Histological type and typing of breast carcinomas and the WHO classification changes over time.

The World Health Organization's new classification of breast tumors has just been published. This review aims to examine the morphological categorization of breast carcinomas which is still principally based on histological features and follows the traditions of histological typing. It gives a subjective and critical view on the WHO classifications and their changes over time, and describes the changes related to some of the most common or challenging breast carcinomas: in situ carcinomas, invasive breast carcinomas of no special type, lobular, cribriform, tubular, mucinous, papillary, metaplastic carcinomas and carcinomas with medullary pattern and those with apocrine differentiation are discussed in more details. Although the 5th edition of the classification is not perfect, it has advantages which are mentioned along with problematic issues of classifications

Emlőrákok TNM-8 szerinti anatómiai és prognosztikai stádiumainak retrospektív vizsgálata elhunyt, valaha emlőrákos betegek adatai alapján | Evaluation of anatomic and prognostic stages of breast cancer according to the 8th edition of the TNM staging system – Retrospective analysis based on data from deceased patients once diagnosed with breast cancer

Absztrakt: Bevezetés: A tumor-nodus-metastasis (TNM) alapú stádiumbesorolás új, nyolcadik változata a hagyományos T, N és M kategóriákon alapuló anatómiai stádium mellett egy biomarkereket figyelembe vevő prognosztikai stádiumot is definiált emlőrákban. Célkitűzés: A nyolcadik stádiumbesorolásban figyelembe vett prognosztikus változók, valamint az anatómiai és prognosztikai stádiumok megoszlásának vizsgálata elhunyt, de korábban emlőrákkal diagnosztizált beteganyagban a teljes túlélés alapján. Módszer: Retrospektív vizsgálatunkba a 2010 és 2015 között a Bács-Kiskun Megyei Kórházban műtött, reszekciós mintából kórismézett, dokumentált okok miatt elhunyt emlőrákos betegeket vontuk be. A prognosztikus markerek adatait a betegek kórszövettani leleteiből nyertük. Statisztikai modelljeink az egyutas ANOVA, a Dunn-féle post hoc teszt, valamint a Kaplan–Meier-analízis voltak. Eredmények: 303 beteg adatait vizsgálva a legtöbb prognosztikus tényezőben, így az anatómiai és prognosztikai stádiumok vonatkozásában is, szignifikáns különbséget találtunk a tumoros halálozás (n = 168) és a nem tumoros halálozás (n = 135) csoportja között. Ugyancsak szignifikáns különbségeket tudtunk kimutatni egyes pT- és pN-kategóriák, gradusok, ösztrogénreceptor-státuszok között az ötéves teljes túlélés alapján. Vizsgálatunk eredményei szerint az I. és II. stádium kivételével, valamennyi további anatómiai és prognosztikai stádium különbözik a többitől túlélés tekintetében (p<0,001). Kiemelendő, hogy az egységes IV. stádiumú betegségben is adódott túlélésbeli különbség az ösztrogénreceptor-, progeszteronreceptor- és HER2-státuszok alapján determinált betegcsoportok között: a tripla negatív és ösztrogénreceptor-pozitív, HER2-negatív tumorok túlélése ebben a stádiumban is különbözött. Következtetések: Valós túlélési adatokon alapuló elemzésünk szerint az újszerű prognosztikai stádiumok a korábbi anatómiai stádiumokhoz hasonlóan elkülönítik a betegeket teljes túlélésük szerint. Eredményeink validálják az új prognosztikai stádiumbesorolást, de előre is mutatnak a jelenleg egységes IV. stádium tagolása irányában. Orv Hetil. 2017; 158(35): 1373–1381. | Abstract: Introduction: The 8th edition of the Tumor-Node-Metastasis (TNM) based staging of breast cancer introduces a prognostic stage influenced by biomarkers along the traditional T, N and M categories. Aim: To retrospectively assess stage influencing prognostic variables; and the anatomic and prognostic stages on the basis of the overall survival (OS) of a cohort of deceased patients once diagnosed with breast cancer. Method: We included patients with known causes of death certified at the Bács-Kiskun County Teaching Hospital and having a history of breast cancer diagnosed on a resection specimen at the same institution. Prognostic factors were obtained from the histopathological reports. Statistics included one-way ANOVA, Dunn’s post hoc test and Kaplan-Meier curve analyses. Results: The 303 patients grouped as breast cancer related death (n = 168) or unrelated (n = 135) showed significant differences in most stage defining prognostic factors and the anatomic and prognostic stages. Significant differences in 5-year OS were observed between pT and pN categories, histological grades and estrogen receptor statuses. Except for stages I and II, significant differences were found between both different anatomic and prognostic stages (p<0.001). Stage IV is by definition uniform, but we identified survival differences between biomarker based subgroups: triple negative carcinomas had worse OS than estrogen receptor positive and HER2 negative carcinomas. Conclusions: Our analysis based on real survival data suggests that the prognostic stages separate patients according to OS similarly to the anatomic stages. The results validate the prognostic stages, but also suggest that separating stage IV disease according to biomarkers makes sense. Orv Hetil. 2017; 158(35): 1373–1381

Emlőelváltozások multidiszciplináris értékelése és ennek eredményei a Decker-féle korrelációs rendszer ötéves tapasztalatai alapján | Five-year experience with the multidisciplinary evaluation of breast lesions according to the Decker radio-pathologic correlation system

Absztrakt: Bevezetés: Az emlőbetegségek képalkotó diagnosztikája során felfedezett elváltozások gyakran mikroszkópos vizsgálatot igényelnek. A jelenleg érvényes ajánlások szerint a radiológiai, fizikális, citológiai és hengerbiopsziás eltéréseket öt kategória egyikébe kell osztályozni. A Decker-féle rendszer ezeken felül a klinikai észlelés és a patológiai értékelés egymásnak való megfelelésének és a további teendőknek az osztályozását is magában foglalja. Célkitűzés: Beszámolni a Decker-féle rendszer multidiszciplináris emlőbizottságunkban való alkalmazásának első ötéves eredményeiről. Módszer: Retrospektív elemzés a 2010–2014 között emlőbetegség miatt operált, illetve ugyanezen periódusban az emlőbizottság előtt megjelent betegek dokumentációja alapján. Eredmények: Az 1716, kezelés előtti bizottsági megbeszélésre kerülő eset közül 1531-ben nonoperatív diagnosztika tisztázta a felfedezett eltérések mibenlétét, 157 esetben azonban diagnosztikus kimetszésre volt szükség; 1122 eset (65%) bizonyult malignusnak. A citológia használata ellenére, a malignitás kórismézése 69%-ban hengerbiopsziából származott. A nem sebészi megközelítés 14 esetben sikertelen, téves vagy késedelmes volt. Következtetés: Az emlőelváltozásokat multidiszciplináris környezetben kell értékelni. A Decker-féle rendszer alkalmas a radio- és klinikopatológiai korreláció és az ennek függvényében végzendő további teendők kodifikációjára és elemzésére. Orv Hetil. 2017; 158(28): 1100–1108. | Abstract: Introduction: Lesions identified during breast imaging often require microscopic verification. Current recommendations imply the classification of radiological, clinical, cytology and core biopsy findings into one of five predefined categories. The Decker system also includes a classification of both the correlation between radiology and pathology and the actions required on this basis. Aim: To report on the five-year results of the implementation of the Decker system in our pretreatment multidisciplinary breast team. Method: Retrospective analysis of patients operated on because of breast diseases or appearing at the multidisciplinary breast team during the period between 2000 and 2014. Results: Of 1716 cases discussed, 1531 were solved by non-operative diagnostics, 157 required diagnostic excisions; 1122 cases (65%) proved to be malignant. Malignancy was diagnosed by core needle biopsies in 69% of the cases. The non-operative approach was unsuccessful, delayed or wrong in 14 cases. Conclusion: Breast lesions need to be evaluated in a multidisciplinary setting. The Decker-system is suitable for the recording and analysis of the correlation between radiologic/physical and microscopy findings, and of the ensuing diagnostic/therapeutic actions. Orv Hetil. 2017; 158(28): 1100–1108

TRPS1 expression in cytokeratin 5 expressing triple negative breast cancers, its value as a marker of breast origin

The lack of oestrogen receptor, progesterone receptor and human epidermal growth factor receptor-2 expression in breast cancer (BC) is the basis for the categorization of the tumour as triple negative breast carcinoma (TNBC). The majority of TNBCs are aggressive tumours with common metastases and decreased expression of markers that could help in identifying the metastatic lesion as of mammary origin. Breast markers, such as gross cystic disease fluid protein-15 (GCDPF-15), GATA binding protein 3 (GATA3), mammaglobin (MGB) and SOX10, are not uniquely specific to BC. Our aim was to evaluate trichorhinophalangeal syndrome type 1 (TRPS1) protein as a breast marker in a series of cytokeratin-5-expressing TNBC, mostly corresponding to basal-like TNBCs, previously characterized for the expression of other breast markers. One hundred seventeen TNBCs in tissue microarrays were immunostained for TRPS1. The cut-off for positivity was ≥ 10%. The reproducibility of this classification was also assessed. TRPS1 positivity was detected in 92/117 (79%) cases, and this exceeded the expression of previously tested markers like SOX10 82 (70%), GATA3 11 (9%), MGB 10 (9%) and GCDFP-15 7 (6%). Of the 25 TRPS1-negative cases, 11 were positive with SOX10, whereas 5 to 6 dual negatives displayed positivity for the other makers. The evaluation showed substantial agreement. Of the five markers compared, TRPS1 seems the most sensitive marker for the mammary origin of CK5-expressing TNBCs. Cases that are negative are most often labelled with SOX10, and the remainder may still demonstrate positivity for any of the 3 other markers. TRPS1 has a place in breast marker panels

Prognostic Markers of Microinvasive Breast Carcinoma: A Systematic Review and Meta-Analysis

(1) Background: The prognostic factors of microinvasive (≤1 mm) breast carcinoma are not completely clear. The aim of this study was to perform a systematic review and meta-analysis to clarify these factors. (2) Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was followed. Two databases were interrogated, PubMed and Embase, and papers in English were included to address this question. The selected studies were those that reported on female patients affected by microinvasive carcinoma, and on prognostic factors with a hazard ratio (HR) for disease-free survival (DFS) and overall survival (OS). (3) Results: In total, 618 records were identified. After removing duplicates (166), identification, and screening (336 by title and abstract alone, 116 by full text and eventual supplementary material), 5 papers were selected. Seven different meta-analyses were conducted in this study, all referring to DFS, analyzing the following prognostic factors: estrogen receptor, progesterone receptor, HER2 status, multifocality and grade of microinvasion, patient’s age, and lymph node status. Only lymph node status was associated with prognosis and DFS (total number of cases: 1528; Z = 1.94; p = 0.05). The other factors examined did not significantly affect prognosis (p > 0.05). (4) Conclusions: Positive lymph node status significantly worsens prognosis in patients with microinvasive breast carcinoma

Prognostic value of histopathology and trends in cervical cancer: a SEER population study

<p>Abstract</p> <p>Background</p> <p>Histopathology is a cornerstone in the diagnosis of cervical cancer but the prognostic value is controversial.</p> <p>Methods</p> <p>Women under active follow-up for histologically confirmed primary invasive cervical cancer were selected from the United States Surveillance, Epidemiology, and End Results (SEER) 9-registries public use data 1973–2002. Only histologies with at least 100 cases were retained. Registry area, age, marital status, race, year of diagnosis, tumor histology, grade, stage, tumor size, number of positive nodes, number of examined nodes, odds of nodal involvement, extent of surgery, and radiotherapy were evaluated in Cox models by stepwise selection using the Akaike Information Criteria.</p> <p>Results</p> <p>There were 30,989 records evaluable. From 1973 to 2002, number of cases dropped from 1,100 new cases/year to 900/year, but adenocarcinomas and adenosquamous carcinoma increased from 100/year to 235/year. Median age was 48 years. Statistically significant variables for both overall and cause-specific mortality were: age, year of diagnosis, race, stage, histology, grade, hysterectomy, radiotherapy, tumor size and nodal ratio. The histological types were jointly significant, P < 0.001. Cause-specific mortality hazard ratios by histological type relatively to non-microinvasive squamous cell carcinoma were: microinvasive squamous cell carcinoma 0.28 (95% confidence interval: 0.20–0.39), carcinoma not otherwise specified 0.91 (0.79–1.04), non-mucinous adenocarcinoma 1.06 (0.98–1.15), adenosquamous carcinoma 1.35 (1.20–1.51), mucinous adenocarcinoma 1.52 (1.23–1.88), small cell carcinoma 1.94 (1.58–2.39).</p> <p>Conclusion</p> <p>Small cell carcinoma and adenocarcinomas were associated with poorer survival. The incidental observation of increasing numbers of adenocarcinomas despite a general decline suggests the inefficiency of conventional screening for these tumors. Increased incidence of adenocarcinomas, their adverse prognosis, and the young age at diagnosis indicate the need to identify women who are at risk.</p