BRAF V600E mutation co-existing with oncogenic mutations is associated with aggressive clinicopathologic features and poor prognosis in papillary thyroid carcinoma

BACKGROUND

The aim of this study was to evaluate the correlation among mutations in cancer-related genes, clinicopathologic features, and clinical outcome in classical papillary thyroid carcinoma (PTC).

PATIENTS AND METHODS

A total of 130 patients with classical PTC who underwent curative surgery between April 2012 and June 2023 at Hokuto Hospital were included. Mutations in targeted regions of 160 cancer-related genes were detected by next-generation sequencing (NGS)-based cancer panel testing.

RESULTS

The BRAF V600E mutation was detected in 108 (83.1%) of 130 PTC patients. Among the 108 patients with the BRAF V600E mutation, other co-existing oncogenic mutations were found in 12 (9.2%) patients. When we divided into 3 groups of no mutations, BRAF V600E mutation alone, and BRAF V600E and other oncogenic mutations, significant differences were observed in terms of tracheal invasion (P = 0.0024), and bilateral neck lymph node metastasis (P = 0.0047). Kaplan-Meier analysis of overall survival (OS) revealed patients with BRAF V600E and other oncogenic mutations had significantly poorer survival than those with BRAF V600E mutation alone (P = 0.0026). Multivariate cox proportional hazard analysis revealed BRAF V600E and other oncogenic mutations was an independent prognostic factor for OS (HR: 10.559; 95%CI: 1.007-110.656, P = 0.0493).

CONCLUSIONS

The BRAF V600E mutation co-existing with other oncogenic mutations but not the BRAF V600E mutation alone was associated with aggressive clinicopathologic features, resulting in poor prognosis in patients with classical PTC. Detection of oncogenic mutations using NGS-based cancer panel testing could enhance understanding of the clinical features of classical PTC.

Dual-energy computed tomography for improved visualization of internal jugular chain neck lymph node metastasis and nodal necrosis in head and neck squamous cell carcinoma

PURPOSE

To evaluate and compare the utility of 40-keV virtual monochromatic imaging (VMI) reconstructed from dual-energy computed tomography (DECT) in the assessment of neck lymph node metastasis with 70-keV VMI, which is reportedly equivalent to conventional 120-kVp single-energy computed tomography.

MATERIALS AND METHODS

Patients with head and neck squamous cell carcinoma who had neck lymph node metastasis in contact with the sternocleidomastoid muscle (SCM) and underwent contrast-enhanced DECT were included. In 40- and 70-keV VMI, contrast differences and contrast noise ratio (CNR) between the solid component of neck lymph node metastasis (SC) and the SCM and between SC and nodal necrosis (NN) were calculated. Two board-certified radiologists independently and qualitatively evaluated the boundary discrimination between SC and SCM and the diagnostic certainty of NN.

RESULTS

We evaluated 45 neck lymph node metastases. The contrast difference between SC and SCM and SC and NN were significantly higher at 40-keV VMI than at 70-keV VMI (p < 0.001). The CNR between SC and SCM was significantly higher at 40-keV VMI than at 70-keV VMI (p < 0.001). Scoring of the boundary discrimination between SC and SCM as well as the diagnostic certainty of NN at 40-keV VMI was significantly higher than that at 70-keV VMI (p < 0.001). The inter-rater agreements for these scores were higher at 40-keV VMI than at 70-keV VMI.

CONCLUSION

Additional employing 40-keV VMI in routine clinical practice may be useful in the diagnosis of head and neck lymph node metastases and nodal necrosis.

Accurate preoperative staging with [68Ga]Ga-FAPI PET/CT for patients with oral squamous cell carcinoma: a comparison to 2-[18F]FDG PET/CT

OBJECTIVE

To evaluate the potential value of [⁶⁸Ga]Ga-labelled fibroblast activation protein inhibitor ([⁶⁸Ga]Ga-FAPI) positron emission tomography/computed tomography (PET/CT) in preoperative staging for patients with oral squamous cell carcinoma (OSCC) as compared to 2-[¹⁸F]fluoro-2-deoxy-D-glucose (2-[¹⁸F]FDG) PET/CT.

METHODS

Thirty-six treatment-naïve patients with OSCC who underwent 2-[¹⁸F]FDG and [⁶⁸Ga]Ga-FAPI PET/CT for preoperative staging were enrolled. The maximum standardised uptake value (SUV_max) of the primary tumour and suspected cervical metastatic lymph nodes, and the tumour-to-background ratio (TBR) of the primary tumour, were measured. The accuracy of two imaging modalities for preoperative diagnosis of metastatic lymph nodes was analysed. Histopathology served as the standard of reference.

RESULTS

Thirty-seven primary lesions of 36 patients were accurately detected by both [⁶⁸Ga]Ga-FAPI and 2-[¹⁸F]FDG PET/CT. Regarding primary tumours, the SUV_max and TBR of the two imaging modalities in stage T3-T4 were significantly higher than those of stage T1-T2 (all p < 0.05). On the patient analysis, the accuracy for the evaluation of N1-N3 neck status was 52.6% (10/19) for [⁶⁸Ga]Ga-FAPI PET/CT and 57.9% (11/19) for 2-[¹⁸F]FDG PET/CT. Notably, the accuracy for the evaluation of the N0 neck status between [⁶⁸Ga]Ga-FAPI and 2-[¹⁸F]FDG PET/CT was 100% (17/17) and 29% (5/17), respectively. Based on the patient, neck side and neck level, [⁶⁸Ga]Ga-FAPI PET/CT resulted in higher specificity and accuracy in diagnosing metastatic neck lymph nodes than 2-[¹⁸F]FDG PET/CT (all p < 0.05).

CONCLUSION

[⁶⁸Ga]Ga-FAPI PET/CT is a promising tool for preoperative staging of OSCC, and appears to reduce the false positivity seen with 2-[¹⁸F]FDG PET/CT for the detection of neck lymph node metastases.

KEY POINTS

• [⁶⁸Ga]Ga-FAPI PET/CT is a promising tool targeting cancer-associated fibroblasts with comparable diagnostic performance to 2-[¹⁸F]FDG PET/CT for identifying the primary lesions of OSCC. • [⁶⁸Ga]Ga-FAPI PET/CT showed higher specificity and accuracy for the evaluation of neck lymph node metastases of OSCC than 2-[¹⁸F]FDG PET/CT, especially for N0 neck status.

Central neck lymph node metastasis in oral squamous cell carcinoma at the floor of mouth

Background

Our goal was to analyze the incidence of level VI metastasis in previously untreated oral squamous cell carcinoma (SCC) patients and their clinicopathological and prognostic characteristics.

Methods

Oral SCC patients with level VI metastasis were retrospectively enrolled, and their demographic and pathologic features as well as their survival data were descriptively analyzed.

Results

A total of 13 cases from 1875 patients were included, all patients had SCC at the floor of mouth (SCCFOM). Eight (61.5%) patients had a pT4 tumor, and all patients had a pathological N3 neck with multiple positive lymph nodes. Adverse pathologic features were present in 100% of the patients. The size of the metastatic foci in level VI ranged from 2.6 cm to 4.5 cm with a mean value of 3.2 cm, and 5 patients showed a soft tissue deposit with no lymph node component. Recurrence occurred in all patients, and 11 patients died of uncontrolled cancer within 5 years after surgery.

Conclusion

Level VI metastasis in primary oral SCCFOM is rare, and its prognosis is poor.

Pre-treatment MRI predictor of high-grade malignant parotid gland cancer

OBJECTIVES

We aimed to evaluate pre-treatment MRI predictors of high-grade malignant parotid gland cancer by comparing MRI findings and texture parameters between high-grade and intermediate/low-grade parotid gland cancers.

METHODS

Patients underwent a pre-treatment MRI and had a parotid gland cancer resection with pathological evaluation. Evaluation objectives included attributive factors such as age and gender, several MRI findings of T1- and T2-weighted images, post-contrast fat suppression T1-weighted images, ADC value and 40 texture parameters calculated from T2-weighted axial images. Such objects were compared between high-grade and intermediate/low-grade lesions.

RESULTS

Of the parotid gland cancers surveyed, 39 were included for analysis. Of these, 18 were high-grade lesions, 2 were intermediate-grade lesions, and 19 were low-grade lesions. The high-grade group was significantly older than the low- and intermediate-grade groups (p = 0.01). There were more males in the high-grade group than in the low- and intermediate-grade groups (p = 0.01). There were also significantly more MRI findings of neck lymph node metastases in the high-grade group than in the low- and intermediate-grade groups (p < 0.001). Other MRI findings and texture parameters did not show significant differences between the two groups (p = 0.07-1.00).

CONCLUSIONS

Morphological assessment on MRI and texture parameters alone is not sufficient to estimate the grade of parotid cancer. MRI findings of neck lymph node metastases, as well as patient characteristics such as age (older patients) and gender (male) can be suggestive of high-grade parotid gland cancer in pre-treatment evaluation.