Head and Neck Optical Diagnostics Society最新文献

Background: Recent progress in ICG (indocyanine green) fluorescence imaging has provided a means by which we can detect sentinel lymph nodes (SLNs) without the risk of exposing patients to radiation. Neck metastasis is the most significant prognostic factor. It is imperative that early metastasis can be controlled. Intra-arterial chemotherapy is performed in order to preserve organs and to improve prognosis when treating oral cancer.

Objective: Evaluate translymphatic chemotherapy targeting SLNs in patients with oral cancer using intra-arterial chemotherapy. Evaluation will be carried out through the measurement of CDDP concentrations in SLNs.

Methods: Five patients with tongue cancer (T3N0M0) were treated by intra-arterial chemotherapy as neoadjuvant chemotherapy from November 2010 to June 2011. After a week of chemotherapy, patients underwent surgical treatment including the partial resection of the tongue and neck dissection. Intra-arterial chemotherapy was administered at 50 mg/m2 of CDDP either one or two times weekly. 5 mg of ICG was administered to the lingual artery at the beginning of surgery. SLNs were detected using ICG fluorescence imaging. 0.1 g of SLNs and non-SLNs were resected in order to measure CDDP concentrations. The rests of each of the SLNs were examined intraoperatively by routine frozen pathological examination. SLNs were also identified using radioactive injection the day prior to surgery.

Results: The mean CDDP concentrations in the SLNs and non-SLNs were 1.2 μg/g and 0.35 μg/g, respectively. Our intra- arterial infusion revealed that all metastatic lymph nodes, including SLNs, were without false negative SLNs. However, of 7 metastatic lymph nodes, one was not identified by means of conventional method.

Conclusion: Our findings verified the possibility that intra-arterial chemotherapy may be effective not only for organ preservation therapy, but also efficient in translymphatic chemotherapy targeting SLNs in patients with oral cancer through the use of ICG fluorescence imaging.

Traditionally, in the United Kingdom and Europe the surgeon was generally not troubled by litigation from patients presenting as elective as well as emergency cases, but this aspect of custom has changed. Litigation by patients now significantly affects surgical practice and vicarious liability often affects hospitals. We discuss some fundamental legal definitions, a must to know for a surgeon, and highlight some interesting cases.

Cancer of the parotid gland is relatively rare, but carries poor prognosis owing to its prevailing distant metastases. In addition to the disease's basic epidemiology and pathology, we review some current discoveries of its tumorigenesis molecular mechanism. Based on published salivary gland cancer clinical trial data, non-surgical antitumor efficacies amongst a range of chemotherapy, radiation, and concurrent therapy regimens are compared. We also present the current development status of novel radiation therapy and targeted therapeutics, focusing on intensity-modulated radiation therapy (IMRT), and epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF) blockages, which are showing promise for improving parotid gland cancer management.

Background: Cancer of the oral cavity is the sixth most common malignancy reported worldwide and one with the highest mortality rate among all malignancies. There is a paucity of reliable diagnostic methods to detect early malignancies. This study was performed to evaluate the sensitivity and specificity of brush biopsy in identifying oral premalignant and malignant lesions.

Methods: Oral brush and scalpel biopsies were performed on 85 consecutive patients presenting with an oral lesion deemed to be minimally suspicious by clinical examination and the results were compared.

Results: Of 79 patients with adequate brush biopsy samples with matching scalpel biopsies, 27 revealed histopathologic evidence of dysplasia or carcinoma, 26 of which were independently identified with the oral brush biopsy (sensitivity: 96.3%-95% CI, 87%-100%). 52 oral lesions did not reveal any histopathologic evidence of dysplasia or carcinoma and of these, brush biopsy reported 47 as "negative" and 5 as "atypical"(specificity of "positive" brush biopsy result is 100%- 95% CI, 93%-100%; specificity for "atypical" brush biopsy result is 90.4%-95% CI, 82%-97%. The positive predictive value of an abnormal oral brush biopsy was 84% and the negative predictive value was 98%.

Conclusion: Our study demonstrated that the oral brush biopsy is an accurate test in identifying oral premalignant and malignant lesions, even if minimally suspicious.

While histopathology of excised tissue remains the gold standard for diagnosis, several new, non-invasive diagnostic techniques are being developed. They rely on physical and biochemical changes that precede and mirror malignant change within tissue. The basic principle involves simple optical techniques of tissue interrogation. Their accuracy, expressed as sensitivity and specificity, are reported in a number of studies suggests that they have a potential for cost effective, real-time, in situ diagnosis.We review the Third Scientific Meeting of the Head and Neck Optical Diagnostics Society held in Congress Innsbruck, Innsbruck, Austria on the 11th May 2011. For the first time the HNODS Annual Scientific Meeting was held in association with the International Photodynamic Association (IPA) and the European Platform for Photodynamic Medicine (EPPM). The aim was to enhance the interdisciplinary aspects of optical diagnostics and other photodynamic applications. The meeting included 2 sections: oral communication sessions running in parallel to the IPA programme and poster presentation sessions combined with the IPA and EPPM posters sessions.

Background: Intraorbital metastases of breast cancer is rare with only 3-10% of all ocular metastases. We report a case of orbital metastases as first sign of systemic metastatic spread in a female patient with breast cancer.

Methods: The patient had been diagnosed with breast cancer 3 years before. Her present complain was local pain, diplopia and periorbital swelling. A CT scan revealed extensive bony destruction of the orbital roof/anterior skull base. Bone scintigraphy demonstrated additional uptake at the level of the skull base, cervical spine, ilium and ribs suggesting metastatic spread to the skeleton. A navigation-assisted intraorbital biopsy from the orbital roof revealed a metastasis of breast cancer. With the confirmed diagnosis of metastatic breast cancer the patient was refered to the oncologist for further tumor staging. As further treatment she received systemic palliative chemotherapy in addition to intravenous treatment with bisphosphonates.

Conclusion: In patients with a previous history of breast cancer who complain even of mild ophthalmologic symptoms such as local pain, periorbital edema, it is important to consider ocular or orbital metastatic disease. Adequate 3D-Imaging followed by a biopsy will usually confirm the diagnosis.

A case of lipomatous tubular adenoma (LTA) with syringocystadenom papilliferum (SCAP) arising from the external auditory canal in a 25-year-old man is described and to the best of our knowledge through literature review, this kind of morphologic entity has not been reported before. Herein we reported the first case in the English literature in the world.

Background: Hypoxia seems to be an influencing factor for oral squamous cell carcinomas (SCC), and several immunohistochemical markers have been discussed in this regard. The aim of the present study was to evaluate preoperative hemoglobin levels as a prognostic factor for oral SCC.

Materials and methods: The files of 287 patients who had been treated for oral SCC between 1999 and 2008 were studied retrospectively. Hemoglobin levels between 1 and 5 days prior to surgical treatment were compared to Tumor (T)- and Nodal (N)- status, local recurrence, and lymph node metastases rate. The minimum follow-up period was 12 months.

Results: From a total of 287 patients with oral SCC, 205 (71.4%) were in the normal hemoglobin (Hb) group (female Hb ≥ 12.0 g/dl; male Hb ≥ 13.0 g/dl), 53 (18.5%) in the mild anemia (female Hb = 11.0-11.9 g/dl; male Hb = 11.0-12.9 g/dl), and 29 (10.1%) in the severe anemia group (female & male Hb<11.0 g/dl). Anemia was significant for the development of lymph node metastasis (p = 0.005) as well as for local recurrence (p = 0.001). No significant correlation was found to the initial T status (p = 0.183).

Conclusion: Our data suggests that an Hb of below 11 g/dl contributes to and is an indicator for a poor prognosis. Consequently, pre-treatment Hb corrections may significantly improve outcome, but further investigations, including blood transfusion/application of erythropoietin due to tumor anemia, independent of intraoperative blood-loss are necessary to ascertain their role in an improved survival.

Background and purpose: Previous work by our group suggests smaller target volumes may result in equivalent locoregional control for head and neck cancer. We evaluated whether smaller target volumes may also result in improved normal tissue sparing.

Methods and materials: Ten patients with Stage III-IV head and neck cancer were contoured and planned according to target definitions in RTOG 0522 in a two dose level plan (RTOG), as well as a three dose level plan, using smaller target volumes and an intermediate dose prescription (3Dose). Plans were compared for coverage of targets and sparing of normal tissues

Results: The high dose target, elective nodal target, and total volume targeted were significantly smaller in 3Dose plans (p < 0.001). There was no difference in volume receiving 100% of each prescription level in RTOG or 3Dose plans. Mean dose to contralateral parotid, mandible, larynx, and inferior pharyngeal constrictor, and maximum dose to brainstem were significantly lower in 3Dose plans. There was no significant difference in maximum dose to spinal cord or volume of tissue not otherwise specified receiving 70 Gy.

Conclusions: Smaller target volumes with the addition of an intermediate dose volume results in improved sparing of most normal tissues.

The prognosis for patients with oral squamous cell carcinoma remains poor in spite of advances in therapy of many other malignancies. Early diagnosis and treatment remains the key to improved patient survival. Because the scalpel biopsy for diagnosis is invasive and has potential morbidity, it is reserved for evaluating highly suspicious lesions and not for the majority of oral lesions which are clinically not suspicious. Furthermore, scalpel biopsy has significant interobserver and intraobserver variability in the histologic diagnosis of dysplasia. There is an urgent need to devise critical diagnostic tools for early detection of oral dysplasia and malignancy that are practical, noninvasive and can be easily performed in an out-patient set-up. Diagnostic tests for early detection include brush biopsy, toluidine blue staining, autofluorescence, salivary proteomics, DNA analysis, biomarkers and spectroscopy. This state of the art review critically examines these tests and assesses their value in identifying oral squamous cell carcinoma and its precursor lesions.