Ultrasonic Screening of the Thyroid in Patients with Breast Complaints

Ultrasonic Screening of the Thyroid in Patients with Breast Complaints

Yasuhisa Fujimoto

, Masahiro Hatama

, Kenji Tezuka

, Hiroshi Otani

, Yuuichi Arimoto

, Katsumi Ikeda

,

Sadatoshi Shimizu

, Yoshinari Ogawa

, and Yukio Nishiguchi

167 Summary. From 1994 until 2002, we performed 6956 ultrasonic screenings of the thyroid for all patients who received breast examination by ultrasonography. We discovered 14 thyroid cancers (0.32%) from 4327 cases with breast complaints. The incidence of thyroid cancer with breast cancer (0.25%) was three times higher than that of thyroid cancer without breast cancer (0.73%). It was concluded that ultrasonic screening of the thyroid was useful in patients with breast complaints.

Key words. Ultrasonic screening of thyroid, Thyroid cancer, Thyroid cancer with breast cancer

Purpose

A possible association between breast disease and thyroid disease has been discussed in many reports. In 1988, we reported the usefulness of the ultrasonic screening of thyroid in patients with breast complaints at the 5th World Federation for Ultrasound in Medicine and Biology in Washington D.C. [1]. In 1994, we started a new series of ultrasonic screening of the thyroid for all patients who received breast examination by ultrasonography at the newly opened Osaka City General Hospital. The purpose of the present study is to reevaluate its usefulness.

Materials and Methods

From 1994 until 2002, we performed 6956 ultrasonic examinations of the thyroid and breast concurrently on 4327 patients who came to Osaka City General Hospital with breast complaints. The number of the patients with breast cancer was 682. We used Aloka SSD 650CL, GE Logiq 500, GE Logiq 700, and ATL HDI 5000. In most cases, at the time of examination, we placed a pillow under the left shoulder and examined the left breast first. We then moved the pillow under the neck, and examined the thyroid.

1

Osaka City Sumiyoshi Hospital, 1-2-16 Higashikagaya, Suminoe-ku, Osaka 559-0012, Japan

2

Osaka City General Hospital, 2-3-22 Miyakojimahondori, Miyakojima-ku, Osaka 534-0021,

Japan

Finally, we examined the right breast with the pillow under the right shoulder (Fig. 1).

Results

In 4327 examinations, 35 cases (0.81%) had malignant findings in the thyroid by ultra- sonography. The maximum size of these 35 nodules was 1.11 ± 0.41 cm. Of the 682 cases with breast cancer, 9 cases (1.32%) had malignant findings in the thyroid by ultrasonography. Of the 3645 cases without breast cancer, 26 cases (0.71%) had malig- nant findings in thyroid by ultrasonography.

Fourteen cases were operated and diagnosed histologically. In the 14 cases, we found 13 thyroid cancers, which included 12 papillary carcinomas and 1 medullary carcinoma, with 6 negative, 6 positive, and 1 unknown for lymph node metastasis.

One nonoperative case was diagnosed cytologically as thyroid cancer and 14 cases (0.32%) were thyroid cancers diagnosed pathologically. Maximum size of these 14 cancer nodules was 1.14 ± 0.23 cm.

Of the 682 cases with breast cancer, 5 cases (0.73%) were thyroid cancer. Of the 3645 cases without breast cancer, 9 cases (0.25%) were thyroid cancer. The incidence of thyroid cancer with breast cancer was three times higher than that of thyroid cancer without breast cancer.

Of the 35 cases with malignant findings, 21 cases were tracked. There were 8 cases that were tracked over 2 years by ultrasonography. Of the 8 cases, 3 cases had an increase in tumor size and 5 cases had no change in size. The increase was 1.3 to 1.6 cm in diameter over 4 years, 1.7 to 2.1 cm in diameter over 3 years, and 0.9 to 1.0 cm in diameter over 2 years.

Discussion

In this study, the discovery rate of thyroid cancer was 0.25% in the cases without breast cancer. This incidence of thyroid cancer may show in general in people who come to common mass screening. It was concluded that the ultrasonic screening of thyroid 168 Y. Fujimoto et al.

Fig. 1. Position for the examination

was useful in the patients with breast complaints. The incidence rate, which was three times higher with breast cancer, was noteworthy. This result showed that a relation- ship between thyroid cancer and breast cancer might be present.

There is no evidence for this explanation. However, there is the Cowden syndrome, which is characterized by a high risk of breast and thyroid cancers. Perren et al. [2]

reported that this syndrome causes genetic disorders. With the exception of genetic factors, environmental factors, such as exposure to X-rays of the thyroid and the breast, may be a candidate for this explanation.

References

1. Fujimoto Y, Kato Y, Maekawa H, et al (1988) Ultrasonic screening of thyroid in the patients with breast complaints. J Ultrasound Med 7:39–S283

2. Perren A,Weng L, Boag AH, et al (1999) Immunohistochemical evidence of loss of PTEN expression in primary ductal adeocarcinomas of the breast. Am J Pathology 155:

1253–1260

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