C-11 methionine PET and 18-F FDG-PET for identifying recurrent laryngeal carcinoma

Het behoud van het strottenhoofd is een belangrijk doel bij de behandeling van strottenhoofdkanker. Strottenhoofdkanker wordt daarom vaak bestraald. Na bestraling is de kans dat de tumor terug komt ongeveer 30%. Na de bestraling kan het lastig zijn bestralingsschade te onderscheiden van een recidief tumor. Er is vaak oedeem na de bestraling en daarbij komt dat een recidief in tegenstelling tot de oorspronkelijke tumor vaak in losse velden onder het slijmvlies ligt. De gouden standaard om recidieven aan te tonen is een biopsie. De patiënt moet hiervoor echter vaak onder narcose worden gebracht en een weefselproef geeft vaak schade aan het hiervoor door de bestraling extra gevoelige strottenhoofd. Vaak blijkt dat er geen recidief is. Beeldvorming zoals CT en MRI kunnen een primair strottenhoofdkanker goed weergeven. Helaas kunnen ze lastig bestralingsschade van een recidief na bestraling onderscheiden. Tumoren hebben echter een verhoogde suiker opname. Door Positron Emissie Tomografie (PET) kan deze verhoogde suikeropname d.m.v. het kustmatige suiker 18F-fluoro-2-deoxy-D-glucose ([18F] FDG) in beeld worden gebracht. Wij hebben aangetoond dat we d.m.v. een negatieve [18F] FDG-PET goed kunnen uitsluiten of er een recidief is, maar een positieve [18F] FDG-PET is helaas vaak onterecht positief. Een PET kan echter veel meer processen visualiseren. We zochten naar alternatieven voor [18F] FDG en kwamen uit op [11C] methionine ([11C] MET). Methionine is een aminozuur en maligniteiten hebben vaak een verhoogde opname van aminozuren. Bovendien is [11C] MET relatief gemakkelijk te produceren. Op theoretische gronden verwachten we met [11C] MET minder onterecht positieve PET-scans dan met [18F] FDG. De resultaten van het onderzoek lieten zien dat met [11C]MET het aantal onterechte positieve PET-scans afnam maar dat het aantal onterecht afgegeven negatieve juist toenam. [11C]MET is daardoor geen alternatief voor[18F] FDG. We kunnen concluderen dat [18F] FDG de eerste keuze is om een recidief strottenhoofdkanker na bestraling aan te tonen.Preservation of the larynx is an important goal in the treatment of laryngeal cancer. Laryngeal cancer is therefore usually treated with radiotherapy. The recurrence rate after therapy is on an average 30%. The differentiation between radiation reactions may be difficult. A biopsy under general anesthesia with all its negative consequences for the patient is the gold standard to confirm a recurrence. During the last decades several studies have been published which indicate that [18F]FDG-PET may detect recurrent laryngeal cancer. Our study shows that [18F] FDG -PET is an alternative for a traditional work-up, although the number false positive results remains high. We searched for alternatives to [18F] FDG. The alternative we have tested [11C] methionine reduced the number of false positive results. On the other hand the number of false negative results inclined. [11C]MET is no alternative to [18F] FDG

Narrow-Band Imaging in Transoral Laser Surgery for Early Glottic Cancer:A Randomized Controlled Trial

Objective: Assessing whether the additional use of narrow-band imaging (NBI) in transoral laser surgery (TOLS) for early laryngeal cancer improves clinical outcomes. Study Design: Randomized controlled trial, performed between September 2015 and November 2022. Setting: A tertiary referral hospital in The Netherlands. Methods: TOLS was carried out in 113 patients. The procedure was performed with white light imaging (WLI, n = 56) alone, or combined with NBI (n = 57). Patients received frequent follow-up laryngoscopy. Resection margin status, recurrence rate, and recurrence-free survival at 12 months, 18 months, and after study termination (maximum 86 months) were analyzed. Results: Thirty-one cases in the WLI group had a positive resection margin, versus 16 in the NBI group (p =.002). After 12 months, the recurrence-free survival was 92%: 87% for WLI versus 96% for NBI, p =.07. The recurrence rate was 7/56 (13%) for WLI, versus 2/57 (4%) for NBI, p =.09. After 18 months, the recurrence-free survival was 84% for WLI versus 96% for NBI, p =.02. The recurrence rate was 9/56 (16%) for WLI, versus 2/57 (4%) for NBI, p =.02. After study termination, the recurrence-free survival was 71% for WLI versus 83% for the NBI group (p =.08). The recurrence rate was 16/56 for WLI, versus 10/57 for NBI (p =.16). Conclusion: The additional use of NBI during TOLS significantly decreased the number of positive resection margins. Although not statistically significant at all time points, patients treated with NBI-supported TOLS showed a lower recurrence rate and better recurrence-free survival. Further studies in larger patient groups are needed to confirm these results.</p

Evaluating Laryngopharyngeal Tumor Extension Using Narrow Band Imaging Versus Conventional White Light Imaging

OBJECTIVE/HYPOTHESIS: Comparing detection and extension of malignant tumors by flexible laryngoscopy in the outpatient setting with laryngoscopy under general anesthesia using both White Light Imaging (WLI) and Narrow Band Imaging (NBI). STUDY DESIGN: Prospective randomized controlled trial. METHODS: Two hundred and thirty-three patients with laryngeal and pharyngeal lesions underwent flexible and rigid laryngoscopy, with both WLI and NBI. Extension of malignant lesions (n = 132) was compared between both techniques in detail. RESULTS: Sensitivity of NBI during flexible endoscopy (92%), was comparable with that of WLI during rigid endoscopy (91%). The correlation of tumor extension between flexible and rigid laryngoscopy was high (rs = 0.852-0.893). The observed tumor extension was significantly larger when using NBI in both settings. The use of NBI during flexible laryngoscopy leads to upstaging (12%) and downstaging (2%) of the T classification. CONCLUSIONS: NBI during flexible laryngoscopy could be an alternative to WLI rigid endoscopy. NBI improves visualization of tumor extension and accuracy of T staging. LEVEL OF EVIDENCE: 3 Laryngoscope, 2021

High-definition videolaryngoscopy is superior to fiberoptic laryngoscopy:a 111 multi-observer study

PURPOSE: This study aims to analyse differences in fiberoptic laryngoscopy (FOL) versus high definition laryngoscopy (HDL) by examining videolaryngoscopy images by a large group of observers with different levels of clinical expertise in ear, nose and throat (ENT) medicine. METHODS: This study is a 111 observer paired analysis of laryngoscopy videos during an interactive presentation. During a National Meeting of the Dutch Society of ENT/Head and Neck Surgery, observers assessed both FOL and HDL videos of nine cases with additional clinical information. Observers included 41 ENT consultants (36.9%), 34 ENT residents (30.6%), 22 researchers with Head and Neck interest (19.8%) and 14 with unspecified clinical expertise (12.6%). For both laryngoscopic techniques, sensitivity, specificity, positive and negative predictive value and diagnostic accuracy were determined for identifying a normal glottis, hyperkeratosis, radiotherapy adverse effects and squamous cell carcinoma. The sensitivities for FOL and HDL were analysed with regard to the different levels of clinical expertise. RESULTS: The overall sensitivity for correctly identifying the specific histological entity was higher in HDL (FOL 61% vs HDL 66.3%, p < 0.05). HDL was superior to FOL in identifying a normal glottis (FOL 68.1% vs HDL 91.6%, p < 0.01) and squamous cell carcinoma (FOL 70.86% vs HDL 79.41%, p = 0.02). Residents and researchers with Head and Neck interest diagnosed laryngeal lesions more correctly with HDL (p < 0.05). CONCLUSIONS: In a large population of observers with different levels of clinical expertise, HDL is superior to FOL in identifying laryngeal lesions

Differences in the diagnostic value between fiberoptic and high definition laryngoscopy for the characterisation of pharyngeal and laryngeal lesions:A multi-observer paired analysis of videos

Objectives High definition laryngoscopy (HDL) could lead to better interpretation of the pharyngeal and laryngeal mucosa than regularly used fiberoptic laryngoscopy (FOL). The primary aim of this study is to quantify the diagnostic advantage of HDL over FOL in detecting mucosal anomalies in general, in differentiating malignant from benign lesions and in predicting specific histological entities. The secondary aim is to analyse image quality of both laryngoscopes. Design Retrospective paired analysis with multiple observers evaluating endoscopic videos simulating daily clinical practice. Setting A tertiary referral hospital. Participants In 36 patients, both FOL and HDL videos were obtained. Six observers were provided with additional clinical information, and 36 FOL and HDL videos were evaluated in a randomised order. Main outcome measures Sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of observers using both flexible laryngoscopes were calculated for detection of mucosal lesions in general and uncovering malignant lesions. Sensitivities were calculated for prediction of specific histological entities. Image quality (scale 1-10) was assessed for both flexible laryngoscopes. Results HDL reached higher sensitivity compared to FOL for detection of mucosal abnormalities in general (96.0% vs 90.4%; P = .03), differentiating malignant from benign lesions (91.7% vs 79.8%; P = .03) and prediction of specific histological entities (59.7% vs 47.2%; P <.01). Image quality was judged better with HDL in comparison with FOL (mean: 8.4 vs 5.4, P <.01). Conclusions HDL is superior to FOL in detecting mucosal anomalies in general, malignancies and specific histological entities. Image quality is considered as superior using HDL compared to FOL

Virtual 3D planning of tracheostomy placement and clinical applicability of 3D cannula design:A three-step study

AIM: We aimed to investigate the potential of 3D virtual planning of tracheostomy tube placement and 3D cannula design to prevent tracheostomy complications due to inadequate cannula position. MATERIALS AND METHODS: 3D models of commercially available cannula were positioned in 3D models of the airway. In study (1), a cohort that underwent tracheostomy between 2013 and 2015 was selected (n = 26). The cannula was virtually placed in the airway in the pre-operative CT scan and its position was compared to the cannula position on post-operative CT scans. In study (2), a cohort with neuromuscular disease (n = 14) was analyzed. Virtual cannula placing was performed in CT scans and tested if problems could be anticipated. Finally (3), for a patient with Duchenne muscular dystrophy and complications of conventional tracheostomy cannula, a patient-specific cannula was 3D designed, fabricated, and placed. RESULTS: (1) The 3D planned and post-operative tracheostomy position differed significantly. (2) Three groups of patients were identified: (A) normal anatomy; (B) abnormal anatomy, commercially available cannula fits; and (C) abnormal anatomy, custom-made cannula, may be necessary. (3) The position of the custom-designed cannula was optimal and the trachea healed. CONCLUSIONS: Virtual planning of the tracheostomy did not correlate with actual cannula position. Identifying patients with abnormal airway anatomy in whom commercially available cannula cannot be optimally positioned is advantageous. Patient-specific cannula design based on 3D virtualization of the airway was beneficial in a patient with abnormal airway anatomy