1692 No Longer Unknown: A Systematic Review & Meta-Analysis of The Effectiveness of Trans-Oral Surgical Techniques in Identifying Head and Neck Primary Cancer in Carcinoma Unknown Primary

Aim

The use of transoral robotic surgery (TORS), transoral laser microsurgery (TLM) and more recently reported transoral endoscopic electrocautery (TOEC) in the identification of the primary cancer in CUP patients has gained popularity. This systematic review aims to assess the effectiveness of TORS, TLM and TOEC.

Method

A systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting methodology was carried out to assess the effectiveness of the three trans-oral surgical techniques. EMBASE, MEDLINE and CINAHL databases were searched from inception to September 2020. Primary outcome measure was detection rates of primary cancer of the different techniques. Secondary outcome measures were complications and length of hospital stay.

Results

289 studies were identified of which 30 met the inclusion criteria (28 case series and 2 case reports). The overall combined primary identification rate was 72.3% (567 /777 patients). The primary identification rates were 49.7% and 34.2% in lingual (n = 273) and palatine tonsillectomy (n = 118) respectively. The primary cancer identification rates by surgical techniques are: TORS was 60% (CI 0.49, 0.70), TLM was 80% (CI 0.58, 1.01), TOEC was 41% (CI 0.05, 0.76). The commonest complication was haemorrhage (5.3%).

Conclusions

This is the largest systematic review in the subject and incorporates the more recently published surgical technique of TOEC. Lingual tonsillectomy is an effective procedure in CUP work up. Further larger, multi-centre, prospective studies of PET CT negative CUP patients is needed to draw conclusive results

Ensuring patient safety when implementing a new diagnostic pathway for thyroid nodules

Introduction The aim of this study was to determine whether ultrasound alone is sufficient to safely exclude malignancy in thyroid nodules in a district general hospital setting, to comply with the latest British Thyroid Association guidelines. Methods This retrospective study investigated the quality of ultrasound reporting and the correlation between ultrasound report and histology for individual thyroid nodules. Cases were selected from the thyroid multidisciplinary meeting and included all patients having undergone surgery for a thyroid malignancy in a one-year period. Results Forty-seven patients were included in the study. Ultrasound reports were reviewed and assessed, in which 21 clinicians were involved; 36% of scans included a summary of whether the nodule(s) overall appeared benign, equivocal, suspicious or malignant; 4% of reports included a U classification; 81% of reports commented on cervical lymph nodes. Ultrasound was compared with histology. The sensitivity of ultrasound in correctly identifying nodules requiring further investigation was of 56% and specificity was 81%. Positive predictive value was 81% and negative predictive value was 56%. Discussion These findings suggest that, in a district general hospital setting without a dedicated head and neck radiologist, using only ultrasound and limiting fine-needle aspiration cytology to identify suspicious nodules may not be safe, as a high number of nodules appearing benign on ultrasound may ultimately prove to be malignant.

A novel extractionless hplc fluorescence method for the determination of glyburide in the human plasma: application to a bioequivalence study

PURPOSE

To develop a simple, sensitive and rapid HPLC fluorescence method with single step sample preparation for the determination of glyburide in the human plasma.

METHODS

Glyburide and ketoconazole (internal standard) were extracted from the 0.5 mL plasma by addition of 0.5 mL acetonitrile and 50 microL CuSO(4) solution (5% w/v in water). The separation was achieved on the Kingsorb 3 microm, C8 reverse phase column at ambient temperature with a mobile phase consisted of 45% buffer solution (0.05 M NH(4)H(2)P(4)), 40% acetonitrile and 15% methanol adjusted to pH 5.7 by diluted ammonia solution. A fluorescence detector was set at 235 nm excitation wavelength and 354 nm emission wavelengths to monitor eluted components.

RESULTS

The internal standard and glyburide eluted at about 6.7 and 9.6 min, respectively at the flow rate of 1 mL/min. The regression equation was established for every calibration curves (5 ng/mL to 400 ng/mL), which resulted in the correlation coefficient of 0.99 or greater. The absolute recovery ranged from 94.32 to 98.12% and the relative recovery ranged from 91.12 to 97.15%. The intraday coefficient of variation (CV) ranged from of 6.52 to 12.35% and interday varied from 6.21 to 16.07%. The limit of quantitation (LOQ) of glyburide was set to five ng/mL.

CONCLUSION

This simple, rapid and sensitive method is suitable for pharmacokinetic, bioavailability and biequivalence studies.