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Objective: FDG-PET/CT (fluorodeoxyglucose-positron emission tomography/computed tomography) is effective to assess for occult neck nodal disease. We report risks and patterns of nodal disease based on primary site and nodal level from data on the dissected cN0 per the results from ACRIN 6685.Study Design: Prospective nonrandomized enrollment included participants with first-time head and neck squamous cell carcinoma and at least 1 cN0 neck side to be dissected.Setting: Twenty-four ACRIN-certified centers internationally (American College of Radiology Imaging Network).Methods: A total of 287 participants were enrolled. Preoperative FDG-PET/CT findings were centrally reviewed and compared with pathology. Incidence, relative risk, pattern of lymph node involvement, and impact upon neck dissection were reported.Results: An overall 983 nodal levels were dissected (n = 261 necks, n = 203 participants). The highest percentages of ipsilateral positive nodes by primary location and nodal level were oral cavity (level I, 17/110, 15.5%), pharynx (level II, 6/30, 20.0%), and larynx (level VI, 1/3, 33.3%).Conclusion: Levels at greatest risk for nodal disease in cN0 in terms of ipsilateral neck dissection are level I (oral cavity), II (pharynx), and VI (larynx). These data should be considered when treating patients presenting with cN0. This is the first study to comprehensively report the incidence, location, and risk of metastases in cN0 in the FDG-PET/CT era. [ABSTRACT FROM AUTHOR]

Abstract: Background: Revision parathyroid is challenging due to possible diagnostic uncertainty as well as the technical challenges it can present. Methods: A multidisciplinary panel of distinguished experts from the American Head and Neck Society (AHNS) Endocrine Section, the British Association of Endocrine and Thyroid Surgeons (BAETS), and other invited experts have reviewed this topic with the purpose of making recommendations based on current best evidence. The literature was also reviewed on May 12, 2017. PubMed (1946‐2017), Cochrane SR (2005‐2017), CT databases (1997‐2017), and Web of Science (1945‐2017) were searched with the following strategy: revision and reoperative parathyroidectomy to ensure completeness. Results: Guideline recommendations were made in 3 domains: preoperative evaluation, surgical management, and alternatives to surgery. Eleven guideline recommendations are proposed. Conclusion: Reoperative parathyroid surgery is best avoided if possible. Our literature search and subsequent recommendations found that these cases are best managed by experienced surgeons using precision preoperative localization, intraoperative parathyroid hormone (PTH), and the team approach. [ABSTRACT FROM AUTHOR]

Background We present our experience with the use of an immunocompetent medium-sized animal model of tongue cancer that may be suitable for imaging and surgical studies. Methods A New Zealand white rabbit model of tongue cancer was created by injecting a VX tumor cell suspension grown in culture into the tongue of our model. The tumor was examined 7 days following implantation by physical examination, photography, and 18fluoro 2-deoxyglucose-positron emission tomography (FDG-PET). At 12 days postimplantation, the model was again studied as described above prior to euthanization, and then tongue excision and bilateral neck dissections were performed. All tissue was examined by histology. Results We confirmed a successful orthotopic tongue cancer model that resulted in cervical nodal metastases. Conclusion This model may be a useful model of orthotopic head and neck cancer for future surgical or imaging research. © 2012 Wiley Periodicals, Inc. Head Neck, 2013 [ABSTRACT FROM AUTHOR]

Objectives. To determine if standardized uptake values (SUV) on positron emission tomography (PET) are predictive of thyroid pathology and the significance of serial SUV measurements of thyroid nodules over time.Study Design. Case series with chart review.Setting. Academic health center.Subjects. In total, 23,384 PET and PET/computed tomography (CT) scans were performed between December 2001 and April 2011.Methods. Patients with incidental thyroid uptake were identified. SUVmax, age, sex, size of thyroid lesion, indication for PET scan, and cytology/pathology were collected.Results. Incidental thyroid uptake was noted in 1309 PET scans (5.60%), focal uptake in 690 (2.95%), and diffuse uptake in 619 (2.65%). Complete data were available for 359 PET scans from 103 patients. Malignancy was identified in 28 patients (27%). Twenty-five of the 28 lesions (89%) were primary thyroid malignancies. A significant difference between malignant SUVmax and benign SUVmax was found (mean ± SD, 7.04 ± 7.88 for malignancies vs 3.85 ± 3.06 for benign tumors, P = .0292). Receiver operating characteristics curves were constructed on patients with PET data within 3 months of diagnosis and indicated that a SUVmax of 4.2 differentiated maximally between benign and malignant lesions. Serial SUV uptake had no significant change over time.Conclusion. All thyroid nodules with focal uptake on 18F-fluorodeoxyglucose–PET/CT should be considered at higher risk of malignancy than those discovered incidentally by other imaging modalities. Higher SUVmax values are more indicative of malignant lesions. All lesions should be evaluated with ultrasonography ± fine-needle aspiration if no clinical contraindications exist. Size of the primary nodule does not influence SUVmax uptake. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: The objective was to determine whether low-frequency repetitive transcranial magnetic stimulation (rTMS) improves tinnitus by decreasing neural activity in auditory processing regions of the temporal cortex and the utility of positron emission tomography (PET) for targeting treatment. Study Design: Randomized, sham-controlled crossover. Methods: Patients received a five-day course of active and sham 1-Hz rTMS (1800 pulses at 110% of motor threshold) to the temporal cortex, with a week separating active and sham treatment. Visual analogue ratings of tinnitus loudness (VARL) were assessed at baseline and the end of each treatment week; regional brain blood flow (rBBF) and glucose metabolism (via PET) were measured before and after treatment in regions of interest (ROI) beneath the stimulating coil and control sites. Results: The VARL for both ears significantly decreased after active but not sham treatment. Responders comprised 43% of patients, experiencing at least a 33% drop in tinnitus loudness. The site most consistently associated with a positive response was the secondary auditory cortex (Brodmann Area 22) in either hemisphere. PET asymmetries were variable across patients and not always accessible to rTMS. Whereas PET activity decreased significantly beneath the stimulating coil following active treatment, similar changes occurred at control sites and after sham stimulation. Change in tinnitus perception did not correlate significantly with change in PET activity at the treatment site ROI. Conclusions: Active TMS led to a significant reduction in tinnitus loudness, but PET scans failed to support the hypothesis that low-frequency rTMS improves tinnitus by reducing cortical activation at the stimulation site, questioning the utility of PET for targeting rTMS. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: A single patient was tested to examine the safety and feasibility of using maintenance sessions of low-frequency repetitive transcranial magnetic stimulation (1 Hz rTMS) to reduce tinnitus loudness and prevent its return over time. Study Design: Interrupted time series with multiple replications. Methods: Tinnitus loudness was assessed using a visual analogue rating (VAR) with 0 = no tinnitus, and 100 = loudest tinnitus experienced; 1,800 TMS pulses delivered at 1 Hz and 110% of motor threshold were administered over the posterior, superior lateral temporal gyrus of the subject's right hemisphere until subjective tinnitus fell to a VAR of 25. TMS was reapplied as tinnitus returned to a VAR of 25 or higher. Cerebral metabolism was measured using positron emission tomography before and after treatment. Results: In this patient, tinnitus could be reduced to a VAR of 6 or lower each time it reoccurred using one to three maintenance sessions of rTMS. Tinnitus loudness remained at or below a VAR of 25 and was reported to be unobtrusive in daily life when last assessed 4 months after the third and final round of maintenance treatment. Asymmetric increased cerebral metabolism in the right hemisphere reduced following treatment and as tinnitus improved. Maintenance treatment was well tolerated with no side effects. Conclusions: Although a case study cannot establish treatment efficacy, this study demonstrates for the first time that it is feasible to use maintenance rTMS to manage chronic tinnitus. Maintenance rTMS might impede cortical expansion of the tinnitus frequency into adjacent cortical areas, but group studies are necessary to confirm this speculation. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Correlate subjective improvements in tinnitus severity with restoration of cortical symmetry and sustained attention after neuronavigated low-frequency, repetitive transcranial magnetic stimulation (rTMS). Study Design: Case study. Methods: Positron emission tomography and computed tomography imaging (PET-CT) guided rTMS was performed on a 43-year-old white male with more than a 30 year history of bilateral tinnitus. rTMS was administered to the area of increased cortical activation visualized on PET-CT at a rate of 1 Hz for 30 minutes (1,800 pulses/session) for each of 5 consecutive days, with optimization applied on day 5 using single pulses of TMS to temporarily alter tinnitus perception. Subjective tinnitus severity was rated before and after rTMS using the tinnitus severity index with analogue scale. Attention and vigilance were assessed before and after therapy using the psychomotor vigilance task (PVT), a simple reaction time test that is sensitive to thalamocortical contributions to sustained attention. Posttherapy PET-CT was used to evaluate any change in asymmetric cortical activation. Results: The most marked reduction in tinnitus severity occurred after rTMS optimization; this persisted up to 4 weeks after rTMS. PVT testing showed the patient exhibited a statistically significant improvement in mean slowest 10% reaction times after rTMS ( P = .004). PET-CT imaging 2 days after the cessation of rTMS showed no changes in cortical blood flow or metabolic asymmetries. Conclusions: Low-frequency rTMS applied to the primary auditory cortex can reduce tinnitus severity, with rTMS optimization yielding the most favorable results. Beneficial changes occurring in the patient's slowest reaction times suggest that attentional deficits associated with tinnitus may also respond to low-frequency rTMS. [ABSTRACT FROM AUTHOR]

Radio-guided surgery is an established means for surgeons to identify a target of interest for biopsy or excision. This technique is used for a variety of malignancies as well as minimally invasive parathyroid surgery. The primary radionuclide used for these procedures is technetium-99m (Tc-99m), but others have been used. Use of (18)fluorine-fluorodeoxyglucose ((18)F-FDG) in oncology has proliferated. This has created the opportunity to use (18)F-FDG as a potential radio tracer in the operating room. A pilot study of three patients with non-iodine avid thyroid cancers undergoing (18)F-FDG-guided revision thyroid cancer surgery is reported. Radiation exposure to operating room personnel was measured. Radiation exposure to the surgeon and staff members of an operating room is well below the limits of the National Regulatory Commission. Therefore, utilization of this radiopharmaceutical intraoperatively should not be limited in the future because of concern regarding exposure of operating room personnel to radiation. [ABSTRACT FROM AUTHOR]

Abstract: Radio-guided surgery is an established means for surgeons to identify a target of interest for biopsy or excision. This technique is used for a variety of malignancies as well as minimally invasive parathyroid surgery. The primary radionuclide used for these procedures is technetium-99m (Tc-99m), but others have been used. Use of 18fluorine-fluorodeoxyglucose (18F-FDG) in oncology has proliferated. This has created the opportunity to use 18F-FDG as a potential radio tracer in the operating room. A pilot study of three patients with non-iodine avid thyroid cancers undergoing 18F-FDG–guided revision thyroid cancer surgery is reported. Radiation exposure to operating room personnel was measured. Radiation exposure to the surgeon and staff members of an operating room is well below the limits of the National Regulatory Commission. Therefore, utilization of this radiopharmaceutical intraoperatively should not be limited in the future because of concern regarding exposure of operating room personnel to radiation. [Copyright &y& Elsevier]

Objectives/hypothesis: Low-frequency repetitive transcranial magnetic stimulation (rTMS) has been shown to alleviate tinnitus perception, presumably by inhibiting cortical activity associated with tinnitus. We conducted a pilot study to assess effectiveness of neuronavigated rTMS and its effects on attentional deficits and cortical asymmetry in four patients with chronic tinnitus using objective and subjective measures and employing an optimization technique refined in our laboratory., Study Design: Randomized, placebo-controlled (sham stimulation) crossover study., Methods: Patients received 5 consecutive days of active, low-frequency rTMS or sham treatment (using a 45-degree coil-tilt method) before crossing over. Subjective tinnitus was assessed at baseline, after each treatment, and 4 weeks later. Positron emission tomography/computed tomography (PET/CT) scans were obtained at baseline and immediately after active treatment to examine change in cortical asymmetry. Attentional vigilance was assessed at baseline and after each treatment using a simple reaction time test., Results: All patients had a response to active (but not sham) rTMS, as indicated by their best tinnitus ratings; however, tinnitus returned in all patients by 4 weeks after active treatment. All patients had reduced cortical activity visualized on PET immediately after active rTMS. Mean reaction time improved (P < .05) after active but not sham rTMS., Conclusions: rTMS is a promising treatment modality that can transiently diminish tinnitus in some individuals, but further trials are needed to determine the optimal techniques required to achieve a lasting response. It is unclear whether the improved reaction times were caused by tinnitus reduction or a general effect of rTMS. PET/CT scans immediately after treatment suggest that improvement may be related to reduction of cortical asymmetry associated with tinnitus.