Lateral cervical lymph node mapping in papillary thyroid carcinoma: a prospective cohort study / 中国肿瘤临床

Objective: To explore the value of nanoparticles (CN) in lateral cervical lymph node mapping in papillary thyroid carcinoma using carbon. Methods: Thyroid cancer patients with suspicious lymph node metastasis but without typical signs of metastatic disease from March 2016 to November 2017 in Fudan University Shanghai Cancer Center were prospectively included in the cohort. Neck dissection was performed in all patients (compartmentsⅡ-Ⅴ). Suspicious lateral lymph node metastasis was identified using pre-operative ultrasound or computed tomography. CN were used for lymph node mapping during surgery. Results: A total of 70 surgeries were performed in 67 patients, among which 57 were found to have lateral lymph node metastasis (81.4%). The median number of CN-dyed lateral lymph nodes was 6. Compartment IV had the highest number of CN-dyed positive lymph nodes as well as the highest rate of metastasis, followed by compartmentⅢ. In compartmentsⅢandⅣ, the incidence of lymph node metastasis was significantly higher in the CN-dyed group than in the CN-undyed group (P<0.001). When the final pathology of neck dissection was set as the gold standard, lateral CN-dyed lymph node biopsy was found to have a sensitivity of 86.0%; its negative predictive value was 61.9% and its overall accuracy was 88.6%. Conclusions:Injection of CN during surgery was a potential method of mapping lateral lymph nodes in papillary thyroid carcinoma. CompartmentⅢ-ⅣCN-dyed lymph node biopsy had a satisfactory sensitivity and thus, served as a reasonable range for lymph node biopsy.

The necessity of a specialized training program for head and neck surgeon: what should be done to become an extraordinary head and neck surgeon / 中国癌症杂志

Head and neck cancers contain a wide range of diseases which put threats to public health. Training of specialized head and neck surgeon is a must for the development of the specialty. Surgical treatment of head and neck cancers can easily compromise normal appearance and function of patients owing to the complicated anatomical structures of the area. Therefore, treatments often demand multidisciplinary involvement led by surgeons. Attentions should be paid to diverse cancers, multiple techniques, distinct surgeries, complex anatomy and function protection when training a specialized head and neck surgeon. A specialized surgeon must be devoted to basic research, have a full picture of the disease, be involved in multidisciplinary treatment and focus on specialized surgical maneuvers. To become a specialized head and neck surgeon, one should go through basic knowledge of the area, read extensively, keep up with the literature and never stops practicing. The undisputed factor is that an extraordinary head and neck surgeon can not only benefit patients but also promote the profession.

Review in the surgical management for residual and recurrent neck lymph node of nasopharyngeal carcinoma after radiotherapy and chemotherapy / 中国癌症杂志

Metastasis is one of the main complaints of nasopharyngeal carcinoma. After radiotherapy and chemotherapy, residual and recurrent lymph nodes in the neck are still partially seen. Neck dissection is an important salvage treatment to improve survival and life quality. The present review summarizes the distribution of residual and recurrent lymph nodes, the applications of different salvage surgeries and outcomes.

Retrospective comparison of screening criteria for active surveillance for papillary thyroid microcarcinoma / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the rationality of management of active surveillance for papillary thyroid microcarcinoma (PTMC) and the main indications for active surveillance for PTMC.@*Methods@#In this study, two criteria were used to evaluate patients with PTMC: low-risk PTMC conditions defined by Kuma hospital and Chinese Association of Thyroid Oncology (CATO) consensus on PTMC management of active surveillance. The patients had received surgical treatment. Clinicopathological characteristics and prognosis of the patients in different groups were compared.@*Results@#A total of 778 patients were enrolled in the study, 565 (72.6%) of them met Kuma screening criteria and only 112 (14.4%) met CATO screening criteria. Kuma low-risk subgroup had lower incidence of cervical lymph node metastasis than Kuma high-risk PTMC subgroup(30.6% vs 47.9%, P<0.05). There were significant differences in multifocal lesions(6.3% vs 16.4%), extrathyroidal extension (1.8% vs 7.5%) and cervical lymph node metastasis(19.6% vs 38.0%) between low-risk and high-risk CATO PTMC subgroups. Patients in the CATO low-risk PTMC subgroup had lower recurrence and longer disease-free survival (DFS) than those in the CATO high-risk PTMC subgroup. But there was no significant difference in recurrence or DFS between Kuma low-risk and high-risk Kuma PTMC subgroups.The Chi-square test of Fisher′s exact probabilities test was used to compare clinicopathological characteristics of patients between different groups.Rates of disease-free survival were calculated using the Kaplan-Meier method.@*Conclusion@#CATO screening criteria is relatively strict and may be more suitable for Chinese patients with active surveillance for PTMC.

Risk for metastasis of lymph node between sternocleidomastoid and sternohyoid muscle in papillary thyroid cancer / 中华耳鼻咽喉头颈外科杂志

Objective@#To analyze the risk factors for metastasis of lymph nodes between sternocleidomastoid and sternohyoid muscle (LNSS) in papillary thyroid cancer (PTC).@*Methods@#Papillary thyroid cancer patients with clinically positive lateral lymph node metastasis (cN1) who underwent surgery including LNSS dissection between May 1, 2013 and May 31, 2016 at the Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center were retrospectively studied. Logistic regression analysis was performed to evaluate possible clinicopathological factors related to LNSS metastasis.@*Results@#In 85 patients, 54 patients (63.5%) showed LNSS in their surgical specimen, and 20 patients (23.5%) had pathologically positive LNSS metastasis. Patients with LNSS showed preoperatively higher levels of serum thyroid stimulating hormone (TSH) and thyroid peroxidase antibody (TPO-Ab) compared to patients only with fibrofatty tissues between sternocleidomastoid and sternohyoid muscle (P<0.05), and they also displayed a higher proportion of multifocality in ipsilateral thyroid lobe (P<0.05). Multi-factor analysis indicated that LNSS metastasis was correlated with original tumor size (OR=1.819, 95%CI 1.050-3.850, P=0.002) and Level Ⅳ lymph node metastasis (OR=2.190, 95%CI 1.132-2.334, P=0.005). Furthermore, the number of positive LNSS was tightly correlated to that of level Ⅳ lymph node metastasis(P<0.05).@*Conclusion@#LNSS metastasis is occult but not quite rare in PTC. Patients with extensive lymph node metastasis in Level Ⅳhave a higher risk for metastasis of LNSS.

Treatment progress of thyroid cancer in children and adolescents / 中国癌症杂志

Thyroid cancer is uncommon in children and adolescents. This article analyzed the current data and stated the treatment progress of the thyroid cancer in children and adolescents. Even though in the advanced stage at diagnosis, the prognosis is good for pediatric patients. Surgery is the treatment for pediatric thyroid cancer. Although there is no optimal surgery recommendation, most surgeons preferred total and (or) subtotal thyroidectomy. Hemi-thyroidectomy could also be considered in the low-risk patients with small unifocal tumors. We recommend routine central compartment clearance in pediatric thyroid cancers to reduce the local recurrence. Radioactive iodine therapy is also recommended in particular pediatric patients. Recurrences after treatment in childhood thyroid cancer may take place over a long period of time. Therefore, a life-long follow-up is mandatory.

Outcome and prognostic factors of 125 loco-regionally advanced head and neck squamous cell carcinoma treated with multi-modality treatment / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the treatment outcome of loco-regionally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) after been treated with multi-modality approach since 2005 in our hospital and to explore the prognostic factors for treatment outcomes.</p><p><b>METHODS</b>Clinical data of 125 postoperative LA-SCCHN patients treated in our department with radiotherapy/chemoradiotherapy from May 2005 to December 2011 were collected and reviewed in this study. The radiotherapy technique was intensity-modulated radiotherapy (IMRT) (93.6%) and a minority of patients received 3D-conformal radiotherapy (3D-CRT).</p><p><b>RESULTS</b>Up to January 6th, 2013, 124 patients were followed up with a median follow-up duration of 25 months. The 3-year overall survival (OS), disease-free survival (DFS), loco-regional control (LRC), distant metastasis-free survival (DMFS) were 69.7%, 56.1%, 80.8%, and 73.1%, respectively. A total of 37 patients died during the follow-up period. Among the 43 patients presented with treatment failure, 13 patients had loco-regional relapse, 20 patients had distant metastasis and 10 patients presented with both loco-regional and distant relapses. Distant metastasis accounted for the predominant cause of death. Lung and mediastinal lymph nodes are the most common sites involved by distant metastasis.Univariate analysis indicated that patients who underwent non-radical surgery, with larger size of invaded lymph nodes, higher N stage (N2b and above) and vascular tumor embolism had a lower OS (P = 0.001, 0.000, 0.032, 0.007, respectively). Patients who underwent neck dissection only, or those with higher N stage (N2b and above) or higher TNM stage or vascular tumor thrombi had higher distant metastasis rates (P = 0.017, 0.002, 0.008, 0.001, respectively). The multivariate analysis showed that non-radical surgery was an independent prognostic factor for OS (P = 0.001), larger size of invaded lymph nodes was an independent prognostic factor for poorer LRC (P = 0.001); higher N stage (N2b and above) or T4 stage and vascular tumor thrombi were independent prognostic factors for poorer distant metastasis-free survival (P = 0.035, 0.008 and 0.050, respectively).</p><p><b>CONCLUSIONS</b>Our results indicate that multi-modality treatment for LA-SCCHN has achieved better outcome than before. Distant metastasis has become the predominant pattern of failure as well as the primary cause of death instead of loco-regional relapse as a result of improved local control modality. More efforts should be made to decrease the rate of distant metastasis in the future.</p>

Lymph nodes metastases in central compartment of laryngeal cancer:A 11-year review of surgical ;treatment cases / 中国癌症杂志

Background and purpose: The aim of this study was to determine the necessity of central compartment neck dissection in laryngeal cancer.Study Design: Retrospective study at a tertiary referral medical center. Methods:Patients with laryngeal squamous cell cancer who underwent neck dissection were evaluated, and a retrospective analysis of clinicopathologic factors and follow-up data were performed. Results: One hundred and eighteen patients from 1999 to 2009 were enrolled. There were 11.9% central compartment lymph node metastasis in all patients, including the 10 patients with central compartment lymph node metastasis in 34 patients underwent compartment neck dissection and 4 patients do not underwent compartment neck dissection but had central neck recurrence in the follow up time. Subglottic or pyriform extension were risk factors in central compartment lymph node metastasis and central neck recurrence (P=0.002). Central compartment lymph node metastasis had closed relationship with levelⅣmetastasis (P<0.001), extracapsular extension (P=0.001), vascular extension (P=0.015) and poor local control rates (P=0.035) respectively. Patients who were positive for lateral neck lymph node metastasis had poor disease-free survival rate (P=0.014) and poor local control rates (P=0.025), and supraglottic cancer had a trend to metastases to levelⅡ(P=0.044). Conclusion:Central compartment neck dissection might be considered a potential therapeutic approach for patients with laryngeal cancer.

Elastography in the detection of thyroid nodules:compared with pathology / 中华超声影像学杂志

Objective To discuss the clinical value of ultrasonic elastography for thyroid nodules,and compared with pathology.Methods 77 patients with 105 thyroid lesions were analyzed.Tissue stiffness on elastography was scored from one(greatest elastics train)to five (no strain).Results On elastography:scores 1 and 2 were found in 75％ benign lesions.Scores 3 to 5 were found in 97.4％ malignant lesions.There were statistically difference in the scores of elastography between the benign and malignant lesions (P ＜0.01).Conclusions The ultrasonic elastography had positive significance in differentiating benign and malignant thyroid nodules.If the score of elastography is more than or equal to 3,the thyroid nodule is highprobablely malignant.

Advances in the treatment of parotid gland adnoid cystic carcinoma / 中国癌症杂志

Adenoid cystic carcinoma is regarded as one of the most common malignant tumors in parotid gland. The local control rate and long term survival rate of salivary gland adenoid cystic carcinoma, which tends to spread along the perinerve and metastasis distantly, are not good. This review focused on the advances in the treatment of adenoid cystic carcinoma of parotid gland.

The clinicopathologic characteristics of desmoplastic fibroblastoma in neck and nape / 中国耳鼻咽喉头颈外科

OBJECTIVE To describe the clinical, CT or MRI, pathological characteristics of desmoplastic fibroblastoma for helping the diagnosis and treatment. METHODS The clinical data of 4 cases with desmoplastic fibroblastoma were retrospectively analyzed. RESULTS The tumors of all 4 cases were found in the compartment of muscles, and can be removed by conservative excision. The 4 cases were followed up for 38, 7, 6, 3 months respectively, and no local recurrences were found. CONCLUSION Desmoplastic fibroblastoma is a benign fibroblastic neoplasm with distinctive clinical, CT or MRI imaging and pathological characteristics. Optimal management is conservative excision with functional preservation. Needle aspiration cytology and immunohistochemistry are of non-diagnostic value.

Familial papillary thyroid carcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical features of familial papillary thyroid carcinoma (FPTC) and the criteria for its diagnosis and surgical treatment.</p><p><b>METHODS</b>One hundred and forty-five patients with PTC were investigated randomly between January 1999 and November 2001, and 17 of them were from 7 families. Of the 17 patients, 14 were operated on at this hospital, and 3 were operated elsewhere. The specimens from the 17 patients were confirmed pathologically. They accounted for 9.3% (14/145) of all PTC patients.</p><p><b>RESULTS</b>The patients were aged from 30 to 74 years (mean 45 years). The diameter of original focuses ranged from 0.8 to 2.8 cm (mean diameter 1.7 cm). Of the 17 patients with PTC, 8 (47.5%) had bilateral carcinoma. In 3 families, 3 patients suffered from PTC (42.8%). In 4 families, other members suffered from benign thyroid tumor or non-tumorous thyroid disease. Among the 17 patients, 10 had nodular goiters. Thyroidectomy, unilateral thyroidectomy plus isthmusectomy, and combined radical operation were performed in 8, 9, 14 patients, respectively. Early metastatic spread to local regional lymph nodes was noted in 14 patients (82.3% or 14/17).</p><p><b>CONCLUSIONS</b>In this study, a FPTC rate of 10% was found. Almost 50% of FPTC patients had bilateral carcinoma. The frequency of metastatic spread to local-regional lymph nodes was high. Follow-up survey of family members should be performed in a long period of time.</p>

Regularity of lymph node metastasis in 100 patients of thoracic esophageal carcinoma / 中国癌症杂志

Purpose:To explore the regularity of lymph node metastasis in thoracic esophageal carcinoma.Methods:From March 2000 to June 2001,100 patients with thoracic esophageal carcinoma underwent radical esophagectomy with three field lymphadenectomy. Dissection was done through a right lateral thoracotomy followed by repositioning and simultaneous laparotomy and neck incision. Results:The hospital mortality rate was 0%.Nodal metastases occurred in 54% (54/100) of patients. The rate of metastasis to neck, mediastinum and abdomen were 31%, 34% and 26%. Cervical nodal metastasis was not correlated with the depth of tumor penetration. There was a higher frequency in nodal metastasis near the bilateral recurrent laryngeal nerves than that in the bilateral supraclavicular region. Conclusions:①Neck, mediastinum and abdomen nodal metastases occurred frequenthy in thoracic esophageal carcinoma. ②Cervical nodal metastasis could occur in early stage of tumor infiltration.③Cervical lymphadenectomy was a very important factor for accurate staging of thoracic esophageal cancer.

Research progress of the relationship between HGF/Met and invasion of thyroid carcinoma / 中国癌症杂志

Activation of HGF/Met has been complicated in tumorigenesis, invasion and metastasis of various tumors. We summarize current knowledge on their association with invasion of thyroid carcinoma. By discussing the expression of Met and its possible mechanism and analyzing the activation of Met with tumor motility, angiogenesis and inflammatory reaction, we conclude that the research of the possible role of HGF/Met in thyroid carcinoma will advance knowledge on the diagnosis and management of this disease,as well as tumor invasion.

Surgical treatment of substernal benign thyroid tumor / 中国癌症杂志

Purpose:To investigate the type of surgery appropriate for substernal benign thyroid tumor. Methods:A study of 19 substernal benign thyroid tumors operated between 1990 and 1999 was made. Surgery via cervical collar incision were performed in all cases. Results:Among them 4 cases was adenoma, 16 cases goiter. There were no complications except for 1 case with recurrent laryngeal nerve paralysis. Conclusions:Surgery via cervical collar incision for substernal benign thyroid tumors is safe.

A study on serum thyroid hormone level alterations after hemithyroidectomy / 中国普通外科杂志

Objective To investigate serum T_3? T_4? TSH alterations after hemithyroidectomy in patients suffering from thyroid benign nodules.Methods Forty-eight patients were divided into two groups by age of 45.All patients were treated with hemithyroidectomy and without substitutional therapy after operation.The levels of serum TT_3? TT_4? FT_3? FT_4? TSH were assessed on day 5, first month, 3rd month, 6th month and one year after operation and compared with pre-operative levels.Results The change of serum T_3? T_4 was not significant; while the levels of serum FT_3? FT_4 in patients over 45 years decreased on day 5 post-op and on the first month ( F=7.853, F=4.247, P

The surgical treatment of failure in cervical lymph nodes after radiotherapy for nasopharyngeal carcinoma:an analysis of 83 patients / 中华放射肿瘤学杂志

Objective To analyze the results of neck dissection in patients who failed in cervical lymph nodes after radiotherapy for nasopharyngeal carcinoma.Methods Eighty-three patients who received neck dissection due to lymph node persistence or recurrence after definitive radiotherapy were analyzed retrospectively according to the following relevant factors: age, sex, the interval between completion of radiotherapy and surgery, rN stage, postoperative radiotherapy given or not, the adjacent tissues involved or not and the number of positive nodes. Kaplan-Meier method, Log-rank method and Cox method were used in the statistical analysis.Results The 1-, 3- and 5-year overall survival rates were 80.7%, 47.1% and 34.9%. The interval between completion of radiotherapy and surgery, postoperative radiotherapy given or not, the adjacent tissues involved or not were significantly prognostic factors in statistic analysis. Conclusions Neck dissection can be applied in the management of cervical lymph node failure in nasopharyngeal carcinoma after radiotherapy. Postoperative radiotherapy should be considered in patients with capsular invasion and/or adjacent tissue involvement.