Publications by authors named "Michael W Yeh"
Background: Patients residing in rural and frontier areas experience worse thyroid cancer outcomes than those in urban areas. This novel qualitative study sought the perspectives of rural surgeons to identify practical measures that could mitigate the disparities in thyroid cancer care between rural and urban contexts.
Methods: We contacted general and head and neck surgeons at all of California's Critical Access Hospitals (n = 35), which are remote, rural hospitals, and requested self-referral to our study through the American College of Surgeons.
Article Synopsis
- The study examines thyroid tumors with isolated RAS mutations, comparing their oncologic outcomes to tumors with isolated BRAF mutations using comprehensive molecular testing.
- A total of 368 patients with Bethesda III-VI thyroid nodules were reviewed, revealing that 14% had isolated RAS mutations, with a 46% malignancy rate but no instances of structural recurrence after 5 years.
- The findings suggest that isolated RAS-mutated tumors have lower aggressive characteristics, indicating that thyroid lobectomy may be an adequate treatment option for these patients.
Context: BRAF V600E mutation is the most common genetic driver of papillary thyroid cancer (PTC), where it is found with various allele frequency (AF), reflecting the proportion of cells carrying the mutant and wild-type gene alleles.
Objective: To determine whether BRAF V600E AF can improve prognostication and inform initial surgical management of PTC.
Design: Retrospective cohort study (2016-2019).
Higher center and surgeon volume correspond to better outcomes for patients with thyroid cancer. This study aims to investigate how a hospital's safety-net burden, the proportion of a hospital's patients who are insured by state Medicaid plans or are uninsured, influences the outcomes of high-volume (HV) surgeons. We performed a retrospective cohort study of all patients who underwent surgery for thyroid cancer in California from 1999 to 2017.
View Article and Find Full Text PDFContext: Primary hyperparathyroidism (PHPT) has initially been implicated in adverse maternal and neonatal outcomes, while subsequent population studies have failed to show an association.
Objective: To compare maternal, pregnancy, and neonatal outcomes in patients with and without PHPT.
Design: Retrospective matched-cohort study (2005-2020).
Active Surveillance and Conversion Surgery for Low-Risk Thyroid Cancer-The Disconnect Between Literature and Practice.
JAMA Otolaryngol Head Neck Surg
December 2024
Context: Use of artificial intelligence (AI) to predict clinical outcomes in thyroid nodule diagnostics has grown exponentially over the past decade. The greatest challenge is in understanding the best model to apply to one's own patient population, and how to operationalize such a model in practice.
Evidence Acquisition: A literature search of PubMed and IEEE Xplore was conducted for English-language publications between January 1, 2015 and January 1, 2023, studying diagnostic tests on suspected thyroid nodules that used AI.
Context: Molecular testing can refine the risk of malignancy in thyroid nodules with indeterminate cytology to decrease unnecessary diagnostic surgery.
Objective: This study was performed to evaluate the outcomes of cytologically indeterminate thyroid nodules managed with Afirma genomic sequencing classifier (GSC) testing.
Methods: Adult patients who underwent a biopsy at 3 major academic centers between July 2017 and June 2021 with Bethesda III or IV cytology were included.
Extent of Surgery for Medullary Thyroid Cancer and Prevalence of Occult Contralateral Foci.
JAMA Otolaryngol Head Neck Surg
March 2024
Article Synopsis
- The standard treatment for medullary thyroid cancer (MTC) is total thyroidectomy with central neck dissection, but reasons for this approach in patients with only one affected side are not well-defined.
- A study aimed to find hidden contralateral MTC lesions, which weren't visible through ultrasounds, to justify the total thyroid removal.
- From 176 patients studied, 26% had contralateral disease, and 5% had undetected lesions, suggesting genetic background influences the likelihood of hidden cancer in the other thyroid lobe.
Objective: The objective of this study was to analyze the risk of malignancy and the histopathology of telomerase reverse transcriptase promoter mutated cytologically indeterminate thyroid nodules (ITN).
Methods: A PUBMED search of molecularly tested ITN was conducted and data on mutated ITN with histopathology correlation were extracted.
Results: Twenty-six manuscripts (published between 2014 and 2022) reported on 77 mutated ITN.
Article Synopsis
- Rural and frontier areas have worse thyroid cancer outcomes compared to urban regions, with higher disease incidence and mortality rates.
- The study analyzed data from nearly 93,000 thyroid cancer patients in California between 1999-2017, highlighting demographic differences and disease stages at diagnosis.
- Key findings show that rural and frontier patients are more likely to be Native American or White, uninsured, and face socioeconomic disadvantages, leading to increased likelihood of distant disease at diagnosis and being lost to follow-up care.*
Article Synopsis
- Indeterminate thyroid nodules with Hürthle cell cytology pose diagnostic challenges, prompting a study on the effectiveness of molecular tests like Afirma Gene Sequencing Classifier and Thyroseq v3.
- In a trial with 140 nodules, Afirma showed a higher benign call rate (84%) compared to Thyroseq (56%), indicating better reliability in identifying non-cancerous nodules.
- The results suggest that these molecular tests can significantly help patients avoid unnecessary surgeries, highlighting their importance in managing Hürthle cell nodules.
Racially minoritized patients with thyroid cancer are less likely to receive high-quality and guideline-concordant care. Inaccessibility of high-volume centers may contribute to inequalities in thyroid cancer outcomes. This study sought to understand the extent to which access to higher volume thyroid cancer centers is associated with patient outcomes.
View Article and Find Full Text PDFImportance: Limited evidence supports kidney dysfunction as an indication for parathyroidectomy in asymptomatic primary hyperparathyroidism (PHPT).
Objective: To investigate the natural history of kidney function in PHPT and whether parathyroidectomy alters renal outcomes.
Design: Matched control study.
Article Synopsis
- Molecular testing plays a significant role in diagnosing thyroid nodules, particularly those with indeterminate cytology, but its effectiveness in predicting outcomes for nodules that are already suspicious or malignant remains uncertain.
- This study aimed to assess whether molecular profiling of Bethesda V and VI thyroid nodules can improve the prognostication of oncological outcomes and aid in determining initial treatment strategies.
- Among 105 patients studied, ThyroSeq identified genomic alterations in 95% of samples, revealing that patients classified as low risk did not experience recurrence, while those at intermediate risk had some recurrence, and high-risk patients had multiple concerning mutations.
Context: Molecular testing has improved risk stratification and increased nonoperative management for patients with indeterminate thyroid nodules, but data on the long-term outcomes of current molecular tests Afirma Gene Sequencing Classifier (GSC) and Thyroseq v3 are limited.
Objective: To determine the rate of delayed operation and the false negative rate of the Afirma GSC and Thyroseq v3 in Bethesda III and IV thyroid nodules.
Methods: Prospective follow-up of a single center, randomized, clinical trial comparing the performance of Afirma GSC and Thyroseq v3 in the diagnosis of indeterminate thyroid nodules at the University of California, Los Angeles (UCLA).
Background: Recent studies examining treatment disparities in thyroid cancer care found that appropriate use of surgery and radioactive iodine may be improving over time.
Methods: California Cancer Registry and California Office of Statewide Health Planning and Development data was evaluated for the effect of race on overall and disease-specific survival for thyroid cancer in California (1999-2017). Reoperation data was also examined.
Parathyroidectomy (PTX) is the treatment of choice for symptomatic primary hyperparathyroidism (PHPT). It is also the treatment of choice in asymptomatic PHPT with evidence for target organ involvement. This review updates surgical aspects of PHPT and proposes the following definitions based on international expert consensus: selective PTX (and reasons for conversion to an extended procedure), bilateral neck exploration for non-localized or multigland disease, subtotal PTX, total PTX with immediate or delayed autotransplantation, and transcervical thymectomy and extended en bloc PTX for parathyroid carcinoma.
View Article and Find Full Text PDFThis cohort study evaluates an electronic medical record–based tool for diagnosis of primary hyperparathyroidism in patients with chronic hypercalcemia.
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