Audio/Video Insights, Implications, Questions, Answers: Report of the Investigators of Surgical and Pathology Issues at Three Essex County Hospitals

Note: this audio/video (62 minutes) refers to the investigation into this year's media reports concerning unnecessary mastectomies/pathology issues and national public exposure of the issue; quality of surgical and pathology care in Windsor/Essex counties (Ontario); notes co-operative investigation (patients??...still listening - terms of reference....)

Quality of pathology reports for advanced ovarian cancer: Are we missing essential information? An audit of 479 pathology reports from the EORTC-GCG 5

Quality of pathology reports for advanced ovarian cancer: Are we missing essential information? An audit of 479 pathology reports from the EORTC-GCG 55971/NCIC-CTG OV13 neoadjuvant trial

 

CONCLUSION: This audit of ovarian cancer pathology reports reveals that in a substantial number of reports basic pathologic data are missing, with possible adverse consequences for the quality of cancer care. Specialisation by pathologists and the use of standardised synoptic reports can lead to improved quality of reporting. Further research is needed to better define pre- and post-operative diagnostic criteria for ovarian cancer treated with neoadjuvant chemotherapy.

Quality of pathology reports for advanced ovarian cancer: Are we missing essential information?: (multinational study)

Note: a related is the international shortage of oncologic pathologists

Quality of pathology reports for advanced ovarian cancer: Are we missing essential information?: An audit of 479 pathology reports from the EORTC-GCG 55971/NCIC-CTG OV13 neoadjuvant trial  

Conclusion This audit of ovarian cancer pathology reports reveals that in a substantial number of reports basic pathologic data are missing, with possible adverse consequences for the quality of cancer care. Specialisation by pathologists and the use of standardised synoptic reports can lead to improved quality of reporting. Further research is needed to better define pre- and post-operative diagnostic criteria for ovarian cancer treated with neoadjuvant chemotherapy.

Subspecialisation and despecialisation in anatomical pathology -- Journal of Clinical Pathology

Abstract: Which staging system to use for gynaecological cancers: a survey with recommendations for practice in the UK

Aims
There are two commonly used staging systems for gynaecological cancers, namely Federation Internationale de Gynecologie et d'Obstetrique (FIGO) and TNM. The authors wished to ascertain which staging system is most commonly used in dealing with gynaecological cancers in the UK.
Methods
The authors undertook a survey among participants in the National Gynaecological Pathology EQA scheme to investigate whether gynaecological pathologists in the UK use FIGO or TNM staging in their routine reporting of gynaecological cancers.
Results
There were 105 respondents out of 278 participants (38%). Of the analysed results, a majority of respondents (64%) use FIGO staging, while 32% use both FIGO and TNM. 80% of respondents stated that their multidisciplinary team meeting uses FIGO staging, while 18% use both FIGO and TNM. Only an extremely small minority of pathologists and multidisciplinary team meetings use TNM alone. A survey of members of the British Gynaecological Cancer Society revealed similar findings.
Conclusions
Since FIGO and TNM are not always equivalent, and there may be confusion when more than one staging system is used, it is recommended that FIGO staging be used for gynaecological cancers. The survey revealed support for the use of TNM, as well as FIGO, only for cervical cancer, since FIGO does not take the lymph node status into account. Given the prevalent practice in the UK, the British Association of Gynaecological Pathologists, British Gynaecological Cancer Society and gynaecological clinical reference group of the National Cancer Intelligence Network recommend that FIGO staging be used for gynaecological cancers with recording of the lymph node status for cervical cancer. This may be done by providing a TNM stage for this cancer type only or by recording the lymph-node status at the multidisciplinary team meeting.

abstract: DNA copy numbers profiles in affinity-purified ovarian clear cell carcinoma (research/pathology)

Note: in research

CONCLUSIONS: This study provides the first high resolution, genome-wide view of DNA copy number alterations in ovarian CCC. The findings provide a genomic landscape for future studies aimed at elucidating the pathogenesis and developing new target-based therapies for CCCs.


Abstract

PURPOSE: Advanced ovarian clear cell carcinoma (CCC) is one of the most aggressive ovarian malignancies, in part because it tends to be resistant to platinum-based chemotherapy. At present, little is known about the molecular genetic alterations in CCCs except that there are frequent activating mutations in PIK3CA. The purpose of this study is to comprehensively define the genomic changes in CCC based on DNA copy number alterations.

EXPERIMENTAL DESIGN: We performed 250K high-density single nucleotide polymorphism array analysis in 12 affinity-purified CCCs and 10 CCC cell lines. Discrete regions of amplification and deletion were also analyzed in additional 21 affinity-purified CCCs using quantitative real-time PCR.

RESULTS: The level of chromosomal instability in CCC as defined by the extent of DNA copy number changes is similar to those previously reported in low-grade ovarian serous carcinoma but much less than those in high-grade serous carcinoma. The most remarkable region with DNA copy number gain is at chr20, which harbors a potential oncogene, ZNF217. This discrete amplicon is observed in 36% of CCCs but rarely detected in serous carcinomas regardless of grade. In addition, homozygous deletions are detected at the CDKN2A/2B and LZTS1 loci. Interestingly, the DNA copy number changes observed in fresh CCC tissues are rarely detected in the established CCC cell lines.

CONCLUSIONS: This study provides the first high resolution, genome-wide view of DNA copy number alterations in ovarian CCC. The findings provide a genomic landscape for future studies aimed at elucidating the pathogenesis and developing new target-based therapies for CCCs.

Upstaging pathologic stage I ovarian carcinoma based on dense adhesions is not warranted: A clinicopathologic study of 84 patients originally originally classified as FIGO stage II

Note: very interesting study, albeit abstract

 

Abstract

BACKGROUND: 

FIGO stage II ovarian cancer comprises 8% of ovarian cancers. It is a common but not universal practice to upstage densely adherent pathologic stage I tumors to stage II. FIGO guidelines are not clear, and data supporting this practice are sparse.

METHODS:

We retrospectively reviewed patients with stage II ovarian cancer and grouped them based upon histologic evidence of extraovarian extension. Tumors densely adherent to extraovarian structures but without histologic tumor outside the ovary were considered pathologic stage I. All others were considered surgical-pathologic stage II. Three histologic patterns of extraovarian tumor involvement were identified.

RESULTS:

Eighty-four patients were studied. Twenty-four patients had pathologic stage I disease and 60 had histologic evidence of extraovarian pelvic spread and were surgical-pathologic stage II. The 5-year survival for stage I was 100%, and the median survival was not reached. The 5-year survival for those with surgical-pathologic stage II disease was 56.8% and the median survival was 73months. There were no differences observed based upon pattern of extraovarian spread. The survival difference between pathologic stage I and surgical-pathologic stage II was significant (p<0.001). There were no differences seen in 5-year survival among surgical-pathologic stage II patients with serous, endometrioid or clear cell histologies (64.5%, 64.8% and 64.3% respectively).

CONCLUSION:

These retrospective data suggest that the practice of upstaging densely adherent pathologic stage I tumors to stage II may not be warranted. Cell type is not a prognostic factor in stage II.

abstract: Ovarian Cancer Development and Metastasis American Journal of Pathology

abstract: Diagnosis of ovarian carcinoma cell type is highly reproducible: a transcanadian study

Quality in Cancer Diagnosis (diagnostic pathology)

Summary

The quality of oncologic pathology testing currently is focused on the evaluation of testing steps involved in the ordering, procuring, processing, interpreting, reporting, and decision making based on pathology test results. Most errors in cancer diagnosis are related to several factors and not simply a pathologist's interpretation. Clinical practitioners may improve the safety of oncologic pathology testing services by facilitating communication between clinical services and pathology laboratories at all levels of testing.

The pathology of and controversial aspects of ovarian borderline tumours

Abstract
PURPOSE OF REVIEW: Ovarian borderline tumours are relatively uncommon, but not rare, neoplasms. Pathologists and oncologists often struggle with various aspects of borderline tumours which are sometimes controversial and poorly understood.

from website: mybiopsy.org: CAP and ASCO ER/PgR Test Guideline - College of American Pathologists

What to Know: The CAP and ASCO Guideline on Estrogen and Progesterone Receptor Testing for Breast Cancer Introduction To help doctors give their patients the best possible care, the College of American Pathologists and the American Society of Clinical Oncology (ASCO) developed evidence-based recommendations to improve the accuracy of testing for estrogen and progesterone receptors for breast cancer. This guide for patients is based on CAP’s and ASCO’s recommendations. Key Points: * Estrogen and progesterone receptors are found on breast cancer cells that depend on estrogen and related hormones to grow. * All patients with invasive breast cancer or a breast cancer recurrence should have their tumors tested for estrogen and progesterone receptors. * This testing should be performed by an accredited laboratory that follows specific testing procedures and handles the samples in a consistent way.

Hormone replacement therapy (HRT), breast cancer and tumor pathology