ULTRASONOGRAPHY AND COMPUTED TOMOGRAPHY COMPARISON IN ASSESSING THYROID CARTILAGE INVASION IN LARYNGEAL CANCER IN A TERTIARY CARE HOSPITAL

Objective:To study the efcacy of ultrasonography (US) in the assessment of Laryngeal Cancers along with computed tomography (CT). Materials and methods: 30 consecutive patients were undergoing US and CT to stage laryngeal cancer in this study. Two radiologists, who were blinded to the patients' clinical histories and histopathology, evaluated thyroid cartilage invasion on US and CT separately and independently. Result:CT achieved a sensitivity of 86.2% anda specicity of 100%, while USG attained a sensitivity of 62.1%and a specicity of 100%.Association of US ndings vs. HPE was not statistically signicant (p=0.2128).Association of CT Finding vs. HPE was not statistically signicant (p=0.0229). USG and CT compare pretherapeutic stagingaccuracy of laryngeal ca Conclusion: ncers and thereby impacting the management strategy.

Mathematical Models for Intraoperative Prediction of Metastasis to Lymph Nodes in the Hilar-intrapulmonary or the Mediastinal Region in Patients With Clinical Stage I Non-small Cell Lung Cancer: a Retrospective Cohort Study

Background: It remains challenging to determine the regions of metastasis to lymph nodes during operation for clinical stage I non-small cell lung cancer (NSCLC). This study aimed to establish intraoperative mathematical models with nomograms for predicting the hilar-intrapulmonary node metastasis (HNM) and the mediastinal node metastasis (MNM) in patients with clinical stage I NSCLC.Methods: The clinicopathological variables of 585 patients in a derivation cohort who underwent thoracoscopic lobectomy with complete lymph node dissection were retrospectively analysed for their association with the HNM or the MNM. After analysing the variables, we developed multivariable logistic models with nomograms to estimate the risk of lymph node metastasis in different regions. The predictive efficacy was then validated in a validation cohort of 418 patients.Results: It was confirmed that CEA (> 5.75 ng/ml), CYFRA211 (> 2.85 ng/ml), the maximum diameter of tumour (> 2.75 cm), tumour differentiation (grade III), bronchial mucosa and cartilage invasion, and vascular invasion were predictors of HNM, and CEA (>8.25 ng/ml), CYFRA211 (> 2.95 ng/ml), the maximum diameter of tumour (> 2.75 cm), tumour differentiation (grade III), bronchial mucosa and cartilage invasion, vascular invasion, and visceral pleural invasion were predictors of MNM. The validation of the prediction models based on the above results demonstrated good discriminatory power.Conclusions: Our predictive models are helpful in the decision‑making process of specific therapeutic strategies for the regional lymph node metastasis in patients with clinical stage I NSCLC.

CT-based radiomics features in the prediction of thyroid cartilage invasion from laryngeal and hypopharyngeal squamous cell carcinoma

Background Laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC) with thyroid cartilage invasion are considered T4 and need total laryngectomy. However, the accuracy of preoperative diagnosis of thyroid cartilage invasion remains lower. Therefore, the purpose of this study was to assess the potential of computed tomography (CT)-based radiomics features in the prediction of thyroid cartilage invasion from LHSCC. Methods A total of 265 patients with pathologically proven LHSCC were enrolled in this retrospective study (86 with thyroid cartilage invasion and 179 without invasion). Two head and neck radiologists evaluated the thyroid cartilage invasion on CT images. Radiomics features were extracted from venous phase contrast-enhanced CT images. The least absolute shrinkage and selection operator (LASSO) and logistic regression (LR) method were used for dimension reduction and model construction. In addition, the support vector machine-based synthetic minority oversampling (SVMSMOTE) algorithm was adopted to balance the dataset and a new LR-SVMSMOTE model was constructed. The performance of the radiologist and the two models were evaluated with receiver operating characteristic (ROC) curves and compared using the DeLong test. Results The areas under the ROC curves (AUCs) in the prediction of thyroid cartilage invasion from LHSCC for the LR-SVMSMOTE model, LR model, and radiologist were 0.905 [95% confidence interval (CI): 0.863 to 0.937)], 0.876 (95%CI: 0.830 to 0.913), and 0.721 (95%CI: 0.663–0.774), respectively. The AUCs of both models were higher than that of the radiologist assessment (all P < 0.001). There was no significant difference in predictive performance between the LR-SVMSMOTE and LR models (P = 0.05). Conclusions Models based on CT radiomic features can improve the accuracy of predicting thyroid cartilage invasion from LHSCC and provide a new potentially noninvasive method for preoperative prediction of thyroid cartilage invasion from LHSCC.

CHARACTERISTICS AND SPREAD PATTERN OF LARYNGEAL CARCINOMA : A TERTIARY CARE STUDY

INTRODUCTION Laryngeal cancer is the eighteenth most common cancer in the UK. It has strong socioeconomic association, wide geographical variations. This study is highly relevant in India where factors like poor socio-economic conditions, oral consumption of tobacco in its various forms, alcohol, smoking habits in form of beedi and cigarette, lack of awareness about cancer, negligence towards the symptom of voice change and primary treatment from quacks , are highly prevalent. MATERIALS AND METHODOLOGY This prospective cohort study was carried out at Tertiary care Hospital over a period of 1 year 4 months( April 2018 to July 2019). Patients attending at our OPD with symptoms of horseness, dysphagia, stridor and other symptoms of Laryngeal Carcinoma were subjected to detailed clinical examination including FOL to confirm the presence of any growth. All patients with growth or vocal cord irregularity or any suspicious lesions underwent biopsy. Socio-demographic, risk factors , characteristics of primary tumor- endoscopic, radiological and histopathological and spread pattern and node status analysed. RESULTS Major bulk of patients belonged to 55-74 years (combined). The mean age of diagnosis is 66.06 years.Males were affected more than females (7.57:1).Majority of patients were farmers (57%) and majority 45(75%) belonged to rural areas. Most patients belonged to low socioeconomic class 30 (50%).Smoke tobacco and smoke tobacco plus alcohol were the major risk factors for laryngeal carcinoma.Majority of patients presented with dysphagia (75%), followed by foreign body sensation (72%), hoarseness (67%), Neck swelling (50%). Cartilage invasion was present among 25% of cases , Both pre-epiglottic and paraglottic space involvement was around 18% and exolaryngeal spread present in 8% of cases.Among them 100% cases delayed symptom recognition was present. 50% cases was attributed due to socio-demographic pattern, 33% due to pshycosocial and behavioural (anxiety) and 13% due to delay in practitioner referral.Among Proliferative and Ulceroproliferative N+ is more than N0.Both moderately differentiated and poorly differentiated had more percentage of N+.In Supraglottic tumor Pre-epiglottic space, Paraglottic Space and cartilage invasion was present in equal proportions. In glottic tumor cartilage invasion and exolaryngeal spread was more common. CONCLUSION Supraglottic tumor being common have tendency for lymphatic spread. It mainly presents with dysphagia and hoarseness later. Majority of patients were diagnosed in stage III and stage IV. This is not desirable and causes for delayed diagnosis must be addressed publicly. Early stage tumor have excellent prognosis with advent of radiotherapy and surgical morbidities can be avoided. The HPE reveals high grade of differentiation is associated with low node status. CT features serve as an excellent tool in identifying spread and node involvement and also management protocol.