Intraoperative frozen-section analysis for thyroid nodules: a step toward clarity or confusion?

OBJECTIVES: To determine accuracy and intertest agreement of preoperative fine-needle aspiration cytology (FNAC) and intraoperative frozen-section analysis (FS) findings in thyroid surgery, and to assess the influence of intraoperative FS findings on decision making and the utility of FS in thyroid surgery. DESIGN: Retrospective analysis. The results of preoperative FNAC, intraoperative FS, and final histopathological analyses were taken from the histopathology reports. We calculated intertest agreement using the kappa statistic. PATIENTS: Two-hundred fifteen patients who underwent primary thyroid surgery. All patients were treated by the same surgeon (S.J.W.). RESULTS: T he sensitivity and specificity of FNAC were 57.4% and 91.7%, respectively. The sensitivity and specificity of FS were 32.4% and 96.5%, respectively. The intertest agreement was poor (kappa = 0.17). In case of malignant FNAC findings, the FS result did not influence treatment decisions; in case of a malignant FS result on the background of a benign, indeterminate, or nondiagnostic FNAC finding, the FS result influenced treatment decisions in 88% of cases. CONCLUSIONS: Intraoperative FS did not give additional information in cases where a malignant neoplasm was predicted by the FNAC finding. In this setting, it led to conflicting results and did not contribute to correct decision making.

Endometrial cancer survival among U.S. black and white women by birth cohort.

BACKGROUND: Endometrial cancer incidence is lower but mortality is higher among black relative to white women. This disparity results from a relatively higher level of case-fatality in African Americans. We investigated whether the inter-racial difference in survival has diminished in more recent birth cohorts. METHODS: Women diagnosed with endometrial malignancies during 1977-1996 were identified from the U.S. Surveillance, Epidemiology and End Results program (45,261 white and 1986 black women). We calculated cumulative 5-year relative survival for 6 birth cohorts. RESULTS: Survival was relatively higher in younger women than older women and in women diagnosed in earlier years compared with more recent years. Higher survival was evident in more recent birth cohorts for groups of women 60+ years of age and in all time periods, particularly for black women. CONCLUSIONS: Although black women with endometrial cancer have a poorer prognosis than white women, the inter-racial difference in survival has narrowed in more recent birth cohorts.

Risk factors for colorectal cancer following breast cancer.

OBJECTIVE: To investigate risk factors for colorectal cancer following breast cancer. METHODS: In this nested case-control study, all women (n = 14,900) with a first primary breast cancer (1978-1992) were identified from the western Washington population-based Surveillance, Epidemiology, and End Results Cancer Registry. Cases (n = 160) developed a second primary colorectal cancer before 1995, at least 6 months after the first cancer diagnosis. Controls (n = 310, matched to the cases on calendar year, age and breast cancer stage) were randomly selected from those who did not develop a second primary cancer and who survived to the case's colorectal cancer diagnosis date. Characteristics of the cases and controls at initial diagnosis were compared using conditional logistic regression. RESULTS: The incidence of colorectal cancer was associated with a family history of breast cancer (v.s. no family history, matched odds ratio (mOR) = 2.1, 95% confidence interval (CI): 1.1-4.1), high body mass index (> or = 30kg/m2 v.s. < 30kg/m2, mOR = 2.2, CI: 1.2-3.9), and lobular breast cancer histology (v.s. ductal, mOR = 2.0, CI: 0.9-4.4). Risk was unrelated to menopausal status, prior hormone replacement therapy and estrogen/progesterone receptor status of the breast tumors. CONCLUSIONS: The risk of developing a second primary colorectal cancer may be elevated among certain subsets of breast cancer patients.

A review of p53 expression and mutation in human benign, low malignant potential, and invasive epithelial ovarian tumors.

BACKGROUND: In the current study, the authors present pooled data from studies that investigated p53 protein expression and/or mutation in human epithelial ovarian tumors. METHODS: The English literature in the MEDLINE, PubMed, and Ingenta databases was searched to the end of the year 2000 to identify relevant studies. Data were pooled across eligible studies, and the prevalence of p53 expression and mutation among benign, low malignant potential (LMP), and invasive tumors was determined. Prevalence estimates by tumor histology, International Federation of Gynecology and Obstetrics (FIGO) stage, and grade also were calculated. RESULTS: The pooled prevalence estimate for p53 overexpression among epithelial ovarian carcinomas was 51% (95% confidence intervals [95% CI], 50-53%) compared with 17% (95% CI, 15-20%) among LMP tumors and 7% (95% CI, 5-10%) among benign tumors. p53 mutation prevalence estimates were 45% (95% CI, 42-47%), 5% (95% CI, 2-9%), and 1% (95% CI, 0-5%), respectively, for invasive, LMP, and benign tumors. The prevalence of these p53 abnormalities was found to be associated positively with increasing tumor grade and stage. Differences based on histologic subtype also were found. CONCLUSIONS: Although these pooled estimates might appear to offer support for various hypotheses regarding the role of p53 in ovarian carcinoma, the limitations inherent in these data hamper the interpretation of the significance of any of the findings. Future studies will require innovative methods to address the limitations of many previous investigations and more comprehensive investigation into defective tumor suppression mechanisms.