Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P168

P168		
Otolaryngology-Head and Neck Surgery 163(1S)
Presentation schedule is subject to change. The Official Program Abstracts supplement does not reflect changes made after August 10, 2020.
Results: LT was identified in 38 patients. Fifty-eight percent of patients were symptomatic and, of those, 59% had
obstructive symptoms. Surgery was performed on 77% of
these patients, all of whom had symptomatic resolution.
Nonsurgical candidates with obstructive symptoms received
a trial of suppressive therapy followed by RAI if symptoms
failed to improve. All 10 of these patients ultimately experienced symptomatic resolution. In those with nonobstructive
symptoms, 50% underwent treatment with thyroid suppression, with improvement in symptoms, while the remaining
50% underwent observation, with no change in symptoms.
Six patients had a history of thyroid carcinoma with LT
found on I-123 uptake scan. These patients were treated
with RAI and required no additional treatment. All asymptomatic patients underwent observation without requiring
treatment.
Conclusions: The treatment of LT is nuanced and individualized. Options include observation, thyroid suppression, RAI,
and surgery. Our management algorithm highlights the key
decision points, which include symptoms, concern for malignancy, and surgical candidacy.

Endocrine

Risk Factors Predictive of Papillary Thyroid
Carcinoma Nodal Recurrence
Rachel Elisa Weitzman, MS (Presenter); Natalie S. Justicz, MD;
Dipti Kamani, MD; Natalia Kyriazidis, MD; Ming-Hsu
Chen, MD; Gregory W. Randolph, MD
Objectives: Papillary thyroid carcinoma (PTC) accounts for
most thyroid malignancies; it has been demonstrated that risk
of PTC recurrence over a 30-year period is approximately
30%, of which 70% occur as nodal metastases. Certain clinical and histopathological factors have been speculated to
increase risk of disease recurrence overall, but most of these
studies do not consider risk factors for nodal recurrence. We
aim to determine variables predictive of nodal recurrence of
PTC to inform clinical decision making.
Methods: Retrospective chart review at a tertiary academic
medical institution identified 41 patients who experienced
nodal recurrence of PTC and 284 who did not experience
recurrence following thyroid surgery from 2000 to 2015.
Patients who recurred were compared with those without
nodal recurrence with regard to clinical history and tumor
characteristics.
Results: Results demonstrate that patients without nodal
recurrence had significantly more central neck dissection,
right lateral lymph node dissection, and left lateral lymph
node dissection performed, compared with those with nodal
recurrence (P = .004). Maximum tumor size (P = .001), extrathyroidal extension (P = .001), size of largest lymph node
focus (P = .029), lymph node ratio (P < .001), postoperative
thyroglobulin level (P = .038) and postoperative radioactive
iodine (P = .016) were significantly increased in the PTC
nodal recurrence group compared with the no nodal recurrence group.

Conclusions: This study demonstrates characteristics to help
identify patients' risk of nodal recurrence of PTC. Next steps
include developing a "recurrence calculator" to inform clinical decision making.
Surgery Plays an Important Role in
Management of Early-Stage Primary Thyroid
Lymphoma: The MSK Experience
Catherine Beverly Kappauf, MD (Presenter); Brandon
Imber, MD; Jisun Lee; Karen Chau; Joachim Yahalom, MD
Objectives: Primary thyroid lymphoma (PTL) accounts for
2% to 5% of all thyroid malignancies. We present data from
the largest US series of early-stage PTL patients since 2000
and discuss the role of surgery.
Methods: In a retrospective cohort of newly diagnosed
early-stage PTL patients (Ann Arbor stage IE or II), we compared treatment of diffuse large B-cell lymphoma (DLBCL)
and indolent lymphoma, defined as extranodal marginal zone
(MALT) or follicular lymphoma (FL).
Results: Seventy-two patients (67% female, median age at
diagnosis: 63 years) were treated from 1999 to 2018, most
(67%) for DLBCL, followed by MALT (18%) and FL (8%).
Patients were split between stage IE (51%) and II (49%).
DLBCL patients were treated with systemic (98%) and local
therapy (79%). Strategies for local control included radiotherapy (RT) alone (66%), surgery plus RT (18%), or surgery
alone (16%). Surgery was lobectomy (77%) or total thyroidectomy (23%) with limited or no regional lymph node dissection (92%). For indolent lymphoma, 95% of patients received
local therapy and only 16% systemic. Local therapy consisted
of RT alone (44%), surgery plus RT (28%), or surgery alone
(28%). Surgery included lobectomy (60%), total thyroidectomy (30%), or local excision (10%), typically without lymph
node dissection (90%). Overall, 33% of patients had surgical
management, usually with other treatment modalities. An
additional 18% of patients required excisional biopsy because
inconclusive needle and core biopsies. In total, 51% of patients
required surgical biopsy for pathologic diagnosis.
Conclusions: Surgical management contributed to the diagnosis or treatment of more than 50% of patients treated for
PTL at our institution, demonstrating an important role for
surgeons in the care of these patients.
Systemic Tuberculosis Presenting as Parotid
Abscess: Case Report and Review of the
Literature
Eliezer C. Kinberg, MD (Presenter); Brandon S. Gold; David
Lerner, MD; Fred Y. Lin, MD
Objectives: Head and neck tuberculosis (HNTB) accounts
for 10% of all tuberculosis (TB) cases. An uncommon manifestation of HNTB is TB parotitis, with only 100 cases reported.
We present the case of a Bangladeshi woman with a parotid
abscess that was drained and cultured, with no organisms
Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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