Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
The Advanced Training Council of the AHNS is pleased to announce the results of our Fellowship Year 2022 Match. Congratulations to these applicants and best of luck for your 2022 Fellowship year!
| 2022 Fellow | AHNS-Accredited Program |
| Michael Berger | Icahn Mt Sinai School of Medicine |
| Michael Bobian | MD Anderson Cancer Center |
| Danielle Bottalico | Cleveland Clinic Foundation |
| Ryan Carey | University of Miami Hospital and Clinics |
| Harrison Cash | University of Washington |
| Stephanie Chen | Emory University School of Medicine |
| Kate Clancy | University of Pittsburgh Medical Center |
| Jared Crothers | University of Florida |
| Steven Dennis | University of California – Davis |
| Dipan Desai | Johns Hopkins University-Endocrine |
| Gabriela DeVries | University of Pennsylvania Health System |
| Prashanthi Divakar | Memorial Sloan-Kettering Cancer Center |
| Aaron Domack | University of Cincinnati Medical Center |
| Janice Farlow | The Ohio State University |
| Samuel Frasier | Nebraska Methodist Hospital |
| Mica Glaun | MD Anderson Cancer Center |
| Michael Hajek | University of Toronto-Mt Sinai |
| Tyler Halle | University of Pennsylvania Health System |
| Chelsea Hamill | University of Kansas Medical Center |
| Albert Han | MD Anderson Cancer Center |
| Curtis Hanba | Medical University of South Carolina |
| Brette Harding | UT Southwestern Medical Center |
| Neal Molly Heft | Washington University at St. Louis |
| Melanie Hicks | Vanderbilt University Medical Center |
| Adam Howard | Oregon Health & Science University |
| Kia Jones | Roswell Park Cancer Institute |
| Emily Kamen | Northwestern University |
| Andrew Katz | Vanderbilt University Medical Center |
| Nayel Khan | Thomas Jefferson University |
| Maxwell Kligerman | Memorial Sloan-Kettering Cancer Center |
| Natalia Kyriazidis | Massachusetts Eye & Ear – Endocrine |
| Ciaran Lane | Penn State Hershey Medical Center |
| Hilary McCrary | The Ohio State University |
| Charles Meyer | Massachusetts Eye & Ear |
| Taha Mur | University of Pittsburgh Medical Center |
| Akash Naik | Indiana University School of Medicine |
| Samih Nassif | AdventHealth |
| Lindsay Olinde | Case Western Reserve /University Hospitals/Cleveland Med Ctr |
| Seerat Poonia | University of Miami Hospital and Clinics |
| Pablo Quadri | Moffitt Cancer Center |
| Jesse Qualliotine | University of California – San Francisco |
| Samuel Rubin | Mount Sinai Beth Israel |
| Kristen Seligman | University of Wisconsin |
| Awni Shahait | Augusta University – Endocrine |
| Andrew Skillington | Henry Ford Health System |
| Blaine Smith | University of North Carolina – Chapel Hill |
| Jessica Tang | Johns Hopkins University |
| Arielle Thal | Medical University of South Carolina |
| Kiranya Tipirneni | University of Iowa Hospitals and Clinics |
| Katherine Wai | Stanford University Medical Center |
| Ray Wang | Washington University at St. Louis |
| Forest Weir | University of Alabama-Birmingham |
| Melina Windon | University of Michigan |
| Linda Yin | University of Michigan |
The 2020 Margaret F. Butler Mentor of Women in Head and Neck Surgery Award Winner
Dr. Cherie-Ann Nathan
Ahead of the AHNS 10th International Conference on Head and Neck Cancer, we pay tribute to the 2020 Winner of the Margaret Butler Outstanding Mentor of Women in Head and Neck Surgery – Dr. Cherie-Ann Nathan.
Named in honor of Dr. Butler, the first woman chair of Otolaryngology-Head and Neck Surgery in the United States, this award recognizes individuals with significant impact and measurable outcomes in the mentorship of women in head and neck surgery. Dr. Nathan has had a great impact on the careers and lives of countless individuals in our specialty. She is a deserving and fitting winner of this Award and we are grateful for her leadership in promoting equity, diversity and inclusion in AHNS.
Please join us, her family and friends, in congratulating Dr. Nathan!
VIEW VIDEO TRIBUTE ON THIS LINK HERE
#BeLikeButler
Trinitia Cannon, MD
Chair, AHNS Women in Head and Neck Surgery Committee.
Shirley Y. Su, MBBS FRACS
Vice Chair, AHNS Women in Head and Neck Surgery Committee
Co-Chair, Margaret F. Butler Outstanding Mentor of Women in Head and Neck Surgery Award
Kelly Michelle Malloy, MD
Co-Chair, Margaret F. Butler Outstanding Mentor of Women in Head and Neck Surgery Award
The American Head and Neck Society (AHNS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide Continuing Medical Education for physicians.
The American Head and Neck Society (AHNS) designated this live activity for a maximum of 1 AMA PRA 1 Credit(s)TM. Physicians should claim only the credit they commensurate with the extent of their participation in the activity.
Registration: This Course is Free for AHNS members and $25.00 for non-AHNS-members.
By William R. Ryan, MD, University of California-San Francisco
Preoperative imaging for high-risk cutaneous squamous cell carcinoma (HRcSCC) of the head and neck lacks robust diagnosis-specific data regarding utility and lacks established guidelines regarding indications. Ultimately, physicians can exercise their own preferences for imaging of patients with HRcSCC in order to evaluate 1) the extent of local invasion, 2) the possibility of regional metastases to the parotid and/or neck, and 3) the presence of distant metastases. The following text outlines the definition of HRcSCC and some possible strategies for the choice of preoperative imaging for patients with HRcSCC of the head and neck.
“High-risk” features of cSCC are defined as those that are associated with increased risk of recurrence, increase risk of regional and/or distant metastasis, and/or increased risk disease-specific death. High risk features of head and neck cSCC include the following:
Head and Neck Cutaneous Squamous Cell Carcinoma High-Risk Features1-4
Clinical:
Histopathology:
All of these factors, usually when multiple factors are present, increase the likelihood of recurrence. Brigham and Womens’ stage T2b (defined as 2-3 of the following risk factors: tumor diameter ≥ 2 cm, poorly differentiated histology, depth of tumor invasion beyond fat, and/or perineural invasion ≥ 0.1 mm) has been shown to have a 21-30% risk of regional micrometastases, thereby indicating a significant risk for occult metastasis.5 Imaging can be considered when any of these features are found during a physical exam and/or incisional or excisional biopsies, especially if there are 2 or more of these features present. If there is a palpable regional lymph node on physical exam, imaging should be performed with the plan for a fine needle aspiration biopsy to determine the presence of regional metastatic disease.
In HRcSCC patients, imaging has been shown, at least by one study6, to change management in one-third of patients and may even improve outcomes. The HRcSCC patients who underwent imaging in this retrospective study had a significantly better 5-year disease-free survival rate compared to patients who did not (78% vs. 51%). Thus, earlier identification and appropriate treatment intervention may improve oncologic outcomes for HRcSCC.
The specific choices of imaging modality depends on the clinical picture. For the assessment of extent of local invasion, computed tomography (CT) head/neck with contrast can be performed when bone invasion is suspected while magnetic resonance imaging (MRI) head and neck with gadolinium can be performed when deep soft tissue and/or nerve invasion are suspected. Although CT and MRI also provide fairly accurate and equivalent assessments of lymph node metastases, ultrasound and PET/CT have been shown to have a slightly superior accuracy for this function.7 Positron emission tomography (PET)/CT provides additional information about the presence or absence of distant metastases. However, insurance approvals for PET/CT in this setting can be challenging.
For lymph node metastasis assessment, the majority of studies that evaluate the utility and accuracy of head and neck imaging are in patients with mucosal SCC, not cutaneous SCC. Cutaneous SCC are anatomically different with less predictable lymphatic spread patterns than mucosal SCC. However, one can extrapolate the imaging characteristics of suspicious lymph nodes from head and neck mucosal SCC to cSCC of the head and neck.8 A review of 17 studies that each compared imaging assessments of neck lymph nodes to histopathologic findings in patients with head and neck aerodigestive SCC found that CT, MRI, and US all had fairly similar sensitivities, ranging from 80-87%, with US having the highest sensitivity.7 In cases of sub-centimeter sized lymph nodes, the following characteristics are associated with metastatic lymph nodes: irregular or intense enhancement, surrounding fat stranding, adherent or fused lymph nodes, asymmetry, and especially central necrosis.9-10
The following is an outline of the advantages and disadvantages of each imaging modality in the evaluation of HRcSCC:
Ultrasound (US)
US has the following advantages: 1) a more sensitive lymph node assessment compared to other modalities; 2) the least expensive modality; 3) poses no risks to the patient; 4) can be performed by the clinician in real time, which provides immediate dynamic information that can be discussed during a clinic visit. US has the following disadvantages in having: 1) limited assessment of depth of invasion or invasion alone nerves; 2) no information of tissue in or deep to bone; and 3) no information about distant metastases.
Computed tomography (CT) head and/or neck
CT has the following advantages: 1) the most superior assessment for cortical bone invasion whether it be calvarium, temporal, mandible, maxilla, or spine boney structure; 2) a more rapid capture time than MRI; and 3) less expensive than MRI. Disadvantages include: 1) poorer soft tissue delineation as compared to MRI; 2) radiation to the patient; and 3) iodinated contrast risks including allergic reaction and kidney damage.
Magnetic resonance imaging (MRI) head and neck
MRI has the following advantages: 1) superior evaluation of soft tissue, nerves, particularly for the parotid gland and facial nerve; 2) superior evaluation of the skullbase and brain; 3) a superior evaluation of bone marrow invasion; and 4) no irradiation risks. Disadvantages include: 1) time of imaging capture; 2) expense; and 3) risk of claustrophobia and migration of metallic materials/retained foreign bodies.
Positron Emission Tomography/Computed Tomography (PET/CT)
PET/CT has the following advantages: 1) concurrent evaluation for lymph node and/or distant metastases; 2) for chronic lymphocytic leukemia, a PET/CT can help for the differentiation from lymphoma. Disadvantages include: 1) increased dose of radiation compared to other modalities; 2) expense; and 3) increased risk of incidental and/or artifactual findings.
There is certainly some overlap in the capabilities of these modalities. Also, a combination of these modalities can be performed; however, attention to cost and time impact on the patient can be contributing factors for these decisions.
The author regularly performs ultrasound in the office setting, which often enables an immediate assessment of lymph nodes at the time of initial diagnosis and workup. This assessment helps determine the need for same-day fine needle aspiration (FNA) of suspicious lymph nodes, helps inform the need for PET/CT if suspicious lymph nodes are present, and enhances discussions of stage and the extent of surgery with the patient in the same clinic encounter.
Conclusions
Imaging is important in the management of HRcSCC to evaluate the extent of local disease, to assess the presence of regional and/or distant metastases, and to guide management, such as the need for lymph node FNA, and planning the extent of surgery. There is flexibility of choice of imaging modality for HRcSCC. I have outlined some strategies for modality specific indications that are hopefully helpful.
References
