Necessity of Intraoperative Level IIA Lymph Node Dissection in Patients with Carotid Body Tumors: A Retrospective Study of 126 Cases.

BACKGROUND: Carotid body tumors (CBTs) are relatively uncommon neoplasms that rarely have malignant potential. However, malignant CBTs (MCBTs) are still associated with a poor prognosis and the treatment is still challenging clinically. Therefore, we evaluated the necessity of intraoperative level IIA lymph node dissection in patients with CBT. METHODS: The clinical characteristics, intraoperative details, and pathological diagnosis of 126 CBT patients who had undergone surgery were retrospectively reviewed. The patients were divided into 2 groups according to whether level IIA lymph node dissection was performed. The prognosis was analyzed using Kaplan-Meier curves and Cox model multivariate survival analysis. RESULTS: Among the 126 patients, 7 patients (10.3%) in the selective lymph node dissection (SLND) group (68 patients) were diagnosed with MCBTs with evidence of lymph node metastasis. Two patients (3.4%) in the lymph node nondissection (LNND) group (58 patients) were diagnosed with MCBTs later after the second operation because they could not be diagnosed as malignant initially because of the lack of lymph node pathology results although the pathology of the primary lesion showed features of malignancy. The SLND group had a significantly higher relapse-free survival rate than the LNND group (94.1% vs. 79.3%, p = 0.021). Patients with a confirmed diagnosis had a better prognosis than those with insufficient evidence of a malignancy due to the lack of lymph node information. Twenty-nine patients in the SLND group and 26 patients in the LNND group had postoperative nerve injuries, with no significant difference between the groups (p = 0.879). CONCLUSION: Intraoperative dissection of level IIA lymph nodes around the tumor in CBT patients can help improve the diagnosis and prognosis of MCBTs without causing additional cranial nerve injury.

Quality Control Circle Practices to Reduce Specimen Rejection Rates.

Background: Quality assurance in laboratory testing significantly impacts patient care. The pre-analytical phase is particularly error-prone, contributing to around 70% of laboratory errors. High specimen rejection rates can delay diagnosis and treatment, cause patient discomfort, and increase healthcare costs. Quality Control Circles (QCC) have been introduced to medical institutions to improve process efficiency and reduce errors. This study aims to evaluate the effectiveness of QCC practices in reducing specimen rejection rates in a hospital clinical laboratory. Methods: A QCC initiative was implemented in the clinical laboratory from July 2021 to August 2022. The QCC comprised members from the clinical laboratory, nursing department, and administration. The initiative followed the PDCA (Plan-Do-Check-Act) cycle and involved multiple quality control methods, including flowchart analysis, Pareto analysis, and Fishbone diagrams. The effectiveness of the initiative was evaluated using statistical analyses of specimen rejection rates before and after implementation. Results: The QCC initiative led to a significant reduction in specimen rejection rates. The monthly specimen rejection rate decreased from an average of 1.13% before the intervention to 0.27% after the intervention. The most significant factors contributing to specimen rejection were identified as lack of sample collection information and blood clotting. Targeted interventions, such as appointing specimen collection liaisons, establishing a quality control team, and providing training on blood collection procedures, were implemented. These measures resulted in a notable decrease in the proportion of rejected specimens due to the identified factors. Conclusion: The implementation of QCC practices effectively reduced specimen rejection rates in the hospital laboratory. The study highlights the importance of systematic quality control methods and targeted interventions in improving laboratory processes. The success of the QCC initiative demonstrates its potential for broader application in other healthcare settings to enhance quality and efficiency.