Spalvinė doplerografija diagnozuojant nečiuopiamus skydliaukės piktybinius mazgus

Edita Mišeikytė Kaubrienė,  Albertas Ulys Vilniaus universiteto Onkologijos institutas, Santariškių g. 1, LT-08660 Vilnius El paštas: [email protected] Įvadas / tikslas Realaus laiko pilkos skalės ultragarsinio tyrimo duomenys suteikia galimybę įtarti skydliaukės vėžį, o spalvinės doplerografijos vaidmuo diagnozuojant skydliaukės vėžį išlieka neaiškus. Šio darbo tikslas yra nustatyti, ar realaus laiko pilkos skalės ultragarsinis tyrimas ir spalvinė doplerografija gali būti naudinga diagnozuojant piktybinius ir nepiktybinius skydliaukės mazgus. Ligoniai ir metodai Tiriamuoju laikotarpiu atliktos 184 nečiuopiamų skydliaukės mazgų (mazgo skersmuo <1,5 cm) ultragarsu kontroliuojamos plonos adatos aspiracinės biopsijos. Į tyrimą buvo įtraukti tie ligoniai, kuriems diagnozuoti nečiuopiami skydliaukės mazgai turėjo echosemiotinių piktybiškumo požymių. Prieš atliekant ultragarsu kontroliuojamą plonos adatos aspiracinę biopsiją, nečiuopiami skydliaukės mazgai buvo ištirti spalvinės doplerografijos metodu. Šie mazgai pagal vaskuliarizacijos pobūdį sugrupuoti į keturias grupes – nuo avaskulinių mazgų iki mazgų, turinčių intensyvią kraujotaką. Pooperacinis histologinis tyrimas buvo atliktas 85 pacientams. Rezultatai Nečiuopiamų skydliaukės mazgų spalvinės doplerografijos duomenys palyginti su pooperaciniais histologiniais duomenimis. Atlikus 184 nečiuopiamų skydliaukės mazgų ultragarsu kontroliuojamas plonos adatos aspiracines biopsijas, 48 ligoniams pooperaciniu histologiniu tyrimu nustatytas skydliaukės vėžys, 37 atvejais skydliaukės pakitimai buvo nepiktybiniai. Piktybiniams nečiuopiamiems skydliaukės mazgams būdingesnė intranodulinė ir perinodulinė kraujotaka (p = 0,026 pagal 2 kriterijų). Išvada Nečiuopiami piktybiniai skydliaukės mazgai dažniau nei nepiktybiniai būna hipoechogeniniai, tolygios struktūros, turintys intranodulinę ir perinodulinę kraujotaką. Pagrindiniai žodžiai: skydliaukės mazgai, skydliaukės vėžys, ultragarsinis tyrimas, spalvinė doplerografija, ultragarsu kontroliuojama plonos adatos biopsija Color Doppler sonography in the diagnostic of nonpalpable thyroid cancer Edita Mišeikytė Kaubrienė,  Albertas Ulys Insitute of Oncology, Vilnius University, Santariškių str. 1, LT-08660 Vilnius, Lithuania E-mail: [email protected] Background / objective Several gray scale sonographic characteristics have been found to be highly suggestive of thyroid cancer, but the role of color Doppler sonography in the evaluation of a thyroid nodule for malignancy has not been defined. The purpose of this study was to determine whether gray scale and color Doppler sonography can be used to diagnose or exclude malignancy in a thyroid nodule. Patients and methods 184 patients with nonpalpable thyroid nodules (diameter less than 1.5 cm) were studied by means of ultrasound-guided fine-needle aspiration biopsy. Patients were included in the study on the basis of sonographical features implicating a possible malignant nature of nodules. We obtained color Doppler images of nonpalpable thyroid nodules undergoing ultrasound-guided fine-needle aspiration. The color Doppler appearance of nonpalpable thyroid nodule was graded from I for no visible flow through IV for extensive internal flow. Of the studied patients, 85 underwent subsequent surgery with histological examination of obtained specimens. Results Characteristic Doppler-sonographical features of nonpalpable thyroid nodules were analysed taking into consideration their histological form. There were 184 nonpalpable thyroid nodules sampled, of which 48 were malignant (all confirmed at surgery), and 37 were benign. Benign nonpalpable nodules frequently had extranodular blood flow, whereas malignant thyroid nodules frequently had intra- and perinodular blood flow (p = 0.026 of the chi-square test). Conclusions Small nonpalpable malignant thyroid nodules more frequently are visualized as hypoechoic and solid in comparison with non-malignant small thyroid nodules. A characteristic Doppler-sonographical feature of small malignant thyroid nodules is intra- and perinodular blood flow. Key words: thyroid nodules, thyroid cancer, ultrasound, color Doppler sonography, ultrasound-guided fine-neddle aspiration biops

Plonos adatos aspiracinė biopsija diagnozuojant skydliaukės vėžį

Edita Mišeikytė Kaubrienė1,  Albertas Ulys1, Mantas Trakymas1,  Jolita Rimienė2 1 Vilniaus universiteto Onkologijos institutas, Santariškių g. 1, LT-08660 Vilnius 2 Valstybinis patologijos centras, Santariškių g. 1, LT-08660 Vilnius El paštas: [email protected] Plonos adatos aspiracinė biopsija yra patikimiausias skydliaukės mazgų diagnostikos metodas („aukso standartas“). Plonos adatos aspiracinė biopsinė – tai pradinis čiuopiamų ir nečiuopiamų skydliaukės mazgų stebėjimo ir gydymo strategijos žingsnis. Šio diagnostikos metodo patikimumui turi įtakos tyrėjų, atliekančių aspiracines biopsijas ir citologinius tyrimus, įgūdžiai, ypač svarbūs diferencijuojant nepiktybinius ir piktybinius folikulinius pakitimus. Tyrimas leidžia sumažinti dėl mazginės strumos atliekamų tiroidektomijų skaičių. Šios literatūros apžvalgos tikslas – įvertinti plonos adatos aspiracinės biopsijos reikšmę diagnozuojant skydliaukės mazgus. Straipsnyje pateikiamas plonos adatos aspiracinės biopsijos rezultatų įvertinimas. Daroma išvada, kad skydliaukės mazgų plonos adatos aspiracinė biopsija yra saugus, nebrangus, minimaliai invazinis ir informatyvus tyrimo metodas. Pagrindiniai žodžiai: skydliaukės mazgas, skydliaukės vėžys, ultragarsinis tyrimas, plonos adatos aspiracinė biopsija Fine-needle aspiration biopsy in thyroid cancer diagnostics Edita Mišeikytė Kaubrienė1,  Albertas Ulys1, Mantas Trakymas1,  Jolita Rimienė2 1 Institute of Oncology Vilnius University, Santariškių str. 1, LT-08660 Vilnius, Lithuania 2 National Center of Pathology, Santariškių str. 1, LT-08660 Vilnius, Lithuania E-mail: [email protected] Fine-needle aspiration biopsy is considered the most reliable test, a “gold standard” for the diagnosis of thyroid nodules. Fine-needle aspiration biopsy has made its mark as an initial diagnostic step in the management of palpable and nonpalpable thyroid nodules. Limitations of fine-needle aspiration are related to the skill of the aspirator, the expertise of the cytologist, and the difficulty in distinguishing some benign cellular adenomas from their malignant counterparts. This technique has resulted in an overall decline in the number of thyroidectomies performed for thyroid nodules. The objective of the article is to review the literature on the utility of fine-needle aspiration biopsy in the diagnostic management of nodular thyroid disease. Fine-needle aspiration biopsy of the thyroid gland is a safe, inexpensive, minimally invasive and highly accurate test in the diagnosis of nodular thyroid disease. Keywords: thyroid nodule, thyroid cancer, ultrasound, fine-needle aspiration biops

Neįprastas tiesiosios žarnos vėžio metastazavimas: atvejo pristatymas

Metastasis of rectal cancer to the penis is a very rare condition with less than 40 cases found in the literature. The prognosis is poor and life expectancy is short. The mechanism of rectal cancer metastasis spread to penis is unknown. The most popular theory is retrograde venous spread. There are several treatment options, but no single treatment option has emerged with superior results. The authors report a case of a 41 old man who was diagnosed with rectal cancer, treated with neoadjuvant radiotherapy, underwent rectal resection, had adjuvant chemotherapy, and despite that, 2 years after had penal metastasis. After diagnosis, he survived 2 months.Labai retai tiesiosios žarnos vėžio metastazės plinta į varpą. Literatūros duomenimis, tokių atvejų yra aprašyta mažiau kaip 40. Prognozė yra bloga ir išgyvenamumas trumpas. Tiesiosios žarnos vėžio metastazių plitimo į varpą mechanizmas nežinomas. Populiariausia teorija yra apie retrogradinį veninį plitimą. Aprašoma keletas gydymo metodų, tačiau nė vienas nėra pranašesnis. Autoriai pristato 41 metų amžiaus vyro klinikinį atvejį. Vyrui buvo diagnozuotas tiesiosios žarnos vėžys, prieš operaciją taikyta radioterapija, paskui operacinis gydymas ir pooperacinė chemoterapija. Nepaisant to, po dvejų metų išsivystė metastazės varpoje. Po metastazių diagnozės ligonis išgyveno du mėnesius

Non-Coding RNAs in Glioma

Glioma is the most aggressive brain tumor of the central nervous system. The ability of glioma cells to migrate, rapidly diffuse and invade normal adjacent tissue, their sustained proliferation, and heterogeneity contribute to an overall survival of approximately 15 months for most patients with high grade glioma. Numerous studies indicate that non-coding RNA species have critical functions across biological processes that regulate glioma initiation and progression. Recently, new data emerged, which shows that the cross-regulation between long non-coding RNAs and small non-coding RNAs contribute to phenotypic diversity of glioblastoma subclasses. In this paper, we review data of long non-coding RNA expression, which was evaluated in human glioma tissue samples during a five-year period. Thus, this review summarizes the following: (I) the role of non-coding RNAs in glioblastoma pathogenesis, (II) the potential application of non-coding RNA species in glioma-grading, (III) crosstalk between lncRNAs and miRNAs (IV) future perspectives of non-coding RNAs as biomarkers for glioma.This work was funded by the Research Council of Lithuania, project MIP-015/201

Thyroid cancer in Lithuania: relationship between incidence and diagnostic

The aim of this study is to analyse changes in thyroid cancer incidence trends in Lithuania during the period of 1978–2003 and the relationship between incidence and diagnostic strategies. Annual percentage changes in the age-standardized rates over this period were 4.2% (p<0.0001) and 6.1% (p<0.0001) for men and women, respectively, for all carcinomas combined. During study period the age-standardized incidence rates increased in males from 0.7 to 2.5 cases per 100000 and in females from 1.5 to 11.4 per 100000. Mortality due to thyroid cancer did not change during the period of 1978–2003. By histopathology, number of papillary thyroid carcinoma cases increased in 1998-2003. Also, there was increase in the number of early stages of thyroid cancer. The increase in thyroid cancer incidence in Lithuania seems to be mainly due to the changes in the management of thyroid nodules and increased usage of ultrasound guided fine needle aspiration biopsy in clinical practice

Cystic lymph node metastasis in papillary thyroid carcinoma

Background. Thyroid cancer, especially papillary carcinoma, metastasizes most often into cervical lymph nodes. Cervical ultrasound and ultrasound-guided fine-needle aspiration biopsy are the most sensitive modalities in detecting locoregional neck recurrence. Objective. The aim of this study was to illustrate the ultrasound spectrum of lymph node metastases from papillary thyroid carcinoma. Patients and methods. During 1998–2002 years due to suspicion of recurrence of thyroid cancer, 75 ultrasound-guided fine-needle aspiration biopsies of regional lymph nodes were performed. Ultrasound examination of 75 patients with thyroid cancer (56 women and 19 men; mean age of patients was 54.67±12.89 years) was performed. All biopsies were performed on nonpalpable lesions (lymph node short axis £1.5 cm). Results. A total of 75 ultrasound-guided fine-needle aspiration biopsies of regional lymph nodes under suspicion of malignancy were performed. Only 5 (6.7%) of the 75 lymph nodes were cystic with internal septation. Other 70 (93.3%) lymph nodes were solid. Cytopathological results of 75 ultrasound-guided fine-needle aspiration biopsies from regional cervical lymph nodes were noninformative in 4 (5.3%) cases, benign – 40 (53.4%), suspicion – 4 (5.3%), and malignant – 27 (36.0%) cases. Eighteen patients underwent surgery for regional lymph nodes. All cystic metastases were confirmed to be papillary thyroid carcinoma on pathologic examination. Conclusion. Ultrasound cannot exactly distinguish benign from malign lesions, but sonographic appearance can suggest malignancy and help in selection of the correct lymph nodes to aspirate with ultrasound-guided fine-needle aspiration biopsy. Cystic lymph node metastases may occur in papillary thyroid carcinoma. Cystic neck lesion patients with thyroid papillary carcinoma should always be verified with fine-needle aspiration biopsy

The frequency of malignant disease in cytological group of suspected cancer (ultrasound-guided fine-needle aspiration biopsy of nonpalpable thyroid nodules)

Background. Fine-needle aspiration biopsy is the most important procedure for differentiating benign thyroid nodules from malignant ones. Traditionally, findings of fine-needle aspiration biopsy are divided into four categories: nondiagnostic, benign lesions, suspected cancer, and malignant lesions. Group suspicious for cancer largely involves follicular neoplasms as well as lesions with cytological features of malignancy. Objective. The purpose of this study was to establish the value of ultrasound-guided fine-needle aspiration biopsy in the diagnosis of nonpalpable thyroid cancer and to assess the frequency of malignant disease in the group of suspected cancer. Patients and methods. A total of 184 patients with nonpalpable thyroid nodules (less than 1.5 cm in diameter) were examined by means of ultrasound-guided fine-needle aspiration biopsy. Patients were included in the study based on sonographic findings implicating possible malignant nature of nodules. Results. During 1997–2002, 204 ultrasound-guided fine-needle aspiration biopsies of thyroid nodules were performed; findings were nondiagnostic in 5.9% of cases. In 59.8% of cases, cytological examination revealed benign lesions; in 11.8%, suspected cancer; and in 22.5%, malignant lesions. Eighty-five patients underwent subsequent surgery with histological examination of specimens obtained. In 45 cases, cytological diagnosis of malignant or suspected thyroid cancer was confirmed by histological examination after surgery. Conclusion. We conclude that ultrasound-guided fine-needle aspiration biopsy has a high accuracy in the diagnostic evaluation of nonpalpable thyroid nodule with cytological features of malignancy. However, fineneedle aspiration biopsy is not effective diagnostic method for differentiating benign thyroid nodules from malignant ones in follicular neoplasm group

Prostatos urotelio karcinoma, diagnozuota atlikus biopsiją. Klinikinis atvejis ir literatūros apžvalga

Algimantas Sruogis1, Ugnius Mickys2, Tadas Petraitis1, Edita Kaubrienė3, Feliksas Jankevičius11 Vilniaus universiteto Onkologijos institutoUrologijos skyrius,Santariškių g. 1, LT-08661 VilniusEl paštas: [email protected] Lietuvos nacionalinis patologijos centras3 Vilniaus universiteto Onkologijos institutoIntervencinės echoskopijos irultragarsinės diagnostikos skyrius Tikslas Nustatyti diagnostinius prostatos urotelio karcinomos kriterijus, diferencijuojant urotelio karcinomą, peraugančią šlapimo pūslės kaklelį ir prostatą, nuo prostatos adenokarcinomos, peraugančios šlapimo pūslę. Atvejis Pacientas, 37 metų, trejus metus gydytas nuo lėtinio prostatito. Prostatos sekrete nustačius atipinių ląstelių, įtarus prostatos vėžį, ligonis nusiųstas į VU Onkologijos institutą. Tyrimo pro tiesiąją žarną, cistoskopijos, rentgenologinio, ultragarso ir serumo žymenų tyrimo duomenimis, diddesnių pokyčių nerasta. Atlikus transuretrinę šlapimo pūslės gleivinės biopsiją (TUR) iš šlapimo pūslės sienelių, kaklelio ir šlaplės prostatinės gleivinės, histologiškai nustatyti normalūs urotelio audiniai. Šlapimo citologinis tyrimas buvo neigiamas. Atlikus transrektalinę prostatos biopsiją, diagnozuotas prostatos urotelio navikas, imunohistochemiškai neigiamas PSA (prostatos specifiniam antigenui) ir teigiamas citokeratinams CK8 ir CK HMW. Pacientui buvo atlikta radikali cistoprostatektomija, pašalinti dubens limfmazgiai ir suformuotas šlapimo nuotėkis į ileum segmentą, išvestą į priekinę pilvo sieną (Brycker būdu). Morfologinė diagnozė – prostatos urotelio karcinoma. Taip pat diagnozuota prostatos adenokarcinoma ir prostatos intraepitelinė neoplazija. Po 15 mėnesių PSA lygis buvo 0,2 ng/ml, jokių ligos progresavimo požymių nepasireiškė. Remiantis šiuo klinikiniu atveju straipsnyje apžvelgiama literatūra, aiškinantis prostatos urotelio karcinomos ir adenokarcinomos skirtumus. Išvados Diagnozuojant prostatos urotelio karcinomą reikia vadovautis tam tikrais kriterijais: 1) prostatos urotelio karcinoma turi būti verifikuota makro-, mikroskopiškai ir imunohistocheminiais metodais, 2) neturėtų būti kitų urotelio karcinomos židinių organizme. Būtent prostatos biopsija leidžia patologui nustatyti tikslią diagnozę prieš operaciją. Imunohistocheminis tyrimas padeda atlikti diferencinę diagnostiką. Po operacijos tiriant pašalintus audinius, diagnozė patikslinama histomorfologiškai, naudojant imunohistocheminius tyrimus, net jei ir labai retai nustatoma prostatos urotelio karcinoma. Reikšminiai žodžiai: prostatos vėžys, urotelio karcinoma, prostatos urotelio karcinoma, prostatos biopsija Prostate urothelial carcinoma diagnosed on prostatic needle biopsy. Case report with literature overview Algimantas Sruogis1, Ugnius Mickys2, Tadas Petraitis1, Edita Kaubrienė3, Feliksas Jankevičius11 Vilnius University Institute of Oncology,Urology Department,Santariškių str. 1,LT-08661 Vilnius, LithuaniaE-mail: [email protected] Lithuanian National Centre of Pathology3 Vilnius University Institute of Oncology,Radiology Department Objective To establish criteria for the diagnosis of primary urothelial prostate carcinoma after the differential diagnosis including high-grade urothelial carcinoma extending into the bladder neck and prostate versus poorly differentiated prostate adenocarcinoma extending into the bladder. Case report The patient was a 37-year-old man with severe prostatism symptoms, who presented with an atypical seminal vesicles fluid cytological test result. The prostate was also normal by the digital examination, endoscopy, roentgenography, ultrasonography and serum markers. A diagnostic transurethral resection of bladder mucosa, bladder neck specimen revealed normal urothelial tissues. The urine cytological test result was negative. The transrectal biopsy of the prostate revealed an urothelial carcinoma with a negative staining of PSA (prostate-specific antigen) and positive of cytokeratins CK 8 and CK HMW. The patient subsequently underwent radical cystoprostatectomy and pelvic lymphadenectomy with ileal conduit m. Brycker creation. The histological diagnosis was the urothelial carcinoma of the prostate. Also, the prostate showed foci of High Grade PIN and prostate adenocarcinoma. After 15 months the patient has a PSA level of 0.2 ng/mL, no symptoms, no evidence of progression. Based on this case of the urothelial carcinoma of prostate, the literature was reviewed and the morphological differentiation between urothelial carcinoma and adenocarcinoma of the prostate was discussed. Conclusions The diagnostic criteria are the following: (1) the tumor should be a macro-, microscopically and imunohistochemically verified as urothelial carcinoma localized exclusively in the prostate gland; (2) there must be no other primary urothelial carcinoma in the body. These criteria can be readily applied when evaluating surgical resection specimens. With the use of radiologically guided or endoscopically derived biopsies, however, the pathologist is increasingly called upon to make a diagnosis before definitive surgical resection. In these circumstances, the pathologist will often resort to immunostains to help refine the differential diagnosis. Moreover, even when surgical resection specimens are evaluated, immunostains are still used in conjunction with histomorphology to confirm the diagnosis, particularly when a rare entity such as primary urothelial prostate carcinoma is encountered. Keywords: prostate cancer, urothelial carcinoma, prostate urothelial carcinoma, prostatic needle biops

Mažų inkstų navikų aukšto dažnio termoabliacija: veiksminga, saugu, ekonomiška

Albertas Ulys, Robertas Adomaitis, Mantas Trakymas, Edita Kaubrienė, Ramūnas Ambrozaitis, Feliksas JankevičiusVilniaus universiteto Onkologijos institutas,Santariškių g.1, LT-08660 VilniusEl paštas: [email protected] Įvadas / tikslas Pastaraisiais metais vis dažniau diagnozuojami maži (iki 3 cm) inkstų navikai. Pasaulyje sparčiai plėtojasi minimaliai invazyvios gydymo technologijos, tarp jų ir navikų aukšto dažnio termoabliacija (ADTA). Naujausiais duomenimis, šis metodas gydant mažus inkstų navikus savo veiksmingumu artimas tradicinei nefrektomijai. Darbas buvo skirtas išanalizuoti pasaulyje sukauptai inkstų navikų ADTA patirčiai ir apibendrinti pirmuosius šios minimaliai invazyvios metodikos taikymo Lietuvoje rezultatus. Ligoniai ir metodai Vilniaus universiteto Onkologijos institute nuo 2003 m. inksto naviko ADTA atlikta 6 pacientams, tik vienam iš jų procedūrą teko kartoti dėl atsinaujinusio naviko. Rezultatai Keturiems ligoniams navikai sumažėjo arba nedidėjo, vienam visiškai išnyko. Vienam ligoniui, kurio navikas buvo 4,3 cm, po 4 mėn. buvo konstatuotas naviko didėjimas ir ADTA pakartota. Po ADTA procedūros pavojingų komplikacijų nebuvo. Vienam ligoniui buvo pirmo laipsnio odos nudegimas įžeminimo elektrodo vietoje. Išvados Šio metodo universalumas, minimalus traumiškumas, retos komplikacijos ir palyginti nedidelė kaina leidžia tikėtis, kad aukšto dažnio termoabliacija taps visaverte metodika onkologijoje. Reikšminiai žodžiai: inkstų navikai, aukšto dažnio termoabliacija, minimaliai invazyvi chirurgija Radiofrequency ablation (RFA) of small renal tumours: efficient, safe, cost-effective Albertas Ulys, Robertas Adomaitis, Mantas Trakymas, Edita Kaubrienė, Ramūnas Ambrozaitis, Feliksas JankevičiusVilnius University, Institute of Oncology,Santariškių str. 1, LT-08660 Vilnius, LithuaniaE-mail: [email protected] Background Over the recent years the proportion of diagnosed small renal tumors has been growing. Minimal invasive techniques are more often employed in treatment of such lesions. RFA is one of those minimal invasive procedures, and it is developing rapidly. Now we can find more and more encouraging reports on RFA of renal tumors in the literature. Intermediate results in groups of carefully selected patients are comparable to those of radical nephrectomy. Patients and methods In Vilnius University Institute of Oncology, RFA of renal tumors has been performed since 2003. The monopolar system (Berchtold) with a "cool-tip" electrode was used (50W 10–15 min and needle track ablation). Six patients with histologically verified renal cancer were treated so far. Tumor size varied from 2.3 to 4.3 cm. Results All tumors developed zones of necrosis and decreased after ablation. One biggest lesion required a second RFA session after 4 months (growth was detected by follow-up ultrasound). One patient had light skin burns under the pad electrode. Conclusions Our experience using RFA of small renal tumors is in accordance with that reported in the literature. RFA is an effective and safe procedure for well-selected patients who are not candidates for surgery. Taking into account the minimal trauma of percutaneous RFA, its reported effectiveness and rather low costs, this method is a good candidate to become a viable treatment option in case of small renal cancer. Keywords: renal tumors, radiofrequency ablation, minimally invasive surger

Parity and risk of thyroid cancer: a population-based study in Lithuania

An association between parity and thyroid cancer risk has been investigated in a number of independent studies but yielded contradictory findings. The aim of this study was to explore the association between parity and thyroid cancer risk. The population-based cohort study in Lithuanian was conducted. The study dataset based on the linkages between all records from the 2001 population census, all cancer incidence records from the Lithuanian Cancer Registry, and all death and emigration records from Statistics Lithuania for the period between 6 April 2001 and 31 December 2009. Cox's proportional hazards regression models were used to estimate the hazard ratios (HRs) for parity, age at first birth, number of children, place of residence, education, and age at census. The cohort of 868,105 women was followed for 8.6 years, and 1775 thyroid cancer cases were diagnosed during the study period. The significantly higher thyroid cancer risk was observed among parous women (HR = 1.45, 95% CI: 1.20, 1.75) and in women with 1, 2, and 3 children, after adjusting for the possible confounding effects of relevant demographic variables. The findings of this study are consistent with the hypothesis that parity might be associated with the risk of thyroid cancer in womenNacionalinis vėžio institutasSocialinių tyrimų centrasVilniaus universitetasVytauto Didžiojo universiteta