|
February 2003
Scarring as a prognostic indicator in small peripheral lung adenocarcinomas
Several studies have demonstrated the prognostic value of desmoplasia
for lung adenocarcinomas. The authors evaluated the density and
extent of desmoplasia by modifying the scar grade and the prognostic
impact on patient survival. Modified scar grade was defined as:
grade 1, no desmoplasia; grade 2, sparse desmoplastic reaction;
grade 3, dense desmoplastic reaction with diameter of 10 mm or less;
grade 4, dense desmoplastic reaction with diameter of more than
10 mm. In addition, the prognostic impact of conventional histologic
factors and modified scar grade was analyzed in 239 cases of small
peripheral lung adenocarcinoma (maximum dimension, < 30 mm)
for which long-term followup data were available. The five- and
10-year survival rates according to the modified scar grade were,
respectively, 100 percent and 100 percent for grade 1 lung adenocarcinoma
(n=29); 91.7 percent and 83.7 percent for grade 2 (n=61); 67.6 percent
and 52.7 percent for grade 3 (n=78); and 50 percent and 37.5 percent
for grade 4 (n=71). A significant difference in patient survival
was found between grade 1 or 2 versus grade 3 or 4 (P<0.0001
by log rank test). Multivariate analysis showed that modified scar
grade was an independent prognostic factor (P=0.0176),
as were pathologic stage (P=0.0293), lymph node metastasis
(P=0.0191), lymphatic permeation (P=0.0022), and
pleural involvement (P=0.0452). Modified scar grade also
had a significant impact on survival in various subsets of patients,
including those with pathologic stage IA disease, patients with
tumors of 20 mm or less diameter, or patients with mixed subtype
tumors with a bronchioloalveolar component. The authors concluded
that the modified scar grade is a useful prognostic factor in patients
with small lung adenocarcinoma. Tumors with a sparse fibroblastic
reaction (modified scar grade 2) may represent early invasive cancers
or invasive cancers with low malignant potential, which should be
distinguished from frankly invasive cancers (modified scar grade
3 or 4).
Maeshima AM, Niki T, Maeshima A, et al. Modified
scar grade: a prognostic indicator in small peripheral lung adenocarcinoma.
Cancer. 2002;95:2546-2554.
Reprints: Dr. Yoshihiro Matsuno, Clinical Laboratory Division,
National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo,
104-0045, Japan; ymatsuno@ncc.go.jp
Imprint cytology
in evaluation of sentinel lymph nodes in
breast cancer
An upswing in lymphatic mapping techniques for breast carcinoma
has increased the attractiveness of intraoperative evaluation of
sentinel lymph nodes. Axillary lymph node dissection can be performed
during initial surgery if the sentinel lymph node is positive, potentially
avoiding a second operative procedure. An optimal technique for
rapidly assessing sentinel lymph nodes has not been determined.
Many institutions use frozen sectioning and intraoperative imprint
cytology for rapid intraoperative sentinel lymph node evaluation.
The authors performed a study of imprint cytology for intraoperative
evaluation of sentinel lymph nodes in patients with breast cancer.
They conducted a retrospective review of the intraoperative imprint
cytology results of 678 sentinel lymph node mappings for breast
carcinoma. Sentinel nodes were evaluated intraoperatively by bisecting
or slicing them into 4-mm sections. Imprints were made of each cut
surface and stained with hematoxylin and eosin or Diff-Quik, or
both. Permanent sections were evaluated with up to four H&E stained
levels and cytokeratin immunohistochemistry. Intraoperative imprint
cytology results were compared with final histologic results. Imprint
cytology had a sensitivity of 53 percent, specificity of 98 percent,
positive predictive value of 94 percent, negative predictive value
of 82 percent, and accuracy of 84 percent. The sensitivity for detecting
macrometastases (>2 mm) was significantly better than for detecting
micrometastases (<2 mm) at 81 percent versus 21 percent,
respectively (P<00001). The authors concluded that the
sensitivity and specificity of imprint cytology are similar to that
of intraoperative frozen section evaluation. Imprint cytology is,
therefore, a viable alternative to frozen sectioning when intraoperative
evaluation is required. If sentinel lymph node micrometastasis is
used to determine whether further lymphadenectomy is needed, then
more sensitive intraoperative methods will be necessary to avoid
a second operation.
Creager, AJ, Geisinger KR, Shiver SA, et al. Intraoperative
evaluation of sentinel lymph nodes for metastatic breast carcinoma
by imprint cytology. Mod Pathol. 2002;15(11):1140-1147.
Reprints: Dr. Andrew J. Creager, Dept. of Pathology, Duke University
Medical Center, DUMC 3712, Durham, NC 27710; creag001@mc.duke.edu
Role of histology
in predicting behavior of some
neuroendocrine tumors
Metastasized neuroendocrine tumors of the gastrointestinal tract
and of unknown origin have a highly variable clinical course. Within
this group, low-grade and high-grade malignant tumors can be recognized
based on the revised classification of neuroendocrine tumors of
the lung, pancreas, and gut (Capella, et al, 1995). The authors
investigated whether it is possible to fine-tune the prediction
of prognosis by dividing the group of low-grade malignant tumors
of the midgut and of unknown origin into typical and atypical carcinoids
by grading them according to the World Health Organization classification
criteria for neuroendocrine tumors of the lung. They also evaluated
the prognostic value of immunohistochemical stainings and clinical
parameters. The study group comprised patients diagnosed between
1983 and 1999 with liver metastases of a neuroendocrine tumor of
the midgut (n=40) or of unknown origin (n=16). Tumors of the midgut
and of unknown origin were evaluated together because they were
clinically similar. As a control for consistency of grading, the
authors also evaluated 10 patients with metastasized neuroendocrine
tumors of the lung. They performed immunohistochemical staining
for several antigens, and the findings were correlated with clinical
parameters. In this group of 56 patients, the Capella and the WHO
classification systems recognized the high-grade malignant tumors
with a bad prognosis. When the low-grade malignant tumors (Capella)
were divided into typical and atypical carcinoids (WHO), the authors
did not note a difference in survival, but when the dichotomy into
typical and atypical was based on mitotic count alone, the difference
became borderline significant (P=.072). Of the immunohistochemical
stains used, synaptophysin, cytokeratin 8, and ki67 had limited
prognostic value. Age of more than 60 years was the only clinical
parameter of unfavorable prognostic significance. The authors concluded
that high-grade malignant neuroendocrine tumors of the midgut and
of unknown origin are recognized by the Capella classification and
the WHO classification of neuroendocrine tumors of the lung. Further
subdividing low-grade malignant tumors at this location appears
to be of less value than in the lung, but assessing the mitotic
activity of these tumors might be of prognostic value.
Van Eeden S, Quaedvlieg PF, Taal BG, et al. Classification
of low-grade neuroendocrine tumors of midgut and unknown origin. Hum
Pathol. 2002;33:1126-1132.
Reprints: Marie-Louise Van Velthuysen, Dept. of Pathology, The
Netherlands Cancer Institute, Plesmanlaan 121 1066 CX, Amsterdam,
Netherlands.
|
|
|
