- Email: [email protected]
Staging accuracy in oral cavity and oropharyngeal tumours with 1.5 and 3 Tesla MRI: radiological and pathological correlation
Poster Presentations / British Journal of Oral and Maxillofacial Surgery 50S (2012) S42–S66
P7 Audit to assess quality of junior doctors’ patient handover sheets A. Wilson ∗ , A. Hunter, K. Anjum Lancashire Teaching Hospitals NHS Trust, United Kingdom Introduction and aims: The introduction of European working time directives has created a shift pattern of work. This has resulted in twice daily handover between teams which forms a vital part of the continuation of safe and effective patient centred care. A good quality handover will be aimed to improve patient safety, reduce the risk of errors and encourage junior doctors to achieve best practice. Many maxillofacial junior doctors are newly qualified with limited exposure to hospital based handovers and are often involved in caring for multiple patients with complex medical and surgical needs. The aim of the audit was to improve the overall content of the handover. Materials and methods: The information documented in the electronic and printed handovers over a period of one month was retrospectively audited and compared to the gold standard (Guidance from the Working Time Directive working party. The Royal College of Surgeons of England March 2007). The guidelines were then circulated to all team members and thirty handovers based on the guidelines were reaudited to complete the audit cycle. Conclusion: A new handover template was designed which was laid out in a systematic way with appropriate headings which guided the team members to record the minimum dataset of information as recommended by the guidelines. The results have shown a more complete handover and has improved recording of information and thereby facilitated safe and efficient handover between junior doctors. http://dx.doi.org/10.1016/j.bjoms.2012.04.086 P8 The frequency of neck metastasis in pT1 tongue squamous cell carcinoma in Oxford John Radcliffe Hospital M. Abu-Serriah ∗ , K. Ahluwalia, F. Smith, S. Bond, K. Shah John Radcliffe Hospital, Oxford, United Kingdom Introduction: The tongue is commonest part of the oral cavity that is affected by squamous cell carcinoma (SCC). Management of the neck in T1 tumours remains controversial. Aims: • To determine the prevalence of pT1 SCC of oral tongue in Oxford John Radcliffe hospital over 10 year period. • To identify any correlation between depth of invasion and neck nodal micro metastasis. Methods: All pT1 SCC of oral tongue during the period between 2000 and 2011 have been included. Demographic
S45
data, tumour depth of invasion and neck nodal status have been recorded. Results: So far, 30 patients with pT1 SCC of the oral tongue have been identified with 57% men and an average age of 62 years (range 31–96 years). An average tumour depth of invasion of 6.8 mm (range 0.6–35 mm) was found. Twenty two patients had selective level I–IV neck dissection with 5 (23%) found to have micrometastatic neck disease. Four of the 5 patients who had positive neck on histopathology had tumour depth of invasion of 10 mm. Conclusion: • Preliminary data suggests that 1 out of 4 patients with pT1 SCC of the oral tongue is likely to have cervical nodal disease. • Data analysis so far suggests that depth of invasion less than 10 mm is unlikely to be associated with neck disease. http://dx.doi.org/10.1016/j.bjoms.2012.04.087 RP9 Staging accuracy in oral cavity and oropharyngeal tumours with 1.5 and 3 Tesla MRI: radiological and pathological correlation M. Alibhai ∗ , Z. Sadiq, R. Pawar, J. Makdissi, S. Whitley Barts and The London NHS Trust, United Kingdom Introduction: The transition of 3 Tesla MRI from largely a research tool to the clinical setting promises faster scans with less image degradation and higher resolution. MRI is used in the staging process of head and neck malignancy and is deemed the gold standard. In our practice the shift from 1.5 to 3 Tesla MRI imaging occurred this year. This study was conducted to compare the correlation between radiological and pathological tumour dimensions of patients imaged by both 1.5 T and 3 T MRI. Methods: 3 T MRI was introduced in May 2010 to the unit. 20 patients who had MRI imaging with T1-T3 oral cavity/oropharyngeal squamous cell carcinomas were identified prior to and after May 2010. All those with previous surgery or previous chemoradiation and T4 tumours were excluded. Two Consultant Radiologists reported all images. Maximum tumour sizes on MRI and from histopathology reports were recorded. Results: The mean discrepancy between radiological and pathological tumour dimensions with 1.5 T imaging was 5.7 and 3.9 mm in AP and depth respectively. In those patients imaged with 3 T MRI, the mean discrepancies were 1.8 and 1.3 mm. Non-parametric data analysis showed the difference in AP and width between 1.5 T and 3 T MRI to be statistically insignificant, p value 0.074 and 0.137 respectively. Conclusion: This pilot study shows no significant difference in image accuracy. The advantage of 3 T MRI has been proved in other specialities, in particular neuroradiology. A
S46
Poster Presentations / British Journal of Oral and Maxillofacial Surgery 50S (2012) S42–S66
study with a larger sample size is needed to show its benefit in head and neck imaging. http://dx.doi.org/10.1016/j.bjoms.2012.04.088 P10 PET with contrast-enhanced CT: its usefulness in head and neck malignancy H. Cottom ∗ , S. Bakhtiari, P. Ameerally Northampton General Hospital, United Kingdom Objective: Radiographic imaging plays an important role in facilitating clinical examination in head and neck cancer. PET-CT has been shown to further improve accurate localisation of primary head and neck neoplasms, the diagnosis of residual/recurrent disease, and may have potential in the detection of occult primaries. The objective was therefore to evaluate PET-CT in these aspects of head and neck malignancy. Method: The Northampton General Hospital PET-CT database was searched for all patients receiving a PETCT scan in relation to a known/suspected head and neck malignancy. The time period of inclusion was September 2009–October 2010. Notes for an identified 60 patients were retrieved with radiographic reports for retrospective analysis. Ethical approval was not required as information was kept entirely confidential, ensuring anonymity. Results: Of the occult primaries PET-CT correctly located the primary site in 5 patients (18.5%). In staging PET-CT appeared most beneficial in providing information on the presence/extent of distant metastatic disease, since in 1/3rd of cases there had been an underestimation by conventional radiography. In 75% PET-CT successfully identified locoregional recurrence, having 1 false-negative result. Conclusion: PET-CT was found to be accurate in surveillance and staging of head and neck cancer, particularly in relation to nodal and distant metastatic disease. In the detection of occult head and neck primaries a lower success rate was found (18.5%) compared to previous studies with falsepositives occurring in 33.3%. Nevertheless PET-CT should remain an important supplement especially in guiding biopsy, but may not be as effective as originally believed. http://dx.doi.org/10.1016/j.bjoms.2012.04.089 P11 Accuracy of MRI in prediction of tumour thickness and nodal stage in oral carcinoma
Disease recurs more commonly in patients with histopathologically invaded nodes.2 Tumour thickness is important in helping to predict local recurrence, nodal metastases and patient survival. An accurate preoperative assessment of tumour thickness is desirable for optimal treatment planning. Aim: To evaluate the correlation and accuracy of MRI measured depth of invasion and histological tumour thickness for various sub sites of oral SCC and determine its predictive accuracy for nodal metastases. Methods: A prospective review of 50 patients (34 males/16 females) with an average age of 66 years (range 38–89) who underwent primary surgery for an oral squamous cell carcinoma. MRI STIR sequence in axial plane and T2 weighted images in coronal plane were used to measure tumour thickness, size and nodal status. These were correlated with histological findings. Results: Significant correlation (p < 0.001) was found between MR measured and histological tumour thickness. Greatest correlation was observed for lateral tongue and least for floor of mouth. Sensitivity of MR at detecting nodal disease was 92% and specificity 84%. Positive predictive value of MRI at predicting nodal metastasis was 76%. 5 patients had pathological Extra Capsular Spread which was not detected on MRI. Conclusion: MRI measured tumour thickness has similar predictability for nodal metastases as histological thickness. Tongue SCC is most accurate and floor of mouth least. MRI tumour thickness is a poor predictor of ECS. Additional pre operative assessment of tumour thickness, using Ultrasound scan may be indicated for certain tumour sites and stages.
References 1. Myers EN, Fagan JJ. Treatment of the N+ neck in squamous cell carcinoma of the upper aerodigestive tract. Otolaryngol Clin North Am 1998;31:671–86. 2. Alvi A, Johnson JT. Extracapsular spread in the clinically negative neck (N0): implications and outcome. Otolaryngol Head Neck Surg 1996;114:65–70.
http://dx.doi.org/10.1016/j.bjoms.2012.04.090 P12 Application of the Oral Health Impact Profile-14 in Norwegian adults following third molar surgery. A pilot study E.C. Vigen ∗ , O. Egeland, G. Lyngstad, A. Skoglund, P. Skjelbred, L.A. Skoglund
L. Dunphy ∗ , V. Sood, W.S. Hislop
Section of Dental Pharmacology and Pharmacotherapy, University of Oslo, Norway
Crosshouse Hospital, Kilmarnock, United Kingdom
Introduction: The intensity of inflammatory symptoms (e.g. pain and swelling) is used to assess the postoperative status of patients following oral surgical procedures. The Oral Health Impact Profile 14 (OHIP) measures patients’ perceptions of the social impact of the oral disorders on their well-being.
Introduction: The presence or absence of lymph node metastases is the most important prognostic factor in patients with squamous cell carcinoma (SCC) of the head and neck.1
P7 Audit to assess quality of junior doctors’ patient handover sheets A. Wilson ∗ , A. Hunter, K. Anjum Lancashire Teaching Hospitals NHS Trust, United Kingdom Introduction and aims: The introduction of European working time directives has created a shift pattern of work. This has resulted in twice daily handover between teams which forms a vital part of the continuation of safe and effective patient centred care. A good quality handover will be aimed to improve patient safety, reduce the risk of errors and encourage junior doctors to achieve best practice. Many maxillofacial junior doctors are newly qualified with limited exposure to hospital based handovers and are often involved in caring for multiple patients with complex medical and surgical needs. The aim of the audit was to improve the overall content of the handover. Materials and methods: The information documented in the electronic and printed handovers over a period of one month was retrospectively audited and compared to the gold standard (Guidance from the Working Time Directive working party. The Royal College of Surgeons of England March 2007). The guidelines were then circulated to all team members and thirty handovers based on the guidelines were reaudited to complete the audit cycle. Conclusion: A new handover template was designed which was laid out in a systematic way with appropriate headings which guided the team members to record the minimum dataset of information as recommended by the guidelines. The results have shown a more complete handover and has improved recording of information and thereby facilitated safe and efficient handover between junior doctors. http://dx.doi.org/10.1016/j.bjoms.2012.04.086 P8 The frequency of neck metastasis in pT1 tongue squamous cell carcinoma in Oxford John Radcliffe Hospital M. Abu-Serriah ∗ , K. Ahluwalia, F. Smith, S. Bond, K. Shah John Radcliffe Hospital, Oxford, United Kingdom Introduction: The tongue is commonest part of the oral cavity that is affected by squamous cell carcinoma (SCC). Management of the neck in T1 tumours remains controversial. Aims: • To determine the prevalence of pT1 SCC of oral tongue in Oxford John Radcliffe hospital over 10 year period. • To identify any correlation between depth of invasion and neck nodal micro metastasis. Methods: All pT1 SCC of oral tongue during the period between 2000 and 2011 have been included. Demographic
S45
data, tumour depth of invasion and neck nodal status have been recorded. Results: So far, 30 patients with pT1 SCC of the oral tongue have been identified with 57% men and an average age of 62 years (range 31–96 years). An average tumour depth of invasion of 6.8 mm (range 0.6–35 mm) was found. Twenty two patients had selective level I–IV neck dissection with 5 (23%) found to have micrometastatic neck disease. Four of the 5 patients who had positive neck on histopathology had tumour depth of invasion of 10 mm. Conclusion: • Preliminary data suggests that 1 out of 4 patients with pT1 SCC of the oral tongue is likely to have cervical nodal disease. • Data analysis so far suggests that depth of invasion less than 10 mm is unlikely to be associated with neck disease. http://dx.doi.org/10.1016/j.bjoms.2012.04.087 RP9 Staging accuracy in oral cavity and oropharyngeal tumours with 1.5 and 3 Tesla MRI: radiological and pathological correlation M. Alibhai ∗ , Z. Sadiq, R. Pawar, J. Makdissi, S. Whitley Barts and The London NHS Trust, United Kingdom Introduction: The transition of 3 Tesla MRI from largely a research tool to the clinical setting promises faster scans with less image degradation and higher resolution. MRI is used in the staging process of head and neck malignancy and is deemed the gold standard. In our practice the shift from 1.5 to 3 Tesla MRI imaging occurred this year. This study was conducted to compare the correlation between radiological and pathological tumour dimensions of patients imaged by both 1.5 T and 3 T MRI. Methods: 3 T MRI was introduced in May 2010 to the unit. 20 patients who had MRI imaging with T1-T3 oral cavity/oropharyngeal squamous cell carcinomas were identified prior to and after May 2010. All those with previous surgery or previous chemoradiation and T4 tumours were excluded. Two Consultant Radiologists reported all images. Maximum tumour sizes on MRI and from histopathology reports were recorded. Results: The mean discrepancy between radiological and pathological tumour dimensions with 1.5 T imaging was 5.7 and 3.9 mm in AP and depth respectively. In those patients imaged with 3 T MRI, the mean discrepancies were 1.8 and 1.3 mm. Non-parametric data analysis showed the difference in AP and width between 1.5 T and 3 T MRI to be statistically insignificant, p value 0.074 and 0.137 respectively. Conclusion: This pilot study shows no significant difference in image accuracy. The advantage of 3 T MRI has been proved in other specialities, in particular neuroradiology. A
S46
Poster Presentations / British Journal of Oral and Maxillofacial Surgery 50S (2012) S42–S66
study with a larger sample size is needed to show its benefit in head and neck imaging. http://dx.doi.org/10.1016/j.bjoms.2012.04.088 P10 PET with contrast-enhanced CT: its usefulness in head and neck malignancy H. Cottom ∗ , S. Bakhtiari, P. Ameerally Northampton General Hospital, United Kingdom Objective: Radiographic imaging plays an important role in facilitating clinical examination in head and neck cancer. PET-CT has been shown to further improve accurate localisation of primary head and neck neoplasms, the diagnosis of residual/recurrent disease, and may have potential in the detection of occult primaries. The objective was therefore to evaluate PET-CT in these aspects of head and neck malignancy. Method: The Northampton General Hospital PET-CT database was searched for all patients receiving a PETCT scan in relation to a known/suspected head and neck malignancy. The time period of inclusion was September 2009–October 2010. Notes for an identified 60 patients were retrieved with radiographic reports for retrospective analysis. Ethical approval was not required as information was kept entirely confidential, ensuring anonymity. Results: Of the occult primaries PET-CT correctly located the primary site in 5 patients (18.5%). In staging PET-CT appeared most beneficial in providing information on the presence/extent of distant metastatic disease, since in 1/3rd of cases there had been an underestimation by conventional radiography. In 75% PET-CT successfully identified locoregional recurrence, having 1 false-negative result. Conclusion: PET-CT was found to be accurate in surveillance and staging of head and neck cancer, particularly in relation to nodal and distant metastatic disease. In the detection of occult head and neck primaries a lower success rate was found (18.5%) compared to previous studies with falsepositives occurring in 33.3%. Nevertheless PET-CT should remain an important supplement especially in guiding biopsy, but may not be as effective as originally believed. http://dx.doi.org/10.1016/j.bjoms.2012.04.089 P11 Accuracy of MRI in prediction of tumour thickness and nodal stage in oral carcinoma
Disease recurs more commonly in patients with histopathologically invaded nodes.2 Tumour thickness is important in helping to predict local recurrence, nodal metastases and patient survival. An accurate preoperative assessment of tumour thickness is desirable for optimal treatment planning. Aim: To evaluate the correlation and accuracy of MRI measured depth of invasion and histological tumour thickness for various sub sites of oral SCC and determine its predictive accuracy for nodal metastases. Methods: A prospective review of 50 patients (34 males/16 females) with an average age of 66 years (range 38–89) who underwent primary surgery for an oral squamous cell carcinoma. MRI STIR sequence in axial plane and T2 weighted images in coronal plane were used to measure tumour thickness, size and nodal status. These were correlated with histological findings. Results: Significant correlation (p < 0.001) was found between MR measured and histological tumour thickness. Greatest correlation was observed for lateral tongue and least for floor of mouth. Sensitivity of MR at detecting nodal disease was 92% and specificity 84%. Positive predictive value of MRI at predicting nodal metastasis was 76%. 5 patients had pathological Extra Capsular Spread which was not detected on MRI. Conclusion: MRI measured tumour thickness has similar predictability for nodal metastases as histological thickness. Tongue SCC is most accurate and floor of mouth least. MRI tumour thickness is a poor predictor of ECS. Additional pre operative assessment of tumour thickness, using Ultrasound scan may be indicated for certain tumour sites and stages.
References 1. Myers EN, Fagan JJ. Treatment of the N+ neck in squamous cell carcinoma of the upper aerodigestive tract. Otolaryngol Clin North Am 1998;31:671–86. 2. Alvi A, Johnson JT. Extracapsular spread in the clinically negative neck (N0): implications and outcome. Otolaryngol Head Neck Surg 1996;114:65–70.
http://dx.doi.org/10.1016/j.bjoms.2012.04.090 P12 Application of the Oral Health Impact Profile-14 in Norwegian adults following third molar surgery. A pilot study E.C. Vigen ∗ , O. Egeland, G. Lyngstad, A. Skoglund, P. Skjelbred, L.A. Skoglund
L. Dunphy ∗ , V. Sood, W.S. Hislop
Section of Dental Pharmacology and Pharmacotherapy, University of Oslo, Norway
Crosshouse Hospital, Kilmarnock, United Kingdom
Introduction: The intensity of inflammatory symptoms (e.g. pain and swelling) is used to assess the postoperative status of patients following oral surgical procedures. The Oral Health Impact Profile 14 (OHIP) measures patients’ perceptions of the social impact of the oral disorders on their well-being.
Introduction: The presence or absence of lymph node metastases is the most important prognostic factor in patients with squamous cell carcinoma (SCC) of the head and neck.1