Rodrigo Arrangoiz MS, MD, FACS, FSSO

04/09/2026

04/09/2026

Perrier ND et al. — A Novel Nomenclature to Classify Parathyroid Adenomas

A novel nomenclature to classify parathyroid adenomas: World Journal of Surgery. 2009;33(3):412–416 Background and Rationale: Traditional descriptions of parathyroid adenomas (e.g., “left inferior,” “ectopic”): Are inconsistent and often imprecise: Particularly in reoperative surgery or when imaging is discordant Problem: Variable embryologic descent → unpredictable locations Poor communication between surgeons, radiologists, and endocrinologists Difficulty standardizing outcomes and reporting Goal of Perrier et al: Develop a standardized, anatomically reproducible nomenclature based on predictable embryologic migration patterns Embryologic Basis (Core Concept) During the fifth to sixth week of intrauterine development: The…...

A novel nomenclature to classify parathyroid adenomas: World Journal of Surgery. 2009;33(3):412–416 Background and Rationale: Traditional descriptions of parathyroid adenomas (e.g., “left inferior,…

04/09/2026

Depth of Invasion in Oral Cavity Cancer

The staging of primary tumors of the oral cavity: As published by the AJCC and UICC is widely accepted In its most recent revision (eighth edition of the AJCC Staging Manual): Depth of invasion (DO…

04/08/2026

Evaluation of Oral Cavity Cancer

The clinical features of primary tumors arising from the mucosal surface of the oral cavity are: Variable The tumor may be: Ulcerative Exophytic Endophytic The gross characteristics of the lesion: …

04/07/2026

Precursor Lesions of Oral Cavity Cancer

There is a sequence of disease progression from: Atypia / dysplasia, to in situ carcinoma, to invasive cancer Leukoplakia and erythroplakia: Are terms given to clinically identifiable lesions: That…

04/06/2026

🔬 Depth of Invasion (DOI) in Oral Cavity Cancer: Why It Matters

Depth of invasion (DOI) has become a cornerstone in the modern management of oral cavity squamous cell carcinoma.

With its integration into the AJCC 8th edition staging system, DOI is no longer just a pathologic descriptor—it is a critical determinant of nodal risk, staging, and surgical decision-making.

💡 Key clinical insights:
• DOI reflects the true biologic aggressiveness of the tumor
• Increasing DOI is strongly associated with occult cervical nodal metastasis
• Even small tumors can be upstaged based on DOI alone

📊 What this means in practice (cT1–T2, cN0):
•

04/05/2026

A liquid biopsy can detect patient’s recurrence months before any scan showed a problem.
The ctDNA was positive. Imaging followed by curative surgery could be performed for small recurrence.

We are now seeing this frequently in our clinics

The data for HPV-positive oropharyngeal cancer is compelling. Studies show ctDNA can detect recurrence up to 500 days before clinical confirmation with 91% sensitivity. When ctDNA goes negative during treatment, outcomes improve dramatically regardless of what therapy we’re using.

But the evidence for HPV-negative disease is still razor-thin.

There has been incredible success with liquid biopsies in lung cancer (EGFR monitoring), breast cancer (ESR1 mutations), and colorectal cancer (KRAS tracking). These cancers taught us that tumor biology matters more than location when it comes to ctDNA shedding patterns.

HPV-negative head and neck cancers are different beasts entirely. They’re often more heterogeneous, shed DNA differently, and have distinct mutational landscapes. The LIONESS study showed promise, but most participants had HPV-positive disease.

There is reason to be cautiously optimistic. The technology is there. The question is whether HPV-negative tumors will behave like their positive counterparts or follow the messier patterns we see in other solid tumors.

We need dedicated trials for HPV-negative disease before we can make real clinical recommendations.

How are you using liquid biopsies in your practice? And do you see potential for HPV-negative HNSCC monitoring?

04/03/2026

Oral Cavity Leukoplakia

Oral cavity leukoplakia: Is a clinical diagnosis defined by the WHO as: A “white plaque of questionable risk having excluded other known diseases or disorders that carry no increased ris…

04/03/2026

RxPONDER Trial (SWOG S1007) In Breast Cancer

RxPONDER (SWOG S1007): Changed adjuvant decision-making for patients with HR-positive, HER2-negative early breast cancer with 1 to 3 positive axillary nodes: By showing that the value of chemothera…