Roles of single photo emission computed tomography-CT in detecting residual tumor from patients with thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>As newly, functional, diagnostic measure-18F-deoxyglucose single photo emission computed tomography (18F-FDG SPECT-CT) has well sensitivity and specialty , it was proved availability in differentiating benign and malignant tumor. In this study, it was compared the efficiency of detecting residual tumor of thyroid cancer between 18F-FDG SPECT-CT and CT-TWIN.</p><p><b>METHODS</b>During May 2004 to August 2004, 56 patients with thyroid disease were divided into two groups, one group was 32 cases suffered thyroid tumor, another was 24 cases suffered improper operation. All cases must take 18F-FDG SPECT-CT and CT-TWIN.</p><p><b>RESULTS</b>Forty eight cases had been performed operation, and 8 cases waited and watched because they didn't be found residual tumor by 18F-FDG SPECT-CT and CT-TWIN. The results in detecting thyroid tumor showed that the same rate of diagnostic correction of SPECT-CT was 87.5% (28/32), and the Youden index of SPECT-CT was 0.667, higher than that of CT which was 87.5% (28/32) and 0.633 respectively. When the results two methods were accordant, the rate of diagnostic correction was 100% (24/24), and Youden index was 1, and the result had statistic signification. The rate of diagnostic correction of SPECT-CT in detecting residual tumor was 84.6%, and its Youden index was 0.675. The rate of diagnostic correction of CT in detecting residual tumor was 75.0%, and its Youden index was 0.492; and the result had statistics signification by being compared two different measures.</p><p><b>CONCLUSIONS</b>SPECT-CT and CT all had higher diagnostic efficacy, and they could promote the diagnostic efficacy when they have the same diagnosis in detecting thyroid tumor. The rate of detecting residual tumor of SPECT-CT was 81.3%, compared with that of CT the diagnostic efficacy has greater raise.</p>

Value of elective neck dissection in patients with clinically stage I squamous cell carcinoma of the tongue / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To determine the value of elective neck dissection in patients with clinically stage I (cT1N0M0) squamous cell carcinoma of the tongue.</p><p><b>METHODS</b>This was a retrospective study of patients with surgical treatment between November 1984 and November 1999. A total of 130 patients were included in the study, all of whom received operation of the primary site, meanwhile, 99 of whom underwent elective neck dissection simultaneously including level I -III or level I -IV neck dissection in 20 patients and level I - V neck dissection in 79 patients. Results Among all these patients, the rate of occult metastasis to the neck were 12. 0%. Local failure rate in patients with only local treatment, level I II, II, III/IV neck dissection and level I - V neck dissection were 25. 8%, 15. 0% and 7. 6% respectively. There were significant difference in regional failure between patients with only local treatment and patients with elective neck dissection (P < 0.05). Also, no significant differences were noted in the survival rate between patients with only local treatment, elective neck dissection (level I -III or level I -IV) and level I -V neck dissection (P > 0.05).</p><p><b>CONCLUSIONS</b>Elective neck dissection significantly reduced regional control failure but was not able to reduce distant metastasis or increase the overall survival. A prospective randomized study is worthwhile to further evaluate the benefit of elective neck dissection in the treatment of clinically stage I squamous cell carcinoma of the tongue.</p>

Pathological character and treatment of epithelial-myoepithelial carcinoma of salivary gland / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To review and evaluate pathologic features and treatment of epithelial-myoepithelial.</p><p><b>METHODS</b>Retrospectively reviewed 14 cases' pathological and clinical materials of epithelial-myoepithelial carcinoma of salivary gland. Eight cases origine from parotid gland, 2 cases from hard palate, 3 cases from submandibular gland and 1 case from nasal cavity. Three cases were performed induction chemotherapy preoperation. One case had palliative radiotherapy. Thirteen cases were performed radical surgery and 6 cases had radiotherapy postoperation.</p><p><b>RESULTS</b>Tumor arisen mostly from parotid gland and neck lymph node metastasis rate was 14.28% (2/14). The survival rate was calculated with Kaplan-Meier method. The overall 3-, 5- and 10-year survival rate were 67.20%, 45.49% and 17.06%. Its histological characteristics were inner layer composed by adenoid cells and outer layer composed by myoepithelial cells. Immunohistochemical exam show cytokeratin, S-100 and actin reaction positive.</p><p><b>CONCLUSIONS</b>Epithelial-myoepithelial carcinoma easily develops recurrence. It is sensitivity to radiotherapy and chemotherapy to some extent. It is suitable to adopt surgical treatment as primary modality combined with other therapies.</p>

Management option for cervical metastases in tongue squamous cell carcinoma with clinically N0 neck / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>This study was designed to explore the optimal management option for cervical metastases in tongue squamous cell carcinoma (SCC) with clinically N0 neck in order to avoid excessive or inadequate treatment in clinical practice.</p><p><b>METHODS</b>Clinical data of 327 cases of tongue SCC with cN0 neck were retrospectively analyzed. Neck control rates affected by different pathoclinical parameters were compared. Prognosis analysis and death analysis were also performed.</p><p><b>RESULTS</b>Overall 3-year survival was 69.7% (228/327), 3-year survival of neck recurrent group and non-recurrent group was 39.1% (25/64) and 77.2% (203/263), and 51.5% (51/99) of the death related to neck failure. Overall neck control rate was 80.4% (263/327); neck control rate of wait and watch group, level I neck dissection, level I + II neck dissection, supraomohyoid neck dissection, radical neck dissection, functional neck dissection, was 67.5% (27/40), 72.7% (24/33), 60.0% (15/25), 84.9% (45/55), 86.8% (131/151), 84.0% (21/25), respectively. Treatment modality and cervical lymph node involvement were independent factors for neck control.</p><p><b>CONCLUSIONS</b>Neck control is a key for prognosis of tongue SCC with cN0 neck. Supraomohyoid neck dissection is the first choice in management of cervical metastases in tongue SCC with cN0 neck, during which the suspected involved lymph nodes should be sent for frozen section to determine whether comprehensive neck dissection required. Multimodal metastasis and/or capsular spread are the indications for postoperative irradiation.</p>

Differentiated thyroid carcinoma in young people / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the factors that influence survival of the patients with differentiated thyroid carcinoma in young people and evaluate the efficiency of unilateral lobectomy plus isthmectomy with therapeutic cervical lymph node dissection and postoperative TSH (thyroid stimulating hormone) suppressive therapy.</p><p><b>METHODS</b>One hundred and thirty-one patients under 30 years old with differentiated thyroid carcinoma treated in this hospital (14 cases no more than and 117 cases more than 16 years) from Jan. 1st, 1985 to Dec. 31st, 1997 were retrospectively reviewed. One hundred and twenty-eight patients were received only surgery and TSH suppressive therapy, and 3 patients received chemotherapy or radiotherapy because of the progressive metastasis in necks or mediastina. A multivariate analysis was performed in these patients by the Cox proportional hazard model.</p><p><b>RESULTS</b>The mean follow-time (x +/- s) of all patients were (140.86 +/- 43.76) months, with range from 20 to 229 months; Ninety-eight patients followed more than 10 years. Ten patients died of thyroid cancer. The overall 10-year survival rate was 97.18%. The 10-year survival rate for patients < or = 16 years of age and > 16 years were 75.97% and 96.57% respectively (P = 0. 0006). The 10-year survival rate for women and men were 94.91% and 93.69% respectively (P = 0.5261). The 10-year survival rates of patients with papillary thyroid carcinoma and follicular thyroid carcinoma were 93.77% and 96. 55% respectively (P = 0.8137). For patients with tumor size of < or = 1 cm, 1-4 cm and >4 cm the survival rate was 100.0%, 96.40%, and 80.67% respectively (P = 0. 0589). The 10-year survival rates of patients with or without lymph node metastasis were 88.37% and 100. 0% respectively (P = 0.0313). For patients of with or without distant metastasis, The survival rate was 96.64% or 60.00% (P = 0.0000). The 10-year survival rates with or without recurrence were 86. 67% and 95.48% respectively (P = 0. 5681). Using multivariate analysis, risk factors that independently influence survival were distant metastasis, tumor size and age.</p><p><b>CONCLUSIONS</b>The distant metastasis, tumor size and age at diagnosis were the independent factors influencing survival significantly. The status of lymph node metastasis may have certain effect on the prognosis. Unilateral lobectomy plus isthmectomy with a therapeutic cervical lymph node dissection followed by postoperative TSH suppressive therapy is a favourable model to children and young adults with DTC without distant metastasis, but to the patients with distant metastasis, their prognosis of this therapy model is disappointing.</p>

Clinical research of sentinel node biopsy in oral tongue carcinoma / 中华口腔医学杂志

<p><b>OBJECTIVE</b>This study was designed to evaluate whether sentinel node (SN) biopsy can accurately assess the cervical lymph node status of oral tongue carcinoma, as well to research the best method and indications of SN biopsy.</p><p><b>METHODS</b>Preoperative lymphoscintigraphy with (99m)Tc-SC and intraoperative sentinel node mapping with methylene blue dye were administered on 20 cases of oral tongue carcinoma with cN(0) neck and 5 cases with cN(+) neck; routine pathological examination was used to assess the status of SNs. The results of routine pathological examination of cervical specimen were set as golden standard to assess the efficacy of SN biopsy in evaluating the cervical lymph node status.</p><p><b>RESULTS</b>53 SNs were detected in 24 cases out of the total 25 cases (96%), averaging 2.2 SNs per case. SNs were detected in all 20 cases with cN(0) neck, in which 4 cases with occult cervical metastasis were detected by SN diopsy, without false negative case found in the procedure. In 5 cases with cN(+) neck, SNs were detected in 4 cases. In 4 cases whose SNs were detected, there were 5 cN(+) necks, out of which SNs were detected in 4 cN(+) necks but failed to predicted the cervical lymph node status in 2 necks. However, SNs were detected in 2 out of the other 3 cN(0) necks, both of which were diagnosed as SN(+)pN(+).</p><p><b>CONCLUSIONS</b>Nuclear lymphoscintigraphy and blue dye mapping can be used to trace the SNs in cases with oral tongue carcinoma, with satisfactory detective rate. SN biopsy can accurately evaluate the cervical lymph node status in cases of oral tongue carcinoma with cN(0) neck. Whether it can be used to evaluate the lymph node status of the cN(0) neck in case with a contralateral cN(+) neck is worthy of further research.</p>

Treatment of second primary malignant tumor induced by radiotherapy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the diagnosis and treatment of a second primary malignant tumor induced by previous radiotherapy.</p><p><b>METHODS</b>From March 1970 to March 1997, 108 nasopharyngeal cancer (NPC) patients who developed a second primary malignant tumor induced by radiotherapy were treated. There were squamous carcinoma 43 (39.8%), sarcoma 26 (24.1%), malignant fibrous histiocytoma 14 (13.0%), adenoid cystic carcinoma 12 (11.1%), thyroid papillary adenocarcinoma 8 (7.4%) and malignant melanoma 5 (4.6%). Fifty patients underwent operation, 32 received radiotherapy, 18 received chemotherapy and 8 received operation combined with chemotherapy.</p><p><b>RESULTS</b>The 3- and 5-year tumor-free survival rates were 64.0% and 36.0% in the operation group. They were 34.4% and 18.8% in the radiotherapy group.</p><p><b>CONCLUSION</b>Surgery, if not contra-indicated, is the first choice for the second primary malignant tumor induced by radiotherapy. Aggressive treatment for these patients is, hence, indicated clinically.</p>