Papers by Jagdish Dhingra
Head & neck, Apr 7, 2022
BACKGROUND Milan system for reporting salivary gland cytopathology (MSRSGC) was introduced to sta... more BACKGROUND Milan system for reporting salivary gland cytopathology (MSRSGC) was introduced to standardize reporting of salivary gland cytopathology. METHODS A retrospective review of ultrasound-guided fine needle biopsy of salivary gland lesions was performed between January 2018 and May 2021 at a community otolaryngology practice. Diagnostic accuracy and rate of diagnostic sialoadenectomy were calculated. RESULTS A total of 203 FNAs (fine needle aspiration) were performed in 184 patients. MSRSGC was utilized in 87/203 cytopathology reports, with a diagnostic accuracy of 84%. Descriptive reporting was used in 115 FNAs, with a diagnostic accuracy of 89% (p = 0.68). Sialoadenectomy rate was 41% for MSRSGC compared to 36% in descriptive cytopathology (p = 0.48). CONCLUSIONS MSRSGC is as accurate as descriptive cytopathology and the rate of diagnostic sialoadenectomy between both groups is similar in our community. The MSRSGC brings uniformity and standardization to the FNA reporting process.
Head & neck, 1997
The fluorescence characteristics of tissues depend upon their biochemical composition and histomo... more The fluorescence characteristics of tissues depend upon their biochemical composition and histomorphological architecture, both of which undergo a change during malignant transformation. These changes are detectable as an alteration in the fluorescence spectral profile of the tissues. Biopsy specimens from clinically suspicious lesions and normal-appearing oral mucosa were obtained from patients. Fluorescence spectroscopic measurements were obtained to study the differences between normal and dysplastic tissues and to determine the most appropriate excitation wavelength(s) for exploiting these differences. Fluorescence spectra from a total of 12 histologically normal (healthy mucosa or benign lesions) and ten abnormal (dysplastic or malignant) tissue samples were compared. Significant spectral differences were seen between the two groups. These differences were most marked at the excitation wavelength of 410 nm. Using this wavelength, fluorescence correctly diagnosed 20 of 22 samples studied. This technique accurately differentiates normal from abnormal tissues in vitro and has the potential applications for in vivo use as a noninvasive diagnostic tool.
Otolaryngology–Head and Neck Surgery, 2021
Objective To study the adoption rate of the American College of Radiology Thyroid Imaging Reporti... more Objective To study the adoption rate of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) scoring system over a 3-year period in a community setting and compare its performance with that of the American Thyroid Association 2015 (ATA 2015) ultrasound risk scoring system. Study Design Case series with prospective data collection and retrospective chart review. Setting Large community-based practice with multiple satellite offices and a dedicated thyroid ultrasound clinic. Methods All patients referred to the thyroid clinic between January 2018 and December 2020 for ultrasound-guided fine-needle biopsy were assigned an ATA 2015 risk score in a prospective manner immediately prior to biopsy. ACR TI-RADS scores were recorded through retrospective chart review of the radiologist report. Performance of the 2 systems was compared with cytology as the gold standard. Results A total of 949 nodules underwent biopsy, of which 236 had available data for bo...
Laryngoscope Investigative Otolaryngology
Cancer, Jan 14, 2017
An international panel of experts in the field of salivary gland cytology (SGC), supported by the... more An international panel of experts in the field of salivary gland cytology (SGC), supported by the American Society of Cytopathology (ASC) and the International Academy of Cytology, conducted a survey to seek evidence and practice patterns regarding SGC. Results were used to provide focus for the proposed Milan System for Reporting Salivary Gland Cytopathology. The study group, formed during the 2015 European Congress of Cytology held in Milan, Italy, generated a survey that included 49 specific questions related to the taxonomies, practices, and diagnostic entities of salivary cytology. Qualtrics software was used as the study platform. Software and server support were provided by the division of information technology at the University of Wisconsin. The survey was available online from November 2015 until February 2016. Participants were invited through the Web sites of the ASC, the International Academy of Cytology, and the Papanicolaou Society of Cytopathology as well as by the A...
OTO Open, 2022
Objective Molecular testing has revolutionized management of indeterminate thyroid nodules (Bethe... more Objective Molecular testing has revolutionized management of indeterminate thyroid nodules (Bethesda categories III and IV). Few studies have attempted to validate the negative predictive value of molecular tests. Using long-term observation as a surrogate for surgical resection, we sought to examine the false-negative rate of “benign” indeterminate thyroid nodules on molecular testing. Study Design Case series with retrospective data collection and chart review. Setting Large community-based practice with multiple satellite offices. Methods All patients with thyroid nodules that underwent ultrasound-guided fine-needle aspiration biopsy between 2013 and 2019 were evaluated through retrospective analysis. Cytologically indeterminate nodules reflexively underwent molecular testing to guide clinical management. Observation was recommended for lesions with benign molecular testing, and these nodules were followed clinically and by ultrasound. Results A total of 2011 nodules underwent fi...
Archives of Otolaryngology - Head and Neck Surgery, 2008
... Radiology Quiz Case 2 T. Justin Way, MD; Paul M. Weinberger, MD; Brian J. McKinnon, MD, MBA U... more ... Radiology Quiz Case 2 T. Justin Way, MD; Paul M. Weinberger, MD; Brian J. McKinnon, MD, MBA University of Kentucky, Lexington (Dr Way), and Medical College of Georgia, Augusta (Drs Weinberger and McKinnon). Arch Otolaryngol Head Neck Surg. 2009;135(8):829. ...
In papillary thyroid carcinoma (PTC), while the role of BRAF is well established, the contributio... more In papillary thyroid carcinoma (PTC), while the role of BRAF is well established, the contribution of BRAF to epithelial-mesenchymal transition is not. To elucidate the relationship between BRAF, surrogates of epithelial-mesenchymal transition (Snail, E-cadherin) and established histopathologic prognosticators in papillary thyroid carcinoma. In this IRB approved cross-sectional study, 50 cases of archived annotated PTC samples were retrieved and immunohistochemically stained for Snail and E-cadherin protein. A semi-quantitative scoring system (incorporating proportion and intensity) was utilized. Snail and E-cadherin expression were noted in 44% and 84% of BRAF mutant and, in 29% and 95% of BRAFWT samples, respectively. No statistically significant correlations were noted between Snail, E-cadherin and histopathologic prognosticators. However, a trend was noted between Snail expression and tumor size <5 cm (P=0.07). Statistically significant differences between BRAF mutant and BRA...
Gland surgery, 2021
Background Surgical management of mega-goiters in endemic areas with extreme iodine deficiency pr... more Background Surgical management of mega-goiters in endemic areas with extreme iodine deficiency presents unique challenges. Based on our initial 5-year experience (2007 to 2011) operating on mega-goiters in Gitwe, Rwanda, Africa, we modified our technique to a lateral approach which affords better exposure of the superior pole vessels and other vital neurovascular structures, thereby improving safety. We describe this lateral approach technique and review outcomes compared to the standard technique. Methods From 2007 to 2019, we have conducted 13 annual surgical missions to low resource setting in Gitwe, Rwanda. Retrospective chart review of surgeries between 2012 and 2019 was performed to study outcomes using standard approach and lateral technique during the same time period. Results Over a period of 8 years (2012 to 2019), out of 192 total cases, lateral approach was used in 35 patients. No patient experienced significant intra-operative blood loss requiring transfusion. One patie...
Otolaryngology–Head and Neck Surgery, 2019
Objective Increasingly, total thyroidectomy is offered as an ambulatory procedure. Most of the re... more Objective Increasingly, total thyroidectomy is offered as an ambulatory procedure. Most of the relevant outcomes research derives from academic centers, but most thyroid surgeries are performed in the community. The goal of this study is to evaluate the safety of total thyroidectomy performed as an ambulatory procedure in a community otolaryngology practice. Study Design Retrospective review and national database analysis. Setting A single community otolaryngology practice. Methods Adult patients undergoing total thyroidectomy by a single otolaryngologist between 2013 and 2019 were divided into 2 cohorts: planned ambulatory and planned admission. Charts were reviewed for demographics and surgical outcomes in the 2 groups. The Healthcare Cost and Utilization Project databases for New York and Florida between 2015 and 2016 were also analyzed to compare outcomes of thyroidectomy as an ambulatory surgery between different practice settings. Results A total of 99 total thyroidectomies we...
OBJECTIVE In papillary thyroid carcinoma (PTC), while the role of BRAF is well established, the c... more OBJECTIVE In papillary thyroid carcinoma (PTC), while the role of BRAF is well established, the contribution of BRAF to epithelial-mesenchymal transition is not. STUDY DESIGN/SETTING To elucidate the relationship between BRAF, surrogates of epithelial-mesenchymal transition (Snail, E-cadherin) and established histopathologic prognosticators in papillary thyroid carcinoma. SUBJECTS/METHODS In this IRB approved cross-sectional study, 50 cases of archived annotated PTC samples were retrieved and immunohistochemically stained for Snail and E-cadherin protein. A semi-quantitative scoring system (incorporating proportion and intensity) was utilized. RESULTS Snail and E-cadherin expression were noted in 44% and 84% of BRAF mutant and, in 29% and 95% of BRAFWT samples, respectively. No statistically significant correlations were noted between Snail, E-cadherin and histopathologic prognosticators. However, a trend was noted between Snail expression and tumor size <5 cm (P=0.07). Statistic...
Archives of Otolaryngology-head & Neck Surgery, 2008
Otolaryngology–Head and Neck Surgery
GeneRAL albumin less than 3.5g/dL, and 12.26 (1.36 to 110.16) (P = .013) for OR time greater than... more GeneRAL albumin less than 3.5g/dL, and 12.26 (1.36 to 110.16) (P = .013) for OR time greater than 10 hours. The mean length of stay was significantly shorter without an ICU transfer 7.9 vs 20.4 days (P < .001). Multiple factors were not predictors of ICU admission. Conclusions: Head and neck cancer patients undergoing free tissue transfer reconstruction can safely and effectively be managed in a ward-level setting. A considerable portion of patients being transferred to the ICU from the ward setting did so secondarily to a subsequent surgery. The impact of these second surgeries and ICU transfer results in longer hospitalizations.
American Journal of Otolaryngology, 1992
FACiAL regarding admission was made beforehand based on age, comorbidities, thyroid pathology wit... more FACiAL regarding admission was made beforehand based on age, comorbidities, thyroid pathology with substernal extension, and plans for lateral neck dissection. In addition, the 2015 and 2016 State Ambulatory Databases for New York and Florida were assessed for outcomes after total thyroidectomy in community settings. Results: In total, 52 patients were identified; 54% underwent total thyroidectomy as an ambulatory surgery and 46% as an inpatient. Of the 24 inpatient cases, 5 required lateral neck dissection, 4 presented with substernal extension, 1 involved a planned tracheostomy in the setting of preexisting vocal cord paralysis, and 3 required the intensive care unit for close airway monitoring. Only 3 patients planned for ambulatory surgery required admission overnight for recovery from anesthesia. Hypocalcemia and vocal cord neuropraxia were the most common postoperative issues in the ambulatory cohort, but no patients were readmitted. One wound seroma occurred but was aspirated in clinic 48 hours after surgery. Conclusions: Our results demonstrate that total thyroidectomy is safe as an ambulatory procedure in the community; however, cases involving lateral neck dissection or substernal goiter may be more appropriate for the inpatient setting. Postoperative issues such as hypocalcemia and wound seroma can be managed in the clinic. These findings are similar or better than those reported in the national database. surgery improves survival of Cervical-spine Metastases in Differentiated Thyroid Cancer
Otolaryngology -- Head and Neck Surgery, 2016
Objective Ultrasound-guided fine-needle aspiration (FNA) biopsy is the primary method of evaluati... more Objective Ultrasound-guided fine-needle aspiration (FNA) biopsy is the primary method of evaluating thyroid nodules. Up to one-third of FNA results are reported to be of “indeterminate” cytology, which carries a 25% malignancy risk. Most of these patients are referred for diagnostic surgery, which results in many unnecessary interventions. We implemented an FNA protocol combining expert thyroid cytopathology and molecular testing of indeterminate lesion in our community practice. This study is a report of the outcomes from this protocol as compared with historical data in the same setting over a similar period. Study Design Case series with planned data collections and retrospective chart reviews. Setting A large community-based practice with multiple satellite offices. Subjects and Methods A total of 264 thyroid nodules (196 patients) were evaluated under the new protocol from January to December 2014, and data were collected in a prospective manner. Historical data for a similar p...
OTO Open
Objective To compare diagnostic capability and patient pain between 25-gauge (25G) and 27G needle... more Objective To compare diagnostic capability and patient pain between 25-gauge (25G) and 27G needles for ultrasound-guided fine-needle biopsy of thyroid nodules. Study Design Prospective blinded randomized trial. Setting Thyroid clinic in otolaryngology practice in a community. Methods A prospective randomized blinded trial was conducted on 148 thyroid nodules in 107 patients undergoing ultrasound-guided fine-needle biopsy. Needle gauge was randomized to individual nodule. Patients were blinded to the needle size used. All specimens were assessed via the Bethesda System for Reporting Thyroid Cytopathology and assigned a morphologic quantitative score based on number of thyroid cells and lymphocytes, amount of colloid, and degree of blood/fibrin artifact in each sample. Patient pain experience was scored. A chi-square test was used to compare nondiagnostic rates, and differences in cytologic morphology and pain scores were compared with 2-sample Student t tests. Results Of the 148 nodu...
OTO Open
Objective To assess the diagnostic accuracy of fine-needle biopsy (FNB) of salivary gland neoplas... more Objective To assess the diagnostic accuracy of fine-needle biopsy (FNB) of salivary gland neoplasms via ultrasound (US) or palpation guidance by an otolaryngologist in a community practice. Study Design Retrospective chart review. Setting Community otolaryngology practice. Methods Retrospective analysis was conducted for all office-based salivary gland FNBs from a community practice from 2005 through 2018. There were 433 FNBs performed among 370 patients. The likelihood of achieving a diagnostic result based on method (US vs palpation guidance) was calculated. Of this cohort, 196 cases had surgical follow-up (parotid gland, n = 168; submandibular gland, n = 28). Correlation of preoperative FNB results to final surgical pathology was performed and measures of diagnostic accuracy computed. Results US-guided FNBs were more likely to achieve a diagnostic result than FNBs obtained via palpation guidance ( P = .00002). Parotid gland FNBs demonstrated a sensitivity and specificity of 78.57...
OTO Open
Objective To study the feasibility, safety, and learning curve of ultrasound-guided fine-needle b... more Objective To study the feasibility, safety, and learning curve of ultrasound-guided fine-needle biopsy (USGFNB) performed by a newly trained otolaryngologist in a community office in a setting. Study Design Collect USGFNB data of all thyroid nodules in a prospective manner. Setting A dedicated ultrasound clinic in a large community-based practice, operated by a single surgeon with the purpose of providing office-based point-of-care diagnostic ultrasonography and USGFNB. Subjects and Methods Data on the first 1000 unselected consecutive thyroid nodules that underwent USGFNB over a 3-year period were analyzed. Chi-square analysis was used to assess the statistical significance of characteristics of diagnostic vs nondiagnostic nodules. A multivariate regression analysis was conducted to determine nodule characteristics predictive of adequate sampling. Diagnostic yield and time efficiency data were plotted over a 3-year period to study the learning curve for the USGFNB procedure perform...
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Papers by Jagdish Dhingra