Perineural spread of malignant head and neck tumors: review of the literature and analysis of cases treated at a teaching hospital (original) (raw)
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Perineural Spread in Head and Neck Cancer : Current Perspectives
2016
Perineural spread is mechanism of tumor dissemination along a nerve in the head and neck with decreased survival and a higher risk of local recurrence and metastasis. Even though several theories have been proposed, pathogenesis of perineural spread is poorly understood. Advances in diagnostic imaging and the development of new fronts like skull base surgery have brought a transcending change in the treatment of perineural spread in head and neck cancer. Present review is an attempt to discuss pathogenesis, pathways of spread, various diagnostic modalities and treatment protocol.
Radiographics, 2013
Certain tumors of the head and neck use peripheral nerves as a direct conduit for tumor growth away from the primary site by a process known as perineural spread. Perineural spread is associated with decreased survival and a higher risk of local recurrence and metastasis. Radiologists play an important role in the assessment and management of head and neck cancer, and positron emission tomography/computed tomography (PET/CT) with 2-[fluorine 18]fluoro-2-deoxy-d-glucose (FDG) is part of the work-up and follow-up of many affected patients. Awareness of abnormal FDG uptake patterns within the head and neck is fundamental for diagnosing perineural spread. The cranial nerves most commonly affected by perineural spread are the trigeminal and facial nerves. Risk of perineural spread increases with a midface location of the tumor, male gender, increasing tumor size, recurrence after treatment, and poor histologic differentiation. Focal or linear increased FDG uptake along the V2 division of the trigeminal nerve or along the medial surface of the mandible, or asymmetric activity in the masticator space, foramen ovale, or Meckel cave should raise suspicion for perineural spread. If FDG PET/ CT findings suggest perineural spread, the radiologist should look at available results of other imaging studies, especially magnetic resonance imaging, to confirm the diagnosis. Knowledge of common FDG PET/CT patterns of neoplastic involvement along the cranial nerves and potential diagnostic pitfalls is of the utmost importance for adequate staging and treatment planning. ©
Perineural spread of head and neck tumors: how accurate is MR imaging?
AJNR. American journal of neuroradiology, 1998
Our aim was to determine the precision of MR imaging evaluation of perineural spread of head and neck tumors. Nineteen patients had complete extirpation of head and neck tumors (10 squamous cell carcinomas, four adenoid cystic carcinomas, one poorly differentiated carcinoma, one salivary duct carcinoma, one mucoepidermoid carcinoma, one chordoma, and one meningioma) with histologic confirmation of perineural spread. Findings at presurgical contrast-enhanced MR imaging were compared with findings at pathologic examination. The sensitivity of MR imaging for detection of perineural spread was 95%; however, the sensitivity for mapping the entire extent of perineural spread fell to 63%. MR imaging may fail to depict microscopic foci of perineural tumor infiltration, leading to underestimation of the extent of perineural spread. Nevertheless, with careful analysis of foraminal architecture and MR enhancement patterns, one can reliably identify the presence if not the extent of perineural ...
Survival outcomes of perineural spread in head and neck cutaneous squamous cell carcinoma
Anz Journal of Surgery, 2022
AimTo present an institution's experience and survival outcomes for patients with head and neck cutaneous squamous cell carcinoma (HNcSCC) and perineural spread (PNS).MethodRetrospective study of patients with HNcSCC and PNS treated between January 2010 and August 2020 from the Sydney Head and Neck Cancer Institute database, Sydney, Australia; a high‐volume, tertiary, academic head and neck centre. Patient demographics, primary site, involved cranial nerves, treatment modality, loco‐regional failure and survival data were obtained.ResultsForty‐five patients were identified, of which 32 patients were male (71%). Mean age at diagnosis was 68.7 years (range 43–90). Median follow‐up was 16.1 months (range 1–107). The trigeminal nerve was most frequently involved (n = 30, 66.6%) followed by facial nerve (n = 13, 28.9%). Most patients underwent surgery followed by radiotherapy (n = 33, 73%) and eight received definitive radiotherapy. The median overall survival (OS) was 4.5 years (95% CI 3.71–5.38), median disease‐specific survival 5.1 years (95% CI 4.21–5.97) and median disease‐free survival (DFS) was 1.7 years (95% CI 1.11–2.22). The estimated 5‐year OS and DFS were 45% and 25%, respectively. Patients treated with surgery and adjuvant radiotherapy with a clear proximal nerve margin had favourable DFS (P = 0.035) and trended towards better OS (P = 0.134) compared with patients with an involved nerve margin. Patients treated surgically with involved proximal nerve margins had similar outcomes compared with patients with treated definitive radiotherapy (HR 0.80, 95% CI 0.29–2.22, P = 0.664).ConclusionThe likelihood of achieving a clear proximal nerve margin should be a strong consideration in the selection of appropriate patients for primary surgery
Post treatment imaging in head and neck tumours
Cancer Imaging, 2005
Cancer is a leading cause of death in most parts of the world. Most patients will undergo multiple imaging studies following treatment. The regular follow up of these patients often leads to the early detection of tumour recurrence or the onset of treatment complications. Early diagnosis may result in the timely institution of appropriate therapy thereby improving the survival and morbidity rates. This review addresses difficulties related to demonstrating early tumour recurrence and nodal metastasis and focuses on the complications seen in the central nervous system, cranial nerves and brachial plexus following radiotherapy.
Insight into the Latest Concepts of Neurotrophism and Perineural Invasion in Head and Neck Cancer
The journal of contemporary dental practice, 2015
The hallmark of cancer includes an aggressive growth pattern, higher rate of locoregional recurrence and an increased propensity to disseminate and involve distant structures. It is a common feature for many cancers, especially head and neck malignant tumors, to involve neural structures. The invasion was attributed to be a part of its local aggressive nature. But, several studies have demonstrated certain tumors to show specific affinity toward neural tissues, while sparing other vital tissues in its vicinity. This affinity towards neural structures is termed as neurotrophism.(1) Studies estimating the rate of neural invasion have largely been biased. This is due to the lack of a standard definition and diagnosing criteria for evaluating neural invasion. The terminologies used to denote neural invasion include neurotrophic carcinomatous spread and perineural spread.
Journal of Surgical Oncology 2008;97:644–648 New Directions in Head and Neck Imaging
2016
Computerized tomography (CT) and magnetic resonance imaging (MRI), positron emission tomography (PET) and the hybrid modality of PET/CT are sensitive and reliable tools for detection and staging of head and neck cancers. This article describes the role of PET/CT in initial staging of head and neck squamous cell carcinoma, the utility of CT/MR perfusion imaging in qualitative analysis of tumor tissue, and the usefulness of diffusion weighted MR and dynamic contrast-enhanced MR imaging in head and neck oncological imaging. J. Surg. Oncol. 2008;97:644–648. 2008 Wiley-Liss, Inc.
Determination of perineural invasion preoperatively on radiographic images
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2008
Perineural invasion in head and neck cancers has important prognostic implications, and even if clinically silent, can be radiographically evident. This study analyzed the frequency of preoperative diagnosis, radiographic features, and importance of the preoperative diagnosis in treatment planning. Radiographic studies of 38 patients with histopathologically proven perineural spread from head and neck cancer were retrospectively reviewed and compared with preoperative reports. The percent agreement with pathology, kappa values, and 95 percent confidence intervals were determined for relevant nerves. Salient radiographic findings were compared with the contralateral normal side. Preoperative agreement was less than 10 percent for all nerves, and retrospectively was 56 percent for the trigeminal nerve and 40 percent for the facial nerve. Radiographic features included neural thickening and enhancement, and foraminal widening. Cancers of the head and neck can spread perineurally. Preop...