Abstract
Purpose
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 (\(p=0.027\)). In nodal staging without TTM, the lymph nodes (N) were significantly underestimated with \(0.39\pm 0.79\) classes compared with \(0.07\pm 0.69\) with TTM (\(p=0.002\)). Likewise, the standard deviation was reduced from 0.79 to 0.69 (\(p=0.032\)). There was no influence of TTM results on the evaluation of distant metastases (M).
Conclusion
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.
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Acknowledgments
We would like to thank all participants and contributors to our study: Prof. Dr. med. Thomas Eichhorn, Dr. med. Eva-Maria Jenzewski, Dr. med. Stefan Koppatz (Cottbus); Prof. Dr. med. Dirk Eßer, Dr. med. Ulrich Kurze (Erfurt); Prof. Dr. med. Markus Jungehülsing, Dr. med. Jörg Berkholz, Dr. med. Christoph Erle (Potsdam); Dr. med. Hans-Joachim Vogel (Riesa); Dr. med. Thomas Berger, Dr. med. Miloš Fischer, Dr. med. Mathias Hofer and Dr. med. Christian Mozet (Leipzig). Special thanks go to Jana Dornheim, Lars Dornheim and Ivo Rössling from Dornheim Medical Images GmbH for providing the “NeckSegmenter” and technical support.
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The authors declare that they have no conflict of interest.
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Pankau, T., Wichmann, G., Neumuth, T. et al. 3D model-based documentation with the Tumor Therapy Manager (TTM) improves TNM staging of head and neck tumor patients. Int J CARS 10, 1617–1624 (2015). https://doi.org/10.1007/s11548-014-1131-8
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DOI: https://doi.org/10.1007/s11548-014-1131-8