Voice Outcome of Total Thyroidectomy in Comparison With Administration of Recombinant Human TSH.

BACKGROUND AND OBJECTIVES: The larynx is an end-organ target for hormones, and thyroid hormone may act on the larynx. We objectively compared and analyzed the phonetic characteristics of patients who underwent total thyroidectomy before and after radioiodine therapy (RIT) according to administration of recombinant human TSH (rh-TSH). SUBJECTS AND METHODS: Ninety-one patients who had undergone a total thyroidectomy participated (50 patients without rh-TSH, 41 patients with rh-TSH). Voice samples were obtained postoperatively (Post-OP), before high-dose RIT (Pre-RIT), and after high-dose RIT (Post-RIT). Frequency-, perturbation-, and noise-related parameters were evaluated for acoustic analysis, and the voice handicap index (VHI) was used for the subjective evaluation. RESULTS: Frequency-related parameters decreased significantly in patients without rh-TSH administration, but not changed at three periods in patients with rh-TSH administration. Pitch perturbation parameters were not changed at each period in two groups, but amplitude perturbation parameters were changed significantly in two groups. The functional scores of the VHI increased significantly at Pre-RIT in two groups and physical scores increased in patients without rh-TSH at Pre-RIT. CONCLUSION: The hypothyroidism after total thyroidectomy affects phonation significantly. Our results suggest that rh-TSH administration during RIT resulted in improving voice results during RIT in the patients with total thyroidectomy.

Survival Benefits From Surgery for Stage IVa Head and Neck Squamous Cell Carcinoma: A Multi-institutional Analysis of 1,033 Cases.

OBJECTIVES: Head and neck squamous cell carcinomas (HNSCs) are frequently diagnosed at the locoregional advanced stage (stage IVa), but controversy remains regarding whether stage IVa HSNCs should be treated with upfront surgery or definitive chemoradiation therapy (CRT). The purpose of this study was to compare overall survival (OS) and disease-free survival (DFS) in patients with stage IVa HNSC treated primarily by surgery with curative intent with/without (neo)adjuvant treatment (surgery group) versus those treated primarily with CRT (CRT group). METHODS: We reviewed data of 1,033 patients with stage IVa HNSC treated with curative intent at 17 cancer centers between 2010 and 2016. RESULTS: Among 1,033 patients, 765 (74.1%) received upfront surgery and 268 (25.9%) received CRT. The 5-year OS and DFS rates were 64.4% and 62.0% in the surgery group and 49.5% and 45.4% in the CRT group, respectively. In multivariate analyses, OS and DFS were better in the surgery group than in the CRT group (odds ratio [OR] for death, 0.762; 95% confidence interval [CI], 0.592-0.981; OR for recurrence, 0.628; 95% CI, 0.492-0.802). In subgroup analyses, the OS and DFS of patients with oropharyngeal cancer were better in the surgery group (OR for death, 0.548; 95% CI, 0.341-0.879; OR for recurrence, 0.598; 95% CI, 0.377-0.948). In the surgery group, patients with laryngeal cancer showed better OS (OR for death, 0.432; 95% CI, 0.211-0.882), while those with hypopharyngeal cancer DFS was improved (OR for recurrence, 0.506; 95% CI, 0.328-0.780). CONCLUSION: A survival benefit from surgery may be achieved even in patients with stage IVa HNSC, particularly those with oropharyngeal and laryngeal cancer. Surgery led to a reduction in the recurrence rate in patients with hypopharyngeal cancer.

Smart needle to diagnose metastatic lymph node using electrical impedance spectroscopy.

OBJECTIVES: The cause of cervical lymphadenopathy varies from inflammation to malignancy. Accurate and prompt diagnosis is crucial as delayed detection of malignant lymph node can lead to a worse prognosis. To improve the diagnostic accuracy of metastatic lymph node, electrical spectroscopy was employed to study human normal and metastatic lymph nodes using a hypodermic needle with fine interdigitated electrodes on its tip (EoN). SUBJECTS AND METHODS: The electrical impedance of samples collected from 8 patients were analyzed in the sweeping frequency range from 1 Hz to 1 MHz. To align the impedance level data of the patients, normalized impedance was employed. RESULTS: The optimal frequency exhibiting the best discrimination results between the normal and cancerous tissues was introduced based on a discrimination index. A high sensitivity (86.2%) and specificity (88.9%) were obtained, which implied that the EoN holds the potential to improve the in vivo diagnostic accuracy of metastatic lymph node during biopsy and surgery. CONCLUSION: EoN has a promising potential to be utilized in real-time in actual clinical trials without a need for any pre/post-treatment during FNA or surgery. We believe that the EoN could reduce unnecessary operations with its associated morbidity.

Bi-institutional experience of transoral endoscopic thyroidectomy: Challenges and outcomes.

BACKGROUND: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a novel remote-access endoscopic approach. In this study, we compared the surgical outcomes of TOETVA with those of conventional transcervical approach (TCA) in two tertiary hospitals. METHODS: A total of 82 patients were done by TOETVA and 233 patients received TCA between January 2018 and April 2019. Propensity score matching was used to reduce selection bias. RESULTS: Operation time of the TOETVA group was longer than that of the TCA group. The mean number or retrieved lymph nodes were significantly higher in the TOETVA group. No significant difference was observed in the overall perioperative complications. CONCLUSION: TOETVA is technically acceptable when compared to TCA in terms of equal baseline characteristics of patients. Although future large-scale multicenter studies with longer follow-up periods are needed, we expect this novel technique can be performed not only for cosmetic purposes but also for patients with papillary thyroid carcinoma.

Seasonal effects on resting energy expenditure are dependent on age and percent body fat.

Seasonal variation in resting energy expenditure (REE) is still under debate. This study investigated seasonal changes in REE and relevant factors among Korean adults. A total of 867 healthy volunteers (385 men and 482 women) aged 20-69 years were divided into four seasonal groups and subgroups based on age, body mass index (BMI), and percent body fat (PBF) quartiles. REE, body composition, glucose metabolism, thyroid hormones, and catecholamines were measured. The seasonal factor contributed to REE independent of anthropometric indices, with additional variation decreasing from 6% to 2% among younger and older persons, respectively. The adjusted REE in the winter was 5.4-13.9%, 7.8-14.3%, and 8.6-11.9% higher than that in the summer in the age, BMI, and PBF subgroups, respectively. T3 and log-transformed norepinephrine (NElog) were higher, whereas log-transformed epinephrine (EPIlog) was lower in the winter compared to the summer. The magnitude of the winter-summer difference in REE and T3 and of the summer-winter difference in EPIlog were reduced three-fold between the lowest and highest intervals of age and PBF, whereas the difference in NElog was constant across all age and PBF intervals. There was no obvious change in seasonal differences in REE or its relevant biomarkers across BMI intervals. In summary, season is an independent predictor of REE and its effect is attenuated by the increment of age and PBF but not BMI.

Which Plosive Consonant Is More Useful for the Aerodynamic Analysis of Pathologic Voice?

OBJECTIVES: Both acoustic and aerodynamic analyses are essential to evaluate the phonetic characteristics of voice pathology. The purpose of the study is to determine the magnitude of their correlation with the different types of bilabial plosive consonants. METHODS: A controlled prospective study of 35 patients diagnosed with unilateral vocal fold paralysis was performed. The sustained vowel /a/ and bilabial voiceless consonants were used. Three common acoustic parameters were measured from a sustained vowel /a/ and aerodynamic parameters from a set of syllables /pi/, /phi/, and /p'i/. We determined the correlation coefficients between acoustic and aerodynamic measurements for the bilabial plosive consonants /pi/, /phi/, and /p'i/. RESULTS: The mean values of acoustic parameters were higher than the thresholds of pathology. The mean values of aerodynamic parameters varied according to the types of consonants. The correlation between acoustic and aerodynamic parameters was significantly larger with the consonant /phi/ compared with the consonants /p'/ and /p/. The magnitudes of correlation were higher with the consonant /phi/ compared with the consonants /p'/ and /p/. CONCLUSION: The plosive consonant /phi/ may represent a more valuable investigative consonant than the consonants /p/ or /p'/ for aerodynamic analysis of voice pathology, especially in patients with unilateral vocal fold paralysis.

Radiologic Features of Papillary Carcinoma in the Second Branchial Cleft Cyst.

Clinically, it may be very difficult to differentiate between benign branchial cleft cyst (BCC) and malignant BCC with papillary carcinoma preoperatively. Radiological features were reviewed retrospectively between benign BCC and malignant BCC with papillary carcinoma using computed tomography (CT) and magnetic resonance (MR) images. All patients had only a mass on the right upper lateral neck without lesion in the thyroid gland. Two patients had a mass in the upper medial part of BCC on CT images and one patient showed a well-circumscribed mass in the upper portion of BCC on MR image. Two patients received BCC removal only and one patient underwent total thyroidectomy including removal of BCC. As results, most cases of papillary carcinoma in the BCC were detected incidentally after surgical resection of BCC. However, we can differentiate between benign BCC and malignant BCC with primary papillary carcinoma by carefully reviewing radiologic images before surgery.

Perceptual and Acoustic Outcomes of Early-Stage Glottic Cancer After Laser Surgery or Radiotherapy: A Meta-Analysis.

Laser surgery (LS) or radiotherapy (RT) is normally recommended in early glottic cancer. The objective of this study was to perform a comprehensive meta-analysis of acoustic and perceptual outcomes to compare voice quality of LS or RT in early-stage glottic cancer. Data sources were obtained after searching PubMed, Google Scholar, EBSCO, and RISS using the following search terms: glottic cancer, glottic carcinoma, endoscopic surgery, laser surgery, radiotherapy, radiation, voice, voice quality, and grade, roughness, breathiness, asthenia, and strain (GRBAS) scale. Articles that compared voice outcomes between LS and RT were identified. This meta-analysis included 15 articles with 744 patients, including 400 in the LS group and 344 in the RT group. Random effects models were selected. Forest plots included standardized mean differences, standard errors, variance, 95% confidence intervals (lower limit to upper limit), z-values, and P-values. In perceptual analysis, grade (G) and asthenia (A) of RT were significantly better than LS. There was no statistically significant difference in roughness (R), breath (B), or strain (S) between LS and RT groups. Jitter, shimmer, and noise to harmonic ratio measurements showed significant differences, resulting in enhanced posttreatment effect of RT compared to LS. Results of our meta-analysis suggested that RT might lead to superior voice quality than LS in early glottic cancer.

Longitudinal Kinematic Evaluation of Pharyngeal Swallowing Impairment in Thyroidectomy Patients.

The aim of this study was to assess pharyngeal swallowing impairments in thyroidectomy patients and to delineate the contributory kinematic components. Forty consecutive patients (mean age = 47.33 years) and fourteen age- and sex-matched heathy adult volunteers (mean age = 42.64 years) participated in this study. A videofluoroscopic swallowing study (VFSS) was performed 1 day prior to surgery, and at 1 week and 3 months post-surgery. VFSS images were evaluated using the Modified Barium Swallowing Impairment Profile (MBSImp). Kinematic and temporal aspects of swallowing were characterized by measurement of maximum hyoid and laryngeal excursion, pharyngeal transit duration, laryngeal response duration (LRD), and laryngeal closure duration at each three time-points. At 1 week post-surgery, only pharyngeal impairment was significantly deteriorated than pre-surgery (p = 0.001). However, at 3 months, a significant improvement was observed to pre-surgery level (p = 0.01). Post-surgery, maximum hyoid excursion was significantly reduced in patients compared controls (p = 0.001). Although the maximal distance of the hyoid and the laryngeal excursion was shorter than before surgery, laryngeal excursion at all three time-points was similar to that of controls. At all three time-points, LRD was significantly longer in patients than in controls (p = 0.01). Following thyroidectomy, pharyngeal aspects of swallowing as measured by the MBSImp and kinematic aspects of swallowing were reduced with incomplete recovery at 3 months. These exploratory data may guide decision regarding management of pharyngeal swallowing impairment with patients undergoing total thyroidectomy.

A case of interdigitating dendritic cell sarcoma studied by whole-exome sequencing.

Interdigitating dendritic cell sarcoma (IDCS) is an aggressive neoplasm and is an extremely rare disease, with a challenging diagnosis. Etiology of IDCS is also unknown and most studies with only case reports. In our case, immunohistochemistry showed that the tumor cells were positive for S100, CD45, and CD68, but negative for CD1a and CD21. This study aimed to investigate the causative factors of IDCS by sequencing the protein-coding regions of IDCS. We performed whole-exome sequencing with genomic DNA from blood and sarcoma tissue of the IDCS patient using the Illumina Hiseq 2500 platform. After that, we conducted Sanger sequencing for validation of sarcoma-specific variants and gene ontology analysis using DAVID bioinformatics resources. Through comparing sequencing data of sarcoma with normal blood, we obtained 15 nonsynonymous single nucleotide polymorphisms (SNPs) as sarcoma-specific variants. Although the 15 SNPs were not validated by Sanger sequencing due to tumor heterogeneity and low sensitivity of Sanger sequencing, we examined the function of the genes in which each SNP is located. Based on previous studies and gene ontology database, we found that POLQ encoding DNA polymerase theta enzyme and FNIP1 encoding tumor suppressor folliculin-interacting protein might have contributed to the IDCS. Our study provides potential causative genetic factors of IDCS and plays a role in advancing the understanding of IDCS pathogenesis.

Identification of lymphatic channels in the tracheoesophageal groove during central neck dissection for thyroid cancer.

BACKGROUND: Chyle leakage after central neck dissection for thyroid carcinoma is an extremely rare condition. We investigated chyle leakage in patients with thyroidectomy and central neck dissection. METHODS: We experienced 3 cases of chyle leakage. The patterns of lymphatic drainage from the central neck to the lateral neck (supraclavicular fossa) were reviewed. The amount and duration of chyle leakage were measured in patients with postoperative chyle leakages. RESULTS: The lymphatic channels were found in 2 cases during central neck dissection on the tracheoesophageal groove. One case did not show chyle leakage and ducts during surgery but showed chyle leakage after surgery. CONCLUSION: Chyle leakage can occur after thyroidectomy with central neck dissection. There have been no reports on identification of lymphatic channels during central neck dissection. This finding will aid in the recognition and treatment of this uncommon complication during or after central neck dissection in patients with thyroid cancer.

The Relationship Between the Non-recurrent Laryngeal Nerve and the Inferior Thyroid Artery.

The non-recurrent inferior laryngeal nerve (NRLN) represents a risk factor for nerve injury during thyroid surgery. The aim of this study is to investigate the traveling patterns of NRLNs and its relationships to inferior thyroid arteries (ITAs). We had 11 patients showing NRLNs on the right side who underwent thyroidectomies. The NRLNs were classified into four different types, according to the traveling patterns. We evaluated the anatomical position of the ITA as follows: (1) three types according to the joint location with the thyroid gland; and (2) three types according to the level of the retro-esophageal subclavian artery (RSA). The traveling patterns of NRLN could be classified into four types, descending, vertical, ascending, and V-shaped. ITA was joined variably with the thyroid gland on the superior, middle, and inferior positions. The levels of the RSA were also located at different positions, the first thoracic vertebra, the second vertebra, and the third vertebra. During thyroid surgery, the surgeon must be aware of the existence of anatomical variations of NRLNs and ITAs. The anatomy of the NRLN and the ITA are frequently irregular, and there is no correlation between the traveling pattern of NRLN and the level of the RSA.

Sequential occurrence of diffuse large B-cell lymphoma and carcinoma in the nasopharynx: A case report.

BACKGROUND: The sequential occurrence of the 2 malignancies development of nasopharyngeal carcinoma (NPC) and lymphoma is extremely rare and their coexistence raises the question of a common etiologic factor. CLINICAL FINDINGS/CLINICAL CONCERNS: A 71-year-old previously healthy man presented with diffuse large B-cell lymphoma (BCL) followed by NPC almost 2 years later with Epstein-Barr virus (EBV) positive. DIAGNOSIS: Endoscopic examination characterized a fixed, hard and nontender mass in the nasopharynx and biopsies were done. INTERVENTION: A patient successfully underwent chemotherapy for lymphoma and chemoradiation for carcinoma sequentially. OUTCOMES: He was followed up every 3 months for 1 year with endoscopic and radiological examinations. The nasopharynx mass was completely resolved after chemoradiation therapy. CONCLUSION: The presentation with diffuse large B-cell lymphoma (BCL) and NPC in this patient was perhaps caused by dual EBV infection or a different oncogenic mechanism.

Characteristics of speech production in patients with T1 glottic cancer who underwent laser cordectomy or radiotherapy.

PURPOSE: Laser cordectomy (LC) or radiotherapy (RT) is often recommended in the early stage of laryngeal cancer. We conducted perceptual and acoustic analysis to compare sustained vowel and stop consonants since there is no article evaluating both the sustained vowel and stop consonants. Eventually, we might determine which management is superior in terms of speech production. SUBJECTS AND METHODS: A total of 28 patients who underwent LC and RT for early T1 glottic cancer were selected. The sustained vowel /a/ and bilabial stop consonants were used to assess the perceptual scores. The fundamental frequency (Fo), jitter, shimmer and noise-to-harmonic ratio (NHR) levels for sustained vowels were evaluated. Voice onset time (VOT), vowel duration (VD) and closure duration of the bilabial plosives were analyzed. A receiver operating characteristic curve analysis was used to evaluate significant results statistically. RESULTS: The GRBAS and discrimination scores were not significantly different between two groups. Fo and jitter were significantly higher in the LC than RT. The cut-off value was statistically higher in the LC group and statistically lower in the RT group. The VOT was significantly longer in the LC than RT. The cut-off value of the /pipida/ VOT was statistically longer in the LC group and statistically shorter in the RT group. CONCLUSIONS: The differences may have been due to muscular fibrosis after RT. Movements of vocal cords with fibrosis were sluggish, when impulsion developed to pronounce the initial /p/ sound, so the VOT was shortened and the VD was longer after RT.