Extended cervical approach for retrosternal multinodular goiter.

Objective: Partial or total sternotomy is required for 10% of retrosternal goiter. This study reviewed our experience with an extended cervicotomic approach as an alternative surgical solution for retrosternal goiter. Methods: A retrospective study was performed on patients who underwent partial or total thyroidectomy for retrosternal goiter between 2014 and 2019 at a tertiary medical centre. Data on clinical, radiologic, and pathologic factors were analysed. Peri- and postoperative outcomes were compared between extended and standard cervical approaches to predict the need for an extended cervical approach. Results: The cohort included 265 patients, of whom 245 (92.4%) were treated by standard thyroidectomy. In 17 (6.4%), the standard approach proved insufficient, and the horizontal incision was extended to a T-shape to improve access. The remaining 3 patients required a sternotomy. Use of the extended cervical approach was significantly associated with clinical features such as male gender, diabetes, high body mass index and postoperative hypocalcaemia. Conclusions: The extended cervicotomic approach is an alternative surgical solution for retrosternal goiter, with no increased risk of significant post-operative complications.

The Clinical Behavior and Recurrence Patterns of Oral Cavity Cancer in Oral Lichen Planus Patients.

OBJECTIVES: Oral lichen planus (OLP) is a chronic inflammatory disorder involving epithelia with squamous differentiation. Although described as a potential malignant precursor, the characteristics of malignancies arising among these patients are not widely described. Our goal was to describe the patterns of disease recurrence of patients with oral cavity squamous cell carcinoma (OSCC) arising on the background of OLP. METHODS: A retrospective analysis of all surgically treated patients with OSCC at a university-affiliated tertiary care center between 2000 and 2020. RESULTS: Two hundred seventy-nine patients with OSCC treated surgically were included. Forty (14.3%) had OLP. The mean age of patients with OLP was 70.9 years compared with 64.3 years for non-OLP patients (p = 0.03). OLP patients had a significantly higher rate of disease recurrence, persistence, or multiple primary disease (70% vs. 33.9%, p < 0.001). The mean number of sequential oncologic events for each patient with recurrence was also significantly higher among OLP patients (1.86 vs. 1.36, p = 0.03), a difference explained by a higher rate of multiple primary presentations (0.71 vs. 0.28, p = 0.008). A significant difference in disease-free survival (DFS) was demonstrated between the groups as patients with OLP had a lower 5-year DFS (34.7% vs. 61.3%, log-rank p value <0.001). On multivariate analysis, OLP was significantly associated with multiple primary events (p < 0.001, Odds ratio = 7.42, 95% confidence interval 2.9-19). CONCLUSIONS: OSCC patients with OLP background demand close clinical follow-up, as multiple primary disease is significantly more common and the DFS is significantly lower among these patients. A thorough clinical evaluation for all oral cavity subsites is mandatory. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:3146-3151, 2024.

Prognostic Significance of Regional Disease in Young Patients with Oral Cancer: A Comparative Study.

BACKGROUND: Regional metastases are considered the most important prognostic factor in OSCC patients. We aimed to investigate the impact of regional disease among different age groups with OSCC. METHODS: A retrospective comparison between patients 40 years old or younger, 41-69 years old, and 70 years or older treated for OSCC between 2000 and 2020 in a tertiary-care center. RESULTS: 279 patients were included. The mean age was 65 ± 17.7 and 133 were male (47.7%). Thirty-six (12.9%) were 40 years old or younger, 101 (36.2%) were 41-69 years and 142 (50.9%) were 70 years or older. Five-year overall survival and disease-specific survival (DSS) were significantly better among patients younger than 40 compared to the mid-age group and patients 70 years or older (76.7% vs. 69.4% vs.48.2%, Log-rank p < 0.001, and 76.7% vs. 75.3% vs. 46.5%, Log-rank p < 0.001, respectively). While an association between regional spread and overall survival and DSS was demonstrated among all age groups, the odds ratio (OR) for death of any cause and death of disease regarding cervical metastasis was much higher among patients younger than 40 compared with the 41-69 and 70+ age groups (death of any cause-OR = 23, p-value = 0.008, OR = 2.6, p-value = 0.026, OR = 2.4, p-value = 0.13, respectively. Death of disease-OR = 23, p-value = 0.008, OR = 2.3, p-value = 0.082, OR = 4.1, p-value = 0.001, respectively). In univariate  analysis, regional metastasis was associated with disease-free survival only among patients younger than 40 (p-value = 0.04). CONCLUSIONS: Regional metastases correspond with worse prognosis in young patients compared to older patients. These patients may benefit from a comprehensive treatment approach with close post-treatment follow-up. LEVEL OF EVIDENCE: 3 Laryngoscope, 134:2212-2220, 2024.

Anterior Skull Base Surgery in the 21st Century: The Role of Open Approaches.

Treating malignant tumors of the anterior skull base (ASB) is a challenging task, given their late presentation, diverse histology, and involvement of an intricate anatomical space requiring complex surgery. Advances in imaging, gradual refinement of surgical and reconstruction techniques, and improvement of perioperative care during recent decades have resulted in improved clinical outcomes for patients. In addition, assessing functional outcomes and quality-of-life issues have become a fundamental part in the holistic care of patients with ASB tumors. Once dominated by open procedures, the modern field of skull base surgery is rapidly incorporating endoscopic techniques. These techniques have been previously reserved for sinonasal inflammatory diseases, but in recent years they have sequentially and increasingly been applied to more complex disorders. The list of indications includes intracranial pathologies and malignant sinonasal neoplasms with skull base involvement. Open ASB surgery in this new era is reserved for selected cases, yet it is still considered the "gold standard" for treating ASB malignancy. The paucity of evidence-based data regarding the management of ASB tumors is still a major limit of the discipline of ASB surgery, resulting from the rarity and high degree of heterogeneity of these tumors. Therefore, no guidelines exist and prospective large cohort collaborative studies are required in order to consolidate our knowledge of the behavior of each histology encountered, and to assess the clinical and quality-of-life outcomes of the different treatment modalities currently used.

[PREOPERATIVE THREE-DIMENSIONAL PLANNING FOR COMPLEX HEAD AND NECK RECONSTRUCTION].

BACKGROUND: The treatment of patients with advanced head and neck cancers requires an extensive oromandibular and craniomaxillofacial resection in many cases. The reconstruction after these extensive resections presents many challenges to the reconstructive surgical team. The purpose of the reconstruction is not only to rehabilitate the physical facial appearance, but also to rehabilitate function, in order to improve future quality of life. To achieve this goal, the use of free tissue reconstruction is often required. The main challenge with osseous free flap reconstruction of the facial bones is the need of perfect alignment at the defect site. The use of different 3D technologies including computerized models and printed 3D stereolithographic models in the preoperative setting improves the accuracy and the outcome of the reconstruction.

Usefulness of ultrasound and fine needle aspiration cytology of major salivary gland lesions.

PURPOSE: To assess the clinical value of ultrasound (US) and fine needle aspiration (FNA) of salivary gland lesions prior to surgery, for preoperative decision-making and long-term follow-up/outcome. MATERIALS & METHODS: We retrospectively analyzed the medical charts of 98 consecutive patients with major salivary gland lesions who were treated in a single medical from 2008 to 2017. Preoperative US and FNA was performed in all patients. Cytology results were compared with histopathological diagnoses. The correlation between preoperative US findings, cytology and histopathological diagnoses was assessed. RESULTS: Twenty-three specimens were histopathologically malignant, and 75 were diagnosed as benign. Three false-positive results diagnosed as malignant in cytology had a final histology of sialadenitis, pleomorphic adenoma and Warthin's tumor, respectively. In six cases, cytology yielded false-negative results. The overall accuracy of FNA in distinguishing benign from malignant lesions was 91%. Sensitivity was 70% and specificity 93%. There was no significant correlation between US features and final pathology, but larger size had some correlation with malignancy (p = 0.306). No complications were observed during or after performing FNA. CONCLUSION: FNA from salivary gland lesions is safe and in many cases can help in preoperative decision making or surgical planning. Hence, the results of FNA cytology should have an integral role in clinical decision-making and management of major salivary gland lesions. False-negative results do occur and therefore should be used only as an adjunctive measure.

Surgeon-Performed Ultrasonographic Evaluation and Predication for Large Thyroid Nodules-A Case-Control Study.

BACKGROUND: The management of large thyroid nodules remains unclear. Ultrasonography is a central tool in the assessment of thyroid nodules, yet its role in risk stratification of large thyroid nodules has been studied only seldomly. OBJECTIVE: The aim of this study was to determine the utility of ultrasonography in characterizing and risk-stratifying thyroid nodules ≥3.0 cm. METHODS: We performed a retrospective, case-control study of all thyroid nodules aspirated between January 2010 and May 2014. Sonographic features of nodules ≥3.0 cm were compared with nodules <3.0 cm. All nodules were assessed by a single high-volume thyroid surgeon. Data collected included size (cm), texture, echogenicity, shape, calcifications, border, spongiform appearance, and vascularity. RESULTS: A total of 537 nodules were included in the study, with 137 nodules (25.5%) ≥3.0 cm comprising the study group, and 400 nodules (74.5%) as the control group. No differences were found between the 2 groups regarding age, sex, and risk factors. Nodules ≥3.0 cm were associated with an increased risk for malignancy (odds ratio 2.41 [1.08-5.38]). Microcalcifications (26.3% vs 17.5%, P = .039), hypoechogenicity (40.8% vs 23.4%, P < .001), and irregular borders (14.3% vs 3.6%, P = .001) were more prevalent in nodules <3.0 cm. Among the large nodules, hypoechogenicity (50% vs 22.8%, P = .043) and irregular margins (28.6% vs 0%, P < .001) were associated with malignancy. The specificity of irregular borders was greater in nodules ≥3.0 cm (100% vs 89.6%, P = .011). CONCLUSION: Sonographic appearances of large nodules differ from those of smaller nodules. Hypoechogenicity and irregular borders were associated with malignancy and should direct management towards a more aggressive policy of fine needle aspiration and consideration of operative resections in large thyroid nodules.

Indeterminate nodules by the Bethesda system for reporting thyroid cytopathology in Israel: Frequency, and risk of malignancy after reclassification of follicular thyroid neoplasm with papillary-like features.

OBJECTIVE: We aimed to determine the frequency and risk of malignancy (ROM) for indeterminate thyroid nodules, categories III (B3) and IV (B4) of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), at a large institution in Israel. Additionally, we investigated the impact of redefining follicular neoplasm with papillary-like nuclear features (NIFTP) as non-malignant on malignancy rates. METHODS: In this retrospective study of all thyroid fine needle aspirations (FNAs) performed at Tel Aviv-Sourasky Medical Center between January 2013 and December 2015, we assessed ROM for B3 and B4 nodules. Potential risk factors thought to affect a-priori ROM were assessed. Suspected NIFTP lesions were re-examined, and if proven, reclassified as benign. RESULTS: 3701 nodules were sampled in 2919 FNAs performed on 2674 patients. B3 reports comprised 7.7% of all nodules (n = 284); B4 represented 3.6% (n = 132). In multivariate logistic regression, male gender, being of former Soviet Union origin, and smoking increased ROM for B3 nodules by a factor of 7.97 (P = 0.002; CI: 2.2-23.4), 9.15 (P = 0.021; CI:1.4-60.0), and 11.0 (P = 0.001; CI 2.8-44.8), respectively. Reclassifying NIFTP decreased ROM from 14% to 12.5% for B3, and from 26.7% to 25% for B4 nodules. NIFTP comprised 9.5% of previously diagnosed resected malignant tumors. CONCLUSIONS: The relative frequencies of B3 and B4 nodules and their associated malignancy rates were consistent with previous series. Risk factors identified for malignancy may help characterize patients most likely to benefit from surgery. Reclassifying NIFTP had a substantial impact on the ROM in the resected tumors previously diagnosed as malignant.

Long-term health-related quality of life after mandibular resection and reconstruction.

PURPOSE: To compare short- and long-term quality of life (QOL) scores in patients undergoing mandibular resection and reconstruction. MATERIALS AND METHODS: All the patients who underwent resection and reconstruction of the mandible between 2000 and 2015 at a large tertiary center were retrospectively reviewed. Their QOL was measured by the University of Washington QOL questionnaire. Between 12 and 189 months (median 83.5 months) had elapsed since the end of treatment. The QOL of the short-term (< 5 years) and long-term (> 5 years) follow-up groups was compared and analyzed. RESULTS: Fifty-eight patients completed the questionnaire. The scores for physical function, emotional function, activity, recreation, and taste domains were significantly higher for the long-term follow-up group. The activity and pain domains posed a significant problem for significantly more patients in the short-term follow-up group. CONCLUSION: Comparison of the short- and long-term QOL scores of patients undergoing mandibular resection and reconstruction revealed that the scores for the latter were significantly higher in several domains. This finding might be indicative of a cumulative effect of time on patients' QOL, even many years post-treatment.

Follow-up of large thyroid nodules without surgery: Patient selection and long-term outcomes.

BACKGROUND: The management of large thyroid nodules remains controversial. Mandatory resection is recommended by some authors. METHODS: All patients with thyroid nodules ≥3 cm between January 2009 and January 2013 were followed until August 2017. Follow-up data were collected using an integrated hospital-community system. RESULTS: A total of 141 nodules were included. Of these, 37/141 (26%) nodules were initially referred to surgery, resulting in a 32% malignancy rate (12/37). The remaining 104/141 (74%) were referred to follow-up. During the follow-up period, 24 additional operations were done, resulting in a 4% malignancy rate (1/24). An indication of nonbenign cytology was significantly associated with malignancy compared with other indications. Median follow-up was 53.5 months. No patient developed regional or distal diseases. The mean change in nodule size during the follow-up period was a 7% reduction, with no significant trend of change over time. CONCLUSION: Careful patient selection based on clinical, sonographic, and cytologic features can reduce diagnostic surgery allowing for safe follow-up of large thyroid nodules without surgery.

Utility of first positron emission tomography-computed tomography scan as a prognostic tool following treatment of sinonasal and skull base malignancies.

BACKGROUND: The prognostic value of the first posttreatment whole body integrated positron emission tomography-computed tomography (PET/CT) scanning in patients with sinonasal/skull base malignancies is undetermined. METHODS: We retrospectively reviewed the data of all patients that underwent surgery for sinonasal/skull base malignancies in 2000-2015. The results of the pretreatment and posttreatment PET/CT findings and the clinical course were retrieved. RESULTS: Thirty-eight patients (average age 60.6 years, 20 males) were included. Sensitivity and specificity, positive predictive value, and negative predictive value of the first PET/CT scan for predicting persistent/recurrent disease were 85.7%, 87.5%, 80%, and 91.3%, respectively. Overall 5-year survival was significantly lower in the first posttreatment PET/CT-positive group (35%) compared to the PET/CT-negative group (93%) (P = .0008). CONCLUSION: Posttreatment PET/CT findings are highly prognostic in patients with sinonasal/skull base malignancies. Negative findings on the first posttreatment PET/CT scan predict a significantly better overall survival.

Nasopharyngeal biopsy in adults presenting with serous otitis media: Cross-sectional study.

BACKGROUND: The purpose of this study was to investigate the association between isolated serous otitis media (SOM) and/or conductive hearing loss (CHL) and nasopharyngeal carcinoma (NPC) in a low-to-intermediate endemic area. METHODS: Medical records of all adult patients (≥17 years) with SOM/CHL who underwent endoscopic-guided nasopharyngeal biopsy to exclude NPC during a 10-year period were reviewed. Statistical analyses were conducted to identify significant predictors for NPC. RESULTS: A total of 195 patients were included (121/195; 62.1% men), among whom 169 (86.7%) presented with isolated SOM/CHL. Overall, 12 patients were diagnosed with NPC (12/195; 6.2%), however, only 1 patient (1/169; 0.6%) had isolated SOM/CHL. Coexisting clinical manifestations and suspicious nasopharyngeal findings on fiber-optic nasopharyngoscopy were found to be significant predictors for NPC on univariate and multivariate analyses (P < .05). CONCLUSION: Patients with isolated SOM/CHL and without coexisting clinical manifestations or suspicious findings on nasopharyngoscopy may avoid a routine nasopharyngeal biopsy.

The incidence of malignancy in clinically benign cystic lesions of the lateral neck: our experience and proposed diagnostic algorithm.

AIM: Solitary cystic masses of the lateral neck in an adult patient can pose a diagnostic dilemma. Malignancy must be ruled out since metastases arising from H&N cancers may mimic the presentation of benign cystic masses. Only a small number of studies have investigated the diagnostic management and malignancy rate of clinically benign solitary cervical cystic lesions. There are no established guidelines for the diagnostic evaluation. METHODS: Retrospective review of the clinical, cytological, radiological, and pathological records of all adult patients (> 18 years) operated on for second branchial cleft cysts (BrCC) between 1/2008-2010/2016. Patients with apparent primary H&N malignancy, history of H&N cancer or irradiation, preoperative fine needle aspiration (FNA) of highly suggestive or confirmed malignancy, missing pertinent data, or age less than 18 years were excluded from analysis. RESULTS: 28 patients were diagnosed as having BrCC. The diagnosis was based on clinical findings, FNA cytology, and typical sonographic features. The histologic analysis determined an overall rate of malignancy of 10.7% (3/28): two patients had metastatic papillary thyroid carcinoma, and one patient had metastatic tonsillar squamous cell carcinoma. Purely cystic features on pre-operative ultrasound was the only significant predictor for true BrCC on final histology (p = .02). CONCLUSIONS: Occult malignancy is not rare among adult patients presenting with a solitary cystic mass of the lateral neck. A diagnostic algorithm is proposed. Further studies are needed to establish the appropriate workup and management of an adult patient presenting with a solitary cystic mass of the lateral neck.

Selection of Atypia/Follicular Lesion of Unknown Significance Patients for Surgery Versus Active Surveillance, Without Using Genetic Testing: A Single Institute Experience, Prospective Analysis, and Recommendations.

BACKGROUND: Atypia/follicular lesion of unknown significance (AUS/FLUS) has variable rates of malignancy. The recommended management includes active surveillance (AS), repeated fine-needle aspiration (RFNA), diagnostic surgery, or genetic testing for malignancy. The objective of this study was to assess the management of AUS/FLUS patients in a dedicated thyroid clinic without implementing genetic testing. METHODS: This was a single institute cohort study of all patients aged ≥18 years who underwent ultrasound-guided FNA thyroid biopsies between January 2009 and January 2013 and were followed until January 2016. The median follow-up time was 4.6 years (range 3.2-6.8 years). Forty-eight (57%) patients were referred to AS, and 36 (43%) patients were referred for diagnostic surgery. Thirty-six (75%) patients from the AS group underwent RFNA. An additional eight patients from the AS group subsequently underwent diagnostic surgery. RESULTS: Malignancies were found in 15/44 (34%) diagnostic surgical samples, and benign cytologies were found in 61.1% of the RFNAs. Analysis of adherence to follow-up in the 36 AS patients showed an adherence rate of only 53%, with males tending to comply better than females did (31.6% vs. 5.8%, respectively; p = 0.052), especially males in their sixth decade of life. CONCLUSIONS: Genetic tests for AUS/FLUS patients are accepted today as complementary evaluations in many well-developed health systems. Yet, when these tests are not feasible due to financial or availability issues, careful management of AUS/FLUS patients may still offer good results in the selection of patients for surgery or AS. The present results also indicate that compliance to follow-up schedules is a major consideration when selecting patients for AS.

Elective Neck Dissection vs Observation in Early-Stage Squamous Cell Carcinoma of the Oral Tongue With No Clinically Apparent Lymph Node Metastasis in the Neck: A Systematic Review and Meta-analysis.

IMPORTANCE: The elective management of no clinical or radiologic evidence of lymph node metastasis in the neck (cN0) in early stage T1-T2 oral tongue squamous cell carcinoma (OTSCC) has been the subject of much debate during the past 3 decades and continues to be controversial. OBJECTIVE: To systematically review the literature and carry out a meta-analysis of studies that compared elective neck dissection (END) with observation in patients with early-stage T1-T2 OTSCC and cN0 neck. DATA SOURCES: The MEDLINE, Scopus, Google scholar, and Cochrane databases were systematically searched for articles published between January 1, 1970, and June 1, 2015. Search terms used were squamous cell carcinoma, oral tongue, mobile tongue, T1, T2, early stage, elective neck dissection, no neck treatment, observation, wait and watch, node-negative neck, and N0 neck. STUDY SELECTION: Controlled clinical trials, prospective and retrospective cohorts, case-control studies, and case series that compared END with observation in patients with early-stage T1-T2 OTSCC who had no clinical or radiologic evidence of lymph node metastasis to the neck were eligible for inclusion in this meta-analysis. All patients included had a histopathologic diagnosis of SCC and at least 6 months of follow-up. Regional (neck) nodal recurrence, overall survival (OS), and disease-specific survival (DSS) were tested. DATA EXTRACTION AND SYNTHESIS: Four researchers independently extracted information on population characteristics, outcomes of interest, and study design. Discrepancies were resolved by consensus. Fixed effects were used to determine hazard ratios (HRs) and odds ratio (ORs) were used for studies including samples without substantial heterogeneity; random effects were evaluated for samples with significant heterogeneity. RESULTS: A total of 20 retrospective and 3 prospective randomized studies that met the inclusion criteria, with a total of 3244 patients, were included in the meta-analysis The results showed that END significantly reduced risk of regional recurrence (random-effects model: OR, 0.32; 95% CI, 0.22-0.46; P < .001) and improved DSS (fixed-effects model: HR, 0.49; 95% CI, 0.33-0.72; P < .001) compared with management by observation. However, END did not significantly improve OS (random-effects model: HR, 0.71; 95% CI, 0.41-1.22; P = .21). CONCLUSIONS AND RELEVANCE: The findings of this systematic review and meta-analysis indicate that END can significantly reduce the rate of regional nodal recurrence and improve DSS in patients with cT1T2N0 OTSCC.

Intraoperative Frozen Section in "Suspicious for Papillary Thyroid Carcinoma" after Adoption of the Bethesda System.

OBJECTIVE: To evaluate the accuracy and utility of intraoperative frozen section examination (iFSE) in patients with a preoperative fine-needle aspiration (FNA) cytology of "suspicious for malignancy" (SFM)-Bethesda V, after the adoption of the Bethesda System for Reporting Thyroid Cytopathology. STUDY DESIGN: Case series with chart review. SETTING: Tertiary medical center. SUBJECTS AND METHODS: All patients with SFM-Bethesda V who underwent thyroid surgery with iFSE between 2010 and 2015 were included. In cases where the iFSE was reported to be malignant, a total thyroidectomy was performed; otherwise, thyroid lobectomy (hemithyroidectomy) was performed. RESULTS: The current series included 47 patients diagnosed preoperatively with FNA cytology of SFM-Bethesda V. The malignancy rate was 74.5% (35 of 47). Twenty-four patients with nonmalignant iFSE results underwent lobectomy during their initial surgery: 12 were subsequently found with benign final histology and did not undergo completion thyroidectomy; the other 12 patients had malignant results on final histology, but only 4 of them underwent completion thyroidectomy. iFSE resulted in a sensitivity and specificity of 65.7% and 100%, respectively, with a positive predictive value of 100% (23 of 23) and a negative predictive value of 50% (12 of 24). Accuracy of the iFSE methodology was 74.5% (35 of 47). CONCLUSIONS: With no significant preoperative clinical or sonographic predictors for thyroid malignancy and given the high specificity of iFSE, our results support the use of iFSE for patients with preoperative FNA cytology of SFM-Bethesda V who are undergoing thyroid surgery, to determine the extent of required surgery.

Impact of preoperative embolization on the outcomes of carotid body tumor surgery: A meta-analysis and review of the literature.

BACKGROUND: There is no consensus on the impact of preoperative embolization (EMB) on the surgical outcomes of carotid body tumor (CBT) resections. METHODS: A systematic review and a meta-analysis were conducted to clarify the role of preoperative EMB in patients undergoing surgical removal of CBTs. RESULTS: Fifteen studies with a total number of 470 patients met the inclusion criteria. The results of the meta-analysis showed that there is no significant difference in estimated blood loss, operative time, length of hospital stay, or risks of cranial nerve injury, vascular injury, and stroke between the EMB and nonembolization (NEMB) groups. CONCLUSION: This systemic review and meta-analysis demonstrate that preoperative EMB does not confer any operative or postoperative advantage in patients scheduled for CBT surgery. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2386-E2394, 2016.

Predictive factors for perioperative blood transfusion in neck dissection.

OBJECTIVES/HYPOTHESIS: There is growing interest in reducing the exposure of patients to allogeneic blood transfusions by lowering preoperative cross-matched blood ordering and adopting alternative practices, such as autologous blood donations. Our aim was to investigate the predictors for perioperative blood transfusion (PBT) in head and neck cancer patients undergoing neck dissection (ND). STUDY DESIGN: Retrospective cohort study. METHODS: Retrospective observational study. All patients who underwent ND between January 2011 and August 2014. The primary outcome measure was PBT. Predictors tested included: gender, age, American Society of Anesthesiologists comorbidity score, Charlson comorbidity index, preoperative hemoglobin level, head and neck primary tumor location, tumor and nodal staging, side and laterality of ND, central versus lateral ND, elective ND, preoperative chemotherapy/radiotherapy/I(131) therapy, history of previous ND, other surgical procedures in addition to the ND, bone resection, use and type of reconstruction, and the use of bony free flap reconstruction. RESULTS: Twenty-one preoperative and operative variables were tested for an association with PBT using univariate and multivariate analyses. Multivariate analysis found only the following three predictors to be significantly associated with PBT in patients undergoing ND: low preoperative hemoglobin level, advanced N stage, and concurrent reconstructive surgery. CONCLUSION: Evaluation of specific risk factors for predicting the need for PBT prior to neck dissection may be helpful in identifying the head and neck cancer patients in whom preoperative ordering of cross-matched blood is required or who could benefit from alternative means, such as preoperative autologous blood donation. LEVEL OF EVIDENCE: 4.

Histopathologic classification of parapharyngeal space tumors: a case series and review of the literature.

The objective of the study is to present a large case series of parapharyngeal space tumors (PPST) and the most comprehensive literature review of tumor histopathologic distribution. The study was designed as internal case series and full Pubmed/MEDLINE electronic database review in a tertiary academic medical center. Tumor histopathology and patient demographics were obtained from a comprehensive Pubmed/MEDLINE database review, as well from an internal case series of 117 patients referred to our center between 1993 and 2013. Main outcome and measures of the study were to define the age, gender, and histopathology of PPST within a large internal case series and among the current body of published literature, and to propose a diagnostic and treatment algorithm for these tumors. Our cohort included 117 cases, 58 females and 59 males, with benign tumors comprising 85 % (n = 99) and malignant tumors 15 % (n = 18). A systematic review of published literature from 1963 to the present revealed 37 case series, and when combined with our present series, yielded a total of 2160 cases. Benign tumors are most common (78.8 %), with tumors of salivary gland (44.4 %), neural (34.4 %), and vascular (2.64 %) origin representing the largest subtypes. Pleomorphic adenomas (30.9 %), paragangliomas (13.1 %), and schwannomas (12.3 %) comprised the majority of all cases. Due to their rarity, data regarding the histopathologic distribution of PPST is scarce. We provide one of the largest case series and the most comprehensive review of these tumors in the literature to date, and offer our algorithm for evaluation and treatment.

Evaluation of clinical presentation and referral indications for ultrasound-guided fine-needle aspiration biopsy of the thyroid as possible predictors of thyroid cancer.

BACKGROUND: Whether initial clinical presentation and thyroid ultrasonography referral indications can significantly predict malignant/suspicious for malignancy (Bethesda System for Reporting Thyroid Cytopathology [Bethesda] V/VI) thyroid ultrasound-guided fine-needle aspiration (FNA) cytology results is unknown. METHODS: Between January 2010 and May 2014, we performed 705 thyroid ultrasound-guided FNA biopsies, according to the American Thyroid Association (ATA) guidelines. Univariate analysis was used to identify significant predictors for Bethesda V/VI thyroid ultrasound-guided FNA cytology, including age, sex, imaging modality, thyroid dysfunction, neck pain, breathing difficulties, dysphagia, odynophagia, fatigue, lateral cervical mass, parotid mass, and hyperparathyroidism. RESULTS: Sixty percent of patients were referred to thyroid ultrasound-guided FNA because of thyroid incidentalomas and 40% because of palpable thyroid nodules found on physical examination. Only positron emission tomography (PET)-CT emerged as being a significant predictor for Bethesda V/VI thyroid ultrasound-guided FNA cytology (odds ratio [OR] = 5.64; 95% confidence interval [CI] = 1.16-27.33; p = .03). CONCLUSION: Patient symptomatology and initial clinical thyroid ultrasound-guided FNA referral indications cannot predict the nature of thyroid nodules. © 2015 Wiley Periodicals, Inc. Head Neck 38: E991-E995, 2016.