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Oral Papers The objective of this study was to identify additional pre-operative factors that could reliably be used to aid in determining the appropriate extent of thyroidectomy. Design: Retrospective chart review. Setting: Tertiary-care academic hospital. Patients: 200 consecutively treated patients who underwent thyroid surgery after having a FNAB at Mount Sinai Hospital that met the criteria for atypical cytology (corresponds to “follicular lesion / atypia of undetermined significance,” 2007 NCI guidelines). Main Outcome Measures: Malignant versus benign final histopathological diagnosis. Results: The final diagnosis was benign in 42.5% of patients and malignant in 57.5%. The presence of microcalcifications within the nodule on ultrasound (US) was significantly associated with a higher risk of malignancy (RR=1.31, p=0.04). When examined individually, age, sex, family history of thyroid malignancy, exposure to head and neck irradiation, nodule size, rim enhancement on US, and intranodular vascularity on US were not significantly associated with an increased risk of malignancy. Multivariate stepwise logistic regression was used to identify a model that could reliably predict a higher probability of malignancy. The final model determined that patients with microcalcifications on US and a nodule greater than or equal to 2.0cm in size had a 74.3% risk of malignancy versus a 47.5% risk in patients with no microcalcifications and a nodule smaller than 2.0cm. This difference was statistically significant. Conclusions: Microcalcifications and nodule size can be used to risk stratify patients with an atypical FNAB result and aid in determining the appropriate extent of thyroidectomy. S037 SURGICAL PRACTICE PATTERNS IN THE MANAGEMENT OF PAPILLARY THYROID MICROCARCINOMA. Arthur W Wu, MD, Marilene B Wang, MD, Chau Nguyen, MD UCLA Division of Head and Neck Surgery, Los Angeles, CA, USA; Anacapa Surgical Associates, Ventura, CA, USA. Background: The incidence of thyroid cancer has increased 6.2 fold from 1997 to 2004, partially stemming from increased detection of small papillary cancers. Recently, there has been debate in the literature regarding the proper treatment of papillary thyroid microcarcinoma (PTMC), with some advising completion total thyroidectomy and others suggesting hemithyroidectomy to be sufficient. Given conflicting opinions, we wished to analyze the prevailing trends for treatment of PTMC. We sought to determine whether a clinician’s experience, age, training background, and practice location affected his/her treatment decision. Methods: A 10 question survey was emailed to members of the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS) and the American Association of Endocrine Surgeons, posted in a general surgery forum on the Sermo website, and advertised in an AAOHNS bulletin. Four clinical scenario questions queried whether a physician would proceed with completion thyroidectomy for a PTMC. Two questions investigated the reasoning behind the surgeon’s decision. Lastly, there were four demographic questions querying training, surgical volume, location, and age. These variables were used to analyze responses to the four clinical scenarios using bivariate and multivariate statistics. Results: Of the total 438 responders who completed the survey, 335 identified themselves as otolaryngologists, 64 as general surgeons, and 32 as other. Given a single sub-centimeter PTMC, 70% of surgeons recommended no further surgery after a hemithyroidectomy, but a significant minority (30%) felt completion thyroidectomy was necessary. The decision to perform total thyroidectomy was significantly greater in the South (p=0.0052) and the West (p=0.0026). Additionally, otolaryngologists (p=0.039) were more willing to perform completion thyroidectomy compared to general surgeons. Given lymphatic invasion, 89.5% recommended completion thyroidectomy. Otolaryngologists again were more inclined to proceed with total thyroidectomy compared to their general surgeon colleagues (p=0.019). In the scenario of multifocal PTMC, 85% chose completion thyroidectomy. The decision to perform completion thyroidectomy in this type of case was greater in the South (p=0.056) and the West (p=0.032) relative to the Northeast. Responding surgeons rated improved survival, surgeon preference, and the need for thyroid suppression as having little significance in their decision. The ease of patient follow-up and multifocality of disease were judged very significant. Of note, influence from literature, guidelines, and recognized authorities were rated as only somewhat or minimally significant. Conclusion: In this survey a majority of surgeons seem to follow national guidelines regarding surgical management of PTMC. However, significant differences in management and perception of PTMC exist. Location and surgical training appear to affect how a surgeon manages PTMC. In the case of PTMC, a consistent consensus for treatment has not emerged, but as more data on outcomes and prognosis come to light, there may be a stronger rationale for evidence-based treatment recommendations for PTMC. S038 VOLUME-BASED TRENDS IN THYROID SURGERY. Christine G Gourin, MD, Robert E Bristow, MD, Ralph P Tufano, MD, Arlene A Forastiere, MD, Wayne M Koch, MD, Timothy M Pawlik, MD; Johns Hopkins Medical Institutions. Objective: Positive volume-outcome relationships exist for diseases treated with technically complex surgery, including thyroid surgery. However, contempory patterns of thyroid surgery are poorly defined. Methods: The Maryland Health Service Cost Review Commission database was queried for hospital and surgeon thyroid surgical case volumes from 1990-2009. Results: Overall, 21,351 thyroid surgeries were performed by 1,034 surgeons at 51 hospitals. Surgical cases increased from 9,459 in 1990-1999 to 11,892 in 2000-2009. The proportion of cases performed by high-volume surgeons increased from 15.8% in 1990-1999 to 31.0% in 2000-2009 (OR=1.96, P
Oral Papers thyroglobulin level after 1st RAI treatment (2nd stimulated Tg) in the TT+CLND group was not different from that in the TT group (0.44 vs. 0.69 ng/mL, P = 0.341). Also, the 3-year locoregional control rates of the TT+CLND group was not different from that of the TT group (98.3% vs. 96.5%, P = 0.368). Complication rates in the TT+CLND group were slightly higher than in the TT group, without statistical significance (P > 0.05). Conclusions: Prophylactic CLND could effectively clear the subclinical LNMs in central neck and reduce postoperative thyroglobulin level without significant increase of complications. However, prophylactic CLND had little prognostic benefit, particularly for patients with RAI treatment. S040 ROUTINE PARATHYROID LOCALIZATION WITH 4-D COMPUTED TOMOGRAPHY/ULTRASOUND IN PATIENTS WITH HYPERPARATHYROIDISM. David I Kutler, MD, Rachel A Moquete, BA, William I Kuhel, MD, Eli Kazam, MD; Weill Cornell Medical Center. Background: Accurate preoperative localization of hyperplastic parathyroid glands increases surgical success and minimizes operative risk. 4D Computed Tomography (4D-CT) was recently shown to be highly sensitive and specific in identifying hyperplastic parathyroid glands in the reoperative setting. The purpose of this study is to document our decade long experience using 4D- Computed Tomography/Ultrasound (4D-CT/US) to localize abnormal parathyroid glands in patients with hyperparathyroidism. Study Design: This is a retrospective chart analysis of 185 patients who underwent a parathyroid localization series at Manhattan Diagnostic Radiology (MDR) and parathyroidectomy at Weill Cornell Medical Center between January 1998 and May 2009. Of the185 patients, 11 were in the reoperative setting. Results from preoperative localization studies were compared to operative findings, pathologic data and biochemical measurements to assess the sensitivity and specificity of the parathyroid localization series. Results: 4D-CT/ US demonstrated 96% sensitivity and 90% specificity when the imaging studies were used to lateralize the hyperfunctioning parathyroid gland to 1 side of the neck. Furthermore, the sensitivity and specificity of the parathyroid series to localize the hyperfunctioning parathyroid gland to a specific quadrant of the neck (ie right superior) was 82% and 92% respectively. Of the 185 patients, 4D-CT/US was felt to show a single adenoma in 146 patients. Of the 146 patients, 4D-CT/US accurately localized the adenoma to the correct side of the neck in 134 cases (92%). Multigland disease was found in 11 patients (8%) believed to have single gland disease. Of the 38 patient who were thought to have multigland disease based on the results of the 4D-CT/US, multigland disease was documented in 28 patients (74%). Only a single parathyroid localization study was non-localizing and that patient was found to have single adenoma. At follow up, 175 patients (95%) were cured, 8 (4%) had persistent primary hyperparathyroidism and 2 (1%) had permanent hypoparathyroidism. Conclusion: 4D-CT/US provides greater sensitivity and specificity when compared to the historical data for sestamibi imaging. When interpreted by a skilled radiologist, 4D-CT/US facilitates accurate preoperative planning in both the primary and reoperative settings. S041 INTRAOPERATIVE PARATHYROID HORMONE MONITORING IN PARATHYROIDECTOMY; IS IT MANDATORY? Aviram Mizrachi, MD, Gideon Bachar, MD, Tuvia Hadar, MD, Raphael Feinmesser, MD, Thomas Shpitzer, MD; Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Objective: To determine the value of intraoperative parathyroid hormone (IOPTH) monitoring in curative parathyroidectomy. Design: Retrospective series. Setting: University-affiliated tertiary medical center. Patients and Methods: Two hundred forty consecutive patients surgically treated for primary hyperparathyroidism were divided into 3 groups by preoperative and intraoperative diagnostic modalities: group 1 (n=109) - technetium 99m sestamibi (MIBI), ultrasonography, and IOPTH monitoring; group 2 (n=102) - ultrasonography and MIBI; group 3 (n=29) - ultrasonography and IOPTH monitoring. The sensitivity and specificity of each combination were compared. Results: Group 1: Ultrasonography and MIBI were concordant in 97% of cases, and additional IOPTH monitoring improved the success rate in the 3 discordant cases. Group www.ahns.info 2: Ultrasonography and MIBI were concordant for the same site in 95% of cases. Group 3: Ultrasonography had a sensitivity of 89% and a positive predictive value (PPV) of 96%. IOPTH monitoring increased the sensitivity to 96%, with no change in the PPV. Operative time was significantly longer (P
Page 1: American Head and Neck Society 2010
Page 4 and 5: General Information The American He
Page 6 and 7: Meeting Leaders AHNS President 2010
Page 8 and 9: John J. Conley Lecture John J. Conl
Page 10 and 11: Guest Of Honor Distinguished Servic
Page 12 and 13: Presidential Citations Corey J. Lan
Page 14 and 15: AHNS Leadership Humanitarian Commit
Page 16 and 17: AHNS Past Lectures & Awards Past Ha
Page 18 and 19: AHNS Awards Christopher O’Brien T
Page 20 and 21: AHNS Accreditation The American Hea
Page 22 and 23: Bally’s Las Vegas Floorplan 22 Am
Page 24 and 25: Scientific Program Wednesday, April
Page 26 and 27: Scientific Program Wednesday, April
Page 28 and 29: Scientific Program Thursday, April
Page 30 and 31: Scientific Program Thursday, April
Page 32 and 33: Faculty, Presenter & Leadership Dis
Page 34 and 35: Oral Papers patients. Grade 3/4 muc
Page 36 and 37: Oral Papers compared to the S group
Page 38 and 39: Oral Papers postoperatively, except
Page 40 and 41: Oral Papers occurred at a median of
Page 42 and 43: Oral Papers S030 RETROSPECTIVE ANAL
Page 46 and 47: Oral Papers weeks). Pretreatment le
Page 48 and 49: Poster Papers P001 (COSM Poster #23
Page 50 and 51: Poster Papers PDH activity thereby
Page 52 and 53: Poster Papers immunohistochemistry.
Page 56 and 57: Poster Papers profession. P031 (COS
Page 58 and 59: Poster Papers manage postoperative
Page 60 and 61: Poster Papers parotoid tumor cases
Page 62 and 63: Poster Papers often confused with h
Page 66 and 67: Poster Papers created department da
Page 68 and 69: Poster Papers Division Head and Nec
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Page 76 and 77: Poster Papers in children. The risk
Page 78 and 79: Poster Papers than 70% in PTH level
Page 80 and 81: Poster Papers 2001 to October 1, 20
Page 82 and 83: Certificate of Incorporation own, t
Page 84 and 85: Bylaws Article I Rights and Duties
Page 86 and 87: Bylaws Section 5. Education Committ
Page 88 and 89: AHNS Program Index FACULTY/PRESENTE
Page 90: Notes 90 American Head and Neck Soc

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