Preoperative neck ultrasound combined with pathological data can significantly impact the outcome of medullary thyroid carcinoma.

The diagnosis of medullary thyroid carcinoma (MTC) is challenging since the accuracy of ultrasound (US) and fine-needle aspiration cytology are suboptimal. As a result, MTC has a generally poor prognosis. The aim of this study was to analyze whether perioperative data can modify the risk of relapse in these patients. The institutional database of Turin Mauriziano Hospital was searched to extract records of MTCs diagnosed between 2000 and 2021. Kaplan-Meier curves and Cox and logistic regression analyses were performed, and the hazard ratio (HR) was calculated. Seventy-three MTC patients (median age 58 yr) were found. Disease-free survival was significantly different according to staging (HR: 9.12; p = 0.037), capsular status (HR: 5.49; p = 0.02), and neck US (HR: 9.19; p = 0.04). In the logistic regression analysis, CEA level (ß: -0.01; p = 0.043), histological multifocality (OR: 7.4; p = 0.034), and metastatic lymph nodes at histology (ß: -0.13; p = 0.006) were significantly associated with structural recurrence. Two logistic multivariate models best explained the variance in recurrence: 1) neck US presentation plus histological multifocality (AIC: 27; r2: 0.37; x2: 12.4; p = 0.002) and 2) number of neck metastases plus capsular invasion (AIC: 26; r2: 0.40; x2: 13.7; p = 0.001). Pathological data are associated with MTC prognosis. Preoperative neck US can significantly help to predict MTC outcome.

Virtual endoscopy of laryngeal carcinoma: is it useful?

OBJECTIVE: To compare virtual endoscopy (VE) with flexible endoscopy in patients with cancer of the larynx. STUDY DESIGN AND SETTINGS: This prospective study includes 24 patients with proven cancer of the larynx. Patients underwent spiral CT according to our standard protocol for upper airway imaging. This same set of axial scans was transferred to a dedicated workstation to obtain VE images. Results of VE were compared with the findings of flexible endoscopy. RESULTS: Quality of the examination was good in 96% of the patients. VE identified all exophytic lesions. Two small flat lesions could be observed as slightly enhanced plaques only on the axial scans. Subglottic extension was correctly demonstrated in all cases by associating VE to the axial scans. CONCLUSION: VE shows high sensitivity in the identification of exophytic lesions of the larynx and can establish relationships between cancer and nearby structures. It can be performed in the presence of severe stenosis and does not require sedation and additional scanning. On the other hand, VE show limits in the identification of flat lesions and does not allow biopsies and functional imaging to be performed. SIGNIFICANCE: VE is a useful tool for staging and presurgery treatment of cancer of the larynx.