Diagnosis, treatment and outcome of parathyroid cancer. A report of eight patients.

Eight patients presented parathyroid cancer between 1963 and 1990. There were seven women and one man with a median age of 55.5 years (range 34-81). At admission the median serum calcium concentration was 3.75 mmol/l (range 3.0-5.0), and four patients presented with a hypercalcaemic crisis. Six patients had a pathological bone resorption and five had reduced kidney function or urinary stones. All cases were treated by en bloc resection of the tumour and affected adjacent structures. One patient with a local lymph node metastasis died after seven months, and one in whom it was impossible to remove the tumour died after 14 months. Two patients had recurrences three and nine years after the operation, respectively. The first was treated with mithramycin, but died 33 months later, the other was reoperated on and was still normocalcaemic 2-9 years after diagnosis.

Mammography is an objective diagnostic method.

Six hundred mammograms from 307 consecutive symptomatic patients with a firm retrospective diagnosis were evaluated blindly and independently by two observers. Each observer identified 43 of 47 tumors (91 per cent) with predictive values of 0.63 and 0.68, respectively, for the positive statement, and 0.98 for the negative statement. The overall interobserver agreement with respect to malignancy was 94 per cent (Kappa 0.84) and concerning the diagnosis of simple cysts 91 per cent (Kappa 0.60). The frequency of subclinical cancer demonstrated by mammography in this material was higher than the prevalence of mammary carcinoma found by screening of risk group populations. Thus, mammography remains an objective and reproducible diagnostic method with distinct complementary value to clinical examination. By utilizing certain mammographic criteria for benign lesions it may be possible to reduce the number of biopsies presently performed on the basis of unspecific palpatory findings.