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The importance of pathologic features of metastatic lymph nodes (LNs), such as size, number, and extranodal extension, has been recently emphasized in patients with papillary thyroid carcinoma (PTC). We evaluated the characteristics of metastatic LNs identified after prophylactic central neck dissection (CND) in patients with PTC. We performed a retrospective review of 1,046 patients who underwent unilateral or bilateral thyroidectomy with ipsilateral prophylactic CND. We reviewed the characteristics of the metastatic LNs and analyzed their correlation to the clinicopathologic characteristics of the primary tumor. Cervical LN metastasis after prophylactic CND was identified in 280 out of 1046 patients (26.8 %). The size of metastatic foci (≥2 mm) was independently correlated with primary tumor size (≥1 cm) (p = 0.016, OR = 1.88). Primary tumor size (≥1 cm) was also correlated to the number of metastatic LNs (≥5) (p = 0.004, OR = 3.14) and extranodal extension (p = 0.021, OR = 2.41) in univariate analysis. The size of the primary tumor affects pathologic features of subclinical LN metastasis in patients with PTC. Patients with primary tumors ≥1 cm have an increased risk of larger LN metastases (≥2 mm), an increased number of LN metastases (≥5), and a higher incidence of ENE, which should be considered in decision for prophylactic CND.

Objectives/hypothesis: To evaluate the outcomes of transoral laser microsurgery (TLM) for T1 glottic carcinoma using longitudinal voice analysis., Study Design: Retrospective analysis of medical records., Methods: We conducted a retrospective review of 57 patients (50 T1a, seven T1b) who underwent TLM for T1 glottic carcinoma, and longitudinal voice analysis was performed before surgery, during the early postoperative period (within 3 months), and during the late postoperative period (more than 6 months). Acoustic, perceptual (Grade, Roughness, Breathiness, Asthenia, Strain scale), and subjective voice analysis using the Voice Handicap Index (VHI) was conducted., Results: Voice quality deteriorated in the early postoperative period in terms of several parameters. However, no significant differences in voice quality were observed in the late postoperative period, whereas Grade (from 1.85 ± 0.83 to 1.50 ± 0.90) and Roughness (from 1.74 ± 0.73 to 1.48 ± 0.87) had improved significantly. Patients who underwent lesser-extent cordectomy (type I, II) showed improvement in VHI-Physical (from 12.93 ± 11.10 to 6.07 ± 8.69) and Grade (from 1.60 ± 0.68 to 0.98 ± 0.83), whereas improvement was not identified in those who underwent larger-extent cordectomy (type III, IV, V). Improvement in Grade (from 1.70 ± 0.80 to 1.23 ± 0.91) and Roughness (from 1.77 ± 0.73 to 1.25 ± 0.76) was identified in patients who had unilateral tumor without involvement of anterior commissure. However, those with involvement of the anterior commissure or bilateral vocal cord showed a tendency toward deterioration in voice quality., Conclusions: Voice quality of patients following TLM for T1 glottic carcinoma may improve significantly over time in cases with lesser-extent types of cordectomy or unilateral tumor without involvement of the anterior commissure., Level of Evidence: 4 Laryngoscope, 126:2051-2056, 2016., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: We sought to validate the feasibility of preserving a functioning recurrent laryngeal nerve (RLN) invaded by papillary thyroid carcinoma (PTC) using a shaving technique followed by high-dose radioactive iodine (RAI) therapy., Methods: A retrospective review of 34 patients with locally invasive PTC who had exclusive tumor involvement of a functioning RLN was performed. All patients underwent total thyroidectomy and high-dose RAI therapy. A shaving technique was conducted with the goal of leaving the smallest amount of residual tumor as possible while attempting to preserve nerve function. Clinicopathologic factors and oncologic outcomes of the patients with resected RLN (group A, n = 14) and preserved RLN (group B, n = 20) were compared., Results: The two groups showed no differences in clinicopathologic factors or follow-up period. Mean dose of radioiodine therapy was 245.0 ± 140.3 mCi (range 100-540 mCi). Permanent postoperative vocal cord paralysis after RLN shaving occurred in two patients of group B (10%). Only one patient (5%) in group B had local recurrence at the thyroid bed where the residual tumor was located. The overall recurrence rate was 35.7% (5/14) and 20.0% (4/20) in groups A and B, respectively showing no significant difference (p = 0.525). There were no cases of death due to PTC during the median follow-up of 75 months (range 36-159 months)., Conclusions: Patients with locally invasive PTC with exclusive involvement of a functioning RLN may be treated by nerve shaving followed by treatment of the macroscopic residual tumor with high-dose RAI therapy.

Background: Cutting the sternothyroid (ST) muscle is a useful technique to expose the superior pole of thyroid gland during thyroidectomy. In this study, we evaluated the impact of partial cutting of the ST muscle on postoperative vocal outcomes after total thyroidectomy., Methods: A retrospective review of 57 patients who underwent total thyroidectomy with central neck dissection for micropapillary thyroid carcinoma was conducted. Group A (n = 26) included those without cutting the ST muscle, while group B (n = 31) included patients whose muscle was partially cut at the superior pole. All patients underwent voice analysis before the operation and 2 weeks and 1 month after the surgery, and the outcomes were compared between the two groups., Results: There were no differences between the two groups regarding the outcomes at each time of voice analysis. Group A showed a decrease of maximum frequency 2 weeks after surgery but showed no difference after 1 month. Group B showed a mild decrease in maximum frequency 2 weeks after surgery, but the difference was not significant., Conclusion: Partial cutting of ST muscle during thyroidectomy is useful to expose the superior pole without significant negative impact on postoperative outcomes of vocal analysis.