Hugh S, Pratt, M.D. September 6, 1979 Pege 2 newspapers, vould probabl y be apprupriate for editorial page publication in major rofessio nal only but nonPr by tions presenta similar carries since the L.A. Times often I don't mean to recommend an extensive crash PR prog arteat ny writers. to suggest that a number of causes could well be served by 3 co sere wide dissemination of the findings of these studies past an preee 5 ane - «ts It would certainly be to our bene it contemplated for the future. rep negative awaiting than rather tions presenta ive public informat forth to which we must react. ‘ As a surgical pathologist (among other avocations), J have personally been a y puzzled by some of the pathological diagnoses rendered in the past, princip in regard to thyroid specimens. The diagnosis and classification of pyper Plastic and neoplastic lesions of the thyroid remains an area of considerable difficulty and controversy, and it is not clear, reading the Marshallese 8 literature, that all of these have been evaluated in a consistent and systema ic fashion. This is certainly not to question the ability of the responsible pathologists, many of whom are obviously recognized and respected authorities. Rather it is a reflection of the controversial nature of this area of pathology that some of the diagnostic terms used in some previous reports would not now be acceptable in a number of other, equally prominent, medical centers. For example, on page 44 of the 20-year report it states that "many of the (thyroid) adenomas were papillary, but all except two....were considered benign.” In a mumber of institutions, including UCLA, a papillary tumor of the thyroid is considered malignant by definition, since meticulous and thorough evaluation of such lesicns almost invariably reveals at least local invasion. With this in mind, I would strongly recommend the following: (1) A central repository of all pathological materials (operative reports, photographs, wet specimens, paraffin blocks, slides, path reports) should be established at Brookhaven rather than have these scattered among Tripler, Cleveland, Boston and wherever else they may be. (2) These materials should be reviewed by a number of recognized authorities empaneled specifically to establish consistent criteria for their evaluation and diagnosis, principally the thyroid lesions. (3) A relatively rigid protocol for handling all future Specimens should be derived by consensus within the panel and adopted for future specimens, A related area also deserves to be more thoroughly evaluat ed in the exposed populations. There is increasing evidence that radiation to the neck region, in doses comparable to those.in the Marshallese, is associa ted with a high incidence of primary hyperparathyroidisn, principally seconda ry to induction ' Of parathyroid adenomas but also because of diffuse hyperplasia. The operative reports and pathologic materials on those patients receiving thyroidectomies or neck explorations should be reviewed with this in mind, and we should consider frequent measurements of serum calcium to detect preclinical hyperparathyroid States. A team member should become proficient in the technique of fine-needle - aspiration biopsy, thereby providing the team with a supplementary capacity for in-field tissue diagnosis of any palpable masses, whether they be in thyroid, breast or elsewhere. These techniques are now well established, medical ly accepted, and, in experienced hands, have very low incidences of false negatives with virtual ly no false positives.