2018-19 Section 7-Neoplastic and Inflammatory Diseases of the Head and Neck eBook

Jug RC, Datto MB, Jiang XS. Molecular testing for indeterminate thyroid nodules: performance of the Afirma gene expression classifier and ThyroSeq panel. Cancer Cytopathol . 2018 Apr 10; doi:10.1002/cncy.21993. [Epub ahead of print]. EBM level 3......................................................153-162 Summary : This paper looks at the performance of two common molecular tests for thyroid nodules while taking into account the new diagnosis of non-invasive follicular thyroid neoplasm with papillary-like nuclear features. Additionally, the authors review the ultrasound findings and compare this to their newly calculated rate of malignancy on indeterminate nodules.

Mostoufi-Moab S, Labourier E, Sullivan L, et al. Molecular testing for oncogenic gene alterations in pediatric thyroid lesions. Thyroid . 2018; 28(1):60-67. EBM level 3............................................163-170

Summary : This paper retrospectively evaluates resected thyroid tissue with respect to mutations in the pediatric population. The authors demonstrate that when a mutation is identified, it correlates with malignancy (97%).

V. Lymphatic

A. New staging system García J, López M, López L, et al. Validation of the pathological classification of lymph node metastasis for head and neck tumors according to the 8th edition of the TNM Classification of Malignant Tumors. Oral Oncol . 2017; 70: 29-33. EBM level 4...................................................171-175 Summary : These authors retrospectively studied 1188 patients with head and neck squamous cell carcinoma treated with neck dissection, excluding the HPV-associated oropharyngeal carcinomas. The pathological nodal (pN) stages were determined using both the AJCC 7th edition and 8th editions. Cause-specific survival curves were analyzed; the pN2 and pN3 curves were similar under the 7th edition, but achieved greater distribution under the 8th edition criteria. The authors also found the 5-year cause-specific survival for patients with extracapsular spread (ECS) was 22.4% ,while for patients without ECS it was significantly more favorable at 51.4% ( p = 0.0001). Zhan KY, Eskander A, Kang SY, et al. Appraisal of the AJCC 8th edition pathologic staging modifications for HPV-positive oropharyngeal cancer, a study of the National Cancer Data Base. Oral Oncol . 2017; 73:152-159. EBM level 4.........................................................................................176-183 Summary : Utilization of the National Cancer Data Base for validation of the new AJCC 8th edition restaging of HPV-associated oropharyngeal cancers demonstrated improved hazard discrimination between the stages, thus illustrating the new system’s greater prognostication value. The data presented also demonstrate that nodal size and nodal laterality are not as predictive as nodal count in HPV-associated oropharyngeal carcinomas. The authors note a potential contribution of extracapsular spread for HPV-associated carcinomas; however, this pathologic feature does not confer survival disadvantage across institutions/studies thus far.