cTNM vs. pTNM: the effect of not applying ultrasonography in the identification of cervical nodal disease
Identifieur interne : 002210 ( Pmc/Curation ); précédent : 002209; suivant : 002211cTNM vs. pTNM: the effect of not applying ultrasonography in the identification of cervical nodal disease
Auteurs : Waseem Jerjes [Royaume-Uni, Iraq] ; Tahwinder Upile [Royaume-Uni] ; Hani Radhi [Iraq] ; Aviva Petrie [Royaume-Uni] ; Jesuloba Abiola [Royaume-Uni] ; Aidan Adams [Royaume-Uni] ; Jacqueline Callear [Royaume-Uni] ; Panagiotis Kafas [Grèce] ; Syedda Abbas [Royaume-Uni] ; Kartic Rajaram [Royaume-Uni] ; Colin Hopper [Royaume-Uni]Source :
- Head & Neck Oncology [ 1758-3284 ] ; 2012.
Abstract
Accurate clinical staging of oral squamous cell cancer can be quite difficult to achieve especially if nodal involvement is identified. Radiologically-assisted clinical staging is more accurate and informs the clinician of loco-regional and distant metastasis.
In this study, we compared clinical TNM (cTNM) staging (not including ultrasonography) to pathological TNM (pTNM) staging in 245 patients presenting with carcinoma of the oral cavity and the oro-pharyngeal region. Tumour size differences and nodal involvement were highlighted. US reports of the neck were then added to the clinical staging and results compared.
Tumour size was clinically underestimated in 4 T1, 2 T2 and 2 T3 oral diseases. Also 20 patients that were reported as nodal disease free had histological proven N1 or N2 nodal involvement; while 3 patients with cTNM showing N1 disease had histologically proven N2 disease.
Overall the agreement between the 2 systems per 1 site was 86.6% (Kappa agreement = 0.80), per 2 sites 90.0% (Kappa agreement = 0.68) and per 3 sites 90.5% (Kappa agreement 0.62).
An accurate clinical staging is of an utmost importance. It is the corner stone in which the surgical team build the surgical treatment plan and decide whether an adjuvant therapy is required to deal with any possible problem that might arise. The failure to achieve an accurate staging may lead to incomplete surgical planning and hence unforeseen problems that may adversely affect the patient's survival.
Url:
DOI: 10.1186/1758-3284-4-5
PubMed: 22410339
PubMed Central: 3351374
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disease</title><author><name sortKey="Jerjes, Waseem" sort="Jerjes, Waseem" uniqKey="Jerjes W" first="Waseem" last="Jerjes">Waseem Jerjes</name><affiliation wicri:level="1"><nlm:aff id="I1">UCL Department of Surgery, University College London, London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>UCL Department of Surgery, University College London, London</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="I2">Oral and Maxillofacial Surgery Unit, AL-Mustansirya University, Baghdad, Iraq</nlm:aff><country xml:lang="fr">Iraq</country><wicri:regionArea>Oral and Maxillofacial Surgery Unit, AL-Mustansirya University, Baghdad</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="I3">Leeds Institute of Molecular Medicine, School of Medicine, University of Leeds, Leeds, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Leeds Institute of Molecular Medicine, School of Medicine, University of Leeds, Leeds</wicri:regionArea></affiliation></author><author><name sortKey="Upile, Tahwinder" sort="Upile, Tahwinder" uniqKey="Upile T" first="Tahwinder" last="Upile">Tahwinder Upile</name><affiliation wicri:level="1"><nlm:aff id="I4">Chase Farm & Barnet NHS Trust, Enfield, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Chase Farm & Barnet NHS Trust, Enfield</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="I5">Head & Neck Unit, University College London Hospital, London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Head & Neck Unit, University College London Hospital, London</wicri:regionArea></affiliation></author><author><name sortKey="Radhi, Hani" sort="Radhi, Hani" uniqKey="Radhi H" first="Hani" last="Radhi">Hani Radhi</name><affiliation wicri:level="1"><nlm:aff id="I2">Oral and Maxillofacial Surgery Unit, AL-Mustansirya University, Baghdad, Iraq</nlm:aff><country xml:lang="fr">Iraq</country><wicri:regionArea>Oral and Maxillofacial Surgery Unit, AL-Mustansirya University, Baghdad</wicri:regionArea></affiliation></author><author><name sortKey="Petrie, Aviva" sort="Petrie, Aviva" uniqKey="Petrie A" first="Aviva" last="Petrie">Aviva Petrie</name><affiliation wicri:level="1"><nlm:aff id="I6">Biostatistics Unit, UCL Eastman Dental Institute, London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Biostatistics Unit, UCL Eastman Dental Institute, London</wicri:regionArea></affiliation></author><author><name sortKey="Abiola, Jesuloba" sort="Abiola, Jesuloba" uniqKey="Abiola J" first="Jesuloba" last="Abiola">Jesuloba Abiola</name><affiliation wicri:level="1"><nlm:aff id="I1">UCL Department of Surgery, University College London, London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>UCL Department of Surgery, University College London, London</wicri:regionArea></affiliation></author><author><name sortKey="Adams, Aidan" sort="Adams, Aidan" uniqKey="Adams A" first="Aidan" last="Adams">Aidan Adams</name><affiliation wicri:level="1"><nlm:aff id="I3">Leeds Institute of Molecular Medicine, School of Medicine, University of Leeds, Leeds, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Leeds Institute of Molecular Medicine, School of Medicine, University of Leeds, Leeds</wicri:regionArea></affiliation></author><author><name sortKey="Callear, Jacqueline" sort="Callear, Jacqueline" uniqKey="Callear J" first="Jacqueline" last="Callear">Jacqueline Callear</name><affiliation wicri:level="1"><nlm:aff id="I3">Leeds Institute of Molecular Medicine, School of Medicine, University of Leeds, Leeds, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Leeds Institute of Molecular Medicine, School of Medicine, University of Leeds, Leeds</wicri:regionArea></affiliation></author><author><name sortKey="Kafas, Panagiotis" sort="Kafas, Panagiotis" uniqKey="Kafas P" first="Panagiotis" last="Kafas">Panagiotis Kafas</name><affiliation wicri:level="1"><nlm:aff id="I7">Department of Oral Surgery and Radiology, School of Dentistry, Aristotle University, Thessalonica, Greece</nlm:aff><country xml:lang="fr">Grèce</country><wicri:regionArea>Department of Oral Surgery and Radiology, School of Dentistry, Aristotle University, Thessalonica</wicri:regionArea></affiliation></author><author><name sortKey="Abbas, Syedda" sort="Abbas, Syedda" uniqKey="Abbas S" first="Syedda" last="Abbas">Syedda Abbas</name><affiliation wicri:level="1"><nlm:aff id="I5">Head & Neck Unit, University College London Hospital, London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Head & Neck Unit, University College London Hospital, London</wicri:regionArea></affiliation></author><author><name sortKey="Rajaram, Kartic" sort="Rajaram, Kartic" uniqKey="Rajaram K" first="Kartic" last="Rajaram">Kartic Rajaram</name><affiliation wicri:level="1"><nlm:aff id="I3">Leeds Institute of Molecular Medicine, School of Medicine, University of Leeds, Leeds, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Leeds Institute of Molecular Medicine, School of Medicine, University of Leeds, Leeds</wicri:regionArea></affiliation></author><author><name sortKey="Hopper, Colin" sort="Hopper, Colin" uniqKey="Hopper C" first="Colin" last="Hopper">Colin Hopper</name><affiliation wicri:level="1"><nlm:aff id="I1">UCL Department of Surgery, University College London, London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>UCL Department of Surgery, University College London, London</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="I5">Head & Neck Unit, University College London Hospital, London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Head & Neck Unit, University College London Hospital, London</wicri:regionArea></affiliation></author></analytic><series><title level="j">Head & Neck Oncology</title><idno type="eISSN">1758-3284</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Accurate clinical staging of oral squamous cell cancer can be quite difficult to achieve especially if nodal involvement is identified. Radiologically-assisted clinical staging is more accurate and informs the clinician of loco-regional and distant metastasis.</p><p>In this study, we compared clinical TNM (cTNM) staging (not including ultrasonography) to pathological TNM (pTNM) staging in 245 patients presenting with carcinoma of the oral cavity and the oro-pharyngeal region. Tumour size differences and nodal involvement were highlighted. US reports of the neck were then added to the clinical staging and results compared.</p><p>Tumour size was clinically underestimated in 4 T1, 2 T2 and 2 T3 oral diseases. Also 20 patients that were reported as nodal disease free had histological proven N1 or N2 nodal involvement; while 3 patients with cTNM showing N1 disease had histologically proven N2 disease.</p><p>Overall the agreement between the 2 systems per 1 site was 86.6% (Kappa agreement = 0.80), per 2 sites 90.0% (Kappa agreement = 0.68) and per 3 sites 90.5% (Kappa agreement 0.62).</p><p>An accurate clinical staging is of an utmost importance. It is the corner stone in which the surgical team build the surgical treatment plan and decide whether an adjuvant therapy is required to deal with any possible problem that might arise. The failure to achieve an accurate staging may lead to incomplete surgical planning and hence unforeseen problems that may adversely affect the patient's survival.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Mukherji, Sk" uniqKey="Mukherji S">SK Mukherji</name></author><author><name sortKey="Castelijns, J" uniqKey="Castelijns J">J Castelijns</name></author><author><name sortKey="Castillo, M" uniqKey="Castillo M">M Castillo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Held, P" uniqKey="Held P">P Held</name></author><author><name sortKey="Langnickel, R" uniqKey="Langnickel R">R Langnickel</name></author><author><name sortKey="Breit, A" uniqKey="Breit A">A Breit</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Leslie, A" uniqKey="Leslie A">A Leslie</name></author><author><name sortKey="Fyfe, E" uniqKey="Fyfe E">E Fyfe</name></author><author><name 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Head Neck Oncol</journal-id><journal-id journal-id-type="iso-abbrev">Head Neck Oncol</journal-id><journal-title-group><journal-title>Head & Neck Oncology</journal-title></journal-title-group><issn pub-type="epub">1758-3284</issn><publisher><publisher-name>BioMed Central</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">22410339</article-id><article-id pub-id-type="pmc">3351374</article-id><article-id pub-id-type="publisher-id">1758-3284-4-5</article-id><article-id pub-id-type="doi">10.1186/1758-3284-4-5</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>cTNM vs. pTNM: the effect of not applying ultrasonography in the identification of cervical nodal disease</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes" id="A1"><name><surname>Jerjes</surname><given-names>Waseem</given-names></name><xref ref-type="aff" rid="I1">1</xref><xref ref-type="aff" rid="I2">2</xref><xref ref-type="aff" rid="I3">3</xref><email>waseem_wk1@yahoo.co.uk</email></contrib><contrib contrib-type="author" id="A2"><name><surname>Upile</surname><given-names>Tahwinder</given-names></name><xref ref-type="aff" rid="I4">4</xref><xref ref-type="aff" rid="I5">5</xref><email>mrtupile@yahoo.com</email></contrib><contrib contrib-type="author" corresp="yes" id="A3"><name><surname>Radhi</surname><given-names>Hani</given-names></name><xref ref-type="aff" rid="I2">2</xref><email>hani_hadi79@hotmail.com</email></contrib><contrib contrib-type="author" id="A4"><name><surname>Petrie</surname><given-names>Aviva</given-names></name><xref ref-type="aff" rid="I6">6</xref><email>A.Petrie@ucl.ac.uk</email></contrib><contrib contrib-type="author" id="A5"><name><surname>Abiola</surname><given-names>Jesuloba</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>ja.abiola@googlemail.com</email></contrib><contrib contrib-type="author" id="A6"><name><surname>Adams</surname><given-names>Aidan</given-names></name><xref ref-type="aff" rid="I3">3</xref><email>aidanadams@doctors.org.uk</email></contrib><contrib contrib-type="author" id="A7"><name><surname>Callear</surname><given-names>Jacqueline</given-names></name><xref ref-type="aff" rid="I3">3</xref><email>um06j2c@leeds.ac.uk</email></contrib><contrib contrib-type="author" id="A8"><name><surname>Kafas</surname><given-names>Panagiotis</given-names></name><xref ref-type="aff" rid="I7">7</xref><email>pankafas@yahoo.com</email></contrib><contrib contrib-type="author" id="A9"><name><surname>Abbas</surname><given-names>Syedda</given-names></name><xref ref-type="aff" rid="I5">5</xref><email>fee@abbas1811.freeserve.co.uk</email></contrib><contrib contrib-type="author" id="A10"><name><surname>Rajaram</surname><given-names>Kartic</given-names></name><xref ref-type="aff" rid="I3">3</xref><email>kartic.rajaram@gmail.com</email></contrib><contrib contrib-type="author" id="A11"><name><surname>Hopper</surname><given-names>Colin</given-names></name><xref ref-type="aff" rid="I1">1</xref><xref ref-type="aff" rid="I5">5</xref><email>c.hopper@ucl.ac.uk</email></contrib></contrib-group><aff id="I1"><label>1</label>UCL Department of Surgery, University College London, London, UK</aff><aff id="I2"><label>2</label>Oral and Maxillofacial Surgery Unit, AL-Mustansirya University, Baghdad, Iraq</aff><aff id="I3"><label>3</label>Leeds Institute of Molecular Medicine, School of Medicine, University of Leeds, Leeds, UK</aff><aff id="I4"><label>4</label>Chase Farm & Barnet NHS Trust, Enfield, UK</aff><aff id="I5"><label>5</label>Head & Neck Unit, University College London Hospital, London, UK</aff><aff id="I6"><label>6</label>Biostatistics Unit, UCL Eastman Dental Institute, London, UK</aff><aff id="I7"><label>7</label>Department of Oral Surgery and Radiology, School of Dentistry, Aristotle University, Thessalonica, Greece</aff><pub-date pub-type="collection"><year>2012</year></pub-date><pub-date pub-type="epub"><day>12</day><month>3</month><year>2012</year></pub-date><volume>4</volume><fpage>5</fpage><lpage>5</lpage><history><date date-type="received"><day>11</day><month>1</month><year>2012</year></date><date date-type="accepted"><day>12</day><month>3</month><year>2012</year></date></history><permissions><copyright-statement>Copyright © 2012 Jerjes et al; licensee BioMed Central Ltd.</copyright-statement><copyright-year>2012</copyright-year><copyright-holder>Jerjes et al; licensee BioMed Central Ltd.</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0">http://creativecommons.org/licenses/by/2.0</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><self-uri xlink:href="http://www.headandneckoncology.org/content/4/1/5"></self-uri><abstract><p>Accurate clinical staging of oral squamous cell cancer can be quite difficult to achieve especially if nodal involvement is identified. Radiologically-assisted clinical staging is more accurate and informs the clinician of loco-regional and distant metastasis.</p><p>In this study, we compared clinical TNM (cTNM) staging (not including ultrasonography) to pathological TNM (pTNM) staging in 245 patients presenting with carcinoma of the oral cavity and the oro-pharyngeal region. Tumour size differences and nodal involvement were highlighted. US reports of the neck were then added to the clinical staging and results compared.</p><p>Tumour size was clinically underestimated in 4 T1, 2 T2 and 2 T3 oral diseases. Also 20 patients that were reported as nodal disease free had histological proven N1 or N2 nodal involvement; while 3 patients with cTNM showing N1 disease had histologically proven N2 disease.</p><p>Overall the agreement between the 2 systems per 1 site was 86.6% (Kappa agreement = 0.80), per 2 sites 90.0% (Kappa agreement = 0.68) and per 3 sites 90.5% (Kappa agreement 0.62).</p><p>An accurate clinical staging is of an utmost importance. It is the corner stone in which the surgical team build the surgical treatment plan and decide whether an adjuvant therapy is required to deal with any possible problem that might arise. The failure to achieve an accurate staging may lead to incomplete surgical planning and hence unforeseen problems that may adversely affect the patient's survival.</p></abstract></article-meta><notes><p>PUBLISHER'S NOTE: Based on the information available to BioMed Central, this article was apparently handled by Waseem Jerjes, the first author of the article and Editor-in-Chief of the journal at that time.
The article states that ‘All applications were accompanied by multidisciplinary team recommendation, ethical approval and informed patient consent.’ UCL’s investigation concluded that this study was a retrospective analysis of data which would be classed as clinical audit and not a research study. Mr Hopper agreed it was a mistake on the part of the authors to state the analysis had ethical approval and informed consent. Mr Hopper has published a correction (<ext-link ext-link-type="uri" xlink:href="https://www.oapublishinglondon.com/article/740">https://www.oapublishinglondon.com/article/740</ext-link>).</p></notes></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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