Dr Michael Topf - Vanderbilt University

Michael Topf, MD

Assistant Professor of Otolaryngology-Head and Neck Surgery

Vanderbilt University Medical Center

 

Dr Topf earned his MD at the University of Rochester School of Medicine and Dentistry and completed a residency in Otolaryngology- Head and Neck Surgery at Thomas Jefferson University. He then trained in Head and Neck Oncologic Surgery at Stanford. Currently he is an Assistant Professor at the Department of Otolaryngology-Head and Neck Surgery at Vanderbilt University. Dr Topf is a pioneer in 3D surgical specimen mapping. He has over 60 published papers and more than 700 citations.

 

 

 

Why did you choose to subspecialize in head and neck cancer surgery after residency? What drew you to this field?

I have always been a bit of an oncology geek. I like clinical oncology, Kaplan-Meier curves and both non-surgical and surgical clinical trials. So, I think what, what drew me to head and surgical oncology fellowship was the care of cancer patients and the field of oncology as a whole.

 

Is there anything that you don't like about the subspecialty?

 I don't like that head and neck squamous cell carcinoma as a solid malignancy still has relatively poor outcomes, and that we have really not improved significantly in the last 2 to 3 decades. And with that comes patients that unfortunately don't do well from an oncologic standpoint. That's always challenging.

 

You're doing a lot of work with 3D specimen mapping. You've published a lot there. Honestly, I think it's quite amazing. I was hoping that you could share a few details about this, and also share how you see this technology involving evolving in the coming years.

Yeah, thanks for the question. It really started with a clinical unmet need. You know, as a fellow at Stanford, I saw difficulty in communication among members of the multidisciplinary cancer care team. This was seen in multiple phases of care. Intraoperatively, when we have anatomically complex resection specimens with multiple different types of tissue, that often require a face-to-face interaction between surgeon and pathologist. Particularly if the approach to margin analysis is a specimen driven approach. And this is time that the surgeon is not scrubbed in in the operating room advancing the case. So, I just wondered if we could do better with regards to intraoperative communication and delivery of frozen section results. If you think about it objectively, compared to other fields, why are we still delivering frozen section analysis results via telephone call without any visual aid in 2023?

You get a pathology report back a week or two after surgery for these complex cases, and inevitably there's some margin that may be close, hopefully not positive, but it happens- probably a fifth of the time for complex, locally advanced specimens. And we're again, left to written descriptions of the margin sectioning and the description of the specimen to try to reconcile those margins. The fact that there is a margin that is positive or close is concerning and potentially, an indication for adjuvant therapy. However, sometimes additional tissue has been resected that supersedes that area. And without a visual aid, those conversations between surgeon and pathologist are very challenging. These are also conversations that are had at multidisciplinary head and neck cancer tumor board, when we're dissecting through the pathology reports.

So, I thought there was a real clinical unmet need for creating 3D visual models of this specimen. I'd like to acknowledge a medical student who came to me with the background in 3D scanning: Kayvon Sharif, who really over a two-year period worked out a way to do this in real time with me and not interfere with normal surgical pathology workflow.

With regards to the second question, which is where I see it going, there are two barriers to widespread adoption. When I show people these scans and the protocol and the technology, I think everyone says “Wow, that's really cool. This is better”. But we still need to prove value, right? We need to prove the value of the technology because there are costs associated with it. So, we need to demonstrate value and that's going to be an academic and personal goal of mine over the next ten years. The other major hurdle is that the hardware and the software is not quite ready for the primetime yet. The vast majority of 3D scanners are not designed to 3D scan human tissue or resected specimens. And there are nuances that come with that. Similarly, the software that we use to annotate our 3D specimens to create these models and visual representations of the processed specimen is not designed for that use. So, we need to create software designed specifically to annotate virtual models of resected tissue. And when both the hardware software improves, I think that it's going to transform surgical oncology.

 

Having a background in Dentistry, when I hear you talking about this, there is one thing that comes to mind: dentists use these 3D scanners to do intraoral scans and they have multiple different software platforms for that. I wonder if you've had any experience with those or if there is any ideas from there that you could maybe apply to the 3D specimen mapping.

I think there's opportunity there. We have an active and ongoing study looking at an intraoral scanner that is used in the dental and oral surgery communities. The major issue is that the soft tissue resolution of a small handheld 3D scanner is not ready for intraoral 3D scanning. It’s really capable for scanning teeth, but when you start moving off of the teeth and start trying to scan the palate or the tongue, the resolution is poor. So in our hands the intraoral 3D scanners are not ready, but I'm sure that the hardware is going to improve in the next few years. In the future we could be using some sort of pencil 3D scanner in a patient's mouth to scan their tumor preoperatively!

 

Thank you. Now I want to transition to something different. Your department is consistently ranked as one of the top in the country. And my question for you is what did you and the rest of the team at Vanderbilt do to get there? And what do you do now to stay there? Because it's one thing to be ranked first, and it's another thing to consistently rank on top for so many years.

Yeah, I'd like to acknowledge that Vanderbilt's reputation and ranking is no thanks to me. I think you have to look at the people and individuals that built the Vanderbilt Department of Otolaryngology. It's a relatively young Department that started in the 1980s. But look at the previous Division Chiefs, Dr Ossoff, Dr Netterville, Dr Garrett, Dr Rees, Dr Haynes, and some of the early faculty members -some of them are still here- that built this Department and expanded it to what it is today. I think it starts with the Vanderbilt culture- we have a really good working environment. Everyone treats each other with respect. It sounds simple, but when you start with the working environment, you can create amazing things. I think that there's excellent support both for residents as well as fellows and faculty for research. There's a strong clinical research coordinator staff within the department that helps take clinician ideas and turn them into actual studies and produce meaningful prospective clinical trial results. Going back to our former chair Dr. Eavey, I think his vision for the Department and the residency training program, and his encouragement of faculty to pursue additional degrees, really had an impact in this place. I'm about to finish a masters of science in clinical investigation. When you look at the Department’s faculty, many of us have additional master's degrees. And I think that, that puts us outside our comfort zone and makes us better clinicians and academic researchers.

 

It is very, very interesting to hear about this approach. Now, I'll go to a different direction: is it talent or is it character that makes a good surgeon?

I would say it's both. But I would say character is probably more important than talent. Inevitably in surgery - particularly head and neck cancer surgery- you're going to have complications. How you handle those complications and the interactions with patients and their families is truly what makes you a good surgeon.

 

What, in your opinion, is a predictor of success during residency? What are you looking for in a resident?

Yeah, that's a good question. I don't know this literature as well as others, but there have been several studies that show that we can't necessarily predict who's going to be a good resident or a bad resident. And I think that the definitions of a good resident or a bad resident are something that is still a little unclear. But, you know, when I'm looking at residency applications, my favorite place to look at is the letters of recommendation. Perhaps I know the letter writer, but even if I don't, I think that you can learn a lot about an individual in a personalized letter of recommendation. And to me, that's where you get most excited to meet one of the applicants. I think the personal statement can also get me really excited to meet a prospective applicant!

 

What qualities are you looking for in a resident? What is important to you? I understand that the letters, based on what you said, are very important to distinguish and realize who's who. But what, what kind of qualities are you looking for in someone?

It might sound simple, but my answer is reliability and trustworthiness. I think you have to start there. My subspecialty is doing large cancer operations and reconstructions on patients. The perioperative care of those patients requires trust. Faculty aren't able to be in the hospital 24/7 but there is a resident in the hospital at all times. You need to trust that individual. So, for me, trustworthiness and reliability are the two most important qualities that a resident should have.

 

How important is research for you when you're evaluating someone. Does it play a role at all?

Yeah, it plays a role. For us at Vanderbilt, as a larger academic department of otolaryngology, it's great to see students that have participated in research. We now have a research track position, under the leadership of Justin Turner, one of our rhinologists. And that particular resident spot is really meant to train clinically and also academically a future surgeon-scientist that's going to have a career of discovery. And that could be in any aspect of research: clinical, translational or basic science. We just had our first match last year and look forward to future matches.

 

Are there any red flags for you in an application or during the interview? Things that are an immediate dealbreaker for you?

I don't know if there are any things that are a complete deal breaker for me on an application or an interview. Our approach to interviews and applications at Vanderbilt is very much a democratic process. We have several faculty reviewing applications, an entire committee, and the majority of the Department interviews candidates. So, I think it's more of a team approach. I trust my partners, and my residents who are also participating in this process. Certainly, if someone said something that I didn't like, that may be reflected in my perception of an applicant. But it's the whole body of the Department's review that I think is most important. Everyone's vote counts and is equal.

 

What are your goals for the next decade as an academic surgeon?

Clinically, I'm in my fourth year of practice now. I look back at how much I've grown as a surgeon, as an oncologist, and I look forward to future growth. Academically, I have aspirations to transform the way we approach surgical oncology, even beyond head and neck cancer. We're now using our protocol in breast oncology and musculoskeletal and bone and soft tissue sarcomas. I look forward to future collaborations in these areas. And personally, my daughter Madelyn just turned one this past week. So, I think further development of me as a father will be important over the next decade. That's what I'm most excited about in the next ten years. And I think I'm at a perfect place to do all three because I have wonderful senior partners: Eben Rosenthal, Sarah Rohde, Kyle Mannion, Robert Sinard, Alex Langerman, Jim Netterville, to develop me as a surgeon, as a clinician, as an oncologist, as a father and as a researcher. So, I'm, I'm very fortunate.

 

I know you have a strong presence on Twitter.  I'm just wondering how important having a presence there is and how influential it can be, in your opinion. I can tell you that from the perspective of a junior trainee it has been very helpful. But I just wanted to hear what you think about that.

Social media is very important for me. I look at social media as a way to learn. Gone are the days of receiving a in print journal as a way to stay up on the literature. I stay up on the literature by going to meetings, but also by social media. I follow JAMA Oncology, Lancet Oncology, Head and Neck, Laryngoscope, JAMA Otolaryngology etc. and that's how I learn my literature. I look at what they've recently published, I click, and I then I read the article. I am often told by or asked by trainees and colleagues, how do you stay up on the literature? And I say Twitter. It’s a powerful tool to learn. I also like to use it to disseminate our team's research. There is data to suggest that researchers that are more active on social media are going to have more reads of their paper. We do research to help our patients and also for people to learn about our research. So, if there's something that is going to apply to a broader audience, then I'm going to do it- particularly if it's if it doesn't take much time, which I don't think social media does. So, that's my approach to it. Also, you can learn from other people posting their experiences or their reviews of papers and trials. It's an awesome way to stay up to date.

 

Thank you so much Dr Topf!

Thank you.