Objectives
Compare the rates of post‐operative chyle leak following therapeutic lateral neck dissection during treatment of papillary thyroid carcinoma (PTC) versus squamous cell carcinoma (SCC) of ...the head and neck.
Methods
A retrospective analysis of 226 consecutive neck dissections in 201 patients who underwent therapeutic neck dissection involving at least levels II‐IV with a final pathologic diagnosis of mucosal SCC of the head and neck or PTC from 2010 to 2020. Specific cases of chyle leak were reviewed. Surgical factors associated with chyle leak were analyzed using logistic regression analysis. Duration of chyle leak was assessed by the Kaplan–Meier curve, and time‐to‐resolution was analyzed by Cox proportional hazard analysis.
Results
Postoperative chyle leak was encountered in 15 (6.6%) neck dissections, eight (12.3%) in PTC, and seven (4.3%) in SCC. High‐volume chyle leak and chyle leak requiring operative intervention were only encountered in neck dissections performed for PTC. Chyle leak was significantly associated with PTC on univariable analysis (OR 3.08, p = 0.037), but not on multivariable analysis (OR 1.35, p = 0.711). High‐volume chyle leak and the need for operative intervention were associated only with PTC patients (OR 23.6, p = 0.006; OR 18.09, p = 0.023 respectively). Median duration of chyle leak was 12.1 days among patients with SCC, and 20.5 days among patients with PTC (p = 0.089).
Conclusions
Among 201 patients undergoing therapeutic neck dissection, chyle leak was associated with PTC pathology on univariable but not multivariable analysis. However, high‐volume leaks and leaks requiring operative intervention only occurred among patients with PTC.
Level of evidence
level III Laryngoscope, 133:2959–2964, 2023
Objectives/Hypothesis
Investigate the relationship between facility volume and type on overall survival (OS) in patients with major salivary gland cancer undergoing surgical treatment.
Study Design
...Retrospective review of the National Cancer Database (NCDB) 2004–2015.
Methods
The NCDB was queried for patients with surgically treated major salivary gland cancer. The mean number of cases treated at each institution was calculated. High‐volume facilities (HVFs) were defined as the top 10% of centers. Univariate and multivariate propensity score‐matched analyses were performed to evaluate the impact of facility volume and type on OS.
Results
A total of 8,658 patients were analyzed. Distribution among facilities was highly skewed, with a median value of 1.38 cases/year (range, 0.11–23.25). On univariate analysis, treatment at HVFs was not associated with improved OS. However, there were significantly more patients with adverse clinical features treated at HVFs. Treatment at HVFs was associated with increased rates of concomitant neck dissections and lower rates of positive margins. In propensity‐score matched cohorts, OS was not significantly improved in patients treated at HVFs (hazard ratio HR: 0.979; 95% confidence interval CI: 0.879‐1.091) or academic/research institutions (HR: 0.914; 95% CI: 0.821‐1.018).
Conclusions
Regionalization of care is occurring in patients with major salivary gland malignancies. Patients treated at HVFs had greater rates of adverse clinical features and more commonly underwent neck dissections, although adjuvant radiotherapy rates were similar between facility types. There was no apparent survival benefit to patients treated at HVFs or academic/research institutions, although there were lower rates of positive margins at HVF.
Level of Evidence
NA
Laryngoscope, 129:2321–2327, 2019
The validity of sentinel lymph node biopsy (SLNB) for T1 or T2, clinically N0, oral cancer was tested by correlation of sentinel node pathologic status with that of nodes within the completion neck ...dissection.
This prospective, cooperative group trial involved 25 institutions over a 3-year period. One hundred forty patients with invasive oral cancers, stage T1 and T2, N0 including 95 cancers of the tongue, 26 of the floor of mouth, and 19 other oral cancers were studied. The study excluded lesions with diameter smaller than 6 mm or minimal invasion. Imaging was used to exclude nonpalpable gross nodal disease. Patients underwent injection of the lesion with (99m)Tc-sulfur colloid, nuclear imaging, narrow-exposure SLNB, and completion selective neck dissection. The major end point was the negative-predictive value (NPV) of SLNB.
In the 106 SLNBs, which were found to be pathologically and clinically node-negative by routine hematoxylin and eosin stain, 100 patients were found to have no other pathologically positive nodes, corresponding to a NPV of 94%. With additional sectioning and immunohistochemistry, NPV was improved to 96%. In the forty patients with proven cervical metastases, the true-positive rate was 90.2% and was superior for tongue tumors relative to floor of mouth. For T1 lesions, metastases were correctly identified in 100%.
For T1 or T2 N0 oral squamous cell carcinoma, SLNB with step sectioning and immunohistochemistry, performed by surgeons of mixed experience levels, correctly predicted a pathologically negative neck in 96% of patients (NPV, 96%).
To quantify changes in tumor size and tumor-free margins following surgical resection and formalin fixation of oral cavity squamous cell carcinoma.
Nineteen patients were studied via cohort design. ...Between May and December 2011, measurements of tumor size and tumor-free margin were made in patients with squamous cell carcinoma of the oral cavity. Mucosal reference points were marked with sutures, representing tumor diameter and two separate resection margins. Measurements were recorded immediately before resection, after resection, and following fixation in formalin.
The overall mean shrinkage in tumor size was 10.7% (95% CI 3.4–18.0, p=0.006). When comparing mean tumor measurements, most of the tumor size decrease (6.4%, 95% CI 0.4–12.4, p=0.039) occurred between pre- and post-excision measurements. To a lesser extent, tumor size decreased following formalin fixation. Comparison of tumor-free margin measurements revealed a pre-excision to post-fixation mean decrease of 11.3% (95% CI 2.9–19.6%, p=0.011), with a statistically significant decrease of 14.9% (95% CI 8.5–21.3%, p<0.001) occurring between pre- and post-excision, and no significant decrease from post-excision to post-formalin fixation.
Mucosal dimensions of both tumor and tumor-free margins in oral cavity squamous cell carcinoma specimens decrease between surgical resection and pathologic analysis. Most of this decrease occurs prior to fixation, especially for margins, and may be due to intrinsic tissue properties rather than formalin effects.
Objectives/Hypothesis
Our objective was to identify the accuracy, sensitivity, and specificity of pathological interpretation of mandibular invasion by oral cavity squamous cell carcinoma (SCC) and ...compare the sensitivity of detecting mandibular invasion in the erosive versus the infiltrative patterns of invasion. We also aimed to describe the significance of the terminology the carcinoma “abuts the mandible” in pathologic interpretation of mandibular invasion.
Study Design
Retrospective case series.
Methods
Mandibulectomy specimens from patients who underwent surgical treatment for oral cavity SCC between January 1, 2005 and December 31, 2015 were retrospectively reviewed by a board‐certified anatomic pathologist. The accuracy of pathologic interpretation of mandibular invasion was calculated using the retrospective interpretation of bone invasion as the true interpretation, which was compared to the interpretation on the original pathology report. Incidence of encountering the terminology the carcinoma “abuts the mandible” in the pathology report was calculated.
Results
A series of 108 consecutive mandibulectomy specimens were reviewed. Sixty‐nine percent (74/108) of cases were interpreted as having mandibular invasion. The accuracy of interpreting mandibular invasion was 84%. The sensitivities for interpretation of mandibular invasion for the erosive and infiltrative patterns of invasion were 77% (30/39) and 91% (32/35), respectively (P = .08). Nine percent (10/108) of pathology reports utilized the terminology the carcinoma “abuts the mandible,” and 80% (8/10) of these cases exhibited mandibular invasion.
Conclusions
The accuracy of identifying mandibular invasion is 84%, indicating a certain degree of sampling error and variability in interpretation. A precise pathologic definition of mandibular invasion should be applied during the interpretation of these specimens to minimize variability.
Level of Evidence
4 Laryngoscope, 130:1721–1724, 2020
Background
The objective of this study was to determine survival outcomes in patients who underwent retreatment of recurrent cases of cutaneous melanoma of the head and neck (CMHN).
Methods
...Retrospective review of all patients who were treated for primary clinical stage I or II CMHN between January 1, 2000 and December 31, 2015.
Results
Twenty percent (33/168) of the patients developed a recurrence. Sixty‐six percent (4/6) of patients who developed local recurrence first and 50% (3/6) of patients who developed regional recurrence first were alive without evidence (NED) of disease at last follow‐up, while 0% (0/21) of patients who developed distant or simultaneous recurrences first were NED at last follow‐up. Among the 7 patients who were NED, the mean time from recurrence to last follow‐up was 735 days.
Conclusions
Of patients with isolated local or regional recurrences, 58% (7/12) obtained durable curative treatment for recurrent melanoma.
Tuft cells are bottle-shaped, microvilli-projecting chemosensory cells located in the lining of a variety of epithelial tissues and, following their identification approximately 60 years ago, have ...been linked to immune system function in a variety of epithelia. Until recently, Tuft cells had not been convincingly demonstrated to be present in salivary glands with their detection by transmission electron microscopy only shown in a handful of earlier studies using rat salivary glands, and no follow-up work has been conducted to verify their presence in salivary glands of other species. Here, we demonstrate that Tuft cells are present in the submandibular glands of various species (i.e., mouse, pig and human) using transmission electron microscopy and confocal immunofluorescent analysis for the POU class 2 homeobox 3 (POU2F3), which is considered to be a master regulator of Tuft cell identity.
Objectives
Determine if Mohs micrographic surgery (MMS) is associated with improved overall survival compared to wide local excision (WLE) when treating cutaneous melanoma of the head and neck (CMHN) ...and to report the proportion of patients treated with MMS versus WLE who also underwent sentinel lymph node biopsy (SLNB).
Methods
Retrospective cohort study of the National Cancer Database (NCDB) analyzing the overall survival of patients diagnosed with T1 to T4 CMHN between 2004 and 2016 who were treated with either WLE or MMS.
Results
On multivariable analysis, treatment with WLE versus MMS was not significantly associated with overall survival (HR, 1.094; 95% CI, 0.997–1.201). On multivariable analysis, lower Charlson‐Deyo score (HR, 0.489; 95% CI, 0.427–0.560), negative margins (HR, 0.754; 95% CI, 0.705–0.807), and N0 classification (HR 0.698; 95% CI, 0.668–0.730) were associated with improved overall survival. Seventy‐seven percent of patients treated with MMS did not undergo SLNB, while 45% of patients treated with WLE did not undergo SLNB (P < .001).
Conclusions
No difference in overall survival between MMS and WLE when treating CMHN. Patients treated with MMS were significantly less likely to undergo SLNB, suggesting an opportunity for enhancement of multidisciplinary care.
Level of Evidence
4 Laryngoscope, 131:2490–2496, 2021
(1) For patients with oral squamous cell carcinoma (OSCC) and mandibular invasion, to determine whether prior radiation to the head and neck region (PXRTHN) affects the density of osteoblasts, ...osteoclasts, or fibroblasts along the tumor interface invading the mandible and whether this is significantly associated with overall survival. (2) To identify clinicopathologic features that are associated with overall survival.
Case series with chart review.
University of Missouri hospital.
Retrospective review of 74 cases with pathologically confirmed mandible invasion by OSCC and surgical treatment between January 1, 2005, and December 31, 2015. A board-certified anatomic pathologist reviewed the slides from all mandibulectomy cases.
The mean density of osteoclasts was 2.0 per linear mm among the patients with PXRTHN and 7.1 among those without PXRTHN ( P < .001). Positive soft tissue frozen section margin was significantly associated with overall survival on univariate analysis ( P < .001; hazard ratio HR, 0.34; 95% CI, 0.19-0.62) and multivariate analysis ( P = .026; HR, 0.41; 95% CI, 0.19-0.90). Maximum tumor dimension was significantly associated with overall survival on univariate analysis ( P = .021; HR, 1.19; 95% CI, 1.03-1.38) and multivariate analysis ( P = .002; HR, 1.49; 95% CI, 1.16-1.93). Osteoclast, osteoblast, and fibroblast density were not associated with overall survival.
(1) Osteoclast density along the tumor front is significantly lower among patients with PXRTHN. Stromal cell density was not associated with overall survival. (2) Positive soft tissue frozen section margin and maximum tumor dimension are significantly associated with overall survival among patients with mandibular invasion by OSCC.
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