Efficacy and safety of ultrasound-guided core needle biopsies (US-CNBs) in cervical lymphadenopathy in patients with suspected head and neck cancer during the COVID-19 pandemic.

BACKGROUND: Cervical lymphadenopathy can be benign or malignant. Its accurate diagnosis is necessary to determine appropriate treatment. Ultrasound-guided core needle biopsies (US-CNBs) are frequently used as a percutaneous sampling approach. OBJECTIVES: Our aim was to identify the efficacy and safety of US-CNBs in 125 patients with cervical lymphadenopathy and clinically suspected head and neck cancer during the COVID-19 pandemic with limited surgical resources. METHODS: US-CNBs of pathological lymph nodes were performed in 146 lymph nodes on 125 patients. Biopsies were performed ultrasound-guided with a reusable gun core biopsy system and a 10-cm-long 16-G needle. Standard of reference for the histological findings were panendoscopy, clinical and sonographic follow-up, surgical biopsy or a repeat US-CNB. RESULTS: Adequate material for histologic diagnosis was obtained in 111 patients (89%), of these 83 patients (75%) were diagnosed as malignant, whereas benign lymphadenopathy accounted for 28 patients (25%). Therefore, US-CNB was able to identify malignant or benign lymphadenopathy with an overall accuracy of 88% and 90%, respectively. CONCLUSIONS: Percutaneous US-CNB is a safe and effective alternative to surgical biopsy in the management of cervical lymphadenopathy in patients with clinically suspected head and neck cancer in a setting with limited resources.

[Analysis of injury incidences in a trauma surgery university hospital during the SARS-CoV­2 pandemic]. / Analyse des Trauma-Aufkommens in einer unfallchirurgischen Universitätsklinik während der SARS-CoV­2-Pandemie.

INTRODUCTION: The corona crisis of 2020 posed previously unknown challenges to hospitals providing acute care. In addition to the treatment of COVID-19 patients, universities and other acute care hospitals had to provide emergency medical care, including for patients undergoing trauma surgery. The challenge was that no reliable planning figures were available regarding the expected volume for such a crisis situation and therefore no reliable resource planning was possible in this respect. Therefore, the aim of this work was to record the incidence of polytrauma and other injuries during the pandemic crisis in a university trauma surgery clinic and to compare it with the years 2017-2019. METHODS: In this single-center study, a retrospective analysis of the injury incidence during calendar weeks with existing exit restrictions (12th-19th week) for the year 2020 for trauma surgery patients of a university hospital was performed. At first, the treatment of COVID-19 patients was recorded daily in order to objectify the burden and expenditure of inpatient treatment for these patients. Then, for the evaluation period from 20.03.2020 to 06.05.2020, the numbers of 1. polytrauma, 2. work-related accidents and 3. leisure-related trauma patients were recorded and compared with the numbers from 2017-2019 during the same period. RESULTS: In total, 118 patients were treated with COVID-19 as inpatients during the period under study, of which up to 43 patients had to be treated simultaneously in intensive care on 1 day. Overall, the number of polytrauma, work-related accidents and leisure-time accident patients was lower in 2020 than in the previous years. Nevertheless, with a decline of only -28% (22 ± 4.9 vs. 16), a considerable number of polytrauma patients were recorded, while all work-related accidents (44%, 304 ± 31.3 vs. 170) and also leisure-time accidents (39%, 173 ± 22.7 vs. 106) considerably decreased. In the group of leisure-time accidents, there was initially a remarkable decline in the number of cases per week after the initial restrictions began, but as the duration of the restrictions increased, the number per week has risen to the level of previous years. DISCUSSION: Even in exceptional situations such as the corona pandemic, there were a significant number of patients in need of acute treatment, especially polytrauma patients. This should be considered in the future in the event of similar exceptional situations in the inpatient care framework when providing trauma surgery care capacities.