STATISTICAL ANALYSIS OF NECK SWELLINGS, PRESENTATION AND DIAGNOSIS AT ALLAMA IQBAL MEMORIAL TEACHING HOSPITAL, SIALKOT.
Objectives: To collect data of the patients presenting with swellings in the neck, its presentations and final diagnosis. Study Design: Epidemiological Prospective study. Place & Duration of Study: Department of General Surgery, Khawaja Muhammad Safdar Medical College, Sialkot from January 2015 to March 2018. Patients and Methods: All patients serially presented in the surgery Department of Allama Iqbal Memorial hospital with palpable swellings and lumps in the neck region were registered. The patients were grouped in two categories Group I OPD patients who were not admitted and workup and investigations were carried out in OPD. Group II Admitted patients who required in door admission for investigations, diagnostic and therapeutic surgeries. When a suspicious node has been found, accurate examination of the upper aerodigestive tract mucosa by mirror examination and/or fiber-optic or rigid endoscopy is required, as well as (bimanual) palpation of the oropharynx and mouth. If this results in the detection of a primary carcinoma, further specific diagnostic measures can be taken. If no primary tumor is detected, the next diagnostic step is the fine needle aspiration cytology (FNAC) of the node by an experienced cytologist or surgeon. If the lesion is more difficult to approach or cytology is nondiagnostic, ultrasound guided fine needle aspiration cytology (USFNAC) has to be performed. All ages and both sex patients were included. Patients having clear swellings of thyroid i.e. goiters were not included. Patients treated and managed by otolaryngologist were included as those were investigated and diagnosed by the surgical department Minimum of three months of follow up was must for inclusion in the study. Data was entered and analysis done by SPSS v 22. Results: A total of 1370 patients were included in the study; 1 year to 59 years of age. Out of which 587 were Males and 783 were females (M: F ratio 1:1.15). Out of which 1105 patients were included via OPD GROUP-I; GROUP-II included 215 admitted to ward. Total number of fine needle aspiration cytology carried out were 963. As far as invasive procedures were concerned, total 163 incision biopsies were done out of which 623 were done under local anesthesia and 145 were done under general anesthesia. 18 patients were advised thyroid scan. Patients with posterior triangle neck swellings were 791 which were 71.58%. swellings in oral cavity were 11 making 0.99% of the total patients in group I. and the aerodigestive tract swellings included 2 patients making 0.18% of the patients in group I. Whereas in Group II, out of 215 patients, 165 presented with swellings in anterior triangle of the neck making 76.74% of the total patients in group II. 15 presented with lumps in the posterior triangle of neck contributing 7% to the total patients in group II. 20 cases were reported with swellings in the oral cavity making 9.3% of the total and finally 15 patients presented with swellings in aerodigestive tract with a percentage of 7%. In group I, out of 1105 patients 715 presented with fever making 64.70% of total patients included in group I. patients presenting will the complain of pain were 632 consisting of 57.19% of the total. All the patients in group I presented with neck swellings which makes 100% of patients. 35 patients had pussy discharge which constituted 3.16% of total patients. 23 complained of change in voice along with the complain of swelling making a total of 2.15%. Non amongst group I had restricted movements of jaw. Along with the complain of swelling 19 patients had white patches in the oral cavity, 1.71% of the total. Few also presented with red patches in the oral cavity consisting of total 8 patients and consisting of 0.72%. In group I, 356 out of 1105 patients (32.22%) were diagnosed to have Bacterial lymphadenitis/abscess. Whereas in group II, 13 out of 215(1.17%) patients had bacterial lymphadenitis. Tuberculous lymphadenitis/abscess was diagnosed in 290 patients (26.2%) and 27 (2.44%) patients in group I and II respectively. 43 patients (4.00%) were diagnosed with Lymphoma in group I while 21 patients (1.90%) had the same disease in group II. None of the patients in group I had any parotid tumor or pleomorphic adenoma, while 49 patients (4.43%) in group were diagnosed as a case of either parotid tumor or pleomorphic adenoma. Similarly no case of submandibular adenocarcinoma was reported in group I, but a total 8 cases (0.72% were reported in group II. 16 cases (1.44%) of Lateral Aberrant Thyroid were diagnosed in group II while none in group I. Metastatic Squamous Cell Carcinoma was diagnosed in 9 patients (0.81%) only in group II and no patient was diagnosed to have squamous cel carcinoma in group II. Nasopharyngeal carcinoma was reported in total 13 patient (1.17%) in group II whereas none on any patient in group I had this disease. 5 patients (0.45%) in group I and 7 patients (0.63%) in group II had cystic hygroma. 3 patients (0.27%) in group I and 2 patients (0.18%) were diagnosed with cervical rib.67 patients (6.11%) in group I had sebaceous cysts while none of any patient in group II were diagnosed to have sebaceous cyst. Carcinoma of tongue was diagnosed in 9 patients (0.81%) and 5 patients (0.45%) in group I and group II respectively.2 patients (0.18%) in group I were diagnosed with swelling in the neck as metastatic carcinoma from testicular tumor while 5 patients (0.45%) in group II were reported to have the same cause of swelling in the neck. Metastasis from Bronchogenic carcinoma was reported in 4 patients in group II while no patient in group I had metastasis from bronchogenic carcinoma as a cause of swelling in the neck region. Cases reported to have metastasis from esophageal and gastric carcinoma were 8(0.72%) in group II and no such cases were reported in group I. In group I out of 1105 patients 134(12.12%) were left either undiagnosed or no pathology was detected. Similarly 17 (1.54%) out of 215 were left undiagnosed in group II. Conclusion: Neck swellings and lumps present a challenge to practicing surgeons. It require a tedious workup and investigations to reach a final diagnosis. With all efforts there remains a percentage of patients which remain undiagnosed.