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Gruszczynski NR, Hasan SS, Brennan AG, De La Chapa J, Reddy AS, Martin DN, Batchala PP, Stelow EB, Dowling EM, Fedder KL, Garneau JC, Shonka DC. Oncocytic carcinoma of the thyroid: Conclusions from a 20-year patient cohort. Head Neck 2024. [PMID: 38390640 DOI: 10.1002/hed.27700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 02/04/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Oncocytic carcinoma (OCA) was recently reclassified as a distinct differentiated thyroid carcinoma (DTC). Given its rarity, OCA studies are limited. This study describes the characteristics of OCA in a 20-year cohort. METHODS Retrospective analysis of patients with OCA at a single tertiary care hospital from 2000 to 2021. RESULTS Fifty-one OCA patients (22M:29F) were identified. The mean age at diagnosis was 60.3 years; 90% presented as palpable mass; 24% had a family history of thyroid cancer. None had vocal fold paresis. On ultrasound, most tumors were solid and hypoechoic. FNA (n = 14) showed Bethesda-4 lesions in 93%. All were treated surgically. Histologically, 63% demonstrated angioinvasion, 35% had lymphovascular invasion, and 15% had extrathyroidal extension. Radioactive iodine was used as adjunct therapy in 77%. CONCLUSION OCA has distinct features that distinguish it from other DTCs, and additional focused studies will help clarify the aggressive nature, treatment options, and prognosis of the disease.
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Affiliation(s)
- Nelson R Gruszczynski
- Department of Otolaryngology - Head & Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Shahzeb S Hasan
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Ana G Brennan
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Julian De La Chapa
- Department of Otolaryngology - Head & Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Adithya S Reddy
- Department of Otolaryngology - Head & Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - David N Martin
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Prem P Batchala
- Department of Radiology and Medicine Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Edward B Stelow
- Department of Pathology, University of Virginia, Charlottesville, Virginia, USA
| | - Eric M Dowling
- Department of Otolaryngology - Head & Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Katherine L Fedder
- Department of Otolaryngology - Head & Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Jonathan C Garneau
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - David C Shonka
- Department of Otolaryngology - Head & Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
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McGarey PO, Hamdi O, Donaldson L, Zhan K, Crandley EF, Wilson DD, Sim AJ, Read PW, Garneau JC, Fedder KL, Shonka DC, Jameson MJ. Diagnostic Delay in HPV-Related Oropharyngeal Squamous Cell Carcinoma. Int Arch Otorhinolaryngol 2024; 28:e42-e49. [PMID: 38322446 PMCID: PMC10843923 DOI: 10.1055/s-0043-1767795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 10/09/2022] [Indexed: 02/08/2024] Open
Abstract
Introduction Human papillomavirus-related (HPV + ) oropharyngeal squamous cell carcinoma (OPSCC) is increasing in incidence and presents diagnostic challenges given its unique clinical presentation. Objective The purpose of the present study is to characterize the impact of the unique clinical presentation of HPV-related OPSCC on delays in diagnosis. Methods Retrospective review of presenting symptoms and clinical characteristics of 284 patients with OPSCC treated from 2002-2014. Delay in diagnosis was defined as the presence of any of the following: multiple non-diagnostic fine needle aspirate (FNA) biopsies; two or more courses of antibiotic therapy; surgery with incorrect preoperative diagnosis; evaluation by an otolaryngologist without further workup; or surgery without definitive postoperative diagnosis. Results p16+ tumors demonstrated a distinct clinical presentation that more commonly involved a neck mass (85.1% versus 57.3% of p16-; p < 0.001) and less frequently included odynophagia (24.6% versus 51.7% of p16-; p < 0.001). Patients who experienced diagnostic delay were more likely to have p16+ tumors (77.7% delayed versus 62.8% not delayed; p = 0.006). p16+ primary tumors were more likely to be undetectable by physical examination of the head and neck including flexible laryngoscopy (19.0% versus 6.7% of p16-; p = 0.007) and more frequently associated with nondiagnostic FNA biopsies of a cervical nodal mass (11.8% versus 3.4% of p16-, p = 0.03). Conclusions Compared with non-HPV related OPSCC, the unique clinical presentation and characteristics of HPV+ OPSCC are associated with an increased incidence of diagnostic delay. Targeted education of appropriate care providers may improve time to diagnosis and treatment.
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Affiliation(s)
- Patrick O. McGarey
- Division of Head and Neck Oncologic and Microvascular Surgery, Department of Otolaryngology, Head and Neck Surgery, University of Virginia, Charlottesville, VA, United States
| | - Osama Hamdi
- Division of Head and Neck Oncologic and Microvascular Surgery, Department of Otolaryngology, Head and Neck Surgery, University of Virginia, Charlottesville, VA, United States
| | - Lane Donaldson
- Division of Head and Neck Oncologic and Microvascular Surgery, Department of Otolaryngology, Head and Neck Surgery, University of Virginia, Charlottesville, VA, United States
| | - Kevin Zhan
- Division of Head and Neck Oncologic and Microvascular Surgery, Department of Otolaryngology, Head and Neck Surgery, University of Virginia, Charlottesville, VA, United States
| | - Edwin F. Crandley
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, United States
| | - David D. Wilson
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, United States
| | - Austin J. Sim
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, United States
| | - Paul W. Read
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, United States
| | - Jonathan C. Garneau
- Division of Head and Neck Oncologic and Microvascular Surgery, Department of Otolaryngology, Head and Neck Surgery, University of Virginia, Charlottesville, VA, United States
| | - Katherine L. Fedder
- Division of Head and Neck Oncologic and Microvascular Surgery, Department of Otolaryngology, Head and Neck Surgery, University of Virginia, Charlottesville, VA, United States
| | - David C. Shonka
- Division of Head and Neck Oncologic and Microvascular Surgery, Department of Otolaryngology, Head and Neck Surgery, University of Virginia, Charlottesville, VA, United States
| | - Mark J. Jameson
- Division of Head and Neck Oncologic and Microvascular Surgery, Department of Otolaryngology, Head and Neck Surgery, University of Virginia, Charlottesville, VA, United States
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Hamdi OA, Dougherty MI, Rasamny JJ, Greyson MA, Christophel JJ, Shonka DC, Fedder KL, Jameson MJ, Garneau JC. The Clinical Utility and Cost of Routine Staging Exam under Anesthesia for Oral Cavity Squamous Cell Carcinoma. ORL J Otorhinolaryngol Relat Spec 2022; 85:72-79. [PMID: 36513031 DOI: 10.1159/000526283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 07/13/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The standard complete evaluation of patients with head and neck squamous cell carcinoma (HNSCC) has included a staging exam under anesthesia (EUA) since the 1970s. The EUA for all sites of HNSCC has historically consisted of panendoscopy for the purpose of diagnostic biopsy, accurate staging of primary disease, and identification of second primary tumors. However, due to the accessibility of the oral cavity, the sole purpose of EUA for tumors of this site is to identify second primary tumors. Since the EUA became the gold standard for evaluation of HNSCC, there have been significant advancements in less invasive technologies such as CT, PET-CT, MRI, and fiberoptic examination. In this study, we sought to determine the value to patient care and cost-effectiveness of EUA in patients with oral cavity squamous cell carcinoma (OCSCC). METHODS A retrospective chart review identified 77 patients who underwent EUA for OCSCC. RESULTS The most common subsites were the oral tongue and floor of mouth (59.7% and 24.7% respectively). All underwent direct laryngoscopy, 94.8% underwent esophagoscopy, and 20.8% underwent flexible transnasal examination in clinic prior to EUA. For 90.9% of patients, the EUA did not change initial T-staging based on clinical examination and imaging. The remaining 9.1% of patients were upstaged after EUA, however this change did not impact the treatment plan. Second primary tumors were identified in 3.9% of patients, all were found in either the oral cavity or oropharynx, and were also identified with clinical examination or imaging. Analysis of patient charges determined an average cost of $8,022.93 per patient under the current paradigm involving EUA, however with a new algorithm eliminating mandatory EUA average cost decreases to $1,448.44. CONCLUSION Formal EUA has historically been the gold standard for all HNSCC tumors. However, when performed for cases of oral cavity carcinoma, it is safe and cost effective to limit its use to select clinical scenarios.
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Affiliation(s)
- Osama A Hamdi
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA,
| | - Michael I Dougherty
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jk J Rasamny
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Mark A Greyson
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - John J Christophel
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - David C Shonka
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Katherine L Fedder
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Mark J Jameson
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jonathan C Garneau
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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Reed R, Strumpf A, Martz TG, Kavanagh KJ, Fedder KL, Jameson MJ, Shonka DC. 2015 American Thyroid Association guidelines and thyroid-stimulating hormone suppression after thyroid lobectomy. Head Neck 2020; 43:639-644. [PMID: 33124116 DOI: 10.1002/hed.26524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 07/14/2020] [Accepted: 10/15/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND 2015 American Thyroid Association (ATA) guidelines recommended more conservative treatment in low-risk well-differentiated thyroid cancer (WDTC), stating that lobectomy alone may be sufficient. The guidelines further recommend mild thyroid-stimulating hormone (TSH) level suppression (0.5-2 mU/L) for this population. Our goal is to evaluate the natural history of patients undergoing lobectomy to determine the percentage that would require postoperative levothyroxine supplementation under these guidelines. METHODS Retrospective chart review of 168 patients that underwent lobectomy between 2010 and 2019 was performed. Preoperative and postoperative TSH values and the rate of patients prescribed levothyroxine were analyzed. RESULTS Thirty-five percent of patients were prescribed levothyroxine postoperatively. At 6 weeks postoperatively, 66% had TSH value of >2; this increased to 76% by 6 to 12 months. CONCLUSION To adhere to ATA guidelines for WDTC managed with lobectomy alone, the majority of patients (76%) would require postoperative levothyroxine supplementation. Low preoperative TSH was found to be the most significant predictor for postoperative TSH < 2.
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Affiliation(s)
- Robert Reed
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Andrew Strumpf
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Teresa G Martz
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Kaitlin J Kavanagh
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Katherine L Fedder
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Mark J Jameson
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - David C Shonka
- Department of Otolaryngology - Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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Dougherty MI, Dougherty W, Kain JJ, Hughley BB, Shonka DC, Fedder KL, Jameson MJ. Non-HPV-Related Head and Neck Squamous Cell Carcinoma in a Young Patient Cohort. Ear Nose Throat J 2020; 100:1101S-1106S. [PMID: 32584613 DOI: 10.1177/0145561320935839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Head and neck squamous cell carcinoma (HNSCC) is rare in patients younger than 40 years. Many practitioners suspect HNSCC is a more aggressive disease in this age group, and perhaps increasing in incidence; however, there are scant and conflicting data to support this assertion. We sought to compare outcomes for young patients with non-human papillomavirus (HPV)-related HNSCC to those of older patients. METHODS A retrospective chart review of patients with HNSCC treated from 2004 to 2016 at 2 tertiary referral centers. Patients aged 18 to 40 with p16-negative HNSCC were included in the young patient cohort (n = 59). A randomly selected stage- and subsite-matched cohort aged 55 to 65 was analyzed for comparison (n = 114). RESULTS When considering all patients with HNSCC, patients younger than 40 were more likely to have oral tongue cancer (62.7%) compared to patients age 55 to 65 (16.9%). When an older patient cohort was stage- and subsite-matched to the young patient cohort, there were more never smokers (49.2% vs 17.5% of older patients, P < .01) and females (40.7% vs 24.6% of older patients, P = .028) in the young patient group. The young patient cohort had better average overall survival than the older group (14.4 vs 8.1 years, respectively, P = .02), but similar average disease-free survival (6.2 years vs 6.6 years, respectively, P = .67); 50.9% of young patients had tumors with adverse histologic features versus 42.0% of older patients (P = .28). The young patients demonstrated a superior average conditional survival after recurrence (9.8 years vs 3.2 years for older patients, P < .01). CONCLUSIONS Despite the limitations of study design, these data suggest that young patients who develop non-HPV-related HNSCC tend to have similarly aggressive disease, but longer overall survival and better survival after recurrence. These findings may be attributable to better overall health as evidenced by fewer comorbidities.
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Affiliation(s)
- Michael I Dougherty
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - William Dougherty
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Joshua J Kain
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brian B Hughley
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David C Shonka
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Katherine L Fedder
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Mark J Jameson
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA, USA
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