Breast carcinoma grading, estimation of tumor size, axillary lymph node status, staging, and nottingham prognostic index scoring on mastectomy specimens.

Introduction: Breast carcinoma is the most common malignant tumor and the leading cause of cancer death in women. In western countries, a sharp increase in the detection of breast carcinoma, largely due to widespread use of mammography, has recently led to a fall in breast cancer mortality. This, however, is not true for less developed countries, in which mortality continues to rise.Objective:The aim of this study was to acquire information about the extent and spread of breast carcinoma in our Patients by grading the tumors, determining the tumor size, and axillary lymph node status, staging of the tumors and Nottingham Prognostic Index (NPI) scoring on the available material. Materials AndMethods:One hundred and twenty consecutive mastectomy specimens with axillary lymph node sampling removed for breast carcinoma and received in the section of histopathology, Aga Khan University, in the year 2005, were included in the study. Standard protocols were used for the processing of the specimens, and reporting was done using a standard format incorporating all relevant tumor parameters. NPI was applied to the cases.Results:Out of the 120 cases, 5 (4.17) were grade 1, 91 (75.83) were grade 2, and 24 (20%) were grade 3. Also, 9 cases (7.5%) were T1 (4 were T1b, and 5 were T1c), 53 (44.16%) were T2, 50 (41.66%) were T3, and 8 (6.66%) were T4. Axillary lymph nodes were available in 107 cases. In 13 cases, no lymph nodes were recovered. Out of 107 cases 27 (25.23%) lymph nodes were negative for metastases pN0, 29 (27.10%) cases were pN1, 26 (24.30) were pN2, and 25 cases (23.36%) were pN3. Extranodal spread was present in 56 (70%) out of the 80 cases in which lymph nodes were positive. The average microscopic size of nodal metastasis was 1.7 cms. Significant statistical association was found between the number of positive nodes and perinodal extension (P = 0.001). Tumor necrosis was present in 76 out of 120 cases (63.33%). Vascular invasion was present in 43 out of 120 cases (35.83%). NPI scores were greater than 5.4 in 60 out of 107 cases (56.1%) indicating poor prognosis.Conclusion:The large majority of the cases were grade 2 tumors. Most cases (all grades) were T2 or T3, and were axillary lymph node positive. Large majority of cases with nodel metastases showed extra nodal spread. The majority of Patients had NPI scores greater than 5.4 indicating poor prognosis. Significant statistical association was found between the number of positive nodes and perinodal extension (P = 0.001). The findings show extensive and advanced disease trends in our Patients

A Two-Step Damage Diagnostic Approach Based on Static Strain Energy and Model-Updating via the Equilibrium Optimizer

Despite the great achievements accomplished so far in the field of damage detection, the need for a more comprehensive damage detection approach that effectively functions despite several real-world obstacles still exists. Among different methods suggested so far, model-updating holds the most appeal; however, its accuracy and efficiency are seriously challenged when the problem size grows as it fails to solve the problem with an increase in the number of variables. In this paper, a two-step approach is suggested that reduces the problem size in model updating-based damage detection methods by identifying potentially damaged elements using a static strain-based damage identification index over the first step. Therefore, only a few unknown variables will be introduced to the next step, which involves an iterative model-updating process that includes a novel damage-sensitive objective function to determine damage severities in the located elements of the previous step. In this stage, a meta-heuristic optimizer, the Equilibrium Optimizer, is utilized to detect the unknown variables, i.e., damage values. This optimization algorithm is used given that it has not been applied to damage detection problems before. The method is also tested on a number of numerical examples to be validated and the effects of external factors such as measurement noise can be taken into account. Apart from that, a comparative study is also carried out to compare the efficacy of the present work with previous references. Interestingly, the method is capable of detecting damaged elements with great speed and accuracy, and the quality of the results has not been seriously affected in the presence of perturbing factors. Moreover, information from even a limited number of first modes has been enough to solve the problem, which means that the approach does not require all vibration modes. Finally, an experimental verification study is also carried out to demonstrate the capability of the method in detecting damaged elements in real structures. It is shown that the method can detect the damaged element successfully, which is indicative of the practicality of the suggested technique in real-world applications

Breast carcinoma grading, estimation of tumor size, axillary lymph node status, staging, and nottingham prognostic index scoring on mastectomy specimens

<b>Introduction:</b> Breast carcinoma is the most common malignant tumor and the leading cause of cancer death in women. In western countries, a sharp increase in the detection of breast carcinoma, largely due to widespread use of mammography, has recently led to a fall in breast cancer mortality. This, however, is not true for less developed countries, in which mortality continues to rise. <b> Objective:</b> The aim of this study was to acquire information about the extent and spread of breast carcinoma in our patients by grading the tumors, determining the tumor size, and axillary lymph node status, staging of the tumors and Nottingham Prognostic Index (NPI) scoring on the available material. <b> Materials and Methods:</b> One hundred and twenty consecutive mastectomy specimens with axillary lymph node sampling removed for breast carcinoma and received in the section of histopathology, Aga Khan University, in the year 2005, were included in the study. Standard protocols were used for the processing of the specimens, and reporting was done using a standard format incorporating all relevant tumor parameters. NPI was applied to the cases. <b> Results:</b> Out of the 120 cases, 5 (4.17) were grade 1, 91 (75.83) were grade 2, and 24 (20&#x0025;) were grade 3. Also, 9 cases (7.5&#x0025;) were T1 (4 were T1b, and 5 were T1c); 53 (44.16&#x0025;) were T2; 50 (41.66&#x0025;) were T3; and 8 (6.66&#x0025;) were T4. Axillary lymph nodes were available in 107 cases. In 13 cases, no lymph nodes were recovered. Out of 107 cases 27 (25.23&#x0025;) lymph nodes were negative for metastases pN0; 29 (27.10&#x0025;) cases were pN1; 26 (24.30) were pN2; and 25 cases (23.36&#x0025;) were pN3. Extranodal spread was present in 56 (70&#x0025;) out of the 80 cases in which lymph nodes were positive. The average microscopic size of nodal metastasis was 1.7 cms. Significant statistical association was found between the number of positive nodes and perinodal extension (<i>P</i> = 0.001). Tumor necrosis was present in 76 out of 120 cases (63.33&#x0025;). Vascular invasion was present in 43 out of 120 cases (35.83&#x0025;). NPI scores were greater than 5.4 in 60 out of 107 cases (56.1&#x0025;) indicating poor prognosis. <b> Conclusion:</b> The large majority of the cases were grade 2 tumors. Most cases (all grades) were T2 or T3, and were axillary lymph node positive. Large majority of cases with nodel metastases showed extra nodal spread. The majority of patients had NPI scores greater than 5.4 indicating poor prognosis. Significant statistical association was found between the number of positive nodes and perinodal extension (<i>P</i> = 0.001). The findings show extensive and advanced disease trends in our patients

Gastric carcinoma: typing, staging, lymph node and resection margin status on gastrectomy specimens

Objective: To determine the extent and stage of gastric carcinoma on gastrectomy specimens in terms of type, grade, location, depth of invasion, resection margins and lymph node status.STUDY Design: Descriptive study.PLACE AND DURATION OF STUDY: Section of Histopathology, Department of Pathology, Aga Khan University, Karachi during 2005 and 2006.MATERIALS AND Methods: A 100 consecutive gastrectomy specimens received during the study period, in which resection was done for gastric carcinoma were included. Exclusion criteria were gastrectomy performed for gastrointestinal stromal tumor (GIST) and gastric lymphoma. Specimens were examined according to standard techniques. The reporting incorporated all relevant parameters including gross examination, tumor location, type and grade, depth of invasion, surgical resection margins and lymph node status. Staging was done according to the TNM staging system. Restults: Fifty three (53%) tumors were located in the distal part of the stomach and 35 (35%) in the proximal part. In 12 (12%) cases, tumor was diffusely involving the entire stomach. Histologically, the tumors were signet ring type in 63 (63%) cases and intestinal type in 37 (37%). At least one peripheral resection margin was positive in 29 (29%) cases. Sixty six (66%) cases were T3, 30 (30%) were T2, 3 (3%) were T1 and one case (1%) was T4. Twenty four cases (24%) were N0, 35 (35%) were N1, 27 (27%) were N2 and 14 (14%) were N3.CONCLUSION: Gastric cancer was at very advanced stage in these patients with full thickness involvement of the gastric wall and positive lymph nodes. It is thus essential to detect and surgically treat these cancers in an early stage. Better surgical techniques are required to ensure negative peripheral resection margins and removal of adequate number of lymph nodes, so that proper staging can be performed

Spectrum of MRI findings in 58 patients with methanol intoxication: Long-term visual and neurological correlation

Purpose: To describe MRI and DWI spectrum of brain and optic pathway changes in cases who survived acute methanol poisoning and explore whether there is correlation between imaging features and long-term visual and neurological sequelae. Materials and methods: We retrospectively reviewed the conventional MRI and DWI of 58 consecutive patients with methanol poisoning. All patients were examined in the chronic phase. Results: Optic nerve enhancement and atrophy were detected in 33 cases (56.9%). Degree of optic nerve atrophy correlated well with cupping and time lag since initial exposure to methanol. Bilateral putamen necrosis was present in 45 cases (77.6%), 19 showed asymmetrical involvement, and caudate was involved in 6 cases. Asymmetrical necrosis and caudate involvement were correlated with higher grade of neurological deficit. Twenty-one cases (36.2%) showed combination of bilateral putamen necrosis and optic nerve enhancement. Subcortical white matter high SI was detected in 25 patients (43.1%). DWI clearly depicted putamen necrosis with non-restricted pattern. Conclusion: Spectrum of residual MRI Findings in patients who survived methanol poisoning included bilateral optic nerve atrophy and enhancement, bilateral putamen and caudate necrosis as well as subcortical white matter high SI at T2WI. Diffusion WI did not have additional value in chronic stage