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Jozaghi Y, Phan J, Hanna EY, Kupferman ME, Su SY. Functional Outcomes and Quality of Life in Patients with Sinonasal, Nasopharyngeal, and Anterior Skull Base Tumors. Curr Oncol Rep 2022; 24:775-781. [PMID: 35290597 DOI: 10.1007/s11912-022-01214-2] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW This article will review functional and QOL outcomes among patients treated predominantly for sinonasal and nasopharyngeal malignancies. RECENT FINDINGS Treatment advances and interdisciplinary supportive care help to lessen the functional impairments and the reduction in quality of life (QOL) that were once accepted as inevitable tradeoffs for cure. Recent progress in QOL and Patient-Reported Outcome (PRO) instruments for this population will be covered. Sinonasal and nasopharyngeal tumors affect patients' quality of life, appearance, and critical functions. Tumors arise in proximity of vital structures including the orbit, cranial nerves, carotid artery, brain, cervical spine, and pituitary gland. Surgical morbidity, along with acute and late effects of systemic therapy and radiotherapy on normal tissues in this functionally critical region, may result in wide-ranging symptoms. Patients with skull base tumors report a high symptom burden at presentation, prior to treatment, relative to other malignancies in the head and neck region.
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Affiliation(s)
- Yelda Jozaghi
- Department of Head and Neck Surgery, The University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Suite 1445, Houston, TX, 77030, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Suite 1445, Houston, TX, 77030, USA
| | - Michael E Kupferman
- Department of Head and Neck Surgery, The University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Suite 1445, Houston, TX, 77030, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Suite 1445, Houston, TX, 77030, USA.
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Jozaghi Y, Zafereo M, Williams MD, Gule-Monroe MK, Wang J, Grubbs EG, Vaporciyan A, Hu MI, Busaidy N, Dadu R, Waguespack SG, Subbiah V, Cabanillas M. Neoadjuvant selpercatinib for advanced medullary thyroid cancer. Head Neck 2020; 43:E7-E12. [PMID: 33169506 PMCID: PMC7756223 DOI: 10.1002/hed.26527] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [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: 08/20/2020] [Revised: 09/22/2020] [Accepted: 10/22/2020] [Indexed: 01/21/2023] Open
Abstract
Background Targeted kinase inhibitors have been increasingly utilized in the treatment of advanced medullary thyroid cancer (MTC) over the last decade. Recently, highly potent next generation selective RET inhibitors have been clinically validated, and selpercatinib was recently Food and Drug Administration (FDA)‐approved for advanced MTC. The advent of highly selective, potent RET inhibitors is broadening the treatment options for patients with RET‐mutated cancers. Methods We report the first published case of neoadjuvant selpercatinib followed by surgery for a patient with initially unresectable, widely metastatic, RET‐mutated MTC who was treated on a single patient protocol. Results After greater than 50% RECIST response, the patient underwent complete surgical resection followed by selpercatinib resumption. He remains locoregionally disease‐free 21 months after starting therapy with stable metastatic disease (after initial partial response); and calcitonin/CEA continue to decline. Conclusion This novel treatment strategy for locoregionally advanced RET‐mutated MTC warrants further study in clinical trials.
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Affiliation(s)
- Yelda Jozaghi
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Mark Zafereo
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Michelle D Williams
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Maria K Gule-Monroe
- Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer Wang
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Elizabeth G Grubbs
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Ara Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Mimi I Hu
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Naifa Busaidy
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Ramona Dadu
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Steven G Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Maria Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Guo T, Kiong KL, Yao CMKL, Windon M, Zebda D, Jozaghi Y, Zhao X, Hessel AC, Hanna EY. Impact of the COVID-19 pandemic on Otolaryngology trainee education. Head Neck 2020; 42:2782-2790. [PMID: 32666664 PMCID: PMC7405272 DOI: 10.1002/hed.26368] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 01/22/2023] Open
Abstract
Background The COVID‐19 pandemic has reduced clinical volume with a negative impact on trainee education. Methods Survey study of Otolaryngology trainees in North America, during the COVID‐19 pandemic in April 2020. Results Of 216 respondents who accessed the survey, 175 (83%) completed the survey. Respondents reported a universal decrease in clinical activities (98.3%). Among participants who felt their program utilized technology well, there were significantly decreased concerns to receiving adequate educational knowledge (29.6% vs 65.2%, P = .003). However, 68% of trainees still expressed concern in ability to receive adequate surgical training. In addition, 54.7% of senior trainees felt that the pandemic had a negative impact on their ability to secure a job or fellowship after training. Conclusions Trainees universally felt a negative impact due to the COVID‐19 pandemic. Use of technology was able to alleviate some concerns in gaining adequate educational knowledge, but decreased surgical training remained the most prevalent concern.
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Affiliation(s)
- Theresa Guo
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kimberley L Kiong
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christopher M K L Yao
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Melina Windon
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Denna Zebda
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Yelda Jozaghi
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xiao Zhao
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy C Hessel
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ehab Y Hanna
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Abstract
In the setting of the coronavirus disease 2019 pandemic, the concept of the disease curve has become ubiquitous in medicine and across society. Nevertheless, even among medical specialists, there are common misconception about the curve and how it affects population outcomes. This article provides a simple review of the various population dynamics at play. Principles such as the area under the curve and the threshold of capacity are discussed and simply conceptualized. Understanding the fundamental characteristics of a problem can allow us to see it with more clarity. By the end of the article, the reader will gain an effortless a sense of insight on this topic.
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Affiliation(s)
- Yelda Jozaghi
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Maniakas A, Jozaghi Y, Zafereo ME, Sturgis EM, Su SY, Gillenwater AM, Gidley PW, Lewis CM, Diaz E, Goepfert RP, Kupferman ME, Gross ND, Hessel AC, Pytynia KB, Nader M, Wang JR, Lango MN, Kiong KL, Guo T, Zhao X, Yao CMKL, Appelbaum E, Alpard J, Garcia JA, Terry S, Flynn JE, Bauer S, Fournier D, Burgess CG, Wideman C, Johnston M, You C, De Luna R, Joseph L, Diersing J, Prescott K, Heiberger K, Mugartegui L, Rodriguez J, Zendehdel S, Sellers J, Friddell RA, Thomas A, Khanjae SJ, Schwarzlose KB, Chambers MS, Hofstede TM, Cardoso RC, Wesson RA, Won A, Otun AO, Gombos DS, Al‐Zubidi N, Hutcheson KA, Gunn GB, Rosenthal DI, Gillison ML, Ferrarotto R, Weber RS, Hanna EY, Myers JN, Lai SY. Head and neck surgical oncology in the time of a pandemic: Subsite-specific triage guidelines during the COVID-19 pandemic. Head Neck 2020; 42:1194-1201. [PMID: 32342541 PMCID: PMC7267348 DOI: 10.1002/hed.26206] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND COVID-19 pandemic has strained human and material resources around the world. Practices in surgical oncology had to change in response to these resource limitations, triaging based on acuity, expected oncologic outcomes, availability of supportive resources, and safety of health care personnel. METHODS The MD Anderson Head and Neck Surgery Treatment Guidelines Consortium devised the following to provide guidance on triaging head and neck cancer (HNC) surgeries based on multidisciplinary consensus. HNC subsites considered included aerodigestive tract mucosa, sinonasal, salivary, endocrine, cutaneous, and ocular. RECOMMENDATIONS Each subsite is presented separately with disease-specific recommendations. Options for alternative treatment modalities are provided if surgical treatment needs to be deferred. CONCLUSION These guidelines are intended to help clinicians caring for patients with HNC appropriately allocate resources during a health care crisis, such as the COVID-19 pandemic. We continue to advocate for individual consideration of cases in a multidisciplinary fashion based on individual patient circumstances and resource availability.
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Vinh DB, Zhao X, Kiong KL, Guo T, Jozaghi Y, Yao C, Kelley JM, Hanna EY. Overview of COVID-19 testing and implications for otolaryngologists. Head Neck 2020; 42:1629-1633. [PMID: 32342570 PMCID: PMC7267427 DOI: 10.1002/hed.26213] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 01/08/2023] Open
Abstract
Background Testing for SARS‐CoV‐2 is important for decision making prior to surgery in otolaryngology. An understanding of current and developing testing methods is important for interpreting test results. Methods We performed a literature review of current evidence surrounding SARS‐CoV‐2 diagnostic testing highlighting its utility, limitations, and implications for otolaryngologists. Results The currently accepted RT‐PCR test for SARS‐CoV‐2 has varying sensitivity according to which subsite of the aerodigestive tract is sampled. Nasal swab sensitivities appear to be about 70%. Chest CT imaging for screening purposes is not currently recommended. Conclusion Due to the current sensitivity of RT‐PCR based testing for SARS‐CoV‐2, a negative test cannot rule out COVID‐19. Full PPE should be worn during high‐risk procedures such as aerosol generating procedures even if testing is negative. Patients who test positive during screening should have their surgeries postponed if possible until asymptomatic and have tested negative for SARS‐CoV‐2.
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Affiliation(s)
- Daniel B Vinh
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Xiao Zhao
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, USA
| | - Kimberley L Kiong
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, USA
| | - Theresa Guo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, USA
| | - Yelda Jozaghi
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, USA
| | - Chris Yao
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, USA
| | - James M Kelley
- Department of Laboratory Medicine, Division of Pathology and Laboratory Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, USA
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Jozaghi Y, Zafereo ME, Perrier ND, Wang JR, Grubbs E, Gross ND, Fisher S, Sturgis EM, Goepfert RP, Lai SY, Best C, Busaidy NL, Cabanillas ME, Dadu R, Gagel RF, Habra MA, Hu MI, Jimenez C, Sherman SI, Thosani S, Varghese J, Waguespack SG, Weitzman S, Ying AK, Graham PH. Endocrine surgery in the Coronavirus disease 2019 pandemic: Surgical Triage Guidelines. Head Neck 2020; 42:1325-1328. [PMID: 32437031 PMCID: PMC7262055 DOI: 10.1002/hed.26169] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 11/17/2022] Open
Abstract
Background In the face of the COVID‐19 pandemic, cancer care has had to adapt rapidly given the Centers for Disease Control and Prevention and the American College of Surgeons (ACS) issuing recommendations to postpone nonurgent surgeries. Methods An institutional multidisciplinary group of Head and Neck Surgical Oncology, Surgical Endocrinology, and Medical Endocrinology devised Surgical Triaging Guidelines for Endocrine Surgery during COVID‐19, aligned with phases of care published by the ACS. Results Phases of care with examples of corresponding endocrine cases are outlined. Most cases can be safely postponed with active surveillance, including most differentiated and medullary thyroid cancers. During the most acute phase, all endocrine surgeries are deferred, except thyroid tumors requiring acute airway management. Conclusions These guidelines provide context for endocrine surgery within the spectrum of surgical oncology, with the goal of optimal individualized multidisciplinary patient care and the expectation of significant resource diversion to care for patients with COVID‐19.
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Affiliation(s)
- Yelda Jozaghi
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mark E Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nancy D Perrier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jennifer R Wang
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Elizabeth Grubbs
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Neil D Gross
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarah Fisher
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Erich M Sturgis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Conor Best
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naifa L Busaidy
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria E Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ramona Dadu
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robert F Gagel
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mouhammed A Habra
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mimi I Hu
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Camilo Jimenez
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Steven I Sherman
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sonali Thosani
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeena Varghese
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Steven G Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Steven Weitzman
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anita K Ying
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Paul H Graham
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Echaniz G, Chan V, Maynes JT, Jozaghi Y, Agur A. Ultrasound-guided maxillary nerve block: an anatomical study using the suprazygomatic approach. Can J Anaesth 2020; 67:186-193. [PMID: 31549339 DOI: 10.1007/s12630-019-01481-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 03/22/2019] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Although a maxillary nerve (MN) block reportedly provides satisfactory analgesia for midface surgery and chronic maxillofacial pain syndromes, a safe and reliable MN block technique has not been reported. The goal of this anatomical study was to quantify the various angles and depth of the block needle, as well as to evaluate the impact of volume on the extent of injectate spread that might influence anesthetic coverage and block-related complications. METHODS Following an ultrasound-guided suprazygomatic MN block with dye injection, a dissection was performed in the pterygopalatine fossa (PPF) of four lightly embalmed cadaveric specimens. Half of the specimens were injected with 5 mL of dye, and the other half with 1 mL of dye. The needle depth was measured from the ultrasound images and using rubber markers. Following injection, dissection was performed to map the area of dye spread. RESULTS The median [interquartile range (IQR)] distance from the skin to the PPF was 37 [36-43] mm and 47 [40-50] mm by ultrasound and rubber marker methods, respectively. The median [IQR] needle orientation was 14 [11-32] degrees inferiorly and 15 [10-17] degrees posteriorly. The PPF was consistently dyed in the 5 mL group, but sporadically dyed in the 1 mL group. In the 5 mL group, spread outside of the PPF was seen. CONCLUSIONS We showed that 5 mL of injectate far exceeds the capacity of the PPF, leading to drug spread outside of the PPF. Moreover, we found that 1 mL of injectate largely covered the nerve, suggesting a more efficacious and safer block procedure. This finding will need confirmation in future clinical studies.
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Affiliation(s)
- Gaston Echaniz
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON, Canada.
- Department of Anesthesiology, Vall d' Hebron Hospital, Universitat Autònoma de Barcelona, Passeig de Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Vincent Chan
- Department of Anesthesia, Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Jason T Maynes
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Yelda Jozaghi
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Anne Agur
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Davies JC, Chan HH, Jozaghi Y, Goldstein DP, Irish JC. Analysis of simulated mandibular reconstruction using a segmental mirroring technique. J Craniomaxillofac Surg 2019; 47:468-472. [DOI: 10.1016/j.jcms.2018.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022] Open
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Madani A, Jozaghi Y, Tabah R, How J, Mitmaker E. Rare metastases of well-differentiated thyroid cancers: a systematic review. Ann Surg Oncol 2014; 22:460-6. [PMID: 25192681 DOI: 10.1245/s10434-014-4058-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND A minority of metastatic well-differentiated thyroid cancer (WDTC) patients present with end-organ disease other than in the lung, bone or lymph nodes. These metastases tend to be overlooked because of their low incidence, and this results in delayed diagnosis. The purpose of this study was to perform a systematic review of the clinical and histologic features of unusual WDTC metastases. METHODS A systematic literature search of bibliographic databases, reference lists of articles, and conference proceedings was performed up to 2013. Studies were included if they reported on adult patients with WDTC and pathology-proven metastases to end-organs other than lung, bone, or lymph nodes. A total of 238 studies were included in a qualitative analysis. Data is expressed as N (%) and median [interquartile range]. RESULTS A total of 492 patients (median age, 62 years [50-70 years]) were identified in 197 case reports and 42 case series. There were 22 different end-organ metastatic sites documented with either papillary [255 (57 %)], follicular [172 (39 %)], or Hürthle-cell [18 (4 %)] histology. A total of 181 (41 %) patients presented with solitary metastasis and 54 (93 %) with elevated serum thyroglobulin. Positron emission tomography and whole-body radioactive iodine scans revealed hypermetabolic foci in 28 (97 %) and 50 (81 %) cases, respectively. Disease-free interval following the initial diagnosis of the primary thyroid cancer was highly variable, ranging from synchronous presentation [66 (33 %)] to metachronous disease after 516 months [mean 86 months (SD 90)]. CONCLUSIONS WDTC can manifest with highly variable and unusual clinical features. Rare sites of metastases should be considered in the absence of the more common extra-cervical disease recurrence locations.
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Affiliation(s)
- Amin Madani
- Division of General Surgery, McGill University, Montreal, QC, Canada,
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Maniakas A, Forest VI, Jozaghi Y, Saliba J, Hier MP, Mlynarek A, Tamilia M, Payne RJ. Tumor classification in well-differentiated thyroid carcinoma and sentinel lymph node biopsy outcomes: a direct correlation. Thyroid 2014; 24:671-4. [PMID: 24199963 DOI: 10.1089/thy.2013.0160] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Predicting locoregional metastasis in well-differentiated thyroid carcinoma (WDTC) is a challenge for thyroid cancer surgeons. Sentinel lymph node biopsy (SLNB) has been shown to be an effective predictive tool. To our knowledge, primary tumor (T) classification has yet to be studied with regard to SLNB. We hypothesized that larger primary tumors would correlate with the rate of malignancy in SLNBs. METHODS A retrospective chart review was conducted on patients operated for WDTC at the McGill Thyroid Cancer Center over a 36-month period. Patients who underwent a total thyroidectomy and SLNB for WDTC were included in this study. RESULTS A total of 311 patients were included and separated into two groups (236 negative and 75 positive SLNBs). Among patients with negative SLNBs, 65% had T1 primary tumors, 17% T2, 16% T3, and 2% T4, whereas 18% of patients with positive SLNBs had T1 primary tumors, 5% T2, 45% T3, and 32% T4 (p<0.001). Patients under the age of 45 years had a higher rate of positive SLNs (36% in those <45 years vs. 17% in those ≥ 45 years; p<0.001). CONCLUSIONS Age (<45 years) and higher T category were found to be associated with a higher rate of positive SLNBs.
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Affiliation(s)
- Anastasios Maniakas
- 1 Department of Otolaryngology-Head and Neck Surgery, McGill Thyroid Cancer Center , Montreal, Canada
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Jozaghi Y, Richardson K, Anand S, Mlynarek A, Hier MP, Forest VI, Sela E, Tamilia M, Caglar D, Payne RJ. Frozen section analysis and sentinel lymph node biopsy in well differentiated thyroid cancer. J Otolaryngol Head Neck Surg 2013; 42:48. [PMID: 24025621 PMCID: PMC3847460 DOI: 10.1186/1916-0216-42-48] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 02/12/2013] [Accepted: 09/02/2013] [Indexed: 11/20/2022] Open
Abstract
Background The aim of this study is to prospectively review the role of sentinel lymph node (SLN) biopsy in the management of well differentiated thyroid carcinoma (WDTC), and to determine the efficacy of intraoperative frozen section analysis at detecting SLN metastasis and central compartment involvement. Methods The SLN biopsy protocol using 1% methylene blue was performed in 300 patients undergoing thyroidectomy for WDTC. A limited pretracheal central compartment neck dissection (CCND) was performed on all patients. Lymph nodes staining blue were considered as SLN’s. Both frozen and permanent section analyses were performed. Results SLN’s with metastasis were found in 14.3% (43/300) of cases. Of this, 11% (33/300) were positive on intraoperative frozen section analysis. Frozen section results failed in predicting central compartment involvement in 15 cases (5%) whereas central neck compartment involvement was missed in 5 cases (1.7%) when based on permanent section results. On frozen section analysis, the sensitivity, specificity, positive predictive value and negative predictive value (95% CI) of our SLN biopsy technique aiming to remove all disease from the central compartment was 68.8% (53.6-80.9), 100% (98.1-100), 100% (87.0-100) and 94.4% (90.7-96.7) respectively with P < 0.0001. On permanent section analysis, the values were 89.6% (76.6-96.1), 100% (98.1-100), 100% (89.8-100), and 98.1% (95.3-99.3) with P < 0.0001. Conclusion This data series demonstrates that patients with WDTC have positive SLN’s in 14.3% of cases. Moreover, when the SLN’s are negative for metastasis on frozen section, the central compartment was disease-free in 94.4% of cases. Finally, this study shows that 23.3% of positive SLN’s were false negatives on intraoperative frozen section. According to this data, SLN involvement is an accurate predictor of central compartment metastasis, however surgeons should use caution when relying on intraoperative frozen section to determine whether to perform a CCND.
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Affiliation(s)
- Yelda Jozaghi
- Department of Otolaryngology Head and Neck Surgery, McGill University Thyroid Cancer Center, 3755 Côte Ste-Catherine, Montreal, PQ, Canada.
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13
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Jozaghi Y, Emil S, Albuquerque P, Klam S, Blumenkrantz M. Prenatal and postnatal features of mesenchymal hamartoma of the chest wall: case report and literature review. Pediatr Surg Int 2013; 29:735-40. [PMID: 23494671 DOI: 10.1007/s00383-013-3280-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2013] [Indexed: 11/24/2022]
Abstract
Mesenchymal hamartoma of the chest wall is a rare, benign chondro-osseous tumor of the bone. Although it most commonly presents at birth or soon after, prenatal detection is rare. We report a case of prenatally detected mesenchymal hamartoma, and provide the rationale, details, and outcomes of our management. The literature is reviewed, with particular attention to prenatal detection and postnatal management options.
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Affiliation(s)
- Yelda Jozaghi
- Division of Pediatric Radiology, McGill University Faculty of Medicine, Montreal, QC, Canada
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14
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Jamal MH, Hassanain M, Chaudhury P, Tran TT, Wong S, Yousef Y, Jozaghi Y, Salman A, Jabbour S, Simoneau E, Al-Abbad S, Al-Jiffry M, Arena G, Kavan P, Metrakos P. Staged hepatectomy for bilobar colorectal hepatic metastases. HPB (Oxford) 2012; 14:782-9. [PMID: 23043668 PMCID: PMC3482675 DOI: 10.1111/j.1477-2574.2012.00543.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study describes the management of patients with bilobar colorectal liver metastases (CRLM). METHODS A retrospective collection of data on all patients with CRLM who were considered for staged resection (n= 85) from January 2003 to January 2011 was performed. Patients who underwent one hepatic resection were considered to have had a failed staged resection (FSR), whereas those who underwent a second or third hepatic resection to produce a cure were considered to have had a successful staged resection (SSR). Survival was calculated from the date of diagnosis of liver metastases. Complete follow-up and dates of death were obtained from the Government of Quebec population database. RESULTS Median survival was 46 months (range: 30-62 months) in the SSR group and 22 months (range: 19-29 months) in the FSR group. Rates of 5-year survival were 42% and 4% in the SSR and FSR groups, respectively. Fifteen of the 19 patients who remained alive at the last follow-up date belonged to the SSR group. CONCLUSIONS In patients in whom staged resection for bilobar CRLM is feasible, surgery would appear to offer benefit.
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Affiliation(s)
- Mohammad H Jamal
- Hepatopancreatobiliary and Multi-Organ Transplant SurgeryMontreal, QC, Canada,Department of Surgery, College of Medicine, Kuwait UniversityKuwait City, Kuwait
| | - Mazen Hassanain
- Hepatopancreatobiliary and Multi-Organ Transplant SurgeryMontreal, QC, Canada,Department of Surgery, College of Medicine, King Saud UniversityRiyadh, Saudi Arabia
| | - Prosanto Chaudhury
- Hepatopancreatobiliary and Multi-Organ Transplant SurgeryMontreal, QC, Canada
| | - Tung T Tran
- Hepatopancreatobiliary and Multi-Organ Transplant SurgeryMontreal, QC, Canada
| | - Stephanie Wong
- Hepatopancreatobiliary and Multi-Organ Transplant SurgeryMontreal, QC, Canada
| | - Yasmine Yousef
- Hepatopancreatobiliary and Multi-Organ Transplant SurgeryMontreal, QC, Canada
| | - Yelda Jozaghi
- Hepatopancreatobiliary and Multi-Organ Transplant SurgeryMontreal, QC, Canada
| | - Ayat Salman
- Hepatopancreatobiliary and Multi-Organ Transplant SurgeryMontreal, QC, Canada
| | - Samir Jabbour
- Hepatopancreatobiliary and Multi-Organ Transplant SurgeryMontreal, QC, Canada
| | - Eve Simoneau
- Hepatopancreatobiliary and Multi-Organ Transplant SurgeryMontreal, QC, Canada
| | - Saleh Al-Abbad
- Hepatopancreatobiliary and Multi-Organ Transplant SurgeryMontreal, QC, Canada
| | - Murad Al-Jiffry
- Hepatopancreatobiliary and Multi-Organ Transplant SurgeryMontreal, QC, Canada
| | - Goffredo Arena
- Hepatopancreatobiliary and Multi-Organ Transplant SurgeryMontreal, QC, Canada
| | - Petr Kavan
- Department of Oncology, McGill University Health CentreMontreal, QC, Canada
| | - Peter Metrakos
- Hepatopancreatobiliary and Multi-Organ Transplant SurgeryMontreal, QC, Canada,Department of Surgery, College of Medicine, King Saud UniversityRiyadh, Saudi Arabia
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