Yonsei Med J.  2007 Feb;48(1):63-68. 10.3349/ymj.2007.48.1.63.

Sonographic Detection of Thyroid Cancer in Breast Cancer Patients

• Park JS
• Oh KK
• Kim EK
• Son EJ
• Chang HS
• Hong SW
• Moon HJ
• Kwack KS

• KMID: 1093525
• DOI: http://doi.org/10.3349/ymj.2007.48.1.63

Abstract

The purpose of our study was to analyze the incidence of incidental thyroid cancers which were detected by simultaneous sonographic examination of breast and thyroid glands. Between January 2001 and March 2004, 518 patients were diagnosed with breast cancer after modified radical mastectomy (n=369) or breast conserving surgery (n=149). We screened thyroid glands when we examined breast for diagnosis and follow-up after surgery. If we found the sonographic finding of suspicious for malignancy in thyroid, we immediately performed ultrasound-guided fine needle aspiration biopsy (FNAB). Forty-two cases showed suspicious sonographic findings and of those, 18 cases (42.9%) were determined to have suspicious malignant cytology by ultrasound guided FNAB. Among 518 breast cancers, total 13 cases (2.5%) were diagnosed with papillary carcinoma after thyroidectomy. The mean longest diameter of the thyroid masses was 9.9mm (range 1-30mm). Six cases (6/13, 46.2%) were diagnosed as simultaneous breast and thyroid cancers, and the rest of the thyroid cancers were detected after 6 to 33 months (mean 16.5 months) after surgery. In conclusion, the patients with breast cancer had a high incidence (2.5%) of thyroid cancer. Sonographic screening is useful for the early detection of thyroid cancer.

Keyword

Breast neoplasms; thyroid neoplasms; ultrasonography

Figure

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  Fig. 1 38-year-old woman with breast and thyroid cancer simultaneously. (A) Breast sonography showed irregular hypoechoic mass with microcalcifications (arrow). (B) Simultaneous thyroid sonography showed about 5mm-sized hypoechoic nodules on both sides (arrows). Infiltrating ductal carcinoma of the breast and papillary carcinoma of both thyroid glands were confirmed.

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  Fig. 2 51-year-old woman with breast cancer; thyroid cancer was detected 12 months after mastectomy. (A) Preoperative breast sonography showed an irregular hypoechoic mass (arrow) at left subareolar area, proving infiltrating ductal carcinoma. Initial thyroid sonography was negative. (B) 12-month follow-up sonography showed an approximately 5mm-sized taller-than-wider hypoechoic nodule at the right thyroid gland, proving papillary carcinoma.

Reference

1. Shin HR, Won YJ, Jung KW, Park JG. 2001 Annual Report of the Korea Central Cancer Registry: based on registered data from 134 hospitals. Cancer Res Treat. 2004. 36:19–30.

2. Tanaka H, Tsukuma H, Koyama H, Kinoshita Y, Kinoshita N, Oshima A. Second primary cancers following breast cancer in the Japanese female population. Jpn J Cancer Res. 2001. 92:1–8.

3. Matesich SM, Shapiro CL. Second cancers after breast cancer treatment. Semin Oncol. 2003. 30:740–748.

4. Rubino C, de Vathaire F, Shamsaldin A, Labbe M, Le MG. Radiation dose, chemotherapy, hormonal treatment and risk of second cancer after breast cancer treatment. Br J Cancer. 2003. 89:840–846.

5. Li CI, Rossing MA, Voigt LF, Daling JR. Multiple primary breast and thyroid cancers: role of age at diagnosis and cancer treatments (United States). Cancer Causes Control. 2000. 11:805–811.

6. Colonna M, Grosclaude P, Remontet L, Schvartz C, Mace-Lesech J, Velten M, et al. Incidence of thyroid cancer in adults recorded by French cancer registries (1978-1997). Eur J Cancer. 2002. 38:1762–1768.

7. Chen AY, Levy L, Goepfert H, Brown BW, Spitz MR, Vassilopoulou-Sellin R. The development of breast carcinoma in women with thyroid carcinoma. Cancer. 2001. 92:225–231.

8. Parkin DM, Whelan SL, Ferlay J, Raymond L, Young J. Cancer incidence in five continents. 1997. vol. VII. Lyon, France: International Agency for Research on Cancer, Scientific Publication;no. 143.

9. Liu S, Semenciw R, Ugnat AM, Mao Y. Increasing thyroid cancer incidence in Canada, 1970-1996: time trends and age-period-cohort effects. Br J Cancer. 2001. 85:1335–1339.

10. Reynolds RM, Weir J, Stockton DL, Brewster DH, Sandeep TC, Strachan MW. Changing trends in incidence and mortality of thyroid cancer in Scotland. Clin Endocrinol (Oxf). 2005. 62:156–162.

11. Miki H, Inoue H, Komaki K, Uyama T, Morimoto T, Monden Y. Value of mass screening for thyroid cancer. World J Surg. 1998. 22:99–102.

12. Eden K, Mahon S, Helfand M. Screening high-risk populations for thyroid cancer. Med Pediatr Oncol. 2001. 36:583–591.

13. Ezzat S, Sarti DA, Cain DR, Braunstein GD. Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch Intern Med. 1994. 154:1838–1840.

14. Lee HK, Hur MH, Ahn SM. Diagnosis of occult thyroid carcinoma by ultrasonography. Yonsei Med J. 2003. 44:1040–1044.

15. Park JS, Oh KK, Kim EK, Chang HS, Hong SW. Sonographic screening for thyroid cancer in female undergoing breast sonography. Am J Roentgenol. 2006. 186:1025–1028.

16. Kim EK, Park CS, Chung WY, Oh KK, Kim DI, Lee JT, et al. New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid. Am J Roentgenol. 2002. 178:687–691.

17. Nagataki S, Nystrom E. Epidemiology and primary prevention of thyroid cancer. Thyroid. 2002. 12:889–896.

18. Vini L, Harmer C. Management of thyroid cancer. Lancet Oncol. 2002. 3:407–414.

19. Hay ID, Grant CS, van Heerden JA, Goellner JR, Ebersold JR, Bergstralh EJ. Papillary thyroid microcarcinoma: a study of 535 cases observed in a 50-year period. Surgery. 1992. 112:1139–1147.

20. Ringel MD, Ladenson PW. Controversies in the follow-up and management of well-differentiated thyroid cancer. Endocr Relat Cancer. 2004. 11:97–116.

21. Noguchi S, Yamashita H, Murakami N, Nakayama I, Toda M, Kawamoto H. Small carcinomas of the thyroid. A long-term follow-up of 867 patients. Arch Surg. 1996. 131:187–191.

22. Huang J, Walker R, Groome PG, Shelly W, Mackillop WJ. Risk of thyroid carcinoma in a female population after radiotherapy for breast carcinoma. Cancer. 2001. 92:1411–1418.

23. Ron E, Lubin JH, Shore RE, Mabuchi K, Modan B, Pottern LM, et al. Thyroid cancer after exposure to external radiation: a pooled analysis of seven studies. Radiat Res. 1995. 141:259–277.

24. Weiss NS, Rossing MA. Healthy screened bias in epidemiologic studies of cancer incidence. Epidemiology. 1996. 7:319–322.

25. Frates MC, Benson CB, Charboneau JW, Cibas ES, Clark OH, Coleman BG, et al. Management of thyroid nodules detected at US: Society of radiologists in ultrasound consensus conference statement. Radiology. 2005. 237:794–800.

26. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna S, Nardi F, et al. Risk of malignancy in nonpalpable thyroid nodules: predictive value of ultrasound and color-Doppler features. J Clin Endocrinol Metab. 2002. 5:1941–1946.

27. Gharib H, Goellner JR. Fine-Needle aspiration biopsy of the thyroid: an appraisal. Ann Intern Med. 1993. 118:282–289.

28. Kim SJ, Kim EK, Park CS, Chung WY, Oh KK, Yoo HS. Ultrasound-guided fine-needle aspiration biopsy in nonpalpable thyroid nodules: is it useful in infracentimetric nodules? Yonsei Med J. 2003. 44:635–640.

29. Schlinkert RT, van Heerden JA, Goellner JR, Gharib H, Smith SL, Rosales RF, et al. Factors that predict malignant thyroid lesions when fine-needle aspiration is "suspicious for follicular neoplasm". Mayo Clin Proc. 1997. 72:913–916.

30. Settakorn J, Chaiwun B, Thamprasert K, Wisedmongkol W, Rangdaeng S. Fine needle aspiration of the thyroid gland. J Med Assoc Thai. 2001. 84:1401–1406.

31. Baloch Z, LiVolsi VA, Jain P, Jain R, Aljada I, Mandel S, et al. Role of repeat fine-needle aspiration biopsy (FNAB) in the management of thyroid nodules. Diagn Cytopathol. 2003. 29:203–206.