Walter Lee

Overview:

Global Health, Virtue-Based Professional Development and Leadership, Device Development for Cancer Detection

Positions:

Associate Professor of Head and Neck Surgery and Communication Sciences

Head and Neck Surgery & Communication Sciences
School of Medicine

Associate Professor in Radiation Oncology

Radiation Oncology
School of Medicine

Affiliate, Duke Global Health Institute

Duke Global Health Institute
Institutes and Provost's Academic Units

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1999

The George Washington University

M.H.S. 2015

Duke University

Grants:

Clinical Evaluation of the OncAlert® RAPID in Subjects Presenting for Evaluation and/or Initial Biopsy

Awarded By
Vigilant Biosciences
Role
Principal Investigator
Start Date
End Date

A Quantitative Optical Sensor to Monitor Tumor Vascular Physiology

Administered By
Radiation Oncology
Awarded By
Zenalux Biomedical, Inc.
Role
Investigator
Start Date
End Date

TERT promoter mutation frequency in subsets of oral tongue cancer patients

Awarded By
American Medical Association Foundation
Role
Principal Investigator
Start Date
End Date

CHECKPOINT Head & Neck Nerve Stimulator/Locator Product Validation Study (9394-CSP-000-B)

Awarded By
Checkpoint Surgical
Role
Principal Investigator
Start Date
End Date

A Virtue Based on-line Leadership Curriculum: A Nationwide Resource for Professional Development

Awarded By
Society of University Otolaryngologists
Role
Principal Investigator
Start Date
End Date

Publications:

Development of a Surgical Video Atlas for Resident Education: 3-Year Experience.

Objective: To create a high-quality annotated online surgical video atlas of key indicator otolaryngology cases and assess its use and overall journal trends over time. Methods: Videos are recorded from multiple viewpoints within the operating room and compiled into a single stream. Postediting includes chaptering videos and overlaying relevant text annotations. Videos are published online and viewership trends analyzed. Results: Over 3 years, 29 otolaryngology videos were published out of 161 journal publications (18%). Eight of the 14 key indicator procedures are included (57%). From the beginning of 2017 to the end of 2019, viewership of otolaryngology pages increased from 548 to 11,139 views per month, totaling >150,000 views. These now represent 10% of the total journal monthly views and 10% of the overall views. Users originate from the United States and from >10 other countries. Discussion: Residents and faculty face challenges of providing the highest standard of clinical care, teaching, and learning in and out of the operating room. Inherent difficulties of surgical training, high-fidelity surgical simulation, and imposed work hour restrictions necessitate additional, more efficient and effective means of teaching and learning. Surgical videos demonstrating key anatomy, procedural steps, and surgical dexterity with hand positioning are increasing in their popularity among learners. Implications for Practice: Surgical video atlases provide a unique adjunct for resident education. They are enduring and easily accessible. In a climate of work hour restrictions or elective case reduction, they may supplement how residents learn to operate outside the operating theater.
Authors
Brown, CS; Cunningham, CD; Lee, WT; Puscas, L
MLA Citation
Brown, C. Scott, et al. “Development of a Surgical Video Atlas for Resident Education: 3-Year Experience.Oto Open, vol. 4, no. 3, July 2020, p. 2473974X20939067. Pubmed, doi:10.1177/2473974X20939067.
URI
https://scholars.duke.edu/individual/pub1452368
PMID
32704610
Source
pubmed
Published In
Oto Open
Volume
4
Published Date
Start Page
2473974X20939067
DOI
10.1177/2473974X20939067

The effect of lateral neck dissection on complication rate for total thyroidectomy.

PURPOSE: To determine the complication profile for total thyroidectomy with and without concomitant lateral neck dissection using a large administrative database. MATERIALS AND METHODS: The IBM MarketScan® Commercial Database (2010-2014) analytic cohort was queried for patients ≥18 years or older undergoing total thyroidectomy (or equivalent procedures) from January 1, 2010 to June 30, 2014. Subgroup analysis was performed for patients undergoing concomitant unilateral and bilateral lateral neck dissection. The complication profiles were described. RESULTS: 55,204 patients underwent total thyroidectomy or equivalent procedures. Hypoparathyroidism or hypocalcemia was coded in 20.3% overall, with 4.7% having permanent hypoparathyroidism. Vocal cord paralysis was coded in 3.3% overall with permanent rate of 0.7%. Tracheotomy was performed in 0.3% of patients. 2743 underwent total thyroidectomy with concomitant unilateral lateral neck dissection, and 560 of these patients underwent bilateral lateral neck dissection. In patients undergoing unilateral lateral neck dissection, 30.5% of patients have hypoparathyroidism/hypocalcemia coded, with a permanent rate of 8.8%. Vocal cord paralysis was coded in 8.3% of patients, with a permanent rate of 1.9%. Tracheotomy was performed in 1.2% of patients. In patients undergoing bilateral lateral neck dissection, 39.6% had hypoparathyroidism/hypocalcemia coded, with a permanent rate of 10.9%. These patients had vocal cord paralysis coded in 10.2% of cases, with a permanent rate of 2.1%. Tracheotomy was performed in 2.5% of patients. CONCLUSION: The addition of unilateral and especially bilateral lateral neck dissection increases both overall and permanent complication rates for total thyroidectomy. These data may help to inform preoperative discussions with patients.
Authors
Rocke, DJ; Mulder, H; Cyr, D; Kahmke, R; Lee, WT; Puscas, L; Schulz, K; Witsell, DL
MLA Citation
Rocke, Daniel J., et al. “The effect of lateral neck dissection on complication rate for total thyroidectomy.Am J Otolaryngol, vol. 41, no. 3, May 2020, p. 102421. Pubmed, doi:10.1016/j.amjoto.2020.102421.
URI
https://scholars.duke.edu/individual/pub1433082
PMID
32089352
Source
pubmed
Published In
Am J Otolaryngol
Volume
41
Published Date
Start Page
102421
DOI
10.1016/j.amjoto.2020.102421

Flow Cytometry Characterization of Cerebrospinal Fluid Monocytes in Patients With Postoperative Cognitive Dysfunction: A Pilot Study.

Animal models suggest postoperative cognitive dysfunction may be caused by brain monocyte influx. To study this in humans, we developed a flow cytometry panel to profile cerebrospinal fluid (CSF) samples collected before and after major noncardiac surgery in 5 patients ≥60 years of age who developed postoperative cognitive dysfunction and 5 matched controls who did not. We detected 12,654 ± 4895 cells/10 mL of CSF sample (mean ± SD). Patients who developed postoperative cognitive dysfunction showed an increased CSF monocyte/lymphocyte ratio and monocyte chemoattractant protein 1 receptor downregulation on CSF monocytes 24 hours after surgery. These pilot data demonstrate that CSF flow cytometry can be used to study mechanisms of postoperative neurocognitive dysfunction.
Authors
Berger, M; Murdoch, DM; Staats, JS; Chan, C; Thomas, JP; Garrigues, GE; Browndyke, JN; Cooter, M; Quinones, QJ; Mathew, JP; Weinhold, KJ; MADCO-PC Study Team,
MLA Citation
Berger, Miles, et al. “Flow Cytometry Characterization of Cerebrospinal Fluid Monocytes in Patients With Postoperative Cognitive Dysfunction: A Pilot Study.Anesth Analg, vol. 129, no. 5, Nov. 2019, pp. e150–54. Pubmed, doi:10.1213/ANE.0000000000004179.
URI
https://scholars.duke.edu/individual/pub1385799
PMID
31085945
Source
pubmed
Published In
Anesth Analg
Volume
129
Published Date
Start Page
e150
End Page
e154
DOI
10.1213/ANE.0000000000004179

Establishing a Healthcare Research Network in Vietnam: A Platform for Collaborative Quality Improvement

© 2020, Springer Nature Singapore Pte Ltd. There is both a demand and need for delivering patient centered care in health systems. This is especially challenging in developing countries in which resources are limited, population health burdens are extensive, and coordination between facilities is fractured. The development of a low cost, centralized, real time data collection platform would be a powerful tool in understanding patient centered healthcare needs and issues. We report a pilot project that seeks to establish such a healthcare research network in Vietnam. This pilot used a web-based database collection tool called REDCap (Research Electronic Data Capture). We programmed a validated general health quality of life questionnaire in both English and Vietnamese that was used to collect patient responses. A total of four hospitals located in Hanoi, Vietnam participated in the pilot project of patients presenting with otolaryngology-head and neck complaints and concerns between January 23 and January 26, 2018. We report outpatient responses and their associated quality of life in ten specific domains. This pilot demonstrates the successful international collaboration among academic, non-profit, clinical entities in establishing this low-cost research network. This will be a platform that could easily be expanded to include other healthcare facilities in conducting quality improvement and research projects. We envision this approach as an important tool in improving health care quality in developing countries throughout the world.
Authors
Bui, AT; Trung, DD; Le Minh, K; Nguyen, T; Le Dinh, H; Tran, L; Nguyen, N; Vohra, P; Ji, KSY; Lee, E; Campbell, J; Lee, WT
MLA Citation
Bui, A. T., et al. “Establishing a Healthcare Research Network in Vietnam: A Platform for Collaborative Quality Improvement.” Ifmbe Proceedings, vol. 69, 2020, pp. 567–70. Scopus, doi:10.1007/978-981-13-5859-3_97.
URI
https://scholars.duke.edu/individual/pub1396460
Source
scopus
Published In
Ifmbe Proceedings
Volume
69
Published Date
Start Page
567
End Page
570
DOI
10.1007/978-981-13-5859-3_97

Distinct Angiogenic Changes during Carcinogenesis Defined by Novel Label-Free Dark-Field Imaging in a Hamster Cheek Pouch Model.

There remain gaps in knowledge concerning how vascular morphology evolves during carcinogenesis. In this study, we imaged neovascularization by label-free dark-field microscopy of a 7,12-Dimethylbenz[a]anthracene (DMBA)-induced hamster cheek pouch model of oral squamous cell carcinoma (SCC). Wavelength-dependent imaging revealed distinct vascular features at different imaging depths and vessel sizes. Vascular tortuosity increased significantly in high-risk lesions, whereas diameter decreased significantly in hyperplastic and SCC lesions. Large vessels preserved the same trends seen in the original images, whereas small vessels displayed different trends, with length and diameter increasing during carcinogenesis. On the basis of these data, we developed and validated a classification algorithm incorporating vascular features from different vessel masks. Receiver operator curves generated from the classification results demonstrated high accuracies in discriminating normal and hyperplasia from high-grade lesions (AUC > 0.94). Overall, these results provided automated imaging of vasculature in the earliest stages of carcinogenesis from which one can extract robust endpoints. The optical toolbox described here is simple, low-cost and portable, and can be used in a variety of health care and research settings for cancer prevention and pharmacology research. Cancer Res; 77(24); 7109-19. ©2017 AACR.
Authors
Hu, F; Martin, H; Martinez, A; Everitt, J; Erkanli, A; Lee, WT; Dewhirst, M; Ramanujam, N
MLA Citation
Hu, Fangyao, et al. “Distinct Angiogenic Changes during Carcinogenesis Defined by Novel Label-Free Dark-Field Imaging in a Hamster Cheek Pouch Model.Cancer Res, vol. 77, no. 24, Dec. 2017, pp. 7109–19. Pubmed, doi:10.1158/0008-5472.CAN-17-1058.
URI
https://scholars.duke.edu/individual/pub1279483
PMID
29021136
Source
pubmed
Published In
Cancer Res
Volume
77
Published Date
Start Page
7109
End Page
7119
DOI
10.1158/0008-5472.CAN-17-1058

Research Areas:

Academic Medical Centers
Adjuvants, Immunologic
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Alcohol Drinking
Algorithms
Ambulatory Care
Anastomosis, Surgical
Animals
Antigen Presentation
Antigens
Antigens, Neoplasm
Attitude of Health Personnel
Attitude to Health
Breast Neoplasms
Cancer Vaccines
Carcinoma, Squamous Cell
Career Choice
Caregivers
Cation Transport Proteins
Cell Differentiation
Cell Fusion
Cell Movement
Cell Separation
Cell Transplantation
Cells, Cultured
Chemotherapy, Adjuvant
Chi-Square Distribution
Child
Clinical Competence
Clinical Trials as Topic
Clinical trials
Cohort Studies
Combined Modality Therapy
Computer Simulation
Conflict of Interest
Constriction, Pathologic
Cranial Nerve Neoplasms
Critical Care
Cross-Sectional Studies
Curriculum
Cysts
Cytoskeletal Proteins
DNA Methylation
Data Interpretation, Statistical
Database
Debridement
Dendritic Cells
Diagnosis, Differential
Disease Models, Animal
Disease-Free Survival
Dose-Response Relationship, Drug
Drug Evaluation, Preclinical
Drug Therapy, Combination
Early Detection of Cancer
Edema
Education, Medical, Graduate
Electric Stimulation
Electrofusion
Electrophoresis
Emergency Treatment
Endoscopy
Enzyme-Linked Immunosorbent Assay
Esophageal Stenosis
Ethics
Evidence-Based Medicine
False Negative Reactions
Female
Fractures, Bone
GTP-Binding Proteins
Genes, Tumor Suppressor
Goiter
Head and Neck Neoplasms
Health Care Surveys
Health Priorities
Heart Defects, Congenital
Hemoglobins
Hernia
Herniorrhaphy
Hoarseness
Homeodomain Proteins
Hospitalization
Human papillomavirus 16
Humans
Hybrid Cells
Hypopharynx
Immunotherapy
Industry
Infant
Interferon-gamma
Interleukin-10
Interleukin-12
Internet
Internship and Residency
Intubation
Intubation, Intratracheal
Inventions
Laryngeal Diseases
Laryngeal Neoplasms
Laryngectomy
Laryngoplasty
Laryngoscopy
Laryngostenosis
Larynx
Laser Therapy
Leadership
Lung Neoplasms
Lymph Nodes
Lymphatic Metastasis
Lymphocyte Activation
Male
Mandibular Diseases
Melanoma
Melanoma, Experimental
Metals
Mice
Mice, Inbred BALB C
Mice, Inbred C57BL
Microsurgery
Microtubule-Associated Proteins
Middle Aged
Military Personnel
Monocytes
Monte Carlo Method
Moral Development
Mouth Neoplasms
Neck Dissection
Neoplasm Metastasis
Neoplasm Recurrence, Local
Neoplasm Staging
Neoplasm Transplantation
Neoplasms
Neoplastic Stem Cells
Nerve Tissue Proteins
Nerve Transfer
Nose
Nose Neoplasms
Organ Sparing Treatments
Organophosphorus Compounds
Osteoradionecrosis
Otolaryngology
Otorhinolaryngologic Diseases
Oxygen
Oxygen Consumption
Pain
Palliative Care
Papillomavirus Infections
Personnel Selection
Phantoms, Imaging
Physicians
Pilot Projects
Politics
Postoperative Care
Postoperative Complications
Prejudice
Preoperative Care
Professional Competence
Prognosis
Program Development
Program Evaluation
Promoter Regions, Genetic
Proto-Oncogene Proteins
Publication Bias
Questionnaires
Radiation Injuries
Radiometry
Radiotherapy
Radiotherapy, Adjuvant
Randomized Controlled Trials as Topic
Recombinant Fusion Proteins
Reconstructive Surgical Procedures
Recovery of Function
Reference Values
Registries
Resource Allocation
Respiratory Tract Neoplasms
Retrospective Studies
Risk Assessment
Sensitivity and Specificity
Sentinel Lymph Node Biopsy
Septins
Sex Factors
Signal Transduction
Skin Neoplasms
Smoking
Software
Specialties, Surgical
Specific Pathogen-Free Organisms
Spectrum Analysis
Statistics, Nonparametric
Surgical Procedures, Operative
Surveys and Questionnaires
Survival Analysis
Survival Rate
Suture Techniques
T-Lymphocytes
Tensile Strength
Terminally Ill
Thyroid Nodule
Time Factors
Toll-Like Receptors
Tongue
Tongue Diseases
Tongue Neoplasms
Tonsillar Neoplasms
Trachea
Tracheal Diseases
Tracheostomy
Tracheotomy
Transcription Factors
Treatment Outcome
Tumor Cells, Cultured
Tumor Markers, Biological
United States
Vaccines
Vaccines, Synthetic
Ventilators, Mechanical
Vestibulocochlear Nerve Diseases
Video Recording
Virtues
Vocal Cord Paralysis
Voice Disorders
Wounds, Nonpenetrating
Young Adult