title: 3D model-based documentation with the Tumor Therapy Manager (TTM) improves TNM staging of head and neck tumor patients.
abstract: OBJECTIVE
  Many treatment approaches are available for head and neck cancer (HNC), leading to challenges for a multidisciplinary medical team in matching each patient with an appropriate regimen. In this effort, primary diagnostics and its reliable documentation are indispensable. A three-dimensional (3D) documentation system was developed and tested to determine its influence on interpretation of these data, especially for TNM classification.
  
  
  METHODS
  A total of 42 HNC patient data sets were available, including primary diagnostics such as panendoscopy, performed and evaluated by an experienced head and neck surgeon. In addition to the conventional panendoscopy form and report, a 3D representation was generated with the "Tumor Therapy Manager" (TTM) software. These cases were randomly re-evaluated by 11 experienced otolaryngologists from five hospitals, half with and half without the TTM data. The accuracy of tumor staging was assessed by pre-post comparison of the TNM classification.
  
  
  RESULTS
  TNM staging showed no significant differences in tumor classification (T) with and without 3D from TTM. However, there was a significant decrease in standard deviation from 0.86 to 0.63 via TTM ([Formula: see text]). In nodal staging without TTM, the lymph nodes (N) were significantly underestimated with [Formula: see text] classes compared with [Formula: see text] with TTM ([Formula: see text]). Likewise, the standard deviation was reduced from 0.79 to 0.69 ([Formula: see text]). There was no influence of TTM results on the evaluation of distant metastases (M).
  
  
  CONCLUSIONS
  TNM staging was more reproducible and nodal staging more accurate when 3D documentation of HNC primary data was available to experienced otolaryngologists. The more precise assessment of the tumor classification with TTM should provide improved decision-making concerning therapy, especially within the interdisciplinary tumor board.
authors.affiliation: Clinic of Otorhinolaryngology - Head and Neck Surgery, Department of Head Medicine and Oral Health, University Hospital of Leipzig, Liebigstraße 10-14, 04103, Leipzig, Germany.|Department of Internal Medicine II, HELIOS Vogtland-Klinikum Plauen, Plauen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pankau
authors.affiliation: Clinic of Otorhinolaryngology - Head and Neck Surgery, Department of Head Medicine and Oral Health, University Hospital of Leipzig, Liebigstraße 10-14, 04103, Leipzig, Germany.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Wichmann
authors.affiliation: Innovation Center Computer Assisted Surgery (ICCAS), Leipzig, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Neumuth
authors.affiliation: Department of Simulation and Graphics, Faculty of Computer Science, University of Magdeburg, Magdeburg, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Preim
authors.affiliation: Clinic of Otorhinolaryngology - Head and Neck Surgery, Department of Head Medicine and Oral Health, University Hospital of Leipzig, Liebigstraße 10-14, 04103, Leipzig, Germany.|Innovation Center Computer Assisted Surgery (ICCAS), Leipzig, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Dietz
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Leipzig, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Stumpp
authors.affiliation: Clinic of Otorhinolaryngology - Head and Neck Surgery, Department of Head Medicine and Oral Health, University Hospital of Leipzig, Liebigstraße 10-14, 04103, Leipzig, Germany. Andreas.Boehm@medizin.uni-leipzig.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Boehm
mesh_terms: D000368:Aged; D004282:Documentation; D004724:Endoscopy; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging
keywords: Documentation; Head and neck cancer; Panendoscopy; Patient data; Reproducibility; TNM staging; Three-dimensional; Tumor Therapy Manager