Mild to moderate dysplasia at surgical margin is a significant indicator of survival in patients with oral cancer

Gokavarapu, Sandhya; Parvataneni, Nagendra; Pavagada, Sreenivasa; Rao, L.M. Chandrasekhara; Raju, K. V. V. N.; Rao, T. Subramanyeshwar

doi:10.1016/j.oooo.2016.10.028

Cited by 13 publications

(5 citation statements)

References 19 publications

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“…Some recent studies showed that only severe dysplasia at the margin has an adverse effect on survival, 25 whereas others suggested that even mild and moderate dysplasia are adverse prognosticators. [26][27][28] Therefore, based on available evidence, it is difficult to develop a consensus as to how dysplasia and CIS at the margin should be classified. The NCCN guidelines currently label CIS as positive margin but does not recommend adjuvant treatment if only CIS is found at the tumor edge.…”

Section: Discussionmentioning

confidence: 99%

Margin Practices in Oral Cavity Cancer Resections: Survey of American Head and Neck Society Members

et al. 2020

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Objectives/Hypothesis: To investigate the definition of a clear margin and the use of frozen section (FS) among practicing head and neck surgeons in oral cancer management. Study Design: Cross-sectional survey. Methods: We designed a survey that was sent to American Head and Neck Society (AHNS) members via an email link. Results: A total of 185 (13% of 1,392) AHNS members completed our survey. Most surgeons surveyed (96.8%) use FS to supplement oral cavity squamous cell carcinoma resections. Fifty-five percent prefer a specimen-based approach. The majority of respondents believe FS is efficacious in guiding re-resection of positive margins, with 81% considering the new margin to be negative. More than half of respondents defined a distance of >5 mm on microscopic examination as a negative margin. Conclusions: To avoid oral cancer resections that result in positive margins on final analysis, and thus the need for additional therapy, most surgeons surveyed use FS. A majority of surveyed surgeons now prefer a specimen-based approach to margin assessment. Although there is a debate on what constitutes a negative margin, most surgeons surveyed believe it to be >5 mm on microscopic examination.

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Section: Discussionmentioning

confidence: 99%

Margin Practices in Oral Cavity Cancer Resections: Survey of American Head and Neck Society Members

et al. 2020

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“…Instead, all studies seemed to focus on the presence of SCC or (severe) dysplasia in the resection plane, some of them not making a difference between the SCC or (severe) dysplasia. Indeed, several studies suggest that residual dysplasia has similar effects on disease-free survival as close margins [ 16 , 17 ]. Hence, dysplasia is preferably resected during SCC surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In many patients, the oral SCC develops in an area of (severe) dysplasia, also known as “field cancerization” [ 15 ]. There is evidence that when there is residual severe dysplasia after SCC resection, there is a high chance of local recurrence or new primaries [ 16 , 17 ]. There is little consensus about the appropriate treatment in case of severe dysplasia in the resection margin.…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative Techniques That Define the Mucosal Margins of Oral Cancer In-Vivo: A Systematic Review

de Koning,

Adriaansens,

Noorlag

et al. 2024

Cancers

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Background: This systematic review investigates techniques for determining adequate mucosal margins during the resection of oral squamous cell carcinoma (SCC). The primary treatment involves surgical removal with ≥5 mm margins, highlighting the importance of accurate differentiation between SCC and dysplasia during surgery. Methods: A comprehensive Embase and PubMed literature search was performed. Studies underwent quality assessment using QUADAS-2. Results: After the full-text screening and exclusion of studies exhibiting high bias, eight studies were included, focusing on three margin visualization techniques: autofluorescence, iodine staining, and narrow-band imaging (NBI). Negative predictive value (NPV) was calculable across the studies, though reference standards varied. Results indicated NPVs for autofluorescence, iodine, and NBI ranging from 61% to 100%, 92% to 99%, and 86% to 100%, respectively. Autofluorescence did not significantly enhance margins compared to white light-guided surgery, while iodine staining demonstrated improvement for mild or moderate dysplasia. NBI lacked comparison with a white light-guided surgery cohort. Conclusions: We recommend studying and comparing the diagnostic accuracy of iodine staining and NBI in larger cohorts of patients with oral SCC, focusing on discriminating between SCC and (severe) dysplasia. Furthermore, we advise reporting the diagnostic accuracy alongside the treatment effects to improve the assessment of these techniques.

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“…High-grade dysplasia often occurs in peritumoral areas of HNSCC in the sense of field cancerization. Even though not yet invasively growing, these dysplasia need to be completely surgically removed due to the risk of the development of malignancy ( 28 , 29 ). The fact that not only intratumoral, but also dysplastically altered peritumoral areas show signs of high OC and resulting hypoxia underlines the importance of adequate resection margins and the relevance of OC as a tool to optimize tumor margin recognition.…”

Section: Introductionmentioning

confidence: 99%

Quantification of oxygen consumption in head and neck cancer using fluorescent sensor foil technology

Stocker,

Blancke Soares,

Liebsch

et al. 2024

Front. Oncol.

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IntroductionHead and neck squamous cell carcinoma (HNSCC) patients suffer from frequent local recurrences that negatively impact on prognosis. Hence, distinguishing tumor and normal tissue is of clinical importance as it may improve the detection of residual tumor tissue in surgical resection margins and during imaging-based surgery planning. Differences in O2 consumption (OC) can be used to this aim, as they provide options for improved surgical, image-guided approaches.MethodsIn the present study, the potential of a fluorescent sensor foil-based technology to quantify OC in HNSCC was evaluated in an in vitro 3D model and in situ in patients. ResultsIn vitro measurements of OC using hypopharyngeal and esophageal cell lines allowed a specific detection of tumor cell spheroids embedded together with cancer-associated fibroblasts in type I collagen extracellular matrix down to a diameter of 440 µm. Pre-surgery in situ measurements were conducted with a handheld recording device and sensor foils with an oxygen permeable membrane and immobilized O2-reactive fluorescent dyes. Lateral tongue carcinoma and carcinoma of the floor of the mouth were chosen for analysis owing to their facilitated accessibility. OC was evaluated over a time span of 60 seconds and was significantly higher in tumor tissue compared to healthy mucosa in the vicinity of the tumor.DiscussionHence, OC quantification using fluorescent sensor foil-based technology is a relevant parameter for the differentiation of tumor tissue of the head and neck region and may support surgery planning.

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Mild to moderate dysplasia at surgical margin is a significant indicator of survival in patients with oral cancer

Cited by 13 publications

References 19 publications

Margin Practices in Oral Cavity Cancer Resections: Survey of American Head and Neck Society Members

Margin Practices in Oral Cavity Cancer Resections: Survey of American Head and Neck Society Members

Intraoperative Techniques That Define the Mucosal Margins of Oral Cancer In-Vivo: A Systematic Review

Quantification of oxygen consumption in head and neck cancer using fluorescent sensor foil technology

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