Enhancing Label-Free Fluorescence Lifetime Imaging for Intraoperative Tumor Margin Delineation in Head and Neck Cancer using Data-Centric AI.

Precise intraoperative delineation of tumor margin is critical for maximizing resection completeness and minimizing recurrence in head and neck cancers (HNC). Label-free Fluorescence Lifetime Imaging (FLIm), which captures the fluorescence decay characteristics of endogenous molecules, offers a real-time method for differentiating malignant from healthy tissue during surgery without the need of contrast agents. Here, we present a data-centric artificial intelligence (AI) framework to enhance the robustness and accuracy of FLIm-based classification models for HNC.

Biochemical Markers of Sarcopenia as Predictors of Outcomes Among Patients Undergoing Laryngectomy.

Background: Sarcopenia, the systemic loss of skeletal muscle mass and function, is prevalent and particularly detrimental to head and neck cancer (HNC) patients. Cancer-associated sarcopenia involves complex mechanisms of poor nutrition and inflammation, highlighting the necessity for preoperative identification of these high-risk patients.

Methods: A multi-site retrospective chart review (2016-2021) was performed on HNC patients undergoing total laryngectomy with or without reconstruction.

Association of Social Vulnerability Index With Declining Recommended Surgical Treatment in Head and Neck Cancer Patients.

Objective: To investigate the impact of county-level social vulnerability on patients' decision to refuse recommended surgical treatment.

Methods: Retrospective cohort analysis conducted on HNSCC cases documented in the latest available SEER databases from 2000 to 2020; various demographic, including county of residence, and disease-related variables were collected. CDC's Social Vulnerability Index (SVI) was assigned based on patients' county of residence, and patients were subsequently categorized into four SVI quartiles.

Clinical Management Update of Oral Leukoplakia: A Review From the American Head and Neck Society Cancer Prevention Service.

Background: Oral potentially malignant disorders (OPMDs) occur in up to 4%-5% of the population, of which oral leukoplakia (OL) is the most common subtype. Predicting high-risk OL remains a challenge. Early diagnosis and effective treatment are thought to be of paramount importance to improve outcomes.

Early Detection of Lymph Node Metastasis Using Primary Head and Neck Cancer Computed Tomography and Fluorescence Lifetime Imaging.

: Early detection and accurate diagnosis of lymph node metastasis (LNM) in head and neck cancer (HNC) are crucial for enhancing patient prognosis and survival rates. Current imaging methods have limitations, necessitating new evaluation of new diagnostic techniques. This study investigates the potential of combining pre-operative CT and intra-operative fluorescence lifetime imaging (FLIm) to enhance LNM prediction in HNC using primary tumor signatures.

Updates on temporomandibular joint reconstruction following ablative surgery.

Purpose Of Review: Considerations regarding reconstruction of the temporomandibular junction (TMJ) following ablation have been underreported in head and neck surgery literature. Here, we discuss the complexity of reconstructing this unique joint and highlight the benefits and drawbacks of free tissue transfer. Additionally, we address the growing role of customized alloplastic implants and virtual surgical planning technologies in TMJ reconstruction.

Sarcopenia may predict recurrence in patients with head and neck cancer.

Background: Malnutrition is a major consequence of head and neck cancer (HNC), often leading to decreased skeletal muscle mass and impacting survival. The goal of this study is to determine the effect of sarcopenia, as defined by skeletal muscle index (SMI), on survival in patients with HNC.

Methods: This is a retrospective review of patients with HNC treated with surgery and/or radiation at a single tertiary care institute.

Efficacy of the nasal airflow-inducing maneuver in the olfactory rehabilitation of laryngectomy patients: A systematic review and meta-analysis.

Introduction: This is the first systematic review and meta-analysis to investigate the effectiveness of the nasal airflow-inducing maneuver (NAIM) in olfactory rehabilitation for total laryngectomy (TL) patients.

Methods: We conducted a systematic literature search following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria required that patients must have undergone a TL with subsequent NAIM training for at least 2 weeks and olfactory evaluation.

Efficacy of FDG-PET/CT in Detecting Synchronous Malignancies in Patients With Head and Neck Cancer: A Systematic Review and Meta-analysis.

Objective: To assess the diagnostic accuracy of fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) in detecting second primary malignancies (SPMs) in patients with treatment naïve head and neck squamous cell carcinoma (HNSCC).

Data Sources: Medline, Embase, Cochrane Library, and Scopus searched from 1946 to December 2022.

Review Methods: Studies reporting the performance of FDG-PET/CT in patients with treatment-naïve, index HNSCC for detection of SPMs were included.

The Use of Chatbots in Head and Neck Mucosal Malignancy Treatment Recommendations.

Objective: As cancer patients increasingly use chatbots, it is crucial to recognize ChatGPT's potential in enhancing health literacy while ensuring validation to prevent misinformation. This study aims to assess ChatGPT-3.5's capability to provide appropriate staging and treatment recommendations for head and neck mucosal malignancies for vulnerable populations.

Gender Bias in Artificial Intelligence-Written Letters of Reference.

Objective: Letters of reference (LORs) play an important role in postgraduate residency applications. Human-written LORs have been shown to carry implicit gender bias, such as using more agentic versus communal words for men, and more frequent doubt-raisers and references to appearance and personal life for women. This can result in inequitable access to residency opportunities for women.

Portrait of a Surgeon: Artificial Intelligence Reflections.

Text-to-image artificial intelligence (AI) programs are popular public-facing tools that generate novel images based on user prompts. Given that they are trained from Internet data, they may reflect societal biases, as has been shown for text-to-text large language model programs. We sought to investigate whether 3 common text-to-image AI systems recapitulated stereotypes held about surgeons and other health care professionals.

Parental leave and family building experiences among head and neck surgeons in the United States: Career impact and opportunities for improvement.

Background: The availability of paid parental leave is an important factor for retention and wellness. The experiences of head and neck surgeons with parental leave have never been reported.

Methods: A survey was electronically distributed to head and neck subspecialty surgeons in the United States.

Functional Laryngectomy and Quality of Life in Survivors of Head and Neck Cancer With Intractable Aspiration.

Importance: Late effects of head and neck cancer (HNC) treatment include profound dysphagia, chronic aspiration, and death. Functional laryngectomy (FL) can improve patient survival and quality of life (QoL); however, removing a failing larynx for a noncancer reason is a difficult decision. Data regarding the ability of FL to improve self-perceptions of voice, swallowing, and QOL in survivors of HNC with intractable aspiration are inconclusive.

Effect of Sarcopenia on Swallowing in Patients With Head and Neck Cancer.

Objective: Sarcopenia, characterized by decreased skeletal muscle mass, is associated with poorer oncologic outcomes in head and neck cancer (HNC) patients. The effect of sarcopenia on swallowing following HNC treatment is unknown. This study aims to investigate the association of sarcopenia and swallowing dysfunction in patients treated for HNC.

CT predictors of sub-centimeter occult lymph node metastases in oral cavity squamous cell carcinoma: A case-control study.

Background: For patients with oral cavity squamous cell carcinoma (OCSCC) without evidence of nodal metastasis (cN0) on pre-operative evaluation, there are no clear guidelines who should undergo elective neck dissection (END) versus clinical surveillance.

Objective: To identify CT imaging characteristics of sub-centimeter lymph nodes that would help predict the likelihood of nodal metastases on pathology.

Methods: Retrospective review of cN0 OCSCC patients at a tertiary academic medical center was performed.

FLIm-Based in Vivo Classification of Residual Cancer in the Surgical Cavity During Transoral Robotic Surgery.

Incomplete surgical resection with residual cancer left in the surgical cavity is a potential sequelae of Transoral Robotic Surgery (TORS). To minimize such risk, surgeons rely on intraoperative frozen sections analysis (IFSA) to locate and remove the remaining tumor. This process, may lead to false negatives and is time-consuming.

Tumor and Nodal Disease Growth Rates in Patients with Oropharyngeal Squamous Cell Carcinoma.

Though specific growth rate (SGR) has potential prognostic value for oropharyngeal squamous cell carcinoma (OPSCC), there is sparse literature defining these rates. Our aims were to establish the SGRs of primary tumors (PTs) and lymph nodes (LNs) in OPSCC and to correlate SGR with oncologic outcome. A pilot study was designed with a retrospective analysis examining 54 patients from the University of California, Davis with OPSCC (diagnosed 2012-2019).

Anatomy-Specific Classification Model Using Label-Free FLIm to Aid Intraoperative Surgical Guidance of Head and Neck Cancer.

Intraoperative identification of head and neck cancer tissue is essential to achieve complete tumor resection and mitigate tumor recurrence. Mesoscopic fluorescence lifetime imaging (FLIm) of intrinsic tissue fluorophores emission has demonstrated the potential to demarcate the extent of the tumor in patients undergoing surgical procedures of the oral cavity and the oropharynx. Here, we report FLIm-based classification methods using standard machine learning models that account for the diverse anatomical and biochemical composition across the head and neck anatomy to improve tumor region identification.

Stratification of surgical margin distances by the millimeter on local recurrence in oral cavity cancer: A systematic review and meta-analysis.

There are limited data supporting the commonly suggested 5 mm margin cutoff as the optimum value in defining clear margins in oral cancer. A database search of Pubmed/Medline, Web of Science, and EBSCOhost was performed from inception to June 2022. A random-effects model was chosen for this meta-analysis.

Using the Patient Health Questionnaire-2 to improve depression screening in head and neck cancer patients.

Purpose: The purpose of this study is to examine the use of the Patient Health Questionnaire-2 (PHQ-2) to screen for depression in patients undergoing treatment for head and neck cancer and to evaluate potential patient-specific risk factors that may contribute to depression.

Materials And Methods: This is a retrospective study at a tertiary-level hospital of outpatient adult patients with head and neck cancer who completed the PHQ-2/9 from 2019 to 2020. Patients were given a PHQ-2 during a surveillance visit.

Predictors of Health Care Utilization Following Major Head and Neck Oncologic Surgery in Older Patients.

Objective: To identify patient factors in older patients associated with making posttreatment visits in the first year after major head and neck oncologic surgery.

Study Design: Retrospective cohort study.

Setting: Academic institution.

Free flap volume changes: can we predict ideal flap size and future volume loss?

Purpose Of Review: Under anticipating free flap volume may lead to deficits in functional and aesthetic outcomes. Alternatively, over anticipating may compromise airway patency, lead to prolonged tracheostomy dependence or poor oral intake, and cause poor cosmetic outcomes. Surgeons face a fine balance in creating a functional reconstruction that accounts adequately for volume changes in the future.

Total laryngectomy negatively impacts sinonasal and olfactory-specific quality of life.

Purpose: The purpose of this study is to characterize deficits in olfactory-specific and sinonasal-specific QoL after total laryngectomy (TL) with validated patient reported outcome measures.

Methods: Thirty patients who had a TL were prospectively enrolled. Patient demographics, as well as scores from the Questionnaire of Olfactory Disorders Negative Statements (QOD-NS) and the Sino-nasal Outcome Test-22 (SNOT-22) were collected.

Intraoperative delineation of p16+ oropharyngeal carcinoma of unknown primary origin with fluorescence lifetime imaging: Preliminary report.

Background: This study evaluated whether fluorescence lifetime imaging (FLIm), coupled with standard diagnostic workups, could enhance primary lesion detection in patients with p16+ head and neck squamous cell carcinoma of the unknown primary (HNSCCUP).

Methods: FLIm was integrated into transoral robotic surgery to acquire optical data on six HNSCCUP patients' oropharyngeal tissues. An additional 55-patient FLIm dataset, comprising conventional primary tumors, trained a machine learning classifier; the output predicted the presence and location of HNSCCUP for the six patients.