American Joint Cancer Committee Research Articles

P1.03-083 Advances in Surgical Staging of NSCLC

Staging of mediastinal lymph nodes in NSCLC defines the extent of thoracic malignancies and the disease process. It is based on the American Joint Committee for Cancer (AJCC), TNM staging system, which describes the best anatomic extent of the disease. This defines operability and surgical resectability, neoadjuvant therapy and predicting prognostic survivability. A well-conducted literature search and review undertaken. All papers or studies in the last 10 years were identified and studied. Surgical and non-surgical staging methods were identified, compared and analyzed for their sensitivity and specificity. Size, location and characteristics of tumor, local invasion or extension, lymphadenopathy and metastatic disease spread were identified as parameters. Early accurate staging improves overall outcomes if therapeutic interventions are well-organized and executed in a timely fashion. Careful selection of staging methods is crucial.

STAGING OF PANCREATIC NEUROENDOCRINE TUMOR (LITERATURE REVIEW)

Survival of patients with pancreatic neuroendocrine tumor is determined by many factors. An important role is played by accurate selection of patients for different treatment modalities, that is clearly determined by adequate cancer staging. To date there are two TNM-classifications of pancreatic neuroendocrine tumors which are differ greatly among themselves - European Neuroendocrine Tumor Society TNM-staging system (2006) and American Joint Cancer Committee TNM staging system (2010). We have reviewed the most significant publications related to the analysis of TNM systems accuracy for these tumors. These data suggest that European Neuroendocrine Tumor Society TNM-staging system is superior to the American Joint Cancer Committee TNM-staging system. Considering the low incidence of pancreatic neuroendocrine tumors only further large multi-center studies will improve the staging of these tumors.

Distant metastases in colorectal carcinoma: A proposal for a new M1 subclassification

IntroductionIn 2010, the seventh Tumour-Node-Metastasis (TNM) cancer staging system of the International Union for Cancer Control (UICC) and the American Joint Committee of Cancer (AJCC) introduced a subdivision of M1 in the TNM classification of colorectal carcinomas. For the eighth TNM edition which will be released in the autumn of 2016 and will become effective in January 2017 new proposals are appreciated. The aim of our study was to define a new and better proposal for M1 subclassification. MethodsIn a total of 814 patients with stage IV colorectal carcinoma treated between 1995 and 2013 prognostic factors were analysed in univariate and multivariate analyses. ResultsAdvanced age, treatment in the earlier period 1995–2003, involvement of multiple metastatic sites, and non-curative resection were found to be independent prognostic factors. In patients with only one metastatic site, survival was good in patients with liver or lung metastasis, moderate in patients with metastasis of the peritoneum or non-regional lymph nodes and poor in patients with other rarely metastatic involved organs. The new proposal defines M1a, Metastasis confined to one organ: liver or lung (2-year survival 51.6%); M1b, Metastasis confined to one organ: peritoneum or non-regional lymph nodes, or Metastasis confined to liver plus lung (2-year survival 39.4%); and M1c, Metastasis confined to one organ: all other sites, or Metastasis in more than one organ, except liver plus lung (2-year survival 21.6%). ConclusionThe new proposal can identify three prognostic groups in stage IV colorectal carcinomas with significant differences in survival.

Exfoliative Cytopathology of Human Lip Neoplasm

Objective: The objective of the present study is to investigate the cytopathology of human lip neoplasms, pattern of cervical lymph node (CLN) metastasis and to analyse the probable etiological risk factors associated with it. Methodology: In this hospital based case-control study, 22 subjects (11 cases of lip neoplasm and 11 healthy individuals as Control group) were included in this study. Scraped exfoliated cytosmears were collected from the affected site of the lip and smearing was done in the precleaned- coded glass-slides. Two such slides were prepared from each subject. The cytosmears were immediately fixed in aceto-alcohol (1part of glacial acetic acid:3 part of absolute ethyl alcohol) fixative. One set of the slide was stained with Papanicolaou’s stain and the other set wascounter-stained with Giemsa’s Solution for cytopathological analysis.The TNM (Tumor- Node-Metastasis) System for staging of lip cancer formulated by American Joint Committee for Cancer (AJCC) Staging and End Results Reporting-2010 was followed. Results: Lower lip is found to be the most common site in the genesis of lip neoplasm. Pleomorphic cytological atypias such as Micronucleated cell (MNC), Plump keratinized squamous cell (PKSC), Keratinized spindle cell (KSC), Keratinized spindle cell (KSC), Keratinized tadpole cell (KTC), Keratinized strap (Anitschkow) cell (KSC-A), Keratinized fiber cell (KFC), Keratinized round cell (KRC) and Non-keratinized malignant squamous cell (NMSC) with drastic modification were frequently observed in lip neoplasm. Unpredictable metastasis is a common feature in lip neoplasm cases. Conclusion: Excluding PKSC and MNC, presence of any other atypias in the cytosmearoflip neoplasm indicates the state of malignancy. Thus, exfoliative cytopathology has a potentiality in early detection of lip carcinoma in particular and oral cancer in general.

Blood preoperative neutrophil-to-lymphocyte ratio is correlated with TNM stage in patients with papillary thyroid cancer

OBJECTIVE:To predict the American Joint Cancer Committee tumor-node-metastasis stage in patients with papillary thyroid carcinoma by evaluating the relationship between the preoperative neutrophil-to-lymphocyte ratio and the tumor-node-metastasis stage.METHODS:We retrospectively examined 161 patients with a diagnosis of papillary thyroid carcinoma. The Neutrophil-to-Lymphocyte Ratio was calculated according to the absolute neutrophil counts and absolute lymphocyte counts on routine blood tests obtained prior to surgery and patients with a Neutrophil-to-Lymphocyte Ratio of 2.0 or more were classified as the high NLR group, while those with a Neutrophil-to-Lymphocyte Ratio less than 2.0 were classified as the low Neutrophil-to-Lymphocyte Ratio group. Clinicopathological variables, which were stratified by the Neutrophil-to-Lymphocyte Ratio, were analyzed. A multivariate analysis was performed to determine factors that affect the Neutrophil-to-Lymphocyte Ratio. The association between the Neutrophil-to-Lymphocyte Ratio and the TNM stage in patients ≥45 years of age was analyzed using the Spearman rank correlation.RESULTS:Various blood indices, including hemoglobin, platelet and thyroid-stimulating hormone levels in the two groups showed no significant differences. Lymph node metastasis, multifocality and tumor size exhibited significant differences in the two groups (p=0.000, p=0.000 and p=0.035, respectively). Correlation analysis indicated that a higher preoperative Neutrophil-to-Lymphocyte Ratio was observed in patients with lymph node metastasis, larger tumor size and multifocality (r=0.341, p=0.000; r=0.271, p=0.000; and r=0.182, p=0.010, respectively). For patients ≥45 years of age, the number of patients with an advanced TNM stage in the high NLR group was higher than that in the low Neutrophil-to-Lymphocyte Ratio group (p=0.013). A linear regression analysis showed that the preoperative Neutrophil-to-Lymphocyte Ratio was positively correlated with the American Joint Cancer Committee tumor-node-metastasis stage (rho=0.403, p=0.000).CONCLUSION:The preoperative Neutrophil-to-Lymphocyte Ratio was closely related to the stage of papillary thyroid carcinoma. The increase in the preoperative Neutrophil-to-Lymphocyte Ratio contributed to the advanced tumor-node-metastasis stage of papillary thyroid carcinoma patients ≥45 years of age.

Association between Metformin Use and Cancer Stage at Diagnosis among Elderly Medicare Beneficiaries with Preexisting Type 2 Diabetes Mellitus and Incident Prostate Cancer.

Objective. To examine the association between metformin use and cancer stage at diagnosis among elderly men with preexisting diabetes mellitus and incident prostate cancer. Methods. This study used a population-based observational cohort of elderly men (≥66 years) with preexisting diabetes and incident prostate cancer between 2008 and 2009 (N = 2,652). Cancer stage at diagnosis (localized versus advanced) was based on the American Joint Cancer Committee classification. Metformin use and other independent variables were measured during the one year before cancer diagnosis. Logistic regressions with inverse probability treatment weights were used to control for the observed selection bias. Results. A significantly lower percentage of metformin users were diagnosed with advanced prostate cancer as compared to nonusers (4.7% versus 6.7%, p < 0.03). After adjusting for the observed selection bias and other independent variables, metformin use was associated with a 32% reduction in the risk of advanced prostate cancer (adjusted odds ratio, AOR: 0.68, 95% confidence interval, CI: 0.48, 0.97). Conclusions. This is the first epidemiological study to support the role of metformin in reducing the risk of advanced prostate cancer. Randomized clinical trials are needed to confirm the causal link between metformin use and prostate cancer diagnosis stage.

MicroRNA Expression and Association with Clinicopathologic Features in Papillary Thyroid Cancer: A Systematic Review.

Studies have suggested that microRNAs (miR) may be useful prognostic markers and are associated with aggressive clinicopathologic features in papillary thyroid cancer (PTC). This systematic review examined associations between miRs and aggressive clinicopathologic features in PTC. A literature search was performed within the PubMed, Embase, Cochrane, Web of Science, and Scopus databases for papers published prior to November 24, 2014. The search was performed by combining the concepts "thyroid tumor" with "microRNA" and by using "and" as the Boolean operator. Upon retrieval of candidate studies, full-text publications were reviewed in their entirety and selected if they examined the prognostic significance between miR expression and established aggressive clinicopathologic features of PTC. Fifteen studies from 13 unique groups that included 807 patients were reviewed. Most of the studies were retrospective, and none included patients who had undergone routine central lymph node dissection. Expression levels of miRs-21, -34b, -130b, -135b, -146b, -151, -181b, -199b-5p, -221, -222, -451, -623, -1271, -2861, and let-7e showed significant association with at least one aggressive feature, such as large tumor size, extrathyroidal extension, multifocality, lymphovascular invasion, lymph node metastases, distant metastasis, advanced American Joint Cancer Committee stage, and presence of the BRAF(V600E) mutation. Herein we summarize the literature with regard to these associations. Further studies are needed to investigate whether miRs are independent predictors of aggressive clinicopathologic features before it can be recommended that miR expression levels should be incorporated into the management algorithm for patients with PTC. A well-designed prospective study is needed to assess these potential associations.

Phosphohistone-H3 (PHH3) is prognostic relevant in Merkel cell carcinomas but Merkel cell polyomavirus is a more powerful prognostic factor than AJCC clinical stage, PHH3, Ki-67 or mitotic indices.

Merkel cell carcinomas (MCCs) associated with Merkel cell polyomavirus (MCPyV) have better prognosis than those without MCPyV. The relationship between mitotic index (MI) and MCC outcome has remained elusive because of the difficulty in differentiating mitotic cells from apoptotic ones. We evaluated the role of phosphohistone-H3 (PHH3) (Ser10), a new mitotic count biomarker, in MCPyV-positive or -negative MCC patients, and assessed its prognostic value in comparison to Ki-67 labeling index or MI using hematoxylin and eosin (HE) staining. We compared the prognostic value of PHH3 mitotic index with that of MI by HE in 19 MCPyV-positive and 9 MCPyV-negative MCC patients. PHH3-positive immunoreactivity was mostly observed in mitotic figures. Multivariate analysis significantly showed that MCPyV status (HR, 0.004; 95% CI 0.0003-0.058) and the American Joint Committee of Cancer (AJCC) stage (HR, 5.02; 95% CI 1.23-20.51) were observed as significantly independent prognostic factors for OS. PHH3-positive cell counts/10 HPF was a slightly significant independent prognostic factor for OS (HR, 4.96; 95% CI 0.93-26.55). PHH3-positive MI and MCPyV status in MCC patients are useful in prognostication, although MCPyV-infection is a more powerful prognostic factor in MCCs than the AJCC scheme on proliferation or mitotic indices.

Clinical-pathological features and prognosis analysis of 218 esophagogastric junction malignant tumor

Objective To explore the relation between clinical-pathological features, Siewert classification and prognosis of esophagogastric junction (EGJ) carcinoma, and to assess the applicability of the new edition of American Joint Committee of Cancer (AJCC) staging guideline on EGJ adenocarcinoma in China. Methods From 2002 to 2012, the clinical data, pathological features, treatment and prognosis of 218 patients with EGJ malignant tumor were retrospectively analyzed. The patients were typed according to Siewert classification criteria and each case was staged according to 7th edition of AJCC TNM staging criteria for esophagus adenocarcinoma and gastric cancer. Kaplan-Meier method and Log-rank test were performed for survival analysis. Results According to the Siewert classification, type Ⅰ was rare (nine cases, 4.1%), type Ⅱ was the most common type (150 cases, 68.8%) and followed by type Ⅲ (59 cases, 27.1%). There was no significant difference in survival curve among the three types (P>0.05). The survival curve was drawn according to 7th edition of AJCC TNM staging criteria for esophagus adenocarcinoma. In T staging, the prognosis of patients at T4b was better than that of patients at T4a, the prognosis of patients at ⅡB was better than that of patients at ⅡA. The survival curve of patients at ⅢC obviously crossed with that of patients at Ⅳ, which was not in conformity with clinical results. The survival curve was drawn according to 7th edition of AJCC staging criteria for gastric cancer. In T staging, the survival curve of patients at Tis was overlapped with that of patients at T1a. The survival rate of patients at ⅡB could not be accurately predicted by the overall staging. In general, the survival of patients with EGJ carcinoma was better predicted according to 7th edition of AJCC staging criteria for gastric cancer than 7th edition for esophagus adenocarcinoma. Conclusions Neither 7th edition of AJCC staging criteria for esophagus adenocarcinoma nor for gastric cancer could accurately predict its prognosis. In our country, EGJ malignant tumor was similar to gastric cancer and had specific clinical-pathological features. It is necessary to research and establish EGJ carcinoma staging criteria instead of applying the current staging criteria for esophagus adenocarcinoma or gastric cancer. Key words: Gastroesophageal junction cancer; Clinical-pathological features; Prognosis; 7th edition of AJCC staging criteria

The impact of socioeconomic status on melanoma clinical trial participation: an observational cohort study from Australia.

This study aims to determine whether socioeconomic status (SES) is associated with participation in melanoma clinical trials. A retrospective, single-center observational study was conducted at the Melanoma Institute Australia. Factors affecting clinical trial participation were assessed using logistic regression. Of 9074 patients, 2304 (25%) participated in a clinical trial. Multivariate analysis indicated males compared with females (odds ratio [OR]: 1.18; 95% CI: 1.07-1.30) and patients with American Joint Cancer Committee stage II or III disease (but not stage IV disease) were more likely to participate in trials than patients with stage I disease (OR: 2.81 [95% CI: 2.50-3.16] and OR: 4.55 [95% CI: 3.91-5.30], respectively). SES did not affect trial participation. Our data suggest that SES is not a significant predictor of melanoma clinical trial participation when adjusted for other factors.

Mélanome desmoplastique : une série de 23 cas dans trois centres des Bouches-du-Rhône

Desmoplastic melanoma (DM) is a rare form of melanoma, often with atypical and potentially misleading aspects that result in difficult and late diagnosis. Because of the high likelihood of local relapse, practitioners must have a good knowledge of such tumours. A retrospective study of the activities of 3 centres in the Bouches-du-Rhône region between 1998 and 2010 enabled us to collate 23 cases of DM and analyse the clinical and histological features of the disease as well as patient survival. Fifteen of the 23 patients (65.2%) were male with a median age of 64.4 years. Mean Breslow thickness was 7.56 mm. The numbers of AJCC (American Joint Committee for Cancer) stages I, II, III, IV were respectively 4.1, 66.7, 20.8 and 4.1%. Thirteen patients presented relapse, with a mean time to onset of 21 months. The initial relapse involved the skin in 1 case, the lymph nodes in 2 cases, the organs in 5 cases, the organs and subcutaneous region in 1 case, the organs and lymph nodes in 2 cases, and the organs, lymph nodes and skin in 1 case. While DM presents a higher rate of local relapse than classical melanoma, this trend appears to subside in the case of thick DM, in which relapse also involves the lymph nodes and/or organs.

Update and Review on the Surgical Management of Primary Cutaneous Melanoma.

The surgical management of malignant melanoma historically called for wide excision of skin and subcutaneous tissue for any given lesion, but has evolved to be rationally-based on pathological staging. Breslow and Clark independently described level and thickness as determinant in prognosis and margin of excision. The American Joint Committee of Cancer (AJCC) in 1988 combined features from each of these histologic classifications, generating a new system, which is continuously updated and improved. The National Comprehensive Cancer Network (NCCN) has also combined several large randomized prospective trials to generate current guidelines for melanoma excision as well. In this article, we reviewed: (1) Breslow and Clark classifications, AJCC and NCCN guidelines, the World Health Organization’s 1988 study, and the Intergroup Melanoma Surgical Trial; (2) Experimental use of Mohs surgery for in situ melanoma; and (3) Surgical margins and utility and indications for sentinel lymph node biopsy (SLNB) and lymphadenectomy. Current guidelines for the surgical management of a primary melanoma of the skin is based on Breslow microstaging and call for cutaneous margins of resection of 0.5 cm for MIS, 1.0 cm for melanomas ≤1.0 mm thick, 1–2 cm for melanoma thickness of 1.01–2 mm, 2 cm margins for melanoma thickness of 2.01–4 mm, and 2 cm margins for melanomas >4 mm thick. Although the role of SLNB, CLND, and TLND continue to be studied, current recommendations include SLNB for Stage IB (includes T1b lesions ≤1.0 with the adverse features of ulceration or ≥1 mitoses/mm2) and Stage II melanomas. CLND is recommended when sentinel nodes contain metastatic deposits.

Comparison of Hand-assisted Laparoscopic and Open Radical Distal Gastrectomy for Obese Patients

To evaluate the feasibility and safety of hand-assisted laparoscopic surgery for gastric cancer in obese patients, we compare the operative outcomes in obese patients who underwent hand-assisted laparoscopic distal gastrectomy (HALDG) and open distal gastrectomy (ODG). One hundred sixty-two obese patients with gastric cancer operated on in our department from January 2009 to December 2011 were divided into two groups: the open distal gastrectomy group (the ODG group) and the hand-assisted laparoscopic distal gastrectomy group (the HALDG group). Operative time, estimated blood loss, number of lymph node retrieval, wound length, times of analgesic injection, time to the first flatus, and postoperative hospital stay were compared between the two groups. Estimated blood loss, wound length, times of analgesic injection, time to the first flatus, and postoperative hospital stay were significantly less or shorter in the HALDG group than in the ODG group. There were no significant differences in tumor size, retrieved lymph nodes, American Joint Cancer Committee /Union Internationale Contre le Cancer staging, and resection margins between the two groups. Obesity should not be seen as a contraindication for HALDG. HALDG for obese patients is a safe, feasible, and oncologically sound procedure and has advantages over ODG.

Comparisons of Sixth and Seventh Edition of the American Joint Cancer Committee Staging Systems for Esophageal Cancer

In the seventh edition of the AJCC TNM system for esophageal cancer, modifications have been made with regard to definition of nodal status; histological grade and tumor location are also added in overall staging. The aim of this study is to evaluate the prognostic value of this new system. From 1995 to 2009, 200 patients with squamous cell carcinoma who underwent esophagectomy with curative intent (R0 resection) without neoadjuvant or postoperative treatment were studied. For nodal staging, survival difference was found between pN0 and pN+groups of the sixth edition. If nodal status was recoded according to the seventh edition, survival distinction was found between different groups except between pN1 (1-2 nodes) and pN2 (3-6 nodes) (p=0.47). When pN1 and pN2 were pooled together (pN1+2), survival distinction between pN0 and pN1+2 (p=0.003), and pN1+2 and pN3 (7 or more nodes) (p<0.001) were identified. For overall staging, stage distributions were stage I=17, stage II=80, stage III=89, and stage IV=14 according to the sixth edition. The respective numbers were stage I=20, stage II=69, stage III=111, using the seventh edition. Using the sixth edition, survival differences between stages were distinct except between stage III and stage IV (p=0.38). In the seventh edition, survival differences were found among all stages: between stage I and II (p=0.01) and between stage II and III (p<0.001). On multivariate analysis, pT and pN were two independent prognostic factors for both editions. In the seventh edition, histological grade and tumor location were not statistically significant prognostic factors. The new staging system provides better survival distinction between stages. pT and pN were independent prognostic factors whereas histological grade and tumor location were not. Nodal metastases may be better reassigned to three groups: pN0, pN1 (1-6), and pN2 (7 or more).

Administration of Concurrent Vaginal Brachytherapy During Chemotherapy for Treatment of Endometrial Cancer

To evaluate the tolerability and toxicity of administering vaginal brachytherapy (VB) concurrently during chemotherapy compared with the sequential approach for patients with endometrial cancer. A retrospective analysis of 372 surgically staged patients with endometrial cancer American Joint Committee on Cancer 2009 stages I to IV treated with adjuvant postoperative radiation therapy (RT) at our institution from 2001 to 2012 was conducted. All patients received VB+external beam RT (EBRT)+6 cycles of adjuvant carboplatin- and paclitaxel-based chemotherapy. The VB mean dose was 15.08 Gy (range, 15-20 Gy), with 3 to 4 weekly applications, and the EBRT mean dose was 45 Gy delivered with 3-dimensional or intensity modulated RT techniques. Hematologic, gastrointestinal (GI), and genitourinary (GU) toxicities were assessed by Common Toxicity Criteria (CTC) and compared between sequential and concurrent chemotherapy and VB schedules. Among patients who received RT and adjuvant chemotherapy, 180 of 372 patients (48%) received RT sandwiched between cycles 3 and 4 of chemotherapy. A separate group of 192 patients (52%) were treated with VB during the first 3 cycles of chemotherapy, with a weekly application on nonchemotherapy days, and received the EBRT portion in a sandwiched fashion. Patients treated with VB during chemotherapy had a decreased overall treatment time by 4 weeks (P<.001; 95% confidence interval: 3.99-4.02) and sustained no difference in CTC-graded acute hematologic, GI, or GU toxicities in comparison with the patients treated with VB and chemotherapy in a sequential manner (P>.05). CTC grade 3 or 4 hematologic, GI, and GU toxicities were zero. VB during chemotherapy is well tolerated, decreases overall treatment time, and does not render more toxicity than the sequential regimen.

Early colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Early colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

New Harmonic Scalpel versus Conventional Hemostasis in Right Colon Surgery: A Prospective Randomized Controlled Clinical Trial

Background: The Harmonic Scalpel (HS) is a device that uses vibrations to coagulate and cut tissues simultaneously. Its advantages are represented by minimal lateral thermal tissue damage, less smoke formation, no neuromuscular stimulation and no transmission of electricity to the patient. Methods: A total of 211 consecutive patients (113 men, 98 women; mean age 64 years) undergoing hemicolectomy for cancer of the right colon were divided into two groups, namely those in whom the operation was performed using a new HS handpiece (NHS; 108 patients) and those assigned to conventional hemostasis (CH; 103 patients). The two surgical groups were compared regarding patients' age and sex, tumor size, location, histotype and local invasiveness assessed by American Joint Cancer Committee stage, operative time, fluid content in the suction balloon (drainage volume) during the first 1-3 days after surgery, hospital stay and complications. Results: Ultrasonic energy delivered through an HS has been shown to be safe and to produce minimal damage to the surrounding tissues because of its minimal heat production. Electrical devices allow hemostatic control in vessels up to 3 mm in diameter, while HS can coagulate vessels up to 5 mm in diameter; thus, HS allows not only better control of bleeding but also of lymphorrhea. In fact, the amount of fluid collected in the drainage was significantly lower in the NHS group compared to the CH group. Protein depletion influences the patient's regenerative capacity and thus also the occurrence of complications and recovery time. Conclusion: NHS is a useful device in colon surgery; it facilitates surgical maneuvers and reduces operative times and blood and lymphatic losses, allowing satisfactory maintenance of protein storage. This results in a lower incidence of complications and faster recovery by patients.

Impact of tumor location on prognosis in patients with thoracic esophageal squamous cell carcinoma

Background The impact of tumor location on prognosis is still controversial in patients with esophageal squamous cell carcinoma (ESCC). The purpose of this study was to investigate the impact of tumor location on prognosis in patients with thoracic ESCC and evaluate the scientific value of adding tumor location as a staging factor in the seventh edition of American Joint Cancer Committee staging system of ESCC.

Proposal for a Standardized Pathology Report of Gastroenteropancreatic Neuroendocrine Tumors: Prognostic Significance of Pathological Parameters

BackgroundThere is confusion in the diagnosis and biological behaviors of gastroenteropancreatic neuroendocrine tumors (GEP-NETs), because of independently proposed nomenclatures and classifications. A standardized form of pathology report is required for the proper management of patients.MethodsWe discussed the proper pathological evaluation of GEP-NET at the consensus conference of the subcommittee meeting for the Gastrointestinal Pathology Study Group of the Korean Society of Pathologists. We then verified the prognostic significance of pathological parameters from our previous nationwide collection of pathological data from 28 hospitals in Korea to determine the essential data set for a pathology report.ResultsHistological classification, grading (mitosis and/or Ki-67 labeling index), T staging (extent, size), lymph node metastasis, and lymphovascular and perineural invasion were significant prognostic factors and essential for the pathology report of GEP-NET, while immunostaining such as synaptophysin and chromogranin may be optional. Furthermore, the staging system, either that of the 2010 American Joint Cancer Committee (AJCC) or the European Neuroendocrine Tumor Society (ENETS), should be specified, especially for pancreatic neuroendocrine neoplasms.ConclusionsA standardized pathology report is crucial for the proper management and prediction of prognosis of patients with GEP-NET.

Malignant Melanoma

Nuclear medicine plays an essential role in the correct staging of patients suffering from melanoma. Both sentinel lymph node biopsy (SLNB) and positron emission tomography (PET) represent its main diagnostic tools. SLNB is the choice procedure for lymphatic regional staging of these patients, including the result of this technique in the 2002 American Joint Cancer Committee melanoma staging. SLNB sensitivity is superior than PET/CT for the detection of lymphatic micrometastases in early stages of the disease. PET/CT is mainly used in confirming clinical metastases suspected, detection of recurrences, and recurrence restaging. PET/CT has also shown superiority against conventional diagnostic methods in the detection of distant metastases, being able to detect illness even six months earlier than those methods.