Iodine and thyroid cancer risk among women in a multiethnic population: the Bay Area Thyroid Cancer Study.

Research on the relationship between iodine exposure and thyroid cancer risk is limited, and the findings are inconclusive. In most studies, fish/shellfish consumption has been used as a proxy measure of iodine exposure. The present study extends this research by quantifying dietary iodine exposure as well as incorporating a biomarker of long-term (1 year) exposure, i.e., from toenail clippings. This study is conducted in a multiethnic population with a wide variation in thyroid cancer incidence rates and substantial diversity in exposure. Women, ages 20-74, residing in the San Francisco Bay Area and diagnosed with thyroid cancer between 1995 and 1998 (1992-1998 for Asian women) were compared with women selected from the general population via random digit dialing. Interviews were conducted in six languages with 608 cases and 558 controls. The established risk factors for thyroid cancer were found to increase risk in this population: radiation to the head/neck [odds ratio (OR), 2.3; 95% confidence interval (CI), 0.97-5.5]; history of goiter/nodules (OR, 3.7; 95% CI, 2.5-5.6); and a family history of proliferative thyroid disease (OR, 2.5; 95% CI, 1.6-3.8). Contrary to our hypothesis, increased dietary iodine, most likely related to the use of multivitamin pills, was associated with a reduced risk of papillary thyroid cancer. This risk reduction was observed in "low-risk" women (i.e., women without any of the three established risk factors noted above; OR, 0.53; 95% CI, 0.33-0.85) but not in "high-risk" women, among whom a slight elevation in risk was seen (OR, 1.4; 95% CI, 0.56-3.4). However, no association with risk was observed in either group when the biomarker of exposure was evaluated. In addition, no ethnic differences in risk were observed. The authors conclude that iodine exposure appears to have, at most, a weak effect on the risk of papillary thyroid cancer.

Effects of formalin-induced injuries on urinary bladder carcinogenesis.

In multistage carcinogenesis, promotion is a long-term or repeated growth stimulation of initiated cells. Possible effects of regenerative hyperplasia induced by repeated intravesical instillation of 0.3% formalin solution on urinary bladder carcinogenesis were examined using heterotopically transplanted rat urinary bladders (HTBs) initiated by N-methyl-N-nitrosourea. The HTB system was chosen because in this system, transient generalized hyperplasia lasting less than a week can be induced readily and repeatedly by intravesical instillation of the formalin solution. No statistically significant tumor enhancement was observed after 15 formalin treatments administered in 30 weeks. It appears that regenerative cytotoxic stimuli, even multiple, may have no significant tumor-promoting activity. Discussed is the possibility that mild and, more importantly, persistent non-cytotoxic stimuli may be more effective as tumor promoters.

Radiofrequency ablation of breast cancer: first report of an emerging technology.

HYPOTHESIS: Radiofrequency (RF) energy applied to breast cancers will result in cancer cell death. DESIGN: Prospective nonrandomized interventional trial. SETTING: A university hospital tertiary care center. PATIENTS: Five women with locally advanced invasive breast cancer, aged 38 to 66 years, who were undergoing surgical resection of their tumor. One patient underwent preoperative chemotherapy and radiation therapy, 3 patients received preoperative chemotherapy, and 1 had no preoperative therapy. All patients completed the study. INTERVENTIONS: While patients were under general anesthesia and just before surgical resection, a 15-gauge insulated multiple-needle electrode was inserted into the tumor under sonographic guidance. Radiofrequency energy was applied at a low power by a preset protocol for a period of up to 30 minutes. Only a portion of the tumor was treated to evaluate the zone of RF ablation and the margin between ablated and nonablated tissue. Immediately after RF ablation, the tumor was surgically resected (4 mastectomies, 1 lumpectomy). Pathologic analysis included hematoxylin-eosin staining and enzyme histochemical analysis of cell viability with nicotinamide adenine dinucleotide-diaphorase (NADH-diaphorase) staining of snap-frozen tissue to assess immediate cell death. MAIN OUTCOME MEASURE: Cancer cell death as visualized on hematoxylin-eosin-stained paraffin section and NADH-diaphorase cell viability stains. RESULTS: There was evidence of cell death in all patients. Hematoxylin-eosin staining showed complete cell death in 2 patients. In 3 patients there was a heterogeneous pattern of necrotic and normal-appearing cells within the ablated tissue. The ablated zone extended around the RF electrode for a diameter of 0.8 to 1.8 cm. NADH-diaphorase cell viability stains of the ablated tissue showed complete cell death in 4 patients. The fifth patient had a single focus of viable cells (<1 mm) partially lining a cyst. There were no perioperative complications related to RF ablation. CONCLUSIONS: Intraoperative RF ablation results in invasive breast cancer cell death. Based on this initial report of the use of RF ablation in breast cancer, this technique merits further investigation as a percutaneous minimally invasive modality for the local treatment of breast cancer.

Ultrasound-guided fine-needle aspiration biopsy of thyroid masses.

The purpose of this study was to determine the impact of ultrasound-guided fine-needle aspiration biopsy (USFNA) in the cytological diagnosis of nodular thyroid disease. It remains unclear exactly what role USFNA should play in the cytological diagnosis of nodular thyroid disease. All patients who underwent fine-needle aspiration (FNA) for nodular thyroid disease at Stanford University Medical Center from 1991 to 1996 were included in the study. Histopathologic diagnoses were compared to cytological diagnoses for those patients who underwent surgery. FNA was performed on a total of 497 thyroid nodules. Palpation-guided FNA (pFNA) was performed on 370 nodules, and USFNA was done on 127. The USFNAs were performed for the following reasons: 95 (75%) for nonpalpable or difficult-to-palpate nodules; 14 (11%) for previously failed FNA; and 18 (14%) for incidentally detected nodules. FNA had an unsuccessful biopsy rate of 16% and a sensitivity and specificity of 89% and 69%, respectively. USFNA had an unsuccessful biopsy rate of 7% and a sensitivity and specificity of 100% and 100%, respectively. The cancer yield at surgery for pFNA was 40%, and the cancer yield at surgery for USFNA was 59%. The complementary use of USFNA with pFNA improves the diagnostic approach to nodular thyroid disease. The use of USFNA has increased the cancer yield at surgery and the sensitivity of thyroid biopsy at our institution.

The electrophysiologic and histologic effects of the Argon Beam Coagulator on peripheral nerves.

The electrophysiologic and histologic effects of the Bard Argon Beam Coagulator (ABC) were investigated in the New Zealand White rabbit. Thirty-four rabbits were divided into three groups. Controls underwent simple femoral exploration and closure. The remaining rabbits' femoral nerves were spot coagulated with either the ABC or standard electrosurgical unit (ESU). Stimulus thresholds were recorded before treatment and again prior to sacrifice at 0, 30, 60, or 120 days. Thresholds were significantly elevated for the ABC and ESU compared to controls (P = .0077 and .0351, respectively). Changes in threshold were greater for the ABC than for the ESU, but were not significant. All ABC- and ESU-treated nerves had significant histologic injury when compared to controls (P < .0002). Although the ABC may be clinically safe, significant injury to rabbit femoral nerves occurs when they are exposed to energy emitted by this instrument.

Prostate specific antigen and acid phosphatase-reactive cells in cystitis cystica and glandularis.

Cystitis cystica (CC) and cystitis glandularis (CG) are common in the urothelium lining the bladder neck and trigone. Because some cases of CG show histologic features strikingly similar to prostatic acini, we hypothesized that some such foci may represent prostatelike metaplasia in the urinary bladder. Forty surgical and autopsy bladder specimens (23 males, 17 females) showing CC or CG were studied using anti-prostate specific antigen and anti-prostate specific acid phosphatase antibodies. Fourteen (35%) of these 40 cases showed positive staining for prostate specific antigen or prostate specific acid phosphatase or both in CC or CG foci. Among these were five female patients. The findings indicate that bladder epithelium is capable of undergoing prostatelike metaplasia and lend support to the hypothesis that the adult bladder stroma closest to the prostate may exert inductive influences on the overlying epithelium to show prostatelike metaplasia.

Epithelioid hemangioendothelioma: cytomorphology and histological features of a case.

A case of epithelioid hemangioendothelioma involving the left lung, the 10th thoracic vertebra, and paravertebral soft tissues is presented. Preoperative sputum cytology was thought to show adenocarcinoma. Histologic examination demonstrated an intravascular bronchioloalveolar tumor; immunohistochemical staining for factor VIII-related antigen revealed strongly positive tumor cells. The cytomorphology of this rare neoplasm is discussed.

MRI-guided needle localization of suspicious breast lesions: results of a freehand technique.

Magnetic resonance imaging (MRI) can detect clinically and mammographically occult breast lesions. In this study we report the results of MRI-guided needle localization of suspicious breast lesions by using a freehand technique. Preoperative MRI-guided single-needle localization was performed in 220 patients with 304 MRI-only breast lesions at our hospital between January 1997 and July 2004. Procedures were performed in an open 0.5-T Signa-SP imager allowing real-time monitoring, with patient in prone position, by using a dedicated breast coil. MRI-compatible hookwires were placed in a noncompressed breast by using a freehand technique. MRI findings were correlated with pathology and follow-up. MRI-guided needle localization was performed for a single lesion in 150 patients, for two lesions in 56 patients, and for three lesions in 14 patients. Histopathologic analysis of these 304 lesions showed 104 (34%) malignant lesions, 51 (17%) high-risk lesions, and 149 (49%) benign lesions. The overall lesion size ranged from 2.0-65.0 mm (mean 11.2 mm). No direct complications occurred. Follow-up MRI in 54 patients showed that two (3.7%) lesions were missed by surgical biopsy. MRI-guided freehand needle localization is accurate and allows localization of lesions anterior in the breast, the axillary region, and near the chest wall.

Prevention of inhibitory effects of alpha-difluoromethylornithine on rat urinary bladder carcinogenesis by exogenous putrescine.

We previously demonstrated that repeated instillation of alpha-difluoromethylornithine (DFMO), an irreversible inhibitor of ornithine decarboxylase (ODC), inhibits (or retards) urinary bladder carcinogenesis in rats. Since ODC catalyzes the first step in polyamine synthesis, the inhibition of polyamine formation may be responsible for tumor inhibition by DFMO. The present experiment was conducted using male Fischer rats with a heterotopically transplanted urinary bladder (HTB) to determine whether the effects of DFMO are prevented by exogeneous Pu. HTBs were treated with 0.25 mg of N-methyl-N-nitrosourea (MNU) once a week for 3 weeks and the animals were then arbitrarily divided into 6 groups. Beginning one week following the last MNU treatment, all rats received twice a week instillation (0.5 ml each) as follows: Group 1 rats, normal rat urine; Group 2, 2% DFMO in urine; Group 3, 250 microM Pu and 2% DFMO in urine; Group 4, 250 microM Pu in urine; Group 5, urine for 10 weeks followed by 2% DFMO in urine; and Group 6, urine for 10 weeks followed by 250 microM Pu and 2% DFMO in urine. At 10 weeks following the last MNU instillation 5 rats from each of Groups 1 through 4 were killed for determination of urothelial polyamine levels. An additional 4 rats of Group 1 were killed at 10 weeks for histological examination. All remaining rats were killed 20 weeks after the last MNU instillation. Polyamine levels showed no significant difference among the 4 groups. The incidence of carcinoma was significantly lower in the group treated with DFMO (p less than 0.001, Group 1 vs Group 2), confirming our previous observation.(ABSTRACT TRUNCATED AT 250 WORDS)

Percutaneous removal of benign mammographic lesions: comparison of automated large-core and directional vacuum-assisted stereotactic biopsy techniques.

OBJECTIVE: The purpose of our study was to evaluate how often histologically benign lesions were completely removed as shown by the initial mammogram after biopsy. We compared three percutaneous biopsy techniques. MATERIALS AND METHODS: Retrospective review was performed on 1206 consecutive impalpable breast lesions having percutaneous stereotactic biopsies done on a prone biopsy table using 14-gauge automated large-core needles (n = 721); 14-gauge directional vacuum-assisted probes (n = 192); and 11-gauge directional vacuum-assisted probes (n = 293). Lesions that were histologically benign and that did not have subsequent surgical excision had mammographic follow-up. The 667 initial mammograms after biopsy (advised to be done at 6 or 12 months and accomplished at 1-53 months [median, 7 months] after biopsy) were reviewed to see if the lesions were no longer apparent. RESULTS: The lesion was absent in 9% (40/422) of lesions for which 14-gauge large-core biopsy was used, 22% (21/95) of lesions for which 14-gauge vacuum-assisted biopsy was used, and 64% (96/150) of lesions for which 11-gauge vacuum-assisted biopsy was used (p < .0001). No mammographic pseudolesions were created by the biopsy. No clinically significant complications occurred. CONCLUSION: The lesion was more often completely removed with directional vacuum-assisted biopsy than with automated large-core biopsy and more often completely removed with 11-gauge probes than with 14-gauge probes.

Primary squamous cell carcinoma of the breast.

Primary squamous cell carcinoma of the breast is a rare cancer. Published reports of prognosis are variable, and most studies are case reports of one or a few patients. We report an additional case of squamous cell carcinoma of the breast occurring in a 53-year-old black woman. In reviewing the reported cases of this tumor over the past 20 years, we compared features of this cancer with those of the more common breast adenocarcinoma with squamous metaplasia. When squamous cell carcinoma of the breast is encountered, a skin primary lesion and metastasis from a distant site should be excluded. Prognosis is determined largely by stage and does not differ significantly from the prognosis in breast adenocarcinoma with squamous metaplasia.

Ultrasonographically guided thyroid biopsy: a review with emphasis on technique.

We describe our technique for ultrasonographically guided fine-needle aspiration biopsy of the thyroid that achieves a high rate of diagnostic specimens. Indications for ultrasonographically guided fine-needle aspiration biopsy included a difficult-to-palpate thyroid nodule and previously unsuccessful palpation-guided fine-needle aspiration. Ultrasonographically guided fine-needle aspiration biopsy was performed on 316 thyroid nodules in 306 patients. Adequate cytologic specimens were obtained in 97.2% of the nodules in which biopsy was performed, with a 2.8% rate of inadequate cellularity. Two helpful aspects of this technique that were thought to improve the overall diagnostic yield were the use of color and power Doppler "vascular mapping" of the nodule just before biopsy and on-site cytologic control.

Milk of calcium in the breast: appearance on prone stereotactic imaging.

Microcalcifications discovered by mammography require careful analysis, occasionally leading to core biopsy to exclude associated breast cancer. We report unrecognized milk of calcium layering on small field of view prone digital stereotactic images. We illustrate important features on prone digital images attributed to milk of calcium which can exclude breast neoplasm, suggest this diagnosis, and prevent unnecessary biopsy.

Cytological atypia in the prostate gland: frequency, distribution and possible relevance to carcinoma.

Frequency and distribution of atypical prostatic hyperplasia were assessed in 51 total prostatectomy specimens for cancer and the data were compared to similar data obtained from analysis of 51 autopsy specimens. Enlargement of columnar cell nuclei in conjunction with preservation of basal cells was chosen as the only criterion for atypia. Depending on the degree of nuclear enlargement, atypia was divided into mild and severe degrees. The evaluation of nuclear atypia was applied to areas of carcinoma as well as to atypical prostatic hyperplasia. There were 3 major findings. 1) Atypical prostatic hyperplasia was found more frequently in prostatectomy specimens (48 of 51 cases) than in autopsy specimens (14 of 37 cases after exclusion of cancer-associated cases) and the difference was significant (p less than 0.001). In addition, atypical prostatic hyperplasia found in prostatectomy specimens was more frequently of severe degree than that in the autopsy specimens (42 of 48 versus 3 of 14 cases, p less than 0.001). 2) The distribution of atypical prostatic hyperplasia and carcinoma in prostatectomy specimens was similar. 3) In a majority of prostatectomy specimens atypical prostatic hyperplasia, when found, was located at sites separate from carcinoma as well as in contiguous areas. Based on these data it is suggested that the presence of a severe degree of nuclear atypia in specimens removed for benign conditions or in prostatic needle biopsies may signify an increased incidence of coexisting carcinoma elsewhere in the prostate or of carcinoma developing in the future. Close followup of these patients may be indicated.

Stereotaxic large-core needle biopsy of 450 nonpalpable breast lesions with surgical correlation in lesions with cancer or atypical hyperplasia.

PURPOSE: To determine whether histologic findings of cancer or atypical hyperplasia at large-core needle biopsy (LCNB) of nonpalpable breast lesions match histologic findings at excision. MATERIALS AND METHODS: Stereotaxic LCNB was performed with an automated prone unit, biopsy gun, and 14-gauge cutting needles in 450 nonpalpable breast lesions. Lesions classified as carcinoma or atypical ductal hyperplasia (ADH) at histologic examination after LCNB were excised. A pathologist retrospectively compared core and excisional histologic findings. RESULTS: Histologic comparison was performed in 116 of 135 carcinomas after LCNB. Histologic findings were concordant in 99 carcinomas. Partial discordance in 17 carcinomas led to an additional surgical procedure in one case. Histologic comparison was performed in 16 of 19 ADHs diagnosed with LCNB. Histologic findings were concordant in five and discordant in 11 ADHs. CONCLUSION: LCNB findings of carcinoma are accurate and allow definitive therapeutic surgery, including mastectomy. LCNB findings of ADH are inaccurate, and excisional biopsy is necessary.

Stereotactic, automated, large-core needle biopsy of nonpalpable breast lesions: false-negative and histologic underestimation rates after long-term follow-up.

PURPOSE: To determine the rate and causes of false-negative findings and histologic underestimates at stereotactic biopsy of nonpalpable breast lesions. MATERIALS AND METHODS: Stereotactic, 14-gauge, automated, large-core needle biopsy (LCNB) was performed in 483 consecutive nonpalpable breast lesions. Excision was advised for the 143 carcinomas, 25 atypical ductal hyperplasia (ADH) lesions, and five radial scars. Mammographic follow-up was advised for the benign lesions without a repeat biopsy. RESULTS: Of the 310 benign lesions, 259 underwent mammographic follow-up at 6-85 months (median, 55 months) without repeat biopsy, 48 underwent repeat biopsy and three were lost to follow-up. On the basis of the histologic diagnosis of carcinoma at surgical biopsy, diagnosis with LCNB was not correct (i.e., disease was underestimated at histologic examination) in 14 (58%) of 24 ADH lesions and two (40%) of five radial scars. Two (1.2%) of 161 lesions with a final diagnosis of carcinoma were benign at LCNB but malignant at repeat biopsy (i.e., false-negative findings at LCNB). Repeat biopsy was prompted by mammographic progression at 6 and 18 months after LCNB. CONCLUSION: The false-negative rate with LCNB was 1.2% in this study and 4.0% in the literature. The presence of carcinoma in ADH and radial scar lesions was often underestimated.

Nongestational choriocarcinoma in the postpartum period: a case report.

PURPOSE: To determine the tissue of origin (gestational versus nongestational) of an extensive metastatic choriocarcinoma in an 18-year-old woman to determine prognosis and treatment. METHODS: DNA microsatellite polymorphisms after polymerase chain reaction (PCR) amplification of the tumor tissue and blood from the patient, husband, and daughter were used to determine the tissue of origin. RESULTS: Molecular analyses revealed that the tumor shared the genetic features of only the patient. She responded well to multiagent chemotherapy. CONCLUSIONS: Molecular analysis is a useful tool to determine whether a choriocarcinoma occurring in a female patient of child-bearing age is gestational or nongestational when clinical findings are not clearly indicative of the primary.

Use of automated microscopy for the detection of disseminated tumor cells in bone marrow samples.

The use of automated microscopy has reached the maturity necessary for its routine use in the clinical pathology laboratory. In the following study we compared the performance of an automated microscope system (MDS) with manual method for the detection and analysis of disseminated tumor cells present in bone marrow preparations from breast carcinoma patients. The MDS System detected rare disseminated tumor cells among bone marrow mononuclear cells with higher sensitivity than standard manual microscopy. Automated microscopy also proved to be a method of high reproducibility and precision, the advantage of which was clearly illustrated by problems of variability in manual screening. Accumulated results from two pathologists who had screened 120 clinical slides from breast cancer patients both by manual microscopy and by use of the MDS System revealed only two (3.8%) missed by the automatic procedure, whereas as many as 20 out of 52 positive samples (38%) were missed by manual screening.

New bilateral microcalcifications at mammography in a postlactational woman: case report.

A 33-year-old woman with a strong family history of breast cancer who was referred for mammography 5 weeks after completing lactation was found to have new diffuse bilateral microcalcifications in the breast ducts. Contrast material-enhanced magnetic resonance imaging of the breast showed bilateral patchy areas of abnormal enhancement. Large-core needle biopsy showed diffuse calcifications within expanded benign ducts in a background of lactational change, without evidence of malignancy. To the authors' knowledge, these calcifications have not been previously reported and are possibly related to milk stasis or apoptosis associated with lactation.

Coaxial transthoracic fine-needle biopsy in patients with a history of malignant lymphoma.

Efficacy and safety of coaxial transthoracic fine-needle biopsy were evaluated in 54 patients with a history of malignant lymphoma and new chest lesions. Twenty-one patients had recurrent lymphoma. Correct diagnosis was made in 17 of the 21 patients (81%) after one biopsy. The sensitivity increased to 95% with repeat needle biopsy in three patients. Immunophenotyping (determining phenotype by means of immunologic examination) was essential for a definitive diagnosis of lymphoma in three patients. Non-lymphomatous malignancies were correctly diagnosed in 14 patients. An infectious organism was identified in 11 of 19 patients (58%) with benign lesions. Pneumothorax occurred in eight patients (15%), necessitating placement of a chest tube in two (4%). Mild hemoptysis was observed in four patients (7%). The authors conclude that coaxial transthoracic fine-needle biopsy in patients with a history of lymphoma is safe and accurate. The use of large cutting needles or surgical biopsy can be restricted to patients with false-negative findings at percutaneous biopsy and to patients in whom histologic transformation of lymphoma is suspected.