Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P166

P166
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.
Recently, machine-learning (ML) approaches have been successfully applied to health care data sets to predict the outcomes
of surgical procedures. The aim of this work is the application
of ML to predict tumor histology (HIS), aggressiveness, and
postsurgical complications of thyroid patients.
Methods: This retrospective study was conducted at the ENT
Division of Eastern Piedmont University, Novara (Italy) and
reported data about 1216 patients who underwent surgery
between January 2006 and December 2018. For each patient,
general information, HIS, and outcomes are reported. For each
prediction task, we train ML models on presurgery features alone
as well as on presurgery and postsurgery data. The ML pipeline
included data cleaning, oversampling to address unbalanced data
sets, exploration of hyperparameter space for random forest models, testing their stability, and ranking feature importance.
Results: The main results are (1) the construction of a rich,
hand-curated, open data set including pre- and postsurgery
features and (2) the development of accurate yet explainable
ML models. Results highlight prescreening as the most important feature to predict HIS and aggressiveness and identify
which variables are related to a higher complication rate and
longer hospital stay.
Conclusions: Our work shows how ML models can find patterns in thyroid patient data and could support clinicians to
refine diagnostic tools and improve their accuracy.

Endocrine

Distant Recurrence of Low-Grade Papillary
Thyroid Carcinoma: A Need for Continued
Vigilance From Thyroid Surgeons
Allen H. Young, MD (Presenter); Albert J. Yang, MD;
Robert C. Wang, MD
Objectives: Papillary thyroid carcinoma (PTC) has a high cure
rate with surgical resection. Although rare, distant recurrences
after 10 years are being reported, necessitating continued vigilance from thyroid surgeons. We report a case of a patient with
stage 1 PTC who developed a recurrence 18 years after total thyroidectomy and radioactive iodine (RAI) along with clinical,
radiographic, and surgical findings.
Methods: A 63-year-old woman with a history of bilateral
PTC and positive central node metastasis status post-total thyroidectomy and RAI 18 years previously presented with a new
left-sided neck mass. Ultrasound thyroid and fine-needle aspiration showed a 1.4-cm left inferior thyroid mass and 0.6-cm
midline mass positive for PTC. RAI uptake test revealed high
uptake at both regions. Her thyroglobulin was low at 0.3 ng/
mL and thyroglobulin antibodies undetectable. She underwent
central nodal dissection with positive PTC on final pathology.
Results: The patient recovered well postoperatively.
Conclusions: PTC recurrence rates follow a logarithmic
trend with a decreasing risk each year and most recurrences
occurring within 10 years of treatment. Advancements in
diagnosis, treatment, and postoperative monitoring have contributed to a 10-year survival rate for stage 1 PTC at 98% to
100%. This has led many experts to reevaluate the American
Thyroid Association guidelines of lifelong follow-up and

propose discharging young (age <45 years) patients with stage
1 disease after 5 years of monitoring. Nonetheless, case reports
have continued to detail recurrences occurring decades after
initial treatment. Annual follow-ups for PTC can be cumbersome, but thyroid surgeons should continue to be vigilant for
PTC recurrence, regardless of time since treatment.
Endoscopic Endonasal Transsphenoidal
Resection of Pituitary Adenomas: Evaluation
of Consecutive Cases
Carlos T. Chone, MD, PhD (Presenter); Marcelo
Sampaio, MD; Eulalia Sakano, MD, PhD; Antonio Vargas;
Yvens Fernandez; Mateus Dal Fabbro; Helder Tedeschi
Objectives: Endoscopic endonasal transsphenoidal surgery
has gained increasing acceptance by otolaryngologists and
neurosurgeons. In many centers throughout the world, this
technique is now routinely used for the same indications as the
conventional microsurgical technique to pituitary tumors. The
aim of this study was to present a surgical experience of consecutive endoscopic endonasal transsphenoidal resections of
pituitary adenomas.
Methods: A series of consecutive patients with pituitary
adenomas from 2009 to 2007 who submitted to endoscopic
endonasal pituitary surgery in a tertiary referral center were
evaluated with regard to rate of residual tumor, functional
cure, symptom relief, complications, and tumor size.
Results: A total of 247 consecutive patients were evaluated.
Of these, 81 had functioning adenomas, 32 had growth
hormone-producing tumors, 30 had Cushing disease, and 19
had prolactinomas. Of these functioning adenomas, 62 were
macroadenomas and 19 microadenomas. A total of 166 cases
were nonfunctioning macroadenomas. Of the patients with
functioning adenomas, 89% improved. Over time, 88% of
patients with visual deficits related to optic nerve compression
improved. Most of the patients with complaints of headaches
improved (86%). Surgical complications occurred in 3% of
patients with 2 carotid lesions, 2 cerebrospinal fluid leaks, and
1 fatality in a patient with a complicated previous history.
Conclusions: Endoscopic endonasal pituitary surgery is a
feasible technique yielding good surgical and functional
outcomes, low morbidity, and better visualization of surgical field.
In-Practice Endocrine Surgery Fellowship
as a Novel Training Model: The Harvard
Experience
Hien T. Tierney, MD (Presenter); Gregory W. Randolph, MD
Objectives: Head and neck endocrine disease is a significant
and expanding surgical need. Traditional fellowships in endocrine surgery focus on new graduates from residency who
have not had an opportunity to start in practice. We hypothesized that a distinct training model in which a senior academic
surgeon mentors 2 board-certified surgeons with established
comprehensive otolaryngology practices in the community
could develop a full high-volume endocrine practice.

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

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