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Background and Objectives: Estimation of the risk of malignancy in a Hürthle cell (HC) neoplasm is important for optimum extent of thyroid surgical treatment. The aim of this retrospective study was to find predictive factors of carcinoma in patients with HC neoplasm., Methods: A total of 279 patients (241 females, 38 males; median age 55 years, range 15-86 years) with HC neoplasm in whom carcinoma was only suspected and who were surgically treated at our Institute in the period 1990-2007, were included in this study. Risk factors for malignancy were identified by the chi-squared test and logistic regression., Results: The histopatological diagnoses were carcinoma, benign goiter and adenoma in 71 (25%), 68 (25%) and 140 (50%) patients, respectively. Predictive factors for carcinoma, shown by chi-square test, were: age of patients, tumor diameter, thyroid volume and T(g) concentration. The independent predictors of malignancy as shown by multivariate logistic regression were age of patients and pre-operative T(g) concentration. Carcinoma was more common in the patients older than 65 years of age and with T(g) concentration over 1,000 ng/ml., Conclusions: The independent predictors of malignancy in HC neoplasm were age of patients and pre-operative T(g) concentration.

Background and Objectives: Cutaneous melanoma patients with positive sentinel lymph node biopsy (SLNB) are being treated with completion lymph node dissection (CLND). The aim of our study was to determine the predictive value of sentinel lymph node (SLN) micrometastases (metastases less than 2 mm in diameter) in assessing further lymph node involvement in CLND., Methods: Between 2001 and 2005, we performed 476 SLNB in patients with stages I and II melanoma; 74 had metastases in SLN. We evaluated retrospectively the metastases in SLN according to their size and number. The presence of additional metastases in non-sentinel lymph nodes after CLND was evaluated., Results: Thirty-nine patients had micrometastases, 22 of them were solitary, 3 were double, and 14 patients had multiple micrometastases in SLN. Out of 22 solitary micrometastases, no patient had additional metastases in non-sentinel lymph nodes. From 3 patients with double micrometastases, 1 patient had further metastases in non-sentinel lymph nodes after CLND. Out of 14 patients with multiple micrometastases, 2 had additional metastases in CLND., Conclusions: No patient with a single SLN micrometastasis had further metastases after CLND in our series. CLND may not be beneficial after detecting a single micrometastasis in SLN.

Background and Objectives: Within the group of patients with papillary thyroid microcarcinoma (PTMC), the prognostic factors have not been well defined and the optimal treatment has not been proved. The aim of this study was to find out the factors associated with the tumor recurrence in the patients with PTMC., Methods: A total of 228 patients with PTMC (189 females, 39 males; age 14-85 years, median 46 years) were treated at our Institute between 1975 and 2006. The data on patients' gender, age, extent of disease, pathomorphological characteristics, therapy, locoregional control, disease-free survival and disease-specific survival were collected. Statistical correlation between possible prognostic factors and the duration of disease-free interval was analyzed by univariate and Cox's multivariate survival analysis., Results: The tumor diameter ranged from 0.1 to 10 mm (mean 6.1 mm). The median length of observation was 84 months (range 1-385). During the follow-up period, the recurrence was diagnosed in 7 patients (6 locoregional and 1 distant). Multivariate analysis showed that tumor size and lymph node metastases were independent prognostic factors for disease-free interval., Conclusions: Longer disease-free interval was found in the patients with a tumor diameter < or =6 mm and without lymph-node metastases., (2007 Wiley-Liss, Inc)

Background and Objectives: In order to predict the nonsentinel lymph node (NSLN) metastases in sentinel lymph node (SLN) positive patients a nomogram was created at the Memorial Sloan Kettering Cancer Centre (MSKCC). The aim of our study was to validate the MSKCC nomogram in patients grouped by the preoperative ultrasound (US) examination of the axillary lymph nodes., Methods: The MSKCC nomogram was validated separately in three groups of patients: (US-0) only clinically preoperatively negative axillary lymph nodes (126 patients), (US-1) US negative axillary lymph nodes (109 patients), and (US-2) US suspicious but fine needle aspiration biopsy (FNAB) negative axillary lymph nodes (41 patients)., Results: The predicted probability underestimates the actual probability with the mean absolute error equal to 0.116 in the US-0 group (P = 0.003), and overestimates the actual probability (mean absolute error equal to 0.084) in US-1 group (P = 0.033) and US-2 group (mean absolute error is 0.110) (P = 0.275)., Conclusion: We found that the MSKCC nomogram overestimates the probability of the NSLN metastases in breast cancer patients with (i) preoperatively US negative or (ii) US suspicious, but FNAB negative axillary lymph nodes. We also found that MSKCC nomogram has only limited value in patients with only clinically negative axillary lymph nodes.

Background and Objectives: Touch imprint cytology (TIC) was reported to be a sensitive method of intraoperative sentinel lymph node (SLN) assessment. The objective of our study was to assess the value of the TIC as an intraoperative SLN evaluation method and to determine a subgroup of patients in whom TIC should not be indicated., Methods: In 250 breast cancer patients with SLN biopsy, TIC of SLNs was performed intraoperatively. The results of TIC were compared to the final histopathological analysis of SLNs. A subgroup analysis of the TIC value was performed with regard to the tumor size., Results: SLN metastases were found in 102/250 patients (41%). Two cases were false positive. The sensitivity of TIC was 34%, specificity 98.6%, accuracy 72%, negative predictive value 69%, and positive predictive value 95%. TIC was significantly more sensitive to detect macrometastases (32/43) compared to micrometastases or ITC (3/59) (P < 0.001). TIC was positive in only 5% (4/77) in T < 10 mm tumors compared to 18% (31/168) in T > 10 mm (P = 0.01)., Conclusions: TIC is a simple, quick, and sensitive method of intraoperative SLNs evaluation for the presence of the macrometastases. TIC has a very limited value in detecting micrometastases and no value in detecting ITC. TIC may not be indicated in T1a + b tumors., (Copyright 2004 Wiley-Liss, Inc.)

Marginal vacuoles (MV) found in Giemsa-stained fine-needle aspirates of the thyroid gland have been observed in toxic and also in non-toxic goiters. The aim of our retrospective study was to disclose the incidence and diagnostic significance of MV in 46 smears from 43 patients with primary and/or metastatic follicular thyroid carcinoma (FTC). Typical MV, MV-like structures, or both were found in 14 of 36 specimens (39%) of the primary tumor and in four of seven specimens (57%) obtained from metastases of FTC. No association between the appearance of MV/MV-like structures and degree of tumor differentiation was demonstrated. On the other hand, MV or/and MV-like structures were more frequently (69%) documented in hyperthyroid patients (P < 0.05). Accordingly, our study demonstrated relatively frequent appearance of MV or MV-like structures in FTC independent of tumor differentiation. Their appearance, however, seems to be associated with hyperthyroidism.