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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Role of Multidetector Computed Tomography in the Detection and Characterisation of Benign and Malignant Non Lymphoid Masses of the Neck and its Concordance with Fine Needle Aspiration Cytology
Correspondence Address :
Dr. Ponshankar Anandaraja,
Assistant Professor, Department of Radiodiagnosis, Government Stanley Medical College and Hospital, Old Jail Road, Old Washer Manpet, Chennai-600001, Tamil Nadu, India.
E-mail: ponshankara@gmail.com
Introduction: Computed Tomography (CT) enables the evaluation of both osseous and soft tissue details and has become an important imaging modality in the evaluation of patients presenting with a neck mass. The study was conducted to justify the usefulness of Multidetector CT (MDCT) in patients presenting with neck lesions.
Aim: To detect benign and malignant non lymphoid lesions of the neck using MDCT imaging features and compare it with Fine Needle Aspiration Cytology (FNAC).
Materials and Methods: This cross-sectional study was conducted in the Department of Radiodiagnosis at Government Stanley Medical College, Chennai, India, from June 2021 to May 2022. Contrast Enhanced CT (CECT) was performed with a 16 slice MDCT scanner pre and postcontrast administration. The benign and malignant lesions were evaluated by their enhancement patterns, necrosis, bony and vascular invasion and extension to adjacent neck space. The results were compared with FNAC being considered the gold standard, sensitivity and accuracy of CT was determined. The collected data was analysed with International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) Version 23.0.
Results: A total of 95 patients who were enrolled in to the study, 38 patients were females and 57 patients were males, the mean age of the subjects studied were 45.1±17.4 years. A total of 67 cases were benign lesions and 28 cases were malignant lesions by FNAC. The sensitivity and specificity of MDCT was found to be 78.6% and 95.5%, respectively with a Positive Predictive Value (PPV) of 88.0% and Negative Predictive Value (NPV) of 91.4%.
Conclusion: MDCT is precise in differentiating malignant from benign lesions of the neck and defining the extent of the lesions and involvement of adjacent structures.
Enhancement patterns, Neck masses, Necrosis, Sensitivity, Specificity
The neck used to be classified based on triangles. But, with the arrival of cross-sectional imaging, the notion of neck spaces arises. The superficial and deep cervical fascias divide the neck into 12 spaces (1),(2). CT enables evaluation of both osseous and soft tissue details and has become an important imaging modality in evaluation of patients presenting with neck mass (3). Conventional dynamic CT scanning (slice-by-slice acquisition) is being rapidly replaced by Spiral CT in most medical centres. Spiral CT has the advantages of rapid scanning time, and less susceptibility to patient motion than conventional CT (4). Volumetric helical data provides best results for creating 3 Dimensional (3D) and multiplanar reconstructions. Multislice-spiral CT enables near isotropic imaging in all directions for the head and neck area, leading to better identification of tumour growth and the spread of cancer to lymph nodes. Additionally, this imaging technique can take full advantage of intravenous contrast agents by obtaining the best images during the time between injection and image capture (5). The use of two and 3-D displays helps visualise pathological findings in relation to the anatomical structures in the affected area. This helps to streamline the diagnostic process and allows for better communication between radiologists and clinicians. Ultimately, this leads to more efficient and accurate diagnosis and treatment planning for patients (6).
The major application of imaging is to evaluate the size and location of the tumour, as well as its infiltration into surrounding tissues and structures, such as blood vessels and nerves which helps the surgeon to best determine surgical and other therapeutic options. Imaging also plays an important role in evaluating the presence and location of lymph nodes, which is crucial in determining the stage of the disease and the appropriate treatment approach. The radiologist will use a standardised classification system to describe the location and extent of nodal involvement, which helps the other members of the healthcare team to plan treatment and monitor the response to therapy (7). Based on the previous study by Gandhi N et al., in which MDCT showed 96% accuracy in diagnosing neck lesions. The aim of the present study was to detect benign and malignant non-lymphoid lesions of the neck using MDCT imaging features and compare it with FNAC.
This study was a single Institutional cross-sectional study was conducted in the Department of Radiodiagnosis at Government Stanley Medical College, Chennai, India, from June 2021 to May 2022. Institutional Ethical Committee approval was acquired (20201219). Informed and written consent was obtained from all subjects. In paediatric patients, the consent was acquired from parents or guardians.
Inclusion criteria: Patients presenting with neck swellings other than those arising from lymph nodes which are determined by ultrasonography screening, patients presenting with symptoms pertaining to the neck such as dysphagia, hoarseness of voice, odynophagia, Patients with ultrasonographically detected non lymphoid neck lesions were included in the study.
Exclusion criteria: All patients with history of trauma, patients who have contraindications to contrast administration such as chronic kidney disease, high renal parameters or contrast hypersensitivity, all pregnant patients, those patients who were not willing to give consent to the study were excluded from the study.
Sample size calculation: The Sample size was estimated by using nMaster software Version 2.0 with an alpha of 0.05 (2-sided) and precision of 4% and a total of 92 sample size was estimated (8). By considering the data loss three more were added and the study was done with 95 subjects.
Study Procedure
The CECT was performed with a 16-slice MDCT scanner (Toshiba Aquilion), pre and postcontrast administration. The patient was scanned in supine position. The head and neck was imaged from top of frontal sinus up to the level of aortic arch with a slice thickness of 3.75 mm, Index-3.75, Field Of View (FOV)-22 and non ionic iodinated water soluble intravenous contrast (Omnipaque) of around 100-150 ccs was given at a rate of 2-3 ccs/sec with a delay of 20 seconds. Arterial and venous phase images were obtained. Soft tissue, bone and lung windows were used for evaluation. The benign and malignant lesions were differentiated by their enhancement patterns, necrosis, bony and vascular invasion and extension to adjacent neck space. The FNAC for those lesions were done under ultrasonography guidance using 26G needle and FNAC results were considered as gold standard.
Statistical Analysis
The collected data was analysed with IBM SPSS version 23.0. (Armonk, NY: IBM Corp). To describe about the data, descriptive statistics, frequency analysis, percentage analysis were used for categorical variables and the mean and SD were used for continuous variables. The results were compared with FNAC reports. To find the efficacy of the CT to predict the FNAC outcome, the Receiver Operating Characteristics (ROC) curve was used with sensitivity, specificity, PPV, NPV and accuracy. In the above statistical tool, the probability value 0.05 is considered as significant level.
A total of 95 patients, who were enrolled in the study, 38 patients were females and 57 patients were males. The mean age of the subjects studied were 45.1±17.4 years (Table/Fig 1). Co-morbidities were present in 49 patients {Type 2 Diabetes Mellitus-19 (38.78%), systemic hypertension-14 (28.5%), hypothyroidism-10 (20.41%), hyperthyroidism-5 (10.2%), seizure disorder-1 (2%)}. The most common presenting symptom was swelling of neck, which was present in about 91 (95.8%) of the study subjects, followed by dysphagia/odynophagia in 39 (41.1%) and hoarseness of voice in 10 (10.5%) of the study subjects. On FNAC, 67 cases were found to be benign lesions and 28 cases were found to be malignant lesions.
On CECT, 82% of the malignant lesions showed heterogeneous enhancement, whereas, majority of the benign lesions were non enhancing (41.8%). Bone and vascular invasion was present in 57.1 and 14.3% of the malignant lesions respectively, whereas it is not noted in benign lesions (Table/Fig 2).
The ROC Curve analysis between CECT characteristics and FNAC diagnosis of benign or malignant lesion is shown below (Table/Fig 3),(Table/Fig 4). Area=0.870, sensitivity=78.6%, specificity=95.5%, PPV=88.0%, NPV=91.4%, accuracy=90.5%, p-value=0.0005.
A 60-year-old male patient, presented with complaints of swelling over the anterior aspect of neck and hoarseness of voice. Non contrast and contrast-enhanced images of the neck show an ill defined heterogeneously enhancing soft tissue dense lesion arising from the left lobe of thyroid gland with multiple foci of calcifications. The lesion shows extension into the trachea-oesophageal groove and hypopharynx (Table/Fig 5). The FNAC report was suspicious for malignancy-Bethesda V with the possibility of papillary carcinoma of the thyroid.
A 47-year-old male patient, who also presented with complaints of swelling over the anterior aspect of neck. Non contrast and contrast enhanced images of the neck show enlargement of isthmus and left lobe of thyroid with multiple foci of calcifications and showing multiple heterogeneously enhancing nodules. With the imaging features, it is suggestive of benign enlargement of thyroid and the FNAC report also correlated well with the imaging findinds, which was multinodular goiter (Table/Fig 6).
A 38-year-old female patient, who presented with complaints of swelling over the left preauricular region. Non contrast and CECT images show a well-defined heterogeneously enhancing soft tissue dense lesion in left parotid gland. The imaging findings are suggestive of a benign lesion and the FNAC report was pleomorphic adenoma (Table/Fig 7).
In the present study, the CT imaging characteristics of benign and malignant tumours of the neck was compared with FNAC. Although the final histopathology report after surgery is the gold standard in arriving at a definitive diagnosis of a benign and malignant lesion, FNAC has reasonable sensitivity and good specificity in differentiating benign and malignant masses and it also has advantages of being less invasive, easily accessible and cost effective. FNAC is almost always the initial mode of investigation in neck masses with imaging features of malignancy. FNAC also helps in diagnosis of inflammatory, infective and degenerative lesions in addition to neoplastic lesions (9).
Regarding enhancement patterns, 41.8% of the beign lesions showed no enhancement, whereas, 82.1% of the malignant lesions showed predominant heterogeneous enhancement. This correlated well with the study done by van Tran NA et al., which showed that majority of the benign lesions showed no enhancement and majority of the malignant lesions showed enhancement on contrast enhanced images (10). Necrosis was present in 82.1% of the malignant lesions. In a study by Eskey C et al., 91 states that necrosis is more frequently seen in malignant lesions (11). Bony involvement was seen in 57.1% of the malignant lesions and none of the benign lesions. In a study done by Imaizumi A et al., it has been shown that MDCT with multiplanar reformations and thin cuts (0.5 mm) has higher specificity in detecting subtle cortical erosions, as bony invasion is an important factor in determining the malignant nature of the tumour (12).
Extension into the adjacent space was seen in 50% of malignant lesions and in 14.9% cases of benign lesions. A study by Tran NA et al., states that malignant lesions tend to be more infiltrative and extend beyond fat or fascial planes (10). The sensitivity of MDCT for evaluating and differentiating the benign and malignant lesions of the neck in comparison to FNAC was 78.6%, and specificity was 95.5%, with a PPV of 88%. This correlated with the findings of the study done by Gupta P et al., which assessed the role of multidetector spiral CT in the evaluation of neck masses. The accuracy of multislice CT in predicting the benign or malignant mass and its extent was observed to be very high (97% and l00%, respectively). (Table/Fig 8) depicts the accuracy values of the present study vs published studies (13),(14). In all cases, the extent of the pathology, the local or contiguous spread, and vascular involvement predicted by multislice CT examination supported well with the surgical findings (15).
Limitation(s)
The major limitation of the present study was that the study included all non lymphoid neck mass lesions irrespective of their diagnoses and histopathological variety. Present study did not include the individual lesions, which are inherent to their respective neck spaces, and thus a large-scale study with greater logistics support and adequate randomisation is recommended with the involvement of other departments.
Multidetector CT is precise in differentiating malignant from benign lesions of the neck. This plays an important role in the planning of surgical excision and also in deciding portals for radiotherapy. MDCT also provides excellent bony details and helps in the identification of bone involvement, which is an important feature of malignancy.
DOI: 10.7860/JCDR/2023/61888.17697
Date of Submission: Nov 08, 2022
Date of Peer Review: Jan 12, 2023
Date of Acceptance: Mar 03, 2023
Date of Publishing: Apr 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Nov 29, 2022
• Manual Googling: Feb 04, 2023
• iThenticate Software: Feb 27, 2023 (8%)
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