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ABSTRACT: Background : The Bethesda classification system for reporting on thyroid fine-needle aspi-ration (FNA) cytology was recently proposed by the National Cancer Institute, USA. We aimed to report our experience with applying this system for thyroid FNA, with a focus on comparing it with the four categorical system. Methods : We retrospectively reviewed the 4,966 thyroid FNAs that were performed at the Seoul St. Mary's Hospital between October 2008 and Sep-tember 2009. All the FNAs were classified according to the Bethesda system and the four tier system. Results : The cytologic diagnoses of the Bethesda system included 10.0% unsatis-factory, 67.7% benign, 3.1% atypia of undetermined significance, 0.6% follicular neoplasm, 0.5% follicular neoplasm, Hürthle cell type, 5.1% suspicious for malignancy and 13.0% malig-nancy. Using four tier system, 10.1%, 67.6%, 9.3%, and 13% were diagnosed as unsatisfac-tory, negative for malignancy, atypical cells and malignancy, respectively. Of the 4,966 nod-ules, 905 were histologically confirmed. The specificity of the Bethesda system and the four tier system for diagnosing malignancy was 99.6% and 82.6%, respectively. Conclusions : The Bethesda system can classify indeterminate thyroid nodules into more detailed categories and provide clinicians with useful information for management. 이경지 • 정찬권 • 이교영 배자성 1 • 임동준 2 • 정소령 3 521 갑상샘 세침흡인세포검사 판독에 있어 베데스다 시스템의 적용 초음파를 이용한 세침흡인세포검사(fine needle aspiration cytology, FNAC)는 갑상샘 결절의 양성과 악성을 감별하는 가 장 효율적인 방법으로, 그 정확도는 95%까지 보고되고 있으며, 1 수술적 또는 보존적 치료를 결정하는 중요한 역할을 하고 있다. 하지만 갑상샘 FNAC 진단은 표준화된 용어나 분류법이 없어 각 기관마다 또는 병리의사마다 서로 다른 진단 분류법을 사용 해 왔다. 이로 인해 갑상샘 결절 환자의 진료에 혼란을 주고 갑 상샘 결절의 통계학적 분석에도 일관된 기준을 적용하기 어려운 문제점이 있었다. 그러나 최근에 미국의 National Cancer Institute (NCI)에서 갑상샘 FNAC 진단을 위한 표준화된 용어와 분류체계인 Beth-esda system을 발표했다. 2,3 Bethesda system은 unsatisfactory, benign, atypia of undetermined significance (AUS), follic-ular neoplasm, suspicious for malignancy, malignancy 등 6 개의 계층적 진단 분류를 기본으로 하며, 4 각 분류별 악성 위험 도를 함께 제안하여 임상의에게 환자 처치를 위한 보다 많은 정 보를 제공해 주고 있다. 이에 저자들은 서울성모병원에서 1년간 시행되었던 갑상샘 FNAC를 Bethesda system으로 재분류하고 기존에 본 기관에 서 사용하고 있던 4단계 계층적 진단 분류법과 비교하여 Beth-esda system의 유용성을 평가하고자 하였다.
The Korean Journal of Pathology 01/2010; 4444:521-7521. · 0.16 Impact Factor
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ABSTRACT: Incidentally found thyroid lesions are frequently detected in patients undergoing FDG-PET/CT. The aim of this study was to investigate the prevalence of incidentally found thyroid lesions in patients undergoing FDG-PET/CT and determine the risk for thyroid cancer.
FDG-PET/CT was performed on 3,379 patients for evaluation of suspected or known cancer or cancer screening without any history of thyroid cancer between November 2003 and December 2005. Medical records related to the FDG-PET/CT findings including maximum SUV(SUVmax) and pattern of FDG uptake, US findings, FNA, histopathology received by operation were reviewed retrospectively.
Two hundred eighty five patients (8.4%) were identified to have FDG uptake on FDG-PET/CT. 99 patients with focal or diffuse FDG uptake underwent further evaluation. The cancer risk of incidentally found thyroid lesions on FDG-PET/CT was 23.2% (22/99) and the cancer risks associated with focal and diffuse FDG uptake were 30.9% and 6.4%. There was a significant difference in the SUVmax between the benign and malignant nodules (3.35 +/- 1.69 vs. 6.64 +/- 4.12; P < 0.001). There was a significant correlation between the SUVmax and the size of the cancer.
The results of this study suggest that incidentally found thyroid lesions by FDG-PET/CT, especially a focal FDG uptake and a high SUV, have a high risk of thyroid malignancy. Further diagnostic work-up is needed in these cases.
World Journal of Surgical Oncology 08/2009; 7:63. · 1.12 Impact Factor
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ABSTRACT: The cribriform-morular variant of papillary thyroid carcinoma (CMVPTC) is an unusual subtype of papillary thyroid carcinoma. The goal of this study was to determine the clinicopathological features of CMVPTC and whether the tumor can be diagnosed by fine-needle aspiration cytology.
We retrospectively analyzed the clinical appearance and pathological findings in five patients with CMVPTC and sequenced exon 3 of CTNNB1 and exon 15 of BRAF in tumor tissue.
All patients were young women, 15-34 years of age at the time of the cancer diagnosis. Preoperative cytological examination showed scattered tall columnar cells, fascicular spindle cells, and cribriform and morular patterns in the fine-needle aspirates of the thyroid from the five patients. Grossly, all tumors were well-circumscribed, solid or cystic. Immunohistochemically, most tumor cells showed nuclear expression of thyroid transcription factor-1, estrogen and progesterone receptors, and p53; cytoplasmic expression of cytokeratins 7 and 19, vimentin, and bcl-2; and cytoplasmic and nuclear accumulation of beta-catenin and galectin-3. There was no expression of thyroglobulin, cytokeratin 5/6, or human mesothelial cell-1. However, among these markers, the morular cells showed only positive immunostaining for beta-catenin, galectin-3, p53, and bcl-2. A CTNNB1 mutation was identified in only one case and no BRAF mutation was found in any of the five cases.
Taken together, these data suggest that CMVPTC can be diagnosed preoperatively, based on careful cytology examination, and shows unique immunohistochemical findings.
Thyroid: official journal of the American Thyroid Association 07/2009; 19(8):905-13. · 2.60 Impact Factor
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ABSTRACT: A recent suggestion is that the predictive value of a single biomarker may rely on the genetic background on the tumor and that different breast cancer subgroups may have different predictive markers of response to chemotherapy. The prognostic value of p53 in the outcome of adjuvant anthracycline-containing chemotherapy was evaluated according to molecular subclasses defined using the expression of estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2.
Subjects were patients (n = 135) with invasive ductal carcinoma treated with adjuvant anthracycline-based chemotherapy between 1994 and 2000 in our hospital. Clinico-pathological features were reviewed by retrospective examination of medical records.
Overall survival rate was not independently predictive by p53 status (P = 0.182). However, in triple-negative cases, there was statistically significant survival difference (P = 0.034) and no statistically significant difference (P = 0.783) in non-triple-negative cases by p53 status. In the Cox proportional hazard analysis, p53 was also strongly predictive for relapse-free survival (P = 0.013) and overall survival (P = 0.049) in triple-negative patients.
p53 status could be a specific prognostic factor in triple-negative breast cancer patients treated by adjuvant anthracycline-based regimen. When p53 is positive in triple-negative breast cancer, we could expect poor survival, prompting aggressive or alternative treatment.
Japanese Journal of Clinical Oncology 05/2009; 39(4):217-24. · 1.78 Impact Factor
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ABSTRACT: Cervical lymph node metastases are quite common in papillary thyroid cancer (PTC) and they usually spread in a contiguous fashion. However, "skip metastasis," defined as lateral lymph node metastasis without central lymph node metastasis, also occurs in patients with PTC. There is little information regarding skip metastasis in papillary thyroid microcarcinoma (PTMC). The goal of this study was to determine the prevalence and associated clinical and imaging features of skip metastasis in PTMC.
We performed a retrospective study of 245 patients with PTMC who underwent either thyroidectomy and central lymph node dissection or thyroidectomy, central lymph node dissection, and lateral lymph node dissection if preoperative ultrasonography or computed tomography suggested lateral node metastasis. Clinicopathologic results were reviewed, and the patterns of cervical lymph node metastasis were analyzed.
Cervical lymph node metastases were present in 26.5% of cases. The frequency of lymph node metastases was 21.8% in the group that only had thyroidectomy and central lymph node dissection and 51.3% in the group that had thyroidectomy, central lymph node dissection, and lateral lymph node dissection. Younger age, larger tumor size, multiplicity, bilaterality, encapsulation, extrathyroid extension, and lymphatic invasion were associated with metastasis to nodes in the central or lateral compartment. Lateral lymph node dissection was performed in 15.9% of patients. Skip metastasis was observed in 7.7% of the cases in which combined central and lateral node dissection was performed. No features of the primary thyroid tumor could be associated with the development of skip metastasis.
Skip metastases occur in a minority of patients with PTMC. We recommend, therefore, that preoperative studies in patients suspected of having PTMC focus not only on nodes in the central compartment but also lateral cervical nodes since the information obtained would guide the extent of surgery.
Thyroid: official journal of the American Thyroid Association 04/2009; 19(3):241-6. · 2.60 Impact Factor
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ABSTRACT: The status of axillary lymph nodes (ALNs) is the most important prognostic factor in breast cancer. The purpose of this study was to evaluate the clinical usefulness of ALN involvement by means of positron emission tomography-computed tomography (PET-CT) compared with breast sonography and mammography in patients with early breast cancer.
This study involved 108 breast cancer patients with non-palpable ALNs. All patients had PET-CT, breast sonography and mammography imaging before sentinel lymph node (SLN) biopsy. After SLN biopsy, all patients underwent complete ALN dissection. ALNs were evaluated by standard hematoxylin and eosin staining techniques. The findings of PET-CT, breast sonography and mammography imaging of 108 patients were compared with pathologic findings after surgery. Sensitivity, specificity and accuracy of individual diagnostic modalities were compared. Diagnostic accuracy was evaluated applying receiver operating characteristic (ROC) curve areas.
The sensitivity, specificity and accuracy of PET-CT imaging were 48.5%, 84% and 73.2%, respectively. The sensitivity, specificity and accuracy of breast sonography were 51.5%, 89.3% and 77.8%, respectively. The sensitivity, specificity and accuracy of mammography were 33.3%, 96% and 76.9%, respectively. For involvement of ALNs, PET-CT imaging, breast sonography and mammography had areas under the ROC curve of 0.662, 0.704 and 0.647, respectively.
Compared with the combination of breast sonography and mammography, PET-CT was less sensitive and had less accuracy in detecting ALN metastasis. Consequently, PET-CT is not a reliable non-invasive modality for assessing ALN involvement that can replace ALN dissection or SLN biopsy before decisions are made on appropriate systemic interventions.
Japanese Journal of Clinical Oncology 04/2009; 39(5):284-9. · 1.78 Impact Factor
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ABSTRACT: The clinical role of endoscopic thyroidectomy and sentinel lymph node biopsy (SLNB) for differentiated thyroid cancer remains open to debate. Conventional thyroidectomy requires a cervical incision and often leaves an unsightly scar on the anterior neck. Endoscopic thyroidectomy is technically feasible and safe, with much better cosmetic results. The prognostic importance of lymph node metastasis in thyroid cancer makes central lymph node dissection a crucial option in thyroid cancer surgery. However, it is associated with an increased risk of complications such as recurrent laryngeal nerve injury or hypoparathyroidism, even in expert hands. Thus, the feasibility and future role of SLNB in thyroid cancer remains controversial. We describe our technique of performing endoscopic thyroidectomy with SLNB and central lymph node dissection via a gasless anterior chest approach for thyroid cancer.
Surgery Today 02/2009; 39(2):178-81. · 1.22 Impact Factor
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Ja Seong Bae,
Young Up Cho,
Gi Young Sung,
Se Jeong Oh,
Eun Jung Jung,
Jae Bok Lee,
Tae Hyun Kim,
Kee-Hyun Nam,
Woong Youn Chung,
Jung Han Yoon, [......],
Byung In Moon,
Jong Riul Lee,
Byoung Un Lee,
Jee-Soo Kim,
Jong Ho Yoon,
Je Ryong Kim,
Euy Young Soh,
Yeo Kyu Youn,
Cheong Soo Park,
Jeong Soo Kim
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ABSTRACT: We investigate the current status of endoscopic thyroidectomy in Korea. A representative questionnaire was sent to 21 members of the Korean Association of Endocrine Surgeons who were thought to be performing endoscopic thyroidectomy. All the reply letters were collected and analyzed. The response rate was 95%. A total of 1616 cases of endoscopic thyroidectomy were performed from the year 1998 to the year 2005. The patients included 71 men and 1545 women, with a mean age of 36.17 years. The mean operation time was 124.18 minutes and overall length of hospital stay was 4.31 days. Thyroid lobectomy and nodular hyperplasia were the most common procedures and prominent pathologic findings. Axillary approach was the most popular operative approach method. Gas insufflation and skin-lifting gasless method were used in 800 cases and 816 cases, respectively. Postoperative complication rate was 14.2%. Skin paresthesia was the most common complication. Conversion rate to conventional thyroidectomy was 2.2%. Korean experiences show that endoscopic thyroidectomy is a technically safe and feasible procedure. It is considered to be an important surgical tool that can be further progressed and that also has an excellent potential in a management of thyroid neoplasm.
Surgical laparoscopy, endoscopy & percutaneous techniques 07/2008; 18(3):231-5. · 1.23 Impact Factor
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ABSTRACT: Bilateral chylothorax is a rare complication of neck dissection, but it is potentially serious and sometimes life threatening. Because of the rarity of chylothorax, surgeons are unfamiliar with its early signs, which allow a prompt diagnosis and effective management. Most cases reported in the literature were associated with a concurrent external chyle leakage, which occurred either during or after surgery. We report two cases of bilateral chylothoraces without concurrent external chyle leakage, which occurred after left-sided neck dissections for thyroid cancer. We treated both patients successfully with conservative management.
Surgery Today 02/2007; 37(8):652-5. · 1.22 Impact Factor
