 |
| Title |
For Patients with History of Cancer of Primary Origin Outside of the Jaw, Use Of CBCT Imaging Can Be Instrumental to the Identification of Cancer Recurrence Through Detection of Metastatic Lesions of the Jaw |
| Clinical Question |
For patients with a history of cancer, will the use of 3D CBCT imaging compared to 2D panoramic imaging or no routine imaging increase the early detection of recurrence through identification of metastatic lesions of the jaw? |
| Clinical Bottom Line |
For patients with a history of cancer of primary origin outside of the jaw, the use of CBCT imaging can be useful in identifying cancer recurrence through detection of metastatic lesions. Although metastases in the jaw are relatively rare and the prognosis after detection of metastases is poor, there is still diagnostic validity in its use. CBCT is useful in the both the detection of and in the differentiation between lesions which originate in the jaw and those that are metastases from elsewhere in the body. |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 32790941 | Kirschnick/2022 | 348 cases from 217 studies, male and female patients with metastatic lesions in oral/maxillofacial region | Systematic review of non-randomized trials | | Key results | A systematic review of 217 studies provided information on the “demographic, clinical, and imaginological features and survival rate” of patients with metastatic lesions (Kirschnick). The imaginological features were reported in 194 cases, 115 (59.28%) of which had a radiolucent image, 21 (10.82%) had a radiopaque image, and 17 (8.76%) had a mixed image.” Thus, it can be interpreted that the imaginologic data are variable. Although metastatic lesions in the jaw are rare, this information is useful for future management of cancer metastases. | | #2) 36371023 | Lopes/2022 | SR of 273 articles for total of 950 cases: M and F patients with oral metastasis | Systematic review of non-randomized trials | | Key results | A systematic review was conducted to evaluate data surrounding the prevalence of metastases in the oral cavity, using histopathologic information for confirmation. In the outcome of the review, it was highlighted that radiologic imaging was useful in detection. In 30.4% of the cases, the metastatic lesions detected were first signs of disease. | |
| Evidence Search |
Cancer AND metastasis AND jaw |
Comments on
The Evidence |
In the Kirschnick paper, a thorough review of existing case studies and case reports was conducted in order to consolidate the data and produce a useful summary of the characteristics of metastases in the oral region. This systematic review illustrates that, although the prevalence of metastases in the jaw is low, it does occur. The Lopes paper is also a systematic review of studies published regarding case series and case reports of patients with metastases in the oral region. Again, this article concludes that metastases to the jaw are relatively rare yet the ability to detect and diagnose them is crucial to the management of the patient. The Kirschnick paper was conducted by doing an electronic search of five academic databases, whereas the Lopes paper used three databases. Both studies are systematic reviews, and the Kirschnick report was conducted with meta-analysis. Both utilized the Kaplan-meier method in their presentation of survival data. |
| Applicability |
Both references provide useful information on the prevalence and description of metastases to the jaw and how imaging plays a part in the detection and management. There is, however, a dearth of evidence on how 3D imaging can be used. Factors that could preclude patients from receiving 3D imaging to screen for metastases include access to care (i.e., geographic proximity to imaging centers or financial limitations) or a lack of referral from a primary health care practitioner. Additionally, there is the concern that the use of imaging, whether it be 2D or 3D, has limited usability as prognosis after presence of oral metastases is often poor. The images would also ideally be interpreted by a professional with adequate training (such as an oral and maxillofacial radiologist) to reduce the likelihood of misdiagnosing or misinterpreting what is on the images. |
| Specialty/Discipline |
(Oral Medicine/Pathology/Radiology) (Oral Surgery) |
| Keywords |
Cancer, metastasis, jaw
|
| ID# |
3544 |
| Date of submission: |
10/19/2023 |
| E-mail |
shepherda@uthscsa.edu |
| Author |
Alexandra Shepherd |
| Co-author(s) |
Issam Ghaben |
| Co-author(s) e-mail |
ghaben@livemail.uthscsa.edu |
| Faculty mentor/Co-author |
|
| Faculty mentor/Co-author e-mail |
|
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
|
|
