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PubMed1995

Psychotic patients with unclear diagnoses. A descriptive analysis.

This report describes the clinical characteristics of psychotic patients who received a 6-month longitudinal research diagnosis of psychosis not otherwise specified (NOS) or for whom no consensus diagnosis was reached. The reasons why these subjects could not be classified into a specific DSM-III-R category, their classification under the proposed DSM-IV criteria, their reclassification at 24-month follow-up, and differences between these groups and patients with schizophrenia and affective disorders in demographic characteristics, initial clinical features, and short-term course are explored. Data were drawn from the first phase of the Suffolk County Mental Health Project. Longitudinal consensus procedures were used to derive 6- and 24-month DSM-III-R diagnoses based on information from a structured diagnostic interview, an interview with the patient's clinician, the medical record and discharge summary, and significant others. Thirteen subjects (4.7%) received a diagnosis of psychosis NOS, and 12 (4.3%) had no consensus diagnosis. Seven with psychosis NOS had an acute onset with rapid remission; this subgroup met DSM-IV criteria for brief psychosis without stressors. As a group, the psychosis NOS subjects were significantly older and had a lower rate of lifetime alcohol abuse/dependence than the schizophrenic and affective disorder groups. Their short-term course was significantly better than that of the schizophrenics and similar to that of patients with an affective disorder. Subjects with no consensus diagnosis were more likely to have lifetime drug abuse/dependence than the other two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Dependability of esophageal pH-monitoring data in infants on cutoff limits: the oscillatory index.

The cutoff limit for pathologic gastroesophageal reflux (GER) has been arbitrary, although generally accepted determined at pH 4.00. The influence of a small pH error (0.25 pH units above or below pH 4.00) was analyzed in 173 consecutive pH monitorings. This appeared to cause a misinterpretation of the data in 51 of 173 infants (29%). We propose the introduction of a new parameter measuring the percent of time of the total investigation that the recorded pH varies between 4.25 and 3.75: the "oscillatory index" (OI). The index ranged from 0-42%. The higher the OI, the more pH data that are recorded between pH 4.25 and 3.75. The OI is related to the arbitrary aspects of a boundary level. The Pearson correlation coefficient between the percent of time of the investigation the pH was less than 4.00 and the OI was 0.75. If an OI of more than 10% in infants with normal pH-monitoring data of more than 15% in infants with a GER pathology would be considered as abnormal, pH-monitoring data of 45 infants should be considered for reclassification (26%). Prior to general application, this parameter should be evaluated by more centers in different patient populations, and other "oscillatory ranges" should be analyzed.

Esophagitis↗
PubMed1987

Computerized axial tomography of pelvic ring fractures.

The radiographs of all patients admitted to the Naval Hospital, Oakland with the diagnosis of pelvic trauma from 1981 through 1985 were reviewed. Thirty-one patients sustained single or double vertical ring fractures. Fifteen of these patients underwent both plain radiography and Computerized Axial Tomographic (CAT) scans in the evaluation of their pelvic injuries. The CAT scans of these pelvic injuries aided in detecting occult sacroiliac disruptions, determining the extent of posterior ring comminution, evaluating possible extension of the pelvic fractures into the acetabulum, assessing pelvic ring stability, and demonstrating soft-tissue injuries within the pelvis. Six pelvic injuries were diagnosed as single vertical breaks in the pelvic ring and nine were diagnosed as double vertical breaks in the pelvic ring by plain radiographs. CAT scanning demonstrated occult posterior ring disruptions in four patients which led to the reclassification of their injuries to double vertical fractures. CAT scanning also demonstrated significant degrees of sacral comminution in five patients which altered surgical treatment plans in all five patients. Two fractures were classified as unstable based on marked sacral comminution demonstrated on CAT scan. Extension of the pelvic ring fractures into the acetabulum was suggested on plain radiographs in three patients and was excluded by review of the CAT scans in these patients. Significant intrapelvic hematomas were demonstrated in three patients and urine extravasation into the hip joint from a bladder laceration was seen in one patient with the CAT scan.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗
PubMed1994

Reporting of perfusion/ventilation lung scintigraphy using an anatomical lung segment chart: a prospective study.

This study prospectively evaluated the effect of the consistent use of a previously described anatomical lung segment chart on the interpretation of lung scans. Simultaneous perfusion/ventilation lung scintigraphy was performed in 221 consecutive patients with clinically suspected pulmonary embolism. Lung scans were immediately reported as normal, high probability or non-diagnostic with the use of an anatomical lung segment chart. After at least 6 months, blinded lung scans were randomly read by a panel of nuclear medicine physicians. Initial lung scan reports were classified as normal, high probability or non-diagnostic in 64, 63 and 94 patients, respectively. Overall observer disagreement was 5.9% (95% confidence interval (CI) 3.2-9.8%), while this was 7.8, 3.2 and 7.9% for lung scans that were initially reported as normal, non-diagnostic and high probability, respectively. Reclassification consisted of normal to non-diagnostic (5), non-diagnostic to normal (1), non-diagnostic to high probability (2), and high probability to non-diagnostic scan results (5). From the literature, an overall disagreement of 20% was expected if no chart had been used. In conclusion, this study confirms that the consistent use of a lung segment chart reduces observer disagreement in the reporting of lung scans.

Adolescent↗
PubMed2003

Comparative impact of standard approach, FDG PET and FDG dual-head coincidence gamma camera imaging in preoperative staging of patients with non-small-cell lung cancer.

We prospectively compared the impact of the standard approach, of fluorodeoxyglucose positron emission tomography (FDG PET) and of FDG dual-head coincidence gamma camera imaging (DHC) in preoperative staging of patients with non-small-cell lung cancer (NSCLC). In addition to traditional staging, 42 patients were studied with a PET system and a DHC system. The number of lesions detected on DHC and on PET were compared independently of the proof of a tumoural invasion. Then, for the sub-group of lesions with the proof of a tumoural invasion, the sensitivity of the different imaging modalities was compared. Finally, stagings were compared with final staging established by histopathological findings (n=28), additional imaging modalities (n=4), clinical and traditional imaging follow-up over at least 4 months. DHC detected 105 of the 145 lesions considered as pathological on PET (73%, P=0.01), with a concurrence of 89% (NS) in lesions larger than 1.5 cm, and only 17% (P=0.03) in those smaller or equal to 1 cm. Traditional staging detected 87 of the 114 verified tumoural lesions (76%), PET 110/114 (96%, P=0.01 vs traditional staging), DHC 88/114 (77%, NS vs traditional staging, P=0.01 vs PET). PET correctly predicted the N stage in 39/42 (93%) patients, DHC in 38/42 (90%), and computed tomography in 32/42 (76%). PET correctly predicted the M stage in 42/42 (100%) patients, DHC in 41/42 (98%), and traditional staging in 38/42 (90%). Identical NM staging was obtained with DHC and PET in 38/42 (90%) patients. Compared to traditional NM staging, PET correctly up-staged 9/42 (21%) patients and down-staged 3/42 (7%), with one additional false N up-staging. DHC correctly up-staged 7/42 (17%) patients and down-staged 3/42 (7%), with one additional false N down-staging. PET correctly reclassified 4/42 (9.5%) patients from resectable to unresectable and incorrectly reclassified one. DHC correctly reclassified 3/42 (7%) patients without false therapeutic reclassification. Although DHC detected fewer lesions than PET, DHC is a possible alternative to PET since the impact on staging was high as compared with traditional staging and was very similar to that of PET.

Adult↗
PubMed1997

The expanding spectrum of Bartonella infections: II. Cat-scratch disease.

Recent advancements and developments in molecular biotechnology have allowed more precise reclassification of many microorganisms. With the use of these new taxonomy tools, several organisms previously thought to belong to other genera have been recently described as bartonellae. Of the 11 organisms now described as Bartonella spp., only four have been shown to be pathogenic for humans. Table 1 lists the four Bartonella human pathogens along with the their known epidemiology and the scope and range of disease associated with each. All are now considered to be bacteria and can be grown on blood-enriched agar although primary isolation in some may best be achieved in cell tissue culture. B. bacilliformis infection is limited to certain geographic regions in South America where the only human reservoir and the sandfly vector(s) that spreads the disease reside together. Specific antibiotic treatment is dramatically effective in treating the highly fatal, acute intraerythrocytic hemolytic form of the disease, but their effectiveness in treating the vascular proliferative forms (verruga peruana) or the chronic asymptomatic, bacteremic, carrier state of the disease has not been effective. This disease should remain confined to its present endemic geographic areas in South American unless asymptomatic bacteremic persons from these areas migrate to areas where sandflies and humans exist that are capable of establishing this infection in new endemic areas. B. quintana and B. henselae cause a wide range of clinical diseases in humans, the type and extent of which varies significantly with the immune status of the host. In immunocompetent hosts the pathologic response is granulomatous, suppurative, extracellular and intracellular, generally self-limited and usually unresponsive to antibiotic treatment, even to those drugs to which the organism is shown to be sensitive in vitro. In contrast, in immunocompromised hosts the pathologic response is vasculoproliferative, organisms may be seen intracellularly but they are often seen in abundance in extracellular clumps and infection is usually progressive and fatal unless treated. In these patients clinical response to treatment with drugs that are effective in vitro against these organisms has usually been dramatic. Of these agents those that penetrate cells and are found in high concentrations intracellularly, such as erythromycin, clarithromycin, azithromycin, rifampin, doxycycline and gentamicin, appear to be most effective. These agents not only appear to provide the most dramatic treatment response in patients with BA, BP and PRFB and other manifestations of B. henselae (and B. quintana as well) in immunocompromised persons, they appear to be the most promising agents for treatment of persons with both typical and atypical CSD. Further studies will be necessary to more clearly elucidated the mechanisms responsible for the diverse clinical presentations of infection with these organisms in human hosts relative to their immune status. In addition clarification of the epidemiology of B. elizabethae infections in humans may be helpful in understanding the nature of infection with Bartonella organisms.

Bartonella henselae↗
PubMed1981

Campylobacter fetus ssp jejuni: isolation from patients with gastroenteritis.

Within a seven-month period, Campylobacter fetus ssp jejuni was isolated in East Tennessee from 18 patients with gastroenteritis; 83% of these patients had bloody diarrhea. Absence of other enteric organisms such as Salmonella, Shigella, and Yersinia implicated C fetus ssp jejuni as the causative agent. A fourfold increase in titer by tube agglutination from four of eight patients studied supported the pathogenicity of this organism. Treatment with erythromycin alleviated gastroenteritis symptoms within 24 to 48 hours, with concurrent disappearance of the organism from the feces. An isolation rate of 8% in our patients indicates that C fetus ssp jejuni is more common as a cause of human diarrhea than Salmonella or Shigella. The severity of the C fetus ssp jejuni gastroenteritis poses a possible reclassification from diarrhea or gastroenteritis to acute dysentery syndrome.

Adult↗
PubMed1996

Advances in the molecular genetics of the limb-girdle type of autosomal recessive progressive muscular dystrophy.

A reclassification of the limb-girdle types of autosomal recessive muscular dystrophy based on genetic and protein information has been made possible by major advances over the past 2 years. At least six different forms of limb-girdle types of autosomal recessive muscular dystrophy can be defined by their genetic basis, with at least two pathogenic mechanisms involved. Three forms are defined by involvement of different proteins of the sarcoglycan complex, while a muscle specific protease (calpain 3) is implicated in another form of the recessive disease. These findings provide the basis for a new diagnostic approach to the group, with molecular techniques now an essential part of the diagnostic process. A scheme for diagnosis in this group is proposed.

Cytoskeletal Proteins↗
PubMed2000

Pediatric renal cell carcinomas: where do they fit in the new histologic classification of renal cell carcinoma?

Genetic, immunohistochemical, and histologic data has led to the reclassification of renal cell carcinoma in the last decade. Recent studies suggest that renal cell carcinomas in children and young adults may represent a distinct group of tumors. These tumors have unique genetic findings (most commonly t(x;1)(p11:q21)), a predominantly papillary architecture, numerous calcifications, granular cytoplasm, and a possible relationship with neuroblastoma.

Adolescent↗
PubMed2003

Endothelial lesions of soft tissues: a review of reactive and neoplastic entities with emphasis on low-grade malignant ("borderline") vascular tumors.

Soft tissue proliferations composed of endothelial cells are a heterogeneous group of lesions that can cause diagnostic difficulty. Further complicating the issue is the constantly changing nomenclature of some entities, as well as reclassification of some vascular tumors from the high-grade malignant category to the low-grade malignant or borderline category. Modern ancillary techniques such as immunohistochemistry and cytogenetics have done little to advance our knowledge of these lesions. This review article outlines the most recent classification of endothelial lesions of the skin and soft tissues, with emphasis on the low-grade malignant (borderline) category. In addition, many tumor-like lesions containing an endothelial component are also discussed.

Angiomatosis↗
PubMed2002

Effect of recorded home blood pressure measurements on the staging of hypertensive patients.

OBJECTIVE: To compare clinic and home blood pressures for use in classifying patients in relation to a recent guideline for the diagnosis of hypertension. METHODS: Fifty patients were studied and classified on the basis of clinic pressures, using the Joint National Committee VI criteria, into the categories of normal, high-normal and stage 1, 2 or 3 hypertension. The patients were given instructions for using the Omron IC home-recording device to take their blood pressure daily for 1 week and then return the units for data recall and entry. Average home-recorded pressures were calculated and patients reclassified in terms of the Joint National Committee VI criteria if their home pressures were higher or lower than their clinic pressures. RESULTS: According to the clinic results, 18% of the participants had normal blood pressure, 16% had high-normal pressure, 48% were hypertensive stage 1, 16% were hypertensive stage 2 and 2% were hypertensive stage 3. Reclassification by recorded home pressures occurred in 54% of the participants: 40% downwards and 14% upwards. Only 46% remained in the same category for both clinic and recorded home pressures. CONCLUSION: Recorded home blood pressure measurement provides an accurate, reliable and unbiased assessment. Using the Joint National Committee VI classification system for both clinic and recorded home blood pressures, the data on the home pressures led, in this sample, to a downward classification three times more frequently than an upward one. We therefore conclude that recording home blood pressure is a highly useful method for assigning the appropriate blood pressure classification when using the Joint National Committee VI guidelines.

Aged↗
PubMed2006

Treatment for Adolescents with Depression Study (TADS): safety results.

OBJECTIVE: To compare the rates of physical, psychiatric, and suicide-related events in adolescents with MDD treated with fluoxetine alone (FLX), cognitive-behavioral therapy (CBT), combination treatment (COMB), or placebo (PBO). METHOD: Safety assessments included adverse events (AEs) collected by spontaneous report, as well as systematic measures for specific physical and psychiatric symptoms. Suicidal ideation and suicidal behavior were systematically assessed by self- and clinician reports. Suicidal events were also reanalyzed by the Columbia Group and expert raters using the Columbia-Classification Algorithm for Suicidal Assessment used in the U.S. Food and Drug Administration reclassification effort. RESULTS: Depressed adolescents reported high rates of physical symptoms at baseline, which improved as depression improved. Sedation, insomnia, vomiting, and upper abdominal pain occurred in at least 2% of those treated with FLX and/or COMB and at twice the rate of placebo. The rate of psychiatric AEs was 11% in FLX, 5.6% in COMB, 4.5% in PBO, and 0.9% in CBT. Suicidal ideation improved overall, with greatest improvement in COMB. Twenty-four suicide-related events occurred during the 12-week period: 5 patients (4.7%) in COMB, 10 (9.2%) in FLX, 5 (4.5%) in CBT, and 3 (2.7%) in placebo. Statistically, only FLX had more suicide-related events than PBO (p =.0402, odds ratio (OR) = 3.7, 95% CI 1.00-63.7). Only five actual attempts occurred (2 COMB, 2 FLX, 1 CBT, 0 PBO). There were no suicide completions. CONCLUSIONS: Different methods for eliciting AEs produce different results. In general, as depression improves, physical complaints and suicidal ideation decrease in proportion to treatment benefit. In this study, psychiatric AEs and suicide-related events are more common in FLX-treated patients. COMB treatment may offer a more favorable safety profile than medication alone in adolescent depression.

Adolescent↗
PubMed2006

Left ventricular hypertrophy and cardiovascular risk stratification: impact and cost-effectiveness of echocardiography in recently diagnosed essential hypertensives.

BACKGROUND: Echocardiography is more accurate than electrocardiography in the assessment of cardiac target organ damage related to hypertension, thus leading to a more precise stratification of total cardiovascular risk. However, ultrasound examination of the heart on a routine basis remains a matter of debate. OBJECTIVE: To evaluate the impact and cost-effectiveness of echocardiographic examination on global risk stratification in low and medium-risk hypertensive patients in relation to age and sex. METHODS: A total of 580 untreated hypertensive individuals (355 men and 225 women, mean age 47.8 +/- 11.4 years), classified at low to medium risk, according to routine clinical work-up suggested by the 2003 European Society of Hypertension/European Society of Cardiology guidelines, were included in the study. Total risk was reassessed by adding the results of ultrasound examination of the heart. Left ventricular hypertrophy (LVH) was defined as a left ventricular mass index of 125 g/m2 or more in men and 110 g/m2 or more in women. The impact of LVH in stratifying risk was assessed according to age (< 50 and > or = 50 years) and sex. RESULTS: According to routine classification, 16.3% (n = 93) of the 580 patients were considered to be at low added risk and 83.7% (n = 487) at medium added risk. In the whole population, echocardiographic LVH was found in 86 patients (14.8%) who were then reclassified in the high-risk stratum. The prevalence rates of patients reclassified in the high-risk class as a consequence of LVH detection, according to age and sex, were as follows: 8.9% in men under 50 years, 12.3% in women under 50 years, 26.7% in men aged 50 years and over and 15.3% in women aged 50 years and over. The cost per detected case of LVH was 595 euros in patients under 50 years of age and 290 euros in those 50 years of age and older. CONCLUSIONS: Our findings indicate that the prevalence of LVH, and consequently the probability of upgrading the total cardiovascular risk profile, is highest in the group of old hypertensive men; echocardiography has a limited impact on the risk reclassification in younger patients and an unfavourable cost-effectiveness profile. Our data thus do not support the systematic ultrasound assessment of the heart in all uncomplicated hypertensive individuals.

Adult↗
PubMed2005

Cancer specific survival for patients with pT3 renal cell carcinoma-can the 2002 primary tumor classification be improved?

PURPOSE: The 2002 primary tumor classification for renal cell carcinoma (RCC) does not distinguish between patients with tumor thrombus involving the renal vein only and those with inferior vena cava tumor thrombus below the diaphragm. We evaluated the association of tumor thrombus level and fat invasion with outcome to determine if further subclassification would improve the prognostic accuracy of the current classification. MATERIALS AND METHODS: We studied 675 patients treated with radical nephrectomy or nephron sparing surgery for pT3a (206, 30.5%), pT3b (422, 62.5%), pT3c (19, 2.8%) or pT4 (28, 4.2%) RCC at the Mayo Clinic between 1970 and 2000. Associations with outcome were evaluated using Cox proportional hazards regression. RESULTS: There were 531 deaths from RCC at a median of 1.5 years following nephrectomy. Patients with pT3b RCC and level I, II or III tumor thrombus were significantly more likely to die of RCC compared to patients with pT3b RCC and level 0 tumor thrombus (risk ratio 1.62, p <0.001). Patients with peripheral perinephric or renal sinus fat invasion were also more likely to die of RCC compared to patients without fat invasion (risk ratio 1.87, p <0.001). Therefore, patients with pT3 RCC were reclassified into 4 groups as thrombus level 0 without fat invasion, fat invasion only, thrombus level 0 with fat invasion or thrombus level I, II or III without fat invasion, and thrombus level I, II or III with fat invasion or thrombus level IV. This reclassification significantly improved prediction of death from RCC compared with the current classification (c indexes of 0.61 versus 0.55, respectively). CONCLUSIONS: Further subclassification of the primary tumor classification for patients with pT3 RCC improved prognostic accuracy.

Carcinoma, Renal Cell↗
PubMed2005

Should direct ipsilateral adrenal invasion from renal cell carcinoma be classified as pT3a?

PURPOSE: The 2002 American Joint Committee on Cancer primary tumor classification for renal cell carcinoma (RCC) defines a tumor as pT3a if it invades the perinephric or renal sinus fat or directly invades the ipsilateral adrenal gland. In the current study we evaluated the association of direct ipsilateral adrenal invasion with outcome to determine if reclassification of these tumors as pT4 would improve the accuracy of the current tumor classification. MATERIALS AND METHODS: We studied 424 patients who underwent nephrectomy and adrenalectomy for unilateral, sporadic, pT3 or pT4 RCC between 1970 and 2000 at the Mayo Clinic. Cancer specific survival was estimated using the Kaplan-Meier method. RESULTS: Cancer specific survival for the 22 patients with pT3a or pT3b tumors that directly invaded the ipsilateral adrenal gland was significantly worse compared with that of patients with pT3a (p <0.001) or pT3b (p = 0.011) disease that did not invade the adrenal gland. There was no significant difference in the 5-year cancer specific survival between the patients with pT3a or pT3b tumors that directly invaded the ipsilateral adrenal gland and patients with pT4 tumors (cancer specific survival rates of 20% and 14%, respectively, p = 0.490). CONCLUSIONS: Although rare, RCC with direct ipsilateral adrenal invasion behaves more aggressively than tumors involving perinephric or renal sinus fat. We believe that RCC tumors with direct adrenal invasion should be classified as pT4.

Adrenal Gland Neoplasms↗
PubMed2005

The impact of under coding of cardiac severity and comorbid diseases on the accuracy of hospital report cards.

CONTEXT: Hospital report cards usually are based on administrative discharge abstracts. However, cardiac severity and comorbidities generally are under-reported in administrative data. OBJECTIVE: We sought to determine how undercoding of cardiac severity and comorbidities affects the determination that some hospitals are high-mortality outliers. DESIGN: Simulations using retrospective data on 18,795 patients admitted with an acute myocardial infarction (AMI) to 109 acute care hospitals in Ontario. MAIN OUTCOME MEASURE: Change in the number of hospitals that remained high-mortality outliers after adjusting for potentially increased prevalence of as many as 9 separate measures of cardiac severity and comorbid conditions, individually or together. RESULTS: For most measures of cardiac severity and comorbidities, increasing the prevalence of each factor to the highest observed hospital-specific prevalence seldom altered the status of high-mortality outlier hospitals. Increases in the prevalence of cardiogenic shock or acute renal failure to even the median level led to reclassification of up to 4 of the 12 high-mortality outlier hospitals to nonoutlier status. Most high-mortality outlier hospitals were reclassified if the maximum prevalence was imputed for these 2 factors. Simultaneously increasing the prevalence of all comorbidities to the median level typically converted the status of about half the outlier hospitals. Not until the prevalence of all measures of cardiac severity and comorbidities were simultaneously increased to the maximum observed hospital-specific prevalence, did all hospitals initially classified as high-mortality outliers revert to nonoutlier status. CONCLUSIONS: Undercoding of severity and comorbidities in administrative data in itself is very unlikely to account for the outlier status of most hospitals. However, some potential for misclassification of individual institutions exists if influential factors are variably coded.

Comorbidity↗
PubMed2006

Diagnosing major depressive disorder III: can some symptoms be eliminated from the diagnostic criteria?

All criteria used to diagnose a psychiatric disorder should contribute to distinguishing cases from noncases. The principal of parsimony argues for defining a disorder with as few criteria as possible. Thus, criteria that do not contribute to the case-noncase distinction should be eliminated from the list of defining features because they unnecessarily increase the complexity of the definition of the disorder. In polythetically defined disorders such as major depressive disorder (MDD), diagnosis is based on the presence of a minimum number of features from a list. For a criterion to be retained on such a list, it should contribute to distinguishing between individuals with and without MDD. Simply demonstrating that a criterion is significantly more common in individuals with MDD than individuals without MDD is not a sufficient demonstration of its necessity. Rather, to demonstrate an impact on diagnosis, it should be shown that eliminating the criterion from the list results in individuals being reclassified from a case to a noncase. A criterion does not contribute to determining caseness if its elimination does not result in diagnostic reclassification. The goal of this report from the Rhode Island Hospital Methods to Improve Diagnostic Assessment and Services project was to determine if any of the criteria of MDD are candidates for elimination because of their lack of impact on diagnosis. The results indicated that the symptoms of increased weight, decreased weight, and indecisiveness rarely influenced diagnostic classification and thus are candidates for elimination.

Affective Symptoms↗
PubMed2005

Follicular thyroid carcinoma: the role of histology and staging systems in predicting survival.

OBJECTIVE: To evaluate the risk factors including tumor histomorphology for survival specific to follicular thyroid carcinoma (FTC) and to apply commonly employed staging systems in predicting survival for patients with FTC. SUMMARY BACKGROUND DATA: FTC is usually analyzed collectively with papillary thyroid carcinoma (PTC) in risk group analysis. Risk factors and risk group analysis are important in the management of patients with FTC, although current published therapeutic guidelines call for total thyroidectomy followed by radioactive iodine (I) ablation for all FTC patients. METHODS: Over a 40-year period, 156 patients surgically treated for FTC with an average follow-up of 14.4 years were retrospectively studied after histologic reclassification according to the type and degree of invasiveness of the tumor. Potential risk factors for survival were calculated using multivariate analysis, and the prognostic accuracy of AMES risk group stratification, UICC/AJCC pTNM staging, Degroot classification, and MACIS scoring schemes in predicting survival was compared. RESULTS: Seventeen (11%) patients had distant metastases at presentation, and bilateral thyroid resection was performed for 131 (84%) patients. Seventeen (11%) patients died of recurrent or metastatic disease. The overall and cancer-specific survival (CSS) rates at 10 years were 79% and 88%, respectively. None of the patients with minimally invasive (n = 49) or angioinvasive (n = 23) carcinomas died compared with 17 of 84 patients with widely invasive carcinomas (P = 0.0007). Using the Cox proportional hazards model, old age, the presence of distant metastases, and incomplete tumor excision were independent prognostic factors for survival. For patients who underwent curative treatment, old age and widely invasive carcinoma were risk factors for poor survival. All staging systems studied accurately predicted CSS, and the pTNM UICC/AJCC staging system yielded the best prognostic information. CONCLUSIONS: Commonly adopted staging systems can be applied specifically to patients with FTC. The distinction of FTC in minimally invasive and widely invasive carcinoma based on the extent of invasiveness rather than vascular invasion is important in identifying low-risk FTC patients for a more conservative management.

Adenocarcinoma, Follicular↗