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Article ; Online: AACE safety alert--glucose monitoring systems AACE-.

Harrell, R Mack

2015 Volume 7, Issue 2, Page(s) 294

MeSH term(s)	Blood Glucose/analysis ; Diabetes Mellitus/diagnosis ; Endocrinology ; Humans ; Monitoring, Physiologic/instrumentation ; Monitoring, Physiologic/methods ; Patient Safety/standards ; Safety Management/standards ; Societies, Medical
Chemical Substances	Blood Glucose
Language	English
Publishing date	2015-03
Publishing country	Australia
Document type	Letter
ZDB-ID	2503337-2
ISSN	1753-0407 ; 1753-0393
ISSN (online)	1753-0407
ISSN	1753-0393
DOI	10.1111/1753-0407.12246
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Article: Surgical utility of Afirma: effects of high cancer prevalence and oncocytic cell types in patients with indeterminate thyroid cytology.

Harrell, R Mack / Bimston, David N

Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

2013 Volume 20, Issue 4, Page(s) 364–369

Abstract: Objective: The Afirma Gene Expression Classifier (GEC) molecular marker assay was developed for the purpose of improving surgical decision-making with indeterminate fine-needle aspiration (FNA) biopsies of thyroid nodules. In this paper, we analyze the ... ...

Abstract	Objective: The Afirma Gene Expression Classifier (GEC) molecular marker assay was developed for the purpose of improving surgical decision-making with indeterminate fine-needle aspiration (FNA) biopsies of thyroid nodules. In this paper, we analyze the performance of the GEC over 27 months in a community hospital-based thyroid surgery practice. Methods: We began using GEC and Thyroid Cytopathology Partners (TCP) exclusively for thyroid FNA analysis in January 2011, shortly after the Afirma GEC became commercially available. In this paper, we focus on patients with indeterminate FNA results and the outcomes of GEC analysis, with particular attention paid to the calculation of the negative predictive value (NPV) of the Afirma test. Results: We performed 645 FNAs in 519 patients over 27 months. Overall, 58 FNAs (9%) were read as indeterminate, with 36 of these classified as suspicious by GEC (62%), 20 characterized as GEC benign (34%), and 2 determined to be inadequate due to low mRNA content. Of the 36 suspicious GEC patients, 30 underwent thyroidectomy, and 21 of the 30 had malignant final pathology. Of the 20 benign GEC patients, 5 underwent thyroid surgery, and 2 were discovered to have malignancies. The NPV for the Afirma GEC in our practice environment was 89.6%. Conclusion: In a practice with a high incidence of thyroid cancer in patients with indeterminate FNAs (33% for our practice), the NPV of the Afirma GEC test may not be as robust as suggested in the existing literature.
MeSH term(s)	Biopsy, Fine-Needle ; Humans ; Predictive Value of Tests ; Prevalence ; Thyroid Gland/pathology ; Thyroid Neoplasms/epidemiology ; Thyroid Nodule/pathology ; Thyroid Nodule/surgery ; Thyroidectomy
Language	English
Publishing date	2013-09-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	1473503-9
ISSN	1530-891X
ISSN	1530-891X
DOI	10.4158/EP13330.OR
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Article ; Online: NEOADJUVANT LENVATINIB IN ADVANCED UNRESECTABLE MEDULLARY THYROID CARCINOMA: A CASE REPORT.

Golingan, Hubert / Hunis, Brian / Golding, Allan C / Bimston, David N / Harrell, R Mack

AACE clinical case reports

2019 Volume 6, Issue 2, Page(s) e73–e78

Abstract: Objective: Medullary thyroid carcinoma, a rare form of thyroid cancer, is typically managed with surgical excision. However, in patients with locally-invasive tumors, an aggressive surgical attempt may result in unnecessary morbidity. Neoadjuvant ... ...

Abstract	Objective: Medullary thyroid carcinoma, a rare form of thyroid cancer, is typically managed with surgical excision. However, in patients with locally-invasive tumors, an aggressive surgical attempt may result in unnecessary morbidity. Neoadjuvant tyrosine kinase inhibition has been utilized to downstage tumors prior to surgical excision but its role in thyroid cancer treatment is not well-established. We describe the potential role that lenvatinib, a tyrosine kinase inhibitor, may have as a neoadjuvant agent in advanced locoregional medullary thyroid carcinoma. Methods: Our patient presented with a large left thyroid mass and bulky left lateral neck lymphadenopathy. Imaging studies revealed a hypervascular and locally-invasive tumor with metastatic central and left lateral lymphadenopathy. A lymph node biopsy cytologic evaluation and plasma calcitonin concentration of 32,926 pg/mL were consistent with medullary thyroid carcinoma. Rearranged during transfection germline mutation testing was negative. A multidisciplinary team of physicians deemed the patient a poor surgical candidate and recommended 4 months of neoadjuvant lenvatinib therapy to reduce tumor burden with a subsequent reassessment of resectability. Given the tumor's hypervascularity, lenvatinib was chosen due its potent vascular endothelial growth factor receptor inhibition, as well as its availability at our institution. Results: Lenvatinib therapy resulted in rapid regression of tumor volume (approximately 70% reduction) as documented by computed tomography and ultrasound. Surgery after 4 months of treatment resulted in a 99% reduction in serum calcitonin and imaging studies 6 months later showed no residual disease. Conclusion: Lenvatinib has potential as a neoadjuvant agent in advanced medullary thyroid carcinoma, and permitted tumor resection in this previously inoperable patient.
Language	English
Publishing date	2019-12-20
Publishing country	United States
Document type	Case Reports
ISSN	2376-0605
ISSN (online)	2376-0605
DOI	10.4158/ACCR-2019-0365
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Article ; Online: Noninvasive Encapsulated Follicular Variant of Papillary Thyroid Cancer: Clinical Lessons from a Community-Based Endocrine Surgical Practice.

Golding, Allan / Shively, Dana / Bimston, David N / Harrell, R Mack

International journal of surgical oncology

2017 Volume 2017, Page(s) 4689465

Abstract: ... ...

Abstract	Objective
MeSH term(s)	Adolescent ; Adult ; Aged ; Algorithms ; Carcinoma in Situ/pathology ; Carcinoma in Situ/radiotherapy ; Carcinoma in Situ/surgery ; Carcinoma, Papillary/pathology ; Carcinoma, Papillary/radiotherapy ; Carcinoma, Papillary/surgery ; Clinical Decision-Making ; Female ; Humans ; Iodine Radioisotopes/therapeutic use ; Lymph Node Excision ; Lymphatic Metastasis ; Male ; Middle Aged ; Neck Dissection ; Neoplasms, Multiple Primary/pathology ; Neoplasms, Multiple Primary/radiotherapy ; Neoplasms, Multiple Primary/surgery ; Registries ; Retrospective Studies ; Thyroid Cancer, Papillary ; Thyroid Neoplasms/pathology ; Thyroid Neoplasms/radiotherapy ; Thyroid Neoplasms/surgery ; Thyroidectomy ; Young Adult
Chemical Substances	Iodine Radioisotopes
Language	English
Publishing date	2017-04-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	2584964-5
ISSN	2090-1410 ; 2090-1402
ISSN (online)	2090-1410
ISSN	2090-1402
DOI	10.1155/2017/4689465
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Article ; Online: Letter to the Editor:

Endo, Mayumi / Nabhan, Fadi / Angell, Trevor E / Harrell, R Mack / Nasr, Christian / Wei, Shuanzeng / Sipos, Jennifer A

Thyroid : official journal of the American Thyroid Association

2020 Volume 30, Issue 9, Page(s) 1390–1392

MeSH term(s)	Biopsy, Fine-Needle ; Cytodiagnosis ; Genomics ; Humans ; Neoplasm Metastasis ; Oxyphil Cells/cytology ; Pathology, Molecular ; Point Mutation ; Predictive Value of Tests ; Risk ; Thyroid Neoplasms/diagnosis ; Thyroid Neoplasms/genetics ; Thyroid Neoplasms/pathology ; Thyroid Nodule/diagnosis ; Thyroid Nodule/genetics ; Thyroid Nodule/pathology ; United States
Language	English
Publishing date	2020-05-04
Publishing country	United States
Document type	Letter
ZDB-ID	1086044-7
ISSN	1557-9077 ; 1050-7256
ISSN (online)	1557-9077
ISSN	1050-7256
DOI	10.1089/thy.2020.0021
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Zs.A 3307: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article: STATISTICAL COMPARISON OF AFIRMA GSC AND AFIRMA GEC OUTCOMES IN A COMMUNITY ENDOCRINE SURGICAL PRACTICE: EARLY FINDINGS.

Harrell, R Mack / Eyerly-Webb, Stephanie A / Golding, Allan C / Edwards, Courtney M / Bimston, David N

Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

2018 Volume 25, Issue 2, Page(s) 161–164

Abstract: Objective: The Veracyte Afirma Gene Expression Classifier (GEC) has been the most widely used negative predictive value molecular classifier for indeterminate cytology thyroid nodules since January 2011. To improve the specificity and further reduce ... ...

Abstract	Objective: The Veracyte Afirma Gene Expression Classifier (GEC) has been the most widely used negative predictive value molecular classifier for indeterminate cytology thyroid nodules since January 2011. To improve the specificity and further reduce unnecessary thyroid surgeries, a second-generation assay (Afirma Genetic Sequence Classifier [GSC]) was released for clinical use in August 2017. We report 11 months of clinical outcomes experience with the GSC and compare them to our 6.5-year experience with the GEC. Methods: We searched our practice registry for FNAB nodules with Afirma results from January 2011through June 2018. GEC versus GSC results were compared overall, in oncocytic and nononcocytic aspirates and by pathologic outcomes. Results: GSC identified less indeterminate cytology nodules as suspicious (38.8%; 54/139) when compared to GEC (58.4%; 281/481). There was a decrease of in the percentage of oncocytic fine-needle aspiration thyroid biopsy (FNAB) subjects classified as suspicious in the GSC group, with 86 of 104 oncocytic indeterminates (82.7%) classified as suspicious by GEC and 12 of 34 (35.3%) classified as suspicious by GSC. The surgery rate in patients with oncocytic aspirates fell from 56% in the GEC group to 31% in the GSC-evaluated group (45%). Pathology analysis demonstrated a false-negative percentage for an incomplete surgical group of 9.5% for GEC and 1.2% for GSC. Conclusion: Our GSC data suggest that the GSC further reduces surgery in indeterminate thyroid nodules by improving the specificity of Afirma technology without compromising sensitivity. A primary determinant for this change is a significant improvement in the specificity of the Afirma GSC test in oncocytic FNAB aspirates. Abbreviations: FNAB = fine-needle aspiration biopsy; GEC = Gene Expression Classifier; GSC = Genetic Sequence Classifier.
MeSH term(s)	Biopsy, Fine-Needle ; Gene Expression Profiling ; Goosecoid Protein ; Humans ; Thyroid Neoplasms ; Thyroid Nodule/surgery
Chemical Substances	GSC protein, human ; Goosecoid Protein
Language	English
Publishing date	2018-11-01
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	1473503-9
ISSN	1530-891X
ISSN	1530-891X
DOI	10.4158/EP-2018-0395
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Article: MANAGING THYROID TUMORS DIAGNOSED AS NON-INVASIVE FOLLICULAR TUMOR WITH PAPILLARY LIKE NUCLEAR FEATURES (NIFTP).

Baloch, Zubair W / Harrell, R Mack / Brett, Elise M / Randolph, Gregory / Garber, Jeffrey R

Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

2017

Abstract: This commentary summarizes the history and reclassification of noninvasive follicular thyroid tumor with papillary like nuclei (NIFTP). The salient histopathologic features, which are based on immunohistochemical and molecular profiles and serve as ... ...

Abstract	This commentary summarizes the history and reclassification of noninvasive follicular thyroid tumor with papillary like nuclei (NIFTP). The salient histopathologic features, which are based on immunohistochemical and molecular profiles and serve as inclusion and exclusion criteria are reviewed. The authors also provide their own point of view regarding the practical issues and possible concerns that may be raised by both clinicians and patients based on the diagnosis of NIFTP.
Language	English
Publishing date	2017-07-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	1473503-9
ISSN	1530-891X
ISSN	1530-891X
DOI	10.4158/EP171940.DSC
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Article: AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY DISEASE STATE COMMENTARY: MANAGING THYROID TUMORS DIAGNOSED AS NONINVASIVE FOLLICULAR THYROID NEOPLASM WITH PAPILLARY-LIKE NUCLEAR FEATURES.

Baloch, Zubair W / Harrell, R Mack / Brett, Elise M / Randolph, Gregory / Garber, Jeffrey R

Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

2017 Volume 23, Issue 9, Page(s) 1150–1155

Abstract: This commentary summarizes the history and reclassification of noninvasive follicular thyroid neoplasm with papillary-like nuclei (NIFTP). It reviews the salient histopathologic features that are based on immunohistochemical and molecular profiles and ... ...

Abstract	This commentary summarizes the history and reclassification of noninvasive follicular thyroid neoplasm with papillary-like nuclei (NIFTP). It reviews the salient histopathologic features that are based on immunohistochemical and molecular profiles and serve as inclusion and exclusion criteria. The authors also provide their own point of view regarding the practical issues and possible concerns that may be raised by both clinicians and patients based on the diagnosis of NIFTP. Abbreviations: AACE = American Association of Clinical Endocrinologists EFVPTC = encapsulated FVPTC FNA = fine-needle aspiration FVPTC = follicular variant of papillary thyroid carcinoma NIFTP = noninvasive follicular thyroid neoplasm with papillary-like nuclear features PTC = papillary thyroid carcinoma.
MeSH term(s)	Adenocarcinoma, Follicular/diagnosis ; Adenocarcinoma, Follicular/pathology ; Biopsy, Fine-Needle ; Carcinoma, Papillary/diagnosis ; Carcinoma, Papillary/pathology ; Endocrinologists ; Humans ; Neoplasm Staging ; Thyroid Cancer, Papillary ; Thyroid Neoplasms/diagnosis ; Thyroid Neoplasms/pathology
Language	English
Publishing date	2017-08-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	1473503-9
ISSN	1530-891X
ISSN	1530-891X
DOI	10.4158/EP171940.DSCR
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Article ; Online: American Association of Clinical Endocrinology And Associazione Medici Endocrinologi Thyroid Nodule Algorithmic Tool.

Garber, Jeffrey R / Papini, Enrico / Frasoldati, Andrea / Lupo, Mark A / Harrell, R Mack / Parangi, Sareh / Patkar, Vivek / Baloch, Zubair W / Pessah-Pollack, Rachel / Hegedus, Laszlo / Crescenzi, Anna / Lubitz, Carrie C / Paschke, Ralf / Randolph, Gregory W / Guglielmi, Rinaldo / Lombardi, Celestino P / Gharib, Hossein

Endocrine, metabolic & immune disorders drug targets

2022 Volume 21, Issue 11, Page(s) 2104–2115

Abstract: Objective: The first edition of the American Association of Clinical Endocrinology/American College of Endocrinology/Associazione Medici Endocrinologi Guidelines for the Diagnosis and Management of Thyroid Nodules was published in 2006 and updated in ... ...

Abstract	Objective: The first edition of the American Association of Clinical Endocrinology/American College of Endocrinology/Associazione Medici Endocrinologi Guidelines for the Diagnosis and Management of Thyroid Nodules was published in 2006 and updated in 2010 and 2016. The American Association of Clinical Endocrinology/American College of Endocrinology/Associazione Medici Endocrinologi multidisciplinary thyroid nodules task force was charged with developing a novel interactive electronic algorithmic tool to evaluate thyroid nodules. Methods: The Thyroid Nodule App (termed TNAPP) was based on the updated 2016 clinical practice guideline recommendations while incorporating recent scientific evidence and avoiding unnecessary diagnostic procedures and surgical overtreatment. This manuscript describes the algorithmic tool development, its data requirements, and its basis for decision making. It provides links to the web-based algorithmic tool and a tutorial. Results: TNAPP and TI-RADS were cross-checked on 95 thyroid nodules with histology-proven diagnoses. Conclusion: TNAPP is a novel interactive web-based tool that uses clinical, imaging, cytologic, and molecular marker data to guide clinical decision making to evaluate and manage thyroid nodules. It may be used as a heuristic tool for evaluating and managing patients with thyroid nodules. It can be adapted to create registries for solo practices, large multispecialty delivery systems, regional and national databases, and research consortiums. Prospective studies are underway to validate TNAPP to determine how it compares with other ultrasound-based classification systems and whether it can improve the care of patients with clinically significant thyroid nodules while reducing the substantial burden incurred by those who do not benefit from further evaluation and treatment.
MeSH term(s)	Biopsy, Fine-Needle ; Endocrinology ; Humans ; Prospective Studies ; Retrospective Studies ; Thyroid Neoplasms/diagnosis ; Thyroid Nodule/diagnostic imaging ; Ultrasonography ; United States
Language	English
Publishing date	2022-01-14
Publishing country	United Arab Emirates
Document type	Journal Article
ZDB-ID	2228325-0
ISSN	2212-3873 ; 1871-5303
ISSN (online)	2212-3873
ISSN	1871-5303
DOI	10.2174/187153032111211230225617
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Article ; Online: AACE response to a candid discussion of obesity.

Gonzalez-Campoy, J Michael / Garvey, W Timothy / Harrell, R Mack

The American journal of medicine

2015 Volume 128, Issue 10, Page(s) e57

MeSH term(s)	Energy Intake/physiology ; Female ; Health Promotion/organization & administration ; Humans ; Male ; Motor Activity/physiology ; Obesity/epidemiology ; School Health Services/organization & administration ; Student Health Services/organization & administration
Language	English
Publishing date	2015-10
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	80015-6
ISSN	1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
ISSN (online)	1555-7162 ; 1873-2178
ISSN	0002-9343 ; 1548-2766
DOI	10.1016/j.amjmed.2015.04.044
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