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Obayashi F, Koizumi K, Ito N, Higaki M, Ishida Y, Hamada A, Yamasaki S, Tani R, Yanamoto S. A Study of the Prognostic Factors for Late Cervical Lymph Node Metastasis and Distant Metastasis in Patients with cT1-2N0 Tongue Cancer. J Clin Med 2024; 13:976. [PMID: 38398289 PMCID: PMC10889310 DOI: 10.3390/jcm13040976] [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: 01/02/2024] [Revised: 02/04/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Early-stage tongue cancer has a good prognosis in general; however, high-risk patients with late cervical lymph node and distant metastases have a poor prognosis. Elective neck dissection and postoperative chemoradiotherapy are considered for these patients, although no clear criteria have been identified for their evaluation. Methods: This retrospective observational study aimed to determine the predictive factors for late cervical lymph node and distant metastases in 102 patients with cT1-2N0 tongue cancer. The data regarding the demographic characteristics, as well as the depth of invasion, tumor budding, histological grade, and tumor-stromal ratio, among other things, were extracted from medical records. Results: We found that the potential lymph node metastasis rate was 27.5%. The significant clinical predictors of late cervical lymph node metastasis were the tumor thickness and endophytic growth pattern and the significant histopathological factors were poorly and moderately differentiated tumors and ≥3 tumor buds. In addition, the prognostic factors for distant metastasis included ≥4 lymph node metastases, ≥7 tumor budding, and moderate and poor tumor differentiation. Conclusions: The usefulness of tumor budding as a predictor of metastasis for tongue cancer was suggested. The findings of this study can help establish the criteria for evaluating the metastasis risk and prognosis of patients with tongue cancers.
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Affiliation(s)
- Fumitaka Obayashi
- Department of Oral Oncology, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8553, Japan
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Caprioli S, Giordano GG, Pennacchi A, Campagnari V, Iandelli A, Parrinello G, Conforti C, Gili R, Giannini E, Marabotto E, Kayali S, Bianchi B, Peretti G, Cittadini G, Marchi F. Can High-Frequency Intraoral Ultrasound Predict Histological Risk Factors in Oral Squamous Cell Carcinoma? A Preliminary Experience. Cancers (Basel) 2023; 15:4413. [PMID: 37686688 PMCID: PMC10486952 DOI: 10.3390/cancers15174413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/26/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Despite advancements in multidisciplinary care, oncologic outcomes of oral cavity squamous cell carcinoma (OSCC) have not substantially improved: still, one-third of patients affected by stage I and II can develop locoregional recurrences. Imaging plays a pivotal role in preoperative staging of OSCC, providing depth of invasion (DOI) measurements. However, locoregional recurrences have a strong association with adverse histopathological factors not included in the staging system, and any imaging features linked to them have been lacking. In this study, the possibility to predict histological risk factors in OSCC with high-frequency intraoral ultrasonography (IOUS) was evaluated. Thirty-four patients were enrolled. The agreement between ultrasonographic and pathological DOI was evaluated, and ultrasonographic margins' appearance was compared to the Brandwein-Gensler score and the worst pattern of invasion (WPOI). Excellent agreement between ultrasonographic and pathological DOI was found (mean difference: 0.2 mm). A significant relationship was found between ultrasonographic morphology of the front of infiltration and both Brandwein-Gensler score ≥ 3 (p < 0.0001) and WPOI ≥4 (p = 0.0001). Sensitivity, specificity, positive predictive value, and negative predictive value for the IOUS to predict a Brandwein-Gensler score ≥3 were 93.33%, 89.47%, 87.50%, and 94.44%, respectively. The present study demonstrated the promising role of IOUS in aiding risk stratification for OSCC patients.
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Affiliation(s)
- Simone Caprioli
- Radiology Unit, IRCCS Ospedale Policlinico San Martino,16132 Genova, Italy; (S.C.); (C.C.); (G.C.)
- Department of Internal Medicine and Medical Specialties, University of Genova, 16100 Genova, Italy; (R.G.); (G.P.); (F.M.)
| | - Giorgio-Gregory Giordano
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
- Department of Surgical Science (DISC), University of Genova, 16100 Genova, Italy
| | - Alessia Pennacchi
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
- Department of Surgical Science (DISC), University of Genova, 16100 Genova, Italy
| | - Valentina Campagnari
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
- Department of Surgical Science (DISC), University of Genova, 16100 Genova, Italy
| | - Andrea Iandelli
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
| | - Giampiero Parrinello
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
| | - Cristina Conforti
- Radiology Unit, IRCCS Ospedale Policlinico San Martino,16132 Genova, Italy; (S.C.); (C.C.); (G.C.)
| | - Riccardo Gili
- Department of Internal Medicine and Medical Specialties, University of Genova, 16100 Genova, Italy; (R.G.); (G.P.); (F.M.)
- Medical Oncology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Edoardo Giannini
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genova, 16132 Genova, Italy; (E.G.); (E.M.); (S.K.)
| | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genova, 16132 Genova, Italy; (E.G.); (E.M.); (S.K.)
| | - Stefano Kayali
- Gastroenterology Unit, Department of Internal Medicine, IRCCS Ospedale Policlinico San Martino, University of Genova, 16132 Genova, Italy; (E.G.); (E.M.); (S.K.)
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Bernardo Bianchi
- Maxillo-Facial Surgery Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Giorgio Peretti
- Department of Internal Medicine and Medical Specialties, University of Genova, 16100 Genova, Italy; (R.G.); (G.P.); (F.M.)
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
| | - Giuseppe Cittadini
- Radiology Unit, IRCCS Ospedale Policlinico San Martino,16132 Genova, Italy; (S.C.); (C.C.); (G.C.)
| | - Filippo Marchi
- Department of Internal Medicine and Medical Specialties, University of Genova, 16100 Genova, Italy; (R.G.); (G.P.); (F.M.)
- Otorhinolaryngology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy; (G.-G.G.); (A.P.); (V.C.); (G.P.)
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The Role of Peritumoral Depapillation and Its Impact on Narrow-Band Imaging in Oral Tongue Squamous Cell Carcinoma. Cancers (Basel) 2023; 15:cancers15041196. [PMID: 36831538 PMCID: PMC9954546 DOI: 10.3390/cancers15041196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
A recent study reported that the occurrence of depapillated mucosa surrounding oral tongue squamous cell carcinomas (OTSCC) is associated with perineural invasion (PNI). The present study evaluates the reliability of depapillation as a PNI predictor and how it could affect narrow-band imaging (NBI) performance. This is thus a retrospective study on patients affected by OTSCC submitted to radical surgery. The preoperative endoscopy was evaluated to identify the presence of depapillation. Differences in distribution between depapillation and clinicopathological variables were analyzed. NBI vascular patterns were reported, and the impact of depapillation on those was studied. We enrolled seventy-six patients. After evaluation of the preoperative endoscopies, 40 (53%) patients had peritumoral depapillation, while 59 (78%) had a positive NBI pattern. Depapillation was strongly correlated to PNI, 54% vs. 28% (p = 0.022). Regarding the NBI pattern, there was no particular association with depapillation-associated tumors. The presence of depapillation did not affect the intralesional pattern detected by the NBI, while no NBI-positive pattern was found in the depapillation area. Finally, the NBI-guided resection margins were not affected by depapillation. Peritumoral depapillation is a reliable feature for PNI in OTSCC. NBI margin detection is not impaired by depapillation.
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Duggar WN, Vengaloor Thomas T, Wang Y, Rahman A, Wang H, Roberts PR, Bian L, Gatewood RT, Vijayakumar S. Preoperative Prediction and Identification of Extracapsular Extension in Head and Neck Cancer Patients: Progress and Potential. Cureus 2023; 15:e34769. [PMID: 36909098 PMCID: PMC10001423 DOI: 10.7759/cureus.34769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 02/11/2023] Open
Abstract
Background This study aimed to demonstrate both the potential and development progress in the identification of extracapsular nodal extension in head and neck cancer patients prior to surgery. Methodology A deep learning model has been developed utilizing multilayer gradient mapping-guided explainable network architecture involving a volume extractor. In addition, the gradient-weighted class activation mapping approach has been appropriated to generate a heatmap of anatomic regions indicating why the algorithm predicted extension or not. Results The prediction model shows excellent performance on the testing dataset with high values of accuracy, the area under the curve, sensitivity, and specificity of 0.926, 0.945, 0.924, and 0.930, respectively. The heatmap results show potential usefulness for some select patients but indicate the need for further training as the results may be misleading for other patients. Conclusions This work demonstrates continued progress in the identification of extracapsular nodal extension in diagnostic computed tomography prior to surgery. Continued progress stands to see the obvious potential realized where not only can unnecessary multimodality therapy be avoided but necessary therapy can be guided on a patient-specific level with information that currently is not available until postoperative pathology is complete.
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Affiliation(s)
- William N Duggar
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | | | - Yibin Wang
- Industrial Systems and Engineering, Mississippi State University, Starkville, USA
| | - Abdur Rahman
- Industrial Systems and Engineering, Mississippi State University, Starkville, USA
| | - Haifeng Wang
- Industrial Systems and Engineering, Mississippi State University, Starkville, USA
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Paul R Roberts
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Linkan Bian
- Industrial Systems and Engineering, Mississippi State University, Starkville, USA
| | - Ronald T Gatewood
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
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