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Aim: This study was performed to evaluate concordance between clinical and pathologic staging of non‐small cell lung cancer (NSCLC) in our hospital network. Methods: We retrospectively reviewed records of 417 patients with NSCLC who received curative surgery and whose pathology was evaluated in our hospital between 2016 and 2021. Cytology, tissue pathology, and associated clinical, surgical, and imaging information were retrieved from hospital digital records. Results: The cohort included 214 female and 203 male patients aged 20.6–85.8 years. Median times among staging computed tomography and surgery (105 days [interquartile range (IQR) 77.0–143.0]), positron emission tomography and surgery (78.5 days [IQR 56.0–109.0]), and endobronchial ultrasound‐guided transbronchial needle aspiration and surgery (59 days [IQR 42–94]) indicated that Australian guidelines of <42 days between original referral and commencement of treatment were not being met in the majority of cases. Discordance between clinical TNM (cTNM) and pathologic TNM staging was 25.9%, including 18.4% cases that were clinically understaged and two patients with undetected stage IVA disease. cTNM understaging was significantly associated with time between the final staging investigation and surgery (p =.023), pleural (p <.05) and vessel (p <.05) invasion, and diagnosis of high‐grade adenocarcinoma (p =.001). Conclusion: Discordance between clinical and pathologic staging of NSCLC is associated with tumor histopathologic characteristics and treatment delays. Although tumor factors that lead to discordant staging cannot be controlled, reduced time to surgery may have resulted in better outcomes for some patients in this potentially curable lung cancer cohort. [ABSTRACT FROM AUTHOR]

BACKGROUND: Radical surgery for cervical cancer has inherent benefits, and as upfront or post neoadjuvant chemotherapy(NACT), is extendable to locally advanced cancer cervix (LACC), with postoperative radiotherapy (PORT) for high‑risk factors. Objective of the study was to compare the effectiveness and survival between non‑PORT and PORT in high‑risk early stages. MATERIALS AND METHODS: Radical hysterectomies conducted between January 2014 and December 2017 were evaluated and followed till December 2019. Clinical, surgical–pathologic characteristics, and oncological outcomes were compared between non‑PORT and PORT groups. A similar comparison was made between alive and dead patients within each group. The impact of PORT was assessed. RESULTS: Of 178 radical surgeries, early‑LACC constituted 70%. Most (37%) of the patients belonged to stage 1b2, while stage 2b formed 5%. Mean age of patients was 46.5 years; 69% were below 50 years of age. Abnormal bleeding (41%) was the predominant symptom, followed by postcoital (20%) and postmenopausal bleeding (12%). Upfront surgeries formed 70.2%, and the average waiting period was 1.93 months (range: 1–10 months). PORT patients were 97 (54.5%) in number and the remaining formed the non‑PORT group. Mean follow‑up was 34 months, with 118 (66%) alive patients. Significant adverse prognostic factors were tumors >4 cm (44.4% patients), positive margins (10%), lymphatic vascular space invasion (LVSI; 42%), malignant nodes (33%), multiple metastatic nodes averaging seven (range: 3–11), and delayed (>6 months) presentation, but not deep stromal invasion (77% patients) and positive parametrium (8.4% patients). PORT overcame the adverse effects of tumors >4 cm, multiple metastatic nodes, positive margins, and LVSI. Total recurrences(25%) were balanced for both groups, but recurrences within 2 years were significantly more for PORT. Two‑year overall survival (78%) and recurrence‑free survival (72%), median overall survival (21 months), and median recurrence‑free interval (19 months) were significantly better for PORT, with the complication rates being similar. CONCLUSION: PORT had significantly better oncological outcomes compared to non‑PORT. Multimodal management is worthwhile. [ABSTRACT FROM AUTHOR]

PurposePathologic staging of bladder cancer patients remains a challenge. Standard-of-care histology exhibits limited sensitivity in detection of micrometastases, which can increase risk of cancer progression and delay potential adjuvant therapies. Here, we sought to develop a proof of concept novel molecular approach to improve detection of cancer micrometastasis.Experimental designWe combined fluorescence activated cell sorting and next-generation sequencing and performed whole-exome sequencing of total cancer cells and cancer cell subpopulations in multiple tumor specimens and regional lymph nodes in a single patient with muscle-invasive urothelial carcinoma of the bladder following radical cystectomy.ResultsMean allele frequency analysis demonstrated a significant correlation between primary tumor cancer cells and cancer cells isolated from the lymph nodes, confirming lymph node disease despite negative pathologic staging. RNA-sequencing revealed intratumoral heterogeneity as well as enrichment for immune system and lipid metabolism gene sets in the micrometastatic cancer cell subpopulations.ConclusionsOur analysis illustrates how next-generation sequencing of cancer cell subpopulations may be utilized to enrich for cancer cell markers and enhance detection of bladder cancer micrometastases to improve pathologic staging and provide insight into cancer cell biology.

Objectives: Neoadjuvant chemoradiation has been shown to improve survival in locally advanced esophageal and gastroesophageal junction cancer. The purpose of our study was to examine the effects of posttreatment persistent lymph node (LN) disease on overall survival (OS) and recurrence in patients with esophageal adenocarcinoma after neoadjuvant chemoradiation as well as the effect of LN harvest and the potential benefit of adjuvant chemotherapy. Methods: The records of patients who underwent esophagectomy in our hospital from January 2005 until December 2016 were analyzed. Our study group consisted of 509 patients. Results: Patient groups were created based on pathologic staging after esophagectomy (ypT N) as 22.0% of patients were ypT0 N0, 46.2% had incomplete response only at the primary tumor level (ypT + N0), and 31.8% had at least 1 metastatic lymph node (ypTx N+). Median OS was 58.3 months. The ypTx N+ group was divided into ypTx N1 and ypTx N2 or N3 subgroups based on the number of metastatic lymph nodes. The OS between the 2 groups was not significantly different (median OS, 37.6 vs 29.8 months; P = .097). The disease-free survival did show a statistically significant difference (median disease-free survival, 27.6 vs 13.7 months; P = .007). The LN harvest was not found to be significantly associated with OS. However, administration of adjuvant chemotherapy was a significant prognosticator for increased OS (hazard ratio, 0.590; P = .043). Conclusions: Our results demonstrate that residual LN disease after neoadjuvant chemoradiation is associated with increased mortality. Adjuvant chemotherapy, but not number of LNs resected, was correlated with increased OS in this subset of patients.

The detrimental impact of lymphovascular invasion (LVI) in prostate cancer on biochemical recurrence has been described; the impact of LVI on overall survival remains unclear. In this study, we determined that patients with LVI identified on final pathology after radical prostatectomy fared worse than those without. Background: The detrimental impact of lymphovascular invasion (LVI) in prostate cancer (PCa) on biochemical recurrence has been described; the impact of LVI on overall survival (OS) remains unclear. This investigation sought to evaluate the impact of LVI on OS in patients with PCa. Methods: We examined men with nonmetastatic PCa treated with radical prostatectomy between 2010 and 2015. Only men with documented LVI status were included (n = 232,704). Patients were stratified according to final pathologic T stage (pT2, pT3a, and pT3b). Results: Of the 232,704 patients who met inclusion cr iter ia, 17,758 (8%) were found to have LVI on final pathology. Overall, 174,838 (75%), 40,281 (17%), and 17,585 (8%) patients had pT2, pT3a, and pT3b disease, respectively. Median follow-up was 42.7 months (27.1-58.7). At 5 years, the OS in LVI versus non-LVI patients was 94% versus 95% in pT2 (P = .0004), 92% versus 95% in pT3a (P < .0001), and 86% versus 92% in pT3b (P < .0001). On multivariable analysis, LVI status was not an independent predictor of OS in pT2 disease (hazard ratio, 1.12; 95% confidence interval [CI], 0.93-1.36; P = .2). In pT3a and pT3b disease, presence of LVI had 1.2-fold (95% CI, 1.03-1.44; P = .02) and 1.4-fold (95% CI, 1.20-1.59; P < .001) higher overall mortality than their counterparts without LVI. Conclusions: Our report demonstrates the detrimental impact of LVI on OS in locally advanced PCa (pT3a and higher). This information may prove valuable when risk stratifying based on final pathology. [ABSTRACT FROM AUTHOR]

Objective: For human papillomavirus–associated oropharynx carcinoma treated with definitive surgery, we aimed to find predictors of adverse histopathology indicating the possible need for adjuvant therapy. Study Design: Retrospective review. Setting: National Cancer Database. Methods: We analyzed 2347 eligible patients from 2010 to 2015. We evaluated (1) the ability of clinical nodal staging and extranodal extension designation per the AJCC, seventh edition (American Joint Committee on Cancer), to predict histopathology and (2) the likelihoods for adverse postsurgery histopathology by common clinical stages. Results: Clinical nodal staging predicted pathologic nodal staging 65% of the time, with 24% (569/2347) being upstaged and 11% (251/2347) being downstaged. In patients with cN+ disease, clinical extranodal extension distinction had the following accuracy for pathologic extranodal extension: positive predictive value, 81% (88/109); negative predictive value, 73.1% (505/691); sensitivity, 32.1% (88/274); and specificity, 96.0% (505/526). Patients with cT1-2, N0-N2c, without clinical extranodal extension had the following proportions of pN2+ without pathologic extranodal extension (indicating consideration for adjuvant radiation): cN0, 11%; cN1, 31%; cN2a, 67% (8% downstaged); cN2b, 66% (6% downstaged); and cN2c, 35% (17% downstaged). From this group, patients had the following proportions of pathologic extranodal extension (indicating consideration for adjuvant chemoradiation): cN0, 6%; cN1, 20%; cN2a, 27%; cN2b, 28%; and cN2c, 48%. Conclusion: For human papillomavirus–associated oropharynx carcinoma, nodal clinical staging per the American Joint Committee on Cancer, seventh edition, predicts pathologic stage about two-thirds of the time, leading to up- and downstaging. Clinical extranodal extension assessment has low sensitivity and moderate predictive capability. With careful selection, definitive surgery can allow patients to often avoid adjuvant chemotherapy and sometimes avoid adjuvant radiation. [ABSTRACT FROM AUTHOR]

The staging for pT2/pT3 penile squamous cell carcinoma (pSCC) has undergone major changes. Some authors proposed criteria wherein the distinction between pT2/pT3 was made using the same histopathological variables that are currently utilized to differentiate pT1a/pT1b. In this single-institution, North American study, we focused on (HPV-negative) pT2/3 pSCCs (i.e., tumors invading corpus spongiosum/corpus cavernosum), and compared the prognostic ability of the following systems: (i) AJCC (8th edition) criteria; (ii) modified staging criteria proposed by Sali et al. (Am J Surg Pathol. 2020; 44:1112-7). In the proposed system, pT2 tumors were defined as those devoid of lymphovascular invasion (LVI) or perineural invasion (PNI), and were not poorly differentiated; whereas pT3 showed one or more of the following: LVI, PNI, and/or grade 3. 48 pT2/pT3 cases were included (AJCC, pT2: 27 and pT3: 21; Proposed, pT2: 22 and pT3: 26). The disease-free survival (DFS) and progression-free survival (PFS) did not differ between pT2 and pT3, following the current AJCC definitions (p = 0.19 and p = 0.10, respectively). When the pT2/3 stages were reconstructed using the modified criteria, however, a statistically significant difference was present in both DFS and PFS between pT2 and pT3 (p = 0.004 and p = 0.003, respectively). The proposed staging system has the potential to improve the prognostication of pT2/pT3 tumors in pSCC. Each of these histopathologic variables has been shown to have a significant association with outcomes in pSCC, which is an advantage. Further studies are needed to demonstrate the utility of this modified staging system in patient populations from other geographic regions., Competing Interests: Declaration of competing interest The authors of this article have no relevant financial relationships with commercial interests to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The objective of this study was to assess the rate of discordance between clinical and pathologic tumor size for women with stage IB1 cervical cancer (FIGO 2009 criteria), assess risk factors for discordance, and determine the impact of discordance on oncologic outcomes. This was a secondary analysis of a prior multi-institutional retrospective review of patients diagnosed with stage IB1 (FIGO 2009 staging) cervical cancer undergoing radical hysterectomy between 2010 and 2017. Demographic, clinicopathologic, and oncologic data were collected. Pathologic upstaging was defined as having a preoperative diagnosis of stage IB1 cervical cancer with pathology demonstrating a tumor size >4 cm. Demographic and clinicopathologic data was compared using chi-square, fisher exact or 2-sided t -test. Survival was estimated using the Kaplan-Meier method. Of the 630 patients, 77 (12%) were upstaged. Patients who were upstaged had lower rates of preoperative conization (p <.001) or preoperative tumor sizes ≤2 cm (p <.001). Upstaged patients had increased odds of deep stromal invasion, lymphovascular space invasion, positive margins and positive lymph nodes. Almost 88% of upstaged patients received adjuvant therapy compared to 29% of patients with tumors ≤4 cm (odds 18.49, 95% CI 8.99–37.94). Finally, pathologic upstaging was associated with an increased hazard of recurrence (hazard ratio [HR] 1.95, 95% CI 1.03–3.67) and all-cause death (HR 2.31, 95% CI 1.04–5.11). Pathologic upstaging in stage IB1 cervical cancer is relatively common. Upstaging is associated with an 18-fold increased risk of receipt of adjuvant therapy. Patients undergoing preoperative conization and those with tumors <2 cm had lower risks of upstaging. Improvement in preoperative assessment of tumor size may better inform primary treatment decisions. • Pathologic upstaging by tumor size in patients with FIGO 2009 stage IB1 cervical cancers affects 12% of patients. • Lower rates of upstaging were seen in patients with preoperative conization and preoperative tumor size estimates ≤2 cm. • Pathologic upstaging was associated with increased odds of presence of other poor prognostic factors. • There was an 18-fold increased risk of receipt of adjuvant therapy following surgery in patients who were upstaged. • Pathologic upstaging was associated with lower recurrence-free and overall survival on unadjusted analysis. [ABSTRACT FROM AUTHOR]

Background Precise staging of lymph node (LN) status is an important clinicopathological prognostic parameter following radical cystectomy. Aim The aim was to assess tumor recurrence in patients with T2 transitional cell carcinoma undergoing radical cystectomy with extended pelvic lymphadenectomy. Patients and methods A total of 80 patients underwent bilateral extended lymphadenectomy during radical cystectomy that reached up to the aortic bifurcation and sentinal LN. This was a multicenter study among Urology Departments of Ain Shams University Hospital, Theodor Bilharz Research Institute, and Saint Louis University Hospital. Comparison was based on classification of patients into two groups: cytokeratin 7 and 20 (CK7 and CK20) positive and negative. Results In this study, the authors used both CK7 and CK20 for evaluating the metastatic and micrometastatic burdens in LNs, and these markers were correlated with the primary bladder and its nodal metastases. After displaying the results, we evaluated the markers as follows: CK7 sensitivity is 100%, whereas specificity is 65% and showed 48.8% positive predictive value and 100% negative predictive value, with overall accuracy of 73.8%. CK20 has a sensitivity of 100%, whereas specificity is 65% and showed 48.8% positive predictive value and 100% negative predictive value, with overall accuracy of 73.8%. Conclusion The use of molecular markers provides a better and proper nodal staging but what is thought to be a disadvantage is the exaggerated sensitivity sometimes gives false-positive results. [ABSTRACT FROM AUTHOR]

We sought to identify the reliability of AJCC clinical staging was in comparison to pathologic staging in surgically resected patients with pancreatic cancer. We used the National Cancer Database Pancreas from 2004 to 2016 and evaluated patients who underwent resection for PDAC with all documented components of clinical and pathologic stage. We first evaluated the distribution of overall clinical stage and pathologic stage and then evaluated for stage migration by assessing the number of patients who shifted from a clinical stage group to a respective pathologic stage group. To further characterize the migratory pattern, we assessed the distribution of clinical and pathologic T-stage and N-stage. In our cohort of 28,338 patients who underwent resection for PDAC, AJCC clinical staging did not reliably predict pathologic stage. Stage migration after resection was responsible for discrepancies between the distribution of overall clinical stage and pathologic stage. The predominant migration was from patients with clinical stage I disease to pathologic stage II disease. Most patients with clinical T1 and T2 disease were upstaged to pathologic T3 disease and over half of patients with clinical N0 disease were upstaged to pathologic N1 disease after resection. Clinical staging appears to overrepresent early T1, T2, and N0 disease, and underrepresent T3 and N1 disease. [ABSTRACT FROM AUTHOR]

Background Radiologic assessment of tumor size is an integral part of the work-up for breast carcinoma. With improved radiologic equipment, surgical decision relies profoundly upon radiologic/clinical stage. We wanted to see the concordance between radiologic and pathologic tumor size to infer how accurate radiologic/clinical staging is. Materials and methods The surgical pathology and ultrasonography reports of patients with breast carcinoma were reviewed. Data were collected for 406 cases. Concordance was defined as a size difference within ±2 mm. Results The difference between radiologic and pathologic tumor size was within ±2 mm in 40.4% cases. The mean radiologic size was 1.73 ± 1.06 cm. The mean pathologic size was 1.84 ± 1.24 cm. A paired t-test showed a significant mean difference between radiologic and pathologic measurements (0.12 ± 1.03 cm, p = 0.03). Despite the size difference, stage classification was the same in 59.9% of cases. Radiologic size overestimated stage in 14.5% of cases and underestimated stage in 25.6% of cases. The concordance rate was significantly higher for tumors ≤2 cm (pT1) (51.1%) as compared to those greater than 2 cm (≥pT2) (19.7%) (p < 0.0001). Significantly more lumpectomy specimens (47.5%) had concordance when compared to mastectomy specimens (29.8%) (p < 0.0001). Invasive ductal carcinoma had better concordance compared to other tumors (p = 0.02). Conclusion Mean pathologic tumor size was significantly different from mean radiologic tumor size. Concordance was in just over 40% of cases and the stage classification was the same in about 60% of cases only. Therefore, surgical decision of lumpectomy versus mastectomy based on radiologic tumor size may not always be accurate. [ABSTRACT FROM AUTHOR]

Introduction: Urothelial Carcinomas (UC) are heterogenous disease with unpredictable outcome. Risk stratification plays an important role in the management as 70% tumours are NonMuscle Invasive (NMI) at the time of diagnosis. It is difficult to make prognosis for individual patients due to high rates of recurrence and progression. Over-expression of p53 cell cycle regulator protein is associated with high grade, high stage of bladder cancer and important in the multistep progression with an unfavourable prognosis. The p53 immunohistochemical staining intensity and score status identifies patients needing early cystectomy for treatment of NMI or aggressive adjuvant therapy after cystectomy. Aim: To assess the immunohistochemical expression patterns of p53 in UC of the urinary bladder and to find out the relationship between p53 over expression with clinicopathological parameters like grading and pathological staging. Materials and Methods: The study was conducted in JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru. A total of 50 cases of UC of the bladder were included in the study (2 years each of retrospective-October 2012 to September 2014 and prospective study-October 2014 to September 2016) over a duration of two years. The over expression of p53 antigen was evaluated by Immunohistochemistry (IHC) as intensity and a score based on the percentage of tumour cells staining positive after counting at least 500 cells in each case using high power objective of the microscope (x400). RESULTS: Among 50 cases, 39 (78%) tumours were high grade and 11 were low grade. A 49 (98%) were positive for p53 over expression and 01 (2%) high grade non papillary tumour was negative. Higher intensity (3+) and score (4+) of p53 over expression was seen with higher grade than lower grade with statistically significant p-value (intensity - < 0.001, score - 0.006). Also, when evaluated separately this correlation was found significant in high grade NMI (p-value: intensity- 0.021, score – 0.025) rather than muscle invasive tumours. No relationship was established between p53 over expression with pathological stage of tumour and other clinicopathological parameters. CONCLUSION: Higher p53 over expression is associated with higher grade, particularly in NMI tumours which may go for progression and recurrence. Therefore, p53 over expression by IHC can provide important prognostic information in risk stratification of UC of the bladder. It aid in appropriate modification of treatment management and better understanding biological behaviour of UC.

Recent advances in minimally invasive endoscopic approaches have introduced new resection techniques including the Endoscopic Full Thickness Resection (EFTR) for therapeutic and diagnostic applications. EFTR offers minimally invasive surgery for mucosal or subepithelial lesions that cannot be resected with standard Endoscopic Mucosal Resection or Endoscopic Submucosal Dissection techniques, due to anatomical location or presence of fibrosis (nonlifting epithelial lesions) allowing a safe and effective method to resect the entire gastrointestinal (GI) wall. EFTR is particularly useful for resecting small (<2 cm) subepithelial lesions that arise within the muscular wall that previously required a surgical approach. In addition to therapeutic resections, EFTR biopsies can be diagnostically useful for evaluating a variety of gastrointestinal neuromuscular diseases as well as diagnosing other inflammatory and neoplastic conditions that involve deeper layers of the gut wall. With refinement in resection techniques and increased experience with EFTR, indications for minimally invasive surgery will increase and a standardized pathologic assessment of these specimens will be incorporated into working practice guidelines. [ABSTRACT FROM AUTHOR]

Introduction. The staging of breast carcinoma is mainly dependent on tumor size and lymph node status. Small increments in tumor size upstage the patient. An accurate determination of the tumor size is therefore critically important. Although the final staging is based on microscopic size, pathologists rely on gross measurements in a considerable number of cases. Methods. We investigated the concordance between gross and microscopic measurements of breast carcinoma as well as factors affecting this concordance. This study is a retrospective review of surgical pathology reports of invasive breast carcinomas. Data were collected for 411 cases. Concordance was defined as a size difference within ±2 mm. Results. Gross and microscopic sizes were identical in 33.1% of cases. Gross and microscopic size difference was within ±2 mm in 56% of cases. Despite the size difference, stage classification ended up being the same in 68.6% of cases. Tumor stage was over estimated by gross measurement in 17.0% of cases and underestimated in 14.4% of cases. The concordance was significantly higher for those tumors in which final pathologic tumor (pT) size was greater than 2 cm (≥pT2) as compared with those less than or equal to 2 cm (≤pT1; P < .0001). A higher proportion of mastectomy specimens (61.4%) were concordant as compared with lumpectomy specimens (52.1%). Conclusion. Gross and microscopic tumor sizes were concordant in 56% of cases. Stage classification based on gross and microscopic tumor size was different in nearly one third (31.4%) of cases. Gross tumor size is critically important in accurate staging at least in cases where tumor size cannot be confirmed microscopically. [ABSTRACT FROM AUTHOR]

Objective: The rapid worldwide rise in incidence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) has generated studies confirming this disease as an entity distinct from traditional OPSCC. Based on pathology, surgical studies have revealed prognosticators specific to HPV-positive OPSCC. The current AJCC/UICC staging and pathologic nodal (pN)-classification do not differentiate for survival, demonstrating the need for new, HPV-specific OPSCC staging. The objective of this study was to define a pathologic staging system specific to HPV-positive OPSCC.Methods: Data were assembled from a surgically-managed, p16-positive OPSCC cohort (any T, any N, M0) of 704 patients from five cancer centers. Analysis was performed for (a) the AJCC/UICC pathologic staging, (b) newly published clinical staging for non-surgically managed HPV-positive OPSCC, and (c) a novel, pathology-based, "HPVpath" staging system that combines features of the primary tumor and nodal metastases.Results: A combination of AJCC/UICC pT-classification and pathology-confirmed metastatic node count (⩽4 versus ⩾5) yielded three groups: stages I (pT1-T2, ⩽4 nodes), II (pT1-T2, ⩾5 nodes; pT3-T4, ⩽4 nodes), and III (pT3-T4, ⩾5 nodes), with incrementally worse prognosis (Kaplan-Meier overall survival of 90%, 84% and 48% respectively). Existing AJCC/UICC pathologic staging lacked prognostic definition. Newly published HPV-specific clinical stagings from non-surgically managed patients, although prognostic, showed lower precision for this surgically managed cohort.Conclusions: Three loco-regional "HPVpath" stages are identifiable for HPV-positive OPSCC, based on a combination of AJCC/UICC primary tumor pT-classification and metastatic node count. A workable, pathologic staging system is feasible to establish prognosis and guide adjuvant therapy decisions in surgically-managed HPV-positive OPSCC. [ABSTRACT FROM AUTHOR]

Background Histopathologic diagnostic features such as tumor thickness, ulceration, mitoses, microsatellitosis and nodal metastases are principal pathologic staging components of cutaneous melanomas. We chose to focus on evaluating the presence of multinucleated giant cells in microscopic sections as a putative novel prognosticating diagnostic feature of melanoma. Methods We assembled a retrospective cohort comprised of 562 cases of melanoma. We annotated each case for a multitude of known clinicopathologic variables to allow robust statistical evaluation of our cohort. Results Only 37 cases (6.6%) exhibited the multinucleated giant cells phenotype. Virtually all multinucleated giant cells were localized in the reticular dermis. Of interest, melanomas with multinucleated giant cells were roughly twice more likely to occur on head and neck sites (p = 0.04). Melanomas with multinucleated giant cells phenotype had both comparable melanoma recurrence (p = 0.12) and similar melanoma-specific mortality when compared with melanomas without multinucleated giant cells phenotype (p = 0.26). Conclusion Despite prior anecdotal reports possibly linking multinucleated giant cells phenotype to more aggressive clinical course, we find that melanomas with multinucleated giant cells phenotype is not associated with shorter survival. [ABSTRACT FROM AUTHOR]

In this work, samples of non-neoplastic and adenocarcinoma-affected human colon tissue samples were analyzed using multipoint transmission time-domain THz spectroscopy (THz-TDS) to sort out the contrast-contributing factors other than water, the main contrast mechanism factor in in-vivo or in freshly excised bio-tissue. Solving the electromagnetic inverse problem through THz-TDS and, analyzing the transmittance spectra that yielded the frequency-dependent absorption coefficient α and refractive index n of non-neoplastic and neoplastic tissues, we show that it is possible to distinguish between non-neoplastic and neoplastic regions in paraffin-embedded dehydrated. Results and discussion are presented. [ABSTRACT FROM AUTHOR]

The purposes of this study are to evaluate the adequacy of pathologic lymph node (LN) staging in radical cystectomy specimens from patients with urothelial carcinoma of the bladder and to analyze the frequency of LN metastases among different anatomic regions. All radical cystectomies performed for primary urothelial bladder cancer over a 5-year period (January 2007-September 2012) at a single institution were reviewed. Particular attention was paid to the total number of LNs examined, the number and location of LNs with metastases (positive LNs), and the presence or absence of extranodal tumor extension and/or lymphovascular invasion in the cystectomy specimen. Results and data were analyzed with Origin 6.0 and Microsoft Office Excel 2007 software. A total of 248 radical cystectomies with 8,432 LNs were reviewed. A total of 60 (24 %) cases, with 274 positive LNs out of the 1,982 total (13.8 %), were identified with a male to female ratio of 6.5:1 (52 male, 8 female patients). The average number of LNs examined in each case was 33.0 ± 20.9 (range 5-112). The average number of positive LNs identified in each case was 4.5 ± 4.8 (range 1-26). Among all of the LNs, the hypogastric/obturator (internal iliac) LNs were the most commonly submitted (35.2 %) and also yielded the highest number of positive LNs (46.0 %). On average, for cases staged pN1 and pN2, there was one positive LN per 17.8 and 8.9 LNs examined from the primary drainage LNs, respectively. For pN3 cases, one out of 4.4 secondary drainage LNs was found to be positive. Similarly, one out of 4.0 distant LNs was found to be positive in cases with pM1 staging. Our study suggests that, on average, 23 LNs (including 18 primary drainage LNs and five secondary drainage LNs) should be submitted for optimal pN staging. For adequate pM1 staging, an average of four distal LNs should be evaluated. In total, an average of 27 LNs (23 for pN staging and 4 for pM staging) should be examined in radical cystectomy specimens. We also propose to stratify the number of positive LNs according to the drainage area. [ABSTRACT FROM AUTHOR]

Staging and reporting of cancers of the urinary tract have undergone major changes in the past decade to meet the needs for improved patient management. Substantial progress has been made. There, however, remain issues that require further clarity, including the substaging of pT1 tumors, grading and reporting of tumors with grade heterogeneity, and following NAC. Multi-institutional collaborative studies with prospective data will further inform the accurate diagnosis, staging, and reporting of these tumors, and in conjunction with genomic data will ultimately contribute to precision and personalized patient management., Competing Interests: Disclosure Authors have no conflicts of interest to declare that are relevant to the content of this article., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objectives: To review the diagnosis, staging, and treatments (both standard and novel) for advanced melanoma and discuss the nursing role in the care of patients with melanoma. Data Sources: Published research and education articles, on-line journals, recent texts, and references from pertinent articles. Conclusion: Most melanomas are diagnosed at early localized stages when surgery alone can be curative. For patients diagnosed with metastatic disease, treatment options have been limited and generally considered ineffective. Recent developments in tumor genetics and a greater understanding of the role of the immune system in cancer have translated to better treatments. Implications for Nursing Practice: Nurses play a key role in ensuring that patients with melanoma understand their diagnosis, treatment recommendations (including supportive care, palliative chemotherapy, immunotherapies), and participation in clinical trials. [Copyright &y& Elsevier]

Introduction: Pathologic stage is a critically important prognostic factor after radical cystectomy (RC) that is used to guide the use of secondary therapies. However, the risk of disease recurrence, for patients clinically diagnosed with muscle-invasive tumors who are found not to have muscle-invasive disease at RC are poorly defined. Therefore, we reviewed the long-term outcomes in patients who were downstaged to non-invasive urothelial carcinoma at time of RC. Methods: We identified 1,177 consecutive patients with muscle-invasive urothelial carcinoma of the bladder who underwent radical cystectomy at our institution between 1980 and 1999 without neoadjuvant therapy. Postoperative disease recurrence and survival were estimated using the Kaplan-Meier method and compared using the log rank test. Cox proportional hazard regression models were used to analyze the impact of pathologic stage on survival. Results: Pathologic downstaging to non-muscle invasive disease was identified in 538 (45.7 %) patients. The 10-year cancer-specific survival was 84.1, 77.4, 71.1 and 58.5 % for those with pT0, pTis, pT1 and pT2 tumors, respectively. On multivariate analysis, the risk of cancer-specific mortality was significantly decreased for patients with non-muscle invasive disease than those with organ-confined muscle invasion (RR−0.39; p = 0.002). There was no difference in disease-specific mortality among patients who had non-invasive (pT0, pTa, or pTis) disease ( p = 0.19). Conclusions: Downstaging from clinical muscle-invasive bladder cancer to non-muscle invasive disease at RC is associated with a significant reduction in cancer-specific mortality. However, even patients with residual non-muscle invasive disease may suffer disease recurrence and require continued surveillance after surgery. [ABSTRACT FROM AUTHOR]

Introduction: The impact of the number of lymph node (LN) evaluated pathologically on accurate staging is unknown. Our primary aim was to determine a minimum number of evaluated LN needed to provide accurate staging of pancreatic cancer. Methods: Four hundred ninety-nine patients underwent a curative pancreatectomy for pancreatic adenocarcinoma cancer from 1981-2007. The probability of understaging a patient as N0 was estimated based on the number of LN evaluated. The prognostic value of LN ratio (LNR) was assessed. Results: Survival for node-negative (pN0) patients with <11 LN examined was worse than for pN0 patients with ≥11 LNs with a hazard ratio (95 % CI) of 1.33 (1.1-1.7, p = 0.01) with 3-year survivals of 32 vs. 50%, respectively. Three-year survival for pN1 patients with <11 nodes evaluated was similar to pN1 patients with ≥11 nodes (25 vs. 30%). LNR ≥ 0.17 predicted worse survival with hazard ratio of 1.76 (1.3-2.4, p = 0.001) than LNR < 0.17; 3-year survivals were 37 vs. 19%. Conclusion: Patients with 'N0' disease with <11 LN evaluated pathologically have worse survival, suggesting that metastatic nodes were missed by evaluating too few nodes. For pN1 patients, LNR stratifies survival of patient cohorts more accurately. Adequate staging of pancreatic cancer requires pathologic evaluation of ≥11 LNs. [ABSTRACT FROM AUTHOR]

Background: The management of Merkel cell carcinoma (MCC) has been complicated by a lack of detailed prognostic data and by the presence of conflicting staging systems. Objective: We sought to determine the prognostic significance of tumor size, clinical versus pathologic nodal evaluation, and extent of disease at presentation and thereby derive the first consensus staging/prognostic system for MCC. Methods: A total of 5823 prospectively enrolled MCC cases from the National Cancer Data Base had follow-up data (median 64 months) and were used for prognostic analyses. Results: At 5 years, overall survival was 40% and relative survival (compared with age- and sex-matched population data) was 54%. Among all MCC cases, 66% presented with local, 27% with nodal, and 7% with distant metastatic disease. For cases presenting with local disease only, smaller tumor size was associated with better survival (stage I, ≤2 cm, 66% relative survival at 5 years; stage II, >2 cm, 51%; P < .0001). Patients with clinically local-only disease and pathologically proven negative nodes had better outcome (76% at 5 years) than those who only underwent clinical nodal evaluation (59%, P < .0001). Limitations: The National Cancer Data Base does not capture disease-specific survival. Overall survival for patients with MCC was therefore used to calculate relative survival based on matched population data. Conclusion: Although the majority (68%) of patients with MCC in this nationwide cohort did not undergo pathologic nodal evaluation, this procedure may be indicated in many cases as it improves prognostic accuracy and has important treatment implications for those found to have microscopic nodal involvement. [ABSTRACT FROM AUTHOR]

The article reports on the study which examined the pathologic characteristics of patients with epithelioid malignant pleural mesothelioma (MPM). It compared the survival rates of patients who underwent extrapleural pneumonectomy (EPP) with or without the tumor or lymph node guided adjustments. It implies that the proposed adjustments had improved the outcome stratification of patients with epithelial tumor histology from the surgical EPP therapy and complete pathologic assessment.

The article discusses the study by Vanderbilt University Medical Center to determine the difference in survival between patients with lymph node-negative pathologic t3a against pathologic T3b urothelial carcinoma of the bladder. The study conducted from 1995 to 2005 wherein patients undergo radical cystectomy for urothelial carcinoma. It shows no significant difference between pT3a and pT3b urothelial cancer of the bladder based on the American Joint Committee on Cancer staging system.

Abstract: Keeping current with medical innovations is a challenge that all health care professionals are faced with. The closed expert meeting “New Horizons in Urology” (NHU), which takes place yearly, aims to give practising urologists an overview of new information and its potential implementation in clinical practice. The NHU2007 meeting was held in June in Monte Carlo, Monaco. The meeting focused on the multidisciplinary management of the prostate cancer (PCa) patient, which included the concept of modern androgen-deprivation therapy (ADT) for optimal control of testosterone as well as considerations about a new paradigm in clinical practice, integrative medicine. Furthermore, some pitfalls of pathological staging in PCa regarding core needle biopsies and radical prostatectomy specimens were highlighted. In addition, the technical advances of modern external beam radiation therapy (RT) as well as the clinical application of RT after radical prostatectomy and in combination with ADT were discussed. [Copyright &y& Elsevier]

Abstract: Objectives: This manuscript reviews the possible pitfalls that may appear when the extent of prostate cancer is assessed by studying core biopsies and radical prostatectomy specimens. Methods: The data presented are the result of a review of the literature and the author''s experience contrasted with and implemented in discussion with a group of European urologists during a meeting in Monte Carlo, Monaco. Results: A core biopsy of the extent of prostate cancer is made by means of indirect data with Gleason score and tumour volume as the main ones, in addition to intraprostatic perineural invasion. Consequently, they can only determine the risk of invasion but not the extent of prostate cancer. Radical prostatectomy pathologic staging, on the other hand, is a direct determination of prostate cancer, but the urologist must be perfectly aware of a series of limitations, such as quantity of periprostatic fat tissue, handling artefacts, and diagnosis of morphologic criteria, before deciding on further treatment. Conclusions: Although pathologic staging appears easy and totally reproducible among observers, we must be aware of its limitations in the interests of improving the evaluation and being able to make more solidly based decisions. Excellence results from a close relationship between the pathologist and urologist that leads to better handling of the specimens and improvement of the morphologic criteria. [Copyright &y& Elsevier]

The article discusses the invasive procedures for confirmatory staging of the mediastinum in patients with lung cancer. Particular focus is on patients in whom there is a strong suspicion of lung cancer. Such presumptive clinical diagnosis is generally possible by an experienced clinician after an assessment of risk factors, and a review of the clinical presentation and the radiographic appearance on a computed tomography (CT) scan.

Objective: Clinical staging of non-small cell lung cancer helps to determine the extent of disease and separate patients with potentially resectable disease from those that are unresectable. Since, clinical staging is based on radiologic and bronchoscopic findings, overstaging or understaging may occur comparing to the final surgical-pathologic evaluation. We aimed to analyze preoperative and postoperative stagings in order to evaluate stage migrations and our surgical strategy for marginally resectable patients. Methods: We did a retrospective analysis of 180 patients with non-small cell lung cancer who underwent resectional surgery between 1994 and 2000. In all patients, a thoracic computerized tomography and bronchoscopy were performed to define clinical staging (cTNM). Results: In 86 patients (47.7%) clinical and surgical-pathologic staging concurred. When comparing T subsets alone, correct staging, overstaging and understaging occurred in 133 (73.9%), 28 (15.5%), 47 (26.1%) patients, respectively. Only 13 of 21 patients (61.9%) who were thought to have T4 tumor preoperatively were found to have pT4. Also six patients with cT2 and five patients with cT3 were subsequently found to have T4 disease according to pathology. Clinical staging overestimated the nodal staging in 35 patients (19.4%), while underestimated the lymph node involvement in 45 patients (25%). Conclusion: Construction of cTNM stage remains a crude evaluation, preoperative mediastinoscopy in every patient must be performed. Preoperative limited T4 disease is not to deny surgery to patients since a considerable number of patients with cT4 are to be understaged following surgery. [Copyright &y& Elsevier]