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Wang D, Chazen JL, Kutler DI, Tassler AB, Phillips CD, Strauss SB. Paramaxillary CT-guided fine needle aspiration of head and neck lesions: technique, diagnostic yield, and safety profile. Neuroradiology 2022; 64:2207-2211. [PMID: 35969251 DOI: 10.1007/s00234-022-03037-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/04/2022] [Indexed: 10/15/2022]
Abstract
Computed tomography (CT)-guided percutaneous biopsy of deep-seated head and neck lesions can be a less invasive and equally effective alternative to surgical techniques. There are multiple approaches for needle biopsy that target varying spaces within the head and neck while successfully avoiding critical anatomy. In the paramaxillary approach, the needle is advanced through the infrazygomatic buccal space, in between the maxilla and mandible. In this study, we examine the safety and diagnostic yield of FNA without core needle biopsy performed via the paramaxillary approach in 19 patients yielding 20 fine needle aspirates between 2014 and 2022. Of the fine needle aspirates, 85.0% (17/20) were diagnostic. Concordant histopathologic diagnosis was obtained in 100% (17/17) diagnostic fine needle aspirates. There were no postprocedural complications.
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Affiliation(s)
- Daiqi Wang
- Department of Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, 1300 York Ave, New York, NY, 10021, USA.
| | - J Levi Chazen
- Department of Radiology, Hospital for Special Surgery, New York, NY, USA
| | - David I Kutler
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Andrew B Tassler
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - C Douglas Phillips
- Department of Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, 1300 York Ave, New York, NY, 10021, USA
| | - Sara B Strauss
- Department of Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, 1300 York Ave, New York, NY, 10021, USA
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2
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Long SM, Chern A, Cooley V, Chung S, Feit NZ, Craney A, Simon MS, Tassler AB. Temporal Dynamics of Nasopharyngeal and Tracheal SARS-CoV-2 Cycle Thresholds in COVID-19 Patients with Tracheostomy. Clin Infect Dis 2022; 75:1649-1651. [PMID: 35442449 PMCID: PMC9047213 DOI: 10.1093/cid/ciac316] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Indexed: 11/14/2022] Open
Abstract
In this study of 45 patients with COVID-19 undergoing tracheostomy, nasopharyngeal and tracheal cycle threshold (Ct) values were analyzed. Ct values rose to 37.9 by the time of tracheostomy and remained >35 postoperatively, demonstrating that persistent test positivity may not be associated with persistent transmissible virus in this population.
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Affiliation(s)
- Sallie M Long
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College and NewYork-Presbyterian Hospital, New York, New York USA.,Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons and Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York USA
| | - Alexander Chern
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College and NewYork-Presbyterian Hospital, New York, New York USA.,Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons and Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York USA
| | - Victoria Cooley
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, New York USA
| | - Sei Chung
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College and NewYork-Presbyterian Hospital, New York, New York USA.,Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons and Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York USA
| | - Noah Z Feit
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College and NewYork-Presbyterian Hospital, New York, New York USA
| | - Arryn Craney
- Clinical Molecular and Microbiology, Orlando Health Regional Medical Center, Orlando, Florida USA.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York USA
| | - Matthew S Simon
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York USA
| | - Andrew B Tassler
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College and NewYork-Presbyterian Hospital, New York, New York USA
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3
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Long SM, Feit NZ, Chern A, Cooley V, Hill SS, Rajwani K, Schenck EJ, Stiles B, Tassler AB. Percutaneous and Open Tracheostomy in Patients With COVID-19: The Weill Cornell Experience in New York City. Laryngoscope 2021; 131:E2849-E2856. [PMID: 34037983 PMCID: PMC8242792 DOI: 10.1002/lary.29669] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/09/2021] [Accepted: 05/20/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Report long-term tracheostomy outcomes in patients with COVID-19. STUDY DESIGN Review of prospectively collected data. METHODS Prospectively collected data were extracted for adults with COVID-19 undergoing percutaneous or open tracheostomy between April 4, 2020 and June 2, 2020 at a major medical center in New York City. The primary endpoint was weaning from mechanical ventilation. Secondary outcomes included sedation weaning, decannulation, and discharge. RESULTS One hundred one patients underwent tracheostomy, including 48 percutaneous (48%) and 53 open (52%), after a median intubation time of 24 days (IQR 20, 31). The most common complication was minor bleeding (n = 18, 18%). The all-cause mortality rate was 15% and no deaths were attributable to the tracheostomy. Eighty-three patients (82%) were weaned off mechanical ventilation, 88 patients (87%) were weaned off sedation, and 72 patients (71%) were decannulated. Censored median times from tracheostomy to sedation and ventilator weaning were 8 (95% CI 6-11) and 18 (95% CI 14-22) days, respectively (uncensored: 7 and 15 days). Median time from tracheostomy to decannulation was 36 (95% CI 32-47) days (uncensored: 32 days). Of those decannulated, 82% were decannulated during their index admission. There were no differences in outcomes or complication rates between percutaneous and open tracheostomy. Likelihood of discharge from the ICU was inversely related to intubation time, though the clinical relevance of this was small (HR 0.97, 95% CI 0.943-0.998; P = .037). CONCLUSION Tracheostomy by either percutaneous or open technique facilitated sedation and ventilator weaning in patients with COVID-19 after prolonged intubation. Additional study on the optimal timing of tracheostomy in patients with COVID-19 is warranted. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E2849-E2856, 2021.
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Affiliation(s)
- Sallie M. Long
- Department of Otolaryngology—Head and Neck SurgeryNewYork‐Presbyterian Hospital/Weill Cornell MedicineNew YorkNew YorkU.S.A.
| | - Noah Z. Feit
- Weill Cornell Medical CollegeNew YorkNew YorkU.S.A.
| | - Alexander Chern
- Department of Otolaryngology—Head and Neck SurgeryNewYork‐Presbyterian Hospital/Weill Cornell MedicineNew YorkNew YorkU.S.A.
| | - Victoria Cooley
- Division of Biostatistics and EpidemiologyWeill Cornell MedicineNew YorkNew YorkU.S.A.
| | - Shanna S. Hill
- Department of AnesthesiologyNewYork‐Presbyterian Hospital/Weill Cornell MedicineNew YorkNew YorkU.S.A.
| | - Kapil Rajwani
- Division of Pulmonary and Critical Care MedicineNewYork‐Presbyterian Hospital/Weill Cornell MedicineNew YorkNew YorkU.S.A.
| | - Edward J. Schenck
- Division of Pulmonary and Critical Care MedicineNewYork‐Presbyterian Hospital/Weill Cornell MedicineNew YorkNew YorkU.S.A.
| | - Brendon Stiles
- Department of Cardiothoracic SurgeryNewYork‐Presbyterian Hospital/Weill Cornell MedicineNew YorkNew YorkU.S.A.
| | - Andrew B. Tassler
- Department of Otolaryngology—Head and Neck SurgeryNewYork‐Presbyterian Hospital/Weill Cornell MedicineNew YorkNew YorkU.S.A.
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4
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Shomorony A, Chern A, Long SM, Feit NZ, Ballakur SS, Gadjiko M, Liu K, Skaf DA, Tassler AB, Sclafani AP. Essential inpatient otolaryngology: what COVID-19 has revealed. Eur Arch Otorhinolaryngol 2021; 279:1053-1062. [PMID: 34247264 PMCID: PMC8272617 DOI: 10.1007/s00405-021-06963-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/25/2021] [Indexed: 11/06/2022]
Abstract
Purpose To identify areas of critical otolaryngology contributions to inpatient care resistant to disruption by the COVID-19 pandemic. Methods Medical records of 614 otolaryngology consults seen between January and June of 2019 and 602 seen between January and June of 2020 were reviewed. Extracted data included patient demographics, SARS-CoV-2 status, medical comorbidities, consult location, consult category, reason for consult, procedures performed, and overall outcome. Prevalence of data items was compared using t tests and Chi-squared tests. Results The number of monthly consults to the otolaryngology service remained approximately stable after the onset of the COVID-19 pandemic. However, there was a substantial increase in ICU consults and a decrease in ER and floor consults. The proportion of otology, rhinology, and head and neck consults decreased while that of airway consults—most of which were tracheostomy-related—greatly increased. While the top ten reasons for consult remained essentially the same, they dramatically increased as a percentage of consults during COVID-19 (55–92%), whereas there was a dramatic decrease in the proportion of less frequent consults. Conclusion The changes in otolaryngology consultation patterns seen after the onset of the pandemic are multifactorial, but may be attributed to novel pathologies, attitudes, and policies. Nonetheless, these patterns reveal that a set of core otolaryngologic issues, including acute airway issues, head and neck lesions, severe sinusitis and epistaxis, are essential and need to be addressed in the inpatient setting, whereas the significant drop in other consults suggests that they may be appropriately managed on an outpatient basis. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-021-06963-7.
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Affiliation(s)
- Andre Shomorony
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue, 5thFloor, New York, NY, 10021, United States of America.
| | - Alexander Chern
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue, 5thFloor, New York, NY, 10021, United States of America
| | - Sallie M Long
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue, 5thFloor, New York, NY, 10021, United States of America
| | - Noah Z Feit
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue, 5thFloor, New York, NY, 10021, United States of America
| | - Sarita S Ballakur
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue, 5thFloor, New York, NY, 10021, United States of America
| | - Mariam Gadjiko
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue, 5thFloor, New York, NY, 10021, United States of America
| | - Katie Liu
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue, 5thFloor, New York, NY, 10021, United States of America
| | - Daniel A Skaf
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue, 5thFloor, New York, NY, 10021, United States of America
| | - Andrew B Tassler
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue, 5thFloor, New York, NY, 10021, United States of America
| | - Anthony P Sclafani
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, 1305 York Avenue, 5thFloor, New York, NY, 10021, United States of America
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5
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Long SM, Chern A, Feit NZ, Chung S, Ramaswamy AT, Li C, Cooley V, Hill S, Rajwani K, Villena-Vargas J, Schenck E, Stiles B, Tassler AB. Percutaneous and Open Tracheostomy in Patients with COVID-19: Comparison and Outcomes of an Institutional Series in New York City. Ann Surg 2021; 273:403-409. [PMID: 32889885 DOI: 10.1097/sla.0000000000004428] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to report the safety, efficacy, and early results of tracheostomy in patients with COVID-19 and determine whether differences exist between percutaneous and open methods. SUMMARY BACKGROUND DATA Prolonged respiratory failure is common in symptomatic patients with COVID-19, the disease process caused by infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Tracheostomy, although posing potential risk to the operative team and other healthcare workers, may be beneficial for safe weaning of sedation and ventilator support. However, short- and long-term outcomes remain largely unknown. METHODS A prospectively collected database of patients with COVID-19 undergoing tracheostomy at a major medical center in New York City between April 4 and April 30, 2020 was reviewed. The primary endpoint was need for continued mechanical ventilation. Secondary outcomes included complication rates, sedation weaning, and need for intensive care unit (ICU) level of care. Patient characteristics, perioperative conditions, and outcomes between percutaneous and open groups were analyzed. RESULTS During the study period, 67 consecutive patients underwent tracheostomy, including 48 males and 19 females with a median age of 66 years [interquartile range (IQR) 52-72]. Two surgeons alternated techniques, with 35 tracheostomies performed percutaneously and 32 via an open approach. The median time from intubation to tracheostomy was 23 days (IQR 20-26). At a median follow-up of 26 days, 52 patients (78%) no longer required mechanical ventilation and 58 patients (87%) were off continuous sedation. Five patients (7.5%) died of systemic causes. There were 11 total complications (16%) in 10 patients, most of which involved minor bleeding. There were no significant differences in outcomes between percutaneous and open methods. CONCLUSIONS Tracheostomy under apneic conditions by either percutaneous or open technique can be safely performed in patients with respiratory failure due to COVID-19. Tracheostomy facilitated weaning from continuous intravenous sedation and mechanical ventilation. Continued follow-up of these patients to ascertain long-term outcome data is ongoing.
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Affiliation(s)
- Sallie M Long
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY
| | - Alexander Chern
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY
| | | | - Sei Chung
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY
| | - Apoorva T Ramaswamy
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY
| | - Carol Li
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY
| | - Victoria Cooley
- Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY
| | - Shanna Hill
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY
| | - Kapil Rajwani
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY
| | | | - Edward Schenck
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY
| | - Brendon Stiles
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Andrew B Tassler
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY
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6
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Roytman M, Tassler AB, Kacker A, Schwartz TH, Dobri GA, Strauss SB, Capalbo AM, Magge RS, Barbaro M, Lin E, Osborne JR, Jana Ivanidze. [68Ga]-DOTATATE PET/CT and PET/MRI in the diagnosis and management of esthesioneuroblastoma: illustrative cases. Journal of Neurosurgery: Case Lessons 2021; 1:CASE2058. [PMID: 35854930 PMCID: PMC9241319 DOI: 10.3171/case2058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/06/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Esthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, is a rare sinonasal neuroectodermal malignancy with a slow onset of symptoms, favorable 5-year survival, and a propensity for delayed locoregional recurrence. Current treatment options include resection, adjuvant radiotherapy, and/or chemotherapy; however, because of its rarity and location, determining the optimal treatment for ENB has been challenging. OBSERVATIONS ENBs strongly express somatostatin receptors (SSTRs), particularly SSTR2, providing a molecular target for imaging and therapy. LESSONs The authors present a case series of ENBs imaged with [68Ga]-DOTATATE PET/MRI and PET/CT and discuss the emerging role of [68Ga]-DOTATATE PET for ENB diagnosis, staging, and treatment response monitoring.
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Affiliation(s)
| | | | | | | | | | | | | | - Rajiv S. Magge
- Neuro-Oncology, Weill Cornell Medicine, New York, New York
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7
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Gray KD, McCloskey JE, Vedvyas Y, Kalloo OR, Eshaky SE, Yang Y, Shevlin E, Zaman M, Ullmann TM, Liang H, Stefanova D, Christos PJ, Scognamiglio T, Tassler AB, Zarnegar R, Fahey TJ, Jin MM, Min IM. PD1 Blockade Enhances ICAM1-Directed CAR T Therapeutic Efficacy in Advanced Thyroid Cancer. Clin Cancer Res 2020; 26:6003-6016. [PMID: 32887724 DOI: 10.1158/1078-0432.ccr-20-1523] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/17/2020] [Accepted: 09/01/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Advanced thyroid cancers, including poorly differentiated and anaplastic thyroid cancer (ATC), are lethal malignancies with limited treatment options. The majority of patients with ATC have responded poorly to programmed death 1 (PD1) blockade in early clinical trials. There is a need to explore new treatment options. EXPERIMENTAL DESIGN We examined the expression of PD-L1 (a ligand of PD1) and intercellular adhesion molecule 1 (ICAM1) in thyroid tumors and ATC cell lines, and investigated the PD1 expression level in peripheral T cells of patients with thyroid cancer. Next, we studied the tumor-targeting efficacy and T-cell dynamics of monotherapy and combination treatments of ICAM1-targeting chimeric antigen receptor (CAR) T cells and anti-PD1 antibody in a xenograft model of ATC. RESULTS Advanced thyroid cancers were associated with increased expression of both ICAM1 and PD-L1 in tumors, and elevated PD1 expression in CD8+ T cells of circulating blood. The expression of ICAM1 and PD-L1 in ATC lines was regulated by the IFNγ-JAK2 signaling pathway. ICAM1-targeted CAR T cells, produced from either healthy donor or patient T cells, in combination with PD1 blockade demonstrated an improved ability to eradicate ICAM1-expressing target tumor cells compared with CAR T treatment alone. PD1 blockade facilitated clearance of PD-L1 high tumor colonies and curtailed excessive CAR T expansion, resulting in rapid tumor clearance and prolonged survival in a mouse model. CONCLUSIONS Targeting two IFNγ-inducible, tumor-associated antigens-ICAM1 and PD-L1-in a complementary manner might be an effective treatment strategy to control advanced thyroid cancers in vivo.
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Affiliation(s)
- Katherine D Gray
- Department of Surgery, Weill Cornell Medicine, New York, New York
| | | | - Yogindra Vedvyas
- Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Olivia R Kalloo
- Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Steve El Eshaky
- Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Yanping Yang
- Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Enda Shevlin
- Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Marjan Zaman
- Department of Radiology, Weill Cornell Medicine, New York, New York
| | | | - Heng Liang
- Department of Surgery, Weill Cornell Medicine, New York, New York
| | | | - Paul J Christos
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | | | - Andrew B Tassler
- Department of Head and Neck Surgery, Weill Cornell Medicine, New York, New York
| | - Rasa Zarnegar
- Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Thomas J Fahey
- Department of Surgery, Weill Cornell Medicine, New York, New York.
| | - Moonsoo M Jin
- Department of Radiology, Weill Cornell Medicine, New York, New York.
| | - Irene M Min
- Department of Surgery, Weill Cornell Medicine, New York, New York.
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8
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Tassler AB, Gooding WE, Ferris RL. Hypopharyngeal cancer treatment: Does initial surgery confer survival benefit? Head Neck 2019; 41:2167-2173. [PMID: 30779398 DOI: 10.1002/hed.25687] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 04/09/2018] [Revised: 01/02/2019] [Accepted: 01/10/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Organ preservation protocols have increasingly been applied for the treatment of head and neck cancers, including hypopharyngeal squamous cell carcinoma (HSCC). We sought to evaluate whether patients treated with primary surgery followed by adjuvant therapy had survival benefit over patients treated with initial nonsurgical modalities. METHODS We retrospectively reviewed patients with new diagnosis of HSCC at the University of Pittsburgh (1994-2014) treated with either primary total laryngectomy with pharyngectomy or organ preservation. RESULTS One hundred thirty-seven patients were identified. Surgical cases were more likely to be of advanced T stage. Initial surgery was more likely to be performed in the earlier years of the cohort. After adjusting for this imbalance using a propensity score, primary surgery was associated with improved survival compared with nonoperative therapy (P = 0.02). CONCLUSIONS Due to its survival advantage, primary surgery followed by adjuvant treatment should be considered as a viable treatment of HSCC.
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Affiliation(s)
- Andrew B Tassler
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - William E Gooding
- Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Robert L Ferris
- Department of Otolaryngology and Immunology, University of Pittsburgh Medical Center and Cancer Institute, Pittsburgh, Pennsylvania
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9
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Min IM, Shevlin E, Vedvyas Y, Zaman M, Wyrwas B, Scognamiglio T, Moore MD, Wang W, Park S, Park S, Panjwani S, Gray KD, Tassler AB, Zarnegar R, Fahey TJ, Jin MM. CAR T Therapy Targeting ICAM-1 Eliminates Advanced Human Thyroid Tumors. Clin Cancer Res 2017; 23:7569-7583. [PMID: 29025766 DOI: 10.1158/1078-0432.ccr-17-2008] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/07/2017] [Accepted: 09/28/2017] [Indexed: 01/28/2023]
Abstract
Purpose: Poorly differentiated thyroid cancer and anaplastic thyroid cancer (ATC) are rare yet lethal malignancies with limited treatment options. Many malignant tumors, including papillary thyroid cancer (PTC) and ATC, are associated with increased expression of ICAM-1, providing a rationale for utilizing ICAM-1-targeting agents for the treatment of aggressive cancer. We developed a third-generation chimeric antigen receptor (CAR) targeting ICAM-1 to leverage adoptive T-cell therapy as a new treatment modality.Experimental Design: ICAM-1 CAR T cells were applied to multiple malignant and nonmalignant target cells to investigate specific target cell death and "off-tumor" toxicity in vitroIn vivo therapeutic efficacy of ICAM-1 CAR T cells was examined in ATC mouse models established from a cell line and patient-derived tumors that rapidly develop systemic metastases.Results: ICAM-1 CAR T cells demonstrated robust and specific killing of PTC and ATC cell lines in vitro Interestingly, although certain ATC cell lines showed heterogeneous levels of ICAM-1 expression, addition of cytotoxic CAR T cells induced increased ICAM-1 expression such that all cell lines became targetable. In mice with systemic ATC, a single administration of ICAM-1 CAR T cells mediated profound tumor killing that resulted in long-term remission and significantly improved survival. Patient-derived ATC cells overexpressed ICAM-1 and were largely eliminated by autologous ICAM-1 CAR T cells in vitro and in animal models.Conclusions: Our findings are the first demonstration of CAR T therapy against both a metastatic, thyroid cancer cell line and advanced ATC patient-derived tumors that exhibit dramatic therapeutic efficacy and survival benefit in animal studies. Clin Cancer Res; 23(24); 7569-83. ©2017 AACR.
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Affiliation(s)
- Irene M Min
- Department of Surgery, Weill Cornell Medicine, New York, New York.
| | - Enda Shevlin
- Department of Radiology, Weill Cornell Medicine, 1300 York Avenue, New York, New York
| | - Yogindra Vedvyas
- Department of Radiology, Weill Cornell Medicine, 1300 York Avenue, New York, New York.,Department of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Marjan Zaman
- Department of Radiology, Weill Cornell Medicine, 1300 York Avenue, New York, New York
| | - Brian Wyrwas
- Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Theresa Scognamiglio
- Department of Pathology, Weill Cornell Medicine, 1300 York Avenue, New York, New York
| | - Maureen D Moore
- Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Weibin Wang
- Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Susan Park
- Department of Radiology, Weill Cornell Medicine, 1300 York Avenue, New York, New York
| | - Spencer Park
- Department of Radiology, Weill Cornell Medicine, 1300 York Avenue, New York, New York.,Department of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Suraj Panjwani
- Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Katherine D Gray
- Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Andrew B Tassler
- Department of Head and Neck Surgery, Weill Cornell Medicine, 1300 York Avenue, New York, New York
| | - Rasa Zarnegar
- Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Thomas J Fahey
- Department of Surgery, Weill Cornell Medicine, New York, New York.
| | - Moonsoo M Jin
- Department of Surgery, Weill Cornell Medicine, New York, New York. .,Department of Radiology, Weill Cornell Medicine, 1300 York Avenue, New York, New York.,Department of Biomedical Engineering, Cornell University, Ithaca, New York
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10
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Cho JK, Ow TJ, Lee AY, Smith RV, Schlecht NF, Schiff BA, Tassler AB, Lin J, Moadel RM, Valdivia A, Abraham T, Gulko E, Neimark M, Ustun B, Bello JA, Shifteh K. Preoperative 18F-FDG-PET/CT vs Contrast-Enhanced CT to Identify Regional Nodal Metastasis among Patients with Head and Neck Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2017; 157:439-447. [PMID: 28608737 DOI: 10.1177/0194599817703927] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 02/06/2023]
Abstract
Objective Our objective was to compare the accuracy of preoperative positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced CT (CECT) in detecting cervical nodal metastases in patients treated with neck dissection and to scrutinize the ability of each modality to determine nodal stage. Study Design Case series with chart review. Setting Montefiore Medical Center, Bronx, New York. Subjects and Methods Patients who underwent neck dissection at our institution for primary treatment of head and neck squamous cell carcinoma (HNSCC) and had received preoperative PET/CT and CECT were included in this study. Imaging studies were reinterpreted by 3 specialists within the field and compared for interreader agreement. Concordance between radiology and histopathology was measured using neck levels and sides, along with patient nodal stage. Sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and agreement coefficients were calculated. Results Seventy-three patients were included in the study. Sensitivity was 0.69 and 0.94 (level and side) for PET/CT vs 0.53 and 0.66 for CECT ( P = .056, P = .001). Specificity was 0.86 and 0.56 for PET/CT vs 0.91 and 0.76 for CECT ( P = .014, P = .024). No significant difference was found in overall accuracy ( P = .33, P = .88). The overall agreement percentages between N stage called by imaging modality and pathology were 52% and 55% for PET/CT and CECT, respectively. Conclusion No significant difference in sensitivity was found between PET/CT and CECT. CECT was found to have superior specificity compared with PET/CT. The information gleaned from each modality in the pretreatment evaluation of HNSCC appears to be complementary.
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Affiliation(s)
- Joshua K Cho
- 1 Albert Einstein College of Medicine, Bronx, New York, USA
| | - Thomas J Ow
- 2 Montefiore Medical Center, Department of Otorhinolaryngology-Head and Neck Surgery, Bronx, New York, USA
| | - Andrew Y Lee
- 2 Montefiore Medical Center, Department of Otorhinolaryngology-Head and Neck Surgery, Bronx, New York, USA
| | - Richard V Smith
- 2 Montefiore Medical Center, Department of Otorhinolaryngology-Head and Neck Surgery, Bronx, New York, USA
| | - Nicolas F Schlecht
- 1 Albert Einstein College of Medicine, Bronx, New York, USA.,3 Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Bradley A Schiff
- 2 Montefiore Medical Center, Department of Otorhinolaryngology-Head and Neck Surgery, Bronx, New York, USA
| | - Andrew B Tassler
- 4 Weill Cornell Medical College, Department of Otolaryngology-Head and Neck Surgery, New York, New York, USA
| | - Juan Lin
- 1 Albert Einstein College of Medicine, Bronx, New York, USA
| | - Renee M Moadel
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Ana Valdivia
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Tony Abraham
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Edwin Gulko
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Matthew Neimark
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Berrin Ustun
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Jacqueline A Bello
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Keivan Shifteh
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
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Du E, Smith RV, Ow TJ, Tassler AB, Schiff BA. Tumor Debulking in the Management of Laryngeal Cancer Airway Obstruction. Otolaryngol Head Neck Surg 2016; 155:805-807. [PMID: 27459956 DOI: 10.1177/0194599816661326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 04/04/2016] [Accepted: 07/06/2016] [Indexed: 11/16/2022]
Abstract
Patients presenting with advanced aerodigestive malignancy and respiratory compromise often undergo tracheotomy as initial airway management. Tumor debulking is a potential alternative. We present a case series with chart review to communicate our institutional experience with this technique. T3/4 glottic and supraglottic cancers treated between 2004 and 2014 underwent review, and 14 patients were identified for this study. Of these, 5 (35.7%) required subsequent tracheotomy, and 9 (64.3%) did not. Patients requiring subsequent tracheotomy had a delay in initiating definitive treatment when compared with those who did not (83.3 vs 31.3 days, P = .0025). No patient required a tracheotomy after initiation of definitive treatment. Our experience suggests that tumor debulking may be a viable option in select patients but that a delay in initiating treatment is associated with patients requiring tracheotomy subsequent to debulking. Further research is needed to better delineate patient scenarios in which tumor debulking alone is sufficient.
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Affiliation(s)
- Eugenie Du
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Richard V Smith
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Thomas J Ow
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.,Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrew B Tassler
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Bradley A Schiff
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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12
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Siegel B, Ow TJ, Abraham SS, Loftus PA, Tassler AB, Smith RV, Schiff BA. How radiologic/clinicopathologic features relate to compressive symptoms in benign thyroid disease. Laryngoscope 2016; 127:993-997. [PMID: 27438354 DOI: 10.1002/lary.26124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/25/2015] [Revised: 04/05/2016] [Accepted: 05/09/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To identify compressive symptomatology in a patient cohort with benign thyroid disease who underwent thyroidectomy. To determine radiographic/clinicopathologic features related to and predictive of a compressive outcome. STUDY DESIGN Retrospective cohort study. METHODS Medical records of 232 patients with benign thyroid disease on fine needle aspiration who underwent thyroidectomy from 2009 to 2012 at an academic medical center were reviewed. Data collection and analyses involved subjects' demographics, compressive symptoms, preoperative airway encroachment, intubation complications, specimen weight, and final pathologic diagnosis. RESULTS Subjects were ages 14 to 86 years (mean: 52.4 years). Ninety-six subjects (41.4%) reported compressive symptomatology of dysphagia (n =74; 32%), dyspnea (n = 39; 17%), and hoarseness (n = 24; 10%). Ninety-seven (42.2%) had preoperative airway encroachment. Dyspnea was significantly related to tracheal compression, tracheal deviation, and substernal extension. Dysphagia was related to tracheal compression and tracheal deviation. Compressive symptoms and preoperative airway encroachment were not related to intubation complications. Final pathologic diagnosis was not related to compressive symptoms, whereas specimen weight was significantly related to dyspnea and dysphagia. Final pathology revealed 74 subjects (32%) with malignant lesions. Malignant and benign nodular subject groups differed significantly in substernal extension, gland weight, tracheal deviation, and dyspnea. Logit modeling for dyspnea was significant for tracheal compression as a predictor for the likelihood of dyspnea. CONCLUSION Dyspnea was closely related to preoperative airway encroachment and most indicative of a clinically relevant thyroid in our cohort with benign thyroid disease. Tracheal compression was found to have predictive value for the likelihood of a dyspneic outcome. LEVEL OF EVIDENCE 4. Laryngoscope, 127:993-997, 2017.
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Affiliation(s)
- Bianca Siegel
- Department of Otorhinolaryngology-Head Neck Surgery, Montefiore Medical Center, Bronx, U.S.A
| | - Thomas J Ow
- Department of Otorhinolaryngology-Head Neck Surgery, Montefiore Medical Center, Bronx, U.S.A
| | - Suzanne S Abraham
- Department of Communication Sciences and Disorders, New York University, New York, New York, U.S.A
| | - Patricia A Loftus
- Department of Otorhinolaryngology-Head Neck Surgery, Montefiore Medical Center, Bronx, U.S.A
| | - Andrew B Tassler
- Department of Otorhinolaryngology-Head Neck Surgery, Montefiore Medical Center, Bronx, U.S.A
| | - Richard V Smith
- Department of Otorhinolaryngology-Head Neck Surgery, Montefiore Medical Center, Bronx, U.S.A
| | - Bradley A Schiff
- Department of Otorhinolaryngology-Head Neck Surgery, Montefiore Medical Center, Bronx, U.S.A
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13
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Du E, Ow TJ, Lo YT, Gersten A, Schiff BA, Tassler AB, Smith RV. Refining the utility and role of Frozen section in head and neck squamous cell carcinoma resection. Laryngoscope 2016; 126:1768-75. [DOI: 10.1002/lary.25899] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 12/15/2015] [Accepted: 01/04/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Eugenie Du
- Department of Otorhinolaryngology-Head and Neck Surgery; Albert Einstein College of Medicine; Bronx New York U.S.A
| | - Thomas J. Ow
- Department of Otorhinolaryngology-Head and Neck Surgery; Albert Einstein College of Medicine; Bronx New York U.S.A
- Department of Pathology; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx New York U.S.A
| | - Yung-Tai Lo
- Department of Epidemiology and Population Health; Albert Einstein College of Medicine; Bronx New York U.S.A
| | - Adam Gersten
- Department of Pathology; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx New York U.S.A
| | - Bradley A. Schiff
- Department of Otorhinolaryngology-Head and Neck Surgery; Albert Einstein College of Medicine; Bronx New York U.S.A
| | - Andrew B. Tassler
- Department of Otorhinolaryngology-Head and Neck Surgery; Albert Einstein College of Medicine; Bronx New York U.S.A
| | - Richard V. Smith
- Department of Otorhinolaryngology-Head and Neck Surgery; Albert Einstein College of Medicine; Bronx New York U.S.A
- Department of Pathology; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx New York U.S.A
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Abstract
CONTEXT Calcitonin is a sensitive biomarker that is used for diagnosis and follow-up in medullary thyroid cancer (MTC). In patients with tumors > 1 cm, it is uncommon for preoperative serum calcitonin to be in the normal laboratory reference range in patients with MTC, and even more unusual for serum calcitonin to be undetectable. THE CASE A 39-year-old woman was found to have a left thyroid nodule on magnetic resonance imaging done for neck pain. Ultrasound and fine-needle aspiration biopsy were performed, and cytopathology was positive for malignant cells. The cells also had features suggestive of a neuroendocrine tumor, and the specimen was immune-stained with calcitonin. There was positive immunoreactivity for calcitonin in isolated cells of the cytospin, highly favoring a diagnosis of MTC. Serum calcitonin was < 2 pg/mL (<6 pg/mL), and serum carcinoembryonic antigen was 3.1 ng/mL (<5.2 ng/mL). Given the low calcitonin levels, procalcitonin was also tested and was elevated at 0.21 ng/mL (< 0.1 ng/mL). The patient subsequently underwent a total thyroidectomy and central and ipsilateral lateral lymph node dissection. Histopathology confirmed a 2.6 × 2.0 × 1.2-cm MTC, with strong, diffuse immunostaining for calcitonin. Postoperatively, serum calcitonin has remained undetectable, carcinoembryonic antigen has remained within the reference range, and procalcitonin has become undetectable. CONCLUSIONS We present a rare case of a patient with MTC with undetectable preoperative serum calcitonin, whose tumor demonstrated strong, diffuse immunohistochemical staining for calcitonin. We discuss the possible pathogenesis of calcitonin-negative MTC and the challenges in following patients with this condition.
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Affiliation(s)
- Erika F Brutsaert
- Department of Medicine, Division of Endocrinology (E.F.B., M.I.S.), Department of Pathology (A.J.G.), and Department of Otorhinolaryngology (A.B.T.), Montefiore Medical Center, Bronx, New York 10467
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15
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Loftus PA, Ow TJ, Siegel B, Tassler AB, Smith RV, Cohen HW, Schiff BA. Risk Factors for Perioperative Airway Difficulty and Evaluation of Intubation Approaches Among Patients With Benign Goiter. Ann Otol Rhinol Laryngol 2014; 123:279-85. [DOI: 10.1177/0003489414524171] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The objective was to determine patient and gland characteristics associated with difficult intubation in patients undergoing thyroidectomy for goiter and to assess different methods of intubation in these patients. Methods: This study was an IRB-approved, retrospective chart review of 112 consecutive patients undergoing hemithyroidectomy or total thyroidectomy for thyroid goiter from 2009-2012 at an academic tertiary care facility in Bronx, New York. Patient demographics, thyroid gland characteristics (gland weight and nodule size), presence of preoperative symptoms (dyspnea, dysphagia, and hoarseness), and radiographical findings (tracheal compression, tracheal deviation, and substernal extension of the thyroid gland) were recorded. Anesthesia records were reviewed for method of intubation, as well as success or failure of intubation attempts. Results: Nineteen patients (17.0%) were men and 93 (83.0%) were women. The age of the patients included in the study ranged from 14 to 86 years with a mean ± SD age of 53.5 ± 14.7 years. Difficult intubation was noted with 13 (11.6%) patients. Only patient age was significantly associated with difficult intubation. The mean age of patients with airway difficulty was 60.7 ± 3.7 years compared to 52.1 ± 1.5 years in those who did not experience airway difficulty ( P = .04). No other reviewed risk factors were found to be significantly associated with difficult intubation. Fiberoptic intubation (FOI) was used in 38 patients and difficult intubation occurred in 18.4% (7/38). Direct laryngoscopy with transoral intubation (LTOI) was used in 58 patients, in whom 3.4% (2/58) experienced a difficult intubation. FOI was aborted 6 times and LTOI was subsequently successful in each of these cases. Conclusions: Our results suggest that benign nodular goiter disease does not pose significant challenges to intubation in our patient cohort. The technique of intubation deviated from the initial plan several times in the FOI group, whereas LTOI was ultimately successful in every case. Our data suggest that the role of fiberoptic intubation for patients with large goiters should be further refined.
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Affiliation(s)
- Patricia A. Loftus
- Department of Otorhinolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Thomas J. Ow
- Department of Otorhinolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Bianca Siegel
- Department of Otorhinolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Andrew B. Tassler
- Department of Otorhinolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Richard V. Smith
- Department of Otorhinolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Hillel W. Cohen
- Department of Otorhinolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Bradley A. Schiff
- Department of Otorhinolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
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Chen C, Tibbetts KM, Tassler AB, Schiff BA. Tracheal invasion and perforation from advanced primary thyroid lymphoma: a case report and literature review. Am J Otolaryngol 2013; 34:559-62. [PMID: 23702317 DOI: 10.1016/j.amjoto.2013.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 04/17/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We report a case of an elderly female with primary diffuse large B-cell thyroid lymphoma causing an extensive tracheal defect that was managed expectantly with good results. METHOD Case report RESULTS This is the only known reported case of a patient with tracheal invasion and perforation caused by primary thyroid lymphoma who has subsequently survived. CONCLUSION Due to the rarity of invasive primary thyroid lymphoma there is currently no standard surgical management of the airway. We propose that expectant management with temporary airway protection is an alternative to invasive procedures such as tracheotomy or tracheal stent placement, even in the scenario of serious airway defects.
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Tassler AB, Davidson B, Newkirk K, Wilson M, Harter KW. SP211 – Cyberknife treatment of carotid body tumors: A retrospective review. Otolaryngol Head Neck Surg 2009. [DOI: 10.1016/j.otohns.2009.06.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Bronchogenic cysts are congenital sacs that result from maldevelopment of the primitive foregut. Although they occur predominantly in the chest, there are reports of lesions in extrathoracic locations. The majority of reported bronchogenic cysts located in the neck are found in the pediatric population; a review of the literature reveals few reports of bronchogenic cysts of the neck among adults. The diagnosis of a bronchogenic cyst relies on the histology and location of the lesion. Here, we review our experience in the diagnosis and management of 2 adult patients with pathologically proven bronchogenic cysts. Both patients presented with solitary neck masses that proved to be bronchogenic cysts on histologic examination. Our purpose is to define the histopathologic and clinical characteristics of bronchogenic cysts and discuss the features that distinguish them from other cervical cysts. In conclusion, congenital bronchogenic cysts can occur in the neck of adults and should be considered in the differential diagnosis of cystic cervical masses in adults, as well as children.
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Affiliation(s)
- Kenneth A Newkirk
- Department of Otolaryngology-Head and Neck Surgery, Washington Hospital Center and Georgetown University Medical Center, Washington, DC 20007, USA
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