Author: Rodrigo Arrangoiz MS, MD, FACS, FSSO

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.

Nipple Sparing Mastectomy (NSM)

Rodrigo Arrangoiz MS, MD, FACS, FSSO
👉NSM is an oncologically sound option for selected breast cancer patients (as it is for prophylaxis) but there is no clear consensus as to the selection criteria.
👉Based on careful anatomic studies and recent comprehensive reviews, nipple involvement was present in 11.5% of reported NSM procedures, and was associated with:

  • Tumor-to-nipple distance of less than 2 cm
  • Positive nodes
  • Lymphovascular invasion
  • ER/PR-negative
  • HER2-positive
  • Locally advanced
  • Retroareolar tumors
  • Multicentric tumors

👉Local recurrence occurred more frequently in the skin flaps (4.2%) than in the nipple (0.9%).

👉Nipple necrosis was partial thickness in 6.3% and full thickness in 2.9% of patients.

👉A negative nipple margin is necessary for NSM but is not sufficient for patients whose tumors are otherwise unsuitable.

👉NSM is also not suitable for patients whose breasts are very large and/or ptotic, who are elderly, or who have significant comorbidities.

 REFERENCES

  1. Mallon P, Feron JG, Couturaud B, et al. The role of nipple-sparing mastectomy in breast cancer: a comprehensive review of the literature. Plast Reconstr Surg. 2013;131:969-984.
  2. Rusby JE, Brachtel EF, Michaelson JS, et al. Breast duct anatomy in the human nipple: three-dimensional patterns and clinical implications. Breast Cancer Res Treat. 2007;106:171-179.
  3. Rusby JE, Brachtel EF, Othus M, et al. Development and validation of a model predictive of occult nipple involvement in women undergoing mastectomy. Br J Surg. 2008;95:1356-1361.
  4. Rusby JE, Smith BL, Gui GP. Nipple-sparing mastectomy. Br J Surg. 2010;97:305-316.

👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

  • Es experto en el manejo del cáncer de mama.

 

👉Es miembro de la American Society of Breast Surgeons:

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

 

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

Nerve damage during a modified radical mastectomy.

Rodrigo Arrangoiz MS, MD, FACS, FSSO
👉Nerve damage during a modified radical mastectomy includes transection of sensory nerves to the breast and breast skin and possible transection of motor nerves to the pectoralis major muscle (medial pectoral neurovascular bundle), serratus anterior muscle (long thoracic nerve), and latissimus dorsi muscle (thoracodorsal nerve).
👉Transection of sensory nerves to the breast skin is unavoidable as most of these sensory nerves traverse the breast.
👉The most common complaint after a mastectomy is numbness of the mastectomy skin flaps as well as of the nipple/areolar complex if preserved.
👉Only 10% to 15% of patients report preserved sensation in the nipple areolar complex after nipple-sparing mastectomy.
👉Phantom breast pain is a possible outcome after mastectomy and occurs in 14% to 17% of patients at one-year after surgery.
👉Damage to motor nerves is associated with axillary dissection rather than mastectomy.
👉The medial pectoral neurovascular bundle pierces the pectoralis minor muscle then wraps around the lateral border of the pectoralis major muscle.
👉Transection of this nerve can result in atrophy of the lateral portion of the muscle.
👉Functional deficit associated with this injury is typically minor.
👉Transection of the long thoracic nerve during an axillary dissection will result in a winged scapula.
👉The winged scapula is most visible when a patient is standing straight and pushing against a wall with both arms.
👉The affected scapula will visibly protrude while the normally innervated scapula will remain flush with the back.
👉Injury to the thoracodorsal nerve can impact several activities such as rock climbing, rowing, and standing from a seated position.
👉This latter function is especially significant as an individual ages because the upper body is relied on more often for strength compared with the legs.
👉Injury to the thoracodorsal nerve may also have implications if other components of the thoracodorsal neurovascular bundle are damaged as this may limit use of the latissimus dorsi flap for subsequent breast reconstruction.
👉The relative likelihood of these injuries is low.
👉Injury to the long thoracic nerve is most commonly reported.
👉Damage to the brachial plexus would be very unlikely during a modified radical mastectomy, however, brachial plexopathies can occur as a result of postmastectomy radiation. 

👉REFERENCES

  1. Ahmed A, Bhatnagar S, Rana SP, et al. Prevalence of phantom breast pain and sensation among postmastectomy patients suffering from breast cancer: a prospective study. Pain Pract. 2014;14:E17-28. 
  2. Porzionato A, Macchi V, Stecco C et al. Surgical anatomy of the pectoral nerves and the pectoral musculature. Clin Anat. 2012; 25(5):559-575.
  3. Freeman SR, Washington SJ, Pritchard T et al. Long term results of a randomized prospective study of preservation of the intercostobrachial nerve. Eur J Surg Oncol. 2003;29(3):213-215.

👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

  • Es experto en el manejo del cáncer de mama.

 

👉Es miembro de la American Society of Breast Surgeons:

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

 

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

How diagnostic performance of ThyroSeq compares with other tests?

Rodrigo Arrangoiz MS, MD, FACS, FSSO

👉According to the ThyroSeq clinical validation study supplemental table, reported in JAMA Oncology, ThyroSeq GC has a benign call rate of 61%, as compared to the Afirma GSC rate of 54%, which indicates that ThyroSeq allows more patients to safely avoid diagnostic surgeries.

👉Additionally, ThyroSeq GC has a higher negative call rate for histologically benign nodules with indeterminate cytology (82%) than Afirma GSC (68%).

👉This means that patients with nodules that have indeterminate cytology but are histologically benign would avoid diagnostic surgery with ThyroSeq GC more often than with Afirma GSC.

  • Rodrigo Arrangoiz MS, MD, FACS a head and neck surgeon / endocrine surgeon / surgical oncologist and is a member of Sociedad Quirúrgica S.C at the America British Cowdray Medical Center in Mexico City:

 

prof_739_20190417135234

  • Rodrigo Arrangoiz MS, MD, FACS:
    • Is a member of the American Head and Neck Society

img_4750

    • He is a member of the American Thyroid Association:

Unknown

 

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

 

#Arrangoiz

#Teacher

#Surgeon

#Cirujano

#ThyroidExpert

#ThyroidSurgeon

#CirujanodeTiroides

#ExpertoenTiroides

#ExpertoenParatiroides

#Paratiroides

#Hiperparatiroidismo

#CancerdeTiroides

#ThyroidCancer

#PapillaryThyroidCancer

#SurgicalOncologist

#CirujanoOncologo

#CancerSurgeon

#CirujanodeCancer

#HeadandNeckSurgeon

#CirugiaEndocrina

#CirujanodeTumoresdeCabezayCuello

#OralCavityCancer

#Melanoma

ThyroSeq v3 Clinical Validation Details

Rodrigo Arrangoiz MS, MD, FACS, FSSO

👉Clinical validation of ThyroSeq v3 performed in the recently completed prospective double-blind multicenter international study (ClinicalTrials.gov identifier NCT02352766). 

👉Patients were enrolled in the study at 10 medical centers, 9 located in the U.S. and 1 in Singapore.

👉Totally, 782 patients with one or more thyroid nodules sampled by FNA (1013 samples) were enrolled.

👉Of those, 257 FNA samples from 234 patients had Bethesda III-V cytology, underwent surgery, and had FNA samples sufficient for molecular analysis.

👉These 257 FNA samples comprised a final validation set that determined ThyroSeq v3 performance.

👉The study had no post-unblinding sample exclusion. 

👉Performance of ThyroSeq v3 in the prospective double-blind multicenter study was recently published in JAMA Oncology. (Steward, DL et al. JAMA Oncol. 2018.) 

👉In this multicenter study, clinical performance of ThyroSeq v3 was validated in all main types of thyroid cancer, including Hurthle cell (oncocytic) cancer.

👉In fact, the study included 10 Hurthle cell carcinomas, 34 Hurthle cell adenomas, and 5 hyperplastic nodules with Hurthle cell predominance. 

👉The performance of ThyroSeq v3 allowed to detect all Hurthle cell carcinomas (sensitivity, 100%; 95%CI:69.2-100%), with all 5 hyperplastic nodules with Hurthle cell predominance classified as Negative, and overall test specificity of 66.7% (95%CI: 49.8-80.9%).

👉In the study, the majority of nodules with false-positive test results were clonal neoplasms and not hyperplastic nodules.

👉There were 5 missed cancers (3%) that were all intrathyroidal and low stage. 

👉Additionally, ThyroSeq performance in Hurthle cell lesions was assessed in an independent study from NYUthat included 188 indeterminate Hurthle cell predominant thyroid FNAs that had ThyroSeq v2/v3 results.

👉Surgical follow up was available for 33 cases:

  • The study found that the majority of cases (61%) were negative by ThyroSeq, meaning ThyroSeq had a 61% negative call rate in Hurthle cell lesions in this study.
  • Five of the ThyroSeq-negative cases went for surgery and all were benign on histology, which means ThyroSeq had 100% NPV for Hurthle cell lesions that went to surgery in this study. 
  • 28 samples were ThyroSeq-positive and went for surgery with 18 diagnosed as cancer or NIFTP on final histology, meaning ThyroSeq had a 64% PPV for cancer/NIFTP in Hurthle cell nodules in this study.
  • 👉Please see the table below for details. 

    • Rodrigo Arrangoiz MS, MD, FACS a head and neck surgeon / endocrine surgeon / surgical oncologist and is a member of Sociedad Quirúrgica S.C at the America British Cowdray Medical Center in Mexico City:

     

    prof_739_20190417135234

    • Rodrigo Arrangoiz MS, MD, FACS:
      • Is a member of the American Head and Neck Society

    img_4750

      • He is a member of the American Thyroid Association:

    Unknown

     

    Training:

    • General surgery:

    • Michigan State University:

    • 2004 al 2010

    • Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

    • Fox Chase Cancer Center (Filadelfia):

    • 2010 al 2012

    • Masters in Science (Clinical research for health professionals):

    • Drexel University (Filadelfia):

    • 2010 al 2012

    • Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

    • IFHNOS / Memorial Sloan Kettering Cancer Center:

    • 2014 al 2016

     

    #Arrangoiz

    #Teacher

    #Surgeon

    #Cirujano

    #ThyroidExpert

    #ThyroidSurgeon

    #CirujanodeTiroides

    #ExpertoenTiroides

    #ExpertoenParatiroides

    #Paratiroides

    #Hiperparatiroidismo

    #CancerdeTiroides

    #ThyroidCancer

    #PapillaryThyroidCancer

    #SurgicalOncologist

    #CirujanoOncologo

    #CancerSurgeon

    #CirujanodeCancer

    #HeadandNeckSurgeon

    #CirugiaEndocrina

    #CirujanodeTumoresdeCabezayCuello

    #OralCavityCancer

    #Melanoma

    Diagnostic Utility of Thyroseq as a Thyroid Molecular Test

    Rodrigo Arrangoiz MS, MD, FACS, FSSO

    👉The primary application of ThyroSeq is to provide accurate cancer diagnosis in thyroid nodules with indeterminate FNA cytology. 

    👉Indeterminate FNA cytology encompasses diagnostic categories III, IV, and V of the Bethesda System for Reporting Thyroid Cytopathology.

    👉Uncertain and variable risk of cancer in these nodules hampers clinical management of these patients. 

    👉ThyroSeq stratifies thyroid nodules with indeterminate cytology into those that are most likely benign and can frequently be followed by observation and those that have a high probability of being cancer or pre-cancer, which in most cases need surgical management. 

    👉ThyroSeq Clinical Validation Study Overview

    • Reported in the premiere medical journal – JAMA Oncology(Steward, DL et al. JAMA Oncol. 2018.) 
    • Largest prospective double-blind multicenter study of any commercially available molecular test
    • Highest NPV (97%) and PPV (66%) among well validated tests
    • Highest reduction in diagnostic surgery – allowing avoidance of surgery for up to 61% of all Bethesda III/IV nodules and 82% of indeterminate nodules with benign pathology 
    • Reliable detection of all types of thyroid tumors including Hurthle cell cancer
    • Reports probability of cancer and predicted risk of cancer recurrence, empowering individualized patient management

    👉Rodrigo Arrangoiz MS, MD, FACS a head and neck surgeon / endocrine surgeon / surgical oncologist and is a member of Sociedad Quirúrgica S.C at the America British Cowdray Medical Center in Mexico City:

     

    prof_739_20190417135234

    • Rodrigo Arrangoiz MS, MD, FACS:
      • Is a member of the American Head and Neck Society

    img_4750

      • He is a member of the American Thyroid Association:

    Unknown

     

    Training:

    • General surgery:

    • Michigan State University:

    • 2004 al 2010

    • Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

    • Fox Chase Cancer Center (Filadelfia):

    • 2010 al 2012

    • Masters in Science (Clinical research for health professionals):

    • Drexel University (Filadelfia):

    • 2010 al 2012

    • Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

    • IFHNOS / Memorial Sloan Kettering Cancer Center:

    • 2014 al 2016

     

    #Arrangoiz

    #Teacher

    #Surgeon

    #Cirujano

    #ThyroidExpert

    #ThyroidSurgeon

    #CirujanodeTiroides

    #ExpertoenTiroides

    #ExpertoenParatiroides

    #Paratiroides

    #Hiperparatiroidismo

    #CancerdeTiroides

    #ThyroidCancer

    #PapillaryThyroidCancer

    #SurgicalOncologist

    #CirujanoOncologo

    #CancerSurgeon

    #CirujanodeCancer

    #HeadandNeckSurgeon

    #CirugiaEndocrina

    #CirujanodeTumoresdeCabezayCuello

    #OralCavityCancer

    #Melanoma

    The Ideal Thyroid Surgeon

    Rodrigo Arrangoiz MS, MD, FACS, FSSO

    • El entrenamiento y el volumen del cirujano son factores críticos para obtener el mejor resultado con las menores complicaciones en la cirugía de tiroides.

    •  

    Presentation1

     

    • Ashok Shaha MD, FACS cirujano de cabeza y cuello de Memorial Sloan Kettering Cancer Center experto en tiroides durante su plática inaugural de la American Head and Neck Society nos habla de quien debe estar realizando cirugía de tiroides.

     

     

    👉Rodrigo Arrangoiz MS, MD, FACS cirujano de tumores de cabeza y cuello / cirujanos de tiroides y cirugía endocrina de Sociedad Quirúrgica S.C. cumple con los requisitos determinados por el Dr. Saha para realizar cirugía de tiroides.

    Su entrenamiento fue el siguiente:

    • Cirugia general y gastrointestinal:
    • Michigan State University:
    • 2004 al 2010image-48• Cirugia oncológica / tumores de cabeza y cuello / cirugia endocrina:
    • Fox Chase Cancer Center (Filadelfia):
    • 2010 al 2012image-39• Maestria en ciencias (Clinical research for healthprofessionals):
    • Drexel University (Filadelfia):
    • 2010 al 2012image-50• Cirugia de tumores de cabeza y cuello / cirugiaendocrina
    • IFHNOS / Memorial Sloan Kettering Cancer Center:
    • 2014 al 2016image-51

    http://www.sociedadquirurgica.com

    http://www.hiperparatiroidismo.info

    http://www.cirugiatiroides.com

    #Arrangoiz

    #CirugiadeTumoresdeCabezayCuello

    #CirugiaEndocrina

    #CirugiaOncologica

    #HeadandNeckSurgery

    #EndocrineSurgery

     

    F-18-Dopa Positron Emission Tomography/Computed Tomography Is More Sensitive Than Whole-Body Magnetic Resonance Imaging for the Localization of Persistent / Recurrent Disease of Medullary Thyroid Cancer Patients

    Rodrigo Arrangoiz MS, MD, FACS, FSSO

    F-18-DOPA-PET-CT-3-axial-view-of-the-F-DOPA-positive-recurrent-tumor-in-the-left.png

    • Calcitonin (Ctn) is a highly sensitive and specific tumor marker of medullary thyroid carcinoma (MTC):
      • Postoperatively:
        • High levels of Ctn due to residual disease are frequently observed:
          • Particularly in patients with a:
            • High number of metastatic lymph nodes at initial diagnosis.
    • Elevated Ctn levels correlate with tumor burden:
      • When Ctn levels are:
        • Less than 150 pg/mL and neck ultrasonography (US) is normal:
          • Other imagings are not recommended:
            • Because in most cases, they fail to localize residual disease:
              • The clinical challenge is, however:
                • To localize the disease when a surgical resection can be curative.
    • Based on the ATA and NCCN guidelines:
      • The best imaging methods to explore MTC with postoperative elevated Ctn levels consisted in:
        • Neck US in combination with chest computed tomography (CT) scan, liver magnetic resonance imaging (MRI), and bone scintigraphy or spine MRI.
      • The performances of fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT:
        • Is disappointing:
          • Except for patients with:
            • Short Ctn doubling time.
    • F-18-Dopa (fluoro dihydroxyphenylalanine) PET/CT:
      • Is abnormal in 66% to 75% of MTC patients with elevated Ctn levels:
        • In these studies:
          • All patients have persistent disease:
            • Since they have a postoperatively elevated Ctn level.
        • The detection rate per patient or the patient-based sensitivity is highly dependent on:
          • The tumor burden and the Ctn levels of the patients studied, and the per-lesion sensitivity or the lesion detection rate is highly dependent on the other imaging modalities performed. 
    • In a study of 36 consecutive patients:
      • Results:
        • 21 females
        • Mean age: 57 years
        • Sporadic MTC in 26 cases
        • Median serum Ctn level: 760 pg/mL; range: 21–10,121)
        • The reference assessment:
          • Localized disease in 24 (64%) patients:
            • With 74 lesions detected in the:
              • Thyroid bed, in neck lymph nodes, mediastinal lymph nodes, lungs, liver, bones, and other site.
        • At the patient level:
          • The detection rates were:
            • 64% (CI 0.48–0.80) for F-18-Dopa PET/CT with early acquisitions
            • 40% (CI 0.24–0.56) for F-18-FDG PET/CT
            • 40% (CI 0.24–0.56) for WB MRI
            • 48% (CI 0.31–0.66) for WB CT scan
      • Conclusions:
        • In MTC patients with increased Ctn and no known distant metastases:
          • F-18-Dopa PET/CT is more sensitive:
            • To detect structural disease than any other imaging modality, including WB MRI.

     

    • Marie Terroir, Caroline Caramella, Isabelle Borget, Sophie Bidault, Clarisse Dromain, Khadija El Farsaoui, Désirée Deandreis, Serena Grimaldi, Jean Lumbroso, Amandine Berdelou, Julien Hadoux, Segolene Hescot, Dana Hartl, Eric Baudin, Martin Schlumberger, and Sophie Leboulleux.Thyroid.Oct 2019.1457-1464.http://doi.org/10.1089/thy.2018.0351
      • Published in Volume: 29 Issue 10: October 15, 2019
      • Online Ahead of Editing: September 18, 2019

     

    cropped-18403652_10206829497335208_5004404657991480104_n1.jpg

    • What is Head and Neck Surgery?:
      • It is a surgical sub-specialty that deals mainly with benign and malignant tumors of the head and neck region, including:
        • The scalp, facial region, eyes, ears, nose, nasal fossae, paranasal sinuses, oral cavity, pharynx (nasopharynx, oropharynx, hypopharynx), larynx (supraglotic larynx, glottis larynx, subglotic larynx), thyroid gland, parathyroid gland, salivary glands (parotid glands, submandibular glands, sublingual glands, minor salivary glands), soft tissues of the neck, skin of the head and neck region.
          • The head and neck surgeon’s work area:
            • Does not cover tumors or diseases of the brain and other areas of the central nervous system or those of the cervical spine:
              • This is the neurosurgeon field.
      • Among the diagnostic procedures performed by the head and neck surgeon,  are the following:
        • Nasopharyngolaryngoscopy:
          • Performed to examine, evaluate and, possibly perform a biopsy, of oral cavity, pharyngeal and laryngeal lesions.
      • The surgeries most commonly performed by the head and neck surgeon are:
        • Total or near total thyroidectomies
        • Hemithryoidectomies (lobectomies)
        • Comprehensive neck dissections
        • Selective neck dissections
        • Maxillectomies:
          • Total maxillectomy
          • Subtotal maxillectomy
          • Infrastructure maxillectomy
          • Suprastructure maxillectomy
          • Medial maxillectomy
        • Mandibulectomy:
          • Segmental
          • Marginal
        • Tracheostomy
        • Salivary gland surgeries:
          • Parotid gland operations:
            • Limited superficial parotidectomy with identification and preservation of the facial nerve
            • Superficial parotidectomy with identification and preservation of the facial nerve
            • Near total parotidectomy with identification and preservation of the facial nerve
            • Total parotidectomy
          • Submandibular gland resection
          • Sublingual gland resection
        • Resection of tumors of the oral cavity:
          • Glossectomy
          • Resection of the floor of the mouth tumors
        • Resection of tumors of the pharynx
        • Resection of tumors of the larynx
        • Split-thickness skin grafts
        • Full-thickness skin grafts
        • Sentinel lymph node mapping and sentinel lymph node biopsy
        • Resection of malignant skin tumors (BCC, SCC, melanoma) of the head and neck region
    • The formation of the head and neck surgeon includes mastering the following subjects:
      • Surgical Anatomy
      • History and Basic Principles of Head and Neck Surgery
      • Epidemiology, Etiology, and Pathology of Head and Neck Diseases
      • Diagnostic Radiology of the Head and Neck Region
      • Tumors of the Scalp, Skin and Melanoma
      • Eyelids and Orbit
      • Nasal Cavity and Paranasal Sinuses
      • Skull Base and Temporal Bone
      • Lips and Oral Cavity
      • Pharynx and Esophagus
      • Larynx and Trachea
      • Cervical Lymph Nodes
      • Thyroid and Parathyroid Glands
      • Salivary Glands
      • Neurogenic Tumors and Paragangliomas
      • Soft Tissue Tumors
      • Bone Tumors and Odontogenic Lesions
      • Reconstructive Surgery
      • Oncologic Dentistry and Maxillofacial Prosthetics
      • Principles of Radiation Oncology
      • Principles of Chemotherapy
      • Molecular Oncology, Genomics and Immunology
      • Nutrition
      • Biostatistic

     

    • Rodrigo Arrangoiz MS, MD, FACS a head and neck surgeon / endocrine surgeon / surgical oncologist and is a member of Sociedad Quirúrgica S.C at the America British Cowdray Medical Center in Mexico City:

     

    prof_739_20190417135234

    • Rodrigo Arrangoiz MS, MD, FACS:
      • Is a member of the American Head and Neck Society

    img_4750

      • He is a member of the American Thyroid Association:

    Unknown

    Training:

    • General surgery:

    • Michigan State University:

    • 2004 al 2010

    • Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

    • Fox Chase Cancer Center (Filadelfia):

    • 2010 al 2012

    • Masters in Science (Clinical research for health professionals):

    • Drexel University (Filadelfia):

    • 2010 al 2012

    • Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

    • IFHNOS / Memorial Sloan Kettering Cancer Center:

    • 2014 al 2016

    #Arrangoiz

    #Teacher

    #Surgeon

    #Cirujano

    #ThyroidExpert

    #ThyroidSurgeon

    #CirujanodeTiroides

    #ExpertoenTiroides

    #ExpertoenParatiroides

    #Paratiroides

    #Hiperparatiroidismo

    #CancerdeTiroides

    #ThyroidCancer

    #PapillaryThyroidCancer

    #SurgicalOncologist

    #CirujanoOncologo

    #CancerSurgeon

    #CirujanodeCancer

    #HeadandNeckSurgeon

    #CirugiaEndocrina

    #CirujanodeTumoresdeCabezayCuello

    #OralCavityCancer

    #Melanoma

    Idiopathic Granulomatous Mastitis (IGM)

    Rodrigo Arrangoiz MS, MD, FACS, FSSO
    • Idiopathic granulomatous mastitis (IGM):
      • Also known as:
        • Non-puerperal mastitis or granulomatous lobular mastitis.
      • Is a rare, benign, chronic inflammatory disorder of the breast:
        • First described by Kessler and Wolloch 1972:
          • Often mimicking breast cancer or an abscess in clinical and radiologic presentation.
        • Is characterized by:
          • Sterile non-caseating lobulocentric granulomatous inflammation:
            • It usually has a:
              • Recurrent or prolonged natural disease course that eventually leads to lesion burnout.
        • IGM usually affects:
          • Parous premenopausal women
          • With a history of lactation
          • Frequently is clinically associated with hyperprolactinemia
      • Diagnostic work-up includes:
          • Mammogram and ultrasound
          • Often a course of antibiotics at initial presentation:
            • When an infectious etiology is suspected.

    IGM 1

      • Needle core biopsy and / or surgical biopsy of the abscess wall:
        • Reveals noncaseating granulomas centered around breast lobules with negative microbiology (sterile).
      • Surgical drainage and biopsy with or without antibiotics has been performed in the past:
        • Current thought suggests:
          • Diagnostic core biopsy
          • Corticosteroid treatment
          • Reserving surgical drainage for refractory cases
    • IGM may recur after resolution in up to:
      • 15% to 30% of cases.
    • Recent studies have evaluated the role of surgical excision after corticosteroid therapy:
      • Finding those completing 0.5 mg/kg/d of methylprednisolone followed by wide surgical excision:
        • Did not experience recurrence:
          • While 30% of those treated with steroids alone recurred (p<0.001).
    • Some have recently tried more aggressive surgical management up front:
      • Suggesting this may result in quicker resolution and a lower recurrence rate though this in additional studies.
    IGM 1
    – Drawings of external anterior oblique view (a) and sagittal view at the nipple axis (b) illustrate typical clinical manifestations of IGM in the left breast. – A peripheral inflamed terminal ductal lobular unit (TDLU) with focal masslike properties is shown in b. The overlying focal skin erythema shown in a is seen less commonly, in about one-third of patients. – However, it would be seen adjacent to the palpable finding and occupying not more than one-third of the breast skin. – A concurrent abscess with a draining cutaneous sinus tract is relatively common. – Clinically palpable axillary lymph nodes, extensive inflammatory skin changes, and nipple retraction are uncommon with IGM.
    • References
      1. Handa P, Leibman AJ, Sun D, et al. Granulomatous mastitis: changing clinical and imaging features with image-guided biopsy correlation. Eur Radiol. 2014;24:2404-2411.
      2. Karanlik H, Ozgur I, Simsek S, et al. Can steroids plus surgery become a first-line treatment of idiopathic granulomatous mastitis? Breast Care (Basel). 2014;9:338-342.
      3. Kessler E, Wolloch Y. Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol. 1972;58:642-646.
      4. Mizrakli T, Velidedeoglu M, Yemisen M, et al. Corticosteroid treatment in the management of idiopathic granulomatous mastitis to avoid unnecessary surgery. Surg Today. 2015;45:457-465.
      5. Mohammed S, Statz A, Lacross JS, et al. Granulomatous mastitis: a 10 year experience from a large inner city county hospital. J Surg Res. 2013;184:299-303.
      6. Yabanoğlu H, Çolakoğlu T, Belli S, et al. A comparative study of conservative versus surgical treatment protocols for 77 patients with idiopathic granulomatous mastitis. Breast J.

     

    👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

    • Es experto en el manejo del cáncer de mama.

    👉Es miembro de la American Society of Breast Surgeons:

    Training:

    • General surgery:

    • Michigan State University:

    • 2004 al 2010

    • Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

    • Fox Chase Cancer Center (Filadelfia):

    • 2010 al 2012

    • Masters in Science (Clinical research for health professionals):

    • Drexel University (Filadelfia):

    • 2010 al 2012

    • Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

    • IFHNOS / Memorial Sloan Kettering Cancer Center:

    • 2014 al 2016

    #Arrangoiz

    #Surgeon

    #Cirujano

    #SurgicalOncologist

    #CirujanoOncologo

    #BreastSurgeon

    #CirujanodeMama

    #CancerSurgeon

    #CirujanodeCancer

    Sentinel Lymph Node Biopsy (SLNB) in Patients Undergoing Neoadjuvant Chemotherapy – Pre or Post Treatment? Part II

    Rodrigo Arrangoiz MS, MD, FACS, FSSO

    breast-cancer

    • Retrospective studies of SLN biopsy validated by ALND:
      • Show that the success rate of SLN biopsy after neoadjuvant chemotherapy is:
        • About 90%:
          • Somewhat less than for SLN biopsy overall
      • The false-negative rate is about 10%:
        • Comparable to SLN biopsy overall)
    • For patients with proven nodal metastases:
      • The prospective American College of Surgeons Oncology Group (ACOSOG) Z1071 and SENTinel NeoAdjuvant (SENTINA) trial:
        • Observe success rates of:
          • 85% to 90%:
            • False-negative rates of :
              • 12% to 14% for SLN biopsy
        • In both studies the false-negative rate was minimized:
          • By dual-agent mapping (dye plus isotope) and the removal of greater than 2 SLN
        • These results suggest that ALND may not be required for node-positive patients postchemotherapy when a technically satisfactory SLN biopsy is negative:
          • Patients with any positive axillary nodes postchemotherapy require ALND and are at increased risk of locoregional recurrence.
    • A new trial:
      • Alliance 11202 is randomizing node-positive patients whose SLN remain positive after neoadjuvant chemotherapy to:
        • ALND / RT versus RT alone
    • REFERENCES
      1. Alliance for Clinical Trials in Oncology. www.allianceforclinicaltrialsinoncology.org. Accessed January 18, 2017.
      2. Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310:1455-1461.
      3. Houssami N, Macaskill P, von Minckwitz G, et al. Meta-analysis of the association of breast cancer subtype and pathologic complete response to neoadjuvant chemotherapy. Eur J Cancer. 2012;48:3342-3354.
      4. Kuehn T, Bauerfeind I, Fehm T, et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol. 2013;14:609-618.
      5. Mamounas EP, Anderson SJ, Dignam JJ, et al. Predictors of locoregional recurrence after neoadjuvant chemotherapy: results from combined analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27. J Clin Oncol. 2012;30:3960-3966.
      6. Mauri D, Pavlidis N, Ioannidis JPA. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst. 2005;97:188-194.
      7. van Deurzen CH, Vriens BE, Tjan-Heijnen VC, et al. Accuracy of sentinel node biopsy after neoadjuvant chemotherapy in breast cancer patients: a systematic review. Eur J Cancer. 2009;45:3124-3130.

    👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

    • Es experto en el manejo del cáncer de mama.

    👉Es miembro de la American Society of Breast Surgeons:

    Training:

    • General surgery:

    • Michigan State University:

    • 2004 al 2010

    • Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

    • Fox Chase Cancer Center (Filadelfia):

    • 2010 al 2012

    • Masters in Science (Clinical research for health professionals):

    • Drexel University (Filadelfia):

    • 2010 al 2012

    • Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

    • IFHNOS / Memorial Sloan Kettering Cancer Center:

    • 2014 al 2016

    #Arrangoiz

    #Surgeon

    #Cirujano

    #SurgicalOncologist

    #CirujanoOncologo

    #BreastSurgeon

    #CirujanodeMama

    #CancerSurgeon

    #CirujanodeCancer

    Sentinel Lymph Node Biopsy (SLNB) in Patients Undergoing Neoadjuvant Chemotherapy – Pre or Post Treatment?

    Rodrigo Arrangoiz MS, MD, FACS, FSSO

    cancer-of-the-vulva-38-638

    • Axillary SLNB:
      • Remains the standard of care in the staging of clinically node-negative patients,:
        • And is endorsed in the 2014 update of the American Society of Clinical Oncology clinical practice guidelines.
    • For patients undergoing neoadjuvant chemotherapy:
      • The optimal timing of SLNB (pre- or postchemotherapy) is debated:
        • Concerns regarding performance of SLNB after neoadjuvant chemotherapy:
          • Have historically centered around the ability to both identify a sentinel node and the sensitivity of the SLNB to predict non-SLN involvement:
            • Particularly among clinically node-positive patients:
              • Whose lymphatic pathways may be occluded by tumor and/or scarring resultant from chemotherapy.
          • However, over the past 10 years, a number of prospective studies have shown:
            • A high accuracy of SLNB in the postneoadjuvant setting in patients presenting as clinically node negative prior to receiving neoadjuvant chemotherapy.
          • Proponents of SLNB subsequent to neoadjuvant chemotherapy tout the fact that:
            • This spares the patient another surgical procedure and that SLN posttreatment is more meaningful for predicting prognosis.
          • In a small, early study published in 2000:
            • 51 patients (postneoadjuvant chemotherapy) underwent SLNB followed by completion ALND:
              • SLN identification rate was high at 94%
              • The false-negative rate was low at 5.8%
          • In 2008, the Austrian Sentinel Node Study group published their results on 167 neoadjuvant chemotherapy patients who underwent postchemotherapy SLNB followed by completion ALND:
            • SLNB was only offered to those with clinically negative nodes after chemotherapy
            • SLN identification rate was:
              • Highest with use of both vital blue dye and radiocolloid:
                • 88% identification with dual tracer
              • False-negative rate of the SLNB was:
                • Only 8%
          • In the larger, multicenter National Surgical Adjuvant Breast and Bowel Project (NSABP) B-27 trial:
            • 428 patients underwent SLNB before a required ALND
            • Successful identification of a SLN was again high:
              • 89% if radiocolloid was used:
                • The 10% false-negative rate comparable to the rate observed for prechemotherapy SLNB in multicenter studies
          • If SLNB is performed and the SLN(s) is positive prior to neoadjuvant chemotherapy:
            • A SLNB should not be repeated subsequent to chemotherapy:
              • The large, multicenter SENTinel NeoAdjuvant (SENTINA) trial:
                • Arm B demonstrated that in this setting, identification rates were:
                  • Low (61%)
                  • False-negative rates unacceptably high (52%)

    👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

    • Es experto en el manejo del cáncer de mama.

    👉Es miembro de la American Society of Breast Surgeons:

    Training:

    • General surgery:

    • Michigan State University:

    • 2004 al 2010

    • Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

    • Fox Chase Cancer Center (Filadelfia):

    • 2010 al 2012

    • Masters in Science (Clinical research for health professionals):

    • Drexel University (Filadelfia):

    • 2010 al 2012

    • Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

    • IFHNOS / Memorial Sloan Kettering Cancer Center:

    • 2014 al 2016

    #Arrangoiz

    #Surgeon

    #Cirujano

    #SurgicalOncologist

    #CirujanoOncologo

    #BreastSurgeon

    #CirujanodeMama

    #CancerSurgeon

    #CirujanodeCancer

    • References:
      1. Breslin TM, Cohen L, Sahin A, et al. Sentinel lymph node biopsy is accurate after neoadjuvant chemotherapy for breast cancer. J Clin Oncol. 2000;18:3480-3486.
      2. Kuehn T, Bauerfeind I, Fehm T, et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol. 2013;14:609-618.
      3. Mamounas EP, Brown A, Anderson S, et al. Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer: results from National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol. 2005;23:2694-2702.
      4. Tan VKM, Goh BKP, Fook-Chong S, et al.The feasibility and accuracy of sentinel lymph node biopsy in clinically node-negative patients after neoadjuvant chemotherapy for breast cancer—a systematic review and meta-analysis. J Surg Oncol. 2011;104:97-103.
      5. Tausch C, Konstantiniuk P, Kugler F, et al; Austrian Sentinel Node Study Group. Sentinel lymph node biopsy after preoperative chemotherapy for breast cancer: findings from the Austrian Sentinel Node Study Group. Ann Sur Oncol. 2008;15:3378-3383.
      6. van Deurzen CH, Vriens BE, Tjan-Heijnen VC, et al. Accuracy of sentinel node biopsy after neoadjuvant chemotherapy in breast cancer patients: a systematic review. Eur J Cancer. 2009;45:3124-3130.
      7. Xing Y, Foy M, Cox DD, et al. Meta-analysis of sentinel lymph node biopsy after preoperative chemotherapy in patients with breast cancer. Br J Surg. 2006;93:539-546.