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Level V Lymph Node Dissection in PTMC Patients: Is This Necessary?
정유승,오은미,이영돈 대한갑상선-내분비외과학회 2012 The Koreran journal of Endocrine Surgery Vol.12 No.3
Purpose: Cervical lymphadenectomy is frequently performed in papillary thyroid carcinoma (PTC) patients with lateral node metastasis to improve regional control, but the cervical levels that require dissection remain controversial. We conducted this study to investigate the necessity of the routine dissection of level V in papillary thyroid microcarcinoma (PTMC). Methods: To identify the relation between PTMC and level V metastases, we analyzed 90 patients who underwent lateral neck dissection (ND). Twenty-five patients underwent lateral ND when metastasis was detected during follow-up, whereas the other 65 patients underwent total thyroidectomy with central and lateral ND at initial surgery. Results: There were 18 PTMC patients and 72 patients with a PTC of >1 cm. Metastasis at level III or IV was detected in 80.0% and 78.9%, respectively, whereas metastasis at level V was only detected in 12.2%, and metastasis at level II occurred in 30%. In PTMC patients, metastatic rates at levels II, III, IV, and V were 11.1%, 61.1%, 61.1%, and 5.6%, respectively, and in patients with a PTC of >1 cm, metastatic rates at levels II, III, IV, and V were 34.7%, 84.7%, 83.3% and 13.9%, respectively. PTMC was not found to be significantly associated with level V metastasis (P=0.452). Conclusion: The level V metastatic rate in PTMC was no different from that of PTC>1 cm statistically. However, the metastatic rate was only 5.6% in PTMC. Therefore, we recommend that care be taken when deciding whether to perform level V dissection when dissecting the lateral cervical nodes in PTMC.
갑상선 결절의 진단에 있어서 ThinPrep® 액상세포검사의 유용성
정유승,구소령,이영돈 대한갑상선-내분비외과학회 2011 The Koreran journal of Endocrine Surgery Vol.11 No.3
Purpose: Fine needle aspiration cytology (FNAC) is the most important diagnostic method for thyroid nodule. Liquid based cytology (LBC) is currently being studied for diagnosing thyroid nodule. We investigated the diagnostic value of ThinPrepⓇ-LBC for thyroid nodules. Methods: From January 2010 to May 2010, 139 patients underwent thyroidectomy based on the FNAC smear results. From November 2010 to February 2011, 153 patients underwent thyroidectomy based on the FNAC smear and ThinPrepⓇ-LBC results. We compared the postoperative pathologic results of the FNAC smear group and the FNAC smear+LBC group. Results: In the FNAC smear group, there were 11.5% unsatisfactory results and 10.1% atypia with undetermined significance results. On the other hand, in the FNAC smear +LBC group, there were no unsatisfactory results and only 2.0% atypia with undetermined significance results. For the results of the diagnostic validity, the sensitivity was 77.7%, the specificity was 94.4% and the accuracy was 82.0% for the FNAC smear group. The false positive rate was 5.6% and the false negative rate was 22.3%. For the FNAC smear+LBC group, the sensitivity was 87.8%, the specificity was 92.9% and the accuracy was 88.2%. The false positive rate was 7.1% and the false negative rate was 12.2%. Conclusions: If LBC is carried out simultaneously with FNAC smear, the rate of unsatisfactory results and atypia with undetermined significance could be decreased compared with that of the FNAC smear only. (Korean J Endocrine Surg 2011;11:146-151)
유방 관상피내암에 있어서 병변의 범위와 예후 결정을 위한 수술 전 자기공명영상의 역할
정유승,이연수,제수경,송병주,김정수,전해명,정상설,박우찬 한국유방암학회 2009 Journal of breast cancer Vol.12 No.2
Purpose: Magnetic Resonance Imaging (MRI) is widely used for the preoperative staging of breast cancer. In this study, we investigated a role of preoperative breast MRI for detecting the extent of disease and predicting the prognosis of ductal carcinoma in situ (DCIS). Methods: From January 2002 to April 2008, preoperative MRI was performed for evaluating the extent of disease in 26 patients with DCIS. The MRI findings, the modified Van Nuys scores and the clinicopathological results were reviewed. The accuracy of breast MRI was analyzed with respect to the detection of tumor multiplicity and disease extending into the nipple, and this was compared with that of mammography. Results: For detecting multiple lesions, the sensitivity and specificity of breast MRI were 25.0% and 86.4%, respectively, and the results of mammography were 0.0% and 86.4%, respectively. The accuracy of breast MRI was 76.9% and that of mammography was 73.1%. For detecting tumor extension into the nipple, the sensitivity and specificity of breast MRI was 100.0% and 80.0%, respectively, and that for mammography was 0.0% and 92.0%. respectively. The accuracy of MRI was 80.8% and that for mammography was 88.5%. The MRI final assessment was not associated with the modified Van Nuys score (p=0.474). Conclusion: For detecting the disease extent of DCIS, preoperative breast MRI is not superior to mammography due to the low specificity and accuracy of MRI. MRI did not show a definite ability to predict the prognosis of DCIS in this study.