ABSTRACT
Background: The aim of the study was to find out the correlation between pretherapeutic clinical and radiological staging of carcinoma larynx. Methods: This was a prospective cross sectional study carried out in department of ENT at Government Medical College & Dr. Susheela Tiwari government hospital, Haldwani during the period of September 2015 to 2016. 50 adult patients (mainly 4th, 5th, 6th,7th decade) having complaints of hoarseness, throat pain, neck mass etc were subjected to clinical evaluation.. Provisional clinical diagnosis of laryngeal mass was made followed by diagnostic rigid 90 degree laryngoscopy in OPD setting. It was followed by FNAC in cases of lymph node swelling. Radiological evaluation was done using CECT scan neck and MRI ( if required). Biopsy of suspected cases (malignant) was done under local or general anesthesia. Pretherapeutic clinical staging was done in patients diagnosed with carcinoma. Using information from CT and MRI pretherapeutic radiological staging was done and these patients were included in the study. Patients having benign neoplasm, lymphoma, recurrent malignant disease and those having undergone radiotherapy were excluded from the study. Comparison between pretherapeutic clinical and radiological staging of carcinoma larynx was done and its impact on treatment options was analyzed during follow up of patients. Results: It was observed in the present study that Carcinoma larynx is a male dominant disease mainly seen in elderly age group with mean age group of 65years consuming alcohol along with habit of smoking. Maximum number of cases were of supraglottic malignancy followed by involvement of glottis with no case of subglottic malignancy. In the present study we found that 32% of cases showed upstaging with CT scan, as a result of deep tumor extent undetectable at clinical examination.Conclusion:Clinical or endoscopic evaluation fails to identify invasion of the laryngeal framework and of extralaryngeal soft tissues in a high percentage of cases. An additional radiologic examination, either CT or MR imaging, is essential in most laryngeal carcinomas for the correct pretherapeutic staging and proper treatment.
ABSTRACT
Preoperative examination intended to detect multifocality, multicentricity and bilaterality-once considered the strongest indication of breast magnetic resonance imaging (MRI)-is currently being strongly questioned in medical literature. This paper aims at evaluating, based on our experience at Clínica Alemana, Santiago, Chile, breast MRI ability to improve preoperative radiological tumour staging by conventional methods, as well as to determine the proportion of patients in which this diagnostic procedure generated changes in the surgical management. We retrospectively reviewed preoperative MRI studies carried out between January 2009 and June 2010. Classification: Group 1: MRI provided no new information. Group 2: by detecting additional lesions, MRI improved radiological staging without changing the type of surgery planned. Group 3: MRI showed new benign lesions and caused unnecessary surgery. Group 4: MRI successfully changed the type of surgery planned based on conventional studies. A total of 419 breast MRI scans were performed during a 18-month period; 39 percent of them were carried out preoperatively. For the analysis, 128 patients were enrolled and distributed in the following categories: Group 1 (66 percent), Group 2 (20 percent), Group 3 (2 percent) and Group 4 (12 percent). In 95.3 percent of the patients, a single surgery with clear margins was performed. This work demonstrated the usefulness of preoperative MRI in our practice, i.e., it allowed for a better radiological staging in one third of the patients and even successfully changed the surgical approach in 12 percent of cases.
El estudio preoperatorio en búsqueda de multifocalidad, multicentricidad y bilateralidad -antes considerada la indicación más sólida de la resonancia magnética (RM) mamaria- hoy se encuentra fuertemente cuestionada en la literatura. En este trabajo nos propusimos evaluar la capacidad de la RM mamaria en nuestro centro para mejorar la etapificación radiológica preoperatoria realizada por métodos convencionales y determinar la proporción de las pacientes en que genera cambio en el enfoque quirúrgico. Hemos revisado retrospectivamente las RM preoperatorias entre enero de 2009 y junio de 2010. Clasificación: Grupo1: la RM no aportó información nueva. Grupo 2: al detectar lesiones adicionales, mejoró la etapificación radiológica, sin cambiar el tipo de la cirugía planificada. Grupo3: demostró nuevas lesiones no malignas y causó cirugía inútil. Grupo 4: cambió correctamente el tipo de cirugía planeada en base a los estudios convencionales. En los 18 meses se realizaron 419 RM mamarias, el 39 por ciento de ellas en preoperatorio. Para el análisis se han reclutado 128 pacientes con la siguiente distribución en los grupos predeterminados: Grupo 1(66 por ciento), Grupo 2(20 por ciento), Grupo 3(2 por ciento) y Grupo 4(12 por ciento). En el 95,3 por ciento de las pacientes se logró realizar una sola cirugía con márgenes libres. Este trabajo demostró la utilidad de la RM preoperatoria en nuestra práctica: permite una mejor etapificación radiológica en el tercio de las pacientes e incluso cambia correctamente el enfoque quirúrgico en el 12 por ciento de los casos.