• Korean Journal of Bronchoesophagology
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• v.17 no.2
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• pp.83-88
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• 2011

Robotic thyroidectomy has been developed to minimize neck scarring, and several authors have described its feasibility and safety, and have reported surgical outcomes comparable with conventional open thyroidectomy. The da Vinci surgical system robot provides a three-dimensional $10-12{\times}$magnified view of the surgical area. It also provides hand-tremor filtration, fine motion scaling, and precise and multi-articulated hand-like motions. Recently, robotic technology has also been applied to lateral compartment neck dissection in thyroid cancer. We have developed a new novel selective neck dissection procedure by a gasless unilateral axillo-breast (GUAB) approach with a da Vinci Surgical System for well-differentiated thyroid carcinoma to avoid a long visible neck scar. Based on our early experience, robotic selective neck dissection by GUAB approach is a safe, feasible and cosmetically excellent procedure. It can be an alternative to conventional open surgery in the highly selected patients with well-differentiated thyroid carcinoma. The oncologic safety of robotic selective neck dissection should be verified with long-term follow-up data.

• The Korean Journal of Cytopathology
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• v.5 no.1
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• pp.35-40
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• 1994

A case of poorly differentiated "insular" carcinoma of the thyroid is presented and discussed with references to the literature. Un fine needle aspiration cytology of our case, the aspirates were highly cellular with tumor cells appearing as dispersed isolated cells as well as in dense clusters and syncytial formations. Occasional microfollicles containing colloid were evident. Most of nuclei were fairly uniform with considerable variability and a few showed definite atypical features. Nuclear grooving was additional features. Necrotic debris was not seen. Our cytologic findings were correlated well with histology, confirming typical insular pattern of tumor cells with the presence of occasional pleomorphic cells and papillary carcinoma-like features. With much attention to cytological features of insular carcinoma, it would be possible to diagnose a preoperative suggestive diagnosis, even though not definitive.

• The Korean journal of internal medicine
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• v.33 no.6
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• pp.1050-1057
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• 2018

Thyroglobulin antibody (TgAb) is a class G immunoglobulin and a conventional marker for thyroid autoimmunity. From a clinical perspective, TgAb is less useful than thyroid peroxidase antibodies for predicting thyroid dysfunction. However, TgAb is found more frequently in differentiated thyroid cancer (DTC) and can interfere with thyroglobulin (Tg) measurements, which are used to monitor the recurrence or persistence of DTC. Recent studies suggested a small but consistent role for preoperative TgAb in predicting DTC in thyroid nodules, and in reflecting adverse tumor characteristics or prognosis, including lymph node metastasis, but this is still controversial. Postoperative TgAb can serve as a biomarker for remnant thyroid tissue, so follow-up measures of TgAb are useful for predicting cancer recurrence in DTC patients. Since high serum TgAb levels may also affect the fine needle aspiration washout Tg levels from suspicious lymph nodes of DTC patients, it is important to use caution when interpreting the washout Tg levels in patients who are positive for TgAb.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.24
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• pp.10905-10909
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• 2015

Purpose: The aim of this study was to evaluate the diagnostic value of FNA-Tg for detecting lymph node metastases in patients with a history of differentiated thyroid cancer (DTC). Materials and Methods: A total of 58 patients with DTC diagnosis and evidence of single or multiple suspicious cervical lymph nodes were assessed. All underwent total or near-total thyroidectomy with (35 cases) or without (23 cases) radioiodine (RAI) ablation, followed by thyroid stimulating hormone (TSH) suppression therapy. A total of 68 lymph nodes were examined by ultrasound-guided fine needle aspiration (US-FNA) for both cytological examination and FNA-Tg measurement. Serum Tg and anti-thyroglobulin antibody (TgAb) levels were also measured. Diagnostic performance including sensitivity, specificity, accuracy, positive (PPV) and negative predictive value (NPV) of FNAC and FNA-Tg were calculated and compared. The Spearman's rank correlation coefficient was used to estimate the relationship between FNA-Tg and serum TgAb. Results: The FNA-Tg levels were significantly higher with DTC metastatic lymph nodes (median 927.7 ng/mL, interquartile range 602.9 ng/mL) than non-metastatic lymph nodes (median 0.1 ng/mL, interquartile range 0.4 ng/mL) (p<0.01). Considering 1.0 ng/mL as a threshold value for FNA-Tg, the sensitivity, specificity, accuracy, PPV and NPV of FNA-Tg were 95.7%, 95.5%, 95.6%, 97.8% and 91.3%, respectively. The sensitivity and accuracy of the combination of FNAC and FNA-Tg were significantly higher than that of FNAC alone (p<0.05). The diagnostic performance of FNA-Tg was not significantly different between cases with or without RAI ablation, and the serum TgAb levels did not interfere with FNA-Tg measurements. Conclusions: Measurement of FNA-Tg is useful. The combination of FNAC and FNA-Tg is more sensitive and accurate for detecting lymph node metastases in patients with a history of DTC than FNAC alone. Serum TgAbs appear to be irrelevant for measurement of FNA-Tg.

• Korean Journal of Bronchoesophagology
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• v.6 no.1
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• pp.16-20
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• 2000

The patient a 24-year-old male, was shown to have milliary shadows on chest radiographs from the age of 20. He was temporarily treated for pulmonary tuberculosis without success. He had left thyroid mass and lymph node metastases in neck CT scan which was taken after admission but fine needle aspiration result in scanty cellularity. He underwent total thyroidectomy with left modified radical neck dissection and right selective neck dissection under the impression of differentiated thyroid cancer with bilateral neck metastases. Then he underwent 131I ablation treatment and postoperative whole body 131I scintigraphy revealed diffuse intensive uptake in the bilateral lung fields, demonstrating that the pulmonary lesions were metastases of the thyroid cancer.

• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.2
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• pp.181-185
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• 2010

Purpose: Several studies report that detection of thyroglobulin (Tg) in fine-needle aspiration (FNA) biopsy washout fluid from lymph nodes identifies recurrences or metastases of differentiated papillary thyroid cancer (DPTC) in the neck with higher sensitivity and specificity than fine-needle aspiration cytology (FNAC). We evaluate the diagnostic efficacy and usefulness of Tg measurement in FNA washout fluid (FNA-Tg) and compare with FNAC. Materials and Methods: Forty-eight FNA samples of 37 patients who undergone ultrasonography to detect cervical lymph node metastasis of DPTC, were included for this study. Lymph node metastasis was confirmed by histopathologic examination or long-term imaging follow-up. Sensitivity, specificity and accuracy of FNA-Tg and FNAC were calculated. In 34 patients, we evaluated diagnostic accuracy of FNA-Tg according to the presence or absence of Tg antibody. Results: Sensitivity, specificity and accuracy of FNAC were 75.0%, 97.2% and 91.7%, respectively, and those of FNA-Tg were 100%, 88.9% and 91.7%, respectively. The presence of Tg antibody was not relevant to the diagnostic accuracy of FNA-Tg. Conclusion: FNA-Tg is a as accurate as FNAC with higher sensitivity. FNA-Tg and FNAC are complement techniques for diagnosing lymph node metastasis of DTPC.

• Korean Journal of Head & Neck Oncology
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• v.21 no.2
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• pp.178-182
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• 2005

Insular carcinoma(poorly differentiated thyroid cancer) is defined as a aggressive, follicular-derived thyroid carcinoma with behavior intermediate between follicular/papillary and anaplastic carcinomas. It was described by Carcangiu in 1984, but its prognosis, classification and the origin is not yet clear. And preoperative fine needle aspiration cytology of insular carcinoma has not been satisfactory. We experienced a case of advanced thyroid insular carcinoma with invasion of the sternum. So we intend to present the case with a review of the related literatures.

• The Korean Journal of Cytopathology
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• v.4 no.2
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• pp.105-110
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• 1993

The major limitation of fine needle aspiration of the thyroid is in the evaluation of follicular tumors. it may be difficult or occasionally, impossible to distinguish on a cytologic basis, between hyperplastic nodular getter, follicular adenoma and well differentiated follicular carcinoma. We reviewed cytologic presentations of 15 histologically confirmed follicular neoplasms of the thyroid. Aspiration smears of 6 follicular adenomas were cell-rich with ball-like or syncytial aggregates of monotonous follicular cells, in contrast to honeycomb-like flat sheets of adenomatous goiter Mild nuclear pleomorphism and a small visible nucleolus were noted in 2 cases, respectively. Nine cases of follicular carcinoma showed very high cellularity, irregularly shaped cell clusters, and numerous isolated tumor cells. Nuclear pleomorphism and visible nucleoli were noted in 6 and 5 cases, respectively. Another characteristic finding, entrapped endothelial cells within the ceil clusters, was noted in 7 carcinomas and 1 adenoma. The background of the smears of all follicular neoplasms was hemorrhagic, with no or scanty colloid. We confirmed that the cytologic features of follicular adenoma and carcinoma were similar in general, with subtle differences in cell morphology, but the presence of isolated tumor cells and entrapped endothelial cells was suggestive of malignancy.

• Korean Journal of Radiology
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• v.24 no.10
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• pp.1028-1037
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• 2023

Objective: To evaluate the computed tomography (CT) features for diagnosing metastatic cervical lymph nodes (LNs) in patients with differentiated thyroid cancer (DTC) and validate the CT-based risk stratification system suggested by the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) guidelines. Materials and Methods: A total of 463 LNs from 399 patients with DTC who underwent preoperative CT staging and ultrasound-guided fine-needle aspiration were included. The following CT features for each LN were evaluated: absence of hilum, cystic changes, calcification, strong enhancement, and heterogeneous enhancement. Multivariable logistic regression analysis was performed to identify independent CT features associated with metastatic LNs, and their diagnostic performances were evaluated. LNs were classified into probably benign, indeterminate, and suspicious categories according to the K-TIRADS and the modified LN classification proposed in our study. The diagnostic performance of both classification systems was compared using the exact McNemar and Kosinski tests. Results: The absence of hilum (odds ratio [OR], 4.859; 95% confidence interval [CI], 1.593-14.823; P = 0.005), strong enhancement (OR, 28.755; 95% CI, 12.719-65.007; P < 0.001), and cystic changes (OR, 46.157; 95% CI, 5.07-420.234; P = 0.001) were independently associated with metastatic LNs. All LNs showing calcification were diagnosed as metastases. Heterogeneous enhancement did not show a significant independent association with metastatic LNs. Strong enhancement, calcification, and cystic changes showed moderate to high specificity (70.1%-100%) and positive predictive value (PPV) (91.8%-100%). The absence of the hilum showed high sensitivity (97.8%) but low specificity (34.0%). The modified LN classification, which excluded heterogeneous enhancement from the K-TIRADS, demonstrated higher specificity (70.1% vs. 62.9%, P = 0.016) and PPV (92.5% vs. 90.9%, P = 0.011) than the K-TIRADS. Conclusion: Excluding heterogeneous enhancement as a suspicious feature resulted in a higher specificity and PPV for diagnosing metastatic LNs than the K-TIRADS. Our research results may provide a basis for revising the LN classification in future guidelines.

• Nuclear Medicine and Molecular Imaging
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• v.41 no.1
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• pp.22-29
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• 2007

Purpose: Metastatic thyroid cancers with I-131 uptake have been known to show no increase of FDG uptake whereas those without I-131 uptake tend to demonstrate increased uptake on PET. In this study, we evaluated the degree of FDG uptake in primary thyroid cancers of papillary histology before surgery. Material & Methods: Forty FDG PET studies were performed on the patients who had papillary cancer proven by fine needle aspiration. The degree of FDG uptake was visually categorized as positive or negative (positive if the tumor showed discernible FDG; negative if the tumor didn't) and the peak standard uptake value (peak SUV) of the papillary thyroid cancer (PTC) were compared with the size of PTC. Results: The mean size of 26 PTC with positive FDG uptake was $1.9{\pm}1.4\;cm(0.5{\sim}5\;cm)$. In 13 PTC with negative FDG uptake, the mean size of those was $0.5{\pm}0.2\;cm\;(0.2{\sim}0.9\;cm)$. All PTC larger than 1cm ($2.5{\pm}1.4\;cm,\;1{\sim}5\;cm$) have positive FDG uptake (peak $SUV=6.4{\pm}5.7,\;1.7{\sim}22.7$). Among the micropapillary thyroid cancer (microPTC; PTC smaller than 1cm), 8 microPTC show positive FDG uptake(peak $SUV=2.9{\pm}1.3,\;1.7{\sim}5.5$), while 13 microPTC show negative finding(peak $SUV=1.3{\pm}0.2,\;1.1{\sim}1.7$). The size of microPTC with positive FDG uptake is significantly larger than that of microPTC with negative FDG uptake ($0.7{\pm}0.1\;cm$ vs $0.4{\pm}0.2\;cm$, p=0.01). Conclusion: All PTCs larger than 1cm show positive FDG uptake in our study. In other words, thyroid lesions larger than 1cm with negative FDG uptake are unlikely to be PTC. So far, only poorly differentiated thyroid cancers are known to show increased FDG uptake. Our results seem to be contradictory to what is known in the literature. Further study is needed to understand better the significance of increased FDG uptake in PTC in relation to expression of NIS and GLUT.