[ON THE INCIDENCE OF THYROID CANCER].
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One hundred and forty-eight basal cell carcinomas were treated by curettage and electrosurgery. Twenty-six recurrent carcinomas were treated and 24 did not recur during a minimum two-year follow-up. Seventy-two newly diagnosed carcinomas were treated by the same method, and a two-year recurrence-free rate of 97.4% was obtained. About 50 new and recurrent lesions were treated in three patients in whom extensive cutaneous changes from actinic atrophy and previous therapy made the distinction between new and recurrent lesions difficult or impossible. This technique has a particular place in the management of multiple lesions. Patient acceptance is good. Lesions at some sites, e.g. on the nose, where closure of a wound is difficult, are better managed by this method than by surgical excision. Secondary infection is rare and the cosmetic results are excellent.
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OBJECTIVE: To determine how to triage patients with a follicular neoplasm (FN), without nuclear atypia reported by fine-needle aspiration, on the basis of risk factors. METHODS: The age, sex, tumor size, and cell type of 397 patients who underwent thyroidectomy for follicular carcinoma (FC) or follicular adenoma between 1991 and 2001 were analyzed statistically. The likelihood ratio and probability of FC for various combinations of tumor size, sex, and cell type were estimated with use of Bayes' theorem. RESULTS: FC was significantly associated with tumor size >2.1 cm (P = 0.048), male sex (P = 0.0007), and Hürthle cell type (P<0.0001). The mean size of minimally invasive FC was significantly smaller (2.9 cm versus 4.8 cm; P = 0.004) and the mean patient age was significantly younger (47.6 years versus 61.0 years; P = 0.003) than for widely invasive FC. The lowest probability (0.31%) for FC was in female patients with a small (< or = 2.1 cm) micro-follicular FN reported by a cytopathology practice with 10% accuracy of true FN at surgical intervention, whereas the highest probability (29.5%) for FC was in male patients with a large (>2.1 cm) Hürthle cell neoplasm reported by a cytopathology practice with 70% accuracy of true FN at surgical intervention. CONCLUSION: Although an estimate of probability for FC based on age, sex, thyroid nodule size, and cell type is provided in this study for patients diagnosed with FN without nuclear atypia on fine-needle aspiration, the variability of the accuracy in cytopathology practice makes it difficult to change the current treatment paradigm, which requires carefully planned prospective studies with long-term follow-up.
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