Collins, Reagan A; DiGennaro, Catherine; Beninato, Toni; Gartland, Rajshri M; Chaves, Natalia; Broekhuis, Jordan M; Reddy, Lekha; Lee, Jenna; Deimiller, Angelina; Alterio, Maeve M; Campbell, Michael J; Lee, Yeon Joo; Khilnani, Tyler K; Stewart, Latoya A; O'Brien, Mollie A; Alvarado, Miguel Valdivia Y; Zheng, Feibi; McAneny, David; Liou, Rachel; McManus, Catherine; Dream, Sophie Y; Wang, Tracy S; Yen, Tina W; Alhefdhi, Amal; Finnerty, Brendan M; Fahey, Thomas J; Graves, Claire E; Laird, Amanda M; Nehs, Matthew A; Drake, Frederick Thurston; Lee, James A; McHenry, Christopher R; James, Benjamin C; Pasieka, Janice L; Kuo, Jennifer H; Lubitz, Carrie Cunningham
Limited disease progression in endocrine surgery patients with treatment delays due to COVID-19 Journal Article
In: Surgery, vol. 173, no. 1, pp. 93–100, 2023, ISSN: 1532-7361.
@article{pmid36210185,
title = {Limited disease progression in endocrine surgery patients with treatment delays due to COVID-19},
author = {Reagan A Collins and Catherine DiGennaro and Toni Beninato and Rajshri M Gartland and Natalia Chaves and Jordan M Broekhuis and Lekha Reddy and Jenna Lee and Angelina Deimiller and Maeve M Alterio and Michael J Campbell and Yeon Joo Lee and Tyler K Khilnani and Latoya A Stewart and Mollie A O'Brien and Miguel Valdivia Y Alvarado and Feibi Zheng and David McAneny and Rachel Liou and Catherine McManus and Sophie Y Dream and Tracy S Wang and Tina W Yen and Amal Alhefdhi and Brendan M Finnerty and Thomas J Fahey and Claire E Graves and Amanda M Laird and Matthew A Nehs and Frederick Thurston Drake and James A Lee and Christopher R McHenry and Benjamin C James and Janice L Pasieka and Jennifer H Kuo and Carrie Cunningham Lubitz},
doi = {10.1016/j.surg.2022.06.043},
issn = {1532-7361},
year = {2023},
date = {2023-01-01},
journal = {Surgery},
volume = {173},
number = {1},
pages = {93--100},
abstract = {BACKGROUND: The COVID-19 pandemic profoundly impacted the delivery of care and timing of elective surgical procedures. Most endocrine-related operations were considered elective and safe to postpone, providing a unique opportunity to assess clinical outcomes under protracted treatment plans.
METHODS: American Association of Endocrine Surgeon members were surveyed for participation. A Research Electronic Data Capture survey was developed and distributed to 27 institutions to assess the impact of COVID-19-related delays. The information collected included patient demographics, primary diagnosis, resumption of care, and assessment of disease progression by the surgeon.
RESULTS: Twelve out of 27 institutions completed the survey (44.4%). Of 850 patients, 74.8% (636) were female; median age was 56 (interquartile range, 44-66) years. Forty percent (34) of patients had not been seen since their original surgical appointment was delayed; 86.2% (733) of patients had a delay in care with women more likely to have a delay (87.6% vs 82.2% of men, χ = 3.84, P = .05). Median duration of delay was 70 (interquartile range, 42-118) days. Among patients with a delay in care, primary disease site included thyroid (54.2%), parathyroid (37.2%), adrenal (6.5%), and pancreatic/gastrointestinal neuroendocrine tumors (1.3%). In addition, 4.0% (26) of patients experienced disease progression and 4.1% (24) had a change from the initial operative plan. The duration of delay was not associated with disease progression (P = .96) or a change in operative plan (P = .66).
CONCLUSION: Although some patients experienced disease progression during COVID-19 delays to endocrine disease-related care, most patients with follow-up did not. Our analysis indicated that temporary delay may be an acceptable course of action in extreme circumstances for most endocrine-related surgical disease.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: The COVID-19 pandemic profoundly impacted the delivery of care and timing of elective surgical procedures. Most endocrine-related operations were considered elective and safe to postpone, providing a unique opportunity to assess clinical outcomes under protracted treatment plans.
METHODS: American Association of Endocrine Surgeon members were surveyed for participation. A Research Electronic Data Capture survey was developed and distributed to 27 institutions to assess the impact of COVID-19-related delays. The information collected included patient demographics, primary diagnosis, resumption of care, and assessment of disease progression by the surgeon.
RESULTS: Twelve out of 27 institutions completed the survey (44.4%). Of 850 patients, 74.8% (636) were female; median age was 56 (interquartile range, 44-66) years. Forty percent (34) of patients had not been seen since their original surgical appointment was delayed; 86.2% (733) of patients had a delay in care with women more likely to have a delay (87.6% vs 82.2% of men, χ = 3.84, P = .05). Median duration of delay was 70 (interquartile range, 42-118) days. Among patients with a delay in care, primary disease site included thyroid (54.2%), parathyroid (37.2%), adrenal (6.5%), and pancreatic/gastrointestinal neuroendocrine tumors (1.3%). In addition, 4.0% (26) of patients experienced disease progression and 4.1% (24) had a change from the initial operative plan. The duration of delay was not associated with disease progression (P = .96) or a change in operative plan (P = .66).
CONCLUSION: Although some patients experienced disease progression during COVID-19 delays to endocrine disease-related care, most patients with follow-up did not. Our analysis indicated that temporary delay may be an acceptable course of action in extreme circumstances for most endocrine-related surgical disease.
METHODS: American Association of Endocrine Surgeon members were surveyed for participation. A Research Electronic Data Capture survey was developed and distributed to 27 institutions to assess the impact of COVID-19-related delays. The information collected included patient demographics, primary diagnosis, resumption of care, and assessment of disease progression by the surgeon.
RESULTS: Twelve out of 27 institutions completed the survey (44.4%). Of 850 patients, 74.8% (636) were female; median age was 56 (interquartile range, 44-66) years. Forty percent (34) of patients had not been seen since their original surgical appointment was delayed; 86.2% (733) of patients had a delay in care with women more likely to have a delay (87.6% vs 82.2% of men, χ = 3.84, P = .05). Median duration of delay was 70 (interquartile range, 42-118) days. Among patients with a delay in care, primary disease site included thyroid (54.2%), parathyroid (37.2%), adrenal (6.5%), and pancreatic/gastrointestinal neuroendocrine tumors (1.3%). In addition, 4.0% (26) of patients experienced disease progression and 4.1% (24) had a change from the initial operative plan. The duration of delay was not associated with disease progression (P = .96) or a change in operative plan (P = .66).
CONCLUSION: Although some patients experienced disease progression during COVID-19 delays to endocrine disease-related care, most patients with follow-up did not. Our analysis indicated that temporary delay may be an acceptable course of action in extreme circumstances for most endocrine-related surgical disease.
Frates, Beth; Cron, David; Lubitz, Carrie Cunningham; Boland, Genevieve; Srivastava, Sunita; Hodin, Richard A; Stephen, Antonia E; Carney, Kelsey; Phitayakorn, Roy
In: Am J Lifestyle Med, vol. 17, no. 2, pp. 213–215, 2023, ISSN: 1559-8284.
@article{pmid36896035,
title = {Incorporating Well-Being into Mentorship Meetings: A Case Demonstration at Massachusetts General Hospital Department of Surgery a Harvard Medical School Affiliate},
author = {Beth Frates and David Cron and Carrie Cunningham Lubitz and Genevieve Boland and Sunita Srivastava and Richard A Hodin and Antonia E Stephen and Kelsey Carney and Roy Phitayakorn},
doi = {10.1177/15598276221105830},
issn = {1559-8284},
year = {2023},
date = {2023-01-01},
urldate = {2023-01-01},
journal = {Am J Lifestyle Med},
volume = {17},
number = {2},
pages = {213--215},
abstract = {Surgeons have been under great pressure during the COVID pandemic. Their careers are filled with fast paced decisions, life and death situations, and long hours at work. The COVID pandemic created more tasks and even new responsibilities at times, but when the operating rooms were closed down, there was less work. The COVID experience invited the opportunity to rethink mentoring in the surgery department at the Massachusetts General Hospital. The leadership experimented with a new style of mentoring which involved a team approach. In addition, they tried something else that was new: adding a lifestyle medicine expert and wellness coach to the mentoring team. The program was tested on 13 early stage surgeons who found the experience to be beneficial, and they commented that they wished they had it even earlier in their careers. Including a non-surgeon who was a lifestyle medicine physician and wellness coach added an element of whole person health that was acceptable to the surgeons and even embraced as the majority of them elected to follow up with one on one coaching after the mentoring meeting. This team mentoring program with senior surgeons and a lifestyle medicine expert is one that can be explored by other departments and other hospitals given its success at the department of surgery at Massachusetts General Hospital.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Surgeons have been under great pressure during the COVID pandemic. Their careers are filled with fast paced decisions, life and death situations, and long hours at work. The COVID pandemic created more tasks and even new responsibilities at times, but when the operating rooms were closed down, there was less work. The COVID experience invited the opportunity to rethink mentoring in the surgery department at the Massachusetts General Hospital. The leadership experimented with a new style of mentoring which involved a team approach. In addition, they tried something else that was new: adding a lifestyle medicine expert and wellness coach to the mentoring team. The program was tested on 13 early stage surgeons who found the experience to be beneficial, and they commented that they wished they had it even earlier in their careers. Including a non-surgeon who was a lifestyle medicine physician and wellness coach added an element of whole person health that was acceptable to the surgeons and even embraced as the majority of them elected to follow up with one on one coaching after the mentoring meeting. This team mentoring program with senior surgeons and a lifestyle medicine expert is one that can be explored by other departments and other hospitals given its success at the department of surgery at Massachusetts General Hospital.
Panda, Nikhil; Solsky, Ian; Cauley, Christy; Lipsitz, Stuart; Desai, Eesha V.; Huang, Emily J.; Benjamin, Evan M.; Lubitz, Carrie C.; Onnela, Jukka-Pekka; Haynes, Alex B.
In: Annals of surgery, vol. 276, iss. 1, pp. 193-199, 2022, ISSN: 1528-1140.
@article{Panda2020b,
title = {Smartphone-Based Assessment of Preoperative Decision Conflict and Postoperative Physical Activity Among Patients Undergoing Cancer Surgery: A Prospective Cohort Study.},
author = {Nikhil Panda and Ian Solsky and Christy Cauley and Stuart Lipsitz and Eesha V. Desai and Emily J. Huang and Evan M. Benjamin and Carrie C. Lubitz and Jukka-Pekka Onnela and Alex B. Haynes},
doi = {10.1097/SLA.0000000000004487},
issn = {1528-1140},
year = {2022},
date = {2022-07-01},
urldate = {2022-07-01},
journal = {Annals of surgery},
volume = {276},
issue = {1},
pages = {193-199},
abstract = {To determine the prevalence of clinically significant decision conflict (CSDC) among patients undergoing cancer surgery and associations with postoperative physical activity, as measured through smartphone accelerometer data. Patients with cancer face challenging treatment decisions, which may lead to CSDC. CSDC negatively affects patient-provider relationships, psychosocial functioning, and health-related quality of life; however, physical manifestations of CSDC remain poorly characterized. Adult smartphone-owners undergoing surgery for breast, skin-soft-tissue, head-and-neck, or abdominal cancer (July 2017-2019) were approached. Patients downloaded the Beiwe application that delivered the Decision Conflict Scale (DCS) preoperatively and collected smartphone accelerometer data continuously from enrollment through 6 months postoperatively. Restricted-cubic-spline regression, adjusting for a priori potential confounders (age, type of surgery, support status, and postoperative complications) was used to determine trends in postoperative daily physical activity among patients with and without CSDC (DCS score≥25/100). Among 99 patients who downloaded the application, 85 completed the DCS (86% participation rate). Twenty-three (27%) reported CSDC. These patients were younger (mean age 48.3 [standard deviation 14.2]-vs.-55.0 [13.3},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
To determine the prevalence of clinically significant decision conflict (CSDC) among patients undergoing cancer surgery and associations with postoperative physical activity, as measured through smartphone accelerometer data. Patients with cancer face challenging treatment decisions, which may lead to CSDC. CSDC negatively affects patient-provider relationships, psychosocial functioning, and health-related quality of life; however, physical manifestations of CSDC remain poorly characterized. Adult smartphone-owners undergoing surgery for breast, skin-soft-tissue, head-and-neck, or abdominal cancer (July 2017-2019) were approached. Patients downloaded the Beiwe application that delivered the Decision Conflict Scale (DCS) preoperatively and collected smartphone accelerometer data continuously from enrollment through 6 months postoperatively. Restricted-cubic-spline regression, adjusting for a priori potential confounders (age, type of surgery, support status, and postoperative complications) was used to determine trends in postoperative daily physical activity among patients with and without CSDC (DCS score≥25/100). Among 99 patients who downloaded the application, 85 completed the DCS (86% participation rate). Twenty-three (27%) reported CSDC. These patients were younger (mean age 48.3 [standard deviation 14.2]-vs.-55.0 [13.3
Wachtel, Heather; Roses, Robert E.; Kuo, Lindsay E.; Lindeman, Brenessa M.; Nehs, Matthew A.; Tavakkoli, Ali; Parangi, Sareh; Hodin, Richard A.; Fraker, Douglas L.; James, Benjamin C.; Carr, Azadeh A.; Wang, Tracy S.; Solórzano, Carmen C.; Lubitz, Carrie C.
Adrenalectomy for Secondary Malignancy: Patients, Outcomes, and Indications. Journal Article
In: Annals of surgery, vol. 274, no. 6, pp. 1073-1080, 2021, ISSN: 1528-1140, ().
@article{Wachtel2020,
title = {Adrenalectomy for Secondary Malignancy: Patients, Outcomes, and Indications.},
author = {Heather Wachtel and Robert E. Roses and Lindsay E. Kuo and Brenessa M. Lindeman and Matthew A. Nehs and Ali Tavakkoli and Sareh Parangi and Richard A. Hodin and Douglas L. Fraker and Benjamin C. James and Azadeh A. Carr and Tracy S. Wang and Carmen C. Sol\'{o}rzano and Carrie C. Lubitz},
url = {https://www.ncbi.nlm.nih.gov/pubmed/32427760},
doi = {10.1097/SLA.0000000000003876},
issn = {1528-1140},
year = {2021},
date = {2021-12-01},
urldate = {2020-05-01},
journal = {Annals of surgery},
volume = {274},
number = {6},
pages = {1073-1080},
abstract = {The goal of this study was to examine a multi-institutional experience with adrenal metastases to describe survival outcomes and identify subpopulations who benefit from adrenal metastasectomy. Adrenalectomy for metastatic disease is well-described, although indications and outcomes are incompletely defined. A retrospective cohort study was performed of patients undergoing adrenalectomy for secondary malignancy (2002-2015) at 6 institutions. The primary outcomes were disease free survival (DFS) and overall survival (OS). Analysis methods included Kaplan-Meier and Cox proportional hazards. Of 269 patients, mean age was 60.1 years; 50% were male. The most common primary malignancies were lung (n = 125, 47%), renal cell (n = 38, 14%), melanoma (n = 33, 12%), sarcoma (n = 18, 7%), and colorectal (n = 12, 5%). The median time to detection of adrenal metastasis after initial diagnosis of the primary tumor was 17 months (interquartile range: 6-41). Post-adrenalectomy, the median DFS was 18 months (1-year DFS: 54%, 5-year DFS: 31%). On multivariable analysis, lung primary was associated with longer DFS [hazard ratio (HR): 0.4},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The goal of this study was to examine a multi-institutional experience with adrenal metastases to describe survival outcomes and identify subpopulations who benefit from adrenal metastasectomy. Adrenalectomy for metastatic disease is well-described, although indications and outcomes are incompletely defined. A retrospective cohort study was performed of patients undergoing adrenalectomy for secondary malignancy (2002-2015) at 6 institutions. The primary outcomes were disease free survival (DFS) and overall survival (OS). Analysis methods included Kaplan-Meier and Cox proportional hazards. Of 269 patients, mean age was 60.1 years; 50% were male. The most common primary malignancies were lung (n = 125, 47%), renal cell (n = 38, 14%), melanoma (n = 33, 12%), sarcoma (n = 18, 7%), and colorectal (n = 12, 5%). The median time to detection of adrenal metastasis after initial diagnosis of the primary tumor was 17 months (interquartile range: 6-41). Post-adrenalectomy, the median DFS was 18 months (1-year DFS: 54%, 5-year DFS: 31%). On multivariable analysis, lung primary was associated with longer DFS [hazard ratio (HR): 0.4
Zhou, Jingan; Singh, Preeti; Yin, Kanhua; Wang, Jin; Bao, Yujia; Wu, Menghua; Pathak, Kush; McKinley, Sophia K; Braun, Danielle; Lubitz, Carrie C.; Hughes, Kevin S
Non-medullary Thyroid Cancer Susceptibility Genes: Evidence and Disease Spectrum. Journal Article
In: Annals of surgical oncology, vol. 28, no. 11, pp. 6590-6600, 2021, ISSN: 1534-4681, ().
@article{Zhou2021,
title = {Non-medullary Thyroid Cancer Susceptibility Genes: Evidence and Disease Spectrum.},
author = {Jingan Zhou and Preeti Singh and Kanhua Yin and Jin Wang and Yujia Bao and Menghua Wu and Kush Pathak and Sophia K McKinley and Danielle Braun and Carrie C. Lubitz and Kevin S Hughes},
url = {https://pubmed.ncbi.nlm.nih.gov/33660127/},
doi = {10.1245/s10434-021-09745-x},
issn = {1534-4681},
year = {2021},
date = {2021-10-01},
journal = {Annals of surgical oncology},
volume = {28},
number = {11},
pages = {6590-6600},
abstract = {The prevalence of non-medullary thyroid cancer (NMTC) is increasing worldwide. Although most NMTCs grow slowly, conventional therapies are less effective in advanced tumors. Approximately 5-15% of NMTCs have a significant germline genetic component. Awareness of the NMTC susceptibility genes may lead to earlier diagnosis and better cancer prevention. The aim of this study was to provide the current panorama of susceptibility genes associated with NMTC and the spectrum of diseases associated with these genes. Twenty-five candidate genes were identified by searching for relevant studies in PubMed. Each candidate gene was carefully checked using six authoritative genetic resources: ClinGen, National Comprehensive Cancer Network guidelines, Online Mendelian Inheritance in Man, Genetics Home Reference, GeneCards, and Gene-NCBI, and a validated natural language processing (NLP)-based literature review protocol was used to further assess gene-disease associations where there was ambiguity. Among 25 candidate genes, 10 (APC, DICER1, FOXE1, HABP2, NKX2-1, PRKAR1A, PTEN, SDHB, SDHD, and SRGAP1) were verified among the six genetic resources. Two additional genes, CHEK2 and SEC23B, were verified using the NLP protocol. Seventy-nine diseases were found to be associated with these 12 NMTC susceptibility genes. The following diseases were associated with more than one NMTC susceptibility gene: colorectal cancer, breast cancer, gastric cancer, kidney cancer, gastrointestinal stromal tumor, paraganglioma, pheochromocytoma, and benign skin conditions. Twelve genes predisposing to NMTC and their associated disease spectra were identified and verified. Clinicians should be aware that patients with certain pathogenic variants may require more aggressive surveillance beyond their thyroid cancer risk.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The prevalence of non-medullary thyroid cancer (NMTC) is increasing worldwide. Although most NMTCs grow slowly, conventional therapies are less effective in advanced tumors. Approximately 5-15% of NMTCs have a significant germline genetic component. Awareness of the NMTC susceptibility genes may lead to earlier diagnosis and better cancer prevention. The aim of this study was to provide the current panorama of susceptibility genes associated with NMTC and the spectrum of diseases associated with these genes. Twenty-five candidate genes were identified by searching for relevant studies in PubMed. Each candidate gene was carefully checked using six authoritative genetic resources: ClinGen, National Comprehensive Cancer Network guidelines, Online Mendelian Inheritance in Man, Genetics Home Reference, GeneCards, and Gene-NCBI, and a validated natural language processing (NLP)-based literature review protocol was used to further assess gene-disease associations where there was ambiguity. Among 25 candidate genes, 10 (APC, DICER1, FOXE1, HABP2, NKX2-1, PRKAR1A, PTEN, SDHB, SDHD, and SRGAP1) were verified among the six genetic resources. Two additional genes, CHEK2 and SEC23B, were verified using the NLP protocol. Seventy-nine diseases were found to be associated with these 12 NMTC susceptibility genes. The following diseases were associated with more than one NMTC susceptibility gene: colorectal cancer, breast cancer, gastric cancer, kidney cancer, gastrointestinal stromal tumor, paraganglioma, pheochromocytoma, and benign skin conditions. Twelve genes predisposing to NMTC and their associated disease spectra were identified and verified. Clinicians should be aware that patients with certain pathogenic variants may require more aggressive surveillance beyond their thyroid cancer risk.
Kuo, Lindsay E.; Bird, Sarah H.; Lubitz, Carrie C.; Pandian, T. K.; Parangi, Sareh; Stephen, Antonia E.
Four-dimensional computed tomography (4D-CT) for preoperative parathyroid localization: A good study but are we using it? Journal Article
In: American journal of surgery, vol. 224, iss. 4, pp. 694-698, 2021, ISSN: 1879-1883.
@article{Kuo2021,
title = {Four-dimensional computed tomography (4D-CT) for preoperative parathyroid localization: A good study but are we using it?},
author = {Lindsay E. Kuo and Sarah H. Bird and Carrie C. Lubitz and T. K. Pandian and Sareh Parangi and Antonia E. Stephen},
url = {https://pubmed.ncbi.nlm.nih.gov/34579935/},
doi = {10.1016/j.amjsurg.2021.09.015},
issn = {1879-1883},
year = {2021},
date = {2021-09-01},
urldate = {2021-09-01},
journal = {American journal of surgery},
volume = {224},
issue = {4},
pages = {694-698},
abstract = {Four-dimensional computed tomography (4D-CT) scan to localize abnormal parathyroid glands is diagnostically superior to ultrasound (US) and sestamibi. The implementation of 4D-CT imaging is unknown. The Collaborative Endocrine Surgery Quality Improvement Program (CESQIP) database from 2014 to 2018 was utilized. Patients with hyperparathyroidism undergoing an initial operation were included. The rate of US, sestamibi and 4D-CT performance was calculated for the entire study population, and for each institution. 7,959 patients were included. In 311(3.9%) patients, no preoperative imaging was recorded. Of patients with imaging, US was performed in 6,872(86.3%), sestamibi in 5,094(64.0%), and 4D-CT in 1,630(20.4%). The combination of US and sestamibi was most frequent (3,855, 48.4%). Institutional rates of 4D-CT performance varied from 0.1% to 88.7%. Of the imaging modalities, 4D-CT was utilized least frequently and with greatest variability. Given the high accuracy of 4D-CT, efforts to reduce this variation may improve overall preoperative localization in patients with hyperparathyroidism.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Four-dimensional computed tomography (4D-CT) scan to localize abnormal parathyroid glands is diagnostically superior to ultrasound (US) and sestamibi. The implementation of 4D-CT imaging is unknown. The Collaborative Endocrine Surgery Quality Improvement Program (CESQIP) database from 2014 to 2018 was utilized. Patients with hyperparathyroidism undergoing an initial operation were included. The rate of US, sestamibi and 4D-CT performance was calculated for the entire study population, and for each institution. 7,959 patients were included. In 311(3.9%) patients, no preoperative imaging was recorded. Of patients with imaging, US was performed in 6,872(86.3%), sestamibi in 5,094(64.0%), and 4D-CT in 1,630(20.4%). The combination of US and sestamibi was most frequent (3,855, 48.4%). Institutional rates of 4D-CT performance varied from 0.1% to 88.7%. Of the imaging modalities, 4D-CT was utilized least frequently and with greatest variability. Given the high accuracy of 4D-CT, efforts to reduce this variation may improve overall preoperative localization in patients with hyperparathyroidism.
Fligor, Scott C; Lopez, Betzamel; Uppal, Nishant; Lubitz, Carrie C.; James, Benjamin C
ASO Visual Abstract: Time to Surgery and Thyroid Cancer Survival in the United States. Journal Article
In: Annals of surgical oncology, vol. 28, no. 7, pp. 3566, 2021, ISSN: 1534-4681, ().
@article{Fligor2021a,
title = {ASO Visual Abstract: Time to Surgery and Thyroid Cancer Survival in the United States.},
author = {Scott C Fligor and Betzamel Lopez and Nishant Uppal and Carrie C. Lubitz and Benjamin C James},
url = {https://pubmed.ncbi.nlm.nih.gov/33768401/},
doi = {10.1245/s10434-021-09834-x},
issn = {1534-4681},
year = {2021},
date = {2021-07-01},
journal = {Annals of surgical oncology},
volume = {28},
number = {7},
pages = {3566},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Fligor, Scott C; Lopez, Betzamel; Uppal, Nishant; Lubitz, Carrie C.; James, Benjamin C
Time to Surgery and Thyroid Cancer Survival in the United States. Journal Article
In: Annals of surgical oncology, vol. 28, no. 7, pp. 3556-3565, 2021, ISSN: 1534-4681, ().
@article{Fligor2021b,
title = {Time to Surgery and Thyroid Cancer Survival in the United States.},
author = {Scott C Fligor and Betzamel Lopez and Nishant Uppal and Carrie C. Lubitz and Benjamin C James},
url = {https://pubmed.ncbi.nlm.nih.gov/33768394/},
doi = {10.1245/s10434-021-09797-z},
issn = {1534-4681},
year = {2021},
date = {2021-07-01},
journal = {Annals of surgical oncology},
volume = {28},
number = {7},
pages = {3556-3565},
abstract = {Longer time to surgery worsens survival in multiple malignancies, including lung, colorectal, and breast cancers, but limited data exist for well-differentiated thyroid cancer. We sought to investigate the impact of time to surgery on overall survival in patients with papillary thyroid cancer. In a retrospective cohort study of the National Cancer Database, we used Cox proportional hazard models to investigate overall survival as a function of time between diagnosis and surgery for adults with papillary thyroid cancer, adjusting for demographic, patient, and cancer-related variables. Time to surgery was investigated both as a continuous variable and as intervals of 0-90 days, 90-180 days, and \> 180 days. Subgroup analyses were conducted by T stage. Overall, 103,812 adults with papillary thyroid cancer were included from 2004 to 2016. Median follow-up was 55.2 months (interquartile range 28.4-89.5). Increasing time to surgery was associated with increased mortality: delaying by 91-180 days increased the risk by 30% (adjusted hazard ratio [aHR] 1.30, 95% CI 1.19-1.43) and delaying by over 180 days increased the risk by 94% (aHR 1.94, 95% CI 1.68-2.24). Five-year overall survival was 95.7% for 0-90 days, 93.0% for 91-180 days, and 87.9% for over 180 days. On subgroup analysis, increasing delay was associated with worse overall survival for T1, T2, and T3 tumors, but not T4 tumors. Increasing time to surgery in papillary thyroid cancer is associated with reduced overall survival. Further research is necessary to assess the impact of surgical delay on disease-specific survival.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Longer time to surgery worsens survival in multiple malignancies, including lung, colorectal, and breast cancers, but limited data exist for well-differentiated thyroid cancer. We sought to investigate the impact of time to surgery on overall survival in patients with papillary thyroid cancer. In a retrospective cohort study of the National Cancer Database, we used Cox proportional hazard models to investigate overall survival as a function of time between diagnosis and surgery for adults with papillary thyroid cancer, adjusting for demographic, patient, and cancer-related variables. Time to surgery was investigated both as a continuous variable and as intervals of 0-90 days, 90-180 days, and > 180 days. Subgroup analyses were conducted by T stage. Overall, 103,812 adults with papillary thyroid cancer were included from 2004 to 2016. Median follow-up was 55.2 months (interquartile range 28.4-89.5). Increasing time to surgery was associated with increased mortality: delaying by 91-180 days increased the risk by 30% (adjusted hazard ratio [aHR] 1.30, 95% CI 1.19-1.43) and delaying by over 180 days increased the risk by 94% (aHR 1.94, 95% CI 1.68-2.24). Five-year overall survival was 95.7% for 0-90 days, 93.0% for 91-180 days, and 87.9% for over 180 days. On subgroup analysis, increasing delay was associated with worse overall survival for T1, T2, and T3 tumors, but not T4 tumors. Increasing time to surgery in papillary thyroid cancer is associated with reduced overall survival. Further research is necessary to assess the impact of surgical delay on disease-specific survival.
Fligor, Scott C; Lubitz, Carrie C.; James, Benjamin C
ASO Author Reflections: Does Timely Surgery Matter in Papillary Thyroid Cancer? Journal Article
In: Annals of surgical oncology, vol. 28, no. 7, pp. 3567, 2021, ISSN: 1534-4681, ().
@article{Fligor2021,
title = {ASO Author Reflections: Does Timely Surgery Matter in Papillary Thyroid Cancer?},
author = {Scott C Fligor and Carrie C. Lubitz and Benjamin C James},
url = {https://pubmed.ncbi.nlm.nih.gov/33755830/},
doi = {10.1245/s10434-021-09799-x},
issn = {1534-4681},
year = {2021},
date = {2021-07-01},
journal = {Annals of surgical oncology},
volume = {28},
number = {7},
pages = {3567},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Garber, Jeffrey R.; Papini, Enrico; Frasoldati, Andrea; Lupo, Mark A.; Harrell, R. Mack; Parangi, Sareh; Patkar, Vivek; Baloch, Zubair W.; Pessah-Pollack, Rachel; Hegedus, Laszlo; Crescenzi, Anna; Lubitz, Carrie C.; Paschke, Ralf; Randolph, Gregory W.; Guglielmi, Rinaldo; Lombardi, Celestino P.; Gharib, Hossein
American Association of Clinical Endocrinology And Associazione Medici Endocrinologi Thyroid Nodule Algorithmic Tool. Journal Article
In: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, vol. 27, no. 7, pp. 649-660, 2021, ().
@article{Garber2021,
title = {American Association of Clinical Endocrinology And Associazione Medici Endocrinologi Thyroid Nodule Algorithmic Tool.},
author = {Jeffrey R. Garber and Enrico Papini and Andrea Frasoldati and Mark A. Lupo and R. Mack Harrell and Sareh Parangi and Vivek Patkar and Zubair W. Baloch and Rachel Pessah-Pollack and Laszlo Hegedus and Anna Crescenzi and Carrie C. Lubitz and Ralf Paschke and Gregory W. Randolph and Rinaldo Guglielmi and Celestino P. Lombardi and Hossein Gharib},
url = {https://pubmed.ncbi.nlm.nih.gov/34090820/},
year = {2021},
date = {2021-07-01},
urldate = {2021-07-01},
journal = {Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists},
volume = {27},
number = {7},
pages = {649-660},
address = {United States},
abstract = {OBJECTIVE: The first edition of the American Association of Clinical Endocrinology/American College of Endocrinology/Associazione Medici Endocrinologi Guidelines for the Diagnosis and Management of Thyroid Nodules was published in 2006 and updated in 2010 and 2016. The American Association of Clinical Endocrinology/American College of Endocrinology/Associazione Medici Endocrinologi multidisciplinary thyroid nodules task force was charged with developing a novel interactive electronic algorithmic tool to evaluate thyroid nodules. METHODS: The Thyroid Nodule App (termed TNAPP) was based on the updated 2016 clinical practice guideline recommendations while incorporating recent scientific evidence and avoiding unnecessary diagnostic procedures and surgical overtreatment. This manuscript describes the algorithmic tool development, its data requirements, and its basis for decision making. It provides links to the web-based algorithmic tool and a tutorial. RESULTS: TNAPP and TI-RADS were cross-checked on 95 thyroid nodules with histology-proven diagnoses. CONCLUSION: TNAPP is a novel interactive web-based tool that uses clinical, imaging, cytologic, and molecular marker data to guide clinical decision making to evaluate and manage thyroid nodules. It may be used as a heuristic tool for evaluating and managing patients with thyroid nodules. It can be adapted to create registries for solo practices, large multispecialty delivery systems, regional and national databases, and research consortiums. Prospective studies are underway to validate TNAPP to determine how it compares with other ultrasound-based classification systems and whether it can improve the care of patients with clinically significant thyroid nodules while reducing the substantial burden incurred by those who do not benefit from further evaluation and treatment.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: The first edition of the American Association of Clinical Endocrinology/American College of Endocrinology/Associazione Medici Endocrinologi Guidelines for the Diagnosis and Management of Thyroid Nodules was published in 2006 and updated in 2010 and 2016. The American Association of Clinical Endocrinology/American College of Endocrinology/Associazione Medici Endocrinologi multidisciplinary thyroid nodules task force was charged with developing a novel interactive electronic algorithmic tool to evaluate thyroid nodules. METHODS: The Thyroid Nodule App (termed TNAPP) was based on the updated 2016 clinical practice guideline recommendations while incorporating recent scientific evidence and avoiding unnecessary diagnostic procedures and surgical overtreatment. This manuscript describes the algorithmic tool development, its data requirements, and its basis for decision making. It provides links to the web-based algorithmic tool and a tutorial. RESULTS: TNAPP and TI-RADS were cross-checked on 95 thyroid nodules with histology-proven diagnoses. CONCLUSION: TNAPP is a novel interactive web-based tool that uses clinical, imaging, cytologic, and molecular marker data to guide clinical decision making to evaluate and manage thyroid nodules. It may be used as a heuristic tool for evaluating and managing patients with thyroid nodules. It can be adapted to create registries for solo practices, large multispecialty delivery systems, regional and national databases, and research consortiums. Prospective studies are underway to validate TNAPP to determine how it compares with other ultrasound-based classification systems and whether it can improve the care of patients with clinically significant thyroid nodules while reducing the substantial burden incurred by those who do not benefit from further evaluation and treatment.
Beninato, Toni; Laird, Amanda M.; Graves, Claire E.; Drake, F. Thurston; Alhefdhi, Amal; Lee, Janie; Kuo, Jennifer H.; Grubbs, Elizabeth G.; Wang, Tracy S.; Pasieka, Janice L.; Lubitz, Carrie C.
Impact of the COVID-19 pandemic on the practice of endocrine surgery. Journal Article
In: American journal of surgery, vol. 223, iss. 4, pp. 670-675, 2021, ISSN: 1879-1883.
@article{Beninato2021,
title = {Impact of the COVID-19 pandemic on the practice of endocrine surgery.},
author = {Toni Beninato and Amanda M. Laird and Claire E. Graves and F. Thurston Drake and Amal Alhefdhi and Janie Lee and Jennifer H. Kuo and Elizabeth G. Grubbs and Tracy S. Wang and Janice L. Pasieka and Carrie C. Lubitz},
url = {https://pubmed.ncbi.nlm.nih.gov/34315576/},
doi = {10.1016/j.amjsurg.2021.07.009},
issn = {1879-1883},
year = {2021},
date = {2021-07-01},
urldate = {2021-07-01},
journal = {American journal of surgery},
volume = {223},
issue = {4},
pages = {670-675},
abstract = {This study investigates the impact of the COVID-19 pandemic on endocrine surgeons. A survey on the professional, educational, and clinical impact was sent to active and corresponding members of the American Association of Endocrine Surgeons (AAES) in September 2020. Chi-square and paired t-test were used for analysis. 77 surgeons responded (14.8 %). All reported suspension of elective surgeries; 37.7 % were reassigned to other duties during this time. The median number of cases backlogged was 30 (IQR 15-50). Most surgeons reported decreased clinical volume (74.6 %). The use of virtual platforms for clinical and educational purposes increased from pre-COVID-19 levels (all p \< 0.001). Use of in-office procedures (p \< 0.001) and length of observation prior to discharge for thyroid surgery (p \< 0.05) decreased. The COVID-19 pandemic led to suspension of operations and decreased practice volume for endocrine surgeons. Surgeons increased use of virtual platforms, decreased in-office procedures, and decreased duration of observation for thyroid surgery in response.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
This study investigates the impact of the COVID-19 pandemic on endocrine surgeons. A survey on the professional, educational, and clinical impact was sent to active and corresponding members of the American Association of Endocrine Surgeons (AAES) in September 2020. Chi-square and paired t-test were used for analysis. 77 surgeons responded (14.8 %). All reported suspension of elective surgeries; 37.7 % were reassigned to other duties during this time. The median number of cases backlogged was 30 (IQR 15-50). Most surgeons reported decreased clinical volume (74.6 %). The use of virtual platforms for clinical and educational purposes increased from pre-COVID-19 levels (all p < 0.001). Use of in-office procedures (p < 0.001) and length of observation prior to discharge for thyroid surgery (p < 0.05) decreased. The COVID-19 pandemic led to suspension of operations and decreased practice volume for endocrine surgeons. Surgeons increased use of virtual platforms, decreased in-office procedures, and decreased duration of observation for thyroid surgery in response.
Toumi, Asmae; DiGennaro, Catherine; Vahdat, Vahab; Jalali, Mohammad S.; Gazelle, G. Scott; Chhatwal, Jagpreet; Kelz, Rachel R; Lubitz, Carrie C.
Trends in Thyroid Surgery and Guideline-Concordant Care in the United States, 2007-2018. Journal Article
In: Thyroid : official journal of the American Thyroid Association, vol. 31, no. 6, pp. 941-949, 2021, ISSN: 1557-9077, ().
@article{Toumi2020,
title = {Trends in Thyroid Surgery and Guideline-Concordant Care in the United States, 2007-2018.},
author = {Asmae Toumi and Catherine DiGennaro and Vahab Vahdat and Mohammad S. Jalali and G. Scott Gazelle and Jagpreet Chhatwal and Rachel R Kelz and Carrie C. Lubitz},
url = {https://pubmed.ncbi.nlm.nih.gov/33280499/},
doi = {10.1089/thy.2020.0643},
issn = {1557-9077},
year = {2021},
date = {2021-06-18},
urldate = {2021-06-18},
journal = {Thyroid : official journal of the American Thyroid Association},
volume = {31},
number = {6},
pages = {941-949},
abstract = {\textbf{Background:} The American Thyroid Association (ATA) published the 2015 Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer recommending a shift to less aggressive diagnostic, surgical, and post-operative treatment strategies. At the same time and perhaps related to the new guidelines, there has been a shift to outpatient thyroid surgery. The aim of the current study was to assess physician adherence to these recommendations by identifying and quantifying temporal trends in the rates and indications for thyroid procedures in the inpatient and outpatient settings. \textbf{Methods:} Using the IBM® MarketScan® Commercial database, we identified employer-insured patients in the United States who underwent outpatient and inpatient thyroid surgery from 2007 to 2018. Thyroid surgery was classified as total thyroidectomy (TT), thyroid lobectomy (TL) or a completion thyroidectomy. The surgical indication diagnosis was also determined and classified as either benign or malignant thyroid disease. We compared outpatient and inpatient trends in surgery between benign and malignant thyroid disease before and after the release of the 2015 ATA guidelines. \textbf{Results:} A total of 220,088 patients who underwent thyroid surgery were included in the analysis. Approximately 80% of thyroid lobectomies (TL) were performed in the outpatient setting vs. 70% of total thyroidectomies (TT). Longitudinal analysis showed a statistically significant changepoint for TT proportion occurring in November 2015. The proportion of TT as compared to TL decreased from 80% in September 2015 to 39% by December 2018. For thyroid cancer, there is an increasing trend in performing TL over TT, increasing from 17% in 2015 to 28% by the end of 2018. \textbf{Conclusions:} There was a significant changepoint occurring in November 2015 in the operative and management trends for benign and malignant thyroid disease.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: The American Thyroid Association (ATA) published the 2015 Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer recommending a shift to less aggressive diagnostic, surgical, and post-operative treatment strategies. At the same time and perhaps related to the new guidelines, there has been a shift to outpatient thyroid surgery. The aim of the current study was to assess physician adherence to these recommendations by identifying and quantifying temporal trends in the rates and indications for thyroid procedures in the inpatient and outpatient settings. Methods: Using the IBM® MarketScan® Commercial database, we identified employer-insured patients in the United States who underwent outpatient and inpatient thyroid surgery from 2007 to 2018. Thyroid surgery was classified as total thyroidectomy (TT), thyroid lobectomy (TL) or a completion thyroidectomy. The surgical indication diagnosis was also determined and classified as either benign or malignant thyroid disease. We compared outpatient and inpatient trends in surgery between benign and malignant thyroid disease before and after the release of the 2015 ATA guidelines. Results: A total of 220,088 patients who underwent thyroid surgery were included in the analysis. Approximately 80% of thyroid lobectomies (TL) were performed in the outpatient setting vs. 70% of total thyroidectomies (TT). Longitudinal analysis showed a statistically significant changepoint for TT proportion occurring in November 2015. The proportion of TT as compared to TL decreased from 80% in September 2015 to 39% by December 2018. For thyroid cancer, there is an increasing trend in performing TL over TT, increasing from 17% in 2015 to 28% by the end of 2018. Conclusions: There was a significant changepoint occurring in November 2015 in the operative and management trends for benign and malignant thyroid disease.
Panda, Nikhil; Solsky, Ian; Neal, Brandon J; Hawrusik, Becky; Lipsitz, Stuart; Lubitz, Carrie C.; Gibbons, Chris; Brindle, Mary; Sinyard, Robert D; Onnela, Jukka-Pekka; Cauley, Christy; Haynes, Alex B
Expected Versus Experienced Health-Related Quality of Life Among Patients Recovering From Cancer Surgery: A Prospective Cohort Study. Journal Article
In: Annals of surgery open : perspectives of surgical history, education, and clinical approaches, vol. 2, pp. e060, 2021, ISSN: 2691-3593.
@article{Panda2021,
title = {Expected Versus Experienced Health-Related Quality of Life Among Patients Recovering From Cancer Surgery: A Prospective Cohort Study.},
author = {Nikhil Panda and Ian Solsky and Brandon J Neal and Becky Hawrusik and Stuart Lipsitz and Carrie C. Lubitz and Chris Gibbons and Mary Brindle and Robert D Sinyard and Jukka-Pekka Onnela and Christy Cauley and Alex B Haynes},
url = {https://pubmed.ncbi.nlm.nih.gov/34179891/},
doi = {10.1097/AS9.0000000000000060},
issn = {2691-3593},
year = {2021},
date = {2021-06-01},
urldate = {2021-06-01},
journal = {Annals of surgery open : perspectives of surgical history, education, and clinical approaches},
volume = {2},
pages = {e060},
abstract = {Patient expectations of the impact of surgery on postoperative health-related quality of life (HRQL) may reflect the effectiveness of patient-provider communication. We sought to compare expected versus experienced HRQL among patients undergoing cancer surgery. Adults undergoing cancer surgery were eligible for inclusion (2017-2019). Preoperatively, patients completed a smartphone-based survey assessing expectations for HRQL 1 week and 1, 3, and 6 months postoperatively based on the 8 short-form 36 (SF36) domains (physical functioning, physical role limitations, pain, general health, vitality, social functioning, emotional role limitations, and mental health). Experienced HRQL was then assessed through smartphone-based SF36 surveys 1, 3, and 6 months postoperatively. Correlations between 1- and 6-month trends in expected versus experienced HRQL were determined. Among 101 consenting patients, 74 completed preoperative expectations and SF36 surveys (73%). The mean age was 54 years (SD 14), 49 (66%) were female, and the most common operations were for breast (34%) and abdominal (31%) tumors. Patients expected HRQL to worsen 1 week after surgery and improve toward minimal disability over 6 months. There was poor correlation (≤±0.4) between 1- and 6-month trends in expected versus experienced HRQL in all SF36 domains except for moderate correlation in physical functioning (0.50, 95% confidence interval [0.22-0.78], \< 0.001) and physical role limitations (0.41, 95% confidence interval [0.05-0.77], = 0.024). Patients expected better HRQL than they experienced. Preoperative expectations of postoperative HRQL correlated poorly with lived experiences except in physical health domains. Surgeons should evaluate factors which inform expectations around physical and psychosocial health and use these data to enhance shared decision-making.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Patient expectations of the impact of surgery on postoperative health-related quality of life (HRQL) may reflect the effectiveness of patient-provider communication. We sought to compare expected versus experienced HRQL among patients undergoing cancer surgery. Adults undergoing cancer surgery were eligible for inclusion (2017-2019). Preoperatively, patients completed a smartphone-based survey assessing expectations for HRQL 1 week and 1, 3, and 6 months postoperatively based on the 8 short-form 36 (SF36) domains (physical functioning, physical role limitations, pain, general health, vitality, social functioning, emotional role limitations, and mental health). Experienced HRQL was then assessed through smartphone-based SF36 surveys 1, 3, and 6 months postoperatively. Correlations between 1- and 6-month trends in expected versus experienced HRQL were determined. Among 101 consenting patients, 74 completed preoperative expectations and SF36 surveys (73%). The mean age was 54 years (SD 14), 49 (66%) were female, and the most common operations were for breast (34%) and abdominal (31%) tumors. Patients expected HRQL to worsen 1 week after surgery and improve toward minimal disability over 6 months. There was poor correlation (≤±0.4) between 1- and 6-month trends in expected versus experienced HRQL in all SF36 domains except for moderate correlation in physical functioning (0.50, 95% confidence interval [0.22-0.78], < 0.001) and physical role limitations (0.41, 95% confidence interval [0.05-0.77], = 0.024). Patients expected better HRQL than they experienced. Preoperative expectations of postoperative HRQL correlated poorly with lived experiences except in physical health domains. Surgeons should evaluate factors which inform expectations around physical and psychosocial health and use these data to enhance shared decision-making.
Lubitz, Carrie C.; Kiernan, Colleen M; Toumi, Asmae; Zhan, Tiannan; Roth, Mara Y; Sosa, Julie A; Tuttle, R Michael; Grubbs, Elizabeth G
Patient Perspectives on the Extent of Surgery and Radioactive Iodine Treatment for Low-Risk Differentiated Thyroid Cancer. Journal Article
In: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, vol. 27, no. 5, pp. 383-389, 2021, ISSN: 1530-891X, ().
@article{Lubitz2021,
title = {Patient Perspectives on the Extent of Surgery and Radioactive Iodine Treatment for Low-Risk Differentiated Thyroid Cancer.},
author = {Carrie C. Lubitz and Colleen M Kiernan and Asmae Toumi and Tiannan Zhan and Mara Y Roth and Julie A Sosa and R Michael Tuttle and Elizabeth G Grubbs},
url = {https://pubmed.ncbi.nlm.nih.gov/33840638/},
doi = {10.1016/j.eprac.2021.01.005},
issn = {1530-891X},
year = {2021},
date = {2021-05-01},
journal = {Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists},
volume = {27},
number = {5},
pages = {383-389},
abstract = {To understand patient perspective regarding recommended changes in the 2015 American Thyroid Association (ATA) guidelines. Specifically, in regard to active surveillance (AS) of some small differentiated thyroid cancer (DTC), performance of less extensive surgery for low-risk DTC, and more selective administration of radioactive iodine (RAI). An online survey was disseminated to thyroid cancer patient advocacy organizations and members of the ATA to distribute to the patients. Data were collected on demographic and treatment information, and patient experience with DTC. Patients were asked "what if" scenarios on core topics, including AS, extent of surgery, and indications for RAI. Survey responses were analyzed from 1546 patients with DTC: 1478 (96%) had a total thyroidectomy, and 1167 (76%) underwent RAI. If there was no change in the overall cancer outcome, 606 (39%) of respondents would have considered lobectomy over total thyroidectomy, 536 (35%) would have opted for AS, and 638 (41%) would have chosen to forego RAI. Moreover, (774/1217) 64% of respondents wanted more time with their clinicians when making decisions about the extent of surgery. A total of 621/1167 of patients experienced significant side effects with RAI, and 351/1167 of patients felt that the risks of treatment were not well explained. 1237/1546 (80%) of patients felt that AS would not be overly burdensome, and quality of life was the main reason cited for choosing AS. Patient perspective regarding choice in the management of low-risk DTC varies widely, and a large proportion of DTC patients would change aspects of their care if oncologic outcomes were equivalent.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
To understand patient perspective regarding recommended changes in the 2015 American Thyroid Association (ATA) guidelines. Specifically, in regard to active surveillance (AS) of some small differentiated thyroid cancer (DTC), performance of less extensive surgery for low-risk DTC, and more selective administration of radioactive iodine (RAI). An online survey was disseminated to thyroid cancer patient advocacy organizations and members of the ATA to distribute to the patients. Data were collected on demographic and treatment information, and patient experience with DTC. Patients were asked "what if" scenarios on core topics, including AS, extent of surgery, and indications for RAI. Survey responses were analyzed from 1546 patients with DTC: 1478 (96%) had a total thyroidectomy, and 1167 (76%) underwent RAI. If there was no change in the overall cancer outcome, 606 (39%) of respondents would have considered lobectomy over total thyroidectomy, 536 (35%) would have opted for AS, and 638 (41%) would have chosen to forego RAI. Moreover, (774/1217) 64% of respondents wanted more time with their clinicians when making decisions about the extent of surgery. A total of 621/1167 of patients experienced significant side effects with RAI, and 351/1167 of patients felt that the risks of treatment were not well explained. 1237/1546 (80%) of patients felt that AS would not be overly burdensome, and quality of life was the main reason cited for choosing AS. Patient perspective regarding choice in the management of low-risk DTC varies widely, and a large proportion of DTC patients would change aspects of their care if oncologic outcomes were equivalent.
Workman, Alan D; Soylu, Selen; Kamani, Dipti; Nourmahnad, Anahita; Kyriazidis, Natalia; Saade, Ryan; Ren, Yin; Wirth, Lori; Faquin, William C; Onenerk, Ayşe M; Nikiforov, Yuri E; Al-Qurayshi, Zaid; Kandil, Emad; Kloos, Richard T; Eldeiry, Leslie; Lubitz, Carrie C.; Stathatos, Nikolaos; Randolph, Gregory W
In: Head & neck, vol. 43, no. 3, pp. 920-927, 2021, ISSN: 1097-0347, ().
@article{Workman2020,
title = {Limitations of preoperative cytology for medullary thyroid cancer: Proposal for improved preoperative diagnosis for optimal initial medullary thyroid carcinoma specific surgery.},
author = {Alan D Workman and Selen Soylu and Dipti Kamani and Anahita Nourmahnad and Natalia Kyriazidis and Ryan Saade and Yin Ren and Lori Wirth and William C Faquin and Ay\c{s}e M Onenerk and Yuri E Nikiforov and Zaid Al-Qurayshi and Emad Kandil and Richard T Kloos and Leslie Eldeiry and Carrie C. Lubitz and Nikolaos Stathatos and Gregory W Randolph},
url = {https://pubmed.ncbi.nlm.nih.gov/33269526/},
doi = {10.1002/hed.26550},
issn = {1097-0347},
year = {2021},
date = {2021-03-01},
journal = {Head \& neck},
volume = {43},
number = {3},
pages = {920-927},
abstract = {Preoperative diagnosis of medullary thyroid carcinoma (MTC) is often difficult, given the poor sensitivity of fine-needle aspiration (FNA) cytology for MTC. This study investigates this issue and presents recommendations for improving preoperative diagnostic paradigms in MTC cases. Histopathologically confirmed MTC patients with preoperative cytologic assessment of index nodules were enrolled. FNA diagnosis, final pathology, and surgery details were collected. Out of 71 patients, 49 (69%) were diagnosed by FNA as either definitive MTC (35, 49%) or suspected MTC (14, 20%) and 22 (31%) patients had no indication of MTC on FNA. In a tertiary-care setting, one-third of subjects had an FNA interpretation that did not suggest the possibility of MTC. The limitations of preoperative diagnosis are especially problematic for MTC as they can cause delayed or incomplete treatment. Additional testing is proposed to improve preoperative diagnosis and surgical care of MTC patients.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Preoperative diagnosis of medullary thyroid carcinoma (MTC) is often difficult, given the poor sensitivity of fine-needle aspiration (FNA) cytology for MTC. This study investigates this issue and presents recommendations for improving preoperative diagnostic paradigms in MTC cases. Histopathologically confirmed MTC patients with preoperative cytologic assessment of index nodules were enrolled. FNA diagnosis, final pathology, and surgery details were collected. Out of 71 patients, 49 (69%) were diagnosed by FNA as either definitive MTC (35, 49%) or suspected MTC (14, 20%) and 22 (31%) patients had no indication of MTC on FNA. In a tertiary-care setting, one-third of subjects had an FNA interpretation that did not suggest the possibility of MTC. The limitations of preoperative diagnosis are especially problematic for MTC as they can cause delayed or incomplete treatment. Additional testing is proposed to improve preoperative diagnosis and surgical care of MTC patients.
Panda, Nikhil; Solsky, Ian; Hawrusik, Becky; Liu, Gang; Reeder, Harrison; Lipsitz, Stuart; Desai, Eesha V.; Lowery, Kurt W.; Miller, Kate; Gadd, Michele A.; Lubitz, Carrie C.; Smith, Barbara L.; Specht, Michelle; Onnela, Jukka-Pekka; Haynes, Alex B.
Smartphone Global Positioning System (GPS) Data Enhances Recovery Assessment After Breast Cancer Surgery. Journal Article
In: Annals of surgical oncology, vol. 28, no. 2, pp. 985-994, 2021, ISSN: 1534-4681, ().
@article{Panda2020,
title = {Smartphone Global Positioning System (GPS) Data Enhances Recovery Assessment After Breast Cancer Surgery.},
author = {Nikhil Panda and Ian Solsky and Becky Hawrusik and Gang Liu and Harrison Reeder and Stuart Lipsitz and Eesha V. Desai and Kurt W. Lowery and Kate Miller and Michele A. Gadd and Carrie C. Lubitz and Barbara L. Smith and Michelle Specht and Jukka-Pekka Onnela and Alex B. Haynes},
url = {https://pubmed.ncbi.nlm.nih.gov/32812109/},
doi = {10.1245/s10434-020-09004-5},
issn = {1534-4681},
year = {2021},
date = {2021-02-01},
journal = {Annals of surgical oncology},
volume = {28},
number = {2},
pages = {985-994},
abstract = {We sought to determine whether smartphone GPS data uncovered differences in recovery after breast-conserving surgery (BCS) and mastectomy, and how these data aligned with self-reported quality of life (QoL). In a prospective pilot study, adult smartphone-owners undergoing breast surgery downloaded an application that continuously collected smartphone GPS data for 1 week preoperatively and 6 months postoperatively. QoL was assessed with the Short-Form-36 (SF36) via smartphone delivery preoperatively and 4 and 12 weeks postoperatively. Endpoints were trends in daily GPS-derived distance traveled and home time, as well as SF36 Physical (PCS) and Mental Component Scores (MCS) comparing BCS and mastectomy patients. Thirty-one patients were included. Sixteen BCS and fifteen mastectomy patients were followed for a mean of 201 (SD 161) and 174 (107) days, respectively. There were no baseline differences in demographics, PCS/MCS, home time, or distance traveled. Through 12 weeks postoperatively, mastectomy patients spent more time at home [e.g., week 4: 16.7 h 95% CI (14.3, 19.6) vs. 11.0 h (9.4, 12.9), p 0.001] and traveled shorter distances [e.g., week 4: 52.5 km 95% CI (36.1, 76.0) vs. 107.7 km (75.8-152.9},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
We sought to determine whether smartphone GPS data uncovered differences in recovery after breast-conserving surgery (BCS) and mastectomy, and how these data aligned with self-reported quality of life (QoL). In a prospective pilot study, adult smartphone-owners undergoing breast surgery downloaded an application that continuously collected smartphone GPS data for 1 week preoperatively and 6 months postoperatively. QoL was assessed with the Short-Form-36 (SF36) via smartphone delivery preoperatively and 4 and 12 weeks postoperatively. Endpoints were trends in daily GPS-derived distance traveled and home time, as well as SF36 Physical (PCS) and Mental Component Scores (MCS) comparing BCS and mastectomy patients. Thirty-one patients were included. Sixteen BCS and fifteen mastectomy patients were followed for a mean of 201 (SD 161) and 174 (107) days, respectively. There were no baseline differences in demographics, PCS/MCS, home time, or distance traveled. Through 12 weeks postoperatively, mastectomy patients spent more time at home [e.g., week 4: 16.7 h 95% CI (14.3, 19.6) vs. 11.0 h (9.4, 12.9), p 0.001] and traveled shorter distances [e.g., week 4: 52.5 km 95% CI (36.1, 76.0) vs. 107.7 km (75.8-152.9
Roth, Eve M.; Lubitz, Carrie C.; Swan, J. Shannon; James, Benjamin Christopher
Patient-reported quality of life outcome measures in the thyroid cancer population. Journal Article
In: Thyroid : official journal of the American Thyroid Association, vol. 30, no. 10, pp. 1414-1431, 2020, ISSN: 1557-9077, ().
@article{Roth2020,
title = {Patient-reported quality of life outcome measures in the thyroid cancer population.},
author = {Eve M. Roth and Carrie C. Lubitz and J. Shannon Swan and Benjamin Christopher James},
url = {https://www.ncbi.nlm.nih.gov/pubmed/32292128},
doi = {10.1089/thy.2020.0038},
issn = {1557-9077},
year = {2020},
date = {2020-10-01},
journal = {Thyroid : official journal of the American Thyroid Association},
volume = {30},
number = {10},
pages = {1414-1431},
abstract = {Background - There is an escalating worldwide population of thyroid cancer survivors. In addition to conventional metrics of quality of care, quality of life (QoL) assessment in thyroid cancer patients is imperative. Thyroid cancer survivors face unique impediments to health-related QoL (HRQoL), including thyroid-specific symptoms and exposure to disease-related stressors-including fear of recurrence and financial toxicity-over a prolonged survival period. Survey instruments currently used to assess HRQoL in TC survivors may be insufficient to accurately capture the burden of disease in this population. We aimed to identify the HRQoL instruments in the literature which have been applied in the thyroid cancer survivor population, and to present the psychometric properties of the scales and indexes that have been used. We hypothesize that few instruments have shown evidence of validity in this population. Summary - Of the 927 articles identified by search criteria, only 28 studies using 15 HRQoL instruments met inclusion criteria. Of the 15 HRQoL instruments identified, 9 were psychometric health status instruments and 6 were preference-based indexes, but none had been validated in the thyroid cancer survivor population. While the majority of reviewed studies demonstrated impaired psychological and emotional well-being in thyroid cancer survivors, these findings were not uniformly demonstrated across studies, and the longevity of the impact of thyroid cancer on HRQoL was variably reported. Conclusions -- Discrepancies in the literature regarding the impact of thyroid cancer survivorship on HRQoL emphasize the challenges of accurately assessing patient perspectives, reinforcing the importance of using well-constructed instruments to measure patient-reported outcomes in the target population. Care providers involved in the treatment of thyroid cancer survivors should be aware of longitudinal effects on HRQoL, especially pertaining to chronic psychological debilitation. Further development and rigorous validation of thyroid cancer-specific instruments will allow for better data gathering and understanding of the barriers to achieving high long-term HRQoL in thyroid cancer survivors throughout their long post-survival treatment course.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background - There is an escalating worldwide population of thyroid cancer survivors. In addition to conventional metrics of quality of care, quality of life (QoL) assessment in thyroid cancer patients is imperative. Thyroid cancer survivors face unique impediments to health-related QoL (HRQoL), including thyroid-specific symptoms and exposure to disease-related stressors-including fear of recurrence and financial toxicity-over a prolonged survival period. Survey instruments currently used to assess HRQoL in TC survivors may be insufficient to accurately capture the burden of disease in this population. We aimed to identify the HRQoL instruments in the literature which have been applied in the thyroid cancer survivor population, and to present the psychometric properties of the scales and indexes that have been used. We hypothesize that few instruments have shown evidence of validity in this population. Summary - Of the 927 articles identified by search criteria, only 28 studies using 15 HRQoL instruments met inclusion criteria. Of the 15 HRQoL instruments identified, 9 were psychometric health status instruments and 6 were preference-based indexes, but none had been validated in the thyroid cancer survivor population. While the majority of reviewed studies demonstrated impaired psychological and emotional well-being in thyroid cancer survivors, these findings were not uniformly demonstrated across studies, and the longevity of the impact of thyroid cancer on HRQoL was variably reported. Conclusions -- Discrepancies in the literature regarding the impact of thyroid cancer survivorship on HRQoL emphasize the challenges of accurately assessing patient perspectives, reinforcing the importance of using well-constructed instruments to measure patient-reported outcomes in the target population. Care providers involved in the treatment of thyroid cancer survivors should be aware of longitudinal effects on HRQoL, especially pertaining to chronic psychological debilitation. Further development and rigorous validation of thyroid cancer-specific instruments will allow for better data gathering and understanding of the barriers to achieving high long-term HRQoL in thyroid cancer survivors throughout their long post-survival treatment course.
Enumah, Samuel; Fingeret, Abbey; Parangi, Sareh; Dias-Santagata, Dora; Sadow, Peter M.; Lubitz, Carrie C.
BRAF(V600E) Mutation is Associated with an Increased Risk of Papillary Thyroid Cancer Recurrence. Journal Article
In: World journal of surgery, vol. 44, no. 8, pp. 2685-2691, 2020, ISSN: 1432-2323, ().
@article{Enumah2020,
title = {BRAF(V600E) Mutation is Associated with an Increased Risk of Papillary Thyroid Cancer Recurrence.},
author = {Samuel Enumah and Abbey Fingeret and Sareh Parangi and Dora Dias-Santagata and Peter M. Sadow and Carrie C. Lubitz},
url = {https://www.ncbi.nlm.nih.gov/pubmed/32347351},
doi = {10.1007/s00268-020-05521-2},
issn = {1432-2323},
year = {2020},
date = {2020-08-01},
journal = {World journal of surgery},
volume = {44},
number = {8},
pages = {2685-2691},
abstract = {Papillary thyroid carcinoma is the most common endocrine malignancy and one of the most common cancers worldwide. However, the optimal timing and frequency of surveillance to assess for recurrence remain undetermined. As the incidence of thyroid cancer continues to rise worldwide, identifying risk factors for recurrence and investigating intervals and durations of surveillance are paramount to adapt treatment and follow-up plans to high-risk individuals and to reduce interventions for low-risk patients. Our dataset included an unselected cohort of papillary thyroid carcinoma (PTC) patients who underwent a total thyroidectomy (or unilateral then completion thyroidectomy) at a single institution from 2000 to 2007. BRAF genotyping was performed on available specimens by a validated PCR-based assay. Pathologic structural recurrence was the primary outcome. We performed univariate and multivariable analyses to identify predictors of cancer recurrence. In total, 599 patients underwent complete resection of the thyroid gland for PTC. The cohort was young (mean age 45.0 years), predominately female (n = 462, 76.9%), and median follow-up was 10.3 years (IQR 5.4-12.2). Recurrence occurred more commonly in the BRAF group (18.6 vs. 9.9},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Papillary thyroid carcinoma is the most common endocrine malignancy and one of the most common cancers worldwide. However, the optimal timing and frequency of surveillance to assess for recurrence remain undetermined. As the incidence of thyroid cancer continues to rise worldwide, identifying risk factors for recurrence and investigating intervals and durations of surveillance are paramount to adapt treatment and follow-up plans to high-risk individuals and to reduce interventions for low-risk patients. Our dataset included an unselected cohort of papillary thyroid carcinoma (PTC) patients who underwent a total thyroidectomy (or unilateral then completion thyroidectomy) at a single institution from 2000 to 2007. BRAF genotyping was performed on available specimens by a validated PCR-based assay. Pathologic structural recurrence was the primary outcome. We performed univariate and multivariable analyses to identify predictors of cancer recurrence. In total, 599 patients underwent complete resection of the thyroid gland for PTC. The cohort was young (mean age 45.0 years), predominately female (n = 462, 76.9%), and median follow-up was 10.3 years (IQR 5.4-12.2). Recurrence occurred more commonly in the BRAF group (18.6 vs. 9.9
White, Craig; Weinstein, Milton C; Fingeret, Abbey L; Randolph, Gregory W; Miyauchi, Akira; Ito, Yasuhiro; Zhan, Tiannan; Ali, Ayman; Gazelle, G. Scott; Lubitz, Carrie C.
In: Annals of surgery, vol. 271, no. 4, pp. 765-773, 2020, ISSN: 1528-1140, ().
@article{White2018,
title = {Is Less More? A Microsimulation Model Comparing Cost-effectiveness of the Revised American Thyroid Association's 2015 to 2009 Guidelines for the Management of Patients With Thyroid Nodules and Differentiated Thyroid Cancer.},
author = {Craig White and Milton C Weinstein and Abbey L Fingeret and Gregory W Randolph and Akira Miyauchi and Yasuhiro Ito and Tiannan Zhan and Ayman Ali and G. Scott Gazelle and Carrie C. Lubitz},
url = {https://www.ncbi.nlm.nih.gov/pubmed/30339630},
doi = {10.1097/SLA.0000000000003074},
issn = {1528-1140},
year = {2020},
date = {2020-04-01},
urldate = {2020-04-01},
journal = {Annals of surgery},
volume = {271},
number = {4},
pages = {765-773},
abstract = {To assess relative clinical and economic performance of the revised American Thyroid Association (ATA) thyroid cancer guidelines compared to current standard of care. Diagnosis of thyroid cancer in the United States has tripled whereas mortality has only marginally increased. Most patients present with small papillary carcinomas and have historically received at least a total thyroidectomy as a treatment. In 2015, the ATA released the revised guidelines recommending an option for active surveillance (AS) of small papillary thyroid carcinoma and thyroid lobectomy for larger unifocal tumors. We created a Markov microsimulation model to evaluate the performance of the ATA's 2015 guidelines compared to the ATA's 2009 guidelines. We modeled a cohort of simulated patients with demographic and thyroid nodule characteristics representative of those presenting clinically in the United States. Outcome measures include life expectancy, quality-adjusted life years, costs, and frequency of surgical adverse events. In our base case analysis, the ATA 2015 strategy dominates the ATA 2009 strategy. The ATA 2015 strategy delivers greater discounted average quality-adjusted life years (13.09 vs 12.43) at a lower discounted average cost ($14,752 vs $20,126). Deaths due to thyroid cancer under the 2015 strategy are higher than the 2009 strategy but this is offset by a reduction in surgical deaths, leading to greater average life expectancy under the ATA 2015 strategy. The optimal strategy is sensitive to patients who experience a greater decrement in quality of life while undergoing AS. The ATA 2015 Guidelines represent a cost-effective strategy regarding AS and extent of surgery.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
To assess relative clinical and economic performance of the revised American Thyroid Association (ATA) thyroid cancer guidelines compared to current standard of care. Diagnosis of thyroid cancer in the United States has tripled whereas mortality has only marginally increased. Most patients present with small papillary carcinomas and have historically received at least a total thyroidectomy as a treatment. In 2015, the ATA released the revised guidelines recommending an option for active surveillance (AS) of small papillary thyroid carcinoma and thyroid lobectomy for larger unifocal tumors. We created a Markov microsimulation model to evaluate the performance of the ATA's 2015 guidelines compared to the ATA's 2009 guidelines. We modeled a cohort of simulated patients with demographic and thyroid nodule characteristics representative of those presenting clinically in the United States. Outcome measures include life expectancy, quality-adjusted life years, costs, and frequency of surgical adverse events. In our base case analysis, the ATA 2015 strategy dominates the ATA 2009 strategy. The ATA 2015 strategy delivers greater discounted average quality-adjusted life years (13.09 vs 12.43) at a lower discounted average cost ($14,752 vs $20,126). Deaths due to thyroid cancer under the 2015 strategy are higher than the 2009 strategy but this is offset by a reduction in surgical deaths, leading to greater average life expectancy under the ATA 2015 strategy. The optimal strategy is sensitive to patients who experience a greater decrement in quality of life while undergoing AS. The ATA 2015 Guidelines represent a cost-effective strategy regarding AS and extent of surgery.
Patel, Kepal N; Yip, Linwah; Lubitz, Carrie C.; Grubbs, Elizabeth G; Miller, Barbra S; Shen, Wen; Angelos, Peter; Chen, Herbert; Doherty, Gerard M; Fahey, Thomas J; Kebebew, Electron; Livolsi, Virginia A; Perrier, Nancy D; Sipos, Jennifer A; Sosa, Julie A; Steward, David; Tufano, Ralph P; McHenry, Christopher R; Carty, Sally E
The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Journal Article
In: Annals of surgery, vol. 271, no. 3, pp. e21–e93, 2020, ISSN: 1528-1140, ().
@article{Patel2020b,
title = {The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults.},
author = {Kepal N Patel and Linwah Yip and Carrie C. Lubitz and Elizabeth G Grubbs and Barbra S Miller and Wen Shen and Peter Angelos and Herbert Chen and Gerard M Doherty and Thomas J Fahey and Electron Kebebew and Virginia A Livolsi and Nancy D Perrier and Jennifer A Sipos and Julie A Sosa and David Steward and Ralph P Tufano and Christopher R McHenry and Sally E Carty},
url = {https://www.ncbi.nlm.nih.gov/pubmed/32079830},
doi = {10.1097/SLA.0000000000003580},
issn = {1528-1140},
year = {2020},
date = {2020-03-01},
journal = {Annals of surgery},
volume = {271},
number = {3},
pages = {e21--e93},
abstract = {To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy. Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US. The medical literature from 1/1/1985 to 11/9/2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content. These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches to Thyroidectomy, Laryngology, Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation. Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy. Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US. The medical literature from 1/1/1985 to 11/9/2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content. These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches to Thyroidectomy, Laryngology, Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation. Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.
Ren, Yin; Kyriazidis, Natalia; Faquin, William C; Soylu, Selen; Kamani, Dipti; Saade, Rayan; Torchia, Nicole; Lubitz, Carrie C.; Davies, Louise; Stathatos, Nikolaos A; Stephen, Antonia; Randolph, Gregory W
The presence of Hürthle cells does not increase the risk of malignancy in most Bethesda categories in thyroid fine-needle aspirates. Journal Article
In: Thyroid : official journal of the American Thyroid Association, vol. 30, no. 3, pp. 425-431, 2020, ISSN: 1557-9077, ().
@article{Ren2020,
title = {The presence of H\"{u}rthle cells does not increase the risk of malignancy in most Bethesda categories in thyroid fine-needle aspirates.},
author = {Yin Ren and Natalia Kyriazidis and William C Faquin and Selen Soylu and Dipti Kamani and Rayan Saade and Nicole Torchia and Carrie C. Lubitz and Louise Davies and Nikolaos A Stathatos and Antonia Stephen and Gregory W Randolph},
url = {https://www.ncbi.nlm.nih.gov/pubmed/32013786},
doi = {10.1089/thy.2019.0190},
issn = {1557-9077},
year = {2020},
date = {2020-03-01},
journal = {Thyroid : official journal of the American Thyroid Association},
volume = {30},
number = {3},
pages = {425-431},
abstract = {H\"{u}rthle cell/oncocytic change is commonly reported on thyroid fine needle aspiration (FNA) and may be considered an "atypical cell" by clinicians. This study aims to delineate the association between H\"{u}rthle cells in preoperative cytology and subsequent pathology of the indexed thyroid nodule and to report rates of malignancy. Retrospective review of records of 300 patients with H\"{u}rthle cell/oncocytic change on FNA and final surgical pathology at a tertiary referral center between 2000 and 2013 was performed and compared to a multi-institutional FNA cohort. The degree of H\"{u}rthle cell presence was correlated with histopathologic diagnoses. In our H\"{u}rthle cell FNA group, Bethesda System for Reporting Thyroid Cytopathology categories (BSRTC) were: I (non-diagnostic) - 14 (4.7%); II (benign) - 113 (37.7%); III (atypia of undetermined significance/follicular lesion of undetermined significance) - 33 (11%); IV (follicular neoplasm/suspicious for a follicular neoplasm) - 125 (41.6%); V (suspicious for malignancy) -12 (4%); and VI (malignant)- 3 (1%). When categorized based on the degree of H\"{u}rthle cell change, our H\"{u}rthle cell FNA group, 59 (29%) were classified as mild, 13 (6%) moderate, and 131 (65%) predominant. When comparing our results with a multi-institutional FNA cohort (all with surgical confirmation), the presence of H\"{u}rthle cells was found to be associated with a lower risk of malignancy in all BSRTC categories, with a statistically significant difference in the BSRTC IV and V groups. The sole exception was when H\"{u}rthle cell presence was classified as predominant (defined as greater than 75% of the cellular population), the rate of malignancy was significantly elevated in FNAs interpreted as benign/Bethesda II. Although H\"{u}rthle cells have been considered by clinicians as an "atypical cell" their presence does not increase the risk of malignancy within BSRTC categories overall. However, when predominant H\"{u}rthle cell change is present, the risk of malignancy is increased in the benign cytology/BSRTC category II.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Hürthle cell/oncocytic change is commonly reported on thyroid fine needle aspiration (FNA) and may be considered an "atypical cell" by clinicians. This study aims to delineate the association between Hürthle cells in preoperative cytology and subsequent pathology of the indexed thyroid nodule and to report rates of malignancy. Retrospective review of records of 300 patients with Hürthle cell/oncocytic change on FNA and final surgical pathology at a tertiary referral center between 2000 and 2013 was performed and compared to a multi-institutional FNA cohort. The degree of Hürthle cell presence was correlated with histopathologic diagnoses. In our Hürthle cell FNA group, Bethesda System for Reporting Thyroid Cytopathology categories (BSRTC) were: I (non-diagnostic) - 14 (4.7%); II (benign) - 113 (37.7%); III (atypia of undetermined significance/follicular lesion of undetermined significance) - 33 (11%); IV (follicular neoplasm/suspicious for a follicular neoplasm) - 125 (41.6%); V (suspicious for malignancy) -12 (4%); and VI (malignant)- 3 (1%). When categorized based on the degree of Hürthle cell change, our Hürthle cell FNA group, 59 (29%) were classified as mild, 13 (6%) moderate, and 131 (65%) predominant. When comparing our results with a multi-institutional FNA cohort (all with surgical confirmation), the presence of Hürthle cells was found to be associated with a lower risk of malignancy in all BSRTC categories, with a statistically significant difference in the BSRTC IV and V groups. The sole exception was when Hürthle cell presence was classified as predominant (defined as greater than 75% of the cellular population), the rate of malignancy was significantly elevated in FNAs interpreted as benign/Bethesda II. Although Hürthle cells have been considered by clinicians as an "atypical cell" their presence does not increase the risk of malignancy within BSRTC categories overall. However, when predominant Hürthle cell change is present, the risk of malignancy is increased in the benign cytology/BSRTC category II.
Patel, Kepal N; Yip, Linwah; Lubitz, Carrie C.; Grubbs, Elizabeth G; Miller, Barbra S; Shen, Wen; Angelos, Peter; Chen, Herbert; Doherty, Gerard M; Fahey, Thomas J; Kebebew, Electron; Livolsi, Virginia A; Perrier, Nancy D; Sipos, Jennifer A; Sosa, Julie A; Steward, David; Tufano, Ralph P; McHenry, Christopher R; Carty, Sally E
In: Annals of surgery, vol. 271, no. 3, pp. 399–410, 2020, ISSN: 1528-1140, ().
@article{Patel2020a,
title = {Executive Summary of the American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults.},
author = {Kepal N Patel and Linwah Yip and Carrie C. Lubitz and Elizabeth G Grubbs and Barbra S Miller and Wen Shen and Peter Angelos and Herbert Chen and Gerard M Doherty and Thomas J Fahey and Electron Kebebew and Virginia A Livolsi and Nancy D Perrier and Jennifer A Sipos and Julie A Sosa and David Steward and Ralph P Tufano and Christopher R McHenry and Sally E Carty},
url = {https://www.ncbi.nlm.nih.gov/pubmed/32079828},
doi = {10.1097/SLA.0000000000003735},
issn = {1528-1140},
year = {2020},
date = {2020-03-01},
urldate = {2020-03-01},
journal = {Annals of surgery},
volume = {271},
number = {3},
pages = {399--410},
abstract = {The aim of this study was to develop evidence-based recommendations for safe, effective and appropriate thyroidectomy. Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the United States. The medical literature from January 1, 1985 to November 9, 2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content. These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches Laryngology Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation. Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The aim of this study was to develop evidence-based recommendations for safe, effective and appropriate thyroidectomy. Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the United States. The medical literature from January 1, 1985 to November 9, 2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content. These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches Laryngology Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation. Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.
Wrenn, Sean M.; Vaidya, Anand; Lubitz, Carrie C.
Primary aldosteronism. Journal Article
In: Gland surgery, vol. 9, pp. 14–24, 2020, ISSN: 2227-684X, ().
@article{Wrenn2020,
title = {Primary aldosteronism.},
author = {Sean M. Wrenn and Anand Vaidya and Carrie C. Lubitz},
url = {https://www.ncbi.nlm.nih.gov/pubmed/32206595},
doi = {10.21037/gs.2019.10.23},
issn = {2227-684X},
year = {2020},
date = {2020-02-01},
journal = {Gland surgery},
volume = {9},
pages = {14--24},
abstract = {Primary aldosteronism (PA) is a common cause of secondary hypertension caused by excessive and inappropriate secretion of the hormone aldosterone from one or both adrenal glands. The prevalence of PA ranges from 10% in the general hypertensive population to 20% in resistant hypertension, yet only a small fraction of patients is diagnosed. Disease and symptom recognition, screening in indicated populations, multidisciplinary communication, and appropriate imaging and biochemical workup can identify patients who might benefit from effective and targeted treatment modalities. Effective treatments available include both surgical and medical approaches, usually dependent on the subtype of PA present. Our collective understanding of the pathophysiology of PA is expanded by recent developments in molecular biology and genetics, including understanding the specific somatic and germline mutations involved in pathogenesis. We review the pathophysiology, diagnostic workup, and treatment considerations for this disease process.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Primary aldosteronism (PA) is a common cause of secondary hypertension caused by excessive and inappropriate secretion of the hormone aldosterone from one or both adrenal glands. The prevalence of PA ranges from 10% in the general hypertensive population to 20% in resistant hypertension, yet only a small fraction of patients is diagnosed. Disease and symptom recognition, screening in indicated populations, multidisciplinary communication, and appropriate imaging and biochemical workup can identify patients who might benefit from effective and targeted treatment modalities. Effective treatments available include both surgical and medical approaches, usually dependent on the subtype of PA present. Our collective understanding of the pathophysiology of PA is expanded by recent developments in molecular biology and genetics, including understanding the specific somatic and germline mutations involved in pathogenesis. We review the pathophysiology, diagnostic workup, and treatment considerations for this disease process.
Barrows, Courtney E; Belle, Janeil M; Fleishman, Aaron; Lubitz, Carrie C.; James, Benjamin C
Financial burden of thyroid cancer in the United States: An estimate of economic and psychological hardship among thyroid cancer survivors. Journal Article
In: Surgery, vol. 167, no. 2, pp. 378-384, 2020, ISSN: 1532-7361, ().
@article{Barrows2019,
title = {Financial burden of thyroid cancer in the United States: An estimate of economic and psychological hardship among thyroid cancer survivors.},
author = {Courtney E Barrows and Janeil M Belle and Aaron Fleishman and Carrie C. Lubitz and Benjamin C James},
url = {https://www.ncbi.nlm.nih.gov/pubmed/31653488},
doi = {10.1016/j.surg.2019.09.010},
issn = {1532-7361},
year = {2020},
date = {2020-02-01},
journal = {Surgery},
volume = {167},
number = {2},
pages = {378-384},
abstract = {Annual cancer-related healthcare expenditure in the United States is estimated to exceed $150 billion by 2020. As the prevalence of thyroid cancer increases worldwide, thyroid cancer survivorship is associated with increasing personal and cumulative costs. Few studies have examined the psychological and material economic costs experienced by thyroid cancer survivors. We seek to estimate the comparative prevalence of financial and psychological hardship among thyroid cancer and non-thyroid cancer patients in the United States. The 2011 Medical Expenditure Panel Survey Experiences with Cancer databank was queried to identify thyroid and non-thyroid (colon, breast, lung, prostate) cancer survivors. This survey includes assessments of financial stress, material hardship, and psychological financial hardship. Cancer incidence-based weighted estimates of responses were compared between thyroid and non-thyroid cancer survivors. Independent predictors of material and psychological financial burden were identified through separate multivariate regression models. Thyroid cancer survivors more frequently reported psychological financial burden compared to non-thyroid cancer (46.1% vs 24.0},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Annual cancer-related healthcare expenditure in the United States is estimated to exceed $150 billion by 2020. As the prevalence of thyroid cancer increases worldwide, thyroid cancer survivorship is associated with increasing personal and cumulative costs. Few studies have examined the psychological and material economic costs experienced by thyroid cancer survivors. We seek to estimate the comparative prevalence of financial and psychological hardship among thyroid cancer and non-thyroid cancer patients in the United States. The 2011 Medical Expenditure Panel Survey Experiences with Cancer databank was queried to identify thyroid and non-thyroid (colon, breast, lung, prostate) cancer survivors. This survey includes assessments of financial stress, material hardship, and psychological financial hardship. Cancer incidence-based weighted estimates of responses were compared between thyroid and non-thyroid cancer survivors. Independent predictors of material and psychological financial burden were identified through separate multivariate regression models. Thyroid cancer survivors more frequently reported psychological financial burden compared to non-thyroid cancer (46.1% vs 24.0
Panda, Nikhil; Solsky, Ian; Huang, Ed; Lipsitz, Stuart; Pradarelli, Jason C.; Delisle, Megan; Cusack, James C.; Gadd, Michele A.; Lubitz, Carrie C.; Mullen, John T.; Qadan, Motaz; Smith, Barbara L.; Specht, Michelle; Stephen, Antonia E.; Tanabe, Kenneth K.; Gawande, Atul A.; Onnela, Jukka-Pekka; Haynes, Alex B.
Using Smartphones to Capture Novel Recovery Metrics After Cancer Surgery. Journal Article
In: JAMA surgery, vol. 155, pp. 123–129, 2020, ISSN: 2168-6262, ().
@article{Panda2020a,
title = {Using Smartphones to Capture Novel Recovery Metrics After Cancer Surgery.},
author = {Nikhil Panda and Ian Solsky and Ed Huang and Stuart Lipsitz and Jason C. Pradarelli and Megan Delisle and James C. Cusack and Michele A. Gadd and Carrie C. Lubitz and John T. Mullen and Motaz Qadan and Barbara L. Smith and Michelle Specht and Antonia E. Stephen and Kenneth K. Tanabe and Atul A. Gawande and Jukka-Pekka Onnela and Alex B. Haynes},
doi = {10.1001/jamasurg.2019.4702},
issn = {2168-6262},
year = {2020},
date = {2020-02-01},
urldate = {2020-02-01},
journal = {JAMA surgery},
volume = {155},
pages = {123--129},
abstract = {Patient-generated health data captured from smartphone sensors have the potential to better quantify the physical outcomes of surgery. The ability of these data to discriminate between postoperative trends in physical activity remains unknown. To assess whether physical activity captured from smartphone accelerometer data can be used to describe postoperative recovery among patients undergoing cancer operations. This prospective observational cohort study was conducted from July 2017 to April 2019 in a single academic tertiary care hospital in the United States. Preoperatively, adults (age ≥18 years) who spoke English and were undergoing elective operations for skin, soft tissue, head, neck, and abdominal cancers were approached. Patients were excluded if they did not own a smartphone. Study participants downloaded an application that collected smartphone accelerometer data continuously for 1 week preoperatively and 6 months postoperatively. The primary end points were trends in daily exertional activity and the ability to achieve at least 60 minutes of daily exertional activity after surgery among patients with vs without a clinically significant postoperative event. Postoperative events were defined as complications, emergency department presentations, readmissions, reoperations, and mortality. A total of 139 individuals were approached. In the 62 enrolled patients, who were followed up for a median (interquartile range [IQR]) of 147 (77-179) days, there were no preprocedural differences between patients with vs without a postoperative event. Seventeen patients (27%) experienced a postoperative event. These patients had longer operations than those without a postoperative event (median [IQR], 225 [152-402] minutes vs 107 [68-174] minutes; P \< .001), as well as greater blood loss (median [IQR], 200 [35-515] mL vs 25 [5-100] mL; P = .006) and more follow-up visits (median [IQR], 2 [2-4] visits vs 1 [1-2] visits; P = .002). Compared with mean baseline daily exertional activity, patients with a postoperative event had lower activity at week 1 (difference, -41.6 [95% CI, -75.1 to -8.0] minutes; P = .02), week 3 (difference, -40.0 [95% CI, -72.3 to -3.6] minutes; P = .03), week 5 (difference, -39.6 [95% CI, -69.1 to -10.1] minutes; P = .01), and week 6 (difference, -36.2 [95% CI, -64.5 to -7.8] minutes; P = .01) postoperatively. Fewer of these patients were able to achieve 60 minutes of daily exertional activity in the 6 weeks postoperatively (proportions: week 1, 0.40 [95% CI, 0.31-0.49]; P \< .001; week 2, 0.49 [95% CI, 0.40-0.58]; P = .003; week 3, 0.39 [95% CI, 0.30-0.48]; P \< .001; week 4, 0.47 [95% CI, 0.38-0.57]; P \< .001; week 5, 0.51 [95% CI, 0.42-0.60]; P \< .001; week 6, 0.73 [95% CI, 0.68-0.79] vs 0.43 [95% CI, 0.33-0.52]; P \< .001). Smartphone accelerometer data can describe differences in postoperative physical activity among patients with vs without a postoperative event. These data help objectively quantify patient-centered surgical recovery, which have the potential to improve and promote shared decision-making, recovery monitoring, and patient engagement.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Patient-generated health data captured from smartphone sensors have the potential to better quantify the physical outcomes of surgery. The ability of these data to discriminate between postoperative trends in physical activity remains unknown. To assess whether physical activity captured from smartphone accelerometer data can be used to describe postoperative recovery among patients undergoing cancer operations. This prospective observational cohort study was conducted from July 2017 to April 2019 in a single academic tertiary care hospital in the United States. Preoperatively, adults (age ≥18 years) who spoke English and were undergoing elective operations for skin, soft tissue, head, neck, and abdominal cancers were approached. Patients were excluded if they did not own a smartphone. Study participants downloaded an application that collected smartphone accelerometer data continuously for 1 week preoperatively and 6 months postoperatively. The primary end points were trends in daily exertional activity and the ability to achieve at least 60 minutes of daily exertional activity after surgery among patients with vs without a clinically significant postoperative event. Postoperative events were defined as complications, emergency department presentations, readmissions, reoperations, and mortality. A total of 139 individuals were approached. In the 62 enrolled patients, who were followed up for a median (interquartile range [IQR]) of 147 (77-179) days, there were no preprocedural differences between patients with vs without a postoperative event. Seventeen patients (27%) experienced a postoperative event. These patients had longer operations than those without a postoperative event (median [IQR], 225 [152-402] minutes vs 107 [68-174] minutes; P < .001), as well as greater blood loss (median [IQR], 200 [35-515] mL vs 25 [5-100] mL; P = .006) and more follow-up visits (median [IQR], 2 [2-4] visits vs 1 [1-2] visits; P = .002). Compared with mean baseline daily exertional activity, patients with a postoperative event had lower activity at week 1 (difference, -41.6 [95% CI, -75.1 to -8.0] minutes; P = .02), week 3 (difference, -40.0 [95% CI, -72.3 to -3.6] minutes; P = .03), week 5 (difference, -39.6 [95% CI, -69.1 to -10.1] minutes; P = .01), and week 6 (difference, -36.2 [95% CI, -64.5 to -7.8] minutes; P = .01) postoperatively. Fewer of these patients were able to achieve 60 minutes of daily exertional activity in the 6 weeks postoperatively (proportions: week 1, 0.40 [95% CI, 0.31-0.49]; P < .001; week 2, 0.49 [95% CI, 0.40-0.58]; P = .003; week 3, 0.39 [95% CI, 0.30-0.48]; P < .001; week 4, 0.47 [95% CI, 0.38-0.57]; P < .001; week 5, 0.51 [95% CI, 0.42-0.60]; P < .001; week 6, 0.73 [95% CI, 0.68-0.79] vs 0.43 [95% CI, 0.33-0.52]; P < .001). Smartphone accelerometer data can describe differences in postoperative physical activity among patients with vs without a postoperative event. These data help objectively quantify patient-centered surgical recovery, which have the potential to improve and promote shared decision-making, recovery monitoring, and patient engagement.
Pandian, T K; Lubitz, Carrie C.; Bird, Sarah H; Kuo, Lindsay E; Stephen, Antonia E
Normocalcemic hyperparathyroidism: A Collaborative Endocrine Surgery Quality Improvement Program analysis. Journal Article
In: Surgery, vol. 167, no. 1, pp. 168-172, 2020, ISSN: 1532-7361, ().
@article{Pandian2019,
title = {Normocalcemic hyperparathyroidism: A Collaborative Endocrine Surgery Quality Improvement Program analysis.},
author = {T K Pandian and Carrie C. Lubitz and Sarah H Bird and Lindsay E Kuo and Antonia E Stephen},
url = {https://www.ncbi.nlm.nih.gov/pubmed/31543325},
doi = {10.1016/j.surg.2019.06.043},
issn = {1532-7361},
year = {2020},
date = {2020-01-01},
journal = {Surgery},
volume = {167},
number = {1},
pages = {168-172},
abstract = {Normocalcemic primary hyperparathyroidism may be more challenging to cure compared with classical primary hyperparathyroidism. The aim of this study was to utilize a multi-institutional database to better characterize this condition. The Collaborative Endocrine Surgery Quality Improvement Program database was queried for all patients who underwent parathyroidectomy for sporadic primary hyperparathyroidism. Patient characteristics, operative details, pathology, and outcomes data were compared between patients with normocalcemic primary hyperparathyroidism and those with hypercalcemia. Among 7,569 patients, 9.7% (733) were normocalcemic primary hyperparathyroidism. Mean age at surgery and sex were similar for normocalcemic primary hyperparathyroidism and primary hyperparathyroidism with hypercalcemia. The primary hyperparathyroidism with hypercalcemia cohort had a single parathyroid resected more frequently than the normocalcemic primary hyperparathyroidism group (73.3%% vs 47.5%, P .05). Patients with normocalcemic primary hyperparathyroidism had a higher rate of subtotal (3.5 gland) resection (10.0% vs 4.7%, P .05). Pathology reported a higher frequency of multigland hyperplasia in the normocalcemic primary hyperparathyroidism cohort (43.1% vs 21.9%, P .05). In the normocalcemic primary hyperparathyroidism cohort, 47 patients (6.4%) underwent remedial surgery compared with 307 patients (4.5%) with primary hyperparathyroidism with hypercalcemia (P .05). The rate of clinical concern for persistent hyperparathyroidism was similar between the 2 groups (P = .09) but not reported in 25% overall. Patients with normocalcemic primary hyperparathyroidism have higher rates of multigland disease and remedial surgery compared with primary hyperparathyroidism with hypercalcemia.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Normocalcemic primary hyperparathyroidism may be more challenging to cure compared with classical primary hyperparathyroidism. The aim of this study was to utilize a multi-institutional database to better characterize this condition. The Collaborative Endocrine Surgery Quality Improvement Program database was queried for all patients who underwent parathyroidectomy for sporadic primary hyperparathyroidism. Patient characteristics, operative details, pathology, and outcomes data were compared between patients with normocalcemic primary hyperparathyroidism and those with hypercalcemia. Among 7,569 patients, 9.7% (733) were normocalcemic primary hyperparathyroidism. Mean age at surgery and sex were similar for normocalcemic primary hyperparathyroidism and primary hyperparathyroidism with hypercalcemia. The primary hyperparathyroidism with hypercalcemia cohort had a single parathyroid resected more frequently than the normocalcemic primary hyperparathyroidism group (73.3%% vs 47.5%, P .05). Patients with normocalcemic primary hyperparathyroidism had a higher rate of subtotal (3.5 gland) resection (10.0% vs 4.7%, P .05). Pathology reported a higher frequency of multigland hyperplasia in the normocalcemic primary hyperparathyroidism cohort (43.1% vs 21.9%, P .05). In the normocalcemic primary hyperparathyroidism cohort, 47 patients (6.4%) underwent remedial surgery compared with 307 patients (4.5%) with primary hyperparathyroidism with hypercalcemia (P .05). The rate of clinical concern for persistent hyperparathyroidism was similar between the 2 groups (P = .09) but not reported in 25% overall. Patients with normocalcemic primary hyperparathyroidism have higher rates of multigland disease and remedial surgery compared with primary hyperparathyroidism with hypercalcemia.
Gartland, Rajshri M; Bloom, Jordan P; Parangi, Sareh; Hodin, Richard; DeRoo, Courtney; Stephen, Antonia E; Narra, Vinod; Lubitz, Carrie C.; Mort, Elizabeth
A Long, Unnerving Road: Malpractice Claims Involving the Surgical Management of Thyroid and Parathyroid Disease. Journal Article
In: World journal of surgery, vol. 43, no. 11, pp. 2850-2855, 2019, ISSN: 1432-2323, ().
@article{Gartland2019,
title = {A Long, Unnerving Road: Malpractice Claims Involving the Surgical Management of Thyroid and Parathyroid Disease.},
author = {Rajshri M Gartland and Jordan P Bloom and Sareh Parangi and Richard Hodin and Courtney DeRoo and Antonia E Stephen and Vinod Narra and Carrie C. Lubitz and Elizabeth Mort},
url = {https://www.ncbi.nlm.nih.gov/pubmed/31384995},
doi = {10.1007/s00268-019-05102-y},
issn = {1432-2323},
year = {2019},
date = {2019-11-01},
urldate = {2019-11-01},
journal = {World journal of surgery},
volume = {43},
number = {11},
pages = {2850-2855},
abstract = {Given their profound emotional, physical, and financial toll on patients and surgeons, we studied the characteristics, costs, and contributing factors of thyroid and parathyroid surgical malpractice claims. Using the Controlled Risk Insurance Company Strategies' Comparative Benchmarking System database, representing ~30% of all US paid and unpaid malpractice claims, 5384 claims filed against general surgeons and otolaryngologists from 1995-2015 were reviewed to isolate claims involving the surgical management of thyroid and parathyroid disease. These claims were studied, and multivariable regression analysis was performed to identify factors associated with plaintiff payout. One hundred twenty-eight thyroid and parathyroid surgical malpractice claims were isolated. The median time from alleged harm event to closure of a malpractice case was 39 months. The most common associated complications were bilateral recurrent laryngeal nerve (RLN) injury (n = 23) and hematoma (n = 18). Complications led to death in 18 cases. Patient payout occurred in 33% of claims (n = 42), and the median cost per claim was $277,913 (IQR $87,343-$783,663). On multivariable analysis, bilateral RLN injury was predictive of patient payout (OR 3.5},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Given their profound emotional, physical, and financial toll on patients and surgeons, we studied the characteristics, costs, and contributing factors of thyroid and parathyroid surgical malpractice claims. Using the Controlled Risk Insurance Company Strategies' Comparative Benchmarking System database, representing ~30% of all US paid and unpaid malpractice claims, 5384 claims filed against general surgeons and otolaryngologists from 1995-2015 were reviewed to isolate claims involving the surgical management of thyroid and parathyroid disease. These claims were studied, and multivariable regression analysis was performed to identify factors associated with plaintiff payout. One hundred twenty-eight thyroid and parathyroid surgical malpractice claims were isolated. The median time from alleged harm event to closure of a malpractice case was 39 months. The most common associated complications were bilateral recurrent laryngeal nerve (RLN) injury (n = 23) and hematoma (n = 18). Complications led to death in 18 cases. Patient payout occurred in 33% of claims (n = 42), and the median cost per claim was $277,913 (IQR $87,343-$783,663). On multivariable analysis, bilateral RLN injury was predictive of patient payout (OR 3.5
Gartland, Rajshri M; Alves, Kristin; Brasil, Níssia C; Mossanen, Matthew; Mort, Elizabeth; Wright, Cameron D; Lubitz, Carrie C.; May, Collin
Does overlapping surgery result in worse surgical outcomes? A systematic review and meta-analysis Journal Article
In: American journal of surgery, vol. 218, pp. 181–191, 2019, ISSN: 1879-1883, ().
@article{Gartland2019a,
title = {Does overlapping surgery result in worse surgical outcomes? A systematic review and meta-analysis},
author = {Rajshri M Gartland and Kristin Alves and N\'{i}ssia C Brasil and Matthew Mossanen and Elizabeth Mort and Cameron D Wright and Carrie C. Lubitz and Collin May},
url = {https://www.ncbi.nlm.nih.gov/pubmed/30553459},
doi = {10.1016/j.amjsurg.2018.11.039},
issn = {1879-1883},
year = {2019},
date = {2019-07-01},
journal = {American journal of surgery},
volume = {218},
pages = {181--191},
abstract = {The practice of overlapping surgery impacts patients, providers, and policy-makers. While several studies have examined the relationship between overlapping surgery and clinical outcomes, a combined analysis of all available data has not been performed. We aimed to evaluate the impact of overlapping surgery on 30-day mortality, morbidity, and length of surgery. A systematic literature review revealed all relevant studies examining outcomes of overlapping versus non-overlapping surgery as of March 2018. A pooled meta-analysis with stratification by study quality grade was performed, and heterogeneity and publication bias were assessed. A total of 14 sets of analyses met inclusion and exclusion criteria. Meta-analysis revealed no significant differences in 30-day mortality (OR = 0.84; p = 0.277) or overall morbidity (OR = 0.96; p = 0.632) between patients who underwent overlapping versus non-overlapping surgery. The standardized mean difference for length of surgery between the groups indicated a small statistically significant increase in length of surgery for the overlapping surgery group (SMD = 0.079, p \< 0.05). While further study is warranted, current literature suggests that overlapping surgery is not associated with increased risk of mortality or morbidity.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The practice of overlapping surgery impacts patients, providers, and policy-makers. While several studies have examined the relationship between overlapping surgery and clinical outcomes, a combined analysis of all available data has not been performed. We aimed to evaluate the impact of overlapping surgery on 30-day mortality, morbidity, and length of surgery. A systematic literature review revealed all relevant studies examining outcomes of overlapping versus non-overlapping surgery as of March 2018. A pooled meta-analysis with stratification by study quality grade was performed, and heterogeneity and publication bias were assessed. A total of 14 sets of analyses met inclusion and exclusion criteria. Meta-analysis revealed no significant differences in 30-day mortality (OR = 0.84; p = 0.277) or overall morbidity (OR = 0.96; p = 0.632) between patients who underwent overlapping versus non-overlapping surgery. The standardized mean difference for length of surgery between the groups indicated a small statistically significant increase in length of surgery for the overlapping surgery group (SMD = 0.079, p < 0.05). While further study is warranted, current literature suggests that overlapping surgery is not associated with increased risk of mortality or morbidity.
Gartland, Rajshri M; Lubitz, Carrie C.
Impact of Extent of Surgery on Tumor Recurrence and Survival for Papillary Thyroid Cancer Patients Journal Article
In: Annals of surgical oncology, vol. 25, no. 9, pp. 2520-2525, 2018, ISSN: 1534-4681, ().
@article{Gartland2018,
title = {Impact of Extent of Surgery on Tumor Recurrence and Survival for Papillary Thyroid Cancer Patients},
author = {Rajshri M Gartland and Carrie C. Lubitz},
url = {https://www.ncbi.nlm.nih.gov/pubmed/29855833},
doi = {10.1245/s10434-018-6550-2},
issn = {1534-4681},
year = {2018},
date = {2018-09-01},
urldate = {2018-09-01},
journal = {Annals of surgical oncology},
volume = {25},
number = {9},
pages = {2520-2525},
abstract = {The extent of surgery for low-risk papillary thyroid cancer (PTC) has been the subject of debate among experts for decades. In this paper, we aimed to systematically review whether thyroid lobectomy versus total thyroidectomy for PTC patients with tumors measuring 1.0-4.0 cm impacts tumor recurrence and survival. A systematic review of the literature from January 1990 to February 2018 yielded 13 relevant studies, including eight national cancer registry database studies, one multi-institutional thyroid cancer-specific database, three large-scale institutional series, and one meta-analysis. Data from these studies demonstrate that total thyroidectomy for the treatment of PTC measuring 1.0-4.0 cm does not confer a clinically significant improvement in disease-specific survival compared with thyroid lobectomy. Four of six studies also reported that total thyroidectomy is associated with a small but statistically significant improvement in disease-free survival, although it is argued whether this difference is clinically significant. While the quality of the data limit the strength of our conclusions, and while tumor characteristics, patient risk factors, and preferences should be considered, most data support that lobectomy and total thyroidectomy yield comparable oncologic outcomes for PTC measuring 1.0-4.0 cm.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The extent of surgery for low-risk papillary thyroid cancer (PTC) has been the subject of debate among experts for decades. In this paper, we aimed to systematically review whether thyroid lobectomy versus total thyroidectomy for PTC patients with tumors measuring 1.0-4.0 cm impacts tumor recurrence and survival. A systematic review of the literature from January 1990 to February 2018 yielded 13 relevant studies, including eight national cancer registry database studies, one multi-institutional thyroid cancer-specific database, three large-scale institutional series, and one meta-analysis. Data from these studies demonstrate that total thyroidectomy for the treatment of PTC measuring 1.0-4.0 cm does not confer a clinically significant improvement in disease-specific survival compared with thyroid lobectomy. Four of six studies also reported that total thyroidectomy is associated with a small but statistically significant improvement in disease-free survival, although it is argued whether this difference is clinically significant. While the quality of the data limit the strength of our conclusions, and while tumor characteristics, patient risk factors, and preferences should be considered, most data support that lobectomy and total thyroidectomy yield comparable oncologic outcomes for PTC measuring 1.0-4.0 cm.
Gopal, Raj K; Kübler, Kirsten; Calvo, Sarah E; Polak, Paz; Livitz, Dimitri; Rosebrock, Daniel; Sadow, Peter M; Campbell, Braidie; Donovan, Samuel E; Amin, Salma; Gigliotti, Benjamin J; Grabarek, Zenon; Hess, Julian M; Stewart, Chip; Braunstein, Lior Z; Arndt, Peter F; Mordecai, Scott; Shih, Angela R; Chaves, Frances; Zhan, Tiannan; Lubitz, Carrie C.; Kim, Jiwoong; Iafrate, A John; Wirth, Lori; Parangi, Sareh; Leshchiner, Ignaty; Daniels, Gilbert H; Mootha, Vamsi K; Dias-Santagata, Dora; Getz, Gad; McFadden, David G
Widespread Chromosomal Losses and Mitochondrial DNA Alterations as Genetic Drivers in Hürthle Cell Carcinoma. Journal Article
In: Cancer cell, vol. 34, no. 2, pp. 242–255.e5, 2018, ISSN: 1878-3686, ().
@article{Gopal2018,
title = {Widespread Chromosomal Losses and Mitochondrial DNA Alterations as Genetic Drivers in H\"{u}rthle Cell Carcinoma.},
author = {Raj K Gopal and Kirsten K\"{u}bler and Sarah E Calvo and Paz Polak and Dimitri Livitz and Daniel Rosebrock and Peter M Sadow and Braidie Campbell and Samuel E Donovan and Salma Amin and Benjamin J Gigliotti and Zenon Grabarek and Julian M Hess and Chip Stewart and Lior Z Braunstein and Peter F Arndt and Scott Mordecai and Angela R Shih and Frances Chaves and Tiannan Zhan and Carrie C. Lubitz and Jiwoong Kim and A John Iafrate and Lori Wirth and Sareh Parangi and Ignaty Leshchiner and Gilbert H Daniels and Vamsi K Mootha and Dora Dias-Santagata and Gad Getz and David G McFadden},
url = {https://www.ncbi.nlm.nih.gov/pubmed/30107175},
doi = {10.1016/j.ccell.2018.06.013},
issn = {1878-3686},
year = {2018},
date = {2018-08-01},
journal = {Cancer cell},
volume = {34},
number = {2},
pages = {242--255.e5},
abstract = {H\"{u}rthle cell carcinoma of the thyroid (HCC) is a form of thyroid cancer recalcitrant to radioiodine therapy that exhibits an accumulation of mitochondria. We performed whole-exome sequencing on a cohort of primary, recurrent, and metastatic tumors, and identified recurrent mutations in DAXX, TP53, NRAS, NF1, CDKN1A, ARHGAP35, and the TERT promoter. Parallel analysis of mtDNA revealed recurrent homoplasmic mutations in subunits of complex I of the electron transport chain. Analysis of DNA copy-number alterations uncovered widespread loss of chromosomes culminating in near-haploid chromosomal content in a large fraction of HCC, which was maintained during metastatic spread. This work uncovers a distinct molecular origin of HCC compared with other thyroid malignancies.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Hürthle cell carcinoma of the thyroid (HCC) is a form of thyroid cancer recalcitrant to radioiodine therapy that exhibits an accumulation of mitochondria. We performed whole-exome sequencing on a cohort of primary, recurrent, and metastatic tumors, and identified recurrent mutations in DAXX, TP53, NRAS, NF1, CDKN1A, ARHGAP35, and the TERT promoter. Parallel analysis of mtDNA revealed recurrent homoplasmic mutations in subunits of complex I of the electron transport chain. Analysis of DNA copy-number alterations uncovered widespread loss of chromosomes culminating in near-haploid chromosomal content in a large fraction of HCC, which was maintained during metastatic spread. This work uncovers a distinct molecular origin of HCC compared with other thyroid malignancies.
Lubitz, Carrie C.; Zhan, Tiannan; Gunda, Viswanath; Amin, Salma; Gigliotti, Benjamin J; Fingeret, Abbey L; Holm, Tammy M; Wachtel, Heather; Sadow, Peter M; Wirth, Lori J; Sullivan, Ryan J; Panka, David J; Parangi, Sareh
Circulating BRAF V600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma. Journal Article
In: Thyroid : official journal of the American Thyroid Association, vol. 28, pp. 328–339, 2018, ISSN: 1557-9077, ().
@article{Lubitz2018,
title = {Circulating BRAF V600E Levels Correlate with Treatment in Patients with Thyroid Carcinoma.},
author = {Carrie C. Lubitz and Tiannan Zhan and Viswanath Gunda and Salma Amin and Benjamin J Gigliotti and Abbey L Fingeret and Tammy M Holm and Heather Wachtel and Peter M Sadow and Lori J Wirth and Ryan J Sullivan and David J Panka and Sareh Parangi},
url = {https://www.ncbi.nlm.nih.gov/pubmed/29378474},
doi = {10.1089/thy.2017.0322},
issn = {1557-9077},
year = {2018},
date = {2018-03-01},
journal = {Thyroid : official journal of the American Thyroid Association},
volume = {28},
pages = {328--339},
abstract = {BRAF is the most common mutation in papillary thyroid carcinoma (PTC) and can be associated with aggressive disease. Previously, a highly sensitive blood RNA-based BRAF assay was reported. The objective of this study was to assess the correlation of BRAF circulating tumor RNA levels with surgical and medical treatment. Circulating BRAF levels were assessed in (i) a murine model of undifferentiated (anaplastic) thyroid carcinoma with known BRAF mutation undergoing BRAF -inhibitor (BRAFi) treatment, and (ii) in 111 patients enrolled prior to thyroidectomy (n = 86) or treatment of advanced recurrent or metastatic PTC (n = 25). Blood samples were drawn for BRAF analysis before and after treatment. Testing characteristics were assessed and positivity criteria optimized. Changes in blood BRAF values were assessed and compared to clinical characteristics and response to therapy. In a murine model of anaplastic thyroid carcinoma with BRAF mutation, blood BRAF RNA correlated with tumor volume in animals treated with BRAFi. In tissue BRAF -positive (n = 36) patients undergoing initial surgery for PTC, blood BRAF levels declined postoperatively (median 370.0-178.5 fg/ng; p = 0.002). In four patients with metastatic or poorly differentiated thyroid carcinoma receiving targeted therapies, blood BRAF declined following therapy and corresponded with radiographic evidence of partial response or stable disease. This study shows the correlation of blood BRAF levels in response to treatment in both an established animal model of thyroid cancer and in patients with BRAF -positive tumors with all stages of disease. This assay represents an alternative biomarker in patients with positive thyroglobulin antibodies, and tumors, which do not express thyroglobulin.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BRAF is the most common mutation in papillary thyroid carcinoma (PTC) and can be associated with aggressive disease. Previously, a highly sensitive blood RNA-based BRAF assay was reported. The objective of this study was to assess the correlation of BRAF circulating tumor RNA levels with surgical and medical treatment. Circulating BRAF levels were assessed in (i) a murine model of undifferentiated (anaplastic) thyroid carcinoma with known BRAF mutation undergoing BRAF -inhibitor (BRAFi) treatment, and (ii) in 111 patients enrolled prior to thyroidectomy (n = 86) or treatment of advanced recurrent or metastatic PTC (n = 25). Blood samples were drawn for BRAF analysis before and after treatment. Testing characteristics were assessed and positivity criteria optimized. Changes in blood BRAF values were assessed and compared to clinical characteristics and response to therapy. In a murine model of anaplastic thyroid carcinoma with BRAF mutation, blood BRAF RNA correlated with tumor volume in animals treated with BRAFi. In tissue BRAF -positive (n = 36) patients undergoing initial surgery for PTC, blood BRAF levels declined postoperatively (median 370.0-178.5 fg/ng; p = 0.002). In four patients with metastatic or poorly differentiated thyroid carcinoma receiving targeted therapies, blood BRAF declined following therapy and corresponded with radiographic evidence of partial response or stable disease. This study shows the correlation of blood BRAF levels in response to treatment in both an established animal model of thyroid cancer and in patients with BRAF -positive tumors with all stages of disease. This assay represents an alternative biomarker in patients with positive thyroglobulin antibodies, and tumors, which do not express thyroglobulin.
Mainthia, Rajshri; Wachtel, Heather; Chen, Yufan; Mort, Elizabeth; Parangi, Sareh; Sadow, Peter M; Lubitz, Carrie C.
In: Surgery, vol. 163, no. 1, pp. 60-65, 2018, ISSN: 1532-7361, ().
@article{Mainthia2017,
title = {Evaluating the projected surgical impact of reclassifying noninvasive encapsulated follicular variant of papillary thyroid cancer as noninvasive follicular thyroid neoplasm with papillary-like nuclear features.},
author = {Rajshri Mainthia and Heather Wachtel and Yufan Chen and Elizabeth Mort and Sareh Parangi and Peter M Sadow and Carrie C. Lubitz},
url = {http://www.ncbi.nlm.nih.gov/pubmed/29146229},
doi = {10.1016/j.surg.2017.04.037},
issn = {1532-7361},
year = {2018},
date = {2018-01-01},
urldate = {2018-01-01},
journal = {Surgery},
volume = {163},
number = {1},
pages = {60-65},
abstract = {The reclassification of noninvasive encapsulated follicular variant of papillary thyroid cancer to noninvasive follicular thyroid neoplasm with papillary-like nuclear features will reduce nonefficacious and potentially harmful care. Reclassification is estimated in 18.6% of patients with papillary thyroid carcinoma; we aimed to quantify the implications of this change. Pathology reports from April 2006 to April 2016 were reviewed to isolate cases that would have been designated as neoplasm with papillary-like nuclear features. Of the 1,335 cases of papillary thyroid carcinomas, 194 cases (14.5%) met criteria. Cases in which neoplasm with papillary-like nuclear features was found in combination with other thyroid malignancies (n = 25) and cases of prior thyroid lobectomy (n = 5) were excluded. Demographic, pathologic, treatment, and follow-up data were assessed for the remaining 164 potential neoplasm with papillary-like nuclear features cases. Logistic regression analysis was performed to evaluate association between fine-needle aspiration result and index procedure. Of the 164 patients with tumors who met neoplasm with papillary-like nuclear features criteria, fine-needle aspiration results were nondiagnostic (2%), benign (18%), atypia/follicular lesion of undetermined significance (26%), follicular neoplasm or suspicious for follicular neoplasm (20%), suspicious for malignancy (19%), malignant (6%), and not obtained (9%). Eighty-five (52%) patients underwent total thyroidectomy. A "suspicious for malignancy" fine-needle aspiration result was associated with undergoing total thyroidectomy versus thyroid lobectomy (P = .006). Thyroid lobectomy was the index procedure for 79 patients (48%); of these patients, 54% (n = 43, 3.2% of all patients with papillary thyroid carcinomas) underwent subsequent total thyroidectomy, and 24% received postoperative radioactive iodine treatment. There were no recurrences among the 125 patients with \>3 months of follow-up. The reclassification of noninvasive encapsulated follicular variant of papillary thyroid cancer as neoplasm with papillary-like nuclear features will decrease nonefficacious treatment and reduce costs. However, the impact of this change with regard to extent of surgery was limited to 3.2% of patients with papillary thyroid carcinomas compared with the projected potential impact on 18.6%. (Surgery 2017;160:XXX-XXX.).},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The reclassification of noninvasive encapsulated follicular variant of papillary thyroid cancer to noninvasive follicular thyroid neoplasm with papillary-like nuclear features will reduce nonefficacious and potentially harmful care. Reclassification is estimated in 18.6% of patients with papillary thyroid carcinoma; we aimed to quantify the implications of this change. Pathology reports from April 2006 to April 2016 were reviewed to isolate cases that would have been designated as neoplasm with papillary-like nuclear features. Of the 1,335 cases of papillary thyroid carcinomas, 194 cases (14.5%) met criteria. Cases in which neoplasm with papillary-like nuclear features was found in combination with other thyroid malignancies (n = 25) and cases of prior thyroid lobectomy (n = 5) were excluded. Demographic, pathologic, treatment, and follow-up data were assessed for the remaining 164 potential neoplasm with papillary-like nuclear features cases. Logistic regression analysis was performed to evaluate association between fine-needle aspiration result and index procedure. Of the 164 patients with tumors who met neoplasm with papillary-like nuclear features criteria, fine-needle aspiration results were nondiagnostic (2%), benign (18%), atypia/follicular lesion of undetermined significance (26%), follicular neoplasm or suspicious for follicular neoplasm (20%), suspicious for malignancy (19%), malignant (6%), and not obtained (9%). Eighty-five (52%) patients underwent total thyroidectomy. A "suspicious for malignancy" fine-needle aspiration result was associated with undergoing total thyroidectomy versus thyroid lobectomy (P = .006). Thyroid lobectomy was the index procedure for 79 patients (48%); of these patients, 54% (n = 43, 3.2% of all patients with papillary thyroid carcinomas) underwent subsequent total thyroidectomy, and 24% received postoperative radioactive iodine treatment. There were no recurrences among the 125 patients with >3 months of follow-up. The reclassification of noninvasive encapsulated follicular variant of papillary thyroid cancer as neoplasm with papillary-like nuclear features will decrease nonefficacious treatment and reduce costs. However, the impact of this change with regard to extent of surgery was limited to 3.2% of patients with papillary thyroid carcinomas compared with the projected potential impact on 18.6%. (Surgery 2017;160:XXX-XXX.).
Adler, Joel T; Yeh, Heidi; Barbesino, Giuseppe; Lubitz, Carrie C.
Reassessing risks and benefits of living kidney donors with a history of thyroid cancer Journal Article
In: Clinical transplantation, vol. 31, no. 11, 2017, ISSN: 1399-0012, ().
@article{Adler2017,
title = {Reassessing risks and benefits of living kidney donors with a history of thyroid cancer},
author = {Joel T Adler and Heidi Yeh and Giuseppe Barbesino and Carrie C. Lubitz},
url = {http://www.ncbi.nlm.nih.gov/pubmed/28963768},
doi = {10.1111/ctr.13114},
issn = {1399-0012},
year = {2017},
date = {2017-11-01},
journal = {Clinical transplantation},
volume = {31},
number = {11},
abstract = {Many potential and willing living kidney donors are excluded from donating for a history of malignancy. There is appropriate caution toward patients with a history of malignancy because of concern for transmission of donor-derived malignancy. Thyroid cancer is common and increasing in incidence, and outcomes are very good in otherwise young, healthy potential donors. We review the evidence and guidelines regarding recurrence and transmission risk of thyroid cancer, and then we suggest a standardized guideline for otherwise healthy donors with a history of thyroid malignancy.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Many potential and willing living kidney donors are excluded from donating for a history of malignancy. There is appropriate caution toward patients with a history of malignancy because of concern for transmission of donor-derived malignancy. Thyroid cancer is common and increasing in incidence, and outcomes are very good in otherwise young, healthy potential donors. We review the evidence and guidelines regarding recurrence and transmission risk of thyroid cancer, and then we suggest a standardized guideline for otherwise healthy donors with a history of thyroid malignancy.
Fong, Zhi Ven; Alvino, Donna M; Castillo, Carlos Fernández-Del; Nipp, Ryan D; Traeger, Lara N; Margaret, Ruddy; Lubitz, Carrie C.; Johnson, Colin D; Chang, David C; Warshaw, Andrew L; Lillemoe, Keith D; Ferrone, Cristina R
Health-related Quality of Life and Functional Outcomes in 5-year Survivors After Pancreaticoduodenectomy Journal Article
In: Annals of surgery, vol. 266, no. 4, pp. 685-693, 2017, ISSN: 1528-1140, ().
@article{Fong2017,
title = {Health-related Quality of Life and Functional Outcomes in 5-year Survivors After Pancreaticoduodenectomy},
author = {Zhi Ven Fong and Donna M Alvino and Carlos Fern\'{a}ndez-Del Castillo and Ryan D Nipp and Lara N Traeger and Ruddy Margaret and Carrie C. Lubitz and Colin D Johnson and David C Chang and Andrew L Warshaw and Keith D Lillemoe and Cristina R Ferrone},
url = {http://www.ncbi.nlm.nih.gov/pubmed/28657944},
doi = {10.1097/SLA.0000000000002380},
issn = {1528-1140},
year = {2017},
date = {2017-10-01},
journal = {Annals of surgery},
volume = {266},
number = {4},
pages = {685-693},
abstract = {Our aim was to assess quality of life (QOL) and functionality in a large cohort of patients ≥5-years after pancreaticoduodenectomy (PD). Long-term QOL outcomes after PD for benign or malignant disease are largely undocumented. We administered the EORTC QLQ-C30 questionnaire to patients who underwent PD for neoplasms from 1998 to 2011 and compared their scores with an age- and sex-matched normal population. Clinical relevance (CR) of differences was scored as small (5-10), moderate (10-20), or large (\>20) based on validated interpretation of clinically important differences. Of 305 PD survivors, 245 (80.3%) responded, of whom 157 (64.1%) underwent PD for nonmalignant lesions. Median follow-up was 9.1 years (range 5.1 -21.2 yrs). New-onset diabetes developed in 10.6%; 50.4% reported taking pancreatic enzymes; 54.6% reported needing antacids. Compared with the age- and sex-adjusted controls, PD survivors demonstrated higher global QOL (78.7 vs 69.7, CR small, P 0.001), physical (86.7 vs 77.9, CR small, P 0.001) and role-functioning scores (86.3 vs 74.1, CR medium, P 0.001). Using linear regression and adjusting for socioeconomic variables, there were no differences in QOL or functional scores in the benign versus malignant subgroups. Older age at operation was associated with worse physical-functioning (-0.4/y},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Our aim was to assess quality of life (QOL) and functionality in a large cohort of patients ≥5-years after pancreaticoduodenectomy (PD). Long-term QOL outcomes after PD for benign or malignant disease are largely undocumented. We administered the EORTC QLQ-C30 questionnaire to patients who underwent PD for neoplasms from 1998 to 2011 and compared their scores with an age- and sex-matched normal population. Clinical relevance (CR) of differences was scored as small (5-10), moderate (10-20), or large (>20) based on validated interpretation of clinically important differences. Of 305 PD survivors, 245 (80.3%) responded, of whom 157 (64.1%) underwent PD for nonmalignant lesions. Median follow-up was 9.1 years (range 5.1 -21.2 yrs). New-onset diabetes developed in 10.6%; 50.4% reported taking pancreatic enzymes; 54.6% reported needing antacids. Compared with the age- and sex-adjusted controls, PD survivors demonstrated higher global QOL (78.7 vs 69.7, CR small, P 0.001), physical (86.7 vs 77.9, CR small, P 0.001) and role-functioning scores (86.3 vs 74.1, CR medium, P 0.001). Using linear regression and adjusting for socioeconomic variables, there were no differences in QOL or functional scores in the benign versus malignant subgroups. Older age at operation was associated with worse physical-functioning (-0.4/y
Loehrer, Andrew P; Murthy, Shilpa S; Song, Zirui; Lubitz, Carrie C.; James, Benjamin C
Association of Insurance Expansion With Surgical Management of Thyroid Cancer Journal Article
In: JAMA surgery, vol. 152, no. 8, pp. 734-740, 2017, ISSN: 2168-6262, ().
@article{Loehrer2017,
title = {Association of Insurance Expansion With Surgical Management of Thyroid Cancer},
author = {Andrew P Loehrer and Shilpa S Murthy and Zirui Song and Carrie C. Lubitz and Benjamin C James},
url = {http://www.ncbi.nlm.nih.gov/pubmed/28384780},
doi = {10.1001/jamasurg.2017.0461},
issn = {2168-6262},
year = {2017},
date = {2017-08-01},
urldate = {2017-08-01},
journal = {JAMA surgery},
volume = {152},
number = {8},
pages = {734-740},
abstract = {To our knowledge, thyroid cancer incidence is increasing faster than any other cancer type and is currently the fifth most common cancer among women. While this rise is likely multifactorial, there has been scarce consideration of the effect of insurance statuses on the treatment of thyroid cancer. We evaluate the association of insurance expansion with thyroid cancer treatment using the 2006 Massachusetts health reform, which serves as a unique natural experiment. We used the Agency for Healthcare Research and Quality State Inpatient Databases to identify patients with government-subsidized or self-pay insurance or private insurance who were admitted to a hospital with thyroid cancer and underwent a thyroidectomy between 2001 and 2011 in Massachusetts (n = 8534) and 3 control states (n = 48 047). Difference-in-differences models were used to evaluate an association between the 2006 Massachusetts health care reform and thyroid cancer treatment, and participants were controlled for age, sex, comorbidities, and secular trends. Change in the thyroidectomy rate for thyroid cancer treatment was the primary outcome evaluated. The Massachusetts cohort consisted of 6443 women (75.5%) and 2091 men (24.5%), of whom 6388 (79.6%) were white, 391 (4.9%) were black, 527 (6.6%) were Hispanic, 424 (5.3%) were Asian/Pacific Islander, 63 (0.8%) were Native American, and 228 (2.8%) were other. The participants from control states included 36 818 women (76.6%) and 11 229 men (23.4%), of whom 30 432 (65.5%) were white, 3818 (8.2%) were black, 6462 (13.9%) were Hispanic, 2591 (5.6%) were Asian/Pacific Islander, 211 (0.5%) were Native American, and 2947 (6.3%) were other. Before the 2006 Massachusetts insurance expansion, patients with government-subsidized or self-pay insurance had lower thyroidectomy rates for thyroid cancer in Massachusetts and the control states compared with patients with private insurance. The Massachusetts insurance expansion was associated with a 26% increased rate of undergoing a thyroidectomy (incident rate ratio, 1.26; 95% CI, 1.04-1.52; P = .02) and a 22% increased rate of neck dissection (incident rate ratio, 1.22; 95% CI, 1.07-1.37; P = .002) for treating cancer compared with control states. The 2006 Massachusetts health reform, which is a model for the Affordable Care Act, was associated with a 26% increased rate of thyroidectomy for treating thyroid cancer. Our study suggests that insurance expansion may be associated with increased access to the surgical management of thyroid cancer. Further studies need to be conducted to evaluate the effect of healthcare expansion at a national level.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
To our knowledge, thyroid cancer incidence is increasing faster than any other cancer type and is currently the fifth most common cancer among women. While this rise is likely multifactorial, there has been scarce consideration of the effect of insurance statuses on the treatment of thyroid cancer. We evaluate the association of insurance expansion with thyroid cancer treatment using the 2006 Massachusetts health reform, which serves as a unique natural experiment. We used the Agency for Healthcare Research and Quality State Inpatient Databases to identify patients with government-subsidized or self-pay insurance or private insurance who were admitted to a hospital with thyroid cancer and underwent a thyroidectomy between 2001 and 2011 in Massachusetts (n = 8534) and 3 control states (n = 48 047). Difference-in-differences models were used to evaluate an association between the 2006 Massachusetts health care reform and thyroid cancer treatment, and participants were controlled for age, sex, comorbidities, and secular trends. Change in the thyroidectomy rate for thyroid cancer treatment was the primary outcome evaluated. The Massachusetts cohort consisted of 6443 women (75.5%) and 2091 men (24.5%), of whom 6388 (79.6%) were white, 391 (4.9%) were black, 527 (6.6%) were Hispanic, 424 (5.3%) were Asian/Pacific Islander, 63 (0.8%) were Native American, and 228 (2.8%) were other. The participants from control states included 36 818 women (76.6%) and 11 229 men (23.4%), of whom 30 432 (65.5%) were white, 3818 (8.2%) were black, 6462 (13.9%) were Hispanic, 2591 (5.6%) were Asian/Pacific Islander, 211 (0.5%) were Native American, and 2947 (6.3%) were other. Before the 2006 Massachusetts insurance expansion, patients with government-subsidized or self-pay insurance had lower thyroidectomy rates for thyroid cancer in Massachusetts and the control states compared with patients with private insurance. The Massachusetts insurance expansion was associated with a 26% increased rate of undergoing a thyroidectomy (incident rate ratio, 1.26; 95% CI, 1.04-1.52; P = .02) and a 22% increased rate of neck dissection (incident rate ratio, 1.22; 95% CI, 1.07-1.37; P = .002) for treating cancer compared with control states. The 2006 Massachusetts health reform, which is a model for the Affordable Care Act, was associated with a 26% increased rate of thyroidectomy for treating thyroid cancer. Our study suggests that insurance expansion may be associated with increased access to the surgical management of thyroid cancer. Further studies need to be conducted to evaluate the effect of healthcare expansion at a national level.
Lubitz, Carrie C.; Ali, Ayman; Zhan, Tiannan; Heberle, Curtis; White, Craig; Ito, Yasuhiro; Miyauchi, Akira; Gazelle, G. Scott; Kong, Chung Yin; Hur, Chin
The thyroid cancer policy model: A mathematical simulation model of papillary thyroid carcinoma in The U.S. population Journal Article
In: PloS one, vol. 12, no. 5, pp. e0177068, 2017, ISSN: 1932-6203.
@article{Lubitz2017,
title = {The thyroid cancer policy model: A mathematical simulation model of papillary thyroid carcinoma in The U.S. population},
author = {Carrie C. Lubitz and Ayman Ali and Tiannan Zhan and Curtis Heberle and Craig White and Yasuhiro Ito and Akira Miyauchi and G. Scott Gazelle and Chung Yin Kong and Chin Hur},
url = {http://www.ncbi.nlm.nih.gov/pubmed/28481909},
doi = {10.1371/journal.pone.0177068},
issn = {1932-6203},
year = {2017},
date = {2017-05-01},
urldate = {2017-05-01},
journal = {PloS one},
volume = {12},
number = {5},
pages = {e0177068},
abstract = {Thyroid cancer affects over ½ million people in the U.S. and the incidence of thyroid cancer has increased worldwide at a rate higher than any other cancer, while survival has remained largely unchanged. The aim of this research was to develop, calibrate and verify a mathematical disease model to simulate the natural history of papillary thyroid cancer, which will serve as a platform to assess the effectiveness of clinical and cancer control interventions. Herein, we modeled the natural pre-clinical course of both benign and malignant thyroid nodules with biologically relevant health states from normal to detected nodule. Using established calibration techniques, optimal parameter sets for tumor growth characteristics, development rate, and detection rate were used to fit Surveillance Epidemiology and End Results (SEER) incidence data and other calibration targets. Model outputs compared to calibration targets demonstrating sufficient calibration fit and model validation are presented including primary targets of SEER incidence data and size distribution at detection of malignancy. Additionally, we show the predicted underlying benign and malignant prevalence of nodules in the population, the probability of detection based on size of nodule, and estimates of growth over time in both benign and malignant nodules. This comprehensive model provides a dynamic platform employable for future comparative effectiveness research. Future model analyses will test and assess various clinical management strategies to improve patient outcomes related to thyroid cancer and optimize resource utilization for patients with thyroid nodules.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Thyroid cancer affects over ½ million people in the U.S. and the incidence of thyroid cancer has increased worldwide at a rate higher than any other cancer, while survival has remained largely unchanged. The aim of this research was to develop, calibrate and verify a mathematical disease model to simulate the natural history of papillary thyroid cancer, which will serve as a platform to assess the effectiveness of clinical and cancer control interventions. Herein, we modeled the natural pre-clinical course of both benign and malignant thyroid nodules with biologically relevant health states from normal to detected nodule. Using established calibration techniques, optimal parameter sets for tumor growth characteristics, development rate, and detection rate were used to fit Surveillance Epidemiology and End Results (SEER) incidence data and other calibration targets. Model outputs compared to calibration targets demonstrating sufficient calibration fit and model validation are presented including primary targets of SEER incidence data and size distribution at detection of malignancy. Additionally, we show the predicted underlying benign and malignant prevalence of nodules in the population, the probability of detection based on size of nodule, and estimates of growth over time in both benign and malignant nodules. This comprehensive model provides a dynamic platform employable for future comparative effectiveness research. Future model analyses will test and assess various clinical management strategies to improve patient outcomes related to thyroid cancer and optimize resource utilization for patients with thyroid nodules.
Lubitz, Carrie C.; Gregorio, Lucia De; Fingeret, Abbey L; Economopoulos, Konstantinos; Teremzawi, Diana; Hassan, Mursal; Parangi, Sareh; Stephen, Antonia; Halpern, Elkan F.; Donelan, Karen; Swan, J. Shannon
Measurement and Variation in Estimation of Quality of Life Effects of Patients Undergoing Treatment for Papillary Thyroid Carcinoma Journal Article
In: Thyroid : official journal of the American Thyroid Association, vol. 27, no. 2, pp. 197-206, 2017, ISSN: 1557-9077, ().
@article{Lubitz2016b,
title = {Measurement and Variation in Estimation of Quality of Life Effects of Patients Undergoing Treatment for Papillary Thyroid Carcinoma},
author = {Carrie C. Lubitz and Lucia De Gregorio and Abbey L Fingeret and Konstantinos Economopoulos and Diana Teremzawi and Mursal Hassan and Sareh Parangi and Antonia Stephen and Elkan F. Halpern and Karen Donelan and J. Shannon Swan},
url = {http://www.ncbi.nlm.nih.gov/pubmed/27824301},
doi = {10.1089/thy.2016.0260},
issn = {1557-9077},
year = {2017},
date = {2017-02-01},
journal = {Thyroid : official journal of the American Thyroid Association},
volume = {27},
number = {2},
pages = {197-206},
abstract = {Thyroid cancer incidence is increasing. The effect of diagnosis and treatment on health related quality of life (HRQoL) is an essential variable given no change in life span for the majority of patients. HRQoL instruments, with data useful for between-disease comparisons, are being increasingly used for health policy and outcomes evaluation. Variation exits among the instruments based on the impact of a specific disease. We assessed which of four well-validated preference-based surveys detect changes in health and clinical intervention in patients diagnosed with the papillary thyroid cancer (PTC). Four commonly used HRQoL questionnaires (Short Form-12v2® (SF6D), EuroQol-5D (EQ5D), and Health Utilities Index Mark 2 and 3 (HUI2, HUI3) were administered to patients with the diagnosis of PTC at three perioperative time points during the first year of treatment. Clinicopathological and treatment course data were assessed for HRQoL impact including complications from surgery, re-operation for persistence/early recurrence, and adjuvant radioactive iodine treatment. We compared standard metrics, including ceiling effect, intraclass correlation coefficient, effect sizes, and quality-adjusted life-years (QALYs) among the four instruments. Of 117 patients, 27% had a preoperative diagnosis of anxiety or depression, 41% had regional lymph node metastases, three had distant metastases and 49% underwent adjuvant radioactive iodine treatment. The ceiling effect (i.e. proportion with a perfect score) was greatest with the EQ5D and least with the SF6D. Index scores ranged from 0.77 (SF6D) to 0.90 (EQ5D). All scores declined at 2 weeks' post-op, and returned to pretreatment at six-months. The SF6D was the only instrument to exceed the conventional minimal-important difference between all three time points. QALYs were as follows: SF6D - 0.79, EQ5D - 0.90, HUI2 - 0.88, HUI3 - 0.86. Our results reflect the general good health of PTC patients. The effect on quality of life is primarily related to emotional and social impacts of treatment. The results support the measurement of a similar underlying construct, although variation in detecting changes in health exists between the instruments. Of the instruments assessed, the SF6D is the most responsive to treatment effects and should be utilized in future economic analyses in this patient population.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Thyroid cancer incidence is increasing. The effect of diagnosis and treatment on health related quality of life (HRQoL) is an essential variable given no change in life span for the majority of patients. HRQoL instruments, with data useful for between-disease comparisons, are being increasingly used for health policy and outcomes evaluation. Variation exits among the instruments based on the impact of a specific disease. We assessed which of four well-validated preference-based surveys detect changes in health and clinical intervention in patients diagnosed with the papillary thyroid cancer (PTC). Four commonly used HRQoL questionnaires (Short Form-12v2® (SF6D), EuroQol-5D (EQ5D), and Health Utilities Index Mark 2 and 3 (HUI2, HUI3) were administered to patients with the diagnosis of PTC at three perioperative time points during the first year of treatment. Clinicopathological and treatment course data were assessed for HRQoL impact including complications from surgery, re-operation for persistence/early recurrence, and adjuvant radioactive iodine treatment. We compared standard metrics, including ceiling effect, intraclass correlation coefficient, effect sizes, and quality-adjusted life-years (QALYs) among the four instruments. Of 117 patients, 27% had a preoperative diagnosis of anxiety or depression, 41% had regional lymph node metastases, three had distant metastases and 49% underwent adjuvant radioactive iodine treatment. The ceiling effect (i.e. proportion with a perfect score) was greatest with the EQ5D and least with the SF6D. Index scores ranged from 0.77 (SF6D) to 0.90 (EQ5D). All scores declined at 2 weeks' post-op, and returned to pretreatment at six-months. The SF6D was the only instrument to exceed the conventional minimal-important difference between all three time points. QALYs were as follows: SF6D - 0.79, EQ5D - 0.90, HUI2 - 0.88, HUI3 - 0.86. Our results reflect the general good health of PTC patients. The effect on quality of life is primarily related to emotional and social impacts of treatment. The results support the measurement of a similar underlying construct, although variation in detecting changes in health exists between the instruments. Of the instruments assessed, the SF6D is the most responsive to treatment effects and should be utilized in future economic analyses in this patient population.
Pitt, Susan C; Lubitz, Carrie C.
Editorial: Complex decision making in thyroid cancer: Costs and consequences-is less more? Journal Article
In: Surgery, vol. 161, pp. 134–136, 2017, ISSN: 1532-7361, ().
@article{Pitt2017,
title = {Editorial: Complex decision making in thyroid cancer: Costs and consequences-is less more?},
author = {Susan C Pitt and Carrie C. Lubitz},
url = {http://www.ncbi.nlm.nih.gov/pubmed/27855971},
doi = {10.1016/j.surg.2016.09.014},
issn = {1532-7361},
year = {2017},
date = {2017-01-01},
urldate = {2017-01-01},
journal = {Surgery},
volume = {161},
pages = {134--136},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Pitt, Susan C; Lubitz, Carrie C.
Complex decision-making in thyroid cancer: Costs and consequences-Is less more? Journal Article
In: Surgery, 2016, ISSN: 1532-7361, ().
@article{Pitt2016,
title = {Complex decision-making in thyroid cancer: Costs and consequences-Is less more?},
author = {Susan C Pitt and Carrie C. Lubitz},
url = {http://www.ncbi.nlm.nih.gov/pubmed/27855971},
doi = {10.1016/j.surg.2016.09.014},
issn = {1532-7361},
year = {2016},
date = {2016-11-01},
journal = {Surgery},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Lubitz, Carrie C.; Sosa, Julie A.
The changing landscape of papillary thyroid cancer: Epidemiology, management, and the implications for patients Journal Article
In: Cancer, 2016, ().
@article{Lubitz2016,
title = {The changing landscape of papillary thyroid cancer: Epidemiology, management, and the implications for patients},
author = {Carrie C. Lubitz and Julie A. Sosa},
url = {http://www.ncbi.nlm.nih.gov/pubmed/27517675},
doi = {10.1002/cncr.30201},
year = {2016},
date = {2016-08-01},
urldate = {2016-08-01},
journal = {Cancer},
institution = {Departments of Surgery and Medicine, Duke Cancer Institute, and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.},
abstract = {The incidence of thyroid cancer has tripled over the past 3 decades, with the vast majority of the increase noted to be among small, indolent papillary thyroid carcinomas. Substantial overdiagnosis and potential overtreatment have led to a shift in clinical practice toward less aggressive approaches and a focus on improved risk stratification. This shift in practice may be associated with recent evidence suggesting that the increase in the incidence of thyroid cancer is slowing. Because patients are often young when they are diagnosed with thyroid cancer and because there is excellent long-term, disease-specific survival, there is an ever-growing population of survivors of thyroid cancer in the United States who accumulate substantial associated health care costs as they undergo surveillance and/or remedial treatment. Survivors of thyroid cancer can experience significant detriments to their quality of life and endure financial hardship. Future research should focus on the appropriateness of treatment as well as the financial and quality-of-life effects of thyroid cancer survivorship. Cancer 2016. © 2016 American Cancer Society.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The incidence of thyroid cancer has tripled over the past 3 decades, with the vast majority of the increase noted to be among small, indolent papillary thyroid carcinomas. Substantial overdiagnosis and potential overtreatment have led to a shift in clinical practice toward less aggressive approaches and a focus on improved risk stratification. This shift in practice may be associated with recent evidence suggesting that the increase in the incidence of thyroid cancer is slowing. Because patients are often young when they are diagnosed with thyroid cancer and because there is excellent long-term, disease-specific survival, there is an ever-growing population of survivors of thyroid cancer in the United States who accumulate substantial associated health care costs as they undergo surveillance and/or remedial treatment. Survivors of thyroid cancer can experience significant detriments to their quality of life and endure financial hardship. Future research should focus on the appropriateness of treatment as well as the financial and quality-of-life effects of thyroid cancer survivorship. Cancer 2016. © 2016 American Cancer Society.
Shindo, Maise; Lee, James A.; Lubitz, Carrie C.; McCoy, Kelly L.; Orloff, Lisa A.; Tufano, Ralph P.; Pasieka, Janice L.
In: J Am Coll Surg, vol. 222, no. 6, pp. 1240-50, 2016, ().
@article{Shindo2016,
title = {The Changing Landscape of Primary, Secondary, and Tertiary Hyperparathyroidism: Highlights from the American College of Surgeons Panel, "What's New for the Surgeon Caring for Patients with Hyperparathyroidism" },
author = {Maise Shindo and James A. Lee and Carrie C. Lubitz and Kelly L. McCoy and Lisa A. Orloff and Ralph P. Tufano and Janice L. Pasieka},
url = {http://www.ncbi.nlm.nih.gov/pubmed/27107975},
doi = {10.1016/j.jamcollsurg.2016.02.024},
year = {2016},
date = {2016-06-01},
urldate = {2016-06-01},
journal = {J Am Coll Surg},
volume = {222},
number = {6},
pages = {1240-50},
institution = {University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada. Electronic address: .},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Gregorio, Lucia De; Lubitz, Carrie C.; Hodin, Richard A.; Gaz, Randall D.; Parangi, Sareh; Phitayakorn, Roy; Stephen, Antonia E.
The Truth about Double Adenomas: Incidence, Localization, and Intraoperative Parathyroid Hormone Journal Article
In: J Am Coll Surg, vol. 222, no. 6, pp. 1044–1052, 2016, ().
@article{DeGregorio2016,
title = {The Truth about Double Adenomas: Incidence, Localization, and Intraoperative Parathyroid Hormone},
author = {Lucia De Gregorio and Carrie C. Lubitz and Richard A. Hodin and Randall D. Gaz and Sareh Parangi and Roy Phitayakorn and Antonia E. Stephen},
url = {http://www.ncbi.nlm.nih.gov/pubmed/27234627},
doi = {10.1016/j.jamcollsurg.2015.12.048},
year = {2016},
date = {2016-06-01},
urldate = {2016-06-01},
journal = {J Am Coll Surg},
volume = {222},
number = {6},
pages = {1044--1052},
institution = {Department of Surgery, Massachusetts General Hospital, Boston, MA. Electronic address: .},
abstract = {Double adenoma is reported in 3% to 12% of patients with primary hyperparathyroidism. The aim of this study was to determine the true incidence of double adenoma and analyze the use of localization studies and intraoperative parathyroid hormone (IOTPH) assay in these cases.We conducted a retrospective review of a series of consecutive parathyroid surgical operations from 2010 to 2013. According to the surgical findings, the series was divided into single-gland disease (SGD), double-gland disease (DGD), and multi-gland disease (MGD, more than 2 glands). The sensitivity of ultrasound, technetium 99m-sestamibi, and 4-dimensional CT to correctly lateralize each gland in the DGD group was calculated. Results of the IOPTH assay and how they impacted the extent of surgery were analyzed.Three hundred and forty-seven patients had SGD (69%), 68 patients had DGD (13.5%), and 86 had MGD (17%). In the DGD group, sensitivity of ultrasound, technetium 99m-sestamibi, and 4-dimensional CT to lateralize each adenoma was 42%, 34.5%, and 64%, respectively. Initially, 27 patients (40%) with DGD had been planned for a focal exploration. The conversion to bilateral neck exploration was due to the IOPTH assay in 18 cases (two-thirds of the initially planned focal explorations). At 6-month follow-up, all DGD patients were normocalcemic.Localization studies in DGD can be misleading by reporting SGD. Four-dimensional CT seems to have the highest sensitivity. In focal explorations, the excision of all hyperfunctioning parathyroid tissue should be verified by IOPTH measurement.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Double adenoma is reported in 3% to 12% of patients with primary hyperparathyroidism. The aim of this study was to determine the true incidence of double adenoma and analyze the use of localization studies and intraoperative parathyroid hormone (IOTPH) assay in these cases.We conducted a retrospective review of a series of consecutive parathyroid surgical operations from 2010 to 2013. According to the surgical findings, the series was divided into single-gland disease (SGD), double-gland disease (DGD), and multi-gland disease (MGD, more than 2 glands). The sensitivity of ultrasound, technetium 99m-sestamibi, and 4-dimensional CT to correctly lateralize each gland in the DGD group was calculated. Results of the IOPTH assay and how they impacted the extent of surgery were analyzed.Three hundred and forty-seven patients had SGD (69%), 68 patients had DGD (13.5%), and 86 had MGD (17%). In the DGD group, sensitivity of ultrasound, technetium 99m-sestamibi, and 4-dimensional CT to lateralize each adenoma was 42%, 34.5%, and 64%, respectively. Initially, 27 patients (40%) with DGD had been planned for a focal exploration. The conversion to bilateral neck exploration was due to the IOPTH assay in 18 cases (two-thirds of the initially planned focal explorations). At 6-month follow-up, all DGD patients were normocalcemic.Localization studies in DGD can be misleading by reporting SGD. Four-dimensional CT seems to have the highest sensitivity. In focal explorations, the excision of all hyperfunctioning parathyroid tissue should be verified by IOPTH measurement.
Qu, Xuanlu; Lubitz, Carrie C.; Rickard, Jennifer; Bergeron, Stephane G.; Wasif, Nabil
A Meta-Analysis of the Association Between Radiation Ŧherapy and Survival for Surgically Resected Soft-Ŧissue Sarcoma Journal Article
In: Am J Clin Oncol, vol. 41, no. 4, pp. 348-356, 2016, ().
@article{Qu2016,
title = {A Meta-Analysis of the Association Between Radiation {T}herapy and Survival for Surgically Resected Soft-{T}issue Sarcoma},
author = {Xuanlu Qu and Carrie C. Lubitz and Jennifer Rickard and Stephane G. Bergeron and Nabil Wasif},
url = {http://www.ncbi.nlm.nih.gov/pubmed/26886948},
doi = {10.1097/COC.0000000000000274},
year = {2016},
date = {2016-04-01},
urldate = {2016-04-01},
journal = {Am J Clin Oncol},
volume = {41},
number = {4},
pages = {348-356},
institution = {*Department of Oncology, Queen's University, Kingston, ON †Department of Surgery, Massachusetts General Hospital ‡Department of Surgery, Brigham and Women's Hospital, Boston, MA §Department of Orthopedic Surgery, Jewish General Hospital, Montreal, QC, Can},
abstract = {Radiotherapy for soft-tissue sarcoma (STS) has been shown to reduce local recurrence, but without clear improvement in survival. We conducted a meta-analysis to study the association between radiotherapy and survival in patients undergoing surgery for STS.A systematic review was conducted from PubMed, EMBASE, Web of Science, and Cochrane databases. Our population of interest consisted of adults with primary extremity, chest wall, trunk, or back STS. Our metameters were either an odds or hazard ratio for mortality. A bias score was generated for each study based on margin status and grade.Of 1044 studies, 30 met inclusion criteria for final analysis. The pooled odds ratio in patients receiving radiation was 0.94 (95% confidence interval [CI], 0.78-1.14). The pooled estimate of the hazards ratio in patients receiving radiation was 0.87 (95% CI, 0.73-1.03) overall and 0.65 (95% CI, 0.52-0.82) for studies judged to be at low risk of bias. Significant publication bias was not seen.High-quality studies reporting adjusted hazard ratios are associated with improved survival in patients receiving radiotherapy for STS. Studies in which odds ratios are calculated from event data and those that do not report adjusted outcomes do not show the same association, likely due to confounding by indication.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Radiotherapy for soft-tissue sarcoma (STS) has been shown to reduce local recurrence, but without clear improvement in survival. We conducted a meta-analysis to study the association between radiotherapy and survival in patients undergoing surgery for STS.A systematic review was conducted from PubMed, EMBASE, Web of Science, and Cochrane databases. Our population of interest consisted of adults with primary extremity, chest wall, trunk, or back STS. Our metameters were either an odds or hazard ratio for mortality. A bias score was generated for each study based on margin status and grade.Of 1044 studies, 30 met inclusion criteria for final analysis. The pooled odds ratio in patients receiving radiation was 0.94 (95% confidence interval [CI], 0.78-1.14). The pooled estimate of the hazards ratio in patients receiving radiation was 0.87 (95% CI, 0.73-1.03) overall and 0.65 (95% CI, 0.52-0.82) for studies judged to be at low risk of bias. Significant publication bias was not seen.High-quality studies reporting adjusted hazard ratios are associated with improved survival in patients receiving radiotherapy for STS. Studies in which odds ratios are calculated from event data and those that do not report adjusted outcomes do not show the same association, likely due to confounding by indication.
Chen, Yufei; Sadow, Peter M.; Suh, Hyunsuk; Lee, Kyu Eun; Choi, June Young; Suh, Yong Joon; Wang, Tracy S.; Lubitz, Carrie C.
In: Thyroid, vol. 26, no. 2, pp. 248-55, 2016.
@article{Chen2016,
title = {BRAF(V600E) Is Correlated with Recurrence of Papillary Thyroid Microcarcinoma: A Systematic Review, Multi-Institutional Primary {D}ata Analysis, and Meta-Analysis},
author = {Yufei Chen and Peter M. Sadow and Hyunsuk Suh and Kyu Eun Lee and June Young Choi and Yong Joon Suh and Tracy S. Wang and Carrie C. Lubitz},
url = {http://www.ncbi.nlm.nih.gov/pubmed/26671072},
doi = {10.1089/thy.2015.0391},
year = {2016},
date = {2016-02-01},
urldate = {2016-02-01},
journal = {Thyroid},
volume = {26},
number = {2},
pages = {248-55},
institution = {6 Institute for Technology Assessment , Boston, Massachusetts.},
abstract = {Given the increasing incidence of papillary thyroid carcinoma despite stable disease-specific mortality rates, the potential for the disease to reoccur is a key outcome to predict. The BRAF(V600E) mutation has been associated with recurrent disease in larger tumors. However, its correlation in papillary thyroid microcarcinoma (PTMC) is not clear in individual series.The MEDLINE, EMBASE, Web of Science, and Cochrane databases were searched for studies including patients with PTMC undergoing initial surgical treatment. Studies with at least two years of follow-up, BRAF genotyping (the comparator), and recurrence as an outcome were included, as were unpublished primary data on 485 patients from two institutions. The metameter analyzed was odds ratio (OR) for recurrence between patients with BRAF(V600E) versus BRAF wild type (BRAFwt).The initial search identified 431 references. After screening of the abstracts for inclusion, 44 manuscripts were reviewed in full by two independent reviewers. Four published studies and primary data from two institutional cohorts were included in the final analysis. A meta-analysis of 2247 PTMC patients revealed that patients with a BRAF(V600E) mutation had a higher likelihood for recurrence (odds ratio 2.09 [confidence interval 1.31-3.33},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Given the increasing incidence of papillary thyroid carcinoma despite stable disease-specific mortality rates, the potential for the disease to reoccur is a key outcome to predict. The BRAF(V600E) mutation has been associated with recurrent disease in larger tumors. However, its correlation in papillary thyroid microcarcinoma (PTMC) is not clear in individual series.The MEDLINE, EMBASE, Web of Science, and Cochrane databases were searched for studies including patients with PTMC undergoing initial surgical treatment. Studies with at least two years of follow-up, BRAF genotyping (the comparator), and recurrence as an outcome were included, as were unpublished primary data on 485 patients from two institutions. The metameter analyzed was odds ratio (OR) for recurrence between patients with BRAF(V600E) versus BRAF wild type (BRAFwt).The initial search identified 431 references. After screening of the abstracts for inclusion, 44 manuscripts were reviewed in full by two independent reviewers. Four published studies and primary data from two institutional cohorts were included in the final analysis. A meta-analysis of 2247 PTMC patients revealed that patients with a BRAF(V600E) mutation had a higher likelihood for recurrence (odds ratio 2.09 [confidence interval 1.31-3.33
Economopoulos, Konstantinos; Phitayakorn, Roy; Lubitz, Carrie C.; Sadow, Peter M.; Parangi, Sareh; Stephen, Antonia E.; Hodin, Richard A.
Should specific patient clinical characteristics discourage adrenal surgeons from performing laparoscopic transperitoneal adrenalectomy? Journal Article
In: Surgery, vol. 159, no. 1, pp. 240-8, 2016, ().
@article{Economopoulos2015,
title = {Should specific patient clinical characteristics discourage adrenal surgeons from performing laparoscopic transperitoneal adrenalectomy?},
author = {Konstantinos Economopoulos and Roy Phitayakorn and Carrie C. Lubitz and Peter M. Sadow and Sareh Parangi and Antonia E. Stephen and Richard A. Hodin},
url = {http://www.ncbi.nlm.nih.gov/pubmed/26453136},
doi = {10.1016/j.surg.2015.07.045},
year = {2016},
date = {2016-01-01},
journal = {Surgery},
volume = {159},
number = {1},
pages = {240-8},
institution = {Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: .},
abstract = {Although laparoscopic transperitoneal adrenalectomy (LTA) has become a standard operative approach to patients with benign adrenal masses, some authors have suggested that LTA should be avoided in obese patients, patients who have had previous abdominal surgery, and in cases of bilateral adrenalectomy. We sought to determine whether LTA in these clinical situations is associated with worse outcomes.Consecutive patients who underwent LTA at a tertiary care center (1/2002-8/2014) were reviewed retrospectively. Study endpoints included operative time, duration of stay, conversion to open procedure, and postoperative complications. Statistical analyses were performed by use of Wilcoxon rank sum test, Kruskal-Wallis test, Fisher exact test, χ(2) test, and binary logistic regression analyses.A total of 365 patients had a planned LTA, 6 of whom were converted to an open adrenalectomy. Obesity, history of previous abdominal surgery, and bilateral adrenalectomy were not associated with greater conversion rates or postoperative complications. Male sex, tumor size ≥4 cm and obesity (body mass index ≥30 kg/m(2)) were significant factors associated with increased operative time. Bilateral adrenalectomy, age, and pheochromocytomas were associated with increased hospital stays.Obesity, history of prior abdominal surgery and bilateral adrenalectomy should not be used to discourage experienced adrenal surgeons from performing LTA.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Although laparoscopic transperitoneal adrenalectomy (LTA) has become a standard operative approach to patients with benign adrenal masses, some authors have suggested that LTA should be avoided in obese patients, patients who have had previous abdominal surgery, and in cases of bilateral adrenalectomy. We sought to determine whether LTA in these clinical situations is associated with worse outcomes.Consecutive patients who underwent LTA at a tertiary care center (1/2002-8/2014) were reviewed retrospectively. Study endpoints included operative time, duration of stay, conversion to open procedure, and postoperative complications. Statistical analyses were performed by use of Wilcoxon rank sum test, Kruskal-Wallis test, Fisher exact test, χ(2) test, and binary logistic regression analyses.A total of 365 patients had a planned LTA, 6 of whom were converted to an open adrenalectomy. Obesity, history of previous abdominal surgery, and bilateral adrenalectomy were not associated with greater conversion rates or postoperative complications. Male sex, tumor size ≥4 cm and obesity (body mass index ≥30 kg/m(2)) were significant factors associated with increased operative time. Bilateral adrenalectomy, age, and pheochromocytomas were associated with increased hospital stays.Obesity, history of prior abdominal surgery and bilateral adrenalectomy should not be used to discourage experienced adrenal surgeons from performing LTA.
Lubitz, Carrie C.; Parangi, Sareh; Holm, Tammy M.; Bernasconi, M Jordana; Schalck, Aislyn P.; Suh, Hyunsuk; Economopoulos, Konstantinos; Gunda, Viswanath; Donovan, Samuel E.; Sadow, Peter M.; Wirth, Lori J.; Sullivan, Ryan J.; Panka, David J.
Detection of Circulating BRAF(V600E) in Patients with Papillary Thyroid Carcinoma Journal Article
In: J Mol Diagn, vol. 18, no. 1, pp. 100–108, 2016, ().
@article{Lubitz2016a,
title = {Detection of Circulating BRAF(V600E) in Patients with Papillary Thyroid Carcinoma},
author = {Carrie C. Lubitz and Sareh Parangi and Tammy M. Holm and M Jordana Bernasconi and Aislyn P. Schalck and Hyunsuk Suh and Konstantinos Economopoulos and Viswanath Gunda and Samuel E. Donovan and Peter M. Sadow and Lori J. Wirth and Ryan J. Sullivan and David J. Panka},
url = {http://www.ncbi.nlm.nih.gov/pubmed/26631873},
doi = {10.1016/j.jmoldx.2015.08.003},
year = {2016},
date = {2016-01-01},
urldate = {2016-01-01},
journal = {J Mol Diagn},
volume = {18},
number = {1},
pages = {100--108},
institution = {Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.},
abstract = {BRAF(V600E) is a common mutation in papillary thyroid carcinoma (PTC) correlated with aggressive features. Our objective was to assess the feasibility and accuracy of a novel RNA-based blood assay to identify individuals with a high-risk tumor mutation in patients with PTC. Patients with benign or malignant thyroid disorders were included between September 2013 and July 2014 before either thyroidectomy (n = 62) or treatment of recurrent or metastatic PTC (n = 8). RNA was isolated from peripheral blood lymphocytes and reverse transcribed and followed by two rounds of nested PCR amplification with a restriction digest specific for wild-type BRAF. BRAF(V600E) levels were quantified with standardization curves. Circulating BRAF(V600E) levels were compared with BRAF mutation status from surgical pathologic DNA-based tissue assays. Testing characteristics and receiving-operator curve using tissue results as the gold standard were assessed. Matched blood and tissue assays for BRAF(V600E) were performed on 70 patients with PTC (stages I to I},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BRAF(V600E) is a common mutation in papillary thyroid carcinoma (PTC) correlated with aggressive features. Our objective was to assess the feasibility and accuracy of a novel RNA-based blood assay to identify individuals with a high-risk tumor mutation in patients with PTC. Patients with benign or malignant thyroid disorders were included between September 2013 and July 2014 before either thyroidectomy (n = 62) or treatment of recurrent or metastatic PTC (n = 8). RNA was isolated from peripheral blood lymphocytes and reverse transcribed and followed by two rounds of nested PCR amplification with a restriction digest specific for wild-type BRAF. BRAF(V600E) levels were quantified with standardization curves. Circulating BRAF(V600E) levels were compared with BRAF mutation status from surgical pathologic DNA-based tissue assays. Testing characteristics and receiving-operator curve using tissue results as the gold standard were assessed. Matched blood and tissue assays for BRAF(V600E) were performed on 70 patients with PTC (stages I to I
Lubitz, Carrie C.
Editorial: Is molecular testing cost effective? It depends Journal Article
In: Surgery, vol. 159, no. 1, pp. 130-1, 2016, ().
@article{Lubitz2015,
title = {Editorial: Is molecular testing cost effective? It depends},
author = {Carrie C. Lubitz},
url = {http://www.ncbi.nlm.nih.gov/pubmed/26453134},
doi = {10.1016/j.surg.2015.07.047},
year = {2016},
date = {2016-01-01},
urldate = {2016-01-01},
journal = {Surgery},
volume = {159},
number = {1},
pages = {130-1},
institution = {Department of Surgery, Massachusetts General Hospital, and the Institute for Technology Assessment, Boston, MA. Electronic address: .},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Chen, Yufei; Sadow, Peter M.; Suh, Hyunsuk; Lee, Kyu Eun; Choi, June Young; Suh, Yong Joon; Wang, Tracy S.; Lubitz, Carrie C.
In: Thyroid, 2015, ().
@article{ChenA2015,
title = {BRAFV600E is correlated with recurrence of papillary thyroid microcarcinoma: A systematic review, multi-institutional primary data analysis, and meta-analysis},
author = {Yufei Chen and Peter M. Sadow and Hyunsuk Suh and Kyu Eun Lee and June Young Choi and Yong Joon Suh and Tracy S. Wang and Carrie C. Lubitz},
url = {http://www.ncbi.nlm.nih.gov/pubmed/26671072},
doi = {10.1089/thy.2015.0391},
year = {2015},
date = {2015-12-01},
journal = {Thyroid},
institution = {Institute for Technology Assessment, Boston, Massachusetts, United States , 617-643-9473 ; .},
abstract = {Given the increasing incidence of papillary thyroid carcinoma despite stable disease-specific mortality rates, the potential to develop recurrent disease is a key outcome to predict. The BRAFV600E mutation has been associated with recurrent disease in larger tumors; however, its correlation in papillary thyroid microcarcinoma (PTMC) is not clear in individual series.We searched the MEDLINE, EMBASE, Web of Science, and Cochrane databases for studies including patients with PTMC undergoing initial surgical treatment. Studies with at least two-year follow-up, BRAF genotyping (the comparator), and recurrence as an outcome were included, as were unpublished primary data on 485 patients from two institutions. The metameter analyzed was odds ratio (OR) for recurrence between patients with BRAFV600E versus BRAFwt.The initial search identified 431 references. After screening of the abstracts for inclusion, 44 manuscripts were reviewed in full by two independent reviewers. Four published studies and primary data from two institutional cohorts were included in the final analysis. A meta-analysis of 2247 PTMC patients revealed that patients with a BRAFV600E mutation had a higher likelihood for recurrence (OR 2.09, 95% CI [1.31, 3.33},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Given the increasing incidence of papillary thyroid carcinoma despite stable disease-specific mortality rates, the potential to develop recurrent disease is a key outcome to predict. The BRAFV600E mutation has been associated with recurrent disease in larger tumors; however, its correlation in papillary thyroid microcarcinoma (PTMC) is not clear in individual series.We searched the MEDLINE, EMBASE, Web of Science, and Cochrane databases for studies including patients with PTMC undergoing initial surgical treatment. Studies with at least two-year follow-up, BRAF genotyping (the comparator), and recurrence as an outcome were included, as were unpublished primary data on 485 patients from two institutions. The metameter analyzed was odds ratio (OR) for recurrence between patients with BRAFV600E versus BRAFwt.The initial search identified 431 references. After screening of the abstracts for inclusion, 44 manuscripts were reviewed in full by two independent reviewers. Four published studies and primary data from two institutional cohorts were included in the final analysis. A meta-analysis of 2247 PTMC patients revealed that patients with a BRAFV600E mutation had a higher likelihood for recurrence (OR 2.09, 95% CI [1.31, 3.33
Lubitz, Carrie C.; Economopoulos, Konstantinos; Sy, Stephen; Johanson, Colden; Kunzel, Heike E.; Reincke, Martin; Gazelle, G. Scott; Weinstein, Milton C.; Gaziano, Thomas A.
Cost-Effectiveness of Screening for Primary Aldosteronism and Subtype Diagnosis in the Resistant Hypertensive Patients Journal Article
In: Circ Cardiovasc Qual Outcomes, vol. 8, no. 6, pp. 621-30, 2015, ().
@article{Lubitz2015a,
title = {Cost-Effectiveness of Screening for Primary Aldosteronism and Subtype Diagnosis in the Resistant Hypertensive Patients},
author = {Carrie C. Lubitz and Konstantinos Economopoulos and Stephen Sy and Colden Johanson and Heike E. Kunzel and Martin Reincke and G. Scott Gazelle and Milton C. Weinstein and Thomas A. Gaziano},
url = {http://www.ncbi.nlm.nih.gov/pubmed/26555126},
doi = {10.1161/CIRCOUTCOMES.115.002002},
year = {2015},
date = {2015-11-01},
urldate = {2015-11-01},
journal = {Circ Cardiovasc Qual Outcomes},
volume = {8},
number = {6},
pages = {621-30},
institution = {From the Departments of Surgery (C.C.L., K.P.E.) and Radiology (G.S.G.), Massachusetts General Hospital, Boston; Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA (C.C.L., K.P.E., C.J., G.S.G.); Depar},
abstract = {Primary aldosteronism (PA) is a common and underdiagnosed disease with significant morbidity potentially cured by surgery. We aim to assess if the long-term cardiovascular benefits of identifying and treating surgically correctable PA outweigh the upfront increased costs in patients at the time patients are diagnosed with resistant hypertension (RH).A decision-analytic model compares aggregate costs and systolic blood pressure changes of 6 recommended or implemented diagnostic strategies for PA in a simulated population of at-risk RH patients. We also evaluate a 7th "treat all" strategy wherein all patients with RH are treated with a mineralocorticoid-receptor antagonist without further testing at RH diagnosis. Changes in systolic blood pressure are subsequently converted into gains in quality-adjusted life years (QALYs) by applying National Health and Nutrition Examination Survey data on concomitant risk factors to an existing cardiovascular disease simulation model. QALYs and lifetime costs were then used to calculate incremental cost-effectiveness ratios for the competing strategies. The incremental cost-effectiveness ratio for the strategy of computerized tomography (CT) followed by adrenal venous sampling (AVS) was $82 000/QALY compared with treat all. Incremental cost-effectiveness ratios for CT alone and AVS alone were $200 000/QALY and $492 000/QALY; the other strategies were more costly and less effective. Integrating differential patient-reported health-related quality of life adjustments for patients with PA, and incremental cost-effectiveness ratios for screening patients with CT followed by AVS, CT alone, and AVS alone were $52 000/QALY, $114 000/QALY, and $269 000/QALY gained.CT scanning followed by AVS was a cost-effective strategy to screen for PA among patients with RH.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Primary aldosteronism (PA) is a common and underdiagnosed disease with significant morbidity potentially cured by surgery. We aim to assess if the long-term cardiovascular benefits of identifying and treating surgically correctable PA outweigh the upfront increased costs in patients at the time patients are diagnosed with resistant hypertension (RH).A decision-analytic model compares aggregate costs and systolic blood pressure changes of 6 recommended or implemented diagnostic strategies for PA in a simulated population of at-risk RH patients. We also evaluate a 7th "treat all" strategy wherein all patients with RH are treated with a mineralocorticoid-receptor antagonist without further testing at RH diagnosis. Changes in systolic blood pressure are subsequently converted into gains in quality-adjusted life years (QALYs) by applying National Health and Nutrition Examination Survey data on concomitant risk factors to an existing cardiovascular disease simulation model. QALYs and lifetime costs were then used to calculate incremental cost-effectiveness ratios for the competing strategies. The incremental cost-effectiveness ratio for the strategy of computerized tomography (CT) followed by adrenal venous sampling (AVS) was $82 000/QALY compared with treat all. Incremental cost-effectiveness ratios for CT alone and AVS alone were $200 000/QALY and $492 000/QALY; the other strategies were more costly and less effective. Integrating differential patient-reported health-related quality of life adjustments for patients with PA, and incremental cost-effectiveness ratios for screening patients with CT followed by AVS, CT alone, and AVS alone were $52 000/QALY, $114 000/QALY, and $269 000/QALY gained.CT scanning followed by AVS was a cost-effective strategy to screen for PA among patients with RH.
Lubitz, Carrie C.; Parangi, Sareh; Holm, Tammy M.; Bernasconi, M Jordana; Schalck, Aislyn P.; Suh, Hyunsuk; Economopoulos, Konstantinos; Gunda, Viswanath; Donovan, Samuel E.; Sadow, Peter M.; Wirth, Lori J.; Sullivan, Ryan J.; Panka, David J.
Detection of Circulating BRAF(V600E) in Patients with Papillary Thyroid Carcinoma Journal Article
In: J Mol Diagn, 2015, ().
@article{Lubitz2015b,
title = {Detection of Circulating BRAF(V600E) in Patients with Papillary Thyroid Carcinoma},
author = {Carrie C. Lubitz and Sareh Parangi and Tammy M. Holm and M Jordana Bernasconi and Aislyn P. Schalck and Hyunsuk Suh and Konstantinos Economopoulos and Viswanath Gunda and Samuel E. Donovan and Peter M. Sadow and Lori J. Wirth and Ryan J. Sullivan and David J. Panka},
url = {http://www.ncbi.nlm.nih.gov/pubmed/26631873},
doi = {10.1016/j.jmoldx.2015.08.003},
year = {2015},
date = {2015-11-01},
urldate = {2015-11-01},
journal = {J Mol Diagn},
institution = {Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.},
abstract = {BRAF(V600E) is a common mutation in papillary thyroid carcinoma (PTC) correlated with aggressive features. Our objective was to assess the feasibility and accuracy of a novel RNA-based blood assay to identify individuals with a high-risk tumor mutation in patients with PTC. Patients with benign or malignant thyroid disorders were included between September 2013 and July 2014 before either thyroidectomy (n = 62) or treatment of recurrent or metastatic PTC (n = 8). RNA was isolated from peripheral blood lymphocytes and reverse transcribed and followed by two rounds of nested PCR amplification with a restriction digest specific for wild-type BRAF. BRAF(V600E) levels were quantified with standardization curves. Circulating BRAF(V600E) levels were compared with BRAF mutation status from surgical pathologic DNA-based tissue assays. Testing characteristics and receiving-operator curve using tissue results as the gold standard were assessed. Matched blood and tissue assays for BRAF(V600E) were performed on 70 patients with PTC (stages I to I},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BRAF(V600E) is a common mutation in papillary thyroid carcinoma (PTC) correlated with aggressive features. Our objective was to assess the feasibility and accuracy of a novel RNA-based blood assay to identify individuals with a high-risk tumor mutation in patients with PTC. Patients with benign or malignant thyroid disorders were included between September 2013 and July 2014 before either thyroidectomy (n = 62) or treatment of recurrent or metastatic PTC (n = 8). RNA was isolated from peripheral blood lymphocytes and reverse transcribed and followed by two rounds of nested PCR amplification with a restriction digest specific for wild-type BRAF. BRAF(V600E) levels were quantified with standardization curves. Circulating BRAF(V600E) levels were compared with BRAF mutation status from surgical pathologic DNA-based tissue assays. Testing characteristics and receiving-operator curve using tissue results as the gold standard were assessed. Matched blood and tissue assays for BRAF(V600E) were performed on 70 patients with PTC (stages I to I
Chen, Yufei; Lubitz, Carrie C.; Shikora, Scott A.; Hodin, Richard A.; Gaz, Randall D.; Moore, Francis D; McKenzie, Travis J.
Primary hyperparathyroidism after Roux-en-Y gastric bypass Journal Article
In: Obes Surg, vol. 25, no. 4, pp. 700–704, 2015, ().
@article{Chen2015,
title = {Primary hyperparathyroidism after Roux-en-Y gastric bypass},
author = {Yufei Chen and Carrie C. Lubitz and Scott A. Shikora and Richard A. Hodin and Randall D. Gaz and Francis D Moore and Travis J. McKenzie},
doi = {10.1007/s11695-014-1444-2},
year = {2015},
date = {2015-04-01},
journal = {Obes Surg},
volume = {25},
number = {4},
pages = {700--704},
institution = {9},
abstract = {Primary hyperparathyroidism (PHPT) in the setting of previous roux-en-Y gastric bypass (RYGBP) is not well described. The diagnosis can be difficult, as secondary hyperparathyroidism (SHPT) commonly occurs in patients after RYGBP due to calcium malabsorption and vitamin D deficiency.All patients from 2000 to 2012 who underwent cervical exploration for diagnosis of primary hyperparathyroidism with history of preceding RYGBP were identified and analyzed retrospectively.Ten patients were identified. The average age was 58.4 and all patients were female. Time interval between RYGBP and cervical exploration was 67 months with median follow-up of 19 months. Average preoperative calcium was 10.8 mg/dL, PTH 155 pg/mL, and 25-vitamin-D 32 ng/mL. Eighty percent of patients presented with symptoms and 90% underwent preoperative imaging. Seventy percent underwent initial focused parathyroidectomy with 20% being converted to four-gland exploration. Seventy percent of patients had a single adenoma with two patients having multi-gland disease. Intraoperative PTH was used in seven patients with successful drop to 50% of baseline in all. Ninety percent of patients had greater then 6-month follow-up without evidence of persistent or recurrent PHPT. Average 6-month calcium was 9.3 mg/dL, PTH 73 pg/mL, and 25-vitamin-D 44 ng/ML. Four patients had evidence of persistently elevated PTH despite normalization of calcium.PHPT after RYGBP is rare but surgery with either a focused approach following successful localization or four-gland exploration is indicated when the biochemical diagnosis holds true. The presence of SHPT can make diagnosis and follow-up difficult and may predispose them to severe post-operative hypocalcemia.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Primary hyperparathyroidism (PHPT) in the setting of previous roux-en-Y gastric bypass (RYGBP) is not well described. The diagnosis can be difficult, as secondary hyperparathyroidism (SHPT) commonly occurs in patients after RYGBP due to calcium malabsorption and vitamin D deficiency.All patients from 2000 to 2012 who underwent cervical exploration for diagnosis of primary hyperparathyroidism with history of preceding RYGBP were identified and analyzed retrospectively.Ten patients were identified. The average age was 58.4 and all patients were female. Time interval between RYGBP and cervical exploration was 67 months with median follow-up of 19 months. Average preoperative calcium was 10.8 mg/dL, PTH 155 pg/mL, and 25-vitamin-D 32 ng/mL. Eighty percent of patients presented with symptoms and 90% underwent preoperative imaging. Seventy percent underwent initial focused parathyroidectomy with 20% being converted to four-gland exploration. Seventy percent of patients had a single adenoma with two patients having multi-gland disease. Intraoperative PTH was used in seven patients with successful drop to 50% of baseline in all. Ninety percent of patients had greater then 6-month follow-up without evidence of persistent or recurrent PHPT. Average 6-month calcium was 9.3 mg/dL, PTH 73 pg/mL, and 25-vitamin-D 44 ng/ML. Four patients had evidence of persistently elevated PTH despite normalization of calcium.PHPT after RYGBP is rare but surgery with either a focused approach following successful localization or four-gland exploration is indicated when the biochemical diagnosis holds true. The presence of SHPT can make diagnosis and follow-up difficult and may predispose them to severe post-operative hypocalcemia.
Chen, Yufei; Lubitz, Carrie C.; Shikora, Scott A.; Hodin, Richard A.; Gaz, Randall D.; Moore, Francis D; McKenzie, Travis J.
Primary Hyperparathyroidism After Roux-en-Y Gastric Bypass Journal Article
In: Obes Surg, 2014, ().
@article{Chen2014,
title = {Primary Hyperparathyroidism After Roux-en-Y Gastric Bypass},
author = {Yufei Chen and Carrie C. Lubitz and Scott A. Shikora and Richard A. Hodin and Randall D. Gaz and Francis D Moore and Travis J. McKenzie},
url = {http://www.ncbi.nlm.nih.gov/pubmed/25248510},
doi = {10.1007/s11695-014-1444-2},
year = {2014},
date = {2014-09-01},
urldate = {2014-09-01},
journal = {Obes Surg},
institution = {Massachusetts General Hospital, GRB-425, 55 Fruit Street, Boston, MA, 02114, USA, .},
abstract = {Primary hyperparathyroidism (PHPT) in the setting of previous roux-en-Y
gastric bypass (RYGBP) is not well described. The diagnosis can be
difficult, as secondary hyperparathyroidism (SHPT) commonly occurs
in patients after RYGBP due to calcium malabsorption and vitamin
D deficiency.All patients from 2000 to 2012 who underwent cervical
exploration for diagnosis of primary hyperparathyroidism with history
of preceding RYGBP were identified and analyzed retrospectively.Ten
patients were identified. The average age was 58.4 and all patients
were female. Time interval between RYGBP and cervical exploration
was 67 months with median follow-up of 19 months. Average preoperative
calcium was 10.8 mg/dL, PTH 155 pg/mL, and 25-vitamin-D 32 ng/mL.
Eighty percent of patients presented with symptoms and 90 % underwent
preoperative imaging. Seventy percent underwent initial focused parathyroidectomy
with 20 % being converted to four-gland exploration. Seventy percent
of patients had a single adenoma with two patients having multi-gland
disease. Intraoperative PTH was used in seven patients with successful
drop to 50 % of baseline in all. Ninety percent of patients had
greater then 6-month follow-up without evidence of persistent or
recurrent PHPT. Average 6-month calcium was 9.3 mg/dL, PTH 73 pg/mL,
and 25-vitamin-D 44 ng/ML. Four patients had evidence of persistently
elevated PTH despite normalization of calcium.PHPT after RYGBP is
rare but surgery with either a focused approach following successful
localization or four-gland exploration is indicated when the biochemical
diagnosis holds true. The presence of SHPT can make diagnosis and
follow-up difficult and may predispose them to severe post-operative
hypocalcemia.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Primary hyperparathyroidism (PHPT) in the setting of previous roux-en-Y
gastric bypass (RYGBP) is not well described. The diagnosis can be
difficult, as secondary hyperparathyroidism (SHPT) commonly occurs
in patients after RYGBP due to calcium malabsorption and vitamin
D deficiency.All patients from 2000 to 2012 who underwent cervical
exploration for diagnosis of primary hyperparathyroidism with history
of preceding RYGBP were identified and analyzed retrospectively.Ten
patients were identified. The average age was 58.4 and all patients
were female. Time interval between RYGBP and cervical exploration
was 67 months with median follow-up of 19 months. Average preoperative
calcium was 10.8 mg/dL, PTH 155 pg/mL, and 25-vitamin-D 32 ng/mL.
Eighty percent of patients presented with symptoms and 90 % underwent
preoperative imaging. Seventy percent underwent initial focused parathyroidectomy
with 20 % being converted to four-gland exploration. Seventy percent
of patients had a single adenoma with two patients having multi-gland
disease. Intraoperative PTH was used in seven patients with successful
drop to 50 % of baseline in all. Ninety percent of patients had
greater then 6-month follow-up without evidence of persistent or
recurrent PHPT. Average 6-month calcium was 9.3 mg/dL, PTH 73 pg/mL,
and 25-vitamin-D 44 ng/ML. Four patients had evidence of persistently
elevated PTH despite normalization of calcium.PHPT after RYGBP is
rare but surgery with either a focused approach following successful
localization or four-gland exploration is indicated when the biochemical
diagnosis holds true. The presence of SHPT can make diagnosis and
follow-up difficult and may predispose them to severe post-operative
hypocalcemia.
gastric bypass (RYGBP) is not well described. The diagnosis can be
difficult, as secondary hyperparathyroidism (SHPT) commonly occurs
in patients after RYGBP due to calcium malabsorption and vitamin
D deficiency.All patients from 2000 to 2012 who underwent cervical
exploration for diagnosis of primary hyperparathyroidism with history
of preceding RYGBP were identified and analyzed retrospectively.Ten
patients were identified. The average age was 58.4 and all patients
were female. Time interval between RYGBP and cervical exploration
was 67 months with median follow-up of 19 months. Average preoperative
calcium was 10.8 mg/dL, PTH 155 pg/mL, and 25-vitamin-D 32 ng/mL.
Eighty percent of patients presented with symptoms and 90 % underwent
preoperative imaging. Seventy percent underwent initial focused parathyroidectomy
with 20 % being converted to four-gland exploration. Seventy percent
of patients had a single adenoma with two patients having multi-gland
disease. Intraoperative PTH was used in seven patients with successful
drop to 50 % of baseline in all. Ninety percent of patients had
greater then 6-month follow-up without evidence of persistent or
recurrent PHPT. Average 6-month calcium was 9.3 mg/dL, PTH 73 pg/mL,
and 25-vitamin-D 44 ng/ML. Four patients had evidence of persistently
elevated PTH despite normalization of calcium.PHPT after RYGBP is
rare but surgery with either a focused approach following successful
localization or four-gland exploration is indicated when the biochemical
diagnosis holds true. The presence of SHPT can make diagnosis and
follow-up difficult and may predispose them to severe post-operative
hypocalcemia.
Lubitz, Carrie C.; Economopoulos, Konstantinos; Pawlak, Amanda C.; Lynch, Kerry; Dias-Santagata, Dora; Faquin, William C.; Sadow, Peter M.
Hobnail Variant of Papillary Thyroid Carcinoma: An Institutional Case Series and Molecular Profile Journal Article
In: Thyroid, vol. 24, no. 6, pp. 958-65, 2014, ().
@article{Lubitz2014,
title = {Hobnail Variant of Papillary Thyroid Carcinoma: An Institutional Case Series and Molecular Profile},
author = {Carrie C. Lubitz and Konstantinos Economopoulos and Amanda C. Pawlak and Kerry Lynch and Dora Dias-Santagata and William C. Faquin and Peter M. Sadow},
url = {http://www.ncbi.nlm.nih.gov/pubmed/24417340},
doi = {10.1089/thy.2013.0573},
year = {2014},
date = {2014-06-01},
urldate = {2014-06-01},
journal = {Thyroid},
volume = {24},
number = {6},
pages = {958-65},
institution = {Massachusetts General Hospital, Harvard Medical School, Department of Surgery, Boston, Massachusetts, United States ; .},
abstract = {Background: Papillary thyroid carcinoma (PTC) is increasing in incidence
while mortality is unchanged. Identifying patients with higher risk
of recurrence and death is essential. Case series identify the hobnail
variant of PTC (HVPTC), which is characterized by micropapillary
architecture, apocrine features and loss of cellular polarity. Herein,
we describe the clinical course, pathological features, and mutational
profile of patients at our institution with HVPTC. Methods: A query
into the surgical pathological database (2009-2012) was performed
and clinicopathological data were collected on all patients carrying
the diagnosis of HVPTC. BRAFV600E testing was performed on paraffin-embedded
blocks using SNaPshot mutational analysis. Results: Twelve patients
with the HVPTC were identified with an average age of 54.1 ± 18.8
years. Seven patients (63.6%) were AJCC Stage III or IV at presentation.
Tumors were large (3.7 ± 2.0 cm), some were multifocal (33.3%),
and frequently with extra-thyroidal extension (58.3%), lymphovascular
invasion (41.7%), and lymph node metastasis (75%). Fourty-percent
of the patients had concomitant tall cell features (TCF) and two
had small foci of undifferentiated (anaplastic) thyroid carcinoma
(ATC). Eight out of ten (80%) tumors undergoing mutational analysis
had the BRAFV600E mutation, and the remainder two cases (20%) harbored
a RET/PTC1 gene rearrangement. No other known thyroid cancer mutations
were identified on SNaPshot analysis. At median follow-up of 26 months,
four patients had recurrent or persistent disease, one of whom died
from the disease one year after surgery.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Papillary thyroid carcinoma (PTC) is increasing in incidence
while mortality is unchanged. Identifying patients with higher risk
of recurrence and death is essential. Case series identify the hobnail
variant of PTC (HVPTC), which is characterized by micropapillary
architecture, apocrine features and loss of cellular polarity. Herein,
we describe the clinical course, pathological features, and mutational
profile of patients at our institution with HVPTC. Methods: A query
into the surgical pathological database (2009-2012) was performed
and clinicopathological data were collected on all patients carrying
the diagnosis of HVPTC. BRAFV600E testing was performed on paraffin-embedded
blocks using SNaPshot mutational analysis. Results: Twelve patients
with the HVPTC were identified with an average age of 54.1 ± 18.8
years. Seven patients (63.6%) were AJCC Stage III or IV at presentation.
Tumors were large (3.7 ± 2.0 cm), some were multifocal (33.3%),
and frequently with extra-thyroidal extension (58.3%), lymphovascular
invasion (41.7%), and lymph node metastasis (75%). Fourty-percent
of the patients had concomitant tall cell features (TCF) and two
had small foci of undifferentiated (anaplastic) thyroid carcinoma
(ATC). Eight out of ten (80%) tumors undergoing mutational analysis
had the BRAFV600E mutation, and the remainder two cases (20%) harbored
a RET/PTC1 gene rearrangement. No other known thyroid cancer mutations
were identified on SNaPshot analysis. At median follow-up of 26 months,
four patients had recurrent or persistent disease, one of whom died
from the disease one year after surgery.
while mortality is unchanged. Identifying patients with higher risk
of recurrence and death is essential. Case series identify the hobnail
variant of PTC (HVPTC), which is characterized by micropapillary
architecture, apocrine features and loss of cellular polarity. Herein,
we describe the clinical course, pathological features, and mutational
profile of patients at our institution with HVPTC. Methods: A query
into the surgical pathological database (2009-2012) was performed
and clinicopathological data were collected on all patients carrying
the diagnosis of HVPTC. BRAFV600E testing was performed on paraffin-embedded
blocks using SNaPshot mutational analysis. Results: Twelve patients
with the HVPTC were identified with an average age of 54.1 ± 18.8
years. Seven patients (63.6%) were AJCC Stage III or IV at presentation.
Tumors were large (3.7 ± 2.0 cm), some were multifocal (33.3%),
and frequently with extra-thyroidal extension (58.3%), lymphovascular
invasion (41.7%), and lymph node metastasis (75%). Fourty-percent
of the patients had concomitant tall cell features (TCF) and two
had small foci of undifferentiated (anaplastic) thyroid carcinoma
(ATC). Eight out of ten (80%) tumors undergoing mutational analysis
had the BRAFV600E mutation, and the remainder two cases (20%) harbored
a RET/PTC1 gene rearrangement. No other known thyroid cancer mutations
were identified on SNaPshot analysis. At median follow-up of 26 months,
four patients had recurrent or persistent disease, one of whom died
from the disease one year after surgery.
Lubitz, Carrie C.; Kong, Chung Yin; McMahon, Pamela M.; Daniels, Gilbert H.; Chen, Yufei; Economopoulos, Konstantinos; Gazelle, G. Scott; Weinstein, Milton C.
Annual financial impact of well-differentiated thyroid cancer care in the United States Journal Article
In: Cancer, vol. 120, no. 9, pp. 1345-52, 2014, ().
@article{LubitzCan2014,
title = {Annual financial impact of well-differentiated thyroid cancer care in the United States},
author = {Carrie C. Lubitz and Chung Yin Kong and Pamela M. McMahon and Gilbert H. Daniels and Yufei Chen and Konstantinos Economopoulos and G. Scott Gazelle and Milton C. Weinstein},
url = {http://www.ncbi.nlm.nih.gov/pubmed/24481684},
doi = {10.1002/cncr.28562},
year = {2014},
date = {2014-05-01},
urldate = {2014-05-01},
journal = {Cancer},
volume = {120},
number = {9},
pages = {1345-52},
institution = {Massachusetts; Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts.},
abstract = {Well-differentiated thyroid cancer (WDTC) is a prevalent disease,
which is increasing in incidence faster than any other cancer. Substantial
direct medical care costs are related to the diagnosis and treatment
of newly diagnosed patients as well as the ongoing surveillance of
patients who have a long life expectancy. Prior analyses of the aggregate
health care costs attributable to WDTC in the United States have
not been reported.A stacked cohort cost analysis was performed on
the US population from 1985 to 2013 to estimate the number of WDTC
survivors in 2013. Incidence rates, and cancer-specific and overall
survival were based on Surveillance, Epidemiology, and End Results
(SEER) data. Current and projected direct medical care costs attributable
to the care of patients with WDTC were then estimated. Health care-related
costs and event probabilities were based on Medicare reimbursement
schedules and the literature.Estimated overall societal cost of WDTC
care in 2013 for all US patients diagnosed after 1985 is $1.6 billion.
Diagnosis, surgery, and adjuvant therapy for newly diagnosed patients
(41%) constitutes the greatest proportion of costs, followed by
surveillance of survivors (37%), and nonoperative death costs attributable
to thyroid cancer care (22%). Projected 2030 costs (in 2013 US dollars)
based on current incidence trends exceed $3.5 billion.Health care
costs of WDTC are substantial. Unlike other cancers, the majority
of the cost is incurred in the initial and continuing phases of care.
With the projected increasing incidence, population, and survival
trends, costs will continue to escalate. Cancer 2014. © 2014 American
Cancer Society.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Well-differentiated thyroid cancer (WDTC) is a prevalent disease,
which is increasing in incidence faster than any other cancer. Substantial
direct medical care costs are related to the diagnosis and treatment
of newly diagnosed patients as well as the ongoing surveillance of
patients who have a long life expectancy. Prior analyses of the aggregate
health care costs attributable to WDTC in the United States have
not been reported.A stacked cohort cost analysis was performed on
the US population from 1985 to 2013 to estimate the number of WDTC
survivors in 2013. Incidence rates, and cancer-specific and overall
survival were based on Surveillance, Epidemiology, and End Results
(SEER) data. Current and projected direct medical care costs attributable
to the care of patients with WDTC were then estimated. Health care-related
costs and event probabilities were based on Medicare reimbursement
schedules and the literature.Estimated overall societal cost of WDTC
care in 2013 for all US patients diagnosed after 1985 is $1.6 billion.
Diagnosis, surgery, and adjuvant therapy for newly diagnosed patients
(41%) constitutes the greatest proportion of costs, followed by
surveillance of survivors (37%), and nonoperative death costs attributable
to thyroid cancer care (22%). Projected 2030 costs (in 2013 US dollars)
based on current incidence trends exceed $3.5 billion.Health care
costs of WDTC are substantial. Unlike other cancers, the majority
of the cost is incurred in the initial and continuing phases of care.
With the projected increasing incidence, population, and survival
trends, costs will continue to escalate. Cancer 2014. © 2014 American
Cancer Society.
which is increasing in incidence faster than any other cancer. Substantial
direct medical care costs are related to the diagnosis and treatment
of newly diagnosed patients as well as the ongoing surveillance of
patients who have a long life expectancy. Prior analyses of the aggregate
health care costs attributable to WDTC in the United States have
not been reported.A stacked cohort cost analysis was performed on
the US population from 1985 to 2013 to estimate the number of WDTC
survivors in 2013. Incidence rates, and cancer-specific and overall
survival were based on Surveillance, Epidemiology, and End Results
(SEER) data. Current and projected direct medical care costs attributable
to the care of patients with WDTC were then estimated. Health care-related
costs and event probabilities were based on Medicare reimbursement
schedules and the literature.Estimated overall societal cost of WDTC
care in 2013 for all US patients diagnosed after 1985 is $1.6 billion.
Diagnosis, surgery, and adjuvant therapy for newly diagnosed patients
(41%) constitutes the greatest proportion of costs, followed by
surveillance of survivors (37%), and nonoperative death costs attributable
to thyroid cancer care (22%). Projected 2030 costs (in 2013 US dollars)
based on current incidence trends exceed $3.5 billion.Health care
costs of WDTC are substantial. Unlike other cancers, the majority
of the cost is incurred in the initial and continuing phases of care.
With the projected increasing incidence, population, and survival
trends, costs will continue to escalate. Cancer 2014. © 2014 American
Cancer Society.
Cho, N. L.; Moalem, J.; Chen, L.; Lubitz, Carrie C.; Moore, F. D.; Ruan, D. T.
Surgeons and Patients Disagree on the Potential Consequences from Hypoparathyroidism Journal Article
In: Endocr Pract, vol. 20, no. 5, pp. 427-46, 2014, ().
@article{pmid24325999,
title = {Surgeons and Patients Disagree on the Potential Consequences from Hypoparathyroidism},
author = {N. L. Cho and J. Moalem and L. Chen and Carrie C. Lubitz and F. D. Moore and D. T. Ruan},
url = {http://www.ncbi.nlm.nih.gov/pubmed/24325999},
year = {2014},
date = {2014-05-01},
urldate = {2014-05-01},
journal = {Endocr Pract},
volume = {20},
number = {5},
pages = {427-46},
abstract = {Objective: To test the hypothesis that surgeons and their patients
underestimate the potential negative impact that permanent hypoparathyroidism
has on quality of life (QOL).Methods: We used a modified SF-36 assessment
tool to compare the perceptions of patients with permanent hypoparathyroidism
to the perceptions of control subjects who were given a standardized
preoperative statement about the complications of hypoparathyroidism.
We also elicited the perceptions of endocrine surgeons regarding
the QOL impacts of hypoparathyroidism using a subset of questions
from the modified SF-36.Results: Three hundred forty postsurgical
patients with permanent hypoparathyroidism, 200 controls, and 102
surgeons participated in the study. Both surgeons and controls underestimated
the negative impact of hypoparathyroidism on QOL when compared to
patients living with permanent hypoparathyroidism. Forty-seven percent
of hypoparathyroid patients believed that their health was "much
worse" than before surgery compared with 16% of surgeons (p},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Objective: To test the hypothesis that surgeons and their patients
underestimate the potential negative impact that permanent hypoparathyroidism
has on quality of life (QOL).Methods: We used a modified SF-36 assessment
tool to compare the perceptions of patients with permanent hypoparathyroidism
to the perceptions of control subjects who were given a standardized
preoperative statement about the complications of hypoparathyroidism.
We also elicited the perceptions of endocrine surgeons regarding
the QOL impacts of hypoparathyroidism using a subset of questions
from the modified SF-36.Results: Three hundred forty postsurgical
patients with permanent hypoparathyroidism, 200 controls, and 102
surgeons participated in the study. Both surgeons and controls underestimated
the negative impact of hypoparathyroidism on QOL when compared to
patients living with permanent hypoparathyroidism. Forty-seven percent
of hypoparathyroid patients believed that their health was "much
worse" than before surgery compared with 16% of surgeons (p
underestimate the potential negative impact that permanent hypoparathyroidism
has on quality of life (QOL).Methods: We used a modified SF-36 assessment
tool to compare the perceptions of patients with permanent hypoparathyroidism
to the perceptions of control subjects who were given a standardized
preoperative statement about the complications of hypoparathyroidism.
We also elicited the perceptions of endocrine surgeons regarding
the QOL impacts of hypoparathyroidism using a subset of questions
from the modified SF-36.Results: Three hundred forty postsurgical
patients with permanent hypoparathyroidism, 200 controls, and 102
surgeons participated in the study. Both surgeons and controls underestimated
the negative impact of hypoparathyroidism on QOL when compared to
patients living with permanent hypoparathyroidism. Forty-seven percent
of hypoparathyroid patients believed that their health was "much
worse" than before surgery compared with 16% of surgeons (p
McKenzie, T. J.; Chen, Y.; Hodin, R. A.; Shikora, S. A.; Hutter, M. M.; Gaz, R. D.; Moore, F. D.; Lubitz, Carrie C.
Recalcitrant hypocalcemia after thyroidectomy in patients with previous Roux-en-Y gastric bypass Journal Article
In: Surgery, vol. 154, no. 6, pp. 1300–1306, 2013, ().
@article{pmid23978591,
title = {Recalcitrant hypocalcemia after thyroidectomy in patients with
previous Roux-en-Y gastric bypass},
author = {T. J. McKenzie and Y. Chen and R. A. Hodin and S. A. Shikora and M. M. Hutter and R. D. Gaz and F. D. Moore and Carrie C. Lubitz},
url = {http://www.ncbi.nlm.nih.gov/pubmed/23978591},
year = {2013},
date = {2013-12-01},
journal = {Surgery},
volume = {154},
number = {6},
pages = {1300--1306},
abstract = {Hypocalcemia is a potential complication after thyroidectomy. Patients
with previous roux-en-Y gastric bypass (RYGBP) may be at increased
risk for recalcitrant symptomatic hypocalcemia after thyroidectomy.
This complication is poorly described and there is no current consensus
on optimal management in this unique population. All patients from
2000 to 2012 who underwent thyroidectomy with history of preceding
RYGBP were identified retrospectively. Each of the 19 patients meeting
inclusion criteria were matched 2:1 for age, gender, and body mass
index (BMI) to a cohort who underwent thyroidectomy without previous
RYGBP. The study cohort and matched controls were compared for incidence
of symptomatic postoperative hypocalcemia, requirement of intravenous
(IV) calcium supplementation, and duration of hospital stay. Age,
proportion of female patients, and BMI were equivalent between cases (n = 19) and controls (n = 38). Comparison of primary outcomes demonstrated
that the study group had a significantly higher incidence of symptomatic
hypocalcemia (42% vs 0%; P \< .01), administration of IV calcium (21%
vs 0%; P \< .01), and duration of hospital stay (2.2 vs 1.2 day},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Hypocalcemia is a potential complication after thyroidectomy. Patients
with previous roux-en-Y gastric bypass (RYGBP) may be at increased
risk for recalcitrant symptomatic hypocalcemia after thyroidectomy.
This complication is poorly described and there is no current consensus
on optimal management in this unique population. All patients from
2000 to 2012 who underwent thyroidectomy with history of preceding
RYGBP were identified retrospectively. Each of the 19 patients meeting
inclusion criteria were matched 2:1 for age, gender, and body mass
index (BMI) to a cohort who underwent thyroidectomy without previous
RYGBP. The study cohort and matched controls were compared for incidence
of symptomatic postoperative hypocalcemia, requirement of intravenous
(IV) calcium supplementation, and duration of hospital stay. Age,
proportion of female patients, and BMI were equivalent between cases (n = 19) and controls (n = 38). Comparison of primary outcomes demonstrated
that the study group had a significantly higher incidence of symptomatic
hypocalcemia (42% vs 0%; P < .01), administration of IV calcium (21%
vs 0%; P < .01), and duration of hospital stay (2.2 vs 1.2 day
with previous roux-en-Y gastric bypass (RYGBP) may be at increased
risk for recalcitrant symptomatic hypocalcemia after thyroidectomy.
This complication is poorly described and there is no current consensus
on optimal management in this unique population. All patients from
2000 to 2012 who underwent thyroidectomy with history of preceding
RYGBP were identified retrospectively. Each of the 19 patients meeting
inclusion criteria were matched 2:1 for age, gender, and body mass
index (BMI) to a cohort who underwent thyroidectomy without previous
RYGBP. The study cohort and matched controls were compared for incidence
of symptomatic postoperative hypocalcemia, requirement of intravenous
(IV) calcium supplementation, and duration of hospital stay. Age,
proportion of female patients, and BMI were equivalent between cases (n = 19) and controls (n = 38). Comparison of primary outcomes demonstrated
that the study group had a significantly higher incidence of symptomatic
hypocalcemia (42% vs 0%; P < .01), administration of IV calcium (21%
vs 0%; P < .01), and duration of hospital stay (2.2 vs 1.2 day
Campbell, M. J.; McCoy, K. L.; Shen, W. T.; Carty, S. E.; Lubitz, Carrie C.; Moalem, J.; Nehs, M.; Holm, T.; Greenblatt, D. Y.; Press, D.; Feng, X.; Siperstein, A. E.; Mitmaker, E.; Benay, C.; Tabah, R.; Oltmann, S. C.; Chen, H.; Sippel, R. S.; Brekke, A.; Vriens, M. R.; Lodewijk, L.; Stephen, A. E.; Nagar, S.; Angelos, P.; Ghanem, M.; Prescott, J. D.; Zeiger, M. A.; Han, P. Aragon; Sturgeon, C.; Elaraj, D. M.; Nixon, I. J.; Patel, S. G.; Bayles, S. W.; Heneghan, R.; Ochieng, P.; Guerrero, M. A.; Ruan, D. T.
A multi-institutional international study of risk factors for hematoma after thyroidectomy Journal Article
In: Surgery, vol. 154, no. 6, pp. 1283–1291, 2013, ().
@article{pmid24206619,
title = {A multi-institutional international study of risk factors for hematoma after thyroidectomy},
author = {M. J. Campbell and K. L. McCoy and W. T. Shen and S. E. Carty and Carrie C. Lubitz and J. Moalem and M. Nehs and T. Holm and D. Y. Greenblatt and D. Press and X. Feng and A. E. Siperstein and E. Mitmaker and C. Benay and R. Tabah and S. C. Oltmann and H. Chen and R. S. Sippel and A. Brekke and M. R. Vriens and L. Lodewijk and A. E. Stephen and S. Nagar and P. Angelos and M. Ghanem and J. D. Prescott and M. A. Zeiger and P. Aragon Han and C. Sturgeon and D. M. Elaraj and I. J. Nixon and S. G. Patel and S. W. Bayles and R. Heneghan and P. Ochieng and M. A. Guerrero and D. T. Ruan},
url = {http://www.ncbi.nlm.nih.gov/pubmed/24206619},
year = {2013},
date = {2013-12-01},
urldate = {2013-12-01},
journal = {Surgery},
volume = {154},
number = {6},
pages = {1283--1291},
abstract = {Cervical hematoma can be a potentially fatal complication after thyroidectomy,
but its risk factors and timing remain poorly understood. We conducted
a retrospective, case-control study identifying 207 patients from
15 institutions in 3 countries who developed a hematoma requiring
return to the operating room (OR) after thyroidectomy. Forty-seven
percent of hematoma patients returned to the OR within 6 hours and
79% within 24 hours of their thyroidectomy. On univariate analysis,
hematoma patients were older, more likely to be male, smokers, on
active antiplatelet/anticoagulation medications, have Graves' disease,
a bilateral thyroidectomy, a drain placed, a concurrent parathyroidectomy,
and benign pathology. Hematoma patients also had more blood loss,
larger thyroids, lower temperatures, and higher blood pressures postoperatively.
On multivariate analysis, independent associations with hematoma
were use of a drain (odds ratio, 2.79), Graves' disease (odds ratio,
2.43), benign pathology (odds ratio, 2.22), antiplatelet/anticoagulation
medications (odds ratio, 2.12), use of a hemostatic agent (odds ratio,
1.97), and increased thyroid mass (odds ratio, 1.01). A significant
number of patients with a postoperative hematoma present \>6 hours
after thyroidectomy. Hematoma is associated with patients who have
a drain or hemostatic agent, have Graves' disease, are actively using
antiplatelet/anticoagulation medications or have large thyroids.
Surgeons should consider these factors when individualizing patient
disposition after thyroidectomy.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Cervical hematoma can be a potentially fatal complication after thyroidectomy,
but its risk factors and timing remain poorly understood. We conducted
a retrospective, case-control study identifying 207 patients from
15 institutions in 3 countries who developed a hematoma requiring
return to the operating room (OR) after thyroidectomy. Forty-seven
percent of hematoma patients returned to the OR within 6 hours and
79% within 24 hours of their thyroidectomy. On univariate analysis,
hematoma patients were older, more likely to be male, smokers, on
active antiplatelet/anticoagulation medications, have Graves' disease,
a bilateral thyroidectomy, a drain placed, a concurrent parathyroidectomy,
and benign pathology. Hematoma patients also had more blood loss,
larger thyroids, lower temperatures, and higher blood pressures postoperatively.
On multivariate analysis, independent associations with hematoma
were use of a drain (odds ratio, 2.79), Graves' disease (odds ratio,
2.43), benign pathology (odds ratio, 2.22), antiplatelet/anticoagulation
medications (odds ratio, 2.12), use of a hemostatic agent (odds ratio,
1.97), and increased thyroid mass (odds ratio, 1.01). A significant
number of patients with a postoperative hematoma present >6 hours
after thyroidectomy. Hematoma is associated with patients who have
a drain or hemostatic agent, have Graves' disease, are actively using
antiplatelet/anticoagulation medications or have large thyroids.
Surgeons should consider these factors when individualizing patient
disposition after thyroidectomy.
but its risk factors and timing remain poorly understood. We conducted
a retrospective, case-control study identifying 207 patients from
15 institutions in 3 countries who developed a hematoma requiring
return to the operating room (OR) after thyroidectomy. Forty-seven
percent of hematoma patients returned to the OR within 6 hours and
79% within 24 hours of their thyroidectomy. On univariate analysis,
hematoma patients were older, more likely to be male, smokers, on
active antiplatelet/anticoagulation medications, have Graves' disease,
a bilateral thyroidectomy, a drain placed, a concurrent parathyroidectomy,
and benign pathology. Hematoma patients also had more blood loss,
larger thyroids, lower temperatures, and higher blood pressures postoperatively.
On multivariate analysis, independent associations with hematoma
were use of a drain (odds ratio, 2.79), Graves' disease (odds ratio,
2.43), benign pathology (odds ratio, 2.22), antiplatelet/anticoagulation
medications (odds ratio, 2.12), use of a hemostatic agent (odds ratio,
1.97), and increased thyroid mass (odds ratio, 1.01). A significant
number of patients with a postoperative hematoma present >6 hours
after thyroidectomy. Hematoma is associated with patients who have
a drain or hemostatic agent, have Graves' disease, are actively using
antiplatelet/anticoagulation medications or have large thyroids.
Surgeons should consider these factors when individualizing patient
disposition after thyroidectomy.
Dhyani, M.; Faquin, W.; Lubitz, Carrie C.; Daniels, G. H.; Samir, A. E.
In: AJR Am J Roentgenol, vol. 201, no. 6, pp. 1335–1339, 2013, ().
@article{pmid24261375,
title = {How to interpret thyroid fine-needle aspiration biopsy reports: a guide for the busy radiologist in the era of the bethesda classification system},
author = {M. Dhyani and W. Faquin and Carrie C. Lubitz and G. H. Daniels and A. E. Samir},
url = {http://www.ncbi.nlm.nih.gov/pubmed/24261375},
year = {2013},
date = {2013-12-01},
urldate = {2013-12-01},
journal = {AJR Am J Roentgenol},
volume = {201},
number = {6},
pages = {1335--1339},
abstract = {OBJECTIVE. Fine-needle aspiration biopsy (FNAB) is the current primary
test to risk stratify thyroid nodules. However, in up to one third
of biopsies, cytology is indeterminate. The Bethesda System for Reporting
Thyroid Cytopathology categorizes thyroid cytology findings into
six groups, with each group assigned a putative malignancy risk.
This article reviews the Bethesda System, emphasizing the key facts
necessary to understand thyroid biopsy results and effectively manage
patients after FNAB. CONCLUSION. It is important to diagnose and
stratify the risk of malignancy in thyroid nodules. A working knowledge
of the Bethesda System permits accurate, evidence-based risk stratification
of patients with thyroid nodules and thereby facilitates their management.
Because it is a uniform diagnostic approach, the Bethesda System
allows comparisons of different management strategies across different
institutions.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE. Fine-needle aspiration biopsy (FNAB) is the current primary
test to risk stratify thyroid nodules. However, in up to one third
of biopsies, cytology is indeterminate. The Bethesda System for Reporting
Thyroid Cytopathology categorizes thyroid cytology findings into
six groups, with each group assigned a putative malignancy risk.
This article reviews the Bethesda System, emphasizing the key facts
necessary to understand thyroid biopsy results and effectively manage
patients after FNAB. CONCLUSION. It is important to diagnose and
stratify the risk of malignancy in thyroid nodules. A working knowledge
of the Bethesda System permits accurate, evidence-based risk stratification
of patients with thyroid nodules and thereby facilitates their management.
Because it is a uniform diagnostic approach, the Bethesda System
allows comparisons of different management strategies across different
institutions.
test to risk stratify thyroid nodules. However, in up to one third
of biopsies, cytology is indeterminate. The Bethesda System for Reporting
Thyroid Cytopathology categorizes thyroid cytology findings into
six groups, with each group assigned a putative malignancy risk.
This article reviews the Bethesda System, emphasizing the key facts
necessary to understand thyroid biopsy results and effectively manage
patients after FNAB. CONCLUSION. It is important to diagnose and
stratify the risk of malignancy in thyroid nodules. A working knowledge
of the Bethesda System permits accurate, evidence-based risk stratification
of patients with thyroid nodules and thereby facilitates their management.
Because it is a uniform diagnostic approach, the Bethesda System
allows comparisons of different management strategies across different
institutions.
Phitayakorn, R.; Morales-Garcia, D.; Wanderer, J.; Lubitz, Carrie C.; Gaz, R. D.; Stephen, A. E.; Ehrenfeld, J. M.; Daniels, G. H.; Hodin, R. A.; Parangi, S.
Surgery for Graves' disease: a 25-year perspective Journal Article
In: Am. J. Surg., vol. 206, no. 5, pp. 669–673, 2013, ().
@article{pmid24011567,
title = {Surgery for Graves' disease: a 25-year perspective},
author = {R. Phitayakorn and D. Morales-Garcia and J. Wanderer and Carrie C. Lubitz and R. D. Gaz and A. E. Stephen and J. M. Ehrenfeld and G. H. Daniels and R. A. Hodin and S. Parangi},
url = {http://www.ncbi.nlm.nih.gov/pubmed/24011567},
year = {2013},
date = {2013-11-01},
urldate = {2013-11-01},
journal = {Am. J. Surg.},
volume = {206},
number = {5},
pages = {669--673},
abstract = {Optimal treatment of Graves' disease (GD) remains controversial. The
authors retrospectively reviewed the surgical cases of GD at a single
academic tertiary center. Demographic, clinical, and surgical data
were analyzed for all patients with GD undergoing thyroidectomy over 25 years, in 3 periods: 1985 to 1993 (n = 32), 1994 to 2002 (n = 91), and 2003 to 2010 (n = 177). There were 300 patients with GD
(85.7% women; mean age, 39.3 years; median length of follow-up, 24.6
months). Overall, perioperative morbidity occurred in 36 patients
(12.0%), and there was no mortality. Thyroidectomy-specific morbidity
was very low, and the incidental malignancy rate was 10.3%. Surgical
treatment of GD has a very high safety profile, with low perioperative
and thyroidectomy-specific morbidity, even in patients with overt
hyperthyroidism. Incidental malignancy in patients with GD is not
uncommon.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Optimal treatment of Graves' disease (GD) remains controversial. The
authors retrospectively reviewed the surgical cases of GD at a single
academic tertiary center. Demographic, clinical, and surgical data
were analyzed for all patients with GD undergoing thyroidectomy over 25 years, in 3 periods: 1985 to 1993 (n = 32), 1994 to 2002 (n = 91), and 2003 to 2010 (n = 177). There were 300 patients with GD
(85.7% women; mean age, 39.3 years; median length of follow-up, 24.6
months). Overall, perioperative morbidity occurred in 36 patients
(12.0%), and there was no mortality. Thyroidectomy-specific morbidity
was very low, and the incidental malignancy rate was 10.3%. Surgical
treatment of GD has a very high safety profile, with low perioperative
and thyroidectomy-specific morbidity, even in patients with overt
hyperthyroidism. Incidental malignancy in patients with GD is not
uncommon.
authors retrospectively reviewed the surgical cases of GD at a single
academic tertiary center. Demographic, clinical, and surgical data
were analyzed for all patients with GD undergoing thyroidectomy over 25 years, in 3 periods: 1985 to 1993 (n = 32), 1994 to 2002 (n = 91), and 2003 to 2010 (n = 177). There were 300 patients with GD
(85.7% women; mean age, 39.3 years; median length of follow-up, 24.6
months). Overall, perioperative morbidity occurred in 36 patients
(12.0%), and there was no mortality. Thyroidectomy-specific morbidity
was very low, and the incidental malignancy rate was 10.3%. Surgical
treatment of GD has a very high safety profile, with low perioperative
and thyroidectomy-specific morbidity, even in patients with overt
hyperthyroidism. Incidental malignancy in patients with GD is not
uncommon.
Lubitz, Carrie C.; Stephen, Antonia E; Hodin, Richard A; Pandharipande, Pari
Preoperative Localization Strategies for Primary Hyperparathyroidism: An Economic Analysis Journal Article
In: Annals of surgical oncology, vol. 16, no. 368(20), pp. 1898-906, 2013, ISSN: 1534-4681, ().
@article{lubitz_preoperative_2012,
title = {Preoperative Localization Strategies for Primary Hyperparathyroidism: An Economic Analysis},
author = {Carrie C. Lubitz and Antonia E Stephen and Richard A Hodin and Pari Pandharipande},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22825773},
doi = {10.1245/s10434-012-2512-2},
issn = {1534-4681},
year = {2013},
date = {2013-05-01},
urldate = {2013-05-01},
journal = {Annals of surgical oncology},
volume = {16},
number = {368(20)},
pages = {1898-906},
abstract = {BACKGROUND: Strategies for localizing parathyroid pathology preoperatively vary in cost and accuracy. Our purpose was to compute and compare comprehensive costs associated with common localization strategies. METHODS: A decision-analytic model was developed to evaluate comprehensive, short-term costs of parathyroid localization strategies for patients with primary hyperparathyroidism. Eight strategies were compared. Probabilities of accurate localization were extracted from the literature, and costs associated with each strategy were based on 2011 Medicare reimbursement schedules. Differential cost considerations included outpatient versus inpatient surgeries, operative time, and costs of imaging. Sensitivity analyses were performed to determine effects of variability in key model parameters upon model results. RESULTS: Ultrasound (US) followed by 4D-CT was the least expensive strategy ($5,901), followed by US alone ($6,028), and 4D-CT alone ($6,110). Strategies including sestamibi (SM) were more expensive, with associated expenditures of up to $6,329 for contemporaneous US and SM. Four-gland, bilateral neck exploration (BNE) was the most expensive strategy ($6,824). Differences in cost were dependent upon differences in the sensitivity of each strategy for detecting single-gland disease, which determined the proportion of patients able to undergo outpatient minimally invasive parathyroidectomy. In sensitivity analysis, US alone was preferred over US followed by 4D-CT only when both the sensitivity of US alone for detecting an adenoma was ≥94 %, and the sensitivity of 4D-CT following negative US was ≤39 %. 4D-CT alone was the least costly strategy when US sensitivity was ≤31 %. CONCLUSIONS: Among commonly used strategies for preoperative localization of parathyroid pathology, US followed by selective 4D-CT is the least expensive.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Strategies for localizing parathyroid pathology preoperatively vary in cost and accuracy. Our purpose was to compute and compare comprehensive costs associated with common localization strategies. METHODS: A decision-analytic model was developed to evaluate comprehensive, short-term costs of parathyroid localization strategies for patients with primary hyperparathyroidism. Eight strategies were compared. Probabilities of accurate localization were extracted from the literature, and costs associated with each strategy were based on 2011 Medicare reimbursement schedules. Differential cost considerations included outpatient versus inpatient surgeries, operative time, and costs of imaging. Sensitivity analyses were performed to determine effects of variability in key model parameters upon model results. RESULTS: Ultrasound (US) followed by 4D-CT was the least expensive strategy ($5,901), followed by US alone ($6,028), and 4D-CT alone ($6,110). Strategies including sestamibi (SM) were more expensive, with associated expenditures of up to $6,329 for contemporaneous US and SM. Four-gland, bilateral neck exploration (BNE) was the most expensive strategy ($6,824). Differences in cost were dependent upon differences in the sensitivity of each strategy for detecting single-gland disease, which determined the proportion of patients able to undergo outpatient minimally invasive parathyroidectomy. In sensitivity analysis, US alone was preferred over US followed by 4D-CT only when both the sensitivity of US alone for detecting an adenoma was ≥94 %, and the sensitivity of 4D-CT following negative US was ≤39 %. 4D-CT alone was the least costly strategy when US sensitivity was ≤31 %. CONCLUSIONS: Among commonly used strategies for preoperative localization of parathyroid pathology, US followed by selective 4D-CT is the least expensive.
Nagarkatti, S. S.; Faquin, W. C.; Lubitz, Carrie C.; Garcia, D. M.; Barbesino, G.; Ross, D. S.; Hodin, R. A.; Daniels, G. H.; Parangi, S.
Management of thyroid nodules with atypical cytology on fine-needle aspiration biopsy Journal Article
In: Ann. Surg. Oncol., vol. 20, no. 1, pp. 60–65, 2013, ().
@article{pmid22941160,
title = {Management of thyroid nodules with atypical cytology on fine-needle
aspiration biopsy},
author = {S. S. Nagarkatti and W. C. Faquin and Carrie C. Lubitz and D. M. Garcia and G. Barbesino and D. S. Ross and R. A. Hodin and G. H. Daniels and S. Parangi},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22941160},
year = {2013},
date = {2013-01-01},
journal = {Ann. Surg. Oncol.},
volume = {20},
number = {1},
pages = {60--65},
abstract = {Fine-needle aspiration biopsy (FNAB) of the thyroid categorized as
atypia of undetermined significance/follicular lesion of undetermined
significance (AUS/FLUS) is a newly defined category according to
the recent Bethesda guidelines. We sought to assess the characteristics
and treatment of patients with an AUS/FLUS FNAB at our institution.
Additionally, we evaluated the utility of the recommended 3-month
timing of repeat FNAB. A retrospective study of all patients with
an FNAB categorized as AUS/FLUS at an academic tertiary-care center.
Clinical, cytological, and ultrasound variables were compared among
management groups. Differences in patients receiving repeat FNAB
before or after a 3-month interval were compared. A total of 203
patients of the 5,391 FNABs performed at our institution met the
Bethesda criteria for AUS/FLUS; 62% were sent directly to surgery, 25% had a repeat FNAB, and 13% were observed. Younger (p=0.006) and male patients (p=0.04) were more likely to go directly to surgery.
Microcalcifications, irregular margins, and marked hypoechogenicity
on ultrasound did not appear to influence the decision to repeat
the FNAB, observe the patient, or refer the patient for surgery.
Timing of repeat FNAB (\<3 months or ≥3 months) did not alter the diagnostic results of the second FNAB (p=0.73). The overall rate
of malignancy in patients undergoing surgery was 15.7%. Gender
and age, not ultrasound characteristics, appear to influence the
decision for surgery in AUS/FLUS patients. Timing of repeat biopsy
did not alter management, repeat FNAB diagnosis, or rate of malignancy
in our cohort.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Fine-needle aspiration biopsy (FNAB) of the thyroid categorized as
atypia of undetermined significance/follicular lesion of undetermined
significance (AUS/FLUS) is a newly defined category according to
the recent Bethesda guidelines. We sought to assess the characteristics
and treatment of patients with an AUS/FLUS FNAB at our institution.
Additionally, we evaluated the utility of the recommended 3-month
timing of repeat FNAB. A retrospective study of all patients with
an FNAB categorized as AUS/FLUS at an academic tertiary-care center.
Clinical, cytological, and ultrasound variables were compared among
management groups. Differences in patients receiving repeat FNAB
before or after a 3-month interval were compared. A total of 203
patients of the 5,391 FNABs performed at our institution met the
Bethesda criteria for AUS/FLUS; 62% were sent directly to surgery, 25% had a repeat FNAB, and 13% were observed. Younger (p=0.006) and male patients (p=0.04) were more likely to go directly to surgery.
Microcalcifications, irregular margins, and marked hypoechogenicity
on ultrasound did not appear to influence the decision to repeat
the FNAB, observe the patient, or refer the patient for surgery.
Timing of repeat FNAB (<3 months or ≥3 months) did not alter the diagnostic results of the second FNAB (p=0.73). The overall rate
of malignancy in patients undergoing surgery was 15.7%. Gender
and age, not ultrasound characteristics, appear to influence the
decision for surgery in AUS/FLUS patients. Timing of repeat biopsy
did not alter management, repeat FNAB diagnosis, or rate of malignancy
in our cohort.
atypia of undetermined significance/follicular lesion of undetermined
significance (AUS/FLUS) is a newly defined category according to
the recent Bethesda guidelines. We sought to assess the characteristics
and treatment of patients with an AUS/FLUS FNAB at our institution.
Additionally, we evaluated the utility of the recommended 3-month
timing of repeat FNAB. A retrospective study of all patients with
an FNAB categorized as AUS/FLUS at an academic tertiary-care center.
Clinical, cytological, and ultrasound variables were compared among
management groups. Differences in patients receiving repeat FNAB
before or after a 3-month interval were compared. A total of 203
patients of the 5,391 FNABs performed at our institution met the
Bethesda criteria for AUS/FLUS; 62% were sent directly to surgery, 25% had a repeat FNAB, and 13% were observed. Younger (p=0.006) and male patients (p=0.04) were more likely to go directly to surgery.
Microcalcifications, irregular margins, and marked hypoechogenicity
on ultrasound did not appear to influence the decision to repeat
the FNAB, observe the patient, or refer the patient for surgery.
Timing of repeat FNAB (<3 months or ≥3 months) did not alter the diagnostic results of the second FNAB (p=0.73). The overall rate
of malignancy in patients undergoing surgery was 15.7%. Gender
and age, not ultrasound characteristics, appear to influence the
decision for surgery in AUS/FLUS patients. Timing of repeat biopsy
did not alter management, repeat FNAB diagnosis, or rate of malignancy
in our cohort.
Prescott, J. D.; Sadow, P. M.; Hodin, R. A.; Le, L. P.; Gaz, R. D.; Randolph, G. W.; Stephen, A. E.; Parangi, S.; Daniels, G. H.; Lubitz, Carrie C.
BRAF V600E status adds incremental value to current risk classification systems in predicting papillary thyroid carcinoma recurrence Journal Article
In: Surgery, vol. 152, no. 6, pp. 984–990, 2012, ().
@article{pmid23158172,
title = {BRAF V600E status adds incremental value to current
risk classification systems in predicting papillary thyroid carcinoma
recurrence},
author = {J. D. Prescott and P. M. Sadow and R. A. Hodin and L. P. Le and R. D. Gaz and G. W. Randolph and A. E. Stephen and S. Parangi and G. H. Daniels and Carrie C. Lubitz},
url = {http://www.ncbi.nlm.nih.gov/pubmed/23158172},
year = {2012},
date = {2012-12-01},
journal = {Surgery},
volume = {152},
number = {6},
pages = {984--990},
abstract = {Papillary thyroid cancer (PTC) recurrence risk is difficult to predict.
No current risk classification system incorporates BRAF mutational
status. Here, we assess the incremental value of BRAF mutational
status in predicting PTC recurrence relative to existing recurrence
risk algorithms. Serial data were collected for a historical cohort
having undergone total thyroidectomy for papillary thyroid carcinoma
(PTC) during a 5-year period. Corresponding BRAF(V600E) testing was
performed and Cox proportional hazard regression modeling, with and
without BRAF status, was used to evaluate existing recurrence risk
algorithms. The 5-year cumulative PTC recurrence incidence within
our 356 patient cohort was 15%. A total of 205 (81%) of associated
archived specimens were successfully genotyped, and 110 (54%) harbored
the BRAF(V600E) mutation. The 5-year cumulative recurrence incidence
among BRAF(V600E) patients was 20% versus 8% among BRAF wild type.
BRAF(V600E) was significantly associated with time to recurrence
when added to the following algorithms: AMES (hazard ratio [HR] 2.43
[confidence interval 1.08-5.49]), MACIS category (HR 2.46 [1.09-5.54]),
AJCC-TNM (HR 2.51 [1.11-5.66]), and ATA recurrence-risk category
(HR 2.44 [1.08-5.50]), and model discrimination improved (incremental
c-index range 0.046-0.109). The addition of BRAF mutational status
to established risk algorithms improves the discrimination of risk
recurrence in patients undergoing total thyroidectomy for PTC.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Papillary thyroid cancer (PTC) recurrence risk is difficult to predict.
No current risk classification system incorporates BRAF mutational
status. Here, we assess the incremental value of BRAF mutational
status in predicting PTC recurrence relative to existing recurrence
risk algorithms. Serial data were collected for a historical cohort
having undergone total thyroidectomy for papillary thyroid carcinoma
(PTC) during a 5-year period. Corresponding BRAF(V600E) testing was
performed and Cox proportional hazard regression modeling, with and
without BRAF status, was used to evaluate existing recurrence risk
algorithms. The 5-year cumulative PTC recurrence incidence within
our 356 patient cohort was 15%. A total of 205 (81%) of associated
archived specimens were successfully genotyped, and 110 (54%) harbored
the BRAF(V600E) mutation. The 5-year cumulative recurrence incidence
among BRAF(V600E) patients was 20% versus 8% among BRAF wild type.
BRAF(V600E) was significantly associated with time to recurrence
when added to the following algorithms: AMES (hazard ratio [HR] 2.43
[confidence interval 1.08-5.49]), MACIS category (HR 2.46 [1.09-5.54]),
AJCC-TNM (HR 2.51 [1.11-5.66]), and ATA recurrence-risk category
(HR 2.44 [1.08-5.50]), and model discrimination improved (incremental
c-index range 0.046-0.109). The addition of BRAF mutational status
to established risk algorithms improves the discrimination of risk
recurrence in patients undergoing total thyroidectomy for PTC.
No current risk classification system incorporates BRAF mutational
status. Here, we assess the incremental value of BRAF mutational
status in predicting PTC recurrence relative to existing recurrence
risk algorithms. Serial data were collected for a historical cohort
having undergone total thyroidectomy for papillary thyroid carcinoma
(PTC) during a 5-year period. Corresponding BRAF(V600E) testing was
performed and Cox proportional hazard regression modeling, with and
without BRAF status, was used to evaluate existing recurrence risk
algorithms. The 5-year cumulative PTC recurrence incidence within
our 356 patient cohort was 15%. A total of 205 (81%) of associated
archived specimens were successfully genotyped, and 110 (54%) harbored
the BRAF(V600E) mutation. The 5-year cumulative recurrence incidence
among BRAF(V600E) patients was 20% versus 8% among BRAF wild type.
BRAF(V600E) was significantly associated with time to recurrence
when added to the following algorithms: AMES (hazard ratio [HR] 2.43
[confidence interval 1.08-5.49]), MACIS category (HR 2.46 [1.09-5.54]),
AJCC-TNM (HR 2.51 [1.11-5.66]), and ATA recurrence-risk category
(HR 2.44 [1.08-5.50]), and model discrimination improved (incremental
c-index range 0.046-0.109). The addition of BRAF mutational status
to established risk algorithms improves the discrimination of risk
recurrence in patients undergoing total thyroidectomy for PTC.
Lubitz, Carrie C.; Chen, H.
Sestamibi-negative patients: to operate or image? Journal Article
In: Ann. Surg. Oncol., vol. 19, no. 7, pp. 2086–2087, 2012, ().
@article{pmid22526912,
title = {Sestamibi-negative patients: to operate or image?},
author = {Carrie C. Lubitz and H. Chen},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22526912},
year = {2012},
date = {2012-07-01},
journal = {Ann. Surg. Oncol.},
volume = {19},
number = {7},
pages = {2086--2087},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Lubitz, Carrie C.; Nagarkatti, S. S.; Faquin, W. C.; Samir, A. E.; Hassan, M. C.; Barbesino, G.; Ross, D. S.; Randolph, G. W.; Gaz, R. D.; Stephen, A. E.; Hodin, R. A.; Daniels, G. H.; Parangi, S.
Diagnostic yield of nondiagnostic thyroid nodules is not altered by timing of repeat biopsy Journal Article
In: Thyroid, vol. 22, no. 6, pp. 590–594, 2012, ().
@article{pmid22667452,
title = {Diagnostic yield of nondiagnostic thyroid nodules is not altered by timing of repeat biopsy},
author = {Carrie C. Lubitz and S. S. Nagarkatti and W. C. Faquin and A. E. Samir and M. C. Hassan and G. Barbesino and D. S. Ross and G. W. Randolph and R. D. Gaz and A. E. Stephen and R. A. Hodin and G. H. Daniels and S. Parangi},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22667452},
year = {2012},
date = {2012-06-01},
urldate = {2012-06-01},
journal = {Thyroid},
volume = {22},
number = {6},
pages = {590--594},
abstract = {Guidelines from the National Cancer Institute Thyroid Fine Needle
Aspiration State of the Science Conference recommend a repeat fine-needle
aspiration biopsy (FNAB) after 3 months for thyroid nodules with
a nondiagnostic (ND) result. Our aims were to assess which factors
influenced their clinical management and to determine if the timing
of the repeat FNAB affects the diagnostic yield. A retrospective
institutional review of 298 patients from 1/2006 to 12/2007 with
an ND FNAB was performed. The factors influencing the next step in
management, including age, gender, history of radiation, presence
of Hashimoto's thyroiditis, thyroid-stimulating hormone levels, and
ultrasound characteristics, were evaluated. The effect of the time
of the repeat FNABs on their diagnostic yield was assessed. Of
the 298 patients in our cohort, 9% were referred directly for surgery,
76% had a repeat FNAB, and 15% were observed. Tumor size was the
only independent variable correlated with treatment strategy after
a ND FNAB. There was not a significant difference in diagnostic yields
between repeat FNABs performed earlier than 3 months compared to those preformed later (p=0.58). The timing of repeat FNAB for an
initial ND FNAB does not affect diagnostic yield of the repeat FNAB.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Guidelines from the National Cancer Institute Thyroid Fine Needle
Aspiration State of the Science Conference recommend a repeat fine-needle
aspiration biopsy (FNAB) after 3 months for thyroid nodules with
a nondiagnostic (ND) result. Our aims were to assess which factors
influenced their clinical management and to determine if the timing
of the repeat FNAB affects the diagnostic yield. A retrospective
institutional review of 298 patients from 1/2006 to 12/2007 with
an ND FNAB was performed. The factors influencing the next step in
management, including age, gender, history of radiation, presence
of Hashimoto's thyroiditis, thyroid-stimulating hormone levels, and
ultrasound characteristics, were evaluated. The effect of the time
of the repeat FNABs on their diagnostic yield was assessed. Of
the 298 patients in our cohort, 9% were referred directly for surgery,
76% had a repeat FNAB, and 15% were observed. Tumor size was the
only independent variable correlated with treatment strategy after
a ND FNAB. There was not a significant difference in diagnostic yields
between repeat FNABs performed earlier than 3 months compared to those preformed later (p=0.58). The timing of repeat FNAB for an
initial ND FNAB does not affect diagnostic yield of the repeat FNAB.
Aspiration State of the Science Conference recommend a repeat fine-needle
aspiration biopsy (FNAB) after 3 months for thyroid nodules with
a nondiagnostic (ND) result. Our aims were to assess which factors
influenced their clinical management and to determine if the timing
of the repeat FNAB affects the diagnostic yield. A retrospective
institutional review of 298 patients from 1/2006 to 12/2007 with
an ND FNAB was performed. The factors influencing the next step in
management, including age, gender, history of radiation, presence
of Hashimoto's thyroiditis, thyroid-stimulating hormone levels, and
ultrasound characteristics, were evaluated. The effect of the time
of the repeat FNABs on their diagnostic yield was assessed. Of
the 298 patients in our cohort, 9% were referred directly for surgery,
76% had a repeat FNAB, and 15% were observed. Tumor size was the
only independent variable correlated with treatment strategy after
a ND FNAB. There was not a significant difference in diagnostic yields
between repeat FNABs performed earlier than 3 months compared to those preformed later (p=0.58). The timing of repeat FNAB for an
initial ND FNAB does not affect diagnostic yield of the repeat FNAB.
Yip, D. T.; Hassan, M.; Pazaitou-Panayiotou, K.; Ruan, D. T.; Gawande, A. A.; Gaz, R. D.; Moore, F. D.; Hodin, R. A.; Stephen, A. E.; Sadow, P. M.; Daniels, G. H.; Randolph, G. W.; Parangi, S.; Lubitz, Carrie C.
In: Surgery, vol. 150, no. 6, pp. 1168–1177, 2011, ().
@article{pmid22136837,
title = {Preoperative basal calcitonin and tumor stage correlate with postoperative
calcitonin normalization in patients undergoing initial surgical
management of medullary thyroid carcinoma},
author = {D. T. Yip and M. Hassan and K. Pazaitou-Panayiotou and D. T. Ruan and A. A. Gawande and R. D. Gaz and F. D. Moore and R. A. Hodin and A. E. Stephen and P. M. Sadow and G. H. Daniels and G. W. Randolph and S. Parangi and Carrie C. Lubitz},
url = {http://www.ncbi.nlm.nih.gov/pubmed/22136837},
year = {2011},
date = {2011-12-01},
journal = {Surgery},
volume = {150},
number = {6},
pages = {1168--1177},
abstract = {The optimal initial operative management of medullary thyroid cancer
(MTC) and the use of biomarkers to guide the extent of operation
remain controversial. We hypothesized that preoperative serum levels
of calcitonin and carcinoembryonic antigen (CEA) correlate with extent
of disease and postoperative levels reflect the extent of operation
performed. We assessed retrospectively clinical and pathologic
factors among patients with MTC undergoing at least total thyroidectomy;
these factors were correlated with biomarkers using regression analyses.
Data were obtained from 104 patients, 28% with hereditary MTC. Preoperative
calcitonin correlated with tumor size (P \< .001) and postoperative serum calcitonin levels (P = .01) after multivariable adjustment
for lymph node positivity, extent of operation, and hereditary MTC. No patient with a preoperative calcitonin level of \<53 pg/mL (n = 20) had lymph node metastases. TNM stage (P = .001) and preoperative calcitonin levels (P = .04), but not extent of operation, independently
correlated with the failure to normalize postoperative calcitonin. Postoperative CEA correlated with positive margins (adjusted P =
04). Neither preoperative nor postoperative CEA was correlated with
lymph node positivity or extent of surgery. Preoperative serum
calcitonin and TMN stage, but not extent of operation, were independent
predictors of postoperative normalization of serum calcitonin levels.
Future studies should evaluate preoperative serum calcitonin levels
as a determinate of the extent of initial operation.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The optimal initial operative management of medullary thyroid cancer
(MTC) and the use of biomarkers to guide the extent of operation
remain controversial. We hypothesized that preoperative serum levels
of calcitonin and carcinoembryonic antigen (CEA) correlate with extent
of disease and postoperative levels reflect the extent of operation
performed. We assessed retrospectively clinical and pathologic
factors among patients with MTC undergoing at least total thyroidectomy;
these factors were correlated with biomarkers using regression analyses.
Data were obtained from 104 patients, 28% with hereditary MTC. Preoperative
calcitonin correlated with tumor size (P < .001) and postoperative serum calcitonin levels (P = .01) after multivariable adjustment
for lymph node positivity, extent of operation, and hereditary MTC. No patient with a preoperative calcitonin level of <53 pg/mL (n = 20) had lymph node metastases. TNM stage (P = .001) and preoperative calcitonin levels (P = .04), but not extent of operation, independently
correlated with the failure to normalize postoperative calcitonin. Postoperative CEA correlated with positive margins (adjusted P =
04). Neither preoperative nor postoperative CEA was correlated with
lymph node positivity or extent of surgery. Preoperative serum
calcitonin and TMN stage, but not extent of operation, were independent
predictors of postoperative normalization of serum calcitonin levels.
Future studies should evaluate preoperative serum calcitonin levels
as a determinate of the extent of initial operation.
(MTC) and the use of biomarkers to guide the extent of operation
remain controversial. We hypothesized that preoperative serum levels
of calcitonin and carcinoembryonic antigen (CEA) correlate with extent
of disease and postoperative levels reflect the extent of operation
performed. We assessed retrospectively clinical and pathologic
factors among patients with MTC undergoing at least total thyroidectomy;
these factors were correlated with biomarkers using regression analyses.
Data were obtained from 104 patients, 28% with hereditary MTC. Preoperative
calcitonin correlated with tumor size (P < .001) and postoperative serum calcitonin levels (P = .01) after multivariable adjustment
for lymph node positivity, extent of operation, and hereditary MTC. No patient with a preoperative calcitonin level of <53 pg/mL (n = 20) had lymph node metastases. TNM stage (P = .001) and preoperative calcitonin levels (P = .04), but not extent of operation, independently
correlated with the failure to normalize postoperative calcitonin. Postoperative CEA correlated with positive margins (adjusted P =
04). Neither preoperative nor postoperative CEA was correlated with
lymph node positivity or extent of surgery. Preoperative serum
calcitonin and TMN stage, but not extent of operation, were independent
predictors of postoperative normalization of serum calcitonin levels.
Future studies should evaluate preoperative serum calcitonin levels
as a determinate of the extent of initial operation.
Lubitz, Carrie C.; Hunter, G. J.; Hamberg, L. M.; Parangi, S.; Ruan, D.; Gawande, A.; Gaz, R. D.; Randolph, G. W.; Moore, F. D.; Hodin, R. A.; Stephen, A. E.
Accuracy of 4-dimensional computed tomography in poorly localized patients with primary hyperparathyroidism Journal Article
In: Surgery, vol. 148, no. 6, pp. 1129–1137, 2010, ().
@article{pmid21134543,
title = {Accuracy of 4-dimensional computed tomography in poorly localized patients with primary hyperparathyroidism},
author = {Carrie C. Lubitz and G. J. Hunter and L. M. Hamberg and S. Parangi and D. Ruan and A. Gawande and R. D. Gaz and G. W. Randolph and F. D. Moore and R. A. Hodin and A. E. Stephen},
url = {http://www.ncbi.nlm.nih.gov/pubmed/21134543},
year = {2010},
date = {2010-12-01},
urldate = {2010-12-01},
journal = {Surgery},
volume = {148},
number = {6},
pages = {1129--1137},
abstract = {Four-dimensional computed tomography (4D-CT) utilizes multiplanar
images and perfusion characteristics to identify abnormal parathyroid
glands. We assessed the role of 4D-CT in patients with inconclusive
preoperative ultrasound and sestamibi localization studies. Adult
patients with primary hyperparathyroidism with negative or discordant
standard imaging who underwent both localization with 4D-CT and operative
intervention for curative intent were included. Patient characteristics,
4D-CT scan results compared with operative findings, and curative
proportion were assessed. Of the 60 patients, 4D-CT accurately
lateralized 73% and localized 60% of abnormal glands found at operation.
Single candidate lesions (46/60) were confirmed at operation in 70%.
When multiple lesions were identified on 4D-CT (14/60), accuracy dropped to 29% (P = .03). The accuracy of 4D-CT was not different between primary and reoperative cases (P = .79). Of the 8 patients
with multigland disease diagnosed perioperatively, 5 had multiple
candidate lesions noted on 4D-CT. In 94% (48/51) of patients, a \>50%
drop in intraoperative parathormone (IOPTH) level was achieved after
resection and 87% (48/55) had long-term cure with a median follow-up
of 221 days. 4D-CT identifies the more than half of abnormal parathyroids
missed by traditional imaging and should be considered in cases with
negative or discordant sestamibi and ultrasound. Bilateral exploration
is warranted when multiple candidate lesions are reported on 4D-CT.
Multigland disease remains a challenging entity.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Four-dimensional computed tomography (4D-CT) utilizes multiplanar
images and perfusion characteristics to identify abnormal parathyroid
glands. We assessed the role of 4D-CT in patients with inconclusive
preoperative ultrasound and sestamibi localization studies. Adult
patients with primary hyperparathyroidism with negative or discordant
standard imaging who underwent both localization with 4D-CT and operative
intervention for curative intent were included. Patient characteristics,
4D-CT scan results compared with operative findings, and curative
proportion were assessed. Of the 60 patients, 4D-CT accurately
lateralized 73% and localized 60% of abnormal glands found at operation.
Single candidate lesions (46/60) were confirmed at operation in 70%.
When multiple lesions were identified on 4D-CT (14/60), accuracy dropped to 29% (P = .03). The accuracy of 4D-CT was not different between primary and reoperative cases (P = .79). Of the 8 patients
with multigland disease diagnosed perioperatively, 5 had multiple
candidate lesions noted on 4D-CT. In 94% (48/51) of patients, a >50%
drop in intraoperative parathormone (IOPTH) level was achieved after
resection and 87% (48/55) had long-term cure with a median follow-up
of 221 days. 4D-CT identifies the more than half of abnormal parathyroids
missed by traditional imaging and should be considered in cases with
negative or discordant sestamibi and ultrasound. Bilateral exploration
is warranted when multiple candidate lesions are reported on 4D-CT.
Multigland disease remains a challenging entity.
images and perfusion characteristics to identify abnormal parathyroid
glands. We assessed the role of 4D-CT in patients with inconclusive
preoperative ultrasound and sestamibi localization studies. Adult
patients with primary hyperparathyroidism with negative or discordant
standard imaging who underwent both localization with 4D-CT and operative
intervention for curative intent were included. Patient characteristics,
4D-CT scan results compared with operative findings, and curative
proportion were assessed. Of the 60 patients, 4D-CT accurately
lateralized 73% and localized 60% of abnormal glands found at operation.
Single candidate lesions (46/60) were confirmed at operation in 70%.
When multiple lesions were identified on 4D-CT (14/60), accuracy dropped to 29% (P = .03). The accuracy of 4D-CT was not different between primary and reoperative cases (P = .79). Of the 8 patients
with multigland disease diagnosed perioperatively, 5 had multiple
candidate lesions noted on 4D-CT. In 94% (48/51) of patients, a >50%
drop in intraoperative parathormone (IOPTH) level was achieved after
resection and 87% (48/55) had long-term cure with a median follow-up
of 221 days. 4D-CT identifies the more than half of abnormal parathyroids
missed by traditional imaging and should be considered in cases with
negative or discordant sestamibi and ultrasound. Bilateral exploration
is warranted when multiple candidate lesions are reported on 4D-CT.
Multigland disease remains a challenging entity.
Mekel, M.; Stephen, A. E.; Gaz, R. D.; Randolph, G. W.; Richer, S.; Perry, Z. H.; Lubitz, Carrie C.; Nehs, M. A.; Parangi, S.; Hodin, R. A.
Surgical drains can be safely avoided in lateral neck dissections for papillary thyroid cancer Journal Article
In: Am. J. Surg., vol. 199, no. 4, pp. 485–490, 2010, ().
@article{pmid20359568,
title = {Surgical drains can be safely avoided in lateral neck dissections
for papillary thyroid cancer},
author = {M. Mekel and A. E. Stephen and R. D. Gaz and G. W. Randolph and S. Richer and Z. H. Perry and Carrie C. Lubitz and M. A. Nehs and S. Parangi and R. A. Hodin},
url = {http://www.ncbi.nlm.nih.gov/pubmed/20359568},
year = {2010},
date = {2010-04-01},
journal = {Am. J. Surg.},
volume = {199},
number = {4},
pages = {485--490},
abstract = {Drains are widely used in lateral neck dissections (LNDs). Our objective
was to compare outcomes of LNDs for papillary thyroid cancer (PTC)
with and without drains. One hundred sixty-five LNDs in 129 patients
operated on from July 2001 to October 2008 were analyzed retrospectively.
LNDs were divided according to the number of excised lymph nodes
as follows: group A \< median and group B \> median. Further categorization
was based on the use of a drain. Main outcome measures were wound
complications requiring intervention. One hundred two LNDs were
performed with a drain and 63 without. The overall rate of wound
complications was 3%. There was no significant difference in complication
rate between the drain and the non-drain group (group A: 1.8% vs
0; group B: 2.2% vs 7.9%, respectively). Significant seromas/hematomas
are rare complications of LNDs. Patients who undergo LND for PTC
without a drain show no significantly increased rate of these complications.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Drains are widely used in lateral neck dissections (LNDs). Our objective
was to compare outcomes of LNDs for papillary thyroid cancer (PTC)
with and without drains. One hundred sixty-five LNDs in 129 patients
operated on from July 2001 to October 2008 were analyzed retrospectively.
LNDs were divided according to the number of excised lymph nodes
as follows: group A < median and group B > median. Further categorization
was based on the use of a drain. Main outcome measures were wound
complications requiring intervention. One hundred two LNDs were
performed with a drain and 63 without. The overall rate of wound
complications was 3%. There was no significant difference in complication
rate between the drain and the non-drain group (group A: 1.8% vs
0; group B: 2.2% vs 7.9%, respectively). Significant seromas/hematomas
are rare complications of LNDs. Patients who undergo LND for PTC
without a drain show no significantly increased rate of these complications.
was to compare outcomes of LNDs for papillary thyroid cancer (PTC)
with and without drains. One hundred sixty-five LNDs in 129 patients
operated on from July 2001 to October 2008 were analyzed retrospectively.
LNDs were divided according to the number of excised lymph nodes
as follows: group A < median and group B > median. Further categorization
was based on the use of a drain. Main outcome measures were wound
complications requiring intervention. One hundred two LNDs were
performed with a drain and 63 without. The overall rate of wound
complications was 3%. There was no significant difference in complication
rate between the drain and the non-drain group (group A: 1.8% vs
0; group B: 2.2% vs 7.9%, respectively). Significant seromas/hematomas
are rare complications of LNDs. Patients who undergo LND for PTC
without a drain show no significantly increased rate of these complications.
Kato, M. A.; Finley, D. J.; Lubitz, Carrie C.; Zhu, B.; Moo, T. A.; Loeven, M. R.; Ricci, J. A.; Zarnegar, R.; Katdare, M.; Fahey, T. J.
Selenium decreases thyroid cancer cell growth by increasing expression of GADD153 and GADD34 Journal Article
In: Nutr Cancer, vol. 62, no. 1, pp. 66–73, 2010, ().
@article{pmid20043261,
title = {Selenium decreases thyroid cancer cell growth by increasing expression
of GADD153 and GADD34},
author = {M. A. Kato and D. J. Finley and Carrie C. Lubitz and B. Zhu and T. A. Moo and M. R. Loeven and J. A. Ricci and R. Zarnegar and M. Katdare and T. J. Fahey},
url = {http://www.ncbi.nlm.nih.gov/pubmed/20043261},
year = {2010},
date = {2010-01-01},
journal = {Nutr Cancer},
volume = {62},
number = {1},
pages = {66--73},
abstract = {Selenium (Se) supplementation is reported to decrease the incidence
and total mortality of cancer. Whereas in vitro and in vivo studies
have shown a decrease in prostate, lung, and liver cancers, this
has not been shown in thyroid cancer. ARO (anaplastic), NPA (BRAF
positive papillary), WRO (BRAF negative papillary), and FRO (follicular)
cells treated with 150 microM seleno-l-methionine (SM) were assessed
for viability at 24, 48, and 72 h. Treated FRO cells were examined
for cell cycle using flow cytometry, for apoptosis using terminal
deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL)
assay, and for gene expression using microarray. Genes identified
as upregulated were confirmed by real-time PCR (RT-PCR) and proteins
by Western blot analysis. SM treatment significantly decreased the
proliferation of all cell lines. TUNEL assay showed no evidence of
apoptosis, and flow cytometry showed a significant cell-cycle arrest in S (271% increas},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Selenium (Se) supplementation is reported to decrease the incidence
and total mortality of cancer. Whereas in vitro and in vivo studies
have shown a decrease in prostate, lung, and liver cancers, this
has not been shown in thyroid cancer. ARO (anaplastic), NPA (BRAF
positive papillary), WRO (BRAF negative papillary), and FRO (follicular)
cells treated with 150 microM seleno-l-methionine (SM) were assessed
for viability at 24, 48, and 72 h. Treated FRO cells were examined
for cell cycle using flow cytometry, for apoptosis using terminal
deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL)
assay, and for gene expression using microarray. Genes identified
as upregulated were confirmed by real-time PCR (RT-PCR) and proteins
by Western blot analysis. SM treatment significantly decreased the
proliferation of all cell lines. TUNEL assay showed no evidence of
apoptosis, and flow cytometry showed a significant cell-cycle arrest in S (271% increas
and total mortality of cancer. Whereas in vitro and in vivo studies
have shown a decrease in prostate, lung, and liver cancers, this
has not been shown in thyroid cancer. ARO (anaplastic), NPA (BRAF
positive papillary), WRO (BRAF negative papillary), and FRO (follicular)
cells treated with 150 microM seleno-l-methionine (SM) were assessed
for viability at 24, 48, and 72 h. Treated FRO cells were examined
for cell cycle using flow cytometry, for apoptosis using terminal
deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL)
assay, and for gene expression using microarray. Genes identified
as upregulated were confirmed by real-time PCR (RT-PCR) and proteins
by Western blot analysis. SM treatment significantly decreased the
proliferation of all cell lines. TUNEL assay showed no evidence of
apoptosis, and flow cytometry showed a significant cell-cycle arrest in S (271% increas
Lubitz, Carrie C.; Faquin, W. C.; Yang, J.; Mekel, M.; Gaz, R. D.; Parangi, S.; Randolph, G. W.; Hodin, R. A.; Stephen, A. E.
Clinical and cytological features predictive of malignancy in thyroid follicular neoplasms Journal Article
In: Thyroid, vol. 20, no. 1, pp. 25–31, 2010, ().
@article{pmid20025540,
title = {Clinical and cytological features predictive of malignancy in
thyroid follicular neoplasms},
author = {Carrie C. Lubitz and W. C. Faquin and J. Yang and M. Mekel and R. D. Gaz and S. Parangi and G. W. Randolph and R. A. Hodin and A. E. Stephen},
url = {http://www.ncbi.nlm.nih.gov/pubmed/20025540},
year = {2010},
date = {2010-01-01},
journal = {Thyroid},
volume = {20},
number = {1},
pages = {25--31},
abstract = {The preoperative diagnosis of malignancy in nodules suspicious for
a follicular neoplasm remains challenging. A number of clinical and
cytological parameters have been previously studied; however, none
have significantly impacted clinical practice. The aim of this study
was to determine predictive characteristics of follicular neoplasms
useful for clinical application. Four clinical (age, sex, nodule
size, solitary nodule) and 17 cytological variables were retrospectively
reviewed for 144 patients with a nodule suspicious for follicular
neoplasm, diagnosed preoperatively by fine-needle aspiration (FNA),
from a single institution over a 2-year period (January 2006 to December
2007). The FNAs were examined by a single, blinded pathologist and
compared with final surgical pathology. Significance of clinical
and cytological variables was determined by univariate analysis and
backward stepwise logistic regression. Odds ratios (ORs) for malignancy,
a receiver operating characteristic curve, and predicted probabilities
of combined features were determined. There was an 11% incidence of malignancy (16/144). On univariate analysis, nodule size \>OR=4.0 cm nears significance (p = 0.054) and 9 of 17 cytological features
examined were significantly associated with malignancy. Three variables
stay in the final model after performing backward stepwise selection in logistic regression: nodule size (OR = 0.2},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The preoperative diagnosis of malignancy in nodules suspicious for
a follicular neoplasm remains challenging. A number of clinical and
cytological parameters have been previously studied; however, none
have significantly impacted clinical practice. The aim of this study
was to determine predictive characteristics of follicular neoplasms
useful for clinical application. Four clinical (age, sex, nodule
size, solitary nodule) and 17 cytological variables were retrospectively
reviewed for 144 patients with a nodule suspicious for follicular
neoplasm, diagnosed preoperatively by fine-needle aspiration (FNA),
from a single institution over a 2-year period (January 2006 to December
2007). The FNAs were examined by a single, blinded pathologist and
compared with final surgical pathology. Significance of clinical
and cytological variables was determined by univariate analysis and
backward stepwise logistic regression. Odds ratios (ORs) for malignancy,
a receiver operating characteristic curve, and predicted probabilities
of combined features were determined. There was an 11% incidence of malignancy (16/144). On univariate analysis, nodule size >OR=4.0 cm nears significance (p = 0.054) and 9 of 17 cytological features
examined were significantly associated with malignancy. Three variables
stay in the final model after performing backward stepwise selection in logistic regression: nodule size (OR = 0.2
a follicular neoplasm remains challenging. A number of clinical and
cytological parameters have been previously studied; however, none
have significantly impacted clinical practice. The aim of this study
was to determine predictive characteristics of follicular neoplasms
useful for clinical application. Four clinical (age, sex, nodule
size, solitary nodule) and 17 cytological variables were retrospectively
reviewed for 144 patients with a nodule suspicious for follicular
neoplasm, diagnosed preoperatively by fine-needle aspiration (FNA),
from a single institution over a 2-year period (January 2006 to December
2007). The FNAs were examined by a single, blinded pathologist and
compared with final surgical pathology. Significance of clinical
and cytological variables was determined by univariate analysis and
backward stepwise logistic regression. Odds ratios (ORs) for malignancy,
a receiver operating characteristic curve, and predicted probabilities
of combined features were determined. There was an 11% incidence of malignancy (16/144). On univariate analysis, nodule size >OR=4.0 cm nears significance (p = 0.054) and 9 of 17 cytological features
examined were significantly associated with malignancy. Three variables
stay in the final model after performing backward stepwise selection in logistic regression: nodule size (OR = 0.2
Arora, N.; Scognamiglio, T.; Lubitz, Carrie C.; Moo, T. A.; Kato, M. A.; Zhu, B.; Zarnegar, R.; Chen, Y. T.; Fahey, T. J.
Identification of borderline thyroid tumors by gene expression array analysis Journal Article
In: Cancer, vol. 115, no. 23, pp. 5421–5431, 2009, ().
@article{pmid19658182,
title = {Identification of borderline thyroid tumors by gene expression array analysis},
author = {N. Arora and T. Scognamiglio and Carrie C. Lubitz and T. A. Moo and M. A. Kato and B. Zhu and R. Zarnegar and Y. T. Chen and T. J. Fahey},
url = {http://www.ncbi.nlm.nih.gov/pubmed/19658182},
year = {2009},
date = {2009-12-01},
urldate = {2009-12-01},
journal = {Cancer},
volume = {115},
number = {23},
pages = {5421--5431},
abstract = {A subset of follicular lesions of the thyroid is encapsulated similar
to follicular adenomas but with partial nuclear features suggestive
of papillary thyroid carcinoma (PTC), raising the possibility of
biologically borderline tumors. Gene expression profiling and advanced
significance analyses were performed on 50 histologically unequivocal
benign and malignant tumors, and a list of 61 differentially expressed
genes was generated. By using this 61-gene list, unsupervised hierarchical
and K-means cluster analyses were performed on 40 additional tumors,
including 15 histologically borderline tumors, 11 benign tumors,
and 14 PTCs. Analysis revealed 3 distinct tumor groups-benign,
malignant, and intermediate. Tumors in the intermediate group (n = 15) were mostly histologic borderline tumors and had an expression
profile overlapping with the benign and malignant groups. Twenty-seven
genes were expressed differentially between the benign and intermediate
groups, including the cyclic AMP response element-binding protein/p300-interactivator
with glutamic acid/aspartic acid-rich carboxy-terminal domain 1 or
CITED1 gene and the fibroblast growth factor receptor 2 or FGFR2
gene. Fourteen genes were expressed differentially between the intermediate
group and malignant tumors, notably overexpression of the met proto-oncogene
and of the high-mobility group adenine/thymine-hook 2 or HMGA2 gene
in malignancies. Mutations of the v-raf murine sarcoma viral oncogene
homolog B1 or BRAF gene were identified in 4 of 14 malignant tumors
but not in benign or intermediate tumors. Patients who had either
histologically or molecularly borderline tumors did not have metastasis
or recurrences. Gene expression profiling supported the finding
that encapsulated thyroid follicular lesions with partial nuclear
features of PTC are biologically borderline tumors that are distinct
molecularly from benign and malignant tumors.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
A subset of follicular lesions of the thyroid is encapsulated similar
to follicular adenomas but with partial nuclear features suggestive
of papillary thyroid carcinoma (PTC), raising the possibility of
biologically borderline tumors. Gene expression profiling and advanced
significance analyses were performed on 50 histologically unequivocal
benign and malignant tumors, and a list of 61 differentially expressed
genes was generated. By using this 61-gene list, unsupervised hierarchical
and K-means cluster analyses were performed on 40 additional tumors,
including 15 histologically borderline tumors, 11 benign tumors,
and 14 PTCs. Analysis revealed 3 distinct tumor groups-benign,
malignant, and intermediate. Tumors in the intermediate group (n = 15) were mostly histologic borderline tumors and had an expression
profile overlapping with the benign and malignant groups. Twenty-seven
genes were expressed differentially between the benign and intermediate
groups, including the cyclic AMP response element-binding protein/p300-interactivator
with glutamic acid/aspartic acid-rich carboxy-terminal domain 1 or
CITED1 gene and the fibroblast growth factor receptor 2 or FGFR2
gene. Fourteen genes were expressed differentially between the intermediate
group and malignant tumors, notably overexpression of the met proto-oncogene
and of the high-mobility group adenine/thymine-hook 2 or HMGA2 gene
in malignancies. Mutations of the v-raf murine sarcoma viral oncogene
homolog B1 or BRAF gene were identified in 4 of 14 malignant tumors
but not in benign or intermediate tumors. Patients who had either
histologically or molecularly borderline tumors did not have metastasis
or recurrences. Gene expression profiling supported the finding
that encapsulated thyroid follicular lesions with partial nuclear
features of PTC are biologically borderline tumors that are distinct
molecularly from benign and malignant tumors.
to follicular adenomas but with partial nuclear features suggestive
of papillary thyroid carcinoma (PTC), raising the possibility of
biologically borderline tumors. Gene expression profiling and advanced
significance analyses were performed on 50 histologically unequivocal
benign and malignant tumors, and a list of 61 differentially expressed
genes was generated. By using this 61-gene list, unsupervised hierarchical
and K-means cluster analyses were performed on 40 additional tumors,
including 15 histologically borderline tumors, 11 benign tumors,
and 14 PTCs. Analysis revealed 3 distinct tumor groups-benign,
malignant, and intermediate. Tumors in the intermediate group (n = 15) were mostly histologic borderline tumors and had an expression
profile overlapping with the benign and malignant groups. Twenty-seven
genes were expressed differentially between the benign and intermediate
groups, including the cyclic AMP response element-binding protein/p300-interactivator
with glutamic acid/aspartic acid-rich carboxy-terminal domain 1 or
CITED1 gene and the fibroblast growth factor receptor 2 or FGFR2
gene. Fourteen genes were expressed differentially between the intermediate
group and malignant tumors, notably overexpression of the met proto-oncogene
and of the high-mobility group adenine/thymine-hook 2 or HMGA2 gene
in malignancies. Mutations of the v-raf murine sarcoma viral oncogene
homolog B1 or BRAF gene were identified in 4 of 14 malignant tumors
but not in benign or intermediate tumors. Patients who had either
histologically or molecularly borderline tumors did not have metastasis
or recurrences. Gene expression profiling supported the finding
that encapsulated thyroid follicular lesions with partial nuclear
features of PTC are biologically borderline tumors that are distinct
molecularly from benign and malignant tumors.
Lubitz, Carrie C.; Fahey, T. J.
Gene expression profiling of thyroid tumors--clinical applicability Journal Article
In: Nat Clin Pract Endocrinol Metab, vol. 2, no. 9, pp. 472–473, 2006, ().
@article{pmid16957755,
title = {Gene expression profiling of thyroid tumors--clinical applicability},
author = {Carrie C. Lubitz and T. J. Fahey},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16957755},
year = {2006},
date = {2006-09-01},
journal = {Nat Clin Pract Endocrinol Metab},
volume = {2},
number = {9},
pages = {472--473},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Lubitz, Carrie C.; Ugras, S. K.; Kazam, J. J.; Zhu, B.; Scognamiglio, T.; Chen, Y. T.; Fahey, T. J.
Microarray analysis of thyroid nodule fine-needle aspirates accurately classifies benign and malignant lesions Journal Article
In: J Mol Diagn, vol. 8, no. 4, pp. 490–498, 2006, ().
@article{pmid16931590,
title = {Microarray analysis of thyroid nodule fine-needle aspirates accurately
classifies benign and malignant lesions},
author = {Carrie C. Lubitz and S. K. Ugras and J. J. Kazam and B. Zhu and T. Scognamiglio and Y. T. Chen and T. J. Fahey},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16931590},
year = {2006},
date = {2006-09-01},
journal = {J Mol Diagn},
volume = {8},
number = {4},
pages = {490--498},
abstract = {Current preoperative diagnostic procedures for thyroid nodules rely
mainly on the cytological interpretation of fine-needle aspirates
(FNAs). DNA microarray analysis has been shown to reliably distinguish
benign and malignant thyroid nodules in surgically resected specimens,
but its diagnostic potential in thyroid FNA has not been examined.
In the present study, the expression profiles of 50 benign thyroid
lesions and papillary thyroid carcinoma tissue samples were compared,
generating a list of 25 differentially expressed genes from this
training set. A test set of 22 FNA specimens was evaluated by unsupervised
hierarchical cluster analysis using this gene list, and the results
were compared to FNA cytology. FNA specimens were found to fall into three clusters: malignant (n = 10), benign (n = 7), and indeterminate (n = 5). The benign and malignant groups showed complete concordance
with the final histological diagnosis except for one histologically
benign lesion, which was rediagnosed as follicular variant of papillary
thyroid carcinoma on histological review. Paired analysis between
FNA and matched tissues samples illustrated adequate sampling with
FNA. These results illustrate that microarray analysis of FNA is
feasible and has the potential to improve the accuracy of FNA in
categorizing benign from malignant lesions beyond routine cytological
evaluation.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Current preoperative diagnostic procedures for thyroid nodules rely
mainly on the cytological interpretation of fine-needle aspirates
(FNAs). DNA microarray analysis has been shown to reliably distinguish
benign and malignant thyroid nodules in surgically resected specimens,
but its diagnostic potential in thyroid FNA has not been examined.
In the present study, the expression profiles of 50 benign thyroid
lesions and papillary thyroid carcinoma tissue samples were compared,
generating a list of 25 differentially expressed genes from this
training set. A test set of 22 FNA specimens was evaluated by unsupervised
hierarchical cluster analysis using this gene list, and the results
were compared to FNA cytology. FNA specimens were found to fall into three clusters: malignant (n = 10), benign (n = 7), and indeterminate (n = 5). The benign and malignant groups showed complete concordance
with the final histological diagnosis except for one histologically
benign lesion, which was rediagnosed as follicular variant of papillary
thyroid carcinoma on histological review. Paired analysis between
FNA and matched tissues samples illustrated adequate sampling with
FNA. These results illustrate that microarray analysis of FNA is
feasible and has the potential to improve the accuracy of FNA in
categorizing benign from malignant lesions beyond routine cytological
evaluation.
mainly on the cytological interpretation of fine-needle aspirates
(FNAs). DNA microarray analysis has been shown to reliably distinguish
benign and malignant thyroid nodules in surgically resected specimens,
but its diagnostic potential in thyroid FNA has not been examined.
In the present study, the expression profiles of 50 benign thyroid
lesions and papillary thyroid carcinoma tissue samples were compared,
generating a list of 25 differentially expressed genes from this
training set. A test set of 22 FNA specimens was evaluated by unsupervised
hierarchical cluster analysis using this gene list, and the results
were compared to FNA cytology. FNA specimens were found to fall into three clusters: malignant (n = 10), benign (n = 7), and indeterminate (n = 5). The benign and malignant groups showed complete concordance
with the final histological diagnosis except for one histologically
benign lesion, which was rediagnosed as follicular variant of papillary
thyroid carcinoma on histological review. Paired analysis between
FNA and matched tissues samples illustrated adequate sampling with
FNA. These results illustrate that microarray analysis of FNA is
feasible and has the potential to improve the accuracy of FNA in
categorizing benign from malignant lesions beyond routine cytological
evaluation.
Lubitz, Carrie C.; Gallagher, L. A.; Finley, D. J.; Zhu, B.; Fahey, T. J.
Molecular analysis of minimally invasive follicular carcinomas by gene profiling Journal Article
In: Surgery, vol. 138, no. 6, pp. 1042–1048, 2005, ().
@article{pmid16360389,
title = {Molecular analysis of minimally invasive follicular carcinomas
by gene profiling},
author = {Carrie C. Lubitz and L. A. Gallagher and D. J. Finley and B. Zhu and T. J. Fahey},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16360389},
year = {2005},
date = {2005-12-01},
journal = {Surgery},
volume = {138},
number = {6},
pages = {1042--1048},
abstract = {While the majority of minimally invasive follicular thyroid carcinoma
(MIFTC) behave like follicular adenomas, some recur or metastasize.
These studies were conducted to determine if molecular profiling
can enhance our understanding of MIFTC and to perhaps offer a better
classification schema. Microarray analysis was performed on 27
follicular neoplasms. Thirteen follicular adenomas (FAs) were compared
with 7 widely invasive follicular thyroid carcinomas (WIFTCs) to
generate a list of differentially expressed genes. Next, 7 MIFTCs
were analyzed along with the other samples in a cluster analysis.
The MIFTCs were then compared directly against both the adenoma and
WIFTC groups to investigate genetic relatedness. FAs and WIFTCs
have distinct genetic profiles, with 401 differentially expressed
genes. The 7 MIFTCs were added to the analysis. Six of 7 of the MIFTCs
were grouped with the adenomas, 4 of which created their own subgroup.
When analyzed directly, MIFTCs had 223 differently expressed genes,
compared with FAs, and 365, compared with WIFTCs. Molecular profiling
illustrates that the majority of MIFTCs comprise a subclass of follicular
neoplasms, and, while most MIFTCs are genetically similar to adenomas,
our patient data suggest that these tumors may deserve greater suspicion
of malignant potential. Gene profiling can provide insight into the
molecular pathogenesis of MIFTC.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
While the majority of minimally invasive follicular thyroid carcinoma
(MIFTC) behave like follicular adenomas, some recur or metastasize.
These studies were conducted to determine if molecular profiling
can enhance our understanding of MIFTC and to perhaps offer a better
classification schema. Microarray analysis was performed on 27
follicular neoplasms. Thirteen follicular adenomas (FAs) were compared
with 7 widely invasive follicular thyroid carcinomas (WIFTCs) to
generate a list of differentially expressed genes. Next, 7 MIFTCs
were analyzed along with the other samples in a cluster analysis.
The MIFTCs were then compared directly against both the adenoma and
WIFTC groups to investigate genetic relatedness. FAs and WIFTCs
have distinct genetic profiles, with 401 differentially expressed
genes. The 7 MIFTCs were added to the analysis. Six of 7 of the MIFTCs
were grouped with the adenomas, 4 of which created their own subgroup.
When analyzed directly, MIFTCs had 223 differently expressed genes,
compared with FAs, and 365, compared with WIFTCs. Molecular profiling
illustrates that the majority of MIFTCs comprise a subclass of follicular
neoplasms, and, while most MIFTCs are genetically similar to adenomas,
our patient data suggest that these tumors may deserve greater suspicion
of malignant potential. Gene profiling can provide insight into the
molecular pathogenesis of MIFTC.
(MIFTC) behave like follicular adenomas, some recur or metastasize.
These studies were conducted to determine if molecular profiling
can enhance our understanding of MIFTC and to perhaps offer a better
classification schema. Microarray analysis was performed on 27
follicular neoplasms. Thirteen follicular adenomas (FAs) were compared
with 7 widely invasive follicular thyroid carcinomas (WIFTCs) to
generate a list of differentially expressed genes. Next, 7 MIFTCs
were analyzed along with the other samples in a cluster analysis.
The MIFTCs were then compared directly against both the adenoma and
WIFTC groups to investigate genetic relatedness. FAs and WIFTCs
have distinct genetic profiles, with 401 differentially expressed
genes. The 7 MIFTCs were added to the analysis. Six of 7 of the MIFTCs
were grouped with the adenomas, 4 of which created their own subgroup.
When analyzed directly, MIFTCs had 223 differently expressed genes,
compared with FAs, and 365, compared with WIFTCs. Molecular profiling
illustrates that the majority of MIFTCs comprise a subclass of follicular
neoplasms, and, while most MIFTCs are genetically similar to adenomas,
our patient data suggest that these tumors may deserve greater suspicion
of malignant potential. Gene profiling can provide insight into the
molecular pathogenesis of MIFTC.
Finley, D. J.; Lubitz, Carrie C.; Wei, C.; Zhu, B.; Fahey, T. J.
Advancing the molecular diagnosis of thyroid nodules: defining benign lesions by molecular profiling Journal Article
In: Thyroid, vol. 15, no. 6, pp. 562–568, 2005, ().
@article{pmid16029122,
title = {Advancing the molecular diagnosis of thyroid nodules: defining benign lesions by molecular profiling},
author = {D. J. Finley and Carrie C. Lubitz and C. Wei and B. Zhu and T. J. Fahey},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16029122},
year = {2005},
date = {2005-06-01},
urldate = {2005-06-01},
journal = {Thyroid},
volume = {15},
number = {6},
pages = {562--568},
abstract = {Thyroid nodules are common and most are benign. Previous data from
our laboratory and others has suggested that gene profiling can accurately
distinguish between benign and malignant thyroid nodules and provide
new leads in the study of thyroid tumorigenesis. Current preoperative
techniques do not permit distinction between neoplastic and hyperplastic
follicular neoplasms. These studies were undertaken to determine
whether benign follicular tumors could be subcategorized by molecular
profiling. Molecular profiles of 8 follicular adenomas and 8 hyperplastic
nodules were analyzed by oligonucleotide microarray analysis. A list
of 402 differentially expressed genes was produced based on a comparison
of these two groups. Seven additional benign follicular lesions were
then added to the analysis. A hierarchical clustering analysis was
performed on all 23 samples, utilizing the gene list generated from
the test set, to examine the groups for potential differences and
the ability of the gene list to distinguish tumor types. Cluster
analysis of all 23 samples produced two distinct groups, one containing
the adenomas and one containing the hyperplastic lesions. The analysis
was able to identify follicular adenomas with a sensitivity of 84.6%
and a specificity of 100%. These data indicate that benign thyroid
lesions can be separated into distinct groups through molecular profiling.
Analysis of the gene list may help further the understanding of thyroid
tumorigenesis. Expression profiling may ultimately allow us to distinguish
potentially malignant from benign follicular nodules.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Thyroid nodules are common and most are benign. Previous data from
our laboratory and others has suggested that gene profiling can accurately
distinguish between benign and malignant thyroid nodules and provide
new leads in the study of thyroid tumorigenesis. Current preoperative
techniques do not permit distinction between neoplastic and hyperplastic
follicular neoplasms. These studies were undertaken to determine
whether benign follicular tumors could be subcategorized by molecular
profiling. Molecular profiles of 8 follicular adenomas and 8 hyperplastic
nodules were analyzed by oligonucleotide microarray analysis. A list
of 402 differentially expressed genes was produced based on a comparison
of these two groups. Seven additional benign follicular lesions were
then added to the analysis. A hierarchical clustering analysis was
performed on all 23 samples, utilizing the gene list generated from
the test set, to examine the groups for potential differences and
the ability of the gene list to distinguish tumor types. Cluster
analysis of all 23 samples produced two distinct groups, one containing
the adenomas and one containing the hyperplastic lesions. The analysis
was able to identify follicular adenomas with a sensitivity of 84.6%
and a specificity of 100%. These data indicate that benign thyroid
lesions can be separated into distinct groups through molecular profiling.
Analysis of the gene list may help further the understanding of thyroid
tumorigenesis. Expression profiling may ultimately allow us to distinguish
potentially malignant from benign follicular nodules.
our laboratory and others has suggested that gene profiling can accurately
distinguish between benign and malignant thyroid nodules and provide
new leads in the study of thyroid tumorigenesis. Current preoperative
techniques do not permit distinction between neoplastic and hyperplastic
follicular neoplasms. These studies were undertaken to determine
whether benign follicular tumors could be subcategorized by molecular
profiling. Molecular profiles of 8 follicular adenomas and 8 hyperplastic
nodules were analyzed by oligonucleotide microarray analysis. A list
of 402 differentially expressed genes was produced based on a comparison
of these two groups. Seven additional benign follicular lesions were
then added to the analysis. A hierarchical clustering analysis was
performed on all 23 samples, utilizing the gene list generated from
the test set, to examine the groups for potential differences and
the ability of the gene list to distinguish tumor types. Cluster
analysis of all 23 samples produced two distinct groups, one containing
the adenomas and one containing the hyperplastic lesions. The analysis
was able to identify follicular adenomas with a sensitivity of 84.6%
and a specificity of 100%. These data indicate that benign thyroid
lesions can be separated into distinct groups through molecular profiling.
Analysis of the gene list may help further the understanding of thyroid
tumorigenesis. Expression profiling may ultimately allow us to distinguish
potentially malignant from benign follicular nodules.
Lubitz, Carrie C.; Fahey, T. J.
Ŧhe differentiation of benign and malignant thyroid nodules Journal Article
In: Adv Surg, vol. 39, pp. 355–377, 2005, ().
@article{pmid16250561,
title = {{T}he differentiation of benign and malignant thyroid nodules},
author = {Carrie C. Lubitz and T. J. Fahey},
url = {http://www.ncbi.nlm.nih.gov/pubmed/16250561},
year = {2005},
date = {2005-01-01},
journal = {Adv Surg},
volume = {39},
pages = {355--377},
keywords = {},
pubstate = {published},
tppubtype = {article}
}