Head and Neck Oncology, Department of Otolaryngology, Head and Neck Surgery, University Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Research Group Molecular Mechanisms of Head and Neck Tumors, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | | | - Maren Lauterbach
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Klinikum Rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
| | - Barbara Wollenberg
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Klinikum Rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
| | - Anna Maria Stefanie Buchberger
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Klinikum Rechts der Isar, Ismaningerstr. 22, 81675, Munich, Germany
| | - Moritz Jesinghaus
- Institute of Pathology, School of Medicine, Technical University of Munich (TUM), 81675, Munich, Germany
- Institute of Pathology, University Hospital Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Peter Schirmacher
- University of Heidelberg, Institute of Pathology, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- German Cancer Consortium (DKTK), Munich and Heidelberg partner sites, Munich and Heidelberg, Germany
| | - Albrecht Stenzinger
- University of Heidelberg, Institute of Pathology, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- German Cancer Consortium (DKTK), Munich and Heidelberg partner sites, Munich and Heidelberg, Germany
| | - Wilko Weichert
- Institute of Pathology, School of Medicine, Technical University of Munich (TUM), 81675, Munich, Germany
- German Cancer Consortium (DKTK), Munich and Heidelberg partner sites, Munich and Heidelberg, Germany
| | - Melanie Boxberg
- Institute of Pathology, School of Medicine, Technical University of Munich (TUM), 81675, Munich, Germany.
- Pathologie München-Nord, 80992, Munich, Germany.
- German Cancer Consortium (DKTK), Munich and Heidelberg partner sites, Munich and Heidelberg, Germany.
| | - Jan Budczies
- University of Heidelberg, Institute of Pathology, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany.
- German Cancer Consortium (DKTK), Munich and Heidelberg partner sites, Munich and Heidelberg, Germany.
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10
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Bark R, Kolev A, Elliot A, Piersiala K, Näsman A, Grybäck P, Georén SK, Wendt M, Cardell LO, Margolin G, Marklund L. Sentinel node-assisted neck dissection in advanced oral squamous cell carcinoma-A new protocol for staging and treatment. Cancer Med 2023. [PMID: 37084007 DOI: 10.1002/cam4.5966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is used to improve the staging of and guide treatment in patients with early-stage T1-T2 N0 oral squamous cell carcinoma (OSCC). The role of sentinel nodes (SNs) and the use of SN-technique in advanced OSCC (T3-T4 and/or N+) remain to be evaluated. This study investigates the nodal drainage and the rate of positive SNs (SNs+) in all stages of OSCC. MATERIALS AND METHODS In total, 85 patients with T1-T4 OSCC diagnosed 2019-2021 were included. We used a prolonged interval between peritumoral injection of radionuclide and SPECT-CT to include all SNs. RESULTS Patients with advanced OSCC presented a higher proportion of contralateral lymphatic drainage and a higher rate of SN+ compared to patients with early-stage disease. T3-T4 and N+ tumors presented a tendency for a higher rate of contralateral lymphatic drainage compared to T1-T2 and N0 tumors (p = 0.1). The prevalence of positive nodes (SNs+) was higher among patients with advanced disease, T3-T4 versus T1-T2 (p = 0.0398). CONCLUSION SN-assisted ND enables identification and removal of all SNs + and has the potential for more accurate staging and could possibly give prognostic advantages regarding regional recurrence for all OSCC patients, especially among those with advanced disease. The precise localization of the SNs + also suggests that a more individualized ND approach might be possible in the future even for patients with advanced OSCC.
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Affiliation(s)
- Rusana Bark
- Department of Clinical Sciences Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
- Medical Unit Head Neck Lung and Skin cancer, Department of Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Aeneas Kolev
- Department of Clinical Sciences Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
- Medical Unit Head Neck Lung and Skin cancer, Department of Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Alexandra Elliot
- Department of Clinical Sciences Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
- Medical Unit Head Neck Lung and Skin cancer, Department of Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Krzysztof Piersiala
- Department of Clinical Sciences Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Näsman
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Per Grybäck
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Susanna Kumlien Georén
- Department of Clinical Sciences Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
| | - Malin Wendt
- Department of Clinical Sciences Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Olaf Cardell
- Department of Clinical Sciences Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Gregori Margolin
- Department of Clinical Sciences Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
- Medical Unit Head Neck Lung and Skin cancer, Department of Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Linda Marklund
- Department of Clinical Sciences Intervention and Technology, Division of ENT Diseases, Karolinska Institute, Stockholm, Sweden
- Medical Unit Head Neck Lung and Skin cancer, Department of Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Surgical Sciences, Section of Otolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden
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11
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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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12
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McGurk M. Sentinel lymph node biopsy for early oral cancer - accuracy and considerations for patient selection. Br J Oral Maxillofac Surg 2023; 61:248-250. [PMID: 36725490 DOI: 10.1016/j.bjoms.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/08/2022] [Accepted: 09/22/2022] [Indexed: 01/15/2023]
Affiliation(s)
- Mark McGurk
- Head and Neck Academic Centre, Division of Surgery & Interventional Science, UCL, United Kingdom.
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13
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Thoenissen P, Heselich A, Burck I, Sader R, Vogl T, Ghanaati S. The role of magnetic resonance imaging and computed tomography in oral squamous cell carcinoma patients' preoperative staging. Front Oncol 2023; 13:972042. [PMID: 36959788 PMCID: PMC10028140 DOI: 10.3389/fonc.2023.972042] [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: 06/17/2022] [Accepted: 02/20/2023] [Indexed: 03/09/2023] Open
Abstract
Introduction The aim of the study was to evaluate the accuracy of MRI and CT with regard to the detection of lymph node metastases based on the data of specific patients with OSCC who received bilateral neck dissection. Materials and methods In a retrospective analysis from 01/2014 to 12/2020 patients who underwent primary tumor resection and bilateral neck dissection were evaluated. Results 174 preoperative MRI (78.74%, N=137) and CT (21.26%, N=37) were correlated with the histopathological findings. CT had a sensitivity of 67% and specificity of 68% (p=0.76). MRI showed an overall sensitivity of 66% and a specificity of 68% (p=0.76). In 52.87% of all cases no differences between cN and pN were found. MRI is the method to overestimate lymph node involvement compared to CT (overestimation in 27% vs. 21.62%). Conclusion The current data indicate that MR and CT show poor efficacy in the detection of cervical metastases. Accordingly, attention must be paid to alternatives to correct local staging modalities. The application of structured bilateral neck dissection needs to be questioned.
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Affiliation(s)
- Philipp Thoenissen
- Department of Oral, Cranio-Maxillofacial and Plastic Facial Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany
- *Correspondence: Philipp Thoenissen,
| | - Anja Heselich
- Department of Oral, Cranio-Maxillofacial and Plastic Facial Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Iris Burck
- Department of Diagnostic and Interventional Radiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Robert Sader
- Department of Oral, Cranio-Maxillofacial and Plastic Facial Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Thomas Vogl
- Department of Diagnostic and Interventional Radiology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Shahram Ghanaati
- Department of Oral, Cranio-Maxillofacial and Plastic Facial Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany
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14
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Chiti LE, Gariboldi EM, Stefanello D, De Zani D, Grieco V, Nolff MC. Sentinel Lymph Node Mapping and Biopsy in Cats with Solid Malignancies: An Explorative Study. Animals (Basel) 2022; 12:3116. [PMID: 36428344 PMCID: PMC9686746 DOI: 10.3390/ani12223116] [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: 10/10/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022] Open
Abstract
There is increasing evidence on the utility of sentinel lymph node (SLN) biopsy (SLNB) for the staging of dogs with various malignancies; however, comparable information is missing in cats. This multi-institutional study aims at reporting the feasibility and detection rate of SLNB guided by lymphoscintigraphy and the blue dye or near-infrared fluorescent lymphography (NIRF-L) in cats with solid tumors. In total, 12 cats presented with 14 solid malignancies that underwent curative-intent surgical excision of the primary tumor and SLNB were retrospectively enrolled. The mapping technique used, location and number of SLN, correspondence with the regional lymph node (RLN), and histological status of the SLN were retrieved. The detection rate and complications of SLNB were also recorded. NIRF-L was performed in 64.3% of tumors and lymphoscintigraphy in 35.7%. The detection rate was 100% for both techniques. The SLN did not correspond (fully or partially) to the RLN in 71.4% of cases, with multiple SLN being excised in 9/14 tumors. No complications related to SLNB were recorded. At histopathology, metastases were identified in 41.7% of cats, all with mast cell tumors (MCT). SLNB guided by NIRF-L or lymphoscintigraphy is feasible and safe in cats with solid tumors and should be suggested for correct tumor staging in cats, especially with MCT.
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Affiliation(s)
- Lavinia Elena Chiti
- Clinic for Smal Animals Surgery, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland
| | - Elisa Maria Gariboldi
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Damiano Stefanello
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Donatella De Zani
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Valeria Grieco
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Mirja Christine Nolff
- Clinic for Smal Animals Surgery, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland
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15
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What is the optimum operative approach for the N0 neck in patients with early mouth cancer - a review of current status. Br J Oral Maxillofac Surg 2022; 60:864-867. [PMID: 35843759 DOI: 10.1016/j.bjoms.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/03/2021] [Indexed: 11/22/2022]
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16
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Mahieu R, Donders DNV, Dankbaar JW, de Bree R, de Keizer B. CT Lymphography Using Lipiodol® for Sentinel Lymph Node Biopsy in Early-Stage Oral Cancer. J Clin Med 2022; 11:jcm11175129. [PMID: 36079061 PMCID: PMC9456579 DOI: 10.3390/jcm11175129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/27/2022] [Accepted: 08/28/2022] [Indexed: 11/18/2022] Open
Abstract
This study evaluated sentinel lymph node (SLN) identification with CT lymphography (CTL) following peritumoral administration of Lipiodol® relative to conventional 99mTc-nanocolloid lymphoscintigraphy (including SPECT/CT) in 10 early-stage oral cancer patients undergoing SLN biopsy. Patients first underwent early dynamic and static scintigraphy after peritumoral administration of 99mTc-nanocolloid. Subsequently, Lipiodol® was administered at the same injection sites, followed by fluoroscopy and CT acquisition. Finally, late scintigraphy and SPECT/CT were conducted, enabling the fusion of late CTL and SPECT imaging. The next day, designated SLNs were harvested, radiographically examined for Lipiodol® uptake and histopathologically assessed. Corresponding images of CT, 99mTc-nanocolloid lymphoscintigraphy and SPECT/late CTL fusion were evaluated. 99mTc-nanocolloid lymphoscintigraphy identified 21 SLNs, of which 7 were identified with CTL (33%). CTL identified no additional SLNs and failed to identify any SLNs in four patients (40%). Out of six histopathologically positive SLNs, two were identified by CTL (33%). Radiographic examination confirmed Lipiodol® uptake in seven harvested SLNs (24%), of which five were depicted by CTL. CTL using Lipiodol® reached a sensitivity of 50% and a negative predictive value (NPV) of 75% (median follow-up: 12.3 months). These results suggest that CTL using Lipiodol® is not a reliable technique for SLN mapping in early-stage oral cancer.
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Affiliation(s)
- Rutger Mahieu
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Dominique N. V. Donders
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Correspondence: ; Tel.: +31-887550819
| | - Bart de Keizer
- Department of Radiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Nuclear Medicine, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
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17
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Tsai M, Huang H, Chuang H, Lin Y, Yang K, Lu H, Chien C. Patients of stage I oral cancer with pathologically low-risk feature managed by primary tumor resection alone: Impact of depth of invasion and a nomogram analysis. Laryngoscope Investig Otolaryngol 2022; 7:1025-1032. [PMID: 36000051 PMCID: PMC9392408 DOI: 10.1002/lio2.872] [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: 04/13/2022] [Revised: 05/26/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives To evaluate the importance of depth of invasion (DOI) in patients with pathologically low-risk feature stage I oral squamous cell carcinoma (OSCC) managed by primary tumor resection alone. Methods Patients with stage I OSCC, at pathologically low risk, underwent primary tumor resection without neck dissection were enrolled retrospectively between 2007 and 2015. Low risk was defined as the absence of positive or close margins, lymphovascular invasion, perineural invasion, worst pattern of invasion-5, and poor differentiation in histologic grade. The primary endpoints included overall survival (OS), cancer specific survival (CSS), local recurrence free survival (LRFS), and regional recurrence free survival (RRFS). A nomogram based on the DOI was established for predicting RRFS. Results A total of 198 patients were enrolled in this study. DOI was the only prognosticator to achieve statistical significance in all primary endpoints according to univariate analysis. Patients with DOI <3 mm tumor showed better five-year OS, CSS, LRFS, and RRFS than those with DOI ≥3 mm tumor. The concordance index of the nomogram model without DOI was 0.684, which could increase to 0.733 when DOI was included in the calculation. Conclusion Patients with pathologically low-risk stage I OSCC correlate with a higher chance in occult neck metastasis if increasing DOI (≥3 mm) is noticed. Indeed, the chance of occult neck metastasis is significantly higher in this group (14% vs. 2%) than in those with DOI <3 mm. Elective neck dissection is advised if DOI is ≥3 mm to achieve better clinical outcomes. Level of Evidence 4.
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Affiliation(s)
- Ming‐Hsien Tsai
- Department of OtolaryngologyKaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan
- Kaohsiung Chang Gung Head and Neck Oncology Group, Cancer CenterKaohsiung Chang Gung Memorial HospitalKaohsiungTaiwan
- College of Pharmacy and Health CareTajen UniversityPingtungTaiwan
| | - Hui‐Shan Huang
- Department of Pathology, Kaohsiung Chang Gung Memorial HospitalChang Gung University College of MedicineKaohsiungTaiwan
| | - Hui‐Ching Chuang
- Department of OtolaryngologyKaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan
- Kaohsiung Chang Gung Head and Neck Oncology Group, Cancer CenterKaohsiung Chang Gung Memorial HospitalKaohsiungTaiwan
| | - Yu‐Tsai Lin
- Department of OtolaryngologyKaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan
- Kaohsiung Chang Gung Head and Neck Oncology Group, Cancer CenterKaohsiung Chang Gung Memorial HospitalKaohsiungTaiwan
- College of Pharmacy and Health CareTajen UniversityPingtungTaiwan
| | - Kun‐Lin Yang
- Department of OtolaryngologyKaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan
- Kaohsiung Chang Gung Head and Neck Oncology Group, Cancer CenterKaohsiung Chang Gung Memorial HospitalKaohsiungTaiwan
| | - Hui Lu
- Department of OtolaryngologyKaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan
| | - Chih‐Yen Chien
- Department of OtolaryngologyKaohsiung Chang Gung Memorial Hospital and Chang Gung University College of MedicineKaohsiungTaiwan
- Kaohsiung Chang Gung Head and Neck Oncology Group, Cancer CenterKaohsiung Chang Gung Memorial HospitalKaohsiungTaiwan
- Institute for Translational Research in BiomedicineKaohsiung Chang Gung Memorial HospitalKaohsiungTaiwan
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18
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Cervical lymph node staging in head and neck tumors: bridging the gap between humans and companion animals. Eur J Nucl Med Mol Imaging 2022; 49:3306-3308. [PMID: 35511279 DOI: 10.1007/s00259-022-05829-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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Miura K, Kawakita D, Oze I, Suzuki M, Sugasawa M, Endo K, Sakashita T, Ohba S, Suzuki M, Shiotani A, Kohno N, Maruo T, Suzuki C, Iki T, Hiwatashi N, Matsumoto F, Kobayashi K, Toyoda M, Hanyu K, Koide Y, Murakami Y, Hasegawa Y. Predictive factors for false negatives following sentinel lymph node biopsy in early oral cavity cancer. Sci Rep 2022; 12:6917. [PMID: 35484369 PMCID: PMC9050642 DOI: 10.1038/s41598-022-10594-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 04/07/2022] [Indexed: 11/18/2022] Open
Abstract
Prophylactic elective neck dissection (ND) with navigation surgery using radioisotope-based sentinel lymph node biopsy (SLNB) is non-inferior to elective ND in terms of survival but has an advantage in postoperative functional disability. We conducted a subgroup analysis to identify predictive factors for false-negative (FN)-SLNB in patients with early oral cavity cancer. This study is a supplementary analysis using the dataset of a previously reported randomized clinical trial on SLN navigation surgery for oral cancers. This study investigated the association of clinical and SLN-related factors with false-negative cases in the SLNB group. From 2011 to 2016, 275 patients were enrolled and randomly assigned to the ND and SLNB study groups, with 134 patients assigned to the SLNB group. In the SLNB group, seven cases with negative SLNs and neck recurrences were judged as FN-SLNBs according to the general definition. The number of detected SLNs with and without adjusting for the propensity score was significantly associated with FNs in the logistic analysis. FN-SLNB was associated with the number of identified SLNs, suggesting the need for careful postoperative monitoring for neck recurrence in patients with one or two identified SLNs after acquiring sufficient experience in the identification technique.
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Affiliation(s)
- Kouki Miura
- International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Daisuke Kawakita
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Isao Oze
- Aichi Cancer Center Research Institute, Nagoya, Japan
| | | | - Masashi Sugasawa
- Saitama Medical University International Medical Center, Saitama, Japan
| | - Kazuhira Endo
- Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | | | - Shinichi Ohba
- Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mikio Suzuki
- University of the Ryukyus Faculty of Medicine, Okinawa, Japan
| | | | | | - Takashi Maruo
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Chiaki Suzuki
- Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | | | - Nao Hiwatashi
- Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | | | | | | | - Kenji Hanyu
- International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | | | | | - Yasuhisa Hasegawa
- Asahi University Hospital, 3-23 Hashimotocho, Gifu, 500-8523, Japan.
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McMahon JD, Zubair F, McNicol S, Stuart Hislop S, Salem S, Howard D, Utam D, Wales C, McCaul J. Survival in node positive early oral SCC: Sentinel Node Biopsy versus Elective Neck Dissection. Br J Oral Maxillofac Surg 2022; 60:890-895. [DOI: 10.1016/j.bjoms.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/08/2022] [Accepted: 01/12/2022] [Indexed: 11/29/2022]
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21
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Vuity D, McMahon J, Hislop S, McCaul J, Wales C, Ansell M, Thomson E, McGarvie J, McLaughlin I, Nicol A, McLellan D. Sentinel lymph node biopsy for early oral cancer - accuracy and considerations in patient selection. Br J Oral Maxillofac Surg 2022; 60:830-836. [PMID: 35331563 DOI: 10.1016/j.bjoms.2021.12.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/03/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Abstract
Sentinel lymph node biopsy (SLNB) for staging oral squamous cell carcinoma (OSCC) patients presenting with early (T1 and T2 N0) disease in preference to elective neck dissection (END) remains controversial worldwide. A retrospective analysis of 145 patients who underwent sentinel lymph node biopsy for a previously untreated early oral cancer between 2010 and 2020 was performed. The primary outcome measures were predictors of occult metastases, accuracy of SLNB and disease specific plus overall survival. The negative predictive value, the false negative rate, and sensitivity for SLNB were 97%, 7.8%, and 92%, respectively. Depth of invasion (DOI) was a significant predictor of N status, overall survival, and disease specific survival. There was a significant difference in the incidence of the neck node metastasis in patients with DOI <5mm compared to those with DOI >5mm. For tumours >5mm there was a moderate to good correlation between radiological depth on contrast enhanced computed tomography (CECT) and histopathological DOI. Preoperative estimation of DOI may be a useful tool in the counselling of patients in the selection of either SLNB or END for N staging purposes in early OSCC.
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Affiliation(s)
- Drazsen Vuity
- Department of Oral and Maxillofacial Surgery, University Hospital Crosshouse, Kilmarnock Rd, Crosshouse, Kilmarnock KA2 0BE, UK.
| | - Jeremy McMahon
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - Stuart Hislop
- Department of Oral and Maxillofacial Surgery, University Hospital Crosshouse, Kilmarnock Rd, Crosshouse, Kilmarnock KA2 0BE, UK
| | - James McCaul
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - Craig Wales
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - Mark Ansell
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - Ewen Thomson
- Department of Oral and Maxillofacial Surgery, Forth Valley Royal Hospital, Stirling Rd, Larbert FK5 4WR, UK
| | - Jim McGarvie
- Department of Medical Physics, University Hospital Crosshouse, Kilmarnock Rd, Crosshouse, Kilmarnock KA2 0BE, UK
| | - Ian McLaughlin
- Department of Radiology & Nuclear Medicine, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - Alice Nicol
- Department of Nuclear Medicine, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
| | - Douglas McLellan
- Department of Pathology, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
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22
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Sentinel lymph node biopsy in head & neck cancers. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Within-patient comparison between [ 68Ga]Ga-tilmanocept PET/CT lymphoscintigraphy and [ 99mTc]Tc-tilmanocept lymphoscintigraphy for sentinel lymph node detection in oral cancer: a pilot study. Eur J Nucl Med Mol Imaging 2021; 49:2023-2036. [PMID: 34962582 DOI: 10.1007/s00259-021-05645-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare sentinel lymph node (SLN) identification using [68Ga]Ga-tilmanocept PET/CT lymphoscintigraphy to [99mTc]Tc-tilmanocept lymphoscintigraphy (including SPECT/CT) in early-stage oral cancer. Furthermore, to assess whether reliable intraoperative SLN localization can be performed with a conventional portable gamma-probe using [99mTc]Tc-tilmanocept without the interference of [68Ga]Ga-tilmanocept in these patients. METHODS This prospective within-patient comparison pilot study evaluated SLN identification by [68Ga]Ga-tilmanocept PET/CT lymphoscintigraphy compared to conventional lymphoscintigraphy using [99mTc]Tc-tilmanocept (~ 74 MBq) in 10 early-stage oral cancer patients scheduled for SLN biopsy. After conventional [99mTc]Tc-tilmanocept lymphoscintigraphy, patients underwent peritumoral administration of [68Ga]Ga-tilmanocept (~ 10 MBq) followed by PET/CT acquisition initiated 15 min after injection. Intraoperative SLN localization was performed under conventional portable gamma-probe guidance the next day; the location of harvested SLNs was correlated to both lymphoscintigraphic images in each patient. RESULTS A total of 24 SLNs were identified by [99mTc]Tc-tilmanocept lymphoscintigraphy, all except one were also identified by [68Ga]Ga-tilmanocept PET/CT lymphoscintigraphy. [68Ga]Ga-tilmanocept PET/CT lymphoscintigraphy identified 4 additional SLNs near the injection site, of which two harbored metastases. Lymphatic vessels transporting [68Ga]Ga-tilmanocept were identified by PET/CT lymphoscintigraphy in 80% of patients, while draining lymphatic vessels were visualized by [99mTc]Tc-tilmanocept lymphoscintigraphy in 20% of patients. Of the 33 SLNs identified by [68Ga]Ga-tilmanocept PET/CT lymphoscintigraphy, 30 (91%) were intraoperatively localized under conventional gamma-probe guidance. CONCLUSION [68Ga]Ga-tilmanocept PET/CT lymphoscintigraphy provided more accurate identification of SLNs and improved visualization of lymphatic vessels compared to [99mTc]Tc-tilmanocept lymphoscintigraphy. When combined with peritumoral administration of [99mTc]Tc-tilmanocept, SLNs detected by [68Ga]Ga-tilmanocept PET/CT lymphoscintigraphy can be reliably localized during surgery under conventional gamma-probe guidance.
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24
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Zeeuw M, Mahieu R, de Keizer B, de Bree R. Evaluation of a streamlined sentinel lymph-node imaging protocol in early-stage oral cancer. Ann Nucl Med 2021; 35:1353-1360. [PMID: 34518977 PMCID: PMC8557191 DOI: 10.1007/s12149-021-01677-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Sentinel lymph-node (SLN) mapping for early-stage oral squamous cell carcinoma (OSCC) is comprehensive and consequently time-consuming and costly. This study evaluated the clinical value of several SLN imaging components and analyzed the accuracy for SLN identification using a streamlined SLN imaging protocol in early-stage OSCC. MATERIALS AND METHODS This retrospective within-patient evaluation study compared both number and localization of identified SLNs between the conventional SLN imaging protocol and a streamlined imaging protocol (dynamic lymphoscintigraphy (LSG) for 10 min directly post-injection and SPECT-CT at ~ 2 h post-injection). LSG and SPECT-CT images of 77 early-stage OSCC patients, scheduled for SLN biopsy, were evaluated by three observers. Identified SLNs using either protocol were related to histopathological assessment of harvested SLNs, complementary neck dissection specimens and follow-up status. RESULTS A total of 200 SLNs were identified using the streamlined protocol, and 12 additional SLNs (n = 212) were identified with the conventional protocol in 10 patients. Of those, 9/12 were identified on early static LSG and 3/12 on late static LSG. None of the additionally identified SLNs contained metastases; none of those in whom additional SLNs were identified developed regional recurrence during follow-up. Only inferior alveolar process carcinoma showed a higher rate of additionally identified SLNs with the conventional protocol (p = 0.006). CONCLUSION Early dynamic LSG can be reduced to 10 min. Late static LSG may be omitted, except in those with a history of oncological neck treatment or with OSCC featuring slow lymphatic drainage. Early static LSG appeared to be contributory in most OSCC subsites.
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Affiliation(s)
- Michiel Zeeuw
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Rutger Mahieu
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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25
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Kaul P, Majumdar K, Kumar R, Garg PK. Isolated Tumor Cells in Sentinel Lymph Nodes: A Management Dilemma. J Clin Oncol 2021; 39:3517-3518. [PMID: 34506213 DOI: 10.1200/jco.21.01107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Pallvi Kaul
- Pallvi Kaul, MS, and Kinjal Majumdar, MS, Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, India; Rahul Kumar, MS, Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, India; and Pankaj Kumar Garg, MCh, Department of Surgical Oncology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India
| | - Kinjal Majumdar
- Pallvi Kaul, MS, and Kinjal Majumdar, MS, Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, India; Rahul Kumar, MS, Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, India; and Pankaj Kumar Garg, MCh, Department of Surgical Oncology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India
| | - Rahul Kumar
- Pallvi Kaul, MS, and Kinjal Majumdar, MS, Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, India; Rahul Kumar, MS, Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, India; and Pankaj Kumar Garg, MCh, Department of Surgical Oncology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India
| | - Pankaj Kumar Garg
- Pallvi Kaul, MS, and Kinjal Majumdar, MS, Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, India; Rahul Kumar, MS, Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, India; and Pankaj Kumar Garg, MCh, Department of Surgical Oncology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India
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26
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Saleem MI, Peng T, Zhu D, Wong A, Pereira LM, Tham T. Sentinel Lymph Node Biopsy Versus Elective Node Dissection in Stage cT1-2N0 Oral Cavity Cancer. Laryngoscope 2021; 132:989-998. [PMID: 34637145 DOI: 10.1002/lary.29895] [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: 08/06/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare overall survival (OS) and disease-free survival (DFS) between sentinel lymph node biopsy (SNB) and elective neck dissection (END) in the surgical management of cT1-2N0 oral cavity squamous cell carcinoma (OCSCC). METHODS English full-text articles were searched in PubMed and Embase on May 9, 2021. Articles had to compare SNB with END in cT1-T2N0 OCSCC patients; report hazard ratios (HRs), Kaplan-Meier curves, or P-values with total number of events for survival outcomes; be from a clinical trial, cohort, or case-control study. Two reviewers reviewed articles and a third settled disagreements. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Risk of Bias in Non-randomized Studies of Interventions tool and revised Cochrane risk-of-bias tool for randomized trials were used. The generic inverse variance method with a random-effect model was used for meta-analysis. RESULTS Ten studies, five retrospective, three prospective, and two randomized controlled trials, were included (total number of patients [n] = 10,498, END n = 9102, SNB n = 1396). No significant differences were found in OS (HR = 0.92; 95% confidence interval [CI]: 0.65-1.31) or DFS (HR = 0.70; 95% CI: 0.41-1.20). Heterogeneity was not detected in pooled OS analysis (P = .18; I2 = 30%), but was in pooled DFS analysis (P = .003; I2 = 66%). CONCLUSIONS No statistically significant differences in OS or DFS were observed between SNB and END in cT1-2N0 OCSCC, suggesting that SNB might be an alternative to END in the management of early-stage, clinically node-negative OCSCC. Laryngoscope, 2021.
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Affiliation(s)
- Matthew I Saleem
- Department of Otolaryngology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, U.S.A
| | - Travis Peng
- Department of Otolaryngology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, U.S.A
| | - Daniel Zhu
- Department of Otolaryngology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, U.S.A
| | - Amanda Wong
- Department of Otolaryngology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, U.S.A
| | - Lucio M Pereira
- Department of Otolaryngology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, U.S.A
| | - Tristan Tham
- Department of Otolaryngology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, U.S.A
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27
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Sentinel node biopsy or elective neck dissection in early oral cancer: a point of contention. Eur Arch Otorhinolaryngol 2021; 278:5107-5108. [PMID: 34623500 DOI: 10.1007/s00405-021-07110-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
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28
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Ventura E, Barros J, Salgado I, Millán A, Vilares M, Zagalo C, Gomes P. Pretreatment Blood Markers in the Prediction of Occult Neck Metastasis: A 10-Year Retrospective Study. Cureus 2021; 13:e16641. [PMID: 34458043 PMCID: PMC8384393 DOI: 10.7759/cureus.16641] [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] [Accepted: 07/26/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction The purpose of this study was to clarify the role of inflammatory blood markers in the management of early-stage (T1-T2) oral squamous cell carcinoma (OSCC) of the tongue in patients with a clinically negative neck. Materials and methods We undertook a retrospective chart review of 102 patients with early-stage OSCC of the tongue, subjected to tumor resection and elective neck dissection. Based on postsurgical histopathological examination results, we divided our cohort into pN+ and pN0 groups. Afterwards, we analyzed the role of pretreatment inflammatory blood markers in predicting occult neck metastasis. We also evaluated neutrophil-lymphocyte ratio (NLR) association with the depth of invasion (DOI) of the primary tumor. Results We found a significant association of NLR (p=0.001) and monocyte-lymphocyte ratio (p=0.011) with neck status on univariate analysis. Multivariate analysis showed that only NLR (p=0.02) was an independent risk factor for occult metastasis among inflammatory blood markers. Receiver Operating Characteristic curve analysis and Younden’s Index determined the NLR value of 2.96 as the most adequate cut-off value for neck status prediction. NLR values of pretreatment workup also had a significant association with the DOI of the primary tumor (p=0.018). Conclusion Our study supports the role of pretreatment NLR in predicting occult neck metastasis in early-stage OSCC of the tongue. It also sheds some light over the potential of NLR as a predictor of the primary tumor’s DOI.
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Affiliation(s)
- Eduardo Ventura
- Oral and Maxillofacial Surgery Unit, Centro Hospitalar e Universitário do Porto, Porto, PRT
| | - João Barros
- Oral and Maxillofacial Surgery Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, PRT
| | - Inês Salgado
- Department of Head and Neck Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, PRT
| | - Ana Millán
- Department of Head and Neck Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, PRT
| | - Miguel Vilares
- Department of Head and Neck Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, PRT
| | - Carlos Zagalo
- Department of Head and Neck Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, PRT.,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz - Cooperativa de Ensino Superior, CRL, Monte da Caparica, PRT
| | - Pedro Gomes
- Department of Head and Neck Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, PRT
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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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30
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Ding Z, Li Y, Pan X, Xuan M, Xie H, Wang X. Sentinel lymph node biopsy versus elective neck dissection in squamous cell carcinoma of the oral cavity with a clinically N0 neck: Systematic review and meta-analysis of prospective studies. Head Neck 2021; 43:3185-3198. [PMID: 34245070 DOI: 10.1002/hed.26803] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/29/2021] [Accepted: 06/28/2021] [Indexed: 02/05/2023] Open
Abstract
Sentinel lymph node biopsy (SLNB) is an emerging strategy for managing early-stage oral squamous cell carcinoma (SCC) with a clinically N0 (cN0) neck. However, the role of SLNB in this scenario is debatable. Herein, relevant literature was systematically reviewed, and a meta-analysis was performed to evaluate the potential dividends of SLNB compared to elective neck dissection (END) for these patients. The meta-analysis, including six prospective studies, showed comparable results of the two management strategies in terms of regional recurrence (risk ratio [RR] = 0.99; 95% confidence interval [CI], 0.58-1.70), 5-year disease-free survival (RR = 0.99; 95% CI, 0.87-1.11), and 5-year overall survival (RR = 1.01; 95% CI, 0.90-1.13). Fewer adverse events occurred in the SLNB arm than in the END arm (RR = 0.12; 95% CI, 0.02-0.70). Overall, SLNB results in as favorable an oncologic prognosis for patients with cN0 oral SCC as END, while significantly lessening side effects and unnecessary surgeries.
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Affiliation(s)
- Zhangfan Ding
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China.,Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yike Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China.,Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xun Pan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China.,Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ming Xuan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China.,Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Huixu Xie
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China.,Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiaoyi Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China.,Department of Head and Neck Oncology Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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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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[ 68Ga]Ga-tilmanocept PET/CT lymphoscintigraphy: a novel technique for sentinel lymph node imaging. Eur J Nucl Med Mol Imaging 2021; 48:963-965. [PMID: 33159222 DOI: 10.1007/s00259-020-05101-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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33
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Boeve K, Mastik MF, Slagter-Menkema L, van Dijk BAC, Roodenburg JLN, van der Laan BFAM, Witjes MJH, van der Vegt B, Schuuring E. Cortactin expression assessment improves patient selection for a watchful waiting strategy in pT1cN0-staged oral squamous cell carcinomas with a tumor infiltration depth below 4 mm. Head Neck 2021; 43:2688-2697. [PMID: 34008248 PMCID: PMC8453862 DOI: 10.1002/hed.26746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/21/2021] [Accepted: 05/04/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In this feasibility study we aimed to evaluate the value of previously reported molecular tumor biomarkers associated with lymph node metastasis in oral squamous cell carcinoma (OSCC) to optimize neck strategy selection criteria. METHODS The association between expression of cortactin, cyclin D1, FADD, RAB25, and S100A9 and sentinel lymph node status was evaluated in a series of 87 (cT1-2N0) patients with OSCC treated with primary resection and SLNB procedure. RESULTS Tumor infiltration depth and tumor pattern of invasion were independent prognostic markers for SLN status, while none of the tumor makers showed a better prognostic value to replace SLNB as neck staging technique in the total cohort. However, in the subgroup of patients with pT1N0 OSCC, cortactin expression (OR 16.0, 95%CI 2.0-127.9) was associated with SLN classification. CONCLUSIONS Expression of cortactin is a promising immunohistochemical tumor marker to identify patients at low risk that may not benefit from SLNB or END.
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Affiliation(s)
- Koos Boeve
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Department of Pathology & Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Mirjam F Mastik
- Department of Pathology & Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Lorian Slagter-Menkema
- Department of Pathology & Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Department of Otorhinolaryngology - Head & Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Boukje A C van Dijk
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - Jan L N Roodenburg
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology - Head & Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Bert van der Vegt
- Department of Pathology & Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Ed Schuuring
- Department of Pathology & Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Mahieu R, den Toom IJ, van Rooij R, van Es RJJ, Hobbelink MGG, Krijger GC, Tijink BM, de Keizer B, de Bree R. Diagnostic accuracy of [ 99m Tc]Tc-tilmanocept compared to [ 99m Tc]Tc-nanocolloid for sentinel lymph node identification in early-stage oral cancer. Clin Otolaryngol 2021; 46:1383-1388. [PMID: 33960126 DOI: 10.1111/coa.13798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/02/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Rutger Mahieu
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Inne J den Toom
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rob van Rooij
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Robert J J van Es
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Monique G G Hobbelink
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Gerard C Krijger
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Bernard M Tijink
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
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35
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Mahieu R, den Toom IJ, Boeve K, Lobeek D, Bloemena E, Donswijk ML, de Keizer B, Klop WMC, Leemans CR, Willems SM, Takes RP, Witjes MJH, de Bree R. Contralateral Regional Recurrence in Lateralized or Paramedian Early-Stage Oral Cancer Undergoing Sentinel Lymph Node Biopsy-Comparison to a Historic Elective Neck Dissection Cohort. Front Oncol 2021; 11:644306. [PMID: 33968742 PMCID: PMC8103896 DOI: 10.3389/fonc.2021.644306] [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: 12/20/2020] [Accepted: 02/15/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction: Nowadays, two strategies are available for the management of the clinically negative neck in early-stage (cT1-2N0) oral squamous cell carcinoma (OSCC): elective neck dissection (END) and sentinel lymph node biopsy (SLNB). SLNB stages both the ipsilateral and the contralateral neck in early-stage OSCC patients, whereas the contralateral neck is generally not addressed by END in early-stage OSCC not involving the midline. This study compares both incidence and hazard of contralateral regional recurrences (CRR) in those patients who underwent END or SLNB. Materials and Methods: A retrospective multicenter cohort study, including 816 lateralized or paramedian early-stage OSCC patients, staged by either unilateral or bilateral END (n = 365) or SLNB (n = 451). Results: The overall rate of occult contralateral nodal metastasis was 3.7% (30/816); the incidence of CRR was 2.5% (20/816). Patients who underwent END developed CRR during follow-up more often than those who underwent SLNB (3.8 vs. 1.3%; p = 0.018). Moreover, END patients had a higher hazard for developing CRR than SLNB patients (HR = 2.585; p = 0.030). In addition, tumor depth of invasion was predictive for developing CRR (HR = 1.922; p = 0.009). Five-year disease-specific survival in patients with CRR was poor (42%) compared to patients in whom occult contralateral nodal metastases were detected by SLNB or bilateral END (88%), although not statistically different (p = 0.066). Conclusion: Our data suggest that SLNB allows for better control of the contralateral clinically negative neck in patients with lateralized or paramedian early-stage OSCC, compared to END as performed in a clinical setting. The prognosis of those in whom occult contralateral nodal metastases are detected at an earlier stage may be favorable compared to those who eventually develop CRR, which highlights the importance of adequate staging of the contralateral clinically negative neck.
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Affiliation(s)
- Rutger Mahieu
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Inne J den Toom
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Koos Boeve
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Daphne Lobeek
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Elisabeth Bloemena
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands.,Oral Pathology, Academic Center for Dentistry (ACTA) Amsterdam, Amsterdam, Netherlands.,Department of Pathology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Maarten L Donswijk
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands
| | - W Martin C Klop
- Department of Head and Neck Surgery, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Stefan M Willems
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
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36
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Chiti LE, Stefanello D, Manfredi M, Zani DD, De Zani D, Boracchi P, Giudice C, Grieco V, Di Giancamillo M, Ferrari R. To map or not to map the cN0 neck: Impact of sentinel lymph node biopsy in canine head and neck tumours. Vet Comp Oncol 2021; 19:661-670. [PMID: 33886154 DOI: 10.1111/vco.12697] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 12/24/2022]
Abstract
Tumour stage is a prognostic indicator for canine malignant head and neck tumours (MHNT). However, consensus is lacking on nodal staging in the absence of clinically apparent nodal disease (cN0 neck). This prospective observational study aims to determine the diagnostic accuracy of radiopharmaceutical and blue dye for sentinel lymph node biopsy (SLNB), to assess the correspondence between sentinel lymph node (SLN) and clinically expected regional lymph node (RLN) and the impact on staging of the procedure in dogs with MHNT and cN0 neck. Twenty-three dogs with MHNT and cN0 neck underwent tumour excision and SLNB guided by preoperative lymphoscintigraphy and intraoperative gamma-probe and blue dye. Diagnostic performances and detection rate were calculated. Correspondence between SLN and RLN, number of nodes excised, histopathological status of the SLN and complications related to the procedure were recorded. The mapping technique identified at least one SLN in 19/23 dogs, with a detection rate of 83%. The SLN did not correspond to the RLN in 52% of dogs. Multiple nodes were removed in 61% of dogs. At histopathology, eight (42%) dogs had SLN+, of which four differed from the RLN. Only minor self-limiting complications occurred in five (22%) dogs. Radiopharmaceutical and blue dye guidance is accurate (sensitivity 88.9%; specificity 100%) for SLNB in dogs with MHNT and cN0 and allowed the extirpation of unpredictable and/or multiple SLN with minimal morbidity. Incorporation of SLNB in the management of MHNT is desirable to correctly stage the cN0 neck, owing the unpredictability of the lymphatic drainage.
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Affiliation(s)
- Lavinia E Chiti
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - Damiano Stefanello
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - Martina Manfredi
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - Davide D Zani
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - Donatella De Zani
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - Patrizia Boracchi
- Dipartimento di Scienze Cliniche e di Comunità, Laboratorio di Statistica Medica, Biometria ed Epidemiologia "G.A. Maccacaro", Università degli Studi di Milano, Milan, Italy
| | - Chiara Giudice
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - Valeria Grieco
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - Mauro Di Giancamillo
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
| | - Roberta Ferrari
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Milan, Italy
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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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38
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Henn TE, Anderson AN, Hollett YR, Sutton TL, Walker BS, Swain JR, Sauer DA, Clayburgh DR, Wong MH. Circulating hybrid cells predict presence of occult nodal metastases in oral cavity carcinoma. Head Neck 2021; 43:2193-2201. [PMID: 33835633 DOI: 10.1002/hed.26692] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/23/2021] [Accepted: 03/16/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Levels of circulating hybrid cells (CHCs), a newly identified circulating tumor cell (CTC), correlate with disease stage and progression in cancer. We investigated their utility to risk-stratify patients with clinically N0 (cN0) oral cavity squamous cell carcinoma (OCSCC), and to identify patients with occult cervical lymph node metastases (pN+). METHODS We analyzed peripheral blood samples for CHCs with co-expression of cytokeratin (tumor) and CD45 (leukocyte) from 22 patients with cN0 OCSCC using immunofluorescence microscopy, then correlated levels with pathologic lymph node status. RESULTS CHC levels exceeded CTCs and correlated with the presence of both clinically overt (p = 0.002) and occult nodal metastases (p = 0.006). CONCLUSIONS For evaluated cN0 OCSCC patients, those with cN0 → pN+ status harbored elevated CHC levels compared to patients without occult disease. Our findings highlight a promising blood-based biologic assay with potential utility to determine the necessity of surgical neck dissection for staging and treatment.
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Affiliation(s)
- Tara E Henn
- Department of Otolaryngology, Oregon Health & Science University, Portland, Oregon, USA
| | - Ashley N Anderson
- Department of Cell, Developmental and Cancer Biology, Oregon Health & Science University, Portland, Oregon, USA
| | - Yvette R Hollett
- Department of Otolaryngology, Oregon Health & Science University, Portland, Oregon, USA
| | - Thomas L Sutton
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Brett S Walker
- Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - John R Swain
- Department of Cell, Developmental and Cancer Biology, Oregon Health & Science University, Portland, Oregon, USA
| | - David A Sauer
- Department of Otolaryngology, Oregon Health & Science University, Portland, Oregon, USA.,Department of Pathology, Oregon Health & Science University, Portland, Oregon, USA
| | - Daniel R Clayburgh
- Department of Otolaryngology, Oregon Health & Science University, Portland, Oregon, USA.,Operative Care Division, Veterans Affairs Medical Center, Portland, Oregon, USA.,Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Melissa H Wong
- Department of Cell, Developmental and Cancer Biology, Oregon Health & Science University, Portland, Oregon, USA.,Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
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de Bree R, de Keizer B. Comparison of different diagnostic approaches in the management of the clinically negative neck in early oral cancer patients. Cancer 2021; 127:1959-1962. [PMID: 33635542 DOI: 10.1002/cncr.33443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/20/2020] [Accepted: 12/23/2020] [Indexed: 11/12/2022]
Affiliation(s)
- Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands
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40
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Li J, Tang X. Increased expression of PFKFB3 in oral squamous cell carcinoma and its association with lymphangiogenesis. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:57-65. [PMID: 34020913 DOI: 10.1016/j.oooo.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/20/2021] [Accepted: 02/06/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study aimed to investigate the expression of 6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3 (PFKFB3) and its association with lymphangiogenesis in oral squamous cell carcinoma (OSCC). STUDY DESIGN The expression of PFKFB3 in OSCC and adjacent normal tissues was detected by immunohistochemistry, Western blot, and quantitative reverse transcription polymerase chain reaction in 78 patients with OSCC. Immunohistochemical analysis was performed to quantify lymphatic vessel density (LVD), which was labeled using podoplanin (PDPN) proteins of lymphatic endothelial cells, and PDPN mRNA was evaluated by quantitative reverse transcription polymerase chain reaction. RESULTS Compared with adjacent normal tissues, the expression of PFKFB3 and PDPN protein was significantly higher in OSCC tissues (P < .0001). Moreover, PFKFB3 protein was associated with LVD and lymph node metastasis (P < .05). Compared with the normal tissues, increased mRNA expression of PFKFB3 and PDPN in the OSCC group (P < .05). In addition, the mRNA expression of PDPN was positively correlated with that of PFKFB3 (P < .0001) in the OSCC group. CONCLUSIONS PFKFB3 and PDPN expression was increased in OSCC. Further, PFKFB3 expression was associated with PDPN expression and LVD, suggesting that PFKFB3 may be considered to mediate lymphangiogenesis and predict lymph node metastasis in OSCC.
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Affiliation(s)
- Jiajia Li
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
| | - Xiufa Tang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China; Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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41
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Tomita H, Yamashiro T, Heianna J, Nakasone T, Kobayashi T, Mishiro S, Hirahara D, Takaya E, Mimura H, Murayama S, Kobayashi Y. Deep Learning for the Preoperative Diagnosis of Metastatic Cervical Lymph Nodes on Contrast-Enhanced Computed ToMography in Patients with Oral Squamous Cell Carcinoma. Cancers (Basel) 2021; 13:cancers13040600. [PMID: 33546279 PMCID: PMC7913286 DOI: 10.3390/cancers13040600] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/23/2021] [Accepted: 01/31/2021] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Cervical lymph node (LN) metastasis in patients with oral squamous cell carcinoma is one of the important prognostic factors. Pretreatment cervical nodal staging is performed using computed tomography (CT) as the first-line examination. However, imaging findings focused on morphology are not specific for detecting cervical LN metastasis. In this study, deep learning (DL) analysis of pretreatment contrast-enhanced CT was evaluated and compared with radiologists’ assessments at levels I–II, I, and II using the independent test set. The DL model achieved higher diagnostic performance in discriminating between benign and metastatic cervical LNs at levels I–II, I, and II. Significant difference in the area under the curves of the DL model and the radiologists’ assessments at levels I–II and II were observed. Our findings suggest that this approach can provide additional value to treatment strategies. Abstract We investigated the value of deep learning (DL) in differentiating between benign and metastatic cervical lymph nodes (LNs) using pretreatment contrast-enhanced computed tomography (CT). This retrospective study analyzed 86 metastatic and 234 benign (non-metastatic) cervical LNs at levels I–V in 39 patients with oral squamous cell carcinoma (OSCC) who underwent preoperative CT and neck dissection. LNs were randomly divided into training (70%), validation (10%), and test (20%) sets. For the validation and test sets, cervical LNs at levels I–II were evaluated. Convolutional neural network analysis was performed using Xception architecture. Two radiologists evaluated the possibility of metastasis to cervical LNs using a 4-point scale. The area under the curve of the DL model and the radiologists’ assessments were calculated and compared at levels I–II, I, and II. In the test set, the area under the curves at levels I–II (0.898) and II (0.967) were significantly higher than those of each reader (both, p < 0.05). DL analysis of pretreatment contrast-enhanced CT can help classify cervical LNs in patients with OSCC with better diagnostic performance than radiologists’ assessments alone. DL may be a valuable diagnostic tool for differentiating between benign and metastatic cervical LNs.
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Affiliation(s)
- Hayato Tomita
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan;
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan; (T.Y.); (J.H.); (S.M.)
- Correspondence: ; Tel.: +81-44-977-8111
| | - Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan; (T.Y.); (J.H.); (S.M.)
| | - Joichi Heianna
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan; (T.Y.); (J.H.); (S.M.)
| | - Toshiyuki Nakasone
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan;
| | - Tatsuaki Kobayashi
- Department of Advanced Biomedical Imaging Informatics, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan; (T.K.); (Y.K.)
| | - Sono Mishiro
- Department of AI Research Lab, Harada Academy, 2-54-4 Higashitaniyama, Kagoshima, Kagoshima 891-0113, Japan; (S.M.); (D.H.)
| | - Daisuke Hirahara
- Department of AI Research Lab, Harada Academy, 2-54-4 Higashitaniyama, Kagoshima, Kagoshima 891-0113, Japan; (S.M.); (D.H.)
| | - Eichi Takaya
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama, Kanagawa 223-8522, Japan;
| | - Hidefumi Mimura
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan;
| | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan; (T.Y.); (J.H.); (S.M.)
| | - Yasuyuki Kobayashi
- Department of Advanced Biomedical Imaging Informatics, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan; (T.K.); (Y.K.)
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de Bree R, Witjes MJH, de Keizer B. The prognostic impact of micrometastases and isolated tumor cells in early oral squamous cell carcinoma. Eur Arch Otorhinolaryngol 2021; 278:5105-5106. [PMID: 33386440 DOI: 10.1007/s00405-020-06500-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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de Bree R, de Keizer B, Civantos FJ, Takes RP, Rodrigo JP, Hernandez-Prera JC, Halmos GB, Rinaldo A, Ferlito A. What is the role of sentinel lymph node biopsy in the management of oral cancer in 2020? Eur Arch Otorhinolaryngol 2020; 278:3181-3191. [PMID: 33369691 PMCID: PMC8328894 DOI: 10.1007/s00405-020-06538-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/30/2020] [Indexed: 02/06/2023]
Abstract
Approximately 70–80% of patients with cT1-2N0 oral squamous cell carcinoma (OSCC) ultimately prove to have no cancer in the cervical lymphatics on final pathology after selective neck dissection. As a result, sentinel lymph node biopsy (SLNB) has been adopted during the last decade as a diagnostic staging method to intelligently identify patients who would benefit from formal selective lymphadenectomy or neck irradiation. While not yet universally accepted, SLNB is now incorporated in many national guidelines. SLNB offers a less invasive alternative to elective neck dissection (END), and has some advantages and disadvantages. SLNB can assess the individual drainage pattern and, with step serial sectioning and immunohistochemistry (IHC), can enable the accurate detection of micrometastases and isolated tumor cells (ITCs). Staging of the neck is improved relative to END with routine histopathological examination. The improvements in staging are particularly notable for the contralateral neck and the pretreated neck. However, for floor of mouth (FOM) tumors, occult metastases are frequently missed by SLNB due to the proximity of activity from the primary site to the lymphatics (the shine through phenomenon). For FOM cancers, it is advised to perform either elective neck dissection or superselective neck dissection of the preglandular triangle of level I. New tracers and techniques under development may improve the diagnostic accuracy of SLNB for early-stage OSCC, particularly for FOM tumors. Treatment of the neck (either neck dissection or radiotherapy), although limited to levels I–IV, remains mandatory for any positive category of metastasis (macrometastasis, micrometastasis, or ITCs). Recently, the updated EANM practical guidelines for SLN localization in OSCC and the surgical consensus guidelines on SLNB in patients with OSCC were published. In this review, the current evidence and results of SLNB in early OSCC are presented.
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Affiliation(s)
- Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Francisco J Civantos
- Department of Otolaryngology, Sylvester Cancer Center, University of Miami, Florida, USA
| | - Robert P Takes
- Department of Otolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, ISPA, IUOPA, Oviedo, Spain
| | | | - Gyorgy B Halmos
- Department of Otolaryngology/Head and Neck Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Alessandra Rinaldo
- Department of Otolaryngology, University of Udine School of Medicine, Udine, Italy
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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Mahieu R, Krijger GC, Ververs FFT, de Roos R, de Bree R, de Keizer B. [ 68Ga]Ga-tilmanocept PET/CT lymphoscintigraphy for sentinel lymph node detection in early-stage oral cavity carcinoma. Eur J Nucl Med Mol Imaging 2020; 48:1246-1247. [PMID: 33188442 PMCID: PMC8041664 DOI: 10.1007/s00259-020-05060-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/29/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Rutger Mahieu
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gerard C Krijger
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - F F Tessa Ververs
- Department of Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Remmert de Roos
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands.
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Mahieu R, de Maar JS, Nieuwenhuis ER, Deckers R, Moonen C, Alic L, ten Haken B, de Keizer B, de Bree R. New Developments in Imaging for Sentinel Lymph Node Biopsy in Early-Stage Oral Cavity Squamous Cell Carcinoma. Cancers (Basel) 2020; 12:cancers12103055. [PMID: 33092093 PMCID: PMC7589685 DOI: 10.3390/cancers12103055] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/03/2020] [Accepted: 10/15/2020] [Indexed: 12/18/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) is a diagnostic staging procedure that aims to identify the first draining lymph node(s) from the primary tumor, the sentinel lymph nodes (SLN), as their histopathological status reflects the histopathological status of the rest of the nodal basin. The routine SLNB procedure consists of peritumoral injections with a technetium-99m [99mTc]-labelled radiotracer followed by lymphoscintigraphy and SPECT-CT imaging. Based on these imaging results, the identified SLNs are marked for surgical extirpation and are subjected to histopathological assessment. The routine SLNB procedure has proven to reliably stage the clinically negative neck in early-stage oral squamous cell carcinoma (OSCC). However, an infamous limitation arises in situations where SLNs are located in close vicinity of the tracer injection site. In these cases, the hotspot of the injection site can hide adjacent SLNs and hamper the discrimination between tracer injection site and SLNs (shine-through phenomenon). Therefore, technical developments are needed to bring the diagnostic accuracy of SLNB for early-stage OSCC to a higher level. This review evaluates novel SLNB imaging techniques for early-stage OSCC: MR lymphography, CT lymphography, PET lymphoscintigraphy and contrast-enhanced lymphosonography. Furthermore, their reported diagnostic accuracy is described and their relative merits, disadvantages and potential applications are outlined.
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Affiliation(s)
- Rutger Mahieu
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Josanne S. de Maar
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands; (J.S.d.M.); (R.D.); (C.M.)
| | - Eliane R. Nieuwenhuis
- Department of Magnetic Detection & Imaging, University of Twente, 7522 NB Enschede, The Netherlands; (E.R.N.); (L.A.); (B.t.H.)
| | - Roel Deckers
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands; (J.S.d.M.); (R.D.); (C.M.)
| | - Chrit Moonen
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands; (J.S.d.M.); (R.D.); (C.M.)
| | - Lejla Alic
- Department of Magnetic Detection & Imaging, University of Twente, 7522 NB Enschede, The Netherlands; (E.R.N.); (L.A.); (B.t.H.)
| | - Bennie ten Haken
- Department of Magnetic Detection & Imaging, University of Twente, 7522 NB Enschede, The Netherlands; (E.R.N.); (L.A.); (B.t.H.)
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands;
- Correspondence: ; Tel.: +31-88-7550819
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