Testing tumor type dependent relations between expression of ER and PgR with Ki-67 values in a single series of 1180 invasive ductal cancer patients

Background: Model of cancer-associated epigenetic changes (Kurbel S. Tumour Biol. 2013;34:2011-7) proposes that dysfunctional estrogen receptors (ER), unable to adequately express progesterone receptors (PgR), beside in the ER+PgR– breast cancers might also be present in ER+PgR+ tumors showing weak PgR expression. Methods: In 1180 patients with invasive ductal cancers, ER and PgR positivity were semiquantitatively classified in four groups: “0” means no positive cells; “1+” <10% positive cells; “2+” 11–30% positive cells; and “3+” 31–100% positive cells. Tumors were divided in breast cancer types. Results: Among patients older than 54, Luminal A and B1 tumors were frequently ER3+ (p20%). The predicted values matched well with the found shares of ER3+PgR1+ tumors within these three types (p>0.10). Conclusions: The results support heterogeneity among ER+PgR+ tumors. Future studies of ER+PgR+ phenotype variants are required since hypothetical dysfunctional ERs in some ER+PgR+ breast cancer patients might alter their endocrine treatment outcomes

Vrijednost mjerljivih i nemjerljivih značajka ultrazvučnog prikaza limfnih čvorova u otkrivanju zloćudnog zauzeća

The aim of the study was to assess diagnostic value and utility of selected morphological features in predicting lymph node (LN) malignancy using B-mode, Doppler ultrasonography and multivariate settings in a tertiary radiological referral center. The study included 123 patients having undergone ultrasound-guided fine-needle aspiration and cytologic analysis (FNAC) of cervical, axillary and inguinal LNs. Each LN was characterized by long/L and short/T-axis, shape, margins, echogenicity, cortical thickness, vascularization, and examiner’s subjective impression. Within the limitations of FNAC, altered shape and vascularization had relatively high specificity and positive predictive value (>80%), whereas subjective impression had high sensitivity and negative predictive value (100%) for malignancy. The cut-off levels for different features of LN by ROC analysis were as follows: long-axis 23 mm, short-axis 11 mm, L/T ratio 2.19, and maximal cortical thickness 5.1 mm. On multivariate analysis (adaptive regression splines, n=108), the addition of long-axis, L/T ratio, age and sex considerably improved diagnostic accuracy (88%), sensitivity (margins + vascularization) and specificity (subjective impression) of the diagnostic model. The combination of morphological and demographic features could improve diagnostic accuracy, usually with a trade-off between the sensitivity and specificity of the predictive model. The performance may depend on the level of expertise and institutional settings.Cilj istraživanja bio je odrediti dijagnostičku vrijednost i korisnost odabranih morfoloških značajka u predviđanju malignosti limfnog čvora (LČ) upotrebom B-moda, Dopplerova ultrazvuka i multivarijatnih postavka u tercijarnom radiološkom referentnom centru. U 123 bolesnika je učinjena ultrazvučno vođena aspiracijska punkcija i citološka analiza LČ vrata, pazuha i prepona. Svaki LČ je opisan uzdužnim/L i poprečnim/T promjerom, oblikom, rubom, ehogenošću, debljinom kore, vaskularizacijom i subjektivnim dojmom pregledavatelja. Unutar ograničenja citološke analize, izmijenjen oblik i vaskularizacija su imali visoku specifičnost i pozitivnu prediktivnu vrijednost (>80%), dok je subjektivni dojam imao visoku osjetljivost i negativnu prediktivnu vrijednost (100%) za malignost. Optimalne granične vrijednosti za različite značajke LČ dobivene analizom ROC su bile 23 mm za uzdužni promjer, 11 mm za poprečni promjer, 2,19 za omjer L/T i 5,1 mm za maksimalnu debljinu korteksa. U multivarijatnoj analizi (adaptive regression splines, n=108) dodatak uzdužnog promjera, omjera L/T, dobi i spola semikvalitativnim obilježjima LČ značajno je povećao dijagnostičku točnost (88%), osjetljivost (rubovi + vaskularizacija, 87%) i specifičnost (subjektivni dojam, 83%) konačnog dijagnostičkog modela. U zaključku, kombinacija morfoloških i demografskih značajka može poboljšati dijagnostičku točnost, obično uz kompromis između osjetljivosti i specifičnosti prediktivnog modela. Učinkovitost može ovisiti o razini stručnosti i institucionalnim postavkama

Vrijednost mjerljivih i nemjerljivih značajka ultrazvučnog prikaza limfnih čvorova u otkrivanju zloćudnog zauzeća

The aim of the study was to assess diagnostic value and utility of selected morphological features in predicting lymph node (LN) malignancy using B-mode, Doppler ultrasonography and multivariate settings in a tertiary radiological referral center. The study included 123 patients having undergone ultrasound-guided fine-needle aspiration and cytologic analysis (FNAC) of cervical, axillary and inguinal LNs. Each LN was characterized by long/L and short/T-axis, shape, margins, echogenicity, cortical thickness, vascularization, and examiner’s subjective impression. Within the limitations of FNAC, altered shape and vascularization had relatively high specificity and positive predictive value (>80%), whereas subjective impression had high sensitivity and negative predictive value (100%) for malignancy. The cut-off levels for different features of LN by ROC analysis were as follows: long-axis 23 mm, short-axis 11 mm, L/T ratio 2.19, and maximal cortical thickness 5.1 mm. On multivariate analysis (adaptive regression splines, n=108), the addition of long-axis, L/T ratio, age and sex considerably improved diagnostic accuracy (88%), sensitivity (margins + vascularization) and specificity (subjective impression) of the diagnostic model. The combination of morphological and demographic features could improve diagnostic accuracy, usually with a trade-off between the sensitivity and specificity of the predictive model. The performance may depend on the level of expertise and institutional settings.Cilj istraživanja bio je odrediti dijagnostičku vrijednost i korisnost odabranih morfoloških značajka u predviđanju malignosti limfnog čvora (LČ) upotrebom B-moda, Dopplerova ultrazvuka i multivarijatnih postavka u tercijarnom radiološkom referentnom centru. U 123 bolesnika je učinjena ultrazvučno vođena aspiracijska punkcija i citološka analiza LČ vrata, pazuha i prepona. Svaki LČ je opisan uzdužnim/L i poprečnim/T promjerom, oblikom, rubom, ehogenošću, debljinom kore, vaskularizacijom i subjektivnim dojmom pregledavatelja. Unutar ograničenja citološke analize, izmijenjen oblik i vaskularizacija su imali visoku specifičnost i pozitivnu prediktivnu vrijednost (>80%), dok je subjektivni dojam imao visoku osjetljivost i negativnu prediktivnu vrijednost (100%) za malignost. Optimalne granične vrijednosti za različite značajke LČ dobivene analizom ROC su bile 23 mm za uzdužni promjer, 11 mm za poprečni promjer, 2,19 za omjer L/T i 5,1 mm za maksimalnu debljinu korteksa. U multivarijatnoj analizi (adaptive regression splines, n=108) dodatak uzdužnog promjera, omjera L/T, dobi i spola semikvalitativnim obilježjima LČ značajno je povećao dijagnostičku točnost (88%), osjetljivost (rubovi + vaskularizacija, 87%) i specifičnost (subjektivni dojam, 83%) konačnog dijagnostičkog modela. U zaključku, kombinacija morfoloških i demografskih značajka može poboljšati dijagnostičku točnost, obično uz kompromis između osjetljivosti i specifičnosti prediktivnog modela. Učinkovitost može ovisiti o razini stručnosti i institucionalnim postavkama

Measurable and Unmeasurable Features of Ultrasound Lymph Node Images in Detection of Malignant Infiltration

The aim of the study was to assess diagnostic value and utility of selected morphological features in predicting lymph node (LN) malignancy using B-mode, Doppler ultrasonography and multivariate settings in a tertiary radiological referral center. The study included 123 patients having undergone ultrasound-guided fine-needle aspiration and cytologic analysis (FNAC) of cervical, axillary and inguinal LNs. Each LN was characterized by long/L and short/T-axis, shape, margins, echogenicity, cortical thickness, vascularization, and examiner’s subjective impression. Within the limitations of FNAC, altered shape and vascularization had relatively high specificity and positive predictive value (>80%), whereas subjective impression had high sensitivity and negative predictive value (100%) for malignancy. The cut-off levels for different features of LN by ROC analysis were as follows: long-axis 23 mm, short-axis 11 mm, L/T ratio 2.19, and maximal cortical thickness 5.1 mm. On multivariate analysis (adaptive regression splines, n=108), the addition of long-axis, L/T ratio, age and sex considerably improved diagnostic accuracy (88%), sensitivity (margins + vascularization) and specificity (subjective impression) of the diagnostic model. The combination of morphological and demographic features could improve diagnostic accuracy, usually with a trade-off between the sensitivity and specificity of the predictive model. The performance may depend on the level of expertise and institutional settings

Nonelective surgery at night and in-hospital mortality - Prospective observational data from the European Surgical Outcomes Study

BACKGROUND Evidence suggests that sleep deprivation associated with night-time working may adversely affect performance resulting in a reduction in the safety of surgery and anaesthesia. OBJECTIVE Our primary objective was to evaluate an association between nonelective night-time surgery and in-hospital mortality. We hypothesised that urgent surgery performed during the night was associated with higher in-hospital mortality and also an increase in the duration of hospital stay and the number of admissions to critical care. DESIGN A prospective cohort study. This is a secondary analysis of a large database related to perioperative care and outcome (European Surgical Outcome Study). SETTING Four hundred and ninety-eight hospitals in 28 European countries. PATIENTS Men and women older than 16 years who underwent nonelective, noncardiac surgery were included according to time of the procedure. INTERVENTION None. MAIN OUTCOME MEASURES Primary outcome was in-hospital mortality; the secondary outcome was the duration of hospital stay and critical care admission. RESULTS Eleven thousand two hundred and ninety patients undergoing urgent surgery were included in the analysis with 636 in-hospital deaths (5.6%). Crude mortality odds ratios (ORs) increased sequentially from daytime [426 deaths (5.3%)] to evening [150 deaths (6.0%), OR 1.14; 95% confidence interval 0.94 to 1.38] to night-time [60 deaths (8.3%), OR 1.62; 95% confidence interval 1.22 to 2.14]. Following adjustment for confounding factors, surgery during the evening (OR 1.09; 95% confidence interval 0.91 to 1.31) and night (OR 1.20; 95% confidence interval 0.9 to 1.6) was not associated with an increased risk of postoperative death. Admittance rate to an ICU increased sequentially from daytime [891 (11.1%)], to evening [347 (13.8%)] to night time [149 (20.6%)]. CONCLUSION In patients undergoing nonelective urgent noncardiac surgery, in-hospital mortality was associated with well known risk factors related to patients and surgery, but we did not identify any relationship with the time of day at which the procedure was performed