JAMA Otol Logo Orlando 2013 AHNS Meeting Location
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American Head & Neck Society
Annual Meeting, April 10-11, 2013
JW Marriott Grande Lakes
Orlando, Florida

During the
Combined Otolaryngology Spring Meeting
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CONCORDANCE RATES OF HEAD AND NECK TUMOR CLINICAL STAGING VS. PATHOLOGICAL STAGING IN A TERTIARY CARE CENTER: HOW ACCURATE ARE WE?.

Presentation: P044
Topic: Clinical - Gen. Head & Neck Surgery
Type: Poster
Date: Wednesday - Thursday, April 10 - 11, 2013
Session: Designated Poster viewing times
Authors: Paul D Kim, MD, Kien Tran, MSII, Niklaus Eriksen, MD
Institution(s): Loma Linda University

Head and neck malignancies account for an estimated 3-5% of all cancers in the United States. Clinical staging of the patients are based on the use of physical exam, imaging, and endoscopy. The clinical staging information is often used in determining treatment options based on National Comprehensive Cancer Network (NCCN) guidelines. Prior studies have demonstrated inaccuracies in imaging and physical exams compared to pathological findings, but currently there is no previous literature comparing the overall staging of patients from a tertiary care multidisciplinary head and neck tumor board and pathologic staging.

Methods:
Institutional review board approval was obtained for a retrospective review of patients that were presented to the Head and Neck tumor board from the years 2000 to 2011. Participants included head and neck surgeons, neuroradiologists, pathologists,  radiation therapists and medical oncologists. Patients with squamous cell cancer of the oral cavity, oropharynx and larynx were selected for the study. A total of 293 patients were available with information on both clinical and pathological staging using the American Joint Committee on Cancer (AJCC) criteria and were included in the study.

Results:
Overall Tumor staging concordance was 56%. Tumor staging concordance for T1 and T4 were better than T2 and T3 (63 and 64% vs. 46 and 43%). Overall Nodal staging concordance was 69%. Nodal staging concordance for N1 was poor (20%), and often was understaged. Overall Tumor staging concordance of radiated vs. nonradiated patients was similar ( 57% vs. 53%) but radiated T1 patients had poor concordance (39%) especially in the oropharynx and larynx subsites and were often understaged.

Conclusion:
Using AJCC criteria based on physical exam, endoscopy and imaging, a tertiary care multidisciplinary head and neck tumor board has poor clinical staging concordance with pathological data. This was worse with intermediate Tumor stage T2 and T3 and early nodal stage N1 disease. After radiation therapy tumor stage T1 often understaged the tumor. Due to the inaccuracies in clinical staging every effort must be made to obtain pathological data to definitively stage the patient, the patient may then have the best therapeutic options offered based on NCCN guidelines.




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