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Biomedical subjects

J A Castelijns

Publications and source records attributed to J A Castelijns.

15 recordsLinked to original sources
PubMed1992

Radioimmunoscintigraphy of head and neck cancer using 99mTc-labeled monoclonal antibody E48 F(ab')2.

The diagnostic value of 99mTc-labeled monoclonal antibody E48 F(ab')2 (750 MBq, 1 mg) was evaluated in 10 patients with a histologically proven squamous cell carcinoma of the head and neck and with clinical evidence of cervical lymph node involvement. Preoperative findings on lymph node status obtained by radioimmunoscintigraphy (RIS), computerized tomography, magnetic resonance imaging, and palpation were defined per side (left and/or right side of the neck) as well as per lymph node level (I through V) and compared with the histopathological outcome of the neck dissection specimen. In 10 patients, all 8 known tumors at the primary site were detected by RIS. Furthermore, RIS was correct in 13 of 13 tumor involved neck sides and in 17 of 20 tumor involved lymph node levels. False-negative observations comprised 3 levels containing tumor deposits smaller than 1 cm in diameter, 2 of which were not detected by any other diagnostic modality. Palpation, computerized tomography, and magnetic resonance imaging were correct in, respectively, 13, 15, and 15 of the 20 tumor involved levels. There were 2 false-positive observations with monoclonal antibody E48 and 3 with palpation. No false-positive detections occurred with computerized tomography or magnetic resonance imaging. In two of the patients, RIS provided clinically important information which was not provided by any other diagnostic method. In one patient, recurrence of laryngeal carcinoma was established at the primary site after previous radiotherapy. In another patient, bilateral instead of unilateral lymph node involvement became apparent. These preliminary data indicate that radioimmunoscintigraphy with monoclonal antibody E48 may be helpful in the diagnosis of metastatic and recurrent head and neck cancer.

Adolescent↗
PubMed1991

Magnetic resonance imaging vs palpation of cervical lymph node metastasis.

In a series of 100 patients with head and neck carcinoma, the preoperative histopathologic findings of palpation and magnetic resonance imaging were compared with regard to both laterality and lymph node level (I through V). The overall error for palpation in detecting affected sides was 32%. Gadolinium-enhanced magnetic resonance images reliably upgraded 60% of the clinically negative necks, the overall error of magnetic resonance imaging being 16%. However, for both modalities, the sensitivity per level was too low to allow for selective neck dissections in case of only one positive level. These findings show that apart from primary tumor grading, magnetic resonance imaging can improve the preoperative grading of cervical lymph nodes. In selected cases, this may change the treatment plan to a "wait-and-see" policy or a more conservative type of neck dissection.

Aged↗
PubMed1991

Lymph node staging in patients with clinically negative neck examinations by ultrasound and ultrasound-guided aspiration cytology.

To assess the usefulness of ultrasound and ultrasound-guided fine-needle aspiration cytology in detecting occult cervical lymph node metastases, 107 patients with squamous cell carcinoma of the head and neck, who underwent 132 elective neck dissections, had preoperative ultrasound examination. During the assessment of the last 54 patients, who underwent 70 elective neck dissections, ultrasound-guided aspiration cytology was available. Although ultrasound was able to detect lymph node metastases in the majority of patients, the accuracy of this technique never exceeded 70% (93 of 132 procedures). With ultrasound-guided aspiration cytology, accuracy was 89% (62 of 70 procedures). This latter technique seems to be the modality of choice for the assessment of the clinically negative neck. Its use obviates the need for elective neck dissection, done because of the high risk of occult metastasis.

Biopsy, Needle↗
PubMed1991

Diagnostic radiology of head and neck oncology.

The rapid development of computed tomography and magnetic resonance imaging has resulted in numerous applications of these modalities in head and neck oncology. In the past year further refinements in diagnostic capabilities have been obtained in magnetic resonance imaging. Computed tomography is rapidly being replaced by magnetic resonance imaging as the study of choice in the majority of lesions in the larynx, pharynx, tongue, paranasal sinuses, and parapharyngeal space. Magnetic resonance imaging, ultrasound-guided fine-needle aspiration cytology, and in potential radioimmunolocalization of cancer deposits by monoclonal antibodies have great value for the detection of lymph node metastasis in the neck. Because more effective locoregional treatment has been developed, there is an increasing interest in the early diagnosis of distant metastases. The value of new technologies such as three-dimensional imaging and spectroscopy for imaging of primary tumors must be assessed.

Head and Neck Neoplasms↗
PubMed1991

Occult metastatic neck disease: detection with US and US-guided fine-needle aspiration cytology.

The authors performed a prospective study of the value of ultrasonography (US) and US-guided fine-needle aspiration cytology (FNAC) for assessment of N0 lesions in the neck. Preoperative US was performed in 107 patients with squamous cell carcinoma of the head and neck, who underwent 132 elective neck dissections. During the US examination of the last 54 patients, who underwent 70 elective neck dissections, US-guided FNAC was performed. US alone was found to be an unreliable method for detecting occult lymph node metastasis; the accuracy never exceeded 70% (93 of 132), with a sensitivity of 60% (32 of 53) and a specificity of 77% (61 of 79). In contrast, US-guided FNAC had an accuracy of 89% (62 of 70), a sensitivity of 76% (25 of 33), and a specificity of 100% (37 of 37). Because of the high sensitivity and specificity of US-guided FNAC for the assessment of the N0 neck, this modality may play an important role in directing treatment of these patients in the future.

Biopsy, Needle↗
PubMed1990

MR findings of cartilage invasion by laryngeal cancer: value in predicting outcome of radiation therapy.

Thirty-nine patients who underwent radiation therapy with curative intent for laryngeal cancer were examined before treatment with magnetic resonance (MR) imaging, between November 1985 and January 1987. MR findings of cartilage invasion were correlated with the effectiveness of radiation treatment. Adequate interpretation of the MR examinations was not possible in four cases (10%). Cartilage invasion was found in 16 of the 35 remaining patients and was found even in small glottic lesions, clinically staged as T1b and T2. Laryngeal cancer recurred in 10 of the 16 patients with cartilage invasion shown by MR imaging. The presence of even small foci of invasion of the thyroid cartilage by laryngeal cancer appeared to increase the subsequent risk of tumor recurrence. Cartilage invasion seen at MR imaging might therefore shift the preference to partial laryngectomy as the initial treatment for small glottic tumors. Alternatively, radiation therapy alone would appear to require stringent follow-up to detect possible recurrence.

Adult↗
PubMed1990

Cervical lymph node metastasis: assessment of radiologic criteria.

To estimate the accuracy of different radiologic criteria used to detect cervical lymph node metastasis in patients with head and neck carcinoma, seven different characteristics of 2,719 lymph nodes in 71 neck dissection specimens from 55 patients were assessed. Three lymph node diameters, their location, their number, the presence of a tumor, and the amount of necrosis and fatty metaplasia were recorded. The minimal diameter in the axial plane was found to be the most accurate size criterion for predicting lymph node metastasis. A minimal axial diameter of 10 mm was determined to be the most effective size criterion. The size criterion for lymph nodes in the subdigastric region was 1 mm larger (11 mm). Groups of three or more borderline nodes were proved to increase the sensitivity but did not significantly decrease the specificity. Radiologically detectable necrosis (3 mm or larger) was found only in tumorous nodes and was present in 74% of the positive neck dissection specimens. Shape was not a valuable criterion for the radiologic assessment of the cervical lymph node status.

Carcinoma, Squamous Cell↗
PubMed1989

[Diagnosis of laryngeal carcinoma using proton spin resonance tomography].

Seventy-eight patients were investigated by magnetic resonance (MR) imaging using optimal scan parameters and a surface coil. Forty-two patients were also examined by computer tomography (CT). Sixteen patients underwent laryngectomy. MR imaging of cancerous tissue in the larynx, and particularly of non-invaded and invaded cartilages, was examined by comparing MR images with sliced surgical specimens. Pre-operative CT and MRI findings were evaluated by comparing them with postoperative histopathological findings. MR T1-weighted images demonstrate localisation and extent of cancerous tissue. With combined use of T1-weighted and proton-density images MR imaging is superior to CT for showing cartilage invasion. Unfortunately, gross movement artifacts, which resulted in non-diagnostic images, occurred in 16% of the examinations.

Aged↗
PubMed1988

Invasion of laryngeal cartilage by cancer: comparison of CT and MR imaging.

Forty-two patients with laryngeal carcinomas were examined with computed tomography (CT) and magnetic resonance (MR) imaging. The accuracy of both CT and MR imaging in the depiction of cartilage invasion was evaluated in 16 patients by comparing findings at CT and MR with pathologic findings. Calcified cartilage that has been invaded by cancer is frequently seen on CT scans as having an intact contour. Tumor approaching nonossified cartilage may simulate cartilage invasion. On T1-weighted MR images, invaded marrow of ossified cartilage is of intermediate signal intensity, allowing it to be differentiated from normal bone marrow. On proton-density images, tumor is of increased signal intensity, which allows it to be differentiated from nonossified cartilage. In our experience, the specificities of CT and MR imaging were approximately equal (91% and 88%, respectively), but CT had a considerably lower sensitivity than MR (46% vs. 89%). Gross movement artifacts, which resulted in nondiagnostic images, occurred in 16% of the MR examinations. MR imaging is recommended as the modality of choice in the diagnosis of cartilage invasion.

Aged↗
PubMed1987

MRI of normal or cancerous laryngeal cartilages: histopathologic correlation.

MRI appearances of laryngeal cartilages, normal or invaded by cancer, are still relatively unfamiliar to most clinicians. Twelve primary laryngeal tumors out of a series of 65 patients which have been investigated by MRI were examined postoperatively by macroscopic and microscopic sectioning of the surgical specimens. Images were obtained with a 0.6 Tesla superconductive system using a solenoid surface coil. The authors emphasize the value of a combined use of T1-weighted and balanced (relatively T2-weighted images with still T1-characteristics) Spin Echo images. T1-weighted images permit differentiation between pathological and normal bone marrow. Balanced images allow separation between nonossified cartilage and tumor tissue. MRI is an additional tool in the diagnostic workup of cartilage invasion by tumor.

Aged↗
PubMedDate not supplied

MR imaging of the normal larynx.

Magnetic resonance imaging of the larynx was performed on 15 volunteers. Searching for optimal images in the sagittal, frontal, and transverse planes, we compared images made with a special surface coil and the standard head coil, images with different slice thicknesses, images with different repetition times (TR) and images with different matrices. The field of view and the scan times were kept as small as possible. Using a surface coil, we obtained high resolution images in all three planes. These images provide clinically relevant information, not shown by current radiological techniques: hyoepiglottic ligament, thyrohyoid ligament, thyroepiglottic ligament and cricothyroid ligament, the borders between the preepiglottic space and both paraglottic spaces (PGS), the borders between both PGS and thyroid cartilage, and the vocalis and thyroarytenoid muscles. Short TR is preferred because, with shorter scan time, more measurements could be made. Images with a 128 X 128 matrix size had a much better signal-to-noise ratio than images with a 256 X 256 matrix size. Magnetic resonance has great potential in imaging normal and pathological anatomy of the larynx.

Adult↗
PubMedDate not supplied

MR imaging of laryngeal cancer.

Forty-four consecutive patients with laryngeal carcinomas presenting at different stages of the disease were investigated by magnetic resonance (MR) imaging. Twelve patients (six with primary lesions and six with recurrent tumors) underwent laryngectomy, and the macro- and microscopic appearance of the slice specimens were correlated with MR imaging. In the remaining patients surgery was not performed, and MR results are compared with the laryngoscopic findings. Cancerous tissue was seen on T1-weighted images as a homogeneous mass of intermediate signal intensity. slightly higher than infrahyoid muscles. The MR examinations failed mainly in patients with tumor recurrence who had undergone previous radiation treatment.

Aged↗
PubMedDate not supplied

Detection and characterization of metastatic cervical adenopathy by MR imaging: comparison of different MR techniques.

Thirty-five patients scheduled to undergo a neck dissection for squamous cell carcinoma of the head and neck were evaluated preoperatively by magnetic resonance (MR) imaging. Axial and occasionally sagittal and coronal images were obtained. To define the most reliable technique to detect cervical lymph node metastasis, we compared several MR pulse sequences with and without Gd-DTPA administration to histopathologic findings in the neck dissection specimens. T1-weighted spin echo combined with T2-weighted gradient recalled echo (GE) sequences were found to be more useful than any other combination of pulse sequences in localizing lymph nodes. On T2-weighted GE images, lymph nodes were depicted with intermediate to high signal intensity in contrast to low signal muscular and fatty tissue. Gadolinium DTPA enhanced T1-weighted GE images reliably depict central lymph node necrosis, the most specific criterion for lymph node metastasis.

Adult↗