Background
The relationship between breast cancer (BC) and thyroid disease (TD) is still controversial. The aim of the study was to investigate the possible coexistence of TD in patients with newly diagnosed BC and its correlation with BC clinical presentation with regard to menopausal status and stage of disease.
Methods
This is a retrospective cohort study of all patients treated for primary BC between 2014 and 2016 at the Breast Unit of Trieste University Hospital. Clinical charts and reports were reviewed for coexisting thyroid disorders (i.e. hyperthyroidism, hypothyroidism, benign TD, thyroid cancer, thyroid autoimmunity) and menopausal status at the time of BC diagnosis. Biomolecular profile, stage, and grading of BC were also evaluated.
Results
A total of 786 women and 7 men were included in the study. Co-presence of TD was found in 161(20.3%) cases: of these, 151(19.4%) patients presented benign TD and 10(1.3%) patients presented thyroid carcinoma. Thyroid autoimmunity was found in 51(32%) patients. Regarding thyroid function, 88(55%) patients had hypothyroidism, 19(12%) hyperthyroidism, and 54(33%) normal thyroid function. No statistically significant correlation was found between age and TD (p = 0.16), although TD was more common in women aged ≥60 years. Women with BC diagnosed at pre-menopausal age were more likely to have thyroid autoimmune diseases (45% vs. 29%, p = 0.05). No association was detected among BC molecular profiles with either thyroid autoimmunity (p = 0.26) or altered thyroid function (p = 0.63). High-grade BC was more frequent in women with hyperthyroidism (52.9%, p = 0.04), but the grading was independent from the presence of thyroid autoimmune disease (p = 0.87). BC stage was related to both thyroid autoimmunity (p = 0.04) and thyroid function (p < 0.001), with 55.2% of women affected by benign TD presenting with stage I BC and more aggressive BCs found in hypothyroid patients.
Conclusions
According our study results, patients with primary BC present a greater incidence of autoimmunity disorders, especially when diagnosed in the pre-menopausal setting. However, further prospective studies are required to definitively prove causality.
Purpose. Aim of the study was to assess the impact of the Italian Society of Anatomic Pathology and Diagnostic Cytology (SIAPEC) classification of 2014, on the treatment of indeterminate thyroid lesions (TIR3). Methods. We retrospectively analyzed patients undergoing thyroid surgery for TIR3 lesions between 2013 and 2018, at the General Surgery Department of Trieste University Hospital. According to the SIAPEC classification, patients were divided into TIR3A and TIR3B groups. All patients treated before 2014 underwent surgical treatment, and surgical specimens were retrospectively classified after revision of fine-needle aspiration cytology. Starting 2014, TIR3A patients were treated only when symptomatic (i.e., coexistent bilateral thyroid goiter or growing TIR3A nodules), whereas TIR3B patients always received surgical treatment. Hemithyroidectomy (HT) was the procedure of choice. Total thyroidectomy (TT) was performed in case of concurrent bilateral goiter, autoimmune thyroid disease, and/or presence of BRAF and/or RAS mutation. Lastly, we analyzed the malignancy rate in the two groups. Results. 29 TIR3A and 90 TIR3B patients were included in the study. HT was performed in 10 TIR3A patients and 37 TIR3B patients, respectively, with need for reoperation in 4 TIR3B (10.8%) patients due to histological findings of follicular thyroid carcinoma >1 cm. The malignancy rates were 17.2% in TIR3A and 31.1% in TIR3B, (p=0.16). Predictability of malignancy was almost 89% in BRAF mutation and just 47% in RAS mutation. Conclusions. The new SIAPEC classification in association with biomolecular markers has improved diagnostic accuracy, patient selection, and clinical management of TIR3 lesions.
Background: Despite mortality in pancreatic surgery has decreased over the last decade, morbidity still remains high. One of the most important causes for this is the occu pancreatic fistula. Recent studies have demonstrated the importance of fluid management during the post-operative period in major abdominal surgeries. This finding was observed in colonic surgery as well, demonstrating that the overcharge of fluids increases post-operative complications. We aime to evaluate the impact of fluid management on post-operative complications after videolaparoscopic distal pancreatectomy (VDP). Methods: Descriptive, retrospective study of a prospective database of patients who underwent VDP from November 2011 to September 2018. Thirty patients were evaluated and divided into two different groups according to the fluid management protocol used (restrictive or liberal). The data were collected from the anesthesia`s protocols and nursery reports (until 3rd post-operative day). Demographics, length of stay, kind of fluid management and complications were analyzed. For statistical analysis SPSSÒv.21 was used (p= < 0.05 was considered significant) Results: Out of 30 patients, 17 (%) were male, mean age was 55 years(r 19-82); 17 patients (57%) were included in liberal group (LG) and 13 (43%) in restrictive group (RG). Twenty-three patients developed complications;16 (53 %) belonged to LG whereas7 (23 %) to RG(p=0,01). Fourteen patients of LG vs. 6 patients of RG had post-operative pancreatic fistula (p=0.04). There were 7 patients (23 %) in LG and 4 (13 %) patients in RG with POPF-CS (13 %, p=ns). 90-day-mortality was 3.3 % Conclusion: After videolaparoscopic distal pancreatectomy, liberal fluid administration at the perioperative period is associated with an increase in the incidence of complication, specially the development of POPF.
Background: Aim of this study was to analyse our results of oriented parathyroidectomy (minimally-invasive parathyroidectomy (MIP) minimally-invasive video-assisted parathyroidectomy (MIVAP); and to confirm the usefulness of intra-operative parathyroid hormone (PTH) monitoring (ioPTH) when using minimally invasive techniques for treatment of sporadic primary hyperparathyroidism (pHTP).
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