Overlooked Histologic Characteristics Underlie Latrogenic Tumor Seeding: A Systematic Review

Wednesday, October 4, 2023

9:57 AM - 10:03 AM East Coast USA Time

Location: 201AB

Presenting Author(s)

Pavel A. Kipnis, BS

Medical Student
Case Western Reserve University School of Medicine
Cleveland, MD, United States

Co-Author(s)

Diya Ramanathan, BA

Medical student
Case Western Reserve University School of Medicine
Cleveland, OH, United States

Author(s)

Ashok R. Jethwa, MD

Resident Physician
University of Minnesota, Department of Otolaryngology-Head and Neck Surgery
Minneapolis, Minnesota, United States
JM

Jonathan Mark, MD, FACS

Eastern Virginia Medical School, USA
Shawn Li, MD

Assistant Professor
Case Western Reserve University
San Jose, California, United States
EC

Emiro E. Caicedo Granados, MD

Dr.
University of Minnesota
Minneapolis, Minnesota, United States

Senior Author(s)

BC

Bryan Carroll, MD, PhD

University Hospitals Cleveland Medical Center, USA

Disclosure(s):

Pavel A. Kipnis, BS: No relevant relationships to disclose.

Diya Ramanathan, BA: No relevant relationships to disclose.

Ashok R. Jethwa, MD: No relevant relationships to disclose.

Jonathan Mark, MD, FACS: No relevant relationships to disclose.

Introduction: Iatrogenic seeding of neoplasms is a known complication of invasive diagnostic techniques and surgical interventions, but despite decades of reports, national otolaryngology (ENT) cancer guidelines exclude prophylactic recommendations to reduce its impact on patient outcomes. The aim of this study was to identify trends in neoplasm histology associated with seeding across specialties and specifically in ENT.

Methods: A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA-P) statement and registered at the Prospective Register of Systematic Reviews (PROSPERO) was conducted using PubMed and Web of Science, including only studies with five or more reports of seeding. Seeding was defined as transplantation of tumor cells or secondary tumor growth at a site distinct from the primary tumor, with confirmed shared origins (i.e., histological features).

Results: 7893 papers were screened with 146 papers included after full-text review. There were 311,004 patients with 8800 reports of seeding overall. Within the ENT literature, there were 436 reports of seeding (11.2% of all studies).

97.9% of papers across all specialties and 100% of papers in ENT supported the biological existence of seeding. 47.2% of papers across all specialties and 57.1% of papers in ENT emphasized the clinical significance of seeding.

Tumor staging was categorized as low (stage 1 or 2) or high (stage 3 or 4); 60.9% were low-stage and 39.1% of cases were high-stage. In ENT, the most frequently seeded tumors were squamous cell carcinoma (SCC) (n=258), chordomas (n=71), craniopharyngioma (n=36), and papillary thyroid carcinoma (PTC) (n=19).

Conclusions: These data suggest that SSC, chordomas, craniopharyngiomas, and PTC are at higher risk of iatrogenic seeding. Reported risk factors included high growth activity, poor differentiation, and immunoreactivity of tumors. These findings underscore the importance of detecting high-risk histologic characteristics and precautionary monitoring for signs of seeding to improve patient outcomes.