bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Thyroid Molecular Testing with Surgeon Performed FNAC and Immediate On‐Site Cytopathological Interpretation
Authors: Sukumor Ray , Witt Robert L. , Gerges Fady 
Published: September 2014

Objectives:(1) Describe how thyroid molecular testing affects surgeon‐performed ultrasound‐guided fine‐needle aspiration (FNA) with immediate on‐site cytopathological interpretation. (2) Analyze percentage of inadequate FNA cytology (FNAC) and number of aspirations, comparing with and without surgeon‐performed ultrasound guidance.Methods:Retrospective cohort comparison. A cytopathologist is present for on‐site staining (Diff‐Quik) adequacy evaluation and molecular testing triage. This is followed by pap stain, cell block, and liquid‐based cytology. Cytological adequacy and number of aspirations for 200 consecutive patients undergoing surgeon‐performed ultrasound‐guided FNA are compared with a series from the same surgeon without ultrasound guidance. A questionnaire subjectively scoring anticipated and actual pain from 1 through 10 (10 severe) was recorded immediately before and after FNAC.Results:Patients with an inadequate FNAC, with and without ultrasound guidance, were 0% and 3% (P >. 05). The mean number of aspirations with and without ultrasound guidance were 1.7 and 4.0 (P <. 05). Using ultrasound guidance, benign, indeterminate, and malignant FNA results were 173 out of 200 (87%), 18 out of 200 (9%), and 9 out of 200 (4%). All indeterminate cytology (9%) underwent BRAF testing. Six out of 200 (3%) indeterminate FNAC underwent multigene expression testing. The mean anticipated versus actual discomfort experienced with surgeon‐performed ultrasound‐guided FNA was 5.3 and 1.9 (P <. 05).Conclusions:Surgeon‐performed ultrasound‐guided FNAC with on‐site cytopathology can largely eliminate inadequate FNA, potentially reducing the number of aspirations. Indeterminate FNAC can be triaged for molecular testing, performed in 9% of patients, potentially improving patient selection for surgery. The cytological interpretation can often be immediately communicated to the patient. Discomfort experienced is minimal.
Interest of the Parathyroid Hormone Assay: An Early Predictor of Post‐thyroidectomy Hypocalcemia
Authors: La Croix Candice , Potard Gael , Valette Gerald , Marianowski Remi 
Published: September 2014

Objectives:Hypocalcemia linked to a diminished circulating intact parathormone (iPTH) is the most common complication after total thyroidectomy. The outcome of our single‐center prospective study is to determine the interest of iPTH as a predictor of post‐thyroidectomy hypocalcemia.Methods:One hundred eight patients who underwent total thyroidectomy were included. Blood samples (iPTH, calcium, and albumin) were performed at different times: preoperatively (H0), after removal of the gland (Hdrop), 6 hours (H6) after surgery, and one day (D1) after surgery. A measurement of calcium and albumin was performed on the second postoperative day (D2). The area under the receiver‐operating characteristic (ROC) curve (AUC) was used to determine the best cutoff value and predictability of iPTH for hypocalcemia in terms of absolute value (ng/L), decrease in the slope (ng/L), and decline (%) between 2 times.Results:Seven patients were excluded. Of the remaining 101 patients, 39 had hypocalcemia (38.6%). At H6, an iPTH absolute value less than 14.35 ng/L (Se = 0.706; Sp = 0.917) and a decline from the preoperative time of more than 59.5% (Se = 0.850; Sp = 0.820) were predictive of hypocalcemia. Other absolute values, decrease in the slope, and decline between preoperative and postoperative values are less efficient.Conclusions:The iPTH 6 hours after total thyroidectomy is predictive of hypocalcemia. It could be used to identify patients not at risk of hypocalcemia, and earlier discharge could be considered.
Intraoperative Detection of Parathyroid Glands: A Systematic Review and Novel Low‐Tech Alternative
Authors: Sebelik Merry E. , Allen Shawn M. 
Published: September 2014

Objectives:(1) Perform systematic review of the literature discussing methods of intraoperative detection of parathyroid glands. (2) Determine the feasibility of a low‐cost visual identification method using cell phone camera and photographic color analysis.Methods:A systematic review of the literature was undertaken to characterize experimental and existing techniques for real‐time, intraoperative detection of parathyroid glands, a quest meant to reduce the incidence of post‐thyroidectomy hypoparathyroidism. As an alternative to published techniques, photographs were taken during thyroid and other central neck surgery, using a variety of cell phone‐based cameras, under variable lighting conditions. An app used for red‐green‐blue (RGB) color analysis was employed to stratify known parathyroid tissue and surrounding fat and thyroid gland by RGB content.Results:The majority of published techniques were dependent on specialized, high‐tech, and high‐cost imaging equipment such as optical coherence tomography, or patient exposure to chemicals such as methylene blue. RGB analysis of camera phone photographs revealed a consistent pattern of red saturation in parathyroid tissue, regardless of lighting conditions or camera type. Using the same app to subtract red from the photograph visually enhanced the difference between parathyroid and surrounding fat and thyroid and confirmed the RGB findings.Conclusions:Photographic RGB analysis used by the amateur photographer at little cost shows promise as an intraoperative parathyroid detection method. Cell phone photography is universally available, and this technique can be employed in a low‐resource setting to prevent inadvertent removal of parathyroid tissue.
Intraoperative Frozen Biopsy for the Evaluation of Extrathyroidal Extension in Papillary Thyroid Cancer
Authors: Park Young Min , Park Young Dae , Lee Won Yong , Lee Jin‐Choon , Wang Soo‐Geun , Lee Byung‐Joo 
Published: September 2014

Objectives:We investigated extrathyroidal extension (ETE) through frozen biopsy for intraoperative decision‐making in patients with papillary thyroid cancer (PTC).Methods:During the period of the study an operation was performed in 268 patients with PTC and ETE was evaluated using intraoperative frozen biopsies of thyroid tissue.Results:ETE was confirmed in 54 patients (20%) on frozen biopsy. Fifty‐three patients among 54 patients showing ETE on frozen biopsy were confirmed on permanent pathologic analysis. Accordingly, frozen biopsy had a sensitivity of 66%, a specificity of 99%, a positive predictive value of 98%, and a negative predictive value of 87%. Tumor size (odds ratio 4.373; confidence interval 2.257‐8.475, P <. 001) was an independent factor for predicting ETE on frozen biopsy.Conclusions:Intraoperative frozen biopsy can be a useful tool in identifying the presence of ETE. It can also help the operator decide the extent of surgery and central neck dissection in patients with PTC.
Fistula Rate after Primary Repair of Cleft Palate: Novel Exposed Inverted Horizontal Mattress Nasal Closure
Authors: Hyde Blake J. , Steffen Caleb M. , Miller Jason J. 
Published: September 2014

Objectives:Discuss options for midline nasal suture during 2‐flap palatoplasty (2FPP). Compare effects of patient demographics, Veau class, associated syndromes, surgeon experience, and use of a previously unreported exposed inverted horizontal mattress suture for nasal mucoperiosteal closure on fistula rates and velopharyngeal insufficiency (VPI).Methods:Retrospective case series review of all children who underwent 2FPP by the attending surgeon (J.J.M.). Fifty‐five consecutive patients were analyzed over a 5.5‐year period. Study variables were obtained from multidisciplinary craniofacial/cleft records. All patients underwent 2FPP with intravelar veloplasty using the suture technique described herein. No patients were excluded from primary review and statistical analysis.Results:Eighty‐nine percent of patients were Veau class 2 or 3. Twenty‐four (44%) patients had an associated syndrome. Patients with a lower Veau class were 3.6 times more likely to have an associated syndrome (P =. 0001). Two (3.6%) patients developed a fistula. There was no association between Veau class, presence of an associated syndrome, or use of dermal allograft with the development of a fistula (P = 1.0, all). Postoperative VPI was noted in 11 (20%) patients, without association between Veau class, syndrome, or dermal allografting (P = 1.0,. 74, and. 45, respectively). Repairs in the first half of the patient sample had a 10‐fold increased risk of postoperative VPI (P =.0024).Conclusion:Our use of an exposed inverted horizontal mattress suture for nasal mucoperiosteal closure during 2FPP appears safe and is comparable with the lowest published rates of postoperative fistula and VPI. Further standardized studies are needed in this area.
Issues in Oncologic Surveillance of Patients with Maxillectomy Defects
Authors: Likhterov Ilya , Fritz Michael A. , El‐Sayed Ivan H. , Seth Rahul , Rayess Hani , Knott Daniel 
Published: September 2014

Objectives:(1) Describe locoregional and distant disease recurrence patterns among patients undergoing maxillectomy from 2001‐2011 at Cleveland Clinic and UCSF Medical Center. (2) Analyze the pattern of recurrence in this cohort in order to evaluate whether microvascular reconstruction may delay clinical detection of early cancer recurrence.Methods:Retrospective review of patients undergoing inferior, subtotal, or total maxillectomy, with or without reconstruction, for control of malignant disease from 2001‐2011 from 2 tertiary centers (Cleveland Clinic and University of California, San Francisco).Results:A total of 76 patients across the 2 institutions met the inclusion criteria for the study. Squamous cell carcinoma was the most prevelant pathologic diagnosis with overall disease progression of 29%. Recurrence at the skull base and regional lymphatic spread were the most common patterns identified (18 and 32%, respectively). Surveillance imaging, rather than direct observation on physical examination, raised suspicion for disease progression in the majority of cases. A total of 9 patients were found to have disease recurrence that could be surgically salvaged, with only 4 patients requiring modification to their reconstruction as part of the salvage operation.Conclusions:Locoregional recurrence of malignancy after partial or total maxillectomy is uncommon, and the suspicion for disease recurrence is significantly more commonly raised on surveillance imaging, rather than on physical examination. Further, locoregional recurrence is rarely amenable to successful surgical salvage. This suggests that primary microvascular reconstruction of maxillectomy defects does not delay diagnosis or treatment of disease recurrence.
Management of Primary Hyperparathyroidism in a VAMC Health System: Evidence‐Based Management Protocol and Future Directions
Authors: Wood Joshua W. , Rosen Philip , Sebelik Merry E. 
Published: September 2014

Objectives:(1) Establish a best practices guideline for the surgical treatment of primary hyperparathyroidism within the context of single hospital system. (2) Stratify the group of patients who underwent directed excision by the accuracy of preoperative localization studies, and whether intraoperative techniques impacted cure, and at what resource costs.Methods:In this retrospective chart review, patients were identified by searching all parathyroid‐related procedures that took place at our institution from January 1, 2002, to December 31, 2013. Information related to the aims of the study, including demographics, operative details, and laboratory values were recorded, and imaging studies were reviewed by the senior investigator.Results:Of those patients with preoperative localization and directed excision, the preoperative studies most predictive of cure were a combination of Sestamibi parathyroid scan and surgeon‐performed ultrasound. When these were in disagreement, surgical findings supported the ultrasound results. Intraoperative parathyroid hormone rapid assay was helpful in predicting cure, but added 68 minutes to the operating time on average. Most patients were surgically cured, and of the few patients with persistent high parathyroid hormone levels, vitamin D deficiency was the primary associated lab abnormality.Conclusions:Analysis of techniques that predict a surgical cure allowed the development of a best practices algorithm that includes the following: (1) Obtain 2 preoperative localization studies, including a surgeon‐performed ultrasound; (2) Obtain preoperative vitamin D levels and supplement as indicated; and (3) Reserve intraoperative parathyroid hormone assay only for those patients who do NOT have 2 corroborating localization studies.
Oncologic Outcomes in Patients with Oropharyngeal Squamous Cell Carcinoma Treated with TORS versus Definitive CRT
Authors: Ling Diane C. , Vangara Bhavana S. , Kabolizadeh Peyman , Clump David A. , Ferris Robert L. , Kim Seungwon , Duvvuri Umamaheswar 
Published: September 2014

Objectives:It has been postulated that treatment outcomes are similar between transoral robotic surgery (TORS) and definitive chemoradiation (CRT) for patients with oropharyngeal squamous cell carcinomas (OPSCC). We compared oncologic outcomes between OPSCC patients treated with definitive CRT and those treated with TORS only.Methods:An observational comparison study was performed on 23 patients treated with TORS without adjuvant therapy and 33 patients treated with definitive CRT between July 2005 and December 2013. All patients had early stage disease with T0‐T2 and N0‐N2. Median age was 57 (range: 36‐82) years and 80.4% of patients were male, which was similar between groups. Human papillomavirus (HPV)+ disease was present in 70.0% of TORS and 33.3% of CRT patients, although HPV status was not tested in 63.6% of the CRT patients.Results:Median follow‐up was 22.5 months (range, 0.33‐83.4 months). Local failure rate for the entire cohort was 7.1% (9.1% for definitive CRT, 4.3% for TORS, P =. 85). Overall regional failure rate was 3.6% (3.0% for definitive CRT, 4.3% for TORS, P =. 48). Overall distant failure rate was 5.4% (9.1% for definitive CRT, 0.0% for TORS, P =. 24). Two‐year actuarial disease‐free survival (DFS) was 86.7% for definitive CRT patients and 80.0% for patients treated with TORS alone (P =. 69).Conclusions:Definitive CRT and TORS alone offer similar rates of locoregional control, distant control, and DFS in patients with early stage OPSCC. Further studies are needed to assess the effect of CRT and TORS on quality of life in this patient population.
Oropharyngeal Carcinomas Harboring HPV‐E6 Display Resistance to Liberation of P53 and Sensitivity to Oxidative Stress
Authors: Lau Andrew S. , Jones Terence M. , Boyd Mark T. 
Published: September 2014

Objectives:Analyze the effect of (1) Nutlin‐3, a small molecule liberator of p53, on human papillomavirus (HPV) E6 protein‐driven oropharyngeal squamous cell carcinoma (OPSCC) cell lines and (2) the response of such cell lines to oxidative stress.Methods:Reproducible drug sensitivity (MTT) and clonogenic assays were performed, with treatments with Nutlin‐3 and hydrogen peroxide. Western blots were performed for p53 and MDM2 expression.Results:Our data show that UM‐SCC‐47, an oropharyngeal cancer cell line harboring HPV E6, displays no growth or radiation sensitivity to Nutlin‐3. As expected from previous work UM‐SCC‐74A, an oropharyngeal cancer cell line not driven by HPV and harboring wild‐type p53, displayed both growth and radiation sensitivity. Similarly, UM‐SCC‐4, an oropharyngeal cancer cell line not driven by HPV but harboring mutant p53, displayed minimal growth or radiation sensitivity. Early results show that UM‐SCC‐47 displays significantly greater sensitivity to oxidative stress than cell lines negative for HPV and harboring wild‐type p53.Conclusions:We have shown for the first time that Nutlin‐3 has no effect in cells expressing HPV E6. We have also shown that p53‐deficient cells have an impaired response to oxidative stress. Such impaired regulation of oxidative stress and metabolism could be exploited in a number of different ways and may have implications for the targeting of cancers that have mutant or no p53, which typically carry a worse prognosis.
Parapharyngeal Space Neoplasms: A 50‐Year Experience
Authors: Modest Mara C. , Van Abel Kathryn M. , Moore Eric J. , Janus Jeffrey R. , Price Daniel L. , Kasperbauer Jan L. , Olsen Kerry D. 
Published: September 2014

Objectives:(1) Describe the presentation, histopathology, and workup for parapharyngeal space (PPS) neoplasms. (2) Analyze management and long‐term oncologic outcomes.Methods:A chart review was performed from 1960‐2010 on patients with primary PPS neoplasms treated at a tertiary center with intent‐to‐cure.Results:A total of 381 patients were included (160 males; mean, 50.9 years; range, 2 days‐89 years). The most common symptom was a neck mass (182/381, 48%). Of the patients, 78.7% (300/381) had preoperative imaging: 44% (167/381) had computed tomography and 41% (156/381) had magnetic resonance imaging. Of the patients, 20.2% (77/381) underwent fine‐needle aspiration biopsy. A total of 299 tumors were benign (78.5%), pleomorphic adenomas comprising the majority (151/299, 50.5%). Eighty‐two were malignant (21.5%), adenocarcinomas (16/82, 19.5%) being the most common. All patients underwent primary surgical management ± adjuvant therapy. The cervical‐parotid approach was the most common (253/381, 66.4%), with mandibulotomies required in 4.5% (17/381). Postoperative cranial neuropathies were identified in 18.7% (70/374); 48.5% (34/70) were related to neurogenic tumors. No perioperative mortalities were reported. Mean follow‐up was 89.9 months (N = 345; range: 1 month‐42 years). The 5‐/10‐/ 20‐year recurrence‐free survival was 93.2%/86.3%/77.9% for benign and 48.2%/38.3%/21.3% for malignant lesions (P <. 0001). The 5‐/10‐/20‐year cancer‐specific survival was 98.7%/97.9%/96.2% for benign and 59.0%/52.3%/14.0% for malignant lesions (P <. 0001). The 5‐/10‐/20‐year overall survival was 96.4%/89.3% /70.0% for benign and 56.0%/46.0%/7.3% for malignant lesions (P <. 0001).Conclusions:While the rate of recurrence for benign PPS lesions is low, these patients remain at risk for recurrence >20 years following surgery. Long‐term surveillance should be considered. Patients with malignant lesions are at higher risk for recurrence and have a poor oncologic prognosis. The cervical‐parotid approach remains safe and effective for most PPS neoplasms.
Patient Outcomes in Total Rhinectomies
Authors: Bayrak Sinehan , Vural Emre A. 
Published: September 2014

Objectives:(1) Evaluate the outcomes of patients who underwent total rhinectomies. (2) Give physicians a better understanding of prior treatment modalities, postoperative survival outcomes, and rehabilitation options.Methods:Retrospective chart review of patients who underwent a total rhinectomy during the past 17 years. The variables collected included age, sex, presenting symptoms and signs, tumor size, tumor location, tumor histology, incorrect initial diagnoses, initial treatments, postoperative chemoradiation, and any recurrence of disease, as well as outcomes of prosthetic rehabilitation.Results:Seventeen patients had squamous cell carcinoma (SCC), 13 patients had basal cell carcinoma, and 2 patients had adenoid SCC. Nineteen patients had postoperative chemoradiation. Eleven patients had recurrence of their disease with an average recurrence time of 20 months. Of the 26 patients fitted with prosthesis, half had specific complaints, the most common of which were bad fit and irritation. At the time of this study, 17 patients were dead, 9 patients were alive, and 6 patients had been lost to follow‐up.Conclusions:Only 8 out of 32 patients had no record of other prior treatment, which speaks to the importance of appropriately managing nasal malignancies. Most patients fitted with a prosthesis were ultimately unhappy in terms of both appearance and comfort, suggesting a need for better rehabilitation options.
Patient Priorities in Decision Making for Laryngeal Cancer Treatment
Authors: Shuman Andrew G. , Larkin Knoll , Thomas Dorothy , Palmer Frank L. , Shah Jatin P. , Patel Snehal , Fagerlin Angela 
Published: September 2014

Objectives:(1) Ascertain the priorities of laryngeal cancer patients concerning oncologic and functional outcomes. (2) Describe how these priorities and professional referral patterns might influence treatment‐related decision making.Methods:This cross‐sectional survey‐based pilot study explored patient preferences and priorities regarding treatment‐related decision making for laryngeal cancer using a validated survey instrument. Other questions assessed patient priorities concerning the desired outcomes of their laryngeal cancer treatment and how professional referral patterns (ie, order in which they are seen by different specialists) and desired provider input affect their decisions. Adults with biopsy‐proven laryngeal carcinoma were eligible to participate (n = 57; 46% treated surgically, 54% treated nonsurgically).Results:The 4 most important priorities for patients with laryngeal cancer are oncologic cure (91%), maximizing survival (66%), being able to swallow (44%), and maintenance of natural voice (41%). When considering the level of involvement of surgeons, radiation oncologists, and medical oncologists in their care, patients thought that the specialist who they saw first was most involved in deciding how to treat their cancer (Fisher's exact, ~χ2(6) = 14.2, P =. 01). Similarly, patients were more likely to believe the specialist who they saw first was the most important factor in deciding how to treat their cancer (Fisher's exact, ~χ2(6) = 16.2, P =. 02).Conclusions:Patient priorities and attitudes coupled with professional referral patterns influence how patients contemplate choices regarding management of their laryngeal cancer. Better understanding of these variables may assist in ensuring that patients’ voices are integrated into individualized laryngeal cancer treatment planning.
PET‐CT for Detecting Nodal Metastasis in cN0 Early‐Stage Oral Cavity Squamous Cell Carcinoma
Authors: Jeffery Caroline C. , Biron Vincent L. , Zhang Han , O'Connell Daniel A. , Harris Jeffrey R. , Seikaly Hadi 
Published: September 2014

Objectives:To determine if positron emission tomography (PET)‐computed tomography (CT) offers any diagnostic advantage over traditional CT neck in assessing the clinically N0 neck in patients with T1 and T2 squamous cell carcinoma (SCC) of the oral cavity.Methods:We performed a retrospective review of patients in the Alberta Cancer Registry who were diagnosed with cT1 or T2N0M0 disease who underwent elective unilateral or bilateral neck dissections. Results of preoperative PET‐CT and CT necks were reviewed for number of “suspicious” lymph nodes. Surgical pathology reports were reviewed to obtain the total number of nodes sampled and number of malignant nodes.Results:Between 2009 and 2011, 148 patients were diagnosed with cT1 or T2N0M0 SCC of the oral cavity. Of these, 62 patients underwent elective neck dissections. Fourteen patients underwent preoperative PET‐CT while 48 patients underwent CT neck alone. Based on final surgical pathology, 6 nodes out of 499 nodes sampled were falsely fludeoxyglucose‐avid in the PET‐CT group while 3 nodes out of 1800 were falsely identified as suspicious on CT neck alone. The overall false positive rate of PET‐CT was significantly higher than CT alone (1.2% vs 0.2%, P <. 001). Both modalities had excellent specificity of >98% for benign nodes in these patients.Conclusions:In patients with cT1 and T2 of the oral cavity and no palpable lymphadenopathy, PET‐CT is no better than CT alone for ruling out nodal metastasis and may have a higher false positive rate.