What is the future of thyroid surgery in the new millennium? How can surgeons keep abreast of advances in thyroid endocrinology, genetics, surgical therapy, and other aspects of thyroid disease management? How should surgeons be trained to become highly competent in thyroid disease and to perform safe, effective thyroid operative procedures? Nine internationally recognized endocrine surgeons were asked to express their views on these and related subjects. They noted that advances in molecular biology, pathology, and genetics of thyroid disease should allow more tailored surgical approaches during the twenty-first century. Current training of general surgical residents in thyroid and other types of endocrine surgery is highly variable, which may contribute to increased complication rates and number of second operations. The leadership for addressing these deficiencies and promoting a more organized approach to thyroid disease management should come from national endocrine surgery associations and their leaders. It is incumbent upon endocrine surgeons to maintain their central role in the management of many aspects of thyroid disease. Organizing teams of specialists into thyroid centers (centers of excellence) can (1) increase efficiency; (2) increase quality of care; (3) decrease costs; (4) encourage a more individualized approach to surgery; (5) lower complication rates; and (6) foster innovation in technology and disease management. Two years of additional fellowship training in thyroid and endocrine surgery is now being advocated by increasing numbers of national endocrine surgical associations as the best way to prepare surgeons for society's needs for highly skilled, competent thyroid surgeons of the future.

Our aim was to describe the patterns of disease recurrence and residual disease in patients treated for cervical carcinoma and to evaluate imaging features, which can help to differentiate recurrence and/or residual disease from posttreatment change. In a retrospective observational study, magnetic resonance imaging (MRI) scans of 48 patients with recurrent or residual cervical carcinoma were reviewed by two radiologists. Sixteen patients had undergone primary surgical treatment and 32 were treated by chemoradiotherapy. Recurrence was confirmed by histology (28), clinical and radiologic progression (6), and by patient death (14) due to progressive disease. Magnetic resonance images were analyzed for the site of recurrent/residual disease, signal characteristics, and invasion of adjacent structures. There were 29 recurrences, while 19 patients had residual disease. Most of the recurrences (70.4%) occurred within the first year of the start of treatment. Recurrent disease was confined to the central axis of the cervix in six patients following chemoradiotherapy and to the vaginal cuff in three of these patients following surgery. The recurrent tumor was isointense to the adjacent muscles on T1-weighted sequence in 95.3% and hyperintense on T2-weighted in 88.9%. The cervix was involved in every case of residual disease and in 10 of 29 (34.5%) patients with recurrent disease. Recurrent disease was present in the vaginal cuff in 14 of 16 (87.5%) postsurgical patients. Parametrial invasion was present in 13 (81.3%) patients treated surgically and in 22 (68.8%) of those receiving chemoradiotherapy. Involvement of the uterosacral ligaments was seen in 8 (57.1%) surgical patients and 14 (43.8%) nonsurgical ones. Bladder invasion was seen in four (25.0%) patients treated surgically and three (9.4%) of those treated with chemoradiotherapy. Radiotherapy change within the marrow was seen in 13 (27.0%) patients in total, whereas bone metastases were present in 4 (8.3%) patients. Recurrent cervical carcinoma can present with varied imaging features. Knowledge of the patterns of recurrence can aid early detection and may determine further therapeutic options.

This case study presents an incidental noting of a lingual thyroid on thyroid scintigraphy that had implications in later breast surgery. This information changed patient management and mitigated risk during intubation for breast cancer surgery.