Betty Tong

Positions:

Associate Professor of Surgery

Surgery, Cardiovascular and Thoracic Surgery
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.S. 1995

Georgia Institute of Technology

M.D. 1999

Duke University

M.H.S. 2009

Johns Hopkins University

Grants:

Access to screening facilities for U.S. populations at risk for lung cancer: A geospatial analysis of access to CT facilities for individuals eligible for lung cancer screening

Administered By
Radiology, Cardiothoracic Imaging
Awarded By
Ge-Aur Radiology Research
Role
Mentor
Start Date
End Date

Publications:

ACR Appropriateness Criteria® Blunt Chest Trauma-Suspected Cardiac Injury.

Blunt cardiac injuries range from myocardial concussion (commotio cordis) leading to fatal ventricular arrhythmias to myocardial contusion, cardiac chamber rupture, septal rupture, pericardial rupture, and valvular injuries. Blunt injuries account for one-fourth of the traumatic deaths in the United States. Chest radiography, transthoracic echocardiography, CT chest with and without contrast, and CT angiography are usually appropriate as the initial examination in patients with suspected blunt cardiac injury who are both hemodynamically stable and unstable. Transesophageal echocardiography and CT heart may be appropriate as examination in patients with suspected blunt cardiac injuries. This publication of blunt chest trauma-suspected cardiac injuries summarizes the literature and makes recommendations for imaging based on the available data and expert opinion. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Authors
Expert Panels on Cardiac Imaging and Thoracic Imaging,; Stojanovska, J; Hurwitz Koweek, LM; Chung, JH; Ghoshhajra, BB; Walker, CM; Beache, GM; Berry, MF; Colletti, PM; Davis, AM; Hsu, JY; Khosa, F; Kicska, GA; Kligerman, SJ; Litmanovich, D; Maroules, CD; Meyersohn, N; Syed, MA; Tong, BC; Villines, TC; Wann, S; Wolf, SJ; Kanne, JP; Abbara, S
MLA Citation
Expert Panels on Cardiac Imaging and Thoracic Imaging, Suhny, et al. “ACR Appropriateness Criteria® Blunt Chest Trauma-Suspected Cardiac Injury.J Am Coll Radiol, vol. 17, no. 11S, Nov. 2020, pp. S380–90. Pubmed, doi:10.1016/j.jacr.2020.09.012.
URI
https://scholars.duke.edu/individual/pub1463438
PMID
33153551
Source
pubmed
Published In
Journal of the American College of Radiology : Jacr
Volume
17
Published Date
Start Page
S380
End Page
S390
DOI
10.1016/j.jacr.2020.09.012

Consensus for Thoracoscopic Left Upper Lobectomy-Essential Components and Targets for Simulation.

BACKGROUND: Simulation-based training is a valuable component of cardiothoracic surgical education. Effective curriculum development requires consensus on procedural components and focused attention on specific learning objectives. Through use of a Delphi process, we established consensus on the steps of video-assisted thoracoscopic surgery (VATS) left upper lobectomy and identified targets for simulation. METHODS: Experienced thoracic surgeons were randomly selected for participation. Surgeons voted and commented on the necessity of individual steps comprising VATS left upper lobectomy. Steps with greater than 80% of participants in agreement of their necessity were determined to have established "consensus." Participants voted on the physical or cognitive complexity of each, or both, and chose steps most amenable to focused simulation. RESULTS: Thirty thoracic surgeons responded and joined in the voting process. Twenty operative steps were identified, with surgeons reaching consensus on the necessity of 19. Components deemed most difficult and amenable to simulation included those related to dissection and division of the bronchus, artery, and vein. CONCLUSIONS: Through a Delphi process, surgeons with a variety of practice patterns can achieve consensus on the operative steps of left upper lobectomy and agreement on those most appropriate for simulation. This information can be implemented in the development of targeted simulation for VATS lobectomy.
Authors
Bryan, DS; Ferguson, MK; Antonoff, MB; Backhus, LM; Birdas, TJ; Blackmon, SH; Boffa, DJ; Chang, AC; Chmielewski, GW; Cooke, DT; Donington, JS; Gaissert, HA; Hagen, JA; Hofstetter, WL; Kent, MS; Kim, KW; Krantz, SB; Lin, J; Martin, LW; Meyerson, SL; Mitchell, JD; Molena, D; Odell, DD; Onaitis, MW; Puri, V; Putnam, JB; Seder, CW; Shrager, JB; Soukiasian, HJ; Stiles, BM; Tong, BC; Veeramachaneni, NK
MLA Citation
Bryan, Darren S., et al. “Consensus for Thoracoscopic Left Upper Lobectomy-Essential Components and Targets for Simulation.Ann Thorac Surg, Oct. 2020. Pubmed, doi:10.1016/j.athoracsur.2020.06.152.
URI
https://scholars.duke.edu/individual/pub1476707
PMID
33127408
Source
pubmed
Published In
The Annals of Thoracic Surgery
Published Date
DOI
10.1016/j.athoracsur.2020.06.152

Stellate Ganglion Blockade: an Intervention for the Management of Ventricular Arrhythmias.

PURPOSE OF REVIEW: To highlight the indications, procedural considerations, and data supporting the use of stellate ganglion blockade (SGB) for management of refractory ventricular arrhythmias. RECENT FINDINGS: In patients with refractory ventricular arrhythmias, unilateral or bilateral SGB can reduce arrhythmia burden and defibrillation events for 24-72 h, allowing time for use of other therapies like catheter ablation, surgical sympathectomy, or heart transplantation. The efficacy of SGB appears to be consistent despite the type (monomorphic vs polymorphic) or etiology (ischemic vs non-ischemic cardiomyopathy) of the ventricular arrhythmia. Ultrasound-guided SGB is safe with low risk for complications, even when performed on anticoagulation. SGB is effective and safe and could be considered for patients with refractory ventricular arrhythmias.
Authors
Ganesh, A; Qadri, YJ; Boortz-Marx, RL; Al-Khatib, SM; Harpole, DH; Katz, JN; Koontz, JI; Mathew, JP; Ray, ND; Sun, AY; Tong, BC; Ulloa, L; Piccini, JP; Fudim, M
MLA Citation
Ganesh, Arun, et al. “Stellate Ganglion Blockade: an Intervention for the Management of Ventricular Arrhythmias.Curr Hypertens Rep, vol. 22, no. 12, Oct. 2020, p. 100. Pubmed, doi:10.1007/s11906-020-01111-8.
URI
https://scholars.duke.edu/individual/pub1462899
PMID
33097982
Source
pubmed
Published In
Curr Hypertens Rep
Volume
22
Published Date
Start Page
100
DOI
10.1007/s11906-020-01111-8

Impact of Age on Surgical Outcomes for Locally Advanced Esophageal Cancer.

BACKGROUND: Older patients are often considered high-risk surgical candidates for locally advanced esophageal cancer, and the benefit of surgery in this population is unclear. This national analysis examines the effect of age on esophagectomy outcomes and compares surgery versus chemoradiation in older patients. METHODS: The National Cancer Database was used to identify patients with clinical stage II to III esophageal adenocarcinoma undergoing surgery or definitive chemoradiation between 2004 and 2015. Restricted cubic splines were used to examine the relationship between age and survival after esophagectomy, and maximally selected rank statistics were used to identify an age at which survival worsened. We used Cox proportional hazard models including an interaction term between age and treatment to compare overall survival, as well as survival of patients receiving esophagectomy versus definitive chemoradiation. RESULTS: Of 17,495 patients, 11,680 underwent esophagectomy and 5815 received chemoradiation. Survival after esophagectomy worsened with increasing age and decreased considerably after age 73 (hazard ratio = 1.05, 95% confidence interval, 1.04-1.06, per increasing year after 73 versus hazard ratio = 1.01, 95% confidence interval, 1.00-1.01, per increasing year to 73; both P < .001). Chemoradiation was increasingly used over surgery as age increased. The interaction between age and treatment was significant, and a graph of this interaction demonstrated a survival benefit for surgery over chemoradiation at most ages, including octogenarians. CONCLUSIONS: Survival worsens with age after esophagectomy for locally advanced esophageal cancer. However, esophagectomy is associated with improved survival compared with definitive chemoradiation at most ages, including octogenarians. Esophagectomy may be considered over chemoradiation for patients who can tolerate surgery regardless of age.
Authors
Farrow, NE; Raman, V; Jawitz, OK; Voigt, SL; Tong, BC; Harpole, DH; D'Amico, TA
MLA Citation
Farrow, Norma E., et al. “Impact of Age on Surgical Outcomes for Locally Advanced Esophageal Cancer.Ann Thorac Surg, vol. 111, no. 3, Mar. 2021, pp. 996–1003. Pubmed, doi:10.1016/j.athoracsur.2020.06.055.
URI
https://scholars.duke.edu/individual/pub1457111
PMID
32853569
Source
pubmed
Published In
The Annals of Thoracic Surgery
Volume
111
Published Date
Start Page
996
End Page
1003
DOI
10.1016/j.athoracsur.2020.06.055

Initial and Longitudinal Cost of Surgical Resection for Lung Cancer.

BACKGROUND: The longitudinal cost of treating patients with non-small cell lung cancer (NSCLC) undergoing surgical resection has not been evaluated. We describe initial and 4-year resource use and cost for NSCLC patients aged 65 years of age or greater who were treated surgically between 2008 and 2013. METHODS: Using clinical data for NSCLC resections from The Society of Thoracic Surgeons General Thoracic Surgery Database linked to Medicare claims, resource use and cost of preoperative staging, surgery, and subsequent care through 4 years were examined ($2017). Cost of hospital-based care was estimated using cost-to-charge ratios; professional services and care in other settings were valued using reimbursements. Inverse probability weighting was used to account for administrative censoring. Outcomes were stratified by pathologic stage and by surgical approach for stage I lobectomy patients. RESULTS: Resection hospitalizations averaged 6 days and cost $31,900. In the first 90 days, costs increased with stage ($12,430 for stage I to $26,350 for stage IV). Costs then declined toward quarterly means more similar among stages. Cumulative costs ranged from $131,032 (stage I) to $205,368 (stage IV). In the stage I lobectomy cohort, patients selected for minimally invasive procedures had lower 4-year costs than did thoracotomy patients ($120,346 versus $136,250). CONCLUSIONS: The 4-year cost of surgical resection for NSCLC was substantial and increased with pathologic stage. Among stage I lobectomy patients, those selected for minimally invasive surgery had lower costs, particularly through 90 days. Potential avenues for improving the value of surgical resection include judicious use of postoperative intensive care and earlier detection and treatment of disease.
Authors
Cowper, PA; Feng, L; Kosinski, AS; Tong, BC; Habib, RH; Putnam, JB; Onaitis, MW; Furnary, AP; Wright, CD; Jacobs, JP; Fernandez, FG
MLA Citation
Cowper, Patricia A., et al. “Initial and Longitudinal Cost of Surgical Resection for Lung Cancer.Ann Thorac Surg, Oct. 2020. Pubmed, doi:10.1016/j.athoracsur.2020.07.048.
URI
https://scholars.duke.edu/individual/pub1462140
PMID
33031776
Source
pubmed
Published In
The Annals of Thoracic Surgery
Published Date
DOI
10.1016/j.athoracsur.2020.07.048

Research Areas:

Esophagus--Cancer--Surgery
Lungs--Cancer--Patients
Lungs--Cancer--Surgery
Mesothelioma
Small cell lung cancer