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Objectives:(1) List the factors that are predictive of non-diagnostic cytology in surgeon-performed ultrasound-guided fine-needle aspiration (FNA) of thyroid nodules. (2) Describe a patient cohort that may benefit from early referral to other clinicians.Methods:Retrospective chart review. Patients included all adults who underwent thyroid nodule FNA by a staff, fellow, or resident otolaryngologist at our center between January 2011 and June 2013. Cytology was interpreted by a staff cytopathologist according to the Bethesda classification system. The predictive factors analyzed were patient age, sex, body mass index (BMI), thyroid gland size, thyroid function, presence of multinodular goiter, presence of Graves’ disease or thyroiditis, nodule size, location, vascularity, echogenicity, calcifications, cystic component, level of performer training, and level of FNA experience. Results were analyzed using chi-squared, Fisher exact test, or unpaired t test.Results:A total of 190 patients were reviewed, for a t...

Objectives:The incidence of depressive symptoms in head and neck cancer (HNC) patients has been shown to be up to 40% during treatment and can affect patients’ desires to rehabilitate after surgery. The objectives in this study were to (1) evaluate the relationship between preoperative depressive symptoms and postoperative functional performance status (PFPS) and (2) assess the effect of preoperative depressive symptoms on length of hospital stay (LOHS), completion of adjuvant therapy (CAT), rate of postoperative readmission, and loss of follow-up.Methods:A prospective cohort study was conducted in new adult HNC patients undergoing surgery as primary therapy from January 2013 to January 2014 measuring baseline preoperative depressive symptomatology on the Quick Inventory of Depressive Symptomatology (QIDS) and PFPS was assessed on the Functional Assessment of Cancer Therapy-Head & Neck (FACT-HN) 6 months from the initial presentation. Secondary outcomes assessed included LOHS, CAT, rate of readmission due...

Objectives:Use 3-dimensional volumetric analysis of postoperative computed tomography (CT) scans to characterize tongue volume and correlate measured values with swallowing function.Methods:Retrospective chart review of prospectively collected data. Fifteen patients treated with surgical resection and free flap reconstruction of the oral and base of tongue with or without postoperative irradiation between 2010 to 2012 were included in the study. Mimics program was used to obtain measurements of the oral tongue and tongue base volume, tongue base to oropharyngeal volume ratio, and tongue base to posterior pharyngeal wall distance by analyzing the postoperative 6-month and 1-year CT scans. Prospectively collected functional outcomes data, including aspiration/penetration score, perceptual evaluation of intelligibility, and G-tube dependence rates, were evaluated and correlated with dimensional analysis measures.Results:Adequate but not excessive tongue base volume correlated with reduced aspiration/penetrat...

Objectives:To determine if positron emission tomography (PET)-computed tomography (CT) offers any diagnostic advantage over traditional CT neck in assessing the clinically N0 neck in patients with T1 and T2 squamous cell carcinoma (SCC) of the oral cavity.Methods:We performed a retrospective review of patients in the Alberta Cancer Registry who were diagnosed with cT1 or T2N0M0 disease who underwent elective unilateral or bilateral neck dissections. Results of preoperative PET-CT and CT necks were reviewed for number of “suspicious” lymph nodes. Surgical pathology reports were reviewed to obtain the total number of nodes sampled and number of malignant nodes.Results:Between 2009 and 2011, 148 patients were diagnosed with cT1 or T2N0M0 SCC of the oral cavity. Of these, 62 patients underwent elective neck dissections. Fourteen patients underwent preoperative PET-CT while 48 patients underwent CT neck alone. Based on final surgical pathology, 6 nodes out of 499 nodes sampled were falsely fludeoxyglucose-avid...

Objectives:Depression in head and neck cancer (HNC) patients is undertreated and under-recognized, yet has been shown to be present in up to 40% of patients. The objective in this study was to perform a systematic review of the literature regarding the optimal psychologic intervention for HNC patients with depressive symptomatology.Methods:A systematic review. PubMed, Medline, and ENCASE were searched in December 2013 for studies examining psychologic interventions in head and neck cancer patients. Results were screened by 2 independent reviewers. The level of evidence for each study and intervention were evaluated using criteria put forth by the Agency for Healthcare Research and Quality US Preventative Services Task Force. Subsequent analysis was then planned according to the criteria in the Cochrane Handbook for Systematic Reviews.Results:Eleven studies met inclusion criteria. Three studies were rated “good” for internal validity and 6 for external validity. Psychologic education and cognitive behavior...

Objectives:Metabolic tumor volume (MTV) obtained from pretreatment 18F-fluorodeoxydeglucose positron emission tomography with computed tomography (PET-CT) has been validated as an independent predictive factor of outcomes in head and neck cancer patients (HNC) treated with primary chemoradiotherapy (CRT). However, its role in patients treated with primary surgery has not yet been studied. The aim of the study was to evaluate the prognostic value of MTV in patients treated with primary surgery for oral cavity squamous cell carcinoma (OCSCC).Methods:Demographic and survival data were obtained from patients diagnosed with OCSCC from 2008 to 2012 in Alberta, Canada. All patients included in the study had positron emission tomography–computed tomography (PET-CT) scan before curative surgical resection. MTV and maximum standardized uptake value (SUVmax) was delineated from pretreatment PET-CT scans using Segami Oasis software (Columbus, OH).Results:A total of 80 patients were analyzed using SPSS (SPSS Inc, Chic...

Objectives:Surgical resection is the standard of care in early stage oral cavity squamous cell carcinoma (OCSCC). Recent literature has shown, however, that adverse pathologic features are potential indications for adjuvant radiotherapy. Objective: 1) Evaluate survival outcomes of early-stage OCSCC patients. 2) Determine whether a subgroup of patients may benefit from adjuvant radiotherapy.Methods:The setting for this study was the two tertiary cancer centers in the province of Alberta and was designed as a prospective population-based multi-institutional review. Demographic, pathologic, treatment, and survival data was obtained from patients diagnosed with early stage OCSCC from 1998 to 2010. Survival outcomes were calculated using Kaplan-Meir and Cox-Regression analysis.Results:A total of 343 patients were analyzed. Five-year survival according to treatment modality were surgery, 83.3 %; surgery + radiation, 94.7 %; radiation, 56.4 %. Cox regression analysis did not show any significant differences betw...