Dear editor, We appreciate the interest shown by Dr Giri in our study and thank him for his comme... more Dear editor, We appreciate the interest shown by Dr Giri in our study and thank him for his comments. In response to the first comment, intrahepatic mass forming cholangiocarcinoma (IHCC) can have varying enhancement patterns which depend on cellularity of the lesion, amount of fibrous stroma, interstitial tissue, central necrotic areas and size of the lesion [1–3]. These include hyperdense, peripheral hyperdense (rim enhancement), hypodense and isodense to liver parenchyma. On dynamic imaging, there can be stable enhancement, progressive enhancement, washin and wash-out pattern [1, 2]. A study by Li R et al. showed progressive centripetal filling pattern to be present in 35% cases [2]. Hence, if this pattern is present in a lesion, it may help differentiating hepatic tuberculosis and IHCC. Secondly, magnetic resonance imaging (MRI) was used only in selected seven patients who were potential surgical candidates (five cases mimicking IHCC, 2—suspected metastasis) as an additional imaging modality to diagnose the lesion without performing biopsy before hepatectomy. The remaining patients with a clinical suspicion of IHCC had multiple liver lesions (14 cases), associated mediastinal or abdominal lymphadenopathy (5) and ascites (1). Hence, biopsy of liver lesion was considered as they were not suitable candidates for surgery from an oncology point of view. Since MRI was performed only in five cases of HTB mimicking IHCC, it was not possible for us to present a full spectrum of the findings. Peripheral rim enhancement (target appearance) on contrast injection was noted in five HTB cases on MRI in our study [4, 5]. Thirdly, localized form of HTB is a rare disease entity (only 43 cases in 10 years in our study) of which 25 mimicked IHCC [3]. IHCC also has varying patterns of contrast enhancement which can change with the size of the tumor [1, 2]. Due to these variations, and also the rarity of HTB, a comparison of enhancement patterns of IHCC with HTB is difficult to perform. Such a study can be considered in the future if a significant number of HTB cases are diagnosed. The main purpose of our present study was to sensitize readers regarding localized forms of hepatic tuberculosis as a cancer mimic so that HTB will be considered as a differential diagnosis while evaluating liver lesions. Lastly, regarding referral bias, all 43 patients were referred to an oncology center with a presumptive diagnosis of liver cancer after initial consultation and evaluation (clinical examination, blood tests, ultrasound or CT abdomen) by family physicians, nursing homes, tertiary care centers and general hospitals. Awareness is needed across all the healthcare disciplines, and not only oncologists regarding benign liver lesions like pseudotumor forms of HTB which closely mimic malignancy.
Background Promoting awareness of tobacco and cancer in the community needs multipronged efforts.... more Background Promoting awareness of tobacco and cancer in the community needs multipronged efforts. We performed a study to evaluate whether we could raise awareness about the harmful effects of tobacco, oral and esophageal cancer among school students by providing them health education. Moreover, we also compared the awareness level in students of age group 12 to ≤14 years with the age group >14 to 18 years. Methods We conducted an awareness program in the schools of Ratnagiri district of Maharashtra state. Students aged 12-18 years participated in this study. We provided health education to school students using a standard presentation; the presentation was rich in illustrations depicting the harmful effects of tobacco as well as oral and esophageal cancer's signs, symptoms, diagnosis, treatment, and preventive measures. After the health talk, a questionnaire was circulated. The questions were focused on tobacco, signs, and symptoms of the diseases along with early detection,...
International Journal Of Community Medicine And Public Health, 2021
Background: Theoretically, health care workers (HCW) are at increased risk of getting infected wi... more Background: Theoretically, health care workers (HCW) are at increased risk of getting infected with COVID-19 compared to the general population. Limited data exists regarding the actual incidence of COVID-19 infection amongst the high risk and low risk HCW of the same hospital. We present an audit from our tertiary cancer care centre comparing the COVID-19 infection rate between the high risk and low risk HCW, all of whom had been provided with adequate protective measures and health education.Methods: This is a retrospective observational study from 01 April 2020 to 30 September 2020, in which all the 970 HCW of Advanced Centre for Treatment, Research and Education in Cancer were divided into high risk and low risk groups. High risk HCW included all the medical and non-medical staff directly involved with the care of COVID-19 patients, and rest were low risk HCW. Adequate protective measures and classes for infection prevention were provided to all the HCW. We calculated the incide...
AIM To assess the overall survival and determine whether pre-TARE shunt fraction, tumor volume an... more AIM To assess the overall survival and determine whether pre-TARE shunt fraction, tumor volume and tumor marker impact the outcome. METHODS This is a retrospective study of 75 patients who were referred for 90Y-glass microsphere radioembolisation by a joint clinic decision between 1 January 2010 and 31 December 2014. All patients underwent pre-TARE CECT and 99mTc-MAA lung shunt fraction (LSF) imaging. RESULTS Overall survival was 19 months for hepatocellular carcinoma (HCC) and 24 months for metastatic colorectal carcinoma. For hepatocellular carcinoma-LSF higher than 6.51 % was predictive of significantly decreased survival (P value 0.00). A progressive disease in survival was observed as LSF increased from less than 6.51 % to more than 20%. Tumor volume and tumor marker did show correlation with patient outcomes. For metastatic colorectal carcinoma-LSF and tumor marker did not show significant correlation with survival and tumor volume showed significant correlation with survival with P value of 0.049.
e17068 Background: HPV positive oropharyngeal cancers have been identified as a favourable progno... more e17068 Background: HPV positive oropharyngeal cancers have been identified as a favourable prognostic subgroup. However impact of HPV positivity on prognosis is also dependent on level of tobacco exposure and on stage of the disease. We wanted to study the impact of HPV in locally advanced and very locally advanced technically inoperable oral cancers undergoing neoadjuvant chemotherapy (NACT) Methods: This was a retrospective analysis of 124 randomly selected patients who underwent NACT at our centre between 2012 to 2013. All of these patients had locally advanced technically unresectable oral cancers ( Stage IVA or IVB disease) and they underwent 2 cycles of NACT followed by response assessment. Depending upon the response these patients either underwent radical intent treatment ( Surgery + adjuvant chemoradiation (CTRT) or radical CTRT or palliative intent treatment ( Palliative RT or Palliative chemotherapy or supportive care).Subsequently these patients were followed till death. p16 IHC was done on th...
Transarterial radioembolization using Y microspheres is a novel therapeutic option for inoperable... more Transarterial radioembolization using Y microspheres is a novel therapeutic option for inoperable hepatic malignancies. As these spheres are radiolucent, real-time assessment of their distribution during the infusion process under fluoroscopic guidance is not possible. Bremsstrahlung radiations arising from 90Y have conventionally been used for imaging its biodistribution. Recent studies have proved that sources of 90Y also emit positrons, which can further be used for PET/computed tomography (CT) imaging. This study aimed to assess the feasibility of 90Y PET/CT imaging in evaluating microsphere distributions and to compare its findings with those of Bremsstrahlung imaging. Thirty-five sessions of 90Y microsphere transarterial radioembolization were performed on 30 patients with hepatic malignancies. 90Y PET/CT imaging was performed within 3 h of therapy. Bremsstrahlung imaging was also performed for each patient. The imaging findings were compared for concordance in the distribution of microspheres. Exact one-to-one correspondence between 90Y PET/CT imaging and 90Y Bremsstrahlung imaging was observed in 97.14% of cases (i.e. in 34/35 cases). Discordance was observed only in one case in which 90Y PET/CT imaging resolved the microsphere uptake in the inferior vena cava tumor thrombus, which was, however, not visualized on Bremsstrahlung imaging. There is good concordance in the imaging findings of 90Y PET/CT and 90Y Bremsstrahlung imaging. 90Y PET/CT imaging scores over the conventionally used Bremsstrahlung imaging in terms of better resolution, ease of technique, and comparable image acquisition time. This makes it a preferred imaging modality for assessment of the distribution of 90Y microspheres.
Minimally invasive techniques such as Image guided thermal ablation are now widely used in the tr... more Minimally invasive techniques such as Image guided thermal ablation are now widely used in the treatment of tumors. Microwave ablation (MWA) is one of the newer modality of thermal ablation and has proven its safety and efficacy in the management of the tumors amenable for ablation for primary and metastatic diseases. It is used in the treatment of primary and secondary liver malignancies, primary and secondary lung malignancies, renal and adrenal tumors and bone metastases. We wanted to share our initial experience with this newer modality. In this article we will describe the mechanism and technique of MWA, comparison done with RFA, advantages and disadvantages of MWA along with pre procedure workup, post procedure follow-up and review of literature.
Pseudoaneurysm formation is an uncommon but fatal complication of pancreatitis. The morbidity and... more Pseudoaneurysm formation is an uncommon but fatal complication of pancreatitis. The morbidity and mortality associated with surgical management is high. Transcatheter embolization is a definitive minimally invasive form of treatment. To review our experience with transcatheter embolization as a therapeutic modality for pseudoaneurysms complicating pancreatitis. This retrospective analysis included data of 30 patients (mean age 37 years, range 25 to 65; 24 men) with visceral pseudoaneurysms secondary to pancreatitis, who underwent diagnostic angiography and transcatheter embolization, during the period March 1993 to February 2003. In 29 patients the pseudoaneurysms were successfully isolated from the circulation, and hemostasis was achieved. Re-bleeding occurred in one patient, for which re-embolization was done. Twenty-nine patients improved clinically. One patient in whom the pseudoaneurysm was successfully embolized died due to septicemic shock. Endovascular embolization is a safe...
Journal of Head & Neck Physicians and Surgeons, 2020
Introduction: The coronavirus disease 2019 pandemic has posed numerous challenges to health care ... more Introduction: The coronavirus disease 2019 pandemic has posed numerous challenges to health care across the globe. Time is of the essence in cancer care to prevent disease progression. Materials and Methods: TrueConf ®, a local area network-based software, has been used for holding joint clinic meetings which are an essential part of cancer management at our hospital. Results: A total of 12 meetings were held over a period of 12 weeks where 42 patients were examined and their clinicoradiological evaluation was done. Further treatment decisions were made based on these joint clinics. Conclusion: TrueConf ® is an economical platform and easily implementable system, easing decision-making for critical cases, avoiding crowding in outpatient departments.
In this abstracts, of hepato-biliary and pancreatic malignancy major common malignancy like Hepat... more In this abstracts, of hepato-biliary and pancreatic malignancy major common malignancy like Hepatocellular carcinoma (HCC), Cholangiocarcinoma, Carcinoma of Gall Bladder and Pancreatic carcinoma are describe in detail. Liver malignancy are divided into hyper vascular and hypovascular lesions depending on the contrast enhancement. HCC is occurs predominantly in the setting of cirrhosis and is one tumour which is diagnosed on imaging. Others liver and cystic pancreatic malignancy are tabulated and given overview. Cholangiocarcinoma has been classified according to the anatomical origin i.e eitherxintrahepatic or extrahepatic, intrahepatic cholangiocarcinoma are furthur divided into peripheral and hilar. CT and MRI with MRCP are useful in Carcinoma of Gall bladder to know the local extend of the disease. Pancreatic MRI contrast media are described since they are important for contrast enhancement and functional imaging. Resectability criteria for pancreatic malignancy is important for ...
Poster: "ECR 2017 / C-1319 / Hydrodissection: Creating Path in Interventional Radiology"... more Poster: "ECR 2017 / C-1319 / Hydrodissection: Creating Path in Interventional Radiology" by: "A. Singh1, R. CHIVATE1, S. Kulkarni1, M. Thakur2, N. Shetty2, A. M. Polnaya3, K. GALA1, A. Janu2, N. ARGULWAR1; 1Mumbai, MAHARASHTRA/IN, 2Mumbai/IN, 3Mangalore, Karnataka/IN"
Poster: "ECR 2017 / C-1318 / Vertebral intervention : A pictorial review" by: "N. ... more Poster: "ECR 2017 / C-1318 / Vertebral intervention : A pictorial review" by: "N. ARGULWAR1, S. Kulkarni1, M. Thakur1, N. Shetty2, A. M. Polnaya3, R. CHIVATE1, K. GALA1, A. Singh1, A. Chavhan2; 1MUMBAI, MAHARASHTRA/IN, 2Mumbai/IN, 3Mangalore, Karnataka/IN"
Presence of jaundice in gallbladder carcinoma (GBC) is considered a sign of inoperability with no... more Presence of jaundice in gallbladder carcinoma (GBC) is considered a sign of inoperability with no defined treatment pathways.
Hepatic tuberculosis (HTB) is rare and mimics neoplastic liver lesions clinico-radiologically lea... more Hepatic tuberculosis (HTB) is rare and mimics neoplastic liver lesions clinico-radiologically leading to misdiagnosis and even unnecessary surgery. We analysed 43 cases of HTB diagnosed at a referral cancer centre over 10 years. Clinical details, investigations and treatment received were noted. The median age was 46 years with a female preponderance (58%). HTB was diagnosed incidentally in 28% cases during surveillance imaging for a previous cancer. Constitutional symptoms (31, 72%), abdominal pain (25, 58%), fever (12, 28%), hepatomegaly (22, 51%), elevated alkaline phosphatase (34, 79%), elevated aminotransferases (18, 42%) and hypoalbuminemia (19, 45%) were common features. All cases had negative HIV serology and normal tumor markers. Twenty-two (52.5%) had solitary liver lesion and lesions > 2 cm in 28 (65%). Ultrasound showed hypoechoic lesions in 31 of 33 cases. Computed tomography showed hypodense lesions (43,100%) with mild peripheral enhancement (32, 74%). Calcifications (5, 12%) and capsular retraction (8, 19%) was uncommon. MRI was performed in seven cases commonly showed T1 hypointense, T2 hyperintense lesions with restricted diffusion. Histopathology showed granulomatous inflammation (42, 97.5%), Langhan’s giant cells (41, 95%) and caseation necrosis (35, 85%). Acid-fast stain and PCR positivity was uncommon. Extrahepatic organs were involved in 20 (46.5%). HTB mimicked cholangiocarcinoma (25, 58%), liver metastasis (11, 26%) and lymphoma (3, 7%). Six patients underwent liver resection with a presumptive diagnosis of cancer without a preoperative biopsy. All patients received antitubercular therapy, 37 had clinico-radiological response, there were 3 deaths and 3 patients were lost to follow-up. HTB is rare and can mimic a malignancy clinico-radiologically. Calcifications and pseudocapsule appearance on multiphase CT scan may help in differentiating HTB from hepatic malignancy. Tumor markers are normal while histopathology is generally diagnostic. A high index of suspicion is required to avoid unnecessary surgery as the patients respond well to ATT. This is a retrospective and observational study hence clinical trial registration is not applicable.
Journal of Clinical Interventional Radiology ISVIR
In this review article, the authors discuss the anatomy and technical aspects of CT-guided biopsy... more In this review article, the authors discuss the anatomy and technical aspects of CT-guided biopsy of vertebral lesions. CT guidance is highly useful for vertebral biopsies, as the anatomy of the spine is complex and varies widely across the levels. Prebiopsy imaging should be reviewed and later correlated with the final histopathological diagnosis. The majority of the spine biopsies are performed under local anesthesia, except those in critical locations and pediatric age groups. The biopsy sample is sent for histopathological analysis and/or microbiological analysis depending on the indications. It is preferable to use a coaxial system for biopsies, so multiple cores can be obtained with a single needle puncture, thus minimizing the negative yield and complications. Complications after image-guided percutaneous biopsy are rare and can be managed easily.
Background Bleeding from the unsalvageable recurrent and metastatic head and neck cancer is not a... more Background Bleeding from the unsalvageable recurrent and metastatic head and neck cancer is not an uncommon occurrence. It is extremely distressing for the patients and their family members and also to the treating doctors. One of the ways to manage this crisis is by selective embolization of the bleeding vessel. Methodology In this retrospective study, we audited the patients with unresectable, unsalvageable recurrent and/or metastatic head and neck cancer who underwent selective (palliative) embolization for bleeding at our institute between Jan 2015 and Nov 2019, and assessed its possible benefit in terms of bleeding free interval achieved. Results Twenty-six palliative embolization was done during the above mentioned period. The majority were male patients ( n = 23, 88.4%) with a median age of 54.5 years. The performance status (PS) of most patients was 2 ( n = 15, 57.6%). The most common bleeding vessel was the external carotid artery or one of its branches, most commonly lingual artery ( n = 5). The bleeding vessel was identified and embolized with PVA/gel foam/coil/glue. All the procedures were uneventful. Out of 26 patients, 3 patients had another bleeding episode subsequently. Most patients had 20 days to 21 months of bleeding free interval. The cost involved in the procedure was between 400 and 2100 US dollars. Conclusions Selective embolization is an option to be considered in certain patients with unresectable, unsalvageable recurrent and/or metastatic head and neck cancer, when they present with sudden and massive bleeding to the emergency department, at centres where the facility and expertise for this procedure might be available.
Dear editor, We appreciate the interest shown by Dr Giri in our study and thank him for his comme... more Dear editor, We appreciate the interest shown by Dr Giri in our study and thank him for his comments. In response to the first comment, intrahepatic mass forming cholangiocarcinoma (IHCC) can have varying enhancement patterns which depend on cellularity of the lesion, amount of fibrous stroma, interstitial tissue, central necrotic areas and size of the lesion [1–3]. These include hyperdense, peripheral hyperdense (rim enhancement), hypodense and isodense to liver parenchyma. On dynamic imaging, there can be stable enhancement, progressive enhancement, washin and wash-out pattern [1, 2]. A study by Li R et al. showed progressive centripetal filling pattern to be present in 35% cases [2]. Hence, if this pattern is present in a lesion, it may help differentiating hepatic tuberculosis and IHCC. Secondly, magnetic resonance imaging (MRI) was used only in selected seven patients who were potential surgical candidates (five cases mimicking IHCC, 2—suspected metastasis) as an additional imaging modality to diagnose the lesion without performing biopsy before hepatectomy. The remaining patients with a clinical suspicion of IHCC had multiple liver lesions (14 cases), associated mediastinal or abdominal lymphadenopathy (5) and ascites (1). Hence, biopsy of liver lesion was considered as they were not suitable candidates for surgery from an oncology point of view. Since MRI was performed only in five cases of HTB mimicking IHCC, it was not possible for us to present a full spectrum of the findings. Peripheral rim enhancement (target appearance) on contrast injection was noted in five HTB cases on MRI in our study [4, 5]. Thirdly, localized form of HTB is a rare disease entity (only 43 cases in 10 years in our study) of which 25 mimicked IHCC [3]. IHCC also has varying patterns of contrast enhancement which can change with the size of the tumor [1, 2]. Due to these variations, and also the rarity of HTB, a comparison of enhancement patterns of IHCC with HTB is difficult to perform. Such a study can be considered in the future if a significant number of HTB cases are diagnosed. The main purpose of our present study was to sensitize readers regarding localized forms of hepatic tuberculosis as a cancer mimic so that HTB will be considered as a differential diagnosis while evaluating liver lesions. Lastly, regarding referral bias, all 43 patients were referred to an oncology center with a presumptive diagnosis of liver cancer after initial consultation and evaluation (clinical examination, blood tests, ultrasound or CT abdomen) by family physicians, nursing homes, tertiary care centers and general hospitals. Awareness is needed across all the healthcare disciplines, and not only oncologists regarding benign liver lesions like pseudotumor forms of HTB which closely mimic malignancy.
Background Promoting awareness of tobacco and cancer in the community needs multipronged efforts.... more Background Promoting awareness of tobacco and cancer in the community needs multipronged efforts. We performed a study to evaluate whether we could raise awareness about the harmful effects of tobacco, oral and esophageal cancer among school students by providing them health education. Moreover, we also compared the awareness level in students of age group 12 to ≤14 years with the age group >14 to 18 years. Methods We conducted an awareness program in the schools of Ratnagiri district of Maharashtra state. Students aged 12-18 years participated in this study. We provided health education to school students using a standard presentation; the presentation was rich in illustrations depicting the harmful effects of tobacco as well as oral and esophageal cancer's signs, symptoms, diagnosis, treatment, and preventive measures. After the health talk, a questionnaire was circulated. The questions were focused on tobacco, signs, and symptoms of the diseases along with early detection,...
International Journal Of Community Medicine And Public Health, 2021
Background: Theoretically, health care workers (HCW) are at increased risk of getting infected wi... more Background: Theoretically, health care workers (HCW) are at increased risk of getting infected with COVID-19 compared to the general population. Limited data exists regarding the actual incidence of COVID-19 infection amongst the high risk and low risk HCW of the same hospital. We present an audit from our tertiary cancer care centre comparing the COVID-19 infection rate between the high risk and low risk HCW, all of whom had been provided with adequate protective measures and health education.Methods: This is a retrospective observational study from 01 April 2020 to 30 September 2020, in which all the 970 HCW of Advanced Centre for Treatment, Research and Education in Cancer were divided into high risk and low risk groups. High risk HCW included all the medical and non-medical staff directly involved with the care of COVID-19 patients, and rest were low risk HCW. Adequate protective measures and classes for infection prevention were provided to all the HCW. We calculated the incide...
AIM To assess the overall survival and determine whether pre-TARE shunt fraction, tumor volume an... more AIM To assess the overall survival and determine whether pre-TARE shunt fraction, tumor volume and tumor marker impact the outcome. METHODS This is a retrospective study of 75 patients who were referred for 90Y-glass microsphere radioembolisation by a joint clinic decision between 1 January 2010 and 31 December 2014. All patients underwent pre-TARE CECT and 99mTc-MAA lung shunt fraction (LSF) imaging. RESULTS Overall survival was 19 months for hepatocellular carcinoma (HCC) and 24 months for metastatic colorectal carcinoma. For hepatocellular carcinoma-LSF higher than 6.51 % was predictive of significantly decreased survival (P value 0.00). A progressive disease in survival was observed as LSF increased from less than 6.51 % to more than 20%. Tumor volume and tumor marker did show correlation with patient outcomes. For metastatic colorectal carcinoma-LSF and tumor marker did not show significant correlation with survival and tumor volume showed significant correlation with survival with P value of 0.049.
e17068 Background: HPV positive oropharyngeal cancers have been identified as a favourable progno... more e17068 Background: HPV positive oropharyngeal cancers have been identified as a favourable prognostic subgroup. However impact of HPV positivity on prognosis is also dependent on level of tobacco exposure and on stage of the disease. We wanted to study the impact of HPV in locally advanced and very locally advanced technically inoperable oral cancers undergoing neoadjuvant chemotherapy (NACT) Methods: This was a retrospective analysis of 124 randomly selected patients who underwent NACT at our centre between 2012 to 2013. All of these patients had locally advanced technically unresectable oral cancers ( Stage IVA or IVB disease) and they underwent 2 cycles of NACT followed by response assessment. Depending upon the response these patients either underwent radical intent treatment ( Surgery + adjuvant chemoradiation (CTRT) or radical CTRT or palliative intent treatment ( Palliative RT or Palliative chemotherapy or supportive care).Subsequently these patients were followed till death. p16 IHC was done on th...
Transarterial radioembolization using Y microspheres is a novel therapeutic option for inoperable... more Transarterial radioembolization using Y microspheres is a novel therapeutic option for inoperable hepatic malignancies. As these spheres are radiolucent, real-time assessment of their distribution during the infusion process under fluoroscopic guidance is not possible. Bremsstrahlung radiations arising from 90Y have conventionally been used for imaging its biodistribution. Recent studies have proved that sources of 90Y also emit positrons, which can further be used for PET/computed tomography (CT) imaging. This study aimed to assess the feasibility of 90Y PET/CT imaging in evaluating microsphere distributions and to compare its findings with those of Bremsstrahlung imaging. Thirty-five sessions of 90Y microsphere transarterial radioembolization were performed on 30 patients with hepatic malignancies. 90Y PET/CT imaging was performed within 3 h of therapy. Bremsstrahlung imaging was also performed for each patient. The imaging findings were compared for concordance in the distribution of microspheres. Exact one-to-one correspondence between 90Y PET/CT imaging and 90Y Bremsstrahlung imaging was observed in 97.14% of cases (i.e. in 34/35 cases). Discordance was observed only in one case in which 90Y PET/CT imaging resolved the microsphere uptake in the inferior vena cava tumor thrombus, which was, however, not visualized on Bremsstrahlung imaging. There is good concordance in the imaging findings of 90Y PET/CT and 90Y Bremsstrahlung imaging. 90Y PET/CT imaging scores over the conventionally used Bremsstrahlung imaging in terms of better resolution, ease of technique, and comparable image acquisition time. This makes it a preferred imaging modality for assessment of the distribution of 90Y microspheres.
Minimally invasive techniques such as Image guided thermal ablation are now widely used in the tr... more Minimally invasive techniques such as Image guided thermal ablation are now widely used in the treatment of tumors. Microwave ablation (MWA) is one of the newer modality of thermal ablation and has proven its safety and efficacy in the management of the tumors amenable for ablation for primary and metastatic diseases. It is used in the treatment of primary and secondary liver malignancies, primary and secondary lung malignancies, renal and adrenal tumors and bone metastases. We wanted to share our initial experience with this newer modality. In this article we will describe the mechanism and technique of MWA, comparison done with RFA, advantages and disadvantages of MWA along with pre procedure workup, post procedure follow-up and review of literature.
Pseudoaneurysm formation is an uncommon but fatal complication of pancreatitis. The morbidity and... more Pseudoaneurysm formation is an uncommon but fatal complication of pancreatitis. The morbidity and mortality associated with surgical management is high. Transcatheter embolization is a definitive minimally invasive form of treatment. To review our experience with transcatheter embolization as a therapeutic modality for pseudoaneurysms complicating pancreatitis. This retrospective analysis included data of 30 patients (mean age 37 years, range 25 to 65; 24 men) with visceral pseudoaneurysms secondary to pancreatitis, who underwent diagnostic angiography and transcatheter embolization, during the period March 1993 to February 2003. In 29 patients the pseudoaneurysms were successfully isolated from the circulation, and hemostasis was achieved. Re-bleeding occurred in one patient, for which re-embolization was done. Twenty-nine patients improved clinically. One patient in whom the pseudoaneurysm was successfully embolized died due to septicemic shock. Endovascular embolization is a safe...
Journal of Head & Neck Physicians and Surgeons, 2020
Introduction: The coronavirus disease 2019 pandemic has posed numerous challenges to health care ... more Introduction: The coronavirus disease 2019 pandemic has posed numerous challenges to health care across the globe. Time is of the essence in cancer care to prevent disease progression. Materials and Methods: TrueConf ®, a local area network-based software, has been used for holding joint clinic meetings which are an essential part of cancer management at our hospital. Results: A total of 12 meetings were held over a period of 12 weeks where 42 patients were examined and their clinicoradiological evaluation was done. Further treatment decisions were made based on these joint clinics. Conclusion: TrueConf ® is an economical platform and easily implementable system, easing decision-making for critical cases, avoiding crowding in outpatient departments.
In this abstracts, of hepato-biliary and pancreatic malignancy major common malignancy like Hepat... more In this abstracts, of hepato-biliary and pancreatic malignancy major common malignancy like Hepatocellular carcinoma (HCC), Cholangiocarcinoma, Carcinoma of Gall Bladder and Pancreatic carcinoma are describe in detail. Liver malignancy are divided into hyper vascular and hypovascular lesions depending on the contrast enhancement. HCC is occurs predominantly in the setting of cirrhosis and is one tumour which is diagnosed on imaging. Others liver and cystic pancreatic malignancy are tabulated and given overview. Cholangiocarcinoma has been classified according to the anatomical origin i.e eitherxintrahepatic or extrahepatic, intrahepatic cholangiocarcinoma are furthur divided into peripheral and hilar. CT and MRI with MRCP are useful in Carcinoma of Gall bladder to know the local extend of the disease. Pancreatic MRI contrast media are described since they are important for contrast enhancement and functional imaging. Resectability criteria for pancreatic malignancy is important for ...
Poster: "ECR 2017 / C-1319 / Hydrodissection: Creating Path in Interventional Radiology"... more Poster: "ECR 2017 / C-1319 / Hydrodissection: Creating Path in Interventional Radiology" by: "A. Singh1, R. CHIVATE1, S. Kulkarni1, M. Thakur2, N. Shetty2, A. M. Polnaya3, K. GALA1, A. Janu2, N. ARGULWAR1; 1Mumbai, MAHARASHTRA/IN, 2Mumbai/IN, 3Mangalore, Karnataka/IN"
Poster: "ECR 2017 / C-1318 / Vertebral intervention : A pictorial review" by: "N. ... more Poster: "ECR 2017 / C-1318 / Vertebral intervention : A pictorial review" by: "N. ARGULWAR1, S. Kulkarni1, M. Thakur1, N. Shetty2, A. M. Polnaya3, R. CHIVATE1, K. GALA1, A. Singh1, A. Chavhan2; 1MUMBAI, MAHARASHTRA/IN, 2Mumbai/IN, 3Mangalore, Karnataka/IN"
Presence of jaundice in gallbladder carcinoma (GBC) is considered a sign of inoperability with no... more Presence of jaundice in gallbladder carcinoma (GBC) is considered a sign of inoperability with no defined treatment pathways.
Hepatic tuberculosis (HTB) is rare and mimics neoplastic liver lesions clinico-radiologically lea... more Hepatic tuberculosis (HTB) is rare and mimics neoplastic liver lesions clinico-radiologically leading to misdiagnosis and even unnecessary surgery. We analysed 43 cases of HTB diagnosed at a referral cancer centre over 10 years. Clinical details, investigations and treatment received were noted. The median age was 46 years with a female preponderance (58%). HTB was diagnosed incidentally in 28% cases during surveillance imaging for a previous cancer. Constitutional symptoms (31, 72%), abdominal pain (25, 58%), fever (12, 28%), hepatomegaly (22, 51%), elevated alkaline phosphatase (34, 79%), elevated aminotransferases (18, 42%) and hypoalbuminemia (19, 45%) were common features. All cases had negative HIV serology and normal tumor markers. Twenty-two (52.5%) had solitary liver lesion and lesions > 2 cm in 28 (65%). Ultrasound showed hypoechoic lesions in 31 of 33 cases. Computed tomography showed hypodense lesions (43,100%) with mild peripheral enhancement (32, 74%). Calcifications (5, 12%) and capsular retraction (8, 19%) was uncommon. MRI was performed in seven cases commonly showed T1 hypointense, T2 hyperintense lesions with restricted diffusion. Histopathology showed granulomatous inflammation (42, 97.5%), Langhan’s giant cells (41, 95%) and caseation necrosis (35, 85%). Acid-fast stain and PCR positivity was uncommon. Extrahepatic organs were involved in 20 (46.5%). HTB mimicked cholangiocarcinoma (25, 58%), liver metastasis (11, 26%) and lymphoma (3, 7%). Six patients underwent liver resection with a presumptive diagnosis of cancer without a preoperative biopsy. All patients received antitubercular therapy, 37 had clinico-radiological response, there were 3 deaths and 3 patients were lost to follow-up. HTB is rare and can mimic a malignancy clinico-radiologically. Calcifications and pseudocapsule appearance on multiphase CT scan may help in differentiating HTB from hepatic malignancy. Tumor markers are normal while histopathology is generally diagnostic. A high index of suspicion is required to avoid unnecessary surgery as the patients respond well to ATT. This is a retrospective and observational study hence clinical trial registration is not applicable.
Journal of Clinical Interventional Radiology ISVIR
In this review article, the authors discuss the anatomy and technical aspects of CT-guided biopsy... more In this review article, the authors discuss the anatomy and technical aspects of CT-guided biopsy of vertebral lesions. CT guidance is highly useful for vertebral biopsies, as the anatomy of the spine is complex and varies widely across the levels. Prebiopsy imaging should be reviewed and later correlated with the final histopathological diagnosis. The majority of the spine biopsies are performed under local anesthesia, except those in critical locations and pediatric age groups. The biopsy sample is sent for histopathological analysis and/or microbiological analysis depending on the indications. It is preferable to use a coaxial system for biopsies, so multiple cores can be obtained with a single needle puncture, thus minimizing the negative yield and complications. Complications after image-guided percutaneous biopsy are rare and can be managed easily.
Background Bleeding from the unsalvageable recurrent and metastatic head and neck cancer is not a... more Background Bleeding from the unsalvageable recurrent and metastatic head and neck cancer is not an uncommon occurrence. It is extremely distressing for the patients and their family members and also to the treating doctors. One of the ways to manage this crisis is by selective embolization of the bleeding vessel. Methodology In this retrospective study, we audited the patients with unresectable, unsalvageable recurrent and/or metastatic head and neck cancer who underwent selective (palliative) embolization for bleeding at our institute between Jan 2015 and Nov 2019, and assessed its possible benefit in terms of bleeding free interval achieved. Results Twenty-six palliative embolization was done during the above mentioned period. The majority were male patients ( n = 23, 88.4%) with a median age of 54.5 years. The performance status (PS) of most patients was 2 ( n = 15, 57.6%). The most common bleeding vessel was the external carotid artery or one of its branches, most commonly lingual artery ( n = 5). The bleeding vessel was identified and embolized with PVA/gel foam/coil/glue. All the procedures were uneventful. Out of 26 patients, 3 patients had another bleeding episode subsequently. Most patients had 20 days to 21 months of bleeding free interval. The cost involved in the procedure was between 400 and 2100 US dollars. Conclusions Selective embolization is an option to be considered in certain patients with unresectable, unsalvageable recurrent and/or metastatic head and neck cancer, when they present with sudden and massive bleeding to the emergency department, at centres where the facility and expertise for this procedure might be available.
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