Metastatic Neck Nodes Research Articles

Using texture analysis of ultrasonography images of neck lymph nodes to differentiate metastasis to non-metastasis in oral maxillary gingival squamous cell carcinoma

ObjectTo differentiate between metastatic neck nodes and non-metastatic neck nodes in oral maxillary gingival squamous cell carcinoma, textural analysis of these lymph nodes in ultrasound images was performed in this study. MethodsTwenty five metastatic neck nodes and 28 non-metastatic neck nodes were enrolled in this study. Seventy eight texture characteristics were retrieved from the US images using the LIFEx software.The Mann Whitney U test was measurably utilized to survey on the off chance that there was a measurably noteworthy distinction within the textural characteristics between metastatic neck nodes and non-metastatic neck nodes. The capacity of the surface highlights to recognize between metastatic neck nodes and non-metastatic neck nodes was illustrated utilizing the Receiver Operating Characteristic analysis curves (ROC). Youden's J statistic was used to determine the cut-off positions in each ROC curve that maximized sensitivity and specificity. ResultsZone size non uniformity (ZSNU) highlight appeared the foremost noteworthy contrast between these nodes (p < 0.001).Strength had Area Under the Curve (AUC) of 0.811, specificity of 0.821 and sensitivity of 0.8, when measured at the cutoff value of 896.344. ConclusionsOur results come about uncovered that quality highlight may be the finest surface highlight to distinguish from non-metastatic neck nodes and to anticipate metastatic neck nodes in oral maxillary gingival squamous cell carcinoma.

The posterolateral neck dissection: indications, planning, and techniques

The posterolateral neck dissection removes the occipital and retroauricular lymph nodes in addition to nodal groups two through five. This procedure is performed for the removal of metastatic or at-risk lymph nodes in the posterolateral neck, which most commonly originate from the cutaneous surfaces of the scalp and neck posterior to a coronal plane connecting the external auditory canals. The major surgical consideration is the identification and preservation of the spinal accessory nerve.

Specifics of regional recurrences in lateral tissue of the neck after surgical treatment of highly differentiated thyroid cancer

Introduction: Despite the fact that highly differentiated thyroid cancer is included in the group of malignant neoplasms with a favorable prognosis, data on the high frequency and recurrence of relapses are reported. The presence of metastatic lymph nodes in HDTC increases the risk of regional relapse by up to 27 %. According to the literature, the factors that increase the risk of recurrence are: histological type, stage, depth of extrathyroid invasion, the presence of metastatic lymph nodes, age, and the volume of primary surgical intervention. Lateral neck dissection should be performed in patients with morphologically verified metastatic thyroid cancer, but there is still no clear consensus on the volume of dissection. Aim: Assessment of factors affecting the risk of regional recurrence in the lateral neck tissue and the localization of recurrence. Materials and methods: The study included 56 patients with HDTC, in whom metastatic lateral neck nodes were identified and verified. All patients previously underwent unilateral or bilateral neck lymph node dissection in various institutions. During the period of dynamic follow-up, these patients revealed regional recurrences in the lateral tissue of the neck. The patients were observed and treated for recurrence at the N. N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia. Results: Age over 55 years is a prognostically significant factor affecting the frequency of regional relapse in the lateral neck tissue (p = 0.002). The presence of metastatic nodes in the lateral tissue of the neck at the initial treatment is a prognostically significant factor that increases the risk of regional recurrence in the lateral tissue of the neck (p = 0.017). According to the results of a single-factor analysis, a statistically significant effect of the stage on the risk of regional relapses in the lateral neck tissue was noted (p = 0.014). In 35.7 % of cases, recurrent nodes were localized in the level V. Conclusion: Main risk factors for relapse are clinico-morphological, such as age, aggressive type of HDTC, stage of the disease, N1b status after primary surgery, as well as technical defects during primary surgical treatment.

Advances and residual knowledge gaps in the neck management of head and neck squamous cell carcinoma patients with advanced nodal disease undergoing definitive (chemo)radiotherapy for their primary.

Substantial changes have been made in the neck management of patients with head and neck squamous cell carcinomas (HNSCC) in the past century. These have been fostered by changes in cancer epidemiology and technological progress in imaging, surgery, or radiotherapy, as well as disruptive concepts in oncology. We aimed to review changes in nodal management, with afocus on HNSCC patients with nodal involvement (cN+) undergoing (chemo)radiotherapy. Anarrative review was conducted to review current advances and address knowledge gaps in the multidisciplinary management of the cN+ neck in the context of (chemo)radiotherapy. Metastatic neck nodes are associated with poorer prognosis and poorer response to radiotherapy, and have therefore been systematically treated by surgery. Radical neck dissection (ND) has gradually evolved toward more personalized and less morbid approaches, i.e., from functional to selective ND. Omission of ND has been made feasible by use of positron-emission tomography/computed tomography to monitor the radiation response in cN+ patients. Human papillomavirus-driven oropharyngeal cancers and their cystic nodes have shown dramatically better prognosis than tobacco-related cancers, justifying aspecific prognostic classification (AJCC) creation. Finally, considering the role of lymph nodes in anti-tumor immunity, de-escalation of ND and prophylactic nodal irradiation in combination are intense areas of investigation. However, the management of bulky cN3 disease remains an issue, as aggressive multidisciplinary strategies or innovative combined treatments have not yet significantly improved their prognosis. Personalized neck management is an increasingly important aspect of the overall therapeutic strategies in cN+ HNSCC.

Auto-segmentation of neck nodal metastases using self-distilled masked image transformer on longitudinal MR images.

Auto-segmentation promises greater speed and lower inter-reader variability than manual segmentations in radiation oncology clinical practice. This study aims to implement and evaluate the accuracy of the auto-segmentation algorithm, "Masked Image modeling using the vision Transformers (SMIT)," for neck nodal metastases on longitudinal T2-weighted (T2w) MR images in oropharyngeal squamous cell carcinoma (OPSCC) patients. This prospective clinical trial study included 123 human papillomaviruses (HPV-positive [+]) related OSPCC patients who received concurrent chemoradiotherapy. T2w MR images were acquired on 3 T at pre-treatment (Tx), week 0, and intra-Tx weeks (1-3). Manual delineations of metastatic neck nodes from 123 OPSCC patients were used for the SMIT auto-segmentation, and total tumor volumes were calculated. Standard statistical analyses compared contour volumes from SMIT vs manual segmentation (Wilcoxon signed-rank test [WSRT]), and Spearman's rank correlation coefficients (ρ) were computed. Segmentation accuracy was evaluated on the test data set using the dice similarity coefficient (DSC) metric value. P-values <0.05 were considered significant. No significant difference in manual and SMIT delineated tumor volume at pre-Tx (8.68 ± 7.15 vs 8.38 ± 7.01 cm3, P = 0.26 [WSRT]), and the Bland-Altman method established the limits of agreement as -1.71 to 2.31 cm3, with a mean difference of 0.30 cm3. SMIT model and manually delineated tumor volume estimates were highly correlated (ρ = 0.84-0.96, P < 0.001). The mean DSC metric values were 0.86, 0.85, 0.77, and 0.79 at the pre-Tx and intra-Tx weeks (1-3), respectively. The SMIT algorithm provides sufficient segmentation accuracy for oncological applications in HPV+ OPSCC. First evaluation of auto-segmentation with SMIT using longitudinal T2w MRI in HPV+ OPSCC.

The implication of failure patterns after neoadjuvant chemoradiotherapy with small involved-field in esophageal squamous cell carcinoma.

376 Background: In this study, we aimed to analyze failure patterns, the clinical and biological prognostic factors for treatment outcomes, and evaluate the feasibility of involved-field irradiation (IFI) in patients with esophageal squamous cell carcinoma (ESCC) undergoing neoadjuvant chemoradiotherapy (CCRT). Methods: We retrospectively reviewed the medical records of 511 patients diagnosed with ESCC and underwent neoadjuvant CCRT and radical esophagectomy between January 2016 and February 2022 at Samsung Medical Center. For IFI, the clinical target volume (CTV) was defined as the primary gross tumor volume (GTV) plus a 2.0-3.0 cm longitudinal margin and a 0.5-1.0 cm circumferential margin, as well as the GTV of lymph nodes (LN) plus a 0.5-1.0 cm margin. For elective nodal irradiation (ENI), the CTV encompassed supraclavicular, mediastinal, or abdominal LN regions based on the primary tumor location. IFI was applied in most cases (98%). The failure patterns, loco-regional control (LRC), and survival outcome were analyzed. Regional lymph nodes (LNs) were defined and classified according to the AJCC 8th edition. Non-regional LNs were defined as metastatic LNs in neck, thorax, abdominal area except regional LNs. Results: With a median follow-up of 44.4 months, 213 (41.7%) patients experienced recurrence. The first recurrent sites were locoregional (LR) in 98 patients (19.2%), non-regional LN in 81 (15.9%), and distant organs in 152 (29.7%). Among the 98 patients with LR recurrence, RT in-field failure occurred in 53 (10.4%) patients, in &amp; out-field failure in 18 (3.5%), and out-field failure in 27 (5.3%). In 27 cases of out-field failure only, LR recurrent lesion could be included in the target volume in 7 (1.4%) cases if ENIs were applied. Among the 27 patients, 10 received salvage treatment and 2 did not experience further recurrence. The analysis for the detailed LN recurrence showed that the upper mediastinal and supraclavicular LNs were the most frequent area, regardless of the primary tumor location and other clinical factors. Among 213 recurrent cases, 54 (10.5%) recurred in upper paratracheal LN and 40 (7.8%) in supraclavicular LN. The 5-year LRC rates, disease-control rates, and overall survival (OS) rates were 77.5%, 53%, and 54.3%, respectively. Multivariate analysis revealed that gender, age, cStage, ypStage, and resection margin status were independent prognostic factors for OS. Conclusions: Neoadjuvant CCRT using IFI with a small margin showed favorable treatment outcomes and out-field recurrence that the traditional ENI field could cover accounted for a small portion; thus, it might be feasible in the neoadjuvant setting. However, we need to consider that the upper mediastinal and supraclavicular areas were the most frequent recurrence sites.

OGC P57 Are Cervical Lymph Node Dissections in Oesophageal Cancer Patients Undergoing Oesophagectomy Beneficial?

Abstract Background Cervical lymph node dissection in patients undergoing oesophagectomy can be indicated when there is suspicion of involved cervical nodes, although there is controversy around the benefits of this additional procedure on the prognosis of these patients. This study aims to assess the consequences and survival after cervical lymph node dissection, and to weigh the risks and benefits of this procedure. Methods This retrospective study included seven patients with oesophageal squamous cell carcinoma (SCC), and one with oesophageal adenocarcinoma who underwent cervical lymph node dissection in addition to oesophagectomy at the Churchill Hospital. There was a male to female ratio of 1:3, and all had neoadjuvant chemotherapy and were staged with PET-CT. PET staging scan results were compared pre and post neo-adjuvant therapy (NAT) to assess nodal involvement. Final histopathology was also recorded. Results All patients had evidence of cervical nodal involvement on PET scan, two of whom developed nodal involvement only after NAT. Only two patients had neck node involvement on histopathology: one had SCC and showed good response to NAT; the other had undifferentiated carcinoma and showed new para-tracheal node involvement after NAT, later developing supraclavicular node recurrence. Two cases were complicated by recurrent laryngeal nerve (RLN) injury, one with bilateral and one with partial vocal cord palsy. There was a 5-year survival rate of 62.5%, with non-survivors uniquely having recurrent disease. Conclusions Lymph node dissection alongside oesophagectomy achieved good 5-year survival in this small cohort, but with a significant risk of RLN injury. Further studies investigating the proportion of metastatic neck nodes found on dissection, long term survival benefits and cancer reoccurrence are required.

Involvement of submandibular gland in oral squamous cell carcinoma

BackgroundThe submandibular gland (SMG) is sacrificed during neck dissection in patients undergoing curative surgery for oral squamous cell carcinoma (OSCC). This may cause a decrease in the production of saliva and result in xerostomia. PurposeThis study aimed to determine the incidence, invasion patterns, risk factors, and prognosis of SMG involvement in OSCC. MethodsThe primary predictor variable in this study was SMG involvement, and the secondary predictor was prognosis. Main findingsThe primary outcome variables were patient characteristics and pathological results for extranodal extension (ENE), perineural invasion (PNI), and pN stage. Four out of 173 patients (2.23 %) showed SMG involvement. Of these cases, one (25 %) was from the primary lesion and three (75 %) were from the metastatic neck lymph nodes (LNs). The primary lesion was located on the lower gingiva, and the other three were from level-Ib LNs with ENE. The pathological PNI was observed in three of the four patients, and ENE was observed in three of the four patients. Preoperative CT and MR revealed SMG invasion and contact in two patients. There were significant differences in the ENE and pN stages between patients with and without SMG involvement (P<0.05). There was a significant difference in the overall survival between patients with (25.0 %) and without (71.5 %) SMG involvement (P = 0.011). ConclusionsSMG involvement was associated with ENE, pN stage, and poor prognosis.

Tuberculosis a diagnostic pitfall of Nasopharyngeal carcinoma? Two case report

Nagaland has the highest AAR (age adjusted rates) of Nasopharyngeal carcinoma (NPC) in India. The frequent presentation of metastatic neck nodes of nasopharyngeal carcinoma can lead to diagnostic errors if preliminary investigations are not done properly. We present two patients with metastatic NPC who were initially treated with anti-tubercular therapy presumed to have tuberculosis. Metastasis was confirmed with fine needle aspiration cytology and NPC diagnosis was made on histopathological examination of endoscopic nasal biopsy. Both patients were treated with neoadjuvant chemotherapy, followed with concurrent chemo-radiation and are on follow-up.

Correlation of Diffusion-weighted MR imaging and FDG PET/CT in the Diagnosis of Metastatic Lymph Nodes of Head and Neck Malignant Tumors

Objectives: The aim of this study was to investigate the efficacy of DW-MRI as a reliable imaging modality for detecting metastatic neck lymph nodes of head and neck SCC.&#x0D; Methods: 32 patients underwent FDG PET/CT and diffusion-weighted MRI were evaluated. Histopathologic analysis of lymph node metastases was used as the gold standard for assessment. We analyzed differences in sensitivity, specificity, accuracy, positive predictive value and negative predictive value among the imaging modalities using the Chi-square test. Their discriminative power evaluated using the Receiver-Operating Characteristic curve and calculation of the area under the curve. The correlation between ADCmin and SUVmax was calculated using the Spearman test. SPSS 24 was used for statistical analyses. P value of 0.05 indicates a statistically significant difference.&#x0D; Results: A total of 32 patients with 50 neck dissections with head and neck SCC included. Sensitivity, specificity, accuracy, positive and negative predictive value of neck palpation was %72, %60, %70, %62 and %80 respectively. Sensitivity, specificity, accuracy, positive and negative predictive value of DW-MRI was %87,5, %96,2, %92, %95,5 and %89,3 respectively, according to ADCmin cutoff value 0.82×10-3s/mm2 . Sensitivity, specificity, accuracy, positive and negative predictive value of FDG-PET/CT was %91,7, %100, %96, %100 and %92,9 , respectively ,according to SUVmax cutoff value 3.4. For all neck dissections, there was a statistically significant inverse correlation between ADCmin and SUVmax (P&lt;001).&#x0D; Conclusion: DW-MRI is reliable as detecting cervical lymph node metastases as FDG-PET/CT. DWI and FDG PET/CT could play a complementary role in clinical assessment.

CDKN2A/p16 evaluation in cytology specimens.

CDKN2A/p16 evaluation in cytology specimens.

Head and neck mucosal melanoma: radiological considerations and UK imaging guidelines.

Awareness of head and neck mucosal melanoma (HNMM) is important, as incorrect work-up can impact on the investigation and management of this rare and aggressive cancer. Following on from the 2020 HNMM UK guidelines, we set out the imaging recommendations and their rationale. To illustrate the key imaging characteristics, we also include a case series from our centre. All HNMM cases managed at our institution from January 2016 to January 2021 were identified, and the available imaging for each patient was reviewed. For each patient, the age, gender and location of primary tumour was recorded together with key staging and diagnostic imaging parameters. A total of 14 patients were identified. The median age was 65years with a female to male ratio of 1.33:1. Primary tumours were sinonasal in location in 93% of cases, with 7% of patients having metastatic neck nodes at presentation and 21% of cases having distant metastatic disease at presentation. This data set is in general concordance with other published series regarding the sinonasal origin of the vast majority of HNMM tumours along with the proportion of patients with metastatic neck nodes and distant metastases at presentation. We recommend dual-modality imaging with computed tomography (CT) and magnetic resonance imaging (MRI) of primary tumours whenever possible. In the systematic staging of HNMM, positron emission tomography (PET)-CT should be strongly considered, together with MRI of the brain. Pre-biopsy imaging of HNMM tumours is advisable whenever possible.

Frequency of Regional Metastasis in Supraglottic Carcinoma of Larynx

Background: Incidence of laryngeal cancer still high among the upper aerodigestive tract. 85–95% of these laryngeal cancer is squamous cell carcinoma. Locally advanced laryngeal cancer metastasize more. Supraglottic cancers have the highest prevalence of regional metastases among laryngeal cancers.&#x0D; Objectives: To evaluate the frequency of regional metastasis in supraglottic carcinoma of larynx.&#x0D; Methods: This cross-sectional study was conducted including 40 patients with supraglottic Carcinoma of Larynx over a period of six months from June to November 2014 in the ENT and Head Neck Surgery department of Rajshahi Medical College Hospital, Rajshahi. Those with glottic carcinoma, subglottic carcinoma, hypopharyngeal carcinoma, metastatic neck node without any primary site (Occult primary) were excluded from the study. FNAC from neck node was done in patients with palpable neck node.&#x0D; Results: Most of the patients 19 (47.5%) was in age group 50-60 years with mean age 54.5±13.2 years. Most of the patients present with more than one symptom &amp; the commonest presenting symptoms was cough and irritation 35(87.5%) followed by dysphagia 26(65%) and change of voice 24(60%). A good number of patients, 16(40%) was presented with neck swelling. Among 40 patients, 16(40%) had their regional lymph nodes involved. Level-II lymph nodes were involved in higher number of cases 10(62.5%). Nodes in early stage of involvement were found in most cases 9(56.5%). Homolateral involvement of nodes was found in most cases 13(81.3%).Most of the supraglottic growths 22(55.0%) was exophytic in appearance. The common site of supraglottic carcinoma in this study was aryepiglottic fold and arytenoids 20(50.0%). Among the patients, 31(77.5%) had T2 tumours. Amon them, 16(40%) were in stage-III followed by stage-II 10(25%).&#x0D; Conclusion: Regional metastasis is a very useful prognostic indicator. Supraglottis is rich in lymphatic drainage and a high proportion of these tumors spread to lymph nodes.&#x0D; Bangladesh J Otorhinolaryngol 2022; 28(2): 180-185

Caudal distribution pattern of metastatic neck lymph nodes in nasopharyngeal carcinoma and prognostic significance of nodal spread distances

ObjectiveTo investigate the caudal distribution pattern of metastatic neck lymph nodes (LNs) in nasopharyngeal carcinoma (NPC) and the prognostic significance of nodal spread distances (SDs). Materials and methodsNPC patients with neck metastatic LNs were enrolled. The most caudally located LNs were marked. SD was defined as the distance from marked LNs to the lateral process of the atlantoaxial spine (LPC1). Univariate and multivariate analyses were performed to assess association between MRI-identified nodal features and survival. Harrell’s concordance index (C-index) and area under the curve (AUC) were used to compare AJCC (8th edition) N staging with the proposed N staging. Survival after induction chemotherapy plus concurrent chemoradiotherapy (IC + CCRT) versus CCRT alone was compared between different SD groups. ResultsA total of 1907 LNs (1164 patients) were contoured. SD > 7 cm was an independent predictor of overall survival (OS), distant metastasis-free survival (DMFS), and progression-free survival (PFS), with hazard ratios of 1.725, 1.553 and 1.414, respectively. When patients with SD > 7 cm were upgraded one N stage higher, the proposed N classification showed better stratification in OS, DMFS, and PFS between N1 and N2 stages. C-indices and AUCs of the proposed N staging were superior to AJCC N staging. IC + CCRT showed negative effect in N1-2 patients with SD ≤ 7 cm but improved OS in those with SD > 7 cm. ConclusionSD of metastatic LNs can predict survival in NPC. Integration of SD into AJCC N staging could improve its prognostic value and help identify patients requiring IC.

The negative predictive value of FDG PET/CT staging in early oropharyngeal squamous cell carcinoma and implications to transoral robotic surgery patient selection

ObjectivesOur objective was to determine the negative predictive value (NPV) of preoperative FDG PET/CTfor detecting locoregional nodal disease. The aim was to help inform the decision-making process when identifying patients with early-stage OPSCC that would be suitable for transoral robotic surgery (TORS) as a single-modality treatment. Materials and methodsA retrospective cohort study was conducted of adults with primary stage cT1-2 OPSCC with up to one metastatic neck lymph node (cN0-1) planned for TORS. Patients with a preoperative PET/CT and who had undergone staging neck dissection (ND) were included. Clinical and pathological nodal staging was established based on PET/CT and ND, respectively. The primary outcome was the frequency of occult (not seen on PET/CT) nodal disease on ND. ResultsEighty-eight patients were included (N = 88). The rate of occult nodal disease was 28.4 % (n = 25). The NPV of PET/CT in the clinically negative neck was 79 % and 66 % in cases with a single clinical node. Following staging ND, thetreatment plan changed in 27 % of cases overall, 7 % in cN0 and 36.7 % in cN1. Among these, 18 % met criteria for radiotherapy and 9 % for CRT. This represented a decrease in the number of ideal candidates for TORS as single-modality treatment from 88 to 64 (73 %). ConclusionsPET/CT is a useful tool in the workup of patients for primary TORS. However, about one third of patients with early-stage OPSCC might benefit from adjuvant therapy not predicted by preoperative PET/CT. A staging ND helps confirm candidates for single-modality treatment with TORS.

Neck Lymph Node Recurrence in HNC Patients Might Be Predicted before Radiotherapy Using Radiomics Extracted from CT Images and XGBoost Algorithm.

The five-year overall survival rate of patients without neck lymph node recurrence is over 50% higher than those with lymph node metastasis. This study aims to investigate the prognostic impact of computed tomogram (CT)-based radiomics on the outcome of metastatic neck lymph nodes in patients with head and neck cancer (HNC) receiving definitive radiotherapy or chemoradiotherapy for organ preservation. The pretreatment 18F-FDG PET/CT of 79 HNC patients was retrospectively analyzed with radiomics extractors. The imbalanced data was processed using two techniques: over-sampling and under-sampling, after which the prediction model was established with a machine learning model using the XGBoost algorithm. The imbalanced dataset strategies slightly decreased the specificity but greatly improved the sensitivity. To have a higher chance of predicting neck cancer recurrence, however, clinical data combined with CT-based radiomics provides the best prediction effect. The original dataset performed was as follows: accuracy = 0.76 ± 0.07, sensitivity = 0.44 ± 0.22, specificity = 0.88 ± 0.06. After we used the over-sampling technique, the accuracy, sensitivity, and specificity values were 0.80 ± 0.05, 0.67 ± 0.11, and 0.84 ± 0.05, respectively. Furthermore, after using the under-sampling technique, the accuracy, sensitivity, and specificity values were 0.71 ± 0.09, 0.73 ± 0.13, and 0.70 ± 0.13, respectively. The outcome of metastatic neck lymph nodes in patients with HNC receiving radiotherapy for organ preservation can be predicted based on the results of machine learning. This way, patients can be treated alternatively. A further external validation study is required to verify our findings.

The management of metastatic neck nodes following induction chemotherapy in N2/3 classification hypopharyngeal carcinoma.

For patients with less chemosensitive neck nodes, poor prognosis after chemoradiotherapy (CRT) could be predicted and neck dissection is needed. Ninety-two N2/3 hypopharyngeal carcinoma patients were retrospectively studied. According to response after induction chemotherapy (ICT), patients were treated with neck dissection followed by concurrent CRT (CCRT) (group 1), surgery plus postoperative CRT (group 2), or CCRT for primary and regional sites (group 3). Overall survival and disease-free survival rates of group 1 were significantly higher than group 2 (p=0.038, p=0.031) and group 3 (both p=0.018). Regional control rate of group 1 was significantly higher than group 3 (p=0.041). There were no significant differences between groups 1 and 2 regarding local and regional control (p=0.746, p=0.302). Neck dissection followed by CCRT is the best choice for patients with responsive primary but nonresponsive nodes.

A Nomogram to Predict Nodal Response after Induction Chemotherapy for Hypopharyngeal Carcinoma.

For hypopharyngeal carcinoma, metastatic neck nodes with a low response to induction chemotherapy (ICT) should not be managed with concomitant chemoradiotherapy (CCRT), and the prediction of chemosensitivity before ICT could prevent adverse events from occurring during chemotherapy. In this study, we developed a nomogram to predict the regional response to ICT. A total of 153 hypopharyngeal carcinoma patients with regional metastasis treated with ICT in our institution from January 2010 to September 2020 were retrospectively studied. According to ICT response evaluated by RECIST 1.1, patients were divided into chemo-insensitive (PR < 70%/SD/PD) (group 1) and chemosensitive (CR/PR ≥ 70%) (group 2) groups. Patients' clinical, image, and hematologic data before ICT were collected. The nomogram was built based on multivariate analysis and stepwise logistic regression and was evaluated from the aspects of discrimination and calibration. A nomogram based on five critical predictors, namely, tumor differentiation degree, T classification, metastatic lymph node size, number of lymph node metastases, and cervical nodal necrosis, was developed. The areas under the curve (AUC) values were 0.76 and 0.70 after adjusting the results using bootstrap methods. The calibration curve showed relatively good agreement between the predicted and observed probabilities. Our nomogram yielded good accuracy in predicting the regional ICT response and will be a useful tool to assist clinicians in decision making. 4 Laryngoscope, 133:849-855, 2023.

Predictors of Locoregional Recurrence in Oral Squamous Cell Carcinoma

Introduction: Lip and oral cavity cancer is the third and fifth most frequent cancer for men &amp; women respectively in Bangladesh. Locoregional recurrence after primary surgery is common for oral cancer due to aggressive local invasion and metastasis. The objective of this study was to analyze the predictors of locoregional failure in a tertiary center hospital. Materials and Methods: A prospective cohort study was designed to analyze the presence of recurrences of OSCC patients after surgery. The purposive sampling technique was used to include patients in the study. Excision of the primary tumor was done with neck dissection followed by reconstruction with local or regional flap. The variables considered were demographic information, site, TNM stage at diagnosis, margin status, lymph node metastasis, perineural invasion, recurrence, and the adjuvant therapy used for disease control. Patients were followed up by hospital revisits or phone calls and necessary information was collected through a standardized data collection sheet. Results: A total of 39 patients were included for data analysis. The male to female ratio was 1:2 and the most common primary site was mandibular alveolar mucosa (31%). Nearly 90% of patients were admitted with stage ׀׀׀ or ׀ᴠ lesions and tumor margin was positive in 21% of cases. Lymph node metastasis and perineural invasion were identified in 64% and 23% of cases respectively. Recurrence developed in 14 patients (36%) during the average follow-up of 13 months. Recurrences were more common in females (42%) and Postoperative histopathology showed a positive margin, perineural invasion, and N3 neck node. Univariate logistic regression analysis for locoregional recurrence showed no significant association between the variables and recurrence. Patients with clinically palpable lymph node, grade 2 lesion, presence of perineural invasion, presence of co-morbidity, patients who did not receive any adjuvant therapy, and patients who had metastatic neck node showed an increased odds ratio (OR&gt;1). Conclusion: The clinicopathologic and treatment-related factors of recurrence in OSCC were explored in this study. Although no significant association was identified between the variables and recurrence of lesions, a high recurrence rate was observed in a shorter span of the follow-up period. Update Dent. Coll. j: 2022; 12 (1): 12-16

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

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. 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 (SUVmax) 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. 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 SUVmax 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). [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. • [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.