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Predictive Risk Factors for Recurrence or Metastasis in Papillary Thyroid Cancer
김완욱,이지연,정진향,박호용,정지윤,박지영,Ralph P. Tufano 대한갑상선학회 2020 International Journal of Thyroidology Vol.13 No.2
Background and Objectives: This study investigated predictive risk factors for cervical nodal recurrence ormetastasis in papillary thyroid carcinoma (PTC). Materials and Methods: From September 2014 to February 2015,a total of 321 PTC patients were enrolled retrospectively. Except for 154 N0 patients, the remaining 167 patientswere divided into two groups as follows: Group I (n=140), central lymph node (LN) metastasis (pN1a); GroupII (n=27), lateral LN metastasis (pN1b, n=23) or LN recurrence (n=4). The patients who had LN metastasis orrecurrence underwent selective LN dissection or recurrent LN excision. Results: Central LN metastases were foundin 44.0% (142/321) of patients. Two hundred thirty patients (71.7%) were classified as being at low-risk forLN disease, as evidenced by N0 or fewer than five micrometastases. The mean size of central metastatic LNs was0.37±0.34 cm. A total of 76 patients (46.6%) presented with micrometastasis, and ten (3.1%) presented withextranodal extension (ENE). The multiple/bilateral cancer, Extrathyroidal extension, size of metastatic LN, ENE, highrisk LN disease (>5, macrometastasis, >3.0 cm) and high thyroglobulin were significant risk factors in predictingLN recurrence or lateral LN metastasis (p<0.05) in univariate analysis. Patients with ENE were 10.3 times moreat risk for recurrence or metastasis than patients without ENE. Conclusion: We consider the ENE was the mostpotent risk factors for LN recurrence or lateral LN metastasis in PTC.
Intraoperative Neural Monitoring in Thyroid Surgery: Role and Responsibility of Surgeon
Hoon Yub Kim,Ralph P. Tufano,Young Jun Chai,Marcin Barczynski,ozer Makay,Che-Wei Wu,Eren Berber,Hui Sun,Gianlorenzo Dionigi,the Korean Intraoperative Neural Monitoring Society (KINMoS) 대한갑상선-내분비외과학회 2018 The Koreran journal of Endocrine Surgery Vol.18 No.1
Surgeons who introduce intraoperative neural monitoring (IONM) or a new IONM accessory, or related procedure in their practice should have completed relevant surgical training, possess operating privileges in the affected endocrine system, and be able to address anticipated complications. Surgeon responsibility in monitoring is dual component. First, technical component is using and setting up the IONM equipment correctly and understanding the inherent properties of the system to avoid an erroneous setup (e.g., no muscle relaxation, correct electrode placement, low impedance, etc.). Second, interpretive component is performing the monitoring able to distinguish between a true response versus an artifactual one. Organizations such as the International Neural Study Group and the Korean Intraoperative Neural Monitoring Society provide training courses for surgeon, as well as a means to certify levels of monitoring interpretative competence.
김완욱,Jeeyeon Lee,정진향,Ho Yong Park,김원화,Hye Jung Kim,박지영,Ralph P. Tufano 영남대학교 의과대학 2020 Yeungnam University Journal of Medicine Vol.37 No.4
Background: This study evaluated the usefulness of judgment of central lymph node (LN) metastasis by surgeon’s palpation in papillary thyroid cancer. Methods: This study included 127 patients who underwent thyroidectomy and central compartment node dissection between October 2014 and February 2015. The criterion for suspicious LNs was hardness. Results: Of the 20.5% (28/127) of suspicious for metastatic LNs according to surgeon determination, 92.8% (26/28) were confirmed to be metastatic in the final pathological examinations. Metastatic LNs were found in 38 (38.3%) of 99 patients without suspicious LNs, 29 of whom (76.3%) had micrometastases. The sensitivity, specificity, and positive and negative predictive values for the determination of LN metastasis by a surgeon were 40.6%, 96.8%, 92.9%, and 61.6%, respectively. Conclusion: Determination of central LN metastasis by a surgeon’s palpation may be useful to evaluate LNs owing to the high specificity and positive predictive values, especially in macrometastasis or high-risk LN disease.