Review of Carcinoma Skin: Retrospective Analysis of Five Years Anil Kumar Dhull, Peoli Mukutawat, Sheeba Bhardwaj, Anjali Bhola, Anthialisha Nongkynrih, Anil Khurana, Rajeev Atri, Rakesh Dhankhar, Ashok Chauhan, Vivek Kaushal Department of Radiation Oncology, Post Graduate Institute of Medical Sciences Rohtak, Haryana, India Aims: We retrospectively reviewed the records of patients of skin cancer to analyse their demographic & clinical presentation and response to various treatment protocols. Material and Methods: Retrospective analysis of patients of skin Cancer presented in Department of Radiation Oncology, PGIMS Rohtak from year 2012- 16 was done to achieve aim. Results: Out of 15, 932 total cancer patients, skin carcinoma were identified in 61-patients constituting 0.4% of total cancer patients. The median age of presentation was 55-years (range 11-93 years). Fifth decade of life was the commonest presentation. Male to female ratio was 1.3:1. 74% patients belongs to rural area while 26% were of urban population. 48% patients had a history of tobacco intake, while 15% were alcoholic. Mean duration of symptoms were 3-months at the time of initial presentation. 85% patients were having fair to good general condition while 15% were having poor general condition (KPS ? 50). The common site of Title: Ultrasound Correlation of Groin Nodes with clinical and pathological findings in Squamous cell Carcinoma of Vulva. INTRODUCTION: Carcinoma of the vulva is a rare genital malignancy which accounts for 4 % of all genital malignancies . Patients with vulvar carcinoma are traditionally managed by surgical staging by radical/modified radical vulvectomy and inguinofemoral lymphadenectomy. As regional lymph node metastatic spread is the most important prognostic factor that correlates with depth of tumor invasion, preoperative information about regional nodal metastasis and depth of tumor invasion is essential in tailoring the treatment. Clinical examination by palpation of the inguinofemoral lymph nodes is a simple approach for determining the inguinofemoral lymph node status but is impaired by several conditions like obesity of the patients, small sized metasatic nodes, metastases located deep in the subcutaneous fatty tissue, and scar tissue due to former surgery and / or radiation. There is limited data on the role of imaging in the diagnosis and staging of vulvar carcinoma. The resolution of computed tomography is too poor to detect disease in lymph nodesmeasuring lessthan 1 cm in diameter and magnetic resonance imaging has not so far been able to characterise nodal tissue accutely. Ultrasound examination of the groin nodes on the otherhand is safe, noninvasive, cheap and highly acceptable to patients. This study was undertaken to evaluate the significance of routine ultrasonography of inguinal lymphnodes in operable squamous cell carcinoma of vulva with the primary objective of Determining whether the value of ultrasound reporting of groin node positivity is complete for confirmed cases of vulval cancer and to correlate Ultrasound and clinical findings with the final histological finding. MATERIALS AND METHODS. This was a prospective study which was conducted in The Department of Gynaecologic oncology of Dr B Borooah Cancer Institute (Regional cancer Centre), Guwahati. Patients were recruited the from the period of June 2013 to June 2014. Patients were followed up for a period of 2 years. All operable patients with proven histology of squamous cell carcinoma vulva were included. Patients with advanced inoperable disease, early stage disease not fit for surgery, non squamous histology and recurrent disease were excluded from the study. The scans were performed by radiologist without knowledge of the size, location or depth of the primary tumour or the clinical nodal status. The histological status of the lymph nodes was correlated to the ultrasound and clinical findings. The sensitivity, specificity and predictive values of ultrasound and clinical examinations were calculated using the standard 2 x2 method. Comparisons between the groups were done by using Man Whitany - U test. Results were statistically analysed IBM SPSS Statistics 19. RESULTS & OBSERVATIONS Total of 15 patients were enrolled in the study over a period of 1 year. Majority of tumour was located in the labia majora (53.3%). Clitoral involvement was secondary to involvement of labia majora and minora. Leukoplakia was associated with vulval growth in 3 patients(20%).Maximum tumour diameter was 7cm and minimum was 1cm. Mean tumour diameter was 3.7cm and median was 3cm. Clinically 10(66.67%) patients were suspected to have enlarged metastatic lymphnodes whereas 8 (53.33%) patients were suspected to have enlarged metastatic lymphnodes. Final histopahological examination revealed metastatic lymphnodes in 6 patients(40%) . Maximum patients had hisopathology of well differentiated squamous cell carcinoma of vulva(80%) whereas none of the patients had poorly differentiated carcinoma in our study group. Radical vulvectomy with bilateral inguinal lymphadenectomy was the surgical procedure done in 7 patients(46.67%) hemivulvectomy with bilateral inguinal lymphadenectomy in 4 patients, hemivulvectomy with unilateral inguinal lymphadenectomy in 3 patients, and radical vulvectomy with bilateral inguinal lymphadenectomy with resection of terminal 1/3rd of urethra in 1 patient. 26.67%(4) patients belonged to stage IA and 33.33% in stage IB. 40%(6) were in stage III[IIIA(i): (4)26.67%; IIIB(i)(1)6.66%; IIIc (1) 6.66%)] None of the patients were in stage II. On statistical analysis it was found that sensitivity of USG examination of groin nodes was 85.71% (95% CI: 42.23 % to 97.63 %) whereas specificity was 71.43% (95% CI: 29.27 % to 95.48 %). On the other hand sensitivity for clinical examination was 71.43% (95% CI: 29.27 % to 95.48 %) whereas specificity was 44.44% (95% CI: 13.97 % to 78.60 %). DISCUSSION On the final histopathological examination only 6 [40%] patients had metastatic deposits in the lymph nodes. Based on the histopathological results 6[40%] patients were given postoperative radiotherapy. One patient received radiotherapy after recurrence in the groin. None of the patients receiving postoperative radiotherapy had recurrence during the two year followup. On statistical analysis it was found that sensitivity of USG examination of groin nodes was 85.71% (95% CI: 42.23 % to 97.63 %) whereas specificity was 71.43% (95% CI: 29.27 % to 95.48 %). On the other hand sensitivity for clinical examination was 71.43% (95% CI: 29.27 % to 95.48 %) whereas specificity was 44.44% (95% CI: 13.97 % to 78.60 %). From our study we found that USG examination of the groin nodes was more sensitive as well as specific than clinical examination for detection of lymph node involvement in vulvar cancer[p value=0.04 ]. The sensitivity of our study was found to be similar a study by Gregorio et al 2013. It was a retrospective study of 60 patients who had vulvar malignancies of whom 92% were squamous cell carcinomas. Sensitivity was 76.3%, specificity was 91.3% for ultrasound examination of groin nodes [80]. Another study by Land R et al compared CT scanning of the vulva and the groin and groin ultrasound scanning alone or with fine needle aspiration cytology (FNAC) (USS/FNAC). The calculated sensitivity, specificity CT were 58%, 75%, for USS alone was 87% and 69% and for USS-guided FNAC-80% and 100% respectively. They concluded that their data did not support the routine use of CT scanning in patients with primary squamous cell carcinoma of the vulva, either in assessment of the primary vulval carcinoma or in detecting groin nodal metastases. They also found USG with FNAC of groin nodes to be superior to USG of groin nodes alone and CT scan. Even though our study was a comparision between USG of the groin nodes alone with clinical examination the sensitivity and specificity was comparable to the sensitivity and specificity of USG alone of this study. Similar comparison can also be drawn from other studies[9, 82]. Our study demonstrates that ultrasound is a sensitive investigative tool in assessing the preoperative inguinal node status. However a negative inguinal nodal status cannot be used to omit inguinal node dissection as it lacks the high sensitivity and specificity that are necessary to avoid surgery. It should be remembered that recurrence in the groin node can be a fatal complication. Based on our results and observations from the available literature regarding the low sensitivity and specificity of other modalities like CT and MRI routine preoperative ultrasound evaluation of the groin nodes will be continued in our institute. [ABSTRACT FROM AUTHOR]
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