CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Taskin OC, Reid MD, Bagci P, et al. Infiltration pattern predicts metastasis and progression better than the T-stage and grade in pancreatic neuroendocrine tumors: a proposal for a novel infiltration-based morphologic grading. Mod Pathol. 2022;35(6):777–785.
Correspondence: Dr. Volkan Adsay at vadsay@kuh.ku.edu.tr
Features of undetected dysplasia found in total colectomy or proctocolectomy specimens of IBD patients
Whether targeted biopsies should replace random biopsies for dysplasia surveillance in patients with inflammatory bowel disease remains controversial. Several histologic patterns of nonconventional dysplasia have been described in inflammatory bowel disease (IBD). The authors conducted a study to investigate the rate and clinicopathologic features of dysplastic lesions in total colectomy and proctocolectomy specimens that were undetected on prior colonoscopy. The study analyzed 207 consecutive IBD patients who underwent total colectomy (n=126) or proctocolectomy (n=81, including total colectomy with subsequent completion proctectomy) and had at least one high-definition colonoscopy prior to colectomy. Dysplasia found in the colectomy specimens was classified as undetected only when no corresponding site of dysplasia was detected on previous colonoscopic biopsies. Twenty-seven (13 percent) patients had 49 undetected dysplastic lesions found only at colectomy, and 22 (11 percent) patients had 31 previously detected dysplastic lesions only. The remaining 158 (76 percent) patients had no dysplasia. A greater proportion of the undetected (19 percent) and previously detected (23 percent) dysplasia groups had concurrent primary sclerosing cholangitis than did the group that did not have dysplasia (three percent; P<0.001). The undetected dysplastic lesions were more likely to have nonconventional dysplastic features (76 percent), low-grade dysplasia (94 percent), and a flat/invisible gross appearance (73 percent) compared with the previously detected dysplastic lesions (13 percent, 68 percent, and 48 percent, respectively; P<0.05). Almost all patients (93 percent) with undetected dysplasia had a colonoscopy within one year of colectomy. The rate of undetected dysplasia (13 percent) is not insignificant, suggesting that increased random biopsies may improve the rate of dysplasia detection, including detection of nonconventional dysplasia.
Bahceci D, Lauwers GY, Choi WT. Clinicopathologic features of undetected dysplasia found in total colectomy or proctocolectomy specimens of patients with inflammatory bowel disease. Histopathology. 2022;81:183–191.
Correspondence: Dr. Won-Tak Choi at won-tak.choi@ucsf.edu
Study of the prognostic and predictive value of a proposed grading system for invasive pulmonary adenocarcinoma
The authors conducted a study to validate and analyze the prognostic impact of the novel International Association for the Study of Lung Cancer Pathology Committee proposed grading system for invasive pulmonary adenocarcinomas in Chinese patients and to evaluate its utility in predicting survival benefit from adjuvant chemotherapy. The multicenter, retrospective, cohort study included 926 Chinese patients with completely resected stage I invasive pulmonary adenocarcinomas. The patients were divided into three groups (grade 1, n=119; grade 2, n=431; grade 3, n=376) based on the proposed grading system. Recurrence-free and overall survival were estimated by the Kaplan-Meier method, and prognostic factors were assessed using univariable and multivariable Cox proportional hazards models. All cohorts were well stratified, in terms of recurrence-free and overall survival, by the grading system. Furthermore, the grading system was independently associated with recurrence and death in the multivariable analysis. Among patients with stage IB invasive pulmonary adenocarcinoma (n=490), the grading system identified patients who could benefit from adjuvant chemotherapy but who were undergraded by the adenocarcinoma classification. Therefore, the grading system potentially provides clinical value in selecting a therapeutic regimen for patients with stage I invasive pulmonary adenocarcinoma.
Hou L, Wang T, Chen D, et al. Prognostic and predictive value of the newly proposed grading system of invasive pulmonary adenocarcinoma in Chinese patients: a retrospective multicohort study. Mod Pathol. 2022;35(6):749–756.
Correspondence: Dr. Chunyan Wu at wuchunyan581@163.com or Dr. Chang Chen at chenthoracic@163.com