Time elapsed between the first symptoms, diagnosis and treatment of oral cancer patients in Belo Horizonte, Brazil

Objective: One of the most important objectives of a public health service is early diagnosis of disease, which provides a better prognosis and reduction in treatment cost. We investigated the delay for diagnosis and treatment of oral cancer in a public hospital. Material and methods: One hundred eighty records of patients who attended for their first consultation in the department of head and neck surgery in a public hospital from Belo Horizonte?Brazil, between the period from 1 January 1999 to 31 December 2001 were analysed. The following variables were analyzed: gender, age, evolution time (ET), time elapsed from referral to hospital and first appointment (RT), time elapsed from first appointment and treatment (TT), total time elapsed from first noticing the lesion and starting treatment (TTE), sites and staging. Results: Results for males and females were, respectively: mean age = 57.9 and 60.8 years; ET= 169.4 and 215.4 days; RT = 27.9 and 40.6 days; TT = 40.9 and 44.9days; TTE = 207.9 and 263.8 days. No correlation was observed between age and TTE for either gender. Women presented the highest mean values for ET and TTE (p<0.01). Conclusion: It was concluded that public health policy should be developed to address the excessively long time lapsed between diagnosis and treatment as well as improve public health education programs to promote early oral cancer identification

Perioperative frozen section examination in parotid gland tumors

CONTEXT: The minimal recommended surgical approach to parotid tumors is partial parotidectomy with resection of the superficial lobe of the gland. Histologic diagnosis prior to surgery is not possible, as incisional biopsies are contraindicated due to the possibility of facial nerve injury or incomplete tumor resection. Thus, the biopsies tend to be perioperative. OBJECTIVE: To compare the results of frozen section examination with the definitive pathological diagnosis. DESIGN: Accuracy study by retrospective analysis. SETTING: Head and Neck Surgery Service of Heliópolis Hospital, São Paulo, Brazil. SAMPLE: 153 cases of parotid gland tumors treated between 1977 and 1994. DIAGNOSTIC TEST: Frozen section and pathological diagnosis. MAIN MEASUREMENTS: Sensibility and specificity of the frozen section examination. RESULTS: Frozen section study diagnosed 19 (12.4%) malignant and 127 (83.7%) benign tumors. Sensitivity of the frozen sections for malignancy was 61.5% (95% CI 54 to 69%) and specificity was 98% (95% CI 94 to 100%), and this result is comparable to the literature. CONCLUSIONS: We consider that frozen section examination for salivary gland tumors is not sufficient on its own for deciding on the best management. Their interpretation must be correlated with clinical and intraoperative findings, in association with the surgeon's experience