Identification of residual-recurrent cholesteatoma in operated ears: diagnostic accuracy of dual-energy CT and MRI.

PURPOSE: The aim of this study was to compare the diagnostic accuracy of magnetic resonance imaging (MRI) and dual-energy computed tomography (DECT) to identify residual-recurrent cholesteatoma using the second-look surgery as the reference standard. METHODS: This prospective, institutional review board-approved study included 19 consecutive patients (11 males and 8 females; mean age of 62.2, range 34-80 years). Since five patients were studied bilaterally, a total of 24 ears were evaluated with DECT and MRI between February 2017 and June 2018. Any abnormal middle ear attenuation on high-resolution CT images (HRCT) or DECT color-coded maps, and any abnormal signal on MRI images was evaluated by four experienced radiologists. Diagnostic accuracy values of HRCT, DECT maps and CT numbers (by using receiver operator curves) and MRI were compared. Interobserver and intraobserver agreement were calculated. RESULTS: Residual-recurrent cholesteatoma was diagnosed at surgery in 16/24 ears (66.6%). MRI and DECT revealed a total of 15/16 and 14/16 cholesteatomas, respectively. The sensitivity, specificity, PPV and NPV and accuracy of MRI and DECT were 93.7, 87.5, 93.7, 87.5, and 91.6% and 87.5, 87.5, 93.3, 87.5 and 87.5%, respectively. CT numbers were significantly different between positive (mean 57.6 HU, range - 65, 112 HU) and negative cases (mean 5.4 HU, range - 100, 66 HU) with p < 0.001. The interobserver and intraobserver agreement were k = 0.87 and k = 0.83, respectively. CONCLUSION: DECT may provide an accurate demonstration of residual-recurrent middle ear cholesteatoma.

[Clinical and histological latero-cervical nodal metastases in squamous oropharyngeal carcinoma]. / Metastasi laterocervicali nelle neoplasie squamose del distretto orofaringeo.

The goal of our study was to estimate the presence (or absence) of latero-cervical nodal metastases (pN+), in patients with squamous oropharyngeal cancer, correlating this finding with T stage. We examined 255 patients out of 329 affected by squamous oropharyngeal cancer, from 1976 to 2005. The 255 patients examined were treated surgically (both T and N). As far as clinical latero-cervical nodal metastases were concerned, 215 patients (84%) were cN+, while 40% (16%) were cN-. The result of the histological examination showed that 82% of the neck dissections (both cN+ and cN-) actually had latero-cervical metastases, while the remaining patients had reactive lymph nodes. The false-positive (cN+ -->pN-) patients, were 14% while false-negative patients (cN- -->pN+) amounted to 63%. The correlation between T and pN+ of the patients classified as cN- showed that 24% of patients were T1, 44% T2, 32% T3, and none T4; the pN+ patients, who clinically manifested latero-cervical lymph-node metastases were: T1 8%, T2 15%, T3 37%, T4 40%. Analysis of these data led us to the conclusion that, in view of the high lymphophilia of squamous cancer in the oropharyngeal district, it would be advisable to treat N metastases, both cN+ and cN-, at any T stage of cancer, surgically or with chemo- or radiotherapy, according to the patient's performance status.