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Gu D.H.,Hallym University | Yoon D.Y.,Hallym University | Yoon D.Y.,Ilsong Memorial Institute of Head and Neck Cancer | Park C.H.,Hallym University | And 6 more authors.
Acta Radiologica | Year: 2010

Background: A reliable assessment of mandibular invasion is crucial for treatment planning to obtain both radical tumor resection and good functional results. Purpose: To retrospectively compare the diagnostic value of three different imaging methods computed tomography (CT), magnetic resonance (MR) imaging, 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT and their combined use for detection of mandibular invasion by squamous cell carcinoma (SCC) of the oral cavity. Material and Methods: Forty-six patients (39 men and 7 women; mean age, 59.4 years) suspected of having mandibular invasion by SCC of the oral cavity underwent CT, MR, and PET/CT within 2 weeks before surgery. First, each study was reviewed separately for the presence of mandibular invasion by tumors. Then, the value of combined images was assessed based on a confidence rating score for each modality assigned by observers. These results were verified with histopathologic findings. Results: Histopathologic examination revealed mandibular invasion in 12 of 46 SCCs. The sensitivity, specificity, and accuracy were 41.7%, 100%, and 84.8% for CT; 58.3%, 97.1%, and 87.0% for MR; and 58.3%, 97.1%, and 87.0% for PET/CT, respectively. The comparison of these modalities showed no statistically significant difference among them (P > 0.05). The combination of CT, MR, and PET/CT improved sensitivity (83.3%), without loss of specificity (100%) and accuracy (95.7%), although the difference failed to reach statistical significance (P > 0.05). Conclusion: The combined analysis of CT, MR, and PET/CT can improve sensitivity in the detection of mandibular invasion by SCC of the oral cavity. © 2010 Informa Healthcare. Source


Kim H.C.,Kangwon National University | Kim H.C.,Hallym University | Yoon D.Y.,Hallym University | Chang S.K.,Hallym University | And 8 more authors.
Journal of Ultrasound in Medicine | Year: 2010

Objective. The purpose of this study was to assess the probability of metastasis of small atypical cervical lymph nodes detected on sonography in patients with squamous cell carcinoma (SCC) of the head and neck. Methods. We reviewed, retrospectively and blindly, sonographic findings of 148 patients (118 men and 30 women; mean age, 58.2 years) who underwent curative neck dissection. Each lymph node was classified by using a 4-point scale: 1, definitely benign; 2, indeterminate (small [short-axis diameter <10 mm for levels I and II and <7 mm for levels III-VI] atypical node); 3, definitely metastatic; and 4, large (>3-cm) metastatic. Lymph nodes were considered atypical if they met at least 1 of the following criteria: a long- to short-axis diameter ratio of less than 2.0, absence of a normal echogenic hilum, and heterogeneous echogenicity of the cortex. These results were verified, on a level-by-level basis, with histopathologic findings. Results. Small atypical nodes were found on sonography in 63 cervical levels of 48 patients, of which 18 (28.6%) were proved to have metastatic nodes. The probability of metastasis was significantly higher with than without a large (>3-cm) ipsilateral metastatic node (0.50 versus 0.20; P = .038) and marginally higher with than without an ipsilateral metastatic node (0.41 versus 0.16; P = .061) but not significantly associated with the T stage of the primary tumor (P = .238) or the presence of an ipsilateral tumor (P = .904). Conclusions. Metastasis was encountered in about 30% of small atypical cervical nodes on sonography in patients with SCC of the head and neck. Our results indicate that small atypical nodes must be interpreted with consideration of metastatic nodes in the ipsilateral neck. © 2010 by the American Institute of Ultrasound in Medicine. Source


Yoon S.J.,Hallym University | Yoon D.Y.,Hallym University | Kim S.S.,Kangwon National University | Rho Y.-S.,Ilsong Memorial Institute of Head and Neck Cancer | And 3 more authors.
Acta Radiologica | Year: 2013

Background: Differentiation of postoperative neck abscess from non-infected fluid is important because the treatment is different. Purpose: To determine specific CT findings that might help to differentiate abscesses from non-infected fluid collections in the postoperative neck. Material and Methods: We retrospectively reviewed CT scans of 50 patients (43 men and 7 women; mean age, 62.5 ± 8.9 years) who had postoperative fluid collections in the neck (26 abscesses and 24 non-infected fluid collections). Diagnosis of an abscess was determined by a positive bacteria culture from the fluid collection. Diagnoses were correlated with the following CT findings: anatomic spaces involved, the maximum transverse diameter, margin, attenuation, rim enhancement, gas bubbles, and manifestations of soft tissue adjacent to a fluid collection. Results: Rim enhancement pattern and soft tissue manifestations showed significant differences between abscess and non-infected fluid. The reliable CT findings for abscess were: (i) rim enhancement > 50% of the circumference, 54% sensitive, 71% specific, and 62% accurate; and (ii) severe soft tissue manifestations, 39% sensitive, 92% specific, and 64% accurate. There were no significant differences in the anatomic spaces involved, the maximum transverse diameter, margin, attenuation, and gas bubbles between abscess and non-infected fluid. Conclusion: CT findings that may help differentiate postoperative neck abscess from non-infected fluid were rim enhancement > 50% of the circumference and severe soft tissue manifestations. Source


Kim H.C.,Hallym University | Yoon D.Y.,Hallym University | Seo Y.L.,Hallym University | Namkung S.,Hallym University | And 9 more authors.
Acta Radiologica | Year: 2013

Background: Thyroid cancer is one of the common head and neck malignancies and may be found incidentally with other head and neck cancers. Purpose: To evaluate the prevalence and risk of malignancy in incidental thyroid lesions identified by ultrasound (US) in patients with head and neck cancer. Material and Methods: We retrospectively reviewed medical records of all patients with head and neck cancer other than of thyroid origin between January 2004 and December 2011. A total of 690 patients (537 men and 153 women; mean age, 58.9±12.9 years) underwent US of the neck for the evaluation of cervical lymph node status (including thyroid gland). We evaluated the prevalence of patients with incidental thyroid lesions identified by US and the risk of malignancy in these patients. Results: Of the 690 patients with head and neck cancer, 234 (33.9%) had incidental thyroid lesions on US. Based on US findings, 61 patients underwent fine-needle aspiration, with 39 eventually undergoing thyroidectomy. Among these thyroid lesions, 24 incidental thyroid lesions of 22 patients were histologically proven to be malignant (23 papillary and 1 follicular carcinomas). The risk of malignancy was 9.4% on a patient-by-patient basis. Conclusion: Screening of the thyroid gland should be included in the preoperative US examination for cervical lymph node metastases in patients with non-thyroidal head and neck cancer. © The Foundation Acta Radiologica 2013. Source


Seo Y.L.,Hallym University | Seo Y.L.,Ilsong Memorial Institute of Head and Neck Cancer | Yoon D.Y.,Hallym University | Yoon D.Y.,Ilsong Memorial Institute of Head and Neck Cancer | And 5 more authors.
American Journal of Roentgenology | Year: 2012

OBJECTIVE. The purpose of this study was to assess the manual compressibility of thyroid masses with an ultrasound probe and to determine whether this ultrasound feature can be used to differentiate benign from malignant thyroid lesions. SUBJECTS AND METHODS. We prospectively compared images obtained during compression with an ultrasound probe and noncompressed ultrasound images of 180 pathologically proven thyroid masses (51 malignant, 129 benign) smaller than 2 cm in 169 patients (127 women, 42 men; mean age, 51.2 years). The size (anteroposterior and transverse dimensions) and shape (ratio of anteroposterior to transverse dimension) of the selected lesions were measured on both noncompressed and compressed ultrasound images at a computer workstation, and the compressibility (anteroposterior-to-transverse ratio on noncompressed images minus anteroposterior-to-transverse ratio on compressed images) was calculated. Compressibility was analyzed to determine its association with histopathologic results (benign versus malignant) and the characteristics of the thyroid mass (involved lobe, location in lobe, halo, and composition). The area under the receiver operating characteristic curve was used as an indicator of performance. RESULTS. The mean anteroposterior-to- transverse ratio of a thyroid mass on compressed ultrasound images was significantly lower than that on noncompressed images (0.78 ± 0.28 vs 0.92 ± 0.30; p < 0.001). The compressibility of masses was greater for benign than for malignant lesions (0.19 ± 0.16 vs 0.05 ± 0.12; p < 0.001). No statistically significant association was identified between compressibility and other characteristics of a lesion. The area under the receiver operating characteristic curve for compressibility of thyroid masses was 0.78. On the basis of a cutoff value for malignancy of compressibility less than 0.10, the sensitivity, specificity, and accuracy were 72.5%, 72.9%, and 72.8%. CONCLUSION. Compressibility with an ultrasound probe is a useful criterion for differentiating benign from malignant lesions of the thyroid. © American Roentgen Ray Society. Source

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