Altered molecular profile in thyroid cancers from patients affected by the Three Mile Island nuclear accident.

OBJECTIVES/HYPOTHESIS: In 1979, Three Mile Island (TMI) nuclear power plant experienced a partial meltdown with release of radioactive material. The effects of the accident on thyroid cancer (TC) in the surrounding population remain unclear. Radiation-induced TCs have a lower incidence of single nucleotide oncogenic driver mutations and higher incidence of gene fusions. We used next generation sequencing (NGS) to identify molecular signatures of radiation-induced TC in a cohort of TC patients residing near TMI during the time of the accident. STUDY DESIGN: Case series. METHODS: We identified 44 patients who developed papillary thyroid carcinoma between 1974 and 2014. Patients who developed TC between 1984 and 1996 were at risk for radiation-induced TC, patients who developed TC before 1984 or after 1996 were the control group. We used targeted NGS of paired tumor and normal tissue from each patient to identify single nucleotide oncogenic driver mutations. Oncogenic gene fusions were identified using quantitative reverse transcription polymerase chain reaction. RESULTS: We identified 15 patients in the at-risk group and 29 patients in the control group. BRAFV600E mutations were identified in 53% patients in the at-risk group and 83% patients in the control group. The proportion of patients with BRAF mutations in the at-risk group was significantly lower than predicted by the The Cancer Genome Atlas cohort. Gene fusion or somatic copy number alteration drivers were identified in 33% tumors in the at-risk group and 14% of tumors in the control group. CONCLUSIONS: Findings were consistent with observations from other radiation-exposed populations. These data raise the possibility that radiation released from TMI may have altered the molecular profile of TC in the population surrounding TMI. LEVEL OF EVIDENCE: 4 Laryngoscope, 127:S1-S9, 2017.

Decisional Conflict and Regret in Parents Whose Children Undergo Tonsillectomy.

OBJECTIVE: To determine if decisional regret (DR) in parents following tonsillectomy/adenotonsillectomy (TA) in their children is related to preoperative decisional conflict, perceived outcome of surgery, complications of surgery, or other factors. STUDY DESIGN: Observational analytic cohort study. SETTING: Tertiary care children's hospital. SUBJECTS AND METHODS: Preoperative decisional conflict (DC) and SURE tests were administered to a parent of a child scheduled for TA between July 2014 and July 2015. The DR tests were given 1 to 3 months postoperatively. Data were collected on patient age, sex, perceived outcome of surgery, complications (including bleeding), emergency room visits, and clinic phone calls. RESULTS: A total of 102 families were studied, including 48 female and 54 male patients with an average age of 6.29 years. Parental respondents included 83 mothers, 14 fathers, and 5 grandmothers. Overall, DC and DR were both low in this group, with a median of 0 for each (means: 7.74 for DC and 8.78 for DR). DC was higher in parents who canceled surgery or failed to keep follow-up appointments (27.19) versus parents who brought their children for surgery (6.78; P < .05). DR was significantly higher in parents with DC (20.00 vs 7.59; P < .05). It was not related to age of the patient, sex, parental perception of resolution of preoperative complaints, complications (including bleeding or dehydration), emergency department visits, or parental phone calls to the otolaryngology clinic. SURE tests indicated that every parent was confident of his or her decision on the day of surgery. CONCLUSION: Preoperative DC is likely the most important factor in determining parental DR after the child undergoes TA.