• Asian Pacific Journal of Cancer Prevention
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• v.15 no.18
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• pp.7719-7724
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• 2014

Background: Lymph node metastasis is believed to be a dependent negative prognostic factor of esophageal cancer. To explore detection methods with high sensitivity and accuracy for metastases to regional and distant lymph nodes in the clinic is of great significance. This study focused on clinical application of FDG PET/CT and contrast-enhanced multiple-slice helical computed tomography (MSCT) in lymph node staging of esophageal cancer. Materials and Methods: One hundred and fifteen cases were examined with enhanced 64-slice-MSCT scan, and FDG PET/CT imaging was conducted for neck, chest and upper abdomen within one week. The primary lesion, location and numbers of metastatic lymph nodes were observed. Surgery was performed within one week after FDG PET/CT detection. All resected lesions were confirmed histopathologically as the gold standard. Comparative analysis of the sensitivity, specificity, and accuracy based on FDG PET/CT and MSCT was conducted. Results: There were 946 lymph node groups resected during surgery from 115 patients, and 221 were confirmed to have metastasis pathologically. The sensitivity, specificity, accuracy of FDG PET/CT in detecting lymph node metastasis were 74.7%, 97.2% and 92.0%, while with MSCT they were 64.7%, 96.4%, and 89.0%, respectively. A significance difference was observed in sensitivity (p=0.030), but not the others (p>0.05). The accuracy of FDG PET/CT in detecting regional lymph node with or without metastasis were 91.9%, as compared to 89.4% for MSCT, while FDG PET/CT and MSCT values for detecting distant lymph node with or without metastasis were 94.4% and 94.7%. No significant difference was observed for either regional or distant lymph node metastasis. Additionally, for detecting para-esophageal lymph nodes metastasis, the sensitivity of FDG PET/CT was 72%, compared with 54.7% for MSCT (p=0.029). Conclusions: FDG PET/CT is more sensitive than MSCT in detecting lymph node metastasis, especially for para-esophageal lymph nodes in esophageal cancer cases, although no significant difference was observed between FDG PET/CT and MSCT in detecting both regional and distant lymph node metastasis. However, enhanced MSCT was found to be of great value in distinguishing false negative metastatic lymph nodes from FDG PET/CT. The combination of FDG PET/CT with MSCT should improve the accuracy in lymph node metastasis staging of esophageal cancer.

• 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.

• International journal of thyroidology
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• v.11 no.2
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• pp.143-151
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• 2018

Background and Objectives: Sirtuins (SIRTs) play important roles in cellular and organismal homeostasis. They have distinct gene expression patterns in various cancers; however, the relationship between SIRT expression and the progression of thyroid cancer is unclear. We investigated the expression of SIRTs in patients with papillary thyroid carcinoma (PTC) and their role as biomarkers for predicting the aggressiveness of this disease. Materials and Methods: We used immunohistochemical staining to evaluate the expression of SIRT1 and SIRT3 in tumor specimens from 270 patients with PTC. We also evaluated the potential association between SIRT expression and diverse clinicopathological features. Results: High SIRT1 expression was negatively correlated with lymphovascular invasion, central lymph node metastasis, and lateral lymph node metastasis. Multivariate analyses revealed that high SIRT1 expression was a negative independent risk factor for lateral lymph node metastasis. By contrast, high SIRT3 expression was positively correlated with locoregional recurrence. Interestingly, when patients were grouped by tumor SIRT expression patterns, the group with low SIRT1 expression and high SIRT3 expression was correlated with more aggressive cancer phenotypes including central lymph node metastasis and lateral lymph node metastasis. Conclusion: Our results suggest that SIRTs play dual roles in tumor progression, and the combination of decreased SIRT1 expression and increased SIRT3 expression is significantly associated with a poor prognosis in patients with PTC.

• Korean Journal of Head & Neck Oncology
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• v.35 no.2
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• pp.11-17
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• 2019

Background/Objectives: Papillary thyroid carcinoma (PTC) has generally an indolent character with a good prognosis. However, recurrence remains a major concern for the patients during their lifetime. Despite the slowly progressing character of PTC, recurrence can occur within a short period after initial surgery. This study aimed to determine the clinical findings and cause of recurrence in patients who underwent re-operative surgery due to neck node recurrence by reviewing the CT (computed tomographic) scan imaging of the recurrence of PTC retrospectively. Materials & Methods: We reviewed the medical records of patients referred to Ajou University Hospital from January 2002 to January 2018. All patients had re-operative surgery due to neck node recurrence and CT scan results of preoperative evaluation and postoperative follow up. Over this period, 110 patients who underwent re-operation due to neck node recurrence with a CT scan were included in our cohort, resulting in a total of 220 re-operations. Results: The time from initial operation to first re-operation was examined in 110 patients. The median time to re-operation was 28 months, with a range of 4 months to 186 months. Most re-operations (82.7%) occurred within the first five years, 43.6% were in the first two years from the initial surgery. The result of the retrospective CT review showed newly developed cases (21,19.1%), missed diagnosis cases (42,38.2%), real recur cases after surgery (33,30.0%), and remnant lymph nodes (LNs) cases (14,12.7%). We further sub-analyzed 14 cases with remnant LNs. Reasons for remnant LNs included insufficient operation (N=5) and beyond general surgical extent. (N=9). Conclusion: Re-operation due to cervical lymph node recurrence is mostly a persistent disease. They included a missed diagnosis and incomplete operation. These finding may reduce the reoperation of cervical lymph node recurrence by accurate preoperative evaluation and complete surgical resection at the initial surgery.

• Korean Journal of Head & Neck Oncology
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• v.16 no.1
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• pp.83-86
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• 2000

Thyroglossal duct cyst is common midline mass, which is related to hyoid bone and may show signs of inflammation. Carcinoma arising in the thyroglossal duct cyst is rare, occuring in less than 1% of thyroglossal duct cyst. Papillary adenocarcinoma is the most common histologic type(75-85%). The initial treatement of choice is wide excision of the tumor bearing tissue(Sistrunk procedure), resection of associated lymph node alone is enough when they are small and isolated, but a modified neck dissection must be done if regional involvement is more extensive. Its prognosis is excellent(the incidence of regional lymph node metastasis is 7% compare to 89% for papillary cancer of thyroid gland proper).

• Korean Journal of Head & Neck Oncology
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• v.20 no.2
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• pp.194-197
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• 2004

Castleman's disease was first described from Benjamin Castleman in 1956. The disease today is enumerated among lymphoproliferative disorders and has unknown etiology. Although the mediastinum is a their most common location, they also occurs in other areas of the body, usually where lymph nodes are normally found. Castleman's disease of the neck is very rare. We describe a case of Castleman's disease of the neck in a middle aged man, and discuss the clinical presentation, radiological findings, and pathological features.

• Korean Journal of Head & Neck Oncology
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• v.12 no.2
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• pp.147-152
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• 1996

For advanced head and neck cancers that originate in midline structures, bilateral neck dissection should be considered even if the lymph nodes were negative clinically. But, many complications and mortalities may occur in synchronous bilateral neck dissection at sacrifing of both internal jugular vein. Therefore several types of bilateral neck dissection have been proposed, but the effective and safe methods were not determined yet. So, we have prefered the method of synchronous bilateral neck dissection with preserving one internal jugular vein at least. We operated 21 patients who might be expected high incidences of bilateral neck metastases with above type of neck dissection. We analyzed the data of 21 cases(42 sides) retrospectively. The results were as follows: 1) The primary sites were transglottic(33%), supraglottic(29%), hypopharynx(29%) and tongue base(9%). 2) Types of neck dissection were RND(4 sides), MND(7 sides), FND(16 sides), and SND (15 sides). 3) Postoperative complications were minimal and did not influenced morbidity. 4) Mean interval time of neck recurrence was 21 months. Overall neck recurrent rate after bilateral neck dissecton was 19%. In 19%, neck recurrence from positive lymph nodes was 63% and from negative lymph nodes was 37%. As a results, synchronous bilateral neck dissection with preservation of one internal jugular vein minimally should be done in cases which were suspected high incidence of bilateral lymph node metastases for cure and prevention of neck recurrence.

• Korean Journal of Bronchoesophagology
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• v.6 no.1
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• pp.80-86
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• 2000

Background : Stomal recurrence that occasionally follows total laryngectomy is associated with very poor prognosis regardless of treatment modality, so it is very important to identify high risk patients to prevent stomal recurrence. Objectives : We attempted to select an optimal management method to prevent stomal recurrence by analyzing risk factors in each patient who was found to have stomal recurrence following total laryngectomy. Materials and Methods : Risk factors in each of eleven patients who had stomal recurrence out of 159 patients who underwent total laryngectomy in the last ten years were analyzed retrospectively. Data were gathered on risk factors such as the presence of subglottic extension, extralaryngeal extension, thyroid gland invasion, lymph node metastasis, timing of tracheotomy, tumor stage, postoperative radiotherapy, and inclusion of the stoma in the radiotherapy field. Results : There were eight cases of subglottic extension, six cases of extralaryngeal invasion, one case of pharyngocutaneous fistula that occurred as a postoperative complication, and one case who was taken completion laryngectomy following conservation surgery. With the exception of one case who was taken tracheotomy prior to total laryngectomy, all tracheotomies were performed intra-operatively after endotracheal intubation. There was no evidence of paratracheal lymph node or prelaryngeal lymph node metastasis on preoperative neck CT scan. There were six cases of T4 tumors, four cases of T3 tumors, and one case of T2 tumor. Salvage surgery was performed following radiotherapy in three cases, and aside from one case who was not taken post-operative radiotherapy, postoperative radiotherapy including the stoma was performed in the remaining seven cases within one month after surgery. Conclusion : Total laryngectomy with wide paratracheal lymph node dissection, thyroidectomy, and tracheotomy should be performed for patients who have high risk factors such as subglottic extension and advanced stage. We believe that tracheotomy should be precede endotracheal intubation. Efforts should be made to prevent stomal recurrence by utilizing postoperative radiotherapy and by minimizing postoperative complications such as infection and fistula.

• Korean Journal of Head & Neck Oncology
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• v.23 no.2
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• pp.138-141
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• 2007

Objectives : Well differentiated thyroid carcinoma(WDTC) has relatively good prognosis. But recurrence is associated with increased morbidity and mortality, and always results in reoperation. So it is important to evaluate the risk factors relative to the recurrence. The aim of this study is to evaluate the risk factors of recurrence. Materials and Method : Two hundred seventeen patients who had undergone thyroidectomy and proved as WDTC from January 1999 to December 2004 was included in the study. We reviewed patient-related and tumorrelated factors respectively and analyzed the correlation with tumor recurrence. Results : Fourteen patients from two hundreds seventeen had recurred. Recurrence rate was 6.5%, and average interval of recurrence was 28 month. Male, age over 45, multiple mass, and advanced TMN stage patient group show higher recurrence rate, but no statistical significance. However, the recurrence rate of lymph node metastasis, tumor size>1.5cm, and extracapsular invasion group were statistically high. Conclusion : Lymph node metastasis, tumor size and extracapsular invasion are significant risk factors related to the recurrence of WDTC.

• Korean Journal of Head & Neck Oncology
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• v.34 no.1
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• pp.49-53
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• 2018

Primary non-Hodgkin's lymphoma (NHL) rarely involves the parotid gland and its incidence is only 1.7% to 3.1% of all salivary gland neoplasms. The mucosa associated lymphoid tissue (MALT) is the most common subtype of NHL, followed by follicular lymphoma (FL) and diffuse large B cell lymphoma (DLBCL). However, two distinct types of lymphomas occurring synchronously in the parotid gland and cervical lymph node have not been reported earlier. A 72-year-old man with rubbery-hard and fixed mass on the left parotid area came to our clinic. We performed the left total parotidectomy with ipsilateral excision of lymph node (level II), and he was finally diagnosed as DLBCL in parotid gland and FL in upper neck. It is presumed that the DLBCL appeared to be a transformation from FL. We report the unique and rare disease entity with brief literature review.