Salvage neck surgery in recurrent nodal NPC: Do all patients require a comprehensive neck dissection in the modern MRI era?

Q3 Medicine Medical Journal of Malaysia Pub Date : 2024-03-01
D X C Yin, S M Chiow, A Karandikar, J P N Goh, B M Manish, J W J Gan, E W Z Fu, H Li, M Y Lim
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Abstract

Objective: The standard treatment for regional failure in nasopharyngeal carcinoma (NPC) is the radical neck dissection (RND). Our study sought to determine if magnetic resonance imaging (MRI) may accurately predict nodal involvement to allow selected levels of neck dissection to be preserved.

Study design and setting: We analysed retrospectively all NPC patients in our centre undergoing neck dissections as salvage therapy for nodal recurrence. Nodal involvement based on the preoperative MRI was assessed and compared with postoperative histopathology.

Methods: This is a retrospective study conducted on patients in our centre with recurrent NPC from February 2002 to February 2017. Patients were identified from the database of the otolaryngology oncology division at our institution. Of these, 28 patients met all our inclusion and exclusion criteria. We calculated sensitivity and specificity as well as average number of nodes per patient.

Results: In our study, we calculated the false negative and false positive rates of preoperative MRI neck by levels. Overall sensitivity of MRI picking up disease by level was 76% and specificity was 86%.

Conclusion: Based on our study, we will be missing a total of 10 (7.1%) diseased neck levels in eight (28.5%) patients. MRI alone, therefore, does not provide enough information to allow safe selective preservation of neck levels in surgical salvage of neck recurrences in NPC.

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复发性结节性鼻咽癌的颈部挽救手术:在现代磁共振成像时代,是否所有患者都需要进行全面的颈部切除术?
目的:鼻咽癌(NPC)区域治疗失败的标准治疗方法是根治性颈部切除术(RND)。我们的研究旨在确定磁共振成像(MRI)是否可以准确预测结节受累情况,从而选择保留颈部切除术:我们对本中心所有因结节复发而接受颈部切除挽救治疗的鼻咽癌患者进行了回顾性分析。根据术前磁共振成像评估结节受累情况,并与术后组织病理学进行比较:这是一项回顾性研究,研究对象是本中心2002年2月至2017年2月期间的复发性鼻咽癌患者。患者是从我院耳鼻咽喉肿瘤科的数据库中筛选出来的。其中,28 名患者符合我们的所有纳入和排除标准。我们计算了灵敏度和特异性以及每位患者的平均结节数:在我们的研究中,我们计算了术前颈部磁共振成像的假阴性和假阳性率。核磁共振检查发现疾病的总体敏感性为 76%,特异性为 86%:根据我们的研究,我们将在 8 名(28.5%)患者中遗漏总共 10 个(7.1%)颈部病变层面。因此,仅靠核磁共振成像无法提供足够的信息,从而无法在鼻咽癌颈部复发的手术抢救中安全地选择性保留颈部水平。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Medical Journal of Malaysia
Medical Journal of Malaysia Medicine-Medicine (all)
CiteScore
1.20
自引率
0.00%
发文量
165
期刊介绍: Published since 1890 this journal originated as the Journal of the Straits Medical Association. With the formation of the Malaysian Medical Association (MMA), the Journal became the official organ, supervised by an editorial board. Some of the early Hon. Editors were Mr. H.M. McGladdery (1960 - 1964), Dr. A.A. Sandosham (1965 - 1977), Prof. Paul C.Y. Chen (1977 - 1987). It is a scientific journal, published quarterly and can be found in medical libraries in many parts of the world. The Journal also enjoys the status of being listed in the Index Medicus, the internationally accepted reference index of medical journals. The editorial columns often reflect the Association''s views and attitudes towards medical problems in the country. The MJM aims to be a peer reviewed scientific journal of the highest quality. We want to ensure that whatever data is published is true and any opinion expressed important to medical science. We believe being Malaysian is our unique niche; our priority will be for scientific knowledge about diseases found in Malaysia and for the practice of medicine in Malaysia. The MJM will archive knowledge about the changing pattern of human diseases and our endeavours to overcome them. It will also document how medicine develops as a profession in the nation. We will communicate and co-operate with other scientific journals in Malaysia. We seek articles that are of educational value to doctors. We will consider all unsolicited articles submitted to the journal and will commission distinguished Malaysians to write relevant review articles. We want to help doctors make better decisions and be good at judging the value of scientific data. We want to help doctors write better, to be articulate and precise.
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