Postoperative Pathology Report Research Articles

An Incidental Fallopian Tube Focal Serous Tubal Intraepithelial Lesion (STIL) Discovered on a Postoperative Pathology Report Following Hysterectomy and Salpingectomy: A Case Report

An Incidental Fallopian Tube Focal Serous Tubal Intraepithelial Lesion (STIL) Discovered on a Postoperative Pathology Report Following Hysterectomy and Salpingectomy: A Case Report

Gross morphologic features of surgical specimen in rectal cancer patients with pathological complete response following neoadjuvant chemoradiotherapy: A cross-sectional study.

pathological complete response (pCR) is achieved in 10%-30% of rectal cancer patients following neoadjuvant chemoradiotherapy and surgery. Residual mucosal abnormalities, which make patients ineligible for nonoperative management, may not be an accurate indicator of the pCR. The purpose of this study was to report the gross findings of rectal cancer patients with pathological complete responses. This study was conducted at Tehran University of Medical Sciences, Tehran, Iran. A total of 130 patients with rectal adenocarcinoma, treated by neoadjuvant chemoradiotherapy, followed by surgical resection between March 2007, and March 2017, with a surgical pathology report of pCR, were included. Patients' demographics and pretreatment tumor characteristics were collected from the medical records. Data regarding residual mucosal abnormalities were extracted from postoperative surgical pathology reports. Abnormal findings were reported as "ulcer" or " non-ulcerative lesion". One hundred and fifteen patients (88.5%; 95% CI: 81.7%-93.4%) had at least one abnormal finding in the gross examination, including ulcer or non-ulcerative lesion (any mucosal abnormalities other than ulcers, including polyps, telangiectasia, etc.). Patients with higher-stage tumors had a higher chance of having an ulcerative lesion (p=0.05). Younger patients tended to have deeper layers of involvement (p=0.013). Patients with different gross findings were not significantly different regarding baseline characteristics, except for the pretreatment stage, where patients with a higher stage had higher odds of having ulcerative lesions. Most rectal cancer patients achieving a pCR exhibit abnormalities on gross examination. The higher pretreatment stages were significantly associated with gross abnormalities especially ulcers.

Abstract PO2-16-06: Treatment Patterns of Neoadjuvant Therapy in Chinese Patients with HR-Positive/HER2-Positive Early or Locally Advanced Breast Cancer: A Real-World Study Using NCID Data in 2019-2022

Abstract Background: With the approval of pertuzumab (P) in China in 2019, P plus trastuzumab (T) and chemotherapy has become a standard of care in the neoadjuvant setting for patients with HER2-positive (HER2+) early or locally advanced breast cancer (BC). As a unique subtype, HR-positive (HR+)/HER2+ BC is less responsive to neoadjuvant chemotherapy plus HER2 targeted therapy with lower pathologic complete response (pCR) rates compared with the HR−/HER2+ subgroup. In China, the treatment pattern of HR+/HER2+ BC patients is unclear. In this real-world study, we summarized the current treatment patterns of Chinese patients diagnosed with HR+/HER2+ BC at an early or locally advanced stage based on national-level data to drive clinical decision support. Methods: A representative sample of 51 hospitals (31 cancer centers and 20 general hospitals) covering 29 provinces from NCID (National Cancer Information Database) were generated. Anonymous individual patient data from electronic medical records (EMR) were retrieved to extract information on therapy modalities. Early or locally advanced HR+/HER2+ BC patients who were initially diagnosed between January 1, 2019 and May 31, 2022 were included. Data were analyzed both by year and in the aggregate to ensure accuracy and stability. Results: The types of hospitals and study period reflected the current treatment landscape of HR+/HER2+ early or locally advanced BC in Chinese clinical practice. From 2019 to 2022, the results were consistent by year. In the aggregate, a total of 290,626 patients were initially diagnosed with BC during the study period. 84% (243,528/290,626) were at an early or locally advanced stage, of which 50% (121,548/243,528) had a pathologic diagnosis, 24% (29,390/121,548) were identified as HER2+, 69% (20,370/29,390) were both HR+ and HER2+, and 87% (17,630/20,370) underwent surgery. After excluding those without post-operative pathologic reports or with other primary cancers, 15,368 patients were analyzed regarding treatment patterns. 30% (4,598/15,368) received neoadjuvant therapy but 69% (10,677/15,368) had no neoadjuvant therapy. Among 4,598 patients, 31% (1,434/4,598) received T as single anti-HER2 targeted therapy, 36% (1,649/4,598) received dual HER2 blockade (1,522 T plus P, 127 T plus a TKI [tyrosine kinase inhibitor]), and the rest (1,515) received treatment that not contain a targeted agent. For patients treated with T plus P, 1,465 received concurrent chemotherapy (410 anthracyclines-based, 828 platinum-based); for patients treated with T plus TKI, 123 received concurrent chemotherapy (15 anthracyclines-based, 79 platinum-based). The most frequently prescribed chemotherapies were platinum-based regimens (57% for T plus P plus chemotherapy and 64% for T plus TKI plus chemotherapy). Conclusions: Based on the largest nationwide database, strong representativeness and stability of our data sources, our findings are of great significance to clinical decision-making. The proportion of patients who underwent neoadjuvant therapy of HR+HER2+ BC is much lower than in many other countries, with T plus P in combination with chemotherapy appearing to be the most commonly used targeted regimen. We also found some distinctions between neoadjuvant patterns of early-stage BC in the real world of China and guidelines, which would be further explored in subsequent research. Citation Format: Zhenzhen Liu, Jiujun Zhu, Chengzheng Wang, Zhenduo Lu, Xiuchun Chen, Lianfang Li, Xianfu Sun, Chongjian Zhang, Jianghua Qiao, Min Yan. Treatment Patterns of Neoadjuvant Therapy in Chinese Patients with HR-Positive/HER2-Positive Early or Locally Advanced Breast Cancer: A Real-World Study Using NCID Data in 2019-2022 [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-16-06.

Abstract PO1-02-09: Efficacy of breast conserving treatment of minimal residual tumors after neoadjuvant therapy for breast cancer

Abstract Background. Determining the most effective drug therapy regimens is one of the top priorities in the individualization of the treatment of patients with breast cancer (BC). Achievement of pathological complete response (pCR) is important prognostic factor, and used as the surrogate primary end point in many clinical trials. According to the literature, the achievement of pCR after neoadjuvant systemic treatment (NST) in breast cancer varies from 30 to 70%. Patients who do not achieve pCR require post-neoadjuvant treatment, even when reaching minimal size of residual tumors. Initially, primary minimal tumors are characterized by high survival rates, which are proved by international and domestic studies. It is required to clarify the survival rates in the presence of a minimal residual tumor (ypT < 10mm) after neoadjuvant systemic therapy and to compare with primary minimal forms of breast cancer (pT1a-b N0M0), characterized by the most favorable prognosis. Objective. Improvement of the effectiveness of treatment of residual minimal forms (ypT1a-b) of BC after NST. Determination of the correlation between the schemes of NST and the rates of tumor response based on the results of postoperative pathological reports including RCB scale. Methods. The study included 602 patients aged 18–65 years with early and locally advanced I–IIIC stage T1-3N1-3M0 breast cancer,who underwent complex or combined treatment. This study included patients treated at the N.N. Petrov National Medical Research Center of Oncology from 2015 to 2021 Conclusion. After reaching a complete pathomorphological response of the tumor to NST (RCB 0), the 5-year disease-free (DFS) and overall (OS) survival rates (DFS – 78.5%; OS 90.4%) were inferior to the survival rates of patients with primary minimal breast cancer (pT1ab N0M0) [DFS – 86.4%; OS – 98.6%]. Neoadjuvant chemotherapy regimens that allow achieving a pathological complete response in triple-negative and HER2- positive breast cancer have been defined. An assessment of adverse factors that affect the effectiveness of breast conserving treatment and correlate with a deterioration in overall survival was performed. Results. Our data analysis revealed that the survival rates (DFS and OS) of patients with minimal residual tumor after neojuvant systemic therapy were not comparable with those in the group of patients with primary minimal breast cancer. Data analysis revealed the most effective combinations of drugs expressed in the rates of pathomorphological response according to the RCB scale. An assessment of adverse factors that affect the effectiveness of organ-preserving treatment and correlate with a deterioration in overall survival was performed. Citation Format: Roman Pesotsky, Vladimir Semiglazov, Petr Krivorotko, Tengiz Tabagua, Konstantin Zernov, Alexander Emelyanov, Viktoria Mortada, Nikolay Amirov, Daria Ulrikh, Valerii Levchenko, Yana Bondarchuk, Diana Enaldieva, Nestan Bekkeldieva, Konsantin Zirov, Sergey Yerechshenko, Vladislav Evseev, Kirill Rychagov, Sergey Novikov, Maria Kazantseva, Larisa Gigolaeva, Elena Zhiltsova, Denis Nesterov, Olga Ivanova, Tatiana Semiglazova. Efficacy of breast conserving treatment of minimal residual tumors after neoadjuvant therapy for breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-02-09.

Size Matters: In-Office Hysteroscopy and Successful Removal of Endometrial Polyp [ID 2683670

INTRODUCTION: Hysteroscopy serves as the gold standard for investigating intrauterine pathologies. Previous studies suggest successful in-office hysteroscopic polypectomy in younger, lower body mass index, premenopausal patients with smaller polyps and painless examinations. We share our in-office hysteroscopic polypectomy experience and aim to determine the threshold for estimated polyp size on ultrasound imaging most associated with successful in-office removal. METHODS: We conducted a retrospective study at a single urban hospital, including all patients who underwent in-office hysteroscopy (IOH) between December 2018 and April 2023. Using standardized protocols, we employed vaginoscopy no-touch techniques with a 5-mm diagnostic hysteroscope (30-degree optic) using normal saline for distension without anesthesia. Polyps were removed using hysteroscopic instruments. Preoperative ultrasound reports provided initial polyp diameter, which was subsequently correlated with intraoperative hysteroscopic impression and postoperative pathology reports. RESULTS: One hundred forty patients underwent IOH. Among them, 53 (38%) were referred for suspected endometrial polyps identified on ultrasound. 10 patients were excluded from the study: 6 lacked available imaging, 2 showed no polyps on imaging, and 2 had unsuccessful entry due to cervical stenosis. Successful entry into the endometrial cavity was achieved in 95.3% of cases, with cervical stenosis and pain as limiting factors. 13.9% (6 patients) experienced failed in-office polypectomy due to large polyp size (mean estimated diameter: 2.23 cm). CONCLUSION: In-office hysteroscopy using the vaginoscopy no-touch technique is a highly advantageous therapeutic modality for managing patients with endometrial polyps. Polyps larger than 2 cm pose challenges, often leading to unsuccessful in-office removal.

Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Predicting Complete Pathological Response in Rectal Cancer Patients Receiving Neoadjuvant Chemoradiotherapy.

BACKGROUND Pathologic response after neoadjuvant therapy has been shown to improve outcomes in rectal cancer. Inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), have been studied to predict pathologic response and survival. This study aimed to evaluate the association between NLR and pathological response as well as outcome in patients with rectal cancer who underwent neoadjuvant chemoradiotherapy (nCRT). MATERIAL AND METHODS We retrospectively analyzed 187 patients with rectal cancer treated with nCRT followed by surgery between 2016 and 2020. The NLR was calculated using archival complete blood count records. Postoperative pathology reports were recorded. The NLR cut-off was determined by receiver operating characteristic curve. Kaplan-Meier survival curves and univariate and multivariate Cox regression analyses were used to analyze the relationship between NLR and clinicopathologic data to predict survival and prognosis. RESULTS An NLR >3.63 at diagnosis was the optimal cut-off value for predicting progression. Near-complete response rates were higher in patients with NLR <3.63 (38%) than in those with NLR >3.63 (18%) (P=0.035). The NLR <3.63 group had a significantly higher 5-year progression-free survival rate compared to the NLR >3.63 group (63.6% vs 40.1%, respectively; P=0.007). The NLR <3.63 group also had a higher 5-year overall survival (OS) rate than the NLR >3.63 group (72.3% vs 63.1%, respectively), but the difference was not statistically significant (P=0.077). CONCLUSIONS Our study showed a higher near-complete response rate in rectal cancer patients with NLR <3.63 receiving nCRT. This finding supports that a low preoperative NLR is a good prognostic factor in indicating pathological response.

The Role of Lymphovascular Space Invasion and Cytology in the Prognosis of Endometrial Cancer.

Lymphovascular space invasion (LVSI) and cytology are both independent and strong prognostic factors in endometrial cancer. This study aims to highlight the impact of LVSI and cytology positivity on prognosis, in addition to molecular classification. A retrospective review was conducted on the records of 223 patients with endometrial cancer diagnosed between January 2011 and January 2021. The inclusion criteria stipulated that the patients were diagnosed with endometrial cancer by endometrial biopsy and were operated in the clinic. The exclusion criteria included sarcoma in the postoperative pathology report results or synchronous tumor. Staging was performed according to the Fédération internationale de gynécologie et d'obstétrique (FIGO) 2009 criteria. Cytology (using 50 cc saline) was obtained upon entry into the peritoneal cavity. In 20 patients, saline was not used due to the presence of ascites in the abdomen. The Kaplan-Meier method was employed to evaluate overall survival and progression-free survival. Survival rates were compared in terms of cytology and LVSI. After analyzing the postoperative pathology results, it was found that the mean tumor size was 4.03 ± 2.3 cm. The most common histological type was endometrioid carcinoma, with stage IA being the most common stage. Out of 223 patients with endometrial cancer, the overall survival rate was 82.4%, and the progression-free survival rate was 88.3%. For patients negative for LVSI, the progression-free survival rate was 93%, while for LVSI-positive patients, it was 77.3% (p < 0.001). Additionally, the progression-free survival rate for patients negative for cytology was 90.4%, whereas for cytology-positive patients, it was 77.1% (p < 0.05). In our study, we observed that LVSI positivity and cytology positivity also reduced the overall survival rate. We aimed to highlight that, in addition to molecular classification, cytology positivity and LVSI positivity are still highly significant and independent factors in prognosis.

Efficacy and safety of three - dimensional laparoscopic adrenalectomy: a single - center experience

Background: Laparoscopic adrenalectomy has emerged as the standard treatment for adrenal tumors. Although the application of high - resolution cameras has enhanced visualization in conventional two - dimensional laparoscopy, it has not fully overcome the limitations of depth perception and spatial recognition. However, thanks to significant advancements in three - dimensional technology in laparoscopic surgery, these issues have been totally solved. This study aims to evaluate the outcome of three - dimensional laparoscopic adrenalectomy. Methods: A prospective study included 38 patients with adrenal tumors who underwent three - dimensional laparoscopic adrenalectomy from April 2020 to December 2022 at the Department of Urology, Hue Central Hospital. Results: The mean age was 42.5 ± 5.1 years old. The most common reason for hospitalization was back pain, accounting for 39.5%. Adrenal incidentalomas were detected in 23.7% of patients. The proportion of patients with functional adrenal tumors was 55.3%; nonfunctioning adrenal lesion with progressive growth 13.1% and pheochromocytoma was 7.9%. Computed tomography showed a mean tumor size of 30.5 ± 9.2 mm. The mean operative time was 108.8 ± 12.3 minutes. There were no cases of intraoperative complications or conversion to open surgery. Early postoperative complications include wound infection (5.3%) and fluid accumulation (2.6%). The mean postoperative hospital stay was 5.5 ± 1.9 days. Postoperative pathological reports showed adrenocortical tumors in 81.6%. At follow - up, 35 of 38 (92.1%) cases were asymptomatic and had normal follow - up results in laboratory tests. Conclusions: Three - dimensional laparoscopic adrenalectomy is a minimally invasive, safe, and effective method.

Comparison of indocyanine green-near-infrared fluorescence guided and traditional mediastinal lymphadenectomy during radical esophagectomy: A randomized controlled trial

BackgroundThe extent of lymph node dissection during radical esophagectomy remains a controversial topic. Thus, this study mainly aimed to explore the location of sentinel lymph nodes in esophageal squamous cell carcinoma and the application value of the indocyanine green–near-infrared fluorescence system in lymphadenectomy. MethodsThis randomized controlled clinical trial (ClinicalTrials.gov, NCT04615806) included 42 participants without neoadjuvant therapy who were lymph node negative based on positron emission tomography/computed tomography findings. Traditional esophagectomy with indocyanine green–near-infrared fluorescence imaging was performed after injecting 0.5 mL indocyanine green (1.25 mg/mL) into the esophageal submucosa in the 4 peritumoral quadrants. The primary endpoint was to determine the location of the sentinel lymph node in esophageal squamous cell carcinoma based on postoperative pathologic reports. ResultsA total of 40 patients, with 20 in each group, were included in the final analysis. In the indocyanine green group, indocyanine green–near-infrared fluorescence imaging was successful in all subjects. Seven cases (cases 2, 3, 9, 11, 17, 18, and 20) in the indocyanine green group exhibited lymph node metastases, all of which were near-infrared positive. The detection rate, positive predictive value, negative predictive value, sensitivity, and specificity were 100% (20 of 20 cases), 8.7% (13/150), 100% (265/265), 100% (13/13), and 65.9% (265/402), respectively. All near-infrared–negative lymph nodes were nonmetastatic lymph nodes. In addition, the number of mediastinal lymph nodes resected in the indocyanine green group was significantly higher than in the non–indocyanine green group. ConclusionIndocyanine green–near-infrared might be an important and promising technique in predicting sentinel lymph nodes of esophageal squamous cell carcinoma and could significantly improve the detection rate of lymph nodes of esophageal squamous cell carcinoma.

Brown tumor due to primary hyperparathyroidism in a familial case: a case report

BackgroundPrimary hyperparathyroidism (PHPT) is an uncommon disorder characterised by hypercalcemia with an increased parathyroid hormone level. We reported a PHPT familial case with two subjects, a father and a daughter, and both of them had suffered from the brown tumor.Case presentationThe proband, a 43-year-old patient, developed parathyroid adenomas at the age of 15; a histologically confirmed right parathyroid adenoma was removed by parathyroidectomy; and after six months follow-up, the serum calcium level was normalised. At the age of thirty-three, a CT scan of his head and neck revealed a mass in the right maxilla, as well as PHPT (i.e., left inferior parathyroid adenoma). Then, he underwent a biopsy of an exophytic lesion in the right maxilla and was diagnosed by pathology as a brown tumor, with the serum calcium and PTH levels at 2.78 mmol/L and 221 pg/mL, respectively. Subsequently, the patient took a left inferior parathyroid microwave ablation with ultrasound guidance. After three months of follow-up, the serum calcium and PTH levels returned to normal, and the brown tumor was resolved. After three years, it mineralised as revealed in a CT scan. By the time he was 43 years old, during the 28-year follow-up period, the serum calcium and PTH levels were still within the normal range, and there was no discomfort reported. He has consistently taken calcium supplements throughout the 28 years. Since the initial diagnosis, his blood indicators of kidney function have been normal, and ultrasound showed renal calculus in the right kidney and a normal left kidney. The proband’s daughter, a 15-year-old girl, experienced left upper extremity pain for ten months. CT scan revealed a mass in the distal left radius, and a giant cell tumor was suspected. A surgical internal fixation was performed, and the pathology showed a brown tumor. Laboratory tests revealed a serum parathyroid hormone (PTH) level of 1554pg/mL, calcium level of 3.14 mmol/L, phosphorus level of 0.72 mmol/L, and alkaline phosphatase level of 1892 U/L. Given the osteitic changes and elevated levels of calcium and PTH, ultrasonography was performed, after which a mass was detected measuring 19 × 9 × 7 mm mixed with solid components and cystic fluid in the right thyroid gland. The results of 99mTc-MIBI scintigraphy confirmed the abnormal accumulation of 99mTc-MIBI in the right thyroid gland but not seen in the bilateral parathyroid glands. The patient underwent thyroidectomy, and the postoperative pathology report indicated an intra-thyroid ectopic parathyroid adenoma. The serum calcium and PTH levels became normal at 4 h after surgery. One to three months after operation, the serum calcium level was low, while the serum PTH level was high. Then, the patient was advised to take calcium supplements. Until the sixth month after the operation, the serum calcium level and serum PTH level returned to normal, and the bone pain was relieved. The patient’s blood tests for kidney function remained normal. There was no evidence of bilateral kidney disease (such as nephrolithiasis or nephrocalcinosis) detected by ultrasound scan. There were several similarities in the state of illness between these two subjects. Both the father and the daughter developed parathyroid adenomas at the age of 15, and there was no lesion in other endocrine glands. And genetic testing revealed mutations in the CDC73 genes in both father and daughter. On the other hand, there were also a few differences. The father’s first signs of brown tumor were in the right maxilla, while the daughter’s appeared in the distal left radius. The father presented pathological changes in the left and right parathyroid glands, whereas the daughter presented with an ectopic parathyroid adenoma in the right thyroid gland.ConclusionWe report a familial case in which father and daughter were diagnosed to have brown tumors due to parathyroid adenoma and ectopic parathyroid adenoma, and genetic testing revealed CDC73 gene mutations in both. Therefore, in the diagnostic and differential process of young patients having bone disease, clinicians should not only focus on the clinical manifestations of the skeleton, but also implement a comprehensive analysis of systemic symptoms, considering the possibility that the patient has familial PHPT.

Evaluation of the effect of intraoperative frozen section on overall timeliness and survival in lung cancer surgery

Background/Aim: We aimed to find out whether there is any delay in the management of the process in patients operated on for lung cancer and to understand the effect of intraoperative frozen section on this process.&#x0D; &#x0D; Methods: 176 patients were analyzed in total. The dates of admission, diagnosis, operation, and postoperative pathology results were noted. Five intervals were defined as time from first evaluation to diagnosis, first evaluation to surgery, diagnosis to surgery, first evaluation to the day of the postoperative pathology report, and diagnosis to the day of the postoperative pathology report.&#x0D; &#x0D; Results: The majority of patients (81.8%) were male, and the median age was 63 years (iqr = 11). The median time between the first assessment and the final pathological examination result was 62 days (iqr = 70). The time from initial presentation to surgery was significantly shorter (p 0.001), and the time from diagnosis to final pathology was also significantly shorter (p 0.001) in patients diagnosed by frozen section. However, there was no significant difference in the time from initial evaluation to diagnosis between the two groups (0.052). There was no significant difference in survival between patients diagnosed by freezing and patients diagnosed by other methods (p = 0.508).&#x0D; &#x0D; Conclusion: Solutions to increase the timeliness of care for patients with lung cancer can be designed with a better understanding of delays. Intraoperative frozen section diagnosis improves overall timeliness but has no effect on survival in lung cancer patients undergoing surgery.

Basal cell adenoma of parotid gland: two case reports and literature review.

Most of salivary tumors are benign in nature and are typically diagnosed and classified based on their histopathological presentation. Basal cell adenoma of the salivary glands is a rare, benign disease accounting for 1% to 3% of salivary gland tumors. Despite its low incidence, basal cell adenoma is the third most common benign tumor of the salivary gland after pleomorphic adenoma and Warthin's tumor. It usually appears as a firm and slow-growing mass. Due to the prognosis, differential diagnosis with basal cell adenocarcinoma, adenoid cystic carcinoma and basaloid squamous cell carcinoma is required. In this report, we present two cases; a 62-year-old woman who presented with an asymptomatic, and slow-growing mass and a 64-year-old woman with a static-sized mass in the parotid gland. In both cases, the mass was completely excised, postoperative pathology reports confirmed the diagnosis of basal cell adenoma. We also review the literature and discuss this rare entity.

Accuracy of DOTATATE PET imaging in the preoperative planning of small bowel neuroendocrine tumor resection.

We assessed the accuracy of preoperative gallium-68 DOTA-Tyr3-octreotate (DOTATATE) positron emission tomography (PET) imaging in estimating multifocality and nodal metastases of small bowel neuroendocrine tumors (sbNETs). A multicenter analysis was performed on patients with sbNETs who underwent preoperative DOTATATE PET imaging and surgical resection, with manual palpation of the entire length of the small bowel, between January 2016 and August 2022. Preoperative imaging reports and blinded secondary imaging reviews were compared to the final postoperative pathology reports. Descriptive statistics were applied. One-hundred and four patients met inclusion criteria. Pathology showed 53 (51%) patients had multifocal sbNETs and 96 (92%) had nodal metastases. The original preoperative DOTATATE PET imaging identified multifocal sbNET in 28 (27%) patients and lymph node(LN) metastases in 80 (77%) patients. Based on original radiology reports, sensitivity for multifocal sbNET identification was 45%, specificity was 92%, positive predictive value (PPV) was 86%, and negative predictive value (NPV) was 62%. For the identification of LN metastases, sensitivity was 82%, specificity was 88%, PPV was 99%, and NPV was 29%. Although DOTATATE PET imaging is specific and relatively accurate, sensitivity and NPV are insufficient to guide surgical planning. Preoperative use should not replace open palpation to identify additional synchronous lesions or to omit regional lymphadenectomy.

Diagnostic accuracy of pre-operative breast magnetic resonance imaging (MRI) in predicting axillary lymph node metastasis: variations in intrinsic subtypes, and strategy to improve negative predictive value—an analysis of 2473 invasive breast cancer patients

BackgroundThe value and utility of axillary lymph node (ALN) evaluation with MRI in breast cancer were not clear for various intrinsic subtypes. The aim of the current study is to test the potential of combining breast MRI and clinicopathologic factors to identify low-risk groups of ALN metastasis and improve diagnostic performance.Material and methodsPatients with primary operable invasive breast cancer with pre-operative breast MRI and post-operative pathologic reports were retrospectively collected from January 2009 to December 2021 in a single institute. The concordance of MRI and pathology of ALN status were determined, and also analyzed in different intrinsic subtypes. A stepwise strategy was designed to improve MRI-negative predictive value (NPV) on ALN metastasis.Results2473 patients were enrolled. The diagnostic performance of MRI in detecting metastatic ALN was significantly different between intrinsic subtypes (p = 0.007). Multivariate analysis identified tumor size and histologic type as independent predictive factors of ALN metastases. Patients with HER-2 (MRI tumor size ≤ 2 cm), or TNBC (MRI tumor size ≤ 2 cm) were found to have MRI–ALN-NPV higher than 90%, and these false cases were limited to low axillary tumor burden.ConclusionThe diagnostic performance of MRI to predict ALN metastasis varied according to the intrinsic subtype. Combined pre-operative clinicopathologic factors and intrinsic subtypes may increase ALN MRI NPV, and further identify some groups of patients with low risks of ALN metastasis, high NPV, and low burdens of axillary disease even in false-negative cases.

A rare case of pituitary metastasis from hepatocellular carcinoma: case report and literature review.

Presence of pituitary metastases (PMs) is a relatively rare clinical situation, especially when originating from hepatocellular carcinoma (HCC). A 73-year-old man presented with headaches, diplopia, and soon impaired vision, as well as gastrointestinal symptoms. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain revealed a space-occupying mass in the sellar region. The patient had a history of hepatocellular carcinoma and recent abdominal ultrasound and positron emission tomography (PET) indicated recurrence and metastases. Endoscopic transnasal transsphenoidal tumor excision was performed, and postoperative pathological report confirmed the diagnosis of HCC PM. In the literature review, 17 published cases of HCC PMs were summarized. Both the diagnosis and management of HCC PMs are difficult. Patients who had HCC-related history and new-onset headaches or diplopia should be inspected with a suspicion of metastatic lesions. Surgical intervention with transnasal endoscope is only recommended to ameliorate the symptoms and improve the life quality.

Pathologic complete response of ductal carcinoma in situ to neoadjuvant systemic therapy in HER2-positive invasive breast cancer patients: a nationwide analysis

PurposeDuctal carcinoma in situ (DCIS) is present in more than half of HER2-positive invasive breast cancer (IBC). Recent studies show that DCIS accompanying HER2-positive IBC can be completely eradicated by neoadjuvant systemic therapy (NST). Our aim was to determine the percentage of pathologic complete response of the DCIS component in a nationwide cohort and to assess associated clinicopathologic variables. Furthermore, the impact on surgical treatment after NST was investigated.MethodsWomen diagnosed with HER2-positive IBC, treated with NST and surgery, between 2010 and 2020, were selected from the Netherlands Cancer Registry. Pre-NST biopsy and postoperative pathology reports were obtained from the Dutch Nationwide Pathology Databank and assessed for the presence of DCIS. Clinicopathologic factors associated with DCIS response were assessed using logistic regression analyses.ResultsA DCIS component was present in the pre-NST biopsy in 1403 (25.1%) of 5598 included patients. Pathologic complete response of the DCIS component was achieved in 730 patients (52.0%). Complete response of DCIS occurred more frequently in case of complete response of IBC (63.4% versus 33.8%, p < 0.001). ER-negative IBC (OR 1.79; 95%CI 1.33–2.42) and more recent years of diagnosis (2014–2016 OR 1.60; 95%CI 1.17–2.19, 2017–2019 OR 1.76; 95%CI 1.34–2.34) were associated with DCIS response. Mastectomy rates were higher in IBC+DCIS compared to IBC (53.6% versus 41.0%, p < 0.001).ConclusionPathologic complete response of DCIS occurred in 52.0% of HER2-positive IBC patients and was associated with ER-negative IBC and more recent years of diagnosis. Future studies should investigate imaging evaluation of DCIS response to improve surgical decision making.

Association of clinical outcomes and the predictive value of T lymphocyte subsets within colorectal cancer patients.

Tumor immunity is a hot topic in tumor research today, and human immunity is closely related to tumor progression. T lymphocyte is an important component of human immune system, and the changes in their subsets may influence the progression of colorectal cancer (CRC) to some extent. This clinical study systematically describes and analyzes the association of CD4+ and CD8+ T-lymphocyte content and CD4+/CD8+ T-lymphocyte ratio with CRC differentiation, clinical pathological stage, Ki67 expression, T-stage, N-stage, carcinoembryonic antigen (CEA) content, nerve and vascular infiltration, and other clinical features, as well as preoperative and postoperative trends. Furthermore, a predictive model is constructed to evaluate the predictive value of T-lymphocyte subsets for CRC clinical features. Strict inclusion and exclusion criterion were formulated to screen patients, preoperative and postoperative flow cytometry and postoperative pathology reports from standard laparoscopic surgery were assessed. PASS and SPSS software, R packages were invoked to calculate and analyze. We found that a high CD4+ T-lymphocyte content in peripheral blood and a high CD4+/CD8+ ratio were associated with better tumor differentiation, an earlier clinical pathological stage, lower Ki67 expression, shallower tumor infiltration, a smaller number of lymph node metastases, a lower CEA content, and a lower likelihood of nerve or vascular infiltration (P < 0.05). However, a high CD8+ T-lymphocyte content indicated an unpromising clinical profile. After effective surgical treatment, the CD4+ T-lymphocyte content and CD4+/CD8+ ratio increased significantly (P < 0.05), while the CD8+ T-lymphocyte content decreased significantly (P < 0.05). Further, we comprehensively compared the merits of CD4+ T-lymphocyte content, CD8+ T-lymphocyte content, and CD4+/CD8+ ratio in predicting the clinical features of CRC. We then combined the CD4+ and CD8+ T-lymphocyte content to build models and predict major clinical characteristics. We compared these models with the CD4+/CD8+ ratio to explore their advantages and disadvantages in predicting the clinical features of CRC. Our results provide a theoretical basis for the future screening of effective markers in reflecting and predicting the progression of CRC. Changes in T lymphocyte subsets affect the progression of CRC to a certain extent, while their changes also reflect variations in the human immune system.

The evaluation of locoregional tumoral involvement in the cooccurrence of hashimoto thyroiditis with papillary thyroid cancer: a case controlled study

BackgroundPapillary thyroid carcinoma PTC is the most prevalent of all thyroid carcinomas. On the other hand, Hashimoto’s thyroiditis (HT), as part of the spectrum of autoimmune thyroid diseases, is a major cause of thyroid hypofunction worldwide. Several studies have aimed to indicate a possible correlation between PTC and HT over the years. This study aims to investigate the correlation between HT disease and PTC tumor invasion rate.MethodIn the present cross-sectional study, PTC patients with HT were selected among patients referred to the surgical ward of Shariati hospital from 2016 to 2019 and compared in terms of tumor invasion and central LN dissection. Also, a similar group of PTC patients without HT undergoing total thyroidectomy was selected for comparison. The tumor invasion rate was assessed based on invasion indices obtained from postoperative permanent pathology specimens. These indices included tumor type and size, number of involved LNs, lymphovascular involvement, perineural involvement, thyroid capsule involvement, multifocal or unifocal tumor, extrathyroidal proliferation, marginal status, and necrosis. Data were obtained and compared in the two groups with SPSS version 22.0 software.ResultsBased on the postoperative pathology reports, 50 (56.2%) PTC patients with Hashimoto thyroiditis were compared against 39 PTC patients without Hashimoto thyroiditis. No significant difference was found between the two groups regarding tumor invasion factors such as multifocality, lymphovascular invasion, marginal invasion, extrathyroidal invasion, capsular invasion, and necrosis.ConclusionHT could not be mentioned as an aggravating factor of PTC invasion based on the invasion factors evaluated in pathology specimens.

Should multifocality be an indication for prophylactic central neck dissection in papillary thyroid cancer?

Although multifocality is common in patients with papillary thyroid cancer, its effects on lymphatic metastasis and the necessity of central dissection in the presence of multifocality are still controversial. In our clinic, 258 patients who underwent thyroidectomy between 2015 and 2020 and were found to have papillary thyroid cancer in postoperative pathology reports were analyzed. The tumor characteristics contributing to central lymph node metastasis positivity were evaluated. Lymph node metastases were not significantly increased in the presence of multifocality. In cases with bilateral multifocal tumors, compared to cases with unilateral multifocal tumors, capsular invasion (p = 0.02), vascular invasion (p = 0.01) and cervical lymphatic metastasis (p = 0.004) were observed to increase. Bilateral multifocal tumors have more aggressive clinicopathological features than unilateral tumors. We found that the risk of central lymph node metastasis increased significantly in bilateral multifocal tumors in our study. Prophylactic central lymph node dissection may be considered in patients with no preoperative or intraoperative lymph node metastasis but thought to have a multifocal tumor.

Abstract P4-06-02: Complete response of ductal carcinoma in situ to neoadjuvant systemic therapy in HER2-positive invasive breast cancer patients: a nationwide analysis

Abstract Introduction Neoadjuvant systemic therapy (NST) is increasingly applied in breast cancer to increase breast-conserving surgery (BCS) rates and to improve oncological outcomes. Ductal carcinoma in situ (DCIS) can be present adjacent to invasive breast cancer (IBC), especially in HER2-positive IBC. DCIS was previously considered to be insensitive to NST. Consequently, mastectomy rates are higher in IBC with adjacent DCIS. Recent studies have shown that DCIS can be sensitive to NST, however, only small populations were investigated. Therefore, the aim of this study was to determine the rate of complete response of adjacent DCIS in HER2-positive IBC and to assess the potential influence of clinicopathological variables in a nationwide cohort. Methods All women diagnosed with HER2-positive IBC, treated with NST and surgery between January 2010 and December 2019, were selected from the Netherlands Cancer Registry (NCR). Of these patients, all pre-NST biopsy and postoperative specimen pathology reports were obtained from PALGA, the Dutch Pathology Registry, and assessed for presence of DCIS. Response of DCIS was defined as absence of DCIS in postoperative pathology when a DCIS component was present in the pre-NST biopsy. Clinicopathological factors associated with DCIS response were assessed using logistic regression analyses. Results In total, 5834 patients were included, of whom 1443 (24.7%) had a DCIS component in the pre-NST biopsy. Mastectomy rates were higher in IBC with adjacent DCIS compared to IBC without adjacent DCIS in the pre-NST biopsy (53.6% versus 41.0%, p&amp;lt; 0.001). Of these 1443 patients, 743 (51.5%) showed complete response of the DCIS component. Complete response of DCIS occurred more frequently in patients who also had a complete response of IBC (63.4% versus 33.8%, p&amp;lt; 0.001). Multivariable logistic regression analysis showed ER negative IBC (OR 1.79; 95% CI 1.33-2.42) and treatment with HER2-targeted therapy (OR 5.97; 95% CI 1.82-19.55) to be independently associated with complete response of DCIS. Conclusion More than half of HER2-positive IBC patients with adjacent DCIS in the pre-NST biopsy showed a complete response of the DCIS component to NST. Complete response of DCIS should be considered, especially in ER-negative HER2-positive IBC and in case of complete response of IBC. Future studies should investigate the evaluation of DCIS response by imaging and the possibility of increasing breast-conserving surgery rates. Citation Format: Roxanne Ploumen, Eva Claassens, Loes Kooreman, Kristien Keymeulen, Maartje van Kats, Suzanne Gommers, Sabine Siesling, Thiemo van Nijnatten, Marjolein Smidt. Complete response of ductal carcinoma in situ to neoadjuvant systemic therapy in HER2-positive invasive breast cancer patients: a nationwide analysis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-06-02.