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Joo L, Bae YJ, Choi YJ, Lee YS, Chung SR, Suh CH, Kim SO, Baek JH, Lee JH. Prediction model for cervical lymph node metastasis in human papillomavirus-related oropharyngeal squamous cell carcinomas. Eur Radiol 2021; 31:7429-7439. [PMID: 33779817 DOI: 10.1007/s00330-021-07766-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/14/2021] [Accepted: 02/08/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To develop and validate a risk scoring system based on clinical and imaging findings to predict lymph node metastasis from HPV-related oropharyngeal squamous cell carcinomas. METHODS This study population who had undergone neck dissections or lymph node biopsies in patients with HPV+ OPSCC was obtained from a historical cohort from two tertiary referral hospitals. The training set from one hospital included 455 lymph nodes from 82 patients, and the test set from the other hospital included 150 lymph nodes from 42 patients. The baseline clinical and imaging findings on pretreatment CT or MR were investigated and the reference standards were the histopathologic results. A risk scoring system was constructed based on logistic regression and validated both internally and externally. RESULTS A 7-point risk scoring system was developed based on the following variables: central necrosis, infiltration of adjacent planes, lymph node level, and the maximal axial diameter of the lymph node. This risk scoring system showed good discriminative ability for metastasis in the training set (C-statistic 0.952; 95% CI, 0.931-0.972) and test set (C-statistic 0.968, 95% CI, 0.936-0.999) and good calibration ability in the training set (p = 0.723) and test set (p = 0.253). CONCLUSIONS We developed and validated a reliable risk scoring system that predicts lymph node metastasis from HPV+ OPSCCs based on the clinical data and pretreatment imaging findings. We expect this risk scoring system to be a useful guide for better decision-making in practice. KEY POINTS • It is important to diagnose lymph node metastasis from HPV+ OPSCC for treatment planning; however, there has been little research on that. • We developed and externally validated a new scoring system for stratifying the risk of lymph node metastasis from HPV+ OPSCC based on clinical and imaging data. • A predictive model combining both clinical and imaging data showed high diagnostic accuracy and efficiency for lymph node metastasis from HPV+ OPSCC.
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Affiliation(s)
- Leehi Joo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam, Gyeonggi, 13620, Republic of Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea.
| | - Yoon Se Lee
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
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Kim SY, Kim S, Chang H, Kim B, Lee YS, Chang H, Park CS. Lateral neck metastases in the ipsilateral and contralateral compartments of papillary thyroid carcinoma located in one lobe. ANZ J Surg 2019; 89:E498-E501. [DOI: 10.1111/ans.15458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 08/08/2019] [Accepted: 08/18/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Soo Young Kim
- Thyroid Cancer Center, Gangnam Severance HospitalYonsei University College of Medicine Seoul Korea
- Institute of Refractory Thyroid CancerYonsei University Seoul Korea
| | - Seok‐Mo Kim
- Thyroid Cancer Center, Gangnam Severance HospitalYonsei University College of Medicine Seoul Korea
- Institute of Refractory Thyroid CancerYonsei University Seoul Korea
| | - Hojin Chang
- Thyroid Cancer Center, Gangnam Severance HospitalYonsei University College of Medicine Seoul Korea
- Institute of Refractory Thyroid CancerYonsei University Seoul Korea
| | - Bup‐Woo Kim
- Thyroid Cancer Center, Gangnam Severance HospitalYonsei University College of Medicine Seoul Korea
- Institute of Refractory Thyroid CancerYonsei University Seoul Korea
| | - Yong Sang Lee
- Thyroid Cancer Center, Gangnam Severance HospitalYonsei University College of Medicine Seoul Korea
- Institute of Refractory Thyroid CancerYonsei University Seoul Korea
| | - Hang‐Seok Chang
- Thyroid Cancer Center, Gangnam Severance HospitalYonsei University College of Medicine Seoul Korea
- Institute of Refractory Thyroid CancerYonsei University Seoul Korea
| | - Cheong Soo Park
- Thyroid Cancer Center, Gangnam Severance HospitalYonsei University College of Medicine Seoul Korea
- Institute of Refractory Thyroid CancerYonsei University Seoul Korea
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Chung MS, Choi YJ, Kim SO, Lee YS, Hong JY, Lee JH, Baek JH. A Scoring System for Prediction of Cervical Lymph Node Metastasis in Patients with Head and Neck Squamous Cell Carcinoma. AJNR Am J Neuroradiol 2019; 40:1049-1054. [PMID: 31072971 DOI: 10.3174/ajnr.a6066] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/13/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE An accurate and comprehensive assessment of lymph node metastasis in patients with head and neck squamous cell cancer is crucial in daily practice. This study constructed a predictive model with a risk scoring system based on CT characteristics of lymph nodes and tumors for patients with head and neck squamous cell carcinoma to stratify the risk of lymph node metastasis. MATERIALS AND METHODS Data included 476 cervical lymph nodes from 191 patients with head and neck squamous cell carcinoma from a historical cohort. We analyzed preoperative CT images of lymph nodes, including diameter, ratio of long-to-short axis diameter, necrosis, conglomeration, infiltration to adjacent soft tissue, laterality and T-stage of the primary tumor. The reference standard comprised pathologic results. Multivariable logistic regression analysis was performed to develop the risk scoring system. Internal validation was performed with 1000-iteration bootstrapping. RESULTS Shortest axial diameter, ratio of long-to-short axis diameter, necrosis, and T-stage were used to develop a 9-point risk scoring system. The risk of malignancy ranged from 7.3% to 99.8%, which was positively associated with increased scores. Areas under the curve of the risk scoring systems were 0.886 (95% CI, 0.881-0.920) and 0.879 (95% CI, 0.845-0.914) in internal validation. The Hosmer-Lemeshow goodness-of-fit test indicated that the risk scoring system was well-calibrated (P = .160). CONCLUSIONS We developed a comprehensive and simple risk scoring system using CT characteristics in patients with head and neck squamous cell carcinoma to stratify the risk of lymph node metastasis. It could facilitate decision-making in daily practice.
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Affiliation(s)
- M S Chung
- From the Department of Radiology (M.S.C.), Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Y J Choi
- Departments of Radiology and Research Institute of Radiology (Y.J.C., J.H.L., J.H.B.)
| | - S O Kim
- Clinical Epidemiology and Biostatistics (S.O.K.)
| | | | - J Y Hong
- Oncology (J.Y.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J H Lee
- Departments of Radiology and Research Institute of Radiology (Y.J.C., J.H.L., J.H.B.)
| | - J H Baek
- Departments of Radiology and Research Institute of Radiology (Y.J.C., J.H.L., J.H.B.)
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Choi JB, Lee SG, Kim MJ, Kim TH, Ban EJ, Lee CR, Lee J, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS. Oncologic outcomes in patients with 1-cm to 4-cm differentiated thyroid carcinoma according to extent of thyroidectomy. Head Neck 2018; 41:56-63. [PMID: 30536465 DOI: 10.1002/hed.25356] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 02/15/2018] [Accepted: 05/16/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Recent guidelines advocate unilateral thyroidectomy for low-risk 1-cm to 4-cm differentiated thyroid cancer (DTC). This study was designed to examine the association between the extent of thyroidectomy and oncologic outcomes in patients with 1-cm to 4-cm DTC. MATERIALS AND METHODS From April 1978 to December 2011, 16 057 patients with DTC underwent thyroidectomy at Yonsei University Hospital. Among them, 5266 (32.8%) patients were classified as having 1-cm to 4-cm DTC and were enrolled in this study. Clinicopathologic features and prognostic results (disease-free survival [DFS] and disease-specific survival [DSS] rates) were analyzed by retrospective medical record review. The mean follow-up duration was 57.3 ± 58.1 months. RESULTS Of tumor subtypes in the study group, papillary thyroid carcinoma was the most common (97.5%) and follicular thyroid carcinoma occurred at a rate of 2.5%. In this study, the mean tumor size was 1.84 ± 0.74 cm. Patients had extrathyroidal extension (69.3%), multiplicity (35.1%), bilaterality (26.4%), central lymph node metastasis (53.0%), and lateral neck node metastases (19.9%). Of the 5266 patients, 4292 (81.5%) underwent total thyroidectomy and 974 (18.5%) had lobectomies. Recurrence rates in the total thyroidectomy and lobectomy groups were 5.7% and 9.4%, respectively. The lobectomy group had lower DFS (P = .007) and higher DSS (P = .034) than the total thyroidectomy group. A multivariate analysis for DFS revealed that tumor size, N classification, and extent of thyroidectomy were independent risk factors. On multivariate analysis, independent risk factors for DSS were age, sex, tumor size, and M classifications. CONCLUSION Although extent of thyroidectomy does not affect DSS, total thyroidectomy is beneficial for reducing recurrence in patients with 1-cm to 4-cm DTC. However, if such tumors have such low-risk features as being unifocal, intrathyroidal, and lymph node metastasis-negative, extent of thyroidectomy does not affect oncologic outcome and lobectomy may be sufficient.
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Affiliation(s)
- Jung Bum Choi
- Department of Surgery, Pusan National University College of Medicine, Busan, Korea
| | - Seul Gi Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jhi Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hyung Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Jeong Ban
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Cho Rok Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jandee Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Wook Kang
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Ju Jeong
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kee-Hyun Nam
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Youn Chung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Cheong Soo Park
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Abbasian Ardakani A, Reiazi R, Mohammadi A. A Clinical Decision Support System Using Ultrasound Textures and Radiologic Features to Distinguish Metastasis From Tumor-Free Cervical Lymph Nodes in Patients With Papillary Thyroid Carcinoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2527-2535. [PMID: 29603330 DOI: 10.1002/jum.14610] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/06/2018] [Accepted: 01/23/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES This study investigated the potential of a clinical decision support approach for the classification of metastatic and tumor-free cervical lymph nodes (LNs) in papillary thyroid carcinoma on the basis of radiologic and textural analysis through ultrasound (US) imaging. METHODS In this research, 170 metastatic and 170 tumor-free LNs were examined by the proposed clinical decision support method. To discover the difference between the groups, US imaging was used for the extraction of radiologic and textural features. The radiologic features in the B-mode scans included the echogenicity, margin, shape, and presence of microcalcification. To extract the textural features, a wavelet transform was applied. A support vector machine classifier was used to classify the LNs. RESULTS In the training set data, a combination of radiologic and textural features represented the best performance with sensitivity, specificity, accuracy, and area under the curve (AUC) values of 97.14%, 98.57%, 97.86%, and 0.994, respectively, whereas the classification based on radiologic and textural features alone yielded lower performance, with AUCs of 0.964 and 0.922. On testing the data set, the proposed model could classify the tumor-free and metastatic LNs with an AUC of 0.952, which corresponded to sensitivity, specificity, and accuracy of 93.33%, 96.66%, and 95.00%. CONCLUSIONS The clinical decision support method based on textural and radiologic features has the potential to characterize LNs via 2-dimensional US. Therefore, it can be used as a supplementary technique in daily clinical practice to improve radiologists' understanding of conventional US imaging for characterizing LNs.
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Affiliation(s)
- Ali Abbasian Ardakani
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Reiazi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Medical Image and Signal Processing Research Core, Iran University of Medical Sciences, Tehran, Iran
| | - Afshin Mohammadi
- Solid Tumor Research Center, Faculty of Medicine, Imam Khomeini Hospital, Urmia University of Medical Science, Urmia, Iran
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Ardakani AA, Rasekhi A, Mohammadi A, Motevalian E, Najafabad BK. Differentiation between metastatic and tumour-free cervical lymph nodes in patients with papillary thyroid carcinoma by grey-scale sonographic texture analysis. Pol J Radiol 2018; 83:e37-e46. [PMID: 30038677 PMCID: PMC6047085 DOI: 10.5114/pjr.2018.75017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/18/2017] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Papillary thyroid carcinoma (PTC) is the most common thyroid cancer, and cervical lymph nodes (LNs) are the most common extrathyroid metastatic involvement. Early detection and reliable diagnosis of LNs can lead to improved cure rates and management costs. This study explored the potential of texture analysis for texture-based classification of tumour-free and metastatic cervical LNs of PTC in ultrasound imaging. MATERIAL AND METHODS A total of 274 LNs (137 tumour-free and 137 metastatic) were explored using the texture analysis (TA) method. Up to 300 features were extracted for texture analysis in three normalisations (default, 3sigma, and 1-99%). Linear discriminant analysis was employed to transform raw data to lower-dimensional spaces and increase discriminative power. The features were classified by the first nearest neighbour classifier. RESULTS Normalisation reflected improvement on the performance of the classifier; hence, the features under 3sigma normalisation schemes through FFPA (fusion Fisher plus the probability of classification error [POE] + average correlation coefficients [ACC]) features indicated high performance in classifying tumour-free and metastatic LNs with a sensitivity of 99.27%, specificity of 98.54%, accuracy of 98.90%, positive predictive value of 98.55%, and negative predictive value of 99.26%. The area under the receiver operating characteristic curve was 0.996. CONCLUSIONS TA was determined to be a reliable method with the potential for characterisation. This method can be applied by physicians to differentiate between tumour-free and metastatic LNs in patients with PTC in conventional ultrasound imaging.
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Affiliation(s)
- Ali Abbasian Ardakani
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Rasekhi
- Department of Vascular and Interventional Radiology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afshin Mohammadi
- Department of Vascular and Interventional Radiology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ebrahim Motevalian
- Department of Surgery, School of Medicine, Baqiyatallah Hospital, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Bahareh Khalili Najafabad
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Al-Hilli Z, Strajina V, McKenzie TJ, Thompson GB, Farley DR, Richards ML. The role of lateral neck ultrasound in detecting single or multiple lymph nodes in papillary thyroid cancer. Am J Surg 2016; 212:1147-1153. [DOI: 10.1016/j.amjsurg.2016.09.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 09/02/2016] [Accepted: 09/04/2016] [Indexed: 10/20/2022]
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Conzo G, Tartaglia E, Avenia N, Calò PG, de Bellis A, Esposito K, Gambardella C, Iorio S, Pasquali D, Santini L, Sinisi MA, Sinisi AA, Testini M, Polistena A, Bellastella G. Role of prophylactic central compartment lymph node dissection in clinically N0 differentiated thyroid cancer patients: analysis of risk factors and review of modern trends. World J Surg Oncol 2016; 14:149. [PMID: 27185169 PMCID: PMC4869299 DOI: 10.1186/s12957-016-0879-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/21/2016] [Indexed: 12/17/2022] Open
Abstract
In the last years, especially thanks to a large diffusion of ultrasound-guided FNBs, a surprising increased incidence of differentiated thyroid cancer (DTC), "small" tumors and microcarcinomas have been reported in the international series. This led endocrinologists and surgeons to search for "tailored" and "less aggressive" therapeutic protocols avoiding risky morbidity and useless "overtreatment". Considering the most recent guidelines of referral endocrine societies, we analyzed the role of routine or so-called prophylactic central compartment lymph node dissection (RCLD), also considering its benefits and risks. Literature data showed that the debate is still open and the surgeons are divided between proponents and opponents of its use. Even if lymph node metastases are commonly observed, and in up to 90% of DTC cases micrometastases are reported, the impact of lymphatic involvement on long-term survival is subject to intensive research and the best indications of lymph node dissection are still controversial. Identification of prognostic factors for central compartment metastases could assist surgeons in determining whether to perform RLCD. Considering available evidence, a general agreement to definitely reserve RCLD to "high-risk" cases was observed. More clinical researches, in order to identify risk factors of meaningful predictive power and prospective long-term randomized trials, should be useful to validate this selective approach.
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Affiliation(s)
- Giovanni Conzo
- Department of Anesthesiologic, Surgical and Emergency Sciences, Division of General and Oncologic Surgery, School of Medicine-Second University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Ernesto Tartaglia
- Department of Anesthesiologic, Surgical and Emergency Sciences, Division of General and Oncologic Surgery, School of Medicine-Second University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Nicola Avenia
- Endocrine Surgery Unit, University of Perugia, Perugia, Italy
| | - Pier Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Annamaria de Bellis
- Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
| | - Katherine Esposito
- Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
| | - Claudio Gambardella
- Department of Anesthesiologic, Surgical and Emergency Sciences, Division of General and Oncologic Surgery, School of Medicine-Second University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Sergio Iorio
- Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
| | - Daniela Pasquali
- Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
| | - Luigi Santini
- Department of Anesthesiologic, Surgical and Emergency Sciences, Division of General and Oncologic Surgery, School of Medicine-Second University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Maria Antonia Sinisi
- Department of Cardio-Thoracic and Respiratory Sciences, Endocrinology Unit, Second University of Naples, Naples, Italy
| | - Antonio Agostino Sinisi
- Department of Cardio-Thoracic and Respiratory Sciences, Endocrinology Unit, Second University of Naples, Naples, Italy
| | - Mario Testini
- Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy
| | | | - Giuseppe Bellastella
- Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
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Zhang J, Wang Y, Yu B, Shi X, Zhang Y. Application of Computer-Aided Diagnosis to the Sonographic Evaluation of Cervical Lymph Nodes. ULTRASONIC IMAGING 2016; 38:159-171. [PMID: 26025577 DOI: 10.1177/0161734615589080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We initiated an observer study to evaluate a computerized system developed in our previous study for automatic extraction of 10 features and estimation of the malignancy probability of cervical nodes in sonograms. In the present study, five expert radiologists and five resident radiologists interpreted the sonograms of 178 nodes. The malignancy rating and patient management recommendation (biopsy or follow-up) were made without and then with the computer aid. Under these two reading conditions, the performances of radiologists and agreement among a group of radiologists were evaluated by using the receiver operating characteristic (ROC) analysis and the κ statistic, respectively. With the computer aid, the performances of radiologists improved significantly, as indicated by the increase in the area under the ROC curve (Az) from 0.843 to 0.896 (p = 0.031) and from 0.705 to 0.822 (p < 0.001), for the expert and resident groups, respectively. Agreement among all 10 radiologists improved from slight to moderate as indicated by an increase in the κ value from 0.195 to 0.421 (p < 0.001). The average performance of residents with aid (Az = 0.822) was close to that of experts without aid (Az = 0.843). Results indicate that computer-aided diagnosis is useful to improve radiologist performance (especially that of inexperienced radiologists) in the ultrasonographic evaluation of cervical nodes and to reduce variability among radiologists.
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Affiliation(s)
- Junhua Zhang
- Department of Electronic Engineering, Yunnan University, Kunming, People's Republic of China
| | - Yuanyuan Wang
- Department of Electronic Engineering, Fudan University, Shanghai, People's Republic of China
| | - Bo Yu
- Department of Ultrasound Diagnostics, First People's Hospital of Yunnan Province, Kunming, People's Republic of China
| | - Xinling Shi
- Department of Electronic Engineering, Yunnan University, Kunming, People's Republic of China
| | - Yufeng Zhang
- Department of Electronic Engineering, Yunnan University, Kunming, People's Republic of China
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Suman P, Wang CH, Abadin SS, Moo-Young TA, Prinz RA, Winchester DJ. Risk factors for central lymph node metastasis in papillary thyroid carcinoma: A National Cancer Data Base (NCDB) study. Surgery 2015; 159:31-9. [PMID: 26435436 DOI: 10.1016/j.surg.2015.08.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 08/24/2015] [Accepted: 08/29/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is no consensus regarding prophylactic central lymph node dissection (pCLND) in patients with papillary thyroid carcinoma (PTC). Identification of risk factors for central lymph node metastasis (CLNM) in patients with PTC could assist surgeons in determining whether to perform selective pCLND. METHODS The National Cancer database was queried from 1998 to 2011 for patients with clinical staging T1-4cN0M0 PTC. All patients underwent near, sub-, or total thyroidectomy with or without pCLND. Univariate and multivariable logistic regressions were performed on the following clinical variables: age, sex, race and tumor size as risk factors for pathologic CLNM (pN1a). RESULTS In 39,562 patients with T1-4cN0M0 PTC, 61% underwent pCLND. Patients with age >45 years, African American race, tumor size ≤ 1 cm, unifocal tumors, follicular variant PTC, no insurance, and treatment at community cancer facilities were less likely to have pCLND (P < .001). In the pCLND group, 15.6% of patients had CLNM. On adjusted multivariable logistic regression, age ≤ 45 years, Asian race, male sex, and larger tumors were statistically significantly associated with CLNM. CONCLUSION Age ≤ 45 years, Asian race, male sex, and larger tumors are associated with the presence of CLNM, which allows for selective pCLND in PTC.
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Kim SM, Kim HK, Kim KJ, Chang HJ, Kim BW, Lee YS, Chang HS, Park CS. Thyroidectomy without lateral neck dissection for papillary thyroid carcinoma with lateral neck lymph node metastases and negative intraoperative frozen section. Head Neck 2015; 38:285-9. [PMID: 25327877 DOI: 10.1002/hed.23893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the outcomes of patients with papillary thyroid cancer (PTC) with lateral neck metastasis according to their permanent pathology report but negative frozen section findings who did not undergo lateral neck dissection. METHODS Between September 2009 and December 2011, 575 patients at Gangnam Severance Hospital (Seoul, Korea) underwent frozen section analysis for a suspicious lateral neck lymph node. In 16 patients, the intraoperative findings were negative, but lateral neck metastasis was diagnosed on the basis of permanent pathology findings. The outcomes of these patients who underwent thyroidectomy but not lateral neck dissection were retrospectively investigated. RESULTS One patient underwent a subsequent lateral neck dissection. After a mean (SD) follow-up period of 42.1 (8.5) months, none of the patients had distant metastasis. CONCLUSION Total thyroidectomy with subsequent lateral neck dissection is not necessary in patients with PTC who are diagnosed with lateral neck metastasis according to their permanent pathology report but have negative intraoperative frozen section findings.
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Affiliation(s)
- Seok-Mo Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeung Kyoo Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kuk-Jin Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Jin Chang
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Bup-Woo Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Sang Lee
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hang-Seok Chang
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Cheong Soo Park
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Jun HH, Kim SM, Kim BW, Lee YS, Chang HS, Park CS. Overcoming the limitations of fine needle aspiration biopsy: detection of lateral neck node metastasis in papillary thyroid carcinoma. Yonsei Med J 2015; 56:182-8. [PMID: 25510763 PMCID: PMC4276754 DOI: 10.3349/ymj.2015.56.1.182] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Ultrasound (US) and US-guided fine needle aspiration biopsies (FNAB) are considered the modalities of choice for assessing lymph nodes suspected of containing metastases, but the sensitivity of FNAB varies and is specific to the operator. We analyzed the risk of FNAB providing false negative results of lateral neck node metastasis, and evaluated diagnostic accuracy of FNAB, in patients with papillary thyroid cancer. MATERIALS AND METHODS FNAB was performed in 242 patients suspected of having lateral neck node metastasis on preoperative imaging. Thyroglobulin in the fine-needle aspirate washout (FNA wash-out Tg) and computed tomography enhancement (Hounsfield units) were measured. Patients with negative results on FNAB were examined by intraoperative frozen section. The false negative and true negative groups were compared. RESULTS Of the 242 patients, 130 were confirmed as having lateral neck node metastases. In 74 patients, the metastasis was identified by FNAB. False positive results were observed in 2 patients (0.8%) and false negatives in 58 (44.6%). Risk analysis showed that patient age <45 years (p=0.006), tumor size >1 cm (p=0.008) and elevated FNA wash-out Tg (p=0.004) were significantly associated with false negative results on FNAB. The accuracy of FNAB increased significantly when combined with FNA wash-out Tg (p=0.003). CONCLUSION To reduce the false negative rate of FNAB, patient age (<45 years), tumor size (>1 cm) and FNA wash-out Tg (>34.8 ng/mL) should be considered in preoperative planning. Accuracy may be improved by combining the results of FNAB and FNA wash-out Tg.
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Affiliation(s)
- Hak Hoon Jun
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Seok Mo Kim
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Bup Woo Kim
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Sang Lee
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hang-Seok Chang
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Cheong Soo Park
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Kim SM, Jun HH, Chang HJ, Chun KW, Kim BW, Lee YS, Chang HS, Park CS. Tuberculosis cervical lymphadenopathy mimics lateral neck metastasis from papillary thyroid carcinoma. ANZ J Surg 2014; 86:495-8. [PMID: 24981703 DOI: 10.1111/ans.12727] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Tuberculosis (TB) lymphadenitis is a frequent cause of lymphadenopathy in areas in which TB is endemic. Cervical lymphadenopathy in TB can mimic lateral neck metastasis (LNM) from papillary thyroid carcinoma (PTC). This study evaluated the clinicopathological features of patients with PTC and TB lateral neck lymphadenopathy. METHODS Of the 9098 thyroid cancer patients who underwent thyroid cancer surgery at the Thyroid Cancer Center of Gangnam Severance Hospital between January 2009 and April 2013, 28 had PTC and showed TB lymphadenopathy of the lateral neck node. The clinicopathological features of these 28 patients were evaluated. RESULTS Preoperatively, all 28 patients were diagnosed with PTC and showed cervical lymphadenopathy. All had radiological characteristics suspicious of metastasis in lateral neck nodes. Based upon the results from intraoperative frozen sections, lymph node dissection (LND) was not performed on 19 patients. Seven of eight patients who underwent LND had metastasis combined with tuberculous lymphadenopathy, with the remaining patient negative for LNM. CONCLUSIONS Intraoperative sampling and frozen sectioning of lymph nodes suspicious of metastasis can help avoid unnecessary LND for tuberculous lymphadenopathy.
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Affiliation(s)
- Seok-Mo Kim
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hak Hoon Jun
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho-Jin Chang
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Won Chun
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Bup-Woo Kim
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Sang Lee
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hang-Seok Chang
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Cheong Soo Park
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Predictive Factors for Lymph Node Metastasis in Solitary Papillary Thyroid Carcinomas: A Retrospective Study. Pathol Oncol Res 2014; 21:59-64. [DOI: 10.1007/s12253-014-9788-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 04/20/2014] [Indexed: 11/25/2022]
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Kim SM, Chun KW, Chang HJ, Kim BW, Lee YS, Chang HS, Park CS. Solitary lateral neck node metastasis in papillary thyroid carcinoma. World J Surg Oncol 2014; 12:109. [PMID: 24755464 PMCID: PMC4016639 DOI: 10.1186/1477-7819-12-109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 04/07/2014] [Indexed: 11/18/2022] Open
Abstract
Background Papillary thyroid carcinoma (PTC) is associated with a high incidence of regional node metastasis, but the patterns of lateral neck node metastasis (LNM) vary. Occasionally, a solitary LNM (SLNM) is seen in PTC patients. We therefore assessed whether selective single level node dissection is appropriate in PTC patients with SLNM. Methods We retrospectively reviewed the medical records of 241 PTC patients who underwent total thyroidectomy with central neck dissection plus ipsilateral internal jugular node dissection (level II to IV) between January 2010 and December 2011. Of these patients, 51 had SLNM and 190 had multiple LNM (MLNM). The clinicopathologic characteristics of the two groups were compared. Results Age, gender ratio, and numbers of lateral neck nodes harvested (29.4 ± 11.0 versus 30.3 ± 9.5; P = 0.574) were similar in the SLNM and MLNM groups. Mean primary tumor size was significantly smaller in the SLNM than in the MNLM group (1.03 cm versus 1.35 cm; P = 0.037). The proportion of patients with primary tumor ≤ 1 cm was significantly greater in the SLNM group (60.8% versus 38.4%; P = 0.006), whereas the proportion with maximal node size ≤ 0.7 cm (28.9% versus 73.3%; P <0.001) and the proportion with capsular invasion (62.7% versus 83.7%, P = 0.002) were significantly lower in the SLNM than in the MLNM group. Conclusions Selective single level neck dissection can be considered as an alternative to systemic lateral neck dissection in PTC patients with SLNM, maximal metastatic node size ≤ 0.7 cm, and no extrathyroidal invasion.
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Affiliation(s)
| | | | | | | | | | - Hang-Seok Chang
- Thyroid Cancer Center, Department of Surgery, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu 135-720, Seoul, Korea.
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Abstract
This review provides an overview of current guideline recommendations for the clinical evaluation and surgical management of well-differentiated thyroid cancer, and further examines the evidence for controversial topics such as the minimum degree of primary resection, the role of elective central neck dissection, and the extent of lateral neck dissection. Well-differentiated thyroid cancer comprises the majority of thyroid cancers, about 90%, and includes both papillary and follicular carcinomas. Despite convergence of the medical community in establishing treatment guidelines under the American Thyroid Association, there still remain many areas of disagreement.
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Affiliation(s)
- Selena Liao
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Sciences University, 3181 Southwest Sam Jackson Park Road, SJH01, Portland, OR 97239, USA.
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Current World Literature. Curr Opin Anaesthesiol 2012; 25:260-9. [DOI: 10.1097/aco.0b013e3283521230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Feng W, Jia S. Rapamycin inhibits the invasive ability of thyroid cancer cells by down-regulating the expression of VEGF-C in vitro. Cell Biochem Funct 2012; 30:487-91. [PMID: 22447639 DOI: 10.1002/cbf.2824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 02/28/2012] [Accepted: 03/01/2011] [Indexed: 01/01/2023]
Affiliation(s)
- Wenli Feng
- Department of Head and Neck Surgery, the Third Affiliated Hospital; Harbin Medical University; Harbin; 150081; Heilongjiang; China
| | - Shenshan Jia
- Department of Head and Neck Surgery, the Third Affiliated Hospital; Harbin Medical University; Harbin; 150081; Heilongjiang; China
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Choi Y, Park KJ, Ryu S, Kim DH, Yun J, Kang DK, Chun M. Papillary thyroid carcinoma involving cervical neck lymph nodes: correlations with lymphangiogenesis and ultrasound features. Endocr J 2012; 59:941-8. [PMID: 22785182 DOI: 10.1507/endocrj.ej12-0178] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Stratification of risk factors for cervical lymph node metastasis (LNM) in thyroid papillary carcinoma is important for providing standards for post-operative adjuvant radio-iodine therapy and for patient prognosis. We investigated pathological factors based on the lymphatic vessel system and radiological features associated with tumor with cervical neck LNM. Among patients who had undergone thyroidectomy confirmed to be papillary thyroid carcinoma, we selected 126 age-sex matched paired patients without cervical LNM (group 1) and with LNM (group 2) to evaluate risk factors. Pathological factors evaluated were size, multiplicity, and extra thyroid extension state, based on the pathological reports using stored data. The lymphatic vessel density (LVD) of each tumor was evaluated by staining for VEGFR-3 and D2-40 and correlated with cervical LNM state. Malignant ultrasound features were evaluated to compare the differences between these two groups. Larger tumor size, multiplicity, extrathyroid extension were more common in group 2 (p<0.05). The median percentage of VEGFR-3 for group 1 was 20 (range 0-30) and D2-40 was 13 (range 7-23) while for group 2, VEGFR-3 was 80 (70-90) and D2-40 was 78 (54-114). LVD measured by intratumoral D2-40 staining was 20.6% and 79.4% for group 1 and group 2, respectively. Intra-tumoral lymphatics measured by D2-40 stain had a strong correlation with cervical LNM (Odds 1.230, CI 1.01.-1.499 p value 0.040). Ultrasound (US) features had no significant differences between the two groups although calcifications tended to be higher in group 2 (84% vs. 76% p=0.264). Lymphatic vessel density and nodule echogenicity were not associated with LNM. Intratumoral lymphangiogenesis was most strongly associated with LNM and thus, could be a useful predictive marker for cervical LNM.
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Affiliation(s)
- Yoonjung Choi
- Department of Radiology, Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine, Seoul, Korea
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