Walter Lee

Overview:

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

Positions:

Associate Professor of Surgery

Surgery, Head and Neck Surgery and 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

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

Administered By
Surgery, Head and Neck Surgery and Communication Sciences
Role
Principal Investigator
Start Date
End Date

A Quantitative Optical Sensor to Monitor Tumor Vascular Physiology

Administered By
Radiation Oncology
Role
Investigator
Start Date
End Date

TERT promoter mutation frequency in subsets of oral tongue cancer patients

Administered By
Surgery, Head and Neck Surgery and Communication Sciences
Role
Principal Investigator
Start Date
End Date

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

Administered By
Surgery, Head and Neck Surgery and Communication Sciences
Role
Principal Investigator
Start Date
End Date

Publications:

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; Amundsen, CL; Bengali, S; Brigman, BE; Bullock, WM; Carter, J; Chapman, J; Cheong Yee Ching, V; Cohen, HJ; Colin, B; D'Amico, TA; Devinney, MJ; DeOrio, JK; Ellet, T; Esclamado, RM; Ferrandino, MN; Gadsden, J; Guercio, J; Habib, A; Harpole, DH; Hartwig, MG; Iboaya, E; Inman, BA; Khan, A; Lagoo-Deenadayalan, S; Lee, PS; Lee, WT; Lemm, J; Levinson, H; Mantyh, C; McDonagh, DL; Migaly, J; Mithani, SK; Moretti, E; Moul, JW; Newman, MF; Ni, K; Ohlendorf, B; Perez, A; Peterson, AC; Ponussamy, V; Preminger, GM; Robertson, CN; Roman, SA; Runyon, S; Sandler, A; Scheri, RP; Smith, SK; Talbot, L; Thacker, JKM; Tong, BC; Tu, A; Vaslef, SN; Waldron, N; Wang, X; Whitson, H; Wickenheisser, V; Young, C; MADCO-PC Study Team,; Markers of Alzheimer’s Disease and neuroCognitive Outcomes after Perioperative Care (MADCO-PC),
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

The INTUIT Study: Investigating Neuroinflammation Underlying Postoperative Cognitive Dysfunction.

BACKGROUND/OBJECTIVES: Every year, up to 40% of the more than 16 million older Americans who undergo anesthesia/surgery develop postoperative cognitive dysfunction (POCD) or delirium. Each of these distinct syndromes is associated with decreased quality of life, increased mortality, and a possible increased risk of Alzheimer's disease. One pathologic process hypothesized to underlie both delirium and POCD is neuroinflammation. The INTUIT study described here will determine the extent to which postoperative increases in cerebrospinal fluid (CSF) monocyte chemoattractant protein 1 (MCP-1) levels and monocyte numbers are associated with delirium and/or POCD and their underlying brain connectivity changes. DESIGN: Observational prospective cohort. SETTING: Duke University Medical Center, Duke Regional Hospital, and Duke Raleigh Hospital. PARTICIPANTS: Patients 60 years of age or older (N = 200) undergoing noncardiac/nonneurologic surgery. MEASUREMENTS: Participants will undergo cognitive testing before, 6 weeks, and 1 year after surgery. Delirium screening will be performed on postoperative days 1 to 5. Blood and CSF samples are obtained before surgery, and 24 hours, 6 weeks, and 1 year after surgery. CSF MCP-1 levels are measured by enzyme-linked immunosorbent assay, and CSF monocytes are assessed by flow cytometry. Half the patients will also undergo pre- and postoperative functional magnetic resonance imaging scans. 32-channel intraoperative electroencephalogram (EEG) recordings will be performed to identify intraoperative EEG correlates of neuroinflammation and/or postoperative cognitive resilience. Eighty patients will also undergo home sleep apnea testing to determine the relationships between sleep apnea severity, neuroinflammation, and impaired postoperative cognition. Additional assessments will help evaluate relationships between delirium, POCD, and other geriatric syndromes. CONCLUSION: INTUIT will use a transdisciplinary approach to study the role of neuroinflammation in postoperative delirium and cognitive dysfunction and their associated functional brain connectivity changes, and it may identify novel targets for treating and/or preventing delirium and POCD and their sequelae. J Am Geriatr Soc 67:794-798, 2019.
Authors
Berger, M; Oyeyemi, D; Olurinde, MO; Whitson, HE; Weinhold, KJ; Woldorff, MG; Lipsitz, LA; Moretti, E; Giattino, CM; Roberts, KC; Zhou, J; Bunning, T; Ferrandino, M; Scheri, RP; Cooter, M; Chan, C; Cabeza, R; Browndyke, JN; Murdoch, DM; Devinney, MJ; Shaw, LM; Cohen, HJ; Mathew, JP; INTUIT Investigators,
MLA Citation
Berger, Miles, et al. “The INTUIT Study: Investigating Neuroinflammation Underlying Postoperative Cognitive Dysfunction..” J Am Geriatr Soc, vol. 67, no. 4, Apr. 2019, pp. 794–98. Pubmed, doi:10.1111/jgs.15770.
URI
https://scholars.duke.edu/individual/pub1366900
PMID
30674067
Source
pubmed
Published In
Journal of the American Geriatrics Society
Volume
67
Published Date
Start Page
794
End Page
798
DOI
10.1111/jgs.15770

Microbiomic differences in tumor and paired-normal tissue in head and neck squamous cell carcinomas.

BACKGROUND: While the role of the gut microbiome in inflammation and colorectal cancers has received much recent attention, there are few data to support an association between the oral microbiome and head and neck squamous cell carcinomas. Prior investigations have been limited to comparisons of microbiota obtained from surface swabs of the oral cavity. This study aims to identify microbiomic differences in paired tumor and non-tumor tissue samples in a large group of 121 patients with head and neck squamous cell carcinomas and correlate these differences with clinical-pathologic features. METHODS: Total DNA was extracted from paired normal and tumor resection specimens from 169 patients; 242 samples from 121 patients were included in the final analysis. Microbiomic content of each sample was determined using 16S rDNA amplicon sequencing. Bioinformatic analysis was performed using QIIME algorithms. F-testing on cluster strength, Wilcoxon signed-rank testing on differential relative abundances of paired tumor-normal samples, and Wilcoxon rank-sum testing on the association of T-stage with relative abundances were conducted in R. RESULTS: We observed no significant difference in measures of alpha diversity between tumor and normal tissue (Shannon index: p = 0.13, phylogenetic diversity: p = 0.42). Similarly, although we observed statistically significantly differences in both weighted (p = 0.01) and unweighted (p = 0.04) Unifrac distances between tissue types, the tumor/normal grouping explained only a small proportion of the overall variation in the samples (weighted R2 = 0.01, unweighted R2 < 0.01). Notably, however, when comparing the relative abundances of individual taxa between matched pairs of tumor and normal tissue, we observed that Actinomyces and its parent taxa up to the phylum level were significantly depleted in tumor relative to normal tissue (q < 0.01), while Parvimonas was increased in tumor relative to normal tissue (q = 0.01). These differences were more pronounced among patients with more extensive disease as measured by higher T-stage. CONCLUSIONS: Matched pairs analysis of individual tumor-normal pairs revealed significant differences in relative abundance of specific taxa, namely in the genus Actinomyces. These differences were more pronounced among patients with higher T-stage. Our observations suggest further experiments to interrogate potential novel mechanisms relevant to carcinogenesis associated with alterations of the oral microbiome that may have consequences for the human host.
Authors
Wang, H; Funchain, P; Bebek, G; Altemus, J; Zhang, H; Niazi, F; Peterson, C; Lee, WT; Burkey, BB; Eng, C
MLA Citation
Wang, Hannah, et al. “Microbiomic differences in tumor and paired-normal tissue in head and neck squamous cell carcinomas..” Genome Med, vol. 9, no. 1, Feb. 2017. Pubmed, doi:10.1186/s13073-017-0405-5.
URI
https://scholars.duke.edu/individual/pub1175761
PMID
28173873
Source
pubmed
Published In
Genome Medicine
Volume
9
Published Date
Start Page
14
DOI
10.1186/s13073-017-0405-5

Assessment of the sensitivity and specificity of tissue-specific-based and anatomical-based optical biomarkers for rapid detection of human head and neck squamous cell carcinoma.

OBJECTIVES: We propose the use of morphological optical biomarkers for rapid detection of human head and neck squamous cell carcinoma (HNSCC) by leveraging the underlying tissue characteristics in aerodigestive tracts. MATERIALS AND METHODS: Diffuse reflectance spectra were obtained from malignant and contra-lateral normal tissues of 57 patients undergoing panendoscopy and biopsy. Oxygen saturation, total hemoglobin concentration, and the reduced scattering coefficient were extracted. Differences in malignant and normal tissues were examined based on two different groupings: anatomical site and morphological tissue type. RESULTS AND CONCLUSIONS: Measurements were acquired from 252 sites, of which 51 were pathologically classified as SCC. Optical biomarkers exhibited statistical differences between malignant and normal samples. Contrast was enhanced when parsing tissues by morphological classification rather than anatomical subtype for unpaired comparisons. Corresponding linear discriminant models using multiple optical biomarkers showed improved predictive ability when accounting for morphological classification, particularly in node-positive lesions. The false-positive rate was retrospectively found to decrease by 34.2% in morphologically- vs. anatomically-derived predictive models. In glottic tissue, the surgeon exhibited a false-positive rate of 45.7% while the device showed a lower false-positive rate of 12.4%. Additionally, comparisons of optical parameters were made to further understand the physiology of tumor staging and potential causes of high surgeon false-positive rates. Optical spectroscopy is a user-friendly, non-invasive tool capable of providing quantitative information to discriminate malignant from normal head and neck tissues. Predictive models demonstrated promising results for real-time diagnostics. Furthermore, the strategy described appears to be well suited to reduce the clinical false-positive rate.
Authors
Hu, F; Vishwanath, K; Beumer, HW; Puscas, L; Afshari, HR; Esclamado, RM; Scher, R; Fisher, S; Lo, J; Mulvey, C; Ramanujam, N; Lee, WT
MLA Citation
Hu, Fangyao, et al. “Assessment of the sensitivity and specificity of tissue-specific-based and anatomical-based optical biomarkers for rapid detection of human head and neck squamous cell carcinoma..” Oral Oncol, vol. 50, no. 9, Sept. 2014, pp. 848–56. Pubmed, doi:10.1016/j.oraloncology.2014.06.015.
URI
https://scholars.duke.edu/individual/pub1035269
PMID
25037162
Source
pubmed
Published In
Oral Oncol
Volume
50
Published Date
Start Page
848
End Page
856
DOI
10.1016/j.oraloncology.2014.06.015

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