• Nuclear Medicine and Molecular Imaging
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• v.41 no.1
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• pp.22-29
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• 2007

Purpose: Metastatic thyroid cancers with I-131 uptake have been known to show no increase of FDG uptake whereas those without I-131 uptake tend to demonstrate increased uptake on PET. In this study, we evaluated the degree of FDG uptake in primary thyroid cancers of papillary histology before surgery. Material & Methods: Forty FDG PET studies were performed on the patients who had papillary cancer proven by fine needle aspiration. The degree of FDG uptake was visually categorized as positive or negative (positive if the tumor showed discernible FDG; negative if the tumor didn't) and the peak standard uptake value (peak SUV) of the papillary thyroid cancer (PTC) were compared with the size of PTC. Results: The mean size of 26 PTC with positive FDG uptake was $1.9{\pm}1.4\;cm(0.5{\sim}5\;cm)$. In 13 PTC with negative FDG uptake, the mean size of those was $0.5{\pm}0.2\;cm\;(0.2{\sim}0.9\;cm)$. All PTC larger than 1cm ($2.5{\pm}1.4\;cm,\;1{\sim}5\;cm$) have positive FDG uptake (peak $SUV=6.4{\pm}5.7,\;1.7{\sim}22.7$). Among the micropapillary thyroid cancer (microPTC; PTC smaller than 1cm), 8 microPTC show positive FDG uptake(peak $SUV=2.9{\pm}1.3,\;1.7{\sim}5.5$), while 13 microPTC show negative finding(peak $SUV=1.3{\pm}0.2,\;1.1{\sim}1.7$). The size of microPTC with positive FDG uptake is significantly larger than that of microPTC with negative FDG uptake ($0.7{\pm}0.1\;cm$ vs $0.4{\pm}0.2\;cm$, p=0.01). Conclusion: All PTCs larger than 1cm show positive FDG uptake in our study. In other words, thyroid lesions larger than 1cm with negative FDG uptake are unlikely to be PTC. So far, only poorly differentiated thyroid cancers are known to show increased FDG uptake. Our results seem to be contradictory to what is known in the literature. Further study is needed to understand better the significance of increased FDG uptake in PTC in relation to expression of NIS and GLUT.

• 대한두경부종양학회:학술대회논문집
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• 1999.12a
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• pp.270.1-270.1
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• 1999

• Korean Journal of Head & Neck Oncology
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• v.8 no.1
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• pp.1-5
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• 1992

기관연골까지만 침윤된 갑상선암에서 침윤된 기관연골을 면도식으로 깍아 내는 술식을 선택했을때 효과적인 치료방법이 되는가를 알아보기 위하여 본 연구를 실시하였다. 1979년 부터 1988년까지 10년간수술이 시행된 갑상선암환자 432예중 기관연골까지만 침윤된 환자는 16예 이였다. 남자가 3예, 여자가 13예 이었으며, 이들의 평균 연령은 55.8세 이었고, 조직학적으로는 유두상암이 14예, 여포상암이 2예 였다. 전예에서 침윤된 기관연골을 면도식으로 깍아내였으며, 수술후 보조치료로 방사성 동위원소 치료나 외부 방사선 조사를 추가하였고, 또한 갑상선 홀몬 투여로 TSH 억제 치료를 하였다. 평균 추척 기간은 67.7개월이었다. 16예중 무병생존은 4예에 불과하였고, 12예가 치료에 실패했는데 이중 7예는 갑상선암의 재발로 사망하였다. 이상의 결과로 면도식 절제술은 갑상선암이 기관연골에 침윤되었을 때의 술식으로는 부적당하며 무병 생존율을 향상시키기 위해서는 비록 표재성인 기관연골 침윤이라도 기관제술과 같은 적극적인 술식 선택이 바람직하다고 사료되었다.

• The Korean Journal of Nuclear Medicine
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• v.23 no.2
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• pp.165-173
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• 1989

1983년 1월 부터 1987년 12월까지 5년간 부산의 세곳 대학병원(부산의대, 고신의대, 인제의대)에서 병리조직학적으로 확진된 갑상선암 629예중 병력지 관찰이 가능하였던, 478예를 분석하여 1988년 보사부에서 발행한 Five Years' Report for Cancer Registry Programmme in Republic of Korea (1982 7. 1$\sim$1987. 6.30)의 발생빈도와 비교하였으며, 478예중 311예의 갑상선주사 소견을 분류하여 다음과 같은 결과를 얻었다. 1) 전체 악성암에 대한 갑상선암의 발생빈도는 2.54%(629/24.749)이었으며 이는 한국인에 있어서의 발생빈도와 거의 같았다(2.5%). 2) 여자에서 5배 이상 발생하여 (1 : 5.64) 이것 역시 한국인에서의 성별빈도와 매우 유사하였다(1 : 5.22). 3) 연령분포는 10세에서 91세까지로서 87.03%가 20세에서 59세 사이에 있었다. 4) 유두상암이 가장 흔하였고(78.24%),다음이 여포상암(14.44%) 그 다음이 미분화암(22.30%) 이었다. 5) 갑상선주사 소견상 대부분의 암은 solitary cold nodule을 보였다(82.96% : 258/311).

• Korean Journal of Head & Neck Oncology
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• v.28 no.2
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• pp.135-138
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• 2012

Primary thyroid lymphoma is rare and accounts for less than 5% of all thyroid malignancy. The clinical presentation includes a rapidly enlarging neck mass, associated with dysphagia, dyspnea or hoarseness. The most common histologic type is diffuse large B cell non-Hodgkin's lymphoma. Papillary thyroid carcinoma is the most common type of thyroid malignancy. Co-occurrence of papillary thyroid carcinoma and primary thyroid lymphoma is very rare. Recently, we experienced a case with co-occurrence of papillary thyroid carcinoma and primary thyroid lymphoma in a 79-year-old woman, who had tuberculous lymphadenitis presented as lateral neck mass. We present this case with a review of the literature.

• Korean Journal of Head & Neck Oncology
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• v.31 no.1
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• pp.18-21
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• 2015

기관을 침범한 갑상선 악성종양을 제거한 후에 성문하부에 비교적 큰 기관 결손이 발생할 수 있다. 단단문합술은 넓은 부위의 결손부를 재건하는 방법으로 널리 받아들여지고 있지만, 문합부 파열, 반회후두신경마비, 재협착 등의 합병증이 발생할 수 있다. 본 증례는 기도를 침범한 갑상선 유두암종을 제거한 후 윤상연골과 기관연골의 비교적 큰 결손부를 흉쇄유돌근 근골막피판을 사용하여 안전하게 재건한 사례이다. 55세 남자 환자가 기도를 침범한 갑상선 유두상암으로 내원하였으며 기도침범은 윤상연골(둘레의 약 30%)과 4개의 기관연골(둘레의 약 50%)을 해당하는 넓은 부위였다. 수술 전 기관절개술을 시행하여 주위 기관연골의 상태가 좋지 않아 단단문합술 시행 후 문합부 파열 가능성이 있다고 판단하여 흉쇄유돌근 근골막피판을 이용하여 재건하기로 계획하였다. 갑상선 절제술, 경부림프절 절제술, 흉쇄유돌근 근골막피판을 이용한 재건술을 시행하였으며 수술 후 12일째 별다른 문제없이 퇴원하였다. 환자는 수술 후 현재 22개월 간 기도 협착 등의 별다른 합병증 없이 지내고 있다. 흉쇄유돌근 근골막피판은 성문하부나 기관지 전외측벽의 비교적 큰 결손부를 재건하는 데 유용하게 사용될 수 있다.

• Korean Journal of Head & Neck Oncology
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• v.32 no.1
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• pp.13-19
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• 2016

Background : The 2015 American thyroid association (ATA) guidelines greatly expanded section on risk stratification of thyroid cancer. Definition of "Low risk of recurrence" has expanded, by inclusion of small volume lymph node involvement, such as less than 5 lymph node metastases each smaller than 2mm in central compartment. Purpose : We evaluated the number of positive nodes, Positive node ratio (PNR), recurrence, and radioablation therapy. Also, evaluated the safety of omitting strategy of radioablation after total thyroidectomy with PTC, especially on low-PNR N1a patients compared with high-PNR N1a patients. Methods : Consecutive 147 N1a and 216 N0 patients who underwent total thyroidectomy with central neck dissection between 2003 and 2004 were enrolled. We divided 147 N1a patients into two groups, such as 96 high-PNR versus 51 low-PNR group according to 50% of PNR, and compared these two groups with N0 group. Results: 7.2% (26/363) recurrences were occurred, and 21/147 (14.3 %) recurrences were on N1a patients, and 5/216 (2.3 %) were on N0 patients. Of these 21 recurrences in N1a stage patients, 20 (95.2 %) recurrences were occurred in high-PNR N1a group and only 1 (4.8 %) recurrence was in low-PNR N1a group. The recurrence of low-PNR N1a group was significantly lower than high-PNR N1a group (Log-rank p value = 0.003), but significantly not different from N0 group (Log-rank p value = 0.889). Although this study was a retrospective non-randomized trial with small number of patients, the 10-year recurrence of omitting RAI in low-PNR N1a patients with less than 50% of PNR were shown to be comparable with 216 N0 low risk patients. Conclusion : Positive node ratio could be a useful predictor of recurrence and useful guidance postoperative management -rather than absolute number of positive node.

• Korean Journal of Head & Neck Oncology
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• v.34 no.1
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• pp.1-7
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• 2018

Papillary thyroid carcinoma has a good prognosis, but the frequency of locoregional lymph node metastasis is high and is known to occur stepwise fashion. Prophylactic central node dissection in papillary thyroid carcinoma is widely performed from the past. But, the pros and cons of the prophylactic central node dissection has been ongoing for a long time. In the American Thyroid Association management guideline for thyroid nodules and differentiated thyroid cancer, which is the most widely used, recommendations about prophylactic central node dissection has been changed in past ten years. In recent systematic review and meta-analysis, prophylactic central node dissection increases the rate of transient hypocalcemia and recurrent laryngeal nerve injury, but there is no difference in the frequency of permanent hypocalcemia or recurrent laryngeal nerve injury. Prophylactic central node dissection has not been shown to improve patient survival, but recurrence has been reported to decrease. According to a questionnaire survey of the members of Korean Scociety of Thyroid-Head and Neck Surgery, Korean doctors tend to perform the prophylactic central node dissection more aggressively than other countries. The reason for this is that Korea has a large number of thyroid surgeries and therefore surgeons are more experienced than other countries.

• Korean Journal of Head & Neck Oncology
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• v.29 no.2
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• pp.37-40
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• 2013

Background and Objectives : To assess the usefulness of computed tomography image before papillary thyroid cancer surgery, focus on confirmation of lateral cervical lymph node metastasis not detected by ultrasonography. Material and Methods : From January 2008 to May 2009, total 150 patients who had undergone thyroid surgery and been confirmed papillary thyroid cancer pathologically were enrolled. They had taken neck computed tomography following the ultrasonography. Results : Computed tomography had found suspicious metastatic lateral neck lesion in 13 patients. After the image study, lateral neck lymph node dissection had been included in their surgical plan. Of these, only 7 cases were confirmed pathologically lateral neck lymph node metastasis(positive predictive value=0.54). Taken as whole 150 patients, additionally 4.7% of patients confirmed lateral neck lymph node metastasis by preoperative computed tomography. Conclusion : If preoperative ultrasonography was performed precisely, additional benefits that could be achieved by computed tomography were not much.

• Korean Journal of Head & Neck Oncology
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• v.27 no.1
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• pp.59-65
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• 2011

Background and Objectives : Papillary thyroid carcinoma(PTC) frequently metastasize to the regional neck, however, lateral neck lymph node metastasis is less common. The aim of this study is to investigate clinical and immunohistochemical features of PTC with lateral LN metastasis, and determine the predictive factors for lateral LN metastases. Material and Methods : We undertook a retrospective study of 83 patients treated between January 2007 and December 2009 for PTC by thyroidectomy with or without lateral neck dissection. The following criteria were used to study the clinical predictive value of lateral LN. metastases : sex, age, tumor size, multifocality, extracapsular spread(ECS) and lymphovascular emboli. Immunohistochemical staining for VEGF-A, VEGF-C, Bax, Bcl-2, Cyclin D1, Cyclin E, $p27^{kip1}$ and $p57^{kip2}$ was performed, and quantified blindly by three pathologists who had no clinical information of the patients. Immunohistochemical expression was scored as high(>50% of cells stained) or low(0-49%). Results : With use of univariate and multivariate analysis, tumor size(>2cm) and ECS were independent correlates of lateral LN metastasis in PTC. Expression of VEGF-C, Bax, and Cyclin D1 in the PTC with lateral LN metastasis was scored higher than in PTC without lateral LN metastasis(p<0.05). Conclusion : The important risk factors for lateral LN metastasis in PTC are primary tumor size and the presence of ECS. And expression of VEGF-C, Bax and cyclin D1 may be considered of lateral LN metastatic potential in PTC.