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; 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.