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.

[Apropriateness of hospital admissions due to COVID-19 in the 2nd and 5th phase of the pandemic.] / Adecuación de ingresos hospitalarios por COVID-19 en la 2ª y 5ª fase de la pandemia.

OBJECTIVE: The increase in the demand for healthcare caused by COVID-19 implies a lower availability of health resources and influences the appropriateness of their use. Due to the variability of demand during the pandemic, the study aimed to compare the appropriateness of hospital admissions between the 2nd and 5th phases of the pandemic according to the criteria of the Hospital Emergency Service (CiHRyC). These results were compared with those obtained according to the Pneumonity Severity Index (FINE) and the Appropriateness Evaluation Protocol (AEP). As a secondary objective, the clinical and sociodemographic characteristics of the patients studied were described. METHODS: 80 patients hospitalized from the Emergency Department were randomly selected in two study periods (2nd and 5th pandemic phase) obtained from the registry of hospitalizations of the Preventive Medicine service of Hospital Ramon y Cajal. Prevalences of inappropriateness were estimated according to the CiHRyC, FINE and AEP and an analysis was performed using univariate logistic regression between epidemiological variables of both periods collected through the electronical medical records. RESULTS: Inappropriateness of admissions were 35% and 45% in the 2nd and 5th phase of the pandemic according with CiHRyC, 25% and 5/% according with FINE and 0% and 5% according with AEP. Median age was 71.4 and 50.0 years in 2nd and 5th phase (p=0.02). 72.5% and 17.5% of the patients in the 2nd and 5th phases had at least one risk factor for COVID-19 severe illness (p<0.01). CONCLUSIONS: The measurement tools used identified more inappropriately cases in the 5th phase of the pandemic than in the 2nd one. CiHRyC coincided with FINE and AEP in the result of their evaluation.

OBJETIVO: El aumento de la demanda asistencial hospitalaria producida por la COVID-19 supone una menor disponibilidad de recursos sanitarios e influye en la adecuación de su utilización. Debido a la variabilidad de la demanda durante la pandemia, el objetivo del estudio fue comparar la adecuación de los ingresos hospitalarios entre la 2ª y 5ª fase de la pandemia según los criterios del servicio de Urgencias del Hospital (CiHRyC). Se compararon estos resultados con los obtenidos según el Pneumonity Severity Index (FINE) y el Appropriateness Evaluation Protocol (AEP). Como objetivo secundario se describieron las características clínicas y sociodemográficas de los pacientes estudiados. METODOS: Se seleccionaron aleatoriamente 80 pacientes hospitalizados desde Urgencias en dos periodos de estudio (2ª y 5ª fase pandémica) obtenidos del registro de hospitalizaciones del servicio de Medicina Preventiva del Hospital Ramón y Cajal. Se estimaron las prevalencias de inadecuación según los CiHRyC, el FINE y el AEP para admisiones y se realizó un análisis mediante regresión logística univariante entre las variables epidemiológicas de ambos periodos recogidas mediante la Historia Clínica Electrónica (HCE). RESULTADOS: La inadecuación de la hospitalización fue del 35% y 45% en la 2ª y 5ª fase de la pandemia con los CiHRyC, del 25% y 57% con el FINE y del 0% y 5% con el AEP. La mediana de edad fue de 71,4 y 50 años en la 2ª y 5ª fase (p=0,02). El 72,5% y el 17,5% de los pacientes de la 2ª y 5ª fase tuvieron al menos un factor de riesgo de complicaciones de COVID-19 (p<0,01). CONCLUSIONES: Los instrumentos de medida empleados (CiHRyC, el FINE y el AEP) identificaron más casos inadecuadamente ingresados en la 5ª fase de la pandemia que en la 2ª, coincidiendo el CiHRyC con el FINE y el AEP en el resultado de su evaluación.

Adecuación de ingresos hospitalarios por COVID-19 en la 2ª y 5ª fase de la pandemia / Apropriateness of hospital admissions due to COVID-19 in the 2nd and 5th phase of the pandemic

Fundamentos: El aumento de la demanda asistencial hospitalaria producida por la COVID-19 supone una menor disponibilidad de recursos sanitarios e influye en la adecuación de su utilización. Debido a la variabilidad de la demanda durante la pandemia, el objetivo del estudio fue comparar la adecuación de los ingresos hospitalarios entre la 2ª y 5ª fase de la pandemia según los criterios del servicio de Urgencias del Hospital (CiHRyC). Se compararon estos resultados con los obtenidos según el Pneumonity Severity Index (FINE) y el Appropriateness Evaluation Protocol (AEP). Como objetivo secundario se describieron las características clínicas y sociodemográficas de los pacientes estudiados. Métodos: Se seleccionaron aleatoriamente 80 pacientes hospitalizados desde Urgencias en dos periodos de estudio (2ª y 5ª fase pandémica) obtenidos del registro de hospitalizaciones del servicio de Medicina Preventiva del Hospital Ramón y Cajal. Se estimaron las prevalencias de inadecuación según los CiHRyC, el FINE y el AEP para admisiones y se realizó un análisis mediante regresión logística univariante entre las variables epidemiológicas de ambos periodos recogidas mediante la Historia Clínica Electrónica (HCE). Resultados: La inadecuación de la hospitalización fue del 35% y 45% en la 2ª y 5ª fase de la pandemia con los CiHRyC, del 25% y 57% con el FINE y del 0% y 5% con el AEP. La mediana de edad fue de 71,4 y 50 años en la 2ª y 5ª fase (p=0,02). El 72,5% y el 17,5% de los pacientes de la 2ª y 5ª fase tuvieron al menos un factor de riesgo de complicaciones de COVID-19 (p<0,01). Conclusiones: Los instrumentos de medida empleados (CiHRyC, el FINE y el AEP) identificaron más casos inadecuadamente ingresados en la 5ª fase de la pandemia que en la 2ª, coincidiendo el CiHRyC con el FINE y el AEP en el resultado de su evaluación.(AU)

Background: The increase in the demand for healthcare caused by COVID-19 implies a lower availability of health resources and influences the appropriateness of their use. Due to the variability of demand during the pandemic, the study aimed to compare the appropriateness of hospital admissions between the 2nd and 5th phases of the pandemic according to the criteria of the Hospital Emergency Service (CiHRyC). These results were compared with those obtained according to the Pneumonity Severity Index (FINE) and the Appropriateness Evaluation Protocol (AEP). As a secondary objective, the clinical and sociodemographic characteristics of the patients studied were described. Methods: 80 patients hospitalized from the Emergency Department were randomly selected in two study periods (2nd and 5th pandemic phase) obtained from the registry of hospitalizations of the Preventive Medicine service of Hospital Ramon y Cajal. Prevalences of inappropriateness were estimated according to the CiHRyC, FINE and AEP and an analysis was performed using univariate logistic regression between epidemiological variables of both periods collected through the electronical medical records. Results: Inappropriateness of admissions were 35% and 45% in the 2nd and 5th phase of the pandemic according with CiHRyC, 25% and 5/% according with FINE and 0% and 5% according with AEP. Median age was 71.4 and 50.0 years in 2nd and 5th phase (p=0.02). 72.5% and 17.5% of the patients in the 2nd and 5 th phases had at least one risk factor for COVID-19 severe illness (p<0.01). Conclusions: The measurement tools used identified more inappropriately cases in the 5th phase of the pandemic than in the 2 nd one. CiHRyC coincided with FINE and AEP in the result of their evaluation.(AU)

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

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.

Activities and Perceived Risk of Transmission and Spread of SARS-CoV-2 among Specialists and Residents in a Third Level University Hospital in Spain.

This study aims to identify factors related with SARS-CoV-2 infection in physicians and internal residents during the SARS-CoV-2 pandemic at a tertiary hospital in Spain, through a cross- sectional descriptive perception study with analytical components through two questionnaires directed at professionals working at the Ramon y Cajal University Hospital between February and April 2020. In total, 167 professionals formed the study group, and 156 professionals comprised the comparison group. Seventy percent of the professionals perceived a shortage of personal protective equipment (PPE), while 40% perceived a shortage of hand sanitiser, although more than 70% said they used it properly. Soap was more available and had a higher percentage of correct use (73.6-79.5%) (p > 0.05). Hand hygiene was optimal in >70% of professionals according to all five WHO measurements. In the adjusted model (OR; CI95%), belonging to a high-risk specialty (4.45; 1.66-11.91) and the use of public transportation (3.27; 1.87-5.73) remained risk factors. Protective factors were changes of uniform (0.53; 0.32-0.90), sanitation of personal objects before the workday (0.55; 0.31-0.97), and the disinfection of shared material (0.34; 0.19-0.58). We cannot confirm that a shortage or misuse of PPE is a factor in the spread of SARS-CoV-2. Fears and assessments are similar in both groups, but we cannot causally relate them to the spread of infection. The perception of the area of risk is different in both groups, suggesting that more information and education for healthcare workers is needed.

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.

Correlation between PET/CT and CT in the staging prior to the treatment of head and neck squamous cell carcinoma.

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.