Multi-level factors associated with more intensive use of radioactive iodine for low-risk thyroid cancer

xlomafota13 shared this article with you from Inoreader Multi-level factors associated with more intensive use of radioactive iodine for low-risk thyroid cancer Via radioactive iodine J Clin Endocrinol Metab. 2021 Mar 4:dgab139. doi: 10.1210/clinem/dgab139. Online ahead of print. ABSTRACT CONTEXT: The use of radioactive iodine (RAI) for low-risk thyroid cancer is common, and variation in its use exists, despite the lack of benefit for low-risk disease and potential harms and costs. OBJECTIVE: To simultaneously assess patient- and physician-level factors associated with patient-reported receipt of RAI for low-risk thyroid cancer. DESIGN, SETTING, PART ICIPANTS: This population-based survey study of patients with newly-diagnosed differentiated thyroid cancer identified via the Surveillance Epidemiology and End Results (SEER) registries of Georgia and Los Angeles County included 989 patients with low-risk thyroid cancer, linked to 345 of their treating general surgeons, otolaryngologists and endocrinologists. MAIN OUTCOMES: Patient-reported receipt of RAI for low-risk thyroid cancer. RESULTS: Among this sample, 48% of patients reported receiving RAI, and 23% of their physicians reported they would use RAI for low-risk thyroid cancer. Patients were more likely to report receiving RAI if they were treated by a physician who reported they would use RAI for low-risk thyroid cancer compared to those whose physician reported they would not use RAI (Adjusted OR: 1.84, 95%CI: 1.29-2.61). The odds of patients reporting they received RAI was 55% lower among patients whose physicians reported they saw a higher volume of patients w ith thyroid cancer (40+ vs. 0-20) (Adjusted OR: 0.45, 0.30-0.67). CONCLUSIONS: Physician perspectives and attitudes about using RAI, as well as patient volume, influence RAI use for low-risk thyroid cancer. Efforts to reduce overuse of RAI in low-risk thyroid cancer should include interventions targeted towards physicians, in addition to patients. PMID:33687063 | DOI:10.1210/clinem/dgab139 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Diagnostic use of fine‐needle aspiration cytology and core‐needle biopsy in head and neck sarcomas

xlomafota13 shared this article with you from Inoreader Diagnostic use of fine‐needle aspiration cytology and core‐needle biopsy in head and neck sarcomas Via Head & Neck Abstract The diagnostic role of fine‐needle aspiration cytology (FNAC) and core‐needle biopsy (CNB) has not been comprehensively assessed in head and neck sarcomas. A systematic review of published cases (1990–2020) was conducted. Diagnostic performance of both FNAC/CNB to determine tumor dignity and histopathological diagnosis was calculated. One hundred and sixty‐eight cases were included for which FNAC (n = 156), CNB (n = 8), or both (n = 4) were used. Predominant histologies were skeletal muscle, chondrogenic and vascular sarcomas. FNAC correctly assessed dignity in 76.3% and histology in 45% of cases. Dignity was significantly better for vascular tumors, metastatic and recurrent specimens, and worse for chondrogenic sarcomas. CNB showed a 92% accuracy to identify dignity and 83% for histopathology. FNAC and CNB are useful methods for the diagnosis of head and neck sarcomas, particularly well‐suited in the context of recurrent or metastatic disease. The role of CNB remains largely unexplored for this indication. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Intensity‐modulated radiation therapy for nasal cavity and paranasal sinus tumors: Experience from a single institute

xlomafota13 shared this article with you from Inoreader Intensity‐modulated radiation therapy for nasal cavity and paranasal sinus tumors: Experience from a single institute Via Head & Neck Abstract Background To assess the efficacy of intensity‐modulated radiation therapy (IMRT) for tumors of the nasal cavity and paranasal sinus (PNS) region. Materials and Methods Two hundred fourteen patients with tumors of the nasal cavity and PNS region treated with curative intent IMRT between 2007 and 2019 were included in this retrospective analysis. Results Fifty‐one (24.1%) received definitive RT/CTRT and 163 (75.9%) received adjuvant RT. Most common histology was squamous cell carcinoma (26.1%) followed by adenoid cystic carcinoma (21.5%). The median follow‐up was 43.5 months. The 5‐year local control (LC), event‐free survival (EFS), and overall survival (OS) for the entire cohort was 66.9%, 59%, and 73.9%, respectively. On univariate analysis treatment with nonsurgical modality, T classification and undifferentiated/poorly differentiated histology were associated with inferior 5‐year LC, EFS, and OS. Four patients had late Grade 3/Grade 4 ocular toxicity. Conclusions IMRT should be the standard of care for tumors of PNS region across all histologies and treatment setting. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Swallowing and communication outcomes following primary transoral robotic surgery

xlomafota13 shared this article with you from Inoreader Swallowing and communication outcomes following primary transoral robotic surgery Via Head & Neck Abstract Background Heterogeneity within studies examining transoral robotic surgery (TORS) for oropharyngeal cancer (OPC) has made it challenging to make clear conclusions on functional outcomes. Infrequent use of instrumental swallow examinations compounds uncertainty surrounding the proposed functional advantage to TORS. Methods A prospective cohort of 49 patients underwent speech and swallowing assessment 12 months following treatment for OPC. Patients were assessed using fibreoptic endoscopic evaluation of swallowing (FEES), clinician‐ and patient‐reported outcomes. Participants were matched according to tumor site, T category, and age. Speech and swallowing outcomes were compared for those receiving TORS versus chemoradiation. Results When adjuvant radiotherapy to the primary site could be avoided, TORS demonstrated an advantage for feeding tube duration, secretion severity, penetration/aspiration, M. D. Anderson Dysphagia Inventory (MDADI), and airway protection. Conclusion This explorative study suggests that a treatment philosophy of selecting patients for TORS where adjuvant therapy can be omitted or confined to the neck warrants further evaluation. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cochlear Nerve Canal Stenosis: Association With MYH14 and MYH9 Genes

xlomafota13 shared this article with you from Inoreader Cochlear Nerve Canal Stenosis: Association With MYH14 and MYH9 Genes Via ear nose throat Ear Nose Throat J. 2021 Mar 8:145561321996839. doi: 10.1177/0145561321996839. Online ahead of print. ABSTRACT The bony cochlear nerve canal transmits the cochlear nerve as it passes from the fundus of the internal auditory canal to the cochlea. Stenosis of the cochlear nerve canal, defined as a diameter less than 1.0 mm in transverse diameter, is associated with inner ear anomalies and severe to profound congenital hearing loss. We describe an 11-month-old infant with nonsyn dromic congenital sensorineural hearing loss with cochlear nerve canal stenosis. Next-generation sequencing revealed heterozygous mutations in MYH9 and MYH14, encoding for the inner ear proteins myosin heavy chain IIA and IIC. The patient's hearing was rehabilitated with bilateral cochlear implantation. PMID:33683976 | DOI:10.1177/0145561321996839 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Solitary Fibrous Tumor of the External Auditory Canal

xlomafota13 shared this article with you from Inoreader Solitary Fibrous Tumor of the External Auditory Canal Via ear nose throat Ear Nose Throat J. 2021 Mar 8:145561321997539. doi: 10.1177/0145561321997539. Online ahead of print. ABSTRACT Solitary fibrous tumors (SFTs) originating from the external auditory canal are uncommon; only few cases have been reported in the literature. In this article, we report a case of a 35-year-old man who presented with a 6-month history of a gradual swelling in the entrance of the left external auditory meatus associated with hearing loss. The tumor was surgically remo ved, and histological examination showed spindle-cell proliferation with a collagenous stroma. Immunohistochemically, the tumor cells were positive for CD34 confirming the diagnosis of an SFT. Although SFTs are benign, complications such as relapses and metastasis after excision were reported. Thus, a careful and long follow-up is recommended. PMID:33683977 | DOI:10.1177/0145561321997539 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Use of Off-Label Nasal Steroid Irrigations in Long-Term Management of Chronic Rhinosinusitis

xlomafota13 shared this article with you from Inoreader Use of Off-Label Nasal Steroid Irrigations in Long-Term Management of Chronic Rhinosinusitis Via ear nose throat Ear Nose Throat J. 2021 Mar 8:145561321998521. doi: 10.1177/0145561321998521. Online ahead of print. ABSTRACT OBJECTIVE: Chronic rhinosinusitis (CRS) is an inflammatory disease of the paranasal sinuses and mucosa. Topical nasal corticosteroids are a mainstay treatment for CRS by reducing sinonasal inflammation and improving mucociliary clearance. However, topical corticosteroids have limited paranasal distribution, and patient response to treatment has been variable in rando mized controlled trials (RCT). Thus, there is significant interest in evaluating the efficacy of nasal steroids delivered by nasal irrigation in order to improve penetration and absorption of topical steroids into the sinonasal mucosa. In this review, we discuss the use of off-label nasal steroid irrigations in the management of CRS. METHODS: A review of clinical trials evaluating the use of nasal steroid irrigations for CRS in the PubMed electronic database was performed. RESULTS: Of the 12 clinical studies identified, 10 evaluated budesonide irrigations while the remaining 2 focused on mometasone. The overwhelming majority of studies for both budesonide and mometasone supported the use of nasal irrigations with corticosteroids over nasal corticosteroid sprays alone. However, the heterogeneity in study design, patient cohort, and volume of steroid irrigation limit the interpretations of these studies. CONCLUSIONS: Nasal irrigation with corticosteroids is beneficia l and safe for the treatment of CRS. Future RCTs controlling for type of surgical intervention, CRS pheno- and endo-type, as well as dosing and duration of nasal corticosteroid irrigations are warranted. PMID:33683979 | DOI:10.1177/0145561321998521 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.