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Background: Fine needle aspiration biopsy represents the critical initial diagnostic test used for evaluation of thyroid nodules. Our objectives were to determine the cytological distribution, the utility of clinicopathologic characteristics for predicting malignancy and the true proportion of cancer among individuals who presented with indeterminate cytology and had undergone thyroid surgery for suspicion of cancer. Methods: We retrospectively reviewed 1040 consecutive primary thyroid operations carried out over an 8-year period at a tertiary care endocrine referral centre. Follicular neoplasm (FN), Hiirthle cell neoplasm (HN), neoplasms suspicious for but not diagnostic of papillary carcinoma (IP) and neoplasms with cellular atypia (IA) were reviewed. Results: In all, 380 individuals presented with cytologically indeterminate thyroid nodules. Of these, 252 (66%) patients had FN, 47 (12%) HN, 44 (12%) IP, 26 (7%) IA and 11 (4%) had mixed diagnoses. Biopsied lesions were found to be malignant on pathological evaluation in 102 (27%) patients: 49 (19%) with FN, 11 (23%) HN, 28 (64%) IP and 9 (35%) with IA. Hemithyroidectomy was adequate definitive treatment in 196 of 225 (87%) patients with FN and 39 of 42 (93%) with HN. Significant associations with a cancer diagnosis were identified for smaller tumour size in patients with FN (p = 0.004) and right thyroid lobe location in patients with IP (p = 0.012), although these factors were nonsignificant in the corrected analyses for multiple comparisons. Conclusion: In a review of the experience at a Canadian centre, 4 operations were carried out to identify each cancer, and hemithyroidectomy was the optimal initial and definitive surgical approach for most patients. Contexte : La biopsie par aspiration a l'aiguille fine represente un test diagnostique initial crucial pour evaluer les nodules de la thyroide. Nos objectifs consistaient a determiner la distribution cytologique, l'utilite des caracteristiques clinico-pathologiques pour la prediction des cancers et la proportion reelle de cancers chez des personnes dont les resultats cytologiques etaient indetermines et qui ont subi une chirurgie de la thyroide pour un cancer presume. Methodes : Nous avons passe en revue de facon retrospective 1040 interventions thyroidiennes primaires consecutives effectuees sur une periode de 8 ans dans un centre de soins endocriniens tertiaires. Nous avons examine les cas de neoplasie folliculaire (NF), de neoplasie a cellules de Hirthle (NCH), de neoplasies papillaires presumees mais non averees (indeterminees, NPI), de meme que les neoplasies a cellules atypiques (NCA). Resultats : En tout, 380 patients ont presente des nodules thyroidiens indetermines a la cytologie. Parmi eux, 252 (66 %) presentaient une NF, 47 (12 %) une NCH, 44 (12 %) une NPI, 26 (7 %) une NCA et 11 (4 %) presentaient un diagnostic mixte. Les lesions soumises a la biopsie se sont revelees malignes a l'examen anatomopathologique chez 102 patients (27 %) : 49 (19 %) presentant une NF, 11 (23 %) une NCH, 28 (64 %) une NPI et 9 (35 %) une NCA. Pour 196 patients sur 225 (87 %) presentant une NF et 39 sur 42 (93 %) presentant une NCH, l'hemithyroidectomie a ete le traitement definitif adequat. Des liens significatifs ont ete etablis entre, d'une part, le diagnostic de cancer et, d'autre part, la taille plus petite des nodules chez les patients presentant une NF (p = 0,004) et la localisation au lobe thyroidien droit chez les patients atteints de NI (p = 0,012), bien que ces facteurs n'aient pas eu de portee significative aux analyses corrigees en fonction de multiples comparaisons. Conclusion : Lors d'une revue de l'experience accumulee dans un centre canadien, 4 interventions ont ete effectuees pour reconnaitre chaque cancer et l'hemithyroidectomie a ete l'approche chirurgicale initiale et definitive optimale chez la plupart des patients., Thyroid nodules are common in the general population; they are identified in about 5% of patients by palpation and 50% by ultrasound examination. (1) Fine needle aspiration biopsy (FNAB) represents [...]

Survivorship care has improved as the sequelae of breast cancer treatment have become better appreciated and understood in an era of increasing focus on patientcentred care. Development of arm lymphedema is a risk following axillary treatment. The introduction of less-invasive surgical procedures has resulted in decreased rates of lymphedema. It is now recognized that physical activity and routine medical procedures on the treated arm are safe and do not increase the risk of lymphedema. Patient education regarding early detection of lymphedema and timely referral to physiotherapy may be beneficial. Cosmesis may represent another survivorship concern. The appearance of the treated breast may impact self-image and recovery. The decision between breast conserving therapy and mastectomy is complex and is best supported through patient education and a patient-centred process of care. Lastly, chronic posttreatment pain may affect certain individuals. The optimal management of posttreatment pain involves a multimodal early-intervention strategy. This approach can be instituted in the pretreatment, intraoperative, and postoperative phase, using balanced multimodal analgesics, self-management techniques, and upper body physical recovery. This article reviews current approaches to arm lymphedema, posttreatment cosmesis, and reducing posttreatment pain. [ABSTRACT FROM AUTHOR]

Definitive treatment of breast cancer is surgical. Typically, the primary tumor is excised and axillary nodes are removed for staging. The decision on optimal treatment for the breast can be challenging for the clinician and the patient because of the wide variety of surgical options, including breast conserving surgery and mastectomy with or without immediate or delayed breast reconstruction. Surgical management of the axilla for clinically nodenegative and node-positive patients has progressed significantly over time. Sentinel node biopsy is now recommended for many clinical scenarios that would have previously required axillary node dissection. As optimal management of breast cancer is becoming more complex, many patients may benefit from early multidisciplinary review to aid in clinical decision making and to develop a patient specific treatment strategy. Current surgical management of breast cancer in British Columbia is based on consensus recommendations from the Breast Tumour Group of the BC Cancer Surgical Oncology Network. [ABSTRACT FROM AUTHOR]

The process leading to diagnosis of breast cancer has changed over the past 20 years with improvements in diagnostic imaging and a shift from surgical biopsy to image-guided core needle biopsy. History-taking and physical examination, diagnostic breast imaging, and biopsy are essential when evaluating breast concerns, as is the use of the Breast Imaging Reporting and Data System (BI-RADS) when describing findings. Assessment of the concordance between physical examination findings, imaging, and biopsy pathology is also essential to diagnosis, and minimizes surgical intervention. The roles of the primary care physician, radiologist, and surgeon have changed as well over the past 20 years, meaning that the optimal management of patients with breast concerns is now multidisciplinary. Referring physicians have different roles in navigating patients through the diagnostic system in different communities. [ABSTRACT FROM AUTHOR]

Background: The 7th edition of the AJCC Cancer Staging Manual (AJCC-7) includes substantial changes for colon cancer (CC), which are particularly complex in patients with stage II and III disease. We used a national cancer database to determine if these changes improved prediction of survival. Study Design: The database of the Surveillance, Epidemiology and End Results Program was queried to identify patients with pathologically confirmed stage I to III CC diagnosed between 1988 and 2008. Colon cancer was staged by the 6th edition of the AJCC Cancer Staging Manual (AJCC-6) and then restaged by AJCC-7. Five-year disease-specific survival and overall survival were compared. Results: After all exclusion criteria were applied, AJCC-6 and AJCC-7 staging was possible in 157,588 patients (68.9%). Bowker's test of symmetry showed that the number of patients per substage was different for AJCC-6 and AJCC-7 (p < 0.001). The Akaike information criteria comparison showed superior fit with the AJCC-7 model (p < 0.001). However, although AJCC-7 staging yielded a progressive decrease in disease-specific survival and overall survival of patients with stage IIA (86.3% and 72.4%, respectively), IIB (79.4% and 63.2%, respectively), and IIC (64.9% and 54.6%, respectively) CC, disease-specific survival and overall survival of patients with stage IIIA disease increased (89% and 79%, respectively). Subset analysis of patients with >12 lymph nodes examined did not affect this observation. Conclusions: The AJCC-7 staging of CC does not address all survival discrepancies, regardless of the number of lymph nodes examined. Consideration of other prognostic factors is critical for decisions about therapy, particularly for patients with stage II CC. [Copyright &y& Elsevier]