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Advanced Diagnostics in Head and Neck Oncology

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A Special Issue of Diagnostics (ISSN 2075-4418) belonging to the section "Clinical Diagnosis and Prognosis".

Deadline for manuscript submissions: 30 June 2027 | Viewed by 5977

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Editors

Prof. Dr. Xindong Fan

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Guest Editor

Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
Interests: vascular malformation; vascular tumor; vascular anomaly; head and neck cancer; interventional radiology

Dr. Siyi Li

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Guest Editor Assistant

Department of Oral & Maxillofacial-Head & Neck Oncology, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
Interests: head and neck cancer; head and neck tumor; surgical oncology; head and neck surgery

Dr. Longwei Hu

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Guest Editor Assistant

Dr. Yuchen Shen

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Guest Editor Assistant

Special Issue Information

Dear Colleagues,

Head and neck tumors (HNTs) are a complex pathological combination that mainly invades the oral cavity, pharynx, nasal cavity and other parts. Among these, head and neck cancer is the seventh most common cancer worldwide and comprises a diverse group of malignant entities affecting the upper aerodigestive tract. Although multiple histological subtypes exist, squamous cell carcinoma is the most prevalent. The complex anatomy of these regions poses significant challenges to precise diagnosis.

The diagnosis of HNTs necessitates specialized teams, equipment and skills. A key challenge in the HNT pathway is the uncertainty and inconsistency of symptoms preceding diagnosis. Healthcare systems worldwide have established targeted, timed pathways; however, financial constraints, especially among countries with low socio-demographic index, have led to insufficient infrastructure to manage the surge in referrals, with the vast majority not receiving a reliable diagnosis. Innovative triage methods have begun to streamline this process through risk stratification, enabling more effective resource allocation. This has enhanced the management of non-cancer patients, yet diagnostic delays remain unresolved.

Furthermore, the application of artificial intelligence (AI) within healthcare in recent years has attracted significant scholarly interest. AI techniques, including machine learning, neural networks and deep learning, when integrated into the comprehensive management of HNTs, hold the potential to enhance the accuracy, safety and effectiveness of diagnostic approaches.

This Special Issue will focus on emerging technologies, methodologies and clinical translation applications in the field of head and neck oncology diagnosis, encompassing molecular diagnostics, medical imaging, AI–assisted diagnostic systems, liquid biopsy, precision pathology and related interdisciplinary areas. We anticipate this collection will serve as a high-quality academic platform for researchers and clinicians, fostering innovation and advancement in diagnostic science.

Original research articles, reviews, guidelines, protocols and interesting images are welcome in this Special Issue. Manuscripts should adhere to the journal's formatting guidelines and ethical standards.

Prof. Dr. Xindong Fan
Guest Editor

Dr. Siyi Li
Dr. Longwei Hu
Dr. Yuchen Shen
Guest Editor Assistants

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

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Keywords

head and neck
tumor
surgical diagnosis
non-invasive diagnostic method
diagnostic biomarkers
intraoperative imaging
pathology
minimally invasive biopsy
artificial intelligence

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Published Papers (8 papers)

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Research

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14 pages, 2560 KB

Open AccessArticle

Evaluation of Bone Invasion in Gingival Squamous Cell Carcinoma Using PET/CT Radiomics

by Junwoo Kwark, Seunggon Jung, Min-Suk Kook, Hong-Ju Park, Junho Chang and Jaeyoung Ryu

Diagnostics 2026, 16(17), 2685; https://doi.org/10.3390/diagnostics16172685 - 22 Aug 2026

Viewed by 233

Abstract

Background: Accurate preoperative assessment of bone invasion is essential for surgical planning in gingival squamous cell carcinoma (SCC). This study evaluated the diagnostic value of conventional ¹⁸F-FDG PET/CT-derived imaging parameters and PET-based radiomic features for predicting histopathologic bone invasion. Methods: This retrospective study included 68 patients with gingival SCC who underwent preoperative ¹⁸F-FDG PET/CT followed by primary surgical treatment. Bone invasion was confirmed histopathologically. Conventional PET parameters (MTD, SUVmax, SUVmean, MTV, and TLG) and PET-based radiomic features were extracted from the primary tumor. Group comparisons, receiver operating characteristic (ROC) analysis, and univariate logistic regression were performed. Results: Patients with bone invasion showed significantly higher MTD, SUVmax, MTV, and TLG than those without bone invasion (all p < 0.05), whereas SUVmean was not significantly different. Entropy, correlation, and zone entropy were significantly higher in the bone invasion-positive group. MTV showed the numerically highest AUC among conventional PET parameters (AUC = 0.748), whereas correlation (AUC = 0.725) and zone entropy (AUC = 0.714) showed the highest performance among radiomic features. Univariate logistic regression showed significant associations of MTD, MTV, TLG, entropy, correlation, and zone entropy with bone invasion. Conclusions: Conventional PET parameters and PET-based radiomic features were significantly associated with histopathologic bone invasion in gingival SCC. Radiomic features reflecting intratumoral heterogeneity may complement conventional metabolic parameters and improve preoperative assessment of bone invasion. Full article

(This article belongs to the Special Issue Advanced Diagnostics in Head and Neck Oncology)

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11 pages, 1054 KB

Open AccessArticle

Plasma Fibrinogen at Recurrence as a Prognostic Blood Biomarker in Oral Cavity Squamous Cell Carcinoma

by Rafael Gómez-Fernández, Jorge Vallejo-Díez, Beatriz Zarauza-Santos, Belén Burgos-Vico, Sonia de las Heras-Losada and Luis Miguel Redondo-González

Diagnostics 2026, 16(14), 2276; https://doi.org/10.3390/diagnostics16142276 - 21 Jul 2026

Viewed by 415

Abstract

Background: Preoperative inflammatory biomarkers, particularly the neutrophil-to-lymphocyte ratio (NLR), are established prognostic markers in oral cavity squamous cell carcinoma (OCSCC), yet their relevance at the biologically distinct timepoint of disease recurrence is unknown. We evaluated blood biomarkers measured at recurrence. Methods: From a retrospective cohort of 168 surgically treated OCSCC patients, 70 (41.7%) developed recurrence (49 local, 21 distant). NLR, lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), plasma fibrinogen, albumin and the prognostic nutritional index (PNI) at relapse were analysed against 5-year overall survival; multivariate logistic regression was adjusted for age and recurrence type. Results: Forty-nine of 70 patients (70.0%) died within 5 years. Fibrinogen was higher in deceased patients (median 595 vs. 464 mg/dL; p = 0.007) and was the only biomarker to retain independent significance (OR 1.005 per mg/dL; 95% CI 1.000–1.010; p = 0.038); in contrast, NLR lost significance (p = 0.156). LMR was significant univariately (p = 0.036); PLR, albumin and PNI were not. Conclusions: In this exploratory single-centre cohort, higher plasma fibrinogen at recurrence was independently associated with 5-year mortality, whereas inflammatory ratios were not. These hypothesis-generating findings warrant validation in larger, multicentre cohorts. Full article

(This article belongs to the Special Issue Advanced Diagnostics in Head and Neck Oncology)

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14 pages, 15096 KB

Open AccessArticle

Sellar Solitary Fibrous Tumor Mimicking Pituitary Adenoma: Diagnostic Pitfalls, Contemporary Pathological Classification, and Management Considerations

by Ozan Baskurt, Mehmet Arda Inan, Kubilay Ukinc and Nurperi Gazioglu

Diagnostics 2026, 16(14), 2161; https://doi.org/10.3390/diagnostics16142161 - 10 Jul 2026

Viewed by 514

Abstract

Background/Objectives: Sellar solitary fibrous tumors (SFTs) are exceptionally rare mesenchymal neoplasms that frequently mimic non-functioning pituitary adenomas (PAs) because of overlapping clinical manifestations and nonspecific radiological findings. Consequently, preoperative diagnosis remains challenging and definitive diagnosis relies on histopathological and immunohistochemical evaluation. Methods: We report a sellar SFT initially diagnosed as a PA and analyze the diagnostic features of previously reported cases to identify recurring diagnostic pitfalls. Clinical, endocrinological, radiological, intraoperative, histopathological, and immunohistochemical findings from a patient with a sellar SFT were retrospectively reviewed. A structured literature review of previously reported sellar SFTs was performed to compare presenting symptoms, endocrine abnormalities, imaging characteristics, pathological findings, and diagnostic features. Results: A 65-year-old man presented with headache, progressive visual impairment, fatigue, and anterior hypopituitarism. Magnetic resonance imaging demonstrated a heterogeneously enhancing sellar lesion with suprasellar extension and cavernous sinus involvement, leading to an initial diagnosis of non-functioning PA. Endoscopic transsphenoidal surgery revealed an unexpectedly hypervascular and firm tumor. Histopathological examination demonstrated a spindle-cell neoplasm with a hemangiopericytoma-like vascular pattern, six mitoses per 10 high-power fields, absence of necrosis, and diffuse nuclear STAT6 positivity, establishing the diagnosis of CNS WHO grade 2 solitary fibrous tumor according to the 2021 WHO classification. Review of the literature demonstrated that most sellar SFTs share similar clinical and radiological features with PAs and are diagnosed only after surgical resection. Conclusions: Sellar SFT should be considered in the differential diagnosis of atypical sellar masses despite the absence of characteristic imaging findings. Recognition of intraoperative features, together with appropriate immunohistochemical evaluation, particularly STAT6 staining, is essential for accurate diagnosis. Current evidence remains insufficient to define the optimal postoperative management of completely resected sellar SFTs, emphasizing the importance of individualized treatment decisions and long-term surveillance. Full article

(This article belongs to the Special Issue Advanced Diagnostics in Head and Neck Oncology)

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14 pages, 857 KB

Open AccessArticle

Cervical Esophageal Characteristics in Smokers Versus Non-Smokers: An Ultrasonographic Comparative Analysis

by Muhammed J. Alsaadi and Abdulrahman M. Alfuraih

Diagnostics 2026, 16(9), 1343; https://doi.org/10.3390/diagnostics16091343 - 29 Apr 2026

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Abstract

Background/Objective: Smoking is known to be associated with reflux-related mucosal damage and deleterious esophageal outcomes, yet no non-invasive imaging biomarkers of smoking-induced esophageal remodeling have been identified. We aimed to compare cervical esophageal ultrasound morphology between habitual smokers and non-smokers, in terms of esophageal wall thickness, number of sonographically discernable wall layers, and esophageal diameter, and investigate whether smoking is an independent predictor of these findings. Methods: In this cross-sectional study, 60 participants (30 smokers, 30 non-smokers) underwent high-resolution B-mode ultrasound of the cervical esophagus. Examinations were performed in transverse and longitudinal planes. Outcomes included esophageal wall thickness (mm), number of discernible wall layers, and esophageal diameters in transverse and longitudinal planes. Group comparisons used independent t-tests and chi-square tests. Multiple linear regression assessed independent associations with smoking status (adjusting for age and weight). Within smokers, Pearson correlation evaluated relationships between smoking duration and ultrasound outcomes; exploratory subgroup analyses compared smoking modalities. Results: Smokers were older and had higher weight and BMI than non-smokers. Compared with non-smokers, smokers had greater wall thickness (3.06 vs 2.61 mm), more discernible wall layers (5.03 vs 3.60), and larger transverse (11.68 vs 7.87 mm) and longitudinal (12.90 vs 8.26 mm) diameters (all p < 0.001). In regression analysis, smoking status independently predicted wall thickness (B = 0.411 mm, 95% CI 0.243–0.578; p < 0.001). Smoking duration showed significant correlations with the number of visible layers (r = 0.82; p < 0.001) and wall thickness (r = 0.42; p = 0.021). Conclusions: High-frequency ultrasound detected significant differences in cervical esophageal morphology between smokers and non-smokers. Smoking was independently associated with differences in the diameter, thickness, and number of visible layers of the cervical esophagus. Further studies with larger sample sizes, improved exposure assessment, and use of reference standards are needed. Full article

(This article belongs to the Special Issue Advanced Diagnostics in Head and Neck Oncology)

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Review

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23 pages, 119441 KB

Open AccessReview

Epithelial Markers in Sinonasal Inverted Papilloma with Malignant Transformation: A Scoping Review and Proposal for an Integrative Model of Malignant Risk Stratification

by Rares-Cristian Oanca, Lorena-Adriana Paun, Mihai Dumitru, Oana Maria Patrascu, Carmen Aurelia Mogoanta, Andreea Marinescu, Adrian Costache and Daniela Vrinceanu

Diagnostics 2026, 16(15), 2347; https://doi.org/10.3390/diagnostics16152347 - 27 Jul 2026

Viewed by 400

Abstract

Background/Objectives: Sinonasal inverted papilloma is a rare Schneiderian epithelial tumor, histologically benign in most cases, but characterized by locally aggressive behavior, a high recurrence rate and a recognized potential for malignant transformation, most frequently into sinonasal squamous cell carcinoma. The present article is a scoping review that maps and critically synthesizes the available evidence on epithelial, immunohistochemical and selected molecular markers in malignant-transformed sinonasal inverted papilloma, rather than a quantitative systematic review or meta-analysis. Methods: The literature search was performed according to PRISMA-ScR principles in PubMed/MEDLINE, Embase, Scopus/Web of Science and Google Scholar, using the search keywords sinonasal inverted papilloma, malignant transformation, markers, HPV, p63, p40, p16 and Ki-67, as well as complementary markers of the cell cycle and of the EGFR/CDKN2A/TP53 pathways. Results: Based on the available data, p40 and p63 have diagnostic value for defining and mapping the squamous phenotype, including invasive carcinomatous nests, but they are not standalone predictive markers of malignant transformation. p16 cannot be automatically used as a surrogate for active HPV infection in inverted papilloma, while the results regarding HPV remain inconclusive in relation to malignant transformation of sinonasal inverted papilloma. Ki-67, especially when interpreted topographically and in relation to dysplasia and invasion, may suggest proliferative acceleration, but prognostic thresholds have not yet been validated. Conclusions: The conclusion of our study is that the risk of malignant transformation cannot be reduced to a single marker; it must be interpreted through an integrative clinical, imaging, histopathological, immunohistochemical and molecular model, which requires prospective multicenter validation. Full article

(This article belongs to the Special Issue Advanced Diagnostics in Head and Neck Oncology)

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13 pages, 800 KB

Open AccessReview

Radiation-Induced Carotid Artery Disease: Pathogenesis, Diagnosis and Management

by Alfredo Mauriello, Adriana Correra, Anna Chiara Maratea, Giovanni Benfari, Federica Ilardi, Giuseppe Giugliano, Matteo Lisi, Alessandro Malagoli, Giulia Elena Mandoli, Maria Concetta Pastore, Simona Sperlongano, Vincenzo Russo, Matteo Cameli and Antonello D’Andrea

Diagnostics 2026, 16(6), 841; https://doi.org/10.3390/diagnostics16060841 - 12 Mar 2026

Cited by 3 | Viewed by 2260

Abstract

Patients undergoing radiotherapy (RT) for head and neck cancers (HNCs) face a significantly increased risk of developing carotid artery stenosis (CAS) and cerebrovascular disease (CVD). This condition, known as accelerated or radiation-induced carotid atherosclerosis, represents a long-term toxicity that profoundly impacts patients’ quality of life and survival. Pathogenesis is complex, involving mechanisms such as direct endothelial damage, oxidative stress, chronic inflammatory activation, peri-adventitial fibrosis, and the acceleration of pre-existing atherosclerotic processes. Despite this elevated risk, universal screening and treatment are not yet standardized across all international guidelines. This narrative review summarizes the epidemiology, pathological mechanisms, and clinical implications of accelerated radiation-induced carotid stenosis (RICS) after neck irradiation. Full article

(This article belongs to the Special Issue Advanced Diagnostics in Head and Neck Oncology)

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Other

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24 pages, 3051 KB

Open AccessCase Report

Parapharyngeal Schwannoma: Limitations Regarding Diagnosis and Surgical Intervention—A Case Report and Focused Literature Review

by Despina Luciana Bereczki-Temistocle, Cecilia Petrovan, Adina Simona Coșarcă, Mihai Vlad Golu, Gabriela Felicia Bereșescu, Bianca-Gabriela Nenec, Andrei Cosmin Nenec and Alina Ormenișan

Diagnostics 2026, 16(18), 2906; https://doi.org/10.3390/diagnostics16182906 - 9 Sep 2026

Abstract

Background: Parapharyngealspace schwannomas are rare benign tumors that may become significantly enlarged prior to producing symptoms. Their deep anatomical location and proximity to major neurovascular structures may pose significant challenges for diagnosis and surgical management. Case Presentation: A 51-year-old woman presented with a slowly enlarging, painless right-side neck mass. Contrast-enhanced CT-scan demonstrated a large, well-circumscribed post-styloid parapharyngeal mass measuring approximately 44 × 53 × 73 mm, displacing rather than invading the adjacent carotid vessels. Paraganglioma was included in the differential diagnosis. MRI-scan was not performed because the CT-scan provided sufficient anatomical information for surgical planning in our clinical setting. The tumor was completely removed through an extended transcervical–cervico-parotidial approach without capsular lesions. The origin nerve was not identified intraoperatively. The histopathological exam confirmed a benign schwannoma. No clinically apparent neurological deficit was observed at the 6- and 12-months follow-ups. Literature Review: A focused literature review of PubMed, Scopus, and Web of Science was performed to contextualize the clinical findings and surgical management. The literature highlights the difficulty of determining the nerve of origin preoperatively and the overlap between post-styloid schwannomas and paragangliomas on imaging studies. Surgical excision remains the main treatment, although evidence regarding optimal surgical technique, long-term functionality and disease-control outcomes remain controversial. Conclusions: This case-study highlights the diagnostic challenges of large post-styloid parapharyngeal schwannomas and the limitations of imaging studies in establishing the nerve of origin. Surgical management should be individualized according to tumor anatomy, spatial neurovascular relationships, and anticipated functional risks. Full article

(This article belongs to the Special Issue Advanced Diagnostics in Head and Neck Oncology)

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11 pages, 1504 KB

Open AccessCase Report

Diagnostic Pitfall in the Carotid Space: Accessory Nerve Schwannoma Simulating Cystic Metastasis—A Case Report

by Roberts Tumelkans, Elza Rate, Madara Mikijanska, Can Özütemiz, Oksana Mahmajeva and Arturs Balodis

Diagnostics 2026, 16(5), 699; https://doi.org/10.3390/diagnostics16050699 - 27 Feb 2026

Viewed by 969

Abstract

Objectives: The aim of this case report is to highlight the diagnostic challenges of carotid space masses, share clinical experience, and educate clinicians by presenting a case of a rare disease. Introduction: Accessory nerve schwannomas are rare, benign peripheral nerve sheath tumors. They make up only a small percentage of all cervical schwannomas. Given their rarity and varying appearance on imaging, these tumors can be difficult to accurately diagnose. Schwannomas may mimic other carotid space pathologies, such as metastatic lymphadenopathy, paragangliomas, or sympathetic chain tumors. Accurately identifying the nerve of origin before surgery is important for effective surgical planning and neurological function protection. Case Description: A 50-year-old woman presented with an asymptomatic left-sided neck mass. Computed tomography (CT) revealed a cystic lesion with a thick, contrast-enhancing capsule in the left carotid space, causing internal jugular vein compression and partial thrombosis. Subsequent MRI showed a 28 mm × 23 mm × 38 mm well-defined mass with characteristic schwannoma features, including T2/Short tau inversion recovery (STIR) hyperintensity, peripheral enhancement, central cystic degenerative components, and peripheral diffusion restriction with corresponding lower apparent diffusion coefficient (ADC) values. Split-fat sign and fascicular sign were also seen on the MRI. Despite these imaging findings, the radiological interpretation suggested a sympathetic chain schwannoma as the most likely diagnosis. The correct diagnosis of accessory nerve schwannoma was established intraoperatively when the mass was visualized to be attached to the accessory nerve. Conclusions: This case highlights that even with suggestive MRI features, the rarity of accessory nerve schwannomas can lead to misidentification of the nerve of origin. Accurate diagnosis may require intraoperative visualization, thus marking the importance of including accessory nerve involvement in the differential diagnosis of carotid space masses. Full article

(This article belongs to the Special Issue Advanced Diagnostics in Head and Neck Oncology)

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