Surgery for Neck Recurrence of Differentiated Thyroid Cancer: Outcomes and Risk Factors.

Background: Persistent/recurrent disease in the neck is frequent in patients with differentiated thyroid cancer (DTC).

Objective: Assess efficacy, safety, and prognostic factors of first neck reoperation in DTC.

Methods: Retrospective study of consecutive patients undergoing neck reoperation for recurrent/persistent DTC in a referral cancer center.

Preoperative localization of neck recurrences from thyroid cancer: charcoal tattooing under ultrasound guidance.

Background: Reoperation for thyroid cancer recurrence is a surgical challenge in previously dissected necks, and there is a need for a reliable procedure for surgeon guidance. In this study, the usefulness of preoperative charcoal tattooing for surgical guidance was evaluated.

Methods: From July 2007 to May 2010, 53 patients (40 females; Mage=44 years, range 19-76 years) were prospectively included for preoperative localization of neck recurrences from differentiated (n=46) or medullary thyroid cancer (n=7).

Optimization of staging of the neck with prophylactic central and lateral neck dissection for papillary thyroid carcinoma.

Objective: To analyze the yield and rate of node metastases (pN1) for prophylactic central (CND) and lateral neck dissection (LND) for papillary thyroid carcinoma, the risk factors for pN1, and outcomes.

Background: Prophylactic CND and LND are not routinely employed. Adjuvant radioiodine treatment may be modulated, however, by surgical staging of the neck.

Is (18)F-fluorodeoxyglucose-PET/CT useful for the presurgical characterization of thyroid nodules with indeterminate fine needle aspiration cytology?

Background: Thyroid nodules found incidentally on (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET) have been shown to be malignant in 30%-50% of cases. The American Thyroid Association recommends performing fine needle aspiration cytology (FNAC) for thyroid nodules showing FDG uptake. On the other hand, the role of FDG-PET in characterizing thyroid nodules with indeterminate cytology before surgery is not clear.

Role of prophylactic thyroidectomy in RET 790 familial medullary thyroid carcinoma.

Background: We describe a family harboring RET 790 mutation and review the role of prophylactic thyroidectomy for medullary thyroid carcinoma.

Methods: We evaluated in detail both clinical and biological follow-up and reviewed literature reports.

Results: Among 86 family members, 15 of 22 members screened harbored the 790 mutation.

Central compartment neck dissection for thyroid cancer: a surgical technique.

Several professional societies have in the past few years joined forces to standardize and define terminology for central compartment neck dissection, with the objective of improving communication among professionals and encouraging a more uniform surgical approach to neck nodes. Precisely defining and describing a technique has the advantage of providing a basis for communication and for discussion. A basic technique should be reproducible with low morbidity and teachable to surgeons in training.

18F-fluorodeoxyglucose positron emission tomography and computed tomography in anaplastic thyroid cancer.

Purpose: Our aim was to evaluate in anaplastic thyroid carcinoma (ATC) patients the value of 18F-FDG PET/CT compared with total body computed tomography (CT) using intravenous contrast material for initial staging, prognostic assessment, therapeutic monitoring and follow-up.

Methods: Twenty consecutive ATC patients underwent PET/CT for initial staging. PET/CT was performed again during follow-up.

Prognostic markers of survival after combined mitotane- and platinum-based chemotherapy in metastatic adrenocortical carcinoma.

To progress in the stratification of the first-line therapeutic management of metastatic adrenocortical carcinoma (ACC), we searched for prognostic parameters of survival in patients treated with combined mitotane- and cisplatinum-based chemotherapy as first-line. We retrospectively studied prospectively collected parameters from 131 consecutive patients with metastatic ACC (44 with a tissue specimen available) treated at the Gustave Roussy Institute with mitotane- and platinum-based chemotherapy. Fifty-five patients with clinical, pathological, and morphological data available together with treatment characteristics including detailed follow-up were enrolled.

High rate of multifocality and occult lymph node metastases in papillary thyroid carcinoma arising in thyroglossal duct cysts.

Background: The incidence of cancer in thyroglossal duct cysts (TDC) is low and management is controversial. The objective was to report the rate of multifocality, lymph node metastases, and long-term results for TDC carcinomas in adults.

Materials And Methods: Files from 1979 to 2008 were reviewed for tumor stage, multifocality in the lobes, lymph node metastases, treatment, and follow-up.

Charcoal suspension tattoo localization for differentiated thyroid cancer recurrence.

Background: The high sensitivity of ultrasound and thyroglobulin determination for follow-up of differentiated thyroid cancer allows early detection of nonpalpable recurrences. Intraoperative localization of these small foci in previously dissected necks is a surgical challenge. We describe a new technique for ultrasound-guided tattooing to facilitate excision.

Prophylactic lymph node dissection for papillary thyroid cancer less than 2 cm: implications for radioiodine treatment.

Objective: Prophylactic neck dissection for small papillary carcinoma remains controversial. Radioiodine ablation is not recommended for tumors less than 10 mm and depends on various factors for tumors between 10 and 20 mm. The aim was to determine the effect of lymph node (LN) staging on the indication for treatment with radioiodine.

Imaging medullary thyroid carcinoma with persistent elevated calcitonin levels.

Purpose: Because calcitonin level remains elevated after initial treatment in many medullary thyroid carcinoma (MTC) patients without evidence of disease in the usual imaging work-up, there is a need to define optimal imaging procedures.

Patients And Methods: Fifty-five consecutive elevated calcitonin level MTC patients were enrolled to undergo neck and abdomen ultrasonography (US); neck, chest, and abdomen spiral computed tomography (CT); liver and whole-body magnetic resonance imaging (MRI); bone scintigraphy; and 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET)/CT scan (PET).

Results: Fifty patients underwent neck US, CT, and PET, and neck recurrence was demonstrated in 56, 42, and 32%, respectively.

Ultrasound criteria of malignancy for cervical lymph nodes in patients followed up for differentiated thyroid cancer.

Context: Neck ultrasonography (US) has become a keystone in the follow-up of patients with differentiated thyroid cancer.

Objective: The aim of this study was to determine specificity and sensitivity of ultrasound criteria of malignancy for cervical lymph nodes (LNs) in patients with differentiated thyroid cancer.

Design: We prospectively studied 19 patients referred to the Institut Gustave Roussy for neck LN dissection.

Tattooing breast cancers treated with neoadjuvant chemotherapy.

Background: In breast carcinomas treated with neoadjuvant chemotherapy, intraoperative identification of residual tumors may be difficult. A well-tolerated, low-diffusion charcoal suspension has been designed to tattoo breast tumors. In this study, we investigated whether this tattooing technique is efficient for localizing the tumor after treatment with chemotherapy.

Prognostic parameters of metastatic adrenocortical carcinoma.

Context: Prognostic parameters of metastatic adrenocortical carcinoma (ACC) are poorly characterized.

Objective: The objective of the study was to describe the clinical presentation of metastatic ACC and determine prognostic factors for survival.

Design: This was a retrospective cohort study (1988-2004).

Thyroid metastases from colorectal cancer: the Institut Gustave Roussy experience.

The prevalence of thyroid metastases in colorectal cancer (CRC) patients is unknown. We retrieved the records of all patients with CRC and pathologically proved thyroid metastasis for the period 1993-2004. Among 5,862 consecutive patients with CRC, 6 (0.

Dermal lymphatic emboli in inflammatory and noninflammatory breast cancer: a French-Tunisian joint study in 337 patients.

Background: We studied whether dermal lymphatic emboli (DLE) add independent prognostic information to the clinical definition of inflammatory breast cancer (IBC).

Patients And Methods: The study was performed in 2 centers, one each in France and Tunisia. For every patient with IBC, 1-3 patients with noninflammatory breast cancer (non-IBC) were included.

Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and/or tumor extension beyond the thyroid capsule at initial diagnosis.

Context: Reliable prognostic factors are needed in papillary thyroid cancer patients to adapt initial therapy and follow-up schemes to the risks of persistent and recurrent disease. OBJECTIVE AND SETTINGS: To evaluate the respective prognostic impact of the extent of lymph node (LN) involvement and tumor extension beyond the thyroid capsule, we studied a group of 148 consecutive papillary thyroid cancer patients with LN metastases and/or extrathyroidal tumor extension. Initial treatment, performed at the Institut Gustave Roussy between 1987 and 1997, included in all patients a total thyroidectomy with central and ipsilateral en bloc neck dissection followed by radioactive iodine ablation.

Follicular cell-derived thyroid cancer in children.

Thyroid carcinoma is a rare disease in childhood. The only known causative factor is radiation exposure during childhood. Most cases can be cured by surgery and eventually radioiodine.

Neck recurrence from thyroid carcinoma: serum thyroglobulin and high-dose total body scan are not reliable criteria for cure after radioiodine treatment.

Background: Local and regional recurrences occur in up to 20% of patients with papillary and follicular thyroid carcinoma. Diagnostic work-up and treatment modalities are still controversial, because nodal control is difficult to ascertain. We assessed the value of serum thyroglobulin (Tg) determination and of high-dose 131I total body scan (TBS) for ascertaining the absence of disease in patients who had already been treated with radioiodine and who subsequently underwent surgery.

Clinical review: Current concepts in the management of unilateral recurrent laryngeal nerve paralysis after thyroid surgery.

Objective: This study was designed to provide an update on the pathophysiological concepts and patient management in a common complication of thyroid surgery, unilateral recurrent laryngeal nerve paralysis (URLNP).

Method: Recent publications in physiology and head and neck surgery were reviewed.

Results: Even for experienced surgeons, URLNP may occur after thyroid surgery, especially for thyroid cancer and in case of reoperation.

Combined treatment of anaplastic thyroid carcinoma with surgery, chemotherapy, and hyperfractionated accelerated external radiotherapy.

Purpose: To analyze a prospective protocol combining surgery, chemotherapy (CT), and hyperfractionated accelerated radiotherapy (RT) in anaplastic thyroid carcinoma.

Methods And Materials: Thirty anaplastic thyroid carcinoma patients (mean age, 59 years) were treated during 1990-2000. Tumor extended beyond the capsule gland in 26 patients, with tracheal extension in 8.

Medullary thyroid carcinoma.

Medullary thyroid carcinoma (MTC) arises from parafollicular or C cells that produce calcitonin (CT), and accounts for 5-10% of all thyroid cancers. MTC is hereditary in about 25% of cases. The discovery of a MTC in a patient has several implications: disease extent should be evaluated, phaeochromocytoma and hyperparathyroidism should be screened for and whether the MTC is sporadic or hereditary should be determined by a direct analysis of the RET proto-oncogene.