Purpose: Ultrasonography and computed tomography of the neck are commonly used for preoperative evaluation of neck lymph node (LN) status in papillary thyroid carcinoma (PTC). This study evaluated the accuracy of preoperative positron emission tomography/magnetic resonance (PET/MR) imaging of cervical LN status in PTC. F-fluorodeoxyglucose uptake and preoperative morphologic abnormalities of nodal shape, cortical thickness, and the fatty hilum of neck nodes were analyzed using PET/MR imaging. Results: Total thyroidectomy and lobectomy were conducted in 78.2% (223/285) and 21.8% (62/285) of cases, respectively. The status of central neck LN were evaluated in all patients during surgery and additional evaluation of lateral neck LN were conducted in 11.9% (34/285) of patients through selective sampling or modified radical neck dissection. In total, 36.1% (103/285) of patients had pathologic neck LN metastasis (LNM). PET/MR imaging showed an accuracy of 68.8%, sensitivity of 32.7%, and specificity of 88.6% for the detection of central neck LNM; moreover, an accuracy of 95.1%, sensitivity 68.4%, and specificity of 97.0% for lateral neck LNM. PET/MR imaging showed higher accuracy for detecting neck LNM in the 164 patients who did not have suspected clinical thyroiditis than others. Conclusion: PET/MR has a high specificity for detecting central LNM, especially for patients diagnosed with PTC without pathologic thyroiditis.

Objective: We determined whether and how malignant node could be diagnosed preoperatively with simultaneous PET/MR imaging. Materials and methods:Two hundred thirty-six consecutive women with breast cancer were recruited to undergo preoperative PET/MR imaging. 52 patients were excluded; 31 DCIS, 7 neoadjuvant chemotherapy and 14 previous excisional biopsy. Thus, 184 women (51.9 ±10.2 years old) were included. Axial T1w without fat saturation, contrast enhanced image and diffusion-weighted images with simultaneous acquired PET images were analyzed by nuclear medicine physicians who were blinded the histologic findings. Visual FDG avidity, long axis and cortical thickness of axillary lymph node (ALN), morphologic feature-loss of fat hilum, cortical thickening, round shape or irregular shape- and ADC value were analyzed in most suspicious ALNs. Results:In total, 70 patients (15 patients have only micrometastasis) exhibited ALN metastasis. Mean size of breast mass was 2.1 ±1.5 cm. Macrometastatic ALN showed high FDG uptake, longer axis, thicker cortex, more frequent morphologic abnormalities, higher signal intensity at DWI and higher ADC values with statistical significance. No significant difference between micrometastatic ALN and benign ALN in PET/MR imaging. With pathologic diagnosis as the reference standard, the sensitivity, specificity and accuracy of PET for determining ALN metastasis were 84%, 58% and 68%, respectively. Those are 77%, 84% and 82% in considering both PET with morphologic change and 81%, 66% and 72% in considering PET, morphologic change and DWI, respectively. Conclusion:PET/MR imaging techniques showed high accuracy in the preoperative evaluation of axillary status in patients with breast cancer. Additional information by DWI is unlikely to be useful in predicting metastatic ALN. Citation Format: Kyung Jun Yeu, Jeong Yeong Park, Jung Eun Choi, Su Hwan Kang, Eun-Jung Kong, Ihn-Ho Cho, Soo Jung Lee. A preoperative PET/MR imaging for diagnosing malignant axillary lymph nodes in women evaluated for breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-01-10.

Background: Skin sparing mastectomy (SSM) has been conducted in breast cancer patient because of both oncologic safety and cosmetic satisfaction. Preservation of nipple-areolar complex (NAC) is helpful to keep more natural breast shape, but, can cause anxiety about local recurrence. This study reviewed long term follow-up result of SSM and nipple-areolar skin sparing mastectomy (NASSM), retrospectively. Patients and methods: This study included 272 primary breast cancer patients who received SSM (94 patients) or NASSM (178 patients) except bilateral breast cancer from September 1996 to December 2008. Frozen section was conducted for analysis of NAC resection margin status. In case of positive resection margin, NAC was sacrificed. Local recurrence and overall survival of SSM and NASSM group was analyzed. Results: The mean follow-up was 94.9 months. 81 NAC resection margins (29.8%) were invaded by tumor cells. The positive resection margin of NAC was associated with presence of ductal carcinoma in situ (p=0.005), especially extensive intraductal component (p=0.005) and invasive carcinoma with multiplicity (p=0.048). The patients in NASSM group tended to have more worse disease free survival than those in SSM group (75.3% vs 86.2%, P=0.087). But, in analysis of only local recurrence including NAC, there were 25 cases (14.0%, 7 in skin flap and 18 in NAC) of local recurrence in NASSM group and 8 (8.5%) in SSM group. Local recurrence free survival of the NASSM group was 86.0% and that of the SSM group was 91.5% (P=0.278). Distant recurrence after surgical treatment for local relapse occurred in only one SSM case. There was no significant difference for the overall survival between NASSM and SSM group (97.8% vs 96.8%, p=0.556). Conclusion: In this study, result of long term follow up showed that patients in NASSM group tend to have more local recurrence than patients in SSM group, even if there is no statistically significance. However, surgically well-controlled local recurrence of skin flap and/or NAC did not affect on overall survival. NASSM is alternative method for SSM with oncological safety and better cosmetic outcome. Citation Format: Kyung Jun Yeu, Jeong Yeong Park, Jung Eun Choi, Su Hwan Kang, Young Kyung Bae, Soo Jung Lee. The oncologic safety of nipple-areolar complex skin sparing mastectomy compared with skin sparing mastectomy: 8 years follow up results [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-13-23.