Document b5OZwYEkdMwrxjo7ZK89nE8Do

FILE NAME Talc TALC DATE 2019 June DOC TALC186 DOCUMENT DESCRIPTION Medical Journal Letter to the Editor - Malignant Mesothelioma and Its Nonasbestos Causes Localized Renal Masses Comment on Recent American Urological Association Guideline To the Editor Localized renal masses are increasingly being detected as incidental findings during imaging studies and the clinician must decide to excise ablate follow or perform limited tissue sampling for diagnosis A guideline on management of localized renal masses was published in 2009 by the American Urological Association AUA In 2014 the AUA assembled a group of experts to update the guideline focusing primarily on evaluating and managing clinically localized masses in adults suspicious for renal cell carcinoma.2 The expert panel that updated the guideline included members of the AUA and representatives from the College of American Pathologists CAP the Society of Urologic Oncology the American College of Radiology the American Society of Nephrology the Endourological Society and the Society of Interventional Radiology. In March 2017 the AUA requested the CAP's formal endorsement of the updated guideline The CAP appointed a small group of pathologists the Endorsement Review Panel to review the AUA recommendations and pro- vide their opinion to the CAP Council on Scientific Affairs and Board of Governors After review and discus- sion the CAP endorsed the AUA guideline with one comment concerning the method of solid renal mass sampling Item 13 in the guideline states that for patients with solid renal masses who elect renal mass biopsy multiple core biopsies are preferred over needle aspiration FNA italics added We originally submit- ted our endorsement comment to the AUA Practice Guidelines Committee and to the Journal of Urology but the year limit on letters related to published articles had lapsed by the time of submission Renal mass sampling is usually performed percutaneously under computed tomography or ultrasound guidance by core biopsy and FNA biopsy In reference to the accuracy of FNA the only study cited in the AUA guideline is one by Patel et al which reported a sensitivity of 62.5 Arch Pathol Lab Med 143 June 2019 Letters to the Editor Several recent studies on FNA of kidney masses have been published that show the diagnostic performance to be far superior to that found in the AUA guideline albeit generally somewhat inferior to core needle biopsies For example in the systematic review and analysis of diagnos- tic accuracy of percutaneous renal tumor biopsy performed by Marconi et al the sensitivity and specificity of diagnostic core biopsies were 99.1 and 99.7 compared with 93.2 and 89.8 respectively for FNA Core needle biopsy and FNA are ideally performed together because the 2 methods are complementary occasionally only the FNA will be diagnostic whereas the core biopsy is nondiagnostic Diagnostic yield for FNAs of the kidney is operator dependent and the yield may be low if the radiologist is not adept at performing FNA Some pathologists perform touch imprints from core biopsies which confirms the adequacy of diagnostic material in biopsies. ,, The recommendation preferring core biopsies over FNA was rated as a moderate recommendation with low strength of evidence grade C In the AUA nomenclature this means that better evidence is likely to change the estimate of its effect such recommen- dations are not considered practice standards The AUA guideline acknowledged the limitation of its as- sessment of FNA based on inclusion criteria of the systematic review. Many pathology practices analyze both kidney FNA and core biopsy therefore we recommend based on the updated evidence that core biopsy and FNA be performed at the discretion of the radiologist and pathologist Lisa A. Fatheree BS ASCP Patrick L. Fitzgibbons MDPriya Rao MD Nicole E. Thomas MPH ASCP Ming Zhou MD PhD Rosemary Tambouret MD5 1 Pathology and Laboratory Quality Center for Evidence Guidelines College of American Pathologists Northfield Illinois 2 Department of Pathology St Jude Medical Center 3 Fullerton California Department of Pathology UT MD Anderson Cancer 4 Center Houston Texas Department of Pathology University of Texas South- western Medical Center Dallas 5 De- partment of Pathology Massachusetts General Hospital Boston 1. Campbell SC Novick AC Belldegrun A et al Guideline for the management of the clinical T1 renal mass J Urol 1271-1279 2. Campbell S Uzzo RG Allaf ME et al Renal mass and localized renal cancer AUA guideline / Urol 520 529 3. Patel HD Johnson MH Pierorazio PM et al Diagnostic accuracy and risks of biopsy in the diagnosis of a renal mass suspicious for localized renal cell carcinoma systematic review of the literatureJ Urol 1340-1347 4. Marconi L Dabestani S Lam TB et al Systematic review and analysis of diagnostic accuracy of percutaneous renal tumour biopsy Eur Urol 660 673 5. Yang CS Choi E Idrees MT et al Percutaneous biopsy of the renal mass FNA or core needle biopsy Cancer Cytopathol 407 415 6. Cate F Kapp ME Arnold SA et al Core needle biopsy and find needle aspiration alone or in combination diagnostic accuracy and impact on management of renal masses J Urol 2017 1396-1402 7. Renshaw AA Cibas ES Kidney and adrenal gland In Cibas ES Ducatman BS eds Cytology Diagnostic Principles and Clinical Correlates 4th ed Philadelphia PA Saunders 423 452 8. Chen AL Brown PA Sweeney BJ et al Smears are important for adequate cytologic diagnosis of kidney lesions J Am Soc Cytopathol 2017 162-164 9. Hahn PF Eisenberg PJ Pitman MB Gazelle GS Mueller PR Cytopathologic touch preparations imprints from core needle biopsies accuracy compared with that of needle aspirates AJR Am J Roentgenol 1277 1279 Accepted for publication February 14 2019 The authors have no relevant financial interest in the products or companies described in this article doi arpa.2019-0023 Malignant Mesothelioma and Its Nonasbestos Causes To the Attanoos and col- leagues,, reviewed the literature concerning nonasbestos causes for malignant mesothelioma They con- cluded that most mesotheliomas not clearly attributable to asbestos expo- sure are spontaneous Their review did not consider a common occult form of asbestos exposure arising from the use of talcum powders In 1976 Rohl et al analyzed consumer talcums and reported that 10 of the 20 products 50 analyzed contained tremolite and anthophyllite Blount reported asbestiform tremolite contamination of the ore used in a popular baby powder Gordon et alt found asbesti- Letters to the Editor 659 Letters to the Editor form tremolite and anthophyllite in a popular body powder and Anderson et als found anthophyllite fibers in the same brand Statista Hamburg Germany a market research company reported that some 100 million Americans used body and baby powders in the years 2011 to 2017. It is possible to draw inferences about the prevalence of exposures to talcum powders in subjects with mesothelioma by querying the database of lung asbestos fiberburden measurements compiled by Victor Roggli MD Duke University Medical Center Durham North Car- olina burden measurements were made on 566 subjects female n = 75 13 with pleural mesothelioma Talc fibers were detected in 332 of 491 68 of the men and 62 of 75 83 of the women The detection of tremolite was significantly associated with the presence of talc P < .001 as was the detection of anthophyllite = .002 The presence of talc and associated amphiboles was more common in women than it was in men odds ratio 3.24 95 CI 1.65-6.35 This would be expected if women were more likely to be users of baby and body powders than men were Lung burdens of talc and its amphi- bole contaminants are markers of exposure to containing dusts In addition to talc exposures from talcum powders there has been occupational and hobby exposure to industrial talc in the United States but the number of persons with exposures to industrial talc is small compared with the 100 million users of baby and body pow- ders I conclude that 1. The use of body and baby powders is common in the United States Consumer surveys found that about third of the population used those powders between 2011 and 2017 2. Measurements of retail talc products have found amphibole asbestos contamination of those products 3. A large series of measurements of asbestos fiber burdens in patients with pleural mesothelioma has found the presence of talc to be common exceeding 65 among both men and women 4. Women were more than twice as likely as men were to have talc in their tissues compatible with the hypothesis that women were more likely to be users of baby and body powders Without accounting for amphibole asbestos exposures arising from the use of baby and body powders it is not possible to conclude as Attanoos and col- leagues have done that In North America few mesotheliomas in women at any site are attributable to asbestos exposure It is my opinion that without accounting for those occult asbestos exposures it is inappropriate to con- clude that most mesotheliomas not clearly attributable to asbestos exposure are spontaneous idiopathic Murray M. Finkelstein PhD MD University of Toronto Family and Community Medicine Toronto On- tario Canada 1. Attanoos RL Churg A Galateau F Gibbs AR Roggli VL Malignant mesothelioma and its asbestos causes Arch Pathol Lab Med 2018 753-760 doi 2017-0365 2. Rohl AN Langer AM Selikoff IJ et al Consumer talcums and powders mineral and chemical characterization/ Toxicol Environ Health 255 284 3. Blount AM Amphibole content of cosmetic and pharmaceutical talcs Environ Health Perspect 225 230 4. Gordon RE Fitzgerald S Millette J. Asbestos in commercial cosmetic talcum powder as a cause of mesothelioma in women published correction appears in Int J Occup Environ Health 2015 347 34I8 ntJ Occup Environ Health 2014 318 232 5. Anderson EL Sheehan PJ Kalmes RM Griffin JR Assessment of health risk from historical use of cosmetic talcum powder Risk Anal 2017 918-929 6. Statista U.S. population most used brands of body and baby powder from 2011 to 2017. https www.statista.com/statistics/285799/brands-of-bodypowder Accessed July 16 2018 Accepted for publication July 16 2018 The author has served as a consultant toplaintiff's lawyers in asbestos and talc litigation doi arpa.2018-0145 Overdiagnosis of Thyroid Cancer The Children in Fukushima Are in Danger To the Editor am writing this letter because I was inspired by the editorial by Vicki J. Schnadig MD The children in Fukushima Japan are in danger In the thyroid screening program of the Fukushima Health 660 Arch Pathol Lab Med 143 June 2019 Management Survey FHMS more than 200 children have received a diagnosis of thyroid cancer by ultrasonography US and needle aspiration cytology and most of them have already undergone surgery.The number is still increasing because there has been no change in the screening program since 2011. We must reconsider the natural history of thyroid cancer There are 2 major theories about thyroid carcinogenesis fetal cell carcinogenesis and early set multistep carcinogenesis.3 It should be noted that in both theories early detection of thyroid cancer in children can be harmful because of either overdiagnosis or diagnosis too early Only a limited number of residents of Fukushima realize the risk of overdiagnosis in thyroid US screening because Fukushima Prefecture pro- vides little information on possible negative effects of this program Fur- thermore the US examination is performed as one of the school programs Thus even though the local government insists that the participation of residents is voluntary most of the children and their parents regard it as mandatory In fact the rate of participation by schoolchildren is more than 90 Only a few Japanese experts have reported on the possible harm caused by the FHMS and there has been no recommendation to stop thyroid screening from related academic societies.5 This might be due to the following 2 reasons First the FHMS which was planned by chief Japanese experts was started as a large national project with a budget of up to 1 billion Currently there is an awkward atmosphere with Japanese experts not willing to talk about the harm caused by this project Second as also happened in the case of Korea numerous experts still do not understand the concept of overdiagnosis They can see no harm in the early detection and treatment of cancer Some say This should not be called overdiagnosis since the FHMS helps to reduce the anxiety of residents Others say The harm caused by US thyroid screening in Fukushima is very limited since the procedures are carried out with care Overdiagnosis of thyroid cancer in Fukushima has occurred in the youn- ger generation The harm is more serious than that which occurred in Korea The children who receive a diagnosis of thyroid cancer are regard- Letters to the Editor