Bio

Bio


Lisa A. Orloff, MD, is Director of the Endocrine Head and Neck Surgery Program and Professor of the Department of Otolaryngology, Division of Head and Neck Surgery, at Stanford University School of Medicine. Her clinical practice focuses on the surgical management of thyroid and parathyroid tumors.
Dr. Orloff's contributions to the field of endocrine head and neck surgery have been significant. Her work understanding and expanding the role of ultrasound within the multidisciplinary management in endocrine head and neck disease has transformed the manner in which thyroid and parathyroid patients are evaluated. Dr. Orloff specializes in ultrasound applications within otolaryngology/head and neck surgery, with an emphasis on thyroid cancer. Dr. Orloff also studies the regeneration of tissue that has been lost as a result of cancer therapies.

Dr. Orloff received her medical degree from the University of California, Los Angeles. She completed her residency in Otolaryngology/Head & Neck Surgery at the University of Washington and her fellowship in Microvascular & Reconstructive Surgery at Mount Sinai Medical Center in New York. Prior to her arrival at Stanford, she was the Robert K. Werbe Distinguished Professor in Head and Neck Cancer, and Chief of the Division of Head and Neck Surgery at the University of California, San Francisco (UCSF.)

Dr. Orloff has served three consecutive terms as the Chair of the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) Endocrine Surgery committee. She holds leadership roles within the American Head and Neck Society, the American College of Surgeons, and the American Thyroid Association. She is a former Fulbright scholar, and she is a voting member of the FDA’s Panel to evaluate medical devices for Otolaryngology.

If you would like to refer a patient to Dr. Orloff, or have any questions, she can be contacted at: by phone 650.498-6000; fax: 650.724.1433

Clinical Focus


  • Cancer > Head and Neck Cancer
  • Otolaryngology
  • Cancer, Thyroid
  • Parathyroidectomy
  • Endocrine Surgical Procedures
  • Ultrasonography

Academic Appointments


Professional Education


  • Residency:University of WashingtonWA
  • Internship:University of WashingtonWA
  • Medical Education:UCLA - School of Medicine (1986) CA
  • Fellowship:Mt Sinai Medical CenterOH
  • Board Certification: Otolaryngology, American Board of Otolaryngology (1993)

Teaching

2015-16 Courses


Publications

All Publications


  • Transoral robotic-assisted surgical excision of a retropharyngeal parathyroid adenoma: A case report. Head & neck Bearelly, S., Prendes, B. L., Wang, S. J., Glastonbury, C., Orloff, L. A. 2015; 37 (11): E150-2

    Abstract

    Transoral robotic surgery has been used with increasing frequency for oropharyngeal malignancies. We present the first known case of a transoral robotic-assisted parathyroidectomy.A 77-year-old woman with primary hyperparathyroidism was suspected of having a parathyroid adenoma. After several nonlocalizing single photon emission CT/CT sestamibi scans, a neck ultrasound revealed a suspicious low level 6 nodule. Surgical excision of this nodule proved to be a reactive lymph node. She then had a dynamic parathyroid protocol MRI and CT, which revealed a small retropharyngeal adenoma candidate. A transoral robotic-assisted surgical approach was utilized to bluntly dissect the retropharyngeal space just above the arytenoids to excise the nodule. After excision, the intraoperative parathyroid hormone (PTH) normalized and surgical pathology confirmed parathyroid adenoma.Transoral robotic-assisted surgery is a novel technique that can be utilized for resection of a parathyroid adenoma in the retropharyngeal space.

    View details for DOI 10.1002/hed.24010

    View details for PubMedID 25809987

  • AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY DISEASE STATE CLINICAL REVIEW: POSTOPERATIVE HYPOPARATHYRODISM - DEFINITIONS AND MANAGEMENT ENDOCRINE PRACTICE Stack, B. C., Bimston, D. N., Bodenner, D. L., Brett, E. M., Dralle, H., Orloff, L. A., Pallota, J., Snyder, S. K., Wong, R. J., Randolph, G. W. 2015; 21 (6): 674-685

    Abstract

    BID = bis in die DSPTC = diffuse sclerosing papillary thyroid cancer FNA = fine-needle aspiration HT = Hashimoto thyroiditis iPTH = intact parathyroid hormone 25OHD = 25-hydroxy vitamin D PTH = parathyroid hormone TPO = thyroid peroxidase US = ultrasonography.

    View details for DOI 10.4158/EP14462.DSC

    View details for Web of Science ID 000357732000014

    View details for PubMedID 26135962

  • Stimulation Threshold Greatly Affects the Predictive Value of Intraoperative Nerve Monitoring LARYNGOSCOPE Faden, D. L., Orloff, L. A., Ayeni, T., Fink, D. S., Yung, K. 2015; 125 (5): 1265-1270

    Abstract

    Using a standardized, graded, intraoperative stimulation protocol, we aimed to delineate the effects of various stimulation levels applied to the recurrent laryngeal nerve on the postoperative predictive value of intraoperative nerve monitoring.A total of 917 nerves at risk were included for analysis. Intraoperatively, patients underwent stimulation of the recurrent laryngeal nerve at 0.3, 0.5, 0.8, and 1.0 mA followed by postoperative laryngoscopy for correlation with intraoperative findings.Sensitivity, specificity, positive predictive value, and negative predictive value were calculated at each stimulation level.Sensitivity, specificity, positive predictive value, and negative predicative values ranged from 100% to 37%, 6% to 99%, 2% to 39%, and 100% to 99%, respectively at 0.3 to 1.0 mA. No demographic variables affected sensitivity or specificity. Receiver operating characteristic analysis identified 0.5 mA as the level of stimulation that optimizes sensitivity and specificity.The predictive value of intraoperative nerve monitoring varies greatly depending on the stimulation levels used. At low amplitudes of stimulation, nerve monitoring has high sensitivity and negative predictive value but low specificity and positive predictive value, related to the high rate of false positives. At high levels of stimulation, specificity and negative predictive value are high, sensitivity is low, and the positive predictive value rises as the rate of false negatives increase and the rate of false positives decrease. A stimulation level of 0.5 mA optimizes the predictive value of nerve monitoring; however, stimulation at multiple levels significantly improves the predictive value of intraoperative nerve monitoring.2b.

    View details for DOI 10.1002/lary.24960

    View details for Web of Science ID 000353996900050

    View details for PubMedID 25302692

  • Management of recurrent and persistent metastatic lymph nodes in well-differentiated thyroid cancer: a multifactorial decision-making guide for the thyroid cancer care collaborative. Head & neck Urken, M. L., Milas, M., Randolph, G. W., Tufano, R., Bergman, D., Bernet, V., Brett, E. M., Brierley, J. D., Cobin, R., Doherty, G., Klopper, J., Lee, S., Machac, J., Mechanick, J. I., Orloff, L. A., Ross, D., Smallridge, R. C., Terris, D. J., Clain, J. B., Tuttle, M. 2015; 37 (4): 605-614

    Abstract

    Well-differentiated thyroid cancer (WDTC) recurs in up to 30% of patients. Guidelines from the American Thyroid Association (ATA) and the National Comprehensive Cancer Network (NCCN) provide valuable parameters for the management of recurrent disease, but fail to guide the clinician as to the multitude of factors that should be taken into account. The Thyroid Cancer Care Collaborative (TCCC) is a web-based repository of a patient's clinical information. Ten clinical decision-making modules (CDMMs) process this information and display individualized treatment recommendations.We conducted a review of the literature and analysis of the management of patients with recurrent/persistent WDTC.Surgery remains the most common treatment in recurrent/persistent WDTC and can be performed with limited morbidity in experienced hands. However, careful observation may be the recommended course in select patients. Reoperation yields biochemical remission rates between 21% and 66%. There is a reported 1.2% incidence of permanent unexpected nerve paralysis and a 3.5% incidence of permanent hypoparathyroidism. External beam radiotherapy and percutaneous ethanol ablation have been reported as therapeutic alternatives. Radioactive iodine as a primary therapy has been reported previously for metastatic lymph nodes, but is currently advocated by the ATA as an adjuvant to surgery.The management of recurrent lymph nodes is a multifactorial decision and is best determined by a multidisciplinary team. The CDMMs allow for easy adoption of contemporary knowledge, making this information accessible to both patient and clinician.

    View details for DOI 10.1002/hed.23615

    View details for PubMedID 24436291

  • Database and registry research in thyroid cancer: striving for a new and improved national thyroid cancer database. Thyroid Mehra, S., Tuttle, R. M., Milas, M., Orloff, L., Bergman, D., Bernet, V., Brett, E., Cobin, R., Doherty, G., Judson, B. L., Klopper, J., Lee, S., Lupo, M., Machac, J., Mechanick, J. I., Randolph, G., Ross, D. S., Smallridge, R., Terris, D., Tufano, R., Alon, E., Clain, J., DosReis, L., Scherl, S., Urken, M. L. 2015; 25 (2): 157-168

    Abstract

    Health registries have become extremely powerful tools for cancer research. Unfortunately, certain details and the ability to adapt to new information are necessarily limited in current registries, and they cannot address many controversial issues in cancer management. This is of particular concern in differentiated thyroid cancer, which is rapidly increasing in incidence and has many unknowns related to optimal treatment and surveillance recommendations.In this study, we review different types of health registries used in cancer research in the United States, with a focus on their advantages and disadvantages as related to the study of thyroid cancer. This analysis includes population-based cancer registries, health systems-based cancer registries, and patient-based disease registries. It is important that clinicians understand the way data are collected in, as well as the composition of, these different registries in order to more critically interpret the clinical research that is conducted using that data. In an attempt to address shortcoming of current databases for thyroid cancer, we present the potential of an innovative web-based disease management tool for thyroid cancer called the Thyroid Cancer Care Collaborative (TCCC) to become a patient-based registry that can be used to evaluate and improve the quality of care delivered to patients with thyroid cancer as well as to answer questions that we have not been able to address with current databases and registries.A cancer registry that follows a specific patient, is integrated into physician workflow, and collects data across different treatment sites and different payers does not exist in the current fragmented system of healthcare in the United States. The TCCC offers physicians who treat thyroid cancer numerous time-saving and quality improvement services, and could significantly improve patient care. With rapid adoption across the nation, the TCCC could become a new paradigm for database research in thyroid cancer to improve our understanding of thyroid cancer management.

    View details for DOI 10.1089/thy.2014.0270

    View details for PubMedID 25517683

  • American Thyroid Association statement on preoperative imaging for thyroid cancer surgery. Thyroid Yeh, M. W., Bauer, A. J., Bernet, V. A., Ferris, R. L., Loevner, L. A., Mandel, S. J., Orloff, L. A., Randolph, G. W., Steward, D. L. 2015; 25 (1): 3-14

    Abstract

    The success of surgery for thyroid cancer hinges on thorough and accurate preoperative imaging, which enables complete clearance of the primary tumor and affected lymph node compartments. This working group was charged by the Surgical Affairs Committee of the American Thyroid Association to examine the available literature and to review the most appropriate imaging studies for the planning of initial and revision surgery for thyroid cancer.Ultrasound remains the most important imaging modality in the evaluation of thyroid cancer, and should be used routinely to assess both the primary tumor and all associated cervical lymph node basins preoperatively. Positive lymph nodes may be distinguished from normal nodes based upon size, shape, echogenicity, hypervascularity, loss of hilar architecture, and the presence of calcifications. Ultrasound-guided fine-needle aspiration of suspicious lymph nodes may be useful in guiding the extent of surgery. Cross-sectional imaging (computed tomography with contrast or magnetic resonance imaging) may be considered in select circumstances to better characterize tumor invasion and bulky, inferiorly located, or posteriorly located lymph nodes, or when ultrasound expertise is not available. The above recommendations are applicable to both initial and revision surgery. Functional imaging with positron emission tomography (PET) or PET-CT may be helpful in cases of recurrent cancer with positive tumor markers and negative anatomic imaging.

    View details for DOI 10.1089/thy.2014.0096

    View details for PubMedID 25188202

  • What Is the Gold Standard for Comprehensive Interinstitutional Communication of Perioperative Information for Thyroid Cancer Patients? A Comparison of Existing Electronic Health Records with the Current American Thyroid Association Recommendations THYROID Dos Reis, L. L., Tuttle, R. M., Alon, E., Bergman, D. A., Bernet, V., Brett, E. M., Cobin, R., Doherty, G., Harris, J. R., Klopper, J., Lee, S. L., Lupo, M., Milas, M., Machac, J., Mechanick, J. I., Orloff, L., Randolph, G., Ross, D. S., Smallridge, R. C., Terris, D. J., Tufano, R. P., Mehra, S., Scherl, S., Clain, J. B., Urken, M. L. 2014; 24 (10): 1466-1472
  • Striving Toward Standardization of Reporting of Ultrasound Features of Thyroid Nodules and Lymph Nodes: A Multidisciplinary Consensus Statement THYROID Su, H. K., Dos Reis, L. L., Lupo, M. A., Milas, M., Orloff, L. A., Langer, J. E., Brett, E. M., Kazam, E., Lee, S. L., Minkowitz, G., Alpert, E. H., Dewey, E. H., Urken, M. L. 2014; 24 (9): 1341-1349

    Abstract

    The use of high-resolution ultrasound (US) imaging is a mainstay of the initial evaluation and long-term management of thyroid nodules and thyroid cancer. To fully capitalize on the diagnostic capabilities of a US examination in the context of thyroid disease, many clinicians consider it desirable to establish a universal format and standard of US reporting. The goals of this interdisciplinary consensus statement are twofold. First, to create a standardized set of US features to characterize thyroid nodules and cervical lymph nodes accurately, and second, to create a standardized system for tracking sequential changes in the US examination of thyroid nodules and cervical lymph nodes for the purpose of determining risk of malignancy.The Thyroid, Head and Neck Cancer (THANC) Foundation convened a panel of nine specialists from a variety of medical disciplines that are actively involved in the diagnosis and treatment of thyroid nodules and thyroid cancer. Consensus was achieved on the following topics: US evaluation of the thyroid gland, US evaluation of thyroid nodules, US evaluation of cervical lymph nodes, US-guided fine needle aspiration (FNA) of thyroid nodules, and US-guided FNA of cervical lymph nodes.We propose that this statement represents a consensus within a multidisciplinary team on the salient and essential elements of a comprehensive and clinically significant thyroid and neck US report with regards to content, terminology, and organization. This reporting protocol supplements previous US performance guidelines by not only capturing categories of findings that may have important clinical implications, but also delineating findings that are clinically relevant within those categories as specifically as possible. Additionally, we have included the specific features of diagnostic and therapeutic interventions that have not been previously addressed.

    View details for DOI 10.1089/thy.2014.0110

    View details for Web of Science ID 000341509300002

    View details for PubMedID 24967994

  • Clinician-Performed Thyroid Ultrasound-Guided Fine-Needle Aspiration OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA Tsao, G. J., Orloff, L. A. 2014; 47 (4): 509-?

    Abstract

    Fine needle aspiration biopsy (FNA) is the key step in selecting most patients with thyroid nodules for or against surgery. Accurate acquisition of cytologic samples from suspicious lesions is achieved by adding ultrasound guidance to optimize targeting as well as to enable sampling from nonpalpable lesions. This article discusses the indications, variations, and technical details of ultrasound-guided FNA.

    View details for DOI 10.1016/j.otc.2014.04.005

    View details for Web of Science ID 000340440800006

    View details for PubMedID 25041954

  • Improving the Quality of Thyroid Cancer Care: How Does the Thyroid Cancer Care Collaborative Cross the Institute of Medicine's Quality Chasm? THYROID Mehra, S., Tuttle, R. M., Bergman, D., Bernet, V., Brett, E., Cobin, R., Doherty, G., Klopper, J., Lee, S., Machac, J., Milas, M., Mechanick, J. I., Orloff, L., Randolph, G., Ross, D. S., Smallridge, R., Terris, D., Tufano, R., Alon, E., Clain, J., Dos Reis, L., Scherl, S., Urken, M. L. 2014; 24 (4): 615-624

    Abstract

    The current systems of healthcare delivery in the United States suffer from problems that often leave patients with inadequate quality of care. In their report entitled "Crossing the Quality Chasm," the Institute of Medicine (IOM) identified reasons for poor and/or inconsistent quality of healthcare delivery and provided recommendations to improve it. The purpose of this review is to describe features of an innovative web-based program called the Thyroid Cancer Care Collaborative (TCCC) and see how it addresses IOM recommendations to improve the quality of healthcare delivery.The TCCC addresses the three actionable IOM recommendations directed at healthcare organizations and clinicians to redesign the care process. It does so by exploiting information technology (IT) in ways suggested by the IOM, and it fits within a set of 10 rules provided by the IOM. Some features of the TCCC include: (i) automated disease staging based on three validated scoring systems; (ii) highly illustrated educational videos on all aspects of thyroid cancer care; (iii) personalized clinical decision-making modules for clinicians and physicians; (iv) portability of data to share among treating physicians; (v) virtual tumor boards, "ask the expert," and frequently asked questions modules; (vi) physician workflow integration; and (vii) data for comprehensive analysis to answer difficult questions in thyroid cancer management.The TCCC has the potential to improve thyroid cancer care delivery and offers several benefits to patients, clinicians, and researchers. The TCCC is a valuable example of how IOM initiatives can improve the healthcare system.

    View details for DOI 10.1089/thy.2013.0441

    View details for Web of Science ID 000334110700001

    View details for PubMedID 24512449