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This retrospective study evaluated the concordance between fine-needle aspiration cytology and histopathology in parotid gland masses and assessed the diagnostic value of magnetic resonance imaging features.
Methods
Forty-two patients who underwent parotidectomy with available fine-needle aspiration cytology, magnetic resonance imaging, and histopathology results were included. fine-needle aspiration cytology–histopathology agreement was analysed for multicategorical and binary (benign vs. malignant) classifications. Magnetic resonance imaging findings, including signal intensity, contrast enhancement, cystic-like appearance and lesion size, were compared, and predictors of malignancy were evaluated using Firth logistic regression.
Results
Thirty-eight lesions (90.5 per cent) were benign and four (9.5per cent) were malignant. Fine-needle aspiration cytology–histopathology concordance was low for histological subtype differentiation (κ = 0.082) but substantial for benign–malignant distinction (κ = 0.636; p < 0.01). All lesions were T2-hyperintense, and cystic-like appearance was strongly associated with Warthin tumour (p = 0.001; odds ratio 38.5).
Conclusion
No magnetic resonance imaging or clinical variable independently predicted malignancy. Overall, these findings support fine-needle aspiration cytology as the cornerstone of pre-operative evaluation of parotid masses, with magnetic resonance imaging serving primarily for surgical planning.
Ménière’s disease is a chronic inner-ear disease attributed to endolymphatic hydrops. Magnetic resonance imaging with gadolinium allows visualisation of endolymphatic hydrops in vivo and may be an adjunct to diagnosis.
Methods
Thirty-eight patients suspected of having Ménière’s disease underwent T2 weighted three-dimensional fluid-attenuated inversion recovery and true inversion recovery sequence magnetic resonance imaging 4 hours post double-dose intra-venous gadolinium. Presence of endolymphatic hydrops was graded by two radiologists at 0 and 4 months. Correlation to clinical diagnosis was assessed using Fisher’s exact test.
Results
Hydrops was identified in 88 per cent, 17 per cent and 27 per cent of patients with Definite Ménière’s, Probable Ménière’s and Undifferentiated disease, respectively. A significant correlation existed between diagnosis and presence of hydrops. Sensitivity and specificity were 88 per cent and 67 per cent, respectively. Intra- and inter-observer agreement for presence and grading of hydrops was near-perfect and substantial to near-perfect, respectively.
Conclusion
Magnetic resonance imaging demonstrates radiographic hydrops with significant correlation to clinical diagnosis and good intra- and inter-observer agreement.
Despite a lot of scientific advancements in otology, canal wall-down mastoidectomy is still considered to be the standard of care in the management of extensive cholesteatoma. To avoid large cavity related problems, mastoid obliteration has been described in the literature for many decades. Controversy prevails among otologists regarding the materials used for obliteration. This study aimed to evaluate the results of mastoid obliteration and reconstruction of posterior meatal wall after mastoidectomy using ready-to-use, self-setting hydroxyapatite bone cement.
Methods
Retrospective analysis was performed of all consecutive patients who underwent canal wall down mastoidectomies and primary mastoid obliteration with ready-to-use, self-setting hydroxyapatite bone cement. Minimum follow-up was 1 year. Primary Outcome measures include need for explantation and post-operative complications.
Results
Total of 26 patients were included in the study. Only one patient required complete explantation. All patients acquired dry cavities in the final follow-up. Few minor complications including external auditory canal granulations and post-aural wound dehiscence. There was no cholesteatoma recidivism.
Conclusion
Ready-to-use, self-setting hydroxyapatite bone cement serves the purpose of mastoid obliteration. In addition, it is time efficient and requires less expertise. It has excellent outcomes in terms of cholesteatoma recidivism. We recommend further research in this area with a large cohort.
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