Shih-Wei Yang

Human papillomavirus in oral leukoplakia is no prognostic indicator of malignant transformation

BACKGROUND Oral leukoplakia is considered as a premalignant lesion for the development of oral squamous cell carcinoma (OSCC); several risks factors have been reported to contribute to this step-wise carcinogenesis; including human papillomavirus (HPV). Nevertheless, few reports have analyzed both the HPV status and the genotype in a single individual who develops OSCC from pre-existing oral leukoplakia. In this study, we surveyed the HPV status, genotype and clinicopathological risk factors in cases of malignant transformation from pre-existing oral leukoplakia. METHODS HPV genomic DNA was detected by PCR (MY09/MY11 in conjugation with nested primer-GP05+/GP06+) from paraffin sections, and the genotype was determined by direct DNA sequencing. Fishers exact test and logistic regression were used to analyze risk factors for malignant transformation of oral cavity leukoplakia. RESULTS One hundred and sixty-seven patients with oral leukoplakia were enrolled; including 12 who had malignant transformation from the pre-existing oral leukoplakia. HPV prevalence was 22.8% in cases with oral leukoplakia. The risk factor associated with malignant transformation was recurrence of leukoplakia after treatment (p=0.03), nevertheless, HPV status was not statistically significant by logistic regression analysis. Among these 12 patients with malignant transformation from pre-existing oral leukoplakia, the status or genotype of HPV was chaotic; the oral habits of these patients might contribute to malignant transformation. CONCLUSIONS Our data suggest that HPV in oral leukoplakia is no prognostic indicator of malignant transformation.

Diagnostic significance of narrow‐band imaging for detecting high‐grade dysplasia, carcinoma in situ, and carcinoma in oral leukoplakia

To investigate the diagnostic accuracy of the established patterns of intraepithelial microvasculature of narrow‐band imaging (NBI) in diagnosing upper aerodigestive tract neoplasm of the squamous epithelium for detecting high‐grade dysplasia, carcinoma in situ, and carcinoma in oral leukoplakia.

Use of endoscopy with narrow-band imaging system in evaluating oral leukoplakia.

The purpose of this study was to analyze the relationship between clinical features of oral leukoplakia using endoscopy with broadband white light, narrow‐band imaging (NBI) illumination, and histopathology, and to discuss the clinical relevance of the NBI system.

Postoperative recurrence as an associated factor of malignant transformation of oral dysplastic leukoplakia.

Purpose: To evaluate the clinically associated factors of malignant transformation in patients who received laser surgery for oral dysplastic leukoplakia. Procedures: The clinicopathological data of patients receiving laser surgery for dysplastic leukoplakia from 2002 to 2008 and HPV genomic DNA extracted from paraffin-embedded specimens were analyzed statistically. Results: A total 114 patients, 90 males and 24 females with an average age of 49.7 ± 12.2 years were enrolled. The follow-up period ranged from 1.07 to 7.43 years (mean 3.4 ± 1.3 years). Thirteen cases had malignant transformation (11.4%). Multiple-focus lesions, non-homogeneous leukoplakia, high-grade dysplasia and recurrence after laser treatment were significant factors in univariate analysis. Multivariate analysis showed that recurrence (relative risk = 9.40) was the independent prognostic factor for malignant transformation. Conclusions: Recurrence after laser treatment is an independent prognostic factor predicting malignant transformation of dysplastic oral leukoplakia.

Clinical Appraisal of Endoscopy with Narrow-Band Imaging System in the Evaluation and Management of Homogeneous Oral Leukoplakia

Purpose: To evaluate the clinical usefulness of endoscopy with a narrow-band imaging (NBI) system for the evaluation and management of homogeneous oral leukoplakia. Methods: The chart records, morphology of vascular architecture of NBI, and histopathology of patients with homogeneous leukoplakia were retrospectively reviewed and analyzed. Results: A total of 160 patients, with an average age of 50.96 ± 10.25 years, were enrolled. In 35 cases of thin leukoplakia, only intraepithelium papillary capillary loop (IPCL) type I was shown by NBI, and only squamous hyperplasia was revealed pathologically. In 125 cases of thick leukoplakia, IPCL type I was found in 94, IPCL type II in 29, and IPCL type III in 2. The Kendall rank correlation between pathology and NBI images was significant (p < 0.0001). Conclusions: The dichotomous classification of homogeneous leukoplakia by NBI is meaningful, and endoscopy with the NBI system is a promising tool for the evaluation and management of homogeneous oral leukoplakia.

Analysis of life-threatening complications of deep neck abscess and the impact of empiric antibiotics.

Background: To review our experience in the treatment of deep neck abscesses, including analysis of the contributing factors related to the life-threatening complications and the effects of empiric antibiotics on the outcomes. Methods: A retrospective study and statistical analysis of patients with deep neck abscesses treated at Chang Gung Memorial Hospital between April 2000 and April 2006. Results: A total of 105 patients were enrolled in this study, including 66 males and 39 females with age ranging from 18 to 93 years. The result of logistic regression showed that old age, patients with underlying systemic diseases (p<0.05) and ineffective empiric antibiotics (p<0.01) had statistically significant correlation with life-threatening complications. When the age was older than 65 years, the empiric antibiotics were not effective, the way of drainage of the abscess was transcervical incision, the initial deep neck abscess involved more than 1 space, or the patient had underlying systemic diseases or complications, the duration of hospital stay tended to be longer (p <0.01). Conclusions: Even when adequately draining the abscess, the treatment of deep neck abscess in old-age patients more than 65 years, or the patients with ineffective empiric antibiotics or underlying systemic diseases should be more aggressive because life-threatening complications happen more frequently.

Implications of morphologic patterns of intraepithelial microvasculature observed by narrow-band imaging system in cases of oral squamous cell carcinoma

PURPOSE To investigate the intraepithelial microvascular morphology of oral squamous cell carcinoma (OSCC) by using narrow-band imaging (NBI) and analyze whether the intraepithelial papillary capillary loop (IPCL) patterns correlate with infiltration depth and disease severity in OSCC. METHODS The clinicopathologic data, morphology of vascular architecture as observed by NBI, and histopathology of patients with OSCC were retrospectively reviewed and analyzed. RESULTS A total of 80 patients, including 73 males and 7 females with an average age of 54.18±12.23 years, were enrolled. Three patterns of intraepithelial microvasculature were revealed by NBI and differences in these three patterns were significant with regard to pathologic T-classification (p<0.0001), N-classification (p=0.00022), TNM stage (p<0.0001), lymphovascular invasion (p<0.0001), perineural invasion (p=0.000299), depth of tumor infiltration (p<0.0001), and tumor differentiation (p<0.0001). A cut-off point of tumor infiltration of 10.012 mm was best predicted for the destructive pattern of IPCL (sensitivity=100%, specificity=90.0%). CONCLUSIONS Three different patterns of IPCL, showing step-wise increased severity according to pathologic parameters, were observed by NBI in cases of OSCC. The pattern indicating IPCL destruction with angiogenesis was associated with more advanced disease stage.

Treatment of wide-based epiglottic cyst by microdebrider

Epiglottic cyst is not an unusual disease in the larynx. Although it is usually a benign lesion, airway problems may occur due to a large cyst. Surgical excision is usually the treatment of choice, with low recurrence. Because of the limited view and mobility of laryngoscopes, there is sometimes difficulty in the procedure of excision or marsupialization, especially in wide-based epiglottic cysts. The microdebrider has been widely used in treatment of otolaryngological diseases, and specialized blades were designed for laryngeal lesions. We report the use of a microdebrider for treatment of wide-based epiglottic cysts in six patients. The follow-up period ranged from five months to 62 months without recurrence. One hand-powered instrument provided a clear surgical field for precise removal of the cyst and synchronized suction, and increased mobility of the laryngoscope held in the other hand. In comparison to traditional microinstrumentation and carbon dioxide laser, the microdebrider offered a rapid and effective alternative in treatment of wide-based epiglottic cyst.

Use of an autologous bony crossbar graft for the management of caudal septal deviation: Our experience in twenty-two patients

Septoplasty for a deviated caudal septum is a technique challenging surgery. The two goals of surgery are adequate correction of the deviated septum and maintenance of the nasal tip structural support. Use of an autologous bony crossbar graft to correct a deviate caudal septum offers the following advantages. No difficult drilling or suturing procedure is needed because the graft was kept in place by the elastic properties of the buttonhole cartilage incisions. Second, a simple endonasal approach is sufficient to expose the entire surgical field. Third, the small strip-shaped bone graft can help preserve the natural mobility of nose. Bone resorption and subsequent recurrence is one concern of this technique, however, previous reports have shown the reliability and persistence of bone graft in caudal septoplasty. Correction of a deviated caudal septum with an autologous bony crossbar graft has the potential to be a useful option for the management of caudal septal deviation. This article is protected by copyright. All rights reserved.