Cancer risk in patients with cold thyroid nodules: relevance of iodine intake, sex, age, and multinodularity.

PURPOSE: We evaluated the frequency of thyroid cancer in patients with cold thyroid nodules in relation to iodine intake, sex, age, and multinodularity in a consecutive series of patients with nodular thyroid diseases. PATIENTS: In the period from 1980 to 1990, 5,637 patients were studied: 4,176 patients were from an iodine-sufficient area (ISA) and 1,461 from an adjacent iodine-deficient area (IDA). Surgery was performed in 792 patients on the basis of a suspicious or malignant finding at fine-needle aspiration biopsy. RESULTS: The overall thyroid cancer frequency was 4.6% (259 patients had cancer). Iodine intake affected the cancer rate in patients with cold nodules. The frequency of cancer in patients with cold thyroid nodules was 5.3% in the ISA and 2.7% in the IDA. This difference, however, was significant only in females. Sex had a major influence on the malignant rate of cold nodules; although female patients were more frequently observed (n = 5,028) than male patients (n = 609), the frequency of cancer was significantly lower in female patients with cold nodules (4.2%) than in males (8.2%). Age was an important factor in both sexes. The proportion of nodules that were malignant was smallest in patients of the 4th decade and was greatest in patients younger than 30 years or older than 60 years. Multivariate analysis showed that sex and age interact in determining the cancer risk in patients with thyroid nodules. Finally, the frequency of thyroid cancer in patients with a solitary nodule was not different from the frequency in patients with multiple nodules. CONCLUSION: Our study indicates that thyroid cancer risk in a patient with a nodular goiter varies markedly according to iodine intake, sex, and age but not in relation to multinodularity, as assessed by clinical examination. The knowledge of these epidemiologic aspects of thyroid cancer may increase the accuracy of the preoperative selection of patients with cold nodules of the thyroid.

Relation between steroid receptor status and body weight in breast cancer patients.

Obesity is known to adversely affect breast cancer prognosis. Since obesity is associated with increased oestrogen levels, and oestrogens are growth stimulators of oestrogen receptor (ER)-positive breast carcinomas, we evaluated the relationship between the ER and progesterone receptor (PR) status of the neoplastic tissue and obesity in a series of 615 breast cancer patients. Both ER and PR concentrations were significantly and positively correlated with obesity by multiple regression analysis. Furthermore, the estimated probability of having an ER+/PR+carcinoma was significantly higher in obese patients (odds ratio 2.65, 95% confidence interval 1.56-4.48). This association between receptor-positive status and obesity was observed both in premenopausal and postmenopausal patients. Our data suggest, therefore, that obesity plays a role in determining the ER status of breast cancer and raise the possibility that ER presence in breast carcinomas occurring in obese patients is not indicative of a favourable prognosis.

The morphometric analysis of cell nuclei from fine needle aspirates of thyroid follicular lesions does not improve the diagnostic accuracy of traditional cytologic examination.

In order to evaluate the usefulness of the morphometric analysis in improving the accuracy of the traditional cytologic examination of follicular thyroid lesions, fine needle aspirates from 17 adenomatous goiters, 19 follicular adenomas and 18 follicular carcinomas were examined. In each case 20-50 follicles, accounting from 100 to 200 thyroid cells, were studied by operators unaware of the histologic diagnosis. Nuclear areas (mean, maximum and minimum area) were derived by means of a semiautomatic system and follicular thyroid lesions were classified into three groups (goiter, adenoma and follicular carcinoma) utilizing cut-off values. The results were then compared to the cytologic diagnosis carried out according to traditional (optic microscopy) criteria. Mean values of nuclear areas showed significant differences among the three groups, but a considerable overlap occurred in the size distribution of cell nuclei. At present, therefore, planimetric measurements of cell nuclei in fine needle aspirates do not improve the accuracy of standard cytologic examination in the differential diagnosis of follicular thyroid lesions.

[Receptor status and ovarian function in carcinoma of the breast]. / Status recettoriale e funzione ovarica nel carcinoma della mammella.

The Authors have evaluated the relationship between the presence of estrogen (ER) and progesterone (PgR) receptors and the ovarian function in 321 consecutive and unselected women who have undergone surgery for breast cancer. A significant relationship was found between the presence and the concentration of steroid receptors (ER and PgR) in the neoplastic tissue and the ovarian function. The Authors confirm the importance of considering the menopausal status in the evaluation of the results of steroid receptor assay.