Correlation between PET-CT and ct in the staging after the treatment of head and neck squamous cell carcinoma

Abstract Objective: The aim of this study is to find out if a single imaging test is enough to follow-up on an oncological post-treatment patient. In such a case, we would know which was more valuable after comparing the two, by CT or PET-CT. Methods: Between January 2012 and July 2018, we collected data from all patients with previous medical history who were treated with a head and neck squamous cell carcinoma in our hospital, through surgery or by using an organ preservation protocol which we had done. Patients were required to have a CT and a PET-CT performed in a maximum period of 30 days between techniques. We compared the post post-treatment stage given to each case by using only the physical examination (only the CT and the PET-CT), with the ones given by the Tumor Board. After treatment, we analysed the similarity through Cramer's V statistic test. Results: We performed a comparative analysis, obtaining a correlation of 0.426 between the stages given by the Tumor Board and the one assigned based on physical examination, without imaging techniques. By only using the computed tomography as an imaging method the correlation was 0.565, whereas with only the use of positron emission computed technology, it was estimated at 0.858. When we compared the statistical association between stages using exclusively one of the two imaging techniques, the correlation was 0.451. Conclusion: Independent of the modality, we have demonstrated that in patients who have received previous treatment, there was a higher correlation in the stages with respect to the diagnostic method conducted by the Tumor Board using PET-CT as the sole image. Level of evidence: Level 1.

Correlation between PET/CT and CT in the staging prior to the treatment of head and neck squamous cell carcinoma / Correlação entre PET/TC e TC no estadiamento pré tratamento do carcinoma espinocelular de cabeça e pescoço

Abstract Introduction: Head and neck squamous cell carcinoma is the seventh most common malignant tumor. The advances in treatment have improved the global survival rates in the past years, although the prognosis is still grave. Objective: The aim of the present study is to evaluate the correlation between positron emission computed tomography and computed tomography at the time of staging a previously untreated head and neck squamous cell carcinoma, and to determine which of the two imaging techniques gives us more information at the time of initial diagnosis. Methods: Data from all patients diagnosed in our hospital of head and neck squamous cell carcinoma by a biopsy of any location or unknown primary tumor was collected, between January 2012 and July 2017. In all cases, computed tomography and positron emission computed tomography were performed with a maximum of 30 days difference between them and patients had not received any prior treatment to staging. The stage given to each case was compared based solely on the physical examination, only on the computed tomography/positron emission computed tomography, with respect to the stage given by the tumor board, observing the concordance obtained through Cramer's V statistical test. Results: We performed a comparative analysis obtaining a correlation of 0.729 between the stage given by the tumor board and the one assigned based on the physical examination without imaging techniques. When only using computed tomography as an imaging method, the correlation was 0.848, whereas with only the use of positron emission computed tomography it was estimated at 0.957. When comparing the statistical association between staging using exclusively one of the two imaging techniques, correlation was 0.855. Conclusion: Positron emission computed tomography is useful for the diagnosis of head and neck squamous cell carcinoma, improving the patient's staging especially when detecting cervical and distant metastases. Therefore, we consider that the use of positron emission computed tomography for the staging of patients with head and neck squamous cell carcinoma is a diagnostic test to be considered.

Resumo Introdução: O carcinoma espinocelular de cabeça e pescoço é o sétimo tumor maligno mais comum. Os avanços no tratamento melhoraram as taxas de sobrevida global nos últimos anos, embora o prognóstico ainda seja grave. Objetivo: Avaliar a correlação entre a tomografia computadorizada por emissão de pósitrons e a tomografia computadorizada no estadiamento de carcinomas espinocelulares da cabeça e pescoço não tratados previamente e verificar qual das duas técnicas de imagem nos fornece mais informações no momento do diagnóstico inicial. Método: Os dados de todos os pacientes diagnosticados em nosso hospital com carcinoma espinocelular de cabeça e pescoço por biópsia de qualquer região ou adenopatias de origem desconhecida foram colhidos no período entre janeiro de 2012 e julho de 2017. Em todos os casos, uma tomografia computadorizada e uma tomografia computadorizada por emissão de pósitrons foram realizadas com um máximo de 30 dias de diferença entre elas. Nenhum paciente deveria ter recebido tratamento antes do estadiamento. O estadiamento atribuído a cada caso foi comparado com base apenas no exame físico, pela tomografia computadorizada ou apenas pela tomografia computadorizada por emissão de pósitrons, com relação ao estadiamento concedido pela margem tumoral, observou-se a concordância obtida pelo teste estatístico de V de Cramer. Resultado: Realizamos a análise comparativa obtendo uma correlação de 0,729 entre o estadio concedido pela margem tumoral e aquele atribuído com base no exame físico sem técnicas de imagem. Usando apenas a tomografia computadorizada como método de imagem, a correlação foi de 0,848, enquanto que a correlação com a tomografia computadorizada por emissão de pósitrons foi estimada em 0,957. Ao comparar a associação estatística entre o estadiamento usando exclusivamente uma das duas técnicas de imagem, foi de 0,855. Conclusão: Tomografia computadorizada por emissão de pósitrons é útil para o diagnóstico de carcinoma espinocelular de cabeça e pescoço, melhora o estadiamento, especialmente na detecção de metástases cervicais e à distância. Portanto, concluimos que seu uso para o estadiamento de pacientes com carcinoma espinocelular de cabeça e pescoço é um exame diagnóstico a ser considerado.

Cierre de una fístula oroantral usando cemento óseo y un colgajo de mucosa yugal / Closure of an oroantral fistula using bone cement and a jugal mucosa flap

Una fístula oroantral es una solución de continuidad patológica entre el seno maxilar y la cavidad oral, producida frecuentemente tras una extracción dentaria, en la mayoría de los casos, del primer o segundo molar. El síntoma más común que provoca es una sinusitis aguda, que evolucionará a la cronicidad si la fístula permanece. El diagnóstico se realiza mediante endoscopia transalveolar, ortopantografía o tomografía computarizada dental. Su cierre quirúrgico es necesario cuando la fístula tiene más de 3 mm, o no sella por sí misma en 3 semanas. Existen, para ello, varias técnicas, usando distintos materiales y colgajos, cuyo fin es ocluir, tanto el defecto óseo, como el mucoso, para solucionar así a la vez la fístula y el problema sinusal(AU)

The oroantral fistula is a solution of pathological continuity between the maxillary sinus and the oral cavity, frequently produced after a teeth extraction in most of cases of the first or second molars. The commonest symptom provoked is an acute sinusitis evolving to chronicity if the fistula remains. The diagnosis is made by transalveolar, orthopantography or dental computerized tomography. Its surgical closure is necessary when the fistula has more than 3 mm or not seal by itself in three weeks. For it, there are some techniques using different materials and flaps where its objective is to occlude the bone defect as well as the mucous one thus solving the fistula and the sinus problem(AU)

Utilidad del botón septal y nivel de satisfacción obtenido en los pacientes con perforaciones del septum: nuestra experiencia / Septal button utility and level of satisfaction obtained in patients with drilling septal: our experience

Introducción: La mayoría de las perforaciones septales suelen ser asintomáticas, aunque algunas pueden presentar una rinitis costrosa, obstrucción nasal, epistaxis recidivante o sibilancias nasales. Su origen es sobre todo iatrogénico o idiopático, pero también podemos encontrar otras causas. Los botones septales constituyen una solución útil por la sencillez de su colocación, siendo de elección en pacientes que no deseen una intervención quirúrgica más compleja. Objetivo: Conocer las características de las perforaciones septales, además de, realizar un estudio sobre los resultados obtenidos en la cirugía de botón septal y el nivel de satisfacción obtenido por los pacientes tras esta intervención. Material y método: Análisis retrospectivo de 22 pacientes intervenidos quirúrgicamente de colocación de botón septal entre enero de 2008 a agosto 2010 en el Hospital Clínico Universitario Lozano Blesa de Zaragoza. El análisis incluye un estudio sobre la etiología, tamaño y sintomatologia de dichas perforaciones candidatas a la utilización del botón septal. Además del análisis de la presencia o ausencia de complicaciones tras la cirugía, la evolución y la mejoría o empeoramiento posoperatorio, en cuanto a los cinco síntomas principales; obstrucción nasal, las sibilancias, las costras endonasales con sequedad, la epistaxis y la rinorrea con tres posibles respuestas; igual, mejor o peor. En el consultorio y a los tres meses de la intervención, se realiza una encuesta con una escala analógica visual (EVA), en la que el paciente realiza una puntuación subjetiva del 1 al 10 para valorar su nivel de satisfacción tras la colocación del obturador Por último se le pregunta si volvería a ponérselo. Los resultados no fueron analizados con pruebas estadísticas dado el pequeño tamaño muestral. Resultados: Nuestros pacientes han presentado una importante mejoría en síntomas como la obstrucción nasal...

Introduction: Most of the septal perforations are usually asymptomatic, although some may have a crusty rhinitis, nasal obstruction, recurrent epistaxis or nasal wheeze. Its origin is mostly iatrogenic or idiopathic but can also find other causes. Septal buttons are a useful solution for the simplicity of their placement, being of choice in patients who do not want surgery more complex. Aim: Knowing the characteristics of septal perforations, in addition, a study on the results of septal button surgery and the level of satisfaction obtained by patients after the intervention. Material and method: Retrospective analysis of 22 patients with surgical septal button surgical placement between January 2008 to August 2010 at the Hospital Clinico Universitario Lozano Blesa from Zaragoza. The analysis includes a study on the etiology, symptoms of such size and drilling candidates for the use of septal button. Besides the analysis of the presence or absence of complications after surgery, and postoperative improvement or worsening in the five main symptoms, stuffy, nose, wheezing, endonasal crust with dryness, epistaxis and rhinorrhea with three possible answers, same, better or worse. Three months after surgery in the office is conducting a survey with a visual analogue scale (VAS), in which the patient makes a subjective score of 1 to 10 to assess their level of satisfaction after the placement of the shutter. Finally asked if he would wear it. The results were analyzed with statistical tests given the small sample size. Results: Our patients have experienced a significant improvement in symptoms such as nasal obstruction and wheezing. Nasal dryness has been with worse clinical outcomes after placement of the button. Subjectively 77.2(0) percent of patients would put him back. Conclusions: The septal buttons are a therapeutic tool to keep in mind for the closure of septal perforations with good results in patients unsuitable for surgical correction.