bluuebunny/crossref_metadata_2025 huggingface dataset:
Cervical Lymph Node P16 Status in Diagnosis of the Unknown Primary
Authors: Martin James R. , Dial Brian , Mehrotra Swati , Jaber James J.
Published: September 2014

Objectives:

(1) Evaluate the role of p16 status of cervical lymph node (LN) metastases in localizing carcinoma of unknown primary (CUP). (2) Compare the sensitivity, specificity, and accuracy of positron emission tomography PET scan for locating the primary site in the setting of p16 positive and p16 negative LN metastases.

Methods:

Retrospective review of 30 patients that were identified from archived tumor board lists from 2010 to 2013. All patients presented to a tertiary care center with squamous cell carcinoma metastases to cervical LN of unknown source despite initial clinical evaluation and computed tomography scan. Fine needle biopsy or excisional biopsy specimens were tested for the p16 biomarker. The accuracy of the PET scan was assessed by comparing the fludeoxyglucose‐avid predicted site against a standard panendoscopy with directed biopsies.

Results:

A primary was identified in 61% of cases presenting as CUP. All p16+ LN metastases were from an oropharyngeal primary or remained unknown. All primaries located outside the upper aerodigestive tract were p16–. The sensitivity and specificity of PET in patients with p16+ LN metastases were worse than in p16‐ metastases (71%, 33% vs 100%, 100%).

Conclusions:

LN p16 status can help localize CUP. In our series, the sensitivity and specificity of PET scan were much worse in p16+ LN metastases. PET scan may be of limited utility for localizing CUP with p16+ LN metastasis.
Variables for Repeated No‐Showing to Clinic Appointments
Authors: Miller Anya J. , Chae Esther , Ko Alvin B.
Published: September 2014

Objectives:

Determine the variables that contribute to non‐compliance with showing up to clinic appointments. Patients no‐showing to their appointments represent a significant burden to the health care system by decreasing access to care and lost potential revenue. Identifying patient factors correlated with missed appointments may help characterize why these appointments are missed and identify opportunities to help patients get the care they need.

Methods:

Retrospective chart review. Patients who did not show up to 3 or more clinic appointments in the otolaryngology department in the Henry Ford system in metro Detroit, Michigan, between July 1, 2011, and June 30, 2012, were analyzed. Controls were patients who had appointments on the same day with the same provider as the no‐show patients.

Results:

A total of 106 patients were identified who no‐showed to 3 or more clinic appointments. Younger age, black race, and lower income were found to be significant factors for patients not showing up to appointments on multiple variate model. On logistic regression, Medicaid insurance, closer distance from home to appointment, less bus transfers, and less time by bus travel were also found to be significant for no‐showing.

Conclusions:

Age, race, and income are significant contributors to patient noncompliance with clinic appointments. Paradoxically, proximity to the clinical appointment location is also a significant factor; we hypothesize this may be the result of relative income inequality in the metro Detroit population. Follow‐up studies include analyzing severity of patient complaints and weather as a factor of noncompliance.
Diagnostic Accuracy of Galectin‐3 for Well‐Differentiated Thyroid Cancer on Fine‐Needle Aspiration: A Meta‐analysis
Authors: Scheffler Patrick , Forest Veronique‐Isabelle , Rochon Louise , Tamilia Michael , Mlynarek Alex M. , Hier Michael P. , Payne Richard J.
Published: September 2014

Objectives:

(1) Examine and meta‐analyze the literature on galectin‐3 staining on fine‐needle aspiration (FNA) samples of thyroid nodules. (2) Summarize the diagnostic test accuracy of galectin‐3 staining on FNA for well‐differentiated thyroid cancer (WDTC).

Methods:

A systematic review of studies from 1990 to 2014 examining the diagnostic test properties of galectin‐3 on thyroid nodule samples obtained by FNA with regard to WDTC. Data were meta‐analyzed using DerSimonian‐Laird random effect models for data pooling. Studies were weighted by inverse variance, and between‐study variance was estimated using the Empirical Bayes method. Study heterogeneity and threshold effects were analyzed using the Cochrane Q and Spearman correlation coefficient, respectively.

Results:

Sixteen studies with 2076 cases were identified. The pooled sensitivity of galectin‐3 for WDTC was 89.4% [confidence interval (CI): 87.2‐91.4], and specificity was 91.9% (CI: 90.2‐93.4). The positive likelihood ratio was 10.05 (CI: 8.24‐12.26), and negative likelihood ratio was 0.12 (CI: 0.10‐0.15). The diagnostic odds ratio of a positive galectin‐3 stain on FNA was 71.3 (CI: 52.7‐96.5). The area under the curve for the summary receiver operating characteristics curve (SROC) was 95.3% (standard error: 0.5%).

Conclusions:

The current study shows galectin‐3 staining of preoperative thyroid nodule FNA samples to be a test with strong diagnostic accuracy for WDTC, as seen by its favorable sensitivity, specificity, diagnostic odds ratio, and SROC curve. This supports its role as a useful adjunct in the preoperative workup of thyroid nodules.
Does Immediate Cytology Improve the Adequacy of Ultrasound‐Guided FNAC?
Authors: Sharma Sunil D. , Kumar Gaurav , Horsburgh Avril , Alkilani Raed , Chawda Sanjiv , Kaddour Hesham
Published: September 2014

Objectives:

Assess whether a dedicated “one stop” neck lump clinic has helped to improve the percentage of adequate fine‐needle aspiration cytology (FNAC) samples and reduce the need for repeat FNAC.

Methods:

Retrospective review of patients attending for ultrasound‐guided FNAC over a 6‐month period from August 2012 to February 2013. Patients were placed within 2 groups (Group 1: FNAC performed by any of the subspecialist radiologists with cytology support (n = 100) and Group 2: FNAC performed by general radiologists without cytology support (n = 112)). In order to test for intra‐observer agreement, 2 further groups were added (Group 3: FNAC performed by particular subspecialist radiologist with cytology support (n = 61) and Group 4: FNAC performed by the same subspecialist radiologist without cytology support (n = 125).

Results:

Seventy‐four percent of neck lumps originated from the thyroid, 13% from the salivary glands, and 4% from lymph nodes. Adequacy rates of FNAC in Group 1 were 87% as compared with 56% in Group 2. Adequacy rates of FNAC in Group 3 were 90% as compared with 78% in Group 4. Thus, the presence of immediate cytology and a subspecialist radiologist increased FNAC adequacy by 31%. The presence of cytology support increased adequacy by 12% and presence of a subspecialist radiologist increased adequacy by 22%.

Conclusions:

Immediate cytology and the presence of a subspecialist radiologist increase the adequacy of FNAC. The adequacy rate of noncytology supported FNAC or nonsubspecialist FNAC is below the adequate rate expected from the literature or as recommended in national guidelines.
Facial Nerve Monitoring during Parotidectomy: A Systematic Review and Meta‐analysis
Authors: Sood Amit J. , Houlton Jeffrey J. , Nguyen Shaun A. , Gillespie M. Boyd
Published: September 2014

Objectives:

Determine the effectiveness of intraoperative facial nerve monitoring (FNM) in preventing immediate and permanent postoperative facial nerve weakness in patients undergoing primary parotidectomy.

Methods:

Systematic review and meta‐analysis. A comprehensive literature search was conducted using the PubMed‐NCBI database from 1970 to 2014. Acceptable studies included controlled series that evaluated facial nerve function following primary parotidectomy with or without FNM (intraoperative nerve monitor vs. control). Primary and secondary endpoints were defined as immediate postoperative and permanent facial nerve weakness (≥2 House‐Brackmann score), respectively.

Results:

A total of 1414 articles were reviewed, resulting in 8 articles that met inclusion criteria. In total, 626 patients were included in the final meta‐analysis. The incidence of immediate postoperative weakness following parotidectomy was significantly lower in the FNM group compared with the unmonitored group (22.4% vs 35.0%, P =. 001). The incidence of permanent weakness was also lower, but this difference was not statistically significant (4.2% vs 7.6%, P =. 10). The number of monitored cases needed to prevent 1 incidence of immediate postoperative facial nerve weakness was 8 given an absolute risk reduction of 12.6%. This corresponded to a 49% decrease in the incidence of immediate facial nerve dysfunction (odds ratio, 0.51; 95% confidence interval, 0.34 to 0.76, P =. 001).

Conclusions:

In primary cases of parotidectomy, intraoperative facial nerve monitoring decreases the risk of immediate postoperative facial nerve weakness, but does not appear to influence the final outcome of permanent facial nerve weakness.
Fluorescence Imaging of Head and Neck Squamous Cell Carcinoma
Authors: Hauff Samantha J. , Raju Sharat C. , Orosco Ryan K. , Nashi Nadia , Savariar Elamprakash N. , Tsien Roger Y. , Nguyen Quyen T.
Published: September 2014

Objectives:

(1) Demonstrate that head and neck squamous cell carcinoma (HNSCC) can be fluorescently imaged using a matrix metalloproteinase (MMP)‐cleavable, ratiometric activatable cell‐penetrating peptide (RACPP). (2) Correlate extent of tumor involvement with fluorescent signal.

Methods:

Increased expression of MMP‐2 and MMP‐9 has been well documented in multiple cancers. We developed an injectable probe (RACPP) that exhibits ratiometric fluorescence (increased Cy5:Cy7 ratio) when cleaved by these proteinases. To examine the utility of MMP2,9‐cleavable RACPPs in HNSCC, mice were injected with 5 human HNSCC cell lines to establish orthotopic tongue xenografts (n = 22). Tumor‐bearing mice were imaged in‐vivo after intravenous RACPP injection. Fluorescent signal was correlated with histology by a blinded pathologist. Gelatinase zymography confirmed MMP‐2,9 activity in these xenografts. For ex‐vivo analysis of human HNSCC specimens, RACPP was applied to homogenized samples (n = 5), and fluorescence was measured on a microplate reader.

Results:

Orthotopic tongue HNSCC xenografts showed excellent ratiometric fluorescent labeling with MMP2,9‐cleavable RACPP (sensitivity = 95.4%, specificity = 95.0%). Signal intensity, as defined by ratiometric contrast, was greater in areas of higher tumor burden (P <. 03). Ex vivo human HNSCC specimens treated with MMP2,9‐cleavable RACPP also had increased signal intensity when compared to normal human fat (P =. 005).

Conclusions:

Fluorescent labeling with MMP2,9‐cleavable RACPP is an effective way to visualize HNSCC in‐vivo in a murine model, and signal intensity correlates with tumor burden. RACPPs have the potential to improve occult tumor identification and margin clearance in HNSCC. Ex‐vivo assays using biopsy specimens may help identify patients who will benefit from intraoperative RACPP use and may be useful in retrospective analyses.
Incidence of Postoperative Hypocalcemia following Total Thyroidectomy versus Completion Thyroidectomy
Authors: Merchavy Shlomo , Forest Veronique‐Isabelle , Marom Tal , Hier Michael P. , Mlynarek Alex M. , McHugh Tobial , Payne Richard J.
Published: September 2014

Objectives:

Study hypocalcemia incidence and trends over time following completion thyroidectomy (CT) versus total thyroidectomy (TT).

Methods:

A retrospective study comparing hypocalcemia and hypoparathyroidism incidence rates in all patients who underwent CT and in a random control group of TT at the McGill University Thyroid Cancer Centre, during the period of 2007 through 2012. Data were collected for demographic, clinical, and pathological characteristics.

Results:

There were 68 CT patients and 146 TT patients. Transient hypocalcemia occurred in 1 out of 68 (2%) and 18 out of 146 (12%) inpatients in the CT and TT groups, respectively. The rate of hypocalcemia was significantly lower in the CT group when compared with the TT group (P =. 02). In both groups, there were no cases of permanent hypocalcemia. In the CT group there were 12 (18%) patients with parathyroid gland or parathyroid tissue found in the surgical specimen, compared with 47 (32%) of patients in the TT group. There were no correlations between the postoperative hypocalcemia rates and the type of the thyroid disease or the numbers of parathyroid glands removed and found within the surgical specimen (P >. 05).

Conclusions:

In this study, the risk of transient hypocalcemia in patients undergoing CT was significantly lower than the rate of hypocalcemia in patients undergoing TT.
Intraoperative Tumor Imaging with Indocyanine Green in Head and Neck Cancer Patients
Authors: Chung Thomas K. , Kovar Joy , Bell Walter , Brandwein‐Gensler Margaret , Rosenthal Eben L.
Published: September 2014

Objectives:

(1) Describe the effectiveness of indocyanine green (ICG) as an imaging agent for head and neck tumors. (2) Illustrate the potential of near‐infrared imaging for intraoperative visualization of cancers.

Methods:

Patients underwent intravenous administration of 7.5mg ICG during the surgical procedure. The SPY/LUNA (Novadaq) near‐infrared intraoperative imaging system was used prior to resection and the Pearl (LICOR) and Odyssey (LICOR) systems for ex‐vivo tumor imaging. Tumor‐to‐background ratio (TBR) was defined as tumor fluorescence divided by normal tissue fluorescence. Histologic analysis was performed with a head and neck cancer board‐certified pathologist.

Results:

Five patients were enrolled into this study between August and September 2013. Three patients had pharyngeal cancer, one had laryngeal cancer, and one had cutaneous cancer. TBR values of confirmed cancer tissue varied among patients (LUNA TBR 3‐9, Pearl TBR 3‐18). However, in 2 patients, areas of highest fluorescence were found to be absent of carcinoma on histological analysis. The epidermal portions of the cutaneous SCC lesion were highly fluorescent, but the tumor did not penetrate this layer in multiple sections. Histologic analysis of these tissues confirmed significant areas of acute and chronic inflammation at areas of high fluorescence intensity. Skin, mucosal surfaces, and perivascular areas were most prone to false‐positive high fluorescence.

Conclusions:

While intravenous ICG does accumulate in head and neck tumors sufficiently to distinguish them from normal tissue, it is not specific enough to serve as a tumor visualization agent. Targeted fluorescent probes will likely be needed for image‐guided surgery.
Locoregional Radiotherapy Combined with Systemic Chemotherapy Improves Survival of NPC Patients with Distant Metastases
Authors: Chen Ming‐Yuan
Published: September 2014

Objectives:

Systemic chemotherapy is the basic palliative treatment for metastatic nasopharyngeal carcinoma (mNPC) at diagnosis; however, the impact of locoregional radiotherapy (lrRT) targeting the primary and regional lymph nodes on the survival of mNPC patients remains unknown and will be evaluated here retrospectively.

Methods:

A total of 408 mNPC patients were included in this study. The mortality risks were compared between the untreated patients and the patients who underwent chemotherapy and lrRT delivered alone or in combination. Univariate and multivariate analyses were conducted. The contributions of independent factors were adjusted by other covariates with significant prognostic association (P <. 05).

Results:

Both lrRT and systemic chemotherapy were found to be significant independent prognostic factors of overall survival (OS). The group receiving lrRT alone exhibited similar mortality risk compared to the group who underwent systemic chemotherapy alone (multiadjusted hazard ratio [HR], 0.9; P =. 529) and 60% reduction compared to the untreated group (HR, 0.4; P =. 004), but a 130% increase compared to those who received the combination treatment of systemic chemotherapy and lrRT (HR, 2.3; P <. 001). In the subgroup of combination treatment (n = 176), induction chemotherapy and high‐dose lrRT (≥66 Gy) showed a significant lower mortality risk compared with the noninduction chemotherapy (HR, 0.5; P =. 007) and low‐dose radiation (<66 Gy) (HR, 0.4; P =. 001).

Conclusions:

Locoregional radiotherapy, particularly combined with systemic chemotherapy, was correlated with the improved survival of mNPC patients.
Driving Revenue during Turbulent Times
Authors: Ellis Joel
Published: September 2014

The speakers’ intention is to explore the medical climate today as it pertains to practicing medicine as a private otolaryngologist: specifically, the challenges a provider faces today and potentially downstream. During turbulent times, medical professionals can often become fixated on what they do best and lose sight peripherally as to what is influencing the market and as a result what additional options may present themselves that would allow a practice to thrive despite the challenges. Areas of focus and learning will include: (1) The increasingly elusive target audience: (a) who makes the buying decision, (b) effects of the Internet and social media on buying decisions. (2) Methodologies to attract the right patient type: (a) practice differentiation—narrow and deep versus shallow and wide, (b) attracting a higher value patient type, (c) marketing as a system versus a series of random activities, (d) traditional media marketing and its applications today in medicine, (e) new media marketing and its applications today and going forward in medicine. (3) Overcoming today's challenge by driving a seven‐figure hearing component. The audience will have a clear introduction to medical practice marketing in today's “instant gratification” climate when pitted against declining reimbursements, a savvy consumer, and fear of acquisition.
Human Papillomavirus among Veterans Treated for Oropharyngeal Squamous Cell Carcinoma
Authors: Gleysteen John P. , Carroll Sarah R. , Sullivan C. B. , Maggiore Ronald J. , Barnes Lynne , Gross Neil D.
Published: September 2014

Objectives:

The prevalence and significance of high‐risk oral human papillomavirus (HPV) among veterans treated for oropharyngeal squamous cell carcinoma (OPSCC) remains unknown. In this study, we aimed to (1) define the prevalence of HPV among veterans with OPSCC and (2) compare outcomes of veterans with OPSCC relative to high‐risk HPV status and other well‐known prognostic factors.

Methods:

Patients from a high‐volume Veterans Administra‐tion (VA) medical center with OPSCC were identified from 2001‐2006. Demographic, surgical, and pathological data were extracted from the electronic medical record. P16 immunohistochemistry testing was performed on archived pathological samples as a surrogate marker for HPV status. Outcomes were compared between HPV‐positive (+) and negative (–) patients using Kaplan‐Meier estimates.

Results:

Seventy‐six veteran patients with available tumor tissue and follow‐up data were included. All of the patients were male (100%) and the vast majority were ever smokers (89%). Most patients presented with advanced stage disease (61, 80%) and were treated nonsurgically (64, 84%). The overall prevalence of p16 positivity was 52 out of 76 (68%). Overall survival at 2 and 5 years was 60% and 38%, respectively, for the entire cohort. HPV+ veteran patients had significantly better survival at 2 years (58% vs 33%) and 5 years (40% vs 17%) than HPV– veteran patients (P =. 014).

Conclusions:

Using p16 as a surrogate marker, HPV is prevalent among veteran patients treated for OPSCC. Veteran patients with HPV‐associated OPSCC have improved survival relative to HPV‐negative patients. However, their prognosis remains poor compared to a nonveteran population.
Human Papillomavirus–Associated Head and Neck Cancer in Hong Kong
Authors: Yau Kay Chung J. , Lam Eddy Wai Hung , Ngai Chi Man , Ma Kwong Hon
Published: September 2014

Objectives:

Human papillomaviruses (HPV) are a well‐documented cause of a subset of head and neck cancer. Studies have shown the prevalence of HPV infection is around 7% in the general US population. Yet data from an Asian population and analysis from different head and neck subsites are sparse. In this retrospective case control study, we systematically reviewed data from subjects diagnosed with squamous cell carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx in Chinese patients at Yan Chai Hospital.

Methods:

Surgical specimens or biopsies were prospectively sent for detection of HPV DNA by polymerase chain reaction and immunohistochemical staining for p16 and p53.

Results:

In the 110 specimens obtained, preliminary results showed the overall prevalence of HPV was 21%. HPV 16 accounted for the majority of HPV‐positive oropharyngeal squamous cell carcinoma (SCC; 85%) and laryngeal SCC (66%). Other oncogenic HPVs, apart from HPV16 and 18, were rarely detected in our series. In the multiple logistic regression analysis, HPV‐associated oropharyngeal and oral cavity patients showed better overall survival, but this was statistically insignificant for laryngeal and hypopharyngeal patients. HPV positive and negative patients showed no statistically significant difference in disease staging on presentation as well as treatment modalities.

Conclusions:

The prevalence of HPV associated head and neck cancer is much lower in Hong Kong Chinese. Our overall survival of HPV associated oropharyngeal and laryngeal cancer showed consistent favorable outcomes compared with those of other western countries.
Human Papillomavirus Infection and p53 Expression in Oral Squamous Cell Carcinoma
Authors: Ali Adnan M. , Awan Sohail M. , Pervez Shahid
Published: September 2014

Objectives:

Determine the human papillomavirus (HPV) infection and p53 protein expression in oral squamous cell carcinoma (OSCC) and their correlation with patient overall survival (OS) and disease‐free survival (DFS).

Methods:

HPV general and type specific 16 and 18 were investigated by means of PCR. P53 protein overexpression was investigated by means of immunohistochemistry. Results of HPV association and p53 overexpression were evaluated in relation to different clinicopathological parameters and survival.

Results:

Out of 140 patient samples HPV was detected in 95 (68%) cases, out of which 85 (90%) were associated with HPV16, 2 (2%) were associated with HPV 18, 2 (2%) were co‐infected (with HPV 16 and 18), and 6 (6%) were positive for HPV by the general primer and could not be type specified. HPV positive patients had comparatively prolonged OS when compared with HPV‐negative patients, but this difference was not statistically significant (P =. 97). Furthermore, overexpression of p53 protein was observed in 75 patients (54%) using a threshold of 10% stained tumor nuclei. Patients with p53 negative tumors had improved OS when compared with patients with p53 positive tumors. This difference was statistically significant (P =. 036) in univariate Cox regression analysis; however, it lost its worth in the multivariate analysis.

Conclusions:

Our study found a high prevalence of HPV (type 16) in OSCC of Pakistani patients with male sex showing significant correlation with HPV. However, we did not find a statistically significant favorable association between p53 overexpression, HPV, survival, and histologic variables.
Improving Oral Tongue Cancer Pathology Margins through Surgical Technique
Authors: Argo Jimmy L. , Pierson Brandon , Gillies Elizabeth M. , Anderson Michael , Vasan Nilesh R.
Published: September 2014

Objectives:

Compare pathology margins of oral tongue cancer patients undergoing partial glossectomy between a novel surgical technique and conventional surgical resection. Describe the horizontal mattress surgical technique for partial glossectomy.

Methods:

Patients with oral tongue cancer underwent partial glossectomy using a new surgical technique by the senior author from February 2011 to July 2013 at a tertiary care medical center. A retrospective comparison cohort was selected from prior patients of the department with age, sex, and tumor stage matching. Anterior, posterior, and medial pathology margins were compared between the groups. Mean values were compared with the Student t test for normally distributed variables, and median values were compared with the Wilcoxon‐Mann‐Whitney test for variables which were not normally distributed. The horizontal mattress technique for partial glossectomy is described.

Results:

Ten patients underwent partial glossectomy with the new technique. The mean medial pathology margin was significantly greater in the novel technique group (1.40 cm, 0.88 cm, P <. 05; novel technique, conventional technique, P value). There were no significant differences in the median anterior margin (1.10 cm, 1.25 cm, P =. 79), mean posterior margin (1.47 cm, 1.13 cm, P =. 15), mean tumor size (1.91 cm, 1.71 cm, P =. 67), or tumor depth of invasion (0.65 cm, 0.80 cm, P =. 73).

Conclusions:

The new surgical technique using horizontal mattress sutures for dissection guidance and specimen orientation yielded significantly larger medial pathology margins compared to the traditional method. This study is limited by the retrospective nature of the comparison group. A prospective trial should be undertaken to confirm these results.
Oncologic Outcomes of Robotic Thyroidectomy: 5 Years’ Experience
Authors: Tae Kyung , Ji Yong Bae , Song Chang Myeon , Lee Seung Hwan , Park Chul Won
Published: September 2014

Objectives:

The feasibility and early surgical outcomes of robotic thyroidectomy have been reported. However, its oncologic outcomes are not well established. The aim of this study is to evaluate oncologic outcomes of robotic thyroidectomy compared with conventional thyroidectomy in differentiated thyroid carcinoma (DTC).

Methods:

We analyzed 925 DTC patients who underwent robotic thyroidectomy (204 cases) using a gasless unilateral axillo‐breast or axillary approach, or conventional open thyroidectomy (721 cases) with or without central neck dissection (CND) from October 2008 to December 2013. We excluded patients who underwent simultaneous lateral neck dissection or completion thyroidectomy and cases with recurrent cancer, other types of malignancy, or distant metastasis.

Results:

The male ratio and the mean age were significantly lower in the robotic group (P <. 001). The mean tumor size, minimal extrathyroidal extension, and stage did not differ between the 2 groups. The rate of total thyroidectomy was higher in the open group (P <. 001). The rate of CND and the mean number of lymph nodes removed in the central compartment was not different between the 2 groups. Operative time was significantly longer in the robotic group (P <. 001). Postoperative complications did not differ between the 2 groups, except transient hypoparathyroidism. Recurrence rate did not differ between the 2 groups after a mean follow‐up of 33 months (0 % vs 0.4% in the robotic vs open groups, P = 1.0).

Conclusions:

The oncologic outcome of robotic thyroidectomy in 5 years’ experience is comparable with conventional thyroidectomy in selected patients with DTC.
Optimal Interventions for Depression after Diagnosis of Head and Neck Cancer: A Systematic Review
Authors: Barber Brittany , Zhang Han , Mitchell Nicholas , O'Connell Daniel A. , Harris Jeffrey R. , Seikaly Hadi
Published: September 2014

Objectives:

Depression in head and neck cancer (HNC) patients is undertreated and under‐recognized, yet has been shown to be present in up to 40% of patients. The objective in this study was to perform a systematic review of the literature regarding the optimal psychologic intervention for HNC patients with depressive symptomatology.

Methods:

A systematic review. PubMed, Medline, and ENCASE were searched in December 2013 for studies examining psychologic interventions in head and neck cancer patients. Results were screened by 2 independent reviewers. The level of evidence for each study and intervention were evaluated using criteria put forth by the Agency for Healthcare Research and Quality US Preventative Services Task Force. Subsequent analysis was then planned according to the criteria in the Cochrane Handbook for Systematic Reviews.

Results:

Eleven studies met inclusion criteria. Three studies were rated “good” for internal validity and 6 for external validity. Psychologic education and cognitive behavior therapy were evaluated by 8 studies, and antidepressant use was examined by 2 studies. Support group therapy was examined by 1 study. Meta‐analysis was precluded by significant heterogeneity. Strongest evidence for successful treatment of depression was demonstrated by psycho‐education.

Conclusions:

Evidence for the optimal psychologic intervention for depression in HNC patients is limited by the small number of studies examining treatment types, lack of high level of evidence in research methodology, and poor comparability of studies. Future studies should target a standardized assessment and diagnosis as well as evaluation of treatment type.
Outcomes and Complications of Locally Advanced Sinonasal Malignancies Treated with Open and Endoscopic Resections
Authors: Trosman Samuel J. , Momin Suhael , Al‐Khudari Samer , Sindwani Raj , Adelstein David J. , Koyfman Shlomo A. , Burkey Brian B.
Published: September 2014

Objectives:

(1) Compare outcomes of patients with sinonasal malignancies (SNM) treated with an open resection to patients treated with an exclusively endoscopic or endoscopic‐assisted approach. (2) Analyze the differences in surgical complications, length of hospital stay, and margin status between open and endoscopic approaches.

Methods:

A retrospective review was performed on 102 patients with a pathologically diagnosed T3 or T4 SNM treated definitively at a tertiary care academic center from 1995 to 2012. Oncologic outcomes were determined.

Results:

Of the 102 patients, 29 presented with T3 disease while 73 presented with T4 disease. The most common histologic subtype was squamous cell carcinoma (56.9%). Fifty‐three patients (52.0%) underwent open resection while 26 (25.5%) underwent an endoscopic or endoscopic‐assisted resection. The 5‐ and 10‐year disease‐specific survival (DSS) for the 2 surgically treated groups was 67.6% and 65.2%, respectively. There was no significant difference between patients treated with open resection and patients treated with endoscopic resection in overall survival (P =. 98) or DSS (P =. 15). There was no significant difference between the groups with regard to length of stay (median for both = 5 days, P =. 39) or margin status (P =. 42). The endoscopic surgery group had significantly more cerebrospinal fluid (CSF) leaks than the open surgery group (42% vs 6%, P <. 001).

Conclusions:

Endoscopic and endoscopic‐assisted resection of locally advanced SNM in the appropriately selected patient results in similar long‐term oncologic control as open resection. There may be a higher rate of CSF leaks during endoscopic resections that contributes to hospital stays similar to those after open resections.
Gradual Approach to Refinement of the Nasal Tip: Surgical Results
Authors: Carvalho Thiago B. , Thomazi Emerson , Leutz Rafael P. , Souza Rafael P. S. F. , Molina Fernando D. , Piatto Vania B. , Maniglia Jose V.
Published: September 2014

Objectives:

The complexity of the nasal tip structure and the impact of surgical holder maneuvers makes prediction of the final outcome very difficult. Therefore, no technique alone is enough to correct the numerous anatomic presentations adequately being the preoperative planning, the basis of rhinoplasty. This study's aim is to present results of rhinoplasty, by gradual surgical approach to nasal tip definition based on anatomic features, and evaluate the degree of satisfaction of patients after the surgical procedure.

Methods:

A retrospective historical cohort study of the medical charts of 533 patients of both sexes who underwent rhinoplasty from January 2005 to January 2012. Cases were allocated into 7 groups: (1) no surgery on nasal tip, (2) interdomal breakup, (3) cephalic trim, (4) domal suture, (5) shield‐shaped graft, (6) vertical dome division, and (7) replacement of lower lateral cartilages.

Results:

Group 4 was the most prevalent. The satisfaction rate was 96%, and revision surgery occurred in 4% of cases.

Conclusions:

The protocol used allowed the association of the gradual surgical approach to nasal tip definition with the nasal anatomic characteristics, high rate of satisfaction with the surgical outcome, and low rate of revision.
Pedicled Parathyroid Autotransposition in Surgical Management of Secondary Hyperparathyroidism
Authors: Shokri Tom , Sadeghi Nader
Published: September 2014

Objectives:

In this study, we report a new, less invasive surgical technique in managing preserved parathyroid tissue in patients with secondary hyperparathyroidism who undergo bilateral parathyroid exploration and excision of all 4 parathyroid glands. We report this technique in 4 patients and evaluate their postoperative parathyroid hormone (PTH) levels as a marker to evaluate efficacy.

Methods:

All 4 glands were first exposed. Superior glands are not possible to transpose and were excised while the inferior glands were mobilized on their pedicles. Once identified, the inferior glands were kept intact until it was determined which gland can be best preserved on its vascular pedicle with adequate length for transposition. This gland was then mobilized through an incision made in the strap muscles, placing it superficial and ventral to the muscles. The majority of the hyperplastic gland was then resected distal to its vascular pedicle. The portion of the gland that was preserved was secured over the strap muscle, making it easily accessible for future exploration and debulking if needed and avoiding a second operative site in the forearm.

Results:

Rapid intraoperative PTH assay confirmed adequate removal of hypersecreting parathyroids and was indicative of a curative outcome. All patients exhibited a greater than 90% initial reduction in the PTH level from their baseline and a sustained decrease in postoperative PTH levels well below their preoperative baselines at one month. The percentage mean reduction in PTH at longest follow‐up was 94.57%. Importantly, none of the patients exhibited postoperative PTH levels indicative of hypoparathyroidism.

Conclusions:

None provided.
Poor Functional Performance following Bidirectional Dilatation of Severe Postradiation Esophageal Stricture
Authors: Gavriel Haim , Chowdhury Aqiq T. , Duong Cuong , Spillane John , Sizeland Andrew
Published: September 2014

Objectives:

Assess the efficacy of bidirectional esophageal dilatation in the severely strictured esophagus induced by radiation therapy following the treatment of head and neck malignancies.

Methods:

Retrospective analysis of 5 patients who underwent bidirectional esophageal dilatation for esophageal stricture secondary to radiation therapy for head and neck malignancies over a 5‐year period. The parameters of the primary tumor, evaluation of preoperative and postoperative esophageal dysfunction, and complications of the procedure were evaluated to assess its efficacy.

Results:

There were 9 episodes of bidirectional dilatation among 5 patients, 3 males and 2 females with a mean age of 63 years. Complete obstruction was demonstrated in 4 patients and severe obstruction was found in one patient during preoperative evaluation. The procedure was uneventful in all but 1 who was found to have postoperative mediastinitis due to microperforations, and healed completely. Four patients had persistent dysphagic symptoms despite post‐dilatation video fluoroscopy failing to reveal any significant narrowing of the esophageal lumen.

Conclusions:

Combined anterograde and retrograde dilatation of severe chemoradiation‐induced esophageal strictures is efficacious in improving luminal patency but ineffective in relieving functional dysphagia.
Predictors of Nondiagnostic Cytology in Surgeon‐Performed Fine‐Needle Aspiration Biopsy of Thyroid Nodules
Authors: Isaac Andre , Jeffery Caroline C. , Al‐Marzouki Hani , Harris Jeffrey R. , Seikaly Hadi , O'Connell Daniel A.
Published: September 2014

Objectives:

(1) List the factors that are predictive of non‐diagnostic cytology in surgeon‐performed ultrasound‐guided fine‐needle aspiration (FNA) of thyroid nodules. (2) Describe a patient cohort that may benefit from early referral to other clinicians.

Methods:

Retrospective chart review. Patients included all adults who underwent thyroid nodule FNA by a staff, fellow, or resident otolaryngologist at our center between January 2011 and June 2013. Cytology was interpreted by a staff cytopathologist according to the Bethesda classification system. The predictive factors analyzed were patient age, sex, body mass index (BMI), thyroid gland size, thyroid function, presence of multinodular goiter, presence of Graves’ disease or thyroiditis, nodule size, location, vascularity, echogenicity, calcifications, cystic component, level of performer training, and level of FNA experience. Results were analyzed using chi‐squared, Fisher exact test, or unpaired t test.

Results:

A total of 190 patients were reviewed, for a total of 301 nodules. The average age was 53 years, with an 88% female predominance. The overall nondiagnostic rate was 23%. Nodules with a predominant cystic component and those less than 1 cm were more likely to yield nondiagnostic cytology (P =. 04, P =. 05, respectively). FNA performed by a trainee with experience of less than 50 FNA were also more likely to yield nondiagnostic cytology (P =. 04). No other factors significantly influenced the nondiagnostic rate.

Conclusions:

Cystic nodules and nodules less than 1 cm are more likely to yield non‐diagnostic cytology in surgeon‐performed thyroid FNA. Caution should be used in trainee‐performed FNA for which the nondiagnostic risk is high. These patients may benefit from early referral to other clinicians.
Primary Placement of a 16 French Voice Prosthesis at the Time of Tracheoesophageal Voice Restoration
Authors: Naunheim Matthew R. , Remenschneider Aaron K. , Bunting Glenn W. , Deschler Daniel G.
Published: September 2014

Objectives:

Tracheoesophageal voice restoration (TEVR) has traditionally been described with fistula tract creation, catheter placement, and secondary prosthesis placement. Successful primary prosthesis placement at the time of primary or secondary puncture using a 20 French prosthesis has been previously described. We now wish to evaluate whether 16 French prostheses can be used safely and effectively.

Methods:

All cases of primary 16 French tracheoesophageal voice prosthesis (TEVP) placements at a large academic medical center were retrospectively reviewed from January 2011 through December 2013. Perioperative complications attributable to device placement were recorded. These included inability to place prosthesis during procedure, intraoperative issues with primary placement, postoperative infection, prosthesis dislodgement, leakage around/through the prosthesis, or inability to obtain voice.

Results:

Twenty‐two patients received primary placement of a 16 French TEVP. All prostheses were successfully placed, and there were no intraoperative complications. Approximately 18% of patients had a postoperative complication, including leakage through the prosthesis (3 of 22) and prosthesis displacement (1 of 22). These were addressed with prosthesis change and replacement, respectively.

Conclusions:

Placement of 16 French TEVPs is effective and safe, with a low rate of complication directly attributable to the prosthesis itself. Therefore, a smaller prosthesis may be primarily placed at the time of TEVR and is preferred over the previously described 20 French prosthesis.
Prognostic Factors Associated with Survival in Recurrent Oral Cavity Squamous Cell Carcinoma
Authors: Ali Syed A. , Schuller David E. , Ozer Enver , Carrau Ricardo L. , Agrawal Amit , Teknos Theodoros N. , Old Matthew O.
Published: September 2014

Objectives:

(1) Analyze the prognostic factors implicated in survival of patients with recurrent oral cavity squamous cell carcinoma (SCC). (2) Highlight the poor salvage and overall survival rates in this patient population.

Methods:

Between 1997 and 2006, 235 patients with oral cavity SCC were identified, of which 85 experienced recurrences. Overall survival and prognostic factors were analyzed, including epidemiologic, tumor‐specific factors, and surgical outcomes.

Results:

Eighty‐five of 235 patients experienced recurrence of their primary oral cavity SCC. Only 8 (9.4%) patients have survived, with follow‐up ranging from 8 to 14 years. Six of the surviving patients had tongue primaries, while the other 2 had buccal mucosa and hard palate primaries. All 8 surviving patients were staged T1 (1) or T2 (7) and were N0 (6), N1 (1), or N2b (1). Among deceased patients, 9 (11.7%) were staged T3 and 16 (20.1%) T4. Tumor volume (cm3) also varied greatly between surviving (3.97) and deceased (22.14) patients.

Conclusions:

Salvage surgery in oral cavity patients remains a difficult clinical problem and our long‐term analysis of these patients reveals that most do not survive. Those who survive have lower initial tumor stage, less nodal disease, and smaller tumor volume than the deceased patient group. This data highlights the poor prognosis of these patients and the dire need of different strategies to improve outcomes.
Immediate Endosseous Dental Implant Placement in Osteocutaneous Radial Forearm Free Flap
Authors: Moneta Lauren B. , Peck Jessica J. , Eftekhari Siavash , Petrisor Daniel , Wax Mark K.
Published: September 2014

Objectives:

(1) Analyze the advantages and disadvantages of immediate endosseous dental reconstruction using osteocutaneous radial forearm free flap (OCRFFF). (2) Describe the “double barrel” technique for dental reconstruction following OCRFFF.

Methods:

A 61‐year‐old man with previous hard palate squamous cell carcinoma (SCC) and fibula flap reconstruction complicated by osteoradionecrosis then underwent OCRFFF for secondary reconstruction of the maxilla using the “double barrel” technique. The Straumann system was used to immediately place 3 endosseus implants in the radial bone graft and one in the previously bone‐grafted site. The purpose of this case report is to evaluate the methodology and outcome of immediate dental reconstruction with endosseous implants into an OCRFFF, which is traditionally thought to be an unsuitable graft for dental implants because of inadequate bone thickness. Outcome measures include hardware stability, aesthetics, and function. Aesthetics and function were subjectively measured through patient and surgeon satisfaction. Additionally, hardware stability was measured through follow‐up imaging studies and functionality.

Results:

Both patients and physicians concluded positive functional and aesthetic outcomes using this reconstruction technique.

Conclusions:

Use of a double‐barrel technique harvest of an OCRFFF provides adequate bone for immediate endosseus dental implants with improved aesthetic and functional outcomes over other reconstructive techniques.
Prognostic Implications of Intraoperative Radiography of Thyroidectomy Specimens
Authors: Frank Robert , Fitzgerald Ryan , Bodenner Donald L. , Stack Brendan C.
Published: September 2014

Objectives:

(1) Analyze radiographic findings of thyroidectomy specimens. (2) Correlate intraoperative radiography to preoperative ultrasound and its guided fine‐needle aspiration biopsy, intraoperative impression, and final pathology. (3) Describe a new intraoperative tool to help identify malignant characteristics of thyroid tissue.

Methods:

Prospective study comprised of consecutive patients undergoing hemi‐ or total thyroidectomy in a tertiary referral center. This is an ongoing study of patients treated from the months of November 2013 to June 2014. After obtaining ultrasound‐guided fine needle aspiration biopsies that were indeterminate or confirmed malignancy, all patients received either a hemi‐ or total thyroidectomy. Prior to pathologic processing, the specimens were passed off the field and underwent intraoperative specimen radiography (IOSR) by the Faxitron Biovision (Tucson, Arizona), generating a plain radiograph. Radiographic characteristics were analyzed by a surgeon and radiologist and correlated with final pathologic diagnosis. Sensitivity, specificity, positive and negative predictive value, and accuracy of IOSR with regard to final pathology will be reported.

Results:

Adequacy of resection of tumors and the presence of microcalcifications are features assessed by IOSR which, when compared with a pathology gold standard, may allow for a intraoperative decision regarding surgery. This technology may reliably detect multifocal microcarcinomas, another indication for total thyroidectomy. This approach may reduce the number of diagnostic hemi‐thyroidectomies that require a later completion thyroidectomy.

Conclusions:

Intraoperative plain film radiography may be an effective tool in the risk stratification of thyroid specimens and could be used as an adjunctive measure to reduce the need of delayed completion thyroidectomy, depending upon permanent pathology.
Surgical Technique for Preservation of Inferior Parathyroid Gland
Authors: Park Young Min , Shin Sung Chan , Lee Won Yong , Lee Jin‐Choon , Wang Soo‐Geun , Lee Byung‐Joo
Published: September 2014

Objectives:

The inferior parathyroid glands receive blood supply from the inferior thyroid artery. The anatomic relationship of the inferior thyroid artery and recurrent laryngeal nerve (RLN) can be described in 3 different patterns. We reconsidered the anatomic relationship of these structures and mentioned the method to maintain vascular supply of inferior parathyroid gland during central neck dissection (CND) according to their anatomical relationship.

Methods:

For removal of fibrofatty tissue in central neck compartment, dissection proceeds along RLN. During the process, surgeons should be careful not to injure the inferior parathyroid gland.

Results:

To preserve the inferior parathyroid gland, dissection should proceed along RLN in the medial side of inferior parathyroid gland, if inferior parathyroid gland usually receives blood supply from posterolateral vascular pedicle. In cases in which inferior thyroid artery travels deep to right RLN and right parathyroid gland receives blood supply from posteromedial vascular pedicle, CND should be carefully performed along the lateral side of inferior parathyroid gland to preserve posteromedial vascular pedicle.

Conclusions:

To preserve the function of inferior parathyroid gland, the anatomical relationship between inferior thyroid artery and RLN should be understood. The direction of dissection along the RLN should be changed according to their anatomical pattern.