Survival and complications after carotid resection for head and neck squamous cell carcinoma: A systematic review and pooled analysis.

OBJECTIVE: The aim of this study is to analyze oncologic outcomes and complications rate after common or internal carotid artery (CCA/ICA) resection for head and neck squamous cell carcinoma (HNSCC). METHODS: This study was conducted in conformity with the PRISMA statement. A systematic review and pooled analysis was performed for overall survival (OS), disease specific survival (DSS) (primary outcomes), and perioperative death rate (secondary outcome). RESULTS: A total of 276 patients (males: 76.7%, n = 191/249) with a median age of 59 years (n = 239/276; 95% CI 55.0-61.7) who underwent CCA/ICA resection for HNSCC were included. The median follow-up time was 11 months (n = 276). Estimated pooled OS rates (95% CI) at 1 and 2 years were 52.7% (46.9-59.2) and 29.8% (24.3-36.5), respectively. The median OS (95% CI) was 14 months (12-17). Estimated pooled DSS rates (95% CI) at 1 and 2 years were 58.6% (52.7-65.2) and 34.6% (28.5-41.9), respectively. The median DSS (95% CI) was 16 months (14-19). The perioperative death rate was 6.9% (n = 19/276). CONCLUSIONS: CCA/ICA resection should be considered as a treatment option for accurately selected patients. Multicentric prospective studies are recommended to develop a predictive score guiding the decision-making process.

Submandibular gland involvement in oral cavity squamous cell carcinoma: a retrospective multicenter study.

BACKGROUND: The submandibular gland (SMG) is routinely excised during neck dissection. Given the importance of the SMG in saliva production, it is important to understand its involvement rate by cancer tissue and the feasibility of its preservation. METHODS: Retrospective data were collected from five academic centers in Europe. The study involved adult patients affected by primary oral cavity carcinoma (OCC) undergoing tumor excision and neck dissection. The main outcome analyzed was the SMG involvement rate. A systematic review and a meta-analysis were also conducted to provide an updated synthesis of the topic. RESULTS: A total of 642 patients were enrolled. The SMG involvement rate was 12/642 (1.9%; 95% CI 1.0-3.2) when considered per patient, and 12/852 (1.4%; 95% CI 0.6-2.1) when considered per gland. All the glands involved were ipsilateral to the tumor. Statistical analysis showed that predictive factors for gland invasion were: advanced pT status, advanced nodal involvement, presence of extracapsular spread and perivascular invasion. The involvement of level I lymph nodes was associated with gland invasion in 9 out of 12 cases. pN0 cases were correlated with a reduced risk of SMG involvement. The review of the literature and the meta-analysis confirmed the rare involvement of the SMG: on the 4458 patients and 5037 glands analyzed, the involvement rate was 1.8% (99% CI 1.1-2.7) and 1.6% (99% CI 1.0-2.4), respectively. CONCLUSIONS: The incidence of SMG involvement in primary OCC is rare. Therefore, exploring gland preservation as an option in selected cases would be reasonable. Future prospective studies are needed to investigate the oncological safety and the real impact on quality of life of SMG preservation.

Machine learning in laryngeal cancer: A pilot study to predict oncological outcomes and the role of adverse features.

BACKGROUND: Laryngeal carcinoma (LC) remains a significant economic and emotional problem to the healthcare system and severe social morbidity. New tools as Machine Learning could allow clinicians to develop accurate and reproducible treatments. METHODS: This study aims to evaluate the performance of a ML-algorithm in predicting 1- and 3-year overall survival (OS) in a cohort of patients surgical treated for LC. Moreover, the impact of different adverse features on prognosis will be investigated. Data was collected on oncological FU of 132 patients. A retrospective review was performed to create a dataset of 23 variables for each patient. RESULTS: The decision-tree algorithm is highly effective in predicting the prognosis, with a 95% accuracy in predicting the 1-year survival and 82.5% in 3-year survival; The measured AUC area is 0.886 at 1-year Test and 0.871 at 3-years Test. The measured AUC area is 0.917 at 1-year Training set and 0.964 at 3-years Training set. Factors that affected 1yOS are: LNR, type of surgery, and subsite. The most significant variables at 3yOS are: number of metastasis, perineural invasion and Grading. CONCLUSIONS: The integration of ML in medical practices could revolutionize our approach on cancer pathology.

Oral cavity carcinoma in patients with and without a history of lichen planus: A comparative analysis.

BACKGROUND: Oral potentially malignant disorders (OPMD) are associated with the risk of malignant transformation (MT) into oral cavity carcinoma (OCC). Oral lichen planus (OLP) is one of the most common OPMDs in western countries. Although there is a substantial amount of research on progression to cancer, a specific analysis of the clinical characteristics and prognosis of cancer developed in patients with a history of OLP versus patients without a history of OLP has not been investigated so far. METHODS: Retrospective evaluation of 82 patients treated for OCC with a known history of OLP compared to a representative sample of 82 patients treated for OCC without a known history of LP. Comparative analyses were performed on age at presentation, sex, TNM staging, clinical characteristics, pathology characteristics, 2- and 5-year overall survival (OS), and disease-free survival (DFS). RESULTS: It was shown that patients with a history of LP were significantly younger at first presentation than patients without a history of LP (mean age difference 6.7 years, 95% CI 3.1-10.3, p < 0.05). Also, patients with a history of OLP were in higher proportion females. The main pathological stage at presentation was significantly lower in the OLP group (p < 0.05). The 2-year survival analysis showed that DFS and OS were significantly lower in patients without a known history of OLP, with a hazard ratio (HR) of 3.1 (95% CI 1.4-6.8) and HR of 2.6 (95% CI 1.3-5.3), respectively. The 5-year survival analysis showed that DFS and OS were significantly lower in patients without a known history of OLP, with a hazard ratio of 3.1 (95% CI 1.6-6.2) and of 2.9 (95% CI 1.5-5.6), respectively. CONCLUSIONS: Cancer arising from OLP has peculiar characteristics compared to cancer in naïve patients. It most commonly affects younger patients, women, and nonsmokers. It is usually diagnosed at earlier stages and appears to have less aggressive behavior at presentation. Moreover, when 2- and 5-year survival is analyzed, it appears that patients in OLP group have an overall and a disease-free survival advantage. These results suggest that cancer from OLP is less aggressive and thus has a potential biological difference with cancer arising in non-OLP patients. Further clinical and basic investigations are needed to confirm the results of this study.

Treatment of oropharyngeal squamous cell carcinoma: Is swallowing quality better after TORS or RT?

BACKGROUND AND PURPOSE: To answer an important question regarding the long-term morbidity of two oncological equivalent treatment for oropharyngeal squamous cell carcinoma (OPSCC), namely a comparison of swallowing function results between patients treated with trans-oral robotic surgery (TORS) versus patients treated with radiotherapy (RT). MATERIALS AND METHODS: Studies included patients with OPSCC treated with TORS or RT. Articles reporting complete data on MD Anderson Dysphagia Inventory (MDADI) and comparing the two treatments (TORS vs RT) were included in the meta-analysis. Swallowing assessed with MDADI was the primary outcome, the evaluation with instrumental methods was the secondary aim. RESULTS: Included studies provided a total of 196 OPSCC primarily treated with TORS vs 283 OPSCC primarily treated with RT. The mean difference in MDADI score at the longest follow-up was not significantly different between TORS and RT group (mean difference [MD] -0.52; 95% CI -4.53-3.48; p = 0.80). After treatment, mean composite MDADI scores demonstrated a slight impairment in both groups without reaching a statistical difference compared to the baseline status. DIGEST score and Yale score showed a significantly worse function in both treatment groups at 12-month follow-up compared to baseline status. CONCLUSION: The meta-analysis demonstrates that up-front TORS (+- adjuvant therapy) and up-front RT (+- CT) appear to be equivalent treatments in functional outcomes in T1-T2, N0-2 OPSCC, however, both treatments cause impaired swallowing ability. Clinicians should have a holistic approach and work with patients to develop an individualized nutrition plan and swallowing rehabilitation protocol from diagnosis to post-treatment surveillance.

Myomucosal island flap in the reconstruction of oral cavity defects: Description of the surgical technique.

Multiple options are available for the reconstruction of the defects of the oral cavity. Among these, the facial artery myomucosal island flap (FAMMIF) is a pedicled flap composed by cheek mucosa, submucosa, and part of the buccinator muscle. The FAMMIF is ideal for the reconstruction of small-to-moderate defects of the oral cavity and the oropharynx. This is due to low operating time, low morbidity, and good functional and aesthetic results. A step-by-step description of the flap harvesting is presented, with particular attention to flap design, identification of the vessels, harvesting of the myomucosal island, tunnel preparation for its passage in the neck and back to the oral cavity, and closure of the cheek donor site with the buccal fat pad.

Occult Neck Metastases in Head and Neck Adenoid Cystic Carcinoma: A Systematic Review and Meta-Analysis.

Introduction: Adenoid cystic carcinoma (AdCC) is a rare tumor whose clinical course is burdened by local recurrence and distant dissemination. Lymph node metastasis is not believed to be common and its clinical impact is controversial. The aim of this study was to determine: (1) the prevalence of occult metastasis at diagnosis in cN0 head and neck AdCC, (2) its prognostic role, and (3) the consequent need to perform elective neck dissection (END). Material and Methods: A systematic review and meta-analyses following PRISMA guidelines was performed. PubMed, Embase, and Central databases were questioned up to July 2021 to identify studies reporting on the prevalence of occult neck metastases in head and neck AdCC. A single-arm meta-analysis was then performed to determine the pooled prevalence of occult lymph node metastases among the retained studies. Results: Of the initial 6317 studies identified, 16 fulfilled the inclusion criteria, and they were included in the meta-analysis. Of a population of 7534 patients, 2530 cN0 patients were treated with END, which revealed 290/2530 cases of occult metastases (pN+/cN0). Meta-analysis of the results of END in the 16 studies estimated an overall prevalence of occult metastases at diagnosis of 17%. No further subgroup analysis was possible to identify factors influencing lymph node involvement and the prognostic role of END. Conclusions: Taking 20% as an historically proposed cut off, a 17% prevalence of occult metastases represents a borderline percentage to get a definitive conclusion about the indication to END for head and neck AdCC. A more advanced UICC stage, an oropharyngeal minor salivary glands origin, and a high-grade transformation are factors to be considered in a comprehensive patient's tailored therapeutic strategy. Multicenter prospective studies are the key to finding stronger recommendations on this topic.

Antibiotic prophylaxis in head and neck cancer surgery: Systematic review and Bayesian network meta-analysis.

Postoperative surgical site infections (SSI) are worrisome complications after head and neck cancer surgery. Due to the lack of direct comparisons, it is difficult to indicate the best antibiotic in the setting of SSI prophylaxis for patients with head and neck cancer. For this reason, we decided to conduct a Bayesian network meta-analysis of clinical studies evaluating various antibiotic classes for SSI prophylaxis; thus, we directly and indirectly compared all the available antibiotics in the setting of head and neck oncological surgery. We performed a systematic review and a network meta-analysis according to the PRISMA-NMA checklist. Regarding inclusion criteria, we included articles with retrospective or prospective design recruiting adult participants with head and neck neoplasm of any subsite that compared different antibiotics or that compared different antibiotic treatment duration with sample sizes of more than 10 patients. Overall, 310 citations were identified by the search on all databases. Of these, 250 were excluded based on title and abstract, leaving 60 publications for full text examination. Finally, 20 papers were included for data extraction and analysis. In total, 8627 patients were evaluated across the included studies. Results of the Bayesian network meta-analysis showed that when compared to clindamycin short course, the antibiotics effective in preventing SSI were ampicillin/sulbactam or other penicillin short course (OR: 0.37, 95%CrI: 0.19-0.72), cefazolin/metronidazole short course (OR: 0.26, 95%CrI: 0.06-0.93), cefazolin (OR: 0.36, 95%CrI: 0.17-0.79), ampicillin/sulbactam long course (OR: 0.20, 95%CrI: 0.04-0.91), cefazolin/metronidazole long course (OR: 0.27, 95%CrI: 0.09-0.64), cefoperazone (OR: 0.05, 95%CrI: 0.002-0.89), cefotaxime (OR: 0.04, 95%CrI: 0.002-0.85). There was no significant difference between clindamycin and no antibiotic (OR: 2.3, 95%CrI: 0.59-9.9). Clindamycin plus aminoglycoside seemed to give a slight protection from SSI compared to clindamycin alone (OR: 0.30, 95%CrI: 0.09-0.99) or no antibiotic (OR: 0.13, 95%CrI: 0.02-067). Antibiotic prophylaxis is important in preventing SSI in head and neck cancer setting. Current evidence suggests that penicillins and cephalosporins are the best choice. Moreover, long duration course does not give any advantage compared to short course prophylaxis. Finally, it is important to implement appropriate antibiotic prophylaxis in patients that are labeled as penicillin allergic, in this regard clindamycin seems to be ineffective and, for this reason, further research is needed to provide a better care for this subset of patients.

De-escalation studies in HPV-positive oropharyngeal cancer: How should we proceed?

Human papilloma virus (HPV) is a well-established causative factor in a subset of squamous cell carcinomas of the head and neck (HNSCC). Although HPV can be detected in various anatomical subsites, HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) is the most common HPV-related malignancy of the head and neck, and its worldwide incidence is constantly rising. Patients with OPSCC are generally younger, have less co-morbidities and generally have better prognosis due to different biological mechanisms of carcinogenesis. These facts have generated hypotheses on potential treatment modifications, aiming to minimize treatment-related toxicities without compromising therapy efficacy. Numerous randomized clinical trials have been designed to verify this strategy and increasingly real-world evidence data from retrospective, observational studies is becoming available. Until now, the data do not support any modification in contemporary treatment protocols. In this narrative review, we outline recent data provided by both randomized controlled trials and real-world evidence of HPV-positive OPSCC in terms of clinical value. We critically analyze the potential value and drawbacks of the available data and highlight future research directions. This article was written by members and invitees of the International Head and Neck Scientific Group.(www.IHNSG.com).

Development and validation of an improved classification and risk stratification system for carotid body tumors: Multinational collaborative cohort study.

BACKGROUND: This study aims to develop and validate a new classification system that better predicts combined risk of neurological and neurovascular complications following CBT surgery, crucial for treatment decision-making. METHODS: Multinational retrospective cohort study with 199 consecutive cases. A cohort of 132 CBT cases was used to develop the new classification. To undertake external validation, assessment was made between the actual complication rate and predicted risk by the model on an independent cohort (n = 67). RESULTS: Univariate analyses showed statistically significant associations between developing a complication and the following factors: craniocaudal dimension, volume, Shamblin classification, and Mehanna types. In the multivariate prognostic model, only Mehanna type remained as a significant risk predictor. The risk of developing complications increases with increasing Mehanna type. CONCLUSIONS: We have developed and then validated a new classification and risk stratification system for CBTs, which demonstrated better prognostic power for the risk of developing neurovascular complications after surgery.

Nutritional therapy for patients with coronavirus disease 2019 (COVID-19): Practical protocol from a single center highly affected by an outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

OBJECTIVES: Coronavirus disease 2019 (COVID-19) carries a high risk for malnutrition owing to the state of debilitation that results from acute respiratory failure symptoms. The aim of this study was to provide an approach to reduce the risk for malnutrition and improve patients' clinical outcomes. METHODS: Short age-adjusted Nutritional Risk Screening was performed with 94 non-intensive care unit (ICU) patients admitted to the Giovanni Borea Civil Hospital in Sanremo. Forty-nine patients in the ICU were considered at risk for malnutrition without screening and were fed with enteral nutrition plus supplemental parenteral nutrition. In the non-ICU setting, patients underwent a personalized nutritional protocol, considering their conditions, which consisted of a high-protein and high-calorie pureed diet, oral nutritional supplements, and/or artificial nutrition or other personalized nutritional path. RESULTS: The nutritional treatment was well tolerated by the patients. Of the non-ICU patients, 19.1% died. They were mainly women, with higher body mass indices and older in age. Of the patients in the ICU, 53.1% died. Of the 94 non-ICU patients, 72 scored positive on at least one nutritional risk screening item (excluding age). Of the 94 non-ICU patients, 68 were >70 y of age. Non-ICU patients whose energy and protein needs were not met were older (P = 0.01) and had a higher death rate than patients whose needs were met (P < 0.001). CONCLUSIONS: This protocol should not be considered as a guideline; rather, it is intended to report the clinical experience of a nutrition team in an Italian reference center for the treatment of patients with COVID-19. Nutritional strategies should be implemented to prevent worsening of clinical outcomes.

Elective neck dissection in primary parotid carcinomas: A systematic review and meta-analysis.

BACKGROUND: To estimate the rate of occult cervical lymph node metastases in cN0 patients affected by primary parotid carcinomas and to scrutinize the evidence on the indication and extent of elective neck dissection in these neoplasms. METHODS: Medline, Embase, Web of Science, Cochrane Library and Scopus were searched until August 31, 2020, to identify studies reporting the use of elective neck dissection in the management of malignant parotid tumours. The PRISMA checklist was used. A single arm meta-analysis was then made to determine the pooled rate of occult lymph node metastases. Risk of bias of the included studies was assessed through the ROBINS-E tool. RESULTS: The initial search returned 20 541 articles, of which twelve met the inclusion criteria and were included in the meta-analysis. They comprised 1310 patients with parotid carcinoma, of whom 542 cN0 underwent elective neck dissection, which led to the diagnosis of lymph node metastasis (pN+/cN0) in 113 cases. Meta-analysis of the results of elective neck dissection showed an overall rate of occult metastases of 0.22 (99% CI: 0.14-0.30). Locally advanced or high-grade tumours were the commonest indications for elective neck dissection in the included studies. The most dissected lymph node levels were I-II-III, and level II was the commonest site of occult nodal metastases. CONCLUSIONS: An occult metastasis rate of 0.22 (99% CI: 0.14-0.30) represents a not negligible percentage value, which should encourage further research to outline the most appropriate elective neck management in cN0 patients with parotid carcinomas.

Endoscopic nasopharyngoscopy and ENT specialist safety in the COVID 19 era: the back endoscopy approach to the patient.

PURPOSE: To propose a way to safely perform endoscopic nasopharyngoscopy in ENT outpatient clinic during the COVID-19 pandemic. METHODS: This manuscript highlights the importance of endoscopy in daily ENT clinical practice, which is a pivotal procedure in the diagnosis of many head and neck pathologies. However, since the beginning of the COVID-19 outbreak, the authors have witnessed a drastic reduction (91%) in the use of endoscopic nasopharyngoscopy at their institutions. In fact, it is considered at risk of contamination for healthcare professionals, as any upper airway manipulation procedure. RESULTS: In the "Back approach to the patient" for endoscopic nasopharyngoscopy, the operator positions himself behind the patient and faces the monitor. The endoscopist, not being positioned in front of the patient, should, therefore, be less exposed to airborne transmission of SARS-CoV-2 virus. CONCLUSION: This simple variation of the physician's position during endoscopic nasopharyngoscopy could potentially reduce the risk of contagion since the operator is not in the trajectory of droplets and/or aerosols.

Performing the nasopharyngeal and oropharyngeal swab for 2019-novel coronavirus (SARS-CoV-2) safely: How to dress, undress, and technical notes.

BACKGROUND: To show how to safely perform nasopharyngeal and/or oropharyngeal swabs for 2019-novel coronavirus. METHODS: The video describes in detail the dressing and undressing procedures of health personnel, with the appropriate personal protective equipment. Technical notes for the execution of the nasopharyngeal and oropharyngeal swab are also provided to avoid sampling errors. RESULTS: The undressing phase is the procedure with the highest risk of self-contamination for the health worker. Following the various steps as shown in the video, there were no cases of contagion among the otolaryngology team appointed to perform the swabs for SARS-CoV-2 testing. CONCLUSIONS: This study demonstrates the technical feasibility of safely performing nasopharyngeal and/or oropharyngeal swabs for identification of SARS-CoV-2 viral RNA.

Lymph node yield and lymph node ratio in oral cavity and oropharyngeal carcinoma: Preliminary results from a prospective, multicenter, international cohort.

OBJECTIVES: Recently, Lymph Node Yield (LNY) and Lymph Node Ratio (LNR) have emerged as prognostic indicators in head and neck cancer. However, there is a lack of data regarding the LNY and LNR values in the specific neck levels dissected and regarding the factors that influence these values. MATERIALS AND METHODS: Preliminary results of the NCT03534778 trial are reported. LNY and LNR values were estimated for 100 patients with oral or oropharynx carcinoma, from November 1, 2018 to September 30, 2019. RESULTS: Overall, the mean number of lymph nodes retrieved was 34.4 (95% confidence interval [CI] 31.6-37.3). LNY means and CI per single neck level were as follows: level I 5.5 lymph nodes harvested (95% CI 3.5-7.5), level II 15.4 (95% CI 10.6-20.2), level III 8.0 (95% CI 4.6-11.3), level IV 6.3 (95% CI 3.4-9.15), level V 6.3 (95% CI 3.6-9.0). cN+ patients had a higher number of lymph nodes retrieved, odds ratio (OR) 1.2 (95% CI 1.05-1.36). Smokers had less lymph nodes harvested, OR 0.78 (95% CI, 0.71-0.87). Mean LNR was 0.063 (95% CI 0.047-0.078). A multiple regression analysis showed that anatomic site, pN, smoking status and LNY statistically significantly predicted the LNR (p < 0.05) CONCLUSIONS: The LNY and LNR values are influenced by various demographic and pathological characteristics of the patient, such as the number of dissected levels, primary site, cN positivity, and smoking status.

Lateral cervical approach for salvage total laryngectomy without pharyngeal reinforcement with pedicled or free flaps: our preliminary experience in six patients.

PURPOSE: To analyze the surgical outcomes in terms of postoperative wound complications in a small case series of six patients treated with lateral cervical approach (LCA) for salvage total laryngectomy (STL) without prophylactic use of the pectoralis major myocutaneous flap (PMMF) or free flaps. METHODS: Between September 2018 and August 2019, six patients with recurrent/residual squamous-cell carcinoma after (chemo)radiotherapy [(C)RT] underwent STL with minimally invasive LCA with the anterior myocutaneous flap (AMCF), sparing the prelaryngeal tissue. Clinical records were retrospectively reviewed. RESULTS: Wound dehiscence and local complications were prevented in five cases. Pharyngocutaneous fistula (PCF) occurred in one case and the closure was achieved by medical dressing with spontaneous healing within 15 days. Oral intake of liquids started 2 weeks after surgery in the five patients without local complications, after 24 days in the patient with PCF. CONCLUSION: STL through the LCA after [(C)RT] failure seems to be feasible and effective in terms of prevention of local complications as wound dehiscence and fistula. More large clinical series are needed to confirm whether the use of LCA reduced the rate of postoperative wound complications following STL without the prophylactic use of pedicled or free flaps.

Trans-oral robotic surgery in the management of parapharyngeal space tumors: A systematic review.

PURPOSE: To perform a systematic review of studies evaluating Trans-oral Robotic Surgery (TORS) in the treatment of parapharyngeal space (PPS) tumors. METHODS: A comprehensive electronic search was performed in PubMed/MEDLINE, Cochrane Library, and Google Scholar databases for appropriate published studies. The last search was conducted on November 9, 2019. RESULTS: Twenty-two studies were included for the systematic review which analyzed a total of 113 patients (median age 53.5, IQR 41.5-58.1). The most common PPS tumor treated with TORS was the pleomorphic adenoma (n = 66; 58.4%). All tumors were successfully resected. The median tumor size was 4.8 cm (n = 73; IQR 3.8-5.4). Combined transcervical (TORS-TC) and transparotid (TORS-TP) approaches were used in 13 (11.5%) and 5 (4.4%) patients, respectively. Capsule disruption was noted in 11 cases (14.5%), while tumor fragmentation was observed in 7 patients (10.3%). The median time of hospitalization was 3 days (n = 79; IQR 2-4.1). Oral diet was possible from the day after surgery in the majority of patients (n = 34, 68%). The most common complication was dysphagia (n = 5, 4.5%). CONCLUSIONS: This systematic review confirms the safety and feasibility of TORS in the treatment of PPS lesions. Given the low quality of included studies, further evidence is needed in order to establish clinical guidelines.

Narrow band imaging in head and neck unknown primary carcinoma: A systematic review and meta-analysis.

OBJECTIVE: To estimate the diagnostic performance of Narrow Band Imaging (NBI) in patients with cervical metastasis from head and neck squamous cell carcinoma of unknown primary (SCCUP) origin. METHODS: PubMed, Embase, and Scopus databases were systematically scrutinized up to July 1, 2019, looking for studies that encompassed the NBI in the SCCUP diagnostic work up. The main inclusion criteria for eligible articles for the meta-analysis were non-evidence of primary tumor after physical examination and conventional cross-section imaging before NBI assessment and the availability of complete data on the diagnostic accuracy of NBI. A set of random-effects model meta-analyses was then performed following the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. RESULTS: Five studies, conducted between January 2003 and September 2016, comprising 169 patients imaged with NBI, were included in the meta-analysis. The pooled sensitivity and specificity of NBI in patients with head and neck SCCUP was 0.83 (99% CI, 0.54-0.95) and 0.88 (99% CI, 0.55-0.97), respectively. The positive and negative likelihood ratios were 6.38 (99% CI, 1.6-25.44) and 0.06 (99% CI, 0.005-0.86). The pooled diagnostic odds ratio (DOR) was 82.15 (99% CI, 7.06-955). The overall detection rate of NBI was 0.35 (99% CI, 0.18-0.53), which allowed localization the primary tumor in 61 out of 169 patients, otherwise not detected by the usual diagnostic work-up. CONCLUSIONS: Current available evidence suggests that NBI has a considerable diagnostic accuracy in patients affected by head and neck SCCUP. Laryngoscope, 130:1692-1700, 2020.

Potentially malignant disorders of the oral cavity and oral dysplasia: A systematic review and meta-analysis of malignant transformation rate by subtype.

IMPORTANCE: Potentially malignant disorders of the oral cavity (OPMD) are a heterogeneous group of lesions associated with a variable risk of malignant transformation (MT) to invasive cancer. Leukoplakia (LE), lichen planus (LP), oral lichenoid lesions (OLL), oral erythroplakia (OE), oral submucous fibrosis (OSF), and proliferative verrucous leukoplakia (PVL) are among the most common of these lesions. Oral dysplasia is a mucosal area characterized by cellular and architectural derangement, which may be associated with OPMDs or not. OBJECTIVE: To define the MT rate of OPMDs and the risk of development into cancer of mild vs moderate/severe oral dysplasia. This in order to implement adequate follow-up strategies and treatment decisions. STUDY DESIGN: We performed a systematic review and meta-analysis on studies reporting the MT rates of OPMDs and oral dysplasia. Ninety-two studies were included for the analysis. Cumulative rates were reported for OPMDs overall and as a subgroup, a comparison was made of mild vs moderate/severe dysplasia. Meta-regression on OPMD and year of publication was also performed. MAIN OUTCOME AND MEASURES: Overall MT rates of OPMDs and odds ratio of MT of mild vs moderate/severe dysplasia. RESULTS: Overall MT rate across all OPMD groups was 7.9% (99% confidence interval [CI] 4.9%-11.5%). MT rates of the specific OPMD subgroups were as follows: LP 1.4% (99% CI 0.9%-1.9%), LE 9.5 (5.9%-14.00%), OLL 3.8% (99% CI 1.6%-7.00%), OSF 5.2% (99% CI 2.9%-8.00%), OE 33.1% (99% CI 13.6%-56.1%), and PVL 49.5% (99% CI 26.7%-72.4%). Regarding the dysplasia grades comparison, the meta-analysis showed that moderate/severe dysplasia is meaningfully associated to a much greater risk of MT compared to mild dysplasia with an odds ratio of 2.4 (95% CI 1.5-3.8) [Correction added on 27 December 2019, after first online publication: CI updated from 99% to 95%.]. Heterogeneity was not significant. Annual MT rates were approximated based on the average follow-up as reported in the various subgroups. Lichen planus had an annual MT of 0.28%, OLL of 0.57%, leukoplakia of 1.56%, PVL of 9.3%, and OSF of 0.98%. Mild dysplasia had an annual MT of 1.7%, while severe dysplasia of 3.57%. Meta-regression showed a significant negative correlation of PVL MT rate and year of the study (P value <.001). CONCLUSIONS AND RELEVANCE: OPMDs and oral dysplasia are relatively common conditions that general practitioners, head and neck, and oral medicine specialists, face in their everyday practice. Our analysis confirms the significant risk of MT of these lesions, although variable among the subgroups. Moderate/severe dysplasia bears a much higher risk of cancer evolution than mild dysplasia. It is important to raise public health awareness on the MT rates of these conditions, at the same time efficacious communication with the patient is of utmost importance. This, coupled with strict follow-up measures and optimal treatment strategies, would help in reducing the transformation of these oral conditions into invasive cancer.