Role of charcoal tattooing in localization of recurred papillary thyroid carcinoma: initial experiences

PURPOSE: Surgical excision is the definitive treatment for localized recurrence of papillary thyroid carcinoma. Reoperation for recurrence, however, is challenging and associated with increased operative times and complication rates. For safe and effective reoperation, ultrasound-guided charcoal tattooing localization can be used. The aim of this study was to investigate the feasibility and safety of the ultrasound-guided charcoal tattooing localization. METHODS: Between November 2012 and August 2013, ten patients underwent preoperative charcoal tattooing localization for twelve recurrent lesions. Patient demographics, pathologic features, and operation results were reviewed. RESULTS: The technical success rate of charcoal tattooing was 100%. Eight patients had one recurrent lesion, and two patients had double lesions. Among these 12 recurrent lesions, three (25%) were found in level II, four (33%) in level IV, four (33%) in level VI, and one (8%) was found in the thyroidectomy bed site. The mean size of lesions was 0.87 +/- 0.35 cm. Of these 10 patients, eight patients underwent selective lymph node dissection, one patient underwent modified radical neck dissection, and one patient underwent recurrent mass excision. Transient hypocalcemia developed in one patient, and no recurrent laryngeal nerve palsy occurred. There were no major complications related to the injection of the charcoal. The mean follow-up period after reoperation was 8.6 +/- 2.7 months; in the follow-up ultrasound, there were no remnant lesions in all patients. CONCLUSION: Preoperative ultrasound-guided charcoal tattooing localization for recurrent thyroid cancer appears to be a feasible and safe procedure for reoperation. Further evaluation is warranted in larger patients' cohorts.

Incidence and Predictive Factors of Central Neck Node Metastasis in Patients with T1, T2 Papillary Thyroid Cancer / 대한내분비외과학회지

PURPOSE: Thyroidectomy without prophylactic central neck dissection may be recommended for small (T1 or T2) papillary thyroid carcinoma (PTC). The aim of this study was to determine the incidence and predictive factors of central cervical lymph node metastasis in T1/2 papillary thyroid carcinoma. METHODS: A retrospective review of 877 patients with T1/2 PTC who underwent thyroidectomy and central lymph node dissection with or without lateral lymph node dissection from March 2007 to February 2014 was performed. The clinicopathologic results were reviewed and the incidence and predictive factors of central cervical lymph node metastasis (LNM) were analyzed. RESULTS: The overall frequency of central LNM was 29.8%. In univariate analysis, male, younger age, bilaterality, multifocality, larger tumor size, lymphovascular invasion, and lateral lymph node metastasis were associated with central LNM. In multivariate analysis, younger age, larger tumor size, lymphovascular invasion, and lateral lymph node metastasis were independent variables of central LNM. CONCLUSION: Central LNM is associated with younger age, larger tumor, lymphovascular invasion, and lateral lymph node metastasis in small (T1/2) PTC patients. Prophylactic central lymph node dissection should be considered in patients with risk factors.

Gene Methylation Associated with Differentiated Thyroid Cancer / 대한갑상선학회지

Epigenetic alteration changes expression of many genes, such as tumor suppressor gene and molecular specific gene, without change in DNA sequence. Cancers, including thyroid cancer, often exhibit an aberrant methylation of gene promoter regions, which is associated with loss of gene function. Aberrant methylation plays a fundamental role in tumorigenesis. Methylation of some genes tends to occur in certain types of thyroid cancer. Methylation of TIMP3, SLC5A8, p16, RARbeta2, DAPK genes is associated with papillary thyroid cancer. Some studies show that aberrant methylation is related to the BRAF V600E mutation. Methylation of PTEN and RASSF1A genes occurs commonly in follicular thyroid cancer. Methylation of thyroid-specific genes, such as sodium/iodide symporter, thyroid-stimulating hormone receptor, and SLC26A4 which encodes pendrine, also has a relation to thyroid cancer. Methylation of these genes could be utilized as markers to detect early disease, to define prognosis and to predict therapeutic targets of thyroid cancer.

Surgical Treatment for Idiopathic Granulomatous Mastitis

PURPOSE: Idiopathic granulomatous mastitis is a rare benign inflammatory breast disease of an unknown etiology and the optimal treatment remains controversial. The aim of this study is to evaluate the efficacy of surgically complete excision in patients with idiopathic granulomatous mastitis. METHODS: Between March 2005 and November 2008, we treated 14 cases that were diagnosed with idiopathic granulomatous mastitis. Prospectively, we treated the cases with complete surgical excision with or without steroid therapy in all patients. RESULTS: The mean age of the patients was 36 years (range 30 to 53 years). All cases performed were complete excision with or without steroid therapy. The median follow up period was 26 months (range 5 to 50 months) and all cases had no recurrence. 13 patients out of the 14 were satisfied with the cosmesis of the treated breast. CONCLUSION: We conclude that the treatment of choice for idiopathic granulomatous mastitis is surgically complete excision.