Search Results (259)

Head and neck cancer represents a heterogeneous group of malignancies. Oral squamous cell carcinoma (OSCC) is the most prevalent form of head and neck cancer, with a rising incidence in recent years. Risk factors for developing OSCC include exposure to carcinogens, such as alcohol and tobacco products, that can lead to molecular alterations in the oral mucosa and progression from premalignant lesions to invasive phenotypes. Despite the relative curative potential of localized OSCC, the overall prognosis of OSCC has not significantly improved for decades due to a frequently delayed diagnosis and limited targeted treatment options. There remains a need to better characterize the molecular biomarkers of OSCC progression, especially in dysplastic mucosal lesions, before their malignant transformation. In this review, we discuss several molecular biomarkers highly implicated in OSCC tumorigenesis that have demonstrated correlation with clinicopathological parameters and clinical outcomes. These biomarkers are typically involved in vital pathways of carcinogenesis, including cell cycle control, growth factor signaling, and stress responses. They include ubiquitous cancer biomarkers such as p53 and PTEN, as well as those more specific to OSCC, such as DJ-1 and Cornulin. Collectively, we envision that a diverse panel of these biomarkers can provide the greatest clinical benefit in enhancing early detection and prognostic accuracy, while some individual biomarkers may also serve as therapeutic targets for personalized approaches to head and neck cancers. Full article

Background/Objectives: Parotid incidentalomas are increasingly detected during brain MRI and PET-CT, particularly in patients with serious diseases such as cancer. This study aimed to evaluate the clinical significance of incidentally identified parotid lesions. Methods: We retrospectively reviewed the records of 44,952 patients (≥19 years) who underwent brain MRI and 10,957 who underwent PET-CT between January 2014 and December 2023. The incidence, imaging findings, and pathological results of parotid incidentalomas were analyzed. Results: Among 44,952 brain MRIs, 100 incidental parotid lesions (0.22%) were detected, compared with 92 lesions (0.84%) among 10,957 PET-CT scans. The mean patient age was slightly higher in the PET-CT group. Of the MRI-detected lesions, 35 patients underwent further evaluation and 14 underwent surgery, with final pathology confirming only benign tumors, including pleomorphic adenomas, Warthin tumors, and basal cell adenomas. In contrast, among 23 PET-CT patients who underwent additional evaluation, 7 had surgery, and final pathology revealed both benign and malignant tumors. Malignant cases included mucoepidermoid carcinoma, metastatic Merkel cell carcinoma, metastatic sebaceous carcinoma, and adenoid cystic carcinoma. Notably, two patients with initially benign cytology and negative PET-CT findings were later confirmed to have malignancies after surgery, Primary sites of metastatic disease included the thyroid, cervix, head and neck, and skin. Conclusions: Most parotid incidentalomas detected on brain MRI are benign and may be managed conservatively. However, incidentalomas identified on PET-CT require thorough evaluation, as they may indicate metastatic disease or a second primary malignancy, particularly in patients with head and neck or skin cancers. Full article

Background: Fractured ribs remain a significant cause of morbidity and are associated with severe injuries requiring several healthcare resources and may be associated with prolonged hospital stays that may require an ICU facility. In our facility, we have a high burden of patients sustaining rib fractures, and we aim to compare management options, outcomes, and factors associated with mortality from a single center. Methods: A retrospective review was performed on patients who presented with rib fractures at a Level 1 Trauma facility in Johannesburg, undergoing medical or surgical management. The study included data from 1 July 2011 until 31 December 2020. All patients were identified using the Medibank database. STATA Version 18 software was used for all data analysis. A p-value of <0.05 was considered statistically significant. Injuries were subdivided according to the Abbreviated Injury Severity score as follows, Mild = AIS Grade I–II, Moderate = AIS Grade III, Severe AIS Grade IV–V. Results: There was a total of 940 patients. The median age was 45 (IQR: 34–55) years, with 22% female patients in a cohort of 940. The mechanism of injury was blunt in 96%. Most patients (93%) fractured 3/> ribs. Only 4.6% sustained a flail chest. The median SBP was 126 mmHg (IQR:109–144), and the pulse rate was 91 (IQR: 79–108) beats per minute. The mean Injury Severity Score (ISS) and New Injury Severity Score (NISS) were 17 (IQR: 10–29) and 22 (IQR: 14–34), respectively. The most common associated injuries were chest trauma in 42%, combined abdominal and pelvic trauma in 35%, and severe extremity trauma in 37%. The mortality rate was 17% (159/940). Most patients required medical and supportive management, with only 8% undergoing rib plating (76/940). The mean length of stay was 14 days (IQR: 6–25). Statistically significant factors associated with mortality were rib fractures 3≥, flail chest, higher ISS, severe head, neck, chest, abdomen and pelvis injuries (p-value 0.001) and severe extremity injury (p-value 0.006). Conclusions: Rib fractures remain a common pathology in the trauma population, and these patients can have significant associated injuries. With an appropriate multidisciplinary approach, our study found an 83% survival rate, and only 8% of patients requiring surgical intervention. Poor outcomes in patients are directly linked to the number of ribs involved, the injury severity score, associated injuries, and advanced age. Full article

Background/Objectives: The solitary fibrous tumor is an uncommon benign mesenchymal neoplasm with relatively indolent and rarely metastasizing behavior. This retrospective study includes 26 cases of head and neck solitary fibrous tumors diagnosed between 2017 and 2024. Methods: The morphological examination with Hematoxylin–Eosin staining was completed via immunohistochemical reactions with specific antibodies. Results: The Ki-67 proliferation index had a median of 11.2%, with an interquartile range of 5% to 15%. CD20-positive B-cells had a score of 0 in 50% of cases (n = 26), while CD3 and CD5 T-cells had a score of 3 in 81% of cases (n = 21). CD4-positive T-cells had a majority score of 1 (81%, n = 21). CD8-positive T-cells had a broader distribution: 65% (n = 17) of cases presented a score of 1, 27% (n = 7) a score of 2, and 8% (n = 8) a score of 0. Antigen-presenting dendritic cells and mast cells presented a majority score of 0 in the entire cohort, being undetectable in 85% (n = 22) and 88% (n = 23) of cases, respectively. CD20-positive B-lymphocytes demonstrated moderately strong correlations with the Ki-67 cell proliferation index (r = 0.77). The time to recurrence was most strongly associated with the Ki-67 mitotic index (r = 0.81), CD4-positive (r = 0.85), and CD5-positive T-lymphocytes (r = 0.55), and CD20-positive B-lymphocyte expression (r = 0.68). Conclusions: This research illustrates our experience with head and neck solitary fibrous tumors, the surgical decisions, and the morphological and immunohistochemical features, while reviewing the cases published in English in the specialized literature. Full article

Background: Dynamic whole-body (D-WB) FDG PET/CT is a novel technique that enables the direct reconstruction of multiparametric images representing the FDG metabolic uptake rate (MR_FDG) and “free” FDG (DV_FDG). Applying complementary parameters with distinct characteristics compared to static SUV images, the aims of this study are as follows: (1) to determine the threshold values of SUV, MR_FDG, and DV_FDG for malignant and benign lesions; (2) to compare the specificity of MR_FDG and DV_FDG images with static SUV_bw images; and (3) to assess whether any of the dynamic imaging parameters correlate more significantly with malignancy or non-malignancy in the examined lesions based on the measured values obtained from D-WB FDG PET/CT. Methods: The study was a retrospective analysis of D-WB PET/CT data from 43 patients (23 males and 20 females) included both in the context of primary staging as well as imaging performed due to suspicion of post-therapeutic relapse or recurrence. Standard scanning was performed using a multiparametric PET acquisition protocol on a Siemens Biograph Vision 600 PET/CT scanner. Pathological findings were manually delineated, and values for SUV_bw, MR_FDG, and DV_FDG were extracted. The findings were classified and statistically evaluated based on their was histological verification of a malignant or benign lesion. Multinomial and binomial logistic regression analyses were used to find parameters for data classification in different models, employing various combinations of the input data (SUV_bw, MR_FDG, DV_FDG). ROC curves were generated by changing the threshold p-value in the regression models to compare the models and determine the optimal thresholds. Results: Patlak PET parameters (MR_FDG and DV_FDG) combined with mean SUV_bw achieved the highest diagnostic accuracy of 0.82 (95% CI 0.75–0.89) for malignancy detection (F1-score = 0.90). Sensitivity reached 0.85 (95% CI 0.77–0.91) and specificity 0.93 (95% CI 0.87–0.98). Classification accuracy in tumors was 0.86 (95% CI 0.78–0.92) and in lymph nodes 0.81 (95% CI 0.73–0.88). Relative contribution analysis showed that DV_FDG accounted for up to 65% of the classification weight. ROC analysis demonstrated AUC values above 0.8 for all models, with optimal thresholds achieving sensitivities of around 0.85 and specificities up to 0.93. Thresholds for malignancy detection were, for mean values, SUV_bw > 5.8 g/mL, MR_FDG > 0.05 µmol/mL/min, DV_FDG > 68%, and, for maximal values, SUV_bw > 8.7 g/mL, MR_FDG > 0.11 µmol/mL/min, DV_FDG > 202%. Conclusions: The D-WB [¹⁸F]FDG PET/CT images in this study highlight the potential for improved differentiation between malignant and benign lesions compared to conventional SUV_bw imaging in patients with locally advanced head and neck cancers presenting with cervical lymphadenopathy and carcinoma of unknown primary origin (CUP). This observation may be particularly relevant in common diagnostic dilemmas, especially in distinguishing residual or recurrent tumors from post-radiotherapy changes. Further validation in larger cohorts with histopathological confirmation is warranted, as the small sample size in this study may limit the generalizability of the findings. Full article

Background/Objectives: Non-melanoma skin cancer (NMSC) is the most common malignancy globally, with cutaneous squamous cell carcinoma (cSCC) posing a significant risk of regional metastasis, especially in high-risk anatomical areas such as the head and neck. While general risk factors for metastasis are well known, few studies have directly compared the clinical and pathological features of synchronous versus metachronous metastatic behavior. This study aimed to evaluate the clinicopathological characteristics and reconstructive implications associated with these two metastatic patterns in head and neck NMSC. Methods: We conducted a retrospective observational study of 46 patients with histologically confirmed metastatic NMSC of the head and neck, treated between January 2022 and May 2024 at a tertiary care center. Patients were stratified into synchronous or metachronous metastasis groups. Clinical data, histopathological features, metastatic sites, and surgical approaches were analyzed. Comparative statistics were applied using chi-square and t-tests, with significance set at p < 0.05. Results: Of the 46 patients, 50% had synchronous and 50% had metachronous metastases. The lower lip was the most common primary tumor site in both groups. Perineural and lymphovascular invasion were more frequent in synchronous metastases. Metachronous cases often required more complex reconstructive procedures, including free flap reconstructions and mandibular resections. Patients with metachronous metastases were significantly older (p = 0.024), and approximately one-third developed metastases more than four years after initial treatment. Conclusions: Head and neck NMSC, particularly involving the lower lip, may exhibit late-onset metastatic potential. Risk-adapted surveillance extending beyond current guidelines is warranted to improve long-term outcomes in high-risk patients. Full article

Background/Objectives: Basal cell carcinoma (BCC) of the skin is a type of non-melanocytic skin cancer. The European incidence of non-melanocytic skin cancers is 14.2 per 100,000 people, with a mortality rate of 0.5, thus ranking Europe third in the world in terms of incidence and mortality rate, according to the WHO Global Cancer Observatory. The objective of this study was to highlight the histological, epidemiological, and clinicopathological aspects of BCCs diagnosed in the Clinical Pathology Department of the Mures Clinical County Hospital between January 2021 and December 2024. Methods: We performed a retrospective, descriptive, observational study between January 2021 and December 2024 in the Mureș Clinical County Hospital, Targu Mureș, Romania, by analysing data from histopathological reports and histological slides from patients with a positive diagnosis of BCC. The inclusion criteria for this study consisted of patients who presented a histopathological diagnosis of BCCs during the study period. Lesions were divided into two study cohorts—a general cohort and head and neck cohort. The collected data included epidemiological data, macroscopic features, and microscopical characteristics. Results: A total of 540 lesions were included in this study (general cohort), of which 395 were included in the head and neck cohort. This study revealed a higher incidence of BCC in 2024, affecting mostly urban patients (p < 0.001), with more aggressive forms (p < 0.001). The tumours found among males (p = 0.0189) and in rural patients (p = 0.0126) were bigger, but the tumoural volumes decreased over time (p < 0.001). The mixed form of BCC was associated with more aggressive histological subtypes (p < 0.001). Conclusions: BCC presents variability depending on age, gender, environment of origin, and topography, as well as histological subtype and aggressiveness, thus highlighting the need for a personalised approach in terms of diagnostics and treatment. Full article

Background/Objectives: Head and neck cancer (HNC) is a heterogeneous group of malignancies in which staging plays a critical role in guiding treatment and prognosis. Large language models (LLMs) such as ChatGPT, DeepSeek, and Grok have emerged as potential tools in oncology, yet their clinical applicability in staging remains unclear. This study aimed to evaluate the accuracy and concordance of LLMs compared to clinician-assigned staging in patients with HNC. Methods: The medical records of 202 patients with HNC, who presented to our center between 1 January 2010 and 13 February 2025, were retrospectively reviewed. The information obtained from the hospital information system by a junior researcher was re-evaluated by a senior researcher, and standard staging was completed. Except for the stage itself, the data used for staging were provided to a blinded third researcher, who then entered them into the ChatGPT, DeepSeek, and Grok applications with a staging command. After all staging processes were completed, the data were compiled, and clinician-assigned stages were compared with those generated by the LLMs. Results: The majority of the patients had laryngeal (45.5%) and nasopharyngeal cancer (21.3%). Definitive surgery was performed in 39.6% of the patients. Stage 4 was the most common stage among the patients (54%). The overall concordance rates, Cohen’s kappa values, and F1 scores were 85.6%, 0.797, and 0.84 for ChatGPT; 67.3%, 0.522, and 0.65 for DeepSeek; and 75.2%, 0.614, and 0.72 for Grok, respectively, with no statistically significant differences between models. Pathological and surgical staging were found to be similar in terms of concordance. The concordance of assessments utilizing only imaging, only pathology notes, only physical examination notes, and comprehensive information was evaluated, revealing no significant differences. Conclusions: Large language models (LLMs) demonstrate relatively high accuracy in staging HNC. With careful implementation and with the consideration of prospective studies, these models have the potential to become valuable tools in oncology practice. Full article

Background: Data on the incidence of IgG4-related disease (IgG4-RD) are scarce. Our aim was to determine the incidence of IgG4-RD in a well-defined region. Methods: This retrospective study covered the Ljubljana region over the period from January 2012 to December 2024. A review of cases diagnosed with IgG4-RD was performed at several departments of the University Medical Centre Ljubljana—an integrated secondary/tertiary university teaching hospital (rheumatology, nephrology, angiology, gastroenterology, abdominal surgery, ENT surgery, ophthalmology). While IgG4-RD cases at the Department of Rheumatology were collected prospectively, potential cases at other departments were retrieved by searching electronic medical database for the keyword “IgG4”. In addition, the Institute of Pathology, Faculty of Medicine, University of Ljubljana, provided a list of patients with histological features consistent with IgG4-RD. Year-specific incidence rates and an average incidence rate over the 13-year period were determined. Clinical features of patients were analysed. Results: During the observation period, 58 cases of IgG4-RD were diagnosed. Of these, 35 patients were residents of the Ljubljana region, which had an average adult population of 541,600. The estimated average annual incidence rate of IgG4-RD was 5.0 per million (95% confidence interval: 3.5; 6.9), with year-specific incidence rates fluctuating between 1.8 and 9.3 per million adults. The cases were stratified into four phenotypic categories: pancreato-hepato-biliary (17%), retroperitoneal fibrosis-aortitis (43%), head and neck-limited (14%), and Mikulicz syndrome with systemic involvement (26%). Conclusions: The average annual incidence rate of IgG4-RD was 5 per million adults, with the retroperitoneal fibrosis-aortitis phenotype predominating in our cohort. Full article

Autoimmune polyendocrine syndrome type 1 (APS-1, APECED) is a rare monogenic disorder caused by biallelic AIRE mutations and is classically associated with chronic mucocutaneous candidiasis (CMC), hypoparathyroidism, and adrenal insufficiency. Apart from the autoimmune manifestations, APS-1 is associated with an increased risk of squamous cell carcinoma (SCC), particularly in the oral cavity and esophagus. However, the evidence is patchy and has not yet been systematically reviewed. We conducted a scoping review according to the PRISMA-ScR guidelines. Pub-Med, Scopus, and Web of Science were searched using the terms APS-1/APECED and malignancy until July 2025. Eligible studies reported on APS-1 patients with histologically confirmed head, neck or esophageal cancer. Clinical, pathological, genetic and outcome data were summarized narratively. Nine publications described 19 APS-1 patients with 26 tumors. The mean age at cancer diagnosis was 35 years, with a latency period of ~24 years from the onset of APS-1. Tumors occurred most frequently in the oral cavity (65%), followed by the lip (19%) and esophagus (15%). In 96% of cases, the tumors were SCC. The grade of the tumor varied, and almost half of the cases were diagnosed at an advanced stage. As far as reported, the usual risk factors were not particularly pronounced; many patients did not smoke or drink alcohol. The main treatment consisted of surgery, often in combination with radiotherapy or chemoradiotherapy, alongside long-term antifungal therapy. Despite the multimodal treatment, outcomes were poor: the overall survival rate was ~50%, with recurrence occurring in 38% of cases and a second primary tumor in 26%. A further 14 cases were reported from another Italian cohort, which together with the national cohort dana suggest a risk of approximately ~10% with APS-1; however, the true lifetime risk remains uncertain. Head and neck malignancies in APS-1 occur early, often without classic risk factors, and have a high recurrence and mortality rate. Lifelong surveillance, antifungal stewardship and increased clinical awareness, ideally as part of multidisciplinary treatment pathways, are critical to improving outcomes in this rare but high-risk population. Full article

Oncological patients or the individuals scheduled for cardiovascular surgeries are at risk of both oral and systemic complications when existing dental pathologies are not addressed before these therapies. This narrative review explores the current literature on the role of pre-treatment dental care in reducing unfavorable outcomes and promoting treatment efficacy in medically compromised patients. The data show that early dental intervention, particularly prior to head and neck radiotherapy, considerably reduces the risk of osteoradionecrosis, rampant radiation caries, and xerostomia. Chemotherapy-associated mucositis, infections, and microbial imbalance are similarly worsened by untreated oral disease but may be managed through early sanitation and hygiene reinforcement. In cardiac patients, conditions such as apical periodontitis and periodontitis may lead to bacteremia, infective endocarditis, or prosthetic valve infections, highlighting the systemic relevance of oral health. Tooth extractions, restorative treatment of carious lesions, and control of active oral infections performed before systemic therapy can reduce complication rates, improve treatment continuity, and enhance patients’ quality of life. Integrating comprehensive dental assessment into routine pre-treatment planning allows early identification of oral health risks and supports a multidisciplinary approach that optimizes overall clinical outcomes. Full article

Background and Clinical Significance: Granulomatosis with polyangiitis (GPA), an immune-mediated systemic small-vessel vasculitis affecting the upper/lower respiratory tracts and kidneys, frequently presents with non-specific nasal symptoms that lead to misdiagnosis. Case Presentation: We report a case of a 55-year-old female with GPA complicated by Bartter syndrome. She presented with one month of left nasal congestion, rhinorrhea, epistaxis, and headache. Initial diagnosis was acute sinusitis. Computed tomography (CT) revealed left maxillary and ethmoid sinus inflammation with bone destruction, while metagenomic next-generation sequencing (mNGS) suggested conventional bacterial infection. Postoperative pathology demonstrated chronic mucosal inflammation with lymphoid tissue hyperplasia. GPA was ultimately diagnosed based on PR3-ANCA seropositivity and chest CT findings of cavitary pulmonary nodules. Postoperatively, severe hypokalemia and hypomagnesemia secondary to Bartter syndrome emerged. Following electrolyte correction, induction therapy with glucocorticoids and cyclophosphamide was initiated. Conclusions: This case underscores that GPA’s head and neck manifestations are frequently misdiagnosed as infections or malignancies. Early diagnosis requires vigilance for GPA ‘red flags’, such as refractory nasal symptoms to conventional therapy (e.g., bloody rhinorrhea), characteristic CT findings (e.g., sinus opacification without ostiomeatal complex obstruction), and nasal endoscopy findings (e.g., ulcers/crusting). Otolaryngologists play a pivotal role in recognizing early disease onset and initiating timely treatment. Full article

Objective: Sinonasal squamous cell carcinoma (SNSCC) is a rare and aggressive malignancy, with limited treatment strategies in the recurrent or metastatic cases. Although immune checkpoint inhibitors (ICIs) have shown efficacy in head and neck cancers (HNCs), clinical data specific to SNSCC are scarce. This study aimed to evaluate the therapeutic efficacy and prognosis of ICIs in patients with SNSCC. Methods: We conducted a retrospective review of 18 patients with pathologically confirmed SNSCC treated with nivolumab or pembrolizumab at Gifu University Hospital between May 2017 and December 2024. Treatment response was assessed using RECIST v1.1 criteria. Overall response rate (ORR) and disease control rate (DCR) were evaluated as treatment effects, and overall survival (OS) and progression-free survival (PFS) were evaluated as prognoses. Subgroup analyses were performed according to treatment regimen. Results: The ORR and DCR for all patients were 43.8% and 56.3%, respectively. Pembrolizumab-treated patients showed higher response rates (ORR: 66.7%; DCR: 83.3%) compared to those treated with nivolumab (ORR: 30%; DCR: 40%). Median OS and PFS were 21.5 and 7.9 months, respectively. Long-term durable responses exceeding two years were observed in several cases. Although pembrolizumab tended to result in better outcomes, no statistically significant difference was found between groups. Immune-related adverse events were infrequent and manageable. Conclusions: This study suggests that a subset of patients with SNSCC may benefit from ICI therapy, particularly in combination with chemotherapy. Despite the rarity of SNSCC, accumulating clinical evidence—including prospective studies—is essential to establish standardized treatment strategies for this disease. Full article

Background: Benign bone tumors and tumor-like lesions in the proximal femur increase the risk of pathological fractures, often requiring surgical intervention. However, no consensus exists on the optimal treatment strategy. We developed a structured approach to guide the selection of implant types (compression hip screw [CHS] or intramedullary nail [IMN]) with or without bone grafting. This study aims to validate our treatment strategy through a retrospective analysis and a review of previous surgical outcomes. Methods: We sought to validate this strategy through a retrospective analysis of 16 patients (6 males and 10 females, mean age at surgery 37.4 years [range, 16–64 years]) with primary benign bone tumors or tumor-like conditions of the proximal femur, including the femoral head and neck. Curettage and synthetic or autologous bone graft was performed according to our treatment flowchart, utilizing either CHS or IMN for internal fixation. We compared the blood loss, operative time, time to full weight bearing, and perioperative complications between the CHS and IMN groups. Results: Blood loss did not significantly differ between the CHS and IMN groups (p = 0.11), but the operative time was significantly longer in the CHS group (p < 0.01). Two CHS cases experienced local recurrence, while no postoperative fractures were observed in either group. The median time to full weight bearing was 5 weeks, consistent with previous reports. No perioperative complications were noted. Conclusions: Our strategy achieved favorable clinical outcomes. IMN was selectively used in patients with non-aggressive benign tumors not involving the femoral head and neck, yielding good results with reduced surgical invasiveness, while in those patients with aggressive disease involving the head and neck, CHS was more appropriate. This approach may serve as a practical guide for surgical decision-making in benign proximal femoral bone tumors. Full article

Background/Objectives: Head and neck squamous cell carcinoma (HNSCC) diagnosis and treatment rely heavily on computed tomography (CT) imaging to evaluate tumor characteristics and lymph node (LN) involvement, crucial for staging, prognosis, and therapy planning. Conventional LN evaluation methods based on morphological criteria such as size, shape, and anatomical location often lack sensitivity for early metastasis detection. This study leverages radiomics to extract quantitative features from CT images, addressing the limitations of subjective assessment and aiming to enhance LN classification accuracy while potentially reducing reliance on invasive histopathology. Methods: We analyzed 234 LNs from 27 HNSCC patients, deriving 120 features per node, resulting in over 25,000 data points classified into reactive, pathologic, and pathologic with extracapsular spread classes. Considering the challenges of high dimensionality and limited dataset size, more than 44,000 experiments systematically optimized machine learning models, feature selection methods, and hyperparameters, including ensemble approaches to strengthen classification robustness. A Pareto front strategy was employed to balance diagnostic accuracy with significant feature reduction. Results: The optimal model, validated via 5-fold cross-validation, achieved a balanced accuracy of 0.90, an area under the curve (AUC) of 0.93, and an F1-score of 0.88 using only five radiomics features. Conclusions: This interpretable approach aligns well with clinical radiology practice, demonstrating strong potential for clinical application in noninvasive LN classification in HNSCC. Full article