Sentinel lymph node biopsy for early squamous cell carcinoma of the lip and oral cavity: Real-world experience in Brazil.

BACKGROUND: This study aimed to evaluate the accuracy and oncological results of sentinel lymph node biopsy in patients with early lip and oral cavity squamous cell carcinoma (SCC) in a real-world scenario. METHODS: Retrospective study including seven Brazilian centers. RESULTS: Four-hundred and seven cN0 patients were accrued for 20 years. The rate of occult metastasis was 23.1% and 22 patients (5.4%) had regional failure. We found, for 5 years of follow-up, 85.3% of regional recurrence-free survival; 77.1% of disease-free survival; 73.7% of overall survival; and 86.7% of disease-specific survival. The rate of false-negative cases was 5.4%. CONCLUSION: In a real-world scenario, sentinel lymph node biopsy for patients with SCC of the lip and oral cavity proved feasible in different settings and to be oncologically safe, with similar rates of occult lymph node metastasis and false-negative cases, when compared to elective neck dissection, and with similar long-term survival to that reported historically.

Long-term Survival, Organ Function, and Malignancy after Hematopoietic Stem Cell Transplantation for Fanconi Anemia.

We report on long-term survival in 157 patients with Fanconi anemia (FA) who survived 2 years or longer after their first transplantation with a median follow-up of 9 years. Marrow failure (80%) was the most common indication for transplantation. There were 20 deaths beyond 2 years after transplantation, with 12 of the deaths occurring beyond 5 years after transplantation. Donor chimerism was available for 149 patients: 112 (76%) reported > 95% chimerism, 27 (18%) reported 90% to 95% chimerism, and 8 (5%) reported 20% to 89% donor chimerism. Two patients have < 20% donor chimerism. The 10- and 15-year probabilities of survival were 90% and 79%, respectively. Results of multivariate analysis showed higher mortality risks for transplantations before 2003 (hazard ratio [HR], 7.87; P = .001), chronic graft-versus-host disease (GVHD) (HR, 3.80; P = .004) and squamous cell carcinoma after transplantation (HR, 38.17; P < .0001). The predominant cause of late mortality was squamous cell carcinoma, with an incidence of 8% and 14% at 10 and 15 years after transplantation, respectively, and was more likely to occur in those with chronic GVHD. Other causes of late mortality included chronic GVHD, infection, graft failure, other cancers, and hemorrhage. Although most patients are disease free and functional long term, our data support aggressive surveillance for long periods to identify those at risk for late mortality.

Expression and epigenetic regulation of DACT1 and DACT2 in oral squamous cell carcinoma.

BACKGROUND: DACT genes regulates Wnt as well TGF-ß pathway, and were already associated with hepatocellular and lung cancer. Alterations on Wnt/ß-catenin were associated with head and neck cancer through ß-catenin cytoplasmatic accumulation. OBJECTIVE: The aim of the study was to evaluate DACT1 and DACT2 expression and methylation on oral squamous cell cancer (OSCC). METHODS: 47 samples of salivary rinse and tissue were collected from 29 OSCC and 18 control patients. qMSP and RT-PCR reactions were performed in order to detect hypermethylation and expression of DACT1 and DACT2 genes. Statistical analysis was conducted to evaluate these genes as possible biomarkers for OSCC. RESULTS: As expected man over 60 years old with tobacco and alcohol consumption history were associated with OSCC. There was no statistical difference between groups concerning DACT1 and DACT2 either in promoter hypermethylation or transcript levels. Age was associated with DACT2 promoter hypermethylation, especially over 56 years old. CONCLUSION: Patients older than 56 years old were about 5 times more likely to have DACT2 promoter hypermethylation. These findings could partially explain why older subjects are more prone to carcinogenesis. Wnt/ß-catenin pathway plays an important role in carcinogenesis, and the study of their regulators may help understand malignant transformation.

Oral squamous cell carcinoma in two siblings with Fanconi anemia after allogeneic bone marrow transplantation.

Fanconi Anemia patients are a high risk group for solid and hematologic malignancies. The risk seems to be influenced by age, chronic graft versus host disease and immunosuppressive drug regimens. Reports of oral malignant transformation in Fanconi Anemia after hematopoietic stem cell transplantation (HSCT) are increasing probably because of longer survival rates. This is the report of an 18- and her 28-year old sister who developed a post-HSCT oral squamous cell carcinoma. There were significant differences regarding time to malignant transformation, marrow donor characteristics and graft versus host disease evolution and treatment. The report reinforce the need for a routine head and neck screening for cancer in this particular syndrome and suggest that familial history should also be considered in Fanconi anemia patients at risk for oral malignancy after HSCT.

Unilateral Gingival Fibromatosis: a case report / Fibromatose Gengival Unilateral: um relato de caso

The gingival fibromatosis is a slow and progressive benign proliferation, which affects the gingival tissues. It may present a genetic inheritance and association with some syndromes. There are conservative and radical treatments, ranging from hygiene care to bloc resection of the affected bone. This case scenario is a 07 year-old child, who presented a nodular unilateral hyperplastic lesion in the right mandible, with sessile base and approximately 5 cm in its largest diameter. The patient presented difficulty of lip closure and slight swelling in the right area of the face. The tomographic image showed infiltration in buccal and lingual cortical of right mandible and tooth displacement. After lesion removal, the histopathologic diagnosis of fibromatosis was confirmed, with no relapse after 20 months of follow-up.

A Fibromatose Gengival é uma proliferação benigna, lenta e progressiva, que afeta os tecidos gengivais. Pode apresentar herança genética e associação à uma série de síndromes. Existem tratamentos conservadores e radicais, desde cuidados com higiene à ressecção em bloco do tecido ósseo afetado. Este é o caso clínico de uma criança, que apresentou lesão hiperplásica unilateral em mandíbula, com deslocamento dentário. Após remoção, o diagnóstico de hiperplasia gengival foi confirmado e não há recidiva da lesão até o momento.

Large desmoplastic fibroma: case report using microvascularized fibula graft for reconstruction / Fibroma desmoplásico de grandes proporções: relato de caso usando enxerto microvascularizado de fibula para reconstrução

The Desmoplastic Fibroma is a benign rare tumor of fibroblastic origin, representing only 0.03% of benign bone tumors. Displays aggressive behavior and high rates of recurrence, which makes the treatment more aggressive. The authors present a case of an 11 years-old female, complaining of increased volume in the jaw. The patient had an extensive swelling of the left mandibular body with invasion of the border of the tongue and floor of the mouth at the same side. She had a history of 4 recurrences at the same site. Image exams revealed expansive lesion in body and ramus of the mandible with involvement of soft tissue on the lingual side of the lesion. The treatment was excision of the lesion with extra oral access and reconstruction with microvascularized fibula graft. The patient has been followed for 2 years with no clinical or radiographic signs and without recurrence

O Fibroma Desmoplásico é um tumor benigno raro de origem fibroblástica que representa apenas 0,03% dos tumores ósseos benignos. Apresenta comportamento agressivo e elevadas taxas de recorrência, o que torna o seu tratamento mais agressivo. Os autores apresentam um relato de caso de uma paciente do sexo feminino de 11 anos de idade com queixa de aumento de volume em mandíbula. A mesma apresentou extensa expansão do corpo mandibular esquerdo, com invasão da borda da língua e assoalho da boca do mesmo lado, com histórico de quatro recorrências na mesma localização. Os exames de imagem revelaram lesão expansiva no corpo e ramo da mandíbula com envolvimento dos tecidos moles do lado lingual da lesão. O tratamento foi a excisão da lesão com acesso extra-oral e reconstrução com enxerto microvascularizado de fíbula. A paciente apresenta seguimento de 2 anos sem sinais clínicos ou radiográficos de recidiva.

Total thyroidectomy with ultrasonic scalpel: a multicenter, randomized controlled trial.

BACKGROUND: The ultrasonic scalpel is a recently introduced device in head and neck surgery. Total thyroidectomy is the most common endocrine procedure performed by surgeons. METHODS: This was an open, phase IV, multicenter, randomized controlled trial (RCT) that compared the use of an ultrasonic scalpel with a conventional technique in patients who underwent total thyroidectomy. The outcomes were surgical complication rate, operative time, drainage volume, postoperative pain, and costs. RESULTS: In all, 261 patients were included in 11 centers. There was a mean difference of 17% of operative time in favor of the ultrasonic scalpel group. There were no differences in postoperative complications. There was a difference in costs of 14% in favor of the ultrasonic scalpel group, but it was not statistically significant. CONCLUSIONS: The use of an ultrasonic scalpel was as safe as that of the conventional technique and had the advantage of a shorter operative time and lower postoperative drainage. Costs were not different between groups.

Paciente HIV-positivo com aumento de volume bilateral da glândula parótida: Relato de caso. / HIV-positive patient with bilateral swelling of parotid gland: Case Report

Introdução: Pacientes HIV-positivo são acometidos por váriossinais e sintomas na região de cabeça e pescoço, sendo o aumentode volume de uma glândula salivar um achado comum. A glândulaparótida é a mais afetada, com frequente comprometimentobilateral. Objetivo: Chamar a atenção para a pesquisa de HIVem pacientes adultos com aumento de volume das glândulassalivares, principalmente a parótida, uma vez que pode ser aprimeira manifestação da infecção viral. Relato de caso: Opresente artigo relata um caso de um paciente masculino, adulto,com aumento de volume bilateral de glândula parótida, associadoà linfadenomegalia cervical generalizada. Após avaliaçãoclínica e tomográfica, solicitou-se exame sorológico para HIV, oqual confirmou positividade. O paciente foi encaminhado paratratamento. Comentários finais: O presente caso ressalta aimportância do exame minucioso da região de cabeça e pescoço,e a correlação do aumento de volume da glândula parótida empacientes infectados pelo HIV.

Reconstrução mandibular com enxerto microvascularizado de fíbula - uma nova técnica (variante IV) / Vascularized fibular graft for mandibular reconstruction - a new tecnique (variety IV)

Introdução: Através deste relato Sassi e col. descrevemuma nova variante do retalho microvascularizado da fíbula,na reconstrução da mandíbula. Objetivo: A técnica, tambémconhecida por método ?macho-fêmea?, tem como finalidadeoferecer uma maior superfície de contato entre o remanescentemandibular e o enxerto ósseo. Relato de caso: Paciente J.B.C.,61 anos, masculino, portador de carcinoma de células escamosasdo assoalho da boca, submetido a pelviglossomandibulectomia eesvaziamento cervical bilateral seguido de radioterapia adjuvante.Após cinco anos foi submetido à reconstrução da mandíbula comretalho osteomiocutâneo de fíbula. A cirurgia utilizou a técnicadescrita pelos autores, com evolução satisfatória em 3 anos deseguimento. Considerações Finais: A técnica descrita parececontribuir para a neoformação óssea dos tecidos e pode serpromissora especialmente na reconstrução de defeitos extensose nas reconstruções pós-radioterapia.

Perfil epidemiológico dos pacientes com câncer de cabeça e pescoço que evoluíram a óbito antes do tratamento / Epidemiologic profile of head and neck cancer patiens who died before treatment

Introdução: O câncer de cabeça e pescoço é o quinto câncermais comum no mundo. Apesar dos importantes avanços nodiagnóstico e tratamento, um pequeno aumento na sobrevida em5 anos foi observado nas últimas décadas. Objetivo: Analisar aepidemiologia dos pacientes com câncer da cabeça e pescoço,atendidos no Hospital Erasto Gaertner, que foram a óbito antes dereceber tratamento. Método: Revisão de dados epidemiológicosde 164 pacientes, admitidos entre janeiro de 2001 e dezembro de2006. Resultados: A idade média foi de 61,6 anos e a localizaçãomais comum foi à orofaringe, em 36,6%. 83% dos pacientesapresentavam Estádio Clínico IV, e o emagrecimento foiobservado em 76,6% dos pacientes. 38,4% dos pacientes eramZubrod 2, 16,5% Zubrod 3 e 7,3% com Zubrod 4. O tempo médioentre a primeira consulta e o óbito foi de 68,7 dias. Conclusão:O estádio clínico avançado e o atraso no reconhecimento dossintomas e na procura da assistência médica parecem ser fatoresdeterminantes dos óbitos dos pacientes estudados.

Prevenção em câncer bucal: 20 anos de campanha anti-tabaco no estado do Paraná, Brasil / Oral cancer prevention: 20 years of anti-tabagism campaign in Paraná, Brazil

Introdução: O câncer de boca é o 6º tipo mais frequente deneoplasia maligna no mundo. Sabe-se que o maior fator de riscoassociado a essa doença é o tabagismo. Objetivo: Relatar aexperiência de 19 anos de campanhas de prevenção de câncerde boca e tabagismo. Método: No período de 1989 a 2007 foramrealizadas campanhas de prevenção ao câncer de boca naregião central da cidade de Curitiba / PR - Brasil. Adicionalmenteao exame clínico intra-oral, os pacientes responderam a umquestionário com informações sócio-econômicas e hábitos derisco, como tabagismo e etilismo. Resultados: Foram examinadasum total de 4.405 pessoas. Foram detectadas 687 lesões oraisclassificadas como traumáticas, inflamatórias, leucoplasias,eritroplasias e malignas. Pudemos observar que porcentagem depacientes fumantes diminuiu de 22,5% em 1989 para 16,7% em2007, seguindo a tendência nacional divulgada pelo Ministério daSaúde. Os pacientes foram encaminhados para o Hospital ErastoGaertner para atendimento e conduta. Conclusão: Em 18 anosde campanha de prevenção pudemos diagnosticar precocementelesões potencialmente malignas, bem como orientar a populaçãosobre os fatores de risco em especial o tabaco. As campanhasde prevenção são um importante instrumento de diagnósticoprecoce para melhorar os indices de morbidade e mortalidade docâncer de boca.

Introduction: Oral cancer is the 6º most frequent type of cancerin the world, and one of the main causes is smoking habits.Objective: Report our 18 years experience on oral cancerprevention and tabagism. Method: We examinated people inthe streets of Curitiba / PR-Brazil, between 1989 and 2007, fororal lesions. In addition to the clinical exam, patients filled outa thorough form with social and economic information and alsoharmful habits, such as smoking and alcohol drinking. Results:4.405 people were examinated. We diagnosed 687 oral lesions(traumatic, inflammatory, leukopakia, erythroplakia, malignancysuggestivelesions). Total average of smoking patients was22.5% on 1989 and 16.7% on 2007, following the national trend,as reported by the Ministry of Health. All patients presentingoral lesions were sent to Hospital Erasto Gaertner in Curitiba.Conclusion: During 18 years of prevention campaigns we wereable to early diagnose potencially malignant lesion and to orientgeneral population about risk factors for oral cancer, speciallytobacco. Oral campaigns and screening are an important tool forprevention and to improve oral cancer morbidity and mortality.

[Oral cancer surgery and oral cutaneous fistulas: risk factors]. / Fístulas orocutâneas após cirurgia de câncer da cavidade oral: fatores de risco.

OBJECTIVE: To quantify the oral cutaneous fistulae after surgery and to identify possible risk factors. METHODS: A retrospective study, interesting patients that were submitted to surgery, with a two years minimum post-operative follow up. The considered variables were: sex, concomitant diseases, tabacco and alcohol use, the anesthesic and pulmonary risks, clinical stage, cervical linphadenectomy, pre or postoperative radiotherapy, accidents during the surgery, wound infection and or hematoma, pulmonary infection, surgery and reconstruction extension. RESULTS: In 159 patients, oral cutaneous fistulae occurred in 48 patients (30,3%): Patients stage T1 in 26,6 %,T2 in 1,8 %,T3 in 16%, and T4 in 40,3% (p=0,0138). The cases N+ developed fistulae in 22.9%, (N2c with 42,8%, (p=0,0136), those with preoperative radiotherapy in 63,6% (p=0,0346) Those with wound infection in 47,3% (p=0,0146), and those with wound deiscense in 53,7 % (p=0,0030). The fistulae rate was of 60% in the regional mucocutaneous flaps reconstruction cases, 39,2% in the myocutaneous ones and 12,5% of microsurgery ones (p=0,0286). CONCLUSION: The general rate of oral cutaneous fistulae was 30,3%. The significant factors were: T stage, cervical linphadenectomy, pre or postoperative radiotherapy, wound infection and deiscense, and the use of flaps.

Fístulas orocutâneas após cirurgia de câncer da cavidade oral: fatores de risco / Oral cancer surgery and oral cutaneous fistulas: risk factors

OBJETIVO: Quantificar as fístulas após cirurgia de câncer da cavidade oral e identificar fatores de risco. MÉTODOS: Estudo retrospectivo, interessando pacientes submetidos à cirurgia. Seguimento pós-operatório mínimo de dois anos. Variáveis estudadas: sexo, comorbidades, tabagismo, etilismo, risco anestésico e pulmonar, estadiamento clínico, linfadenectomia cervical, tratamento radioterápico, acidentes cirúrgicos, infecção ou deiscência de ferida operatória, seroma ou hematoma de sítio cirúrgico, infecção respiratória no pós-operatório, tipo de cirurgia e reconstrução realizadas. RESULTADOS: Estudados 159 pacientes. Ocorreu fístula orocutânea em 30,3 por cento (48 pacientes). Pacientes T3 tiveram fístula em 16 por cento dos casos, T4 em 40,3 por cento e naqueles estádio T1 ou T2, 26,6 por cento e 1,8 por cento respectivamente (p=0,0138). Os casos N+ evoluíram com fístula em 22.9 por cento (N2c com 42,8 por cento, p=0,0136), os com radioterapia pré-operatória em 63,6 por cento (p=0,0346). Aqueles com infecção de sítio cirúrgico em 47,3 por cento (p=0,0146) e aqueles com deiscência de ferida operatória em 53,7 por cento (p=0,0030). O índice de fístula foi de 60 por cento nos retalhos regionais mucocutâneos, de 39,2 por cento nos miocutâneos e de 12,5 por cento com retalho microcirúrgico (p=0,0286). CONCLUSÃO: O índice de fístulas foi de 30,3 por cento. Foram estatisticamente significativos para ocorrência de fístulas: estádio T, linfadenectomia cervical bilateral, radioterapia pré ou pós-operatória, infecção e deiscência de ferida operatória, e o uso de retalhos para reconstrução.

OBJECTIVE: To quantify the oral cutaneous fistulae after surgery and to identify possible risk factors. METHODS:A retrospective study, interesting patients that were submitted to surgery, with a two years minimum post-operative follow up. The considered variables were: sex, concomitant diseases, tabacco and alcohol use, the anesthesic and pulmonary risks, clinical stage, cervical linphadenectomy, pre or postoperative radiotherapy, accidents during the surgery, wound infection and or hematoma, pulmonary infection, surgery and reconstruction extension. RESULTS: In 159 patients, oral cutaneous fistulae occurred in 48 patients (30,3 percent): Patients stage T1 in 26,6 percent,T2 in 1,8 percent,T3 in 16 percent, and T4 in 40,3 percent (p=0,0138). The cases N+ developed fistulae in 22.9 percent, (N2c with 42,8 percent, (p=0,0136), those with preoperative radiotherapy in 63,6 percent (p=0,0346) Those with wound infection in 47,3 percent (p=0,0146), and those with wound deiscense in 53,7 percent (p=0,0030). The fistulae rate was of 60 percent in the regional mucocutaneous flaps reconstruction cases, 39,2 percent in the myocutaneous ones and 12,5 percent of microsurgery ones (p=0,0286). CONCLUSION: The general rate of oral cutaneous fistulae was 30,3 percent. The significant factors were: T stage, cervical linphadenectomy, pre or postoperative radiotherapy, wound infection and deiscense, and the use of flaps.

Carcinoma espinocelular de boca em paciente jovem: relato de caso e avaliação dos fatores de risco / Squamous cell carcinoma of the mouth in ayoung patient: case report and evaluation of risk factors

Introdução: O carcinoma espinocelular (CEC) representa a neoplasia maligna bucal mais comum, a qual acomete preferencialmente homens acima de 50 anos, tendo como principais fatores de risco o tabagismo e o etilismo. A incidência dessa neoplasia em jovens com menos de 40 anos é rara (3 a 6% dos casos). Nesses pacientes, o curso da doença é ainda mais agressivo, apresentando maior risco de metastatização cervical com prognóstico desfavorável. Objetivo: O objetivo deste artigo foi descrever um caso clínico de câncer de boca agressivo e deevolução desfavorável em paciente jovem, tendo o tabagismo e o uso de maconha como possíveis fatores de risco. Fatores predisponentes são discutidos, bem como a revisão da literatura referente ao CEC em pacientes jovens. Relato de caso: Relatou-se um caso de CEC de boca em paciente do sexo masculino, 21 anos, leucoderma, tabagista e usuário de maconha. O paciente foi diagnosticado em estágios muito avançados da doença e tratado com quimioterapia e radioterapia concomitantes, pela irressecabilidade do tumor, porém ele abandonou o tratamento durante a radioterapia e evoluiu com óbito após dois meses do último contato. Conclusão: O caso ressalta a importância do diagnóstico precoce de lesões de câncer bucal, assim como o aumento de campanhas preventivas, enfocando também pacientes jovens usuários de maconha.

Introduction: Squamous cell carcinoma (SCC) is the most common oral malignant neoplasm, affecting mainly men over 50 years, with the main risk factors of smoking and alcoholism. The incidence of this neoplasm in young people under the age of 40 is rare (3 to 6% of cases).In these patients the course of the disease is even more aggressive,showing higher risk of cervical metastatization with unfavorable prognosis. Objective: The aim of this article was to describe a clinical case of aggressive cancer of the mouth and unfavorable developmentin a young patient, considering the use of marijuana and smoking as possible risk factors. Predisposing factors are discussed, as well asthe literature review related to SCC in young people. Case report: It was reported a case of SCC of the mouth in a 21-year-old male patient,who was leukoderma, smoker and user of marijuana. The patient was diagnosed in very advanced stages of the disease and treated with concurrent chemotherapy and radiotherapy, due to the unresectable tumor, but he left the treatment during radiotherapy and evolved todeath after two months of last contact. Conclusion: The case highlights the importance of early diagnosis of lesions of oral cancer, as well as the increase in prevention campaigns, focusing also young patients,users of marijuana.

Contact endoscopy (Stomatoscopy) versus histological diagnosis of lesions of the lower lip vermilion area

In Brazil, the incidence of oral cavity cancer is estimated at 14,160 new cases in 2008. Contact endoscopy (stomatoscopy) applied to the oral cavity may favor early diagnosis. The aim of this study is to compare the contact endoscopy diagnosis to histological diagnosis of lesions of the lower lip vermilion area. Fifty-three prospective, ex vivo, non-consecutive lesions of the lip vermilion area were stained with toluidine blue solution, examined with stomatoscopy and directly biopsied. False-negatives did not occur and false-positives represented 9.4 percent. Sensitivity to diagnosis of malignancy was 100 percent, specificity was 88 percent, positive predicted value was 70.5 percent, negative predictive value was 100 percent and accuracy was 90.3 percent. Sensitivity and specificity of the contact endoscopy were high and the positive predictive value in relation to diagnosis of malignant lesions was good. Thus, stomatoscopy may be useful to diagnose lesions of the lower lip vermilion area.

Predictors of functional decline in locally advanced head and neck cancer patients from south Brazil.

BACKGROUND: Functional decline in Brazilian patients with head and neck squamous cell carcinoma (HNSCC) is associated with impaired recovery, quality of life, and health care costs. METHODS: Sixty patients enrolled at the regional oncology center in Curitiba, Brazil, were assessed over 6 months for toxicities, nutritional status, anthropometry, fatigue, stress, and functionality. RESULTS: Severe mid-arm and mid-calf circumference depletion accompanied weight loss. Total fatigue score increased 64% (p < .001), as did perceived stress and serum cortisol (p = .01). Instrumental activities of daily living (IADL) dependence doubled, and activities of daily living (ADL) dependence quadrupled (p < .001). Difficulty chewing or swallowing, weight loss, fatigue, perceived stress, and IADL dependence accounted for 48.2% of ADL dependence. CONCLUSIONS: The physical and psychological impact of HNSCC and its treatment are universally experienced; yet, screening and intervention for symptoms such as fatigue and stress are not typical clinical practice. Moreover, assessment of functional status is usually limited to chewing and swallowing. This study identified symptoms that require systematic intervention and randomized trials with functional independence as the outcome.

Accuracy, sensitivity and specificity of fine needle aspiration biopsyin salivary gland tumours: A retrospective study

Objective: The aim of this study was to evaluate the diagnostic accuracy, sensitivity and specificity of fine needleaspiration biopsies (FNAB) of salivary gland tumours performed at the Erasto Gaertner Hospital over the courseof a four year period. Study design: A retrospective study was carried out between 2001-2005 to review thecases of patients with salivary gland tumours who had undergone pre-operative FNAB and had been diagnosedduring post-operative histopathology examination. Results: A total of 106 cases of salivary gland tumours wereconsidered for this study, but 27 cases (25.5%) of the samples were considered unsatisfactory for analysis. Thesensitivity, specificity and accuracy were calculated considering only the 79 benign and malignant cases in whichFNAB provided sufficient samples for analysis. Based on these data, the value of sensitivity was 68.2% (15/22),specificity was 87.7% (50/57), accuracy was 82.3% (65/79), positive predictive value was 68.2% (15/22) and negativepredictive value was 87.7% (50/57). Conclusions: Despite the high rate of inadequate samples obtained in theFNAB in this study, the technique offers high specificity, accuracy and acceptable sensitivity (AU)

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Accuracy, sensitivity and specificity of fine needle aspiration biopsy in salivary gland tumours: a retrospective study.

OBJECTIVE: The aim of this study was to evaluate the diagnostic accuracy, sensitivity and specificity of fine needle aspiration biopsies (FNAB) of salivary gland tumours performed at the Erasto Gaertner Hospital over the course of a four year period. STUDY DESIGN: A retrospective study was carried out between 2001-2005 to review the cases of patients with salivary gland tumours who had undergone pre-operative FNAB and had been diagnosed during post-operative histopathology examination. RESULTS: A total of 106 cases of salivary gland tumours were considered for this study, but 27 cases (25.5%) of the samples were considered unsatisfactory for analysis. The sensitivity, specificity and accuracy were calculated considering only the 79 benign and malignant cases in which FNAB provided sufficient samples for analysis. Based on these data, the value of sensitivity was 68.2% (15/22), specificity was 87.7% (50/57), accuracy was 82.3% (65/79), positive predictive value was 68.2% (15/22) and negative predictive value was 87.7% (50/57). CONCLUSIONS: Despite the high rate of inadequate samples obtained in the FNAB in this study, the technique offers high specificity, accuracy and acceptable sensitivity.

Carcinoma anaplásico de tireóde: experiência do Hospital Erasto Gaertner / Anaplastic carcinoma of the thyroid: experience of Hospital Erasto Gaertner

Introdução: O carcinoma anaplásico de tireóide é uma neoplasia maligna agressiva com alta taxa de mortalidade apesar das terapêuticas instituídas. Objetivos: Identificar fatores que possam estar relacionados ao aumento da sobrevida. Métodos: Foram analisados 67 pacientes com carcinoma anaplásico da tireóide tratados entre 1973 e 2006. O tratamento incluiu cirurgia, radioterapia, quimioterapia ou formas associadas de tratamento. A análise da sobrevida foi calculada através do método de Kaplan-Maier. A análise dos fatores e comparação das taxas de sobrevida foi feita pelo teste de log rank. Resultados: A maioria dos pacientes (85%) apresentou massa cervical ao diagnóstico; 32 pacientes (48%) apresentaram linfadenopatia cervical. Metástases à distância estiveram clinicamente presentes em 25 (37%) pacientes. A sobrevida média foi de 5,3 meses e todos (98,5%), exceto uma paciente, foram a óbito em dois anos do diagnóstico. A ausência de linfadenopatia cervical (0,045) e a abordagem com ressecção cirúrgica (p = 0,001) estiveram associadas a melhor sobrevida.Conclusão: O carcinoma anaplásico da tireóide é uma doença de alta mortalidade apesar das estratégias de tratamento. Parece que alguns pacientes se beneficiam com uma abordagem agressiva.

Introduction: Anaplastic thyroid carcinoma is an aggressive malignancy associated with a highly lethal clinical course despite therapeutic intervention. Objective: To identify factors that could potentially improve survival. Methods: The outcome was assessed in 67 patients with anaplastic thyroid carcinoma treated between 1973 and 2006. Treatment included surgery, radiotherapy, chemotherapy and combined treatment. Survival was calculated by the Kaplan-Meier method. Potential factors affecting survival were compared by the log rank test. Results: Most patients (85%) presented with a neck mass; 32 patients (48%) also had cervical lymphadenopathy. Distant metastases were clinically present in 25 (37%). Median survival was 5.3 months and all (98.5%) but one patient died within 2 year of diagnosis. The absence of cervical lymphadenopathy (p= 0,045) and the adoption of surgery (p = 0.001) were associated with best survival. Conclusion: Anaplastic thyroid carcinoma remains a deadly disease despite treatment strategies. It seems that some patients might benefit from an aggressive approach.

Reconstrução da mandíbula utilizando o retalho microvascularizado de fíbula: 11 anos de experiência do Hospital Erasto Gaertner / Mandibular reconstruction with microvascularized fibula free flap: 11-year experience of Hospital Erasto Gaertner

Introdução: Os defeitos da mandíbula causados por mandibulectomias podem trazer seqüelas estéticas e funcionais aos pacientes. Objetivo: Avaliar os pacientes submetidos reconstrução da mandíbula utilizando o retalho microvascularizado da fíbula no período de janeiro de 1997 a dezembro 2007. Métodos: Foram analisados retrospectivamente os prontuários médicos, com tempo de seguimento variando de 12 a 120 meses. Resultados: 26 pacientes foram submetidos à cirurgia, com idade média de 39 anos. Os tipos histológicos mais comuns foram o carcinoma espinocelular em 10 (38,5%) pacientes e o ameloblastoma em sete (26,9%) pacientes. Foi observada alguma complicação em 12 (46,1%) pacientes, incluindo complicações precoces em oito (30,8%) pacientes e tardias em sete (26,9%) pacientes. Dois pacientes apresentaram perda total do retalho e um paciente evoluiu a óbito por complicações clínicas no pós-operatório. Conclusões: O retalho microvascularizado de fíbula mostrou-se eficaz nas reconstruções da mandíbula, porém, com taxas de morbidade consideráveis.

Introduction: Mandibular defects caused by mandibulectomy can result in esthetic and functional sequel for patients. Objective: To investigate the mandibular reconstructions using a composite microvascular free fibula flap from January, 1997 to December, 2007. Methods: A retrospective analysis of the medical records was carried out and the follow-up time varied from 12 to 120 months. Results: Twenty-six patients with an average age of 39 years-old were operated on during the study period. Squamous cell carcinoma was the commonest type of resected tumor, in 10 (38.5%) patients, followed by ameloblastomas, which were found in 7 (26.9%) patients. Other tumors, such as myxomas, fibrous dysplasia and giant cell tumors were also treated. Complications occurred in 12 (46.1%) patients, including precocious complications in 8 (30.8%) patients and late complications in 7 (26.9%) patients. Full flap loss occurred in two patients, and one died of postoperative complications. Conclusion: Mandibular reconstruction with a free fibula flap has an acceptable success rate, but the morbidity associated with this technique is substantial and cannot be ignored.