Computed tomography image characteristics of metastatic lymph nodes in patients with squamous cell carcinoma of the head and neck

Objective

Metastatic neck nodes are commonly described as “heterogenous” or “inhomogenous” on computed tomographic (CT) images, and this remains a highly subjective issue. The purpose of this study is to justify classical criteria and to develop novel supplemental methods for diagnosing a positive neck node on CT scans.

Methods

Fifty-four patients with H&;N SCC were separated into two groups according to their neck nodal status. CT scan digital images were used and the lymph node borders were selected by a radiologist. Lymph node images from the pathologically proven N− (negative for cervical metastases) group were compared to the N+ (positive for cervical metastases) group. Image-analysis software, ImageJ, was used to record and compare various characteristics collected from the images.

Results

The image-analysis comparisons shows, the area (size) of the lymph node in the N+ group is much larger than the N− group (474.02 VS.81.55 mm²) (P < 0.01). There are no significant differences with regards to distribution of pixel values between the two groups (P = 0.79). The lacunarity, a parameter used to describe gappiness or inhomogeneity, of the N+ group was significantly higher than the N− group (P = 0.026).

Conclusions

While size of the lymph node remains an important factor in the interpretation of a clinically suspicious lymph node metastasis on CT scan images, the distribution of pixel values could not clarify a heterogeneous state. Nevertheless, ‘lacunarity’ proves to be a more accurate parameter which correlates better to the subjective heterogeneity.     

Treatment assessment based on computerized lymph node volume and ratio of necrotic area in tuberculous cervical lymphadenitis

Objective

The objective of this study was to investigate the feasibility of computerized segmentation of lymph nodes to evaluate the relationship of treatment outcomes in tuberculous cervical lymphadenitis (TCL).

Methods

The study included 52 subjects with TCL that had CT before standard medical treatment. The relationship between the medication treatment response, volume and ratio of necrotic area of the largest lymph node in patients with TCL was evaluated. The treatment outcome was defined as the ‘responder’ (n = 35) and ‘non-responder’ (n = 17) groups. Seventeen non-responder patients required surgery.

Results

The average lymph node volumes and ratio of necrotic area were 58.59 cm³ (range, 4.96–249.48 cm³) and 0.30 (range, 0–0.59), respectively. There was a significant difference in the lymph node volumes (34.91 ± 24.00 cm³ vs. 107.04 ± 69.12 cm³, p < 0.001) and ratio of necrotic area (0.26 ± 0.12 vs. 0.40 ± 0.14, p = 0.001) between responders and non-responders. The receiver-operating-characteristic (ROC) curve analysis was used for differentiating responders from non-responders; it showed that the area under the curve for the lymph node volumes and ratio of necrotic area was 0.845 and 0.759, respectively. The cut-off value for the lymph node volumes and ratio of necrotic area was 44.15 cm³ and 0.36 based on the ROC curve.

Conclusions

A large lymph node volume and high ratio of necrotic area on the 3D reconstruction of CT images were associated with the response to medical treatment for TB. These findings might be useful for assessing treatment outcomes.     

Expression of Epidermal Growth Factor Receptor variant III in laryngeal carcinoma tissues

Objectives

Epidermal Growth Factor Receptor variant III (EGFRvIII) has been believed to be an attractive tumor-specific candidate for molecular targeting therapy. However, there is little literature dealing with this variant of EGFR expressed in laryngeal carcinomas. In the present study, we try to evaluate the expression of EGFRvIII, as well as EGFR, in laryngeal carcinoma tissues and its correlation with clinicopathological features.

Methods

Real-time polymerase chain reaction (real-time PCR) with TaqMan probes was applied to detect the expression for EGFR and EGFRvIII mRNA in the 39 pairs of samples of laryngeal carcinoma tissues and microscopically normal laryngeal mucosal tissues adjacent to the tumor. 2^−ΔΔCT method was used to obtain the relative quantity of target mRNA expression. The correlation between EGFRvIII expression and its clinicopathological features was analyzed by Pearson's chi-squared test.

Results

Among the 39 pairs of samples of laryngeal carcinoma tissues and microscopically normal laryngeal mucosal tissues adjacent to the tumor, the level of EGFR mRNA of the former (0.030 ± 0.076) was higher than that of the latter (0.011 ± 0.046) (P < 0.01). EGFRvIII mRNA was detected only in six samples of laryngeal carcinoma tissues. While, as control, in 39 samples of microscopically normal laryngeal mucosal tissues, EGFRvIII mRNA was hardly detected. As analyzing the correlation between expression of EGFRvIII and EGFR, we found the positive rate of EGFRvIII expression was higher in samples with relative EGFR mRNA value ≥0.025 than those of EGFR mRNA <0.025. The difference between them was statistically significant (P < 0.05).

Conclusions

Expression of EGFRvIII in laryngeal carcinoma was confirmed in this study. It is tumor-specific and tends to be more frequent in EGFR-over expressing tumor tissues and poorly differentiated ones, which may in part contribute to the malignant phenotype.     

Prognostic value of hypoxia-inducible factors (angiogenin and endoglin) in open partial laryngectomies: uni- and multivariate analyses

Purpose

Advances in transoral laser microsurgery, radiotherapy, and chemotherapy (and their combinations) have reduced the indications for open partial laryngectomies, although they have replaced total laryngectomies in selected advanced or recurrent laryngeal squamous cell carcinomas (LSCCs). Tissue hypoxia in malignancies appears to be strongly associated with tumor cell invasiveness and metastases. Whether hypoxia-inducible factors can contribute to a rational recommendation of open partial laryngectomy should be investigated.

Materials and methods

Fifty consecutive patients who had undergone primary open partial laryngectomy (supraglottic and supracricoid laryngectomies) were investigated, measuring the immunohistochemical expression of the hypoxia-inducible proteins angiogenin and endoglin in their primary LSCCs also with image analysis.

Results

Univariate analysis showed a significantly higher recurrence rate (P = .007) and shorter disease-free survival (P = .0047) in patients with LSCC with endoglin expression more than 9.0%. Multivariate analysis found endoglin expression independently prognostic in terms of disease-free survival (P = .012). Angiogenin expression (in carcinoma or endothelial cells) was not associated with prognosis.

Conclusions

Endoglin should be further studied as a biomarker of patients with LSCC at higher risk for recurrence after open partial laryngectomy who may benefit from more aggressive treatments. Endoglin expression in positive laryngeal biopsies may prove useful as a parameter for choosing between different surgical and multimodality approaches to controversial LSCC cases.     

Expression of CC-chemokine receptor 7 (CCR7) and CXC-chemokine receptor 4 (CXCR4) in head and neck squamous cell carcinoma

Objectives

We tried to clarify the correlation of the expression of CCR7 and CXCR4 with lymph node and distant metastasis.

Materials and methods

We examined expression of CCR7 and CXCR4 in 9 HNSCC cell lines and 25 HNSCC tissues by semi-quantitative RT-PCR and immunohistochemistry study. We examined the expression levels of CCR7 and CXCR4 in undifferentiated and differentiated human normal keratinocyte.

Results

All cell lines expressed CCR7 mRNA, and three expressed CXCR4 mRNA. CCR7 and CXCR4 mRNAs were significantly higher in HNSCC tissues than in non-neoplastic tissues (p < 0.05, respectively) and correlated with lymph node metastasis (p < 0.05, respectively). The level of CXCR4 mRNA also correlated with distant metastasis (p < 0.05). Immunohistochemistry demonstrated localization of CCR7 and CXCR4 to carcinoma cells and lymphocytes and immunohistochemical staining scores of CCR7 and CXCR4 also showed similar correlation to lymph node and distant metastasis with CCR7 and CXCR4 mRNA levels. The level of CCR7 mRNA was significantly higher in poorly and moderately differentiated than in well-differentiated HNSCC (p < 0.05). The level of CCR7 mRNA in undifferentiated keratinocyte was significantly higher than that in differentiated keratinocyte.

Conclusion

The expression of CCR7 in HNSCC increases by dedifferentiation and plays an important role in lymph node metastasis of HNSCC and CXCR4 plays an important role in lymph node metastasis as well as distant metastasis.     

p53 expression in concurrent chemoradiotherapy with docetaxel for head and neck squamous cell carcinoma

Background

The current study aimed to evaluate the significance of an immunohistochemical assessment of tumor suppressor p53 as a prognostic marker in head and neck squamous cell carcinoma (HNSCC) patients treated with docetaxel and radiotherapy.

Methods

The expression of tumor suppressor p53 and its phosphorylated form at the Ser392 residue was retrospectively evaluated by immunohistochemistry in 51 Stage T1-3N0-2M0 (except T1N0 glottis) HNSCC patients who were treated with 10 mg/m²/week docetaxel four to six times and received concurrent chemoradiotherapy.

Results

Kaplan–Meier univariate analysis revealed that no difference in rates for overall and disease-free survival (DFS) between patients with p53-positive and -negative tumors (p = 0.786 and p = 0.924, respectively). The prognostic significance of phosphorylated p53 at the Ser392 residue was neither observed.

Conclusions

An immunohistochemical assessment of the expression of p53 and its phosphorylated form might not be of clinical use in defining subgroups of patients with poor prognosis.     

Efficacy of combined treatment with S-carboxymethylcysteine (carbocisteine) and clarithromycin in chronic rhinosinusitis patients without nasal polyp or with small nasal polyp

Objective

In Japan, fourteen-membered ring macrolides, antibacterial agents, and S-carboxymethylcysteine (SCMC; carbocisteine), a mucolytic, are commonly used to treat chronic rhinosinusitis (CRS), and they are also used in combination. However, no large-scale randomized study has examined the effects of these pharmacotherapies. The aim of this study is to evaluate the effect of combined administration of clarithromycin (CAM), a fourteen-membered ring macrolide, and SCMC, compared with CAM single therapy.

Methods

Patients with CRS were centrally registered and randomly assigned to treatment with CAM (200 mg/day) alone (monotherapy group) or CAM (200 mg/day) in combination with SCMC (1500 mg/day; combination group) for 12 weeks. We assessed the clinical efficacy of the treatments using measures of subjective symptoms and objective findings, health-related quality of life (HRQOL) determined by the 20-Item Sino-Nasal Outcome Test (SNOT-20) score and computed tomography (CT) score.

Results

Four hundred twenty-five subjects were enrolled (combination group, 213; monotherapy group, 212). At week 12 of treatment, the rate of effectiveness was significantly higher in the combination group (64.2%) compared with the monotherapy group (45.6%; P = 0.001). In addition, objective findings, including characteristics of nasal discharge (P = 0.008) and post-nasal discharge (P = 0.002) were significantly improved in the combination group. In both groups, SNOT-20 and CT scores were significantly improved from week 0 (P < 0.001), and were not significantly different between groups.

Conclusion

The results indicated that long-term combination therapy with SCMC at a dose of 1500 mg/day and CAM at a dose of 200 mg/day is effective for improving subjective symptoms and objective findings in adult patients with CRS.     

Concurrent chemoradiotherapy with adjuvant chemotherapy for high-risk nasopharyngeal carcinoma

Objectives

To evaluate the impact of invasion of the prevertebral or parapharyngeal spaces and large tumor volume on treatment outcomes in patients with nasopharyngeal carcinoma (NPC).

Methods

A total of 105 patients with newly diagnosed NPC were enrolled in this study. TNM stage and presence of invasion of the prevertebral or parapharyngeal spaces were recorded. All patients received a total dose of 70–75 Gy.

Results

After controlling for age, sex, and chemotherapy status, invasion of the prevertebral or parapharyngeal spaces and large primary tumor volume produced a significantly increased hazard ratio for distant metastasis and recurrence. We defined patients with two or more such prognostic factors as high-risk patients, in whom the 3-year metastasis-free survival rate, with and without adjuvant chemotherapy, was 100% and 69.6%, respectively (P = 0.02). Their 3-year recurrence-free survival rate, with and without adjuvant chemotherapy, was 93.3% and 70.2% (P = 0.09). This benefit was not observed in low-risk NPC patients.

Conclusion

NPC patients with any two or more of the factors, involvement of the prevertebral space, large primary tumor volume, or advanced parapharyngeal space invasion, had more recurrence and poor survival rates and benefited from concurrent chemoradiotherapy followed by adjuvant chemotherapy.     

High Gpx1 expression predicts poor survival in laryngeal squamous cell carcinoma

Objective

Several studies have demonstrated that abnormal glutathione peroxidases 1 (Gpx1) expression can influence the biological behavior of malignant cells. However, the roles of Gpx1 in laryngeal squamous cell carcinoma (LSCC) remain unknown. The purpose of this study is to analyze the Gpx1 expression and prognostic significance in LSCC patients.

Management of neck metastases in T2N0 lip squamous cell carcinoma

Background

Prophylactic neck dissection (PND) is indicated when the chance of occult lymph node metastases from head and neck tumors is significant. There is no consensus regarding which tumor size PND would be indicated in cases of lip cancer.

Methods

A total of 139 patients with surgically treated lip cancer were selected. The size of the lesion (T) and the presence of lymph node metastases (N) were assessed by examining the medical records. For analysis purposes, the T2 group was divided into T2a (2 to 3 cm) and T2b (3 to 4 cm).

Results

The following distribution of incidence of neck metastases was observed in the study groups: 11.7% in T1, 9% in T2a, 43.7% in T2b, and 52.2% in T3 + T4. Statistical comparison of the groups (p) revealed the following results: T2a X T2b = 0.03; T2a X T3 + T4 = 0.001.

Conclusion

PND is indicated for tumors larger than 3 cm.     

Bacterial biofilms in chronic rhinosinusitis and their relationship with inflammation severity

Aims

To identify the presence of bacterial biofilms on mucosal specimens from chronic rhinosinusitis (CRS) patients, and evaluate their relationship with severity of CRS.

Methods

A prospective study of biofilms presence on 24 CRS patients compared with 12 controls was designed. The presence of biofilms was determined by scanning electron microscopy (SEM), and associations with the preoperative Lund–MacKay CT scores, Johansson endoscopic scores, and the history of ESS were assessed.

Results

Biofilms were found in 13/24 CRS patients (54.2%) but in only 1/12 controls (8.3%; P < 0.01). CRS patients with and without biofilms had similar preoperative Lund–MacKay CT and Johansson endoscopic scores (P > 0.05). Patients with revision ESS showed a tendency of higher biofilms incidence (5/7, 71.4%) than those undergoing their first procedure (8/17, 47.1%), but did not reach a significant difference (P > 0.05).

Conclusions

The higher incidence of biofilms in CRS patients suggests a role in the pathogenesis of CRS, but no correlation with severity of CRS.     

An extremely rare case of large Delphian node metastasis preceding primary laryngeal cancer

Objectives

To present an extremely rare case of large Delphian node metastasis preceding primary laryngeal cancer.

Materials and methods

A 74-year-old male who noted a mass on the lower anterior neck and consulted our department immediately. The mass rapidly grew to 6 cm from 2 cm in diameter within 2 months after the initial presentation.

Results

Fiberoptic laryngoscopy was unremarkable. Surgical excision of the lesion showed well differentiated squamous cell carcinoma with invasion into the surrounding tissues. Postoperative radiotherapy was added. During follow-up after those treatments, thickening of the right vocal cord was observed, which gradually became more apparent. Total laryngectomy was performed 13 months after the initial operation.

Conclusion

Delphian node metastasis is included in the differential diagnosis in a case of rapidly increasing mass in the anterior neck.     

Quantitative measurement of radiofrequency volumetric tissue reduction by multidetector CT in patients with inferior turbinate hypertrophy

Objective

To objectively assess the efficacy of radiofrequency thermal ablation of inferior turbinate hypertrophy.

Methods

Thirty-five patients with nasal obstruction secondary to inferior turbinate hypertrophy were prospectively enrolled. Radiofrequency energy was delivered to four sites in each inferior turbinate. Patients were evaluated before and 8 weeks after intervention. Subjective evaluation of nasal obstruction was performed using a visual analogue scale (VAS), and objective evaluation of the turbinate volume reduction was calculated using multidetector CT. Volumetric measurements of the preoperative inferior turbinate were compared with postoperative values on both sides.

Results

The great majority of patients (91.4%) exhibited subjective postoperative improvement. Mean obstruction (VAS) improved significantly from 7.45 ± 1.48 to 3.54 ± 1.96. Significant turbinate volume reduction was achieved by the surgery on both right and left sides [(preoperative vs. postoperative, right: 6.55 ± 1.62 cm³ vs. 5.10 ± 1.47 cm³, (P < 0.01); left: 6.72 ± 1.53 cm³ vs. 5.00 ± 1.37 cm³, (P < 0.01)] respectively.

Conclusion

Radiofrequency is a safe and effective surgical procedure in reducing turbinate volume in patients with inferior turbinate hypertrophy. Multidetector CT is an objective method of assessment in detecting radiofrequency turbinate volume reduction.     

Effects of benign parotid tumors on unstimulated saliva secretion from the parotid gland

Objective

Salivary tumors can manifest as abnormalities of the gland itself and/or changes in salivary flow. However, effects of salivary tumors on saliva secretion have not been studied in much detail. The aim of the present study was to evaluate effects of benign parotid tumors on unstimulated saliva secretion from the affected gland.

Methods

Unstimulated parotid saliva was collected bilaterally using the swab method in patients with unilateral pleomorphic adenoma (n = 14) or Warthin's tumor (n = 6). Pre-weighted cotton rolls were placed at the opening of each parotid duct for 15 min.

Results

The range of salivary flow was similar to that found in studies on unstimulated parotid saliva. Salivary flow did not differ between the involved and non-involved side. No difference was found between the involved and non-involved side when the patients with pleomorphic adenoma or Warthin's tumor were separately analyzed.

Conclusion

The present results suggest that the most common benign parotid tumors do not alter unstimulated salivary flow from the affected gland.     

Therapeutic effects of a new photosensitizer for photodynamic therapy of early head and neck cancer in relation to tissue concentration

Objective

Talaporfin sodium (Laserphyrin^®, Meiji Seika, Tokyo, Japan) is a second-generation photosensitizer developed in Japan. It is characterized by both mild and short-term skin photosensitivity. The objective of this study was to evaluate the efficacy and the pharmacokinetic characteristics in tumor tissues in patients with head and neck cancer.

Methods

(1) Four hours after administration intravenous injection of talaporfin sodium (40 mg/m²), 100 mg tissue specimens were taken from the central part of the tumor. The samples were analyzed by reverse phase liquid chromatography and concentrations were measured. (2) Four hours after intravenous injection of talaporfin sodium (40 mg/m²), we gave 60–150 J/cm² of 664 nm laser irradiation with a diode laser (PD laser, Panasonic, Japan). Biopsies were performed at 4 weeks and at 3 months after treatment and periodically thereafter to confirm the treatment efficacy of photodynamic therapy (PDT).

Results

Of the 14 patients who grope informed consent, more than 1 μg/g of talaporfin sodium was found in the tumor tissues in 13. Moreover, in 9 patients, tumor-to-normal-tissue ratios ranged from 2.32:1 to 5.69:1, which indicates that more than double the amount of talaporfin sodium was maintained within the tumor than in normal tissues. We have enrolled 22 patients with head and neck cancer with no clinically recognizable metastases after obtaining written informed consent to participate in this study. PDT using talaporfin sodium exhibited the equivalent efficacy to that of conventional PDT using hematoporphyrin derivative (HpD).

Conclusions

The results using a combination of talaporfin sodium and PD laser achieved a primary treatment outcome equivalent to that of conventional PDT. This method has also proven to be advantageous because of the reduced incidence of side effects such as photosensitivity and local edema.     

Long-term results of open cordectomy for the treatment of T1a glottic laryngeal carcinoma

Objective

To assess the long-term results and prognostic factors in patients who have undergone open cordectomy (OC) for the treatment of T_1a glottic laryngeal carcinoma.

Methods

One hundred four epidermoid cancer patients operated from January 1989 through December 1999 were included in the study. Clinical parameters, postoperative complications, and postoperative stay were retrospectively evaluated in all cases.

Results

Mean survival for the patients included in the study was 61.5 ± 24.8 months after the date of operation (range: 11–121 months). Ninety-four patients did not have recurrent tumor (90.4%). Local, regional and distant recurrence were linked with a statistical negative impact on survival rates (p < 0.05). Only sero-hematoma was significantly related to local recurrence (p < 0.05), whereas the remainder complications did not. None of the complications was associated with neck recurrence or distant metastasis (p > 0.05).

Conclusions

Open cordectomy is nowadays a valid technique for the surgical treatment of T_1a glottic laryngeal carcinoma. Its results are comparable with those of other more recent techniques.     

Rotation vectors of slow and quick phase of caloric nystagmus

Objective

The purpose of this study was to elucidate the rotation axes of the slow and quick phase of the caloric nystagmus using the video-oculograhic technique.

Methods

Subjects were placed in a supine position and cold-water stimulation was applied to the right ear canal. The eye movements were recorded in complete darkness by a high-speed infrared CCD camera. The sampling time of the camera was 132 Hz with 640 × 480 effective pixels.

Results

The rotation vectors were calculated from the printed-out chart of the 3D analysis data of the caloric nystagmus. The directions of the rotation vector of the quick phase of the nystagmus were almost opposite to those of the slow phase. The average planer equations of the slow and quick phase of the nystagmus in all subjects were 0.399x + 0.1477y − 0.8656z = 0 and −0.3970x − 0.1940y + 0.8559z = 0, respectively.

Conclusion

We demonstrated that the slow phase and quick phase of the vestibular nystagmus are along with the same axes in human subjects.     

Comparing postoperative quality of life in children after microdebrider intracapsular tonsillotomy and tonsillectomy

Objective

To evaluate postoperative quality of life in patients undergoing microdebrider intracapsular tonsillotomy and adenoidectomy (PITA) in comparison with traditional adenotonsillectomy (AT) and to assess PITA's efficacy in solving upper-airway obstructive symptoms.

Methods

29 children with adenotonsillar hyperplasia referred for AT were included. Patients were divided into two groups: Group 1 (underwent PITA) included 14 children (age 5.1 ± 1.8 years) affected by night-time airway obstruction without a relevant history of recurrent tonsillitis; Group 2 (underwent AT) included 15 children (age 5.2 ± 1.7 years) with a history of upper-airway obstruction during sleep and recurrent acute tonsillitis. Outcomes measures included the number of administered pain medications, time before returning to a full diet, Obstructive Sleep Apnea survey (OSA-18), parent's postoperative pain measure questionnaire (PPPM) and Wong–Baker Faces Pain Rating Scale (WBFPRS).

Results

Postoperative pain was significantly lower in the PITA group, as demonstrated by PPPM and WBFPRS scores and by a lower number of pain medications used. PITA group also resumed a regular diet earlier (P < 0.001). OSA-18 scores proved that both PITA and AT were equally effective in curing upper-airway obstructive symptoms.

Conclusion

PITA reduces post-tonsil ablation morbidity and can be a valid alternative to AT for treating upper-airway obstruction due to adenotonsillar hyperplasia.     

Risk factors for protracted sinusitis in pediatrics after endoscopic sinus surgery

Objectives

The goal of this article is to investigate the factors leading to protracted nasal discharge after pediatric endoscopic sinus surgery.

Methods

A retrospective chart review of all pediatric patients who had received endoscopic sinus surgery for chronic rhinosinusitis between January 2002 and September 2006 was conducted. The patients were assigned to the “protracted” group if they demonstrated persistent mucopurulent nasal discharge for more than 3 months after endoscopic sinus surgery, and otherwise to the “resolved” group.

Results

There were 21 “protracted” patients (39.6%) and 32 “resolved” patients (60.4%). Among these patients, age at diagnosis or operation, time from initial diagnosis to operation, and blood eosinophil count did not differed significantly between the “protracted” and the “resolved” groups. On the other hand, sinonasal polyposis (80.9% vs. 53.1%, P = 0.039), history of allergic rhinitis (52.4% vs. 12.5%, P = 0.002) and gender (male vs. female = 80.9% vs. 43.7%, P = 0.007) were more frequently observed in the “protracted” group than in the “resolved” group. These associations remained significant in a multivariate logistic regression (odds ratio = 9.36, 10.69 and 14.84, respectively).

Conclusion

Sinonasal polyposis, history of allergic rhinitis and gender were significant and independent risk factors for protracted nasal discharge after pediatric endoscopic sinus surgery. These risk factors should be taken into consideration during preoperative counseling.