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While the biological behavior of follicular thyroid carcinoma (FTC) has been studied in great detail using clinical experience, few studies have investigated pre- or intraoperative factors related to the risk of distant metastasis (DM) among patients with FTC. The aim of this study was to analyze the characteristics of FTC with DM.This study retrospectively investigated 102 patients with FTC who underwent surgery between 1988 and 2013. We compared clinicopathological characteristics between FTC with and without DM.Univariate analysis revealed nodal metastasis (p=0.045), serum thyroglobulin (Tg) at initial operation (≥1000ng/ml; p0.0001), widely invasive appearance according to macroscopic findings (p0.0001), thick tumor capsule (≥1mm; p0.0001), vascular invasion (p=0.0003), extrathyroidal invasion (p=0.047), and venous tumor embolism (p=0.045) as significant risk factors for DM. Multivariate analysis conducted using pre- and intraoperative factors identified thick tumor capsule (≥1mm), serum Tg at initial operation (≥1000ng/ml), and macroscopically widely invasive appearance as risk factors independently associated with development of DM.Patients with these risk factors should undergo total thyroidectomy and radioactive iodine ablation.

We evaluated the usefulness and limitations in ultrasonography (US) for diagnosing neck lymph node metastases in patients with hypopharyngeal cancer by comparing the results of preoperative US examinations with postoperative pathological findings following neck dissection. Seventy-five previously untreated patients with hypopharyngeal squamous cell carcinoma underwent a curative procedure that included neck dissection. Preoperatively, all patients were examined by palpation, computed tomography (CT), and US. Postoperatively, all dissected neck lymph nodes were submitted for pathological examination. Results of pre-and postoperative examinations were then compared. US accuracy for each lymph node was 93.9%, while sensitivity was 78.0%, since hypopharyngeal cancer metastasizes early and easily to the neck lymph nodes, and it is difficult to detect small, pathologically positive nodes. Nine of 75 cases showed latent neck recurrence, and two of these were underestimated by US. The major cause for neck recurrence was considered to be the high rate of metastases in such cases, rather than a reduced dissection field. It is not rare to find very small, pathologically positive lymph nodes that US cannot detect in hypopharyngeal cancer. Efforts must therefore be expanded to improve the accuracy of US diagnosis. Care must also be taken when selecting cases for no or limited neck dissection.

The indication and preferred dissection field for prophylactic neck dissection for submandibular gland cancer are controversial and have not been standardized. We reviewed 27 patients who underwent a definitive operation for previously untreated submandibular gland cancer. The 27 patients consisted of 13 patients with adenoid cystic carcinoma, 6 patients with mucoepidermoid carcinoma, 6 patients with adenocarcinoma, and 2 patients with squamous cell carcinoma. The diagnostic accuracies of malignancy and histology with fine needle aspiration cytology were 86% and 56%, respectively. In sixteen out of 21 cases without neck lymph node metastasis, a prophylactic neck dissection was performed and pathological neck lymph node metastases were detected in five cases. On the other hand, in five cases that did not receive a prophylactic neck dissection, latent neck lymph node metastasis was observed in 2 cases. In both cases of neck lymph node metastasis, pathological positive lymph nodes were observed in only level 2 or level 3. The rates of occult neck lymph node metastasis according to the T stage were 0% in TI, 33.3% in T2, 57.1% in T3 and 100% in T4. The rates of occult neck lymph node metastasis according to the histopathology were 46.2% in adenoid cystic carcinoma, 50% in mucoepidermoid carcinoma. 50% in adenocarcinoma, and 50% in squamous cell carcinoma. In conclusion, we believe that supraomohyoid neck dissection is suitable fur NO cases of submandibular gland cancer because of four reasons : 1) rate of occult neck lymph node metastasis in submandibular gland cancer is high, 2) pathological neck lymph node metastasis in No cases and latent neck lymph node metastasis were observed in level 2 and level 3, 3) the prognosis of cases with neck lymph node metastasis was poor, and 4) same skin incision can be used not only for the primary resection but also for the neck dissection.

This study evaluates the use of ultrasonography (USG) to diagnose metastatic cervical lymph nodes. Three-hundred and one lymph nodes were removed from 58 patients with squamous cell carcinomas of the head and neck. None of the patients had received any preoperative treatments for cancer. The lymph nodes were then histopathologically examined: 139 metastatic lymph nodes and 162 non-metastatic nodes were found. USG was then used to evaluate the size, internal echo, and margin of each lymph node. Size was found to be the best criteria for distinguishing metastatic lymph nodes from non-metastatic lymph nodes in all cervical regions (78% accuracy). Superior internal jugular lymph nodes and submandibular lymph nodes larger than 7 mm and mid and inferior internal jugular lymph nodes larger than 6 mm were regarded as metastatic. Internal echoes were classified into five patterns: homogeneous hypoechoic, homogeneous hyperechoic, heterogeneous, eccentric hyperechoic, and centric hyperechoic. Homogeneous hyperechoic and heterogeneous patterns were characteristic of metastatic nodes, while eccentric hyperechoic patterns were characteristic of non-metastatic nodes. Homogeneous hypoechoic patterns were observed in both metastatic and non-metastatic nodes. Regular margins were found in 81% of the metastatic nodes. Of the 22 lymph nodes with irregular margins, however, 91% were metastatic. Evaluations using a combination of USG and clinical feature criteria were compared with evaluations using only thickness as a criterium. Although thickness is the single most important factor in diagnosing metastatic nodes, the combination of USG and clinical feature criteria improved the accuracy of diagnosis to 83%. Thus, diagnostic methods involving a combination of several criteria are more accurate than methods involving only a single criterium.

We reviewed 79 patients with squamous cell carcinoma of the lateral wall of the oropharynx who received treatment at the Cancer Institute Hospital. Tokyo, between 1971 and 1990. There were 67 men and 12 women, aged 31 to 81 years (average 59.2 years). The tumors could be staged by TNM classification (UICC 1987) as follows: Stage 10 Stage II 12, Stage III 27, Stage IV 40. It must be noted that more than 50% of the tumors were classified as stage IV. As the initial treatment, 50 patients underwent radical radiotherapy, and the remaining 29 were treated mainly by surgery after pre-operative radiation. Some patients underwent adjuvant chemotherapy, but the role of chemotherapy was not considered in this study. The purpose of the present study was to determine the prognostic factors and to determine the survival rate after each treatment modality. The results were as follows: i) Patients with either T4, over N2b or a stage IV tumor had a significantly poor prognosis. ii) Cox multivariate analysis revealed that age, local extension (base of tongue, anterior pillar, soft palate and mid-line), pathological findings (poorly, moderately or well differentiated), tumor type (exophytic or endophytic) were not useful prognostic factors. iii) Radiosensitivity was not reflected in the survival rate judging from the high recurrence rate (44%) after radical radiotherapy. On the other hand, local recurrence after radical resection was seen in 18% of the patients. iv) Analysis of the data supported the recommendation of surgery after preoperative radiation as the treatment for stage III patients. It seems difficult to find the best treatment modality for stage IV patients in order to improve the survival rate, and this is an issue that still remains to be resolved. v) From the study of the surgical specimens, we are unable to demonstrate a significant survival advantage of the patients with a high grade radiation effect, or patients with no vessel involvement.