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...after Zbigniew Herbert. A new poem by Kevin Higgins.

Importance. Head and neck squamous cell carcinomas (HNSCC) are responsible for a significant amount of morbidity and mortality in Canada. Surgical margins are one of the most important factors used to guide treatment; however, currently there is a lack of consensus on the ideal surgical margin definition, sampling, and assessment method. Objective. To understand the current perspectives and practice patterns of Canadian head and neck surgeons with respect to surgical margin: (1) definition, (2) sampling, (3) pathological assessment. Design. A 24-question cross-sectional survey was sent via email through the Canadian Society of Otolaryngology—Head & Neck Surgery (CSOHNS), and responses were gathered from December 19, 2023, to March 12, 2024. Responses were aggregated and reported using descriptive statistics. Setting/Participants. The survey was conducted in Canada among self-reported staff head and neck oncology surgeons with membership in the CSOHNS. Results. A total of 36 staff head and neck oncology surgeons responded from across Canada. The most common (58.3%) definition of a negative surgical margin for oral cavity HNSCC was “>5mm formalin fixed paraffin embedded distance.” To obtain surgical margins, surgeons were split with 44.1% using only a tumor bed approach and 32.4% using only a specimen-driven approach. A dedicated head and neck pathologist is always available more commonly for final pathological assessment (63.6%) versus intraoperative frozen section assessment (15.5%). Finally, most surgeons reported having a synoptic standardized reporting system for annotating margin status (78.8%). Conclusions/Relevance. The results of this survey provide a current-state analysis of head and neck surgeons across Canada and set the stage for future efforts to be directed toward standardizing the collection method and reporting criteria for surgical margins in HNSCC. [ABSTRACT FROM AUTHOR]

Background: Lymphatic mapping with SPECT–CT has been demonstrated to accurately define lymphatic drainage patterns in oropharyngeal cancer but there has yet to be a study demonstrating its feasibility across multiple institutions. Methods: Twelve adult patients with lateralized oropharyngeal carcinoma (T1‐T3) who were planned for definitive or adjuvant radiotherapy without contralateral nodal disease underwent injection of 99‐m technetium sulfur colloid followed by static planar lymphoscintigraphy to verify tracer migration, and SPECT–CT acquired at 30 ± 15 min (optional) and 3 h (±1 h) (mandatory time‐point). Results: All 12 patients completed the study with 7/12 patients having the injections performed under local anesthetic and 5 patients requiring general anesthetic. There were no tracer migration failures and there were no serious adverse events or complications encountered. Four out of 12 patients (33%) showed contralateral drainage patterns. Conclusions: Lymphatic mapping with SPECT–CT of lateralized oropharyngeal squamous cell carcinoma can be performed safely across multiple institutions. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid nodules are extremely common being detected by ultrasonography in up to 67% of the population, with current surgical tenet maintaining that lobectomy is required for large symptomatic benign nodules or autonomously functionally nodules resulting in a risk of hypothyroidism or recurrent laryngeal nerve injury even in high volume centres. The introduction of radiofrequency ablation (RFA) has allowed thermal ablation of both benign and autonomously functioning thyroid nodules with minimal morbidity. The moving shot technique is the most well-established technique in performing RFA of thyroid nodules, and has proven to be safe, efficacious, accurate and successful amongst experienced clinicians. The purpose of this article to propose the use of a novel guide when performing RFA of thyroid nodules in clinical practice utilizing the moving shot technique. Methods: The technique proposed of RFA involves the use of a 10MHz linear ultrasound probe attached to an 18G guide which provides robust in line visualisation of a 7cm or 10cm radiofrequency probe tip (STARmed, Seoul, Korea) utilizing the trans isthmic moving shot technique. A geometric analysis of the guide has been illustrated diagrammatically. Results: The use of an 18G radiofrequency probe guide (CIVCO Infiniti Plus™ Needle Guide) maintains in line visualisation of the radiofrequency probe over a cross-sectional area up to 28cm2, facilitating efficient and complete ablation of conceptual subunits during RFA of thyroid nodules. Discussion: Radiofrequency ablation of thyroid nodules can be performed safely and effectively using the novel radiofrequency probe guide proposed which we believe potentially improves both accuracy and overall efficiency, along with operator confidence in maintaining visualisation of the probe tip, and hence we believe provides a valuable addition to the armamentarium of clinicians wishing to embark on performing RFA of thyroid nodules. [ABSTRACT FROM AUTHOR]

Background: Lymph node metastases are associated with poor prognosis in oral cavity squamous cell carcinoma (OCSCC). In other cancers, clinical guidelines on the number of lymph nodes removed during primary surgery, lymph node yield (LNY), exist. Here, we evaluated the prognostic capacity of LNY on regional failure, locoregional recurrence, and disease‐free survival (DFS) in patients with OCSCC treated by primary neck surgery. Methods: This retrospective cohort study took place at Sunnybrook Health Sciences Centre in Toronto, Canada and involved a chart review of all adult patients with treatment‐naive OCSCC undergoing primary neck dissection. For each outcome, we first used the maximally selected rank statistics and an optimism‐corrected concordance to identify an optimal threshold of LNY. We then used a multivariable Cox proportional hazards model to assess the association between high LNY (>threshold) and each outcome. Results: Among the 579 patients with OCSCC receiving primary neck dissection, 61.7% (n = 357) were male with a mean age of 62.9 years (standard deviation: 13.1) at cancer diagnosis. When adjusting for sociodemographic and clinical factors, LNY >15 was significantly associated with improved DFS (adjusted HR [aHR]: 0.73, 95% CI: 0.54–0.98), locoregional recurrence (aHR: 0.68, 95% CI: 0.49–0.95), and regional failure (aHR: 0.61, 95% CI: 0.39–0.93). Conclusions: Our study findings suggested high LNY to be a strong independent predictor of various patient‐level quality of surgical care metrics. The optimal LNY we found (15) was lower than the conventionally recommended (18), which calls for further research to establish validity in practice. [ABSTRACT FROM AUTHOR]

This embedded case study explores the student-teacher relationship in a one-to-one technology environment. The actual change in relationship in a one-to-one classroom was examined. The study was guided by the self-system theory of motivation and its three characteristics of autonomy, relatedness, and competency as a theoretical framework. To explore this topic, the researchers considered the perspectives of four classroom teachers and 207 high school students at a suburban public high school in New Jersey. The case study research utilized teacher interviews, classroom observations, student surveys, and a student focus group. The findings revealed a notable change in the relationship between teachers and students within the one-to-one environment. The change existed in the connectivity between the teachers and their students beyond the classroom and school. The researchers concluded that the teachers and their students did have a positive relationship in a one-to-one environment and that relationship depended on the teacher's ability to engage students using the one-to-one device. The researchers concluded that the one-to-one environment creates an autonomous learning environment for students; teachers and students have a relatedness that extends beyond the traditional boundaries of a school; and a higher level of competency in both teachers and students creates a more engaging classroom. As one-to-one technology environments are becoming more popular across the country, this study contributes to a better understanding of the expected changes in teacher-student relationships before issues of conflict occur.