Diagnostic efficacy of sentinel node biopsy in oral squamous cell carcinoma : cohort study and meta-analysis

Objectives: To evaluate the efficacy of sentinel node biopsy (SNB) in oral squamous cell carcinoma (OSCC). Design: A prospective study of a cohort of 25 consecutive patients with OSCC anatomopathological confirmation through biopsy, without oncological pre-treatment, in clinical stage T1-T4N0, of these 25 patients 14 were T1-T2N0. The absence of regional disease (N0) was determined by means of clinical exploration and cervical tomography (CT). To establish the overall sensitivity of the technique, a meta-analysis was carried out of 10 series published to February 2005 where SNB had been applied to head and neck cancer, adding our 14 T1-T2N0 cases, thus making a total of 260 patients. Results: Identification by SNB was accurate in 96% of the 25 cases, with a sensitivity of 66.7%. Analyzing only the T1-T2N0 cases (n=14), the accuracy was 100% with a sensitivity of 1 (CI 95%, 0.29-1.00). The overall sensitivity was 93%. The accuracy in identifying the sentinel node varied between 66% and 100%. The SN was identified in 251 of 260 cases, of those, 71 were true positive, 5 false negative and 175 true negative. The overall sensitivity was 93.4% (CI 95%, 85.3-97.8), with a specificity of 100% (CI 95%, 0.98-100). The weighted negative probability quotient was 0.176 (CI 0.103-0.301) and that of positive probability 24.75 (CI 95%, 10.8-56.71). The weighted diagnostic odds ratio was 183.71 (CI 95%, 59.36-568.56). If we accept that the prevalence of hidden regional disease is 30%, a negative sentinel node has 5% possibility of having hidden disease. Conclusions: Our data provide a certain degree of evidence that, due to its high sensitivity, the SNB procedure can be applied to the initial stages of OSCC

Global Emergence of Resistance to Fluconazole and Voriconazole in Candida parapsilosis in Tertiary Hospitals in Spain During the OVID-19 Pandemic

Candida parapsilosis is a frequent cause of candidemia worldwide. Its incidence is associated with the use of medical implants, such as central venous catheters or parenteral nutrition. This species has reduced susceptibility to echinocandins, and it is susceptible to polyenes and azoles. Multiple outbreaks caused by fluconazole-nonsusceptible strains have been reported recently. A similar trend has been observed among the C. parapsilosis isolates received in the last 2 years at the Spanish Mycology Reference Laboratory. Yeast were identified by molecular biology, and antifungal susceptibility testing was performed using the European Committee on Antimicrobial Susceptibility Testing protocol. The ERG11 gene was sequenced to identify resistance mechanisms, and strain typing was carried out by microsatellite analysis. We examined the susceptibility profile of 1315 C. parapsilosis isolates available at our reference laboratory between 2000 and 2021, noticing an increase in the number of isolates with acquired resistance to fluconazole, and voriconazole has increased in at least 8 different Spanish hospitals in 2020-2021. From 121 recorded clones, 3 were identified as the most prevalent in Spain (clone 10 in Catalonia and clone 96 in Castilla-Leon and Madrid, whereas clone 67 was found in 2 geographically unrelated regions, Cantabria and the Balearic Islands). Our data suggest that concurrently with the coronavirus disease 2019 pandemic, a selection of fluconazole-resistant C. parapsilosis isolates has occurred in Spain, and the expansion of specific clones has been noted across centers. Further research is needed to determine the factors that underlie the successful expansion of these clones and their potential genetic relatednes