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Ultrasonography guided fine needle aspiration cytology in patients with laryngo-hypopharyngeal lesions.

超声引导下喉-下咽病变患者的细针穿刺细胞学检查。

  • 影响因子:1.09
  • DOI:10.1016/j.bjorl.2018.11.005
  • 作者列表:"Parasuraman L","Singh CA","Sharma SC","Thakar A
  • 发表时间:2020-01-01
Abstract

INTRODUCTION:Laryngeal lesions are usually evaluated by microlaryngoscopy/direct laryngoscopy under anaesthesia for disease mapping and tissue diagnosis. However patients with anticipated airway compromise due to laryngeal mass may require either a protective tracheotomy or emergency tracheotomy to secure the airway. To minimise risk of unplanned tracheotomy and expedite the diagnosis we performed ultrasound-guided transcutaneous fine needle aspiration cytology. OBJECTIVE:To evaluate the feasibility and performance of ultrasound-guided transcutaneous fine needle aspiration cytology of suspicious/recurrent laryngo-hypopharyngeal masses. METHODS:Fine needle aspiration cytology was performed under ultrasound guidance. Twenty- four patients were recruited, of which 17 had a pure laryngeal lesion; 6 patients had laryngo-pharyngeal, and one patient had a base tongue lesion with supra-glottis extension. RESULTS:Out of 24 patients, 21 had positive cytology for squamous cell carcinoma, 2 patients had non-diagnostic cytology (atypical cells) and the other had inadequate tissue for definitive diagnosis. Patients with negative and inconclusive cytology underwent direct laryngoscopy biopsy, which was positive for squamous malignancy. All patients tolerated the procedure well and no adverse events were noted. CONCLUSION:Although direct laryngoscopy remains the standard of care in evaluation of laryngo-hypopharyngeal lesions, this pilot study has shown that ultrasound-guided transcutaneous fine needle aspiration cytology was feasible as an out-patient procedure, employing safe and sensitive technique enabling rapid diagnosis and avoiding the need for direct laryngoscopy under GA for tissue diagnosis.

摘要

引言: 喉部病变通常在麻醉下通过显微喉镜/直接喉镜进行疾病定位和组织诊断。然而,由于喉部肿块导致预期气道受损的患者可能需要保护性气管切开或紧急气管切开来保护气道。为了最大限度地降低计划外气管切开的风险,加快诊断,我们进行了超声引导下经皮细针穿刺细胞学检查。 目的: 评价超声引导下经皮细针穿刺细胞学检查可疑/复发性喉-下咽肿块的可行性和性能。 方法: 在超声引导下进行细针穿刺细胞学检查。纳入 24 例患者,其中 17 例为单纯喉部病变; 6 例为喉-咽,1 例为舌根病变伴声门上延伸。 结果: 24 例患者中,21 例为鳞状细胞癌细胞学阳性,2 例为非诊断性细胞学 (非典型细胞),另 1 例组织不足以明确诊断。细胞学检查阴性且不确定的患者进行直接喉镜活检,结果为鳞状细胞癌阳性。所有患者对手术耐受性良好,未观察到不良事件。 结论: 虽然直接喉镜检查仍然是喉咽病变评估的标准护理,这项初步研究表明,超声引导下经皮细针穿刺细胞学检查作为门诊手术是可行的,采用安全敏感的技术,能够快速诊断,避免在GA下直接喉镜进行组织诊断。

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影响因子:1.09
发表时间:2020-01-01
DOI:10.1016/j.bjorl.2018.11.005
作者列表:["Parasuraman L","Singh CA","Sharma SC","Thakar A"]

METHODS:INTRODUCTION:Laryngeal lesions are usually evaluated by microlaryngoscopy/direct laryngoscopy under anaesthesia for disease mapping and tissue diagnosis. However patients with anticipated airway compromise due to laryngeal mass may require either a protective tracheotomy or emergency tracheotomy to secure the airway. To minimise risk of unplanned tracheotomy and expedite the diagnosis we performed ultrasound-guided transcutaneous fine needle aspiration cytology. OBJECTIVE:To evaluate the feasibility and performance of ultrasound-guided transcutaneous fine needle aspiration cytology of suspicious/recurrent laryngo-hypopharyngeal masses. METHODS:Fine needle aspiration cytology was performed under ultrasound guidance. Twenty- four patients were recruited, of which 17 had a pure laryngeal lesion; 6 patients had laryngo-pharyngeal, and one patient had a base tongue lesion with supra-glottis extension. RESULTS:Out of 24 patients, 21 had positive cytology for squamous cell carcinoma, 2 patients had non-diagnostic cytology (atypical cells) and the other had inadequate tissue for definitive diagnosis. Patients with negative and inconclusive cytology underwent direct laryngoscopy biopsy, which was positive for squamous malignancy. All patients tolerated the procedure well and no adverse events were noted. CONCLUSION:Although direct laryngoscopy remains the standard of care in evaluation of laryngo-hypopharyngeal lesions, this pilot study has shown that ultrasound-guided transcutaneous fine needle aspiration cytology was feasible as an out-patient procedure, employing safe and sensitive technique enabling rapid diagnosis and avoiding the need for direct laryngoscopy under GA for tissue diagnosis.

影响因子:2.32
发表时间:2020-01-01
来源期刊:The Laryngoscope
DOI:10.1002/lary.27873
作者列表:["Mohamed ASR","Smith BD","Smith JB","Sevak P","Malek JS","Kanwar A","Browne T","Gunn GB","Garden AS","Frank SJ","Morrison WH","Phan J","Zafereo M","Skinner H","Lai SY","Hutcheson KA","Lewin JS","Hessel AE","Thekdi AA","Weber RS","Fuller CD","Rosenthal DI"]

METHODS:OBJECTIVES:We aim to report oncologic outcomes after conventional radiotherapy (ConRT) using opposed lateral beams and intensity-modulated radiation therapy (IMRT) for tumor (T)1 nodal (N)0 T1 N0 glottic squamous cell carcinoma. STUDY DESIGN:Retrospective case-control study. METHODS:We retrospectively reviewed demographic, disease, and treatment characteristics for patients treated at our institution during 2000 to 2013. RESULTS:One hundred fifty-three patients (71%) were treated using ConRT and 62 (29%) using IMRT. The median follow-up for all patients was 68 months. There was no statistically significant difference in 5-year local control between patients with T1a versus T1b disease (94% vs. 89%, respectively, P = 0.5). Three-year locoregional control for patients treated with ConRT was 94% compared to 97% with IMRT (P = 0.4). Three-year overall survival (OS) for patients treated with ConRT was 92.5% compared with 100% with IMRT (P = 0.1). Twelve of 14 patients with local recurrence underwent salvage surgery with 5-year ultimate locoregional control of 98.5% and 97.1% in the ConRT and IMRT cohorts, respectively (P = 0.7). Multivariate analysis showed age < 60 years (P < 0.0001) and pretreatment Eastern Cooperative Oncology Group performance status <2 (P = 0.0022) to be independent correlates of improved OS. Postradiation cerebrovascular events were in four patients in the ConRT cohort (3%), whereas no patients in the IMRT cohort suffered any events. CONCLUSION:Because the oncologic outcomes for patients treated with IMRT were excellent and IMRT allows for carotid sparing, we have transitioned to IMRT as our standard for most patients with T1 glottic cancer. LEVEL OF EVIDENCE:3b Laryngoscope, 130:146-153, 2020.

翻译标题与摘要 下载文献
影响因子:2.32
发表时间:2020-01-01
来源期刊:The Laryngoscope
DOI:10.1002/lary.27868
作者列表:["Fang TJ","Chuang HF","Chiang HC","Pei YC"]

METHODS:OBJECTIVES/HYPOTHESIS:Wide variation in postinjury functional recovery is a hallmark of unilateral vocal fold paralysis (UVFP), ranging from zero to full recovery. The present study examined the impact of cricothyroid (CT) muscle involvement on recovery using quantitative laryngeal electromyography (LEMG) of the thyroarytenoid-lateral cricoarytenoid (TA-LCA) muscle complex at multiple times postinjury. STUDY DESIGN:Prospective cohort study in a medical center. METHODS:Eighty-one patients with UVFP (37 males and 44 females) received an initial assessment of quantitative LEMG, stroboscope, acoustic voice analysis and 36-Item Short Form Survey quality-of-life questionnaire at 3 to 6 months after UVFP onset and a follow-up assessment at 12 months after UVFP onset. RESULTS:The initial and follow-up assessments were performed at 4.3 ± 1.9 and 12.5 ± 1.3 months after UVFP onset, respectively. The peak turn frequency of the TA-LCA muscle complex on the lesion side was improved at the follow-up (470 ± 294 Hz) compared with the initial assessment (300 ± 204 Hz) (P < .001). Patients were also divided into two groups with (n = 27) and without (n = 54) CT involvement, respectively. TA-LCA muscle complex turn frequency improved in patients without CT involvement (from 277 ± 198 to 511 ± 301 Hz; P < .001), but not in those with CT involvement (from 345 ± 211 to 386 ± 265 Hz; P = .46). Seventy-one of all patients received early intervention with intracordal hyaluronate injection, showing similar therapeutic effects in those with and without CT involvement. CONCLUSIONS:Acute UVFP with combined TA-LCA muscle complex and CT muscle involvement has a poor prognosis, with poorer recovery of TA-LCA muscle complex recruitment. Early interventions should be considered in patients with UVFP with CT involvement. LEVEL OF EVIDENCE:2 Laryngoscope, 130:139-145, 2020.

喉部疾病方向

喉位于呼吸道的上端,与外界环境直接接触,所以可因环境致病因素的影响,发生各种疾病。后补疾病包括包括喉部的感染、异物、外伤、肿瘤等。

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