Overall Prevalence Of Malignancy Research Articles

Effect of Having Concurrent Mutations on the Degree of Aggressiveness in Patients with Thyroid Cancer Positive for TERT Promoter Mutations.

This study aimed to examine whether concurrent mutations with a TERT promoter mutation are associated with a greater likelihood of more aggressive disease than a TERT promoter mutation alone. The medical records of 1477 patients who underwent thyroid surgery at two tertiary hospitals between 2017 and 2022 were reviewed. Twenty-four patients had TERT promoter mutations based on molecular profile testing. Clinicodemographic data, mutational profiles, and histopathological features were assessed. Descriptive analysis, Fisher's exact test, and binary logistic regression were performed. Seven patients had single-gene TERT promoter mutations, and 17 had concurrent mutations, including BRAF V600E, HRAS, NRAS, PIK3CA, and EIF1AX. The overall prevalence of malignancy was 95.8%, of which 78.3% were aggressive thyroid cancers. There was a statistically significant association between concurrent mutations and disease aggressiveness. The odds of having aggressive disease were 10 times higher in patients with a TERT promoter mutation and a concurrent molecular alteration than in those with a TERT promoter mutation alone. This is an important finding for thyroid specialists to consider when counseling patients concerning risk stratification and management options.

The ADNEX model to triage adnexal masses: An external validation study and comparison with the IOTA two-step strategy and subjective assessment by an experienced ultrasound operator

ObjectivesThe ADNEX (Assessment of Different NEoplasias in the adneXa) model was developed using parameters collected by experienced (level III) ultrasound examiners. Our primary aim was to externally validate the ADNEX model. Then, the discriminatory performance of ADNEX was compared with the two-step strategy and subjective assessment by an experienced ultrasound operator. MethodsBetween February 2013 and January 2017, all patients who were scheduled for surgery for an adnexal mass at the Sant’Anna Hospital in Turin were enrolled in this study. Preoperative transvaginal sonography was performed, and the two-step strategy was applied for triage of the adnexal mass. Two ultrasound examiners, IOTA certified, applied the ADNEX model to all the collected masses based on the ultrasound reports. Finally, an experienced operator assigned the subjective assessment based on recorded ultrasound images. The discrimination and calibration performance of ADNEX were evaluated. The AUC was calculated for the basic discrimination between benign and malignant tumours. In addition, AUCs were computed for each pair of tumour types using the conditional risk method. ResultsA total of 577 patients were included in the analysis: the overall prevalence of malignancy was 25 %. With ADNEX, the AUC to differentiate between benign and malignant masses was 0.9111 (95 % CI 0. 8788-0.9389). At risk cut-offs of 1%, 10 % and 30 %, sensitivities were 100 %, 89.6 % and 79.2 %, respectively, and specificities were 2.8 %, 76.2 % and 89.6 %, respectively. Discrimination between benign and stage II–IV tumours was good (AUC 0.935). The model had the most difficulties discriminating between borderline and stage I tumours (AUC 0.666), and between stages II–IV invasive and secondary metastatic tumours (AUC 0.736). The polytomous discrimination index (PDI) was 0.61 for ADNEX, whereas PDI for random performance would be 0.25. ADNEX proved to be equally or more accurate than the subjective assessment or the two-step strategy in the discrimination between benign and malignant adnexal masses. Conclusionsthe ADNEX model could probably be successfully applied when an expert examiner is not available and, therefore both a subjective assessment and the two-step strategy cannot be performed.

Malignancy in common variable immunodeficiency: a systematic review and meta-analysis

ABSTRACT Background: Common variable immunodeficiency (CVID) is the most common clinically significant primary immunodeficiency (PID) disorder characterized by variable clinical manifestations including recurrent infections, autoimmune disorders, enteropathy, lymphoproliferative disorders, and malignancy. The aim of this study is to estimate the overall prevalence of malignancy in patients with CVID. Methods: PubMed, Web of Science and Scopus were searched systemically to find eligible studies from the earliest available date to March 2019 with standard keywords. Pooled estimates of the malignancy prevalence and the corresponding 95% confidence intervals (CI) were calculated using random effects models. Results: Forty-eight studies with a total of 8123 CVID patients met the inclusion criteria and were finally included in the meta-analysis. Overall prevalence of malignancy was 8.6% (95% CI: 7.1–10.0; I2 = 79.2%). The prevalence of lymphoma, gastric cancer, and breast cancer in CVID patients were 4.1% (95% CI: 3.3–4.9; I2 = 62.6%), 1.5% (95% CI: 0.78–2.2; I2 = 68.9%), and 1.3% (95% CI: 0.64–1.9; I2 = 54.9%), respectively. Moreover, autoimmunity and malabsorption were more frequent in patients with malignancy than those without malignancy. Conclusion: The prevalence of malignancy has increased in CVID patients due to recent improvement in survival rate and the lymphoma is the most common type. This research highlighted the significance of malignancy screening and management in CVID patients.

Rethinking Malignancy Risk in Indeterminate Thyroid Nodules with Positive Molecular Studies: Southern California Permanente Experience.

To recognize that thyroid nodules with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS; Bethesda III) have different risks of malignancy based on genetic mutation and to consider molecular testing of nodules with AUS/FLUS to help avoid unnecessary morbidity or cost. Retrospective cohort study. Multiple locations within Southern California Permanente Medical Group. Patients included those with indeterminate thyroid nodules and AUS/FLUS on 2 separate fine-needle aspirations with positive ThyGenX testing from 2014 to 2017 who underwent thyroid surgery. Patients were classified as having benign or malignant disease. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features was considered benign. A total of 231 patients had repeat AUS/FLUS with positive molecular testing and surgery. The most frequent type of malignancy was papillary carcinoma, followed by follicular carcinoma. The overall prevalence of malignancy in nodules with mutations was 74.0%, although there was considerable variation: BRAF = 100%, RET = 100%, PAX8-PPARγ = 84.6%, HRAS = 70.7%, NRAS = 63.4%, and KRAS = 33%-a statistically significant finding (P < .001). Not all molecular mutations in thyroid nodules with AUS/FLUS have a high risk of malignancy. Of note, patients with BRAF and RET mutations in our population had a 100% risk of malignancy. Patients with PAX, HRAS, or NRAS mutations had a high risk of malignancy, while patients with KRAS mutations had a lower risk of malignancy. Further studies are needed to determine if the presence of certain molecular mutations can help personalize care and aid in the decision for thyroid surgery.

Reliability of IOTA score and ADNEX model in the screening of ovarian malignancy in postmenopausal women

BackgroundThe IOTA (International Ovarian Tumor Analysis) group has developed the ADNEX (Assessment of Different NEoplasias in the adneXa) model to predict the risk that an ovarian mass is benign, borderline or malignant. This study aimed to test reliability of these risks prediction models to improve the performance of pelvic ultrasound and discriminate between benign and malignant cysts. Material and methodsPostmenopausal women with an adnexal mass (including ovarian, para-ovarian and tubal) and who underwent a standardized ultrasound examination before surgery were included. Prospectively and retrospectively collected data and ultrasound appearances of the tumors were described using the terms and definitions of the IOTA group and tested in accordance with the ADNEX model and were compared to the final histological diagnosis. ResultsOf the 107 menopausal patients recruited between 2011 and 2016, 14 were excluded (incomplete inclusion criteria). Thus, 93 patients constituted a cohort in whom 89 had benign cysts (83 ovarian and 6 tubal or para-ovarian cysts), 1 had border line tumor and 3 had invasive ovarian cancers (1 at first stage, 1 at advanced stage and 1 metastatic tumor in the ovary). The overall prevalence of malignancy was 4.3%. Every benign ovarian cyst was classified as probably benign by IOTA score which showed also a high specificity with the totality of probably malignant lesion proved malignant by histological exam. The limit of this score was the important rate of not classified or undetermined cysts. However, the malignancy risks calculated by ADNEX model allowed identifying the totality of malignancy. Thus, the combination of the two methods of analysis showed a sensitivity and specificity rates of respectively 100% and 98%. Evaluation of malignancy risks by these 2 tests highlighted a negative predictive value of 100% (there was no case of false negative) and a positive predictive value of 80%. Discussion and conclusionOn the basis of our findings, the IOTA classification and the ADNEX multimodal algorithm used as risks prediction models can improve the performance of pelvic ultrasound and discriminate between benign and malignant cysts in postmenopausal women, especially for undetermined lesions.

Evaluating the risk of ovarian cancer before surgery using the ADNEX model: a multicentre external validation study.

Background:The International Ovarian Tumour Analysis (IOTA) group have developed the ADNEX (The Assessment of Different NEoplasias in the adneXa) model to predict the risk that an ovarian mass is benign, borderline, stage I, stages II–IV or metastatic. We aimed to externally validate the ADNEX model in the hands of examiners with varied training and experience.Methods:This was a multicentre cross-sectional cohort study for diagnostic accuracy. Patients were recruited from three cancer centres in Europe. Patients who underwent transvaginal ultrasonography and had a histological diagnosis of surgically removed tissue were included. The diagnostic performance of the ADNEX model with and without the use of CA125 as a predictor was calculated.Results:Data from 610 women were analysed. The overall prevalence of malignancy was 30%. The area under the receiver operator curve (AUC) for the ADNEX diagnostic performance to differentiate between benign and malignant masses was 0.937 (95% CI: 0.915–0.954) when CA125 was included, and 0.925 (95% CI: 0.902–0.943) when CA125 was excluded. The calibration plots suggest good correspondence between the total predicted risk of malignancy and the observed proportion of malignancies. The model showed good discrimination between the different subtypes.Conclusions:The performance of the ADNEX model retains its performance on external validation in the hands of ultrasound examiners with varied training and experience.

Colonoscopy after CT-diagnosed acute diverticulitis: Is it really necessary?

Computed tomography (CT) scans are commonly used to diagnose acute diverticulitis, but there are overlapping features between diverticulitis and colorectal cancer (CRC) on imaging studies. Hence, colonoscopy is typically recommended after an episode of acute diverticulitis to rule out underlying malignancy. Currently, 64-slice multidetector CT scanners are capable of providing higher-resolution images and may be able to distinguish malignancy from diverticular inflammation. We aimed to determine the prevalence of CRC among patients with CT-diagnosed acute diverticulitis. We performed a retrospective study of patients with acute diverticulitis diagnosed on CT scan between December 2005 and December 2010 at St. Paul's Hospital, Vancouver, BC. Nonresidents were excluded. We reviewed CT scan reports that included the term "diverticulitis," reports of follow-up colonic evaluation within 1 year of diagnosis and pathology results. We queried the provincial cancer registry to ensure no cases of CRC were missed. A total of 293 patients had acute diverticulitis diagnosed on CT scan, but 8 were nonresidents and were excluded. Of the 285 included in the analysis, the mean age was 59.4 ± 15.1 years, and 167 (58.6%) were men. Among the 114 patients who underwent follow-up evaluation, malignancy was diagnosed in 4 (3.5%). The overall prevalence of malignancy among patients with CT-diagnosed diverticulitis was 1.4%. Routine endoscopic evaluation after an episode of diverticulitis diagnosed with high-resolution CT scan does not appear to be necessary. Selective approach in patients with protracted clinical course or those with mass lesion/obstruction on CT scan may be of benefit.

RADIOLOGICAL AND PATHOLOGICAL CORRELATION OF LUNG NODULES IN A BACKGROUND OF METASTATIC DISEASE

Background: Computed tomography (CT) imaging has improved the chances of detecting small indeterminate (&lt;1 cm) lung nodules. The determination of the underlying malignant or benign nature of a lung nodule poses a great diagnostic challenge and depends on a number of factors, including the radiographic appearance of nodule, the presence of non-pulmonary metastases, characteristics of growth and histological criteria. Methods: The medical records of 89 patients admitted to our specialist cancer centre between 2008 and 2013 were reviewed. Patients of all age groups and tumour category were included in the study. Clinical data of these patients were collected and the following parameters were analysed: Radiographic diagnosis, location, size, laterality and number of nodules and histological impression. The radiological findings were then correlated with histopathological findings. The nodules were sub-classified into groups on the basis of size (A = 0–0.5 cm; B = 0.5–0.9 cm; C = 1.0–1.5 cm and D = &gt;1.5 cm). Results: CT scan reports of 89 patients with lung nodules were reviewed. On radiology, 73/89 (82%) were reported to be malignant nodule. Histopathological review of the biopsies of these 89 nodules confirmed malignancy in 50/89 (56.2%) patients. CT scan was found to be highly sensitive (94%, 95% confidence interval [CI]: 83.43–98.68%) but with a very low specificity (33.3%, 95% CI: 19.10–50.22%). CT scan was found to have a higher negative predictive value (81.2%, 95% CI: 54.34–95.73%) and a lower positive predictive value 64.4% (95% CI: 52.31–75.25%) when correlated with histopathological findings. Pathology of these nodules included metastatic sarcoma (27/89; 30.3%) and carcinoma (18/89; 20.2%). The frequency of the biopsy-proven malignant nodules on the right side was 26/45 (57.8%) and on the left side was 24/44 (54.5%) (P = 0.832). Malignant nodules were more frequent in lower lobes (28/43, 65.1%) than in upper lobes (14/32, 43.8%). These two sites combined accounted for 84% of all malignant nodules. There was a significant correlation between nodule size and likelihood of underlying malignancy. The overall prevalence of malignancy in the larger nodules (C and D) was much higher (23/30 and 76.7%) compared to the smaller sized (A and B) nodules (27/58 and 46.8%), P &lt; 0.05.Conclusion: CT scan is a useful tool in the initial clinical assessment of indeterminate lung nodules with high sensitivity (94%) and a high negative predictive value (81.2%).Key words: Computed tomography, fibrosis, indeterminate lung nodule, infection, lung nodule, malignancy, metastases

Occupational Health Hazards of Working in the Interventional Laboratory: A Multisite Case Control Study of Physicians and Allied Staff

BackgroundThe occupational hazards of working in the interventional laboratory have been inadequately studied for physicians and remain unaddressed for nonphysician personnel. ObjectivesThis study sought to determine whether the prevalence of work-related musculoskeletal pain, cancer, and other medical conditions is higher among physicians and allied staff who work in interventional laboratories compared with employees who do not. MethodsMayo Clinic employees who work in affiliated hospitals with interventional cardiology or interventional radiology laboratories took an electronic survey. Results were stratified on the basis of self-reported occupational exposure to procedures that involve radiation. ResultsThere were 1,543 employees (mean age 43 ± 11.3 years, 33% male) who responded to the survey (response rate of 57%), and 1,042 (67.5%) reported being involved with procedures utilizing radiation. These employees reported experiencing work-related pain more often than the control group before (54.7% vs. 44.7%; p < 0.001) and after adjustment for age, sex, body mass index, pre-existing musculoskeletal conditions, years in profession, and job description (odds ratio: 1.67; 95% confidence interval: 1.32 to 2.11; p < 0.001). Musculoskeletal pain varied significantly by job description, with the highest incidence reported by technicians (62%) and nurses (60%) followed by attending physicians (44%) and trainees (19%; p < 0.001). There was no difference in cancer prevalence between groups (9% vs. 9%; p = 0.96). ConclusionsMusculoskeletal pain is more common among healthcare workers who participate in interventional procedures and is highest in nonphysician employees. The diagnosis of cancer in employees who participate in procedures that utilize radiation was not elevated when compared to controls within the same departments, although any conclusion regarding causality is limited by the cross-sectional nature of the study, as well as the low overall prevalence of malignancy in our study group.

Differentiation of Benign and Malignant Solitary Pulmonary Nodule: Literature Review

The solitary pulmonary nodule (SPN) is frequently seen on chest radiographs and computed tomography (CT), usually the identification is accidental. The overall prevalence of malignancy is relatively low but identification of malignancy of nodule is of prime importance. There are different characters of nodules indicating malignancy, and also the exposure of person to risk factors increases the chances of malignancy of nodule. Chances of malignancy rise with increasing size, the irregular, lobulated border of the nodules is highly associated with higher probability of malignancy and nodules with pure ground grass appearance have higher probability of malignancy, irregularly marginated nodule displaying a corona radiata sign indicating neoplastic infiltration with distortion of neighbouring tissue is almost certainly a malignant nodule. Stippled, punctuate, and eccentric calcifications are suggestive of malignancy. There are 20% - 75% of chances of malignancy if nodule is appeared with ground-glass opacity. Malignant nodules have higher growth rate as compared with benign nodules, malignant nodules usually have doubling time (DT) of 30 - 400 days while DT of more than 450 days is sign of benignity whereas doubling time less than 30 days is usually acute infectious process. The presence of fat within nodule is sign of benignity. Increasing density of the nodule is suggestive of malignancy and requires shorter follow up. Besides the nodule evaluation the chances of malignancy can also be evaluated through the exposure of patient to risk factors like age, current and past smoking status and history of extra thoracic malignancy. The management depends upon various factors mainly three strategies are applied for management including careful observation of nodule, use of diagnostic techniques like CT FNA, PET, and broncoscopy and surgery.

Apport de l’imagerie médicale fonctionnelle dans le diagnostic du nodule pulmonaire

The introduction into clinic of positron emission tomography (PET) with 18F-Flurorodesoxyglucose (FDG) and of hybrid cameras combining PET and computed tomography (PET/CT) has radically changed the management of solitary pulmonary nodules (SPN). Three meta-analyses have shown a high diagnostic accuracy of FDG PET for the diagnosis of cancer in SPN.Small pulmonary nodules (less than 5mm), respiratory movements and histology with low cell density and/or low metabolic activity are the most common cases of false negative FDG PET/CT. The majority of false positive cases are related to benign tumours, granulomatosis and infectious diseases.Likelihood ratio's (LR) of FDG PET/CT for overall prevalence of malignancy in SPN were published and are higher for malignancy diagnosis with PET scan in comparison with most clinical and radiological variables. Today, the Bayesian approach for SPN differential diagnosis must include information from FDG PET/CT.The increasing use of new radiotracers, such as octreotide derivates labeled with 68Gallium (68Ga) for diagnosis and staging of carcinoid tumours and the development of other radiotracers, will lead to an improvement in the management of solitary pulmonary nodules.

FRI0072 Prevalence of Malignancies in Patients with Rheumatoid Arthritis

BackgroundMany reports suggest that inflammatory arthritides are associated with an increased prevalence of malignancies. The risk of developing malignancy seems to increase with arthritis severity and associated with the chronic...

P162 Comparison of clinical characteristics and outcomes of patients with PET positive vs PET negative solitary pulmonary nodules managed by a Lung MDT

BackgroundPET-CT is an important test in the management of patients with solitary pulmonary nodules (SPNs). There is a paucity of data on clinical characteristics, follow-up and outcomes of patients with...

Fine needle aspiration cytology as the primary diagnostic tool in thyroid enlargement

Background:In the preoperative decision-making of the thyroid swellings, fine needle aspiration cytology (FNAC) is becoming an ever more vital tool.Objectives:To compare the advantage of preoperative FNAC of thyroid swellings with postoperative histopathology to reach a consensus protocol as a simple procedure for diagnosis and optimal management of thyroid swellings.Materials and Methods:A prospective study of preoperative FNAC was carried out on 178 incidental thyroid swellings attending a tertiary care centre in Kishanganj, Bihar. Evidence-based surgical interventions were done, irrespective of FNAC findings and diagnosis was confirmed by histopathological examination (HPE) postoperatively in all the cases.Results:In the FNAC, preponderance of the cases (75.84%) was colloid goitre followed by granulomatous thyroiditis; follicular carcinoma was noted in 7.30 percent and anaplastic carcinoma in 3.37 percent of cases. Histopathological examination showed colloid goitre predominantly (76.97%), followed by follicular carcinoma (8.99%). The overall prevalence of malignancy was 11.24 percent diagnosed by HPE and 9.55 percent by FNAC. In our FNAC series sensitivity of was 90 percent while specificity was 100 percent; accuracy was 98.88 percent. Predictive value of a positive test and negative tests was 100 percent and 98.75 percent respectively.Conclusion:The study highlights that FNAC should be treated as a first-line diagnostic test for thyroid swellings to guide the management though this is not a substitute for HPE as a need to improve primary healthcare in India.

Diagnostic accuracy of features predicting lower gastrointestinal malignancy: a colonoscopy database review of 10 603 Chinese patients

The diagnostic accuracy of colonoscopic features in predicting colorectal cancer (CRC) malignancy was studied. Consecutive patients who underwent first-time colonoscopy for lower gastrointestinal (GI) symptoms from 1998 to 2009 were identified. Gender, age, symptoms, endoscopic and pathologic findings were reviewed. There were 10,603 patients. The overall prevalence of malignancy was 3.0% (313). Among these, only 58% (181/313) had features indicative of tumour formation. The overall sensitivity and specificity was 9.6% and 94.1%, respectively. The overall positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio were 2.66, 0.96 and 2.77, respectively. A large proportion of Chinese patients with CRC presented without features indicative of tumour formation.

47IN PULMONARY NODULE: DIFFERENTIAL DIAGNOSIS AND BAYESIAN APPROACH

A solitary pulmonary nodule (defined as <3 cm lesion within and surrounded by pulmonary parenchyma) is a common clinical problem. It is usually detected incidentally. Common causes of malignant SPN include primary lung cancer (mainly adenocarcinoma), carcinoid tumours and metastatic cancer. Benign aetiologies include infectious granulomas (mycobacteria, histoplasmosis, coccidiomycosis) other infections, benign tumour (hamartomas . . . ) and less often cysts, vascular abnormalities . . . . The estimated frequency of each aetiology varies among the population, the methodology used and the age of the study. The prevalence of solitary pulmonary nodule (SPN) in the lung cancer screening study varies from 8% to 51% (with a prevalence of malignant nodule from 1% to 12%). The major question is whether the lesion is malignant or not. The Bayesian approach can help us to identify promptly malignant nodule in order to treat them surgically and to avoid surgery for benign nodules. Therefore, it is needed to estimate the probability of cancer (Pca) in the SPN. Likelihood ratio (LR) for overall prevalence of malignancy and for different clinical and radiological information (age, smoking exposure, asbestos exposure, symptoms, cancer history, nodule size, spiculation, calcification, location, growth, . . . ) can be obtained from the literature. The odds of cancer-malignancy (Odds ca) can be calculated by multiplying all of these LRs together. The Pca = odds ca/(1 + odds ca). Using this Bayeasian approach, the probability of cancer based on an abnormal or normal fluoro-2deoxy-D-glucose-positron emission tomography (FDG-PET) scan has been estimated. Sensitivity, specificity, positive predictive value and negative predictive value of PET scan are respectively about 90%, 80%, 90% and 90%. Moreover, the LR for malignancy are higher with an abnormal PET scan when compared to most clinical and radiological LRs. Today, the Bayesian approach of SPN must include PET scan. Surgical excision of the nodule is indicated if the LR of malignancy according to clinical and radiographic characteristics is high, a FDG-PET is positive or the nodule has been proven to be malignant by a sampling procedure.

Beyond haematuria in uro oncology: imaging biomarkers lag behind needs

Haematuria is the presence of red blood cells in the urine, and it is an important symptom in the diagnosis and treatment of renal and urological disease. Haematuria, which can be suspected on the basis of urine colour, is confirmed by the use of qualitative and/or semiquantitative urine strips to test for occult blood and by microscopic examination of urine sediment. Haematuria can be either microscopic or gross. Microscopic haematuria is the finding of more than three red blood cells per high-powered field in at least two out of three different urine samples collected at different times, whereas gross haematuria is the term used when blood present in urine is visible to the naked eye. Haematuria can originate from the kidneys or urinary tract and bladder [1]. A prospective analysis of the diagnostic yield from over 4,000 patients attending a protocol-driven haematuria clinic demonstrated that 1,950 (48.5%) had microscopic haematuria and 2,073 (51.5%) had macroscopic haematuria. Of the 1,950 patients with microscopic haematuria, 153 (7.8%) had urinary tract calculi, 19 (1.0%) had renal cell cancer (RCC), 3 (0.2%) had upper tract transitional cell cancer (TCC), 73 (3.7%) had bladder TCC, while 87.3% had no detectable cause of the haematuria. The overall prevalence of malignancy in patients with microscopic haematuria was 4.8%. Of the 2,073 patients with macroscopic haematuria, 183 (8.8%) had urinary tract calculi, 41 (2.0%) had RCC, 10 (0.5%) had upper tract TCC, 342 (16.5%) had bladder TCC, while 1,497 (72.2%) had no identifiable cause of their haematuria [2]. Most RCCs are discovered incidentally during CT imaging performed for other reasons. Around 70% of renal cortical tumours are confined to the kidney and 30% will develop into metastatic disease at some time during their course. Of these tumours, one in four will be benign, another one in four will be indolent (with limited metastatic potential), and approximately two in four will be malignant carcinomas. As reported by O’Connor et al. of the Department of Radiology, Cork University Hospital, Republic of Ireland [3], RCC is the most common malignant neoplasm of the kidney, accounting for up to 90% of renal neoplasms and up to 3% of all neoplasms. It is more common in men than in women (3:2 ratio), has a peak incidence between 60 and 70 years of age, and is associated with smoking, obesity, and antihypertensive therapy. TCC accounts for 10% of upper urinary tract neoplasms. Although TCC is most likely to occur in the bladder, the ureters have been reported to be involved in 2%, and the renal pelvis in 5% of patients. TCC may also have a multifocal presentation. Synchronous tumours occur in up to 2% of renal and 9% of ureteric lesions, with metachronous lesions typically occurring in the bladder in up to 50% of patients with upper ureteric tumours on presentation. Imaging is required for primary diagnosis of TCC and is commonly used for the detection of synchronous and metachronous lesions. Bladder neoplasia is the fifth most common cancer in Europe and the fourth most common in the United States. TCC of the bladder also occurs more commonly in men than in women, is associated with smoking (incidence up to fourfold greater than in nonsmokers), exposure to chemicals such as benzene and 2

Prevalence of cancer in follicular thyroid nodules: is there still a role for intraoperative frozen section analysis?

The optimal surgical management of follicular thyroid nodules and the effectiveness of frozen section (FS) analysis in planning the operation are still controversial. In this study, we reviewed the prevalence of cancer in 309 consecutive patients (230 females, 79 males, aged 42 +/- 13 years) with follicular nodules at fine-needle aspiration cytology (FNAC) and the efficacy of FS evaluation in selecting cancers. On the whole, the prevalence of cancer was 20.1%; the occurrence of follicular variants of papillary cancer (14.9%) was threefold higher than follicular cancers (5.2%). The presence of atypical features at FNAC selected nodules with a significantly higher prevalence of cancer (46.7%, p = 0.01). FS analysis was performed in 142 patients and recognized only 8 of 27 (30%) cancers, one fourth of them with atypia at FNAC. In conclusion, this study confirms a 20% overall prevalence of malignancy in patients with follicular thyroid nodules. The association of cell atypia with a follicular pattern may define a subgroup of nodules more likely to be malignant. FS was seldom effective in recognizing cancer confirming the doubt on its cost effectiveness in planning the surgical approach. Protocols aimed at a better cytologic identification of follicular variants of papillary cancer should be considered.

Thyroid cytology and the risk of malignancy in thyroid nodules: importance of nuclear atypia in indeterminate specimens.

Fine needle aspiration (FNA) cytology is the best test for malignancy in thyroid nodules. However, cytologic interpretation of FNA specimens is often difficult, especially in the presence of indeterminate microfollicular cytologic patterns, which are thought to suggest follicular neoplasm (adenoma or carcinoma). To assess the risk of malignancy associated with specific cytologic patterns, we correlated preoperative FNA cytologic patterns (n = 484 reports including repeat aspirations) with final histological diagnoses for 368 surgical thyroid specimens obtained during the period 1994-1998. The overall prevalence of malignancy in the surgical specimens was 31% (113 cancers, including 96 papillary and 9 follicular carcinomas). For nodules with benign FNA cytologic diagnoses of nodular goiter and chronic thyroiditis there was a low risk of malignancy (6/99, or 6.1%). Nodules with indeterminate cytologic patterns in the absence of nuclear atypia (i.e., microfollicles without nuclear atypia) had a similarly low malignancy risk (3/46, or 6.5%). In contrast, 31/52 nodules with cytologic nuclear atypia consistent with follicular neoplasm were malignant (60%), including specimens with or without microfollicular cytology. Nodules with frankly malignant cytologic patterns were almost invariably cancer (54/55), and cytologic diagnoses of papillary carcinoma were confirmed at surgery in all 49 cases. These results indicate that indeterminate microfollicular cytologic patterns in the absence of nuclear atypia are associated with a low risk of malignancy, at least in this series. This finding suggests that many nodules with such microfollicular cytology might be managed conservatively with observation. In contrast, cytologic nuclear atypia consistent with a follicular neoplasm confers a high risk of cancer. In addition, frankly malignant cytologic diagnoses, especially papillary carcinoma, are highly reliable, and thus may be used as a guide for planning surgery appropriate for thyroid cancer.

Percutaneous Transthoracic Needle Aspiration Biopsy: A Comprehensive Review of Its Current Role in the Diagnosis and Treatment of Lung Tumors

The purpose of this study is to examine the accuracy and complications of transthoracic needle aspiration biopsy (TTNA) to determine its optimal role in the evaluation of patients with lung tumors. The charts of 130 consecutive patients who had undergone CT-guided TTNA were reviewed retrospectively. Thirty-two (25%) of these patients had subsequent surgery and 5 had subsequent transbronchial biopsy (TBB). Using the final surgical and TBB diagnosis as a reference, the accuracy, sensitivity, specificity, and prevalence of malignancy were calculated. Each case was also examined to determine the presence or absence of complications. Of the 130 biopsy results, 95 (73%) were malignant, 33 (25%) were nonspecific, and only 2 (2%) had a specific benign diagnosis. Thirty-two patients subsequently underwent surgical resection. The overall prevalence of malignancy after surgical diagnosis was 91%. The overall diagnostic accuracy of TTNA was 76%. The sensitivity of TTNA for the detection of malignancy was 74% and its specificity was 100%. When comparing TTNA results of small (<3 cm) and large (> or = 3 cm) tumors, the occurrence of nonspecific results was 36% and 16%, respectively. Fifty-six (43%) patients had a pneumothorax subsequent to TTNA. Twenty-four (43%) of these patients required a chest tube and remained hospitalized for a mean of 6 days. Patients who are surgical candidates and have a high clinical suspicion for malignancy should undergo surgical biopsy and resection of their lung tumors if indicated. Information gained from TTNAs performed on this patient population will rarely result in a change in their clinical management.