Neoplasm invasiveness Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Rev Bras Ginecol Obstet. 2010;32(3):144-149
DOI 10.1590/S0100-72032010000300008
PURPOSE: to evaluate which clinical, pathological or immunohistochemical factors may be predictive of metastatic involvement of other lymph nodes in patients with breast carcinoma undergoing sentinel lymph node biopsy (SLNB). METHODS: a retrospective study carried out with 1,000 successive patients with SLNB from 1998 to 2008. Age, tumor size, histological grade, lymphovascular invasion, hormone receptor status and HER-2, size of metastasis and number of positive SLN were evaluated. The associations between the characteristics of the tumors and the types of metastases were evaluated through χ2 corrected likelihood ratio tests for insufficient samples. RESULTS: mean age was 57.6 years and mean tumor size was 1.85 cm. A total of 72.2% SLN were negative and 27.8% were positive, but in 61.9% of the cases, the SLN was the only positive one, with 78.4% having macrometastases, 17.3% micrometastases and 4.3% isolated tumor cells (CTI). Tumor size was predictive of metastases in non-sentinel lymph nodes. After 54 months of follow-up, there were no recurrences in patients with CTI, but one local recurrence and two systemic recurrences were observed in the micrometastasis group, as well as four local and 30 distant metastases in the macrometastasis group. CONCLUSIONS: among the clinical parameters studied, only tumor size was correlated with metastatic involvement in axillary lymph nodes. The size of the metastases and the number of positive SLN also directly increased the possibility of systemic recurrence. The different rates of recurrence indicate that the biological significance of these types of metastases is different and that patients with SLN metastases may also have different risks of metastatic involvement of other axillary lymph nodes.
Summary
Rev Bras Ginecol Obstet. 2010;32(3):144-149
DOI 10.1590/S0100-72032010000300008
PURPOSE: to evaluate which clinical, pathological or immunohistochemical factors may be predictive of metastatic involvement of other lymph nodes in patients with breast carcinoma undergoing sentinel lymph node biopsy (SLNB). METHODS: a retrospective study carried out with 1,000 successive patients with SLNB from 1998 to 2008. Age, tumor size, histological grade, lymphovascular invasion, hormone receptor status and HER-2, size of metastasis and number of positive SLN were evaluated. The associations between the characteristics of the tumors and the types of metastases were evaluated through χ2 corrected likelihood ratio tests for insufficient samples. RESULTS: mean age was 57.6 years and mean tumor size was 1.85 cm. A total of 72.2% SLN were negative and 27.8% were positive, but in 61.9% of the cases, the SLN was the only positive one, with 78.4% having macrometastases, 17.3% micrometastases and 4.3% isolated tumor cells (CTI). Tumor size was predictive of metastases in non-sentinel lymph nodes. After 54 months of follow-up, there were no recurrences in patients with CTI, but one local recurrence and two systemic recurrences were observed in the micrometastasis group, as well as four local and 30 distant metastases in the macrometastasis group. CONCLUSIONS: among the clinical parameters studied, only tumor size was correlated with metastatic involvement in axillary lymph nodes. The size of the metastases and the number of positive SLN also directly increased the possibility of systemic recurrence. The different rates of recurrence indicate that the biological significance of these types of metastases is different and that patients with SLN metastases may also have different risks of metastatic involvement of other axillary lymph nodes.
Summary
Rev Bras Ginecol Obstet. 2009;31(9):461-467
DOI 10.1590/S0100-72032009000900007
PURPOSE: to evaluate the expression of erbB-2 and of the estrogen and progesterone (ER/P) hormonal receptors in the transition regions between the in situ and the invasive fractions of ductal breast neoplasia (ISDC and IDC, respectively). METHODS: Eighty-five cases of breast neoplasia, containing contiguous ISDC and IDC areas, were selected. Histological specimens from the ISDC and the IDC areas were obtained through the tissue microarray (TMA) technique. The erbB-2 and the ER/PR expressions were evaluated through conventional immunohistochemistry. The McNemar's test was used for the comparative analysis of the expressions of erbB-2 protein and the ER/PR in the in situ and invasive regions of the tumors. The confidence intervals were set to 5% (p=0.05). Intraclass correlation coefficients (ICC) were calculated to assess the cross-tabulation agreement of the erbB-2 and the ER/PR expression in the ISDC and the IDC areas. RESULTS: the erbB-2 expression has not differed between the ISDC and the IDC areas (p=0.38). Comparing the two areas in each case, there was agreement in the expression of erbB-2 (ICC=0.64), PR (ICC=0.71) and ER (ICC=0.64). Restricting the analysis to tumors with the in situ component harboring necrosis (comedo), the ICC for erbB-2 was 0.4, compared to 0.6 for the whole sample. In this select group, the ICC for PR/ER did not differ substantially from those obtained with the complete dataset: as for the ER, ICC=0.7 (versus 0.7 for the entire sample) and for PR, ICC=0.7 (versus 0.6 for the entire sample). CONCLUSIONS: our findings suggest that the erbB-2 and the ER/PR expressions do not differ in the contiguous in situ and invasive components of breast ductal tumors.
Summary
Rev Bras Ginecol Obstet. 2009;31(9):461-467
DOI 10.1590/S0100-72032009000900007
PURPOSE: to evaluate the expression of erbB-2 and of the estrogen and progesterone (ER/P) hormonal receptors in the transition regions between the in situ and the invasive fractions of ductal breast neoplasia (ISDC and IDC, respectively). METHODS: Eighty-five cases of breast neoplasia, containing contiguous ISDC and IDC areas, were selected. Histological specimens from the ISDC and the IDC areas were obtained through the tissue microarray (TMA) technique. The erbB-2 and the ER/PR expressions were evaluated through conventional immunohistochemistry. The McNemar's test was used for the comparative analysis of the expressions of erbB-2 protein and the ER/PR in the in situ and invasive regions of the tumors. The confidence intervals were set to 5% (p=0.05). Intraclass correlation coefficients (ICC) were calculated to assess the cross-tabulation agreement of the erbB-2 and the ER/PR expression in the ISDC and the IDC areas. RESULTS: the erbB-2 expression has not differed between the ISDC and the IDC areas (p=0.38). Comparing the two areas in each case, there was agreement in the expression of erbB-2 (ICC=0.64), PR (ICC=0.71) and ER (ICC=0.64). Restricting the analysis to tumors with the in situ component harboring necrosis (comedo), the ICC for erbB-2 was 0.4, compared to 0.6 for the whole sample. In this select group, the ICC for PR/ER did not differ substantially from those obtained with the complete dataset: as for the ER, ICC=0.7 (versus 0.7 for the entire sample) and for PR, ICC=0.7 (versus 0.6 for the entire sample). CONCLUSIONS: our findings suggest that the erbB-2 and the ER/PR expressions do not differ in the contiguous in situ and invasive components of breast ductal tumors.
Summary
Rev Bras Ginecol Obstet. 2009;31(9):468-473
DOI 10.1590/S0100-72032009000900008
The uterine cervix invasive carcinoma represents a major public health problem, mainly in the developing countries. Its treatment, based on radical hysterectomy, radiotherapy and/or chemotherapy presents a considerable morbidity. Prognostic markers should be taken into consideration in the therapeutic planning, so that the results would be optimized, complications reduced, and patients' survival prolonged. Accepted prognostic markers are: stage, tumoral size, histological type, degree of differentiation, lymphovascular invasion, depth of the stromal invasion, presence of lymph nodal metastases, and surgical margins involvement. This study aims at making a literature review concerning the use of theses markers in the therapeutic planning of women with uterine cervix invasive carcinoma. The treatment based on these markers may present better results, with lower ratio of complications and an improvement in the patients' survival.
Summary
Rev Bras Ginecol Obstet. 2009;31(9):468-473
DOI 10.1590/S0100-72032009000900008
The uterine cervix invasive carcinoma represents a major public health problem, mainly in the developing countries. Its treatment, based on radical hysterectomy, radiotherapy and/or chemotherapy presents a considerable morbidity. Prognostic markers should be taken into consideration in the therapeutic planning, so that the results would be optimized, complications reduced, and patients' survival prolonged. Accepted prognostic markers are: stage, tumoral size, histological type, degree of differentiation, lymphovascular invasion, depth of the stromal invasion, presence of lymph nodal metastases, and surgical margins involvement. This study aims at making a literature review concerning the use of theses markers in the therapeutic planning of women with uterine cervix invasive carcinoma. The treatment based on these markers may present better results, with lower ratio of complications and an improvement in the patients' survival.
Summary
Rev Bras Ginecol Obstet. 2008;30(11):550-555
DOI 10.1590/S0100-72032008001100004
PURPOSE: to analyze interobserver variability in the histopathological diagnosis of premalignant breast lesions before and after training with diagnostic standardized criteria. METHODS: Slides containing histological sections representative of three kinds of breast lesions (atypical ductal hyperplasia, ductal carcinoma in situ and ductal carcinoma in situ with microinvasion), revised by an international specialist in breast pathology whose diagnoses were considered as golden standard, have been used. The same slides have been evaluated at two different times by five pathologists from the community according to a specific protocol for classifying the lesions. In the first evaluation, the cases were analyzed and classified according to the specific criteria adopted in each service. At the second time, the pathologists were given a tutorial containing diagnostic criteria and representative images, and the lesions were classified again, employing the standardized criteria. Interobserver analysis using percent agreement and weighted Kappa index has been performed. RESULTS: There has been a large diagnostic variation among the pathologists in the initial analysis without the use of standardized diagnostic criteria concerning the diagnostic, nuclear grade and histological grade (weighted Kappa indexes related to diagnosis varied from 0.15 to 0.40). In the second evaluation using standardized criteria, there has been a significant improvement in the diagnostic concordance among the five pathologists concerning the diagnosis, nuclear grade and histological grade (weighted Kappa indexes related to diagnosis have varied from 0.42 to 0.80). CONCLUSIONS: interobserver concordance related to diagnosis and classification of breast premalignant lesions may be improved with specific training and the use of standardized histopathological criteria.
Summary
Rev Bras Ginecol Obstet. 2008;30(11):550-555
DOI 10.1590/S0100-72032008001100004
PURPOSE: to analyze interobserver variability in the histopathological diagnosis of premalignant breast lesions before and after training with diagnostic standardized criteria. METHODS: Slides containing histological sections representative of three kinds of breast lesions (atypical ductal hyperplasia, ductal carcinoma in situ and ductal carcinoma in situ with microinvasion), revised by an international specialist in breast pathology whose diagnoses were considered as golden standard, have been used. The same slides have been evaluated at two different times by five pathologists from the community according to a specific protocol for classifying the lesions. In the first evaluation, the cases were analyzed and classified according to the specific criteria adopted in each service. At the second time, the pathologists were given a tutorial containing diagnostic criteria and representative images, and the lesions were classified again, employing the standardized criteria. Interobserver analysis using percent agreement and weighted Kappa index has been performed. RESULTS: There has been a large diagnostic variation among the pathologists in the initial analysis without the use of standardized diagnostic criteria concerning the diagnostic, nuclear grade and histological grade (weighted Kappa indexes related to diagnosis varied from 0.15 to 0.40). In the second evaluation using standardized criteria, there has been a significant improvement in the diagnostic concordance among the five pathologists concerning the diagnosis, nuclear grade and histological grade (weighted Kappa indexes related to diagnosis have varied from 0.42 to 0.80). CONCLUSIONS: interobserver concordance related to diagnosis and classification of breast premalignant lesions may be improved with specific training and the use of standardized histopathological criteria.
