Concordance of fine needle aspiration cytology and final histology of salivary gland tumours.

BACKGROUND: Fine needle aspiration cytology (FNAC) is a widely used diagnostic tool to evaluate salivary gland tumours. The Milan system for reporting salivary gland cytopathology allows for standardisation and facilitates cytologicalhistological correlation. However, FNAC findings can still pose a diagnostic challenge. The accuracy of FNAC should be assessed at each centre. The aim of this study was to assess the concordance of FNAC and final histology of salivary gland tumours in three academic hospitals affiliated with the University of Pretoria, South Africa. METHODS: The study was a cross-sectional retrospective analytical study of 214 patients who underwent an operation for salivary gland tumours. All patients with FNAC and histology results between 2007-2017 were included. Patients were recruited from three University of Pretoria, South Africa, affiliated hospitals: Steve Biko Academic, Kalafong Provincial Tertiary and Tembisa Provincial Tertiary Hospital. RESULTS: Of the 214 patients with salivary gland tumours, the majority were located in the parotid gland (56.1%). Pleomorphic adenoma was the most common tumour (62.6%). The FNAC sensitivity, specificity and diagnostic accuracy (receiver operating characteristic) were 92.7%, 98.1% and 0.95 respectively. The concordance between salivary gland tumour FNAC and final histology was 96.95% with a Cohen's kappa coefficient of 0.91 (p= 0.0001). CONCLUSION: There is strong concordance between FNAC and histology of salivary gland tumours. FNAC is an accurate, minimally invasive diagnostic tool with high sensitivity and specificity. It provides the clinician with a reliable preoperative diagnosis determining whether the salivary gland tumour is benign or malignant.

South African surgical trainees Master of Medicine dissertation survey.

BACKGROUND: Since 2011, South African specialist registration requires a research component in the form of a Master of Medicine (MMed) degree. The aim of the study was to assess opinion regarding research and the progression and obstacles toward the completion of the research component of the MMed amongst South African surgical registrars. METHODS: One hundred and sixty-eight (24%) from 708 nationally registered surgical registrars participated. The participants completed an electronic survey that focused on research progression timeline, registrar research perspectives, factors affecting research success and obstacles, and interest in future research. RESULTS: There was an expected progression of research with increasing seniority. Forty-two (25%) started their research 6-12 months into their training time. One hundred and ten (66%) were confident their research would be completed timeously. Obstacles to timeous completion included clinical responsibilities with lack of protected research time in 130 (75%) and lack of funding in 46 (28%). From the registrars' perspective, their confidence to complete their research timeously was increased when they had attended a structured research course and had prior research experience. CONCLUSION: Completion of the MMed research component was considered to be hampered by a lack of dedicated time and funding and aided by prior research experience and a structured research training course.

Relationship of depth of invasion to survival outcomes and patterns of recurrence for T3 oral tongue squamous cell carcinoma.

INTRODUCTION: Current research is elucidating how the addition of depth of invasion (DOI) to the 8th edition of the American Joint Committee on Cancer (AJCC) TNM staging for oral cavity squamous cell carcinoma influences its prognostic accuracy. However, there is limited research on survival in pT3N0M0 oral tongue SCC (OTSCC) patients when stratifying by DOI. OBJECTIVES: Determine 5-year overall survival (OS), and cancer-specific survival (CSS) for patients with pT3N0M0 oral OTSCC based on shallow DOI (<10 mm) and deep DOI (10-20 mm). METHODS: Retrospective review involving three tertiary care cancer centers in North America. cT3N0M0 OTSCC patients receiving primary surgical treatment from 2004 to 2018 were identified. Inclusion: age > 18 years old and confirmation of pT3N0M0 OTSCC on surgical pathology. Exclusion: patients undergoing palliative treatment or previous head and neck surgery/radiotherapy. Analysis comprised two groups: shallow pT3 (tumor diameter > 4 cm, DOI < 10 mm) and deep pT3 (DOI 10 mm-20 mm). RESULTS: One hundred and four patients with pT3N0M0 OTSCC were included. Mean age was 59.1 years (range: 18-80.74). Age, gender, and Charlson Comorbidity Index were similar between the two groups (p > 0.05). Recurrence, LVI, PNI, and positive margins were more common in deep T3 tumors (P < 0.05). 5-year OS (50% vs 26%, p = 0.006) and CSS (72% vs 24%, p = 0.005) were worse in deep pT3 tumors. Deep pT3 disease was an independent predictor of OS (p = 0.004) and CSS (p = 0.01) on Cox-Regression analysis. CONCLUSION: DOI is an independent predictor of poor survival in pT3N0M0 OTSCC patients. Consideration should be given to escalating adjuvant therapy for deep pT3N0M0 OTSCC patients.

Correlation between thyroid ultrasound and histology in patients with indeterminate cytology results: a local experience.

BACKGROUND: Thyroid nodules are common. Most patients with indeterminate fine needle aspiration cytology (FNAC) results are subjected to thyroidectomy for fear of malignancy. However, only 20-30% of these cases are found to be malignant. The aim was to determine the value of thyroid ultrasound in diagnosing malignancy in patients with indeterminate fine needle aspiration cytology results in our practice. Fine needle aspiration was performed after ultrasound, thereby preventing architectural distortion of the nodule and to ensure that the most suspicious nodule was biopsied. METHODS: A retrospective review of records of patients who presented to two University of Pretoria academic hospitals, in South Africa, from 2001 to 2015 with nodular thyroid goitre was undertaken. Patients had a thyroid ultrasound scan, FNAC and had undergone thyroid surgery. RESULTS: Records of 104 patients were retrospectively evaluated. Patients were predominantly female (93.3%). Histology report was available for 101 of the 104 patient records. Malignancy was identified in 23 (22.8%). The overall sensitivity and specificity of thyroid image reporting and data system (TIRADS) score in this study were 69.5% and 61.5% respectively. The TIRADS classification had high sensitivity amongst the 26 patients with indeterminate cytology, with sensitivity and specificity of 85.7% and 52.6% respectively, however it was not statistically significant (p = 0.28). CONCLUSION: There was poor identification of malignancy with the use of ultrasound TIRADS classification in cases of indeterminate FNAC results, Bethesda III or IV, in our study. This is probably related to the diversity of ultrasonographers in our practice. It is recommended that there should be a dedicated thyroid ultrasonographer for a better and consistent TIRADS classification that surgeons can rely on for guiding surgical intervention.

Mammary analogue secretory carcinoma: A rare salivary gland tumour.

Mammary analogue secretory carcinoma (MASC) is a rare and recently described tumour of the salivary glands. MASC has similar histomorphological and immunohistochemical features of secretory carcinoma of the breast. MASC can be mistaken for other salivary gland tumours, especially acinic cell carcinoma. A 28-year-old man was diagnosed with a rare salivary gland tumour in Pretoria, South Africa (SA). To our knowledge, a report of MASC in SA has not previously been published. The surgeons dealing with salivary gland tumours should be aware of the clinical presentation. Current treatment is similar to that of other salivary gland malignancies.

Long-term biopsychosocial effects of interleukin-2 therapy.

This three-year project evaluates the biopsychosocial effects of interleukin-2 (IL-2) therapy on the first 45 patients treated with the therapy at the Moses Division of the Montefiore Medical Center in Bronx, NY, starting in April 1986. Therapy with IL-2 and lymphokine-activated killer (LAK) cells is a promising new development but requires an extensive amount of supportive care. Various important issues must be considered in planning the care of patients being treated with IL-2, including the effects of the treatment on quality of life, the cost of resources necessary for providing therapy, and the emotional effects of treatments. The instruments used to measure the various aspects of quality of life were the Sickness Impact Profile, the Inventory of Current Concerns, the Symptom Distress Scale, the Acute Physiology and Chronic Health Evaluation Scale, and the Therapeutic Intervention Scoring System. The researchers believe that, in addition to tumor response, the biopsychosocial and financial effects of treatment should be understood.

Testing hypotheses derived from the Roy Adaptation Model.

This study investigated the role of perception and biopsychosocial adaptation in patients with cancer entering an aggressive cancer treatment program. The Roy adaptation model provided the framework from which hypotheses were derived and tested. The hypotheses proposed that physiological stimuli are translated by the cognator through perception that alters the biopsychosocial responses. Forty-five patients were tested as they entered into the chemotherapy program. The APACHE II was used to measure actual physiological status; the Symptom Distress Profile was used to measure subjects' perceived physiological discomfort, and the Sickness Impact Profile was used to measure subjects' perceived effect of the cancer on their psychosocial adaptation. The results supported the theoretical predictions that perception of symptoms is positively correlated with psychosocial adaptation and not with actual physiological status. In addition, perception of symptoms and psychosocial adaptation were correlated with survival at six months and not with actual physiological status. Discussion of findings addresses theoretical and practice issues.

Methotrexate/fluorouracil scheduling influences normal tissue toxicity but not antitumor effects in patients with squamous cell head and neck cancer: results from a randomized trial.

To test the hypothesis that sequential scheduling of methotrexate (MTX) and fluorouracil (FU) produces a synergistic antitumor effect, we randomized 113 patients with recurrent or locally advanced squamous cell carcinoma of the head and neck to receive MTX-FU either 18 hours apart or simultaneously, with leucovorin rescue. There were 100 patients with locally advanced newly presenting disease and 13 patients with recurrence. Excessive toxicity was observed in the first 11 patients who received MTX 250 mg/m2 administered intravenously (IV) and leucovorin at 36 hours, therefore all subsequent patients received MTX 200 mg/m2 administered IV and leucovorin at 24 hours. FU 600 mg/m2 IV was administered to all patients, and treatment was given on days 1 and 8 of 21-day cycles. The treatment groups were well balanced for known prognostic variables. The response rate was 47.3% (26 of 55) for simultaneous v 44.8% (26 of 58) for sequential therapy. These results exclude a 20% difference in response rate favoring sequential therapy at P = .04. There was no observed difference in survival between the two treatment arms (P = .55) with a minimum follow-up of 8 months. Toxicity was greater in patients who received sequential therapy, and the difference was confined to the gastrointestinal (GI) tract. A comparison of the distribution in maximum Eastern Cooperative Oncology Group (ECOG) toxicity scores during chemotherapy for the two treatment groups showed greater stomatitis (P = .001), diarrhea (P = .04), and overall toxicity (P = .02) for sequential treatment without an observed difference in bone marrow toxicity. The results of this trial indicate that sequential MTX-FU is not superior to simultaneous therapy for the treatment of patients with head and neck cancer. Biochemical modulation of MTX-FU by drug scheduling may occur in vivo and may be organ specific.

Laryngeal lymphoscintigraphy.

A method of studying lymphatic drainage of the larynx was undertaken using radioactive colloids. Sites of injection were the true and false cords, aryepiglottic folds, anterior and posterior commissure, epiglottis and arytenoid. The patient was then scanned with the gamma camera 3 to 5 hours and again 24 hours post injection. Thirty-six patients were injected and results were recorded as to previous X-ray therapy, nodal activity post scanning, ipsilateral or contralateral and distant spread, and the type of radioactive particle--99mTc labeled sulfur colloid, 99mTc microalbumin (200-800 nm diameter), and 99mTc minimicroalbumin (less than 50 nm diameter). The three radiopharmaceuticals gave similar results. Previous X-ray therapy did not alter lymphatic drainage. Of 36 patients, 23 showed nodal activity on scintiscanning: none showed any axillary nor mediastinal activity.

Colostomates' reactions to hospitalization and colostomy surgery.

Six patients having colostomy surgery on an emergency or urgent basis were observed during the morning care period for the entire length of hospitalization. The primary purpose of this clinical study was to provide nurses with information on new colostomates' behaviors which have implications for nursing care during hospitalization and in planning for discharge. The evidence presented strongly suggests that colostomates' reactions and behaviors reflect their struggling with catastrophic events, the resolution of which is not reached by discharge. Colostomates are unique because of the nature of their surgery and the specific learning needs entailed, plus the skill, time, and money required to provide care. Yet their anxieties, fears, affects, the nature of their information-seeking and goal-setting, their efforts to deal with reality by controlling imput, and the ways in which they seek help and socialize, are all themes common among other groups of patients experiencing stress as the result of sudden illness or injury.