PURPOSE: Cervical lymphadenectomy is frequently performed in patients with lateral cervical lymph node metastasis to improve regional control of disease. However, there is controversy regarding appropriate levels of the neck that need to be dissected. In particular, the routine dissection of level V remains an annoying and time consuming procedure due to the injury of the spinal accessory nerve. METHODS: To identify clinical and pathological predictors of cervical node metastases to level V in papillary thyroid carcinoma, we analyzed 42 patients who underwent modified radical neck dissection (MRND), which were separately performed by each strict anatomical level. Five patients underwent both MRND, 29 patients received total thyroidectomy with central neck node dissection and MRND at the time of initial operation. Thirteen patients underwent MRND later when lateral neck metastases were found at the follow-up after total thyroidectomy with central neck node dissection. RESULTS: In our series, 11.9% of neck specimens harbored metastatic thyroid carcinoma at level V. The metastatic rate of level II, III, and IV was 54.7%, 85.7%, and 64.2%, respectively. The presence of level V metastases was not significantly associated with level II, III metastases, age, sex, and histopathologic findings. But, it seemed to be associated with level IV metastases if the proportion of metastasis of level IV exceeded 50%. CONCLUSION: Cervical node metastasis seems to be associated with level IV metastases if the proportion of metastasis of level IV exceeds 50%.
Accessory Nerve ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neck Dissection ; Neck* ; Neoplasm Metastasis* ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: The ability to accurately predict the likelihood of achieving breast conservation surgery (BCS) after neoadjuvant chemotherapy (NCT) is important in deciding whether NCT or surgery should be the first-line treatment in patients with operable breast cancers. MATERIALS AND METHODS: We reviewed the data of 513 women, who had stage II or III breast cancer and received NCT and surgery from a single institution. The ability of various clinicopathologic factors to predict the achievement of BCS and tumor size reduction to < or = 3 cm was assessed. Nomograms were built and validated in an independent cohort. RESULTS: BCS was performed in 50.1% of patients, with 42.2% of tumors reduced to < or = 3 cm after NCT. A multivariate logistic regression analysis showed that smaller initial tumor size, longer distance between the lesion and the nipple, absence of suspicious calcifications on mammography, and a single tumor were associated with BCS rather than mastectomy (p < 0.05). Negative estrogen receptor, smaller initial tumor size, higher Ki-67 level, and absence of in situ component were associated with residual tumor size < or = 3 cm (p < 0.05). Two nomograms were developed using these factors. The areas under the receiver operating characteristic curves for nomograms predicting BCS and residual tumor < or = 3 cm were 0.800 and 0.777, respectively. The calibration plots showed good agreement between the predicted and actual probabilities. CONCLUSION: We have established a model with novel factors that predicts BCS and residual tumor size after NCT. This model can help in making treatment decisions for patients who are candidates for NCT.
Breast Neoplasms ; Breast* ; Calibration ; Cohort Studies ; Drug Therapy* ; Estrogens ; Female ; Humans ; Logistic Models ; Mammography ; Mastectomy ; Mastectomy, Segmental ; Neoadjuvant Therapy ; Neoplasm, Residual ; Nipples ; Nomograms* ; ROC Curve

PURPOSE: Patients with triple-negative breast cancer (TNBC) with pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) have superior survival outcomes compared to those with residual disease after NAC. This study investigated the value of three biomarkers, p53, Ki-67, and Bcl-2 for predicting pCR in NAC-treated patients with TNBC. METHODS: Between 2003 and 2012, 198 patients with pathologically confirmed primary TNBC were treated with two different taxane-based chemotherapeutic regimens prior to surgery. Before NAC, expression of p53 (cutoff 25%), Ki-67 (cutoff 10%), and Bcl-2 (cutoff 10%) was assessed immunohistochemically in core biopsy specimens. The incidence of pCR was correlated with the expression of these biomarkers. RESULTS: Overall, pCR occurred in 37 of the 198 patients (18.7%). A significant association was observed between the pCR rate and overexpression of the p53 and Ki-67 biomarkers. Multivariate analysis showed that only p53 expression was independently associated with pCR to NAC (odds ratio, 3.961; p=0.003). The sensitivity, specificity, positive predictive value, and negative predictive value of p53 expression for predicting pCR were 77.8%, 50.3%, 26.2%, and 90.9%, respectively. The pCR rate was the lowest (5.2%) in patients with low expression of both p53 and Ki-67, and it was the highest (25.8%) when both biomarkers showed high expression. CONCLUSION: Expression of p53 was significantly associated with pCR after NAC in patients with TNBC, suggesting that this biomarker might be particularly valuable in identifying TNBC patients prone to have residual disease after NAC.
Biomarkers ; Biopsy ; Drug Therapy* ; Humans ; Incidence ; Multivariate Analysis ; Neoadjuvant Therapy ; Polymerase Chain Reaction ; Sensitivity and Specificity ; Triple Negative Breast Neoplasms* ; Tumor Suppressor Protein p53