Malignant Population Research Articles

Epidemiological, Clinical, Ultrasonographic and Cytological Characteristics of Thyroid Nodules in an Afro-Caribbean Population: A Series of 420 Patients.

Simple SummaryThis study describes the epidemiological, clinical and ultrasound characteristics of malignancy in thyroid nodules and evaluates the value of cytology in the diagnosis of malignancy in an Afro-Caribbean population. Our results revealed that none of the standard ultrasound criteria of malignancy were significantly predictive of cancer, but hypoechogenicity and central vascularity were frequently found in malignant nodules. These results could increase awareness and guide practitioners in their diagnostic approach and management of thyroid nodules in Afro-Caribbean populations. Bethesda system-based cytology revealed low sensitivity in analyzing the risk of malignancy in this population. The high prevalence of papillary microcarcinomas may explain the inconclusive ultrasound and cytological results.The incidence of thyroid cancer is increasing worldwide. The aim of this study is to describe the epidemiological, clinical and ultrasound characteristics of malignancy in thyroid nodules and to evaluate the predictive value of the Bethesda system for thyroid cytology in the diagnosis of malignancy in an Afro-Caribbean population. We conducted a retrospective study in Martinique involving 420 patients with a diagnosis of thyroid nodules between 2011 and 2014. Of the 192/420 (45.7%) patients operated on for thyroid nodules, 9% had thyroid cancer. All patients with thyroid cancer were obese women with a mean age of 50 years. The final histological examination revealed papillary microcarcinomas in 61% of cases and papillary carcinomas in 39% of cases. Thyroid cytology alone had a low sensitivity (22.2%) and positive predictive value (15.4%) for the diagnosis of malignancy, with a good specificity (91.1%) and negative predictive value (94.2%). None of the standard ultrasound criteria of malignancy were significantly predictive of cancer, but hypoechogenicity and central vascularity were frequently found in malignant nodules. These epidemiological, clinical and ultrasound results could increase awareness and guide practitioners in their diagnostic approach and management of thyroid nodules in an Afro-Caribbean population. Bethesda system-based cytology revealed lower sensitivity in analyzing the risk of malignancy in this population. The high prevalence of papillary microcarcinomas may explain the inconclusive ultrasound and cytological results.

Systematic Review and Meta-analysis of the Impact of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) on Cytological Diagnosis and Thyroid Cancer Prevalence.

A re-named diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) likely impacts the prevalence of thyroid cancer and risk of malignancy in populations based on the established Bethesda System of Reporting Thyroid Cytopathology (TBSRTC). This study was done to investigate the prevalence and cytological distribution of NIFTP. PRISMA guided systematic review was done from a database search of Pubmed, EMBASE, and Medline using the search terms "non-invasive follicular thyroid neoplasm with papillary-like nuclear features", "non-invasive follicular variant of papillary carcinoma", "niftp", and "Bethesda" until November 2018. Original articles with surgically proven diagnoses of NIFTP using strict NIFTP criteria were included. Twenty-nine studies with 1563 cases of NIFTP were included. The pooled prevalence of NIFTP in cases which would be classified previously as the follicular variant of papillary thyroid cancer (FVPTC) and papillary thyroid cancer (PTC) were 43.5% (95% CI 33.5-54.0%) and 4.4% (95% CI 2.0-9.0%) respectively. The pooled TBSRTC distribution of cases diagnosed as NIFTP was: from the non-diagnostic category 3.6% (95% CI 2.4-5.3%), benign 10.0% (95% CI 7.2-13.6%), AUS/FLUS 34.2% (95% CI 28.2-40.8%), FN/SFN 22.7% (95% CI 17.2-29.4%), suspicious for malignancy 22.4% (95% CI 17.7-27.9%), and malignant 7.5% (95% CI 4.2-12.9%). While a significant reduction in FVPTC prevalence is anticipated, a modest reduction of PTC prevalence is also expected with adoption of the NIFTP terminology that would be distributed mainly among lesions classified as indeterminate thyroid nodules. Further studies are needed to identify unique clinical characteristics of these lesions preoperatively.

Propensity Score Matched Analysis of Risk for Malignancies in Sickle Cell Anemia

BACKGROUND:The survival of sickle cell patients is limited as compared to the general population. The major morbidity and mortality comes from sickle cell complications including cardiovascular disease, renal failure, infections and thrombosis (Manci Br J Haematol 2013). However, literature is conflicting about risk for malignancies in this population and remains to be investigated by larger studies. Our retrospective study is aimed at studying the prevalence of different malignancies in a large cohort of hospitalized sickle cell patients in the year 2014 using the National Inpatient Sample (NIS).METHODS:Study Population:We identified hospitalized sickle cell patients in NIS using ICD-9 codes (282.5,282.6X -282.6X) for year 2014. We also identified the various malignancies through ICD-9 codes and studied the prevalence of individual malignancies in hospitalized sickle cell patients (SCD/cases) compared to a matched cohort of hospitalized patients with no sickle cell disease (No SCD/controls).Statistical Analysis:The 1:N Case-Control Matching Macro (Parsons LS et al SUGI 29) was used to match cases with controls with respect to potential confounders including age, race, gender in the ratio of 1:4. Chi Square was used to determine the difference in the proportions of individual malignancies between the two groups. P value <0.05 was considered statistically significant. All analyses were performed using SAS 9.4.RESULTS:We identified 117,405 hospitalized sickle cell patients in the NIS database who were matched to 469,620 controls (Table 1). A total of 1890 malignancies were found in sickle cell cohort. The prevalence of malignancies in hospitalized sickle cell patients was 1.6% as compared to 4.6% in controls (OR 0.34; range:0.30-0.38). The prevalence of all studied malignancies including hematological malignancies was lower in hospitalized sickle cell patients as compared to a matched population of hospitalized patients with no sickle cell disease (Table 2).CONCLUSION:Our study showed a lower prevalence of both solid tumors and hematological malignancies in patients with sickle cell disease as compared to matched cohorts. Future prospective cohort studies are needed to evaluate the risk of malignancies in sickle cell anemia and identify if any protective mechanisms exist against the development of malignancy in this patient population. DisclosuresNo relevant conflicts of interest to declare.

THYROID DISORDERS

Objective: to study the spectrum of various thyroid disorders presentingin peripheral teaching hospitals of Gujranwala region. Study Design: Descriptive, Crosssectional, Interventional. Setting: Department of Surgery Islam Teaching Hospital Sialkot &amp;Surgical Department of Aziz Bhatti Shaheed (Teaching) Hospital. Nawaz Sharif medical College,University of the Gujrat. Study Period: February 2011 to June 2016. Results: A total of 236patients of all age groups with thyroid gland disorders were enrolled in this study. Majority ofpatients were of middle age group with mean age of 43+ years. Male to female ratio was 1:4.Nodular thyroid enlargement was the commonest presentation. Solitary thyroid nodule was thecommonest variant of nodular goitre seen in 48.52% cases. Thyroid carcinoma was found in36.45% cases among the nodular goitres. Conclusion: Thyroid disorders are common in hillyareas of Pakistan, more common in female population. High prevalence thyroid malignancy inpopulation of the Gujranwala Division of Central Punjab is an alarming and worrisome finding inour study. Larger multicenter studies are suggested in this particular region to know the exactincidence, predisposing factors/ carcinogens etc if any responsible for thyroid malignancies inthis region.

Accuracy of FDG-PET to diagnose lung cancer in areas with infectious lung disease: a meta-analysis.

Positron emission tomography (PET) combined with fludeoxyglucose F 18 (FDG) is recommended for the noninvasive diagnosis of pulmonary nodules suspicious for lung cancer. In populations with endemic infectious lung disease, FDG-PET may not accurately identify malignant lesions. To estimate the diagnostic accuracy of FDG-PET for pulmonary nodules suspicious for lung cancer in regions where infectious lung disease is endemic and compare the test accuracy in regions where infectious lung disease is rare. Databases of MEDLINE, EMBASE, and the Web of Science were searched from October 1, 2000, through April 28, 2014. Articles reporting information sufficient to calculate sensitivity and specificity of FDG-PET to diagnose lung cancer were included. Only studies that enrolled more than 10 participants with benign and malignant lesions were included. Database searches yielded 1923 articles, of which 257 were assessed for eligibility. Seventy studies were included in the analysis. Studies reported on a total of 8511 nodules; 5105 (60%) were malignant. Abstracts meeting eligibility criteria were collected by a research librarian and reviewed by 2 independent reviewers. Hierarchical summary receiver operating characteristic curves were constructed. A random-effects logistic regression model was used to summarize and assess the effect of endemic infectious lung disease on test performance. The sensitivity and specificity for FDG-PET test performance. Heterogeneity for sensitivity (I2 = 87%) and specificity (I2 = 82%) was observed across studies. The pooled (unadjusted) sensitivity was 89% (95% CI, 86%-91%) and specificity was 75% (95% CI, 71%-79%). There was a 16% lower average adjusted specificity in regions with endemic infectious lung disease (61% [95% CI, 49%-72%]) compared with nonendemic regions (77% [95% CI, 73%-80%]). Lower specificity was observed when the analysis was limited to rigorously conducted and well-controlled studies. In general, sensitivity did not change appreciably by endemic infection status, even after adjusting for relevant factors. The accuracy of FDG-PET for diagnosing lung nodules was extremely heterogeneous. Use of FDG-PET combined with computed tomography was less specific in diagnosing malignancy in populations with endemic infectious lung disease compared with nonendemic regions. These data do not support the use of FDG-PET to diagnose lung cancer in endemic regions unless an institution achieves test performance accuracy similar to that found in nonendemic regions.

Twelve-month endoscopic and histological analysis following proton-pump inhibitor-based triple therapy in Helicobacter pylori-positive patients with gastric ulcers

Objective. To evaluate endoscopic and histological findings after Helicobacter pylori eradication therapy in gastric ulcer (GU) patients after 12 months' follow-up. Material and methods. A total of 401 GU patients were randomized to receive either twice-daily (b.i.d.) esomeprazole 20 mg+amoxicillin 1000 mg+clarithromycin 500 mg (EAC) for 1 week followed by placebo for 3 weeks, EAC followed by once-daily (o.d.) esomeprazole 20 mg for 3 weeks or esomeprazole 20 mg b.i.d. plus placebo antibiotics for 1 week followed by esomeprazole 20 mg o.d. for 3 weeks. Endoscopy with biopsy was performed at baseline, after treatment and at 6 and 12 months' follow-up (healed patients). Results. Endoscopic abnormalities, particularly in the stomach, were common at baseline and remained similar during follow-up, regardless of ulcer status and treatment. Helicobacter gastritis was present (antrum or corpus) in ≈ 20% of patients following eradication therapy (versus ≈ 80% with esomeprazole alone); these effects were sustained during follow-up. Similar trends were observed for other histological variables (granulocyte and lymphoplasmocytic cell infiltration, replacement of gastric surface cells by regenerative epithelium, and mucous depletion). No changes in atrophy or intestinal metaplasia were observed. Eighteen gastric cancer cases were detected: 11 at baseline endoscopy, and seven during treatment and follow-up. Conclusions. Endoscopic abnormalities are common in GU patients and persist after proton-pump inhibitor-based triple therapy for H. pylori eradication, which is associated with large, sustained improvements in histological variables. Follow-up endoscopy and histology may be necessary, even in patients with apparently non-malignant GU, to improve the detection rate of gastric malignancy in populations with a high prevalence of gastric cancer.

Genetics of basal cell carcinoma

Basal cell carcinoma is the most common human malignancy in populations of European origin, and Australia has the highest incidence of basal cell carcinoma in the world. Great advances in the understanding of the genetics of this cancer have occurred in recent years. Mutations of the patched 1 gene (PTCH1) lead to basal cell carcinoma predisposition in Gorlin syndrome. PTCH1 is part of the hedgehog signalling pathway, and derangements within this pathway are now known to be important in the carcinogenesis of many different cancers including sporadic basal cell carcinoma. The molecular biology of the hedgehog pathway is discussed, and mouse models of basal cell carcinoma based on this pathway are explored. New developments in non-surgical treatment of basal cell carcinoma are based on this knowledge. Other genes of importance to basal cell carcinoma development include the tumour suppressor gene P53 and the melanocortin-1 receptor gene. In addition, we discuss molecules of possible importance such as the glutathione-S-transferases, DNA repair genes, cyclin-dependent kinase inhibitor 2A, Brahma and connexins. Evidence of familial aggregation of this cancer is explored and supports the possibility of genetic predisposition to this common malignancy.

Are Alarm Symptoms Predictive of Upper Gastrointestinal Cancer

Alarm symptoms in Western patients with dyspepsia have long been thought to increase the probability of upper gastrointestinal (GI) malignancy and, as such, to warrant endoscopic evaluation. Helicobacter pylori has been shown to be associated definitively with high risk for GI cancer, but whether alarm symptoms predict malignancy in populations with a high prevalence of H. pylori is unknown. To study …

Serum levels of the extracellular domain of the epidermal growth factor receptor in individuals exposed to arsenic in drinking water in Bangladesh

Epidermal growth factor receptor-dependent mechanisms have been implicated in growth signal transduction pathways that contribute to cancer development, including dermal carcinogenesis. Detection of the extracellular domain of the epidermal growth factor receptor (EGFR ECD) in serum has been suggested as a potential biomarker for monitoring this effect in vivo. Arsenic is a known human carcinogen, producing skin and other malignancies in populations exposed through their drinking water. One such exposed population, which we have been studying for a number of years, is in Bangladesh. The purpose of this study was to examine the EGFR ECD as a potential biomarker of arsenic exposure and/or effect in this population. Levels of the EGFR ECD were determined by enzyme-linked immunosorbent assay in the serum samples from 574 individuals with a range of arsenic exposures from drinking water in the Araihazar area of Bangladesh. In multiple regression analysis, serum EGFR ECD was found to be positively associated with three different measures of arsenic exposure (well water arsenic, urinary arsenic and a cumulative arsenic index) at statistically significant levels (p≤0.034), and this association was strongest among the individuals with arsenic-induced skin lesions (p ≤ 0.002). When the study subjects were stratified in tertiles of serum EGFR ECD levels, the risk of skin lesions increased progressively for each increase in all three arsenic measures (also stratified in tertiles) and this increasing risk became more pronounced among subjects within the highest tertile of EGFR ECD levels. These results suggest that serum EGFR ECD levels may be a potential biomarker of effect of arsenic exposure and may indicate those exposed individuals at greatest risk for the development of arsenic-induced skin lesions.

Veterans with Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL) have a Markedly Increased Rate of Second Malignancy, which is the Most Common Cause of Death

Patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) have an increased incidence of high-grade lymphoid malignancy. The risk of non-lymphoid second malignancy in this population is not well-defined to date. To test the hypothesis that patients with CLL/SLL have an increased risk of second malignancy, we studied the rate of second malignancy in 132 CLL/SLL patients and compared it to the rate of malignancy (excluding non-melanomatous skin cancer) in the Central Arkansas Veterans Healthcare System population of approximately 38,000 veterans over a period of 11.5 years. The rate of second malignancy, diagnosed concomitantly or after CLL/SLL, and the age-adjusted rate of malignancy calculated from tumor registry reports and demographic data, were used to calculate a Standardized Morbidity Ratio (SMR) with 95% confidence interval (CI). Twenty-one (16%) of the CLL/SLL patients had second malignancies (19 non-lymphoid, 1 Richter's transformation and 1 Hodgkin's disease), which were fatal in 15 (71%) patients. The SMR for the CLL/SLL population was 2.97 (95% CI 1.84 – 4.55) for second malignancy and 2.69 (95% CI 1.62 – 4.21) for non-lymphoid second malignancy. This study of a well-defined CLL/SLL population shows a significantly increased risk of second malignancy, which was the primary cause of death for 9% of all CLL/SLL patients (34% of all patient deaths).

Prediction of trend between water environment pollution of D Lake and death rate of malignancy in population.

Grey system analysis method was used to study the correlation between water pollution in D Lake area and death rate of malignancy with death rate of malignancy as effect sequence and a variety of water pollution index as factor sequence. On the basis of grey correlation analysis, grey system predication model was established for death rate of malignancy in population in D Lake area including GM(1, N) model for death rate of malignancy [MR(t+1) = (9.9987E1 + 5.0001E2 + 10.8994E3 + 1.1114E4 + 165.1029) x e(-0.0070t) - 9.9987E1 - 5.0001E2 - 10.8994E3 - 1.1114E4] and GM(1, 1) model for related factors [E1(t+1) = 52.1214 - 46.9468e(-0.0058t), E2(t+1) = 4.6114 - 4.5664e(0.0015t), E3(t+1) = 1.1389 - 1.1212e(0.0065t), E4(t+1) = 554.5867 - 549.8006e(0.0016t)], and the trend of death rate of malignancy from 2000 to 2010 was predicted.

Late Mortality in Childhood Cancer: Time to Count Our Chips

Late Mortality in Childhood Cancer: Time to Count Our Chips