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Mascarella MA, Ferdus J, Vendra V, Sridharan S, Sultanem K, Tsien C, Shenouda G, Bouganim N, Esfahani K, Richardson K, Mlynarek A, Sadeghi N, Hier M, Kergoat MJ. Sarcopenia predicts short-term treatment-related toxicity in patients undergoing curative-intent therapy for head and neck cancer: A systematic review and meta-analysis. Head Neck 2024; 46:1500-1509. [PMID: 38353170 DOI: 10.1002/hed.27688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/27/2023] [Accepted: 02/05/2024] [Indexed: 05/14/2024] Open
Abstract
Sarcopenia is an increasingly recognized biomarker associated with poorer outcomes. The objective of this study was to ascertain the effect of sarcopenia on treatment tolerance and short-term toxicity in head and neck cancer (HNC). A systematic review was performed using multiple databases. An inverse-variation, random-effects model was used to perform the meta-analysis to evaluate the effect of sarcopenia on severe treatment toxicity and poor treatment tolerance. Sixteen observational studies, including 3187 patients with HNC, were analyzed. The combined odds ratio (OR) for severe treatment toxicity and tolerance was 2.22 (95%CI 1.50-3.29) and 1.40 (95%CI 0.84-2.32), respectively. The effect of sarcopenia on short-term severe treatment toxicity was similar with upfront surgery (OR 2.03, 95%CI 1.22-3.37) and definitive radiotherapy (OR 2.24, 95%CI 1.18-4.27) Patients with sarcopenia are more than twice as likely to suffer a short-term treatment-related toxicity when undergoing curative-intent HNC treatment.
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Affiliation(s)
- Marco A Mascarella
- Department of Biomedical Sciences, Université de Montréal, Montreal, Quebec, Canada
- Department of Otolaryngology, McGill University, Montreal, Quebec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
| | - Jannatul Ferdus
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada
| | - Varun Vendra
- Department of Otolaryngology - Head and Neck Surgery, Temple University, Philadelphia, Pennsylvania, USA
| | - Shaum Sridharan
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Khalil Sultanem
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | - Christina Tsien
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | - George Shenouda
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | - Nathaniel Bouganim
- Division of Medical Oncology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Khashayar Esfahani
- Division of Medical Oncology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Keith Richardson
- Department of Otolaryngology, McGill University, Montreal, Quebec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology, McGill University, Montreal, Quebec, Canada
| | - Nader Sadeghi
- Department of Otolaryngology, McGill University, Montreal, Quebec, Canada
| | - Michael Hier
- Department of Otolaryngology, McGill University, Montreal, Quebec, Canada
| | - Marie-Jeanne Kergoat
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Research Center, Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-sud-de-l'Ile- de-Montréal, Montreal, Quebec, Canada
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Silver JA, Bouganim N, Richardson K, Henry M, Mascarella MA, Ramirez-GarciaLuna J, Golabi N, Mlynarek AM, Zeitouni A, Hier MP, Caglar D, Esfahani K, Sadeghi N. Quality of Life After Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Oropharynx Cancer. JAMA Otolaryngol Head Neck Surg 2024; 150:65-74. [PMID: 38060238 PMCID: PMC10704343 DOI: 10.1001/jamaoto.2023.3781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/09/2023] [Indexed: 12/08/2023]
Abstract
Importance Efforts are underway to deintensified treatment protocols for patients with human papillomavirus virus-associated oropharyngeal squamous cell carcinoma (HPV-OPSCC) to achieve similar excellent oncologic outcomes while reducing treatment-related adverse effects. Transoral robotic surgery (TORS) as primary treatment often requires adjuvant therapy due to the high incidence of nodal metastasis. Treatment with neoadjuvant chemotherapy followed by TORS and neck dissection (NECTORS), reserving radiation therapy for salvage, yields excellent oncologic outcomes. Objective To assess patient-reported quality of life (QOL) and functional outcomes among patients with HPV-OPSCC who undergo NECTORS. Design, Settings, and Participants This was a multicenter prospective cohort study of patients with HPV-OPSCC treated with the NECTORS protocol in 2017 to 2022. Consecutive patients with stage III or IVa HPV-OPSCC treated with NECTORS in 2017 to 2022 who had completed the primary QOL questionnaire at baseline and at least once during the 24-month follow-up period were included. Ninety-four patients were eligible, and 67 were included in the analyses. Outcome Measures QOL questionnaires at baseline, and at month 1, 3, 6, 12, 18, and 24 posttreatment. Global score on the 30-item European Organization for Research and Treatment of Cancer Core quality of life questionnaire (EORTC QLQ-C30) was the primary outcome; the head and neck extension module (EORTC QLQ-HN35); the MD Anderson Dysphagia Inventory for dysphagia-related QOL; and the Decision Regret Scale were also used. Paired t tests assessed change between the baseline and 12- or 24-month patient-reported outcomes. Results Among the study population of 67 patients (median [range] age, 63 [58-67] years; 54 [80.6%] male) with HPV-OPSCC, the most frequent cancer subsites were palatine tonsil (41 [61%]) and base of tongue (26 [39%]); none required adjuvant RT. Global QOL at 24 months improved compared with baseline (mean difference, 9.49; 95% CI, 2.45 to 16.53). All EORTC QLQ-C30 functional scores returned to baseline or improved within 3 to 6 months posttreatment and remained stable at 24 months. EORTC QLQ-HN35 symptom scale scores improved or were stable at 24 months. The MD Anderson Dysphagia Inventory scores demonstrated no significant difference between baseline and month 12 for global scores (mean difference, 6.15; 95% CI, -4.18 to 16.49) and composite scores (mean difference, 2.73; 95% CI, -1.62 to 7.09). Median (range) score on the Decision Regret Scale was 5 of 100 (0-30), representing mild overall regret. Conclusion and Relevance The findings of this multicenter cohort study indicate that use of the NECTORS protocol is associated with excellent QOL outcomes. QOL measures returned to baseline levels or were better than baseline, which represents positive outcomes for patients with HPV-OPSCC who undergo this treatment regimen.
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Affiliation(s)
- Jennifer A. Silver
- Department of Otolaryngology−Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nathaniel Bouganim
- Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Keith Richardson
- Department of Otolaryngology−Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Melissa Henry
- Department of Otolaryngology−Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada
- Lady Davis Research Institute, McGill University, Montreal, Quebec, Canada
- Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Marco A. Mascarella
- Department of Otolaryngology−Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Otolaryngology−Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Nahid Golabi
- Department of Otolaryngology−Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Alex M. Mlynarek
- Department of Otolaryngology−Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Anthony Zeitouni
- Department of Otolaryngology−Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Michael P. Hier
- Department of Otolaryngology−Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Derin Caglar
- Department of Pathology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Khashayar Esfahani
- Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nader Sadeghi
- Department of Otolaryngology−Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada
- Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
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Quttaineh D, Pusztaszeri M, Mlynarek A, Hier MP, Mascarella MA. Latent Granulomatous Foreign Body Reaction to Dermal Fillers: A Case Report. Ear Nose Throat J 2023:1455613231213256. [PMID: 38140878 DOI: 10.1177/01455613231213256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Affiliation(s)
- Danah Quttaineh
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Marc Pusztaszeri
- Department of Pathology, McGill University, Montreal, QC, Canada
| | - Alex Mlynarek
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Michael P Hier
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Marco A Mascarella
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Clinical Epidemiology, Lady Davis Institute of the Jewish General Hospital, Montreal, QC, Canada
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Marcotte A, Mascarella MA, Nguyen LH, Nemeth J. Just the facts: indications and technique for emergency tracheotomy. CAN J EMERG MED 2023; 25:653-655. [PMID: 37300653 DOI: 10.1007/s43678-023-00538-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Audrey Marcotte
- Department of Emergency Medicine, McGill University, Montreal, QC, Canada.
- McGill University Health Center, Montreal, QC, Canada.
| | - Marco A Mascarella
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - L H Nguyen
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
- Department of Pediatric Surgery, McGill University, Montreal, QC, Canada
- Institute of Health Sciences Education, McGill University, Montreal, QC, Canada
| | - Joe Nemeth
- Department of Emergency Medicine, McGill University, Montreal, QC, Canada
- McGill University Health Center, Montreal, QC, Canada
- Department of Pediatrics, McGill University, Montreal, QC, Canada
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Alghazawi N, Young M, Mascarella MA, Aldea A, Le Blanc G, Nguyen LHP. Delineating Blurred Lines: The Experience of Defining Core Competencies in Canadian Surgical Residency Programs. J Grad Med Educ 2023; 15:432-435. [PMID: 37637329 PMCID: PMC10449342 DOI: 10.4300/jgme-d-22-00833.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Affiliation(s)
- Nebras Alghazawi
- All authors are with McGill University, Montreal, Quebec, Canada. Nebras Alghazawi, MD, at the time of writing, was a Medical Student, McGill University Faculty of Medicine, and is now a Family Physician practicing emergency medicine in Gatineau, Quebec
| | - Meredith Young
- Meredith Young, PhD, is Associate Professor, Institute of Health Sciences Education, and Department of Medicine
| | - Marco A Mascarella
- Marco A. Mascarella, MD, MSc, is an Otolaryngologist and Assistant Professor, Department of Otolaryngology-Head & Neck Surgery
| | - Andrei Aldea
- Andrei Aldea, MD, at the time of writing, was a Medical Student, McGill University Faculty of Medicine, and is now a Family Physician, Urgences Pédiatriques Center for Pediatric Emergencies and Specialized Care, Montreal and is associated with McGill University
| | - Gabriella Le Blanc
- Gabriella Le Blanc, BSc, at the time of writing, was a Medical Student, McGill University Faculty of Medicine, and is now a Resident in Otolaryngology, McGill University; and
| | - Lily HP Nguyen
- Lily HP Nguyen, MD, MSc, is a Pediatric Otolaryngologist and Associate Professor, Department of Otolaryngology-Head & Neck Surgery
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Mascarella MA, Olonisakin TF, Rumde P, Vendra V, Nance MA, Kim S, Kubik MW, Sridharan SS, Ferris RL, Fenton MJ, Clayburgh DR, Ohr JP, Joyce SC, Sen M, Herman JG, Grandis JR, Zandberg DP, Duvvuri U. Response to Neoadjuvant Targeted Therapy in Operable Head and Neck Cancer Confers Survival Benefit. Clin Cancer Res 2023; 29:723-730. [PMID: 36595540 DOI: 10.1158/1078-0432.ccr-22-1768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/01/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Neoadjuvant targeted therapy provides a brief, preoperative window of opportunity that can be exploited to individualize cancer care based on treatment response. We investigated whether response to neoadjuvant therapy during the preoperative window confers survival benefit in patients with operable head and neck squamous cell carcinoma (HNSCC). PATIENTS AND METHODS A pooled analysis of treatment-naïve patients with operable HNSCC enrolled in one of three clinical trials from 2009 to 2020 (NCT00779389, NCT01218048, NCT02473731). Neoadjuvant regimens consisted of EGFR inhibitors (n = 83) or anti-ErbB3 antibody therapy (n = 9) within 28 days of surgery. Clinical to pathologic stage migration was compared with disease-free survival (DFS) and overall survival (OS) while adjusting for confounding factors using multivariable Cox regression. Circulating tumor markers validated in other solid tumor models were analyzed. RESULTS 92 of 118 patients were analyzed; all patients underwent surgery following neoadjuvant therapy. Clinical to pathologic downstaging was more frequent in patients undergoing neoadjuvant targeted therapy compared with control cohort (P = 0.048). Patients with pathologic downstage migration had the highest OS [89.5%; 95% confidence interval (CI), 75.7-100] compared with those with no stage change (58%; 95% CI, 46.2-69.8) or upstage (40%; 95% CI, 9.6-70.4; P = 0.003). Downstage migration remained a positive prognostic factor for OS (HR, 0.22; 95% CI, 0.05-0.90) while adjusting for measured confounders. Downstage migration correlated with decreased circulating tumor markers, SOX17 and TAC1 (P = 0.0078). CONCLUSIONS Brief neoadjuvant therapy achieved pathologic downstaging in a subset of patients and was associated with significantly better DFS and OS as well as decreased circulating methylated SOX17 and TAC1.
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Affiliation(s)
- Marco A Mascarella
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
| | - Tolani F Olonisakin
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Purva Rumde
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Varun Vendra
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Melonie A Nance
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- VA Pittsburgh Health System, Pittsburgh, Pennsylvania
| | - Seungwon Kim
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mark W Kubik
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Shaum S Sridharan
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Robert L Ferris
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Moon J Fenton
- UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Division of Hematology and Oncology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Daniel R Clayburgh
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon
| | - James P Ohr
- UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Division of Hematology and Oncology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sonali C Joyce
- UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Division of Hematology and Oncology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Malabika Sen
- UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Division of Hematology and Oncology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - James G Herman
- UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Division of Hematology and Oncology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jennifer R Grandis
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California
| | - Dan P Zandberg
- UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Division of Hematology and Oncology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Umamaheswar Duvvuri
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- UPMC Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Morand GB, Alsayegh R, Mlynarek AM, Plourde M, Mach T, Mascarella MA, Hier MP, Florianova L, Pusztaszeri MP. Application of the Milan system for reporting salivary gland cytopathology using cell blocks. Virchows Arch 2022; 481:575-583. [PMID: 35750873 DOI: 10.1007/s00428-022-03364-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/24/2022]
Abstract
The Milan system for reporting salivary gland cytopathology (MSRSGC) is a novel standardized classification tool for salivary gland cytology specimens based on the use of direct smears. Formalin-fixed paraffin-embedded (FFPE) cell blocks facilitate the use of ancillary studies, leading to improved diagnostic accuracy. However, the application of the MSRSGC with only cell blocks has not been well established. Consecutive cohort of all parotid gland cytology specimens between 01/01/2018 and 30/06/2021 was performed. All cytology specimens were processed into cell blocks only. Cytologic diagnoses were classified prospectively according to the MSRSGC categories. The risk of malignancy (ROM) for each diagnostic category and the diagnostic performance were calculated. A total of 230 FNA samples from 221 patients were identified, including 47% and 78.4% with surgical or clinical follow-up, respectively. The ROMs based on surgical follow-up for the non-diagnostic, non-neoplastic, AUS, neoplasm: benign, SUMP, SFM and malignant categories were 21.4%,0%,50%,0%,30%,100% and 100%, respectively. The ROMs based on the clinical follow-up for these categories were 7.3%,0%,37.3%,0%,27.3%,100% and 100%, respectively. Following surgical excision, all Milan IVa category samples were confirmed as benign, and all Milan V and VI category samples were confirmed as malignant. This study validates the application of the MSRSGC with the sole use of FFPE cell blocks. The diagnostic accuracy of MSRSGC is high and compares favorably to other institutions using traditional cytology assessment methods. Furthermore, FNA results using this technique enabled to provide optimal patient management based on the ROM of the different Milan system categories.
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Affiliation(s)
- Grégoire B Morand
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Raihanah Alsayegh
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Alex M Mlynarek
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Marianne Plourde
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Tiffany Mach
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Marco A Mascarella
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Michael P Hier
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Livia Florianova
- Department of Pathology, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine Road, Montreal, QC, Canada
| | - Marc P Pusztaszeri
- Department of Pathology, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine Road, Montreal, QC, Canada.
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Morand GB, Sultanem K, Mascarella MA, Hier MP, Mlynarek AM. Historical Perspective: How the Discovery of HPV Virus Led to the Utilization of a Robot. Front Oral Health 2022; 3:912861. [PMID: 35601819 PMCID: PMC9120614 DOI: 10.3389/froh.2022.912861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/20/2022] [Indexed: 12/14/2022] Open
Abstract
The treatment of oropharyngeal cancer has undergone many paradigms shifts in recent decades. First considered a surgical disease, improvements in radiotherapy led to its popularization in the 1990s. Subsequently, the discovery of the human papillomavirus (HPV) in the pathogenesis of oropharyngeal cancer, as well as the increase in HPV-associated oropharynx cancer incidence, have prompted a reevaluation of its management. Its sensitivity to standard treatment with a favorable prognosis compared to non HPV-associated oropharyngeal cancer led to a focus on minimizing treatment toxicity. Advances in radiation and surgical techniques, including the use of transoral robotic surgery, gave the rationale to ongoing de-escalation clinical trials in HPV-associated oropharynx cancer.
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Affiliation(s)
- Grégoire B. Morand
- Department of Otolaryngology Head and Neck Surgery, Centre Intégré Universitaire de Santé et de Services Sociaux West-Central Montreal-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Khalil Sultanem
- Department of Radiation Oncology, Centre Intégré Universitaire de Santé et de Services Sociaux West-Central Montreal-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Marco A. Mascarella
- Department of Otolaryngology Head and Neck Surgery, Centre Intégré Universitaire de Santé et de Services Sociaux West-Central Montreal-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Michael P. Hier
- Department of Otolaryngology Head and Neck Surgery, Centre Intégré Universitaire de Santé et de Services Sociaux West-Central Montreal-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Alex M. Mlynarek
- Department of Otolaryngology Head and Neck Surgery, Centre Intégré Universitaire de Santé et de Services Sociaux West-Central Montreal-Jewish General Hospital, McGill University, Montreal, QC, Canada
- *Correspondence: Alex M. Mlynarek
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Mascarella MA, Patel T, Vendra V, Gardiner L, Kergoat MJ, Kubik MW, Solari MG, Snyderman CH, Traylor KS, Ferris RL, Kim S, Duvvuri U, Sridharan SS. Poor treatment tolerance in head and neck cancer patients with low muscle mass. Head Neck 2022; 44:844-850. [PMID: 35020252 DOI: 10.1002/hed.26978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/05/2021] [Accepted: 01/03/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND We ascertain the role of a low cervical paraspinal skeletal muscle index (CPSMI) as a biomarker for poor treatment tolerance in patients with operable mucosal head and neck squamous cell carcinoma (HNSCC). METHODS A prospective cohort of patients with operable HNSCC requiring microvascular reconstruction was evaluated. Low CPSMI was calculated using preoperative CT neck imaging. Poor treatment tolerance, a composite measure of incomplete therapy or severe morbidity/mortality during treatment, was the primary outcome. RESULTS One hundred and twenty-seven patients underwent extirpative surgery with a mean age was 60.5. Poor treatment tolerance occurred in 71 (56%) patients with 21 not completing recommended adjuvant therapy and 66 having severe treatment-related morbidity. A low CPSMI was independently associated with poor treatment tolerance (OR 2.49, 95%CI 1.10-5.93) and delay to adjuvant therapy (OR 4.48, 95%CI 1.07-27.6) after adjusting for multiple confounders. CONCLUSION Low CPSMI was independently associated with poor treatment tolerance in patients with operable HNSCC.
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Affiliation(s)
- Marco A Mascarella
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Biomedical Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- Lady Davis Institute of the Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Terral Patel
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Varun Vendra
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Lauren Gardiner
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Marie-Jeanne Kergoat
- Department of Biomedical Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- Division of Geriatrics, Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Mark W Kubik
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mario G Solari
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carl H Snyderman
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Katie S Traylor
- Department of Diagnostic Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Robert L Ferris
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Seungwon Kim
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Umamaheswar Duvvuri
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shaum S Sridharan
- Department of Otolaryngology - Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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10
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Mascarella MA, Gardiner L, Patel T, Vendra V, Khan N, Kergoat MJ, Kubik MW, Solari MG, Snyderman CH, Traylor KS, Sridharan SS. Cervical paraspinal skeletal muscle index outperforms frailty indices to predict postoperative adverse events in operable head and neck cancer with microvascular reconstruction. Microsurgery 2021; 42:209-216. [PMID: 34935198 DOI: 10.1002/micr.30848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/17/2021] [Accepted: 11/19/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Sarcopenia is increasingly being recognized as a negative prognostic factor in patients with head and neck cancer (HNC). We associate a sarcopenia biomarker measured radiographically from computed tomography (CT) of the neck to postoperative adverse events in patients with operable HNC. PATIENTS AND METHODS A prospective cohort of treatment-naïve HNC patients undergoing surgery with microvascular reconstruction was performed. Cervical paraspinal skeletal muscle index (CPSMI) was calculated using preoperative CT neck imaging and adjusted for height and sex. Postoperative adverse events, including Clavien-Dindo Grade 3+ complications and fistula, were recorded within 30-days of the index surgery. Multivariate logistic regression was used to evaluate the association between CPSMI and postoperative complications. The modified frailty index (mFI) and Risk Assessment Index (RAI) were compared with CPSMI outcomes. RESULTS A total of 127 patients with mucosal HNC were included in the study. The mean age was 60.5 years, and 87 (68.5%) patients were male. Sixty Clavien-Dindo grade 3+ events occurred; 17 patients developed an oro/pharyngocutaneous fistula. Low CPSMI was independently associated with Clavien-Dindo Grade 3+ events (OR 2.80, 95% CI of 1.18-6.99) and fistula (OR of 6.10, 95% CI of 1.53-24.3) when adjusted for multiple factors. CPSMI outperformed the mFI and RAI frailty indices to predict postoperative adverse events (p < .05). CONCLUSION Low CPSMI is independently associated with postoperative adverse events and outperforms current frailty indices inoperable HNC with microvascular reconstruction.
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Affiliation(s)
- Marco A Mascarella
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Biomedical Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute of the Jewish General Hospital, Montreal, Quebec, Canada
| | - Lauren Gardiner
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Terral Patel
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Varun Vendra
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nayel Khan
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Marie-Jeanne Kergoat
- Department of Biomedical Sciences, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Division of Geriatrics, Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Mark W Kubik
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mario G Solari
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carl H Snyderman
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Katie S Traylor
- Department of Diagnostic Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shaum S Sridharan
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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11
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Mascarella MA, Muthukrishnan N, Maleki F, Kergoat MJ, Richardson K, Mlynarek A, Forest VI, Reinhold C, Martin DR, Hier M, Sadeghi N, Forghani R. Above and Beyond Age: Prediction of Major Postoperative Adverse Events in Head and Neck Surgery. Ann Otol Rhinol Laryngol 2021; 131:697-703. [PMID: 34416844 PMCID: PMC9203666 DOI: 10.1177/00034894211041222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Major postoperative adverse events (MPAEs) following head and neck surgery are not infrequent and lead to significant morbidity. The objective of this study was to ascertain which factors are most predictive of MPAEs in patients undergoing head and neck surgery. METHODS A cohort study was carried out based on data from patients registered in the National Surgical Quality Improvement Program (NSQIP) from 2006 to 2018. All patients undergoing non-ambulatory head and neck surgery based on Current Procedural Terminology codes were included. Perioperative factors were evaluated to predict MPAEs within 30-days of surgery. Age was classified as both a continuous and categorical variable. Retained factors were classified by attributable fraction and C-statistic. Multivariate regression and supervised machine learning models were used to quantify the contribution of age as a predictor of MPAEs. RESULTS A total of 43 701 operations were analyzed with 5106 (11.7%) MPAEs. The results of supervised machine learning indicated that prolonged surgeries, anemia, free tissue transfer, weight loss, wound classification, hypoalbuminemia, wound infection, tracheotomy (concurrent with index head and neck surgery), American Society of Anesthesia (ASA) class, and sex as most predictive of MPAEs. On multivariate regression, ASA class (21.3%), hypertension on medication (15.8%), prolonged operative time (15.3%), sex (13.1%), preoperative anemia (12.8%), and free tissue transfer (9%) had the largest attributable fractions associated with MPAEs. Age was independently associated with MPAEs with an attributable fraction ranging from 0.6% to 4.3% with poor predictive ability (C-statistic 0.60). CONCLUSION Surgical, comorbid, and frailty-related factors were most predictive of short-term MPAEs following head and neck surgery. Age alone contributed a small attributable fraction and poor prediction of MPAEs. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Marco A Mascarella
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute of the Jewish General Hospital, Montreal, QC, Canada
| | - Nikesh Muthukrishnan
- Augmented Intelligence & Precision Health Laboratory (AIPHL) of the Department of Radiology and the Research Institute of McGill University Health Centre, Montreal, QC, Canada.,Department of Radiology, McGill University, Montreal, QC, Canada
| | - Farhad Maleki
- Augmented Intelligence & Precision Health Laboratory (AIPHL) of the Department of Radiology and the Research Institute of McGill University Health Centre, Montreal, QC, Canada.,Department of Radiology, McGill University, Montreal, QC, Canada
| | - Marie-Jeanne Kergoat
- Department of Geriatric Medicine, Geriatric Institute of Montreal, University of Montreal, Montreal, QC, Canada
| | - Keith Richardson
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | | | - Caroline Reinhold
- Augmented Intelligence & Precision Health Laboratory (AIPHL) of the Department of Radiology and the Research Institute of McGill University Health Centre, Montreal, QC, Canada.,Department of Radiology, McGill University, Montreal, QC, Canada
| | - Diego R Martin
- Augmented Intelligence & Precision Health Laboratory (AIPHL) of the Department of Radiology and the Research Institute of McGill University Health Centre, Montreal, QC, Canada.,Department of Radiology, McGill University, Montreal, QC, Canada
| | - Michael Hier
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Nader Sadeghi
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada.,Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Reza Forghani
- Augmented Intelligence & Precision Health Laboratory (AIPHL) of the Department of Radiology and the Research Institute of McGill University Health Centre, Montreal, QC, Canada.,Department of Radiology, McGill University, Montreal, QC, Canada.,Segal Cancer Centre, Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
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12
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Mohtashami S, Richardson K, Forest VI, Mlynarek A, Payne RJ, Tamilia M, Pusztaszeri MP, Hier MP, Sadeghi N, Mascarella MA. Thyroidectomy for Graves' Disease Predicts Postoperative Neck Hematoma and Hypocalcemia: A North American cohort study. Ann Otol Rhinol Laryngol 2021; 131:341-351. [PMID: 34060342 PMCID: PMC8899812 DOI: 10.1177/00034894211021288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: Examine the association of Graves’ disease with the development of
postoperative neck hematoma. Design: A cohort of patients participating in the Thyroid Procedure-Targeted Database
of the National Surgical Quality Improvement Program from January 1, 2016 to
December 31, 2018. Setting: A North American surgical cohort study. Methods: 17 906 patients who underwent thyroidectomy were included. Propensity score
matching was performed to adjust for differences in baseline covariates.
Multivariate logistic regression was used to ascertain the association
between thyroidectomy for Graves’ disease and risk of postoperative adverse
events within 30 days of surgery. The primary outcome was postoperative
hematoma. Secondary outcomes were postoperative hypocalcemia and recurrent
laryngeal nerve injury. Results: One-to-three propensity score matching yielded 1207 patients with mean age
(SD) of 42.6 (14.9) years and 1017 (84.3%) female in the group with Graves’
disease and 3621 patients with mean age (SD) of 46.7 (15.0%) years and 2998
(82.8%) female in the group with indications other than Graves’ disease for
thyroidectomy. The cumulative 30-day incidence of postoperative hematoma was
3.1% (38/1207) in the Graves’ disease group and 1.9% (70/3621) in other
patients. The matched cohort showed that Graves’ disease was associated with
higher odds of postoperative hematoma (OR 1.65, 95% CI 1.10-2.46) and
hypocalcemia (OR 2.04, 95% CI 1.66-2.50) compared with other indications for
thyroid surgery. There was no difference in recurrent laryngeal nerve injury
among the 2 groups. Conclusions: Patients with Graves’ disease undergoing thyroidectomy are more likely to
suffer from postoperative hematoma and hypocalcemia compared to patients
undergoing surgery for other indications.
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Affiliation(s)
- Sadaf Mohtashami
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Keith Richardson
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | | | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Richard J Payne
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Michael Tamilia
- Division of Endocrinology, Department of Medicine, McGill University, Montreal, QC, Canada
| | | | - Michael P Hier
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Nader Sadeghi
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada.,Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | - Marco A Mascarella
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.,Department of Biomedical Sciences, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
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13
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Sadeghi N, Mascarella MA, Khalife S, Ramanakumar AV, Richardson K, Joshi AS, Taheri R, Fuson A, Bouganim N, Siegel R. Neoadjuvant chemotherapy followed by surgery for
HPV
‐associated locoregionally advanced oropharynx cancer. Head Neck 2020; 42:2145-2154. [DOI: 10.1002/hed.26147] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/10/2020] [Accepted: 03/10/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Nader Sadeghi
- Department of Otolaryngology – Head and Neck SurgeryMcGill University Health Center, McGill University Montreal Quebec Canada
- Research Institute of McGill University Health CenterMcGill University Montreal Quebec Canada
| | - Marco A. Mascarella
- Department of Otolaryngology – Head and Neck SurgeryMcGill University Health Center, McGill University Montreal Quebec Canada
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill University Montreal Quebec Canada
| | - Sarah Khalife
- Department of Otolaryngology – Head and Neck SurgeryMcGill University Health Center, McGill University Montreal Quebec Canada
| | - Agnihotram V. Ramanakumar
- Research Institute of McGill University Health CenterMcGill University Montreal Quebec Canada
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill University Montreal Quebec Canada
| | - Keith Richardson
- Department of Otolaryngology – Head and Neck SurgeryMcGill University Health Center, McGill University Montreal Quebec Canada
| | - Arjun S. Joshi
- Department of Otolaryngology – Head and Neck SurgeryGeorge Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Reza Taheri
- Department of Diagnostic RadiologyGeorge Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Andrew Fuson
- Department of Otolaryngology – Head and Neck SurgeryGeorge Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Nathaniel Bouganim
- Department of Oncology, McGill University Health CenterMcGill University Montreal Quebec Canada
| | - Robert Siegel
- Department of Hematology and OncologyGeorge Washington University Washington District of Columbia USA
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14
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Mascarella MA, Schweitzer L, Alreefi M, Silver J, Caglar D, Loo VG, Richardson K, Dufresne P, Lee TC, Sadeghi N. The infectious thyroid nodule: a case report of mucormycosis associated with ibrutinib therapy. J Otolaryngol Head Neck Surg 2019; 48:49. [PMID: 31619294 PMCID: PMC6794875 DOI: 10.1186/s40463-019-0376-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/21/2019] [Indexed: 11/21/2022] Open
Abstract
Background Acute invasive fungal infections of the head and neck secondary to tyrosine kinase inhibitors are rare and potentially life-threatening events. Case presentation We report a case of mucormycosis of the thyroid gland in a patient known for chronic lymphocytic leukemia receiving ibrutinib who presented with a rapidly growing thyroid nodule and dysphonia. An acute invasive fungal infection was identified on a core needle biopsy; mucormycosis was confirmed on culture. The patient was successfully treated with surgical debridement and long-term antifungal therapy. Conclusion Patients on ibrutinib may be at risk of acute invasive fungal infections of the head and neck.
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Affiliation(s)
- Marco A Mascarella
- Department of Otolaryngology-Head and Neck Surgery, McGill University Royal Victoria Hospital, McGill University Health Centre, Glen Site, 1001 Boul. Decarie, D05.5704, Montreal, QC H4A 3 J1, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Lorne Schweitzer
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Mahmoud Alreefi
- Department of Otolaryngology-Head and Neck Surgery, McGill University Royal Victoria Hospital, McGill University Health Centre, Glen Site, 1001 Boul. Decarie, D05.5704, Montreal, QC H4A 3 J1, Canada
| | - Jennifer Silver
- Department of Otolaryngology-Head and Neck Surgery, McGill University Royal Victoria Hospital, McGill University Health Centre, Glen Site, 1001 Boul. Decarie, D05.5704, Montreal, QC H4A 3 J1, Canada
| | - Derin Caglar
- Department of Pathology, McGill University Health Centre, Montreal, Canada
| | - Vivian G Loo
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Keith Richardson
- Department of Otolaryngology-Head and Neck Surgery, McGill University Royal Victoria Hospital, McGill University Health Centre, Glen Site, 1001 Boul. Decarie, D05.5704, Montreal, QC H4A 3 J1, Canada
| | - Philippe Dufresne
- Laboratoire de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Canada
| | - Todd C Lee
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Nader Sadeghi
- Department of Otolaryngology-Head and Neck Surgery, McGill University Royal Victoria Hospital, McGill University Health Centre, Glen Site, 1001 Boul. Decarie, D05.5704, Montreal, QC H4A 3 J1, Canada.
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15
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You E, Mascarella MA, Al Jassim A, Forest VI, Hier MP, Tamilia M, Pusztaszeri M, Payne RJ. Prevalence and aggressiveness of papillary thyroid carcinoma in surgically-treated graves' disease patients: a retrospective matched cohort study. J Otolaryngol Head Neck Surg 2019; 48:40. [PMID: 31462328 PMCID: PMC6714443 DOI: 10.1186/s40463-019-0364-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 08/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Reported rates of thyroid cancer in Graves’ disease (GD) vary widely. The aim of this study was to evaluate the prevalence of papillary thyroid carcinoma (PTC), including aggressive forms, in GD compared to matched controls undergoing thyroidectomy. Furthermore, it seeks to elucidate any patient- or tumour-associated factors predictive of malignancy or an aggressive course. Methods We performed a matched cohort study of GD patients undergoing thyroidectomy at our institution between 2006 to 2018. Clinicodemographic factors, preoperative characteristics, surgical factors, final histopathology as well postoperative course were collected. Aggressive PTC was defined as evidence of lymph node metastasis, extrathyroidal extension, gross vascular invasion and/or aggressive histologic variants. Prevalence of PTC was compared with sex, age and nodule size-matched euthyroid patients that underwent thyroidectomy in the same time period. Results A total of 132 patients were included in the study with a mean age of 46 (±14) years. Malignancy was identified in 36/66 (55%) patients with GD; 20/66 (30%) were incidental carcinomas and 9/66 (14%) were associated with aggressive pathologic features. In the aggressive group, lymph node metastasis to the central compartment was present in 8 (12%) cases, extrathyroidal extension in 4 (6%) cases and one (1.5%) patient had a diffuse sclerosing tumor variant. No significant differences in outcome were found between the two groups. GD patients were more likely to have incidental carcinomas (p = 0.035). Adjusting for baseline patient characteristics, GD patients demonstrated an increased likelihood of harbouring a malignancy (odds ratio (OR) = 2.67; 95% confidence interval (CI) 1.00–7.18) compared to controls. Conclusion More than half of patients with GD undergoing thyroidectomy had concurrent thyroid malignancy with aggressive features present in 14% of patients. GD may confer a heightened risk of thyroid cancer; thyroid nodules should therefore be carefully investigated.
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Affiliation(s)
- Eunice You
- McGill University, Montreal, Quebec, Canada
| | - Marco A Mascarella
- McGill Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.,McGill Department of Epidemiology, Biostatistics and Occupational Health, Montreal, Quebec, Canada
| | - Abrar Al Jassim
- McGill University, Montreal, Quebec, Canada.,Western Otolaryngology - Head and Neck Surgery, London, Ontario, Canada
| | - Veronique-Isabelle Forest
- McGill University, Montreal, Quebec, Canada.,McGill Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Michael P Hier
- McGill University, Montreal, Quebec, Canada.,McGill Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Michael Tamilia
- McGill University, Montreal, Quebec, Canada.,Division of Endocrinology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Marc Pusztaszeri
- McGill University, Montreal, Quebec, Canada.,Department of Pathology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Richard J Payne
- McGill University, Montreal, Quebec, Canada. .,McGill Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, Montreal, Quebec, Canada.
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16
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Mascarella MA, Azzi JL, Silva SD, Mlynarek A, Forest V, Hier M, Richardson K, Sadeghi N. Postoperative infection predicts poor survival in locoregionally advanced oral cancer. Head Neck 2019; 41:3624-3630. [DOI: 10.1002/hed.25885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 07/01/2019] [Accepted: 07/11/2019] [Indexed: 01/08/2023] Open
Affiliation(s)
- Marco A. Mascarella
- Department of Otolaryngology—Head and Neck SurgeryMcGill University Health Centre Quebec Canada
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill University Quebec Canada
| | - Jayson Lee Azzi
- Faculty of MedicineUniversity of Ottawa Ottawa Ontario Canada
| | - Sabrina Daniela Silva
- Department of Otolaryngology—Head and Neck SurgeryMcGill University Health Centre Quebec Canada
| | - Alex Mlynarek
- Department of Otolaryngology—Head and Neck SurgeryJewish General Hospital Quebec Canada
| | | | - Michael Hier
- Department of Otolaryngology—Head and Neck SurgeryJewish General Hospital Quebec Canada
| | - Keith Richardson
- Department of Otolaryngology—Head and Neck SurgeryMcGill University Health Centre Quebec Canada
| | - Nader Sadeghi
- Department of Otolaryngology—Head and Neck SurgeryMcGill University Health Centre Quebec Canada
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17
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Mascarella MA, Alrasheed A, Fnais N, Gourgas O, Jalani G, Cerruti M, Tewfik MA. Raman Spectroscopy for Inverted Papilloma: A Proof-of-Concept Study. Otolaryngol Head Neck Surg 2018; 159:587-589. [PMID: 29763337 DOI: 10.1177/0194599818776640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Inverted papillomas are tumors of the sinonasal tract with a propensity to recur. Raman spectroscopy can potentially identify inverted papillomas from other tissue based on biochemical signatures. A pilot study comparing Raman spectroscopy to histopathology for 3 types of sinonasal tissue was performed. Spectral data of biopsies from patients with normal sinonasal mucosa, chronic rhinosinusitis, and inverted papillomas are compared to histopathology using principal component analysis and linear discriminant analysis after data preprocessing. A total of 18 normal, 15 chronic rhinosinusitis, and 18 inverted papilloma specimens were evaluated. The model distinguished normal sinonasal mucosa, chronic rhinosinusitis, and inverted papilloma tissue with an overall accuracy of 90.2% (95% confidence interval, 0.86-0.94). In conclusion, Raman spectroscopy can distinguish inverted papilloma, normal sinonasal mucosa, and chronically rhinosinusitis tissue with acceptable accuracy.
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Affiliation(s)
- Marco A Mascarella
- 1 Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Abdulaziz Alrasheed
- 1 Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,2 Department of Otolaryngology-Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Naif Fnais
- 1 Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,2 Department of Otolaryngology-Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Ophelie Gourgas
- 3 Biointerface Lab, Department of Materials Engineering, McGill University, Montreal, Quebec, Canada
| | - Ghulam Jalani
- 3 Biointerface Lab, Department of Materials Engineering, McGill University, Montreal, Quebec, Canada
| | - Marta Cerruti
- 3 Biointerface Lab, Department of Materials Engineering, McGill University, Montreal, Quebec, Canada
| | - Marc A Tewfik
- 1 Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
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18
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Abstract
BACKGROUND/PURPOSE Intrathyroidal thymic tissue may be misinterpreted as a thyroid lesion in children, leading to invasive tests or resection. We sought to describe the characteristic imaging features of these lesions and to evaluate the safety of non-operative management. METHODS A retrospective review of all patients less than 18years old with intrathyroidal thymic tissue from 2000 to 2016 was performed. Data collection included patient demographics, imaging results, interventions, and outcomes. RESULTS Eleven patients were identified using institutional radiology and pathology databases. Median patient age and lesion size at presentation were 5years old (range 2 to 8years old) and 0.9cm (range 0.4 to 9.2cm), respectively. Six lesions were incidentally identified, six were left-sided, and the most common location was the lower pole. Ultrasonographic features were reproducible and included well demarcated (10/11), hypoechoic lesions (11/11), containing punctate/linear internal echoes (11/11), and occasional mild hypervascularity (6/11). All cases demonstrated interval size and echotexture stability over a median surveillance period of 3years (range 1 to 8years). While 9 patients were simply observed, the first patient in this series underwent excision, while another had a fine needle aspiration to confirm pathology. LEVEL OF EVIDENCE Study of diagnostic test, Level IV. CONCLUSION Intrathyroidal thymic tissue has typical clinical and sonographic characteristics which allow for appropriate diagnosis and avoids thyroid resection.
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Affiliation(s)
- Emily Kay-Rivest
- Division of Otolaryngology - Head and Neck Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marco A Mascarella
- Division of Otolaryngology - Head and Neck Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Pramod Puligandla
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sherif Emil
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Christine Saint-Martin
- Division of Pediatric Radiology, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Lily H P Nguyen
- Division of Otolaryngology - Head and Neck Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sam J Daniel
- Division of Otolaryngology - Head and Neck Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Robert Baird
- Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
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19
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Mascarella MA, Mannard E, Silva SD, Zeitouni A. Neutrophil-to-lymphocyte ratio in head and neck cancer prognosis: A systematic review and meta-analysis. Head Neck 2018; 40:1091-1100. [PMID: 29356179 DOI: 10.1002/hed.25075] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 07/31/2017] [Accepted: 12/06/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hematologic markers, such as the neutrophil-to-lymphocyte ratio (NLR), characterize the inflammatory response to cancer and are associated with poorer survival in various malignancies. We evaluate the effect of pretreatment NLR on overall survival (OS) in patients with head and neck squamous cell carcinoma (HNSCC). METHODS Using multiple databases, a systematic search for articles evaluating the effect of NLR on OS in patients with HNSCC was performed. An inverse variation, random-effects model was used to analyze the data. RESULTS A total of 24 of 241 articles, including 6479 patients, were analyzed. The combined hazard ratio for OS in patients with an elevated NLR (range 2.04-5) was 1.78 (confidence interval [CI] 1.53-2.07; P < .0001). The hazard ratios for site-specific cancer: oral cavity 1.56 CI 1.23-1.98 (P < .001), nasopharynx 1.66 CI 1.35-2.04 (P < .001), larynx 1.55 CI 1.26-1.92 (P < .001), and hypopharynx 2.36 CI 1.54-3.61 (P < .001). CONCLUSION An elevated NLR is predictive of poorer OS in patients with HNSCC.
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Affiliation(s)
- Marco A Mascarella
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Erin Mannard
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Sabrina Daniela Silva
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Anthony Zeitouni
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
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Roskies M, Kay-Rivest E, Mascarella MA, Sultanem K, Mlynarek A, Hier M. Survival outcomes in patients with oropharyngeal cancer treated with carboplatin/paclitaxel and concurrent radiotherapy. J Otolaryngol Head Neck Surg 2016; 45:50. [PMID: 27724969 PMCID: PMC5057223 DOI: 10.1186/s40463-016-0163-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 10/05/2016] [Indexed: 11/22/2022] Open
Abstract
Background A commonly employed treatment for advanced staged oropharyngeal squamous cell carcinoma (OPSCC) is concurrent radiation and chemotherapy with cisplatin as the gold standard. Carboplatin is reported to have the same radiopotentiation properties and a superior side effect profile; however, its use in head and neck cancer has been limited due to the paucity of data and reported hematologic side effects. In this study, we describe our institution’s experience with carboplatin, paclitaxel and radiation in the treatment of oropharyngeal squamous cell carcinoma over a 10 year period. Methods A retrospective chart review of patients aged 18 to 80 years old with stage III-IV OPSCC treated with weekly carboplatin, paclitaxel and intensity modulated radiotherapy (IMRT) was performed. Data collected included patient demographics, tumor location and stage and survival outcomes. In addition, we noted treatment morbidities according to the Radiation Therapy Oncology Group (RTOG) scoring criteria scale. The data was analyzed using the student’s t-test and analysis of variables. Results Over a 10 year period, 160 patients received chemoradiation with carboplatin and paclitaxel for OPSCC. One-hundred-four and 65 patients were followed for at least 3 and 5 years, respectively. Overall survival for all patients was 81.7 and 70.7 % at 3 and 5 years, respectively. Disease free survival and locoregional recurrence-free survival at 5 years was 64.6 and 89.2 %, respectively. There was no association of survival with stage, regional nodal status or subsite. The most common side effect attributed to treatment was acute dysphagia (75.25 %) followed by odynophagia, xerostomia and hypogeusia. Hospitalizations and non-hospitalization emergency department visits attributed to treatment totalled 33 and 11, respectively. Hematologic toxicities greater than grade II were: 11.9 % neutropenia, 6.3 % anemia, 1.8 % thrombocytopenia. The incidence of febrile neutropenia was 5.0 % (8/160). Conclusion In conclusion, the overall, disease-free and locoregional recurrence-free survival of patients treated with carboplatin and radiotherapy for advanced stage OPSCC parallels what has been described in the literature for cisplatin, with an acceptable side effect profile.
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Affiliation(s)
- M Roskies
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
| | - E Kay-Rivest
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - M A Mascarella
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - K Sultanem
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - A Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - M Hier
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Mascarella MA, Lahrichi N, Cloutier F, Kleiman S, Payne RJ, Rosenberg L. High efficiency endocrine operation protocol: From design to implementation. Surgery 2016; 160:1118-1124. [PMID: 27521046 DOI: 10.1016/j.surg.2016.06.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/16/2016] [Accepted: 06/23/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND We developed a high efficiency endocrine operative protocol based on a mathematical programming approach, process reengineering, and value-stream mapping to increase the number of operations completed per day without increasing operating room time at a tertiary-care, academic center. METHODS Using this protocol, a case-control study of 72 patients undergoing endocrine operation during high efficiency days were age, sex, and procedure-matched to 72 patients undergoing operation during standard days. The demographic profile, operative times, and perioperative complications were noted. RESULTS The average number of cases per 8-hour workday in the high efficiency and standard operating rooms were 7 and 5, respectively. Mean procedure times in both groups were similar. The turnaround time (mean ± standard deviation) in the high efficiency group was 8.5 (±2.7) minutes as compared with 15.4 (±4.9) minutes in the standard group (P < .001). Transient postoperative hypocalcemia was 6.9% (5/72) and 8.3% (6/72) for the high efficiency and standard groups, respectively (P = .99). CONCLUSION In this study, patients undergoing high efficiency endocrine operation had similar procedure times and perioperative complications compared with the standard group. The proposed high efficiency protocol seems to better utilize operative time and decrease the backlog of patients waiting for endocrine operation in a country with a universal national health care program.
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Affiliation(s)
- Marco A Mascarella
- Department of Otolaryngology-Head & Neck Surgery, McGill University, Montreal, Canada
| | - Nadia Lahrichi
- Department of Mathematical and Industrial Engineering, Polytehcnique Montreal, Montreal, Canada
| | | | - Simcha Kleiman
- Department of Anesthesia, McGill University, Montreal, Canada
| | - Richard J Payne
- Department of Otolaryngology-Head & Neck Surgery, McGill University, Montreal, Canada
| | - Lawrence Rosenberg
- Department of Surgery, Jewish General Hospital, McGill University, Montreal, Canada.
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Mascarella MA, Forest VI, Nhan C, Leboeuf R, Tamilia M, Mlynarek AM, Payne RJ. Seasonal Difference in Postthyroidectomy Hypocalcemia. Otolaryngol Head Neck Surg 2015; 154:263-7. [DOI: 10.1177/0194599815617126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/23/2015] [Indexed: 11/16/2022]
Abstract
Objective Hypocalcemia following thyroidectomy often prolongs hospital stay and is potentially life-threatening. The objective of this study is to determine whether the season when thyroidectomy is performed is associated with postoperative hypocalcemia. Study Design Retrospective case series of patients undergoing thyroid surgery from 2009 to 2015. Setting Tertiary care academic institution in Montreal, Canada. Subjects and Methods A consecutive sample of 823 patients undergoing thyroidectomy by a single high-volume otolaryngologist for a suspected or confirmed thyroid malignancy. Patient demographics, procedure type, calcium and vitamin D supplementation, and seasonal rate of hypocalcemia postthyroidectomy were calculated and compared. Results Average seasonal rates of postthyroidectomy hypocalcemia in the winter, spring, summer, and autumn were, respectively, 8.3% (8 of 216), 7.3% (12 of 165), 1.5% (3 of 201), and 3.5% (8 of 228; P < .005). Patients operated in the winter were 5.6 times more likely to develop hypocalcemia as compared with those in the summer ( P < .01; 95% confidence interval: 1.7-18.7). In a multiple regression analysis factoring in season when surgery was performed, procedure type, and preoperative vitamin D/calcium supplementation, surgery occurring in the winter predicted a hypocalcemia event (correlation coefficient [SE]: 0.72 [0.024], P = .026; 0.006 [0.025], P = .81; 0.004 [0.019], P = .82, respectively). Conclusion In this study, patients undergoing thyroidectomy in the winter months were more likely to develop postoperative hypocalcemia when compared with those operated in the summer. Further studies are needed to understand the role of vitamin D in the observed seasonal difference in hypocalcemia rates.
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Affiliation(s)
- Marco A. Mascarella
- Department of Otolaryngology–Head and Neck Surgery, McGill University Health Center, Montreal, Canada
| | - Véronique-Isabelle Forest
- Department of Otolaryngology–Head and Neck Surgery, McGill University Health Center, Montreal, Canada
| | - Carol Nhan
- Department of Otolaryngology–Head and Neck Surgery, McGill University Health Center, Montreal, Canada
| | - Rébecca Leboeuf
- Department of Endocrinology, University de Montreal, Notre Dame Hospital, Montreal, Canada
| | - Michael Tamilia
- Division of Endocrinology and Metabolism, Jewish General Hospital, Montreal, Canada
| | - Alex M. Mlynarek
- Department of Otolaryngology–Head and Neck Surgery, McGill University Health Center, Montreal, Canada
| | - Richard J Payne
- Department of Otolaryngology–Head and Neck Surgery, McGill University Health Center, Montreal, Canada
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Schwartz J, Costescu A, Mascarella MA, Young ME, Husein M, Agrawal S, Roth K, Doyle PC, Nguyen LHP. Objective assessment of Myringotomy and tympanostomy tube insertion: A prospective single-blinded validation study. Laryngoscope 2015; 126:2140-6. [DOI: 10.1002/lary.25746] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 09/21/2015] [Accepted: 09/24/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Joseph Schwartz
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
| | - Adrian Costescu
- Faculty of Medicine; McGill University; Montreal Quebec Canada
| | - Marco A. Mascarella
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
| | - Meredith E. Young
- Center for Medical Education; McGill University; Montreal Quebec Canada
- Department of Medicine; McGill University; Montreal Quebec Canada
| | - Murad Husein
- Department of Otolaryngology-Head and Neck Surgery; Western University; London Ontario Canada
| | - Sumit Agrawal
- Department of Otolaryngology-Head and Neck Surgery; Western University; London Ontario Canada
| | - Kathryn Roth
- Department of Otolaryngology-Head and Neck Surgery; Western University; London Ontario Canada
| | - Philip C. Doyle
- Department of Otolaryngology-Head and Neck Surgery; Western University; London Ontario Canada
| | - Lily H. P. Nguyen
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
- Center for Medical Education; McGill University; Montreal Quebec Canada
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Do BA, Lands LC, Mascarella MA, Fanous A, Saint-Martin C, Manoukian JJ, Nguyen LHP. Lund-Mackay and modified Lund-Mackay score for sinus surgery in children with cystic fibrosis. Int J Pediatr Otorhinolaryngol 2015; 79:1341-5. [PMID: 26115934 DOI: 10.1016/j.ijporl.2015.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 06/02/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Patients with cystic fibrosis (CF) frequently present with severe sinonasal disease often requiring radiologic imaging and surgical intervention. Few studies have focused on the relationship between radiologic scoring systems and the need for sinus surgery in this population. The objective of this study is to evaluate the Lund-Mackay (LM) and modified Lund-Mackay (m-LM) scoring systems in predicting the need for sinus surgery or revision surgery in patients with CF. METHODS We performed a retrospective chart review of CF patients undergoing computed tomography (CT) sinus imaging at a tertiary care pediatric hospital from 1995 to 2008. Patient scans were scored using both the LM and m-LM systems and compared to the rate of sinus surgery or revision surgery. Receiver-operator characteristics curves (ROC) were used to analyze the radiological scoring systems. RESULTS A total of 41 children with CF were included in the study. The mean LM score for patients undergoing surgery was 17.3 (±3.1) compared to 11.5 (±6.2) for those treated medically (p<0.01). For the m-LM, the mean score of patients undergoing surgery was 20.3 (±3.5) and 13.5 (±7.3) for those medically treated (p<0.01). Using a ROC curve with a threshold score of 13 for the LM, the sensitivity was 89.3% (95% CI of 72-98) and specificity of 69.2% (95% CI of 39-91). At an optimal score of 19, the m-LM system produced a sensitivity of 67.7% (95% CI of 48-84) and specificity of 84.6% (95% CI of 55-98). CONCLUSION The modified Lund-Mackay score provides a high specificity while the Lund-Mackay score a high sensitivity for CF patients who required sinus surgery. The combination of both radiologic scoring systems can potentially predict the need for surgery in this population.
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Affiliation(s)
- Bao Anh Do
- McGill University, Faculty of Medicine, Montreal, QC, Canada
| | - Larry C Lands
- Division of Peadiatric Respiratory Medicine, McGill University, Montreal, QC, Canada
| | - Marco A Mascarella
- Department of Otolaryngology Head & Neck Surgery, McGill University, Montreal, QC, Canada.
| | - Amanda Fanous
- Department of Otolaryngology Head & Neck Surgery, McGill University, Montreal, QC, Canada
| | | | - John J Manoukian
- Department of Otolaryngology Head & Neck Surgery, McGill University, Montreal, QC, Canada
| | - Lily H P Nguyen
- Department of Otolaryngology Head & Neck Surgery, McGill University, Montreal, QC, Canada.
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Mascarella MA, Schwartz J, Manoukian JJ. Congenital intra-oral adhesions: a surgical approach to cleft palate lateral synechia syndrome. Int J Pediatr Otorhinolaryngol 2015; 79:769-72. [PMID: 25819497 DOI: 10.1016/j.ijporl.2015.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
Abstract
An array of genetic syndromes has been associated with intra-oral adhesions in neonates. The primary medical issues arise from airway obstruction, feeding difficulties and poor oral development, specifically with cleft palate lateral synechia syndrome (CPLSS). Despite this, a paucity of data exists for the clinical management of intra-oral adhesions in this population. We report the cases of a father and daughter diagnosed with CPLSS who presented with respiratory and feeding difficulties at birth undergoing surgical correction. Early surgical ligation of intra-oral bands allows for a stabilization of the airway, improved feeding and oral development with a good long-term outcome.
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Affiliation(s)
- Marco A Mascarella
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.
| | - Joseph Schwartz
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - John J Manoukian
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
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Varshney R, Forest VI, Mascarella MA, Zawawi F, Rochon L, Hier MP, Mlynarek A, Tamilia M, Payne RJ. The Mcgill thyroid nodule score - does it help with indeterminate thyroid nodules? J Otolaryngol Head Neck Surg 2015; 44:2. [PMID: 25645364 PMCID: PMC4323228 DOI: 10.1186/s40463-015-0058-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/16/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Ultrasound guided fine-needle aspiration (USFNA) biopsy of thyroid nodules often gives a result of indeterminate pathology, placing thyroid specialists in difficult management situations. The aim of this study is to evaluate the incidence of malignancy in patients undergoing surgery and to correlate these results with the McGill Thyroid Nodule Score (MTNS). METHODS We performed a retrospective study comparing USFNA results, MTNS and histopathology of patients undergoing thyroid surgery between 2010 and 2012. Pre-operative USFNA results were divided into three subgroups: benign, indeterminate and suspicious for/malignant. The indeterminate USFNA subgroup comprised of Bethesda type III (atypia of undetermined significance) and Bethesda type IV (follicular neoplasms, including Hurthle cell neoplasms) lesions. Post-operative histopathology was divided into benign or malignant groups. RESULTS Of the 437 patient charts reviewed, 57.0% had an indeterminate USFNA biopsy. Within the indeterminate group, the malignancy rate was 39.8%. For indeterminate USFNA, the median MTNS was 7 (32% risk of malignancy) for benign nodules and 9 (63% risk of malignancy) for malignant nodules on post-operative histopathology (p < 0.05). CONCLUSION The rate of malignancy in operated patients with an indeterminate USFNA result was 39.8%. The MTNS can be of value to thyroid specialists in pre-operative decision-making when dealing with an indeterminate result of a thyroid nodule on USFNA.
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Affiliation(s)
- Rickul Varshney
- McGill University, Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, 687 Pine Ave. West, E3-37, Montreal, QC, H3A 1A1, Canada.
| | - Veronique-Isabelle Forest
- McGill University, Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, 687 Pine Ave. West, E3-37, Montreal, QC, H3A 1A1, Canada.
| | - Marco A Mascarella
- McGill University, Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, 687 Pine Ave. West, E3-37, Montreal, QC, H3A 1A1, Canada.
| | - Faisal Zawawi
- McGill University, Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, 687 Pine Ave. West, E3-37, Montreal, QC, H3A 1A1, Canada. .,King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Louise Rochon
- Department of Pathology, Jewish General Hospital, McGill University, 3755 Côte-Ste-Catherine Road, Montreal, QC, H3T 1E2, Canada.
| | - Michael P Hier
- McGill University, Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, 687 Pine Ave. West, E3-37, Montreal, QC, H3A 1A1, Canada.
| | - Alex Mlynarek
- McGill University, Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, 687 Pine Ave. West, E3-37, Montreal, QC, H3A 1A1, Canada.
| | - Michael Tamilia
- Department of Endocrinology and Metabolism, Jewish General Hospital, McGill University, 3755 Côte-Ste-Catherine Road, Montreal, Canada.
| | - Richard J Payne
- McGill University, Otolaryngology-Head and Neck Surgery, Royal Victoria Hospital, 687 Pine Ave. West, E3-37, Montreal, QC, H3A 1A1, Canada.
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Mascarella MA, Forghani R, Di Maio S, Sirhan D, Zeitouni A, Mohr G, Tewfik MA. Indicators of a Reduced Intercarotid Artery Distance in Patients Undergoing Endoscopic Transsphenoidal Surgery. J Neurol Surg B Skull Base 2015. [PMID: 26225301 DOI: 10.1055/s-0034-1396601] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Objective To identify clinicopathologic factors associated with a reduced intercarotid distance (ICD) and subgroups at risk for internal carotid artery injury during transsphenoidal surgery. Design A retrospective case-control study. Setting This study was conducted at the McGill University Health Centre, a university-affiliated tertiary care center. Participants Patients with a sellar or parasellar tumor and nontumor controls were included in the study. Main Outcome Measures The smallest distance between the internal carotid arteries at the clival, cavernous, and paraclinoid segments on coronal magnetic resonance imaging was measured. Demographic profiles, cephalometric measurements, tumor dimensions, and sphenoid configuration were assessed as potential determinants of the ICD. Results A total of 212 cases and 34 controls were analyzed. Widening of the ICD at the three segments of the internal carotid arteries was found in patients with pituitary macroadenomas (p < 0.01). Patients with a growth hormone-secreting adenoma had a markedly reduced ICD at the clivus compared with controls (1.59 cm versus 1.77 cm; p = 0.02; 95% confidence interval [CI], 0.03-0.32). The paraclinoid ICD was reduced in patients with an anterior fossa meningioma (1.24 cm versus 1.33 cm; p = 0.04; 95% CI, 0.01-0.45). Conclusion Identifying clinicopathologic factors affecting the ICD can help surgeons recognize constraints to endoscopic access of the skull base and avoid inadvertent arterial injury.
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Affiliation(s)
- Marco A Mascarella
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Reza Forghani
- Department of Diagnostic Radiology, McGill University, Jewish General Hospital, Montreal, Quebec, Canada
| | - Salvatore Di Maio
- Department of Neurosurgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Denis Sirhan
- Department of Neurosurgery, Montreal Neurological Hospital, Montreal, Quebec, Canada
| | - Anthony Zeitouni
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Gerard Mohr
- Department of Neurosurgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Marc A Tewfik
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada
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Mascarella MA, Nhan C, Payne RJ. Are Patients Undergoing Thyroidectomy in Montreal, Canada, during Winter at Increased Risk for Postoperative Hypocalcemia? Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541627a73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: (1) Review the rate of postoperative hypocalcemia in patients undergoing thyroidectomy in the summer and winter. (2) Identify the association between the season when surgery was completed and the risk of postoperative hypocalcemia. Methods: A retrospective chart review of 436 patients undergoing thyroidectomy at the McGill University Thyroid Cancer Centre from 2006 to 2014 was performed. Patients undergoing total or completion thyroidectomy in the winter months (December to February) and summer months (July to September) were included in the study. Parathyroid hormone (PTH) and serum corrected calcium were recorded according to the McGill post-thyroidectomy protocol. Preoperative PTH and 25-hydroxyvitamin D (25-OHD) were measured. Hypocalcemia was defined as a corrected calcium level <1.9 mmol/L. Results: The rate of postoperative hypocalcemia was 8% for patients operated on in the winter and 1.8% for those in the summer ( P = .01). Patients undergoing surgery in the winter were 4.3 times more likely to develop postoperative hypocalcemia than those in the summer ( P = .01, 95% confidence interval [1.5 to 1 5]). Surgery during the summer months showed a higher preoperative 25-OHD level ( P = .04). Preoperative PTH levels were significantly greater in the winter months as compared with the summer (5 pmol/L and 4.5 pmol/L, respectively; P = .01). Patients with 25-OHD deficiency (≤70nmol/L) were not found to have a higher rate of postoperative hypocalcemia (5.2% and 13.8%, respectively; P = .22). Conclusions: In this study, patients undergoing thyroidectomy during the winter months were 4.3 times more likely to develop postoperative hypocalcemia when compared with patients operated in the summer.
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Mascarella MA, Forghani R, Sirhan D, Maio SD, Mohr G, Zeitouni AG, Tewfik MA. Analysis of Potential Determinants of a Reduced Intercarotid Distance in Patients Undergoing Endoscopic Transsphenoidal Surgery. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541627a258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: (1) Evaluate the anatomic variability of the distance between the internal carotid arteries (ICA) at the paraclival, intracavernous, and paraclinoid segments in normal variants and in patients with sellar or parasellar lesions. (2) Identify clinicopathologic factors associated with a reduced intercarotid distance (ICD) and identify subgroups at higher risk for ICA injury during endoscopic skull base surgery. Methods: A retrospective case-control study was performed at an academic tertiary care center. The smallest distance between the ICAs at the paraclival, intracavernous. and paraclinoid segments on coronal T2-weighted magnetic resonance imaging was measured in patients with sellar or parasellar tumors and in nontumor controls. Factors such as demographic profiles, cephalometric measurements, tumor dimensions, and sphenoid configuration were assessed as potential predictors of the ICD. Results: In total, 154 cases and 34 controls were analyzed. Patients with growth hormone (GH) secreting adenomas had a markedly reduced ICD at the paraclival segment as compared to controls (1.59 cm and 1.77 cm, respectively; P = .02; 95% confidence interval [CI] [0.03-0.32]). The paraclinoid ICD was reduced in patients with a planum sphenoidale meningioma (1.09 cm and 1.33 cm, respectively; P = .04; 95% CI [0.01-0.45]). The transverse dimension of pituitary adenomas was linearly correlated to the ICD ( P < .001). No narrowing of the ICD was associated with sphenoid configuration or cephalometric measurements. Conclusions: Patients with a GH secreting adenoma or planum sphenoidale meningioma had a reduced ICD. Identifying these populations can help surgeons recognize constraints imposed by a reduced ICD to endoscopic access of the skull base and avoid inadvertent ICA injury.
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