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Papazian MR, Chow M, Weed D, Liu JC, Bewley AF, Moore MG, Givi B. Virtual Tumor Boards for Remote Learning in Head and Neck Surgical Oncology. JAMA Otolaryngol Head Neck Surg 2023; 149:899-903. [PMID: 37615974 PMCID: PMC10450583 DOI: 10.1001/jamaoto.2023.2332] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/24/2023] [Indexed: 08/25/2023]
Abstract
Importance In addition to their patient management value, multidisciplinary tumor boards have been recognized as effective learning tools. However, the value of using a virtual tumor board as a learning tool for head and neck surgical oncology fellows has not been studied. Objective To describe the structure and content of the American Head and Neck Society (AHNS) Virtual Tumor Board and assess its educational value as perceived by attendees. Design, Setting, and Participants All sessions of the AHNS Virtual Tumor Board from April 8, 2020, to June 1, 2022, were reviewed. Topics, presenters, participants, and viewership data were collected as of October 15, 2022, from session recordings posted to an online video sharing and social media platform. Additionally, an anonymous, 14-question online survey was designed to elicit feedback from head and neck surgery trainees on virtual tumor board engagement, strengths, and weaknesses. The survey was electronically distributed in June and July 2022 to the 101 fellows enrolled in AHNS-accredited programs between July 1, 2020, and June 30, 2022. Main Outcomes and Measures The primary aim was to tabulate online viewership of the sessions. The secondary aim was to qualitatively assess the experience of head and neck trainees with the AHNS Virtual Tumor Board using a survey. Results Forty-two sessions of the virtual tumor board were held between April 8, 2020, and June 1, 2022. Almost all sessions (41 [98%]) were case based. One hundred and sixteen cases were presented, representing 2 to 3 cases per session, by 75 unique faculty members. Each session was viewed a mean of 217 times (range, 64-2216 views). In the 2021 to 2022 academic year, a mean of 60 viewers (range, 30-92 viewers) attended each live session. In all, 29 survey responses were collected from 101 fellows in AHNS-accredited programs (29% response rate). Most respondents felt the format allowed for excellent teaching (18 of 26 respondents [69%]) and discussion (19 of 26 respondents [73%]). Most respondents (22 of 29 respondents [76%]) believed that practicing head and neck surgeons would benefit from the sessions. Conclusions and Relevance This survey study found that the AHNS Virtual Tumor Board was well-attended and well-reviewed by head and neck surgical oncology trainees. The virtual tumor board format could be used as model of remote learning for other organizations.
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Affiliation(s)
- Michael R. Papazian
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York
- Now Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael Chow
- Department of Otolaryngology–Head and Neck Surgery, NYU Langone Health, New York, New York
| | - Donald Weed
- Department of Otolaryngology–Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Jeffrey C. Liu
- Department of Otolaryngology–Head and Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Arnaud F. Bewley
- Department of Otolaryngology–Head and Neck Surgery, University of California-Davis, Sacramento
| | - Michael G. Moore
- Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
| | - Babak Givi
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Papazian MR, Dublin JC, Patel KN, Oweity T, Jacobson AS, Brandler TC, Givi B. Repeat Fine-Needle Aspiration With Molecular Analysis in Management of Indeterminate Thyroid Nodules. Otolaryngol Head Neck Surg 2023; 168:738-744. [PMID: 35412868 DOI: 10.1177/01945998221093527] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/22/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze clinical outcomes in a series of indeterminate thyroid nodules (ITNs) with repeat fine-needle aspiration (FNA) biopsy and results of genomic classifier. STUDY DESIGN Historical chart review. SETTING Tertiary care center. METHODS We reviewed FNA samples from subjects with Bethesda III or IV diagnoses from January 2015 to December 2018 at a single institution and selected those with repeat FNA and ThyroSeq testing of the same nodule. Patient demographics, Bethesda classifications, ThyroSeq results, treatment detail, and surgical pathology, when available, were analyzed. RESULTS Ninety-six patients with cytologic diagnosis of ITN, repeat FNA, and ThyroSeq testing were identified. Following repeat FNA, 55 nodules (57%) remained ITN; 40 (42%) were reclassified as benign; and 1 (1%) was reclassified as suspicious for malignancy. In 31 patients with ThyroSeq analysis accompanying initial and repeat FNA, 26 (84%) had the same result on each, while 5 (16%) tested ThyroSeq positive following an initially negative result (κ = 0.24). Most nodules that were downgraded to Bethesda II on repeat FNA (37/40, 93%) were managed nonsurgically. Patients with ThyroSeq-positive results were treated with surgery more often (25/28, 89%) than patients with ThyroSeq-negative results (11/68, 16%; P < .0001). In excised nodules, the prevalence of malignancy and noninvasive follicular thyroid neoplasm with papillary-like nuclear features was 28% (n = 10) and 22% (n = 8), respectively, and all malignancies were low risk. CONCLUSION In this case series, repeat FNA helped patients with ITNs avoid diagnostic surgery through reclassification to benign cytology. The risk of high-risk malignancy in ThyroSeq-positive nodules with repeat indeterminate cytology was low.
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Affiliation(s)
- Michael R Papazian
- Grossman School of Medicine, New York University, New York, New York, USA
| | - Jared C Dublin
- Grossman School of Medicine, New York University, New York, New York, USA
| | - Kepal N Patel
- Division of Endocrine Surgery, Department of Surgery, NYU Langone Medical Center, New York, New York, USA
| | - Thaira Oweity
- Department of Pathology, NYU Langone Medical Center, New York, New York, USA
| | - Adam S Jacobson
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Medical Center, New York, New York, USA
| | - Tamar C Brandler
- Department of Pathology, NYU Langone Medical Center, New York, New York, USA
| | - Babak Givi
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Medical Center, New York, New York, USA
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Papazian MR, Chow MS, Jacobson AS, Tran T, Persky MS, Persky MJ. Role of transoral robotic surgery in surgical treatment of early-stage supraglottic larynx carcinoma. Head Neck 2023; 45:972-982. [PMID: 36825894 DOI: 10.1002/hed.27325] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/23/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND There are several options for primary surgical treatment of early-stage supraglottic squamous cell carcinoma (SCC), including transoral robotic surgery (TORS). The purpose of this study was to compare outcomes of TORS to open partial laryngectomy and transoral laser microsurgery (TLM). METHODS Patients with clinical classification T1-2 supraglottic SCC diagnosed 2010-2019, treated with TORS, open partial laryngectomy, or TLM in the National Cancer Database were selected. RESULTS One thousand six hundred three patients were included: 17% TORS, 26.5% TLM, 56.5% open. TORS patients had the lowest rates of adjuvant treatment (28.4% vs. TLM: 45.0%, open: 38.5%, p < 0.001), and lower positive margin rates than TLM (16.9% vs. 30.5%, p < 0.001). Thirty-day and ninety-day post-operative mortality did not differ between the approaches. Five-year survival was higher following TORS compared to open surgery (77.8% vs. 66.1%, p = 0.01); this difference persisted following matched-pair analysis. CONCLUSIONS TORS may be a safe and effective surgical approach for early-stage supraglottic SCC in appropriate patients.
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Affiliation(s)
| | - Michael S Chow
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Adam S Jacobson
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Theresa Tran
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Mark S Persky
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Michael J Persky
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
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Papazian MR, Chow M, Oliver J, Gordon AJ, Jacobson A, Vaezi A, Tam M, Givi B. Surgical Treatment in Very Advanced (T4b) Adenoid Cystic Carcinoma of the Head and Neck. Otolaryngol Head Neck Surg 2023; 168:1411-1419. [PMID: 36892056 DOI: 10.1002/ohn.203] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To compare treatment outcomes for T4b head and neck adenoid cystic carcinoma (ACC). STUDY DESIGN Historical cohort study. SETTING National Cancer Database (NCDB). METHODS Identified all T4b ACC of head and neck origin diagnosed 2004 to 2019 in the NCDB. Demographics, clinical characteristics, treatment details, and survival were analyzed. Treatment outcomes were analyzed using univariable and multivariable Cox regression. RESULTS We identified 606 cases of T4b ACC. Less than half (284, 47.0%) underwent curative-intent treatment. Among these, most were treated with primary surgery: surgery + radiotherapy (RT) (122, 43.0%) or surgery + chemoradiotherapy (CRT) (42, 14.8%). The positive margin rate was 78.7%, and 90-day postoperative mortality was zero. Nonsurgical patients were treated with definitive RT (60, 21.1%) or definitive CRT (60, 21.1%). The median follow-up was 51.5 months. Overall survival was 77.8% at 3 years. Three-year survival was higher for patients treated with surgery compared to those treated nonsurgically (84% vs 70%; p = .005). Surgical treatment remained associated with higher survival on multivariable analysis (hazard ratio [HR]: 0.47, p = .005). This effect was most pronounced for oral cavity tumors (HR: 0.17, p = .01). Among matched cohorts of surgically treated patients, there was no difference in 3-year survival between clinical T4a and T4b tumors (83.3% vs 83.0%, p = .99). CONCLUSION Long-term survival for T4b ACC of the head and neck could be expected. Primary surgical treatments can be performed safely and are associated with longer survival. A carefully selected subset of patients with very advanced ACC might benefit from the consideration of surgical treatments.
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Affiliation(s)
- Michael R Papazian
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Michael Chow
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Jamie Oliver
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, New York, USA
| | - Alex J Gordon
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Adam Jacobson
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Alec Vaezi
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Moses Tam
- Department of Radiation Oncology, NYU Langone Health, New York, New York, USA
| | - Babak Givi
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Cantu-Guerra HL, Papazian MR, Gorsky AL, Alekos NS, Caccavano A, Karagulyan N, Neef J, Vicini S, Moser T, Coate TM. Cochlear hair cell innervation is dependent on a modulatory function of Semaphorin-3A. Dev Dyn 2023; 252:124-144. [PMID: 36284453 PMCID: PMC9812910 DOI: 10.1002/dvdy.548] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/20/2022] [Accepted: 10/06/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Proper connectivity between type I spiral ganglion neurons (SGNs) and inner hair cells (IHCs) in the cochlea is necessary for conveying sound information to the brain in mammals. Previous studies have shown that type I SGNs are heterogeneous in form, function and synaptic location on IHCs, but factors controlling their patterns of connectivity are not well understood. RESULTS During development, cochlear supporting cells and SGNs express Semaphorin-3A (SEMA3A), a known axon guidance factor. Mice homozygous for a point mutation that attenuates normal SEMA3A repulsive activity (Sema3aK108N ) show cochleae with grossly normal patterns of IHC innervation. However, genetic sparse labeling and three-dimensional reconstructions of individual SGNs show that cochleae from Sema3aK108N mice lacked the normal synaptic distribution of type I SGNs. Additionally, Sema3aK108N cochleae show a disrupted distribution of GLUA2 postsynaptic patches around the IHCs. The addition of SEMA3A-Fc to postnatal cochleae led to increases in SGN branching, similar to the effects of inhibiting glutamate receptors. Ca2+ imaging studies show that SEMA3A-Fc decreases SGN activity. CONCLUSIONS Contrary to the canonical view of SEMA3A as a guidance ligand, our results suggest SEMA3A may regulate SGN excitability in the cochlea, which may influence the morphology and synaptic arrangement of type I SGNs.
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Affiliation(s)
- Homero L. Cantu-Guerra
- Department of Biology, Georgetown University, Washington,
District of Columbia, USA
- Interdisciplinary Program in Neuroscience, Georgetown
University, Washington, District of Columbia, USA
| | - Michael R. Papazian
- Department of Biology, Georgetown University, Washington,
District of Columbia, USA
| | - Anna L. Gorsky
- Department of Biology, Georgetown University, Washington,
District of Columbia, USA
| | - Nathalie S. Alekos
- Department of Biology, Georgetown University, Washington,
District of Columbia, USA
| | - Adam Caccavano
- Interdisciplinary Program in Neuroscience, Georgetown
University, Washington, District of Columbia, USA
- Department of Pharmacology, Georgetown University School of
Medicine, Washington, District of Columbia, USA
| | - Nare Karagulyan
- Institute for Auditory Neuroscience and InnerEarLab,
University Medical Center, and Auditory Neuroscience & Synaptic Nanophysiology
Group, Max Planck Institute for Multidisciplinary Sciences, and Cluster of
Excellence “Multiscale Bioimaging: from Molecular Machines to Networks of
Excitable Cells” (MBExC), Göttingen, Germany
| | - Jakob Neef
- Institute for Auditory Neuroscience and InnerEarLab,
University Medical Center, and Auditory Neuroscience & Synaptic Nanophysiology
Group, Max Planck Institute for Multidisciplinary Sciences, and Cluster of
Excellence “Multiscale Bioimaging: from Molecular Machines to Networks of
Excitable Cells” (MBExC), Göttingen, Germany
| | - Stefano Vicini
- Interdisciplinary Program in Neuroscience, Georgetown
University, Washington, District of Columbia, USA
- Department of Pharmacology, Georgetown University School of
Medicine, Washington, District of Columbia, USA
| | - Tobias Moser
- Institute for Auditory Neuroscience and InnerEarLab,
University Medical Center, and Auditory Neuroscience & Synaptic Nanophysiology
Group, Max Planck Institute for Multidisciplinary Sciences, and Cluster of
Excellence “Multiscale Bioimaging: from Molecular Machines to Networks of
Excitable Cells” (MBExC), Göttingen, Germany
| | - Thomas M. Coate
- Department of Biology, Georgetown University, Washington,
District of Columbia, USA
- Interdisciplinary Program in Neuroscience, Georgetown
University, Washington, District of Columbia, USA
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Affiliation(s)
- M R Papazian
- State University of New York, School of Medicine and Biomedical Sciences, Buffalo
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Papazian MR, Castillo MH, Campbell JH, Dalrymple D. Analysis of reconstruction for anterior mandibular defects using AO plates. J Oral Maxillofac Surg 1991; 49:1055-9; discussion 1059-60. [PMID: 1890518 DOI: 10.1016/0278-2391(91)90137-b] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The functional and cosmetic outcome of 11 patients who had anterior arch mandibulectomy for stage II-IV oral cavity carcinoma and were reconstructed with AO stainless-steel or titanium plates was retrospectively analyzed. Although the complication rate was high, plate removal was uncommon. Patients were afforded good function and cosmesis. Severity of postoperative infection corresponded to a low preoperative absolute lymphocyte count, which suggests that increased preoperative diet supplementation may decrease the incidence of early infections. Improved mandibular function and esthetics may allow future patients to be offered early reconstruction routinely.
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Affiliation(s)
- M R Papazian
- Department of Otolaryngology, SUNY School of Medicine, Buffalo
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