title: Tissue characterization of locoregionally advanced head-and-neck squamous cell carcinoma (HNSCC) using quantified ultrasonography: a prospective phase II study on prognostic relevance.
abstract: OBJECTIVE
  Information on a patient's prognosis is important for the clinical decision-making process. This study explored the capacity of quantitative ultrasound imaging to increase prognostic information.
  
  
  METHODS
  High-resolution B-scan and colour-coded duplex-sonography of the neck was prospectively applied to 50 HNSCC-patients stage IVA-B 05/99-01/02 before definite radio-(chemo-)therapy. Every lymph node >1.5 cm was scored for the following Malignancy Criteria: Inhomogeneity, Surface-irregularity, Missing hilar sign, Spherical form, Matting, Aberrant intranodal vessels, Infiltration of surrounding tissue, Intranodal cystic necrosis.
  
  
  RESULTS
  Median Overall Survival (OS) was 1 year. High MMCC (Maximal Malignancy Criteria Count in a single node) predicted a poor outcome with a median OS of 8.1 months (MMCC=7-8, n=24) vs. 24.7 months for low MMCC (1-6, n=26, p=0.0004, logrank). Estimated 1- and 3-year-OS was 25% and 8% for high vs. 69% and 41% for low MMCC. Ten out of eleven living patients (follow-up 2.3-5.3 years) had a low MMCC. Of the clinical parameters determined, only pre-treatment hemoglobin levels <12 g/dl and treatment less radical than chemoradiation to 70 Gy predicted poor OS (univariate p=0.04 and 0.02, respectively). In multivariate Cox analysis, MMCC continued to significantly predict for OS (p=0.002) and Disease-Free Survival (p=0.002).
  
  
  CONCLUSIONS
  Quantification of nodal ultrasonography offers valuable prognostic information for the conservative management of HNSCC.
authors.affiliation: Department of Radiotherapy and Radiation Oncology, Technische Universität München, München, Germany. barbara.roeper@lrz.tu-muenchen.de
authors.forename: Barbara
authors.initials: B
authors.lastname: Röper
authors.forename: Nadine
authors.initials: N
authors.lastname: Nüse
authors.forename: Raymonde
authors.initials: R
authors.lastname: Busch
authors.forename: Frank Bodo
authors.initials: FB
authors.lastname: Zimmermann
authors.forename: Jörg
authors.initials: J
authors.lastname: Nährig
authors.forename: Michael
authors.initials: M
authors.lastname: Molls
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000401:mortality / Q000532:radiotherapy; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D014463:Ultrasonography