Histological Patterns and Mammographic Presentation of Invasive Lobular Carcinoma Show No Obvious Associations

Invasive lobular carcinoma of the breast has different mammographic appearances, including spiculated or lobulated masses, architectural distortion, increased breast density, and the possibility of also being occult. Histologically, the morphology is also variable, as several patterns have been described beside the classical one, including the solid, the alveolar, the trabecular, the one with tubular elements, and others. Of 146 ILC cases, 141 were reviewed for mammographic appearance and 136 for histological patterns by two radiologist and two pathologists, respectively; 132 common cases were analyzed for possible associations between mammographic presentation and the histological patterns. Interobserver agreement on the presence or absence of a given mammographic morphology ranged from 45% (increased density) to 95% (occult lesion); the most common radiomorphology was that of a spiculated mass. Interobserver agreement on the presence or absence of a given histological pattern ranged between 79% (solid) and 99% (classical) but was worse when semi-quantification was also included. The mammography–pathology correlation was less than optimal. Multifocality was more commonly detected by histology. The identification of a mammographic mass lesion often coincided with a mass-like lesion on the histological slides and vice versa, but nearly half of the mammographically occult lesions were felt to have masses on histological slides assessed grossly. Histological patterns showed no obvious associations with one or the other mammographic appearance

A Gleason-osztályozás reprodukálhatóságának vizsgálata prosztata-tűbiopsziás mintákban | Interobserver reproducibility of Gleason grading in prostate biopsy samples

Bevezetés: A Gleason-gradingrendszer jelenleg a legáltalánosabban elterjedt és ajánlott osztályozás prosztatakarcinóma esetében. Célkitűzés: A szerzők célja a Gleason-osztályozás reprodukálhatóságának felmérése, a patológusok közötti egyetértés vizsgálata volt prosztata-tűbiopszás mintákon. Módszer: 23 patológus vizsgált meg 37 prosztatakarcinómát tartalmazó biopsziás mintát hematoxilin-eozinnal festett metszetekben. A Gleason-pontszámokat (score) négy kategóriába sorolták (2–4, 5–6, 7 és 8–10). A vizsgálók közti egyetértés meghatározására kappa-statisztikát használtak. Eredmények: Az összes vizsgálóra vonatkoztatva, a Gleason-pontszámok alapján kialakított kategóriákba történő besorolás reprodukálhatóságát jellemző kappa-érték 0,49 volt. Az egyes kategóriákra és az összes vizsgálóra vonatkoztatva a legkisebb egyetértést (kappa = 0,15) a jól differenciált karcinómáknál, a legnagyobbat (kappa = 0,65) pedig a rosszul differenciált rákoknál találták. Következtetések: Az eredmények alapján a Gleason-pontszám (score) meghatározása a részt vevő magyar patológusok között mérsékelten reprodukálhatónak bizonyult. A különböző kappa-értékek a daganatok differenciáltságának megfelelően változtak, az irodalmi adatoktól lényegében nem tértek el. A reprodukálhatóság növelése érdekében célzott továbbképzés bevezetése mérlegelendő, ami a leletezés minőségének javulását eredményezhetné. Orv. Hetil., 2013, 154, 1219–1225. | Introduction: Gleason grading is the most common method of prostate cancer classification. Aim: The aim of the authors was to assess the reproducibility of Gleason grading among pathologists using the same needle biopsy samples. Method: 23 pathologists examined 37 prostate cancer biopsies stained with hematoxylin and eosin. Gleason scores were categorised into 4 groups (2–4, 5–6, 7 and 8–10). Kappa statistics were used to reflect interobserver agreement. Results: Considering all participating pathologists, grouping into one of the 4 categories resulted in an overall kappa value of 0.49. For the individual categories, the worst agreement (kappa = 0.15) was seen with well differentiated carcinomas, and the best (kappa = 0.65) with poorly differentiated ones. Conclusions: These results suggest that Gleason grading in biopsy samples is moderately reproducible. The kappa values vary according to the differentiation of the cancer, and there is not much difference between the results of the present study and those published in the literature. To increase reproducibility, trainings should be organised, and this could improve the quality of grading. Orv. Hetil., 2013, 154, 1219–1225

Reventilation with room air or 100% oxygen after asphyxia differentially affects cerebral neuropathology in newborn pigs

Aim: To test if reventilation with room air ( RA) or 100% oxygen ( O-2) after asphyxia would differentially affect neuronal damage in different brain areas of newborn pigs. Methods: Anaesthetized piglets were subjected to 10 min asphyxia ( n = 27) or served as time controls ( n = 7). Reventilation started with either RA or O-2 for 1 h, and was continued with RA for an additional 1 - 3 h. Cortical or cerebellar blood flow was assessed with laser-Doppler flowmetry ( LDF). Haematoxylin/eosin-stained sections from six brain regions were prepared for blinded neuropathological examination and scoring. Results: Asphyxia resulted in significant neuronal damage compared to time controls in all areas examined except the pons. O2 ventilation elicited greater neuronal lesions in the hippocampus and the cerebellum but smaller damage in the basal ganglia compared to RA. The assessed physiological parameters including the LDF signals were similar in both ventilation groups, except for PaO2 in the first hour of reventilation ( RA 75 +/- 5 mmHg, O-2 348 +/- 57 mmHg; p < 0.05). Interestingly, however, reactive hyperaemia was much higher in the O-2-sensitive cerebellum as compared with the cortex ( 1101 +/- 227 vs 571 +/- 73; p < 0.05, area under the curve). Conclusion: O-2 toxicity after asphyxia was demonstrated in the piglet hippocampus and cerebellum but not in the cerebral cortex or basal ganglia. The observed regional differences may be associated with local haemodynamic factors

The Petersen prognostic index revisited in Dukes B colon cancer - Inter-institutional differences

A prognostic index (Petersen index, PI) was created for patients with pT3-4 pN0 M0 (Stage II, Dukes' B) colon cancers to distinguish between patients with better and worse outcome, and to help in recommending adjuvant chemotherapy for high risk patients in this stage. The prognostic value of the PI was evaluated in two independent retrospective series of stage II (Dukes' B) colon cancer patients. The parameters defining the PI (venous invasion, peritoneal involvement, circumferential margin involvement, perforation through the tumour) and performance of the PI were compared in two institutions. The two series of patients consisted of 127 and 87 patients. Venous invasion was more frequently detected at one of the centres (p<0.01) and tumour perforation was more frequent at the other (p<0.01). There were no significant differences in the 5-year survival estimates of all patients (p=0.19), and of either the low PI value groups (p=0.52) or that of the high PI value groups (p=0.99) between the two sites. In contrast, there were significant differences in the survival estimates between patients of the low PI category and those of the high PI category altogether (p<0.01) and in either centre. Although, it was expected that differences in the frequency of the parameters involved in the PI would influence its performance, this was not confirmed by the data. Our results suggest that using the PI may be of value in prognostic factor based therapy selection of colon carcinoma patients

The role of sentinel node biopsy in male breast cancer

BACKGROUND: Sentinel lymph node biopsy (SLNB) is a standard procedure in women with breast cancer. The risk of morbidity related to axillary lymph node dissection (ALND) is similar for men and women with breast cancer and SLNB could minimize this risk. METHODS: Between January 2004 and August 2013, 25 men with primary breast cancer were operated on at the Bacs-Kiskun County Teaching Hospital. These were reviewed retrospectively. SLNB was performed following lymphoscintigraphy with intraoperative gamma probe detection and blue dye mapping. RESULTS: SLNB was successful in all 16 male patients (100 %), in whom it was attempted. The SLNs were negative in 4 cases (25 %) and were involved in 12. Intraoperative imprint cytology was positive in 9 of the 12 involved cases (75 %) and resulted immediate completion ALND. In 7 patients, the intraoperative imprint cytology was negative, with 3 false-negative results that resulted in delayed completion ALND. After a median follow-up of 48 months, there was only one axillary recurrence after ALND and none in the SLNB group. CONCLUSIONS: SLNB is successful and accurate in male breast cancer patients too. Although compared to women a larger proportion of men have positive nodes, for men with negative nodes, ALND-related morbidity may be reduced by SLNB. We recommend SLNB in male patients with breast cancer and clinically negative axilla

A hónalji nyirokcsomók további érintettségére vonatkozó modellek elemzése kisméretű (≤15 mm) őrszemnyirokcsomó-áttétes emlőrákokban = Analysis of predictive tools for further axillary involvement in patients with sentinel lymph node positive small (≤15 mm) invasive breast cancer

A kisméretű emlőrákok sok tekintetben más kezelést igényelhetnek, mint a nagyobbak. Axillaris őrszemnyirokcsomó-biopszián átesett, 15 mm-nél nem nagyobb daganattal diagnosztizált betegeknél, 8 prediktív eszköz segítségével értékeltük a pozitív őrszemnyirokcsomóhoz társuló egyéb nyirokcsomók áttéteinek gyakoriságát és annak megjósolhatóságát. Ötszázhat beteg közül pozitív őrszemnyirokcsomó lelete mellett 138 alkalommal történt hónalji blokkdisszekció, és 39 esetben igazolódott további nyirokcsomóáttét. A prediktív eszközök közül a Stanford-nomogram és a mikrometasztatikus nomogram határozott meg egy olyan kis csoportot, akiknél a pozitív őrszemnyirokcsomók mellett is további áttétek kis kockázata miatt elhagyható lehet a kiegészítő blokkdisszekció. Adataink szerint a Tenon-pontszám is alkalmas lehet egy további, áttétek szempontjából kisebb és nagyobb kockázati csoport elkülönítésére. A kis tumorméretük alapján egyébként is alacsonyabb kockázatú őrszemnyirokcsomó-áttétes betegeknél a többváltozós modelleken alapuló prediktív eszközök némelyike segíthet az utólag feleslegesnek tűnő hónalji blokkdisszekciók egy részének elhagyásában. | Small breast cancers often require different treatment than larger ones. The frequency and predictability of further nodal involvement was evaluated in patients with positive sentinel lymph nodes and breast cancers ≤15 mm by means of 8 different predictive tools. Of 506 patients with such small tumors 138 with positive sentinel nodes underwent axillary dissection and 39 of these had non-sentinel node involvement too. The Stanford nomogram and the micrometastatic nomogram were the predictive tools identifying a small group of patients with low probability of further axillary involvement that might not require completion axillary lymph node dissection. Our data also suggest that the Tenon score can separate subsets of patients with a low and a higher risk of non-sentinel node metastasis. Predictive tools based on multivariate models can help in omitting completion axillary dissection in patients with low risk of non-sentinel lymph node metastasis based on their small tumor size