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Swallowing function, body image and uncertainty in illness after reconstruction in oral cancer survivors 口腔癌幸存者重建后的吞咽功能、身体形象和疾病的不确定性
Pub Date : 2025-03-17 DOI: 10.1016/j.oor.2025.100734
Chen-Chan Kuo , Shiu-Yu C. Katie Lee , Chun-Ta Liao

Background

Swallowing and body image are the main concerns after reconstruction for oral cancer. Perceiving uncertainty or an unpredictable future is a significant psychosocial stressor in cancer survivors. This study aimed to explore swallowing function, body image, and uncertainty after the reconstruction for oral cancer, and to examine their associations.

Methods

A consecutive sample of 155 oral cancer adults (147 males and 8 females), with or without adjuvants, and surviving 3–30 months after primary microvascular free flaps, were included. The main outcomes were assessed by the Body Image Scale, EORTC QLQ-HN 35, and Mishel's Uncertainty in Illness Scale.

Results

Participants reported moderate disturbance in appearance, body as a whole, and sexual attraction, and a moderate-to-low level of EORTC swallowing, speech, and social problems. Less than 20 % have pursued cosmetic surgeries after reconstruction. After adjusting for demographic and clinical factors, poor body image (β = .318), poor speech (β = .198), lower household incomes (β = -.153), and farmers v.s. counterparts were more likely to have higher uncertainty in illness (Adj.R2 = .347).

Conclusions

Along with body image disturbance and swallowing problems, financial burden or work-related stress are significant risk factors for higher uncertainty in illness. Providing supportive care to cope with body image disturbances, swallowing and speech problems, and to improve work or financial status are warranted to help oral cancer survivors to cope with uncertainty in illness after free flaps.
口腔癌重建后,吞咽和身体形象是主要关注的问题。对癌症幸存者来说,感知不确定性或不可预测的未来是一个重要的社会心理压力源。本研究旨在探讨口腔癌重建后的吞咽功能、身体形象和不确定性,并探讨它们之间的关系。方法155例成年口腔癌患者(男性147例,女性8例),接受或不接受佐剂治疗,术后存活3-30个月。主要结果采用身体形象量表、EORTC qlq - hn35和michels疾病不确定性量表进行评估。结果研究对象在外观、身体整体和性吸引力方面存在中度障碍,在吞咽、言语和社交方面存在中低程度的EORTC问题。不到20%的人在重建后进行了整容手术。在调整了人口统计学和临床因素后,较差的身体形象(β = .318)、较差的语言(β = .198)、较低的家庭收入(β = -.153)和农民对疾病的不确定性更高(Adj.R2 = .347)。结论身体形象障碍、吞咽问题、经济负担、工作压力是患病不确定性高的重要危险因素。提供支持性护理,以应对身体形象障碍、吞咽和言语问题,以及改善工作或经济状况,以帮助口腔癌幸存者应对游离皮瓣后疾病的不确定性。
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引用次数: 0
Comment on “Resection of a left carotid body tumor in a young female patient” “1例年轻女性患者左侧颈动脉体肿瘤切除术”评论
Pub Date : 2025-03-13 DOI: 10.1016/j.oor.2025.100733
Lucas Alves da Mota Santana , Lara Góis Floresta , Rajiv Gandhi Gopalsamy , Bernardo Ferreira Brasileiro , Cleverson Luciano Trento , Lysandro Pinto Borges
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引用次数: 0
Hypofractionated adjuvant radiotherapy in cutaneous squamous cell and basal cell carcinoma of the head and neck: 50(Gy) in 20 study 低分割辅助放疗治疗头颈部皮肤鳞状细胞癌和基底细胞癌:20项研究中50 Gy
Pub Date : 2025-03-01 DOI: 10.1016/j.oor.2025.100732
Marcus Hu , Howard Liu , Anne Bernard , Michael Efendy , Sandro V. Porceddu

Purpose

To assess clinical outcomes and tolerability of patients with cutaneous squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) of the head and neck region, treated with adjuvant radiotherapy prescribed to a moderately hypofractionated regimen of 50Gy in 20 fractions.

Methods and materials

Eligibility for this retrospective study included patients with cutaneous SCC and BCC of the head and neck who received adjuvant radiotherapy to a dose of 50Gy in 20 fractions (2.5Gy per fraction) between 1/1/2007 and 31/12/2019 at a tertiary Queensland hospital. Primary endpoint was freedom from local failure (FFLF). Secondary outcomes were loco-regional recurrence-free survival (LRRFS), overall survival (OS) and toxicity rates. Acute toxicities were retrospectively collected and reported according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0.

Results

A total of 126 patients were evaluated in this study with a median follow up period of 19.7 months (interquartile range 1.63–121.03). The median age was 68.3 years old. Twenty-six patients were immunosuppressed. Predominant histopathology was SCC (63.5 %). The majority were staged pT1-2 (74.6 %), and clinically or pathologically N0 (96.8 %). 122 patients received adjuvant radiotherapy to the primary tumour bed, and four patients received treatment both the primary and nodal region. FFLF was 95.8 % and 92.2 % at 2 and 5 years, respectively. No statistically significant clinico-pathological factors were prognostic of FFLF. LRRFS was 90.5 % at 2 years and 83.1 % at 5 years. OS was 88.7 % at 2 years and 69.9 % at 5 years. Five of the 21 deaths were related to the index cutaneous carcinoma. Grade 3 radiation dermatitis and mucositis occurred in 13.5 % and 4.0 % of patients, respectively. There were no grade 4/5 toxicities. Four patients required treatment breaks, of which two were planned breaks. No patient required enteral feeding during their RT course.

Conclusion

This is the largest series to date evaluating a single moderately hypofractionated adjuvant radiotherapy regimen for cutaneous SCC and BCC of the head and neck. This regimen was associated with high locoregional control and was well tolerated. A moderately hypofractionated course of adjuvant radiotherapy in cutaneous SCC and BCC can be a suitable option to reduce treatment duration.
目的评价头颈部皮肤鳞状细胞癌(SCC)和基底细胞癌(BCC)患者接受50Gy / 20次中等低分割方案辅助放疗的临床疗效和耐受性。方法和材料本回顾性研究的入选对象包括2007年1月1日至2019年12月31日期间在昆士兰州一家三级医院接受50Gy剂量辅助放疗的头颈部皮肤鳞状细胞癌和BCC患者,这些患者分为20个部分(每个部分2.5Gy)。主要终点为无局部衰竭(FFLF)。次要终点是局部-区域无复发生存期(LRRFS)、总生存期(OS)和毒副反应率。急性毒性根据不良事件通用术语标准(CTCAE) v4.0进行回顾性收集和报告。结果本研究共纳入126例患者,中位随访时间为19.7个月(四分位数差1.63 ~ 121.03)。中位年龄为68.3岁。26例患者免疫抑制。主要组织病理学为SCC(63.5%)。多数分期为pT1-2期(74.6%),临床或病理分期为0期(96.8%)。122例患者接受原发肿瘤床辅助放疗,4例患者同时接受原发和结区治疗。2年和5年FFLF分别为95.8%和92.2%。无统计学意义的临床病理因素影响FFLF的预后。2年和5年的LRRFS分别为90.5%和83.1%。2年生存率为88.7%,5年生存率为69.9%。21例死亡中有5例与原发性皮肤癌有关。3级放射性皮炎和黏膜炎发生率分别为13.5%和4.0%。无4/5级毒性反应。4名患者需要治疗休息,其中2名是计划休息。在放疗过程中,没有患者需要肠内喂养。结论:这是迄今为止评估头颈部皮肤鳞状细胞癌和基底细胞癌单一中度低分割辅助放疗方案的最大系列研究。该方案具有较高的局部控制性,耐受性良好。在皮肤鳞状细胞癌和基底细胞癌的辅助放疗中,适度的低分割疗程可以是减少治疗时间的合适选择。
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引用次数: 0
Oral potentially malignant disorders: Challenges for patient participation due to opacity 口腔潜在恶性疾病:由于不透明,患者参与的挑战
Pub Date : 2025-03-01 DOI: 10.1016/j.oor.2025.100731
Brenda Bogaert
Opacity – or the lack of transparency - impacts patients' ability to participate in and contribute to decision-making. This contribution examines how opacity affects patient engagement in the context of oral potentially malignant disorders. The discussion focuses on three key areas: the effects of unclear disease classifications on patient perceptions of their health; the ways in which ambiguous healthcare pathways create barriers for both patients and providers; and the broader impact of opacity on patient autonomy. The conclusion explores strategies to reduce or mitigate these challenges, including fostering epistemic networks for patients and healthcare providers and embracing the value of humility in care work.
不透明或缺乏透明度会影响患者参与和参与决策的能力。这一贡献探讨了在口腔潜在恶性疾病的背景下,不透明如何影响患者的参与。讨论集中在三个关键领域:疾病分类不明确对患者健康感知的影响;模棱两可的医疗保健途径为患者和提供者创造障碍的方式;以及不透明对患者自主权的更广泛影响。结论探讨了减少或缓解这些挑战的策略,包括促进患者和医疗保健提供者的认知网络,以及在护理工作中拥抱谦逊的价值。
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引用次数: 0
Dysregulation of glucose-6-phosphate dehydrogenase in head and neck squamous cell carcinoma: Pathways, mutations, and therapeutic opportunities 头颈部鳞状细胞癌中葡萄糖-6-磷酸脱氢酶的失调:途径、突变和治疗机会
Pub Date : 2025-02-20 DOI: 10.1016/j.oor.2025.100726
Santhakumar Egambaram , Mohamed Rizwan Ghouse , Anishkiran Balasundar, Rajesh Parsanathan

Objective

Glucose-6-phosphate dehydrogenase (G6PD) deficiency, the most common human enzyme defect, confers malaria resistance and is linked to reduced cancer risk. Its upregulation in malignancies suggests a critical role in tumour progression. This study examines G6PD in head and neck squamous cell carcinoma (HNSCC), focusing on its expression, genetic alterations, interactions, and therapeutic potential.

Materials and methods

Bioinformatics tools, including UALCAN, Human Protein Atlas, GEPIA2, cBioPortal, muTarget, GeneMANIA, Cancer Hallmarks, and GSCA, were used to analyse expression, survival, genomic alterations, protein interactions, pathway enrichment, and drug sensitivity.

Results

G6PD is significantly upregulated in HNSCC, correlating with poor overall and disease-free survival. Genomic alterations predominantly involve amplification, while regulatory mutations in NFE2L2 and KEAP1 increase expression, and mutations in HRAS and TACC2 reduce it. Protein interaction analysis links G6PD to oxidative stress, tumour metabolism, and cell migration, with key interactions involving NFE2L2 and HRAS. Enrichment analysis associates G6PD with metastasis, immune evasion, and metabolic reprogramming. Drug sensitivity analysis reveals a complex relationship between G6PD expression and therapeutic response.

Conclusion

G6PD is critical in HNSCC progression and may serve as a prognostic biomarker and therapeutic target. Further experimental validation is required to explore G6PD inhibition as a treatment strategy, highlighting the importance of metabolic reprogramming in cancer therapy.
葡萄糖-6-磷酸脱氢酶(G6PD)缺乏症是人类最常见的酶缺陷,它赋予疟疾抗性,并与降低癌症风险有关。它在恶性肿瘤中的上调表明在肿瘤进展中起关键作用。本研究探讨了G6PD在头颈部鳞状细胞癌(HNSCC)中的表达、基因改变、相互作用和治疗潜力。材料和方法使用生物信息学工具,包括UALCAN、Human Protein Atlas、GEPIA2、cbiopportal、muTarget、GeneMANIA、Cancer Hallmarks和GSCA,分析表达、存活、基因组改变、蛋白质相互作用、途径富集和药物敏感性。结果g6pd在HNSCC中显著上调,与较差的总生存率和无病生存率相关。基因组改变主要涉及扩增,而NFE2L2和KEAP1的调控突变增加了表达,而HRAS和TACC2的突变减少了表达。蛋白质相互作用分析将G6PD与氧化应激、肿瘤代谢和细胞迁移联系起来,其中关键的相互作用涉及NFE2L2和HRAS。富集分析将G6PD与转移、免疫逃避和代谢重编程联系起来。药物敏感性分析揭示了G6PD表达与治疗反应之间的复杂关系。结论6pd在HNSCC进展中起关键作用,可作为预后生物标志物和治疗靶点。需要进一步的实验验证来探索G6PD抑制作为一种治疗策略,强调代谢重编程在癌症治疗中的重要性。
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引用次数: 0
Post-translational regulation of stemness under DNA damage response contributes to the gingivobuccal oral squamous cell carcinoma relapse and progression DNA损伤应答下干性的翻译后调控参与了龈颊口腔鳞状细胞癌的复发和进展
Pub Date : 2025-02-15 DOI: 10.1016/j.oor.2025.100730
Sachendra Kumar , Annapoorni Rangarajan , Debnath Pal
Tobacco consumption (smoking and specifically smokeless form) in India contributes to a high prevalence of gingivobuccal oral squamous cell carcinoma (OSCC-GB). OSCC-GB exhibits high rates of locoregional relapse and therapeutic resistance, often attributed to the involvement of cancer stem cells (CSCs). The goal of this study is to leverage the generalizability of the machine learning prediction model for ‘Tumor Status’ for a comparative somatic mutation analysis between ‘With Tumor’ (recurred/relapsed/progressed) and ‘Tumor Free’ (disease-free/complete remission) OSCC-GB patients. Our results showed that support vector machines (SVM) classified the ‘Tumor Status’ classes at a mean accuracy of 89% based on clinical features. Furthermore, RNA-seq based somatic mutation analysis using the classified groups revealed molecular mechanisms underlying tumor progression and remission within OSCC-GB subgroups. The identified mutational signature (C>T mutations) related to DNA damage indicates the influence of tobacco-related carcinogens in OSCC-GB subgroups. The analysis of distinct somatic variants, functional impact predictions, protein-protein interactions, and survival analysis highlights the involvement of DNA damage response (DDR)-related genes in ‘With Tumor’, with particular focus on the significant role of the Mitogen-activated protein kinase associated protein 1 (MAPKAP1) gene, a key player in the mTORC2 signaling pathway. The study indicates that loss-of-function in the identified MAPKAP1 somatic variant may promote stemness and elevated risk of relapse and disease progression in OSCC-GB under conditions of DDR in ‘With Tumor’ OSCC-GB, potentially contributing to increased mortality rates among Indian OSCC-GB patients.
印度的烟草消费(吸烟,特别是无烟形式)导致牙龈-口腔鳞状细胞癌(OSCC-GB)的高患病率。OSCC-GB表现出高的局部复发率和治疗耐药性,通常归因于癌症干细胞(CSCs)的参与。本研究的目的是利用“肿瘤状态”机器学习预测模型的通用性,对“有肿瘤”(复发/复发/进展)和“无肿瘤”(无病/完全缓解)OSCC-GB患者进行比较体细胞突变分析。我们的研究结果表明,支持向量机(SVM)基于临床特征对“肿瘤状态”分类的平均准确率为89%。此外,使用分类组进行基于RNA-seq的体细胞突变分析,揭示了OSCC-GB亚组中肿瘤进展和缓解的分子机制。鉴定出的与DNA损伤相关的突变特征(C>;T突变)表明烟草相关致癌物对OSCC-GB亚组的影响。对不同体细胞变异、功能影响预测、蛋白-蛋白相互作用和生存分析的分析强调了DNA损伤反应(DDR)相关基因在“With Tumor”中的参与,特别关注了丝裂原活化蛋白激酶相关蛋白1 (MAPKAP1)基因的重要作用,该基因是mTORC2信号通路的关键参与者。该研究表明,在“伴有肿瘤”的OSCC-GB中,在DDR条件下,鉴定的MAPKAP1体细胞变异的功能丧失可能促进OSCC-GB的干性、复发和疾病进展的风险升高,可能导致印度OSCC-GB患者死亡率增加。
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引用次数: 0
Development and validation of a prediction model for risk stratification and outcome prediction in oral oncology patients 口腔肿瘤患者风险分层和预后预测模型的建立和验证
Pub Date : 2025-02-12 DOI: 10.1016/j.oor.2025.100728
Vishnu Priya Veeraraghavan , Shikhar Daniel , Ravikanth Manyam , Amarender Reddy , Santosh R. Patil

Background

Oral squamous cell carcinoma (OSCC) is a prevalent malignancy with significant morbidity and mortality, particularly in low- and middle-income countries. Despite advancements in treatment, prognostic tools integrating clinical, histopathological, and molecular data remain underdeveloped, limiting personalized risk stratification and survival prediction.

Objective

This study aimed to develop and validate a prediction model for overall survival (OS) and progression-free survival (PFS) in OSCC, incorporating clinical, histopathological, and molecular factors.

Methods

A retrospective cohort of 132 patients with histopathologically confirmed OSCC was analyzed. Data on demographic, clinical (tumor stage, lymph node involvement), histopathological (tumor grade, perineural invasion), and molecular (HPV status) variables were collected. Logistic regression and machine learning algorithms were used to build the prediction model. Internal validation was conducted using bootstrapping, and model performance was assessed using the area under the receiver operating characteristic (ROC) curve, calibration plots, and decision curve analysis (DCA).

Results

The model demonstrated robust predictive performance, with an area under the ROC curve (AUC) of 0.85 for OS and 0.83 for PFS. Tumor stage, lymph node involvement, and HPV status were identified as key predictors of survival. Kaplan-Meier analysis showed steep declines in OS probabilities during the first 24 months, emphasizing the need for early interventions. Calibration plots indicated strong agreement between predicted and observed outcomes, supporting the model's reliability.

Conclusion

This study developed a validated prediction model for OS and PFS in OSCC, demonstrating high discriminatory ability and calibration. Integrating clinical, histopathological, and molecular data enhances personalized risk stratification and treatment planning in oral oncology.
背景:口腔鳞状细胞癌(OSCC)是一种发病率和死亡率很高的普遍恶性肿瘤,特别是在低收入和中等收入国家。尽管治疗取得了进步,但整合临床、组织病理学和分子数据的预后工具仍然不发达,限制了个性化的风险分层和生存预测。目的本研究旨在建立并验证一种结合临床、组织病理学和分子因素的OSCC总生存期(OS)和无进展生存期(PFS)的预测模型。方法对132例经组织病理学证实的OSCC患者进行回顾性分析。收集了人口统计学、临床(肿瘤分期、淋巴结受累)、组织病理学(肿瘤分级、神经周围浸润)和分子(HPV状态)变量的数据。采用逻辑回归和机器学习算法建立预测模型。采用自举法进行内部验证,采用受试者工作特征(ROC)曲线下面积、校准图和决策曲线分析(DCA)评估模型性能。结果该模型具有较强的预测能力,OS和PFS的ROC曲线下面积(AUC)分别为0.85和0.83。肿瘤分期、淋巴结受累和HPV状态被确定为生存的关键预测因素。Kaplan-Meier分析显示,在最初的24个月内,OS概率急剧下降,强调了早期干预的必要性。校正图显示预测结果与观测结果非常吻合,支持模型的可靠性。结论本研究建立了一个经验证的OSCC OS和PFS预测模型,具有较强的区分能力和校准能力。整合临床、组织病理学和分子数据,增强口腔肿瘤的个性化风险分层和治疗计划。
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引用次数: 0
Genetic variants in immune mediators as potential molecular biomarkers for oral cancer evaluation: Insights from a systematic revaluation by computational analyses and Bayesian approaches 免疫介质中的遗传变异作为口腔癌评估的潜在分子生物标志物:通过计算分析和贝叶斯方法进行系统重估的见解
Pub Date : 2025-02-11 DOI: 10.1016/j.oor.2025.100729
Juliana Campos Botelho , Samuel Arcebispo Brasileiro , André Victor Oliveira Monteiro , Alessandro Luiz Araújo Bentes Leal , Naum Neves da Costa dos Santos , Gabrielly Ribeiro Alves , Reyce Santos Koga , Haline Alves da Silva , José Rogério Souza Monteiro , Denis Vieira Gomes Ferreira , Adenilson Leão Pereira , Ana Carolina Alves de Oliveira , Márcia Socorro Silva Lima Duarte , Felipe Rodolfo Pereira da Silva

Background

Oral cancer is a complex disease in which genetic variations in immune mediator play a relevant role in its pathophysiology. This study aimed at assessing the level of false-positive rates on meta-analytic data on genetic variations in immune mediator genes related with oral cancer risk.

Material and methods

A systematic search was performed for meta-analyses in this field that were published before September 22, 2024. The calculations for the False-Positive Rate Probability (FPRP) and the Bayesian False Discovery Probability (BFDP) were performed to assess the noteworthiness with a statistical power of 1.2 and 1.5 of Odds Ratio (OR) at a prior probability of 10−3 and 10−6. A methodological evaluation by the Venice criteria was performed and in silico networks were designed.

Results

Ten meta-analyses on the TNFA/rs361625/rs1800629, VEGF/rs3025039, IL4/rs2070874, IL6/rs1800795, IL8/rs4073 and IL10/rs1800896 genes/polymorphisms and oral cancer have been included. 88 significant OR association values from the meta-analyses included allowed the performance of 336 calculations for FPRP and 176 for BFDP. We found 35 noteworthy values (10.42 %) for FPRP and 59 noteworthy values (33.52 %) for BFDP that demonstrated the variants in VEGF and IL10 with noteworthiness association with oral cancer. The gene-gene and protein-protein networks evidenced the role of VEGF, TNFA, IL4, IL6, IL8 and IL10 genes in the physiopathology of the disease.

Conclusions

The Bayesian calculations and the in-silico analyses indicated the rs3025039 and rs1800896 polymorphisms in the VEGF and IL10 genes, respectively, as noteworthy molecular biomarkers for oral cancer risk evaluation.
背景:口腔癌是一种复杂的疾病,免疫介质的遗传变异在其病理生理中起着重要作用。本研究旨在评估与口腔癌风险相关的免疫中介基因遗传变异的荟萃分析数据的假阳性率水平。材料与方法系统检索该领域在2024年9月22日之前发表的meta分析。计算假阳性率概率(FPRP)和贝叶斯错误发现概率(BFDP),在先验概率为10−3和10−6的情况下,优势比(OR)的统计功率分别为1.2和1.5,以评估值得注意性。通过威尼斯标准进行方法学评估,并设计了计算机网络。结果对TNFA/rs361625/rs1800629、VEGF/rs3025039、IL4/rs2070874、IL6/rs1800795、IL8/rs4073和IL10/rs1800896基因多态性与口腔癌的关系进行meta分析。meta分析包括88个显著OR关联值,FPRP计算336个,BFDP计算176个。我们发现FPRP有35个值得注意的值(10.42%),BFDP有59个值得注意的值(33.52%),这些值表明VEGF和IL10的变异与口腔癌有显著的关联。基因-基因和蛋白-蛋白网络证实了VEGF、TNFA、IL4、IL6、IL8和IL10基因在该疾病的生理病理中的作用。结论贝叶斯计算和芯片分析提示VEGF基因rs3025039和il - 10基因rs1800896的多态性可作为口腔癌风险评估的重要分子生物标志物。
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引用次数: 0
Utilization of ChatGPT as a reliable aide for differential diagnosis of histopathology in head and neck surgery 利用ChatGPT作为头颈部外科组织病理学鉴别诊断的可靠辅助
Pub Date : 2025-02-11 DOI: 10.1016/j.oor.2025.100727
Sayyed Ourmazd Mohseni , Asal Saeid , Patrick Wong , Timothy Neal , Thomas Schlieve

Objectives

The rise of artificial intelligence offers promising advancements in diagnostic workflows in healthcare. In oral and maxillofacial surgery, timely and accurate histopathological diagnosis is crucial for effective treatment planning. This study examines Chat Generative Pretrained Transformer (ChatGPT, OpenAI Inc., California) as an aid to providers in generating differential diagnoses for four common maxillofacial pathologies: ameloblastoma, squamous cell carcinoma, mucoepidermoid carcinoma, and pleomorphic adenoma.

Study design

A retrospective study was conducted with 200 de-identified histopathological cases, evenly divided across the four diagnostic categories. Each case included clinical summaries and histopathological images, which were input into ChatGPT to generate four differential diagnoses. The study evaluated the inclusion and ranking of the correct diagnosis in the differential list using a chi-square goodness-of-fit test.

Results

ChatGPT included the correct diagnosis in all cases (100 %), ranking it first in 49.5 %, second in 32.5 %, third in 14.5 %, and fourth in 3.5 %. Statistical analysis confirmed a significant preference for higher ranking of correct diagnoses (p < 0.001).

Conclusion

ChatGPT shows strong reliability in generating accurate differential diagnoses for maxillofacial histopathology, ranking the correct diagnosis in the top two positions in 82 % of cases. These results highlight AI's potential to augment diagnostic workflows and enhance efficiency.
人工智能的兴起为医疗保健诊断工作流程提供了有希望的进步。在口腔颌面外科手术中,及时准确的组织病理学诊断对于制定有效的治疗方案至关重要。本研究检验了Chat生成预训练转换器(ChatGPT, OpenAI Inc., California)作为辅助提供者对四种常见颌面病理进行鉴别诊断的工具:成釉细胞瘤、鳞状细胞癌、粘液表皮样癌和多形性腺瘤。研究设计对200例去识别的组织病理学病例进行回顾性研究,平均分为四种诊断类别。每个病例包括临床总结和组织病理学图像,这些图像被输入到ChatGPT中以产生四种鉴别诊断。该研究使用卡方拟合优度检验评估正确诊断在鉴别列表中的包含和排名。结果atgpt诊断正确率为100%,排在首位(49.5%)、第二位(32.5%)、第三位(14.5%)和第四位(3.5%)。统计分析证实了患者对正确诊断排序较高的显著偏好(p <;0.001)。结论chatgpt对颌面部组织病理学的准确鉴别诊断具有较强的可靠性,82%的病例正确率排在前两位。这些结果突出了人工智能在增加诊断工作流程和提高效率方面的潜力。
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引用次数: 0
Otolaryngology practitioner attitudes toward human papillomavirus vaccination in academic otolaryngology clinics 耳鼻喉科医生对人乳头瘤病毒疫苗接种在学术耳鼻喉科诊所的态度
Pub Date : 2025-02-11 DOI: 10.1016/j.oor.2025.100722
Dante J. Merlino , Katelyn S. Rourk , George B. Sankar , Adam J. Luginbuhl , Brian J. Boyce , Michelle M. Chen , Eric M. Dowling , Michael C. Topf , Raymond L. Chai , Karthik Rajasekaran , Eric J. Moore , Daniel L. Price , George Saieed , Kathryn M. Van Abel
Despite the existence of a highly effective and safe vaccine against human papillomavirus (HPV) infection, vaccination rates remain low. The most prevalent HPV-associated malignancy in the United States is oropharyngeal cancer, but otolaryngology practitioners do not offer the HPV vaccine, and their feelings around offering HPV vaccination have not been evaluated. A 43-question survey, including a twelve-question knowledge quiz, was sent to otolaryngology practitioners at seven academic institutions. Twelve questions comprised a knowledge quiz testing practitioner understanding of HPV, while the remainder of the questions evaluated comfort with and likelihood of recommending vaccination. Of the 442 practitioners who were sent the survey, 207 (47 %) completed it, including 27 (13 %) advanced practice providers (physician assistants, nurse practitioners, or speech language pathologists), 89 (43 %) residents or fellows, and 91 (44 %) attending physicians. Together, 181/207 (87 %) of providers were “relatively likely” (n = 54, 26 %) or “extremely likely” (n = 127, 61 %) to offer vaccination. Likelihood of offering the vaccine was associated with multiple measures of provider confidence regarding HPV vaccination discussions, and was not associated with provider type, attending physician subspecialty, or knowledge quiz accuracy (p = 0.11, p = 0.35, and p = 0.67, respectively). In summary, this study suggests a possible new avenue for point-of-care vaccines against HPV. Efforts to improve otolaryngology provider confidence with this recommendation are needed.
尽管存在一种非常有效和安全的预防人乳头瘤病毒(HPV)感染的疫苗,但疫苗接种率仍然很低。在美国,最常见的HPV相关恶性肿瘤是口咽癌,但耳鼻喉科医生不提供HPV疫苗,他们对提供HPV疫苗的感受尚未得到评估。一份43个问题的调查问卷,包括12个问题的知识测验,被发送给7个学术机构的耳鼻喉科从业者。12个问题包括一个知识测验,测试从业者对HPV的理解,而其余的问题评估对推荐接种疫苗的舒适度和可能性。在接受调查的442名执业医师中,207名(47%)完成了调查,其中包括27名(13%)高级执业医师(医师助理、执业护士或语言病理学家),89名(43%)住院医师或研究员,91名(44%)主治医师。总共有181/207(87%)的提供者“相对可能”(n = 54,26 %)或“极可能”(n = 127,61 %)提供疫苗接种。提供疫苗的可能性与关于HPV疫苗接种讨论的提供者信心的多种措施相关,而与提供者类型、主治医生亚专科或知识测验准确性无关(p = 0.11, p = 0.35和p = 0.67)。总之,这项研究提出了一种可能的针对HPV的即时疫苗的新途径。需要努力提高耳鼻喉科医生对这一建议的信心。
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Oral Oncology Reports
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