Prognostic value of histological grading in ductal adenocarcinoma of the pancreas (original) (raw)
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REVIEW ARTICLE DIAGNOSTIC MEASURES OF CANCER AT DIFFERENT STAGE
Journal of Medical Pharmaceutical And Allied Sciences www.jmpas.com ISSN NO. 2320 - 7418 Journal of medical Pharmaceutical and allied sciences, V7 - I3, 757, April 2018, 1028-1035, 2018
Abnormal cell growth with the potential to spread or invade to different parts of the body is the primary symptom of cancer. These contrast with benign tumors, which do not spread to other parts of the body it is important to finding out how much cancer is in a person’s body and what the location is?This process is called staging. In development of cancer it has different stages. Stage of cancer diagnosis may be expressed as numbers (I, II, III, and IV) or by terms such as localized, regional, and distant. The lower the number or the more localized the cancer, the better a person’s chances of benefiting from treatment. Tracking the rates of late-stage (distant) cancers is a good way to monitor the impact of cancer screening. When more cancers are detected in early stages, fewer detected in late stages. In process to determine the amount of the cancer in the body, doctors first look at the primary tumor for its size, location, and whether it has grown into nearby areas. Different types tests are performed to figure out a cancer’s stage, Depending on location of the cancer, the physical exam may give indications. Imaging tests like x-rays, CT scans, MRIs, ultrasound, and PET scans may also give information about how much and where cancer is in the body. A biopsy is needed to confirm a cancer diagnosis.
Precision of Histological Grading of Malignancy
Acta Pathologica Microbiologica Scandinavica Section A Pathology, 1980
of variation in a histological scoring system for grading cancer of the larynx. Acta path. microbiol. scand. Sect. A. 88: 307-3 17, 1980.
Role of Cytological Grading in Breast Cancer Prognosis and its Histo-pathological Correlation
Abstract: Objective: Breast carcinoma is the most common cause of death in females globally, which should be detected early and treated promptly. This study aims at establishing Fine Needle Aspiration Cytology (FNAC) as an individual parameter in diagnosing & grading carcinoma breast and to correlate cytological grading with the histopathological grading done post-operatively. Materials & methods: We present here, a series of 44 cases, clinically suspected of carcinoma breast, presenting with hard, painful breast lump with or without axillary lymphadenopathy, sent for cytological examination to our department. Aspiration was done, following using 20G needle and smears were stained with Haematoxyline & Eosin, Papanicolau, and May-Grünwald-Giemsa. Results: The stained smear showed highly pleomorphic ductal cells in large number forming dyscohesive sheets & also lying singly. Cells had nuclei with hyperchromasia, irregular nuclear margin, open chromatin & conspicuous nucleoli. The diagnosis of carcinoma breast was offered and cytological grading was done according to Robinson’s nuclear grading system in all cases. Urgent biopsy was also however, recommended. The mastectomy specimens of these patients, when grossed & stained with Haematoxyline & Eosin proved the cytological diagnosis conclusive and cytological grading of the tumors concordant in 80% of the cases. Higher cytological grades showed increased nodal metastasis. Conclution: So, early diagnosis & precise grading with the help of FNAC itself can prove to be a very good informative tool & prognostic indicator, leading to commencement of early treatment & can prevent many untimely deaths in future. Key Words: Fine needle aspiration cytology, cytological grading, histological grading.
Impact of Tumor Grade on Pancreatic Cancer Prognosis: Validation of a Novel TNMG Staging System
Annals of Surgical Oncology, 2013
Background. Pancreatic ductal adenocarcinoma (PDAC) patients demonstrate highly variable survival within each stage of the American Joint Committee on Cancer (AJCC) staging system. We hypothesize that tumor grade is partly responsible for this variation. Recently our group developed a novel tumor, node, metastasis, grade (TNMG) classification system utilizing Surveillance Epidemiology and End Results (SEER) data in which the presence of high tumor grade results in advancement to the next higher AJCC stage. This study's objective was to validate this TNMG staging system utilizing single-institution data. Methods. All patients with PDAC who underwent resection at UCLA between 1990 and 2009 were identified. Clinicopathologic data reviewed included age, sex, node status, tumor size, grade, and stage. Grade was redefined as a dichotomous variable. The impact of grade on survival was assessed by Cox regression analysis. Disease was restaged into the TNMG system and compared to the AJCC staging system. Results. We identified 256 patients who underwent resection for PDAC. Patients with low-grade tumors experienced a 13-month improvement in median survival compared to those with high-grade tumors. On multivariate analysis, tumor grade was the strongest predictor of survival with a hazard ratio of 2.02 (p = 0.0005). Restaging disease according to the novel TNMG staging system resulted in improved survival discrimination between stages compared to the current AJCC system.
Journal of Thoracic Oncology, 2008
Purpose: To identify, in the international staging database of the International Association for the Study of Lung Cancer, those prognostic factors that were significant and independent of clinical stage. Material and Methods: From the data submitted to the staging data base concerning 100,869 patients, cases were selected for which all the following variables were available: clinical stage, age, gender, performance status (PS), and histologic cell types. For non-small cell lung cancer (NSCLC), 12,428 patients were assessable, and for SCLC, 6609 patients were available for this study. Methods used were Cox regression analyses and recursive partitioning and amalgamation analyses. Results: PS appeared to be a very important prognostic factor for survival in addition to clinical stage. Age and gender were other independent significant variables; For NSCLC and SCLC separately, recursive partitioning and amalgamation allowed the identification of four groups of patients with differing prognoses. In advanced NSCLC (stage IIIB / IV), some routine laboratory tests (mainly white blood cells and hypercalcaemia) were also found to be significant prognostic variables. In SCLC, albumin was an independent biologic prognostic factor.
European Journal of Surgical Oncology (EJSO), 2009
Objective: To compare the interobserver reproducibility and prognostic value of the FIGO grading system with the histological parameters employed in the various recently proposed binary grading systems of endometrial cancer. Methods: Seventy two consecutive stage I endometrioid endometrial carcinomas from hysterectomy specimens were independently graded by two pathologists. Clinical data and outcome were obtained from the patients' records. The following histological parameters were evaluated: FIGO grade (dichotomized to grades 1and 2 vs. grade 3), nuclear atypia, presence of more than 50% solid growth, diffusely infiltrative rather than expansive growth pattern, presence of tumor cell necrosis, and mitotic count. Interobserver agreement was measured by the kappa (k) statistics. KaplaneMeier survival analysis, log-rank tests and Cox proportional hazard regression were used to evaluate the equality of survival distributions and to model the overall effects of the various predictor variables on survival. Results: The interobserver reproducibility was as follows: FIGO grade, k ¼ 0.65; nuclear atypia, k ¼ 0.63; solid growth, k ¼ 0.51; infiltrative growth pattern, k ¼ 0.38; tumor necrosis, k ¼ 0.52; and mitotic index, k ¼ 0.44. In the comparison of the KaplaneMeier curves, the following parameters were associated with a significantly poorer survival: FIGO grade 3, p ¼ 0.02; presence of more than 50% solid growth, p ¼ 0.01; and a high mitotic index, p ¼ 0.01. The other binary histological parameters were not significantly predictive of survival. Conclusions: The proposed novel binary grading parameters are not advantageous in terms of interobserver reproducibility and prognostic significance over dichotomization to FIGO grades 1 and 2 vs. grade 3. A simple binary grade based solely on presence of more than 50% solid growth has a comparable reproducibility and prognostic value.
Prognostic tumour markers in pancreatic cancer
Background. Pancreatic cancer is one of the major causes of cancer death in the industrialised world. The overall survival of patients with ductal pancreatic adenocarcinoma is poor: 5-year survival is only 0.2 to 4%. Tumour stage and histological grade are used as prognostic markers in pancreatic cancer. However, there are differences in survival within stages and histological grades. New, additional and more accurate prognostic tools are needed. Aims. The purpose of this study was to investigate whether the tissue expression of potential and promising tumour markers p27, tenascin C, syndecan-1, COX-2 and MMP-2 are associated with clinicopathological parameters in pancreatic cancer. The expression of p27, tenascin C and syndecan-1 was also evaluated in acute and chronic pancreatitis. The main purpose in the study was to find new prognostic markers for pancreatic adenocarcinoma. Patients. The study included 147 patients with histologically verified pancreatic adenocarcinoma treated a...
Low interobserver agreement in cytology grading of mucinous pancreatic neoplasms
Cancer Cytopathology, 2014
BACKGROUND: Identifying high-grade features in patients with pancreatic mucinous neoplasms (MNs) is important for patient management. The reproducibility of MN cytology grading has been evaluated to a limited extent. In the current study, the authors evaluated interobserver variability in grading MNs and the identification of neoplastic mucin in endoscopic ultrasound-guided fine-needle aspiration specimens. METHODS: A 54-case grading set was created from histologically confirmed MNs (44 MNs) and nonmucinous lesions with abundant gastrointestinal contamination (10 nonmucinous lesions). Six observers received a tutorial, reviewed prescreened slides, and recorded: 1) a diagnosis according to a 6tiered system (TS) (nondiagnostic, atypical [ATP], mucinous cyst low grade [MCLG], mucinous cyst high grade, suspicious for adenocarcinoma, and positive for adenocarcinoma); 2) the cyst fluid carcinoembryonic antigen diagnosis (CEADX); and 3) the presence of neoplastic musin. Interobserver agreement (IOA) was evaluated by calculation of kappa coefficients (Kappa). Diagnostic accuracy was not evaluated. RESULTS: The IOA was lowest for the 6-TS (Kappa, 0.13; P<.001). The CEADX was available for 18 cases (33%), including 6 of 24 MCLG cases (25%). CEADX modestly improved IOA for combined tiers of the 6-TS with ATP and MCLG as separate categories. The highest IOA was noted with a 3-TS (nondiagnostic, ATP/MCLG, and mucinous cyst high grade/suspicious for adenocarcinoma/positive for adenocarcinoma [Kappa, 0.28; P<.001]) and various 4-TS (Kappa, 0.22-0.23). IOA was found to be low for neoplastic mucin (Kappa 5 0.15; P<.001). CONCLUSIONS: In a study using simulated cytology practice, observers demonstrated fair IOA for grading MNs and low IOA for identifying neoplastic mucin. Knowledge of the cyst fluid CEA level was found to modestly improve the IOA for low-grade lesions. Cancer (Cancer Cytopathol) 2015;123:40-
Cancer Science, 2005
For clinicians, the orthodox histological investigation of patients with invasive ductal carcinoma (IDC) remains important for predicting prognoses. The purpose of the present study was to determine the most important of the known prognostic histological parameters (including fibrotic focus and tumor necrosis), enabling the outcomes of 101 patients with IDC of the pancreas to be predicted accurately. Furthermore, we established a scoring classification consisting of important prognostic histological parameters examined in this study. Multivariate survival analyses showed that invasive tumor size of more than 3 cm, the presence of tumor necrosis, the presence of nerve plexus invasion and lymph vessel invasion scores of 2 or 3 were important prognostic factors. Our scoring classification, consisting of the above four parameters, accurately classified the outcome of patients independent of the invasive tumor size of IDC. We concluded that invasive tumor size of 3 cm or more, the presence of tumor necrosis, the presence of nerve plexus invasion and lymph vessel invasion scores of 2 or 3 are important histological prognostic parameters for patients with IDC of the pancreas. Furthermore, the scoring system consisting of the above four histological parameters is probably a very useful prognostic histological classification for patients with IDC of the pancreas. (Cancer Sci 2005; 96: 858-865)