Jennifer B Ogilvie, M.D.

Assessment of medical student clinical reasoning by "lay" vs physician raters: inter-rater reliability using a scoring guide in a multidisciplinary objective structured clinical examination
Berger, Alexandra J; Gillespie, Colleen C; Tewksbury, Linda R; Overstreet, Ivey M; Tsai, Ming C; Kalet, Adina L; Ogilvie, Jennifer B
2012 Jan;203(1):81-86, American journal of surgery
BACKGROUND: To determine whether a 'lay' rater could assess clinical reasoning, interrater reliability was measured between physician and lay raters of patient notes written by medical students as part of an 8-station objective structured clinical examination. METHODS: Seventy-five notes were rated on core elements of clinical reasoning by physician and lay raters independently, using a scoring guide developed by physician consensus. Twenty-five notes were rerated by a 2nd physician rater as an expert control. Kappa statistics and simple percentage agreement were calculated in 3 areas: evidence for and against each diagnosis and diagnostic workup. RESULTS: Agreement between physician and lay raters for the top diagnosis was as follows: supporting evidence, 89% (kappa = .72); evidence against, 89% (kappa = .81); and diagnostic workup, 79% (kappa = .58). Physician rater agreement was 83% (kappa = .59), 92% (kappa = .87), and 96% (kappa = .87), respectively. CONCLUSIONS: Using a comprehensive scoring guide, interrater reliability for physician and lay raters was comparable with reliability between 2 expert physician raters
— id: 147696, year: 2012, vol: 203, page: 81, stat: Journal Article,

Adrenal Extracellular Matrix Scaffolds Support Adrenocortical Cell Proliferation and Function In Vitro
Allen, Robert A.; Seltz, Lara M.; Jiang, Hongbin; Kasick, Rena T.; Sellaro, Tiffany L.; Badylak, Stephen F.; Ogilvie, Jennifer B.
2010 NOV ;16(11):3363-3374, Tissue engineering. Part A
Transplantation of functional adrenal cortex cells could reduce morbidity and increase the quality of life of patients with adrenal insufficiency. Our aim was to determine whether adrenal extracellular matrix (ECM) scaffolds promote adrenocortical cell endocrine function and proliferation in vitro. We seeded decellularized porcine adrenal ECM with primary human fetal adrenocortical (HFA) cells. Adrenocortical function was quantified by cortisol secretion of HFA-ECM constructs after stimulation with adrenocorticotropic hormone. Proliferation was assessed by adenosine triphosphate assay. HFA-ECM construct morphology was evaluated by immunofluorescence microscopy and scanning electron microscopy. Adrenal HFA-ECM constructs coated with laminin were compared to uncoated constructs. Laminin coating did not significantly affect HFA morphology, proliferation, or function. We demonstrated HFA cell attachment to adrenal ECM scaffolds. Cortisol production and HFA cell proliferation were significantly increased in HFA-ECM constructs compared to controls (p<0.05), and cortisol secretion rate per cell is comparable to that of human adult and fetal explants. We conclude that adrenal ECM supports endocrine function and proliferation of adrenocortical cells in vitro. Adrenal ECM scaffolds may form the basis for biocompatible tissue-engineered adrenal replacements
— id: 114597, year: 2010, vol: 16, page: 3363, stat: Journal Article,

Three Adult Acute Abdominal Pain Objective Structured Clinical Examination (OSCE) Cases for Medical Student Assessment
Falcone, John L; Ogilvie, Jennifer
MedEdPORTAL [sl : AAMC],
These Objective Structured Clinical Examination (OSCE) cases are for use in the evaluation of medical students during the surgical clerkship. Three adult patient cases of acute abdominal pain are presented: right upper quadrant pain, left lower quadrant pain, and epigastric pain. The case-specific elements of the history and physical examination are provided for use by standardized patients (SPs). The performance checklists for medical student behaviors in the history, physical examination, and patient-doctor relationship are also given
— id: 5651, year: 2010, vol: , page: ?, stat: Chapter,

Impact of the 2009 American Thyroid Association guidelines on the choice of operation for well-differentiated thyroid microcarcinomas
Ogilvie, Jennifer B; Patel, Kepal N; Heller, Keith S
2010 Dec;148(6):1222-1227, Surgery
BACKGROUND: The 2009 ATA Guidelines state 'lobectomy alone may be sufficient treatment for small (<1 cm), low risk, unifocal, intrathyroidal papillary carcinomas in the absence of . . . nodal metastases.' We determined how often these criteria are satisfied, and whether tumor size alone can dictate operative management. METHODS: Medical records of 346 patients with well-differentiated thyroid cancer (WDTC) who underwent thyroidectomy from January 1, 2007 to November 10, 2009, were reviewed. There were 130 patients with tumors </=1 cm and negative lateral nodes. Pathology reports were reviewed to identify adverse features including multifocality, extrathyroidal extension, vascular invasion, and central node metastases. RESULTS: Eighty-four percent underwent total thyroidectomy and 16% central node dissection. All but 2 patients had papillary cancer. Sixty-one percent with cancers 6-10 mm (group 1) had adverse pathologic features compared with 32% with cancers <6 mm (group 2). Multifocality was most common: 55% in group 1 versus 32% in group 2 (P = .004). Positive central nodes were identified in 23% of group 1 versus 4% of group 2 (P = .004). Of patients in group 1, 88% had positive or suspicious fine-needle aspiration biopsy (FNAB) preoperatively. CONCLUSION: We recommend that total thyroidectomy be considered as the initial operation for thyroid tumors 6-10 mm in size in which the preoperative FNAB is diagnostic or suspicious for WDTC
— id: 115280, year: 2010, vol: 148, page: 1222, stat: Journal Article,

Single nucleotide polymorphisms act as modifiers and correlate with the development of medullary and simultaneous medullary/papillary thyroid carcinomas in 2 large, non-related families with the RET V804M proto-oncogene mutation
Shifrin, Alexander L; Ogilvie, Jennifer B; Stang, Michael T; Fay, Angela Musial; Kuo, Yen-Hong; Matulewicz, Theodore; Xenachis, Cristina Z; Vernick, Jerome J
2010 Dec;148(6):1274-1280, Surgery
BACKGROUND: Single nucleotide polymorphisms (SNPs) may function as modifiers of the RET proto-oncogene, resulting in the expression of medullary thyroid carcinoma (MTC) and papillary thyroid carcinoma (PTC). We present 2 non-related Italian-American families (Family 1, n = 107; Family 2, n = 31) with the RET V804M mutation. We have correlated the presence of specific SNPs and the rare RET V804M mutation to MTC, C-cell hyperplasia (CCH), and PTC. METHODS: Sequencing was performed on exons 10, 11, and 13-16 of the RET proto-oncogene. The presence of MTC, CCH, and PTC were correlated to specific SNPs. RESULTS: In both families, 3 SNPs in exon 11 (G691S), exon 13 (L769L), and exon 15 (S904S) were detected in 100% of patients with overt MTC. The SNP L769L was present in all patients including patients with PTC, MTC, and CCH. CONCLUSION: SNP analysis revealed a similar pattern between the 2 families. SNPs in exon 11 (G691S) and exon 15 (S904S) appear to influence the development of MTC. A SNP in exon 13 (L769L) may serve as a modifier in the development of simultaneous MTC and PTC, as well as presentation of MTC, in patients with the RET V804M mutation
— id: 134413, year: 2010, vol: 148, page: 1274, stat: Journal Article,

Cystic parathyroid lesions: functional and nonfunctional parathyroid cysts
McCoy, Kelly L; Yim, John H; Zuckerbraun, Brian S; Ogilvie, Jennifer B; Peel, Robert L; Carty, Sally E
2009 Jan;144(1):52-56, Archives of Surgery (Chicago)
HYPOTHESIS: Functional parathyroid cysts (FPCs) and nonfunctional parathyroid cysts (NPCs) are 2 distinct clinical and histologic entities. DESIGN: Review of prospective clinical database records. SETTING: Tertiary academic center. PATIENTS: Patients enrolled in a prospective surgical database between January 1, 1990, and May 31, 2007. INTERVENTION: Cervical exploration for primary hyperparathyroidism or cervical mass. MAIN OUTCOME MEASURES: Age, sex, morbidity, imaging results, pathologic findings, cyst characteristics (size, location, and fluid), and perioperative calcium and parathyroid hormone levels. RESULTS: Cystic parathyroid lesions were found in 48 of 1769 patients (3%) studied. Functional parathyroid cysts were more common than NPCs, arising in 41 of 48 patients (85%), and showed no predisposition for sex or embryologic origin. Single-photon emission computed tomographic imaging failed to localize FPCs in 12 of 37 patients (32%). The fluid in FPCs was clear or colorless in 9 of 15 characterized specimens (60%). Rupture of cystic parathyroid lesions during resection was associated with prolonged elevation of intraoperative parathyroid hormone levels (P =.045). Cystic parathyroid lesions weighing 4 g or more were associated with the development of postoperative symptomatic hypocalcemia (P =.03). Functional parathyroid cysts occurred exclusively in adenomas with cystic change, whereas NPCs (with 1 exception) were without associated adenoma on final histologic examination. CONCLUSIONS: Cystic parathyroid lesions often contain turbid or colored fluid, and FPCs are more common than NPCs. Neck cysts of uncertain origin should be diagnostically aspirated for parathyroid hormone content. During resection, cyst rupture should be avoided, and patients with large cysts should be managed expectantly to forestall the development of symptomatic hypocalcemia. Functional parathyroid cysts and NPCs are likely 2 separate clinical and histologic entities
— id: 103780, year: 2009, vol: 144, page: 52, stat: Journal Article,

Localization of parathyroid adenomas by sonography and technetium tc 99m sestamibi single-photon emission computed tomography before minimally invasive parathyroidectomy: are both studies really needed?
Tublin, Mitchell E; Pryma, Daniel A; Yim, John H; Ogilvie, Jennifer B; Mountz, James M; Bencherif, Badreddine; Carty, Sally E
2009 Feb;28(2):183-190, Journal of ultrasound in medicine
OBJECTIVE: The purpose of this study was to determine the utility of radiologist-performed sonography as the principal modality for parathyroid localization before minimally invasive parathyroidectomy. METHODS: Both sonography and technetium Tc 99m sestamibi single-photon emission computed tomography (SPECT) are commonly performed during imaging evaluation of patients with primary hyperparathyroidism (HPTH). Sonographic examinations ordered during the study period were performed by 1 author (M.E.T.), and results were immediately reported. Findings of a subsequent Tc 99m sestamibi study were recorded blinded to the sonographic results. The sensitivity and specificity of sonography and Tc 99m sestamibi SPECT were assessed with the use of surgery and pathology reports as a reference standard. The 2007 global Medicare reimbursement rates were used to assess the costs of preoperative localization. RESULTS: Parathyroidectomy was performed in 144 of 172 patients evaluated by both modalities. The sensitivity, specificity, and positive predictive value of sonography for identifying abnormal parathyroid glands were 74%, 96%, and 90%, respectively. Sonography correctly localized a single adenoma or suggested multiglandular disease in 112 of 144 patients (78%). The sensitivity, specificity, and positive predictive value of SPECT were 58%, 96%, and 89%. Technetium 99m sestamibi SPECT correctly predicted an adenoma or multiglandular disease in 88 of 144 patients (61%). Five patients with negative sonographic findings were shown to have uniglandular disease on Tc 99m sestamibi SPECT. Selective use of Tc 99m sestamibi SPECT (ie, when sonographic findings were negative or equivocal) would have decreased the cost of imaging by 53%. CONCLUSIONS: Radiologist-performed sonography may potentially be used as a principal imaging modality for patients with HPTH. Selective use of Tc 99m sestamibi in cases with negative or equivocal sonographic findings can decrease the cost of imaging before parathyroid resection considerably
— id: 103779, year: 2009, vol: 28, page: 183, stat: Journal Article,

Sestamibi SPECT intensity scoring system in sporadic primary hyperparathyroidism
Yip, Linwah; Pryma, Daniel A; Yim, John H; Carty, Sally E; Ogilvie, Jennifer B
2009 Mar;33(3):426-433, World journal of surgery
BACKGROUND: Most cases of sporadic primary hyperparathyroidism (PHP) are due to a single parathyroid adenoma and can be treated with minimally invasive parathyroid exploration guided by sestamibi SPECT imaging and intraoperative parathyroid hormone monitoring. Successful surgery depends on identification of the 10-15% of patients with multiglandular disease. Failed initial parathyroid exploration is both costly and morbid. We examined whether a sestamibi SPECT scoring system could predict anatomic findings in patients with PHP. METHODS: Prospective data from 1,061 consecutive patients undergoing initial parathyroid exploration for PHP from March 6, 2000 to September 28, 2007 were reviewed. One nuclear medicine physician performed independent blinded review of 577 available dual time-point sestamibi SPECT scans, and scored the results into 1 of 5 categories: 0-negative, 1-possible, 2-probable, 3-definite adenoma, or 4-multiglandular disease. Intraoperative findings and outcomes at >5 months follow-up were examined. Chi-square and nonparametric analyses were used to evaluate variables for correlation. RESULTS: Among patients with sestamibi SPECT scan results classified as either 0--negative or 1--possible adenoma, only 211/262 (81%) had a single adenoma, compared to 263/288 (91%) patients with scan results classified as 2--probable or 3--definite adenoma (p < 0.001). Positive predictive values increased in stepwise correlation with sestamibi SPECT image intensity: 1--possible 78.5%, 2--probable 94.3%, and 3--definite adenoma 98.8%. Multiglandular disease was present in 31/144 (22%) patients with a 0--negative scan versus 13/166 (8%) patients with a 3--definite adenoma scan (p = 0.0005). Only 7/27 (26%) patients with scans classified as 4-multiglandular had actual multiglandular disease. Negative scan results were associated with a greater risk of operative failure (p < 0.001). CONCLUSIONS: A simple scoring system based on sestamibi SPECT intensity can predict the likelihood of single adenoma in PHP. Even the best localizing study cannot exclude multiglandular disease preoperatively. Negative sestamibi SPECT scans are associated with a higher rate of operative failure. Because sestamibi SPECT scans of any category do not reliably identify multiglandular disease, expert surgeons must use validated adjuncts to avoid operative failure
— id: 103781, year: 2009, vol: 33, page: 426, stat: Journal Article,

Parathyroid lipoadenomas and lipohyperplasias: clinicopathologic correlations
Seethala, Raja R; Ogilvie, Jennifer B; Carty, Sally E; Barnes, E Leon; Yim, John H
2008 Dec;32(12):1854-1867, American journal of surgical pathology
Parathyroid lipoadenomas and lipohyperplasias are rare histologic variants with both an increase in stromal fat and parenchyma. We report the most comprehensive single institution series of lipoadenomas and lipohyperplasias to date and review the literature. Eight lipoadenomas and 3 lipohyperplasias (27 y period) were reviewed. The mean age was 60.3 years (range: 50 to 77 y) with a female predilection (1.75:1). The most common symptoms on presentation were fatigue (55.6%) and bone/joint pain (44.4%). Only 1 patient was euparathyroid. Ultrasound localized lipoadenomas in 50% of tested cases whereas sestamibi was successful in 71.4%. Despite increased stromal fat (median: 50%), the weight and the appearance of large, occasionally nodular expansions of parathyroid parenchyma within the fatty stroma distinguished lipoadenomas and lipohyperplasias from normal parathyroid tissue; none of the cases were misclassified as normal on frozen section. Mean weight for lipoadenomas was 1553 mg (range: 173 to 4587 mg), whereas the mean weight for lipohyperplasia glands was 389.1 mg. Variant morphologies included follicular patterned, oxyphil predominant, and thymic elements (thymolipoadenoma). In 1 lipohyperplasia case, not all glands were involved. Oil Red O stains showed decreased intracytoplasmic lipid in most cases. Median follow-up was 9.2 months (range: <1 to 51 mo). Only 1 lipohyperplasia patient had persistent hypercalcemia, but was asymptomatic. Lipoadenomas and lipohyperplasias are clinically similar and as histologically diverse as their conventional counterparts. Lipoadenomas are more difficult to localize preoperatively by imaging. Despite the potential difficulty at frozen section, accurate weight documentation and recognition of key histologic features diminish this challenge
— id: 103784, year: 2008, vol: 32, page: 1854, stat: Journal Article,

Identification of multiple endocrine neoplasia type 1 in patients with apparent sporadic primary hyperparathyroidism
Yip, Linwah; Ogilvie, Jennifer B; Challinor, Susan M; Salata, Rose A; Thull, Darcy L; Yim, John H; Carty, Sally E
2008 Dec;144(6):1002-1006, Surgery
BACKGROUND: In the evaluation of patients with primary hyperparathyroidism (PHP), specific query for a personal or family history of MEN1 (Hx) is recommended widely, but responses are rarely positiv. We instituted a 6-question panel (6Q) to routinely screen for MEN1 preoperatively. METHODS: The clinical database entries of 939 patients explored for apparent sporadic PHP from June 1992 to November 2007 were examined for presenting diagnosis, demographics, anatomic findings, MEN1 analysis, and final diagnosis. To directly compare the results of 6Q and Hx, we also reviewed the charts of 654/939 PHP patients screened systematically from January 2000 to November 2007. RESULTS: MEN1 was undiagnosed until the preoperative evaluation in 1.6% of patients referred with apparent sporadic PHP. To date, MEN1 has been diagnosed in 42 of 939 (4.5%) PHP patients. Compared with those who have sporadic PHP, MEN1 patients were often male (38.1% vs 20.2%; P = .005) and young (mean, 38 +/- 17 years vs 60 +/- 13 years; P < .001). When hyperplasia was present at initial parathyroid exploration, the likelihood of MEN1 was 26% (32/123). For the 15 patients diagnosed by a surgeon to have MEN1, Hx was positive in 3 patients (20%) and 6Q in 13 (87%) (P = .0002). In a multivariate analysis of 635 patients with negative Hx, the likelihood of MEN1 increased with (1) younger age at initial parathyroid exploration and (2) number of positive 6Q responses. CONCLUSION: MEN1 occurs relatively often and can be missed. Systematic use of a simple 6-question panel helps to identify MEN1 prior to parathyroid exploration. Young male patients with parathyroid hyperplasia and positive 6Q results should be evaluated for MEN1
— id: 103782, year: 2008, vol: 144, page: 1002, stat: Journal Article,

Can a lightbulb sestamibi SPECT accurately predict single-gland disease in sporadic primary hyperparathyroidism?
Yip, Linwah; Pryma, Daniel A; Yim, John H; Virji, Mohamed A; Carty, Sally E; Ogilvie, Jennifer B
2008 May;32(5):784-792, World journal of surgery
BACKGROUND: Technetium-99m sestamibi scintigraphy with single photon emission computed tomography (SPECT) is widely used to guide minimally invasive exploration in patients with sporadic primary hyperparathyroidism (SPH), although its sensitivity in multiglandular disease is limited. We examined the incidence of missed multiglandular disease and associated anatomic findings when sestamibi SPECT was positive for a single intense focus of delayed tracer uptake, termed a lightbulb scan (LBS). METHODS: Prospectively entered data from 764 patients with SPH treated with initial parathyroid exploration from March 5, 2000, to December 31, 2006, were reviewed. A single radiologist performed blinded interpretation of 585 available sestamibi SPECT images, classifying 167 (28.5%) patients with a LBS. Clinical findings were compared among LBS patients with a single adenoma (true positive) and LBS patients with multiglandular disease (false negative). RESULTS: One hundred fifty of 167 (89.8%) LBS patients had a single adenoma and 3 (1.8%) had carcinoma. Multiglandular disease was anatomically present in 14 of 167 (8.4%) LBS patients compared with 60 of 418 (15.6%) non-LBS patients (p=0.05). Parathyroid hyperplasia occurred less frequently in LBS patients [5/167 (3%)] compared with non-LBS patients [36/418 (8.6%)], (p=0.02), while double adenomas occurred equally often in LBS patients [9/167 (5.4%)] compared with non-LBS patients [24/418 (5.7%)], (p=0.87). Double adenomas in LBS patients were more likely ipsilateral (7/9, p=0.005) and left-sided (7/7, p=0.008). LBS patients with multiglandular disease were more likely to have a history of neck irradiation, prior neck exploration, and concomitant thyroid pathology. CONCLUSIONS: In patients with SPH, sestamibi SPECT studies show a single bright focus of uptake in only 29% of patients. LBS findings do not exclude multiglandular disease. To avoid unacceptable rates of failure at initial parathyroid exploration, the expert surgeon should use validated adjuncts such as intraoperative PTH monitoring or four-gland exploration
— id: 103785, year: 2008, vol: 32, page: 784, stat: Journal Article,

Loss of heterozygosity of selected tumor suppressor genes in parathyroid carcinoma
Yip, Linwah; Seethala, Raja R; Nikiforova, Marina N; Nikiforov, Yuri E; Ogilvie, Jennifer B; Carty, Sally E; Yim, John H
2008 Dec;144(6):949-955, Surgery
BACKGROUND: The histologic diagnosis of parathyroid carcinoma (PC) is challenging. We evaluated a large PC series for loss of heterozygosity (LOH) of selected tumor suppressor genes with histopathologic correlation. METHODS: Among 2,238 patients explored for primary hyperparathyroidism (PHP), the cytoarchitectural parameters of 60 patients with surgical and/or pathologic suspicion for PC were examined by 1 pathologist. PC was diagnosed with >/=1 of the following: extracapsular, thyroidal, perineural, or angiolymphatic invasion; atypical mitoses; or metastasis. LOH was determined for PC or parathyroid adenoma (PA) using a panel of 12 tumor suppressor gene loci. Fractional allelic loss (FAL) was calculated as the percentage of loci with LOH divided by the number of informative loci. RESULTS: PC occurred in 0.8% of patients with PHP. Angiolymphatic (68%) and soft tissue (47%) invasion were the most common histologic findings. For PC, mean FAL was 32% vs 14% for PA (P = .03). Among informative cases, LOH was found at the HRPT2 locus in 7 of 14 (50%) PC vs 0 of 7 (0%) PA; the Rb locus in 4 of 15 (27%) PC vs 0 of 8 (0%) PA; the MEN1 locus in 6 of 15 (40%) PC vs 1 of 8 (13%) PA; and the 1p35.2-36.2 (including p21) locus in 8 of 13 (62%) PC vs 2 of 6 (33%) PA. CONCLUSION: In PC diagnosed by strict histologic criteria, LOH for a selected tumor suppressor gene panel was common. Specific tumor suppressor genes such as HRPT2 demonstrated LOH in up to 50% of PC, while not seen in any PA. Evaluation of LOH may be useful for the definitive diagnosis of PC
— id: 103783, year: 2008, vol: 144, page: 949, stat: Journal Article,

Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism
Johnson, Nathan A; Tublin, Mitchell E; Ogilvie, Jennifer B
2007 Jun;188(6):1706-1715, American journal of roentgenology
OBJECTIVE: This article discusses the commonly used techniques for imaging the parathyroid glands and their role in the preoperative evaluation of patients with primary hyperparathyroidism. CONCLUSION: The importance of sonography and sestamibi scintigraphy in the preoperative evaluation of patients with primary hyperthyroidism has increased with the adoption of minimally invasive parathyroidectomy techniques at most medical centers. When the results of these studies are concordant, the cure rates of minimally invasive surgery equal those of traditional bilateral neck exploration
— id: 103789, year: 2007, vol: 188, page: 1706, stat: Journal Article,

The incidence of cancer and rate of false-negative cytology in thyroid nodules greater than or equal to 4 cm in size
McCoy, Kelly L; Jabbour, Noel; Ogilvie, Jennifer B; Ohori, N Paul; Carty, Sally E; Yim, John H
2007 Dec;142(6):837-844, Surgery
BACKGROUND: High false-negative rates for fine needle aspiration biopsy (FNAB) of thyroid nodules greater than 3 cm have prompted recommendations for diagnostic lobectomy. We considered the presence of a greater than 4 cm nodule an independent indication for thyroidectomy regardless of FNAB results. METHODS: We reviewed clinical data from 223 patients with thyroid nodules greater than or equal to 4 cm operated on from July 2003 to November 2006. Unifocal micropapillary cancer was considered clinically insignificant. RESULTS: Clinically significant thyroid cancer was frequent, occurring in 57 of 223 patients (26%). Subgroup analysis showed that 43 of 223 patients (19.3%) had carcinoma within the mass and that 7 of 223 patients (3.1%) had significant carcinoma elsewhere in the resected thyroid. Multifocal micropapillary cancer was found in an additional 7 of 223 patients (3.1%). Preoperative FNAB was read incorrectly as benign in 9 of 71 patients with cancer (13%) (16% including multifocal micropapillary carcinoma). Benign FNAB results failed to identify 24 (34%) follicular lesions (including 7 cancers). In patients with preoperative FNAB results categorized as indeterminate lesions, 17 of 43 patients (40%) had carcinoma of the mass on final pathology. CONCLUSIONS: In thyroid nodules greater than or equal to 4 cm, the incidence of carcinoma is high with a high false-negative rate for preoperative benign cytology. Thyroid nodules greater than or equal to 4 cm should be considered for diagnostic lobectomy regardless of FNAB results
— id: 103787, year: 2007, vol: 142, page: 837, stat: Journal Article,

Same-day ultrasound guidance in reoperation for locally recurrent papillary thyroid cancer
McCoy, Kelly L; Yim, John H; Tublin, Mitchell E; Burmeister, Lynn A; Ogilvie, Jennifer B; Carty, Sally E
2007 Dec;142(6):965-972, Surgery
BACKGROUND: Reoperation for locally recurrent papillary thyroid cancer (PTC) is technically difficult and associated with higher morbidity. This study evaluated the use of same-day ultrasound guidance (SDUS) as an adjunct. METHODS: We compared 2 cohorts of consecutive patients with a single impalpable focus of recurrent PTC. Group I (August 2001-January 2004) was explored based on results of imaging. Group II (April 2004-January 2007) had an additional SDUS, performed before incision with indelible skin marking directly over the lesion. Outcome measures included failure to resect, lesion size, and postoperative change in thyroglobulin. RESULTS: In group I, in 3 of 6 cases the surgeon was unable to find the preoperatively imaged focus. By contrast, all 19 group II patients had successful resection of the lesion facilitated by SDUS (P < .01). SDUS resection was more likely to succeed even though group II lesions were smaller (mean 17 vs 11 mm; P = .009). Mean operative times did not differ but morbidity was lower (P < .01) in group II. Postresection serum thyroglobulin levels dropped to undetectable in 50% of evaluable cases. CONCLUSIONS: When focused resection of recurrent PTC is considered appropriate, SDUS guidance is an efficient and useful adjunct, allowing resection of lesions as small as 6 mm
— id: 103786, year: 2007, vol: 142, page: 965, stat: Journal Article,

Does routine consultation of thyroid fine-needle aspiration cytology change surgical management?
Tan, Yah Y; Kebebew, Electron; Reiff, Emily; Caron, Nadine R; Ogilvie, Jennifer B; Duh, Quan-Yang; Clark, Orlo H; Ljung, Britt-Marie; Miller, Theodore
2007 Jul;205(1):8-12, Journal of the American College of Surgeons
BACKGROUND: Routine secondary cytologic review of thyroid gland fine-needle aspiration (FNA) specimens in patients referred from other institutions has been the recommended practice at some medical centers. We sought to determine the concordance rates between FNA interpretations at referring institutions and our center to determine if they alter surgical management. STUDY DESIGN: All thyroid gland FNAs referred to our center for cytopathologic opinion from June 2000 to August 2004 were reviewed. Patients in whom FNA biopsies were performed for thyroid cancer recurrences or core biopsies and patients in whom only a cytopathologic opinion was requested without a clinical consultation were excluded from the study. FNA results were divided into benign, indeterminate, suspicious, malignant, and nondiagnostic categories. FNA interpretations at our medical center and the referring institutions were compared with final histology results in patients who underwent operations. RESULTS: One hundred forty-seven patients had secondary review of their thyroid gland FNA specimens. The overall concordance was 82%, with the highest concordance rate in the malignant category (95%) and the lowest in the suspicious category (62%, p<0.001). The sensitivity (94% versus 92%), specificity (76% versus 56%), and positive (93% versus 87%) and negative (79% versus 69%) predictive values were all higher on secondary review. Twenty-seven patients were found to have discordant FNA interpretations. As a result of the discordant FNA result, four patients had their surgical management decisions changed. Another four patients had appropriate oncologic thyroid resection as a result of the secondary review. CONCLUSIONS: Our results suggest that routine secondary cytopathologic review of FNA specimens from referring institutions changes surgical management in some patients with thyroid neoplasms. We recommend this practice be widely used at other centers, especially for suspicious results
— id: 103788, year: 2007, vol: 205, page: 8, stat: Journal Article,

Selective modified radical neck dissection for papillary thyroid cancer-is level I, II and V dissection always necessary?
Caron, N R; Tan, Y Y; Ogilvie, J B; Triponez, F; Reiff, E S; Kebebew, E; Duh, Q Y; Clark, O H
2006 May;30(5):833-840, World journal of surgery
BACKGROUND: There is ongoing controversy as to the indications for and extent of lateral cervical lymphadenectomy for patients with papillary thyroid cancer (PTC). While most now agree that prophylactic lymph node dissections (LND) play no role, at the University of California, San Francisco (UCSF) we limit LND selectively on a level by level basis, and resect only the levels thought to harbor disease or to be at increased risk of metastases. This initial 'selective LND' usually includes levels III and IV (due to the well-documented increased likelihood of metastases to these levels) and levels I, II, and V are included when there is clinical or radiological evidence of disease or increased risk of it. METHODS: A retrospective review of the clinical charts and hospital records of 106 consecutive patients who had metastatic PTC and who underwent at least one lateral cervical LND at UCSF between January 1995 and December 2003 was carried out. Data were collected to assess which patients had levels I, II, and/or V included in their initial ipsilateral and/or contralateral LND and to determine the recurrence rates at these levels if they had previously been excised compared with if they had not. Chi-squared and Fisher exact tests were utilized for statistical comparison, where appropriate. RESULTS: A total of 140 initial lateral LND were performed: 104 ipsilateral and 36 contralateral. In these initial LND, 3.9%, 72.5%, and 18.6% of patients had levels I, II, and V resected on the ipsilateral side, and 2.9%, 60.0%, and 37.1% of patients had levels I, II, and V resected on the contralateral side. Recurrence at levels I and V was uncommon in all patient populations. Recurrence at level II was 19% ipsilaterally and 10% contralaterally when the level was previously resected and 21% ipsilaterally and 14% contralaterally when the level was not previously resected. There was no statistically significant difference in recurrence at level II when the level had previously been resected compared with when it had not. CONCLUSIONS: If utilized in the appropriate patient population, a selective approach to lateral cervical LND for PTC can be a successful alternative to the routine modified radical LND. Levels I and V do not require resection unless there is clinical or radiological evidence of disease. Guidelines for which patients may be considered for this less aggressive approach to level II nodal metastases are suggested
— id: 103792, year: 2006, vol: 30, page: 833, stat: Journal Article,

Indication and timing of thyroid surgery for patients with hereditary medullary thyroid cancer syndromes
Ogilvie, Jennifer B; Kebebew, Electron
2006 Feb;4(2):139-147, Journal of the National Comprehensive Cancer Network : JNCCN
Hereditary medullary thyroid cancer syndromes comprise familial medullary thyroid cancer (FMTC) and multiple endocrine neoplasia types 2A and 2B. Hereditary medullary thyroid cancers have an autosomal dominant pattern of inheritance and are caused by activating germline point mutations in the RET proto-oncogene. Evaluation of the onset, extent, and progression of hereditary medullary thyroid cancer associated with specific RET mutations has enabled clinicians to treat patients based on the level of risk associated with their specific mutation. Children identified by RET screening to be at risk for the development of medullary thyroid cancer can be treated with prophylactic thyroidectomy before developing the disease. This review covers the diagnosis, evaluation, timing of surgical management, and optimal follow-up of patients with hereditary medullary thyroid cancer syndromes
— id: 103793, year: 2006, vol: 4, page: 139, stat: Journal Article,

Current status of fine needle aspiration for thyroid nodules
Ogilvie, Jennifer B; Piatigorsky, Eli J; Clark, Orlo H
2006 ;40:223-238, Advances in surgery
When not to perform fine needle aspiration of a thyroid nodule In summary, FNA of thyroid nodules has become one of the most useful, safe, and accurate tools in the diagnosis of thyroid pathology. Thyroid nodules that should be considered for FNA include any firm, palpable, solitary nodule or nodule associated with worrisome clinical features (rapid growth, attachment to adjacent tissues, new hoarseness, or palpable lymphadenopathy). FNA should also be performed on nodules with suspicious ultrasonographic features (microcalcifications, rounded shape, predominantly solid composition); dominant or atypical nodules in multinodular goiter; complex or recurrent cystic nodules; or any nodule associated with palpable or ultrasonographically abnormal cervical lymph nodes. Finally, FNA should be performed on any abnormal-appearing or palpable cervical lymph nodes. The management of thyroid nodules based on FNA findings is summarized in Table 2. It can be argued that in certain circumstances the results of thyroid FNA do not change the surgical management of a thyroid nodule, and thus preoperative FNA may be unnecessary. These cases include solitary nodules in patients who have a strong family history of thyroid cancer, multiple endocrine neoplasia type II, or radiation to the head and neck. These patients when they have thyroid nodules have at least a 40% risk for thyroid cancer and frequent multifocal or bilateral disease and should undergo total thyroidectomy with or without central neck lymph node dissection. Patients who have multinodular goiter and compressive symptoms, patients who have Graves disease and a thyroid nodule, or patients who have large (greater than 4 cm) or symptomatic unilateral thyroid nodules could also be considered for total thyroidectomy or lobectomy as indicated without preoperative FNA. Finally, patients who have a solitary hyperfunctioning nodule on radioiodine scan and a suppressed TSH have an extremely low incidence of malignancy and may be considered for therapeutic thyroid lobectomy or radioiodine ablation as indicated without undergoing FNA biopsy
— id: 103790, year: 2006, vol: 40, page: 223, stat: Journal Article,

Selective use of adrenal venous sampling in the lateralization of aldosterone-producing adenomas
Tan, Yah Yuen; Ogilvie, Jennifer B; Triponez, Frederick; Caron, Nadine R; Kebebew, Electron K; Clark, Orlo H; Duh, Quan-Yang
2006 May;30(5):879-885, World journal of surgery
INTRODUCTION: It has been suggested that routine adrenal venous sampling (AVS) is necessary to lateralize an aldosterone-producing adenoma in patients with primary hyperaldosteronism. However, the success rate of AVS is variable, with potential risks. We review our experience at University of California San Francisco (UCSF), where AVS is used only selectively, to determine outcomes with this approach. METHODS: All patients undergoing adrenalectomy for aldosteronoma at UCSF from January 1995 to October 2004 were included. Outcome after adrenalectomy was determined based on plasma levels of aldosterone and potassium, rates of persistent hypertension, and reduced use of antihypertensive medications. RESULTS: Altogether, 65 patients were included in the study, 52 (80%) of whom had their adrenal tumors lateralized based on computed tomography scans, magnetic resonance imaging, or both. The remaining 13 (20%) patients had doubtful localization of their lesions on imaging. We did not routinely perform AVS in patients with definitive imaging findings. Thus, only 4 (8%) patients with definitive imaging findings underwent AVS, and one was unsuccessful. Of the 13 patients with doubtful lateralization on imaging, 8 underwent AVS. With this practice, biochemical cure rates after adrenalectomy were up to 100%, and hypertension resolved or was improved in 85% of patients. CONCLUSIONS: AVS may be performed selectively only when preoperative imaging cannot definitively lateralize the aldosteronoma. This practice in our center has resulted in high cure rates. During the era of improved imaging resolution and experience, mandatory routine AVS is not necessary to achieve high cure rates for aldosteronomas
— id: 103791, year: 2006, vol: 30, page: 879, stat: Journal Article,

Parathyroid surgery: we still need traditional and selective approaches
Ogilvie, J B; Clark, O H
2005 Jun;28(6):566-569, Journal of endocrinological investigation
Since the first parathyroidectomy in 1925, the traditional bilateral cervical approach has been the gold standard surgical treatment for patients with primary hyperparathyroidism, with a success rate >95%. Over the past decade, the focus on minimally invasive surgery has led to the development of several innovative approaches to the parathyroid glands including the focused, radio-guided, video-assisted and videoscopic parathyroidectomy. Improvements in pre-operative parathyroid localization studies as well as the use of the intraoperative PTH assay have made these minimally invasive approaches possible, and they have been proven to be safe and effective for the solitary parathyroid adenoma. For patients with multiple gland disease or equivocal localization studies, the traditional bilateral approach remains the standard of care
— id: 103794, year: 2005, vol: 28, page: 566, stat: Journal Article,

On teaching medical students: introducing Mr. Jones
Ogilvie, Jennifer B
2005 Jan-Feb;62(1):73-74, Current surgery
— id: 103796, year: 2005, vol: 62, page: 73, stat: Journal Article,

New approaches to the minimally invasive treatment of adrenal lesions
Ogilvie, Jennifer Braemar; Duh, Quan-Yang
2005 Jan-Feb;11(1):64-72, Cancer journal
The advancement of laparoscopic adrenalectomy over the past decade has completely changed the surgical approach to adrenal tumors. As the incidence of incidentally discovered adrenal tumors increases, most patients with resectable lesions can undergo resection laparoscopically with minimal morbidity, shorter hospitalization, and low mortality. The spectrum of surgical approaches now available make it possible to provide an appropriate resection that is matched to the specific characteristics of each tumor. Experienced surgeons now resect some malignant tumors laparoscopically, with the option to convert to a hand-assisted or traditional open approach
— id: 103795, year: 2005, vol: 11, page: 64, stat: Journal Article,

Tissue-engineered colon exhibits function in vivo
Grikscheit, Tracy C; Ogilvie, Jennifer B; Ochoa, Erin R; Alsberg, Eben; Mooney, David; Vacanti, Joseph P
2002 Aug;132(2):200-204, Surgery
BACKGROUND: Postcolectomy morbidities include important changes in enterohepatic circulation, stool microbiology, and absorption. The surgical substitution of an ileal pouch for the absent colon also has a number of serious complications. We report in vivo colon replacement by tissue-engineered colon (TEC) in lieu of an ileal pouch. METHODS: End-ileostomies were created in 22 male Lewis rats. In 11 animals, side-to-side ileum-TEC anastomosis was performed 1 cm from the stoma. This group was compared with end-ileostomy alone. Serial weights were measured, and animals were harvested sequentially for assessment of histologic signs of pouchitis. Transit times, stool dry and wet weights, and serum and stool colon function markers were collected. RESULTS: Animals survived 41 days. Weight loss was more than 1.5 times greater in the end-ileostomy alone group compared with the ileum-TEC group. Transit times were significantly longer in the ileum-TEC group than the end-ileostomy alone group, with lower stool moisture content and higher total serum bile acids. Animals without TEC had statistically significant hyponatremia, elevated serum urea nitrogen, and lower stool short chain fatty acids (13.5 micromol/kg vs 84.2) with an abnormal distribution. CONCLUSIONS: TEC successfully recapitulates some major physiologic functions of native large intestine in vivo
— id: 103797, year: 2002, vol: 132, page: 200, stat: Journal Article,