Preoperative Fine-needle Aspiration Biopsy Research Articles

Galectin-3 detection on large-needle aspiration biopsy improves preoperative selection of thyroid nodules: A prospective cohort study

Background. New techniques of improving diagnostic reliability of thyroid nodules are needed. Aim and methods. This prospective cohort study includes patients with one (201) or multiple (22) palpable nodule(s). Preoperative fine-needle aspiration biopsy (FNAB), large-needle aspiration biopsy (LNAB), and galectin-3 detection on LNAB (GAL-3-LNAB) (total of 245 nodules) were compared when the FNAB finding was ‘inadequate’ or ‘indeterminate’. The sizes of the needles used for FNAB and LNAB were compared with the size of thyroid follicles. Forty nodules were surgically excised according to current recommendation.Results. GAL-3-LNAB was inadequate in 4% of nodules, compared with 34% using FNAB and 11% using LNAB (P < 0.0001). GAL-3-LNAB showed no indeterminate findings, compared with 15% using FNAB and 13% using LNAB (P < 0.0001). Among the 40 excised nodules, GAL-3-LNAB showed the highest accuracy values. The sensitivity (P = 0.011) and specificity (P < 0.000; P = 0.001) ranges were 40%–100% and 20%–40% for FNAB, 40%–100% and 50%–53.7% for LNAB, and 100% and 76.7%–80% for GAL-3-LNAB, respectively. The largest needles used for LNAB, 20 or 18 gauge, with an internal diameter of 0.6 or 0.91 mm, recorded the lowest rate of inadequate or indeterminate FNAB findings.Conclusions. GAL-3-LNAB reduced inadequate, abolished indeterminate findings, and provided specificity values higher than FNAB or LNAB in palpable thyroid nodules.

Sonography and fine‐needle aspiration biopsy in the diagnosis of benign versus malignant nodules in patients with autoimmune thyroiditis

To correlate sonographic (US) characteristics and results of fine-needle aspiration biopsy (FNAB) of thyroid nodules in autoimmune thyroiditis (AT) with surgical pathological findings. Forty AT patients with 40 nodular lesions were analyzed retrospectively. Five sonographic characteristics were recorded for each nodule: diameter, echogenicity, microcalcification, halo sign, and margin. Preoperative sonograms and FNAB results were compared with postoperative histopathological findings. Twenty-four of the 40 nodules were malignant, including 20 papillary carcinomas, 3 follicular carcinomas, and 1 medullary carcinoma. Of the 16 benign nodules, 8 were nodular hyperplasia, 6 lymphocytic thyroiditis, and 1 each follicular adenoma and Hürthle cell adenoma. The only US parameter that was significant in malignant vs. benign nodules was the presence of poorly defined margins. Based on preoperative cytology, 22 of the 23 malignant nodules were correctly diagnosed, and 10 of the 14 benign nodules were correctly identified. The positive predictive value was 78.6%, and the negative predictive value was 93.7%. No single US parameter can predict thyroid malignancy in patients with AT. A combination of US and FNAB provides the most sensitive and specific approach available preoperatively.

Clinical Efficacy of Fine-Needle Aspiration Biopsy of Thyroid Nodules in Males

It has recently been suggested that the use of fine-needle aspiration (FNA) biopsy of thyroid nodules in male patients is associated with an unacceptably high false-negative rate in the detection of thyroid malignancy. We hypothesize that FNA biopsy is an accurate preoperative tool for detecting thyroid cancer in men, and that false negative rates are significantly lower than recently reported. A retrospective database analysis was performed on all male patients who underwent thyroid surgery from May 1994 through January 2007 at a single institution. The results of preoperative FNA biopsies were compared with final surgical pathologic results. FNA biopsy results were reported as benign, malignant, inconclusive (i.e., follicular neoplasm), or nondiagnostic; final surgical pathology was reported as benign or malignant. Of 1205 patients who underwent thyroidectomy, 273 (23%) were male. Preoperative FNA biopsy results were obtained in 60% of these male patients and were read as benign in 45/165 (27%) patients, malignant in 47/165 (28%) patients, inconclusive in 66/165 (40%) patients, and nondiagnostic in 7/165 (4%) patients. In male patients with cytology reported as benign, 3/45 (6.7%) FNAs were determined to be malignant on final pathology. Our study determined that FNA biopsy of thyroid nodules in male patients has an acceptably low false-negative rate of 6.7% and is, therefore, an accurate and useful diagnostic tool. We recommend preoperative FNA biopsy for all male patients presenting with thyroid nodules as a standard of practice.

Accuracy of Fine-Needle Aspiration Biopsy for Predicting Neoplasm or Carcinoma in Thyroid Nodules 4 cm or Larger

All thyroid nodules 4 cm or larger should be surgically removed regardless of fine-needle aspiration biopsy (FNAB) results because of an unacceptably high rate of false-negative preoperative biopsy results in these large nodules. Retrospective cohort study. Single-institution, tertiary academic referral center. A retrospective analysis was performed on all patients who underwent surgery for a thyroid nodule 4 cm or larger from May 1, 1994, through January 31, 2007. Preoperative FNAB results were correlated with final surgical pathologic results. The FNAB results were reported as nondiagnostic, benign, inconclusive (follicular neoplasm), or malignant, whereas the final surgical pathologic data were reported as benign or malignant. Of 155 patients who underwent a thyroidectomy for a nodule 4 cm or larger, 21 patients (13.5%) had a clinically significant thyroid carcinoma within the nodule on final pathologic analysis. Preoperative cytologic testing of the mass was performed on 97 patients, and the results read as benign for 52, inconclusive for 23, nondiagnostic for 11, and malignant for 11. In lesions 4 cm or larger, 26 of 52 FNAB results reported as benign (50.0%) turned out to be either neoplastic (22) or malignant (4) on final pathologic analysis. Among patients with nondiagnostic FNAB results, the risk of malignant neoplasms was 27.3%. In patients with thyroid nodules 4 cm or larger, the FNAB results are highly inaccurate, misclassifying half of all patients with reportedly benign lesions. Furthermore, those patients with a nondiagnostic FNAB result display a high risk of differentiated thyroid carcinoma. Therefore, we recommend that diagnostic lobectomy be strongly considered in patients with thyroid nodules 4 cm or larger regardless of FNAB cytologic test results.

Low-grade cribriform cystadenocarcinoma of the parotid gland: A case report

Low-grade cribriform cystadenocarcinoma is a rare tumor that is recognized as a variant of cystadenocarcinoma by the 2005 WHO classification. We report a case of low-grade cribriform cystadenocarcinoma. The patient was a 32-year-old woman who presented with a mass in the right parotid region. Computed tomography and magnetic resonance imaging revealed a polycystic mass in the right parotid gland. The preoperative fine needle aspiration biopsy showed no malignancy, however the frozen section during surgery showed carcinoma. The patient subsequently underwent total parotidectomy with preservation of the facial nerve. Microscopically, the tumor had a typical feature of intraductal proliferation. There was a golden brown pigment and PAS-positive/diastase-resistant cytoplasmic granules in the epithelium of the cysts. Immunohistochemically, smooth muscle actin highlighted the cells rimming the cystic spaces. The tumor cells were negative for S-100 protein. The patient has no recurrence and no facial palsy after the treatment.

BRAF Mutation Testing of Thyroid Fine-Needle Aspiration Biopsy Specimens for Preoperative Risk Stratification in Papillary Thyroid Cancer

This study investigated the utility of BRAF mutation testing of thyroid fine-needle aspiration biopsy (FNAB) specimens for preoperative risk stratification in papillary thyroid cancer (PTC). We assessed the T1799A BRAF mutation status in thyroid FNAB specimens obtained from 190 patients before thyroidectomy for PTC and its association with clinicopathologic characteristics of the tumor revealed postoperatively. We observed a significant association of BRAF mutation in preoperative FNAB specimens with poorer clinicopathologic outcomes of PTC. In comparison with the wild-type allele, BRAF mutation strongly predicted extrathyroidal extension (23% v 11%; P = .039), thyroid capsular invasion (29% v 16%; P = .045), and lymph node metastasis (38% v 18%; P = .002). During a median follow-up of 3 years (range, 0.6 to 10 years), PTC persistence/recurrence was seen in 36% of BRAF mutation-positive patients versus 12% of BRAF mutation-negative patients, with an odds ratio of 4.16 (95% CI, 1.70 to 10.17; P = .002). The positive and negative predictive values for preoperative FNAB-detected BRAF mutation to predict PTC persistence/recurrence were 36% and 88% for overall PTC and 34% and 92% for conventional PTC, respectively. Preoperative BRAF mutation testing of FNAB specimens provides a novel tool to preoperatively identify PTC patients at higher risk for extensive disease (extrathyroidal extension and lymph node metastases) and those who are more likely to manifest disease persistence/recurrence. BRAF mutation, as a powerful risk prognostic marker, may therefore be useful in appropriately tailoring the initial surgical extent for patients with PTC.

Fine-needle aspiration biopsies in the management of indeterminate follicular and Hurthle cell thyroid lesions

Objectives To determine the value of fine-needle aspiration biopsies (FNABs) of the thyroid and stratify the risk of malignancy within the indeterminate FNAB diagnostic category at our institution. Study design Case series with chart review of preoperative FNABs of consecutive patients who underwent total thyroidectomy between 2005 and 2007. Subjects and Methods A total of 115 cases were reviewed, and FNABs were categorized into four groups: benign, positive or suspicious for malignancy, indeterminate (follicular or Hurthle cell lesions), and nondiagnostic. Cytohistologic correlation was then established. Results The accuracy of FNAB in detecting thyroid malignancy was 88 percent with false-negative and false-positive rates of 13 percent and 7 percent, respectively. Overall, 52 percent of the indeterminate cases were carcinomas (48 percent of follicular lesions and 62 percent of Hurthle cell lesions). In the presence of cytologic atypia, the rate of malignancy increased to 75 percent and 83 percent for the follicular and Hurthle cell lesions, respectively. Conclusions FNAB is an accurate and helpful method for the evaluation of thyroid nodules with results directly correlating with management. Surgery should be considered for FNABs categorized as indeterminate, especially in the presence of cytologic atypia. Because of the high false-negative rate, benign FNABs require close follow-up with ultrasound examination and periodic biopsies.

Accuracy, sensitivity and specificity of fine needle aspiration biopsy in salivary gland tumours: A retrospective study

The aim of this study was to evaluate the diagnostic accuracy, sensitivity and specificity of fine needle aspiration biopsies (FNAB) of salivary gland tumours performed at the Erasto Gaertner Hospital over the course of a four year period. A retrospective study was carried out between 2001-2005 to review the cases of patients with salivary gland tumours who had undergone pre-operative FNAB and had been diagnosed during post-operative histopathology examination. A total of 106 cases of salivary gland tumours were considered for this study, but 27 cases (25.5%) of the samples were considered unsatisfactory for analysis. The sensitivity, specificity and accuracy were calculated considering only the 79 benign and malignant cases in which FNAB provided sufficient samples for analysis. Based on these data, the value of sensitivity was 68.2% (15/22), specificity was 87.7% (50/57), accuracy was 82.3% (65/79), positive predictive value was 68.2% (15/22) and negative predictive value was 87.7% (50/57). Despite the high rate of inadequate samples obtained in the FNAB in this study, the technique offers high specificity, accuracy and acceptable sensitivity.

Molecular Detection of PPARγ Rearrangements and Thyroid Carcinoma in Preoperative Fine-Needle Aspiration Biopsies

Molecular Detection of PPARγ Rearrangements and Thyroid Carcinoma in Preoperative Fine-Needle Aspiration Biopsies

Papillary Hyperplastic Nodule: Pitfall in the Cytopathologic Diagnosis of Papillary Thyroid Carcinoma

To identify the pitfalls of overdiagnosing papillary formation as papillary thyroid carcinoma (PTC) in thyroid cytology specimens. Patients with papillary hyperplastic nodules who had preoperative fine-needle aspiration biopsy (FNAB) were selected for this study. All patients had been diagnosed as having either PTC or lesions suggestive of PTC on preoperative FNAB. Pathology reports, surgical reports, and cytopathology slides were reviewed and analyzed for demographic data, nature of surgery, and pathologic features. Six women and 2 men with a mean age of 49 years (range, 16-79 years) were included. The lesion size ranged from 1.0 to 3.5 cm. Four patients were diagnosed as having PTC and 4 as having lesions suspicious for PTC. FNAB specimens were available for review in 6 cases. Surgical pathology slides were reviewed in all cases. When cytologic material was evaluated for the morphologic features that led to the misdiagnosis of PTC by comparing it with FNAB specimens of classic variant of PTC, the specimens from these patients showed follicular cells arranged in short, nonbranching papillae in a background of watery colloid and macrophages. The follicular cells were round and demonstrated oncocytic change with nuclear enlargement, prominent central nucleoli, nuclear chromatin clearing, and intranuclear grooves. Caution should be exercised rendering the diagnosis of PTC on FNAB samples when a thyroid lesion shows papillary configurations and oncocytic cells and if convincing nuclear features of PTC are not present. Furthermore, some morphologic features on thyroid aspiration can help differentiate these cases from true PTC.

Sonographic Features of the Follicular Variant of Papillary Thyroid Carcinoma

The purpose of this study was to evaluate the sonographic findings of the follicular variant of papillary thyroid carcinoma (FVPTC) and to assess the role of preoperative fine-needle aspiration biopsy (FNAB). The sonographic findings of 27 thyroid nodules in 26 patients (2 male and 24 female; mean age, 45 years) with surgically proven FVPTC were reviewed retrospectively. Findings were categorized according to the echogenicity, margin, shape, and presence of microcalcifications. Malignant findings included marked hypoechogenicity, irregular or microlobulated margins, a taller-than-wide shape, and microcalcifications. Thyroid nodules with a single malignant finding as described above were classified as malignant. All patients underwent sonographically guided FNAB, and the sensitivity of the cytologic results was calculated. Lesion sizes varied from 3 to 34 mm (mean, 15.2 mm), and lesions were most commonly solid (23 [85.2%]), hypoechoic (14 [51.9%]), and oval (17 [63%]) with well-defined margins (14 [51.9%]) and no microcalcifications (23 [85.2%]). Eighteen lesions (66.7%) were correctly classified as malignant, whereas 9 (33.3%) were classified as benign on the basis of sonographic criteria. Twenty-four samples were adequate for cytologic examination, and 3 were inadequate. Twenty-one of 24 diagnostic cytologic results (87.5%) were suspicious for papillary carcinoma (5 of 21 [20.8%]) or malignant (16 of 21 [66.7%]), whereas 3 lesions (12.5%) had benign results. The sensitivity of FNAB was 77.8% (21 of 27). The follicular variant of papillary thyroid carcinoma tends to have relatively benign sonographic features, such as hypoechogenicity, well-defined margins, an oval shape, and no microcalcifications, but most lesions were correctly classified as malignant by both sonography and FNAB. The possibility of FVPTC should be considered when thyroid nodules with a relatively benign sonographic appearance have suspicious or malignant FNAB results.

Two resected cases of esophageal leiomyoma diagnosed with preoperative endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB)

Leiomyoma is the most common submucosal tumor of the esophagus, and accurate preoperative diagnosis is difficult. We report herein on two resected cases of esophageal leiomyoma preoperatively diagnosed accurately with endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB). The first patient, a 34-year-old man, had complained of dysphagia. Following EUS-FNAB, the pathological diagnosis was leiomyoma. Esophagectomy and reconstruction with a gastric tube were performed because the tumor had almost completely encircled the esophageal wall. The second patient, a 60-year-old woman, had complained of dysphagia. Following EUS-FNAB, the pathological diagnosis was leiomyoma. Enucleation of the tumor was performed because the tumor was not located in the entire circumference of the esophageal wall. The postoperative course of both patients was uneventful, and the final pathological diagnosis of each case was leiomyoma. We conclude that EUS-FNAB is a useful method for diagnosing esophageal submucosal tumors and for selecting an appropriate surgical procedure.

Molecular Detection of PPARγ Rearrangements and Thyroid Carcinoma in Preoperative Fine-Needle Aspiration Biopsies

The pathologic diagnosis of thyroid follicular tumors is difficult, particularly in preoperative fine-needle aspiration biopsies. To investigate whether the molecular diagnosis of PPAR gamma rearrangements can detect thyroid carcinomas in fine-needle aspiration biopsies, we performed interphase fluorescence in situ hybridization on 24 thyroid fine-needle aspiration and 17 follow-up thyroidectomy specimens. Two of the 24 fine-needle aspiration biopsies contained PPAR gamma rearrangements, and both were diagnosed suggestive of a thyroid follicular neoplasm by cytology. The two corresponding thyroidectomies each contained PPAR gamma rearrangements in all tumor cells and, both were diagnosed follicular-patterned thyroid carcinomas-one a follicular carcinoma and the other a follicular variant of papillary carcinoma, the latter by majority of expert endocrine pathologists. Our experiments demonstrate that PPAR gamma rearrangements can detect a subset of follicular-patterned thyroid carcinomas in preoperative thyroid fine-needle aspiration biopsies. The ultimate utility of mutations such as PPAR gamma rearrangements in diagnosis of thyroid carcinoma must be proven by direct correlation of mutation status with thyroid tumor biology and not just with thyroid tumor morphology, a subjective and imprecise marker of clinical behavior. The application of specific mutations to preoperative diagnosis of thyroid carcinoma is predicted to improve the accuracy and reduce the costs of treating patients with thyroid tumors.

The Value of FNABs in the Management of Thyroid Lesions

Objective Determine the value of fine-needle aspiration biopsies (FNAB), and stratify the risk of malignancy within the indeterminate FNAB diagnostic category at our institution. Methods The preoperative FNABs of 115 consecutive patients who underwent thyroidectomy at a teaching hospital between 2005 and 2007 were reviewed and categorized into 4 groups: negative for malignancy, positive or suspicious for malignancy, indeterminate, and nondiagnostic. The final histopathological diagnosis was then compared with the FNAB result. FNABs reported as follicular or Hurthle cell lesions were considered indeterminate diagnoses, and malignancy rates were calculated within this category. Results The FNAB results were as follows: 17% negative for malignancy, 35% positive or suspicious for malignancy, 40% indeterminate, and 8% nondiagnostic. The sensitivity of FNAB in detecting thyroid malignancy was 83%, specificity 92% and accuracy 85%. There were 9 discrepant cases giving a false negative rate of 17% and a false positive rate of 8%. Overall, 52% of the indeterminate cases were carcinomas, with a malignancy rate of 48% for the follicular lesions and 62% for the Hurthle cell lesions. When cytological atypia was present, the rate of malignancy increased to 75% and 83% for the follicular and Hurthle cell lesions, respectively. Conclusions Our study confirms that FNAB is an accurate and helpful method for the evaluation of thyroid nodules with results directly correlating with management. Moreover, surgery should be strongly considered for FNABs categorized as indeterminate cases, especially in the presence of cytological atypia. Due to the high false negative rate, benign FNABs require close follow-up and periodic rebiopsies.

Fine‐needle aspiration cytology of a lipoblastoma: A case report

A lipoblastoma is a rare benign tumor of immature white fat, and more than 90% of lipoblastomas occur before the age of 3 years. The diagnosis of a lipoblastoma is mostly dependent on a histopathological examination of a surgically excised specimen. However, an accurate preoperative diagnosis is essential for the planning of surgery, particularly for a lesion of the head and neck area. We experienced a case of a cervical lipoblastoma of a 23-month-old boy. A preoperative fine-needle aspiration biopsy showed the sample as moderately cellular and showed fragments of mature and immature adipose tissues containing a large number of capillary vessels. There were numerous lipoblast-looking cells with a multivacuolated cytoplasm, and the nuclei were small, compressed by vacuoles, and centrally located. According to the cytological findings, the lesion was diagnosed as a benign adipose tumor suggestive of a lipoblastoma. Subsequent surgical excision confirmed the diagnosis of the fine-needle aspiration biopsy. The cytologic features of lipoblastoma are not well known because of the rarity of the lesion. However, the fine-needle aspiration cytological features of a lipoblastoma are sufficiently characteristic to make a specific preoperative diagnosis.

Cytologic Differentiation of Struma Ovarii from Other Ovarian Neoplasms

To present the cytologic findings of struma ovarii and value of cytology and immunocytochemistry (ICC) using thyroglobulin (TGB) and thyroid transcription factor-1 (TTF-1) in evaluation of this unusual ovarian neoplasm, together with the diagnostic pitfalls.Intraoperative cytologic findings of 7 patients with struma ovarii are reviewed. Cytologic material of both cystic and solid components was collected intraoperatively. ICC staining was done, and cell block preparation performed on selected cases.The cases were divided in to 3 groups: group 1--diagnosis of struma ovarii was made by cytology and confirmed by ICC (1 case); group 2--diagnosis was suggestive on cytology or cell block and confirmed by ICC staining (4 cases); group 3--on cytologic diagnosis indistinguishable from other cystic ovarian neoplasms (2 cases). Cytologic findings were typically colloid with mosaic pattern, follicles, follicular cells only, sheets of follicular cells, both colloid and follicular cells, proteinaceous background or degenerated epithelial cells indistinguishable from other cystic ovarian neoplasms.Cytologic findings of struma ovarii are distinct enough to be suggested intraoperatively, and ICC for TGB or TTF-1 is a valuable tool for preoperative fine needle aspiration biopsy and intraoperative diagnosis of this benign ovarian neoplasm.

Frozen section and fine needle aspiration biopsy in thyroid surgery — needles and sections

To review our own experience with fine needle aspiration biopsy (FNAB) and frozen section (FS) in thyroid surgery and to assess the value of FNAB and FS in predicting malignancy in patient with thyroid disease. The records of 300 patients who underwent thyroid surgery between April 2001 and June 2006 were analyzed. Of the 153 patients who had preoperative FNABs performed, 8 (5.22%) were reported as indeterminate, 100 (65.35%) were read as benign, and 3 (1.96%) were read as malignant. Fourty two of the FNABs were inadequate for evaluation (27.45%). When occult papillary carcinomas were excluded, sensitivity, and accuracy rates for FNAB reached 100%. One hundred and ninety one patients had FSs performed. 184 (96.33%) of these were reported as benign, 4 (2.09%)were reported as malignant, 3 (1.57%) were deferred to permanent paraffin (PP) sections. When occult papillary carcinomas were excluded, sensitivity, and accuracy rates for FS were 42.85%, 43%, and 97.28% respectively. Our data supports the use of FNAB in the confirmation of malignancy and the need for operation. The routine use of FS is not warranted. Selective use of FS when FNAB is nondiagnostic or indeterminate may provide additional information. Both FNAB and FS fail to reveal occult carcinomas of thyroid.

The role of pre-operative CT-guided FNAB for parapharyngeal space tumors

To determine the role of computed tomography (CT)-guided fine needle aspiration biopsy (FNAB) in surgical planning for parapharyngeal space (PPS) tumors. Chart review of 49 consecutive patients with surgically treated PPS tumors from 1995 to 2005. Twenty-nine patients had CT-guided FNAB. A cytopathologic diagnosis that was the same as final pathology was rendered in 14 (48%) patients; suggestive but not conclusive in 6 (21%) patients; discordant in 3 (10%) patients; and 6 (21%) patients had a nondiagnostic result. Fourteen of 15 patients who had a final histopathologic finding of pleomorphic adenoma had a correct or highly suggestive preoperative FNAB diagnosis. The positive predictive value for CT-guided FNAB to identify benign tumors is 90%, (18 of 20) but to identify malignant PPS tumors is 75% (3 of 4). CT-guided FNAB of PPS tumors is helpful to predict the nature of the PPS tumors (especially benign), which allows the surgeon and patient to plan for treatment, accordingly.

Late‐Onset Medullary Carcinoma of the Thyroid: Need for Genetic Testing and Prophylactic Thyroidectomy in Adult Family Members

Sporadic late-onset medullary carcinoma of the thyroid is quite rare. Usually, the patient presents with a thyroid mass or neck node metastasis along with high levels of calcitonin and preoperative fine needle aspiration biopsy suggestive of medullary carcinoma of the thyroid. The role of genetic testing in such individuals, along with testing of other family members, remains somewhat unclear at this stage, especially in patients presenting with familial medullary thyroid carcinoma. Genetic testing with RET proto-oncogene mutational studies is very popular in familial medullary thyroid carcinoma, especially in children, with routine prophylactic thyroidectomy. However, its indications in adults remain unclear at this time. Recently, a 69-year-old woman presented with a thyroid mass and underwent total thyroidectomy and central compartment dissection. She was found to have medullary carcinoma of the thyroid. The patient had four children, three of whom were found to have a RET mutation similar to their mother's, V804M. In view of the RET mutation, the three children were offered prophylactic thyroidectomy at ages 42, 45, and 47. The patient's son was noted to have extensive C-cell hyperplasia in both lobes of the thyroid. The other two individuals had benign pathology with no evidence of C-cell hyperplasia. There is no definite consensus of opinion about the need for prophylactic total thyroidectomy in adults with RET mutation. The rarely reported 804 mutation is, however, a predictor of medullary carcinoma of the thyroid. One individual in this group had extensive C-cell hyperplasia, suggesting that he would have developed medullary carcinoma of the thyroid in the future. Prophylactic thyroidectomy should be recommended in patients with RET mutation and a family history of medullary carcinoma of the thyroid; however, its role in adult family members needs to be evaluated with larger registry of prophylactic thyroidectomy. Whether these adults with rare 804-mutation could be observed and followed with serial calcitonin, ultrasound, or calcitonin stimulation tests remains to be studied.

Lip defects due to tumor excision: Apropos of 899 cases

Reconstructive surgery of the lips after resection of tumors requires a complete understanding of the anatomy of this region. Most lip cancers remain localized and grow slowly, with a propensity for superficial rather than vertical spread. From January 1983 to December of 2005, 899 patients underwent reconstructive surgery for skin tumors involving the lips. SCCs were the most frequent skin tumors on male patients whereas BCCs were most common on the female patients. The lower lip was the anatomic zone most frequently involved in our series. Preoperative evaluation of the patients was performed in all cases. In the last five-years, we have performed preoperative fine needle aspiration (FNA) biopsy of the tumor. The FNA sample was then examined by ThinPrep technique (Cytolyt; Cytyc, Co, Boxborough, MA, USA). In our series, from the 550 patients who had a five-year follow-up we observed 62 recurrences of the primary tumor. The five-year recurrence rate was 11.28%. The aim of this retrospective study is to report our experience in the treatment of lips tumors with selective combination of treatment modalities.