![INTRODUCTION
• Chronic cervical lymphadenopathy is a reasonably common clinical problem in our
community. The cervical lymph nodes, which drain the head, neck, and the portion of
the chest, are representative lymph node of the body.[1]
• Chronic painless lymphadenopathy may be due to tuberculosis (TB) or secondary to
malignant diseases like squamous cell carcinoma.[2]
Other differential diagnoses include
chronic nonspecific inflammation and lymphoma.
• Cervical lymph node metastasis effect one out of every five patients with cancer of
larynx, oral cavity, oropharynx, hypopharynx, and nasopharynx.
• A high-profile index of speculations is required for the diagnosis of TB cervical
lymphadenopathy.
• A comprehensive history and physical examination, tuberculin test, microbial staining,
radiological examination, fine needle aspiration, and biopsy are required for early
‑
diagnosis.](https://image.slidesharecdn.com/acomparativestudyofclosedversusopenhaemorrhoidectomyppt-250404183637-23dc0f22/85/A-comparative-study-of-closed-versus-open-haemorrhoidectomy-ppt-pptx-6-320.jpg)
![It is important to discriminate tuberculous from nontuberculous mycobacterial cervical
lymphadenopathy because their treatment procedures are different. Tuberculous adenitis
is excellently treated as a systemic disease with antituberculosis medication.[3-5]
For the evaluation of cervical lymphadenopathy, different techniques are used which
include automatic core needle biopsy, fine needle aspiration cytology (FNAC), flow
‑
cytometry, open biopsy, and radiologically guided core needle biopsy.[6]
Conventionally,
open cervical lymph node biopsy has played a significant role in the diagnosis of cervical
lymphadenopathy, especially the atypical mycobacterium TB.
The identification of lymphadenopathy by excision of a gland requires anesthesia and
may result in complications. FNAC does not require anesthesia, is easy to perform, and
is safe. Its diagnostic efficacy, particularly in tubercular lymphadenitis, has been reported
to be as high as histopathology.[7
Open biopsy is frequently performed for the diagnostic purpose, when FNAC (for
unexplained cervical lymphadenopathy) yields a nondiagnostic or inconclusive result.](https://image.slidesharecdn.com/acomparativestudyofclosedversusopenhaemorrhoidectomyppt-250404183637-23dc0f22/85/A-comparative-study-of-closed-versus-open-haemorrhoidectomy-ppt-pptx-7-320.jpg)
![Tissue sample sufficiency for diagnostic purpose is the advantage of open biopsy.
However, there are several disadvantages linked to open biopsy including increased
infection risk, very invasive, nerve and vascular injury, and scarring are all disadvantages.
Aside from these, an open biopsy is a expensive procedure because it requires the use of
an operation theater, including a delay in diagnosis followed by a delay in therapy due to
the need to plan the operation theater in advance and sensitivity to general anesthesia. In
addition, open biopsy puts up with a threat of tumor seeding and can infringe on a
potential surgical field, causing surgical treatment more complex.[8]
Over the past 10 years, FNAC has gained a more important role than open biopsy in the
diagnosis of cervical lymphadenopathy with high sensitivity and specificity. The purpose
of this study was to compare the diagnostic accuracy of the both two approaches so that
a technique could be offered to the patients with cervical lymphadenopathy in future.
It was found that, Although FNAC is a quick, safe, reliable, and cost effective diagnostic
‑
techniques for lymphadenopathies, it is important to keep in mind the limitations of the
procedure.](https://image.slidesharecdn.com/acomparativestudyofclosedversusopenhaemorrhoidectomyppt-250404183637-23dc0f22/85/A-comparative-study-of-closed-versus-open-haemorrhoidectomy-ppt-pptx-8-320.jpg)
![RESULTS
• Hundred patients with a diagnosis of cervical lymphadenitis were included in the study
in two groups. Both groups had FNAC followed by an open biopsy of the cervical
lymph nodes. The mean age of the patients was 30.52 + 8.69 years [range 12–70]. Out of
all 59 (59%) patients were male and 41 (41%) female [Table 1]. The female-to-male ratio
was 1:1.4 [Figure 1].
• Histopathology (gold standard) based diagnosis after open biopsy
‑
• The histopathology reports resulted in the diagnosis of TB in 54 (54%) patients, non -
Hodgkin’s lymphoma (NHL) in 14 (14%) patients, Hodgkin’s lymphoma in 4 (4%)
patients, metastatic carcinoma (MC) in 16 (16%) patients, reactive hyperplasia (RH) in 2
(2%) patients, and chronic nonspecific lymphadenitis (CNL) in 3 (3%) patients [Tables 2
and 3].](https://image.slidesharecdn.com/acomparativestudyofclosedversusopenhaemorrhoidectomyppt-250404183637-23dc0f22/85/A-comparative-study-of-closed-versus-open-haemorrhoidectomy-ppt-pptx-11-320.jpg)
A comparative study of closed versus open haemorrhoidectomy ppt.pptx
- 1. • Dr.M.SOMASEKHARAIAH • PGY1 GENERAL SURGERY • SVRRGGH TIRUPATI based on the work by: • Arshad S, Arif A, Shakeel M, Zahra M, Mehwish R, Riaz A, et al. Fine-needle aspiration cytology versus open biopsy for the diagnosis of chronic cervical lymphadenopathy. Biomed Biotechnol Res J 2023;7:67-71. Fine needle Aspiration Cytology versus Open Biopsy ‑ for the Diagnosis of Chronic Cervical Lymphadenopathy
- 2. ABSTRACT • For the diagnosis of cervical lymphadenopathy, an open biopsy is recommended. When compared to open biopsy, fine needle aspiration ‑ cytology (FNAC) is considered safe, less invasive, and cost effective. ‑ However, its diagnostic efficacy remains in debates. This study was conducted to know that how accurately FNAC can detect the pathology as compared to an open biopsy. The purpose of this study was to assess the diagnostic efficacy of FNAC versus open biopsy in the diagnosis of cervical lymphadenopathy.
- 3. ABSTRACT(contd) • Methods: It is a comparative study at Lahore General Hospital, Lahore, for 6 months. The study comprised 100 patients who had been diagnosed with chronic cervical lymphoma. All of the patients underwent FNAC, which was followed by an open biopsy. Calculating the sensitivity, specificity, and diagnostic accuracy of each technique was used to determine the diagnostic efficacy of the both techniques. .
- 4. ABSTRACT(contd) • Results: FNAC had a sensitivity and specificity of 92% overall. Non- Hodgkin’s lymphoma, tuberculosis, Hodgkin’s lymphoma, metastatic carcinoma, reactive hyperplasia, and chronic nonspecific lymphadenopathy had a diagnostic accuracy of 96.2%, 85.7%, 100%, 87.5%, 100%, and 100%, respectively.
- 5. ABSTRACT(contd) • Conclusions: In the management of cervical lymphadenopathy, FNAC is a reliable and safe procedure with a high diagnostic efficacy. It should be used as the first line of examination.
- 6. INTRODUCTION • Chronic cervical lymphadenopathy is a reasonably common clinical problem in our community. The cervical lymph nodes, which drain the head, neck, and the portion of the chest, are representative lymph node of the body.[1] • Chronic painless lymphadenopathy may be due to tuberculosis (TB) or secondary to malignant diseases like squamous cell carcinoma.[2] Other differential diagnoses include chronic nonspecific inflammation and lymphoma. • Cervical lymph node metastasis effect one out of every five patients with cancer of larynx, oral cavity, oropharynx, hypopharynx, and nasopharynx. • A high-profile index of speculations is required for the diagnosis of TB cervical lymphadenopathy. • A comprehensive history and physical examination, tuberculin test, microbial staining, radiological examination, fine needle aspiration, and biopsy are required for early ‑ diagnosis.
- 7. It is important to discriminate tuberculous from nontuberculous mycobacterial cervical lymphadenopathy because their treatment procedures are different. Tuberculous adenitis is excellently treated as a systemic disease with antituberculosis medication.[3-5] For the evaluation of cervical lymphadenopathy, different techniques are used which include automatic core needle biopsy, fine needle aspiration cytology (FNAC), flow ‑ cytometry, open biopsy, and radiologically guided core needle biopsy.[6] Conventionally, open cervical lymph node biopsy has played a significant role in the diagnosis of cervical lymphadenopathy, especially the atypical mycobacterium TB. The identification of lymphadenopathy by excision of a gland requires anesthesia and may result in complications. FNAC does not require anesthesia, is easy to perform, and is safe. Its diagnostic efficacy, particularly in tubercular lymphadenitis, has been reported to be as high as histopathology.[7 Open biopsy is frequently performed for the diagnostic purpose, when FNAC (for unexplained cervical lymphadenopathy) yields a nondiagnostic or inconclusive result.
- 8. Tissue sample sufficiency for diagnostic purpose is the advantage of open biopsy. However, there are several disadvantages linked to open biopsy including increased infection risk, very invasive, nerve and vascular injury, and scarring are all disadvantages. Aside from these, an open biopsy is a expensive procedure because it requires the use of an operation theater, including a delay in diagnosis followed by a delay in therapy due to the need to plan the operation theater in advance and sensitivity to general anesthesia. In addition, open biopsy puts up with a threat of tumor seeding and can infringe on a potential surgical field, causing surgical treatment more complex.[8] Over the past 10 years, FNAC has gained a more important role than open biopsy in the diagnosis of cervical lymphadenopathy with high sensitivity and specificity. The purpose of this study was to compare the diagnostic accuracy of the both two approaches so that a technique could be offered to the patients with cervical lymphadenopathy in future. It was found that, Although FNAC is a quick, safe, reliable, and cost effective diagnostic ‑ techniques for lymphadenopathies, it is important to keep in mind the limitations of the procedure.
- 9. METHODS It was a comparative study conducted at the Lahore General Hospitals Department of Surgery, Lahore, this study comprised a total of 100 patients. The duration of the study was 6 months. Type of sampling The sampling technique was simple random (random table method). The patients above 12 years presenting with undiagnosed chronic cervical lymphadenopathy were included in the study and the children under 12 years were excluded from the study. Data collection procedure and ethical issue All patients were explained about the procedures (FNAC and open biopsy) and their written consent was taken. The patients were asked a lot of questions about their neck inflammation. Detailed clinical examinations were done, noting the site, size, shape, consistency, and matting of the affected cervical lymph nodes. .
- 10. Other systemic and general examinations especially for extra cervical lymph node, hepatomegaly and/or splenomegaly, ascites, jaundice, bleeding tendency, and skin rash were carried out in all patients . Data analysis procedure The data were entered and analyzed using SPSS version16.0 (statistical package for social sciences). Sensitivity and specificity of both open biopsy and FNAC techniques were calculated. The ability of the test to precisely recognize those who had the disease out of the total diseased population was called sensitivity. Specificity refers to a test’s capacity to correctly identify people who do not have the disease within the healthy (un-diseased) population.
- 11. RESULTS • Hundred patients with a diagnosis of cervical lymphadenitis were included in the study in two groups. Both groups had FNAC followed by an open biopsy of the cervical lymph nodes. The mean age of the patients was 30.52 + 8.69 years [range 12–70]. Out of all 59 (59%) patients were male and 41 (41%) female [Table 1]. The female-to-male ratio was 1:1.4 [Figure 1]. • Histopathology (gold standard) based diagnosis after open biopsy ‑ • The histopathology reports resulted in the diagnosis of TB in 54 (54%) patients, non - Hodgkin’s lymphoma (NHL) in 14 (14%) patients, Hodgkin’s lymphoma in 4 (4%) patients, metastatic carcinoma (MC) in 16 (16%) patients, reactive hyperplasia (RH) in 2 (2%) patients, and chronic nonspecific lymphadenitis (CNL) in 3 (3%) patients [Tables 2 and 3].
- 14. One week after surgery all patients experienced mild to moderate pain in closed group, whereas in the open group 1 patient (3.3%) did not experience any pain. * There was no much difference that patient experienced excruciating pain in open group than in the closed group Pain Open hemorrhoidectomy Closed hemorrhoidectomy None 1(3.3%) 0 Mild(1-4) 5(16.6%) 2(6.6%) Moderate(5-7) 16(53.3%) 18(60%) Excruiating(8-10) 8(26.6%) 10(33.3%) Table 3: Pain one week after surgery.
- 15. *The mean time until the patients were pain free after surgery was 21 days in the open group and 22 days in closed group, signifies no difference. *No patient suffered excessive postoperative bleeding. *There were four reoperations for bleeding, all after Milligan-Morgan operations. *A small proportion of patients required catheterization and there was no significant difference incontinence between the two groups. *At follow-up after three weeks 78 percent of the Ferguson patients had completely healed wounds, and none had signs of infection. * Of the Milligan-Morgan patients, only 26 percent had completely healed wounds, and symptoms of delayed wound healing were significantly more frequent
- 16. DISCUSSION Hemorrhoids is a common disease and common in female, but the male:female ratio in our study was found to be higher than in study by Arbman G et al. • In the present study, we found that more number of patients presented with hemorrhoids in the age group of 31 to 50 years. • Hemorrhodectomy was done by two methods open (Milligan-Morgan) and closed (Ferguson) hemorrhoidectomy. • Most of the patients experienced pain following hemorrhoidectomy but it was more in closed group than those who underwent open hemorrhoidectomy. • More emphasis has been applied to the management of pain after haemorrhoidectomy, not only because of the pain but also because of its role in urinary symptom.
- 17. The cases of urinary retention observed in our study (9.23%) are less than those indicated by Toyonaga et al, Pescatori (21.9%), and they are near the data provided by Chik et al, (7.77%) in a study on stapled hemorrhoidopexy. • Pain perception after first bowel movement, there were more patients that experienced excruciating pain in the closed group than in the open group (20 versus 12). • One week after surgery 1 patient (3.3%) in the open hemorrhoidectomy group did not experience any pain, whereas in the closed group all patients experienced mild or moderate pain. • The Ferguson closed haemorrhoidectomy has reportedly been associated with less post-operative discomfort, faster healing, intact postoperative continence, and no need for subsequent anal dilation.
- 18. Wound healing was considerably faster in patients operated on by the Ferguson technique. In the present study more patients (78%) had completely healed wounds following closed hemorrhoidectomy as compared to (26%) open group after three weeks. In study conducted by Arbman G et al, You SY et al, wound healing following closed hemorrhoidectomy was 75% and 86% respectively and healing rates following open hemorrhoidectomy were 18% in both studies. In yet another prospective, randomized trial, Gencosmanoglu et al reported that the open technique is more advantageous, in that patients experience less discomfort during the early post-operative period, although the healing time was shorter with the closed technique. A higher rate ofwound healing was noted following closed hemorrhoidectomy as compared to open in all the studies.
- 19. *Hospital stay was less in closed hemorrhoidectomy but regular follow up revealed common complaint as pain in closed haemorrhoidectomy. • In the present study, the average hospital stay for patients in open group was 5.4 days and closed group was 4.2 days. * The shorter duration of stay in hospital, cost effectiveness and reliable outcome improves the patient compliance
- 20. CONCLUSION The post-operative pain was significantly low in the open compared to closed haemorrhoidectomy group. Closed hemorrhoidectomy leads to faster wound healing. Both methods are fairly efficient treatment for hemorrhoids, without serious drawbacks.
- 21. 1. Goligher JC. Surgery of the arms, rectum and colon, 5 th ed. London: Bailliere Tindall; 1984 2. Sandhu PS, Singh K. A randomized comparative study of micronized flavonoids and rubber band ligation in the treatment of acute internal haemorrhoids. Indian J Surg. 2004;66:281-5 3. . Orlay G. Haemorrhoids: a review. Aust Fam Phy. 2003;32:523-6. 4. . Hartlay GC. Rectal bleeding. Aust Fam Phy. 2000;29:829-33. 5. . Watson N, Liptrott S, Maxwell-Armstrong C. A prospective audit of early pain and patient satisfaction following out-patient band ligation of haemorrhoids. Ann Royal Coll Surg England. 2006;88(3):275. 6. Milligan E, Morgan NC, Jones L, Officer R. Surgical anatomy of the anal canal, and the operative treatment of haemorrhoids. Lancet. 1937;230(5959):1119-24. 6. Aroya A, Perez F, Miranda E, Serrano P, Candela F, Lacueva J, et al. Open versus closed day case haemorrhoidectomy: is there any difference? Results of a prospective randomized study. Int J Colorectal Dis. 2004;19:370-3 7. Ahmed AN, Fatima N, Hussain RA, ChowdhryZA, Qadir SNR. Strengths and limitations of close vs open haemorrhoidectomy of 2nd and 3rd degree. Ann KE Med Coll. 2003;9:219-20. 8. Kim SH, Chung CS. Open vs closedhemorrhoidectomy. Dis Colon Rectum 2005;48:108-13. 9. Arbman G, Krook H, Haapaniemi S. Closed vs open hemarrhoidectomy: is there any difference? Dis colon rectum. 2000;43(1):31-4.
- 22. THANK YOU