Diagnosis of nasopharyngeal carcinoma with convolutional neural network on narrowband imaging / 临床耳鼻咽喉头颈外科杂志

Objective:To evaluate the diagnostic accuracy of the convolutional neural network（CNN） in diagnosing nasopharyngeal carcinoma using endoscopic narrowband imaging. Methods:A total of 834 cases with nasopharyngeal lesions were collected from the People's Hospital of Guangxi Zhuang Autonomous Region between 2014 and 2016. We trained the DenseNet201 model to classify the endoscopic images, evaluated its performance using the test dataset, and compared the results with those of two independent endoscopic experts. Results:The area under the ROC curve of the CNN in diagnosing nasopharyngeal carcinoma was 0.98. The sensitivity and specificity of the CNN were 91.90% and 94.69%, respectively. The sensitivity of the two expert-based assessment was 92.08% and 91.06%, respectively, and the specificity was 95.58% and 92.79%, respectively. There was no significant difference between the diagnostic accuracy of CNN and the expert-based assessment （P=0.282, P=0.085）. Moreover, there was no significant difference in the accuracy in discriminating early-stage and late-stage nasopharyngeal carcinoma（P=0.382）. The CNN model could rapidly distinguish nasopharyngeal carcinoma from benign lesions, with an image recognition time of 0.1 s/piece. Conclusion:The CNN model can quickly distinguish nasopharyngeal carcinoma from benign nasopharyngeal lesions, which can aid endoscopists in diagnosing nasopharyngeal lesions and reduce the rate of nasopharyngeal biopsy.

Analyses of therapeutic and prognostic factors for rN3 neck recurrence of nasopharyngeal carcinoma after primary radiotherapy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the treatment and prognosis for rN3 neck recurrence of nasopharyngeal carcinoma (NPC) after primary radiotherapy.</p><p><b>METHODS</b>A total of 37 cases with rN3 neck recurrence after radiotherapy in NPC between October 2003 and August 2013 were retrospectively analyzed. Of them 19 cases presented with lymph node (LN) metastasis in supraclavicular fossa, 18 cases had metastasis LN > 6 cm, 10 cases received chemoradiotherapy, and 27 cases underwent neck dissection including modified radical neck dissection (MRND) for 9 cases, radical neck dissection (RND) for 18 cases. Six of 18 cases with RND underwent reconstructive surgery with pectoralis major flap, 12 cases received postoperative radiotherapy and 20 cases had postoperative adjuvant chemotherapy.</p><p><b>RESULTS</b>Eight patients had documented recurrence or residue, 17 patients developed distant metastases, one patient showed recurrence and distant metastasis. The 5-year overall survival rate and disease-free survival rate were 27.5% and 21.6% respectively, and the median survival time was 41 months. The survival rate in surgery group was significantly higher than that in chemoradiotherapy group, and the prognosis of patients with LN > 6 cm was better than that of patients with metastasis LN to supraclavicular fossa.</p><p><b>CONCLUSIONS</b>Patients with rN3 NPC are prone to metastasis, and patients with supraclavicular fossa lymph node metastasis had poor prognosis. Surgery combined with chemoradiotherapy is an effective treatment for the patients without distant metastasis.</p>

A prospective study of surgery combined with concurrent radiochemotherapy in the treatment of patients with early stage nasopharyngeal carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the clinical value that surgical treatment with comprehensive treatment in treating early stage nasopharyngeal carcinoma.@*METHOD@#Based on the case selection criteria, patients with early nasopharyngeal carcinoma were divided into surgery group and the conventional group according to patients' wishes. Surgery group were treated with surgery plus Radiochemotherapy as a comprehensive treatment while conventional group were treated with Radiochemotherapy. Outcome indices: (1) 5-year survival rate and 5-year disease-free survival rate; (2) Radiation dose to the nasopharynx; (3) Incidence of xerostomia.@*RESULT@#(1) The overall 5-year follow-up rate was 97.12%; 1 patient was lost to follow-up in surgical group, the 5-year follow-up rate was 96.77%; 2 patients were lost in conventional Group with 5-year rate of 97.26%. (2) The 5-year survival rate of 104 patients was 83.65% (87/104). (3) The 5-year survival rate and 5-year tumor-free survival rate were 96.77% (30/31) and 93.55% (29/31) in surgical group, 78.08% (57/73) and 73.97% (54/73) in conventional group. There were significant differences between the two groups (P < 0.05). (4) The radiation dose to the nasopharynx in surgery group and conventional group were (63.90 +/- 5.56) Gy and (71.48 +/- 4.18)Gy, respectively; the dose in surgical group was significantly less than the conventional group, there were statistical significance between the two groups. (5) The incidence of xerostomia was significantly less in surgical group (22.58%) than conventional group (65.75%), the difference was statistically significant.@*CONCLUSION@#The surgery combined with concurrent chemoradiotherapy is a effective comprehensive therapeutic interchange program for early stage nasopharyngeal carcinoma. These program can increase the long-term survival rate, but also reduce the radiation dose to the nasopharynx and the occurrence of radiation complications. A further aspect is worth consideration.

The histomorphological changes of the nasal mucosa in nasopharyngeal carcinoma patients postradiotherapy / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the histomorphology at the nasal mucosa in the nasopharyngeal carcinoma (NPC) patients postradiotherapy.@*METHOD@#Forty-seven specimens from the nasal mucosa of NPC patients postradiotherapy were observed under light microscope. The changes of the mucosal histomorphology include cells and cilia in epithelium, basal layer, glandular and glandular cells in lamina propria. Six specimens were observed under electron microscope, including the changes of the cilia and ciliated columnar epithelial cells in epithelium.@*RESULT@#The histomorphology of the 47 specimens were normal before radiotherapy. In the 47 specimens, six specimens had no changes but 41 specimens were found various changes postradiotherapy. The mucosal changes of epithelium and cilia desquamating, basal layer thickening, decrease of the serous glands and increase of the mucous glands in lamina propria were observed under light microscope. We found the cilia structural abnormalities and the abnormal phenomena of the epithelium under scanning electron microscope (SEM) and transmission electron microscope (TEM) respectively.@*CONCLUSION@#We found that the various extent of destruction of the nasal mucosa may be the pathological basis of complicating nasal or sinusitis in NPC patients postradiotherapy.

Expression and correlation of COX-2 and VEGF-C in nasopharyngeal carcinoma / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate vascular endothelial growth factor-C (VEGF-C) and cyclooxyegense-2(COX-2) expression in nasopharyngeal carcinoma. METHODS The expression of COX-2 and VEGF-C were stained respectively in nasopharyngeal carcinoma tissues of 45 patients using immunohistochemical method,and were analyzed with clinical data. RESULTS The positive expression rates of COX-2 and VEGF-C were 68.9 % and 53.3 % respectively in nasopharyngeal carcinoma tissue. The expression of COX-2 was positively correlated with VEGF-C (r=0.334,P