# From Removing to Preserving: How Precision Surgery Is Reshaping Head and Neck Cancer Care

Head and neck cancer surgery has changed dramatically over the past 150 years — from radical, disfiguring operations to precise, function-preserving procedures guided by molecular tests and imaging analytics. This comprehensive review reports that comprehensive genomic profiling (full DNA testing of the tumor) finds clinically actionable changes in more than 90% of head and neck squamous cell carcinomas, and that radiomics-based prediction models (computer programs that mine detailed features from scans) reach accuracy above 85% for predicting treatment response. Landmark evidence also shows that multidisciplinary tumor boards can raise five-year disease-specific survival from 52% to 75%, while new surgical technologies such as transoral laser and robotic surgery spare speech and swallowing for many patients. The authors conclude that precision surgery works best when diagnostic biomarkers, imaging prediction models, and perioperative drug therapy are combined — but standardization and prospective survival trials are still needed.

# From Removing to Preserving: How Precision Surgery Is Reshaping Head and Neck Cancer Care

## Table of Contents

- Key Points
- Background: Why This Research Matters
- How This Review Was Conducted
- The Historical Evolution of Head and Neck Cancer Surgery
- Multidisciplinary Care: The Foundation of Modern Treatment
- Who Is on the Modern Treatment Team?
- Modern Surgical Techniques and the Evidence Behind Them
- Diagnostic Biomarkers and Radiomics-Based Prediction Models
- Clinical Implications: What This Means for Patients
- Limitations: What This Review Could Not Prove
- Recommendations for Patients and Care Teams
- Frequently Asked Questions
- Source Information

## Key Points

- Comprehensive genomic profiling finds clinically actionable changes in over 90% of head and neck squamous cell carcinomas, meaning the finding points to a drug or strategy that could work.
- In one study, five-year disease-specific survival improved from 52% to 75% after multidisciplinary tumor board implementation, though another study found no measurable survival benefit.
- Tumor board review added about 13 days before treatment started in one study, and established evidence links treatment delays to tumor progression and clinical upstaging.
- For selected early and intermediate-risk tumors, transoral laser and robotic surgery can spare speech and swallowing; a trial reported 95% aspiration-free swallowing at 12 months.
- Radiomics models reach accuracy above 85% for predicting treatment response when validated across independent cohorts, but standardization and prospective survival trials are still needed.

## Background: Why This Research Matters

Head and neck cancer is a major global health problem. Each year, more than **900,000 new cases** are diagnosed worldwide, and approximately **460,000 people die** from the disease. These tumors rank among the most common cancers globally.

What makes head and neck cancer uniquely challenging is its location. These cancers grow in anatomical regions critical for **speech, swallowing, breathing, and facial appearance**. A cure that destroys these functions can still devastate a patient's quality of life.

This review concentrates on cancers of the **oral cavity (mouth), oropharynx (the middle part of the throat behind the mouth), and larynx (voice box)**. In these sites, **squamous cell carcinoma (SCC)** — a cancer arising from the flat, scale-like cells lining these surfaces — accounts for over **90% of cases**.

Contemporary diagnosis relies on advanced imaging. **Magnetic resonance imaging (MRI)** gives the best detail of soft tissue. **Positron emission tomography combined with computed tomography (PET/CT)** assesses tumor metabolism and lymph node spread. An integrated **PET/MRI** combines anatomical detail with functional information. Recent high-quality meta-analyses (studies that pool results from many trials) have validated the diagnostic accuracy of all three.

Two developments in the past two decades transformed the field. First, researchers identified **human papillomavirus (HPV)** as a cause of oropharyngeal cancer — a biologically distinct disease with a better prognosis than HPV-negative tumors. Second, **immunotherapy** (treatment that helps the immune system attack cancer) emerged, with **PD-1/PD-L1 expression** (proteins that cancer cells use to hide from the immune system) serving as validated predictive biomarkers.

## How This Review Was Conducted

This is a comprehensive literature review, not a single clinical trial. The authors focused on studies published in the **past five years**, while incorporating relevant publications from the **last three decades** and landmark historical papers.

The paper was written by members and invitees of the **International Head and Neck Scientific Group** based in Padua, Italy. The authors examined the evolving role of surgery and placed special emphasis on diagnostic methodologies, including comprehensive genomic profiling and validated imaging biomarkers.

The review also assessed how these tools integrate into clinical practice for treatment selection and response prediction. In other words, the authors asked not just "does the test work?" but "does using it change what we do for patients?"

## The Historical Evolution of Head and Neck Cancer Surgery

### The Era of Radical Surgery (19th Century to the 1970s)

The foundational era was defined by radical open resections with wide margins. Surgeons accepted major functional loss as the price of cancer control. Theodore Billroth pioneered this approach, performing the **first laryngectomy in Vienna in 1873**.

On **January 17, 1888**, Polish surgeon **Franciszek Jawdyński (1851–1896)** performed a successful radical en bloc neck dissection. "En bloc" means removing the entire tumor and surrounding tissue in one intact piece. He published a detailed description in the Polish journal *Gazeta Lekarska*.

His procedure incorporated all elements of modern neck dissection. He removed the lymphoareolar contents (lymph nodes and surrounding fatty tissue) from the jawbone to the collarbone, including the **sternocleidomastoid muscle** (the large muscle on the side of the neck). He tied off the **internal jugular vein** (the major vein draining blood from the head) both below and above, and included it in the removed specimen.

Remarkably, the patient tolerated the ligation of the carotid artery and survived **seven years**, apparently free of disease.

In **1905**, **George Washington Crile (1864–1943)** of Cleveland, Ohio, presented a report titled "On the Surgical Treatment of Cancer of the Head and Neck," summarizing **121 operations performed on 105 patients**. In **June 1906**, he presented similar material based on **132 operations** at the 57th annual meeting of the American Medical Association. This paper, published in the *Journal of the American Medical Association*, had widespread impact and revolutionized head and neck cancer treatment.

Later, the Memorial Hospital approach under **Hayes Martin** became the international standard. His "Commando operation" for advanced oral cancers represented the peak of radical surgical philosophy. However, the substantial illness burden and functional deficits from these operations pushed researchers to seek alternatives.

### The Organ Preservation Movement (1980s to 2000s)

Functional and cosmetic harm from radical surgery — combined with the recognized effectiveness of **cisplatin-based chemotherapy** (a platinum-based drug regimen) — triggered the organ preservation movement.

The landmark **Veterans Affairs laryngeal preservation trial** was a pivotal moment. It showed that organ preservation could be achieved without compromising survival in carefully selected patients. Importantly, these patients were treated by experienced multidisciplinary teams that provided balanced case assessment, therapeutic expertise, follow-up, and timely surgical salvage.

Building on that foundation, the **RTOG 91-11 trial** showed superior laryngeal preservation rates when **cisplatin and radiation were given concurrently** (at the same time) compared with induction chemotherapy. Both sequential and concurrent approaches produced longer laryngectomy-free survival, with the highest organ preservation rates in the concurrent arm.

This era also brought medical oncology permanently into head and neck cancer care, establishing the foundation for modern multidisciplinary management.

### The Era of Minimally Invasive Precision Surgery (2000s to Present)

Advances in **CO₂ laser technology** (carbon dioxide laser), endoscopic optics, robotic manipulation, systemic therapy, and radiotherapy enabled **transoral resections** — surgery performed through the mouth rather than through an incision in the neck. For selected upper aerodigestive tumors (cancers of the upper airway and food passage), these approaches achieved the same locoregional control.

At the same time, standardized multidisciplinary tumor boards and perioperative collaboration became routine. Most significantly, researchers are now intensively studying how to integrate validated diagnostic biomarkers with neoadjuvant immunotherapy and chemotherapy. "Neoadjuvant" means treatment given before the main treatment. The goal is **response-adaptive therapy** — adjusting treatment based on how well the tumor responds.

## Multidisciplinary Care: The Foundation of Modern Treatment

Multidisciplinary care means coordinated team-based management. Specialists evaluate patients together, develop an integrated treatment plan, and deliver synchronized care rather than working in isolation.

Before any treatment plan begins, **histopathological confirmation through biopsy is mandatory** — a tissue sample must confirm the cancer under a microscope. Doctors then combine clinical examination with advanced imaging to assess disease extent and assign an accurate stage.

Staging follows the **Tumor-Node-Metastasis (TNM) system** established by the **Union for International Cancer Control (UICC)** and the **American Joint Committee on Cancer (AJCC)**, currently in its **eighth edition**. This standard framework provides essential prognostic information and guides treatment decisions.

Comprehensive preoperative evaluation integrates clinical, biochemical, and imaging assessments. Clinical evaluation covers tumor examination, cervical lymph node assessment, cranial nerve function, and **airway patency** (whether the breathing passage is open).

Biochemical workup includes complete blood count, kidney and liver function, coagulation profile, and nutritional markers. Cross-sectional imaging with CT or MRI defines tumor extent and whether it can be surgically removed. PET/CT detects distant metastases and characterizes nodal disease. Cardiopulmonary assessment confirms the patient has enough physiologic reserve for major surgery.

### Evidence-Based Benefits of Integrated Care Models

The evidence for multidisciplinary tumor boards (MTBs) is strong but nuanced. **Liu et al.** demonstrated survival benefits after MTB implementation. Five-year disease-specific survival improved from **52% to 75%** (p=0.003) — a 23 percentage-point gain, or roughly 23 more patients surviving out of every 100. Overall survival rose from **40% to 61%** (p=0.008).

These improvements held even after researchers controlled for stage and other confounding variables. Structured multidisciplinary evaluation improved coordination between specialties.

**Burkhardt et al.** showed in a retrospective study that pretherapeutic MTB evaluation significantly improved adherence to evidence-based clinical guidelines. Compliance rates reached **79.6% versus 68%** in non-MTB cohorts (p<0.01) — about 12 more patients in every 100 receiving guideline-concordant care.

The improvement was especially visible in neck dissection procedures. MTB-reviewed cases showed substantially higher rates of comprehensive surgical intervention: **90.5% versus 78.9%** (p<0.001).

However, these benefits come with notable limitations. MTB presentation introduced statistically significant delays in starting treatment. The mean delay was approximately **13 days** longer (**33.5 versus 20.1 days**, p<0.001). This delay appeared consistently across all UICC stages.

That delay matters. Established evidence links treatment delays to tumor progression and clinical upstaging. Perhaps most striking, this particular study found **no measurable survival benefit** — no significant differences in three-year survival, disease-free survival, or five-year survival between MTB and non-MTB cohorts. Enhanced guideline adherence did not necessarily translate into better cancer outcomes for oral cavity cancer patients in that analysis.

A much larger study addressed this question. The **WiZen (Effectiveness of Care in Certified Cancer Centers)** study in Germany analyzed nationwide data from approximately **22 million adult statutory health insurance beneficiaries** between **2009 and 2017**, covering **11 cancer types**, including head and neck cancer.

For head and neck malignancies, **8,173 patients** received initial treatment in German Cancer Society (DKG)-certified centers, compared with **44,576** in non-certified institutions. Certified centers mandate both preoperative and postoperative MTB evaluation.

Initial treatment in certified centers was associated with improved overall survival across all examined cancer types. For head and neck cancer, the adjusted **hazard ratio was 0.94 (95% CI: 0.89–1.00, p=0.038)**. A hazard ratio below 1.0 means lower risk of death over time. This corresponded to an absolute risk reduction of **1.79 months** of survival.

The advantage remained consistent after extensive adjustment for patient-level factors (age, sex, distant metastases, other illnesses) and hospital-level variables (bed capacity, university status, ownership). Sensitivity analyses revealed the benefit tended to strengthen with longer duration of certification. This suggests cumulative effects from sustained use of evidence-based protocols.

Mechanisms behind MTB benefits extend beyond treatment selection. Adding speech-language pathology, nutrition, palliative care, and social work services to the MTB framework produced tangible functional improvements. Pretreatment gastrostomy rates (surgical placement of a feeding tube) fell in advanced disease patients: **39% versus 26%** (p=0.03). Patients also reported improved quality of life and more dignified end-of-life care.

## Who Is on the Modern Treatment Team?

Modern treatment teams typically include surgical oncologists, radiation oncologists, medical oncologists, pathologists, radiologists, speech-language pathologists, nutritionists, palliative care specialists, and psychosocial support specialists. Each contributes specialized expertise toward unified, patient-centered goals.

Within this framework, the surgeon's role has evolved well beyond performing operations. It now includes initial diagnosis and staging, treatment selection, pretreatment support, assessment during chemoradiation, post-treatment evaluation, salvage surgery, and management of late side effects.

Importantly, institutions with well-established multidisciplinary teams remain limited. The authors note that the lack of this organizational structure for most patients seeking therapy represents a major obstacle to accessing adequate care.

Team Member
Primary Responsibilities

Head and Neck Surgical Oncologist
Surgical candidacy determination; timing coordination; tumor resection and neck dissection; reconstruction planning (with plastic surgeon); surgical complication management

Radiation Oncologist
Radiation therapy design and delivery; dose determination; adjuvant (post-surgery) and definitive protocols; radiation toxicity management

Medical Oncologist
Systemic chemotherapy, targeted therapy and immunotherapy; perioperative therapy; clinical trial enrollment; systemic treatment toxicity management

Pathologist
Diagnosis including molecular analysis; margin and lymph node assessment; biomarker testing

Radiologist
Diagnostic imaging interpretation; radiomics analysis; resectability assessment; response evaluation

Speech-Language Pathologist
Swallowing and speech assessment and management; rehabilitation therapy

Nutritionist
Nutritional status evaluation; feeding support coordination; management of nutrition-related treatment complications

Palliative Care Specialist
Pain and symptom control; psychosocial support; goals-of-care discussions

Social Worker
Care coordination; psychosocial barrier management; resource connection

Nurse Navigator
Primary contact; patient and family education; appointment coordination; treatment monitoring

## Modern Surgical Techniques and the Evidence Behind Them

### Transoral Laser Microsurgery: Precision Through Technology

**Transoral laser microsurgery (TLM)** has been a standard technique for the past three decades. It uses precise CO₂ laser technology combined with operative microscopy or exoscopy (a minimally invasive visualization technique) to remove tumors accurately with excellent control of bleeding.

Technological advances include micromanipulators that focus the laser beam precisely, pulsed laser systems that reduce thermal damage to tissue, and specialized surgical laryngoscopes and microinstruments. Standardized methods for processing the removed tissue under the microscope further improved oncologic precision.

Perioperative complications of TLM are low. A tracheostomy (surgical opening in the windpipe) can be avoided in most cases. Functional outcomes are significantly better than open surgery, because surgeons avoid cutting through the neck and preserve more healthy surrounding tissue.

A prospective multicenter trial of TLM for supraglottic carcinoma (cancer of the upper part of the voice box) reported **95% aspiration-free swallowing at 12 months**. Aspiration means food or liquid entering the airway. Importantly, there was **no long-lasting impact on voice- or swallowing-related quality of life**.

TLM is now widely accepted for early laryngeal and selected oropharyngeal cancers. With adequate surgical experience, TLM can replace open partial laryngectomy. In selected cases where tumors are reachable endoscopically and removable with function preserved, cancers of the oral cavity, oropharynx, and hypopharynx can also be resected this way. Combining TLM with selective neck dissection and adjuvant radiation achieves favorable oncologic and functional results.

### Transoral Robotic Surgery: Guidelines and Expanding Applications

**Transoral robotic surgery (TORS)** has revolutionized surgical access to the oropharynx and supraglottic larynx. A multi-institutional randomized clinical trial showed that primary transoral surgery with reduced postoperative radiation improves oncologic and functional outcomes in **intermediate-risk HPV-positive oropharyngeal cancer**.

Recent comprehensive guidelines from the **American Society of Clinical Oncology (ASCO)** establish evidence-based recommendations for TORS in multidisciplinary care. The robotic platform gives surgeons three-dimensional endoscopic visualization, wristed instruments with **seven degrees of freedom**, tremor filtration, and motion scaling — all of which significantly enhance surgical precision.

Newer single-port robotic systems promise to reduce invasiveness further while maintaining precision. A prospective multicenter phase 2 clinical trial evaluated a next-generation single-port robotic system for TORS in **47 patients**.

The results were encouraging:

- All patients safely underwent transoral resection **without conversion to open surgery**

-
**No intraoperative complications** occurred
- Mean estimated blood loss was only **15.4 mL**

The single-port architecture uses three fully articulating 6-mm instruments and a flexible stereoendoscopic camera, all deployed through a compact **25-mm port**.

### Radical Surgical Approaches: Contemporary Indications

Radical surgery still plays an essential role for advanced malignancies where tumor extent rules out function-preserving approaches. **Total laryngectomy** addresses advanced laryngeal cancers with extensive cartilage invasion. It creates a permanent tracheostoma (a surgical opening in the neck for breathing), but it also enables **tracheoesophageal voice rehabilitation** (voice restored using a small valve between the windpipe and food pipe).

**Composite resections** combine mandibulectomy (removal of part of the jawbone) with soft tissue removal for bone-invasive tumors. These require **fibular free flap reconstruction** — using a piece of the leg bone to rebuild the jaw — to restore facial contour and chewing function.

**Maxillectomy** procedures address sinonasal malignancies. Prosthodontic rehabilitation through obturator placement (a removable prosthesis that closes the surgical opening) enables functional restoration.

**Radical neck dissection** removes all lymphatic levels and sacrifices the sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve. It remains indicated for extensive nodal disease with extranodal extension, meaning cancer has broken out of the lymph node capsule. These procedures require extensive preoperative counseling about functional losses.

## Diagnostic Biomarkers and Radiomics-Based Prediction Models

The review's central message is that modern surgery is becoming data-driven. Several specific diagnostic technologies now guide treatment selection.

-
**Comprehensive genomic profiling** (full DNA analysis of the tumor) identifies clinically actionable alterations in **over 90% of head and neck squamous cell carcinomas**. "Actionable" means the finding points to a drug or strategy that could work.
-
**Tumor mutational burden (TMB)** — the total number of mutations in a tumor's DNA — serves as a validated predictive biomarker for immunotherapy response.
-
**Programmed death-ligand 1 (PD-L1) combined positive score** — a laboratory measure of how much of this immune-hiding protein the tumor and surrounding cells carry — functions as a validated diagnostic biomarker for immunotherapy efficacy. It shows significant clinical benefit in biomarker-selected populations.
-
**Radiomics-based predictive models** using machine learning algorithms achieve diagnostic accuracies **exceeding 85%** for treatment response prediction when validated across independent cohorts.
-
**Quantitative ultrasound spectroscopy** combined with **MRI radiomics** demonstrates high sensitivity and specificity for predicting radiation response.
-
**Habitat imaging** — techniques that map different regions within a single tumor based on the microenvironment — predicts **pathologic complete response** (no cancer cells left in the removed tissue) to neoadjuvant chemoimmunotherapy, with **area under the curve (AUC) values approaching 0.90** in validation studies. An AUC near 0.90 indicates excellent ability to tell responders from non-responders.

Together, these methods enable **response-adaptive treatment strategies**. The review reports that neoadjuvant chemotherapy facilitates **mandibular preservation** (avoiding jaw removal) and permits **adjuvant therapy omission** (skipping post-surgery treatment) in **over half of HPV-associated cases** following surgical downstaging. Downstaging means the tumor shrank before surgery.

## Clinical Implications: What This Means for Patients

Clinical validation of these diagnostic platforms enables accurate treatment response prediction and informed surgical decision-making. In practical terms, patients may face fewer "one-size-fits-all" decisions.

For a patient with HPV-positive oropharyngeal cancer, biomarker and imaging data may help the team decide whether surgery alone followed by reduced radiation is enough. For a patient with advanced laryngeal cancer, a multidisciplinary team can weigh organ preservation against total laryngectomy using evidence, not guesswork.

The authors emphasize a paradigm shift. Surgery once stood alone, focused solely on cancer control. It is now one component of carefully coordinated treatment that prioritizes both cure and function, according to patient preferences.

The review also notes that organ preservation strategies achieve equivalent survival outcomes while maintaining physiologic function in appropriately selected patients. Selection is the key word — not every patient qualifies.

## Limitations: What This Review Could Not Prove

This is a literature review, not a prospective randomized trial, so it cannot establish cause and effect on its own. Several specific gaps remain.

-
**Standardization across institutions is lacking.** The authors state that standardization of these diagnostic platforms remains essential for broader implementation.
-
**Survival benefit is unproven for many approaches.** Demonstration of survival benefits through prospective trials is still required.
-
**The multidisciplinary board evidence is mixed.** One study found no measurable survival benefit despite better guideline adherence, and MTB review added about 13 days of delay.
-
**Access is unequal.** Institutions with well-established multidisciplinary teams remain limited, and most patients seeking therapy lack this organizational structure.
-
**Much radiomics and biomarker evidence comes from validation studies** rather than large randomized trials with long-term follow-up.

## Recommendations for Patients and Care Teams

1.
**Ask whether your case has been reviewed by a multidisciplinary tumor board.** Review is associated with better guideline adherence and, in large certified-center data, a modest survival advantage (hazard ratio 0.94).
1.
**Request biomarker testing on your tumor tissue.** Comprehensive genomic profiling finds actionable changes in over 90% of head and neck squamous cell carcinomas. TMB and PD-L1 testing can guide immunotherapy decisions.
1.
**Ask about function-preserving options.** Transoral laser microsurgery and robotic surgery can spare speech and swallowing in appropriately selected early and intermediate-risk tumors.
1.
**Discuss treatment timing.** Multidisciplinary review may add roughly 13 days before treatment starts. Ask your team how they balance thorough planning against delay.
1.
**Request access to supportive services.** Including speech-language pathology, nutrition, and palliative care reduced pretreatment feeding tube placement (26% versus 39%) in advanced disease.
1.
**Ask about clinical trials.** The authors state that prospective trials are still needed to prove survival benefits from precision surgery and biomarker-driven care.

## Frequently Asked Questions

### What is comprehensive genomic profiling and what can it find?

It is full DNA analysis of your tumor. In head and neck squamous cell carcinoma, it identifies clinically actionable changes in more than 90% of cases. Actionable means the finding points to a drug or strategy that could work. Ask your team whether your tumor tissue has had this testing.

### What is a multidisciplinary tumor board and should my case go to one?

It is a coordinated team of specialists who review your case together and plan treatment. One study found five-year disease-specific survival rose from 52% to 75% after tumor board implementation. Ask whether your case has been reviewed by one, and how your team balances thorough planning against delay.

### Does multidisciplinary review delay treatment, and does that matter?

In one study, tumor board presentation added about 13 days before treatment started (33.5 versus 20.1 days). That delay appeared across all UICC stages. Established evidence links treatment delays to tumor progression and clinical upstaging. Ask your team how they weigh thorough planning against this delay.

### Can surgery preserve my speech and swallowing?

For appropriately selected early and intermediate-risk tumors, transoral laser microsurgery and transoral robotic surgery can spare speech and swallowing. A prospective multicenter trial of laser microsurgery for supraglottic carcinoma reported 95% aspiration-free swallowing at 12 months, with no long-lasting impact on voice- or swallowing-related quality of life. Not every patient qualifies.

### What does an accuracy above 85% mean for radiomics prediction models?

Radiomics uses computer programs that mine detailed features from scans. When validated across independent cohorts, these models reach diagnostic accuracies above 85% for predicting treatment response. That means they correctly identify responders versus non-responders in most, but not all, cases. Ask how such results would change your own treatment plan.

### What supportive services can be added to my care team?

Teams may include speech-language pathologists, nutritionists, palliative care specialists, and social workers. Adding these services to the tumor board framework reduced pretreatment feeding tube placement in advanced disease patients: 39% versus 26%. Patients also reported improved quality of life and more dignified end-of-life care. Ask about access to these services.

### Are survival benefits from precision surgery proven?

Not yet for many approaches. The review states that demonstration of survival benefits through prospective trials is still required. One tumor board study found no measurable survival benefit despite better guideline adherence. A large German study of 8,173 head and neck patients treated in certified centers found a modest overall survival advantage (hazard ratio 0.94). Ask about clinical trials.

### When should a patient with head and neck cancer seek a second opinion before surgery?

A second opinion is worth considering when the recommended operation could remove the voice box, jaw, or other structures needed for speech and swallowing, since transoral laser and robotic surgery can preserve these functions in appropriately selected early and intermediate-risk tumors. It also helps when biomarker testing has not been discussed, because comprehensive genomic profiling identifies actionable changes in over 90% of head and neck squamous cell carcinomas, and when it is unclear whether a multidisciplinary tumor board has reviewed the case. Diagnostic Detectives Network provides independent expert second opinions.

## Source Information

**Original article title:** From Radical Resection to Precision Surgery: Integrating Diagnostic Biomarkers, Radiomics-Based Predictive Models, and Perioperative Systemic Therapy in Head and Neck Oncology.

**Authors:** Kowalski LP, Bradford CR, Beitler JJ, Rodrigo JP, Guntinas-Lichius O, Ambrosch P, Forastiere AA, Rao KN, Hamoir M, Saba NF, Sanabria A, Strojan P, Robbins KT, Ferlito A.

**Publication details:** *Diagnostics* 2026, volume 16, article 49. Published 23 December 2025. Received 21 October 2025; revised 3 December 2025; accepted 9 December 2025. Open access under a Creative Commons Attribution (CC BY) license.

**Note:** This patient-friendly article is based on peer-reviewed research.


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