No abstract

Thyroid cancer is the third most common solid tumor in children and adolescents. A review was made of the data on 540 such patients reported from nine large centers renowned for their experience with thyroid cancer. In respect to the pathogenesis the only factor conclusively known to promote development of thyroid cancer in the pediatric age group is irradiation, as documented by the Chernobyl experience. The evidence indicates that thyroid carcinoma in the pediatric age group is a biologically independent and more aggressive entity than in adults; paradoxically the prognosis is good. In the great majority of cases the only presenting sign was a neck mass. In a high percentage (60-80%) there were also palpable lymph nodes. The findings regarding lung metastases were not clear-cut: in most series they were present in about 10%, with a high of 28% in one group and a low of 5% in another group. Papillary carcinoma or the follicular variant of papillary carcinoma were the dominant histologic types, pure follicular carcinoma being found much less frequently than among adults with thyroid cancer. Despite the relatively advanced stage of the disease upon diagnosis, only 13 patients died of the disease, 12 to 33 years postoperatively. Recurrence rates ranged between 10% to 35%, with involvement of the lateral neck, thyroidal bed or distant sites 3 to 33 years after treatment; most failures responded to further surgery or radioactive iodine. There is almost general agreement that surgical intervention should consist of total or near total thyroidectomy despite the high rates of recurrent laryngeal nerve paralysis and hypocalcemia. In regard to neck metastases less than radical surgery has proved during the years to be sufficiently effective. Radioactive iodine, used by all at some stage of management for treatment purposes, should be used prophylactically only after due consideration in view of possible teratogenicity.

In patients with suspected nasopharyngeal carcinoma, fine-needle aspiration can provide tissue for diagnosis by DNA amplification of EBV genomes. The presence of EBV in metastases from an occult primary tumor is predictive of the development of overt nasopharyngeal carcinoma.

A head and neck ultrasound-guided fine-needle aspiration clinic was set up to determine the role of ultrasound and ultrasound-guided fine-needle aspiration in the evaluation of patients with lesions in this region. One hundred ninety-five lesions were biopsied by ultrasound-guided fine-needle aspiration in 203 patients. Ultrasound detected 2 or more lesions in 14 (48%) of 29 patients with a clinically solitary thyroid nodule. Three (8.8%) of 34 lesions thought to be within the parotid gland were determined to be external. A pronounced learning curve was evident in the technique of ultrasound-guided fine-needle aspiration, particularly for nonpalpable disease. Adequacy of sampling for each 3-month period was 71%, 89%, and 94%, respectively. Seventy-four percent of central aspirations were satisfactory compared to 54% of peripheral aspirations. Ultrasound-guided fine-needle aspiration did not alter the clinical staging of metastatic neck disease in 8 patients having 10 neck dissections but proved useful in detecting nodal recurrence in 3 irradiated necks that did not proceed to surgery. The smallest node to harbor malignancy had 4-mm maximal axial diameter. We conclude that ultrasound and ultrasound-guided fine-needle aspiration are valuable adjuncts to the clinical examination.

No abstract

\s=b\The concept of treating prophylactically the neck of the patient with head and neck cancer is based on the presence of neck metastases in a large number of cases, even if not always detected by physical examination. A modality that could reveal abnormal nodes accurately would change this management attitude so that a number of necks could be left untreated. A retrospective comparative study was undertaken to determine whether high-resolution computed tomographic (CT) scanning might play this role, and whether it has any advantage over physical examination. The radiographic findings of 79 patients with head and neck cancer who had undergone a total of 100 neck dissections were compared with the findings of physical and histopathologic examinations. This study shows similar sensitivity rates for both physical examination and CT scanning (61.55% and 59.6%, respectively) and slight superiority of the positive predictive values of physical examination (91.4%) over those of CT scanning (81.6%). The study suggests that CT offers no advantage over physical examination and should therefore not be used for neck management decisions. Measuring the size of involved lymph nodes showed that occult nodes fall within the same range as normal nodes and thus cannot be differentiated from normal nodes by size alone.An imaging method that would -l\-improve staging of the neck in patients with head and neck cancer may have important therapeutic application. Physical examination, the mainstay of staging the neck, is sometimes inaccurate and according

No abstract

This study examines patterns of early metastatic spread as recorded in 19 clinically negative, histologically positive (occult) neck dissection specimens. Microscopic metastatic deposits were detected in this study in nodes measuring 10 mm and less. No nodes with extension of tumor beyond the capsule and into adjacent structures were noted. Central necrosis was detected in only one node. We suggest that the first stages of metastatic disease as evaluated by the pathologist in clinically occult nodes are minimal and may easily evade the eyes of both pathologists and radiologists. Imaging proved to be efficacious in upstaging clinically occult necks that were previously irradiated.