Olger de Souza Tornin

Carcinoma de seio maxilar: análise de dez casos

OBJECTIVE: To evaluate the role, especially of computed tomography, in the staging of maxillary sinus carcinomas. MATERIALS AND METHODS: Ten cases of carcinoma treated in Hospital Heliopolis Department of Diagnostic Imaging and Head and Neck Surgery, Sao Paulo, SP, Brazil, in the period between 1988 and 2002, were evaluated. RESULTS: Nine patients presented with tumor extension to the cheek, eight to the masticator space, seven to the mouth floor and hard palate, five to the pterygoid fossa, five to the orbit, three to the ethmoid bone, and one to the skull base. Three of the patients were staged T3, and seven T4. Two patients had lymph nodes metastases at their initial presentation, and were staged T4. All of the cases were histopathologically confirmed. CONCLUSION: The accurate analysis of the tumor local extent and dissemination by means of computed tomography and magnetic resonance imaging plays a relevant role in the surgical planning, besides influencing the therapeutic conduct and prognosis.

Complexo nasossinusal: anatomia radiológica

Este estudo propoe-se a avaliar o complexo nasossinusal, a fim de identificar os principais achados e determinar as doencas desta area. A analise precisa da extensao local e disseminacao tumoral, dada pela tomografia computadorizada e ressonância magnetica, desempenha papel importante no planejamento terapeutico, influenciando tambem o prognostico.

Value of computed tomography for evaluating the subglottis in laryngeal and hypopharyngeal squamous cell carcinoma

CONTEXT AND OBJECTIVE Subglottic involvement in squamous cell carcinoma is a determining factor for contraindicating conservative partial surgery. The subglottis is easily identified by axial computed tomography sections. The present study aimed to evaluate the occurrence of false-negative and false-positive results, and the overall accuracy of staging by computed tomography, in order to detect the involvement of the subglottic laryngeal compartment, in cases of laryngeal and hypopharyngeal squamous cell carcinoma. DESIGN AND SETTING Retrospective, non-randomized study of patients treated at Hospital Heliópolis, São Paulo, Brazil. METHODS Computed tomography scans were performed on third-generation equipment with 5-mm slice thickness. Afterwards, all patients underwent surgical and anatomopathological examinations as the gold standard procedures. RESULTS Among 60 patients, 14 were diagnosed with subglottic extension by surgical and histopathological examination. There were three false-negative and no false-positive results from computed tomography scans. The sensitivity and negative predictive value were 100.0%. Accuracy was 95.0%, specificity was 93.5% and positive predictive value was 82.4%. CONCLUSIONS Computed tomography could serve as a powerful auxiliary method for staging laryngeal and hypopharyngeal cancer. However, precautions should be taken in analyzing computed tomography scan data, because vegetating lesions may also be projected into the subglottic compartment, without real involvement of the subglottis, which may cause a false-positive result.

Assessment of carotid artery invasion by lymph node metastasis from squamous cell carcinoma of aero-digestive tract

UNLABELLED Carotid involvement by metastatic lymph nodes changes the approach in head and neck tumors. AIM To evaluate interobserver agreement by CT scan analysis regarding the involvement of the carotid artery by metastatic lymph nodes from squamous cell carcinoma of the upper aerodigestive tract and its relation to resection criteria. MATERIALS AND METHODS retrospective study of 99 CT images of patients with SCC were evaluated. Eighty-six were males and 13 females, with ages ranging from 32 to 76 years. Four radiologists, without any previous knowledge of the clinical stage, analyzed imaging results. No patients had received previous treatment and histological diagnoses were obtained through biopsy. The carotid artery invasion was classified as simple (0 to 50% and from to 100%), and complex (0 to 25%; 26 to 50%; 51 to 75% and 76 to 100%). The level of interobserver agreement was obtained through Kappa Index (p < 0,05) and the concordance power varied from despicable to excellent. RESULTS The Kappa Index were moderate (0, 53%) for simple classification and minimum (0, 36%) for complex classification. CONCLUSIONS The computed tomography showed low effectiveness in the evaluation of lymph node metastasis resection concerning carotid artery invasion.

Análise da invasão da artéria carótida por metástases linfonodais de carcinoma epidermóide de vias aero-digestivas superiores

Carotid involvement by metastatic lymph nodes changes the approach in head and neck tumors. AIM: To evaluate interobserver agreement by CT scan analysis regarding the involvement of the carotid artery by metastatic lymph nodes from squamous cell carcinoma of the upper aerodigestive tract and its relation to resection criteria. MATERIALS AND METHODS: retrospective study of 99 CT images of patients with SCC were evaluated. Eighty-six were males and 13 females, with ages ranging from 32 to 76 years. Four radiologists, without any previous knowledge of the clinical stage, analyzed imaging results. No patients had received previous treatment and histological diagnoses were obtained through biopsy. The carotid artery invasion was classified as simple (0 to 50% and from to 100%), and complex (0 to 25%; 26 to 50%; 51 to 75% and 76 to 100%). The level of interobserver agreement was obtained through Kappa Index (p < 0,05) and the concordance power varied from despicable to excellent. RESULTS: The Kappa Index were moderate (0, 53%) for simple classification and minimum (0, 36%) for complex classification. CONCLUSIONS: The computed tomography showed low effectiveness in the evaluation of lymph node metastasis resection concerning carotid artery invasion.

Importância da invasão do espaço pré-epiglótico no planejamento terapêutico do câncer da laringe e faringe

O comprometimento do espaco pre-epiglotico pode alterar a indicacao de cirurgias parciais da laringe. OBJETIVO: Avaliar a concordância inter e intra-observadores da analise da tomografia computadorizada do envolvimento do espaco pre-epiglotico (EPE) por carcinoma epidermoide do trato aerodigestivo superior e sua repercussao no planejamento terapeutico. MATERIAL DE METODO: Foram analisadas retrospectivamente as tomografias computadorizadas, do periodo de 1990 a 2004, de 95 pacientes com carcinoma epidermoide, sendo 87 do sexo masculino e apenas 8 eram do sexo feminino, com idade variando de 32 a 73 anos. Os exames foram avaliados duas vezes por tres radiologistas, separadamente, sem o conhecimento previo do estadiamento clinico. Todos os pacientes nao haviam recebido qualquer tratamento ate o momento do exame de imagem, como cirurgia, quimioterapia ou radioterapia. Todos os casos tiveram o diagnostico confirmado por biopsia. As informacoes foram obtidas baseadas na revisao de prontuarios medicos. RESULTADOS: O indice Kappa foi calculado para estimar a concordância entre os tres observadores. A forca de concordância variou de boa a excelente. CONCLUSAO: Apos um Kappa geral de 0,72, o resultado sugere uma concordância geral boa na avaliacao do envolvimento do espaco EPE atraves de tomografia computadorizada.

Tumor do estroma gastrintestinal: achados clínicos, radiológicos e anatomopatológicos

OBJECTIVE: To investigate and describe clinical, radiologic and pathologic findings of gastrointestinal stromal tumors. MATERIALS AND METHODS: In the period between December 2000 and March 2006, 16 patients were submitted to surgery for gastrointestinal stromal tumors in our institution. The following variables were taken into consideration: sex and age, signs and symptoms at presentation, tumor site and size, radiological and pathological features, and presence of metastasis. RESULTS: The study population was constituted by nine men and seven women. The primary tumor sites of origin were: stomach (n = 5), rectum (n = 4), small bowel (n = 3), mesentery (n = 3), and colon (n = 1). Mean primary tumor size was 9 cm. Computed tomography was the main radiological method utilized. Circumscribed, lobulated and heterogeneously contrast-enhanced mass was the main image finding. Metastasis was found in nine patients (56% of cases) at presentation or tumor recurrence was observed during the follow-up period (mean = 32 months). CONCLUSION: Gastrointestinal stromal tumor occurs in middle-age adults and the elderly, and must be taken into consideration as differential diagnosis for abdominal masses. Early diagnosis, adequate therapy, and rigorous follow-up are essential, considering the high probability of malignancy of these neoplasms as demonstrated by the present study.

Actinomicose laríngea: relato de caso

We report a case of a patient with actinomycosis of the larynx mimicking a neoplasm. A literature review, clinical features, pathology and imaging findings is also presented. This paper reports a rare disease occurring in an atypical location, simulating larynx neoplasm. To our knowledge, there is no report of this disease and locations evaluated with computed tomography.

Biópsia pulmonar percutânea guiada por tomografia computadorizada: dados de um hospital

OBJECTIVE: To present the experience of Santa Cecilia Hospital (Sao Paulo, SP, Brazil) radiology service in the handling of computed tomography-guided fine-needle aspiration biopsy and percutaneous core biopsy of pulmonary lesions, analyzing their importance and associated complications. MATERIALS AND METHODS: One hundred and sixty-eight computed tomography-guided biopsies were performed in 84 men and 84 women. Sixty-four patients underwent fine-needle aspiration biopsy, 68 underwent percutaneous core biopsy and 36 patients underwent both techniques. RESULTS: Pneumothorax occurred in 38 patients, and pulmonary hemorrhage in then cases. The biopsied lesions ranged in size from 0.5 to 15 cm. The diagnosis was achieved at the first attempt in 132 cases and at the second attempt in ten cases. CONCLUSION: The accuracy of fine-needle aspiration and percutaneous core biopsies depends both on the size of the lesion and the patients cooperation. These techniques are relatively safe and present a high diagnostic accuracy when performed by an experienced professional.

The importance of pre-epiglottis space invasion in the treatment planning of larynx and hypopharynx cancer

UNLABELLED The involvement of pre-epiglottis space can change the indication for partial laryngeal resection. AIM The aim of this study was to evaluate inter-observer and intra-observer agreement by means of computed tomography analysis regarding the involvement of the pre-epiglottis space (PES) from carcinoma of the upper aerodigestive tract and its relation with therapeutic planning. MATERIALS AND METHODS Retrospective study of ninety-five computed tomography exams of patients with squamous cell carcinoma, from 1990 to 2004, were selected and evaluated; 87 were males and eight females, with ages ranging from 32 to 73 years. Imaging results were analyzed twice by three radiologists, individually, without any previous knowledge of the clinical stage. No patient had received any previous treatment up to the moment of imaging examination, such as surgery, chemotherapy or radiotherapy. All the cases were confirmed by biopsy. Information was obtained from the medical charts. RESULTS Kappa Index was calculated by assessing agreement between the three observers. We obtained substantial to almost perfect levels of agreement. CONCLUSIONS After a general Kappa Index of 0.72, the results suggest a substantial agreement in the involvement of the PES by means of computed tomography analysis.