Diagnostic accuracy of intraoperative margin assessment techniques in surgery for head and neck squamous cell carcinoma: A meta-analysis.

BACKGROUND: Positive margins following head and neck squamous cell carcinoma (HNSCC) surgery lead to significant morbidity and mortality. Existing Intraoperative Margin Assessment (IMA) techniques are not widely used due to limitations in sampling technique, time constraints and resource requirements. We performed a meta-analysis of the diagnostic performance of existing IMA techniques in HNSCC, providing a benchmark against which emerging techniques may be judged. METHODS: The study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Studies were included if they reported diagnostic metrics of techniques used during HNSCC surgery, compared with permanent histopathology. Screening, manuscript review and data extraction was performed by multiple independent observers. Pooled sensitivity and specificity were estimated using the bivariate random effects model. RESULTS: From an initial 2344 references, 35 studies were included for meta-analysis. Sensitivity (Sens), specificity (Spec), diagnostic odds ratio (DOR) and area under the receiver operating characteristic curve (AUROC) were calculated for each group (n, Sens, Spec, DOR, AUROC): frozen section = 13, 0.798, 0.991, 309.8, 0.976; tumour-targeted fluorescence (TTF) = 5, 0.957, 0.827, 66.4, 0.944; optical techniques = 10, 0.919, 0.855, 58.9, 0.925; touch imprint cytology = 3, 0.925, 0.988, 51.1, 0.919; topical staining = 4, 0.918, 0.759, 16.4, 0.833. CONCLUSIONS: Frozen section and TTF had the best diagnostic performance. Frozen section is limited by sampling error. TTF shows promise but involves administration of a systemic agent. Neither is currently in widespread clinical use. Emerging techniques must demonstrate competitive diagnostic accuracy whilst allowing rapid, reliable, cost-effective results.

Dietary and physiological controls on the hydrogen and oxygen isotope ratios of hair from mid-20th century indigenous populations.

A semimechanistic model has recently been proposed to explain observed correlations between the H and O isotopic composition of hair from modern residents of the USA and the isotopic composition of drinking water, but the applicability of this model to hair from non-USA and preglobalization populations is unknown. Here we test the model against data from hair samples collected during the 1930s-1950s from populations of five continents. Although C and N isotopes confirm that the samples represent a much larger range of dietary "space" than the modern USA residents, the model is able to reproduce the observed delta(2)H and delta(18)O values given reasonable adjustments to 2 model parameters: the fraction of dietary intake derived from locally produced foods and the fraction of keratin H fixed during the in vivo synthesis of amino acids. The model is most sensitive to the local dietary intake, which appears to constitute between 60% and 80% of diet among the groups sampled. The isotopic data are consistent with a trophic-level effect on protein H isotopes, which we suggest primarily reflects mixing of (2)H-enriched water and (2)H-depleted food H in the body rather than fractionation during biosynthesis. Samples from Inuit groups suggest that humans with marine-dominated diets can be identified on the basis of coupled delta(2)H and delta(18)O values of hair. These results indicate a dual role for H and O isotopic measurements of keratin, including both biological (diet, physiology) and environmental (geographic movement, paleoclimate) reconstruction.

Variation of hydrogen, carbon, nitrogen, and oxygen stable isotope ratios in an American diet: fast food meals.

The stable isotopes of hydrogen, carbon, nitrogen, and oxygen provide insights into a heterotrophic organism's diet and geographic origin. Although the contribution of food delta (2)H and delta (18)O to the final tissue signal will not vary for constrained diets, it will for animals eating varied diets, that is, humans. This study surveyed the isotopic range in one portion of the American diet, fast food meals. Hamburger patties, buns, and French fries from national chain restaurants across the United States and from local restaurants (Salt Lake City, UT, and Charleston, SC) were analyzed for delta (2)H, delta (13)C, delta (15)N (patties only) and delta (18)O values. Patties and buns from local Utah restaurants were more depleted for delta (2)H, delta (13)C, and delta (18)O values than samples from other restaurants. There were no significant differences in delta values among French fries. All three components of the fast food meal displayed significant linear delta (2)H versus delta (18)O relationships (delta (2)H = 7.8delta (18)O - 237 per thousand, delta (2)H = 5.9delta (18)O - 258 per thousand, and delta (2)H = 3.3delta (18)O - 231 per thousand for patties, buns, and fries, respectively). The findings show that significant predictable variation exists in the stable isotopic composition of fast food meals. It is proposed that the variation in delta (13)C values of hamburger (beef) patties is indicative of differences in cattle-rearing practices, whereas delta (2)H and delta (18)O values are evidence of geographic variation in food sources. Although the patterns support the concept of a "continental" supermarket diet, there appears to be a strong regional component within the diet.