NYU Division of Endocrine Surgery now offers molecular testing for thyroid nodules

The incidence of thyroid cancer is increasing more rapidly than any other cancer in the US, with an estimated 56,000 new cases expected in 2012. Although the majority of thyroid nodules are benign, current guidelines recommend fine needle aspiration (FNA) biopsy of most nodules, particularly those larger than 1 or 1.5 cm. Thyroid nodules that are biopsied as inconclusive have typically required thyroid surgery for definitive diagnosis, and up to 80% of those patients with inconclusive biopsies do not have thyroid cancer. The New York State Department of Health has recently approved a new molecular diagnostic test for thyroid nodules with inconclusive FNAs. This test, the Veracyte Afirma Gene Expression Classifier, measures the expression of 142 genes to reclassify inconclusive thyroid FNAs as either benign or possibly cancerous. This may enable us to recommend observation rather than surgery in many patients.

The Division of Endocrine Surgery at New York University Langone Medical Center is one of the first institutions in New York to offer this test, which will allow more patients with inconclusive thyroid FNA to be observed without undergoing thyroid surgery. For patients with suspicious thyroid nodules who do require thyroid surgery, we also offer different types of molecular testing that may assist in planning the extent of surgery. Our goal is to provide individualized care for all patients with thyroid nodules.

Minimally Invasive Adrenalectomy

Adrenal Surgery

Minimally invasive adrenalectomy has become the standard of care for most patients with adrenal tumors. Performed laparoscopically through tiny incisions through the side, or retroperitoneoscopic ally through small incisions in the back, minimally invasive adrenalectomy is a safe and extremely well tolerated procedure. Most patients are able to be discharged within 1-2 days after surgery and recover quickly. Our experienced Endocrine Surgeons work closely with specialized Endocrinologists, Radiologists and Pathologists to provide appropriate, safe and effective care for patients with adrenal tumors. Minimally invasive laparoscopic and retroperitoneoscopic adrenalectomy is performed by Dr. Leon Pachter and Dr. Jennifer Ogilvie.

Minimally Invasive, Video-Assisted Thyroid and Parathyroid Surgery

We are pleased to offer video-assisted thyroid and parathyroid surgery at NYU. This new surgical technique, developed in Italy, enables appropriately trained surgeons to perform thyroid and parathyroid surgery through incisions smaller than 1" in length. This technique is appropriate for only a limited number of patients meeting certain strict criteria related to the size of the nodule and the overall size of the thyroid. We strive to offer our patients the latest advances in endocrine surgery, always remembering that the safety and well being of our patients is most important. Dr. Jennifer Ogilvie will be performing video-assisted thyroid and parathyroid surgery at NYU.

Parathyroid Cryopreservation

We are pleased to announce that New York State has granted final approval to our new program of parathyroid cryopreservation, which will be performed in collaboration with the NY Blood Center. Most patients requiring parathyroid surgery have one overactive parathyroid gland. The remaining three parathyroids are normal and are left in place after the abnormal gland is removed. In some patients, all four parathyroids are abnormal and 3 ½ glands need to be removed. In other patients who have had previous thyroid or parathyroid surgery, it may not be possible to know how many parathyroid glands remain. Sometimes after parathyroid surgery in patients like these, the amount of parathyroid tissue remaining is inadequate to maintain normal calcium levels. In these situations, cryopreservation permits us to freeze a small piece of the patient's own parathyroid tissue, store it at the NY Blood Center, and transplant it back into the patient if the calcium level remains low after surgery. While this will be necessary in very few patients, it will significantly benefit some patients with complex parathyroid problems.

Intraoperative Recurrent Laryngeal Nerve Monitoring

The recurrent laryngeal nerve (RLN) is located in the lower neck, directly behind the thyroid gland. An injury to this nerve during thyroid surgery can result in hoarseness. Fortunately, when thyroid surgery is performed by experienced surgeons, this complication is very rare. To further decrease the risk of hoarseness, intraoperative RLN monitoring is now performed routinely on patients undergoing thyroid surgery at NYU. Special monitoring electrodes are used so that the identity and function of the RLN can be continuously assessed as surgery progresses. The availability of this advanced technique reflects our constant commitment to patient safety and to minimizing the risks of surgery.

Dr. Patel Receives Research Grant for Thyroid Cancer

Dr. Kepal Patel, Assistant Professor of Surgery and Biochemistry, has received a grant of $50,000 to support his research into the intracellular molecular changes associated with the development of thyroid cancer. By understanding these fundamental changes within the cell, new approaches to the treatment of thyroid cancer may be devised. This highly competitive grant is awarded by the THANC Foundation in cooperation with the American Thyroid Association.