Fine-needle aspiration cytology for neck lesions in patients with antithrombotic/anticoagulant medications: systematic review and meta-analysis.

OBJECTIVES: This systematic review and meta-analysis aimed to determine the true risk of bleeding and nondiagnostic (ND) specimens associated with fine-needle aspiration cytology (FNAC) for neck lesions in patients taking antithrombotic/anticoagulation (AT/AC) medications. METHODS: Using the Population Intervention Comparison and Outcome modeling, we searched PubMed and Google Scholar databases to identify studies published between January 2000 and March 2023 reporting the safety and sample adequacy of FNAC for neck lesions in patients taking AT/AC medications. The pooled incidences of bleeding and ND specimens and pooled risk ratio (RR) with 95% confidence intervals (CIs) obtained using a fixed-effects model were compared for patients continuing AT/AC (AT/AC group) and patients not receiving AT/AC therapy (no-AT/AC group). RESULTS: We included six original articles involving a total of 3014 patients. The pooled incidence of bleeding was 0.9% (95% CI, 0.344-2.026) and 0.7% (95% CI, 0.390-1.146) in the AT/AC and no-AT/AC groups, respectively. The pooled RR under the fixed-effects model was 1.39 (95% CI, 0.56-3.44) with no evidence of between-study heterogeneity (I2 = 0.0%; p = 0.92). The pooled incidence of ND specimens was 7.6% (95% CI, 5.617-10.073) and 7.6% (95% CI, 6.511-8.752) in the AT/AC and no-AT/AC groups, respectively. The pooled RR under the fixed-effects model was 1.33 (95% CI, 0.98-1.81) with moderate between-study heterogeneity (I2 = 60.0%; p = 0.06). CONCLUSIONS: The AT/AC medication is not associated with increased risk of bleeding or ND specimens in FNAC for neck lesions. Therefore, interruption of the AT/AC medication is not recommended before FNAC even in patients taking AT/AC medications. CLINICAL RELEVANCE STATEMENT: This study is the first meta-analysis evaluating risk of bleeding and nondiagnostic specimens associated with fine-needle cytology for neck lesions in patients taking antithrombotic/anticoagulation (AT/AC) medications. This suggests withholding AT/AC medications is not mandatory for safe and diagnostic FNACs. KEY POINTS: • True risk of fine-needle aspiration cytology (FNAC) for neck lesions in patients taking antithrombotic/anticoagulation (AT/AC) medications is still controversial. • This meta-analysis demonstrated that maintaining AT/AC medication was not associated with increased risk in terms of both bleeding and nondiagnostic samples. • Interruption of the AT/AC medication is not needed for safe and diagnostic FNAC for neck lesions even in patients taking AT/AC medications.

Evaluation of Carotid Space Schwannoma Using Ultrasonography: Characteristics and Role in Defining the Nerve of Origin.

OBJECTIVES: We aimed to evaluate the ultrasonography (US) characteristics of carotid space schwannoma and their role in identifying the nerve of origin. METHODS: This prospective study enrolled patients with cervical carotid space schwannoma accessible by US. The US characteristics of vagus nerve schwannomas (VNSs) and sympathetic nerve schwannomas (SNSs) were assessed; a carotid space schwannoma was defined as a VNS if the tumor originated in the mid-vagal region and an SNS if it arose posterior to the intact vagus nerve, displacing the vagus nerve anteriorly. RESULTS: Twenty patients with carotid space schwannoma were enrolled. The vagus and sympathetic nerves were identified as the nerve of origin in 12 and 8 patients, respectively. VNSs were centered at levels II, III, and IV in 5, 3, and 4 patients, respectively, while SNSs were centered at levels II (7 patients) and IV (1 patient) (P = .105). The maximal diameters were 3.2 and 4.8 cm for VNSs and SNSs, respectively (P = .011). Internal vascularity was absent and low in 9 and 3 VNSs, respectively, and low and intermediate in 4 SNSs each (P = .002). Twelve patients with VNSs underwent active surveillance without immediate surgery; no adverse events occurred during the 55.2-month follow-up period. Eight patients with potential SNSs underwent surgery, confirming the sympathetic nerve as the nerve of origin. CONCLUSIONS: US facilitates identification of the nerve of origin in cervical carotid space schwannoma. VNSs are more frequent in infrahyoid locations and tend to be smaller in size with lower vascularity compared with SNSs on US.

Individualized Use of Facelift, Retroauricular Hairline, and V-Shaped Incisions for Parotidectomy.

PURPOSE: Despite the increased need for better cosmetic outcomes following parotidectomy, there is no study on the individualized use of esthetic approaches for parotidectomy. We aimed to evaluate the feasibility of individualzsed esthetic approaches for parotidectomy using facelift (FL), retroauricular hairline (RAH), and V-shaped incisions, and compare their surgical and cosmetic outcomes. METHODS: This was a retrospective cohort study. Between 2015 and 2019, we included patients who underwent parotidectomy using FL, RAH, and V-shaped incisions for the treatment of benign parotid tumors. The surgical approach for parotidectomy was determined based on tumor location and each patient's cosmetic demand, following a comprehensive discussion of available esthetic approaches. Surgical and cosmetic outcomes were assessed as primary outcome variables, which were compared among the 3 incision groups. One-way analysis of variance/Kruskal-Wallis test and the chi-squared test were used to inspect differences in continuous and categorical variables, respectively, among the groups. RESULTS: A total of 213 patients, consisting of 122, 50, and 41 patients in the FL, RAH, and V-shaped groups, respectively, were included in the present study. In the FL, RAH, and V-shaped groups, the patient age was 53.5, 51.8, and 42.1 years, respectively (P < .001), and the tumor size was 2.8, 2.7, and 1.9 cm, respectively (P < .001). All parotidectomies were successfully completed with no incision extension or major complications. The subjective scar satisfaction scores assessed at 3 months postoperatively were 8.5, 9.1, 9.2 in the FL, RAH, and V-shaped groups, respectively (P < .001). However, the Vancouver scar scale was consistent across all groups. CONCLUSIONS: Individualized use of esthetic approaches for parotidectomy is feasible and yields improved cosmetic results, leading to high patient satisfaction. Although FL incision is still the standard approach for esthetic parotidectomy, both RAH and the V-shaped incisions could further enhance the cosmetic outcomes of parotidectomy.

Levothyroxine Supplementation Following Hemithyroidectomy: Incidence, Risk Factors, and Characteristics.

BACKGROUND: The goal of the present study was to determine the actual incidence, predictive risk factors, and clinical characteristics of levothyroxine supplementation (LT4S) used for the management of hypothyroidism after hemithyroidectomy. METHODS: From 2008 to 2015, we included 535 patients who underwent hemithyroidectomy. LT4S was initiated based on three major criteria: the development of overt hypothyroidism, subclinical hypothyroidism with thyroid-stimulating hormone (TSH) levels > 10 mIU/L, or subclinical hypothyroidism with TSH levels of 4.5-10 mIU/L with associated signs/symptoms. RESULTS: During the 69-month follow-up period, 321 patients (60%) developed overall hypothyroidism following hemithyroidectomy, and 141 ultimately required LT4S, with an overall LT4S incidence of 26.4%. The most common cause of LT4S initiation was subclinical hypothyroidism with TSH levels > 10 mIU/L. In 141 patients with LT4S, the mean maintenance dose of levothyroxine was 1.34 µg/kg, and only 6 patients (4.3%) discontinued LT4S during the follow-up. The 1-, 3-, 5-, and 7-year LT4S-free survival rates of 535 patients were 88.6%, 80.2%, 73.8%, and 69.1%, respectively. Preoperative TSH levels > 2.12 mIU/L and coexistence of Hashimoto's thyroiditis were significantly associated with LT4S following hemithyroidectomy. The risk of LT4S increased by 1.401 times, as preoperative TSH levels increased by 1 mIU/L. DISCUSSION: A quarter of patients required LT4S after hemithyroidectomy for the management of hypothyroidism, with a mean maintenance levothyroxine dose of 1.34 µg/kg. The preoperative TSH level and coexistence of Hashimoto's thyroiditis were significant predictive factors of LT4S following hemithyroidectomy.

Ultrasonographic Characteristics of Pyriform Sinus Fistulas Involving the Thyroid Gland.

OBJECTIVES: Ultrasonography (US) has been considered to have a more limited role in the diagnosis of pyriform sinus fistulas than computed tomography. The aim of this study was to evaluate the US characteristics of pyriform sinus fistulas involving the thyroid gland in an attempt to improve our ability to diagnose this condition using US. METHODS: Between 2005 and 2016, 14 patients with pyriform sinus fistulas presenting as suppurative thyroiditis or as thyroid nodules were enrolled in the study. Their US images were reviewed to identify US characteristics indicating the presence of an underlying pyriform sinus fistula and compared with the computed tomographic images. RESULTS: A hypoechoic tubular lesion across the thyroid gland was identified in 9 patients (64.3%). Hyperechoic foci or echogenic lines were found within the lesion in 10 patients (71.4%). A hypoechoic rim was found at the boundary of the lesion in 7 patients (50.0%). A lesion emerging from the posterolateral aspect of the thyroid cartilage was found in 4 patients (28.6%). Thirteen (92.9%) of the 14 patients had 1 of these 4 findings. CONCLUSIONS: Ultrasonography would be a useful diagnostic modality for indicating the presence of an underlying pyriform sinus fistula in patients with suppurative thyroiditis or a thyroid nodule and can be used as a first-line diagnostic tool to screen for pyriform sinus fistulas.

Relationship between the severity of laryngopharyngeal reflux and sleep apnea: using drug-induced sleep endoscopy (DISE).

OBJECTIVES: The aim of the study is to identify the following associations: (1) severity of obstructive sleep apnea syndrome (OSAS) and laryngopharyngeal reflux (LPR)-related clinical parameters, such as reflux finding score (RFS), reflux symptom index (RSI), and LPR-health-related quality of life (LPR-HRQOL) and (2) complete obstruction on drug-induced sleep endoscopy (DISE) and LPR-related clinical parameters. MATERIALS AND METHODS: Subjects included the OSAS patients without surgery history and all patients perform the polysomnography (PSG) and DISE for their OSAS. Demographics, polysomnographic data, DISE results, and LPR-related parameters were collected prospectively. The patients were divided into age-, sex-, and BMI-matched two groups, according to numbers of complete obstruction on DISE (complete obstruction at 0-1 subsites (unilevel) vs. 2-4 subsites (multilevel). Finally, 19 patients with unilevel complete obstruction and 38 patients with multilevel complete obstruction were compared. The multiple linear regression analysis was employed to determine the predictors of LPR-related quality of life. RESULTS: Among 88 patients, 19 patients demonstrated unilevel complete obstruction, and 69 patients demonstrated multilevel complete obstruction on DISE. There were no significant correlation between OSAS severity and RFS, RSI, and scores of LPR-HRQOL. Multilevel complete obstruction on DISE did not affect the LPR-related clinical parameters (p > 0.05). The result of multiple linear regression demonstrated complete obstruction at the epiglottis had a strong influence on the high scores of LPR-HRQOL. CONCLUSION: LPR is commonly developing disease with OSAS, but the OSAS severity did not affect the LPR-related parameters. The multilevel complete obstruction on DISE was not associated with the LPR-related clinical parameters.

Ultrasound-Guided Core Needle Biopsy for Head and Neck Mass Lesions in Patients Undergoing Antiplatelet or Anticoagulation Therapy: A Preliminary Report.

OBJECTIVES: We compared the complications and diagnostic adequacy of ultrasound (US)-guided core needle biopsy (CNB) for head and neck mass lesions between patients who did and did not receive antiplatelet/anticoagulation therapy. METHODS: This study was designed as a prospective case study including 146 consecutive patients who underwent US-guided CNB for head and neck mass lesions. Of these, 32 patients were undergoing antiplatelet/anticoagulation therapy involving aspirin, clopidogrel, cilostazol, and warfarin. RESULTS: None of the patients had clinical bleeding/hematoma in either group. Subclinical bleeding/hematoma recognized only by a US examination was not significantly different between the groups (P = .229). No other complications were noticed. The rate of unsatisfactory sampling was also not different between the groups (P > .999). Furthermore, when patients receiving aspirin (n = 18) were reclassified into the no-antiplatelet/anticoagulation therapy group, there was still no significant difference in the incidences of complications compared with the patients receiving clopidogrel, cilostazol, or warfarin (n = 14). CONCLUSIONS: Our study suggests that US-guided CNB is safe and provides good diagnostic results without necessitating the discontinuation of antiplatelet/anticoagulation therapy in patients with head and neck mass lesions. However, as this was a preliminary study, the cohort was relatively small. Larger studies are needed to confirm our findings.

Comparison of the Retroauricular Approach and Transcervical Approach for Excision of a Second Brachial Cleft Cyst.

PURPOSE: Although a retroauricular (RA) approach has been proposed for excision of a second brachial cleft cyst (BCC), no studies have performed a direct comparison of the results of the RA approach and those of the conventional transcervical approach. We evaluated the surgical outcomes of the RA approach under direct vision and demonstrate its benefits compared with the conventional transcervical approach for excision of a second BCC. PATIENTS AND METHODS: From January 2012 to May 2016, we enrolled 30 consecutive patients with a second BCC who underwent surgical excision as a primary treatment into the present prospective case-control study. Of the 30 patients, 13 underwent excision of a second BCC with the RA approach and 17 with the conventional transcervical approach. The surgical results, complications, and subjective scar satisfaction scores were estimated and compared between the 2 groups. RESULTS: In all 30 patients, excision of the second BCC was successfully completed under direct vision using the RA or conventional transcervical approach. The mean operating time was significantly less in the conventional group than that in the RA group (68.4 vs 83.4 minutes, respectively; P = .019). No differences were found in the total drainage amount, drainage duration, duration of hospital stay, or postoperative complications between the 2 groups. The mean scar satisfaction score was 6.2 in the conventional group and 8.8 in the RA group, and this difference was statistically significant (P < .001). CONCLUSIONS: The RA approach under direct vision for excision of a second BCC is feasible and results in better cosmetic outcomes than the conventional transcervical approach, with no increase in surgical morbidity.

Feasibility of FDG-PET/CT for the initial diagnosis of papillary thyroid cancer.

To assess the role of [18F]-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) as a preoperative diagnostic tool in papillary thyroid carcinoma (PTC). From 2011 to 2014, 197 patients with PTC (246 tumor foci in all) underwent FDG-PET. Among these patients, 46 underwent neck dissection for lateral neck metastasis. According to the FDG avidity of the tumor foci or lateral neck metastasis, factors associated with the prognostic value were evaluated by univariate and multivariate logistic regression analyses. Among the 197 patients, 7 (3.6 %) were incidentally found to have non-thyroid origin malignancy. Additionally, 63.0 % (155/246) of PTC foci showed FDG uptake on PET/CT. Univariate analysis showed that the tumor size, the presence of extrathyroidal extension, BRAF mutation, and Hashimoto thyroiditis were associated with FDG avidity. However, except for pathological extrathyroidal extension, the other factors showed statistically significant correlations with FDG avidity (p < 0.001, p = 0.008, and p = 0.009, respectively). FDG uptake in lateral neck node metastasis showed high specificity and negative predictive value (NPV). In four cases of nonspecific findings on ultrasonography (USG)/CT, FDG avidity was helpful to diagnose the presence of lateral neck metastasis. The maximum standardized uptake value (SUVmax) of PET/CT was correlated with the maximum diameter of the involved lateral node. FDG avidity did not show any significance in the recurrence-free survival of both the thyroid tumor and lateral neck metastasis. The FDG avidity of PTC did not show prognostic predictive meaning. However, in the case of lateral neck metastasis, FDG avidity showed high sensitivity and NPV, and could provide better information in cases of nonspecific findings on USG and CT.

Chyle Fistula After Neck Dissection: An 8-Year, Single-Center, Prospective Study of Incidence, Clinical Features, and Treatment.

BACKGROUND: Chyle fistula is a relatively rare complication of neck dissection, and there is a lack of consensus regarding its incidence, risk factors, and management. METHODS: Between 2007 and 2014, a total of 472 cases of neck dissection involving the level IV compartment were included in the study. The incidence, risk factors, and clinical course of chyle fistula were investigated, as well as the outcomes of conventional management and the use of octreotide injection in high-output chyle fistula. RESULTS: The overall incidence of chyle fistula was 4.7 % (22/472), with an incidence of 3.0 % and 6.2 % after right and left neck dissection, respectively. The presence of a metastatic lesion around the junction of the internal jugular vein and subclavian vein was the only factor significantly associated with the development of chyle fistula (approximately fourfold higher risk) in univariate and multivariate analyses. In 22 cases of chyle fistula, the mean total drainage volume was 3226 mL during a mean 15.4 days of drain placement. Total parental nutrition for the management of chyle fistula was required in 16 cases. Nine (40.9 %) of 22 cases experienced additional complications related to chyle fistula. Of the six high-output cases, four were managed with conservative methods plus octreotide injection, and three did not require surgery. CONCLUSIONS: The incidence of chyle fistula after neck dissection was higher than expected, especially on the right side. Surgeons should pay greater attention to chyle fistula from preoperative evaluation to postoperative management.

Surgeon-performed ultrasound-guided fine-needle aspiration cytology of head and neck mass lesions: sampling adequacy and diagnostic accuracy.

BACKGROUND: Studies of surgeon-performed ultrasound-guided fine-needle aspiration cytology (US-FNAC) have been limited largely to thyroid nodules. This study evaluated the sampling adequacy and diagnostic accuracy of surgeon-performed US-FNAC for a large range of head and neck mass lesions, including lesions of the thyroid, salivary glands, and lymph nodes. METHODS: The study included 617 cases of US-FNAC performed by a single surgeon between 2009 and 2013. Their medical histories and ultrasound (US) findings were retrospectively reviewed. Sample adequacy was analyzed according to the surgeon's experience, anatomic tumor location, and US tumor characteristics. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of FNAC were calculated after correlation with the surgical histopathologic results. RESULTS: The overall adequacy rate for surgeon-performed US-FNAC was 91.9 % (567/617). Inadequate specimens were obtained from 9.7 % (29/282) of the thyroid glands, 6.1 % of the salivary glands (6/98), and 6.3 % (15/237) of the lymph nodes. The effect of the surgeon's experience plateaued (inadequate sampling rate, 6-8 %) after 100 US-FNAC procedures. Inadequate sampling was associated with tumor characteristics such as cystic change and rim calcification. Overall, US-FNAC showed a sensitivity of 88.2 %, a specificity of 98.2 %, a PPV of 98.5 %, an NPV of 85.7 %, and a diagnostic accuracy of 91.6 %. CONCLUSION: With proper training and experience managing at least 100 US-FNAC cases, surgeons can ensure a low inadequate sampling rate and good diagnostic accuracy for a range of head and neck mass lesions.

Thyrocricotracheal separation with bilateral recurrent laryngeal nerve transsection: report of a survivor.

Thyrocricotracheal separation is an extremely fatal injury that has not been reported in the literature. Although timely and proper management of this injury is paramount to preserve the patient's life, airway, and voice, its rarity has resulted in a lack of consensus regarding the best management option. We report a case of thyrocricotracheal separation with bilateral recurrent laryngeal nerve transsection caused by a self-inflicted injury, which was treated with reanastomosis in conjunction with transverse laser cordotomy. The patient could achieve both decannulation and a serviceable voice and could return to a normal social life. The present case is the first report of a survivor with thyrocricotracheal separation with bilateral recurrent laryngeal nerve transsection. This findings show that appropriate management of the airway is the first step to ensure a successful outcome, and a step-by-step approach to detect and manage the associated injuries is paramount in cases showing the most severe form of laryngeal trauma.

Surgeon-performed intraoperative tumor localization in recurrent papillary thyroid carcinoma by ultrasound-guided intratumoral indigo carmine injection.

BACKGROUND: Identification and removal of small, non-palpable tumors located within previous surgical scar tissue is challenging and time consuming and may be associated with increased risk in patients with recurrent papillary thyroid carcinoma (PTC). The purpose of the present study was to present our surgeon-performed technique and to evaluate the usefulness of ultrasound-guided intratumoral indigo carmine injection (US-III) for intraoperative tumor localization in patients with recurrent PTC. METHODS: Sixteen patients with recurrent PTC in which tumors were <1.5 cm and not palpable were enrolled in this prospective study from January 2012 through March 2013. RESULTS: The mean size of the target tumors was 0.85 cm (range 0.4-1.3 cm) on preoperative US. The average time required for the US-III procedure was 7.7 min (range 5-11 min). The mean volume of injected indigo carmine was 0.56 mL (range 0.3-1.0 mL); this injection expanded the tumors by a mean of 0.2 cm (23.5% increase compared with the initial tumor size; range 0.0-0.4 cm), increasing the mean size of the target tumors to 1.05 cm (range 0.5-1.5 cm). In 15 (93.8%) of the 16 patients, the recurrent tumors were successfully removed with the aid of US-III. No complications occurred in any of the patients as a result of the US-III or subsequent surgeries. CONCLUSIONS: US-III is a safe and effective technique that can be performed by the surgeon for the intraoperative localization of small non-palpable tumors within previous scar tissue in patients with recurrent PTC.

Human Papillomavirus Infection of the Oropharyngeal and Laryngeal Squamous Papilloma: Disparities in Prevalence and Characteristics.

Human papillomavirus (HPV) infection has emerged as an etiologic factor of squamous papilloma (SP). The oropharynx and larynx are common sites of SP, but studies on the prevalence of HPV infection in these sites are lacking. This study aimed to evaluate and compare the prevalence and characteristics of HPV infection in oropharyngeal SP (OPSP) and laryngeal SP (LSP). HPV detection and genotyping data of patients with pathologically confirmed OPSP and LSP were retrospectively analyzed. A total of 119 patients were enrolled, consisting of 93 patients with OPSP and 26 patients with LSP. Of those patients, 13 patients with OPSP and 14 patients with LSP were positive for HPV infection, accounting for a prevalence of 14.0% and 53.8%, respectively (p < 0.001). The most prevalent genotype was HPV16 in OPSP and HPV6 in LSP. Over two-thirds (69.2%) of HPV(+)-OPSP infections were high-risk types compared with 14.3% of HPV(+)-LSP infections (p = 0.004). The prevalence of HPV infection in patients with OPSP and LSP demonstrated no differences in terms of age, sex, and smoking status. These results could provide a better understanding of HPV infection in OPSP and LSP and serve as a background for the epidemiology of HPV-related tumorigenesis of the oropharynx and larynx.

Ultrasound-guided ethanol ablation versus the Sistrunk operation as a primary treatment for thyroglossal duct cysts.

PURPOSE: This study compared ethanol ablation (EA) with the Sistrunk operation (SO) with regard to feasibility, treatment efficacy, and cost-effectiveness. The goal was to evaluate whether EA could replace SO as a primary treatment modality for thyroglossal duct cysts (TGDCs). METHODS: This retrospective case-control study included patients with TGDCs who were treated with either EA or SO between 2016 and 2022. The primary outcome variables evaluated were treatment efficacy (as measured by the volume reduction rate [VRR] and treatment success rate), complications, and cost-effectiveness. RESULTS: A total of 72 patients were enrolled, with 33 in the EA group and 39 in the SO group. The procedure or operation times for the EA and SO groups were 9 and 82 minutes, respectively (P<0.001). At the final follow-up appointment, the VRR was 94.1% for the EA group and 100.0% for the SO group (P<0.001). Treatment success was achieved for 32 patients (97.0%) in the EA group and for all 39 patients (100.0%) in the SO group (P=0.458). The overall complication rates were 0.0% and 17.9% in the EA and SO groups, respectively (P=0.013). The total costs, including all treatment procedures and follow-up ultrasound examinations, were $485 and $1,081.7 for the EA and SO groups, respectively (P<0.001). CONCLUSION: EA demonstrates superiority over SO in terms of feasibility, safety, and costeffectiveness, while maintaining comparable treatment efficacy. Despite the need for multiple treatment sessions in approximately one-quarter of patients, EA can serve as a primary treatment modality for selected patients with TGDCs, supplanting SO.

Preoperative subclinical hypothyroidism in patients with papillary thyroid carcinoma.

OBJECTIVE: To assess the effect of preoperative subclinical hypothyroidism on prognosis and on the tumour's clinicopathological features at initial diagnosis of papillary thyroid carcinoma (PTC). MATERIALS AND METHODS: 328 patients who underwent surgery for PTC between January 2001 and December 2006 were enrolled in this study. Of these, we compared 35 patients with preoperative subclinical hypothyroidism with 257 patients who were euthyroid before the operation, with respect to clinicopathological characteristics and prognosis. RESULTS: No significant differences were observed in tumour size, extrathyroidal extension, and multifocality between subclinical hypothyroidism and euthyroid patients. Patients with subclinical hypothyroidism had a considerably lower percentage of lymph node metastasis than did euthyroid patients (8.6% vs. 21.8%, p=0.068). Although preoperative subclinical hypothyroidism decreased the risk of lymph node metastasis at 0.313 of odds ratio in the multivariate analysis, its significance was not verified (95% confidence internal, 0.089-1.092; p=0.068). Patients with preoperative subclinical hypothyroidism tended to have a better prognosis than did preoperative euthyroid patients, for both recurrence (2.9% vs. 14.0%, p=0.099) and 7-year disease-free survival (97.1% vs. 87.8%, p=0.079), during the 82-month mean follow-up period. However, even as thyroid-stimulating hormone (TSH) concentration increased, there were no consistent relationships observed between the TSH levels and the prognostic parameters. CONCLUSION: We could find neither a consistent positive nor a negative linear relationship between TSH levels and several prognostic parameters, indicating that subclinical hypothyroidism with elevated TSH is not an independent predictor of tumour aggressiveness and poor prognosis in PTC.

Ultrasound-Guided Ethanol Ablation for Thyroglossal Duct Cyst: A Review of Technical Issues and Potential as a New Standard Treatment.

The thyroglossal duct cyst (TGDC) is the most common congenital neck mass, accounting for 70-75% of all congenital neck masses. Although the Sistrunk operation has been used as a standard of treatment, it is accompanied by a considerable surgical burden, including the need for general anesthesia, a visible surgical scar on the neck surface, and postoperative complications. Ultrasound-guided ethanol ablation (US-EA) is a minimally invasive and office-based technique that is widely used as a non-surgical treatment for several benign cystic lesions, particularly benign thyroid cysts. Recently, US-EA has also been gaining popularity as a good alternative for TGDC treatment, which is associated with high feasibility, a high safety profile, and favorable treatment outcomes. To our best knowledge, seven studies on the use of EA as a primary treatment option for TGDC have been published since 2011. Although these studies have reported promising results, there is a lack of consensus on several issues regarding the application of EA for TGDC, particularly its detailed techniques and role as a primary treatment. This article aims to provide a comprehensive review of EA for TGDC, addressing technical issues and its possible role as a new standard of treatment for TGDC.

Intranodal implantation of benign thyroid tissue as a late complication of ethanol ablation: A case report.

RATIONALE: Ethanol ablation (EA) is recommended as the primary treatment for benign thyroid cysts and its use is increasing. Although complications, such as pain, hoarseness, and hematoma, have been reported after EA, implantation of benign thyroid tissue has not been previously reported. Here, we present a case of intranodal implantation of benign thyroid tissue as a late complication of EA. PATIENT CONCERNS: A 46-year-old man underwent EA for a benign cystic nodule in the left thyroid lobe and developed a thyroid abscess after several days. The patient was treated with incision and drainage and was discharged without complications. Two years later, the patient presented with multiple masses in both cervical regions. Ultrasound (US) and computed tomography indicated metastatic papillary thyroid carcinoma (PTC) at bilateral levels III, IV, and VI. The results of US-guided fine-needle aspiration cytology (FNAC) indicated benign lesions; however, thyroglobulin levels in the needle washout fluid were >250,000 ng/mL. DIAGNOSIS: Total thyroidectomy with neck dissection was performed to remove the thyroid and lymph node masses and confirm the diagnosis. Histopathological findings revealed multiple areas of benign thyroid tissue in the bilateral cervical lymph nodes, with no indication of metastatic PTC, even after a BRAF gene mutation study and immunohistochemical staining for HBME-1 and galectin-3. OUTCOMES: No recurrence or complications were observed during the follow-up for 29 months. LESSONS: Complicated EA may be associated with the dissemination of benign thyroid tissue into lymph nodes, with a confusing clinical presentation mimicking metastatic PTC. Radiologists and thyroid surgeons should consider the risk of intranodal implantation of benign thyroid tissue as a late complication of EA.

Parathyroidectomy for primary hyperparathyroidism: A retrospective analysis of localization, surgical characteristics, and treatment outcomes.

OBJECTIVE: To evaluate parathyroidectomy for primary hyperparathyroidism (PHPT) regarding localization, surgical characteristics, and treatment outcomes. METHODS: Seventy-eight patients who underwent parathyroidectomy for PHPT were retrospectively reviewed. The results were analyzed according to intraoperative localization technique (IOLT), intraoperative parathyroid hormone (IOPTH) monitoring, and intraoperative nerve monitoring (IONM). The localization accuracy of ultrasonography (US), computed tomography (CT), and single-photon emission computed tomography (SPECT)-CT with sestamibi Tc99m was evaluated. RESULTS: Parathyroidectomy was successfully completed in all 78 patients, achieving 100% surgical cure. For 60 patients with IOPTH monitoring, 10-min IOPTH decreased >50% from baseline in 57 (95.0%), and they achieved surgical cure. In the remaining three (5.0%) patients with ≤50% decrease in 10-min IOPTH, 20-min IOPTH decreased >50% from baseline in two (3.3%) patients, achieving surgical cure without additional neck exploration. There were no differences in surgical cure and complications as a function of IOLT use or IOPTH monitoring. Operating time was significantly shorter with IOLT and IOPTH monitoring than without (IOLT: 70.9 min vs. 88.0 min, p = 0.013; IOPTH: 74.9 min vs. 91.9 min, p = 0.037). All 78 patients had adenoma including one patient with a double adenoma. Vocal cord paralysis was not observed in our series, regardless of IONM. US, CT, and SPECT-CT localized the pathological parathyroid gland accurately in 88.1%, 85.5%, and 86.8% of patients, respectively (p = 0.894). CONCLUSION: The surgical outcomes of parathyroidectomy for PHPT were excellent regardless of IOLT and IOPTH monitoring. However, these techniques can maximize the performance of parathyroid surgery by reducing operating time and rescuing challenging cases.

Prevalence and Characteristics of Human Papillomavirus Infection in Oropharyngeal Squamous Cell Papilloma.

Studies on human papillomavirus (HPV) infection in oropharyngeal squamous papilloma (OPSP) are lacking, although HPV infection has been recognized as the primary cause of oropharyngeal cancer for several decades. This study aimed to evaluate the prevalence and characteristics of HPV infections in patients with OPSP. We retrospectively enrolled patients with histologically confirmed OPSP in whom the presence of HPV infections and p16 expression were evaluated. The results of HPV infection in OPSP were analyzed according to the clinicodemographic profiles. Of the 83 patients included in this study, HPV test results were positive in 12 patients, with an overall prevalence of 14.5%. HPV genotypes involved low-risk and high-risk HPV types in three (3.6%) and nine (10.8%) patients, respectively. The most prevalent genotype was HPV16, accounting for 58.3% of all HPV infections. None of the OPSPs showed p16 IHC positivity. There were trends toward a higher prevalence of high-risk HPV infection in patients with OPSP aged ≤45 years, never-smokers, and those with multifocal diseases. These findings could enhance our understanding of HPV infection in OPSP and be used as valuable epidemiological data for the management of HPV-associated OPSP and regarding the possible efficacy of HPV vaccinations in OPSP.