Central compartment management in patients with papillary thyroid cancer presenting with metastatic disease to the lateral neck: Anatomic pathways of lymphatic spread.

BACKGROUND: Papillary thyroid cancer (PTC) occasionally presents with metastases to the lateral neck, without clinically evident disease in the central neck. These cases may ultimately manifest as either skip metastases to the lateral compartment or as occult metastases in the central compartment. METHODS: This is a retrospective review of 80 patients with PTC with metastases to the lateral cervical lymph nodes treated from 2006 to 2015. Photographs of the cadaveric dissections were used with permission from the author. Schematic illustrations were created to highlight lymphatic drainage pathways. RESULTS: The rate of skip metastasis in this cohort was 5%. Clinical evidence of central neck disease did not predict the pathologic status of the compartment. CONCLUSION: PTC rarely spreads to the lateral neck without depositing metastases within the central neck. This finding is supported by the anatomic pathways for lymphatic spread, not previously highlighted in the English literature. © 2017 Wiley Periodicals, Inc. Head Neck 39: 853-859, 2017.

Testing with feedback improves recall of information in informed consent: A proof of concept study.

OBJECTIVE: This study investigates whether applying educational testing approaches to an informed consent video for a medical procedure can lead to greater recall of the information presented. METHODS: Undergraduate students (n=120) were randomly assigned to watch a 20-min video on informed consent under one of three conditions: 1) tested using multiple-choice knowledge questions and provided with feedback on their answers after each 5-min segment; 2) tested with multiple choice knowledge questions but not provided feedback after each segment; or 3) watched the video without knowledge testing. RESULTS: Participants who were tested and provided feedback had significantly greater information recall compared to those who were tested but not provided feedback and to those not tested. The effect of condition was stronger for moderately difficult questions versus easy questions. CONCLUSIONS: Inserting knowledge tests and providing feedback about the responses at timed intervals in videos can be effective in improving recall of information. PRACTICAL IMPLICATION: Providing informed consent information through a video not only standardizes the material, but using testing with feedback inserted within the video has the potential to increase recall and retention of this material.

Very delayed cervical lymph node metastases from hyalinizing clear cell carcinoma: report of 2 cases.

BACKGROUND: Hyalinizing clear cell carcinoma (HCCC) is a rare salivary gland neoplasm most often found in the oral cavity. Although it is generally a low-grade malignancy that is treated with wide local excision, there is a growing body of evidence pointing toward the potential for more aggressive behavior. METHODS: We reviewed available records of patients with delayed cervical lymph node metastases from HCCC. RESULTS: Two patients who were treated with wide local resection for HCCC and remained disease-free at the primary site were diagnosed with cervical lymph node metastases 10 and 14 years later. We treated both with neck dissection, and 1 patient received adjuvant radiation therapy. CONCLUSION: These cases illustrate the risk for occult nodal metastases from HCCC with delayed presentation. Clinician awareness of the presence of subclinical metastases in the neck requires thorough long-term surveillance and potential intervention should nodal disease become manifest.