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R027: Correlation Analysis of Oral Lesion Size by Various Criteria
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Otolaryngology-Head and Neck Surgery, Vol 137, No 2S, August 2007
R027
ipsilateral cancer of the head and neck with carotid stenosis was performed. Stage and treatment of cancer, history of XRT, vascular and neurologic symptoms at presentation and workup, as well as outcomes were studied. RESULTS: Nine patients were reviewed; 7/9 patients had previously received XRT; 7/9 presented symptomatically. There was an average carotid occlusion of 84.5%; 7/9 patients received endovascular stents, 2/9 received endarterectomy. There was an average of 13.6 months follow up and 7/8 had carotid patency at their last visit. Average survival, postvascular procedure of 26.1 months was observed. No permanent neurologic events were noted in either stented or endarterectomy patients. CONCLUSION: Patients with head/neck cancer and ipsilateral carotid stenosis who are suitable for endarterectomy may be treated with concurrent endarterectomy followed by appropriate neck dissection and treatment of the primary malignancy if no salivary leakage is anticipated. Unsuitable patients for endarterectomy may be treated with carotid stenting followed by radiation therapy or, if permissible, planned extirpation one month after, with a break in the required anticoagulants. For those patients with a history of head and neck cancer that have been treated with surgery and/or radiation and later develop critical stenosis, endovascular stenting is likely the safest treatment. SIGNIFICANCE: Patients with head and neck cancer frequently have vascular disease. Evaluation and treatment options for vascular disease are discussed.
Correlation Analysis of Oral Lesion Size by Various Criteria Carrie Flanagan, MD (presenter); Frank G Ondrey, MD, PhD PROBLEM: To compare standard bi-dimensional measurement of oral lesions to examine for correlation with Response Evaluation Criteria in Solid Tumors (RECIST) criteria, and to determine the feasibility of digital image analysis for potential automated lesion measurements. METHODS: Thirteen patients with oral dysplastic leukoplakia were evaluated. Bi-dimensional measurements and photographs were taken of the lesion at the time of presentation. Within the photograph, a perioprobe was used as a standardized measure. Using Adobe Photoshop, the photographs were analyzed by measuring the lesion within the photo as well as determining the number of pixels that constituted the lesion. RESULTS: RECIST criteria correlated significantly with bidimensional measurement (r squared ⫽ 0.7925, p⬍0.0001). Additionally, there was significant correlation between digitized measures obtained via the photograph and the bi-dimensional measurement (r squared ⫽ 0.6652, p⬍0.0007). However, there was no correlation between pixel count and RECIST criteria or bi-dimensional measurement. CONCLUSION: Bi-dimensional measurement of oral leukoplakia and RECIST criteria are highly correlated. Additionally digitized measurements obtained from photgraphs were correlated, although very cumbersome and time-consuming to perform. The authors recommend simple bi-dimensional or longest-length measurement with a perioprobe with a simple photograph as a standard of documentation for leukoplakia lesion size. SIGNIFICANCE: Standard documentation for leukoplakia lesion size is recommended. SUPPORT: National Cancer Institute contract
R028 Treating Carotid Stenosis in Patients with Head/ Neck Cancer Terry Robert Fleck, BS (presenter); Paul Dae-Gwon Kim, MD; Christian Bianchi; Theodore Teruya, MD PROBLEM: Standard treatment of carotid stenosis in patients with ipsilateral cancer of the head and neck with endarterectomy may result in complications due to concurrent or previous treatment. Patients previously treated with radiation may result in poor healing and difficult dissection due to scarring. An endarterectomy in patients with ipsilateral untreated cancer poses an increased risk of tumor seeding through the neck wound and salivary contamination. METHODS: A retrospective review of nine patients with
R029 MT1-MMP in Oral Cavity Carcinomas with Micrometastasis Ross M Germani, MD, MA (presenter) PROBLEM: The purpose of this study was to examine the role of MT1-MMP in early lymph node metastasis by demonstrating increased levels in cases with confirmed micrometastasis by sentinel lymph node biopsy (SLNB). In addition, the local concentration of CD-44 (a soluble substrate of MT1-MMP) was analyzed. METHODS: Specimens(N⫽35) were fixed in 10% formalin and then embedded in paraffin. Blocks were sectioned for routine histological and subsequent immunohistochemical examinations. Applied antibodies were mouse anti-MT1-MMP monoclonal antibody (EMD Biosciences: clone 114-6G6, IgG1 subclass, diluted 15:1) and anti-sol CD-44 (Bender MedSystems: clone SFF2, IgG1 subclass, diluted 10:1). The sections were allowed to react with peroxidase-conjugated antimouse IgG polyclonal antibody (Invitrogen: anti-mouse Ig Fab2) for 45 min. and then reaction products were visualized. Immunohistochemical reactivity for MT1-MMP and sol CD-44 was evaluated and classified into three groups: (-)neg., (⫹)pos. and (⫹⫹)strongly pos.
Otolaryngology-Head and Neck Surgery, Vol 137, No 2S, August 2007
R027
ipsilateral cancer of the head and neck with carotid stenosis was performed. Stage and treatment of cancer, history of XRT, vascular and neurologic symptoms at presentation and workup, as well as outcomes were studied. RESULTS: Nine patients were reviewed; 7/9 patients had previously received XRT; 7/9 presented symptomatically. There was an average carotid occlusion of 84.5%; 7/9 patients received endovascular stents, 2/9 received endarterectomy. There was an average of 13.6 months follow up and 7/8 had carotid patency at their last visit. Average survival, postvascular procedure of 26.1 months was observed. No permanent neurologic events were noted in either stented or endarterectomy patients. CONCLUSION: Patients with head/neck cancer and ipsilateral carotid stenosis who are suitable for endarterectomy may be treated with concurrent endarterectomy followed by appropriate neck dissection and treatment of the primary malignancy if no salivary leakage is anticipated. Unsuitable patients for endarterectomy may be treated with carotid stenting followed by radiation therapy or, if permissible, planned extirpation one month after, with a break in the required anticoagulants. For those patients with a history of head and neck cancer that have been treated with surgery and/or radiation and later develop critical stenosis, endovascular stenting is likely the safest treatment. SIGNIFICANCE: Patients with head and neck cancer frequently have vascular disease. Evaluation and treatment options for vascular disease are discussed.
Correlation Analysis of Oral Lesion Size by Various Criteria Carrie Flanagan, MD (presenter); Frank G Ondrey, MD, PhD PROBLEM: To compare standard bi-dimensional measurement of oral lesions to examine for correlation with Response Evaluation Criteria in Solid Tumors (RECIST) criteria, and to determine the feasibility of digital image analysis for potential automated lesion measurements. METHODS: Thirteen patients with oral dysplastic leukoplakia were evaluated. Bi-dimensional measurements and photographs were taken of the lesion at the time of presentation. Within the photograph, a perioprobe was used as a standardized measure. Using Adobe Photoshop, the photographs were analyzed by measuring the lesion within the photo as well as determining the number of pixels that constituted the lesion. RESULTS: RECIST criteria correlated significantly with bidimensional measurement (r squared ⫽ 0.7925, p⬍0.0001). Additionally, there was significant correlation between digitized measures obtained via the photograph and the bi-dimensional measurement (r squared ⫽ 0.6652, p⬍0.0007). However, there was no correlation between pixel count and RECIST criteria or bi-dimensional measurement. CONCLUSION: Bi-dimensional measurement of oral leukoplakia and RECIST criteria are highly correlated. Additionally digitized measurements obtained from photgraphs were correlated, although very cumbersome and time-consuming to perform. The authors recommend simple bi-dimensional or longest-length measurement with a perioprobe with a simple photograph as a standard of documentation for leukoplakia lesion size. SIGNIFICANCE: Standard documentation for leukoplakia lesion size is recommended. SUPPORT: National Cancer Institute contract
R028 Treating Carotid Stenosis in Patients with Head/ Neck Cancer Terry Robert Fleck, BS (presenter); Paul Dae-Gwon Kim, MD; Christian Bianchi; Theodore Teruya, MD PROBLEM: Standard treatment of carotid stenosis in patients with ipsilateral cancer of the head and neck with endarterectomy may result in complications due to concurrent or previous treatment. Patients previously treated with radiation may result in poor healing and difficult dissection due to scarring. An endarterectomy in patients with ipsilateral untreated cancer poses an increased risk of tumor seeding through the neck wound and salivary contamination. METHODS: A retrospective review of nine patients with
R029 MT1-MMP in Oral Cavity Carcinomas with Micrometastasis Ross M Germani, MD, MA (presenter) PROBLEM: The purpose of this study was to examine the role of MT1-MMP in early lymph node metastasis by demonstrating increased levels in cases with confirmed micrometastasis by sentinel lymph node biopsy (SLNB). In addition, the local concentration of CD-44 (a soluble substrate of MT1-MMP) was analyzed. METHODS: Specimens(N⫽35) were fixed in 10% formalin and then embedded in paraffin. Blocks were sectioned for routine histological and subsequent immunohistochemical examinations. Applied antibodies were mouse anti-MT1-MMP monoclonal antibody (EMD Biosciences: clone 114-6G6, IgG1 subclass, diluted 15:1) and anti-sol CD-44 (Bender MedSystems: clone SFF2, IgG1 subclass, diluted 10:1). The sections were allowed to react with peroxidase-conjugated antimouse IgG polyclonal antibody (Invitrogen: anti-mouse Ig Fab2) for 45 min. and then reaction products were visualized. Immunohistochemical reactivity for MT1-MMP and sol CD-44 was evaluated and classified into three groups: (-)neg., (⫹)pos. and (⫹⫹)strongly pos.