Dr. Cunningham (nee Lubitz) is an Associate Professor of Surgery at Harvard Medical School, Section head of the Massachusetts General Hospital Endocrine Surgery Unit, and the Associate Director of the Massachusetts General Hospital Institute for Technology Assessment.
She received her undergraduate and medical degrees at the University of Michigan. She completed general surgery training at New York Presbyterian Hospital/Weill-Cornell Medical College. During residency, she studied the genetic basis of thyroid cancer as a part of the NCI-Surgical Oncology Research Training Program. She then completed her clinical endocrine surgery fellowship in 2010 at the Massachusetts General Hospital and obtained a Master of Public Health through the Harvard School of Public Health and was a fellow in the Dana-Farber/Harvard Cancer Center Program in Cancer Outcomes Research Training. In 2015, Dr. Cunningham was one of the recipients of the Claflin Distinguished Scholars Award at MGH.
Dr. Cunningham is the Association of Endocrine Surgeons research committee chair and executive council member and the President of the Association of Academic Surgery. Her overarching research mission has been to improve the health and well-being of patients with benign and malignant endocrine-related diseases. She is the principal investigator of an NIH/NCI R-37 (R01-type merit award) award to examine the potential impact of new diagnostic technologies and personalized management strategies in patients with thyroid cancer using mathematical disease simulation modeling and an American Cancer Society Research Scholar Award to develop a patient-reported instrument to assess thyroid-cancer specific quality of life.
Selected Publications
Collins, Reagan A; Herman, Tianna; Snyder, Rebecca A; Haines, Krista L; Stey, Anne; Arora, Tania K; Geevarghese, Sunil K; Phillips, Joseph D; Vicente, Diego; Griggs, Cornelia L; McElroy, Imani E; Wall, Anji E; Hughes, Tasha M; Sen, Srijan; Valinejad, Jaber; Alban, Andres; Swan, J Shannon; Mercaldo, Nathaniel; Jalali, Mohammad S; Chhatwal, Jagpreet; Gazelle, G Scott; Rangel, Erika; Yang, Chi-Fu Jeffrey; Donelan, Karen; Gold, Jessica A; West, Colin P; Cunningham, Carrie
Unspoken Truths: Mental Health Among Academic Surgeons Journal Article
In: Ann Surg, 2023, ISSN: 1528-1140.
@article{pmid37991182,
title = {Unspoken Truths: Mental Health Among Academic Surgeons},
author = {Reagan A Collins and Tianna Herman and Rebecca A Snyder and Krista L Haines and Anne Stey and Tania K Arora and Sunil K Geevarghese and Joseph D Phillips and Diego Vicente and Cornelia L Griggs and Imani E McElroy and Anji E Wall and Tasha M Hughes and Srijan Sen and Jaber Valinejad and Andres Alban and J Shannon Swan and Nathaniel Mercaldo and Mohammad S Jalali and Jagpreet Chhatwal and G Scott Gazelle and Erika Rangel and Chi-Fu Jeffrey Yang and Karen Donelan and Jessica A Gold and Colin P West and Carrie Cunningham},
doi = {10.1097/SLA.0000000000006159},
issn = {1528-1140},
year = {2023},
date = {2023-11-01},
journal = {Ann Surg},
abstract = {OBJECTIVE: To characterize the current state of mental health within the surgical workforce in the United States (US).nnSUMMARY BACKGROUND DATA: Mental illness and suicide is a growing concern in the medical community; however, the current state is largely unknown.nnMETHODS: Cross-sectional survey of the academic surgery community assessing mental health, medical error, and suicidal ideation. The odds of suicidal ideation adjusting for sex, prior mental health diagnosis, and validated scales screening for depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol use disorder were assessed.nnRESULTS: Of 622 participating medical students, trainees, and surgeons (estimated response rate=11.4-14.0%), 26.1% (141/539) reported a previous mental health diagnosis. 15.9% (83/523) of respondents screened positive for current depression, 18.4% (98/533) for anxiety, 11.0% (56/510) for alcohol use disorder, and 17.3% (36/208) for PTSD. Medical error was associated with depression (30.7% vs. 13.3%, P<0.001), anxiety (31.6% vs. 16.2%, P=0.001), PTSD (12.8% vs. 5.6%, P=0.018), and hazardous alcohol consumption (18.7% vs. 9.7%, P=0.022). 13.2% (73/551) of respondents reported suicidal ideation in the past year and 9.6% (51/533) in the past two weeks. On adjusted analysis, a previous history of a mental health disorder (aOR: 1.97, 95% CI: 1.04-3.65, P=0.033), and screening positive for depression (aOR: 4.30, 95% CI: 2.21-8.29, P<0.001) or PTSD (aOR: 3.93, 95% CI: 1.61-9.44, P=0.002) were associated with increased odds of suicidal ideation over the past 12 months.nnCONCLUSIONS: Nearly 1 in 7 respondents reported suicidal ideation in the past year. Mental illness and suicidal ideation are significant problems among the surgical workforce in the US.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: To characterize the current state of mental health within the surgical workforce in the United States (US).nnSUMMARY BACKGROUND DATA: Mental illness and suicide is a growing concern in the medical community; however, the current state is largely unknown.nnMETHODS: Cross-sectional survey of the academic surgery community assessing mental health, medical error, and suicidal ideation. The odds of suicidal ideation adjusting for sex, prior mental health diagnosis, and validated scales screening for depression, anxiety, post-traumatic stress disorder (PTSD), and alcohol use disorder were assessed.nnRESULTS: Of 622 participating medical students, trainees, and surgeons (estimated response rate=11.4-14.0%), 26.1% (141/539) reported a previous mental health diagnosis. 15.9% (83/523) of respondents screened positive for current depression, 18.4% (98/533) for anxiety, 11.0% (56/510) for alcohol use disorder, and 17.3% (36/208) for PTSD. Medical error was associated with depression (30.7% vs. 13.3%, P<0.001), anxiety (31.6% vs. 16.2%, P=0.001), PTSD (12.8% vs. 5.6%, P=0.018), and hazardous alcohol consumption (18.7% vs. 9.7%, P=0.022). 13.2% (73/551) of respondents reported suicidal ideation in the past year and 9.6% (51/533) in the past two weeks. On adjusted analysis, a previous history of a mental health disorder (aOR: 1.97, 95% CI: 1.04-3.65, P=0.033), and screening positive for depression (aOR: 4.30, 95% CI: 2.21-8.29, P<0.001) or PTSD (aOR: 3.93, 95% CI: 1.61-9.44, P=0.002) were associated with increased odds of suicidal ideation over the past 12 months.nnCONCLUSIONS: Nearly 1 in 7 respondents reported suicidal ideation in the past year. Mental illness and suicidal ideation are significant problems among the surgical workforce in the US.
Hughes, Tasha M; Collins, Reagan A; Cunningham, Carrie E
Depression and Suicide Among American Surgeons-A Grave Threat to the Surgeon Workforce Journal Article
In: JAMA Surg, 2023, ISSN: 2168-6262.
@article{pmid37792380,
title = {Depression and Suicide Among American Surgeons-A Grave Threat to the Surgeon Workforce},
author = {Tasha M Hughes and Reagan A Collins and Carrie E Cunningham},
doi = {10.1001/jamasurg.2023.4658},
issn = {2168-6262},
year = {2023},
date = {2023-10-01},
journal = {JAMA Surg},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Alzumaili, Bayan A; Krumeich, Lauren N; Collins, Reagan; Kravchenko, Timothy; Ababneh, Emad I; Fisch, Adam S; Faquin, William C; Nosé, Vania; Martinez-Lage, Maria; Randolph, Gregory W; Gartland, Rajshri M; Lubitz, Carrie C; Sadow, Peter M
A Comprehensive Study on the Diagnosis and Management of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features Journal Article
In: Thyroid, vol. 33, no. 5, pp. 566–577, 2023, ISSN: 1557-9077.
@article{pmid36960710,
title = {A Comprehensive Study on the Diagnosis and Management of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features},
author = {Bayan A Alzumaili and Lauren N Krumeich and Reagan Collins and Timothy Kravchenko and Emad I Ababneh and Adam S Fisch and William C Faquin and Vania Nos\'{e} and Maria Martinez-Lage and Gregory W Randolph and Rajshri M Gartland and Carrie C Lubitz and Peter M Sadow},
doi = {10.1089/thy.2023.0035},
issn = {1557-9077},
year = {2023},
date = {2023-05-01},
journal = {Thyroid},
volume = {33},
number = {5},
pages = {566--577},
abstract = { Since the noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTPs) was introduced in 2016, most retrospective studies have included cases diagnosed as encapsulated follicular variant of papillary thyroid carcinoma. We investigate a cohort diagnosed with NIFTP at resection. Retrospective institutional cohort of NIFTP from 2016 to 2022, including clinical, cytological, and molecular data for 319 cases (6.6% of thyroid surgeries, 183 cases as NIFTP-only). The patient cohort had unifocal or multifocal thyroid nodules. Female:male ratio was 2.7:1, mean age was 52 years and median NIFTP size was 2.1 cm. NIFTP was associated with multiple nodules in 23% patients ( = 73) and 12% of NIFTP were multifocal ( = 39). Fine needle aspiration (FNA) of NIFTP ( = 255) were designated as nondiagnostic = 5%, benign = 13%, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) = 49%, follicular neoplasm/suspicious for follicular neoplasm (FN/SFN) = 17%, suspicious for malignancy = 12%, or malignant = 4%. Molecular alterations were identified in 93% ( = 114), or -like. Thyroid Imaging Reporting and Data System (TI-RADS) score 4 was recorded in 50% of NIFTP, followed by scores 3 and 5 (26% and 20%, respectively). We also investigated the factors associated with extent of surgery. In our NIFTP-only group ( = 183), 66% were identified after hemithyroidectomy (HT) and 34% after total thyroidectomy (TT). On univariate analysis, TT patients demonstrated higher Bethesda category by FNA, more often had aberrant preoperative thyroid function, and/or underwent an FNA of additional nodule(s). With multivariable regression, Bethesda V NIFTP, in the presence of other nodules being evaluated by FNA and aberrant preoperative thyroid function, independently predicts TT. Bethesda II NIFTP correlated significantly with HT. Fifty-two patients (28%) with NIFTP-only had at least one postoperative surveillance ultrasound. In the NIFTP-only cohort, no HT patients had completion thyroidectomy or received postoperative radioactive iodine. No recurrence or metastases were recorded with median follow-up of 35 months (6-76 months; = 120). Given this large cohort of NIFTP, including a large subset of isolated NIFTP-only, some with >6 years of follow-up and no tumor recurrences, consensus practical guidelines are needed for adequate postoperative management. Given the American Thyroid Association (ATA) provides guidelines for management of low-risk malignancies, guidance regarding that for borderline/biologically uncertain tumors, including NIFTP, is a reasonable next step.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Since the noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTPs) was introduced in 2016, most retrospective studies have included cases diagnosed as encapsulated follicular variant of papillary thyroid carcinoma. We investigate a cohort diagnosed with NIFTP at resection. Retrospective institutional cohort of NIFTP from 2016 to 2022, including clinical, cytological, and molecular data for 319 cases (6.6% of thyroid surgeries, 183 cases as NIFTP-only). The patient cohort had unifocal or multifocal thyroid nodules. Female:male ratio was 2.7:1, mean age was 52 years and median NIFTP size was 2.1 cm. NIFTP was associated with multiple nodules in 23% patients ( = 73) and 12% of NIFTP were multifocal ( = 39). Fine needle aspiration (FNA) of NIFTP ( = 255) were designated as nondiagnostic = 5%, benign = 13%, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) = 49%, follicular neoplasm/suspicious for follicular neoplasm (FN/SFN) = 17%, suspicious for malignancy = 12%, or malignant = 4%. Molecular alterations were identified in 93% ( = 114), or -like. Thyroid Imaging Reporting and Data System (TI-RADS) score 4 was recorded in 50% of NIFTP, followed by scores 3 and 5 (26% and 20%, respectively). We also investigated the factors associated with extent of surgery. In our NIFTP-only group ( = 183), 66% were identified after hemithyroidectomy (HT) and 34% after total thyroidectomy (TT). On univariate analysis, TT patients demonstrated higher Bethesda category by FNA, more often had aberrant preoperative thyroid function, and/or underwent an FNA of additional nodule(s). With multivariable regression, Bethesda V NIFTP, in the presence of other nodules being evaluated by FNA and aberrant preoperative thyroid function, independently predicts TT. Bethesda II NIFTP correlated significantly with HT. Fifty-two patients (28%) with NIFTP-only had at least one postoperative surveillance ultrasound. In the NIFTP-only cohort, no HT patients had completion thyroidectomy or received postoperative radioactive iodine. No recurrence or metastases were recorded with median follow-up of 35 months (6-76 months; = 120). Given this large cohort of NIFTP, including a large subset of isolated NIFTP-only, some with >6 years of follow-up and no tumor recurrences, consensus practical guidelines are needed for adequate postoperative management. Given the American Thyroid Association (ATA) provides guidelines for management of low-risk malignancies, guidance regarding that for borderline/biologically uncertain tumors, including NIFTP, is a reasonable next step.
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.
DiGennaro, Catherine; Vahdat, Vahab; Jalali, Mohammad; Toumi, Asmae; Watson, Tina; Gazelle, G Scott; Mercaldo, Nathaniel; Lubitz, Carrie C
In: Thyroid, vol. 32, iss. 10, pp. 1144-1157, 2022, ISSN: 1557-9077.
@article{pmid35999710,
title = {Assessing Bias and Limitations of Clinical Validation Studies of Molecular Diagnostic Tests for Indeterminate Thyroid Nodules: Systematic Review and Meta-Analysis},
author = {Catherine DiGennaro and Vahab Vahdat and Mohammad Jalali and Asmae Toumi and Tina Watson and G Scott Gazelle and Nathaniel Mercaldo and Carrie C Lubitz},
doi = {10.1089/thy.2022.0269},
issn = {1557-9077},
year = {2022},
date = {2022-10-01},
urldate = {2022-09-26},
journal = {Thyroid},
volume = {32},
issue = {10},
pages = {1144-1157},
abstract = {BACKGROUND: Molecular tests for thyroid nodules with indeterminate fine needle aspiration results are increasingly used in clinical practice; however, true diagnostic summaries of these tests are unknown. A systematic review and meta-analysis were completed to (1) evaluate the accuracy of commercially available molecular tests for malignancy in indeterminate thyroid nodules and (2) quantify biases and limitations in studies which validate those tests.
METHODS: PubMed, EMBASE, and Web of Science were systematically searched through July 2021. English language articles that reported original clinical validation attempts of molecular tests for indeterminate thyroid nodules were included if they reported counts of true negative, true positive, false negative, and false positive results. We performed screening and full text review, followed by assessment of eight common biases and limitations, extraction of diagnostic and histopathological information, and meta-analysis of clinical validity using a bivariate linear mixed-effects model.
RESULTS: 49 studies were included. Meta-analysis of Afirma GEC (n=38 studies) revealed a sensitivity of 0.92 (95% CI: 0.90-0.94), specificity of 0.26 (0.20-0.32), negative likelihood ratio (LR-) of 0.32 (0.23-0.44), positive likelihood ratio (LR+) of 1.24 (1.15-1.35), and AUC of 0.83 (0.74-0.89). Afirma GSC (n=10) had a sensitivity of 0.94 (0.89-0.96), specificity of 0.38 (0.27-0.50), LR- of 0.18 (0.10-0.30), LR+ of 1.52 (1.28-1.87), and AUC of 0.91 (0.62-0.92). ThyroSeq v1 and v2 (n=10) had a sensitivity of 0.86 (0.82-0.90), specificity of 0.74 (0.59-0.85), LR- of 0.19 (0.13-0.26), LR+ of 3.52 (2.08-5.92), and AUC of 0.86 (0.81-0.90). ThyroSeq v3 (n=6) had a sensitivity of 0.92 (0.86-0.95), specificity of 0.41 (0.18-0.69), LR- of 0.24 (0.09-0.62), LR+ of 1.67 (1.09-2.98), and AUC of 0.90 (0.63-0.92). 14% of studies conducted blinded histopathologic review of excised thyroid nodules, and 8% made the decision to go to surgery blind to molecular test results.
CONCLUSIONS: Meta-analyses reveal high diagnostic accuracy of molecular tests for thyroid nodule assessment of malignancy risk; however, these studies are subject to several limitations. Limitations and their potential clinical impacts must be addressed and, when feasible, adjusted for using valid statistical methodologies.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Molecular tests for thyroid nodules with indeterminate fine needle aspiration results are increasingly used in clinical practice; however, true diagnostic summaries of these tests are unknown. A systematic review and meta-analysis were completed to (1) evaluate the accuracy of commercially available molecular tests for malignancy in indeterminate thyroid nodules and (2) quantify biases and limitations in studies which validate those tests.
METHODS: PubMed, EMBASE, and Web of Science were systematically searched through July 2021. English language articles that reported original clinical validation attempts of molecular tests for indeterminate thyroid nodules were included if they reported counts of true negative, true positive, false negative, and false positive results. We performed screening and full text review, followed by assessment of eight common biases and limitations, extraction of diagnostic and histopathological information, and meta-analysis of clinical validity using a bivariate linear mixed-effects model.
RESULTS: 49 studies were included. Meta-analysis of Afirma GEC (n=38 studies) revealed a sensitivity of 0.92 (95% CI: 0.90-0.94), specificity of 0.26 (0.20-0.32), negative likelihood ratio (LR-) of 0.32 (0.23-0.44), positive likelihood ratio (LR+) of 1.24 (1.15-1.35), and AUC of 0.83 (0.74-0.89). Afirma GSC (n=10) had a sensitivity of 0.94 (0.89-0.96), specificity of 0.38 (0.27-0.50), LR- of 0.18 (0.10-0.30), LR+ of 1.52 (1.28-1.87), and AUC of 0.91 (0.62-0.92). ThyroSeq v1 and v2 (n=10) had a sensitivity of 0.86 (0.82-0.90), specificity of 0.74 (0.59-0.85), LR- of 0.19 (0.13-0.26), LR+ of 3.52 (2.08-5.92), and AUC of 0.86 (0.81-0.90). ThyroSeq v3 (n=6) had a sensitivity of 0.92 (0.86-0.95), specificity of 0.41 (0.18-0.69), LR- of 0.24 (0.09-0.62), LR+ of 1.67 (1.09-2.98), and AUC of 0.90 (0.63-0.92). 14% of studies conducted blinded histopathologic review of excised thyroid nodules, and 8% made the decision to go to surgery blind to molecular test results.
CONCLUSIONS: Meta-analyses reveal high diagnostic accuracy of molecular tests for thyroid nodule assessment of malignancy risk; however, these studies are subject to several limitations. Limitations and their potential clinical impacts must be addressed and, when feasible, adjusted for using valid statistical methodologies.
METHODS: PubMed, EMBASE, and Web of Science were systematically searched through July 2021. English language articles that reported original clinical validation attempts of molecular tests for indeterminate thyroid nodules were included if they reported counts of true negative, true positive, false negative, and false positive results. We performed screening and full text review, followed by assessment of eight common biases and limitations, extraction of diagnostic and histopathological information, and meta-analysis of clinical validity using a bivariate linear mixed-effects model.
RESULTS: 49 studies were included. Meta-analysis of Afirma GEC (n=38 studies) revealed a sensitivity of 0.92 (95% CI: 0.90-0.94), specificity of 0.26 (0.20-0.32), negative likelihood ratio (LR-) of 0.32 (0.23-0.44), positive likelihood ratio (LR+) of 1.24 (1.15-1.35), and AUC of 0.83 (0.74-0.89). Afirma GSC (n=10) had a sensitivity of 0.94 (0.89-0.96), specificity of 0.38 (0.27-0.50), LR- of 0.18 (0.10-0.30), LR+ of 1.52 (1.28-1.87), and AUC of 0.91 (0.62-0.92). ThyroSeq v1 and v2 (n=10) had a sensitivity of 0.86 (0.82-0.90), specificity of 0.74 (0.59-0.85), LR- of 0.19 (0.13-0.26), LR+ of 3.52 (2.08-5.92), and AUC of 0.86 (0.81-0.90). ThyroSeq v3 (n=6) had a sensitivity of 0.92 (0.86-0.95), specificity of 0.41 (0.18-0.69), LR- of 0.24 (0.09-0.62), LR+ of 1.67 (1.09-2.98), and AUC of 0.90 (0.63-0.92). 14% of studies conducted blinded histopathologic review of excised thyroid nodules, and 8% made the decision to go to surgery blind to molecular test results.
CONCLUSIONS: Meta-analyses reveal high diagnostic accuracy of molecular tests for thyroid nodule assessment of malignancy risk; however, these studies are subject to several limitations. Limitations and their potential clinical impacts must be addressed and, when feasible, adjusted for using valid statistical methodologies.
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
Krumeich, Lauren N; 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; Wang, Tracy S; Solórzano, Carmen C; Lubitz, Carrie C; Wachtel, Heather
Survival After Adrenalectomy for Metastatic Lung Cancer Journal Article
In: Ann Surg Oncol, vol. 29, iss. 4, pp. 2571-2579, 2022, ISSN: 1534-4681.
@article{pmid34989938,
title = {Survival After Adrenalectomy for Metastatic Lung Cancer},
author = {Lauren N Krumeich 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 Tracy S Wang and Carmen C Sol\'{o}rzano and Carrie C Lubitz and Heather Wachtel},
doi = {10.1245/s10434-021-11192-7},
issn = {1534-4681},
year = {2022},
date = {2022-04-01},
urldate = {2022-01-01},
journal = {Ann Surg Oncol},
volume = {29},
issue = {4},
pages = {2571-2579},
abstract = {BACKGROUND: Adrenal metastasectomy is associated with increased survival in non-small cell lung cancer (NSCLC) with isolated adrenal metastases. Although clinical use of adrenal metastasectomy has expanded, indications remain poorly defined. The aim of this study was to evaluate the clinical benefit of adrenal metastasectomy for all lung cancer subtypes.
PATIENTS AND METHODS: We performed a retrospective cohort study of patients who underwent adrenal metastasectomy for metastatic lung cancer at six institutions between 2001 and 2015. The primary outcomes were disease-free survival (DFS) and overall survival (OS). Cox proportional hazards regressions and Kaplan-Meier survival analysis were performed.
RESULTS: For 122 patients, the mean age was 60.5 years and 49.2% were female. Median time to detection of the metastasis was 11 months, and 41.8% were ipsilateral to the primary lung cancer. Median DFS was 40 months (1 year: 64.8%; 5 year: 42.9%). Factors associated with longer DFS included primary tumor resection [hazard ratio (HR): 0.001; p = 0.005], longer time to adrenal metastasis (HR: 0.94; p = 0.005), and ipsilateral metastases (HR: 0.13; p = 0.004). Shorter DFS corresponded with older age (HR: 1.11; p = 0.01), R1 resection (HR: 8.94; p = 0.01), adjuvant radiation (HR: 9.45; p = 0.02), and open adrenal metastasectomy (HR: 10.0; p = 0.03). Median OS was 47 months (1 year: 80.2%; 5 year: 35.2%). Longer OS was associated with ipsilateral metastasis (HR: 0.55; p = 0.02) and adjuvant chemotherapy (HR: 0.35; p = 0.02). Shorter OS was associated with extra-adrenal metastases at adrenalectomy (HR: 3.52; p = 0.007), small cell histology (HR: 15.0; p = 0.04), and lung radiation (HR: 3.37; p = 0.002).
DISCUSSION: Durable survival was observed in patients undergoing adrenal metastasectomy and should be considered for isolated adrenal metastases of NSCLC. Small cell histology and extra-adrenal metastases are relative contraindications to adrenal metastasectomy.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Adrenal metastasectomy is associated with increased survival in non-small cell lung cancer (NSCLC) with isolated adrenal metastases. Although clinical use of adrenal metastasectomy has expanded, indications remain poorly defined. The aim of this study was to evaluate the clinical benefit of adrenal metastasectomy for all lung cancer subtypes.
PATIENTS AND METHODS: We performed a retrospective cohort study of patients who underwent adrenal metastasectomy for metastatic lung cancer at six institutions between 2001 and 2015. The primary outcomes were disease-free survival (DFS) and overall survival (OS). Cox proportional hazards regressions and Kaplan-Meier survival analysis were performed.
RESULTS: For 122 patients, the mean age was 60.5 years and 49.2% were female. Median time to detection of the metastasis was 11 months, and 41.8% were ipsilateral to the primary lung cancer. Median DFS was 40 months (1 year: 64.8%; 5 year: 42.9%). Factors associated with longer DFS included primary tumor resection [hazard ratio (HR): 0.001; p = 0.005], longer time to adrenal metastasis (HR: 0.94; p = 0.005), and ipsilateral metastases (HR: 0.13; p = 0.004). Shorter DFS corresponded with older age (HR: 1.11; p = 0.01), R1 resection (HR: 8.94; p = 0.01), adjuvant radiation (HR: 9.45; p = 0.02), and open adrenal metastasectomy (HR: 10.0; p = 0.03). Median OS was 47 months (1 year: 80.2%; 5 year: 35.2%). Longer OS was associated with ipsilateral metastasis (HR: 0.55; p = 0.02) and adjuvant chemotherapy (HR: 0.35; p = 0.02). Shorter OS was associated with extra-adrenal metastases at adrenalectomy (HR: 3.52; p = 0.007), small cell histology (HR: 15.0; p = 0.04), and lung radiation (HR: 3.37; p = 0.002).
DISCUSSION: Durable survival was observed in patients undergoing adrenal metastasectomy and should be considered for isolated adrenal metastases of NSCLC. Small cell histology and extra-adrenal metastases are relative contraindications to adrenal metastasectomy.
PATIENTS AND METHODS: We performed a retrospective cohort study of patients who underwent adrenal metastasectomy for metastatic lung cancer at six institutions between 2001 and 2015. The primary outcomes were disease-free survival (DFS) and overall survival (OS). Cox proportional hazards regressions and Kaplan-Meier survival analysis were performed.
RESULTS: For 122 patients, the mean age was 60.5 years and 49.2% were female. Median time to detection of the metastasis was 11 months, and 41.8% were ipsilateral to the primary lung cancer. Median DFS was 40 months (1 year: 64.8%; 5 year: 42.9%). Factors associated with longer DFS included primary tumor resection [hazard ratio (HR): 0.001; p = 0.005], longer time to adrenal metastasis (HR: 0.94; p = 0.005), and ipsilateral metastases (HR: 0.13; p = 0.004). Shorter DFS corresponded with older age (HR: 1.11; p = 0.01), R1 resection (HR: 8.94; p = 0.01), adjuvant radiation (HR: 9.45; p = 0.02), and open adrenal metastasectomy (HR: 10.0; p = 0.03). Median OS was 47 months (1 year: 80.2%; 5 year: 35.2%). Longer OS was associated with ipsilateral metastasis (HR: 0.55; p = 0.02) and adjuvant chemotherapy (HR: 0.35; p = 0.02). Shorter OS was associated with extra-adrenal metastases at adrenalectomy (HR: 3.52; p = 0.007), small cell histology (HR: 15.0; p = 0.04), and lung radiation (HR: 3.37; p = 0.002).
DISCUSSION: Durable survival was observed in patients undergoing adrenal metastasectomy and should be considered for isolated adrenal metastases of NSCLC. Small cell histology and extra-adrenal metastases are relative contraindications to adrenal metastasectomy.
Krumeich, Lauren N; 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; Wang, Tracy S; Solórzano, Carmen C; Lubitz, Carrie C; Wachtel, Heather
ASO Visual Abstract: Survival After Adrenalectomy for Metastatic Lung Cancer Journal Article
In: Ann Surg Oncol, vol. 29, iss. 4, pp. 2580-2581, 2022, ISSN: 1534-4681.
@article{pmid35094187,
title = {ASO Visual Abstract: Survival After Adrenalectomy for Metastatic Lung Cancer},
author = {Lauren N Krumeich 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 Tracy S Wang and Carmen C Sol\'{o}rzano and Carrie C Lubitz and Heather Wachtel},
url = {https://pubmed.ncbi.nlm.nih.gov/35094187/},
doi = {10.1245/s10434-021-11282-6},
issn = {1534-4681},
year = {2022},
date = {2022-04-01},
urldate = {2022-01-01},
journal = {Ann Surg Oncol},
volume = {29},
issue = {4},
pages = {2580-2581},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
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