6 results on '"Parasher, Arjun K"'
Search Results
2. Optical imaging with a high-resolution microendoscope to identify sinonasal pathology.
- Author
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Kidwai SM, Parasher AK, Schorn VJ, Demicco EG, Richards-Kortum R, Iloreta AM, Govindaraj S, and Miles BA
- Subjects
- Feasibility Studies, Humans, Endoscopy, Microscopy, Nasal Polyps diagnostic imaging, Nose Neoplasms diagnostic imaging, Optical Imaging, Papilloma, Inverted diagnostic imaging
- Abstract
Objectives: High-resolution microendoscopy (HRME) is an optical imaging modality that allows real time imaging of epithelial tissue and structural changes within. We hypothesize that HRME, using proflavine, a contrast agent that preferentially stains cell nuclei and allows detection of cellular morphologic changes, can distinguish sinonasal pathology from uninvolved mucosa, potentially enabling real-time surgical margin differentiation., Study Design: Ex vivo imaging of histopathologically confirmed samples of sinonasal pathology and uninvolved, normal sinus epithelium., Setting: Single tertiary-level institution., Subjects and Methods: Five inverted papillomas, one oncocytic papilloma, two uninvolved sinus epithelia specimens, and three inflammatory polyps were imaged ex vivo with HRME after surface staining with proflavine. Following imaging, the specimens were submitted for hematoxylin and eosin staining to allow histopathological correlation., Results: Results show that sinonasal pathology and normal sinus epithelia have distinct HRME imaging characteristics. Schneiderian papilloma specimens show increased nuclear-to-cytoplasmic ratio, nuclear crowding, and small internuclear separation, whereas normal sinus epithelia specimens show small, bright nuclei with dark cytoplasm and relatively large internuclear separation. Inflammatory polyps, however, have varying imaging characteristics, that resemble both Schneiderian papilloma and normal sinus epithelia., Conclusions: This study demonstrates the feasibility of HRME imaging to discriminate sinonasal pathology from normal sinus epithelia. While the system performed well in the absence of inflammation, discrimination of inflamed tissue was inconsistent, creating a significant limitation for this application. Novel imaging systems such as HRME with alternative contrast agents may assist with real-time surgical margin differentiation, enabling complete surgical resection of inverted papilloma and reducing recurrence rates., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
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3. Sinonasal quality of life after endoscopic resection of malignant sinonasal and skull base tumors.
- Author
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Glicksman JT, Parasher AK, Brooks SG, Workman AD, Lambert JL, Bergman JE, Palmer JN, and Adappa ND
- Subjects
- Adult, Aged, Endoscopy methods, Female, Follow-Up Studies, Humans, Male, Middle Aged, Nose Neoplasms psychology, Nose Neoplasms surgery, Paranasal Sinus Neoplasms physiopathology, Paranasal Sinus Neoplasms psychology, Paranasal Sinus Neoplasms surgery, Postoperative Period, Prospective Studies, Skull Base Neoplasms psychology, Skull Base Neoplasms surgery, Surveys and Questionnaires, Treatment Outcome, Endoscopy statistics & numerical data, Nose Neoplasms physiopathology, Quality of Life, Skull Base Neoplasms physiopathology
- Abstract
Objectives: Improvement in sinonasal quality of life (QoL) following sinus surgery has been well-documented across the literature. To our knowledge, only one series has evaluated long-term QoL in patients undergoing tumor resection, and that study demonstrated no improvement in rhinologic QoL following malignant tumor resection at 2-year follow-up. The objective of the present study was to evaluate QoL in the 2 years following endoscopic malignant tumor resection., Methods: A prospective cohort study was performed, including patients with both malignant and benign sinonasal tumors in a tertiary academic medical center. Patients undergoing endoscopic tumor resection who had completed Sinonasal Outcome Test 22 (SNOT-22) questionnaires were included in the cohort. SNOT-22 questionnaires were administered preoperatively and over a 2-year follow-up period at clinic visits. Longitudinal linear mixed-effects regression was used to compare preoperative QoL to QoL over the 2 years following surgery., Results: Among 145 patients included in this study, 64 had malignant tumors. There was a statistically significant improvement in SNOT-22 score from baseline to 2 years for patients with both malignant tumors (37.0, 95% confidence Interval [CI] 32.0-42.1 at baseline; 26.5 95% CI 20.8-32.2 at 2 years; P < 0.001) and benign tumors (26.5, 95% CI 21.4-30.4 at baseline; 12.9 95% CI 7.6-18.2 at 2 years; P < 0.001)., Conclusion: In contrast to previously reported series, in this cohort endoscopic resection of sinonasal tumors appears to be followed by an improvement in QoL, which is sustained over a 2-year period., Level of Evidence: 2b. Laryngoscope, 128:789-793, 2018., (© 2017 The American Laryngological, Rhinological and Otological Society, Inc.)
- Published
- 2018
- Full Text
- View/download PDF
4. 18 FDG PET/CT in Routine Surveillance of Asymptomatic Patients following Treatment of Sinonasal Neoplasms.
- Author
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Workman AD, Glicksman JT, Parasher AK, Carey RM, Brooks SG, Kennedy DW, Nabavizadeh SA, Learned KO, Palmer JN, and Adappa ND
- Subjects
- Asymptomatic Diseases, Combined Modality Therapy, Female, Humans, Male, Middle Aged, Nose Neoplasms therapy, Paranasal Sinus Neoplasms therapy, Radiopharmaceuticals pharmacology, Retrospective Studies, Fluorodeoxyglucose F18 pharmacology, Neoplasm Recurrence, Local diagnosis, Nose Neoplasms diagnosis, Paranasal Sinus Neoplasms diagnosis, Positron Emission Tomography Computed Tomography methods, Surveys and Questionnaires
- Abstract
Objective Sinonasal neoplasms have a high rate of recurrence following treatment, and current guidelines support the use of a variety of surveillance techniques. Recent work demonstrates that performance parameters of surveillance modalities may differ with sinonasal tumors in particular when compared with head and neck tumors overall. This study aims to characterize the value of
18 fluorodeoxyglucose (18 FDG) positron emission tomography/computed tomography (PET/CT) as a screening tool in asymptomatic patients. Study Design Retrospective cohort study. Setting Hospital of the University of Pennsylvania and Pennsylvania hospital. Methods Records of asymptomatic patients without suspicious endoscopy or suspicious imaging other than PET during the first 3 years following definitive treatment for sinonasal malignancy were screened and analyzed for inclusion in the cohort. Disease recurrence was determined by biopsy following suspicious PET evaluation. Results PET/CT scans (n = 111) were performed for 45 disease-free asymptomatic patients with no evidence of disease on endoscopy, and 6.3% were suspicious and prompted biopsy during this period, revealing 3 cases of disease recurrence. Overall specificity for PET/CT alone was 96.3% (95% CI, 90.7%-99.0%), with a negative predictive value of 99% (95% CI, 94.8%-100%). All recurrences were detected between 7 and 12 months, and all patients with true recurrence diagnosed by PET/CT had extrasinonasal involvement of tumor at the time of surgery. Conclusion We examined performance parameters of18 FDG PET/CT in asymptomatic patients with no evidence of disease on endoscopy during the posttreatment period for sinonasal malignancy. The ability of PET/CT to detect recurrences that may be missed by structural imaging or endoscopy makes it a valuable tool for clinicians.- Published
- 2017
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5. High-resolution microendoscope imaging of inverted papilloma and normal sinonasal mucosa: evaluation of interobserver concordance.
- Author
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Parasher AK, Kidwai SM, Schorn VJ, Goljo E, Weinberg AD, Richards-Kortum R, Sikora AG, Iloreta AM, Govindaraj S, and Miles BA
- Subjects
- Capsule Endoscopes statistics & numerical data, Endoscopy, Humans, Nose Neoplasms pathology, Observer Variation, Otolaryngology, Papilloma, Inverted pathology, Reproducibility of Results, Sensitivity and Specificity, Nasal Mucosa pathology, Nose Neoplasms diagnosis, Papilloma, Inverted diagnosis
- Abstract
Background: High-resolution microendoscopy (HRME) enables real-time imaging of epithelial tissue. The utility of this novel imaging modality for inverted papilloma has not been previously described. This study examines the ability of otolaryngologists to differentiate between images of inverted papilloma and normal sinonasal mucosa obtained with a HRME., Methods: Inverted papilloma and normal sinonasal mucosa specimens were stained with a contrast agent, proflavine. HRME images were subsequently captured. Histopathological diagnosis was obtained for each sample. Quality-controlled images were used to assemble a training set. After reviewing the training images, 6 otolaryngologists without prior HRME experience reviewed and classified test images., Results: Five samples of inverted papilloma and 2 normal sinonasal mucosa samples were collected. Four representative images from each specimen were used for the 28-image test set. The mean accuracy among all reviewers was 89.9% (95% confidence interval [CI], 84.3% to 94.0%). The sensitivity to correctly identify inverted papilloma was 86.7% (95% CI, 79.2% to 92.2%), and the specificity was 92.9% (95% CI, 89.0% to 100.0%). The Fleiss kappa interrater reliability score was 0.80 (95% CI, 0.70 to 0.89)., Conclusion: Inverted papilloma and normal sinonasal mucosa have distinct HRME imaging characteristics. Otolaryngologists can be successfully trained to distinguish between inverted papilloma and normal sinonasal mucosa. HRME is a feasible tool for identification of inverted papilloma. By conducting future in vivo trials, HRME potentially may enable real-time surgical margin determination during surgical excision of inverted papilloma., (© 2015 ARS-AAOA, LLC.)
- Published
- 2015
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6. An unusual presentation of NK/T-cell lymphoma, nasal-type in the United States.
- Author
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Kidwai SM, Parasher AK, and Lin FY
- Subjects
- Adult, Biopsy, Diagnosis, Differential, Humans, Lymphoma, Extranodal NK-T-Cell pathology, Lymphoma, Extranodal NK-T-Cell therapy, Male, Nose Neoplasms pathology, Nose Neoplasms therapy, Lymphoma, Extranodal NK-T-Cell diagnosis, Nose Neoplasms diagnosis
- Abstract
Introduction: NK/T-cell lymphoma (NKCL), nasal-type is rare in the United States, representing only 1.5% of non-Hodgkin lymphomas. Classically, patients initially present with nasal obstruction (70%), caused by invasion of the localized lesion into the sinuses and nasal cavities. Initial presentation with persistent sore throat and odynophagia due to oropharyngeal tumor extension is rare, and thus, is often overlooked as viral or bacterial pharyngitis. By studying a case of NKTCL nasal type, we emphasize the need to apply high clinical suspicion for NKTCL, nasal type for early diagnosis and improved survival., Methods: A case report of a rare presentation of NKTCL, nasal-type is discussed. A literature review is provided to define clinical signs crucial for early diagnosis, appropriate work-up, and expedient treatment of this aggressive, rapidly progressive malignancy., Results: In the present case, a 25year-old healthy male presented with a 2-week history of sore throat and odynophagia. On exam, the patient had an ulcerative lesion of the soft palate, an enlarged uvula, and tonsillar exudate with tender submandibular lymphadenopathy. After the patient failed to respond to antibiotic therapy for presumptive pharyngitis, a biopsy of the oropharyngeal tissue was completed, which identified necrotizing sialometaplasia. High clinical suspicion led to repeat deep-tissue biopsy, where a final diagnosis of NKTCL, nasal type was made. The patient then began definitive treatment with chemotherapy and radiation., Conclusions: High clinical suspicion is key to early diagnosis and improved survival of NKTCL, nasal-type. Otolaryngologists who encounter prolonged, complicated cases of pharyngitis or necrotizing sialometaplasia should consider a diagnosis of NKTCL, nasal-type, in order to prevent rapid disease progression., (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
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