Gi Cheol Park

Prognostic value of metabolic tumor volume measured by 18F-FDG PET/CT in advanced-stage squamous cell carcinoma of the larynx and hypopharynx

BACKGROUND Metabolic tumor volume (MTV) of (18)F-FDG PET/CT is a volumetric measurement of tumor cells with increased 18F-FDG uptake. We evaluated the prognostic value of MTV in patients with locoregionally advanced laryngeal and hypopharyngeal cancer. PATIENTS AND METHODS We evaluated 81 patients with advanced-stage squamous cell carcinoma of the laryngohypopharynx who underwent 18F-FDG PET/CT between January 2004 and September 2009. Clinicopathologic factors and MTV were analyzed for their association with locoregional control (LRC) and overall survival (OS). RESULTS The 3-year LRC and OS for all patients were 70.9 and 78.7%, respectively, with a median follow-up of 40.4 months (range 24.5-90.1). In univariate analyses, MTV, primary site, and primary treatment strategy were associated with both LRC and OS (P<0.05). On multivariate analysis, MTV was an independent prognostic factor for both LRC [P=0.018; HR=3.141, 95% confidence interval (CI)=1.175-8.399] and OS (P=0.008; HR=3.758, 95% CI=1.415-9.982). Primary site was also a significant prognostic factor for LRC (P=0.047). CONCLUSION Pretreatment MTV is an independent prognostic factor in patients with locoregionally advanced squamous cell carcinoma of the larynx and hypopharynx.

Human papillomavirus and p16 detection in cervical lymph node metastases from an unknown primary tumor

OBJECTIVES Human papillomavirus (HPV), a causative agent of oropharyngeal squamous cell carcinoma (SCC), may be detected in metastatic cervical lymph nodes (MCNs). We investigated whether HPV and p16 expression in MCNs can help identify oropharyngeal primaries in patients with cervical lymph node metastases from an unknown primary tumor (CUP) and predict their survival outcomes. MATERIALS AND METHODS SCC MCNs of 58 patients with CUP were assayed for HPV by in situ hybridization and for p16 and p53 expression by immunohistochemistry. The presence of HPV and p16 in MCN was correlated with oropharyngeal tumor location and prognosis. RESULTS Oropharyngeal primaries were found in 20 patients. The sensitivity and negative predictive value (NPV) of HPV for oropharyngeal localization were 90.0% and 92.6%, respectively, and the sensitivity and NPV of p16 were 80.0% and 86.2%, respectively. Multivariate analyses showed that the location of the largest MCN (P=0.035) and HPV (P=0.004) were independent predictors of oropharyngeal tumors. Multivariate analyses showed that p16 expression was an independent predictor of disease-free survival (P=0.030; hazard ratio (HR)=0.286; 95% CI, 0.092-0.887) and that p53 expression (P=0.017; HR=3.154, 95% CI=1.288-8.103) and extracapsular extension of MCN (P=0.010; HR=3.924, 95% CI=1.387-11.097) were independent predictors of overall survival. CONCLUSION Detection of HPV and p16 may help identify hidden oropharyngeal primaries in CUP patients and predict their survival outcomes.

Relationship between histopathology of pleomorphic adenoma in the parotid gland and recurrence after superficial parotidectomy.

This study evaluated the relationships between capsular characteristics and recurrence of parotid pleomorphic adenomas.

Endoscope‐assisted transoral removal of a thyroglossal duct cyst using a frenotomy incision: A prospective clinical trial

Endoscope‐assisted transoral removal of a thyroglossal duct cyst (TGDC) has been introduced to clinical practice. However, the technical feasibility, efficacy, and safety of this procedure have not been studied. Herein, we conducted a prospective clinical trial to evaluate endoscope‐assisted transoral removal of a TGDC.

Partial Superficial Parotidectomy via Retroauricular Hairline Incision

Objectives The purpose of this study was to evaluate the usefulness of retroauricular hair line incision (RAHI) in partial superficial parotidectomy by comparison with modified Blair incision or facelift incision. Methods Medical records of 73 patients with benign parotid tumor who underwent partial superficial parotidectomy were retrospectively reviewed. Size and location of tumors, operative time, occurrence of facial nerve paralysis and Freys syndrome, and cosmetic outcomes were compared among RAHI, facelift incision (FLI), modified Blair incision (MBI) groups. Results RAHI group showed better cosmetic results than FLI group or MBI group compared with other type of incisions (P<0.001, P<0.001, respectively). Among the 3 groups, there were no significant differences of operative time and location of tumor (P=0.377), size of tumor (P>0.999), occurrence of temporary or permanent facial nerve paralysis (P=0.745) and Freys syndrome (P=0.940). Conclusion Partial superficial parotidectomy can be done safely by RAHI in most cases of benign parotid tumor. Compared with MBI or FLI, RAHI has better cosmetic outcome with no increase of operative time or postoperative complications.

Occult lymph node metastasis and risk of regional recurrence in papillary thyroid cancer after bilateral prophylactic central neck dissection: A multi-institutional study

BACKGROUND The impact of occult lymph node metastasis on regional recurrence after prophylactic central neck dissection for preoperative, nodal‐negative papillary thyroid cancer is controversial. We investigated risk factors for regional lymph node recurrence in papillary thyroid cancer patients who underwent total thyroidectomy and bilateral prophylactic central neck dissection. Analysis was according to clinicopathologic characteristics and occult lymph node metastasis patterns. METHODS This multicenter study enrolled 211 consecutive patients who underwent total thyroidectomy with bilateral prophylactic central neck dissection for papillary thyroid cancer without evidence of central lymph node metastasis on preoperative imaging. Clinicopathologic features and central lymph node metastasis patterns were analyzed for predicting regional recurrence. Multivariate Cox regression analysis was used to identify independent factors for recurrence. RESULTS Median follow‐up time was 43 months (24–95 months). Ten patients (4.7%) showed regional lymph node recurrence. The estimated 5‐year, regional recurrence‐free survival was 95.2%. Tumor size ≥1 cm, central lymph node metastasis, lymph node ratio, and prelaryngeal lymph node metastasis were associated with regional recurrence in univariate analysis (P < .05). In multivariate analysis, a lymph node ratio ≥ 0.26 was a significant risk factor for regional lymph node recurrence (odds ratio = 11.63, P = .003). Lymph node ratio ≥ 0.26 was an independent predictor of worse recurrence‐free survival on Cox regression analysis (hazard ratio = 11.49, P = .002). CONCLUSION Although no significant association was observed between the presence of occult lymph node metastasis and regional recurrence, lymph node ratio ≥ 0.26 was an independent predictor of regional lymph node recurrence in papillary thyroid cancer patients who underwent total thyroidectomy and bilateral prophylactic central neck dissection.

Prevalence and risk factors of sialocele formation after partial superficial parotidectomy: A multi-institutional analysis of 357 consecutive patients

The purpose of this study was to identify the prevalence of sialoceles and the risk factors associated with their formation after parotidectomy.

Does post‐infectious olfactory loss affect mood more severely than chronic sinusitis with olfactory loss?

Olfactory deficits that develop after viral upper respiratory infection (URI) may have different effects on patient depression index compared to chronic sinusitis with olfactory loss. However, there have been no controlled trials to evaluate the different effects of chronic sinusitis and URI on depression index.

18F-FDG PET/CT vs. human papillomavirus, p16 and Epstein–Barr virus detection in cervical metastatic lymph nodes for identifying primary tumors

Squamous cell carcinoma of unknown primary of the head and neck (SCCUP) is a heterogeneous disease entity that requires careful examination to locate the occult primary. We examined the diagnostic value of expression of biomarkers, such as human papillomavirus (HPV), p16 and Epstein–Barr virus (EBV), in metastatic lymph nodes vs. 18F‐fluorodeoxyglucose (18F‐FDG) positron emission tomography/computed tomography (PET/CT). We prospectively enrolled 54 consecutive SCCUP patients who received HPV, p16 and EBV analyses of lymph node fine‐needle aspirates and 18F‐FDG PET/CT scans and subsequently underwent examinations and biopsies under general anesthesia to detect primary tumors. The diagnostic performance of the biomarkers and 18F‐FDG PET/CT were compared by using receiver operating characteristics (ROC) curve analyses with histopathological results for identification of primary tumors. Primary tumors were identified in 28 (51.9%) of 54 patients: the palatine tonsil in 24, base of the tongue in 1, nasopharynx in 2, and hypopharynx in 1. The sensitivity of p16 (85.7%) and accuracy of HPV (85.2%) were higher than those (42.9% and 68.5%) of 18F‐FDG PET/CT (p < 0.05). The area under the ROC curve of HPV was higher than that of 18F‐FDG PET/CT (0.857 vs. 0.666, p = 0.007). The disease‐free survival rates were higher in the patients with primary tumor detection or p16 nodal immunopositivity than in the other patients (p < 0.05). The results showed that HPV and p16 detection in metastatic lymph nodes can help locate hidden primary tumors, guide definitive treatment and predict patient survival.

Incidence and risk factors of late recurrence in patients with salivary gland cancer.

Recurrence in the late post‐treatment period is relatively common in salivary gland cancer (SGC), but risk factors and survival associated with late recurrence have been rarely studied. We investigated the incidence and risk factors of SGC recurrence >5 years after treatment and associated survival.