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Incidence of thyroid carcinoma in fluorodeoxyglucose positron emission tomography-positive thyroid incidentalomas.
King DL, Stack BC, Spring PM, Walker R, Bodenner DL
(2007) Otolaryngol Head Neck Surg 137: 400-4
MeSH Terms: Adenoma, Oxyphilic, Carcinoma, Fluorodeoxyglucose F18, Humans, Incidence, Incidental Findings, Positron-Emission Tomography, Radiopharmaceuticals, Retrospective Studies, Thyroid Neoplasms, Whole Body Imaging
Show Abstract · Added March 5, 2014
OBJECTIVE - Fluorodeoxyglucose (FDG) whole body positron emission tomography (PET) scan may show clinically occult second lesions. Such lesions in the thyroid are increasingly common. There are several recent reports of a high probability of malignancy in these lesions ranging from 14% to 63%.
STUDY DESIGN AND SETTING - This is a retrospective review of 15,711 PET scans at a multi-disciplinary thyroid clinic at a tertiary care university medical center. Twenty-two patients were referred with thyroid PET "incidentalomas." The review included 18 FDG-PET scans, ultrasound guided fine needle aspiration biopsies, and thyroid surgery pathology. Aspiration cytology or pathology were the main outcome measures.
RESULTS - Three patients had malignancy of the PET-positive thyroid lesions. Papillary thyroid micro carcinomas were detected in four of the specimens that showed a benign pathology of the dominant nodule.
CONCLUSION - Our experience shows a 14% malignancy rate for the dominant (imaged) nodule and a total malignancy rate of 32% when the incidental micro carcinomas are included. Both of these rates are significantly lower than results published previously.
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11 MeSH Terms
Utility of frozen section analysis of resection margins during partial nephrectomy.
Kubinski DJ, Clark PE, Assimos DG, Hall MC
(2004) Urology 64: 31-4
MeSH Terms: Adenoma, Oxyphilic, Adult, Aged, Aged, 80 and over, Angiomyolipoma, Carcinoma, Renal Cell, Cohort Studies, Cost-Benefit Analysis, Female, Follow-Up Studies, Frozen Sections, Humans, Kidney Diseases, Cystic, Kidney Neoplasms, Lung Neoplasms, Male, Middle Aged, Neoplasm Recurrence, Local, Neoplasms, Multiple Primary, Nephrectomy, Retrospective Studies, Treatment Outcome
Show Abstract · Added May 27, 2014
OBJECTIVES - To evaluate the utility of routine intraoperative frozen-section histologic analysis during partial nephrectomy to ensure negative surgical margins. Partial nephrectomy has gained acceptance for surgical treatment of small renal cancers. Many surgeons send specimens for intraoperative frozen section histologic analysis to ensure negative margins.
METHODS - We reviewed the records of 78 patients who underwent partial nephrectomy for presumed malignancy. Patient demographics, intraoperative findings, and pathologic and clinical outcomes were analyzed.
RESULTS - Seventy-nine partial nephrectomies were performed in 78 patients. Frozen sections were obtained intraoperatively in 76 cases. In 1 case (1.3%), a single margin was interpreted as positive for carcinoma, prompting deeper resection. The final histopathologic finding was interpreted as angiomyolipoma rather than carcinoma. The final pathologic examination revealed renal cell carcinoma in 52 (66%) of 79 cases. The mean oncologic follow-up was 16.2 months. One local recurrence was noted (1.9%). It arose in the resection bed 19 months after removal of a 4.5-cm tumor (pathologic Stage T3a). Both intraoperative frozen section margins and final pathologic margins were negative in this case. One patient developed pulmonary metastases and represented the only metastatic recurrence, as well as the only cancer-related death in our cohort (1.9%).
CONCLUSIONS - Our data suggest that when partial nephrectomy is performed with attention to excising a perimeter of grossly normal-appearing parenchyma, sending specimens for intraoperative frozen section analyses may provide an unnecessary expense without providing meaningful, reliable information. Additional studies, including larger cohorts and extended follow-up, are needed to support these results.
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22 MeSH Terms