Unifocal Tumors Research Articles

Целесообразность выполнения органосохраняющих операций при мультифокальном/мультицентричном раке молочной железы

The incidence of multifocal (MF) and multicentric (MC) carcinomas varies widely among clinical studies, depending on definitions and methods for pathological sampling. Magnetic resonance imaging is increasingly used because it can help identify additional and conven-tionally occult tumors with high sensitivity. However, false positive lesions might incorrectly influence treatment decisions. Therefore, preoperative biopsies must be performed to avoid unnecessary surgery. Most studies have shown higher lymph node involvement rates in MF/MC tumors than in unifocal tumors. However, the rate of local recurrences is usually low after breast conservative treatment (BCT) of MC/MF tumors. It has been suggested that BCT is a reasonable option for MC/MF tumors in women aged 50-69 years, with small tumors and absence of extensive ductal carcinoma in situ. A metaanalysis showed an apparent decreased overall survival in MC/MF tumors but data are controversial. Surgery should achieve both acceptable cosmetic results and negative margins, which requires thorough preoperative radiological workup and localization of lesions. Boost radiotherapy techniques must be evaluated since double boosts might result in increased toxicity, namely fibrosis. In conclusion, BCT is feasible in selected patients with MC/MF but the choice of surgery must be discussed in a multidisciplinary team comprising at least radiologists, surgeons and radiotherapists.

Impact of academic facility type and volume on post-surgical outcomes following diagnosis of glioblastoma

ObjectiveTo identify if facility type and/or facility volume impact overall survival (OS) following diagnosis of glioblastoma (GBM). We also sought to compare early post-surgical outcomes based on these factors. MethodsThe National Cancer Database was queried for patients with GBM diagnosed from 2004 to 2013 with known survival. Patients were grouped based on facility type and facility volume. Multivariable analyses were performed to investigate factors associated OS following diagnosis and Chi-square tests were used to compare early post-surgical outcomes. Results89,839 patients met inclusion criteria. Factors associated with improved OS on multivariable analysis included younger patient age, female gender, race, lower comorbidity score, higher performance score, smaller tumor size, unifocal tumors, MGMT hypermethylation, fully resected tumors, radiotherapy, and chemotherapy (each p < .001). Also, OS was improved among patients treated at centers averaging at least 30.2 cases per year (HR 0.948, compared to <7.4 cases/year, p < .001), and patients treated at Academic/Research programs had improved survival compared to those treated at Comprehensive Community Cancer programs (HR 1.069, p < .001) and Integrated Network Cancer programs (HR 1.126, p < .001). Similarly, Academic/Research programs and high volume centers demonstrated improved 30- and 90-day morality as well as 30-day readmission rates (p < .001). ConclusionsThis study suggests that patients treated in Academic/Research programs and high patient-volume centers have increased survival and more favorable early-postsurgical outcomes. The extent to which differences in patient populations, socioeconomic factors, and/or provider expertise play into this cause will be areas of future research.

Is Multifocality an Indicator of Aggressive Behavior in Small Bowel Neuroendocrine Tumors?

Many patients with small bowel neuroendocrine tumors (SBNETs) have multifocal tumors (MFTs), but the frequency of MFTs has varied widely across SBNET studies. It is also unclear whether patients with MFTs have more advanced disease or worse clinical course than do those with unifocal SBNETs. We set out to determine the frequency of multifocal and unifocal SBNETs and compare clinicopathologic factors, somatostatin receptor 2 expression, and survival. Clinicopathologic variables from 179 patients with surgically managed SBNETs were collected. Statistical comparisons were made using Welch t-test, Wilcoxon test, and Fisher's exact test. Survival was assessed using the Kaplan-Meier method. Somatostatin receptor 2 expression was analyzed by quantitative polymerase chain reaction, and Ki-67 expression by immunohistochemistry. Multifocal tumors were found in 45% of patients with SBNETs. Clinicopathologic factors such as grade, TNM stage, presence of distant metastases, mean somatostatin receptor 2 expression, success of imaging modalities, and preoperative and postoperative hormone levels were not significantly different between multifocal and unifocal groups. Progression-free survival and overall survival were also not significantly affected by multifocality. Clinicopathologic features and survival of patients with MFTs and unifocal tumors are remarkably similar. Although the etiology of MFTs is unclear, patients with MFTs do not have a more aggressive clinical course than patients with unifocal SBNETs.

Clinical Management and Survival of Patients with Central Nervous System Hemangiopericytoma in the National Cancer Database

Abstract Purpose/objectives Hemangiopericytomas are rare central nervous system (CNS) tumors. We sought to investigate existing clinical management strategies and overall survival (OS) among patients with hemangiopericytomas of the CNS. Methods/materials All patients diagnosed with CNS hemangiopericytoma from 2004 to 2014 in the National Cancer Database were included. Clinical and treatment-related characteristics were analyzed for an association with OS following diagnosis using univariable and multivariable analyses. Results Nine-hundred and eighty-one patients were included (0.22% of all CNS tumors). At diagnosis, 22 patients had spinal tumors (2%), 21 patients had multifocal tumors (2%) 28 had disseminated disease (3%), and the remainder were unifocal intracranial tumors. Patients either underwent surgical resection and radiation (48%), surgery alone (37%), radiation alone (6%), or biopsy alone (9%). Of patients with known extent of resection, 53% underwent gross total resection, and, of patients with known radiation modality, 15% received stereotactic radiosurgery. Among the total cohort, 3 and 10 year OS was 87% and 59%, respectively. On multivariable analysis, factors associated with inferior OS included age (HR = 1.05, p p p = 0.04), disseminated disease (HR = 2.67, p = 0.01), and chemotherapy (HR = 2.66, p = 0.01). Patients receiving surgery alone or surgery and radiation demonstrated improved OS compared to biopsy alone (HR = 0.45, p = 0.01 and HR = 0.47, p = 0.02, respectively). However radiation utilization did not impact OS ( p = 0.691). Conclusions The present data provide large-scale prognostic information from a contemporary cohort of patients with hemangiopericytoma and support an initial attempt at surgical extirpation. The benefits of ionizing radiation are likely limited to improved local control and neurologic function.

Multifocal Gastric Histiocytic Sarcoma Presenting as Gastrointestinal Bleeding

Histiocytic sarcoma is a rare malignancy that accounts for less than 1% of hematologic neoplasms, and shows morphologic and immunophenotypic non-Langerhans histiocytic differentiation. Commonly presents with nodal involvement, however extranodal sites are involved in 1/2 of cases. The skin and gastrointestinal (GI) tract are commonly involved. GI involvement manifests as abdominal mass, pain, intestinal obstruction, lower GI bleeding, or weight loss. We present case of histiocytic sarcoma manifesting as upper GI bleeding from innumerable synchronous gastric polyps. A 76 y/o female with CAD requiring multiple coronary stents, CABG, and AICD on dual antiplatelet therapy presented with melena and hematemesis. EGD revealed innumerable sessile and pedunculated polyps in the gastric body, fundus, and antrum. Two oozing polyps up to 5.3cm in diameter required polypectomy. Pathology showed histiocytic sarcoma. CT-scan was negative for metastases. 4 days post-discharge she developed further GI bleeding that required total gastrectomy with Roux-en-Y reconstruction for hemostasis. Intra-operatively no metastases were seen and negative margins were obtained. Two months later, the patient had recurrent hematemesis. CT scan showed small bowel obstruction and an intraluminal lesion, confirmed to be recurrent histiocytic sarcoma on endoscopic biopsies. The patient was discharged with plans for outpatient treatment, but sadly expired one month later. Although histiocytic sarcoma has been described throughout the GI tract, tumor confined to the stomach has only been described in 10 cases. Upon literature review, these have been mainly described in Asian populations and associated with H. pylori infection. Histiocytic sarcoma may present as a unifocal or multifocal tumor. Disease course is difficult to predict due to scarcity of reports, but aggressive behavior has been described. Our case illustrates the propensity for multifocal histiocytic sarcoma to behave aggressively despite complete resection with negative margins. Despite complete resection, distal recurrence has been described in 50% of cases and local recurrence in 20% of the cases. Multifocal disease confers a poor prognosis and is associated with poor response to chemotherapy. Our case represents an unusual case of multifocal disease limited to one organ. Complete margin-negative resection was possible, but the tumor recurred regionally in the jejunum, reflecting propensity to recur distantly rather than locally.Figure. 56: mm oozing pedunculated polyp seen on proximal gastric body on EGD at initial presentation.Figure: Innumerable gastric polyps throughout the fundus and body of the stomach.Figure: Jejunal polyp representing recurrence after margin negative total resection with gastrectomy.

Sentinel Lymph Node Biopsy in the Management of Vulvar Carcinoma: An Evidence-Based Insight.

Lymph node metastasis has been shown to represent the most significant prognostic factor in vulvar carcinoma. Because only 25% to 35% of patients with early stage disease have lymph node metastases, a significant 65% to 75% possibly do not benefit from elective inguinofemoral lymphadenectomy considering the related morbidities of wound infection, breakdown, and lower limb lymphedema. This review article aims to present and summarize the evidence available with regard to sentinel lymph node (SLN)-guided management of vulvar carcinoma. A literature search was performed in MEDLINE resources using the subject headings "vulvar neoplasms," "sentinel lymph node," "sentinel lymph node biopsy," and "lymphatic metastasis." This search returned 886 articles that were published through January 2017. Prospective studies investigating sentinel node identification techniques and their impact on vulvar cancer management and prognosis were considered. Case reports were excluded from the review. Technetium-99-m-labeled nanocolloid with or without blue dye and more recently indocyanine green fluorescence have been the main techniques used for SLN identification in vulvar carcinoma. Radioisotope and near-infrared techniques have been shown to be superior to blue dye particularly with midline lesions that drain bilaterally or that drain directly to a deep pelvic node. Patients with a small unifocal primary tumor (<4 cm) and no obvious preoperative metastasis have been shown to have low groin recurrence rates and excellent disease-specific survival rates with minimal treatment-related morbidity when undergoing SLN biopsy-guided management. Sentinel lymph node biopsy-guided management seems to be safe when restricted to International Federation of Gynecology and Obstetrics IB to II cases where tumors are unifocal, less than 4 cm in size, and when there is no evidence of lymph node metastasis on clinical/radiological assessment. This reduces operative morbidity in this cohort of patients.

Duodenal-Jejunal Flexure GI Stromal Tumor Frequently Heralds Somatic NF1 and Notch Pathway Mutations.

GI stromal tumors (GISTs) are commonly associated with somatic mutations in KIT and PDGFRA. However, a subset arises from mutations in NF1, most commonly associated with neurofibromatosis type 1. We define the anatomic distribution of NF1 alterations in GIST. We describe the demographic/clinicopathologic features of 177 patients from two institutions whose GISTs underwent next-generation sequencing of ≥315 cancer-related genes. We initially identified six (9.7%) of 62 GISTs with NF1 genomic alterations from the first cohort. Of these six patients, five (83.3%) had unifocal tumors at the duodenal-jejunal flexure (DJF). Two additional patients with DJF GISTs had non-NF1 (KIT and BRAF) genomic alterations. After excluding one DJF GIST with an NF1 single nucleotide polymorphism, four (57.1%) of seven sequenced DJF tumors demonstrated deleterious NF1 alterations, whereas only one (1.8%) of 55 sequenced non-DJF GISTs had a deleterious NF1 somatic mutation (P < .001). One patient with DJF GIST had a germline NF1 variant that was associated with incomplete penetrance of clinical neurofibromatosis type 1 features along with a somatic NF1 mutation. Of the five DJF GISTs with any NF1 alteration, three (60%) had KIT mutations, and three (60%) had Notch pathway mutations (NOTCH2, MAML2, CDC73). We validated these findings in a second cohort of 115 GISTs, where two (40%) of five unifocal NF1-mutated GISTs arose at the DJF, and one of these also had a Notch pathway mutation (EP300). Broad genomic profiling of adult GISTs has revealed that NF1 alterations are enriched in DJF GISTs. These tumors also may harbor concurrent activating KIT and/or inactivating Notch pathway mutations. In some cases, germline NF1 genetic testing may be appropriate for patients with DJF GISTs.

AB007. Bladder-sparing treatments for muscle-invasive bladder cancer

Radical cystectomy (RC) with pelvic lymph node dissection remains the gold-standard treatment for muscle-invasive bladder cancer (MIBC). Growing evidence suggests that bladder-sparing treatments may lead to acceptable oncologic outcomes in carefully selected patients and can offer improved quality of life through preservation of a functioning bladder. We summarize our clinical experience of bladder-sparing treatments for MIBC and review articles. MIBC patients with cT2 stage, unifocal tumor, absence of CIS or hydronephrosis are eligible for selective bladder preservation if they refuse or unfit for RC.

Estimation of tumor size in breast cancer comparing clinical examination, mammography, ultrasound and MRI-correlation with the pathological analysis of the surgical specimen.

To evaluate the best method in our center to measure preoperative tumor size in breast tumors, using as reference the tumor size in the postoperative surgical specimen. We compared physical examination vs. mammography vs. resonance vs. ultrasound. There are different studies in the literature with disparate results. This is a retrospective study. All the included patients have been studied by clinical examination performed by gynecologist or surgeon specialists in senology, and radiological tests (mammography, ultrasound and magnetic resonance imaging). The correlation of mammary examination, ultrasound, mammography and resonance with pathological anatomy was studied using the Pearson index. Subsequently, the results of such imaging tests were compared with the tumor size of the infiltrating component measured by anatomopathological study using a student's t test for related variables. The level of significance was set at 95%. Statistical package R. was used. A total of 73 cases were collected from October 2015 to July 2016 with diagnosis of infiltrating breast carcinoma. Twelve cases of carcinoma in situ and seven cases of neoadjuvant carcinoma are excluded. Finally, a total of 56 cases were included in the analysis. The mean age of the patients is 57 years. The histology is of infiltrating ductal carcinoma in 46 patients (80.7%), lobular in 8 (14%) and other carcinomas in 3 cases (5.2%). We verified the relationship between preoperative tumor size by physical examination, mammography, ultrasound (US) and magnetic resonance imaging (MRI), and the final size of the surgical specimen by applying a Pearson correlation test. A strong correlation was found between the physical examination results 0.62 (0.43-0.76 at 95% CI), ultrasound 0.68 (0.51-0.8 at 95% CI), mammography 0.57 (0.36-0.72 at 95% CI) and RM 0.51 (0.29-0.68 at 95% CI) with respect to pathological anatomy. The mean tumor size of the surgical specimen was 16.1 mm. Mean of tumor size by physical examination was 12.1 mm (P<0.05), by 14 mm US (P<0.05), by mammography of 14.3 (P<0.05) and by MRI of 22.53 mm (P>0.05). Ultrasonography is the best predictor of tumor size in breast cancer, compared with clinical examination, mammography, and resonance. Our work could help the decision-making process such as the type of conservative surgery, the possible need for oncoplastic surgery or the decision to start treatment with neoadjuvant therapy, in patients with unifocal tumors.

Multifocal and Multicentric Breast Carcinoma: A Significantly More Aggressive Tumor than Unifocal Breast Cancer.

There are still many questions that surround multifocal or multicentric breast carcinoma (MMBC). The aim of this study was to analyze the clinicopathological characteristics of MMBC and provide feasible suggestions for therapy. A total of 156 cases of MMBC in 3,597 invasive ductal breast carcinomas were collected and reviewed. Some factors related with prognosis such as tumor size, lymph node metastasis and others were assessed in each tumor focus, and mismatches among foci were recorded. The majority of MMBC had aggregate dimensions over 2 cm (85.90%). The rate of axillary lymph node metastasis was 56.41% (88/156) compared to unifocal tumors of 33.01% (1,136/3,441). Most cases had higher Ki-67 proliferative indices (91/156). Mismatches in ER status were present in 6 cases, PR in 4 cases, proliferative index (Ki-67) in 9 cases and HER2-positive status in 2 cases. The larger aggregate dimension of tumor, the higher metastatic rate of axillary lymph node and the high Ki-67 proliferative index seen in most cases, suggest that MMBC is biologically more aggressive than unifocal breast cancer. In addition, every focus should be tested owing to the existence of different expressions of immunostaining between foci.

Relevance of breast MRI in determining the size and focality of invasive breast cancer treated by mastectomy: a prospective study

BackgroundThe aim of this study was the evaluation of breast MRI in determining the size and focality of invasive non-metastatic breast cancers.MethodsThe prospective, single-centre study conducted in 2015 compared preoperative MRI with histological analysis of mastectomy.ResultsOne hundred one mastectomies from 98 patients were extensively analysed. The rates of false-positive and false-negative MRI were 2 and 4% respectively. The sensitivity of breast MRI was 84.7% for the detection of all invasive foci, 69% for single foci and 65.7% for multiple foci. In the evaluation of tumour size, the Spearman rank correlation coefficient r between the sizes obtained by MRI and histology was 0.62. The MRI-based prediction of a complete response to neoadjuvant chemotherapy was 75%.DiscussionMRI exhibits high sensitivity in the detection of invasive breast cancers. False positives were linked to the inflammatory nature of the tumour bed. False negatives were associated with small or low-grade tumours and their retro-areolar location. The size of T1 tumours was overestimated by an average of 7%, but MRI was the most efficient procedure. The sensitivity of MRI for the diagnosis of unifocal tumours was higher than that for multifocal sites. Our study confirmed the positive contribution of preoperative MRI for invasive lobular carcinomas and complete response predictions after neoadjuvant chemotherapy.

Clinical management and survival of patients with central nervous system hemangiopericytoma in the National Cancer Database

Purpose/objectivesHemangiopericytomas are rare central nervous system (CNS) tumors. We sought to investigate existing clinical management strategies and overall survival (OS) among patients with hemangiopericytomas of the CNS. Methods/materialsAll patients diagnosed with CNS hemangiopericytoma from 2004 to 2014 in the National Cancer Database were included. Clinical and treatment-related characteristics were analyzed for an association with OS following diagnosis using univariable and multivariable analyses. ResultsNine-hundred and eighty-one patients were included (0.22% of all CNS tumors). At diagnosis, 22 patients had spinal tumors (2%), 21 patients had multifocal tumors (2%) 28 had disseminated disease (3%), and the remainder were unifocal intracranial tumors. Patients either underwent surgical resection and radiation (48%), surgery alone (37%), radiation alone (6%), or biopsy alone (9%). Of patients with known extent of resection, 53% underwent gross total resection, and, of patients with known radiation modality, 15% received stereotactic radiosurgery. Among the total cohort, 3 and 10year OS was 87% and 59%, respectively. On multivariable analysis, factors associated with inferior OS included age (HR=1.05, p<0.001), WHO grade (p<0.001), multifocal disease (HR=2.59, p=0.04), disseminated disease (HR=2.67, p=0.01), and chemotherapy (HR=2.66, p=0.01). Patients receiving surgery alone or surgery and radiation demonstrated improved OS compared to biopsy alone (HR=0.45, p=0.01 and HR=0.47, p=0.02, respectively). However radiation utilization did not impact OS (p=0.691). ConclusionsThe present data provide large-scale prognostic information from a contemporary cohort of patients with hemangiopericytoma and support an initial attempt at surgical extirpation. The benefits of ionizing radiation are likely limited to improved local control and neurologic function.

3D printed pathological sectioning boxes to facilitate radiological–pathological correlation in hepatectomy cases

Radiogenomics promises to identify tumour imaging features indicative of genomic or proteomic aberrations that can be therapeutically targeted allowing precision personalised therapy. An accurate radiological–pathological correlation is critical to the...

Sexual Sparing Robot-Assisted Radical Cystectomy in Female: Technique Step-by-Step

Introduction and Objective: Anterior pelvic exenteration is often synonym of radical cystectomy (RC) in women, including removal of bladder, urethra, ovaries, fallopian tubes, uterus, and part of the vagina. However, preservation of the gynecologic organs is possible in selected women. After 100 minimally invasive RCs (60 laparoscopic and 40 robotic), we describe the technique of “Sexual-sparing robot-assisted radical cystectomy” (RARC) in a female. Methods: Sexual sparing RC is offered to sexually active, relatively young women affected by low stage clinical localized muscle-invasive bladder cancer (≤T2b, N0, M0), unifocal tumor away from bladder base, and with free internal genital organs. We report the technique of RARC in a female with preservation of genital organs. Results: A four robotic arm configuration is adopted. A bilateral extended pelvic lymph node dissection is performed: the proximal limit is the ureter cross over the common iliac a.; laterally the genitofemural-n. and psoas m.; caudally Cloquet's node; and medially peritoneal sheet, umbilical a. and lateral edge of the bladder. Ureters are dissected down to the ureterovesical junction at level of uterine a. crossing. Ureters are divided and distal ureteral margins are sent bilaterally for frozen section. Vascular pedicles are sealed and sectioned with articulable vessel sealing forceps (Caiman Vessels Sealers; Aesculpa BBraun) or ultrasonic forceps (SonoSurg G2; Olympus). Space between the uterus and the bladder is dissected. A vaginal spatula facilitates dissection along the vaginal wall. The anterior vagina is opened and the plane between the vagina and the bladder is developed. A limited portion of anterior vaginal wall close to the trigone is resected en bloc with the bladder 1 cm above the bladder neck. Dissection is performed along the anterolateral paravaginal plane, no further dorsal than the 2 or 10 o'clock position to preserve the paravaginal fibers and nerves. The bladder is taken down with monopolar cautery. The urethra is identified and dissected. The catheter is removed and a clip is placed to avoid tumor spillage before urethra transection. Retrieval bag is inserted through the vagina opening and bladder is removed under vision. Vagina is then closed in two continuous layers. Conclusions: Sexual sparing RARC performed when possible with orthotopic neobladder offers intact body image and lowers decrease of sexual function and normal voiding function. Those elements play an extremely important role on patient's psychology, sexuality, and potential fertility. Robotic surgery is the perfect tool to perform such a complex minimally invasive technique. No competing financial interests exist. Runtime of video: 7 mins

Total tumour diameter is superior to unifocal diameter as a predictor of papillary thyroid microcarcinoma prognosis

The current American Joint Committee (AJCC) on Cancer TNM classification does not describe the treatment of multifocal papillary thyroid microcarcinomas (PTMCs) with a total tumour diameter (TTD) >1 cm. Herein, we investigated this PTMC subgroup in terms of extrathyroidal extension (ETE), local infiltration, central lymph node metastasis (LNM), and prognosis. Consecutive patients (n = 1102) were identified and the proportions of LNM, ETE, and local infiltration were similar between PTCs with a unifocal tumour diameter >1 cm and ≤2 cm and PTMCs with a multifocal TTD >1 cm and ≤2 cm. The proportions of LNM, ETE, and local infiltration were also similar between PTMCs with a unifocal diameter ≤1 cm vs. multifocal TTD ≤1 cm. However, when comparing PTMCs with a unifocal diameter ≤1 cm vs. multifocal TTD >1 cm, significant differences were observed. In the Kaplan-Meier analysis, significant differences were observed between PTMCs with a unifocal diameter ≤1 cm vs. multifocal TTD >1 cm and multifocal TTD ≤1 cm vs. multifocal TTD >1 cm. Accordingly, TTD may represent a more accurate criterion for tumour size of PTCs and should be considered in the revised AJCC staging system.

Characterisation of multifocal breast cancer using the 70-gene signature in clinical low-risk patients enrolled in the EORTC 10041/BIG 03-04 MINDACT trial

BackgroundIn multifocal breast cancer, guidelines recommend basing adjuvant systemic treatment decisions on characteristics of the largest lesion, disregarding multifocality as an independent prognosticator. We assessed the association between multifocal disease and both the 70-gene signature (70-GS), and distant metastasis-free survival (DMFS) in clinical low-risk breast cancer patients enrolled in the European Organisation for Research and Treatment of Cancer 10041/BIG 03-04 Microarray In Node-negative and 1 to 3 positive lymph node Disease may Avoid ChemoTherapy (MINDACT) trial. Patients and methodsThe analysed population consisted of enrolled patients in the MINDACT trial with clinical low-risk disease, defined by a modified Adjuvant! Online cut-off for the 10-year risk of recurrent disease or death. Eligibility criteria of MINDACT dictate that patients with multifocal disease could be included if the different lesions had similar pathological characteristics. The presence of multifocal disease was deducted from the case report form (CRF)-question for sum of diameter for all invasive tumour foci. Clinicopathological characteristics and gene expression of patients with unifocal and multifocal (largest lesion) disease were compared. Subsequently, the association between multifocal disease and the 70-GS was evaluated as well as the association between multifocality and 5-year DMFS. ResultsThe study included 3090 clinical low-risk patients with unifocal and 238 patients with multifocal disease. Apart from a higher prevalence of lobular tumours (21.8% versus 10.8%, by local pathology), we did not observe differences in baseline characteristics between multifocal and unifocal tumours. Patients with multifocal tumours were more likely to be at high genomic risk as compared to patients with unifocal tumours (22.7% versus 17.3%, odds ratio [OR] 1.45, 95% confidence interval [CI] 1.02–2.07, P = 0.038). We did not find a significant association between tumour focality and DMFS (97.1% for unifocal versus 96.9% for multifocal, hazard ratio [HR] = 1.55, 95% CI 0.68–3.46, P = 0.172), nor a signal for a potential interaction between the prognostic effect of the 70-GS and focality of the tumour regarding DMFS. ConclusionIn the group of clinical low-risk MINDACT patients, multifocal tumours were more likely to have a high-risk 70-GS profile compared to unifocal tumours. We did not observe a significant interaction between multifocality and the 70-GS with respect to survival without distant metastasis in these patients.

Pathological findings in 377 patients with differentiated thyroid cancer in a single centre

The purpose of this study is to review the pathology findings of 377 patients diagnosed with differentiated thyroid cancer (DTC) in a single centre over a period of six years. Retrospective review of all total and near-total thyroidectomies (TT and NTT) performed in a single institution. Clinical records were accessed for patient demographic data and clinical characteristics. Patients with a histopathologic diagnosis of DTC were grouped in incidental DTC and non-incidental DTC groups and TNM staging was used. 1465 thyroidectomies were included. The M:F ratio was 1:2.9. 377/1465 patients had a histologic diagnosis of DTC (26%). T1b group (n=227) had a statistically significant higher number of cases, where tumor invaded the capsule, tumor extending extrathyroidally, tumor invading the blood vessels compared to T1a group (n=64) (p=0.001 for all three variables). T1a group had a statistically significant higher number of papillary conventional variant of DTC and more unifocal tumors (p=0.045 and p=0.004 respectively). In the non-incidental DTC group (n=79), there were 29 patients (37%) in T1a category and 16 of them had a unifocal papillary DTC. 16/79 of patients (20%) operated for DTC had a subcetrimetric, unifocal papillary DTC. According to the 2106 American Thyroid Association (ATA) Management Guidelines, these patients could potentially have been treated with a lobectomy alone. Patients in T1b category present more aggressive histologic features and should undergo multi-disciplinary team discussion to decide optimal surgical treatment.

The Need for Completion Thyroidectomy in Cases of Differentiated Thyroid Cancer.

There are no definitive criteria for the presence of malignancy in the opposite lobe in cases of unilateral lobectomy due to a thyroid mass in which the malignancy was diagnosed histologically. Study design is retrospective, cross sectional study. The present study included patients who underwent a lobectomy in our clinic between 2001 and 2016 with an initial diagnosis of atypia with undetermined significance or suspected malignancy according to fine-needle aspiration biopsy and adult patients who received a thyroidectomy based on thyroid cancer detected in pathological examinations. Tumor histopathological diagnosis, tumor size, and capsular, vascular, or lymphatic invasion were assessed in patients who received thyroid lobectomy. The presence of a multifocal tumor (52.3%) significantly increased the risk of malignancy in the opposite lobe over the risk association with a unifocal tumor (8.9%; p<0001). In patients with a tumor diameter greater than 4cm (83.3%), the risk of malignancy in the opposite lobe was higher than that in patients with a tumor diameter less than 4cm (22.3%; p<0.001). Significant differences were not observed between groups with and without vascular or capsular invasion of the opposite lobe (p=0.913 and p=0.840, respectively). We determined risk factors for the presence of multifocal disease in unilateral lobectomy materials; an aggressive tumor subtype and a size larger than 4cm are the most important factors that increase the risk of malignancy in the opposite lobe. Level of evidence Level 4-Case-control studies.

Is it time to reconsider lobectomy in low-risk paediatric thyroid cancer?

Current guidelines recommend total thyroidectomy for nearly all children with well-differentiated thyroid cancer (WDTC). These guidelines, however, derive from older data accrued prior to current high-resolution imaging. We speculate that there is a subpopulation of children who may be adequately treated with lobectomy. Retrospective analysis of prospectively maintained database. Seventy-three children with WDTC treated between 2004 and 2015. We applied two different risk-stratification criteria to this population. First, we determined the number of patients meeting American Thyroid Association (ATA) 'low-risk' criteria, defined as disease grossly confined to the thyroid with either N0/Nx or incidental microscopic N1a disease. Second, we defined a set of 'very-low-risk' histopathological criteria, comprising unifocal tumours ≤4 cm without predefined high-risk factors, and determined the proportion of patients that met these criteria. Twenty-seven (37%) males and 46 (63%) females were included in this study, with a mean age of 13·4 years. Ipsilateral- and contralateral multifocality were identified in 27 (37·0%) and 19 (26·0%) of specimens. Thirty-seven (51%) patients had lymph node metastasis (N1a = 18/N1b = 19). Pre-operative ultrasound identified all cases with clinically significant nodal disease. Of the 73 patients, 39 (53·4%) met ATA low-risk criteria and 16 (21·9%) met 'very-low-risk' criteria. All 'very-low-risk' patients demonstrated excellent response to initial therapy without persistence/recurrence after a mean follow-up of 36·4 months. Ultrasound and histopathology identify a substantial population that may be candidates for lobectomy, avoiding the risks and potential medical and psychosocial morbidity associated with total thyroidectomy. We propose a clinical framework to stimulate discussion of lobectomy as an option for low-risk patients.

Defining a New Tumor Dimension in Staging of Papillary Thyroid Carcinoma.

Cervical lymph node metastasis is a vital factor associated with local recurrence in papillary thyroid carcinoma (PTC). Tumor size is used in the staging of PTC because it represents the tumor load. This study compared two methods of tumor size assessment to predict tumor behavior in the relationship between size and cervical node involvement for patients with PTC. The study enrolled 1084 patients who underwent initial thyroid surgery and had a pathologic diagnosis of PTC between 2012 and 2014 at The Second Affiliated Hospital Zhejiang University School of Medicine. Cervical lymph node metastasis (LNM) risk was analyzed according to the clinicopathologic features. For each patient with multifocal disease, two tumor size estimates were used: (1) the dominant focus size and (2) the aggregate size, calculated as the sum of the maximal diameters of all tumor foci. Of the 1084 patients, 294 (27.1%) had multifocal cancer lesions, and 49% of these patients had cervical LNM, compared with 38.1% who had unifocal disease (P=0.001). The use of aggregate dimension significantly increased the tumor size and reclassified significant numbers of multifocal PTCs to a more advanced T stage. This aggregate dimension took account of all tumor foci and predicted LNM risk at a proportion identical with that for size-matched, unifocal tumors. Multifocality together with aggregate tumor size is a more accurate predictor of node status and, by inference, tumor behavior in the relationship between tumor size and cervical node involvement.