Background Thyroid nodules affect up to 65% of the population. Although fine needle aspirate (FNA) cytology is the gold standard for diagnosis, 15–30% of results are indeterminate. Molecular testing may aid in the diagnosis of nodules and potentially reduce unnecessary surgery. However, these tests are associated with significant costs. The objective of this study was to evaluate the cost-effectiveness of Afirma, a commercially available molecular test, in cytologically indeterminate thyroid nodules. Methods The base case was a solitary thyroid nodule with no additional high-risk features and an indeterminate FNA. Decision tree analysis was performed from the single payer perspective with a 1-year time horizon. Costing data were collected through micro-costing methodology. A probabilistic sensitivity analysis was performed. The primary outcome was the incremental cost effectiveness ratio (ICER) of cost per thyroid surgery avoided. Results Over 1 year, mean cost estimates were $8176.28 with 0.58 effectiveness for the molecular testing strategy and $6016.83 with 0.07 effectiveness for current standard management. The ICER was $4234.22 per surgery avoided. At a willingness-to-pay (WTP) threshold of $5000 per surgery avoided, molecular testing is cost-effective with 63% certainty. Conclusion This cost-effectiveness analysis suggests utilizing Afirma for indeterminate solitary thyroid nodules is a cost-effective strategy for avoiding unnecessary thyroid surgery. With a $5000 WTP threshold, molecular testing has a 63% chance of being the more cost-effective strategy. The cost effectiveness varies based on the cost of the molecular test and the value of Afirma for patients with indeterminate thyroid nodules depends on the WTP threshold to avoid unnecessary thyroid surgery. Graphical Abstract
Background The majority of chemoradiation (CRT) trials for locally advanced head and neck squamous cell carcinoma (HNSCC) have relied on platinum-based chemotherapy regimens administered every-3-weeks. However, given the increased utilization of weekly platinum regimens, it remains unclear how different chemotherapy schedules compare regarding efficacy and toxicity. Methods We retrospectively identified 212 patients with HNSCC who were treated at a single academic medical center with concurrent platinum-based CRT given weekly ( N = 68) or every-three-weeks ( N = 144). JMP version 10 (SAS Institute) was used for statistical analysis. Discrete variables were compared with the chi-square test and differences in the medians were assessed using the Wilcoxon test. Survival curves were constructed using the Kaplan-Meier method and significance was assessed using the log rank test. For univariate analysis and multivariate analysis, we used Cox proportional hazard or logistic regression models to compare differences in survival or differences in categorical variables, respectively. Results Patients receiving weekly platinum regimens were more likely to be older (median age 61.4 vs. 55.5 y; P < .001), have high or very high Charlson comorbidity index (45.6% vs. 27.8%; P = .01), and receive carboplatin-based chemotherapy (6.3% vs. 76.5%; P < .001). Weekly and every-3-week platinum regimens had similar locoregional control (HR 1.10; 95% CI 0.63–1.88; P = .72), progression-free survival (HR 1.13; 95% CI 0.75–1.69; P = .55), and overall survival (HR 1.11; 95% CI 0.64–1.86; P = .71). Every-3-weeks platinum regimens were associated with increased days of hospitalization (median: 3 days vs. 0 days; P = .03) and acute kidney injury (AKI) during radiotherapy (50.0% vs. 22.1%; P < .001). On multivariate analysis, AKI was significantly associated with every-3-weeks regimens (OR: 24.38; 95% CI 3.00–198.03; P = .003) and high comorbidity scores (OR: 2.74; 95% CI 2.15–5.99; P = .01). Conclusions Our results suggest that every-3-weeks and weekly platinum-containing CRT regimens have similar disease control but weekly platinum regimens are associated with less acute toxicity.
BACKGROUND Fish bones are of particular interest to the otolaryngologist as accidental ingestion is one of the most common reasons for otolaryngology-related emergency department referrals. Furthermore, removal of fish bones deeply lodged in the oropharynx or hypopharynx can be both hazardous and technically difficult, and failure to accomplish safe removal could result in considerable morbidity and various critical complications. OBJECTIVE We present here a literature review on the topic of fish bones in otolaryngology with a focus on selection of patients for intervention and on removal techniques. We emphasize that retained fish bones should be approached with caution as their course can at times be unpredictable, as we describe here.
OBJECTIVE To review the operative morbidity and the overall length of survival following medialization thyroplasty for unilateral vocal cord paralysis (UVCP) due to advanced extralaryngeal malignancy. DESIGN Retrospective review. SETTING Tertiary care laryngology practice. METHOD All cases of medialization thyroplasty over a 3-year period were reviewed. Only patients who had UVCP due to advanced extralaryngeal malignancy were included. Any cases from iatrogenic causes or for any other reason were excluded. Survival days were calculated from the date of the thyroplasty. MAIN OUTCOME MEASURE Survival days postmedialization thyroplasty. RESULTS Twenty-one patients met the inclusion criteria. Two distinct groups within this cohort were identified: (1) those suffering from advanced lung cancer and (2) those with metastatic cancer of another origin (ie, breast, renal cell, esophageal). There were 11 patients in the lung cancer group and 10 in the other group. Average survival was 538 days in the lung cancer group and 668 days in the other group. The procedure was well tolerated, with only one postoperative complication, which was a minor wound infection. CONCLUSION For patients suffering from advanced malignancy, medialization thyroplasty is a safe procedure and an excellent modality for voice palliation.
Background: Endoscopic resection of sinonasal Inverted Papilloma (SNIP) tumors has been shown to reduce intra-operative blood loss and recovery time compared to open approaches. The purpose of this study is to investigate the incidence and requirements of blood transfusion for endoscopic SNIP surgeries.Methods: An individual retrospective cohort study of endoscopic SNIP surgeries over a 10-year period was performed. Age, sex, pre-existing co-morbidity, use of anti-coagulants, tumor type and stage, time of surgery, estimated blood loss and the requirement for blood transfusion were recorded.Results: 82 patients were included (57 males, 25 females). 4 (5%) Stage 1, 7 (8.5%) Stage 2, 62 (75.5%) Stage 3 and 9 (11%) Stage 4 SNIP tumors were identified according to the Krouse staging system. 3 (4%) patients required blood transfusion. 3 of the 9 (33%) Stage 4 tumors required blood transfusion. Stage 4 tumors were significantly associated with blood transfusion (p < 0.05). Higher staged tumors were associated with greater blood loss (p < 0.05) than lower staged cases. No other tumor stage required blood transfusion and no other pre-operative variable was associated with requirement for blood transfusion.Conclusion: Endoscopic SNIP resections rarely require blood transfusions. No pre-operative factor other than tumor stage is associated with the requirement for blood transfusion. We would therefore suggest that only Stage 4 SNIP tumors require pre-operative type and screen.
OBJECTIVE:The Nintendo Wii Balance Board (WBB) is a low-cost, commercially available gaming device that shares many characteristics with a laboratory-grade forceplate. This study evaluates the WBB and explores its potential application as a low-cost posturography system.METHODS:Custom software was written to interface with the WBB and measure the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB). Centre of pressure (COP) path length was the primary outcome measure. Healthy patients without a history of vestibular problems were recruited to undertake testing on the WBB and underwent matched testing on an AMTI forceplate.RESULTS:Evaluation of the WBB transducers demonstrated excellent linearity (r = .994, p < .0001). Bland-Altman plots did not demonstrate any relationship between the mean and the difference for the four tested conditions.CONCLUSIONS:The WBB can be used as part of a portable, low-cost posturography system offering new options for longitudinal telemetry and in-home testing.
Introduction: Kikuchi-Fujimoto disease (KFD) is a rare, self-limiting disorder that typically affects the cervical lymph nodes. Recognition of this condition is crucial, especially because it can easily be mistaken for tuberculosis, lymphoma, or even adenocarcinoma. Awareness of this disorder will help prevent misdiagnosis and inappropriate treatment.Methods: From January 2006 to December 2008, 30 patients who underwent a biopsy of a cervical lymph node and proved histologically to have KFD were enrolled in this study. We studied clinical manifestations, laboratory results, treatment, and recurrence for each patient. Patients were followed up for a mean period of 2 years.Results: There were 24 women and 6 men, with a mean age of 18 years. Two patients had a past history of tuberculosis. Major clinical symptoms and signs were fever (70%) and lymphadenopathy (100%). The affected cervical lymph nodes were most commonly located in the posterior cervical triangle. Unilateral and bilateral cervical lymph nodes were affected in 25 and 5 patients, respectively. The affected lymph nodes were most commonly less than 3 cm in size. Leukopenia was observed in 46.7%, and a raised erythrocyte sedimentation rate was seen in 56.7% of the cases. Treatment strategies included no medication, nonsteroidal antiinflammatory drugs (NSAIDs) alone, steroids alone, or a combination of NSAIDs and steroids. Ninety percent improved within 3 months, whereas one patient showed improvement only after 9 months of continued treatment. No recurrence has since been noted.Conclusion: KFD is a benign disease that masquerades as other more sinister diseases and can lead to unnecessary treatment-induced physiologic, psychological, and financial morbidity to the patient. Tissue diagnosis is necessary in all cases, and an effective communication between the surgeon and the pathologist is imperative in making an accurate diagnosis.
OBJECTIVE:To establish whether outpatient thyroid surgery is safe.DESIGN:Prospective, observational cohort.SETTING:Two tertiary care centres.METHODS:Although there is currently a trend toward ambulatory surgery in many domains, thyroidectomy has traditionally remained an inpatient procedure. We present our 200-case experience of total and partial thyroidectomy in an outpatient setting. Consecutive patients were prospectively recruited between May 2009 and October 2010. Surgeries were performed by four surgeons. A postoperative parathyroid hormone (PTH) level was obtained in the recovery room and used to guide the prescription of calcium and calcitriol oral supplements according to our institutional protocol.MAIN OUTCOME MEASURES:Postoperative complications, admission and readmission rates, patients' satisfaction, and feeling of security on a 10-point scale.RESULTS:A total of 171 patients, for a total of 200 surgical procedures: 100 hemithyroidectomies, 34 completion hemithyroidectomies, and 66 total thyroidectomies (including 14 with central compartment dissection). Immediate admission was decided in 12% of cases due to peroperative findings (15 patients), anesthetic considerations (7 patients), bilateral vocal fold paralysis noted in the recovery room (1 patient), and surgery late in the afternoon (1 patient). Two patients were readmitted for surgical site infections and one due to hypocalcemia. Temporary symptomatic hypocalcemia or decreased PTH level occurred in 10% (20 patients). On average, patients' satisfaction and feeling of security reached 9.3 on a 10-point scale.CONCLUSION:Outpatient thyroid surgery is a safe and desirable option.
OBJECTIVE:To investigate propranolol as a novel treatment for head and neck squamous cell carcinoma (HNSCC) in vitro.METHODS:HNSCC cell lines were cultured and treated with propranolol alone and in combination with cisplatin or γ-irradiation. The alamarBlue assay was performed to assess cell viability, and apoptosis was confirmed via Western immunoblot for cleaved poly-ADP-ribose polymerase (PARP) and caspase-3/7 assays.RESULTS:Propranolol reduced cell viability and induced apoptosis. In response to propranolol, ΔNp63α decreased, whereas TAp73β and downstream proapoptotic p53 family target genes increased. Expression of the proangiogenic protein vascular endothelial growth factor (VEGF) also decreased. Combination treatment with propranolol and cisplatin resulted in synergistic effects. Propranolol treatment also enhanced the effects of γ-irradiation on cell viability.CONCLUSIONS:Our results demonstrate that propranolol reduced HNSCC viability, induced apoptosis, and inhibited production of the proangiogenic protein VEGF. These changes may be due to modulation of p53 family proteins, which are critical regulators of chemotherapy-induced apoptosis in HNSCC. Moreover, propranolol is synergistic in combination with cisplatin and reduces HNSCC viability postradiation in vitro, which may have important implications for novel treatments of HNSCC patients.
BACKGROUND:Early-stage laryngeal squamous cell carcinoma is managed with radiotherapy or endoscopic surgery. Although cure rates are high, radiation failures often require total laryngectomy for salvage. Biomarkers that can predict tumour radioresistance may be useful in modifying the treatment approach for individual patients.METHODS:Retrospective patient chart review yielded 75 patients with T1-T2 glottic squamous cell carcinoma treated with radiation therapy at the London Health Sciences Centre. Pretreatment tumour biopsies were immunostained for B-cell lymphoma 2 (Bcl-2), Ki-67, and epidermal growth factor receptor (EGFR) to correlate biomarker expression with disease-free survival (DFS).RESULTS:Ki-67 expression was strongly associated with recurrence following radiation and independently predicted poor DFS (hazard ratio 4.86, 95% CI 1.58-15.00; p = .006). EGFR and Bcl-2 were not associated with a risk of recurrence.CONCLUSIONS:Ki-67 expression identified a subset of patients with increased risk of local recurrence after radiation therapy. Ki-67 expression can potentially guide improved personalized treatments for patients with early-stage glottic squamous cell carcinomas.
BACKGROUND/PURPOSE:The aim of Canadian medical school curricula is to provide educational experiences that satisfy the specific objectives set out by the Medical Council of Canada. However, for specialties such as otolaryngology, there is considerable variability in student exposure to didactic and clinical teaching across Canadian medical schools, making it unclear whether students receive sufficient teaching of core otolaryngology content and clinical skills. The goal of this review was to assess the exposure to otolaryngology instruction in the undergraduate medical curriculum at the University of Toronto.METHOD:Otolaryngology objectives were derived from objectives created by the Medical Council of Canada and the University of Toronto. The University of Toronto's recently developed Curriculum Mapping System (CMap) was used to perform a keyword search of otolaryngology objectives to establish when and to what extent essential topics were being taught.RESULTS:All (10 of 10) major topics and skills identified were covered in the undergraduate medical curriculum. Although no major gaps were identified, an uneven distribution of teaching time exists. The majority (> 90%) of otolaryngology education occurs during year 1 of clerkship. The amount of preclerkship education was extremely limited.DISCUSSION AND CONCLUSIONS:Essential otolaryngology topics and skills are taught within the University of Toronto curriculum. The CMap was an effective tool to assess the otolaryngology curriculum and was able to identify gaps in otolaryngology education during the preclerkship years of medical school. As a result, modifications to the undergraduate curriculum have been implemented to provide additional teaching during the preclerkship years.
OBJECTIVEA novel method was employed to control the sternocleidomastoid muscle contraction level during vestibular evoked myogenic potential (VEMP) measurement.STUDY DESIGNA prospective study to measure the normal VEMP response.SETTINGSA pressure feedback device composed of a firm rubber bulb and a pressure gauge was employed to monitor the muscular contraction level during measurement.METHODSNineteen normal-hearing subjects (12 males; mean age 34.0 ± 7.7 years) were tested. Subjects were instructed to position the chin on the rubber bulb and use the neck flexors to maintain a pressure of 120 mm Hg during the measurement.MAIN OUTCOME MEASURESThe P13 latencies, N23 latencies, and P13-N23 amplitudes were recorded. In nine subjects, the reproducibility of the technique was tested weekly for 3 consecutive weeks.RESULTSThe average (± SD) latency of P13 was 13.97 ± 1.33 ms, and the latency of N23 was 24.03 ± 1.79 ms. The average amplitude was 66.89 ± 44.1 μV. There was no significant difference between right and left ears in P13 latencies, N23 latencies, and P13-N23 amplitudes. In nine subjects, the average measured interclass correlation coefficient was 0.97 in amplitude, 0.8 in P13 latency, and 0.93 in N23 latency in three consecutive weekly measurements.CONCLUSIONSThe chin-rest pressure feedback method is easy to perform during VEMP testing. Subjects can maintain a constant level of sternocleidomastoid contraction and neck flexion to facilitate this response with a high degree of test-retest reliability. This technique provides a means to compare VEMPs across different clinical scenarios over time.
OBJECTIVE:Advancements in technology and personal computing afford the development of novel teaching modalities such as online Web-based modules. These modules are currently being incorporated into undergraduate medical curricula and, in some paradigms, have been shown to be superior to traditional methods of instruction. The purpose of this study was to evaluate the ability of a computer-assisted learning (CAL) module to demonstrate content and spatial information in the context of cranial nerve anatomy.STUDY POPULATION:Undergraduate anatomy students.METHODS:A prospective, randomized, controlled trial was conducted comparing a CAL module to traditional text-/image-based learning supplements. Indications of the participants' ability to translate spatial relationships between the trigeminal nerve and the craniofacial skeleton were assessed via a postintervention knowledge quiz.RESULTS:No significant difference was identified between the CAL module and the control group. Students in both groups performed poorly in questions testing spatial relationships.CONCLUSIONS:The CAL module used in the present study did not objectively contribute to the understanding of spatial anatomic relationships of the cranial nerves in novice students. Despite this, these modules may help pique student interest and motivation and, as such, may be used in the context of supplemental learning resources in existing university curricula.
Objective: To describe current management practices among Canadian otolaryngologists for small thyroid nodule disease and nodules in the context of goitre.Methods: An online survey was e-mailed to all active members of the Canadian Society of Otolaryngology-Head and Neck Surgery (CSOHNS). The responses were anonymous. Information was gathered on practice demographics and individual practices pertaining to diagnostic workup, surgical management, and follow-up of patients with goitre and small nodule disease.Results: A total of 113 surveys were returned from 431 active CSOHNS members (26% response). The majority of respondents were less than 40 years (54%), resided in Ontario or Quebec (63%), and described their practice as academic (65%). Management of a small thyroid nodule following fine-needle aspiration cytology results reported as benign, nondiagnostic, abnormal, or papillary thyroid cancer was inconsistent. Papillary thyroid cancer was managed by total thyroidectomy (59%), total thyroidectomy plus level VI neck dissection (38%), hemithyroidectomy plus level VI neck dissection (2%), and hemithyroidectomy (1%). Management of goitre was not uniform. Symptomatic goitre management included discharge from practice (6%), follow-up with serial ultrasonography (12%), hemithyroidectomy (15%), and total thyroidectomy (66%). Practice demographics had a significant effect on intraoperative techniques, such as the use of an electromyographic nerve monitor.Conclusion: There was a lack of consensus among Canadian otolaryngologists regarding treatment of small thyroid nodules and nodules in the context of goitre. Canadian guidelines for management of small nodule disease may standardize care.
BACKGROUND:Interruption of mandibular continuity in transmandibular (mandibulotomy and mandibulectomy) surgery for tumour resection in the oral cavity and oropharynx may alter oral and temporomandibular joint (TMJ) morphology and function. OBJECTIVE:To critically analyze available evidence regarding the effects of transmandibular surgeries on morphologic and functional changes in the TMJ and stomatognathic system. DATA SOURCES:Electronic search of Medline, Embase, Evidence-Based Medicine Reviews, Ovid HealthStar, and Scopus and hand searches. INCLUSION CRITERIA:Any article investigating the TMJ morphologic changes and/or functional outcomes following transmandibular surgeries. RESULTS AND SYNTHESIS METHODS:Two hundred seventy-one articles were obtained through the electronic database scan and six articles via a hand search. Twelve full articles were initially selected as potentially meeting the eligibility for this review; however, only five articles finally fulfilled the study inclusion criteria and were analyzed for their methodology. All articles used clinical records and/or patient reports to evaluate TMJ pain, motion, dental occlusion, mouth opening, and deflection during opening as outcome measures. In only four articles was a clinical examination conducted after surgery, with associated patients' interviews and reports. The quality of all included articles was considered poor with a high risk of bias according to the Research Triangle Institute item bank quality of assessment. CONCLUSION:Based on the limited available evidence for this systematic review and a high risk of bias of the analyzed articles, no firm conclusions can be established regarding the effects of transmandibular surgery on morphologic and functional changes in the TMJ and stomatognathic system.
BACKGROUNDThe utility and safety of level VI central compartment lymph node dissection (LND) for the early detection of lymph node (LN) involvement during diagnostic hemithyroidectomy, for the evaluation of suspicious thyroid nodules, has yet to be established in the literature.METHODSA retrospective review of all patients who underwent diagnostic hemithyroidectomy with level VI LND from a large head and neck oncology program from October 1, 2001, to May 10, 2009, was performed.RESULTSA consecutive series of 78 patients were reviewed. Twenty-six patients (29.8%) were diagnosed with malignant neoplasm. All patients with malignant LNs (n = 5; 6.4%) were diagnosed with papillary carcinoma. On average, 4.8 LNs were found through neck dissection in patients with positive nodes compared to 2.4 LNs in those without lymph node involvement (p = .04). No postoperative adverse events in the patient group were attributed to the level VI neck dissection.CONCLUSIONSIn patients undergoing diagnostic hemithyroidectomies, routine level VI LND was able to identify LN metastases in 6.4% of patients. The number of LNs was a strong predictor of positive node disease. Minimal surgical risks are associated with this procedure, and surgeons may avoid the risks of level VI reexploration in subsequent completion thyroidectomy.
BACKGROUND:Vitamin D, classically involved in calcium homeostasis, has garnered recent interest for its potential role in cancer prevention and therapy. Although few risk factors have been established in the development of well-differentiated thyroid carcinoma, some would argue that no clear modifiable risk factor exists. Our study is one of the first to explore the relationship between vitamin D deficiency and thyroid cancer.METHODS:This retrospective cohort study was done at a university-affiliated thyroid cancer centre. In 2010, 212 patients undergoing thyroidectomy had their preoperative 25-hydroxyvitamin D(3) levels recorded in addition to the final pathologies of their resected thyroid nodule. The patients were stratified based on vitamin D status; vitamin D deficiency (VDD), reflecting levels under the established threshold of 37.5 nmol/L; and vitamin D sufficiency (VDS), reflecting levels above it. The primary outcome of malignancy rate was used to compare the proportion of malignant nodules in the VDD versus the VDS groups.RESULTS:The malignancy rate rises when comparing the VDS and VDD groups, from 37.5 (33 of 88) to 75% (9 of 12), respectively, corresponding to a relative risk of 2.0 (p = .03, 95% CI 1.07-2.66).CONCLUSION:This is the first study to demonstrate the inverse relationship between VDD and well-differentiated thyroid carcinoma. Larger prospective studies are needed to replicate these results. Should this happen, VDD may be the first modifiable risk factor for thyroid cancer.
OBJECTIVE:To determine whether patients with vitamin D deficiency (VDD) are at increased risk for hypocalcemia following total thyroidectomy.METHODS:A retrospective study of 246 consecutive patients undergoing thyroidectomy at a McGill University teaching hospital was conducted. Patients who had subtotal thyroidectomy or concomitant parathyroidectomy or whose laboratory tests were incomplete for analysis were excluded, as were pediatric patients. The remaining 139 patients had preoperative 25-hydroxyvitamin D [25(OH)D], corrected calcium, and parathyroid hormone (PTH) measured. Postoperatively, PTH and serum calcium were measured to assess for hypocalcemia. Low vitamin D (LVD) was defined as 25(OH)D ≤ 70 nmol/L (≤ 28 ng/mL), which includes vitamin D insufficiency, 25(OH)D > 35 nmol/L (> 14 ng/mL) but ≤ 70 nmol/L (≤ 28 ng/mL), and VDD, 25(OH)D ≤ 35 nmol/L (≤ 14 ng/mL). Adequate vitamin D (AVD) corresponded to levels > 35 nmol/L (> 14 ng/mL), whereas optimal vitamin D (OVD) levels corresponded to levels > 70 nmol/L (> 28 ng/mL).RESULTS:The rate of postthyroidectomy hypocalcemia in OVD patients was 10.4% (8 of 77) compared to 3.2% (2 of 62) in LVD patients (odds ratio = 0.29, p = .10). There was no hypocalcemia in the 9 VDD patients, meaning that all hypocalcemic episodes occurred in patients with AVD (7.7%; 10 of 130). The mean preoperative PTH levels for LVD patients was 4.65 pmol/L (43 ng/L) compared to 4.18 pmol/L (38.9 ng/L) for OVD patients (p = .073).CONCLUSIONS:In this series, preoperative LVD did not predict early postthyroidectomy hypocalcemia. On the contrary, it showed a trend toward protective effect. Adaptive changes in the parathyroid glands, such as hypertrophy, hyperplasia, or the ability to secrete more hormone secondary to prolonged VDD, may contribute to this phenomenon. A large prospective study is needed to better understand the relationship between preoperative vitamin D levels and postoperative hypocalcemia.
OBJECTIVE To investigate the prevalence and risk of thyroid incidentaloma identified by positron emission tomography/computed tomography (PET/CT). STUDY DESIGN Historical cohort study. SETTING Fudan University Shanghai Cancer Center. METHODS A total of 15 948 non-thyroid disease patients who underwent fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT from November 2006 to September 2010 were included. They were divided into two groups: 12 080 patients for metastatic evaluation and 3868 patients for cancer screening. When thyroid incidentaloma was found, further diagnostic examination was conducted. MAIN OUTCOME MEASURES Prevalence and risk of thyroid incidentaloma. RESULTS The prevalence of incidental thyroid 18F-FDG uptake was approximately 2.5% (395 of 15 948). The prevalence of incidentaloma in healthy subjects (118 of 3868; 3.1%) was statistically higher than that in patients with suspected or known cancer (277 of 12 080; 2.3%) (p < .05). Among 395 incidentalomas, 146 patients had further examinations (53 patients with histologic confirmations, 93 patients with clinical monitoring). Finally, 43 lesions were confirmed to be malignancies. Therefore, the cancer risk was 29.5% (43 of 146), and it was higher in cancer screening patients (24 of 59; 40.7%) than in alleged cancer patients (19 of 87; 21.8%) (p < .05). As for FDG uptake pattern, the prevalence of thyroid cancer was 11.6% (5 of 43) and 36.9% (38 of 103) in the group of patients with diffuse and focal uptake, respectively (p < .05). After logistic regression analysis, age, sex, maximal standardized uptake value, and calcification were the potent predictors of differentiation. CONCLUSION The presence of focal uptake with high SUVmax and calcification detected on CT images correlates with a high likelihood of thyroid malignancy. When a focal thyroid incidentaloma is detected, further examination should be performed.
BACKGROUND:Lateralization of the middle turbinate following endoscopic sinus surgery (ESS) can lead to increased patient morbidity. Numerous techniques have been proposed to avoid this complication, including middle turbinectomy, stents, controlled synechiae formation, and metal clips.OBJECTIVES:To determine if a suture technique is an effective middle turbinate stabilization procedure and to determine the cost savings of this technique compared to commercially available middle meatal stents.MATERIAL AND METHODS:Retrospective review of 60 cases, all performed by the senior author using a middle turbinate suture technique, and the 3-month postoperative results. The efficacy of the technique was determined, as well as its cost compared to other materials for middle meatal preservation.RESULTS:A total of 110 turbinates were treated with the suture technique in 60 patients. The success rate was 98.2% (108 of 110). Commercial stent use cost ranged from 8 to 83 times the price of the suture depending on the stent.CONCLUSION:The middle turbinate suture technique is effective in preventing turbinate lateralization and has a significantly lower cost than commercially available middle meatal spacer materials.
