Definitive Surgical Therapy after Open Neck Biopsy for HPV‐Related Oropharyngeal Cancer

Zenga, Joseph; Graboyes, Evan M.; Haughey, Bruce H.; Paniello, Randal C.; Mehrad, Mitra; Lewis, James S.; Thorstad, Wade L.; Nussenbaum, Brian; Rich, Jason T.

doi:10.1177/0194599815627642

Cited by 20 publications

(22 citation statements)

References 27 publications

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“…However, these calculations are limited by sample size, and there were trends that suggested open neck biopsy patients required both surgery and adjuvant radiotherapy. While a recent study comparing patients diagnosed with HPV‐related HNSCC who underwent open neck mass biopsy with matched controls showed no significant difference in disease‐specific survival, there is still no question that in comparing overall utility of diagnostic tests, FNA compared to open neck mass biopsy is still far less invasive and complication prone. If a test with proven clinical utility and minimal morbidity is available, it should be used to the fullest capacity prior to more invasive tests requiring general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

The current practice of open neck mass biopsy in the diagnosis of head and neck cancer: A retrospective cohort study

Akkina

Kim

Stucken

et al. 2019

Laryngoscope Investig Oto

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Objective To characterize current use of open neck mass biopsy for diagnosis of squamous cell carcinoma in patients presenting with a neck mass. Methods Using the University of Michigan Specialized Program of Research Excellence in Head and Neck Cancer patient database (2008–2014), we reviewed patients’ referral documentation to identify those who received open neck mass biopsies as part of their squamous cell carcinoma diagnosis. We compared subsequent treatment between patients who did and did not receive an open neck mass biopsy. Results Of 940 patients, 50 patients had received open neck mass biopsy leading to squamous cell carcinoma diagnosis. Only 19 of 50 patients (38%) had undergone fine‐needle aspiration prior to open neck mass biopsy. There were no statistically significant differences in treatment or outcomes between patients who did and those who did not receive open neck mass biopsy. Conclusion Optimal care for patients who present with a neck mass is fine‐needle aspiration. Unfortunately, these data show that many patients undergo open neck mass biopsy for diagnosis, often without prior fine‐needle aspirate. Compared to fine‐needle aspiration, open biopsy incurs additional risks of general anesthesia and greater surgical risks. While our data did not find statistically significant differences between treatment offered and outcomes, this small study was not expected to demonstrate a difference in outcomes. Further work is needed to promote the utility of fine‐needle aspiration for diagnosis of neck mass and to discourage use of open neck mass biopsy as a primary diagnostic intervention. Level of Evidence 2c (Outcomes Research)

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Section: Discussionmentioning

confidence: 99%

The current practice of open neck mass biopsy in the diagnosis of head and neck cancer: A retrospective cohort study

Akkina

Kim

Stucken

et al. 2019

Laryngoscope Investig Oto

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“…7,50,51 Although we lack data on the frequency of open biopsy, comprehensive cancer centers report that patients are regularly referred for cancer care following inappropriate open neck biopsy. 52,53 Two large academic tertiary referral head and neck cancer centers reported 45 patients evaluated over a 14-year period and 94 patients evaluated for >13 consecutive years with HNSCC who had undergone open neck biopsy. 52,53 Most of the open biopsies, 100% and 87%, respectively, occurred in patients with HPV-positive HNSCC.…”

Section: Health Care Burdenmentioning

confidence: 99%

“…52,53 Two large academic tertiary referral head and neck cancer centers reported 45 patients evaluated over a 14-year period and 94 patients evaluated for >13 consecutive years with HNSCC who had undergone open neck biopsy. 52,53 Most of the open biopsies, 100% and 87%, respectively, occurred in patients with HPV-positive HNSCC. Presumably this occurs because cervical metastases from HPV-positive HNSCC often have a cystic appearance on imaging and are thus mistaken for a benign cyst or abscess.…”

Section: Health Care Burdenmentioning

confidence: 99%

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Clinical Practice Guideline: Evaluation of the Neck Mass in Adults

Pynnonen

Gillespie

Roman

et al. 2017

Otolaryngol.--head neck surg.

133

140

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Objective Neck masses are common in adults, but often the underlying etiology is not easily identifiable. While infections cause most of the neck masses in children, most persistent neck masses in adults are neoplasms. Malignant neoplasms far exceed any other etiology of adult neck mass. Importantly, an asymptomatic neck mass may be the initial or only clinically apparent manifestation of head and neck cancer, such as squamous cell carcinoma (HNSCC), lymphoma, thyroid, or salivary gland cancer. Evidence suggests that a neck mass in the adult patient should be considered malignant until proven otherwise. Timely diagnosis of a neck mass due to metastatic HNSCC is paramount because delayed diagnosis directly affects tumor stage and worsens prognosis. Unfortunately, despite substantial advances in testing modalities over the last few decades, diagnostic delays are common. Currently, there is only 1 evidence-based clinical practice guideline to assist clinicians in evaluating an adult with a neck mass. Additionally, much of the available information is fragmented, disorganized, or focused on specific etiologies. In addition, although there is literature related to the diagnostic accuracy of individual tests, there is little guidance about rational sequencing of tests in the course of clinical care. This guideline strives to bring a coherent, evidence-based, multidisciplinary perspective to the evaluation of the neck mass with the intention to facilitate prompt diagnosis and enhance patient outcomes. Purpose The primary purpose of this guideline is to promote the efficient, effective, and accurate diagnostic workup of neck masses to ensure that adults with potentially malignant disease receive prompt diagnosis and intervention to optimize outcomes. Specific goals include reducing delays in diagnosis of HNSCC; promoting appropriate testing, including imaging, pathologic evaluation, and empiric medical therapies; reducing inappropriate testing; and promoting appropriate physical examination when cancer is suspected. The target patient for this guideline is anyone ≥18 years old with a neck mass. The target clinician for this guideline is anyone who may be the first clinician whom a patient with a neck mass encounters. This includes clinicians in primary care, dentistry, and emergency medicine, as well as pathologists and radiologists who have a role in diagnosing neck masses. This guideline does not apply to children. This guideline addresses the initial broad differential diagnosis of a neck mass in an adult. However, the intention is only to assist the clinician with a basic understanding of the broad array of possible entities. The intention is not to direct management of a neck mass known to originate from thyroid, salivary gland, mandibular, or dental pathology as management recommendations for these etiologies already exist. This guideline also does not address the subsequent management of specific pathologic entities, as treatment recommendations for benign and malignant neck masses can be found elsewhere. Instead,...

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“…Additionally, therapy recommendations are different for patients with HPV - in contrast to patients with HPV + tumours. For example, HPV + tumours tend to respond better to radiotherapy [ 18 , 19 ], which significantly reduces the risk of regional recurrence. Simultaneously, it appears that radical neck dissection as therapy of choice for recurrent metastatic HNSCC is not recommended for HPV + tumours, but appears unnecessary [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Shooting at Moving and Hidden Targets—Tumour Cell Plasticity and the Notch Signalling Pathway in Head and Neck Squamous Cell Carcinomas

Kałafut

Czerwonka

Anameriç

et al. 2021

Cancers

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Head and Neck Squamous Cell Carcinoma (HNSCC) is often aggressive, with poor response to current therapies in approximately 40–50% of the patients. Current therapies are restricted to operation and irradiation, often combined with a small number of standard-of-care chemotherapeutic drugs, preferentially for advanced tumour patients. Only very recently, newer targeted therapies have entered the clinics, including Cetuximab, which targets the EGF receptor (EGFR), and several immune checkpoint inhibitors targeting the immune receptor PD-1 and its ligand PD-L1. HNSCC tumour tissues are characterized by a high degree of intra-tumour heterogeneity (ITH), and non-genetic alterations that may affect both non-transformed cells, such as cancer-associated fibroblasts (CAFs), and transformed carcinoma cells. This very high degree of heterogeneity likely contributes to acquired drug resistance, tumour dormancy, relapse, and distant or lymph node metastasis. ITH, in turn, is likely promoted by pronounced tumour cell plasticity, which manifests in highly dynamic and reversible phenomena such as of partial or hybrid forms of epithelial-to-mesenchymal transition (EMT), and enhanced tumour stemness. Stemness and tumour cell plasticity are strongly promoted by Notch signalling, which remains poorly understood especially in HNSCC. Here, we aim to elucidate how Notch signal may act both as a tumour suppressor and proto-oncogenic, probably during different stages of tumour cell initiation and progression. Notch signalling also interacts with numerous other signalling pathways, that may also have a decisive impact on tumour cell plasticity, acquired radio/chemoresistance, and metastatic progression of HNSCC. We outline the current stage of research related to Notch signalling, and how this pathway may be intricately interconnected with other, druggable targets and signalling mechanisms in HNSCC.

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Definitive Surgical Therapy after Open Neck Biopsy for HPV‐Related Oropharyngeal Cancer

Abstract: Patients with HPV-related OPSCC who have undergone a prior open neck biopsy can be successfully treated with a definitive surgical paradigm. Although needle biopsy is preferable to establish a diagnosis, previous open neck biopsy does not affect prognosis in these patients.

Cited by 20 publications

References 27 publications

The current practice of open neck mass biopsy in the diagnosis of head and neck cancer: A retrospective cohort study

The current practice of open neck mass biopsy in the diagnosis of head and neck cancer: A retrospective cohort study

Clinical Practice Guideline: Evaluation of the Neck Mass in Adults

Shooting at Moving and Hidden Targets—Tumour Cell Plasticity and the Notch Signalling Pathway in Head and Neck Squamous Cell Carcinomas

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