Purpose: The efficacy of antibody-based therapeutics depends on successful drug delivery into solid tumors; therefore, there is a clinical need to measure intratumoral antibody distribution. This study aims to develop and validate an imaging and computation platform to directly quantify and predict antibody delivery into human head and neck cancers in a clinical study.Experimental Design: Twenty-four patients received systemic infusion of a near-infrared fluorescence-labeled therapeutic antibody followed by surgical tumor resection. A computational platform was developed to quantify the extent of heterogeneity of intratumoral antibody distribution. Both univariate and multivariate regression analyses were used to select the most predictive tumor biological factors for antibody delivery. Quantitative image features from the pretreatment MRI were extracted and correlated with fluorescence imaging of antibody delivery.Results: This study not only confirmed heterogeneous intratumoral antibody distribution in-line with many preclinical reports, but also quantified the extent of interpatient, intertumor, and intratumor heterogeneity of antibody delivery. This study demonstrated the strong predictive value of tumor size for intratumoral antibody accumulation and its significant impact on antibody distribution in both primary tumor and lymph node metastasis. Furthermore, this study established the feasibility of using contrastenhanced MRI to predict antibody delivery.Conclusions: This study provides a clinically translatable platform to measure antibody delivery into solid tumors and yields valuable insight into clinically relevant antibody tumor penetration, with implications in the selection of patients amenable to antibody therapy and the design of more effective dosing strategies.

Objectives/Hypothesis Inverted papillomas (IPs) are benign tumors of the sinonasal tract with a malignant transformation potential. Predicting the transformation propensity of IPs and corresponding risk factors has long been a challenge. In this study, we aimed to use radiographic findings on magnetic resonance imaging (MRI) and computed tomography (CT) to help differentiate IP from IP‐transformed squamous cell carcinomas (IP‐SCC). Study Design Retrospective cohort study. Methods A retrospective analysis was performed at two institutions comparing IP (n = 76) and IP‐SCC (n = 66) tumors, evaluating preoperative radiographic imaging with corresponding surgical pathology reports. The presence of a convoluted cerebriform pattern (CCP) using postcontrast T1‐weighted and T2‐weighted MRI was evaluated. Using MRI diffusion‐weighted imaging (DWI), we calculated the apparent diffusion coefficient (ADC) value of each tumor. We also determined the tumor origin, attachment sites, and presence of bony erosion using CT imaging. Results Benign IPs had a higher prevalence of CCP on MRI compared to IP‐transformed SCC (P = .0001. The mean value ADC of malignant IP‐SCC (ADCb0,1000 = 1.12 × 10−3 mm2/s) was significantly lower than that of benign IPs (ADCb0,1000 = 1.49 × 10−3 mm2/s, P = .002). IP‐SCC tumors were more likely to be have orbital wall attachment (P = .002) and bony erosion (P < .0001) compared to IPs. Conclusions Evaluation of CCP and DWI with ADC values on MRI are promising qualitative and quantitative methods to help differentiate benign IP tumors from their transformed malignant counterparts. Malignant IP‐SCCs are associated with a loss of CCP and lower ADC values. Findings of orbital wall involvement and bony erosion on CT may also help determine presence of malignancy. Level of Evidence 4 Laryngoscope, 129:777–782, 2019

Background Head and neck cancer patients often have multiple risk factors for coronary artery disease. Yet, little is known about the incidence of postoperative myocardial injury after major head and neck cancer surgery and its clinical relevance. The aim of the study was to determine the risk of postoperative myocardial injury in patients undergoing major head and neck cancer surgery. Methods Retrospective cohort study of all patients who underwent major head and neck cancer surgery (n=378) at a single major academic center from April 2003 to July 2008. Peak postoperative troponin I (TnI) concentration was the primary outcome. Results Of 378 patients, who underwent major head and neck cancer surgery, 57 patients (15%) developed an elevated TnI; 90% of which occurred within the first 24 hours after surgery. Pre-existing renal insufficiency (unadjusted OR [OR]: 4.60, 95% CI 1.53–13.82), coronary artery disease (OR: 2.33, 95% CI 1.21–4.50), peripheral vascular disease (OR: 2.83, 95%CI 1.31–6.14), hypertension (OR: 2.22, 95% CI 1.20–4.12), and previous combined chemotherapy and radiation (OR: 2.68, 95% CI 1.04–6.91) were associated with elevated postoperative TnI. Patients with elevated TnI had a significantly longer length of stay in the hospital (8.5 vs. 10.1 days; p= 0.014) and ICU (3 vs. 4.5 days; p= 0.001) and an 8-fold increased risk of death at 60 days after surgery (adjusted OR: 8.01, 95% CI 2.03 – 31.56). At one year, patients with an abnormal postoperative TnI were twice as likely to die (OR 1.93; 95% CI 1.02 – 3.63). Conclusions Patients who undergo major head and neck cancer surgery are at significant risk for postoperative myocardial injury which is a strong predictor of 60-day mortality after surgery. Monitoring of myocardial injury during the first postoperative days as well as optimizing preventive cardiac care may be helpful to reduce postoperative mortality.

The presence of ≥2 mm of dural thickening, loss of hypointense zone, and nodular dural enhancement were highly predictive for presence of dural invasion by sinonasal malignant tumors. Preoperative knowledge of these MRI patterns may better guide surgical planning and patient counseling.

Objective Anterior cervical pain syndromes (ACPS) are a poorly understood entity associated with lateral neck discomfort when talking, chewing, or yawning, and with occasional excruciating pain and dysphagia. This investigation aims to describe patients with ACPS presenting symptoms and treatments. Study Design Retrospective chart review of all patients with ACPS presenting to a tertiary care laryngology practice in 1 year. Methods All patients diagnosed with ACPS for 1 year were reviewed. Patient gender, age, body mass index (BMI), and pain triggers were documented. The hyolaryngeal complex was measured on computed tomography (CT) scans of the neck. Treatments were recorded. Results Nine patients were diagnosed with an ACPS in a 1‐year period. Sixty‐seven percent were female with an average age of 47.3 years ± 16.6. The average BMI of a patient with ACPS was 24.8 ± 3.69. The most common symptom was point tenderness at the lateral aspect of the hyoid or superior cornu of the thyroid cartilage (89%). Pain triggers included speaking (67%), head turn (56%), chewing (44%), yawning (56%), and swallowing (56%). On CT imaging, eight of nine patients had abnormalities of the hyoid bone or the superior cornu of the thyroid cartilage, correlating 100% with point tenderness location. Treatments include physical therapy (33%), steroid injection (44%), lidocaine injection (22%), and surgical intervention (56%). Conclusion ACPS is a frustrating condition for patients and physicians. Evaluation of anterior cervical pain with point tenderness should include imaging measurement of the thyrohyoid complex. Effective treatments include local steroid injection and surgical resection of the abnormal structure. Level of Evidence 4 Laryngoscope, 130:702–705, 2020