ImportanceDue to lack of data from high-powered randomized clinical trials, the differences in functional and survival outcomes for patients with oropharyngeal squamous cell carcinoma (OPSCC) undergoing primary transoral robotic surgery (TORS) vs primary radiation therapy and/or chemoradiation therapy (RT/CRT) are unclear.ObjectivesTo compare 5-year functional (dysphagia, tracheostomy dependence, and gastrostomy tube dependence) and survivorship outcomes in patients with T1-T2 OPSCC receiving primary TORS vs RT/CRT.Design, Setting, and PopulationThis national multicenter cohort study used data from a global health network (TriNetX) to identify differences in functional and survival outcomes among patients with OPSCC who underwent primary TORS or RT/CRT in 2002 to 2022. After propensity matching, 726 patients with OPSCC met inclusion criteria. In the TORS group, 363 (50%) patients had undergone primary surgery, and in the RT/CRT group, 363 (50%) patients had received primary RT/CRT. Data analyses were performed from December 2022 to January 2023 using the TriNetX platform.ExposurePrimary surgery with TORS or primary treatment with radiation therapy and/or chemoradiation therapy.Main Outcomes and MeasuresPropensity score matching was used to balance the 2 groups. Functional outcomes were measured at 6 months, 1 year, 3 years, 5 years, and more than 5 years posttreatment and included dysphagia, gastrostomy tube dependence, and tracheostomy dependence according to standard medical codes. Five-year overall survivorship was compared between patients undergoing primary TORS vs RT/CRT.ResultsPropensity score matching allowed a study sample with 2 cohorts comprising statistically similar parameters with 363 (50%) patients in each. Patients in the TORS cohort had a mean (SD) age of 68.5 (9.9) vs 68.8 (9.7) years in RT/CRT cohort; 86% and 88% were White individuals, respectively; 79% of patients were men in both cohorts. Primary TORS was associated with clinically meaningful increased risk of dysphagia at 6 months (OR, 1.37; 95% CI, 1.01-1.84) and 1 year posttreatment (OR, 1.71; 95% CI, 1.22-2.39) compared with primary RT/CRT. Patients receiving surgery were less likely to be gastrostomy tube dependent at 6 months (OR, 0.46; 95% CI, 0.21-1.00) and 5 years posttreatment (risk difference, −0.05; 95% CI, −0.07 to −0.02). Differences in overall rates of tracheostomy dependence (OR, 0.97; 95% CI, 0.51-1.82) between groups were not clinically meaningful. Patients with OPSCC, unmatched for cancer stage or human papillomavirus status, who received RT/CRT had worse 5-year overall survival than those who underwent primary surgery (70.2% vs 58.4%; hazard ratio, 0.56; 95% CI, 0.40-0.79).Conclusions and RelevanceThis national multicenter cohort study of patients undergoing primary TORS vs primary RT/CRT for T1-T2 OPSCC found that primary TORS was associated with a clinically meaningful increased risk of short-term dysphagia. Patients treated with primary RT/CRT had an increased risk of short- and long-term gastrostomy tube dependence and worse 5-year overall survival than those who underwent surgery.

ObjectiveTo validate and compare novel ultrasound scoring systems for dermoid cysts and thyroglossal duct cysts among pediatric patients.Study DesignRetrospective study.SettingTertiary care children's hospital.MethodsAn electronic medical record query of patients younger than 18 years old who underwent primary excision of a neck mass between January 2005 and February 2022, who underwent preoperative ultrasound, and had final histopathologic diagnosis of either thyroglossal duct cysts or dermoid cysts. This generated 260 results, of which 134 patients met the inclusion criteria. Charts were reviewed for demographic data, clinical impressions, and radiographic studies. Radiologists blindly reviewed ultrasound for SIST score (septae + irregular walls + solid components = thyroglossal), and 4S algorithm (Septations, depth relative to Strap muscles, Shape, Solid parts). Statistical analyses were performed to determine the accuracy of each diagnostic modality.ResultsOf 134 patients, 90 (67%) had a final histopathologic diagnosis of thyroglossal duct cysts, and 44 (33%) were dermoid cysts. The accuracy of clinical diagnosis was 52%, and preoperative ultrasound report accuracy was 31%. The 4S and SIST accuracies were each 84%.ConclusionBoth the 4S algorithm and SIST score provide increased accuracy of diagnosis relative to standard preoperative ultrasound assessment. Neither scoring modality was determined to be superior. Further research is warranted in improving the accuracy of preoperative assessments for pediatric congenital neck masses.