My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida.
I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016.
Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida.
Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.
👉The thyroid gland, located at the base of the neck, is shaped like a butterfly, and produces hormones that regulate heart rate, blood pressure, body temperature, and weight.
👉In thyroid cancer does not cause any symptoms most of the time in the initial stages, but as it grows it can cause:
A lump (nodule) that can be felt through the skin of the neck
Voice changes, including increasing hoarseness
Difficulty to swallow
Pain in the neck and throat
Swollen lymph nodes in the neck
👉Thyroid cancer is classified into different subtypes based on the types of cells found in the tumor:
Papillary thyroid cancer.
Follicular thyroid cancer.
Anaplastic thyroid cancer.
Medullary thyroid cancer.
Dr. Rodrigo Arrangóiz from Center for Advanced Surgical Oncology, is an expert in the treatment of this disease
👉The number of new thyroid cancer cases has increased over recent years, especially the number of small, low-risk papillary thyroid cancers.
👉It is clear now that treating these small cancers aggressively with surgery results in more potential harm to patients than if the small cancer was simply watched.
👉Because of this, simply watching, known as active surveillance, became a promising alternative to surgery for these low-risk cancers in select patients.
👉Active surveillance involves closely monitoring the thyroid cancer over time, instead of treating it with immediate surgery.
👉Prior studies have shown that active surveillance is safe in papillary thyroid cancers measuring 1 cm or smaller and confined to the thyroid without any lymph node involvement or spread outside of the neck.
👉However, little is known about outcomes of active surveillance for patients with larger cancers measuring 1 to 2 cm and confined to the thyroid.
👉This study compared outcomes of active surveillance for these patients to this with cancers less than 1 cm.
👉The authors also examined outcomes of patients who had surgery for these small cancers.
👉THE FULL ARTICLE TITLE: Sakai T et al 2019 Active surveillance for T1bN0M0 papillary thyroid carcinoma. Thyroid 29:59–63. Epub 2019 Jan 8. PMID: 30560718.
👉The study included patients who were followed at the Cancer Institute Hospital in Tokyo, Japan, since 1995.
👉Among 406 patients with papillary thyroid cancer less than 1 cm, 360 (89%) underwent active surveillance and 46 (11%) underwent surgery.
👉Among 392 patients with papillary thyroid cancer 1 to 2 cm, 331 (84%) underwent active surveillance and 61 (16%) underwent surgery.
👉The patients in the active surveillance program were followed with physical exam, neck ultrasound and chest X-rays every 6 to 12 months after diagnosis.
👉These patients were evaluated for increase in cancer size, development of spread to the lymph nodes and spread to other parts of the body.
👉The follow-up was 7.3 – 7.9 years.
👉If progression of the cancer was seen or the patient changed their mind, surgery was performed.
👉The authors found that the 5- and 10-year rates of progression were similar in patients with papillary thyroid cancer less than 1 cm compared with those with 1 cm to 2 cm cancers during active surveillance.
👉A total of 11 patients with 1 to 2 cm cancers had surgery after active surveillance and none had the cancer come back.
👉Of the patients with 1 to 2 cm cancers who had immediate surgery, 8 had the cancer come back.
👉The rate of cancer coming back was significantly higher for cancers ≥ 1.5 cm than < 1.5 cm in this group.
👉WHAT ARE THE IMPLICATIONS OF THIS STUDY? 1. This study showed that patients with 1 to 2 cm papillary thyroid cancers had similar progression rates to patients with less than 1 cm cancers during active surveillance. 2. Additionally, delayed surgery was not associated with any harm in these patients. 3. These findings are important as they show that active surveillance of small thyroid cancers, especially those less than 15 mm in size, is safe. 4. Expanding active surveillance to larger cancers would decrease the number of thyroid surgeries and subsequent complications. However, more research is still needed to determine exactly which thyroid cancer patients are ideal for active surveillance, considering age, other health issues and the expertise of treatment team.
Society of Breast Imaging recently recently guidelines on management of unilateral axillary adenopathy in patients who have recently received Covid vaccine. Also, here’s a newly published paper on this topic we are encountering commonly in clinical practice.
👉The first guidelines ever released for screening mammography for older survivors of breast cancer (>75 years) recommend that routine mammography be discontinued for women whose life expectancy is less than 5 years but that screening continue for those whose life expectancy is more than 10 years.
👉For women who have a life expectancy of 5 to 10 years, the guidelines recommend that consideration be given to discontinuing mammography.
👉Overall, the guidelines encourage shared decision making that is individualized for each woman after weighing the benefits and harms associated with surveillance mammography and patient preferences.
👉The panel also recommended that patients with clinical findings and symptoms receive ongoing clinical breast examinations and diagnostic mammography and that patients be reassured that these practices will continue.
👉Guidelines on breast cancer screening for healthy women already “acknowledge the limitations of mammograms and the need to consider one’s health status and preferences when making decisions on how and when to stop routine mammograms.
The current study validates the clinical performance of Thyroseq v3 at 10 institutions.
Compared to the prior 56-gene version (Thyroseq v2), the expanded 112-gene ThyroSeq v3 showed improved sensitivity (94%, vs. 90–91% for Thyroseq v2) at the expense of a decrease in specificity (82%, vs. 91–93% for ThyroSeq v2) (2-4).
Thyroseq v2 had a very high benign call rate, allowing many patients with cytologically indeterminate thyroid nodules to avoid surgery.
The risk of cancer in nodules with a negative Thyroseq v3 result (false-negative rate) was 3%, which is comparable to the false-negative rate of a benign FNA cytology result.
To be regarded as a simple cyst, a breast nodule must meet three criteria:
The margins must be circumscribed:
i.e., a margin “that is well defined or sharp, with an abrupt transition between the lesion and surrounding tissue”
It must be anechoic:
i.e., “without internal echoes”
It must show posterior acoustical enhancement:
i.e., “a column that is more echogenic deep to the mass”
Simple cysts:
Are almost never associated with cancer in the absence of other abnormalities seen on mammogram or ultrasound
There are numerous reflectors in breast tissue, and all of the sound waves that are reflected do not make it back to the transducer:
Many of them bounce back and forth (reverberate) between reflectors in the tissue, and with each reverberation, part of the echoes return to the transducer, are recorded, and part undergo another excursion between the reflectors
Most of these echoes are obscured by all of the other echoes in the tissue, but when an otherwise anechoic window (a cyst) is present:
The reverberation echoes can be seen in the anterior part of the cyst:
In the image shown, a hyperechoic band can be seen within or just above the anterior wall of the cyst, especially on the left side of the image:
The acoustic mismatches between this band and the less echogenic tissue superficial to it and the anechoic fluid deep to it, cause echoes that reverberate, creating the artifact in the near field of the cyst
References
D’Orsi CJ, Sickles EA, Mendelson EB, Morris EA. ACR BI-RADS® Atlas: Breast Imaging Reporting and Data System, 5th ed. Reston, VA: American College of Radiology; 2013.
Kremkau FW. Diagnostic Ultrasound: Principles and Instruments, 7th ed. Elsevier; 2006:274-292. 1Image/Figure 2: Click on space below to upload image. Use highest available resolution and file size .png format: recommended .jpg format: acceptable .gif format: only recommended for text-based images and basic black and white charts Image/Figure 2 Reprint Permission: Obtain required reprint permissions when using copyrighted material Courtesy of the American Society of Breast Surgeons Breast Ultrasound Certification Reviewers.☐ Reprint permission obtained/attached Image/Figure 2 Caption: Include brief, informative caption for image/figure Ultrasound imaging of the palpable lesion.
Rodrigo Arrangoiz MS, MD, FACS, FSSO 