I am now delighted to be working with McCollum Consultants - one of the UK's leading team of medico-legal experts. Check out my bio here.
This week, I have been over in Washington DC at the ATA. It has been a great opportunity to network and learn from leaders in the field as well as to find out about cutting edge advances in thyroid cancer and thyroid disease.
One of the things I am most excited about is molecular testing. Currently in the UK, if you come and see me in my neck lump clinic you will have an ultrasound scan. Many of these will show benign nodules with no further action needed and I can often reassure and discharge you on the same day. Many people, however, will have a thyroid nodule that does not appear normal. A small number of these will look like an obvious cancer and you will go ahead and have surgery but some will just be in the grey area and so a needle test (FNA) is done. This is reported on a five point scale Thy 1-5 and again some people will be discharged with a diagnosis of a benign nodule whereas others will go straight to surgery. The majority of patients, however, will have a diagnosis of Thy 3a or Thy 3f which means that some cells have been seen that do not look normal but nor is there concrete evidence of a cancer. The risk of a cancer for these groups is 5-15% and 30% respectively and, although this is still low, we usually recommend a hemithyroidectomy to make a diagnosis. This does mean, however, that up to 85% of our patients that we operate on will turn out to have benign disease and, with hindsight, did not need surgery.
This is where molecular testing comes in. After the needle test, as well as looking at the cells under the microscope some is analysed to look at its RNA and DNA and identify genes that are known to cause cancer. The main 4, in increasing order of aggressiveness are:
If any of these come back then we would go ahead and recommend surgery. The company that I have been talking with is called Thyroseq and they produced reports like the ones below.
The really amazing thing is that with the specificity and sensitivity of the tests - if a test comes back as negative then there is a 97% chance of this being a true negative and so surgery would probably not be recommended as long as there were no other patient risk factor. If the test comes back as positive then we would go ahead with surgery. Following results from a multicentre trial - it seems as if up to 60% of patients with indeterminate nodules will have a negative report and can therefore avoid surgery with the consequent risks and anxiety associated with it.
This has been available in the US for some time now and I am excited to see it in the UK, it is truly the future of diagnosis for thyroid nodular disease.
Today was a full day of audit and clinical effectiveness (ACE) at Wythenshawe Hospital. As well as great talks on the Coronial process, mental capacity and a talk to the head and neck unit from our director of operations we had the opportunity to roll out this initiative that has come from East Lancs NHS Trust. It is called 10,000ft (3048m!) and uses a simple concept to allow all team members to highlight problems, concerns and times when extra concentration is needed - particularly in the operating theatre #10000ft #MFT #patientsafety
This weekend I was lucky enough to be invited to crew a 40ft yacht - sailing around the Solent in the 2018 NHS regatta. We had a crew of 8 - consultant colleagues from Wythenshawe Hospital. Over the 2 days of racing, our best positions were 1st, 1st, 2nd and 5th and we won the regatta overall. A proud achievement and a great introduction to sailing.
This year it was a trip down to the NEC in Birmingham for an excellent conference. There was a fascinating talk by barrister Nick Deal on the CPR Part 35 rules and an interesting and interactive session with Scot Darling on a variety of medico-legal scenarios
I had an enjoyable morning discussing interview skills and techniques with some of our really keen and enthusiastic North West and Mersey ENT trainees. As promised - the handout is below to download - good luck for the interviews next year - I'm sure you'll all do really well!
Last week I attended an excellent seminar in London organised by Premex+ The seminar was a great introduction to the basic of medical negligence law and the requirements needed to be an Expert Witness in that field. Thanks to the team for organising it.
I am excited to be going to the American Association of Otolaryngology and Head and Neck Surgery annual meeting next week. This is the largest ENT conference in the World and I am hoping to come back buzzing with new ideas and innovations.
The abstract program has been published and I hope to attend and learn from as many sessions as I can.
Last week, I attended the NoEENT meeting in Bury. It was a packed programme and congratulations to @GhoshENTsurgeon on organising such an interesting and though-provoking day with talks on neck dissection, allergic fungal rhinosinusitis and a fascinating talk by Dr Daniel Sokol - barrister and medical ethicist on truth-telling and deception in medicine.
The 'Gold Standard' treatment for sleep disordered breathing is CPAP. This is not always achievable in all patients and in those who are intolerant of it or in patients in whom it does not work we do sometimes need to resort to surgery. This article has been commissioned by ENT & Audiology News and outlines some of the surgical treatment options available.