Utility of subcategorization of atypia of undetermined significance/follicular lesion of undetermined significance category in ultrasound-guided thyroid fine-needle aspiration in a large referral cancer center.

Introduction: Subclassification of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is encouraged in the Bethesda System. In our practice, we subclassified AUS/FLUS into 3 subcategories: atypical follicular cells of undetermined significance (ACUS) for cases with cytologic atypia; follicular lesion (FL) for cellular cases with follicular cells with-minimal or no atypia, arranged in a macro- and micro-follicular pattern with scant colloid; and indeterminate follicular lesion, favor benign (IFL-FB) for cases with few clusters of follicular cells without atypia associated with minimal or no colloid. The objective of our study was to evaluate the prevalence, clinical management, and risk of malignancy for each subcategory.

Long-Term Outcomes of Lateral Neck Dissection in Patients with Recurrent or Persistent Well-Differentiated Thyroid Cancer.

Background: Well-differentiated thyroid carcinoma (WDTC) has a high predilection for regional metastatic spread. Rates for WDTC lateral neck recurrence are reported to be as high as 24% in patients after initial thyroidectomy, lateral neck surgery, and adjuvant radioactive (RAI) iodine treatment. The objective of the study was to evaluate the efficacy, safety, and long-term outcome of comprehensive lateral neck dissection (LND) of levels II-V for recurrent or persistent WDTC in a tertiary referral center.

Use of transoral sonography with an endocavitary transducer in diagnosis, fine-needle aspiration biopsy, and intraoperative localization of retropharyngeal masses.

Objective: The purpose of this article is to describe the use of transoral sonography in the diagnosis, fine-needle aspiration (FNA) biopsy, and intraoperative localization of retropharyngeal masses.

Materials And Methods: We reviewed images and data for eight patients with a retropharyngeal mass identified on CT, MRI, or PET/CT as being suspicious for a metastatic Rouviere node. Transoral ultrasound was performed using a commercially available endorectal or endovaginal transducer.

Long-term outcome of comprehensive central compartment dissection in patients with recurrent/persistent papillary thyroid carcinoma.

Background: Persistent or recurrent papillary thyroid carcinoma (PTC) occurs in some patients after initial thyroid surgery and often, radioactive iodine treatment. Here, we identify the efficacy, safety, and long-term outcome of our current surgical management paradigm for persistent/recurrent PTC in the central compartment in an interdisciplinary thyroid cancer clinical and research program at a tertiary thyroid cancer referral center.

Methods: We retrospectively analyzed our standardized approach of comprehensive bilateral level VI/VII lymph node dissection (SND [VI, VII]) for cytologically confirmed PTC in the central compartment.

Routine pre-operative ultrasonography for papillary thyroid cancer: effects on cervical recurrence.

Background: Pre-operative ultrasonography (US) is now part of published treatment guidelines for papillary thyroid carcinoma (PTC), despite the lack of long-term data on its potential value in preventing neck recurrence. We report the follow-up of patients with PTC in whom pre-operative US was used to accurately stage the extent of neck disease.

Methods: Patients with PTC who underwent pre-operative US and surgery were evaluated by indication for surgery (primary surgery, surgery for persistent PTC, and surgery for recurrent PTC).

Approach and safety of comprehensive central compartment dissection in patients with recurrent papillary thyroid carcinoma.

Background: Despite the generally favorable prognosis of patients with papillary thyroid cancers, 10-year recurrence rates for patients with stage I to III disease is greater than 20%, with central compartment recurrences common among these recurrent sites.

Methods: This study is a retrospective analysis of consecutive patients treated by a single surgeon over an 18-month period of time terminating in 2003.

Results: Sixty-three patients underwent a comprehensive dissection of levels VI and VII for papillary thyroid carcinoma during this period.

Cortical morphologic features of axillary lymph nodes as a predictor of metastasis in breast cancer: in vitro sonographic study.

Objective: The purpose of this study was in vitro sonographic-pathologic correlation of findings in dissected axillary lymph nodes from breast cancer patients undergoing axillary lymph node dissection and classification of the sonographic appearance of the nodes on the basis of cortical morphologic features to facilitate early recognition of metastatic disease.

Materials And Methods: High-resolution sonography was used for in vitro examination of 171 lymph nodes from 19 axillae in 18 patients with unknown nodal status who underwent axillary lymph node dissection for early infiltrating breast cancer. The images were evaluated by two blinded observers, and discordant readings were referred to a third blinded observer.

Parathyroid exploration in the reoperative neck: improved preoperative localization with 4D-computed tomography.

Background: Reoperation for hyperparathyroidism (HPT) carries an increased risk for morbidity and failure to cure. Accurate preoperative localization minimizes operative risk but is often difficult to achieve in the reoperative setting. Four-dimensional computed tomography (4D-CT) is an emerging technique that uses functional parathyroid anatomy for precise preoperative localization.

Followup of patients with papillary thyroid cancer: in search of the optimal algorithm.

Background: Cervical recurrence occurs in up to 30% of patients after surgical treatment for papillary thyroid cancer. This study sought to determine an appropriate algorithm for followup evaluation.

Study Design: Patients undergoing total thyroidectomy for papillary thyroid cancer were identified.

Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography.

Background: Four-dimensional computed tomography (4D-CT) provides both functional and highly detailed anatomic information about parathyroid tumors. The purpose of this study was to compare 4D-CT with sestamibi imaging and ultrasonography as methods for the accurate preoperative localization of hyperfunctioning parathyroid glands before parathyroidectomy.

Methods: A study of 75 patients with primary hyperparathyroidism was performed at a tertiary-care institution.

Small (< or = 2-cm) breast cancer treated with US-guided radiofrequency ablation: feasibility study.

Purpose: To determine the feasibility and safety of ultrasonographically (US) guided percutaneous radiofrequency (RF) ablation in the local treatment of invasive breast carcinomas 2 cm or less in greatest diameter.

Materials And Methods: RF ablation of 21 malignant lesions was performed in 20 patients immediately before their scheduled lumpectomy or mastectomy. A 15-gauge needle electrode was placed in the lesions, and the prongs of the needle electrode were deployed with real-time US guidance.

Recurrence in autogenous myocutaneous flap reconstruction after mastectomy for primary breast cancer: US diagnosis.

Purpose: To assess the value of ultrasonography (US) and US-guided fine-needle aspiration biopsy (FNAB) in the detection and diagnosis of recurrent cancer in breasts reconstructed with autogenous myocutaneous flaps after mastectomy for primary breast cancer and to describe the US appearances of recurrence in the reconstructed breast.

Materials And Methods: Between July 1994 and March 2001, US of the reconstructed breast was performed in 20 women with autogenous myocutaneous flap reconstruction. US findings were correlated with clinical and mammographic findings.

Interventional breast sonography.

This review article covers the basic applications of and latest developments in interventional breast sonography (US). For breast masses, US has become the standard for guiding needle biopsy, whether a fine needle or a core biopsy needle is used. US has also become the preferred method for guiding insertion of various localization devices for nonpalpable masses, and US's intraoperative use for this purpose is expanding.