INTRODUCTION Surgeon-based ultrasonography (SUS) for parathyroid disease has not been widely adopted by British endocrine surgeons despite reports worldwide of accuracy in parathyroid localisation equivalent or superior to radiology-based ultrasonography (RUS). The aim of this study was to determine whether SUS might benefit parathyroid surgical practice in a British endocrine unit. METHODS Following an audit to establish the accuracy of RUS and technetium sestamibi (MIBI) in 54 patients, the accuracy of parathyroid localisation by SUS and RUS was compared prospectively with operative findings in 65 patients undergoing surgery for primary hyperparathyroidism (pHPT). RESULTS The sensitivity of RUS (40%) was below and MIBI (57%) was within the range of published results in the audit phase. The sensitivity (64%), negative predictive value (86%) and accuracy (86%) of SUS were significantly greater than RUS (37%, 77% and 78% respectively). SUS significantly increased the concordance of parathyroid localisation with MIBI (58% versus 32% with RUS). CONCLUSIONS SUS improves parathyroid localisation in a British endocrine surgical practice. It is a useful adjunct to parathyroid practice, particularly in centres without a dedicated parathyroid radiologist, and enables more patients with pHPT to benefit from minimally invasive surgery.

It is an aggressive malignancy with ap oor prognosis. Five-year survival is reported to be about 30%. 2Because of its rarity,s ingle institutions manage only small numbers annually and optimum treatment modalities are less well establishedt han for more common tumours.Although the majority of ACCs are sporadic of unknown aetiology,t hey may be associated with rare genetic syndromes such as Beckwith-Wiedemann syndrome (IGFII overexpression),L i-Fraumeni syndrome (p53 mutation) and multiple endocrine neoplasia type 1( MEN1).

Background: The role of oestrogen and progesterone receptors in breast cancer has been extensively investigated; however, the androgen receptor has received little attention. We report a flow cytometric method for the measurement of tumour androgen receptor (AR) expression on 43 primary operable breast cancers. AR expression has been correlated with grade, lymph node status, epidermal growth factor receptor (EGFR), and oestrogen receptor alpha (ERα) also measured by flow cytometry. Method: Biotinylated AR antibody AR441 (Dako) was titrated using the LNCaP cell line. Tumour samples were processed through mesh and the resulting suspension were fixed with 2 per cent paraformaldehyde and permeabilized with 0.025 per cent triton prior to incubation with AR antibody, streptavidin PE and 5D3‐FITC. Analysis was performed on cytokeratin‐positive cells by FACScan flow cytometer. Results: Eighty per cent of tumours expressed AR. There was a significant correlation between AR and ERα expression (P‐value = 0.008). No correlation was observed between AR and EGFR expression (P‐value = 0.59). Conclusions: AR appears to be coexpressed with ERα, but not EGFR. The finding of increasing AR expression with increasing grade suggests that AR expression is a more aggressive marker than has hitherto been found by immunohistochemistry. These observations are supported by the previously reported findings of AR expression in 75 per cent of breast cancer metastases, and as the sole steroid receptor in 25 per cent of metastases.

Background: The preliminary results of the IMPACT trial have shown that aromatase inhibitors are the preferred first‐line hormonal treatment for advanced breast cancer. This raises the question as to the significance of circulating testosterone levels in women with breast cancer. Method: We have measured serum testosterone and sex hormone‐binding globulin (SHBG) preoperatively in women presenting with primary operable breast cancer and age‐matched controls. Tumour androgen receptor (AR) expression was measured by flow cytometry on tumour biopsies from 35 patients, and serum testosterone levels were correlated with tumour expression. Results: No correlation was found between serum androgen levels and tumour androgen receptor expression. Conclusions: These results suggest that elevated circulating total testosterone has a role in the aetiology of the breast cancer, presumably by conversion to oestrogens. The finding of a significantly raised free androgen index in postmenopausal controls suggests that ‘active’ testosterone may be protective against the development of breast cancer. This is supported by cell line work, which has shown a growth‐inhibitory affect of androgens on breast cancer proliferation.

Background: The role of androgens in the progression and aetiology of breast cancer has resurfaced in the light of effective aromatase inhibitors. We have measured serum androstenedione, dehydroepiandrosterone sulphate (DHEAS) and cortisol in 53 pre‐ and postmenopausal women with primary operable breast cancer and 39 age‐matched controls to examine the relationship between them. Method: Serum was taken preoperatively from patients with primary operable breast cancer and age‐matched controls recruited from the diagnostic breast clinic. Enzyme‐linked immunoassays (DRG diagnostics) were used to determine serum levels of androstenedione, DHEAS and cortisol. Conclusions: We have observed that compared to controls, adrenal androgens are elevated in patients with breast cancer. In order to examine whether levels were elevated in the patients with breast cancer due to preoperative emotional stress, we have measured serum cortisol levels. Cortisol levels were nonsignificantly raised in patients with breast cancer compared to controls; however, adrenal androgen levels were independent of cortisol levels. These findings suggest that elevated circulating adrenal androgens may have a role in the aetiology and progression of breast cancer.