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Lee AKF, Hui T, Yeung ZWC, Wong EWY, Chan JYK, Lau EHL. Radiofrequency ablation compared to surgery for thyroid nodules: A case for office based treatment. Laryngoscope Investig Otolaryngol 2024; 9:e1276. [PMID: 38895024 PMCID: PMC11184567 DOI: 10.1002/lio2.1276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/29/2024] [Accepted: 05/09/2024] [Indexed: 06/21/2024] Open
Abstract
Objective We aim to evaluate the safety and effectiveness of radiofrequency ablation (RFA) for benign thyroid nodules by ENT surgeons and to compare it to conventional hemithyroidectomy in the public healthcare, operating theater contained setting. Methods 50 patients who underwent a single session of RFA for symptomatic benign thyroid nodules in Prince of Wales Hospital and Tseung Kwan O Hospital in Hong Kong from 2020 to 2022 were evaluated. Objective outcomes including nodule volume, volume reduction rate (VRR) and complications were recorded. Subjective response in the form of a 0-10 point scale for patient symptoms including obstructive, cosmetic, pain and satisfaction scores were collected. Results Significant reduction in mean VRR was found at 3, 6 and 12 months post treatment, accompanied by a significant reduction in the mean obstructive and cosmetic symptom scores. Comparing with conventional hemithyroidectomy, the RFA group had a significantly shorter mean procedure time and lower rate of complications. Estimated cost to patient for RFA was found to be less than half of that of hemithyroidectomy. Conclusion RFA is a safe and effective treatment modality for benign thyroid nodules by ENT surgeons with advantages of being a scarless local anesthetic procedure with shorter procedure time, lower complication rate and lower cost to patient compared to hemithyroidectomy. In Hong Kong, where most of the population is treated in the public sector, there are limited resources, often with high caseload burden and long operation waiting times. Therefore, RFA is an office-based treatment that serves as a valuable alternative to hemithyroidectomy for benign nodules, especially in lower resource settings. Level of evidence 3.
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Affiliation(s)
- Alex K. F. Lee
- Department of Otorhinolaryngology, Head and Neck SurgeryTseung Kwan O HospitalHong KongHong Kong
| | - Thomas Hui
- Department of Otorhinolaryngology, Head and Neck SurgeryTseung Kwan O HospitalHong KongHong Kong
| | - Zenon W. C. Yeung
- Department of Otorhinolaryngology, Head and Neck SurgeryTseung Kwan O HospitalHong KongHong Kong
| | - Eddy W. Y. Wong
- Department of Otorhinolaryngology, Head and Neck SurgeryPrince of Wales HospitalHong KongHong Kong
| | - Jason Y. K. Chan
- Department of Otorhinolaryngology, Head and Neck SurgeryPrince of Wales HospitalHong KongHong Kong
- Department of Otorhinolaryngology, Head and Neck SurgeryThe Chinese University of Hong KongHong KongHong Kong
| | - Eric H. L. Lau
- Department of Otorhinolaryngology, Head and Neck SurgeryPrince of Wales HospitalHong KongHong Kong
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2
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Blom M, Magarey MJR, Flatman S. Diagnostic adequacy and accuracy of surgeon-performed ultrasound guided fine needle aspiration in lateral neck masses. ANZ J Surg 2024; 94:117-121. [PMID: 38205558 DOI: 10.1111/ans.18857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/19/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Surgeon-performed ultrasound guided fine needle aspiration (SUS-FNA) reduces the time to diagnosis and treatment of head and neck pathology. Although it has been validated in the investigation of thyroid pathology, there is a paucity of evidence to support its use in lateral neck masses. This study aims to determine the accuracy and adequacy of SUS-FNA in the investigation of lateral neck masses. METHODS A retrospective cohort analysis was performed of patients who underwent a SUS-FNA for lateral neck mass between June 2018 and October 2022 at a single institution. Pathologist reports were reviewed to determine the rate of FNA sample adequacy. A comparison was made between FNA cytology results and final histopathological diagnosis following surgical excision in a subset of patients to determine FNA accuracy. RESULTS A total of 110 SUS-FNAs were performed on lateral neck masses. Diagnostic adequacy of SUS-FNA was determined to be 91% (100/110). When analysing the subset of patients who proceeded to surgical excision, the diagnostic accuracy of SUS-FNA was determined to be 88% (38/43). CONCLUSION SUS-FNA results in high adequacy rates with good diagnostic accuracy in the investigation of lateral neck masses. This tool has great potential in reducing treatment delay in the management of head and neck cancer.
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Affiliation(s)
- Megan Blom
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Matthew J R Magarey
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Medical Education, University of Melbourne, Melbourne, Victoria, Australia
| | - Samuel Flatman
- Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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3
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Post R, Doxzon K, Goldberg A. Telecytology rapid onsite evaluation, with real-time communication between cytopathologist, cytotechnologist, and proceduralist, offers better adequacy rates for lymph node, but not thyroid, fine-needle aspirations. J Am Soc Cytopathol 2023; 12:407-414. [PMID: 37620222 DOI: 10.1016/j.jasc.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Rapid onsite evaluation (ROSE) decreases rates of inadequate fine-needle aspirations (FNAs). Telecytology allows pathologists to perform ROSE without being physically "on site", thereby saving cytopathologists' travel time and allowing them to perform ROSE for multiple institutions. Little research exists comparing telecytology to non-telecytology ROSE for FNA inadequacy rates. MATERIALS AND METHODS Using previously obtained quality metrics, we compared inadequacy rates for lymph node and thyroid FNAs with and without ROSE and with non-telecytology ROSE compared with telecytology ROSE. Use of ROSE was determined by the proceduralist. Type of ROSE was location-based, as only certain locations at our institution have telecytology capabilities. Chi-squared testing was used to compare proportions of populations and P value was set to 0.05. RESULTS A total of 1168 lymph node and 1177 thyroid FNAs were included in our adequacy analysis. We found any ROSE decreased our inadequacy rate for both lymph node (20.4% to 12.7%, P = 0.002) and thyroid (34.7% to 4.8%, P = 7.4 × 10-18) FNAs. We found telecytology further decreased our inadequacy rate for lymph node (13.8% to 5.9%, P = 0.016), but not thyroid (3.3% to 5.0%, P = 0.34), FNAs. CONCLUSIONS At our institution, when using telecytology, slides are read in real time with the cytotechnologist and the proceduralist looking at slides together near the patient bedside, while the cytopathologist is on the phone looking at slides on the computer screen via Dameware. When non-telecytology ROSE is performed, the cytotechnologist evaluates a slide, brings it to the cytopathologist's office and then the cytopathologist calls the proceduralist to discuss the slide. We believe telecytology offers an opportunity for more inclusive communication thereby improving adequacy rates for more complex cases, like lymph nodes, without affecting adequacy rates for cases where assessment of adequacy is less complex, like thyroid. This research supports use of telecytology especially for complex cases.
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Affiliation(s)
- Robert Post
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
| | - Kelly Doxzon
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Allison Goldberg
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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van Schaik JE, Muller Kobold AC, van der Laan BFAM, van der Vegt B, van Hemel BM, Plaat BEC. SCC Antigen Concentrations in Fine-Needle Aspiration Samples to Detect Cervical Lymph Node Metastases: A Prospective Analysis. Otolaryngol Head Neck Surg 2023; 168:407-412. [PMID: 35639471 DOI: 10.1177/01945998221102870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the diagnostic value of measuring squamous cell carcinoma antigen (SCC-Ag) and cancer antigen 15-3 (CA15-3) concentrations in fine-needle aspiration (FNA) samples for the detection of squamous cell carcinoma (SCC) metastases in cervical lymph nodes. STUDY DESIGN A prospective study with patients consecutively included between November 2018 and May 2021. SETTING A tertiary head and neck oncologic center. METHODS Out of 138 patients, SCC-Ag concentrations were analyzed in 168 FNA cervical lymph node samples and CA15-3 in 152 samples. Results were compared with FNA cytology (FNAC) or definitive histology to establish sensitivity and specificity rates. RESULTS For the detection of cervical SCC lymph node metastases, SCC-Ag measurement had an 89.4% sensitivity and 79.3% specificity at a cutoff concentration of 0.1 µg/L. Measurement of CA15-3 concentration in addition to SCC-Ag concentration did not lead to improved accuracy for the detection of SCC. In histology-confirmed cases, FNAC had an 80.0% sensitivity and 100% specificity, as opposed to 93.3% and 57.1%, respectively, for SCC-Ag. CONCLUSION Measurement of SCC-Ag concentration for detection of SCC lymph node metastases has a sensitivity at least comparable to FNAC and could be used as a relatively cheap screening tool in samples with nondiagnostic or indeterminate FNAC results or when multiple lymph nodes are sampled. However, SCC-Ag in FNA samples has a lower specificity than FNAC assessed by pathologists experienced in head and neck oncology. Addition of CA15-3 measurement did not lead to improved accuracy.
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Affiliation(s)
- Jeroen E van Schaik
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anna C Muller Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bernard F A M van der Laan
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bert van der Vegt
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bettien M van Hemel
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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5
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Haller TJ, Van Abel KM, Yin LX, Lohse CM, Douse D, Badaoui JN, Price DL, Kasperbauer JL, Moore EJ. Ultrasound Guided Biopsy in Patients With HPV-Associated Oropharyngeal Squamous Cell Carcinoma. Laryngoscope 2022; 132:2396-2402. [PMID: 35275423 DOI: 10.1002/lary.30105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To identify the differences in sensitivity and accuracy between ultrasound-guided and palpation-guided fine needle aspirations (FNA) of suspicious lymph nodes in patients with human papillomavirus (HPV) (+) oropharyngeal squamous cell carcinoma (OPSCC). Additional objectives included identifying patient specific factors affecting biopsy accuracy and evaluating potential differences in accuracy between fine and core needle biopsies. STUDY DESIGN Retrospective chart review. MATERIALS AND METHODS A retrospective study of diagnostic sensitivity was completed at a single tertiary care center between 1/1/2006-12/31/2016. Participants included patients who underwent pretreatment FNA biopsy with HPV(+)OPSCC confirmed pathologically following neck dissection or excisional lymph node biopsy. A true positive (TP) on FNA biopsy was defined as an FNA biopsy concerning for squamous cell carcinoma (SCC) that was confirmed on excisional biopsy or neck dissection. A false negative (FN) was defined as a negative FNA but metastatic disease identified on excisional biopsy or neck dissection. Sensitivity was calculated as TPs/(TPs + FNs). Sensitivity was compared among techniques using chi-square and Fisher exact tests. RESULTS A total of 209 FNA biopsies among 198 patients were included in the study, including 31 (15%) palpation-guided FNAs, 160 (77%) ultrasound-guided FNAs, and 18 (9%) ultrasound-guided FNA + core biopsies. Sensitivity was significantly different among palpation-guided FNA, ultrasound-guided FNA, and ultrasound-guided FNA + core biopsies (48% vs. 83% vs. 94%, respectively; P < .001) but there was no significant difference in sensitivity between ultrasound-guided FNA versus ultrasound-guided FNA + core biopsies (P = .31). CONCLUSION The use of ultrasound guidance in FNA biopsies of nodal metastases in HPV(+)OPSCC improves sensitivity compared to palpation guidance alone. Ultrasound guided biopsies are preferred in patients with suspected nodal metastasis from HPV(+)OPSCC. LEVEL OF EVIDENCE 3 Laryngoscope, 132:2396-2402, 2022.
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Affiliation(s)
- Travis J Haller
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Linda X Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Dontre' Douse
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Joseph N Badaoui
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jan L Kasperbauer
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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6
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Toong LY, Ghauth S. Surgeon-performed ultrasound-guided head and neck procedures during COVID-19 pandemic. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022. [PMCID: PMC9166173 DOI: 10.1186/s43163-022-00258-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background The ultrasonographic procedure is a common diagnostic and therapeutic method in daily medical practice. Surgeon-performed ultrasound (SUS) has been gaining popularity, especially during this COVID-19 pandemic. Methods Two ENT surgeons performed US-guided diagnostic or therapeutic procedures in the outpatient clinic. A successful SUS is defined as the diagnostic procedure's ability to facilitate the final histopathological diagnosis that can guide the subsequent treatment and disease resolution following the therapeutic procedure without the need for more invasive open surgical intervention. Results Out of 10 participants, 6 are males, and 4 are females. There were no complications noted. All subjects had successful tissue sampling or intervention on the first attempt for diagnostic and therapeutic SUS. Conclusions With COVID-19, there has been a significant shift in ordinary medical practice. SUS is proven to be a safe and effective method to facilitate the management of head and neck pathologies.
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7
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Hamour AF, Yang W, Lee JJW, Wu V, Ziai H, Singh P, Eskander A, Sahovaler A, Higgins K, Witterick IJ, Vescan A, Freeman J, de Almeida JR, Goldstein D, Gilbert R, Chepeha D, Irish J, Enepekides D, Monteiro E. Association of the Implementation of a Standardized Thyroid Ultrasonography Reporting Program With Documentation of Nodule Characteristics. JAMA Otolaryngol Head Neck Surg 2021; 147:343-349. [PMID: 33570552 DOI: 10.1001/jamaoto.2020.5233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance Although most thyroid nodules are benign, the potential for malignant neoplasms is associated with unnecessary workup in the form of imaging, fine-needle aspiration, and diagnostic surgery. The American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) is commonly used to assess the malignant neoplasm risk potential of thyroid nodules imaged by ultrasonography. However, standardized reporting of ACR TI-RADS descriptors is inconsistent. Objective To increase the documentation rate of ACR TI-RADS thyroid nodule characteristics to 80% in 18 months. Design, Setting, and Participants This prospective interrupted time series quality improvement study was conducted from December 1, 2018, to March 31, 2020, at a tertiary outpatient head and neck clinic among 229 patients who had at least 1 documented thyroid nodule identified on bedside clinic ultrasonography. Data analysis was performed throughout the entire study period because this was a quality improvement study with iterative small cycle changes; final analysis of the data was performed in April 2020. Main Outcomes and Measures The primary outcome was the documentation rates of 6 ACR TI-RADS ultrasonographic descriptors. Secondary outcomes included nodule fine-needle aspiration biopsy rate and physician-reported clinic flow efficiency. Results A total of 229 patients had at least 1 documented thyroid nodule and were included in the analysis. Size was the most frequently documented nodule characteristic (72 of 74 [97.3%]) at baseline, followed by echogenic foci (31 of 74 [41.9%]), composition (23 of 74 [31.1%]), echogenicity (17 of 74 [23.0%]), margin (6 of 74 [8.1%]), and shape (1 of 74 [1.4%]). After 3 Plan, Do, Study, Act (PDSA) cycles, the final intervention consisted of a standardized ultrasonography reporting form and educational initiatives for surgical trainees. After the third PDSA cycle (n = 36), reporting of nodule size, echogenic foci, and composition increased to 100%. Similarly, reporting of echogenicity (34 of 36 [94.4%]), shape (28 of 36 [77.8%]), and margin (25 of 36 [69.4%]) all increased. This represented a cumulative 90.3% documentation rate (195 of 216), a 56.5% increase from baseline (95% CI, 50.0%-61.9%). The standardized reporting form was used in 83.3% of eligible thyroid ultrasonography cases (30 of 36) after PDSA cycle 3, demonstrating good fidelity of implementation. There were no unintended consequences associated with clinic workflow, as a balancing measure, reported by staff surgeons. Conclusions and Relevance This study suggests that implementation of an ACR TI-RADS-based reporting form in conjunction with educational initiatives improved documentation of ultrasonographic thyroid nodule characteristics, potentially allowing for improved bedside risk stratification and communication among clinicians.
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Affiliation(s)
- Amr F Hamour
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Weining Yang
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - John J W Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Wu
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Hedyeh Ziai
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Praby Singh
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Department of Surgery, The Scarborough Hospital, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
| | - Allan Vescan
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
| | - Jeremy Freeman
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - David Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Ralph Gilbert
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Douglas Chepeha
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Jonathan Irish
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, University Health Network, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Sinai Health System, Toronto, Ontario, Canada
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8
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Xia S, Chen Y, Zhan W, Zhou W. Ultrasound-Guided Fine-Needle Aspiration Versus Fine-Needle Capillary Sampling in Evaluation of Lymph Node Metastasis of Thyroid Cancer. Front Oncol 2021; 11:642142. [PMID: 33937044 PMCID: PMC8079778 DOI: 10.3389/fonc.2021.642142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background To compare the sampling adequacy and diagnostic efficiency of ultrasound-guided fine-needle aspiration with 22-, 25-gauge needles and capillary sampling with 22-gauge needle in the biopsy of cervical lymph node. Methods A total of 130 cervical lymph nodes from 103 patients were consecutively included in the prospective study. Each suspected lymph node was aspirated with a 22-gauge needle, capillary sampled with a 22-gauge needle and aspirated with a 25-gauge needle. The adequacy rates and nondiagnostic rates of obtained specimen were calculated. Results Of the 130 suspected lymph nodes, there were 77 lymph nodes<6.0 mm and 53 lymph nodes≥6.0mm in the smallest dimension. Both FNA22G and FNC22G got significantly higher sampling adequacy than FNA25G for the total lymph nodes. For lymph nodes<6.0 mm, the sampling adequacy was significantly higher with FNA22G than with FNA25G for each parameter and the cumulative score (all P<0.05), while no difference were seen between FNA22G and FNC22G, and between FNC22G and FNA25G. There were higher nondiagnostic rates for FNA25G compared with FNA22G and FNC22G in all lymph nodes and in each size subgroups. FNA25G yielded more diagnostically inadequate specimens than FNA22G and FNC22G did in the total lymph nodes (P=0.002), in lymph nodes<6.0 mm (P=0.014), and in those ≥ 6.0 mm (P=0.000). Conclusions FNA22G and FNC22G obtained more diagnostically adequate specimens than FNA25G in cervical lymph nodes. FNA22G and FNC22G may be more suitable than FNA25G in diagnosing cervical lymph nodes. FNA22G and FNC22G may yield specimens with similar quality.
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Affiliation(s)
- Shujun Xia
- Department of Ultrasound, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yilai Chen
- Department of Ultrasound, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiwei Zhan
- Department of Ultrasound, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Zhou
- Department of Ultrasound, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Ultrasound, Ruijin Hospital/Lu Wan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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9
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Lanišnik B, Levart P, Čizmarevič B, Švagan M. Surgeon-performed ultrasound with fine-needle aspiration biopsy for the diagnosis of parotid gland tumors. Head Neck 2021; 43:1739-1746. [PMID: 33547678 DOI: 10.1002/hed.26630] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/14/2020] [Accepted: 01/21/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Ultrasound (US) with or without fine-needle aspiration cytology (FNAC) are readily available and can offer in office and rapid diagnosis of parotid lumps. METHODS We analyzed 398 of patients who underwent blind FNAC or US with FNAC performed by an operating head and neck surgeon. Specificity, sensitivity, as well as accuracy were calculated for US alone, FNAC alone, and US-FNAC combined. RESULTS Nondiagnostic US-guided FNAC rate was 3.1% and 7.2% for blind FNAC. With those cases removed, final accuracy for US alone in diagnosis of malignancy, pleomorphic adenoma (PA), and Warthin tumor (WT) were 90.8%, 81%, and 77.4% respectively. For US-FNAC accuracy for malignancy, PA, and WT were 92.1%, 94 0.8%, and 95.4% respectively. CONCLUSION US with FNAC is cost-effective and rapid diagnostic tool and may help surgeon to deliver more accurate informed consent to a patient.
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Affiliation(s)
- Boštjan Lanišnik
- Department of Otolaryngology - Head and Neck Surgery, University Medical Center Maribor, Maribor, Slovenia
| | - Primož Levart
- Department of Otolaryngology - Head and Neck Surgery, University Medical Center Maribor, Maribor, Slovenia
| | - Bogdan Čizmarevič
- Department of Otolaryngology - Head and Neck Surgery, University Medical Center Maribor, Maribor, Slovenia
| | - Matija Švagan
- Department of Otolaryngology - Head and Neck Surgery, University Medical Center Maribor, Maribor, Slovenia
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10
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Kwok MMK, Choong KWK, Virk J, Magarey MJR, Flatman S. Surgeon-performed ultrasound in a head and neck surgical oncology clinic: saving time and improving patient care. Eur Arch Otorhinolaryngol 2020; 278:2455-2460. [PMID: 32895800 DOI: 10.1007/s00405-020-06344-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Surgeon-performed ultrasound (SUS) for head and neck masses is increasingly being performed by head and neck surgeons. This is the first study assessing its impact in a head and neck surgical oncology clinic, examining the effect on various parameters. METHODS Retrospective analysis was conducted on a database, analysing and comparing all new patients reviewed 6 months prior to (pre-SUS group) and 6 months following (post-SUS group) the introduction of SUS to the outpatient head and neck surgical oncology clinic. The numbers of radiology imaging investigations (ordered through a medical imaging department), fine-needle aspirations (FNAs) performed, clinical appointments and time to definitive treatment decision were analysed and compared. RESULTS A total of 365 patients were included: 169 in the pre-SUS group and 196 in the post-SUS group. There was a statistically significant difference in the number of total radiological imaging investigations performed (1.60 vs. 0.70, p < 0.00001), radiologist-performed FNAs (0.24 vs. 0.10, p = 0.0234), time for definitive treatment decision being made (16.4 days vs. 11.6 days, p = 0.04338), and number of clinical encounters (3.03 vs. 2.29, p < 0.00001). No statistically significant difference was observed in the number of head and neck surgical oncology clinic appointments (1.70 vs. 1.66, p = 0.6672). CONCLUSION Surgeon-performed ultrasound reduces the number of radiological imaging investigations and FNAs performed, reduces time for definitive treatment decision being made, and reduces the number of clinical encounters for patients. This supports its use in head and neck cancer setting and has important implications for both patients and the health-care system.
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Affiliation(s)
- Matthew M K Kwok
- Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
| | - Keith Wai Keong Choong
- Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Jagdeep Virk
- Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Matthew J R Magarey
- Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Samuel Flatman
- Head and Neck Surgical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
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Flatman S, Kwok MMK, Magarey MJR. Introduction of
surgeon‐performed
ultrasound to a head and neck clinic: indications, diagnostic adequacy and a new clinic model? ANZ J Surg 2020; 90:861-866. [DOI: 10.1111/ans.15886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 03/11/2020] [Accepted: 03/15/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Samuel Flatman
- Head and Neck Surgical OncologyPeter MacCallum Cancer Centre Melbourne Victoria Australia
| | - Matthew Ming Kei Kwok
- Head and Neck Surgical OncologyPeter MacCallum Cancer Centre Melbourne Victoria Australia
| | - Matthew J. R. Magarey
- Head and Neck Surgical OncologyPeter MacCallum Cancer Centre Melbourne Victoria Australia
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12
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Ahmed M, Daneshvar C, Breen D. Routine neck ultrasound by respiratory physicians in the diagnosis and staging of patients with lung cancer and mediastinal lymphadenopathy: a prospective pilot study. ERJ Open Res 2020; 6:00180-2019. [PMID: 32055635 PMCID: PMC7008141 DOI: 10.1183/23120541.00180-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/27/2019] [Indexed: 12/25/2022] Open
Abstract
Introduction Cervical lymphadenopathy in lung cancer indicates advanced disease. The presence of mediastinal lymphadenopathy is commonly associated with involvement of neck lymph nodes and some studies suggest routine neck ultrasound (NUS) in this group of patients. We conducted a two-phase study looking at training a respiratory physician to perform ultrasound-guided neck lymph node aspiration in patients with suspected lung cancer. Methods In the first phase of the study, one of the authors underwent training in NUS according to predetermined criteria. The adequacy of sampling was prospectively recorded. In the second phase, consecutive patients with suspected lung cancer and mediastinal lymphadenopathy underwent NUS and sampling of abnormal lymph nodes. The outcomes were the adequacy of samples for pathological analysis and molecular analysis, prevalence of cervical lymphadenopathy, and change in stage. Results Following the period of training, 35 patients underwent neck node sampling with an overall adequacy of 88.6% (95% CI 78.1–99.1%). Cervical lymph node involvement was confirmed in 13 out of 30 patients with lung cancer (43.3%, 95% CI 25.5–62.6%). Further immunohistochemistry and molecular studies were possible in all patients when it was required (nine cases). NUS led to nodal upstaging in four out of 30 (13.3%) cases. Conclusion Training a respiratory physician to perform NUS and needle sampling to an acceptable level is feasible. Benefits of embedding this procedure in lung cancer diagnosis and pathway staging need to be explored in further studies. It is feasible to train respiratory physicians to perform ultrasound-guided sampling of cervical lymph nodes. In lung cancer patients with mediastinal lymphadenopathy, 43% had cervical lymph node involvement with reduction in the number requiring EBUS.http://bit.ly/33LekBa
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Affiliation(s)
- Mohammed Ahmed
- Interventional Respiratory Unit, Galway University Hospital, Galway, Ireland.,The Chest Centre, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Cyrus Daneshvar
- Dept of Thoracic Medicine, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - David Breen
- Interventional Respiratory Unit, Galway University Hospital, Galway, Ireland
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Kahramangil B, Kose E, Donmez M, Aydin H, Reynolds JP, Krishnamurthy V, Jin J, Shin J, Siperstein A, Berber E. Thyroglobulin washout from cervical lymph node fine needle aspiration biopsies in patients with differentiated thyroid cancer: an analysis of different expressions to use in post-total thyroidectomy follow-up. Surgery 2019; 167:34-39. [PMID: 31495510 DOI: 10.1016/j.surg.2019.05.083] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Although frequently used as an adjunct to cytology in patients with differentiated thyroid cancers, interpretation of thyroglobulin washout remains unclear. We aim to compare the utility of different analytic tools to develop recommendations for use in post-total thyroidectomy follow-up. METHODS This is an institutional review board-approved retrospective study of patients who underwent lymph node fine needle aspiration biopsy with thyroglobulin washout between 2012 and 2018, during the post-total thyroidectomy follow-up of differentiated thyroid cancer. The utilities of thyroglobulin washout concentration, thyroglobulin washout/serum thyroglobulin ratio, and absolute thyroglobulin content were compared. RESULTS Sixty-four patients underwent 79 fine needle aspirations with thyroglobulin washout of cervical lymph nodes. Fifty-two lymph nodes were found to be metastatic and 27 benign. One patient had a pathologically confirmed lymph node metastasis despite a thyroglobulin washout of 0. The optimal cutoffs of thyroglobulin washout, thyroglobulin washout/serum thyroglobulin ratio, and absolute thyroglobulin content to predict metastatic involvement were 2.5 ng/ml (94% sensitive, 100% specific), 0.1 (100% sensitive and specific), and 12.5 (94% sensitive, 100% specific), respectively. The second measure lacked utility in patients with undetectable serum thyroglobulin. CONCLUSION The use of thyroglobulin washout concentration or thyroglobulin washout/serum thyroglobulin ratio has drawbacks based on variations in technique and clinical scenario. Absolute thyroglobulin content is an alternative that may be a more objective expression of thyroglobulin washout.
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Affiliation(s)
- Bora Kahramangil
- Department of Endocrine Surgery, Cleveland Clinic, OH; Department of General Surgery, Cleveland Clinic Florida, Weston, FL
| | - Emin Kose
- Department of Endocrine Surgery, Cleveland Clinic, OH
| | | | - Husnu Aydin
- Department of Endocrine Surgery, Cleveland Clinic, OH
| | | | | | - Judy Jin
- Department of Endocrine Surgery, Cleveland Clinic, OH
| | - Joyce Shin
- Department of Endocrine Surgery, Cleveland Clinic, OH
| | | | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, OH.
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Horvath L, Kraft M. Evaluation of ultrasound and fine-needle aspiration in the assessment of head and neck lesions. Eur Arch Otorhinolaryngol 2019; 276:2903-2911. [DOI: 10.1007/s00405-019-05552-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/06/2019] [Indexed: 12/17/2022]
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15
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Otolaryngologist and pediatric oncologist perspectives on the role of fine needle aspiration in diagnosing pediatric head and neck masses. Int J Pediatr Otorhinolaryngol 2019; 121:34-40. [PMID: 30861425 DOI: 10.1016/j.ijporl.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/29/2019] [Accepted: 03/04/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine how otolaryngologists and pediatric oncologists differ in their initial approach to diagnosing head and neck masses in children and adolescents. METHODS We designed an electronic 28-question survey consisting of 4 clinical cases and one referral case varying by patient age, history, and physical exam findings. The survey was sent anonymously to pediatric oncologists and otolaryngologists at institutions in the United States and Canada. RESULTS Two hundred and thirty one pediatric oncologists (29.4%) and 87 otolaryngologists (39.5%) completed the survey. Otolaryngologists were significantly more likely to recommend performing an FNA than oncologists in all four cases; less than 7% of pediatric oncologists recommended FNA for head and neck mass evaluation. Of providers who recommended FNA, otolaryngologists were more likely to do so because of diagnostic yield when compared to pediatric oncologists. However, when referred a patient with an FNA demonstrating non-Hodgkin lymphoma, the majority of pediatric oncologists (73.6%) and otolaryngologists (78.7%) would complete the staging work-up and begin treatment. If the same patient was referred with an FNA that demonstrated non-specific inflammation, most oncologists (91.0%) and otolaryngologists (94.4%) would biopsy the mass. CONCLUSION Otolaryngologists and pediatric oncologists differ in their initial approach to diagnosing head and neck masses in children, yet they both would recommend treating a patient with a positive FNA. This highlights important differences in the diagnostic process depending on which provider sees the patient first. Further studies assessing the sensitivity and specificity are needed to determine the true diagnostic yield of FNAs in the assessment of head and neck masses in children and adolescents, especially with increasing need for molecular and genomic profiling.
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Ahn D, Lee GJ, Sohn JH, Jeong JY. Fine‐needle aspiration cytology versus core‐needle biopsy for the diagnosis of extracranial head and neck schwannoma. Head Neck 2018; 40:2695-2700. [DOI: 10.1002/hed.25520] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 08/12/2018] [Accepted: 10/09/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Dongbin Ahn
- Department of Otolaryngology‐Head and Neck Surgery, School of MedicineKyungpook National University Daegu Republic of Korea
| | - Gil Joon Lee
- Department of Otolaryngology‐Head and Neck Surgery, School of MedicineKyungpook National University Daegu Republic of Korea
| | - Jin Ho Sohn
- Department of Otolaryngology‐Head and Neck Surgery, School of MedicineKyungpook National University Daegu Republic of Korea
| | - Ji Yun Jeong
- Department of Pathology, School of MedicineKyungpook National University Daegu Republic of Korea
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Kahramangil B, Kose E, Donmez M, Aydin H, El-Dabh D, Krishnamurthy V, Jin J, Shin JJM, Siperstein A, Berber E. Efficacy of surgeon-performed, ultrasound-guided lymph node fine needle aspiration in patients with thyroid pathologic conditions. Surgery 2018; 164:657-664. [PMID: 30072253 DOI: 10.1016/j.surg.2018.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Although the concept of surgeon-performed fine needle aspiration of thyroid nodules is established, experience with surgeon-performed lymph node fine needle aspiration is scant. We aimed to study the efficacy of surgeon-performed lymph node fine needle aspiration in patients with thyroid pathologic conditions. METHODS This is an institutional review board-approved study of patients with thyroid pathologic conditions who underwent surgeon-performed lymph node fine needle aspiration between 2002 and 2017. Efficacy and utility were analyzed. RESULTS A total of 201 patients with benign nodular goiter (n = 30) and thyroid cancer (n = 200) underwent 230 lymph node fine needle aspirations (89 during preoperative workup, 141 at postoperative follow-up). Insufficient aspiration rate was 6% and indeterminate cytologic results 3%. In 91% of patients with suspicious lymph nodes, definite diagnosis could be obtained by fine needle aspiration; 51% (n = 118) of fine needle aspirations indicated metastasis from thyroid cancer and 40% (n = 91) benign findings. Sensitivity and specificity of lymph node fine needle aspiration in diagnosing nodal metastasis were 92% and 89%, respectively. Cytologic testing and thyroglobulin washout indicated 95% concordance. On logistic regression, spherical shape, microcalcifications, cystic appearance, and loss of hilum on ultrasound independently predicted lymph node metastasis. CONCLUSION Our data indicate that an adequate surgeon-performed lymph node fine needle aspiration is highly accurate in diagnosing nodal status in thyroid pathologic conditions. We recommend adoption of this technique, when feasible, to develop an efficient, comprehensive thyroid practice.
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Affiliation(s)
- Bora Kahramangil
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH
| | - Emin Kose
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH
| | - Mustafa Donmez
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH
| | - Husnu Aydin
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH
| | - Daniel El-Dabh
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH
| | | | - Judy Jin
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH
| | | | - Allan Siperstein
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH.
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Sellami M, Charfi S, Chaabouni MA, Mrabet S, Charfeddine I, Ayadi L, Kallel S, Ghorbel A. Fine needle non-aspiration cytology for the diagnosis of cervical lymph node tuberculosis: a single center experience. Braz J Otorhinolaryngol 2018; 85:617-622. [PMID: 30017875 PMCID: PMC9443027 DOI: 10.1016/j.bjorl.2018.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/13/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction The fine-needle cytology is being used as a first line of investigation in the diagnosis of head and neck swellings, as it is simple, cost effective and less invasive as compared to biopsy. Objective The aims of this study were to evaluate the results of the fine-needle non-aspiration cytology of cervical lymphadenopathy and to study the factors influencing the rate of non-diagnosis results. Methods This retrospective study was conducted on selected patients with cervical lymphadenopathy that had undergone a fine-needle non-aspiration cytology followed by a histological biopsy. The sensitivity, specificity, positive predictive value and negative predictive value of fine-needle non-aspiration cytology for diagnosing tuberculosis were estimated. The risk factors of non-diagnosis results were evaluated. Results The sensitivity, specificity, positive predictive value rates of fine-needle non-aspiration cytology for tuberculosis were 83.3%, 83.3%, 78.9% and 86.9% respectively. In total, 47 out of the 131 samples (35.8%) were considered non-diagnosis. Of the non-diagnosis samples, 84.2% (38 out of 47) were benign mostly due to tuberculosis (30 cases). Among the studied factors, only tuberculosis (confirmed by histopathological examination) was significantly associated with non-diagnosis cytology (p = 0.02, Odds-Ratio = 2.35). Conclusion Tuberculosis is currently the commonest cause of cervical lymphadenopathy in North Africa. Fine-needle non-aspiration cytology is safe and accurate in the diagnosis of cervical tuberculous lymph node that is associated with the risk of non-diagnosis cytology.
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Affiliation(s)
- Moncef Sellami
- Habib Bourguiba University Hospital, Department of Otorhinolaryngology-Head and Neck Surgery, Sfax, Tunisia.
| | - Slim Charfi
- Habib Bourguiba University Hospital, Department of Anatomopathology, Sfax, Tunisia
| | - Mohamed Amine Chaabouni
- Habib Bourguiba University Hospital, Department of Otorhinolaryngology-Head and Neck Surgery, Sfax, Tunisia
| | - Salma Mrabet
- Habib Bourguiba University Hospital, Department of Otorhinolaryngology-Head and Neck Surgery, Sfax, Tunisia
| | - Ilhem Charfeddine
- Habib Bourguiba University Hospital, Department of Otorhinolaryngology-Head and Neck Surgery, Sfax, Tunisia
| | - Lobna Ayadi
- Habib Bourguiba University Hospital, Department of Anatomopathology, Sfax, Tunisia
| | - Souha Kallel
- Habib Bourguiba University Hospital, Department of Otorhinolaryngology-Head and Neck Surgery, Sfax, Tunisia
| | - Abdelmonem Ghorbel
- Habib Bourguiba University Hospital, Department of Otorhinolaryngology-Head and Neck Surgery, Sfax, Tunisia
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Arlı C, Şanlı A, Aydın S, Evren C, Tezer İ. Baş-Boyun Kitlelerinde İnce İğne Aspirasyon Biyopsisinin Değeri: İİAB ile Cerrahi Sonrası Patoloji Sonuçlarının Karşılaştırılması. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2018. [DOI: 10.17944/mkutfd.446030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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20
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Schmid RL, Cohen MB. Partial Verification Distorts Estimates of Sensitivity in Diagnostic Accuracy Studies for Fine-Needle Aspiration Cytology. Ann Surg Oncol 2017; 24:634-636. [PMID: 29067604 DOI: 10.1245/s10434-017-6155-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Robert L Schmid
- University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Michael B Cohen
- University of Utah School of Medicine, Salt Lake City, UT, USA
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Moshtaghi O, Haidar YM, Mahmoodi A, Tjoa T, Armstrong WB. The Role of In-Office Ultrasound in the Diagnosis of Neck Masses. Otolaryngol Head Neck Surg 2017; 157:58-61. [PMID: 28669308 DOI: 10.1177/0194599817696288] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
To evaluate the efficacy of otolaryngologist-performed in-office ultrasound (US) in the clinical assessment of lateral neck masses, we performed a retrospective review of patients with lateral neck masses who had both a surgeon-performed US and US-guided fine-needle aspiration (USGFNA) at our tertiary academic center from 2012 to 2015. Fifty-nine patients were included. USGFNA results included 32 (54%) malignant lesions, 23 (39%) benign lesions, and 4 (6%) nondiagnostic lesions. USGFNA demonstrated 85% accuracy. In 22 (37%) patients, in-office US revealed additional findings that were not identified on physical examination (eg, nonpalpable lymph nodes or elucidated anatomical structures), which either assisted in surgical planning or altered treatment. In-office US and USGFNA on initial evaluation by the otolaryngologist augment physical examination and have potential value as the primary imaging and diagnostic modality in the workup of lateral neck masses.
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Affiliation(s)
- Omid Moshtaghi
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - Yarah M Haidar
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - Amin Mahmoodi
- 2 Department of Biomedical Engineering, University of California, Irvine, Orange, California
| | - Tjoson Tjoa
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - William B Armstrong
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
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Ahn D, Roh JH, Kim JK. Ultrasound-Guided Core Needle Biopsy for Head and Neck Mass Lesions in Patients Undergoing Antiplatelet or Anticoagulation Therapy: A Preliminary Report. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1339-1346. [PMID: 28370160 DOI: 10.7863/ultra.16.05045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 09/23/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES We compared the complications and diagnostic adequacy of ultrasound (US)-guided core needle biopsy (CNB) for head and neck mass lesions between patients who did and did not receive antiplatelet/anticoagulation therapy. METHODS This study was designed as a prospective case study including 146 consecutive patients who underwent US-guided CNB for head and neck mass lesions. Of these, 32 patients were undergoing antiplatelet/anticoagulation therapy involving aspirin, clopidogrel, cilostazol, and warfarin. RESULTS None of the patients had clinical bleeding/hematoma in either group. Subclinical bleeding/hematoma recognized only by a US examination was not significantly different between the groups (P = .229). No other complications were noticed. The rate of unsatisfactory sampling was also not different between the groups (P > .999). Furthermore, when patients receiving aspirin (n = 18) were reclassified into the no-antiplatelet/anticoagulation therapy group, there was still no significant difference in the incidences of complications compared with the patients receiving clopidogrel, cilostazol, or warfarin (n = 14). CONCLUSIONS Our study suggests that US-guided CNB is safe and provides good diagnostic results without necessitating the discontinuation of antiplatelet/anticoagulation therapy in patients with head and neck mass lesions. However, as this was a preliminary study, the cohort was relatively small. Larger studies are needed to confirm our findings.
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Affiliation(s)
- Dongbin Ahn
- Departments of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jae-Hyung Roh
- Department of Cardiology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jeong Kyu Kim
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Catholic University of Daegu, Daegu, Korea
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Patel R, R. Skandarajah A, Gorelik A, Shears MJ, Tasevski R, Miller JA. One-stop thyroid nodule clinic with same-day fine-needle aspiration cytology improves efficiency of care. ANZ J Surg 2016; 88:354-358. [DOI: 10.1111/ans.13833] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/07/2016] [Accepted: 09/25/2016] [Indexed: 01/26/2023]
Affiliation(s)
- Rajeshbhai Patel
- Endocrine Surgery Unit; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Anita R. Skandarajah
- Endocrine Surgery Unit; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
| | - Alexandra Gorelik
- Melbourne Epicentre; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Matthew J. Shears
- Endocrine Surgery Unit; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Robert Tasevski
- Endocrine Surgery Unit; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
| | - Julie A. Miller
- Endocrine Surgery Unit; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
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Sharma GK, Sofferman RA, Armstrong WB. Evaluation of the American college of surgeons thyroid and parathyroid ultrasound course: Results of a web-based survey. Laryngoscope 2016; 127:1950-1958. [PMID: 27716990 DOI: 10.1002/lary.26335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVES/HYPOTHESIS The American College of Surgeons Thyroid and Parathyroid Ultrasound Skills-Oriented Course (TPUSC) was designed to teach surgeons how to interpret and perform office-based head and neck ultrasound (HNUS). The objective of this study was to survey attendees of the TPUSC to evaluate the usefulness of the course, to track surgeon performed HNUS practice patterns, and to help identify potential roadblocks to incorporation of HNUS into a surgeon's practice. STUDY DESIGN Cross-sectional survey. METHODS A Web-based survey was sent to 952 surgeons who completed the TPUSC between 2010 and 2014. Questions included surgeon specialty, practice type, Likert scale rating of the TPUSC, competency with different HNUS procedures, and current HNUS practice patterns. RESULTS The response rate was 24%. On a scale from 1 (not useful) to 5 (extremely valuable), the mean course usefulness rating was 4.2. Educational goals were met for 194 (92%) surgeons, and 162 (77%) surgeons reported performing HNUS in their practice. Of 48 surgeons not performing HNUS, 24 (50%) attributed insufficient time in their clinic schedule, and 21 (44%) attributed high equipment costs. CONCLUSIONS The TPUSC is a valuable educational experience for surgeons seeking to gain proficiency in HNUS. The majority of TPUSC graduates gain competency with at least one type of HNUS procedure following the course. LEVEL OF EVIDENCE NA Laryngoscope, 127:1950-1958, 2017.
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Affiliation(s)
- Giriraj K Sharma
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
| | - Robert A Sofferman
- Division of Otolaryngology-Head and Neck Surgery, University of Vermont College of Medicine, Burlington, Vermont, U.S.A
| | - William B Armstrong
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
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Ahn D, Sohn JH, Yeo CK, Jeon JH. Feasibility of surgeon-performed ultrasound-guided core needle biopsy in the thyroid and lymph nodes. Head Neck 2015; 38 Suppl 1:E1413-8. [DOI: 10.1002/hed.24235] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Dongbin Ahn
- Department of Otolaryngology - Head and Neck Surgery, School of Medicine; Kyungpook National University; Daegu Korea
| | - Jin Ho Sohn
- Department of Otolaryngology - Head and Neck Surgery, School of Medicine; Kyungpook National University; Daegu Korea
| | - Chang Ki Yeo
- Department of Otolaryngology - Head and Neck Surgery, School of Medicine; Keimyung University; Daegu Korea
| | - Jae Han Jeon
- Department of Endocrinology, School of Medicine; Kyungpook National University; Daegu Korea
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