Wu-Chia Lo

Detection of cervical lymph node metastasis in head and neck cancer patients with clinically N0 neck-a meta-analysis comparing different imaging modalities.

BackgroundHow to properly manage clinically negative neck of head and neck cancer patients is a controversial topic. Research is now directed toward finding a method sensitive enough to bring the risk of occult metastases below 20%. The aim of this review was to compare the diagnostic accuracy of different imaging modalities, including CT, MRI, PET and US, in clinically N0 head and neck cancer patients.MethodsFor this systematic review and meta-analysis, PubMed and the Cochrane Database were searched for relevant original articles published up to May 2011. Inclusion criteria were as follows: articles were reported in English; CT, MRI, PET or US were performed to identify cervical metastases in clinically N0 head and neck squamous cell carcinoma; and data were sufficient for the calculation of true-positive or false-negative values. A bivariate random effect model was used to obtain pooled sensitivity and specificity. The positive and negative test probability of neck metastasis was generated based on Bayesian theory and collected data for different pre-test possibilities.ResultsOf the 168 identified relevant articles, 7 studies fulfilled all inclusion criteria for CT, 6 studies for MRI, 11 studies for PET and 8 studies for US. There was no difference in sensitivity and specificity among these imaging modalities, except CT was superior to US in specificity. The pooled estimates for sensitivity were 52% (95% confidence interval [CI], 39% ~ 65%), 65% (34 ~ 87%) 66% (47 ~ 80%), and 66% (45 ~ 77%), on a per-neck basis for CT, MRI, PET and US, respectively. The pooled estimates for specificity were 93% (87% ~ 97%), 81% (64 ~ 91%), 87% (77 ~ 93%), and 78% (71 ~ 83%) for CT, MRI, PET and US, respectively. With pre-examination nodal metastasis probabilities set at 10%, 20% and 30%, the post-exam probabilities of positive nodal metastasis rates were 47%, 66% and 77% for CT; 27%, 46% and 59% for MRI; 36%, 56% and 69% for PET; and 25%, 42% and 56% for US, respectively. Negative nodal metastasis probabilities were 95%, 89% and 82% for CT; 95%, 90% and 84% for MRI; 96%, 91% and 86% for PET; and 95%, 90% and 84% for US, respectively.ConclusionsModern imaging modalities offer similar diagnostic accuracy to define and diagnose clinically N0 neck. Minimizing morbidity and avoiding elective neck dissection is acceptable in some select cases.

Intralesional steroid injection for benign vocal fold disorders: A systematic review and meta-analysis†

Emerging literature had documented the potential usefulness of vocal fold steroid injection (VFSI) as an alternative treatment option for benign vocal lesions. This study aims to conduct a qualitative synthesis and quantitative meta‐analysis of vocal fold steroid injection

Transnasal endoscopic steroid injection: A practical and effective alternative treatment for benign vocal fold disorders

Emerging literature has documented the effectiveness of intralesional steroid injection as an alternative treatment for benign vocal fold disorders. However, clinical application is frequently limited by the associated technical demands for adequate anesthesia and precise needle placement. This study investigated the applicability and effectiveness of the more practical and less technically demanding method of transnasal endoscopic steroid injection (TESI).

Concurrent image-guided intensity modulated radiotherapy and chemotherapy following neoadjuvant chemotherapy for locally advanced nasopharyngeal carcinoma.

BackgroundTo evaluate the experience of induction chemotherapy followed by concurrent chemoradiationwith helical tomotherapy (HT) for nasopharyngeal carcinoma (NPC).MethodsBetween August 2006 and December 2009, 28 patients with pathological proven nonmetastatic NPC were enrolled. All patients were staged as IIB-IVB. Patients were first treated with 2 to 3 cycles of induction chemotherapy with EP-HDFL (Epirubicin, Cisplatin, 5-FU, and Leucovorin). After induction chemotherapy, weekly based PFL was administered concurrent with HT. Radiation consisted of 70 Gy to the planning target volumes of the primary tumor plus any positive nodal disease using 2 Gy per fraction.ResultsAfter completion of induction chemotherapy, the response rates for primary and nodal disease were 96.4% and 80.8%, respectively. With a median follow-up after 33 months (Range, 13-53 months), there have been 2 primary and 1 nodal relapse after completion of radiotherapy. The estimated 3-year progression-free rates for local, regional, locoregional and distant metastasis survival rate were 92.4%, 95.7%, 88.4%, and 78.0%, respectively. The estimated 3-year overall survival was 83.5%. Acute grade 3, 4 toxicities for xerostomia and dermatitis were only 3.6% and 10.7%, respectively.ConclusionHT for locoregionally advanced NPC is feasible and effective in regard to locoregional control with high compliance, even after neoadjuvant chemotherapy. None of out-field or marginal failure noted in the current study confirms the potential benefits of treating NPC patients by image-guided radiation modality. A long-term follow-up study is needed to confirm these preliminary findings.

RARE INVOLVEMENT OF SUBMANDIBULAR GLAND BY ORAL SQUAMOUS CELL CARCINOMA

The true involvement of the submandibular gland in primary oral cancer seems quite uncommon.

Malignancies of the ear in irradiated patients of nasopharyngeal carcinoma.

Objectives/Hypothesis: To report on the clinical profiles and treatment experiences of patients with second primary ear malignancy after treatment of nasopharyngeal carcinoma (NPC).

Office-Based Potassium Titanyl Phosphate Laser–Assisted Endoscopic Vocal Polypectomy

IMPORTANCE Vocal polyps are common exophytic laryngeal lesions that usually necessitate microscopic laryngeal surgery under general anesthesia. Office-based indirect laryngoscopic procedures provide an alternative management option and can be performed comfortably under flexible endoscopic guidance. Combining angiolytic potassium titanyl phosphate (KTP) laser treatment and flexible endoscopic polypectomy should alleviate the risks of surgery under general anesthesia and expedite lesion regression. OBJECTIVES To combine angiolytic KTP laser treatment and endoscopic polyp removal and to evaluate the clinical applicability, treatment outcomes, and adverse effects of office-based KTP laser-assisted vocal polypectomy. DESIGN Case series of KTP laser treatment (n = 16) and KTP laser-assisted polypectomy (n = 20). Patients underwent pretreatment and 2- and 6-week posttreatment evaluation with videolaryngostroboscopy (VLS), maximal phonation time, and a 10-item voice handicap index. Perceptual (GRB [grade, roughness, breathiness] scale) and acoustic analyses were performed before and 6 weeks after treatment. SETTING Tertiary teaching hospital. PARTICIPANTS Thirty-six outpatients with unilateral hemorrhagic vocal polyps. INTERVENTIONS Under local anesthesia, the KTP laser fiber was passed through the working channel of the flexible laryngoscope to photocoagulate the microvasculature of the polyp in all patients. Removal of coagulated vocal polyp using a flexible, endoscopic, blunt-ended grasping forceps immediately after KTP laser application was performed in the polypectomy group. MAIN OUTCOMES AND MEASURES Results of VLS, maximal phonation time, 10-item voice handicap index, and perceptual and acoustic analyses. RESULTS Six weeks after KTP laser treatment with and without polypectomy, 19 and 12 patients, respectively, experienced complete recovery and much improvement of mucosal wave. Maximal phonation time and the voice handicap index improved significantly 2 weeks after KTP laser with polypectomy (P < .01), whereas significant improvements were noted 6 weeks postoperatively in both treatment groups (P < .05). Acoustic and perceptual analyses also revealed significant improvements in both study groups (P < .05). During follow-up, we did not notice significant adverse effects. CONCLUSIONS AND RELEVANCE Potassium titanyl phosphate laser-assisted vocal polypectomy is a safe, practical, and effective alternative option to treat hemorrhagic vocal polyps in the outpatient department, offering comparable but earlier therapeutic effects than KTP laser alone.

Ultrasonographic differentiation between Kikuchi's disease and lymphoma in patients with cervical lymphadenopathy

PURPOSE Kikuchis disease, or histiocytic necrotizing lymphadenitis, is a self-limited necrotizing lymphadenitis. Clinically, it resembles lymphoma. We want to compare the sonographic features between Kikuchis disease and lymphoma in patients with cervical lymphadenopathy. MATERIALS AND METHODS The study protocol was approved by the institutional review board. Two hundred and twenty six cervical lymph nodes (137 nodes from 21 Kikuchis disease patients and 89 nodes from 20 malignant lymphoma patients) were examined. The demographic and ultrasonographic characteristics of lymph nodes were collected and analyzed. RESULTS The Kikuchis disease patients (mean age, 24.2 years; range, 8-57 years) were younger than those with lymphoma (mean age, 54 years; range, 13-81 years). There was no difference in laterality of nodes (p=0.19). The nodal distribution demonstrated most enlarged neck lymph nodes located at level II, III and V. The ranges of short-axis and long-axis length were 6.5±2.3mm (mean±SD) versus 13.4±5.1mm and 13.4±5.0mm versus 21.2±9.2mm for Kikuchis disease versus lymphoma (p<0.01), respectively. The S/R ratio of Kikuchis disease nodes was 0.5±0.2 compared to 0.7±0.2 in lymphoma nodes (p<0.01). Eighty-seven of 137 nodes (63.5%) of Kikuchis disease, and eight of 89 nodes (9%) of malignant lymphoma had signs of cortical widening (p<0.01). Seventy-six nodes (55.5%) of Kikuchis disease and twenty-eight nodes (31.5%) of malignant lymphoma were matted (p<0.01). Forty-five of 89 nodes among lymphoma and twenty-four among 137 of Kikuchis disease had features of micronodular reticular echotexture (p<0.01). All nodes exhibited hypoechogenicity except one lymphomatous node demonstrated isoechogenicity, and there was no difference in sharpness of border and presence of echogenic hilum between the two diseases (p>0.05). CONCLUSION Analysis of basic ultrasonographic characteristics (size, shape, rims, matting and echotexture) helps differentiate cervical lymph nodes in patients with Kikuchis disease and lymphoma. Cervical lymphadenopathies in patients with Kikuchis disease have smaller size, less round, less micronodular reticular echotexture, and more signs of matting and cortical widening than those with lymphoma examined under ultrasound.

Risk factors for second primary neoplasia of esophagus in newly diagnosed head and neck cancer patients: a case–control study

BackgroundThe prevalence of esophageal neoplasia in head and neck (H&N) cancer patients is not low; however, routine esophageal surveillance is not included in staging of newly-diagnosed H&N cancers. We aimed to investigate the risk factors for synchronous esophageal neoplasia and the impact of endoscopy on management of H&N cancer patients.MethodsA total of 129 newly diagnosed H&N cancer patients who underwent endoscopy with white-light imaging, narrow-band imaging (NBI) with magnifying endoscopy (ME), and chromoendoscopy with 1.5% Lugol’s solution, before definite treatment were enrolled prospectively.Results60 esophageal lesions were biopsied from 53 (41.1%) patients, including 11 low-grade, 14 high-grade intraepithelial neoplasia and 12 invasive carcinoma in 30 (23.3%) patients. Alcohol consumption [odds ratio (OR) 5.90, 95% confidence interval (CI) 1.23-26.44], advanced stage (stage III and IV) of index H&N cancers (OR 2.98, 95% CI 1.11-7.99), and lower body mass index (BMI) (every 1-kg/m2 increment with OR 0.87, 95% CI 0.76-0.99) were independent risk factors for synchronous esophageal neoplasia. NBI with ME was the ideal screening tool (sensitivity, specificity, and accuracy of 97.3%, 94.1%, and 96.3%, respectively, for detection of dysplastic and cancerous esophageal lesions). The treatment strategy was modified after endoscopy in 20 (15.5%) patients. The number needed to screen was 6.45 (95% CI 4.60-10.90).ConclusionsNBI-ME surveillance of esophagus should be done in newly-diagnosed H&N cancer patients, especially those with alcohol drinking, lower BMI, and advanced stage of primary tumor.

Comparison of treatment outcomes of transnasal vocal fold polypectomy versus microlaryngoscopic surgery.

Office‐based procedures have been proposed for the treatment of vocal polyps, including indirect laryngoscopic surgery and angiolytic laser photocoagulation. Our previous report documented good treatment outcomes by combining the two aforementioned procedures. This study was intended to further compare the treatment outcomes of office transnasal vocal fold polypectomy (VFP) with those of microlaryngoscopic surgery (MLS).