Publications by authors named "Jean-Michel Prades"

54 Publications

High endothelial venules are present in pharyngeal and laryngeal carcinomas and they are associated with better prognosis.

Pathol Res Pract 2021 Feb 18;220:153392. Epub 2021 Feb 18.

Departments of Pathology, North Hospital, University Hospital of St-Etienne, France.

Background: Tumors lymphocytic infiltration has prognostic and predictive value. However, the mechanisms involved in lymphocyte recruitment remain poorly characterized. High endothelial venules (HEV) are blood vessels specialized in lymphocyte recruitment, recently showing prognostic significance in some types of cancer. Their implications in laryngeal or pharyngeal cancer is largely unknown.

Aim Of The Study: To investigate the possible presence of HEVs in head and neck cancer.

Material And Methods: Oropharyngeal (n = 61), hypopharyngeal (n = 53) and laryngeal (n = 21) squamous cell carcinomas were immunohistochemically studied with the MECA-79 antibody, which specifically recognizes HEVs. Histological and clinical factors were correlated with HEVs' presence.

Results: HEVs were present in 34% of tumors, showing significant correlations with oropharyngeal localization, higher lymphocytic response, lower tumor budding, lower T status, absence of distant metastases and better overall and progression-free survival.

Conclusion: HEVs represent an important prognostic factor in head and neck cancer.
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http://dx.doi.org/10.1016/j.prp.2021.153392DOI Listing
February 2021

Mini-Invasive Endoscopic Approaches to the Maxillary Sinus Floor: A Comparative Anatomical Study.

Am J Rhinol Allergy 2020 Oct 6:1945892420964096. Epub 2020 Oct 6.

Otolaryngology Unit, ASST Santi Paolo and Carlo, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.

Background: While middle antrostomy (MA) is the most common approach to the maxillary sinus (MS), it is known for not allowing to fully inspect the whole MS, especially in its inferior and anterior portions. To overcome this limitation, alternative approaches have been proposed, such as inferior antrotomy (IA) and canine fossa accesses (CFA).

Objective: Given the lack of studies on the MS floor visualization with different accesses, our study aims, in a cadaver lab setting, to systematically compare three different approaches (MA, IA and CFA) in these regards.

Methods: Eight cadaver heads, previously submitted to CTscan, were prepared inserting fixtures corresponding to teeth 2, 4, 6, 11, 13 and 15 and into the canine fossae. Three approaches were prepared: a wide MA, an IM and a CFA. We endoscopically evaluated, for each specimen, side, access type and scope angle (0°, 30°, 45°, and 70°), which fixtures were visible on the maxillary sinus floor and whether the canine fossa fixture was visible (MA and IA only).

Results: IA allowed to visualize all fixtures in nearly all cases (14/16 with 70° endoscope), while MA showed poor visualization results (3/16 with 70° endoscope); CFA failed to gain full visualization in most specimens (7/16 with 70°endoscope). Such difference was statistically significant. MA proved unable to visualize the canine fossa fixture in most cases while IA showed excellent possibilities. All differences were statistically significant (p < .001, Mcnemar's test).

Conclusions: Our data show that the IA grants a statistically significant superior surgical field vision when compared to MA and CFA, though in vivo validation of these results is still required.
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http://dx.doi.org/10.1177/1945892420964096DOI Listing
October 2020

Correlation Between Semiquantitative Metabolic Parameters After PET/CT and Histologic Prognostic Factors in Laryngeal and Pharyngeal Carcinoma.

Head Neck Pathol 2020 Sep 23;14(3):724-732. Epub 2019 Dec 23.

Department of Pathology, University Hospital of Saint-Etienne, 42055, CEDEX2 Saint-Étienne, France.

Positron emission tomography/computed tomography (PET/CT) has shown prognostic significance in head and neck cancer patients. The underlying pathologic features that could explain the mechanisms associated with this observation are not clear. To analyze the correlation between 18-F-fluoro-2-deoxy-D-glucose (18F-FDG) uptake assessed by PET/CT in head and neck cancer and histopathologic prognostic factors. Ninety-nine patients with laryngeal and pharyngeal squamous cell carcinoma were retrospectively reviewed for pretreatment PET/CT measurements, namely standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). The corresponding histologic material was evaluated for tumor stroma-related prognostic factors such as the amount and type of stroma, lymphocytic response, tumor budding activity, and size of tumor cell nests in the tumor core area and tumor front. TLG and MTV were associated with tumor localization, as they were higher in oropharyngeal tumors. These values were also associated with tumor cell nest size in the tumor core with higher values corresponding to tumors with smaller nests. MTV40% was marginally associated with fibroblastic stroma type and higher budding activity. SUVmax was not associated with the histological factors in the whole sample, but higher values trended with higher tumor budding activity and stroma-rich tumors of the oropharynx. 18F-FDG PET measurements in head and neck squamous cell carcinomas are associated with prognostic histopathologic factors and suggest a possible correlation of glucose metabolism to epithelial-to-mesenchymal transition.
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http://dx.doi.org/10.1007/s12105-019-01116-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413956PMC
September 2020

Gene Expression Comparison Between the Primary Tumor and its Lymph Node Metastasis in Head and Neck Squamous Cell Carcinoma: A Pilot Study.

Cancer Genomics Proteomics 2019 May-Jun;16(3):155-161

Department of Pathology, North Hospital, University Hospital of St-Etienne, Saint-Étienne, France.

Background/aim: In metastatic head and neck squamous cell carcinoma (HNSCC) the metastatic tumor does not always keep the same gene expression profile as the parental tumor, which may influence the course of the disease. The aim of this study was to compare the expression of genes implicated in HNSCC carcinogenesis between the primary tumor and the corresponding lymph node metastasis.

Materials And Methods: Eighteen HNSCC, their corresponding node metastases and non-neoplastic tissues were studied by RT-qPCR for the expression of EGFR, VEGF, claudin7, maspin, survivin and SCCA. The levels of expression were correlated with histological characteristics and patients' prognosis.

Results: All genes except for survivin displayed different expression in node metastasis compared to the primary tumor. The expression of EGFR, survivin, maspin, and claudin7 in node metastasis and SSCA in the primary tumor affected the prognosis. SCCA expression is associated with the expression of claudin7 and maspin. P16-positive tumors expressed low levels of VEGF and SCCA, while keratinizing tumors over-expressed VEGF.

Conclusion: Differential gene expression levels in node metastases compared to the primary tumor is linked to the prognosis of HNSCC patients. The histological/immunohisto-chemical characteristics of the tumor are associated with these genes expression changes.
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http://dx.doi.org/10.21873/cgp.20121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6542642PMC
September 2019

Impact of body mass index on post-thyroidectomy morbidity.

Head Neck 2019 09 19;41(9):2952-2959. Epub 2019 Apr 19.

CHU de Nantes, Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Nantes Cedex 1, France.

Background: The impact of obesity on total thyroidectomy (TT) morbidity (recurrent laryngeal nerve palsy and hypocalcaemia) remains largely unknown.

Methods: In a prospective study (NCT01551914), patients were divided into five groups according to their body mass index (BMI): underweight, normal weight, overweight, obese, and severely obese. Preoperative and postoperative serum calcium was measured. Recurrent laryngeal nerve (RLN) function was evaluated before discharge, and if abnormal, at 6 months.

Results: In total 1310 patients were included. Baseline characteristics were similar across BMI groups except for age and sex. Postoperative hypocalcaemia was more frequent in underweight compared to obese patients but the difference was not statistically significant in multivariate analysis. There was no difference between groups in terms of definitive hypocalcaemia, transient and definitive RLN palsy, and postoperative pain.

Conclusion: Obesity does not increase intraoperative and postoperative morbidity of TT, despite a longer duration of the procedure.
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http://dx.doi.org/10.1002/hed.25773DOI Listing
September 2019

Quality insurance in head and neck cancer multidisciplinary team meetings: A watchful eye on real-life experience.

Oral Oncol 2019 04 26;91:35-38. Epub 2019 Feb 26.

Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint-Priest en Jarez, France. Electronic address:

Introduction: Although Multidisciplinary Team Management (MDT) is integrated in most international head and neck cancer treatment guidelines, its applications and proceedings were rarely described. The present study explores a 6-year real-life experience in a French Comprehensive Cancer Care Center.

Methods: Patients, tumor and meeting characteristics of all consecutive cases discussed in head and neck MDT meetings between 2010 and 2015 were retrospectively reviewed.

Results: From 2010 to 2015, 1849 cases (accounting for 1786 patients) were discussed in 138 MDT meetings. Median age was 62 (range: 15-96). When reported (n = 310, 16.8%), performance status was ≥2 in 36.1% of patients. Tumors were mainly squamous cell carcinomas (n = 1664, 91.5%) of the larynx/hypo-pharynx (n = 630, 34.4%), oropharynx (n = 518; 28.3%) and oral cavity (n = 339; 18.5%). Tumors were diagnosed at a locally (n = 358, 25%), locally advanced (n = 946, 66%) or metastatic setting (n = 53, 3.7%). Mean number of discussed patients per MDT meeting was 16 (range: 3-32). Most patients were discussed once (n = 1663, 97%). Most patients (n = 969, 52%) underwent treatment before MDT meetings: mainly surgery (n = 709, 73.2%). The mean time between MDT meeting and first radiation course was 21 days (range: 1-116).

Discussion: Optimal multimodal treatment management is based on MDT meetings and results from the interaction and coordination of surgeons, medical and radiation oncologists. In the present series, most patients were discussed once despite the number of expected recurrences, suggesting that the management of tumor progression was not discussed in head and neck MDT meetings. Furthermore, most patients had surgery before MDT meeting, pointing out that MDT role and place still needs to be improved. Finally, the present population significantly differed from patients included in phase III clinical trials, with more advanced age and poorer condition. It calls for the necessity of a high-quality head and neck MDT meeting since evidence-based recommendations should be adapted to patient's frailties.
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http://dx.doi.org/10.1016/j.oraloncology.2019.02.020DOI Listing
April 2019

Prognostic significance of tumor budding, tumor-stroma ratio, cell nests size, and stroma type in laryngeal and pharyngeal squamous cell carcinomas.

Head Neck 2019 06 8;41(6):1918-1927. Epub 2019 Jan 8.

Department of Pathology, North Hospital, University Hospital of Saint-Etienne, Saint-Etienne, France.

Background: Despite immune microenvironment of head and neck squamous cell carcinoma (HNSCC) has been studied, there are no sufficient data on the role of tumor stroma factors. The aim of the study was to explore the prognostic and predictive role of these factors in a large series of HNSCC.

Methods: This is a retrospective study of 266 patients with laryngeal and pharyngeal SCC. Clinical data were correlated with the following histological parameters: tumor-stroma ratio (TSR), tumor budding activity (BA), cell nests size (CNS), and stroma type.

Results: Stroma-rich tumors, tumor budding, smaller CNS at core and front area, and fibroblastic stroma type, were all adverse prognostic factors (P < 0.0001, 0.001, 0.003, 0.001, 0.007, respectively). Stroma-poor tumors and with larger CNS showed good response to induction chemotherapy (P = 0.009 and 0.02, respectively).

Conclusions: TSR, tumor budding, CNS, and stroma type are important prognostic and predictive factors in laryngeal and pharyngeal SCC.
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http://dx.doi.org/10.1002/hed.25629DOI Listing
June 2019

Advanced age does not increase morbidity after total thyroidectomy. Result of a prospective study.

Am J Surg 2019 04 25;217(4):767-771. Epub 2018 Jul 25.

CHU de Nantes, Clinique de Chirurgie Digestive et Endocrinienne (CCDE), Nantes Cedex 1, 44093, France. Electronic address:

Background: It is well known that total thyroidectomy is feasible on elderly patients but is linked to complications because of their underlying comorbidities. In this study we analyzed the specific risks linked to surgery, hypoparathyroidism and recurrent nerve palsy.

Methods: materials-methods:Prospective, multicentre trial conducted at 13 hospital sites. The primary endpoint was the percentage of patients with postoperative hypocalcaemia (albumin-corrected serum calcium level <2 mmol/L at day 2). Secondary endpoints included recurrent nerve palsy rate at day 2, the percentage of patients with hypocalcaemia (serum calcium level <2 mmol/L) and recurrent nerve palsy at month 6, operating durations and postoperative pain. Patients were separated in two groups: <70 years and ≥70 years old.

Results: In total, 1329 patients who underwent total thyroidectomy were included (median age 51.17 years [18.10; 80.90], 80% women, and hyperthyroidism in 20%, 101 ≥ 70 years old). Rates of hypocalcaemia at day 2 and month 6 were 20.02% and 1.98% respectively. Nasofibroscopy showed postoperative abnormal vocal cord motility in 9.92% cases (hypo-motility 5.76% - immobility 4.16%) and 0.95% at month 6 (hypo-motility 0.48%, immobility 0.48%). Patients ≥70 years had a lower (but non-significant) postoperative and definitive hypocalcaemia rate than patients < 70 years: 14.85% vs 20.44% at day 2 (p = 0.1773) and 0% vs 2.15% at month 6 respectively (p = 0.2557). Abnormal vocal cord motility rate was 12.00% in patients ≥70 years vs 9.75% in patients <70 years at day 2 (p = 0.4702), and 2.06% in patients ≥70 years vs 0.86% at month 6 (p = 0.2340).

Conclusions: Total thyroidectomy in patients ≥70 years is feasible and safe. Age does not increase the morbidity. The study is registered with ClinicalTrials.gov number NCT01551914.
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http://dx.doi.org/10.1016/j.amjsurg.2018.07.029DOI Listing
April 2019

The anterolateral ligament is a distinct ligamentous structure: A histological explanation.

Knee 2018 Jun 11;25(3):360-366. Epub 2018 Apr 11.

Department of Pathology, University Hospital of Saint Etienne, Saint Etienne, France.

Background: The aim was to determine whether the anterolateral ligament (ALL) had a histological structure that defined it as a real ligament.

Methods: Histological examination of 30 ALL samples taken from fresh-frozen knees were performed. The ALL femoral insertion and its relationship with the lateral collateral ligament (LCL) were studied and the tibial insertion and its relationship with articular cartilage of the tibial joint surface were analyzed. For the ligamentous part, its histological structure and its differences with the articular capsule were studied.

Results: This connective tissue is composed of a dense fibrous core constituted by a network of oriented collagenous fibers. The periphery of this dense connective center is made up of loose fibrocollagenous tissue with vascular structures and focal deposits of adipose tissue. This part was in contact but different to the joint capsule. With a perpendicular orientation of the collagen fibers relative to the bone, a fibrocartilaginous zone with an unmineralized hyalinized aspect, a mineralization front, its bone insertions presented a typical ligamentous insertion. With a cleavage plane between ALL and LCL femoral insertion, the ALL appeared to have a femoral insertion distinct from the LCL. ALL tibial insertion was less characteristic with less organized connective tissue and was at a distance from the articular cartilage.

Conclusion: From its bony insertion to its tissue composition and organization, the ALL has all the histological characteristics of a ligamentous structure. Our study confirms that ALL can be considered a real and distinct ligament.
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http://dx.doi.org/10.1016/j.knee.2018.03.012DOI Listing
June 2018

Inner ear ossification and mineralization kinetics in human embryonic development - microtomographic and histomorphological study.

Sci Rep 2017 07 6;7(1):4825. Epub 2017 Jul 6.

Laboratoire de Biologie des Tissus Ostéoarticulaires, INSERM, U1059 Sainbiose, Université de Lyon, Université Jean Monnet, Faculté de Médecine, Campus Santé Innovation, 42023, Saint-Étienne, France.

Little is known about middle and inner ear development during the second and third parts of human fetal life. Using ultra-high resolution Microcomputed Tomography coupled with bone histology, we performed the first quantitative middle and inner ear ossification/mineralization evaluation of fetuses between 17 and 39 weeks of gestational age. We show distinct ossification paces between ossicles, with a belated development of the stapes. A complete cochlear bony covering is observed within the time-frame of the onset of hearing, whereas distinct time courses of ossification for semicircular canal envelopes are observed in relation to the start of vestibular functions. The study evidences a spatio-temporal relationship between middle and inner ear structure development and the onset of hearing and balance, critical senses for the fetal adaptation to birth.
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http://dx.doi.org/10.1038/s41598-017-05151-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5500530PMC
July 2017

The anterior commissure of the human larynx revisited.

Surg Radiol Anat 2017 Aug 12;39(8):871-876. Epub 2017 Apr 12.

Laboratory of Human Anatomy, Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, University Hospital (Saint-Etienne), University of Saint-Etienne, Saint-Etienne, France.

Background: The anterior commissure (AC) of the human larynx is usually understood as an area of the glottis anteriorly situated between the two vocal folds inserting to the thyroid cartilage (TC). The pattern of spread of AC carcinoma could hypothesize that AC could include other structures of the ventral larynx as developmental anatomy could demonstrate.

Methods: Ten adult larynx specimens from donation program cadavers and 15 selected fetal specimens (from 11 to 34 weeks of amenorrhoea) were studied using microdissection and histological serial sections stained with hematoxylin-eosin and reticuline.

Results: In adult specimens, internal perichondrium of the TC was easily detached from the entire lateral lamina but not from an intermediate lamina superiorly marked by the superior thyroid notch. On this median band of TC is inserted the ventral connective tissue of the three levels of the larynx: the ventral part of the vocal folds with the anterior macula flava, the Broyle's epiglottic ligament, and the subglottic part of the conoid ligament. In young fetuses (11-12 weeks), intermediate lamina of TC joined at the glottic level but not at the supraglottic level; in fetuses at 22-25 weeks, a meshwork of bundles of connective fibers inserted to the intermediate lamina of TC. In fetuses at 33-34 weeks, organization is practically identical to adult specimens.

Conclusion: According to the adult anatomical features and the organogenesis, the AC of the human larynx could be anatomically defined ventrally as being made up of the intermediate lamina of TC beneath the superior thyroid notch and dorsally the ventral insertions of vocal folds with macula flava, supraglottic Broyle's ligament, and subglottic conoid ligament leading to a "developmental" AC definition which could better explain specific spreading of AC carcinoma.
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http://dx.doi.org/10.1007/s00276-017-1814-2DOI Listing
August 2017

FOXA1 in HPV associated carcinomas: Its expression in carcinomas of the head and neck and of the uterine cervix.

Exp Mol Pathol 2017 04 14;102(2):230-236. Epub 2017 Feb 14.

Department of Pathology, North Hospital, University Hospital of St-Etienne, France.

Background: FOXA1 is a major transcription factor involved in the action of human papilloma virus (HPV). However, it has been never studied in HPV-associated tumors.

Aim Of The Study: To investigate its expression in cervical and head and neck tumors.

Material And Methods: 63 cervical carcinomas/dysplasias and 152 head and neck squamous cell carcinomas (HNSCC) were immunohistochemically studied for the expression of FOXA1.

Results: 63.1% of cervical SCC and 40.7% of endocervical adenocarcinomas strongly expressed FOXA1. Most (90%) pre-invasive lesions (CIN3 and in situ adenocarcinomas) strongly expressed FOXA1 and this difference from invasive lesions was statistically significant (p=0.005). No association with clinicopathological factors was found. 51.3% of HNSCC expressed FOXA1. In these tumors, FOXA1 expression was associated with the non-keratinizing morphology but not with the HPV/p16 status neither other clinicopathological features. Of normal structures, salivary glands, endocervical glands and basal/parabasal cell layer of squamous epithelium of both uterine cervix and head and neck mucosa, all strongly expressed FOXA1.

Conclusion: FOXA1 is expressed by basal cells of squamous epithelium, pre-invasion lesions of the uterine cervix and the head/neck and almost half invasive cervical and head/neck carcinomas, supporting its possible implication in HPV pathogenesis.
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http://dx.doi.org/10.1016/j.yexmp.2017.02.010DOI Listing
April 2017

Prognostic impact of immune microenvironment in laryngeal and pharyngeal squamous cell carcinoma: Immune cell subtypes, immuno-suppressive pathways and clinicopathologic characteristics.

Oncotarget 2017 Mar;8(12):19310-19322

Department of Pathology, North Hospital, University Hospital of St-Etienne, St-Etienne, France.

Background: Immune system affects prognosis of various malignancies. Anti-immune pathways like PD-L1 and CTLA4 are used by the tumor to overcome immune system and they serve as immunotherapy targets. The immune microenvironment of head-and-neck squamous cell carcinoma (SCCHN) has not been sufficiently studied.

Patients And Methods: 152 SCCHN were immunohistochemically studied for the expression of CD3, CD8, CD57, CD4, granzyme b, CD20, CD163, S100, PD-L1, CTLA4 and CXCR4.

Results: CD3, CD8, CD57 and stromal S100 higher density is a good prognostic factor (p=0.02, 0.01, 0.02, 0.03 respectively). CTLA4 tumor expression is a poor prognostic factor (p=0.05). The rest immune cells do not affect prognosis. CD3 and CD8 density does not correlate with clinicopathological factors or p16/p53 expression, while CD57 and CD4 higher density is associated with the absence of distant metastases (p=0.03 and 0.07, respectively). Higher CD20 and S100 density is associated with lower T stage (p=0.04 and 0.03, respectively). PD-L1 expression is higher in CD3, CD8, and CD163 infiltrated tumors and in histologically more aggressive tumors. Response to neoadjuvant chemotherapy is better in highly CD3 infiltrated tumors and in tumors with less intraepithelial macrophages.

Conclusion: Rich T-lympocytic and dendritic cell response is a good prognostic factor in SCCHN, whereas tumors expressing CTLA4 show poor prognosis. PDL1 expression does not affect prognosis, but it is expressed in histologically more aggressive tumors and in T-cells rich tumors. Response to induction chemotherapy is better in tumors less infiltrated by macrophages and mostly infiltrated by T cells.
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http://dx.doi.org/10.18632/oncotarget.14242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5386686PMC
March 2017

Clinical and Histologic Predictive Factors of Response to Induction Chemotherapy in Head and Neck Squamous Cell Carcinoma.

Am J Clin Pathol 2016 Nov;146(5):546-553

From the Department of Pathology.

Objectives: Induction chemotherapy (IC) is occasionally used in head and neck cancer, leading to less extensive surgery and reduced need for irradiation. Factors predicting the response to IC have not been determined. In this study, we investigated the clinical and histopathologic factors that predict the response to IC.

Methods: Head and neck squamous cell carcinomas from 81 patients were analyzed; clinical factors, histologic parameters, and expression of p16 and p53 were correlated with response to chemotherapy and prognosis.

Results: Factors predicting a good response to IC were the nonoropharyngeal localization, a rich lymphocytic tissue response, and a low platelet-to-lymphocyte blood ratio before treatment. Response to IC did not correlate with prognosis, whereas a low neutrophil-to-lymphocyte ratio (NLR), the absence of a desmoplastic reaction, a rich lymphocytic tissue response, and the overexpression of p53 were associated with better prognosis.

Conclusions: Lymphocytic tissue response, NLR, and nonoropharyngeal localization are factors predictive of response to IC.
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http://dx.doi.org/10.1093/ajcp/aqw145DOI Listing
November 2016

Intraoperative monitoring of the recurrent laryngeal nerve by vagal nerve stimulation in thyroid surgery.

Eur Arch Otorhinolaryngol 2017 Jan 15;274(1):421-426. Epub 2016 Jul 15.

Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital St Etienne, St Etienne, France.

The aim of the present study was to evaluate the thyroarytenoid muscle response during bilateral thyroid surgery using vagal nerve stimulation. 195 patients (390 nerves at risk) underwent a total thyroidectomy. The recurrent laryngeal nerve's function was checked by analyzing the amplitude and the latency of the thyroarytenoid muscle's responses after a vagal nerve's stimulation (0.5 and 1 mA) using the NIM3 Medtronic system. All patients were submitted to preoperative and postoperative laryngoscopy. 20 patients get no thyroarytenoid muscle response to the vagal nerve stimulation, and 14 postoperative recurrent laryngeal nerve palsies were confirmed (3.8 %). Two palsies were present after 6 months (0.51 %). All the patients with muscle's response have normal mobility vocal fold. The test sensitivity was 100 % and the test specificity was 98 %. Physiologically, the mean latencies of the muscular potentials for the right RLN were, respectively, 3.89 and 3.83 ms (p > 0.05) for the stimulation at 0.5 and 1 mA. The mean latencies for the left RLN were, respectively, 6.25 and 6.22 ms for the stimulation at 0.5 and 1 mA (p > 0.05). The difference of the latencies between the right and the left nerve was 2.30 ms (1.75-3.25 ms) with a stimulation of 0.5 or 1 mA (p < 0.05). Thyroarytenoid muscle's response via a vagal nerve stimulation showed a functional asymmetry of the laryngeal adduction with a faster right response. Surgically, this method can predict accurately an immediate postoperative vocal folds function in patients undergoing a bilateral thyroid surgery.
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http://dx.doi.org/10.1007/s00405-016-4191-2DOI Listing
January 2017

p16 and p53 expression status in head and neck squamous cell carcinoma: a correlation with histological, histoprognostic and clinical parameters.

Pathology 2016 Jun 23;48(4):341-8. Epub 2016 Apr 23.

Department of Pathology, North Hospital, University Hospital of St-Etienne, France.

Different histopathology and prognosis characterise the human papillomavirus (HPV)-related oropharyngeal tumours, but squamous cell carcinomas (SCC) of other localisations have not been exhaustively studied. Tissues from 120 patients with a head and neck SCC were studied for the expression of p16 and p53, and the Brandwein-Gensler (BG) histological risk assessment model. p16 positivity and p53 normal expression were significantly correlated with non-smoking, an earlier T stage and a non-keratinising morphology. The BG risk score was not associated with p16 or p53 expression; p16 expression was associated with a lymphocytic T-cytotoxic response. BG risk score was significantly correlated with overall survival and progression-free survival, while neither p16 nor p53 expression were associated with prognosis. p16 and p53 expression are associated with the histological subtype and the T stage even in non-oropharyngeal-restricted tumours. The BG risk score is not correlated with p16 or p53 and retains its power in non-site-specific SCCs.
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http://dx.doi.org/10.1016/j.pathol.2016.01.005DOI Listing
June 2016

Real-life assessment of Volumetric Modulated Arc Therapy (VMAT) toxicity in Head and Neck Squamous Cell Carcinoma (HNSCC) treatment.

Acta Otolaryngol 2016 27;136(2):181-8. Epub 2015 Oct 27.

a Department of Radiotherapy , Lucien Neuwirth Cancer Institute, Saint Priest en Jarez , France.

Conclusion: The present study demonstrates the feasibility of VMAT in association with platin or cetuximab in HNSCC and reports VMAT-related acute and late toxicities for the first time.

Objectives: New radiotherapy techniques, such as Volumetric Modulated Arc Therapy (VMAT) were developed to lower RT-related toxicity. The aim of the present study was to investigate acute and late toxicities of head and neck squamous cell carcinoma (HNSCC) patients treated using VMAT.

Methods: This study investigated retrospectively all patients with HNSCC who received VMAT in curative intent.

Results: From 2010-2013, 150 patients were treated. Seventy-five patients (50%) received concurrent chemotherapy with VMAT, 51 patients (34%) received VMAT alone and 24 patients (16%) received concurrent cetuximab with VMAT. Mean delivered dose to planning target volume tumor (PTV T), high risk nodes (PTV HNR), low risk nodes (PTV LNR) and prophylactic nodes (PTV PN) were: 65.2 Gy, 62.9 Gy, 55.4 Gy, and 51.5 Gy, respectively. PTV mean coverages were higher than 96.5%. Most common grade 3/4 acute infield toxicities were mucosis (n = 28, 19%), dysphagia (n = 24, 16%), and dermatitis (n = 24, 16%). With a median follow-up of 16.0 months, most common late toxicities were dysphagia (n = 30, 20%), xerostomia (n = 28, 19%), larynx stiff (n = 17, 11%), and skin fibrosis (n = 14, 9%).
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http://dx.doi.org/10.3109/00016489.2015.1101783DOI Listing
October 2016

Chemocauterization with trichloroacetic acid in congenital and recurrent tracheoesophageal fistula: a minimally invasive treatment.

Surg Endosc 2016 Apr 3;30(4):1662-6. Epub 2015 Jul 3.

Department of Pediatric Surgery and Urology, University Hospital of Saint Etienne, 42055, Saint-Etienne Cedex 2, France.

Objective: Recurrent tracheoesophageal fistula (RTEF) is a serious complication after primary repair of esophageal atresia and tracheoesophageal fistula (EA/TEF). Treatment of RTEF involved an open surgery by thoracotomy. Technically it is a challenge with a high morbidity and mortality. Congenital tracheoesophageal fistula (CTEF) traditionally involved an open surgery by thoracotomy or cervicotomy. Many endoscopic techniques have been developed since the past decades: thoracoscopic or bronchoscopic approach for the treatment of RTEF and CTEF; nevertheless, optimal treatment is not still determined because of few numbers of patients, short-term follow-up, and different procedures. We report our experience and evaluated the efficacy in the chemocauterization of CTEF and RTEF, with the use of 50% trichloroacetic acid (TCA) as a technique minimally invasive.

Materials And Methods: From 2010 to 2014, fourteen patients with TEF (twelve RTEF and two CTEF) were selected for endoscopic management in two centers. Twelve patients had RTEF after primary repair of EA/TEF by thoracotomy approach, and two patients had CTEF in the upper pouch, diagnosed after EA/TEF (Type B) long gap, treated by thoracotomy and thoracoscopy, respectively. In all cases the diagnosis was confirmed by esophagram, bronchoscopy, and clinical evaluation. Under general anesthesia, a rigid pediatric bronchoscope with a 0° rod lens telescope and tele-monitoring was used to localize the TEF. Cotton soaked with 50% TCA was applied on the TEF during 30 s, and the procedure was repeated 3 times. The endoscopic treatment was performed monthly until TEF closure was achieved.

Results: RTEF and CTEF were closed in all patients. The mean number of procedure in each patient was 1.8. Closure of TEF was confirmed by esophagram, bronchoscopy, and clinical evaluation. There were a bacterial pneumonia and bronchospasm as postoperative complications. Median follow-up was 41 months (8-72). All of these TEF remain completely obliterated, and all patients are asymptomatic.

Conclusion: Endoscopic management of congenital and recurrent TEF with the use of 50% TCA is as a minimally invasive, effective, simple and safe technique in these patients and avoids the morbidity of open surgery.
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http://dx.doi.org/10.1007/s00464-015-4352-1DOI Listing
April 2016

Around the mandible.

Surg Radiol Anat 2014 Nov;36(9):837

Division in Anatomy and Developmental Biology, Department of Oral Biology, Yonsei University College of Dentistry, 250 Seongsanno, Seodaemoon-gu, Seoul, 120-752, Korea.

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http://dx.doi.org/10.1007/s00276-014-1381-8DOI Listing
November 2014

Surgical anatomy of the ansa cervicalis nerve: which branch to use for laryngeal reinnervation in humans?

Surg Radiol Anat 2015 Mar 28;37(2):139-45. Epub 2014 Aug 28.

Laboratory of Human Anatomy, Department of Otolaryngology Head and Neck Surgery, University of Saint-Etienne, Saint-Etienne, France,

Purpose: The aim of this study has been to obtain some data for the selection of which branch of the ansa cervicalis nerve (AC) could be an attractive candidate for a laryngeal reinnervation using AC to recurrent laryngeal nerve (RLN) neurorrhaphy.

Methods: The AC was dissected in ten human head cadavers with an operating microscope. A vagal nerve stimulation was conducted during a bilateral thyroidectomy with normal vocal fold mobility in ten patients using a NIM Medtronic System(®) to record phasic activity within the thyroarytenoid muscle (vocal fold adduction) and one of the infrahyoid muscle (sternothyroid muscle or sternohyoid muscle).

Results: Despite reported variations of the roots of AC and location of its loop, the lower portion of the STM and SHM was innervated by a prominent common trunk in 80 % of cases, in a close vicinity of the RLN with an excellent size match to the RLN for a tension-free anastomosis. The STM displays slight but significant electrical activity during vocal fold adduction.

Conclusion: The common trunk of the SHM and STM is the prime choice for laryngeal reinnervation using AC-RLN non-selective anastomosis. If the main trunk is missing, the branch to the STM can be an attractive candidate.
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http://dx.doi.org/10.1007/s00276-014-1355-xDOI Listing
March 2015

Reflections about the cranial nerves destinated to the face: plea for a global approach including nerves and their branches, canals, vessels, distribution and clinical relevance.

Surg Radiol Anat 2013 Nov;35(9):755-6

Laboratoire d'Anatomie et d'Organogénèse, Faculté de Médecine d'Amiens, Amiens University, Rue des Louvels, 80036, Amiens, France.

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http://dx.doi.org/10.1007/s00276-013-1217-yDOI Listing
November 2013

Preauricular transmandibular and transzygomatic approach for tumors of the infratemporal fossa revisited.

ORL J Otorhinolaryngol Relat Spec 2013 1;75(4):250-5. Epub 2013 Aug 1.

Department of Otolaryngology, Head and Neck Surgery, North Hospital, Saint-Etienne University Hospital Centre, Saint-Etienne, France.

Aim: To demonstrate the surgical technique and results in patients operated on with a preauricular transmandibular transzygomatic approach.

Methods: This surgical technique was used in 21 patients with benign and malignant tumors of the infratemporal fossa (ITF), operated on between 1999 and 2011.

Results: Twenty-one patients were enrolled in the study. There were 6 patients with benign tumors and 15 with malignant ones. No patients with benign lesions show any disease recurrence 5 years after surgery and present excellent functional and cosmetic results. Postoperatively, a reduction of pain was noted in all patients with malignant lesions. Four patients in this group, who are alive 5 years after surgery, do not demonstrate any disease progression.

Conclusion: The described approach provides an excellent exposure of the ITF and could be the procedure of choice in the management of ITF tumors.
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http://dx.doi.org/10.1159/000351554DOI Listing
April 2014

Human papillomavirus and head and neck squamous cell carcinomas in the South-East of France: prevalence, viral expression, and prognostic implications.

Acta Otolaryngol 2013 May 28;133(5):538-43. Epub 2013 Jan 28.

Department of Otolaryngology Head and Neck Surgery, Saint-Etienne University School of Medecine.

Conclusion: Human papillomavirus (HPV) infection, especially by HPV 16, is frequently detected in oropharyngeal squamous cell carcinoma (OSCC). The expression of viral oncoproteins in tumoral tissues of OSCCs suggests the implication of HPV in tumorogenesis. It should now be systematically detected and considered in each patient's treatment and outcome.

Objectives: To investigate the prevalence of HPV infection, the oncogenic role of HPV in patients from the South-East of France with head and neck squamous cell carcinoma (HNSCC), and the resulting clinical implications.

Methods: Biopsy samples from 200 patients with HNSCC were analyzed. For each patient, one or two biopsies of tumoral tissue were analyzed simultaneously with a biopsy of healthy tissue. Fresh frozen tissues were tested by molecular techniques for HPV DNA detection and genotyping as well as mRNA expression of oncoproteins E6 and E7. Expression of p16 was also analyzed by immunohistochemical staining.

Results: HPV DNA tested positive in 11.5% of biopsy samples. The HPV prevalence was higher in OSCCs (91.3 vs 27.3, p < 0.0001) and in patients not consuming tobacco (65.2% vs 95.4%, p < 0.0001). The estimated 3-year overall survival rates were 67.0% for HPV-infected patients versus 39.9% for non-infected patients. The high-risk HPV 16 was the most common type detected (65.2%). In 12 of 18 patients exhibiting DNA of high-risk HPV in their tumor tissue, the same viral genome was also present in normal tissue. E6 and E7 expression was found in 9 of 14 tumoral biopsies tested for these markers.
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http://dx.doi.org/10.3109/00016489.2012.747221DOI Listing
May 2013

Strategy of modern epistaxis management.

Cardiovasc Intervent Radiol 2012 Jun;35(3):709-10

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http://dx.doi.org/10.1007/s00270-011-0231-xDOI Listing
June 2012

Plastinated nasal model: a new concept of anatomically realistic cast.

Rhinology 2011 Mar;49(1):30-6

Centre Hospitalier Emile Roux, ENT center, Le Puy en Velay, France.

Background: For many years, researchers have been interested in investigating airflow and aerosol deposition in the nasal cavities. The nasal airways appear to be a complex geometrical system. Thus, in vitro experimental studies are frequently conducted with a more or less biomimetic nasal replica.

Aim: This study is devoted to the development of an anatomically realistic nose model with bilateral nasal cavities, i.e. nasal anatomy, airway geometry and aerodynamic properties as close as possible to in vivo behaviour.

Methods: A specific plastination technique of cephalic extremities was developed by the Anatomy Laboratory at the Saint-Etienne University in the last 10 years. The plastinated models obtained were anatomically, geometrically and aerodynamically validated using several techniques (endoscopy, CT scans, acoustic rhinometry and rhinomanometry).

Results: Our plastination model exhibited a high level of anatomic quality, including a very good mucosa preservation. Aerodynamical and geometrical investigations highlighted a global behaviour of plastinated models perfectly in accordance with a nasal decongested healthy subject.

Conclusions: The present plastination model provides a realistic cast of nasal airways, and may be a useful tool for nasal flow, drug delivery and aerosol deposition studies.
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http://dx.doi.org/10.4193/Rhino09.187DOI Listing
March 2011

Posterior cricoarytenoid bellies: relationship between their function and histology.

J Voice 2011 Mar 31;25(2):e67-73. Epub 2011 Jan 31.

Department of Otolaryngology-Head and Neck Surgery, North Hospital, Saint-Etienne University Hospital Center, Saint-Etienne, France.

Objectives/hypothesis: Complete physiological information about human posterior cricoarytenoid muscle (PCA) is essential and is not only of basic science interest but also could lead directly to understanding phonation and many clinical issues in neurolaryngology. The purpose of the study was to investigate and compare the histochemical and morphological properties to know contractile muscle fiber characteristics of two bellies of the PCA.

Study Design: Cross-sectional experimental study.

Methods: The PCAs were harvested from the total laryngectomy simples. Serial transverse sections of the two PCA bellies were performed and studied by immunohistochemical analysis.

Results: Two separate muscle bellies were always identified within 15 PCA. The following muscle fiber types were observed: I, I-IIA, and IIA. Comparisons of the vertical and horizontal bellies of the PCA reveled differences in the fiber-type composition.

Conclusion: In our experience, the PCA should be considered as a combination of two functional subunits, which significantly differ in their muscle fiber-type composition.
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http://dx.doi.org/10.1016/j.jvoice.2010.11.004DOI Listing
March 2011

Endoscopic parathyroidectomy in primary hyperparathyroidism.

Eur Arch Otorhinolaryngol 2011 Jun 3;268(6):893-7. Epub 2010 Nov 3.

Department of Otolaryngology-Head and Neck Surgery, North Hospital, Saint-Etienne University Hospital Centre, 42055 Saint-Etienne Cedex 2, France.

During the past decade, endoscopic video-assisted parathyroidectomy (EP) for primary hyper parathyroidism (PHPT) has gained wider acceptance. The endoscopic gasless procedure described by P. Miccoli (1997-1998) offers an attractive technique. A routine preoperative localization study was performed with both ultrasonography and 99m TC-Sestamibi scintigraphy for each patient with sporadic PHPT. The criteria to select patients eligible for EP included absence of significant nodular goiter, a previous neck surgery, a need for concomitant thyroidectomy, a significant obesity, and multiple enlarged parathyroid glands. The surgical outcome and the use of preoperative localization together with the operative strategy were evaluated. From 2005 to 2009, 59 out of 75 patients (78%) were potentially candidates for this approach. An enlarged parathyroid gland was located by both types of imaging for 34 patients (57%) and by 99 m Tc-Sestamibi scintigraphy for 46 patients (77%). Conversion was required in 11 cases (18%). Nine patients had a negative preoperative imaging study and five underwent a successful EP. The operating time ranged from 35 to 120 min (median 45 min). Usually patients were discharged home at 48 h. There were no cases of permanent hypocalcemia or recurrent laryngeal nerve palsy. Postoperative review showed that all calcium and parathyroid hormone levels remained normal at 3 months except for 1 patient with a double adenoma. EP is a quick, safe, and effective procedure in a selected group of patients. Our results show that this technique can be easily introduced into a general head and neck practice.
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http://dx.doi.org/10.1007/s00405-010-1414-9DOI Listing
June 2011

Preoperative combined 18-fluorodeoxyglucose positron emission tomography and computed tomography imaging in head and neck cancer: does it really improve initial N staging?

Acta Otolaryngol 2010 Dec 25;130(12):1421-4. Epub 2010 Aug 25.

Department of Otolaryngology - Head and Neck Surgery, North Hospital, University Hospital Centre, Saint-Etienne, France.

Conclusion: In our experience PET-CT cannot yet reliably predict the need for surgical neck dissection in patients with N0 neck. According to the results of PET-CT the neck dissection should be extended towards unusual lymph node areas.

Objective: To analyze the value of PET-CT for the initial N staging, comparing PET-CT data with histopathological results of the modified radical neck dissection.

Methods: Fifty patients with previously untreated head and neck squamous cell carcinoma were eligible for inclusion in this study. Modified radical unilateral or bilateral neck dissection was performed in all patients. PET-CT findings and histological findings were compared to determine their diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value.

Results: In all, 105 levels had pathologically diagnosed metastases: PET-CT was positive in 87 levels and negative in 18 levels. Also, 399 levels had negative postoperative histology findings: PET-CT was positive in 24 levels and negative in 375 levels. The false-positive over-staged and the false-negative under-staged rates were 27% and 12%, respectively.
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http://dx.doi.org/10.3109/00016489.2010.502183DOI Listing
December 2010

Lamina propria of the human vocal fold: histomorphometric study of collagen fibers.

Surg Radiol Anat 2010 Apr 20;32(4):377-82. Epub 2009 Oct 20.

Department of Anatomy, Faculty of Medicine, CHU Nord, Saint-Etienne, France.

Background: Since the seminal work of M. Hirano, which defined the three-layered lamina propria of the human vocal fold, there has been confusion in the labeling of each layer. Recent studies described the composition of fibers and interstitial molecules within the lamina propria leading to various biomechanical properties. However, collagen fibers appear as the most important structure component.

Methods: We used an optical analysis and the picrosirius-polarization method to describe collagen fibers from six adult and two fetal human larynges fixed in formalin and frontally sectioned in the middle part of the vocal fold.

Results: The deep layer of the lamina propria is the most densely organized band of collagen fibers penetrating the superficial muscle bundles of the vocal muscle. The mean thickness of this layer is about 36% of the lamina propria and shows a network of strongly birefringent fibers (collagen type I and III). The superficial layer of the lamina propria is a narrow band of collagen fibers immediately below the basement membrane of the epithelium. The mean thickness of this layer is about 13% of the lamina propria and shows strong birefringent fibers. The intermediate layer is the less densely organized band between the deep and superficial layers. The mean thickness of this layer is about 51% of the lamina propria and shows clear, green weakly birefringent fibers characterized as collagen type III. The fetal lamina propria contains only a monolayer distribution of loose collagen fibers between the epithelium and the vocal muscle.

Conclusion: These results help describe the distribution of collagen fibers within the lamina propria of the human vocal fold and have implications to understand the cover-body theory of voice production both in the adult and newborn.
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http://dx.doi.org/10.1007/s00276-009-0577-9DOI Listing
April 2010