• 대한두경부종양학회:학술대회논문집
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• 1996.11a
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• pp.255-256
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• 1996

• The Korean Journal of Nuclear Medicine
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• v.38 no.1
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• pp.52-61
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• 2004

Purpose: Cervical lymph node metastasis is the most important factor of the prognosis and therapeutic planning in head and neck cancer. With increasing interest of minimally invasive neck surgery, more accurate preoperative assessment of cervical lymph node becomes more essential. We evaluated the diagnostic accuracy of $^{18}F$ FDG-PET in the assessment of lymph node metastasis in patients with primary head and neck cancer and compared the results with those of CT/MRI. Materials and Methods: Thirty-two patients (M/F=27/5, $56{\pm}10yr$) with biopsy proven head and neck cancer (16 supraglottic cancer, 9 tongue cancer, 7 others) underwent FDG-PET and CT/MRI (25/7) within 1 month before neck dissection. Based on lymph node level, the diagnostic sensitivity and specificity of FDG PET and CT/MRI for the metastasis of cervical lymph node were compared. Results: Of 153 lymph node levels dissected in 32 patients, 32 lymph node levels of 19 patients were positive for metastasis by histopatholologic examination. The overall sensitivity and specificity of FDG-PET were 88% (28/32) and 93% (113/121), whereas those of CT/MRI were 56% (18/32) (p=0.002) and 92% (112/121), respectively. The diagnostic sensitivity and specificity of FDG-PET were different according to location of lymph node levels, and those of ipsilateral level 11 were lower than those of other levels. Conclusion: FDG-PET is more sensitive in detecting metastatic cervical lymph node in head and neck cancer than CT/MRI. FDG-PET might be useful in guiding the extent of neck dissection.

• Korean Journal of Head & Neck Oncology
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• v.29 no.2
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• pp.37-40
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• 2013

Background and Objectives : To assess the usefulness of computed tomography image before papillary thyroid cancer surgery, focus on confirmation of lateral cervical lymph node metastasis not detected by ultrasonography. Material and Methods : From January 2008 to May 2009, total 150 patients who had undergone thyroid surgery and been confirmed papillary thyroid cancer pathologically were enrolled. They had taken neck computed tomography following the ultrasonography. Results : Computed tomography had found suspicious metastatic lateral neck lesion in 13 patients. After the image study, lateral neck lymph node dissection had been included in their surgical plan. Of these, only 7 cases were confirmed pathologically lateral neck lymph node metastasis(positive predictive value=0.54). Taken as whole 150 patients, additionally 4.7% of patients confirmed lateral neck lymph node metastasis by preoperative computed tomography. Conclusion : If preoperative ultrasonography was performed precisely, additional benefits that could be achieved by computed tomography were not much.

• Korean Journal of Head & Neck Oncology
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• v.27 no.1
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• pp.59-65
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• 2011

Background and Objectives : Papillary thyroid carcinoma(PTC) frequently metastasize to the regional neck, however, lateral neck lymph node metastasis is less common. The aim of this study is to investigate clinical and immunohistochemical features of PTC with lateral LN metastasis, and determine the predictive factors for lateral LN metastases. Material and Methods : We undertook a retrospective study of 83 patients treated between January 2007 and December 2009 for PTC by thyroidectomy with or without lateral neck dissection. The following criteria were used to study the clinical predictive value of lateral LN. metastases : sex, age, tumor size, multifocality, extracapsular spread(ECS) and lymphovascular emboli. Immunohistochemical staining for VEGF-A, VEGF-C, Bax, Bcl-2, Cyclin D1, Cyclin E, $p27^{kip1}$ and $p57^{kip2}$ was performed, and quantified blindly by three pathologists who had no clinical information of the patients. Immunohistochemical expression was scored as high(>50% of cells stained) or low(0-49%). Results : With use of univariate and multivariate analysis, tumor size(>2cm) and ECS were independent correlates of lateral LN metastasis in PTC. Expression of VEGF-C, Bax, and Cyclin D1 in the PTC with lateral LN metastasis was scored higher than in PTC without lateral LN metastasis(p<0.05). Conclusion : The important risk factors for lateral LN metastasis in PTC are primary tumor size and the presence of ECS. And expression of VEGF-C, Bax and cyclin D1 may be considered of lateral LN metastatic potential in PTC.

• Korean Journal of Head & Neck Oncology
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• v.16 no.2
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• pp.177-181
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• 2000

배경 및 목적: Theodor Kocker에 의해 일반화된 전통적인 갑상선 수술방법은 갑상선 질환의 종류 및 정도, 수술범위와 상관없이 광범위한 수술범위로 인한 조직 손상으로 인해 수술후 환자들의 여러가지 불편감은 물론 경부의 넓은 부위의 통증과 경부 피부부종, 장액종, 혈종 등과 같은 후유증을 동반할 수 있다. 최근 본 저자들은 이같은 전통적 갑상선 수술의 부작용을 최소화하기 위해 작은 피부절개($3{\sim}4.5cm$) 후 피하 피판(subplatysmal skin flap) 없이 직접 갑상선으로 접근하는 새로운 수술기법으로서 최소침습 갑상선 수술기법을 개발하였기에 그 술식을 소개하고 전통적인 갑상선 절제술에 대한 우월성을 확인하고자 본 연구를 시행하였다. 대상 및 방법: 1999년 1월 15일 부터 2000년 1월 14일까지 573예의 갑상선 수술 예 중 최소침습 갑상선절제술이 시행되었던 466예와 1998년 1월 15일부터 1999년 1월 14일까지 전통적 갑상선 수술을 시행한 549예 중 거대 종양(양성>6cm, 악성>5cm), 흉골하 선종, 국소진행암, 재발암, 측경부의 다발성 림프절 전이가 있었던 112예를 제외한 437예의 임상병리적 특성과 피부절개 길이, 수술 시간, 수술중 출혈양, 수술후 진통제 요구빈도 및 재윈기간, 수술 후 합병증 발생빈도를 비교 분석하였다. 결 과: 두 군간의 임상병리적 특성상의 유의한 차이는 없었다. 피부절개 길이($3.7{\pm}0.7cm,\;vs\;9.6{\pm}3.3cm$), 수술 시간($57.6{\pm}11.7$분 vs $85.2{\pm}32.3$분) 수술 중 출혈양($18.4{\pm}15.3ml\;vs\;43.1{\pm}21.8ml$), 수술후 재원기간($1.6{\pm}0.5$일 vs $4.3{\pm}1.6$일), 및 수술후 진통제 요구빈도가 전통적 수술군에 비해 최소침습 수술군에서 통계적으로 유의하게 감소되었으나(p<0.05), 수술후 장액종 및 혈종 형성, 일시적인 음색변화, 일시적인 저칼슘혈증과 같은 합병증의 발생빈도는 각각 4.3%(n=20)와 4.8%(n=21)로 두 군간에 유의한 차이가 없었다. 결 론: 최소침습 갑상선 수술법은 새로운 수술기구의 도입 없이도 갑상선 수술의 충분한 시야를 확보할 수 있고 안전하고 간단하게 시행할 수 있으며, 기존 수술법으로 인한 부작용을 최소화할 수 있어 전통적 인 수술법을 대치할 수 있는 새로운 방법으로 사료된다.

• Korean Journal of Head & Neck Oncology
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• v.21 no.2
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• pp.196-200
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• 2005

Objectives: The purpose of this study was to evaluate the incidence and predictive factors of contralateral occult lymph node metastasis in oral cavity squamous cell carcinomas to form a rational basis for elective contralateral neck management. Materials and Methods: We performed a retrospective analysis of 66 N0-2 oral cavity cancer patients undergoing elective neck dissection for contralateral clinically negative necks from 1991 to 2003. Results: Clinically negative but pathologically positive contralateral lymph nodes occurred in 11%(7 of 66) . Of the 11 cases with a clinically ipsilateral node positive neck, contralateral occult lymph node metastases developed in 36%(4 of 10, in contrast with 5%(3/55) in the cases with clinically ipsilateral node negative necks(p<0.05). Based on the clinical staging of the tumor, 8%(3 of 37) of the cases showed lymph node metastases in T2 tumors, 25%(2 of 8) in T3, and 18%(2 of 11) in T4. None of the T1 tumors(10 cases) had pathologically positive lymph nodes. The rate of contralateral occult neck metastasis was significantly higher in advanced stage cases and those crossing the midline, compared to early stage or unilateral lesions(p<0.05). Patients with no evidence of contralateral nodal cancer had significantly improved disease-specific survival over patients with any pathologically positive nodes(5-year disease-specific survival rate was 79% vs. 43%, p<0.05). Conclusion: The risk of contralateral occult neck involvement in the oral cavity squamous cell carcinomas above the T3 stage or those crossing the midline with unilateral metastases was high. Therefore, we advocate an elective contralateral neck treatment with surgery or radiotherapy in oral cavity squamous cell carcinoma patients with ipsilateral node metastases or tumors that are greater than stage T3 or crossing the midline.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.35 no.5
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• pp.376-379
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• 2009

Likely to be the most common oral cancer, squamous cell carcinoma(SCC) of the tongue accounts for about 20% of all oral and pharyngeal cancers. SCC of the tongue frequently arises in the lateral border, and if it metastasize, it occurs on submandibular gland and neck lymph nodes. Location of the primary lesions and neck lymph node metastasis affect the prognosis and decrease survival rate of patients with carcinoma of the tongue. The authors experienced the patient with contralateral neck lymph node metastasis of SCC of the tongue. The patient came to our department with chief complaint of elevated lesion on left lateral border of the tongue. The mass was diagnosed as $T_2N_0M_0$, Stage II invasive SCC of oral tongue. Computed tomography(CT) & magnetic resonance imaging(MRI) which were taken before the operation showed no significant finding of metastasis. Surgical mass removal and preventive neck dissection on the left side were done. While follow up PET/CT, contralateral neck lymph node metastasis(right side, level II) was detected, and re-operation(Rt. side RND) was done. There are few studies concerning the contralateral neck lymph node metastasis related with SCC of the tongue. The purpose of this report is to introduce the uncommon case of contralateral neck lymph node metastasis occurred in the $T_2$-stage of SCC of the tongue treated by surgical resection.

• Radiation Oncology Journal
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• v.24 no.1
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• pp.1-10
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• 2006

Puroose: To present preliminary results of intensity-modulated radiotherapy (IMRT) using the simultaneous modulated accelerated radiation therapy (SMART) boost technique in patients with nasopharyngeal carcinoma (NPC). Materials and Methods: Twenty patients who underwent IMRT for non-metastatic NPC at the Asan Medical Center between September 2001 and December 2003 were prospectively evaluated. IMRT was delivered using the 'step and shoot' SMART technique at prescribed doses of 72 Gy (2.4 Gy/day) to the gross tumor volume (GTV), 60 Gy (2 Gy/day) to the clinical target volume (CTV) and metastatic nodal station, and 46 Gy (2 Gy/day) to the clinically negative neck region. Eighteen patients also received concurrent chemotherapy using cisplatin once per week. Results: The median follow-up period was 27 months. Nineteen patients completed the treatment without interruption; the remaining patient interrupted treatment for 2 weeks owing to severe pharyngitis and malnutrition. Five patients (25%) had RTOG grade 3 mucositis, whereas nine (45%) had grade 3 pharyngitis. Seven patients (35%) lost more than 10% of their pretreatment weight, whereas 11 (55%) required intravenous fluids and/or tube feeding. There was no grade 3 or 4 chronic xerostomia. All patients showed complete response. Two patients had distant metastases and loco-regional recurrence, respectively. Conclusion: IMRT using the SMART boost technique allows parotid sparing, as shown clinically and by dosimetry, and may also be more effective biologically. A larger population of patients and a longer follow-up period are needed to evaluate ultimate tumor control and late toxicity.