Final Pathology Report Research Articles

Abstract P5-12-17: Breast MRI and FDG-PET/CT for Evaluation of Pathologic Response to Neoadjuvant Chemotherapy in Patients With Breast Cancer

Abstract Introduction: This study compared the diagnostic test accuracy of magnetic resonance imaging (MRI) with that of 18F-fluoro-2-glucose-positron emission tomography/ computed tomography (FDG-PET/CT) imaging in assessment of response to neoadjuvant chemotherapy (NAC) in breast cancer. Methods: A total of 202 eligible patients diagnosed with stage II and stage III breast cancer were given neoadjuvant chemotherapy at Mersin University Faculty of Medicine Hospital from 2019 to 2023. When performing data statistics in a continuous structure, mean and standard deviation, median minimum and maximum values ​​of the features; Frequency and percentage values ​​were used when defining categorical variables. Breast MRI and FDG-PET/CT were evaluated to evaluate response to treatment. After surgery, pathological complete response (pCR) was determined based on the final pathology reports. Tumors were divided according to hormone receptor (HR) and human epidermal growth factor receptor (HER2). As the gold standard treatment response method, evaluation was made according to pathological response status. Diagnostic test statistics, sensitivity, specificity, positive predictive value, negative predictive value and accuracy statistics, 95% confidance interval values ​​are given. The statistical significance level of the data was taken as p <0.05. IBM SPSS 21 version was used to evaluate the data. Results: The total age was minimum 30, maximum 75, mean age was 50.4±11.2 and median age was 50. At the time of diagnosis, the disease stage was stage 2 in 24.8% of the patients and stage 3 in 75.2%. Histology was Invasive ductal carcinoma in 65.3%, invasive lobular carcinoma in 13.5%, other in 21.2%. Minimum Ki-67 was 3, maximum was 95, average was 31.9±18.8, and median Ki-67 was 30. Hormon receptor status (estrogen or progesteron positivity) was evaluated. While ER (estrogen reseptor) was positive in 59.4% of the patients, PR (progesteron receptor) was positive in 52.5%. Human epidermal growth factor receptor 2 (HER2) positive was 38.1%. HR+HER2- was in 42.7%, HR+,HER2- in 21.1%, HR+,HER2+ was in 17.6%, and triple negative in 18.6%. Grade 1 was in 11.9% of the patients, grade 2 in 43.6%, and grade 3 in 44.6%. When postoperative pathology reports was evaluated, pathological complete response was achieved in 69 of 202 patients(%34.1). When FDG-PET/CT was evaluated determining complete response; Sensitivity 90% (95% CI: 0.83-0.97, p<0.05), Specificity 51% (95% CI: 0.42-0.59, p<0.05), PPV value 48% (95% CI: 0.40-0.57 , p>0.05), and NPV was 91% (95% CI: 0.84-0.97, p<0.05), and the accuracy rate was low and significantly 64% (95% CI: 0.57-0.71, p<0, 05). As a result of these meaningful statistical calculations; FDG-PET/CT diagnostic method was not reliable in terms of specificity and positive predictive value. When magnetic resonance was evaluated, in determining complete response; Sensitivity 72% (95% CI: 0.63-0.82, p<0.05), Specificity 90% (95% CI: 0.85-0.95, p<0.05), PPV(positive predictive value) 78% (95% CI: 0.68-0.88 , p<0.05), and NPV(negative predictive value was 86% (95% CI: 0.80-0.92, p<0.05), and the accuracy rate was high and significantly 85% (95% CI: 0.78-0.89, p<0, 05). As a result of these meaningful statistical calculations; Response to treatment status (complete response/non-response) MRI diagnostic method was reliable and can be used instead of the currently used Gold Standard pathology diagnostic method. Conclusion: Our study showed that breast MRI is superior to PET CT in predicting pathological complete response. This study showed that MRI is very important in evaluating treatment response in patients diagnosed with breast cancer receiving neoadjuvant chemotherapy. Citation Format: Emel Sezer, Halil Çelik, Kadir Eser, Pınar Pelin Özcan, Yüksel Balcı, Ferah Tuncel, Fatma Esra Erdem Palaz, Elif Ertaş. Breast MRI and FDG-PET/CT for Evaluation of Pathologic Response to Neoadjuvant Chemotherapy in Patients With Breast Cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P5-12-17.

Abstract P1-08-19: Surgical oncoplastic treatment of a rare case of expansive dermatofibrosarcoma protuberans on the breast

Abstract Background: Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma, with low-grade and slow-growing pattern, initiating in the dermis and then invading the subcutaneous tissue, representing less than 0,1% of all malignancies. Its biological behavior is characterized by aggressive local infiltration with high recurrence rate but rarely metastasizes.DFSP normally occurs in middle-aged adults and exhibits a slight male predominance. It corresponds to 6% of all tissue sarcomas and in the breast is extremelly rare. It resembles a keloid or an atrophic lesion like sclero-derma. These features make the early diagnosis difficult. The main treatment is the surgical excision with safe margins up to 3cm extent. Because of this, a wide resection is necessary, usually followed by a oncoplastic technique to minimize aesthect defect. Method: We describe a case of a female patient with an expansive dermatofibrosarcoma protuberans on the left breast, diagnosed after 5 years of progression, with a challenging surgical treatment. Results: A 35-year-old female patient was complaining of a reddish lesion in the left breast with gradually progressive growth for 5 years. There was no history of preceding trauma, surgery, ulceration, papillary discharge, fever or weight loss.The physical examination revealed a light-reddish, delineated nodular cutaneous plaque 7 x 6 cm in the junction of inner quadrant of the left breast. No other finding from the breasts or lymphatic chain was noted. She had an unremarkable personal and family history.She had performed a skin biopsy 1 year before in another service with the following report: “spindle cell injury without atypia in the dermis. The lesion compromises the deep edge of the fragment.”Lesion complete resection with evaluation of intraoperative surgical margins and oncoplastic technique surgery was then indicated for diagnostic elucidation.The intraoperative biopsy report showed a dermis infiltrative spindle cell lesion with atypia and was necessary a wide excision followed by a superior pedicle mastopexy without volume reduction as the patient had requested.The final pathology report confirmed the dermatofibrosarcoma protuberans due to a spindle mesenchymal neoplasm located in the superficial and deep dermis of the breast skin, showing focal extension to the hypodermis, composed of elongated cells with eosinophilic cytoplasm and monomorphic nuclei arranged in a storiform pattern, within a collagenized stroma (figures 1 and 2). Immunohistochemical study was positive for CD34 and negative for Factor XIIIA (figures 3 and 4). Conclusion: In this rare case, the skin location is one of the most challenging sites for reconstruction after de large excision to maintain symmetry. Citation Format: Giovanna Azevedo Gabriele Carlos, Ridania Frederice, Patricia Figueiredo, Karla Prigenzi. Surgical oncoplastic treatment of a rare case of expansive dermatofibrosarcoma protuberans on the breast [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P1-08-19.

An Evaluation of the Diagnostic Accuracy of [68Ga]Ga-PSMA-11 vs. [18F]F-PSMA-1007 PET/CT for Lymph Node Staging in Patient Candidates for Radical Prostatectomy and Lymph Node Dissection: A Single Institutional Analysis

Background/Objectives: This study evaluates and compares the diagnostic accuracy of [68Ga]Ga-PSMA-11 and [18F]F-PSMA-1007 for lymph node staging in patients with prostate cancer (PCa) scheduled for robot-assisted radical prostatectomy (RARP) and lymphadenectomy (LND). Methods: We retrospectively reviewed prospectively collected data on patients referred to our hospital from October 2020 to January 2023. We included all patients who underwent [68Ga]Ga-PSMA-11 or [18F]F-PSMA-1007 PET/CT for primary staging and subsequently had RARP with concomitant LND. The maximum standard uptake value (SUVmax) for lymph nodes (LNs) and the SUV node-to-background ratio were reported. Two different cut-off values for the SUV node-to-background ratio (i.e., ≥2 vs. <2 and ≥15.5 vs. <15.5) were used to evaluate the diagnostic performance of both tracers. The first cut-off was empirically chosen, while the second was based on Liu’s method. Results: A total of 156 patients were included (median age: 67 years). Among them, 83 underwent [68Ga]Ga-PSMA-11 and 73 underwent [18F]F-PSMA-1007 PET/CT. Suspicious lymph nodes were identified in 21 patients (13.5%). Pathological nodal involvement (pN1) was confirmed in 25 cases (16%). Of the 21 patients with suspicious pathological lymph nodes on PSMA PET/CT, 9 (42.9%) had positive nodes on the final pathology report. With an SUV node-to-background ratio cut-off of ≥2, [68Ga]Ga-PSMA-11 showed 37.5% sensitivity (SE) and 98.5% specificity(SP), while [18F]F-PSMA-1007 demonstrated 33.3% SE and 100% SP. Using the ≥15.5 cut-off, SE and SP were 31.3% and 100% for [68Ga]Ga-PSMA-11 and 11.1% and 100% for [18F]F-PSMA-1007, respectively. Conclusions: [18F]F-PSMA-1007 PET/CT showed, even if not statistically significantly, slightly lower SE and higher SP for nodal staging compared to [68Ga]Ga-PSMA-11 PET/CT, irrespective of the SUV ratio used.

Recurrent Fibroadenoma and Concomitant Mucinous Cancer with Ductal Carcinoma In situ Following Benign Phyllodes Tumor Excision: A Rare Case Report

Abstract A 37-year-old woman was diagnosed with a fibroadenoma (FA) with concomitant extensive spreading of ductal carcinoma in situ (DCIS) and multifocal mucinous carcinomas in 2022. Previously, she was first diagnosed with a FA and received excision in 2016. The initial clinical presentation was a palpable mass in the left breast. During periodic breast ultrasound examination in 2020, another newly developed tumor was found in the same region. A core biopsy revealed a fibroepithelial lesion. The patient received wide excision surgery. The final pathology report indicated a phyllodes tumor (PT) with a clear margin. All three events occurred in the same region (left breast, at 2 O’clock and 3–5 cm from the nipple). Our patient had a relapsed FA, which progressed into a benign PT and FA concomitant with DCIS and multifocal mucinous carcinomas. We report this case to highlight the need for continuous follow-up for FA cases even after complete resection and the possibility of recurrence with other fibroepithelial tumors.

Malignancy Risk of Paediatric Thyroid Nodules Classified According to the Bethesda System.

Thyroid nodules are less common in children than in adults; however, when diagnosed, they carry a greater risk of malignancy. The Bethesda System for Reporting Thyroid Cytopathology uses six cytological categories to predict thyroid nodule malignancy using fine-needle aspiration. This study aimed to estimate the malignant potential of thyroid nodules in children using the Bethesda system. We conducted a retrospective study of 121 patients aged ≤ 19 years who underwent thyroid surgery following fine-needle aspiration (FNA) of a suspicious nodule between 2001 and 2019 at two tertiary medical centres. All FNA specimens were evaluated and categorised according to the Bethesda classification system. The prevalence of malignancy for each cytological category was calculated and subsequently compared with the findings of the final pathology. The mean age at the time of operation was 14.8 years, and 79.5% of the patients were female. The mean nodule size was 24.8 mm. The distribution of nodules across Bethesda cytological categories, from B1 to B6, was as follows: 2, 50, 19, 17, 10, 23 nodules. An analysis of the final pathology reports revealed 66 malignant nodules (54.5%). The malignancy risk was 24% for nodules categorised as B2, 52.6% for nodules categorised as B3, 58.8% for nodules categorised as B4, and 100% each for nodules categorised as B5-B6. Our findings indicate that the malignancy rates for all categories of the Bethesda system were higher in paediatric patients than in adults, including a substantial proportion of cytologically benign nodules. Moreover, our observed rates exceeded those previously reported in comparable studies of the paediatric population, as indicated by the American Thyroid Association guidelines. We propose a more intensive approach for paediatric patients with suspected clinical or sonographic features.

Intraoperative Frozen Section Analysis for Margin Status in Breast Conserving Therapy: a Retrospective 6-Year Experience at a Tertiary Centre in North East India

Abstract Breast cancer is the commonest cancer among Indian women as it is globally. Margin status post lumpectomy remains an important predictor of local recurrence after breast conserving surgery. We set out to investigate the positive predictive value of intra operative frozen section analysis in a tertiary cancer center in North East India. Retrospective data from all women who underwent breast conserving Surgery (BCS) from 2017 to 2022 was included. Frozen section analysis reports were compared against final pathology reports. Comparison was in regard to margin status. Two hundred ten women underwent BCT, and mean age was 49.5 years. The sensitivity and specificity of frozen section was 92.5% (86.2–95.64% 95% CI) and 99.8% (62.23–99.9% 95% CI) respectively. The PPV and NPV was 94.8% (87.09–99.86% 95% CI) and 99.8% (95.53–99.9% 95 CI). Our analysis showed an accuracy of 99.63% (95.22–99.96%, 95% CI). We concluded that frozen section analysis is accurate and has a high positive predictive value and negative predictive value for margin status in breast conserving surgery.

Confocal Laser Microscopy for Intraoperative Margin Assessment in Breast-Conserving Surgery: A New Procedure in the Pathology Laboratory Workflow.

One of the breast-conserving surgery goals is to achieve negative resection margins and avoid reoperation. Therefore, accurate intraoperative margin assessment is essential, but still challenging. Recently, confocal microscopy devices, such as Histolog Scanner (HS), have shown promise for intraoperative margin assessment. The aim of this study was to assess HS for the intraoperative examination of lumpectomy specimens by the pathologists of our institute. Intraoperative margin assessment was performed by macroscopic assessment and by HS imaging to provide information for re-excision decision-making. The specific contribution of HS was evaluated by comparing the HS-based findings with the final pathology reports based on formalin-fixed paraffin-embedded tissue analysis. The study population included 20 women with histologically confirmed invasive breast carcinoma who underwent breast-conserving surgery (mean age of 62.9y; 41 to 88y; 21 tumors in total). HS led to the same decision as macroscopic examination in 76.2% of cases and prompted additional re-excisions in 19% of cases. Compared with the pathology reports, the accuracy rates of the macroscopic and HS assessments were 81% (58.1 to 94.6) and 95.2% (76.2 to 99.9), respectively. Moreover, 5 cases are described to illustrate HS practical contribution and limitations. In conclusion, HS is user-friendly, generally reliable, and enhances the routine macroscopic examination by providing detailed imaging of lumpectomy specimens. In combination with macroscopic examination, HS is an effective tool for intraoperative margin assessment, assisting both pathologists and surgeons in making accurate intraoperative decisions regarding margin re-excision, thereby preventing the need for new surgical operations.

An effective surgical approach to treat obese patients with gynecological disease using a subcutaneous abdominal wall-retraction device to perform low-pressure laparoscopy: A prospective, single-center study.

An effective surgical approach to treat obese patients with gynecological disease using a subcutaneous abdominal wall-retraction device to perform low-pressure laparoscopy: A prospective, single-center study.

Trends in Surgical Overtreatment of Prostate Cancer

Overtreatment of prostate cancer is a public health concern that undermines prostate cancer screening efforts. To assess trends in pathologic grade on prostatectomy during the past 2 decades as a surrogate for overtreatment. This retrospective cohort study examined the grade of prostate cancer on final pathology reports among patients undergoing prostatectomy between January 1, 2010, and September 1, 2024, in 2 parallel cohorts: Surveillance, Epidemiology, and End Results (SEER), a nationwide cancer registry, and Michigan Urological Surgery Improvement Collaborative (MUSIC), a statewide clinical registry. The presence of higher-risk features among patients who underwent grade group 1 prostatectomy during this period was also assessed. The primary exposure of interest was year of radical prostatectomy. The primary outcome was the proportion of all prostatectomies that were pathologic grade group 1 (pGG1) on final pathology reports. The secondary outcome was the proportion of pGG1 prostatectomies with a higher-risk preoperative feature, assessed as a binary variable and including at least 1 of the following: more than 50% of biopsy cores positive, prostate-specific antigen of 10 ng/mL or higher, or grade group 2 on biopsy. A total of 162 558 male patients in SEER (median [IQR] age, 63 [57-67] years) and 23 370 in MUSIC (median [IQR] age, 64 [59-69] years) underwent prostatectomy. The proportion of radical prostatectomies resulting in pGG1 on final pathology reports decreased from 32.4% (5852 of 18 071) to 7.8% (978 of 12 500) between 2010 and 2020 in SEER and from 20.7% (83 of 401) to 2.7% (32 of 1192) between 2012 and 2024 in MUSIC. A more recent prostatectomy was associated with a lower likelihood of a pGG1 prostatectomy while controlling for age and race within SEER (odds ratio [OR] per 5 years, 0.41; 95% CI, 0.40-0.42; P < .001) and MUSIC (OR per 5 years, 0.39; 95% CI, 0.36-0.43; P < .001). Within a subset analysis of those prostatectomies that were final pGG1, a more recent prostatectomy was associated with the presence of a higher-risk preoperative feature, including more than 50% of biopsy cores positive, prostate-specific antigen of 10 ng/mL or higher, and grade group 2 on prior biopsy within SEER (OR per 5 years, 1.60; 95% CI, 1.54-1.67; P < .001) and MUSIC (OR per 5 years, 1.60; 95% CI, 1.34-1.90; P < .001). This cohort study found that since 2010, the frequency of pGG1 prostatectomies markedly decreased, and those few that were performed were more likely to have a higher-risk feature. This reduction in the proportion of prostatectomies that are pGG1 likely reflects improved diagnostic pathways, adherence to active surveillance protocols for low-risk cases, and ongoing efforts at both the state and national levels to minimize unnecessary surgical interventions in patients diagnosed with clinically insignificant prostate cancer.

Prevalence of HER2 expression and its association with clinicopathological parameters in gastric and gastroesophageal junction adenocarcinoma: A 10-year experience of an academic center

HER2 overexpression is a marker for targeted therapy in adenocarcinoma of the gastroesophageal junction (GEJ) and stomach. The present study aimed to evaluate the frequency of HER2 overexpression with reference to clinicopathological characteristics in subjects from King Abdulaziz University Hospital, Jeddah, Saudi Arabia over a 10-year period. A retrospective cross-sectional study was conducted on all biopsy and resection specimens diagnosed with either gastric cancer (GC) or GEJ adenocarcinomas from patients between January 2014 and December 2023 that had a final pathology report. Demographic characteristics of 122 patients, including age and sex, were collected, along with pathological details such as tumor grade, histological subtype and HER2 status. χ2 test was used to analyze the association between collected clinicopathological characteristics and HER2 status of the tumor. Most patients were aged 40-60 years. Males constituted 66% of the patients, and the ethnic distribution between Saudi and non-Saudi was almost equal. The most common subtype of cancer was the intestinal type (49%), and the majority of cases were poorly differentiated (64%). HER2 status was assessed in only 61% of cases, with 13.5% showing gene amplification. There was no significant association found between HER2 status and clinicopathological features.

PARAFFIN: A software tool for Pathology Report Automated Feedback for Improved Education of anatomic pathology trainees.

Feedback on the diagnosis and reporting of pathology findings is essential to the training of residents and fellows, but time constraints and other factors can make it difficult to ensure learners are made aware of the outcome of all cases in which they participated. Many trainees attempt to keep track of their cases and later look up final pathology reports in the laboratory information system (LIS); however, this manual and time-consuming process is prone to error and may prevent them from spending time reviewing and learning from these reports. To address this, we developed a software solution, (Pathology Report Automated Feedback for Improved Education; "PARAFFIN"), which provides pathology trainees with a weekly email digest containing an attached case log with the date, accession sequence, attending pathologist initials, and final diagnosis text for each case in which they participated. PARAFFIN is implemented as two R scripts running on a Posit Connect server: a data extraction script, which accesses an interactive report from our enterprise analytics SQL server, and a reporting script, which performs recipient-specific filtering and emails the trainee with their personalized case log attached as .txt and .csv files. After implementation, pathology trainees were surveyed about PARAFFIN's impact on report collection and case feedback. Of the total 51 pathology trainees who were receiving PARAFFIN digests at the long-term follow-up timepoint, 20 responded to our survey. 90% (18 of 20) of respondents report that PARAFFIN allows them to spend more time reviewing the content of final anatomic pathology reports, rather than collecting reports. Trainees report utilizing PARAFFIN for feedback on multiple aspects of pathology reporting, with final diagnosis, wording/style of final diagnostic line, and diagnostic comment being most frequently used. Our automated case feedback solution provides trainees with a record of final pathology reports for cases in which they participated, which allows trainees to spend more time reviewing reports for feedback rather than manually collecting them from the LIS.

A machine learning-based analysis for the definition of an optimal renal biopsy for kidney cancer

A machine learning-based analysis for the definition of an optimal renal biopsy for kidney cancer

HER2 (2+)/SISH-positive vs. HER2 (3+) Breast Cancer: Pre-treatment MRI Differences and Accuracy of pCR Prediction on Post-treatment MRI.

HER2 (2+)/SISH-positive vs. HER2 (3+) Breast Cancer: Pre-treatment MRI Differences and Accuracy of pCR Prediction on Post-treatment MRI.

Robotic sleeve resection of the intermediate bronchial trunk followed by bronchoplasty for a bronchial hamartoma.

Performing a bronchial sleeve resection followed by bronchoplasty is considered technically challenging. This procedure is still frequently performed via a thoracotomy, although thoracoscopic approaches are also used. Compared to the thoracoscopic approach, the robotic approach offers distinct advantages for performing technically demanding procedures. Additionally, a bronchial anastomosis is considered easier to perform with the robotic approach due to its unique characteristics, such as the use of articulated forceps. In this video tutorial, we demonstrate a robotic sleeve resection of the intermediate bronchial trunk followed by bronchoplasty for a bronchial hamartoma and discuss the nuances of this procedure. The console time was 150 minutes, with minimal blood loss. The patient's postoperative course was uneventful. The chest tube was removed on postoperative day 1, and the patient was discharged on postoperative day 3. The final pathology report confirmed the diagnosis of bronchial hamartoma.

A robotic fissureless left upper lobectomy for a dense fissure.

Many articles document the efficacy of the fissureless technique, most of which focus on a right upper lobectomy. However, there are a few reports on a fissureless left upper lobectomy, especially using a robotic approach. This report presents a successful case of a robotic fissureless left upper lobectomy in a patient with a dense fissure. The total console time was 111 minutes. The postoperative course was uneventful, with the chest tube being removed on postoperative day 1. The patient was successfully discharged on postoperative day 2. The final pathology report confirmed adenocarcinoma, staged as pT1cN1M0, stage IIB. Precise preoperative evaluation using three-dimensional computed tomography broncho-angiography is essential to understand the anatomy accurately and to avoid complications in this challenging procedure.

An anatomic checklist for accurate staging of grossly invasive thyroid cancer.

The final surgical pathology report follows the patient throughout their cancer journey. For locoregionally advanced cancers, lack of surgeon-pathologist communication can lead to understaging, adversely impacting management. Our study aims to improve the accuracy of staging grossly invasive thyroid cancer by introducing an anatomic checklist, enhancing surgeon-pathologist communication. We studied 35 consecutive patients with either gross extrathyroidal or extranodal extension, 29 of whom underwent primary resections requiring AJCC staging. Surgeon A initially only dictated an operative report. Surgeon B transmitted an anatomic checklist to the pathologist in addition to the standard operative note. Final pathology reports were reviewed for AJCC staging accuracy. Surgeon A transitioned to submission of an anatomic checklist for his final six cases. 13 of the 14 final pathology reports without a checklist were understaged. All 15 cases with a surgeon completed anatomic checklist were accurately staged. There was a statistically significant improvement in the accuracy of staging reported in the final pathology reports when an anatomic checklist was submitted as compared to when it was not (P < 0.01, Fisher exact test, two-tailed). All final pathology reports for recurrent cases without a checklist failed to define the anatomic parts that were resected. The time to complete the checklist was less than 90 s. A surgeon-completed anatomic checklist allows pathologists to more accurately stage grossly invasive thyroid cancers. This rapidly completed form eliminates the need for pathologists to analyze the operative note and facilitates both risk of recurrence and AJCC stage determination.

Management of Bulky Tumors in Cervical Cancer: Limits of the Surgical Approach.

The standard treatment for cervical tumors larger than 4 cm, known as bulky tumors, currently involves concurrent chemoradiotherapy followed by vaginal brachytherapy. However, radical surgery is an alternative option in some cases, particularly for those in which a combination of risk factors is not anticipated. Recent studies show that neoadjuvant chemotherapy may help reduce tumor size in these bulky tumors, enabling subsequent surgical intervention reducing the adverse effects derived from radiotherapy. Evidence about fertility sparing surgery in patients with bulky tumors is limited, although some retrospective studies reported good oncological outcomes when adequate tumor reduction is achieved through neoadjuvant chemotherapy. Moreover, the administration of adjuvant radiotherapy after radical surgery in patients with tumor sizes ≥ 4 cm in the final pathological report, combined with other intermediate risk factors for recurrence, remains a topic of debate. Current evidence indicates no significant differences in overall survival or disease-free survival between follow-up alone and the use of adjuvant radiotherapy in these cases, although further research is needed to refine treatment strategies for these patients. This narrative review aims to summarize the available evidence on the comprehensive management of bulky cervical tumors, addressing relevant issues and controversies in the field.

Predictors of Pathologic Non-response to Neoadjuvant Approaches in Locally Advanced Rectal Cancer.

Approximately 10-20% of rectal cancer patients do not respond to neoadjuvant treatment. While the current literature has focused on pathological complete response, pinpointing those who will fail to benefit entirely from neoadjuvant approaches is crucial. This study aimed to determine the risk factors associated with pathological non-response (pNR) to neoadjuvant treatment. Patients with stage II-III rectal adenocarcinoma who underwent neoadjuvant treatment followed by curative surgical resection between 2018 and 2023 at a high-volume center were retrospectively reviewed. Patients were divided into two cohorts (pNR and pathologic responder [pR]) based on their response to neoadjuvant therapy. The pNR group included patients with a Tumor Regression Score of grade 3 or those upstaged on the final pathological report. Of the 405 patients included in this study, 53 (13%) were pNR and 352 (87%) were pR. Among patients treated with standard neoadjuvant chemoradiation, 12% were pNR compared with 14% among those treated with total neoadjuvant therapy. Significantly more patients in the pNR cohort had perineural (31% vs. 8%; p < 0.001) and lymphovascular (22% vs. 6%, p = 0.001) invasions when compared with the pR cohort. After adjusting for age, sex, clinical T stages, and clinical nodal status on multivariable analysis, the presence of extramural vascular invasion (EMVI) on pretreatment magnetic resonance imaging (odds ratio 2.08, 95% confidence interval 1.03-4.20, p = 0.04) was identified as a significant predictor of pNR. EMVI was an independent risk factor of pNR in patients with rectal cancer. Identifying pretreatment factors that predict pNR to neoadjuvant therapy is crucial as it allows for better risk stratification and personalized treatment strategies.

Paraovarian Cysts in Pediatrics: Retrospective Analysis of Diagnostic and Laparoscopic Treatment in a Single Institution.

Paraovarian Cysts in Pediatrics: Retrospective Analysis of Diagnostic and Laparoscopic Treatment in a Single Institution.

Prediction of preoperative and postoperative FIGO grade concordance in patients with endometrial cancer

Aims: To determine the factors leading to upgrading in the final pathology result in cases with endometrial cancer. Methods: We retrospectively analyzed the records of patients with endometrioid endometrial adenocarcinoma to evaluate the concordance between FIGO grade in preoperative endometrial sampling and postoperative final pathology grade. As a result of endometrial sampling, FIGO grade was reported as up-grading if it was lower than final pathology report, and as down-grading, if it was higher than final pathology report. The effects of tumor size, degree of myometrial invasion, lymphovascular invasion, FIGO stage, tumor localization, and additional uterine/endometrial pathologies on up-grading were evaluated. Results: A total of 151 patients remained eligible for final analysis. The overall down-grading percentage was 8.6%, and the up-grading percentage was 25.2%. In preoperative endometrial sampling, the up-grading rates for FIGO grades 1 and 2 were analyzed as 30.5% and 20.0%. The concordance rates between preoperative endometrial sampling results and postoperative definitive pathology results were calculated as 69.5%, 55.6%, and 81.8% for FIGO grade 1,2,3, respectively.It was found that patients with more than 50% myometrial invasion (p=0.048), and those with advanced FIGO stages were more up-grading than those with earlier stages (p=0.005). Conclusion: There is a substantial difference between the grade of preoperative endometrial sampling material and the postoperative final pathology grade in patients with endometrioid-type endometrial cancer.In the preoperative evaluation, assessment of additional markers in combination with magnetic resonance imaging may reduce misconceptions in the diagnosis, given that 25% of the patients were up-grading.