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Chatterjee A, Chaudhary A, Ghosh A, Arun P, Mukherjee G, Arun I, Maitra A, Biswas N, Majumder PP. Overexpression of CD73 is associated with recurrence and poor prognosis of gingivobuccal oral cancer as revealed by transcriptome and deep immune profiling of paired tumor and margin tissues. Cancer Med 2023; 12:16774-16787. [PMID: 37392167 PMCID: PMC10501293 DOI: 10.1002/cam4.6299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/16/2023] [Accepted: 06/18/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND For various cancers, differences in response to treatment and subsequent survival period have been reported to be associated with variation in immune contextures. AIM We sought to identify whether such association exists in respect of gingivobuccal oral cancer. MATERIALS AND METHODS We performed deep immune profiling of tumor and margin tissues collected from 46 treatment naïve, Human Papillomavirus (HPV) negative, patients. Each patient was followed for 24 months and prognosis (recurrence/death) noted. Key findings were validated by comparing with TCGA-HNSC cohort data. RESULTS About 28% of patients showed poor post-treatment prognosis. These patients exhibited a high probability of recurrence even within 1 year and death within 2 years. There was restricted immune cell infiltration in tumor, but not in margin, among these patients. Reduced expression of eight immune-related genes (IRGs) (NT5E, THRA, RBP1, TLR4, ITGA6, BMPR1B, ITGAV, SSTR1) in tumor strongly predicted better quality of prognosis, both in our patient cohort and in TCGA-HNSC cohort. Tumors of patients with better prognosis were associated with (a) lower CD73+ cells with concomitant lower expression level of NT5E/CD73, (b) higher proportions of CD4+ and CD8+ T cells, B cells, NK cells, M1 macrophages, (c) higher %Granzyme+ cells, (d) higher TCR and BCR repertoire diversities. CD73 expression in tumor was associated with low CD8+ and CD4+ T cells, low immune repertoire diversity, and advanced cancer stage. DISCUSSION AND CONCLUSION High infiltration of anti-tumor immune cells in both tumors and margins results in good prognosis, while in patients with minimal infiltration in tumors in spite of high infiltration in margins results in poor prognosis. Targeted CD73 immune-checkpoint inhibition may improve clinical outcome.
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Affiliation(s)
- Ankita Chatterjee
- National Institute of Biomedical GenomicsKalyaniIndia
- John C. Martin Centre for Liver Research and InnovationsKolkataIndia
| | | | - Arnab Ghosh
- National Institute of Biomedical GenomicsKalyaniIndia
| | | | | | | | | | - Nidhan Biswas
- National Institute of Biomedical GenomicsKalyaniIndia
| | - Partha P. Majumder
- National Institute of Biomedical GenomicsKalyaniIndia
- John C. Martin Centre for Liver Research and InnovationsKolkataIndia
- Indian Statistical InstituteKolkataIndia
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Gupta R, Das J, Sinha S, Agarwal S, Sharma A, Ahmed R, Chanda A, Arun I, Ray S. Detection of Axillary Lymph Node Involvement in Early-Stage Breast Cancer: Comparison between Staging 18F-2-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography-Computed Tomography Scans, Mammography, and Sentinel Lymph Node Biopsy. Indian J Nucl Med 2023; 38:249-254. [PMID: 38046972 PMCID: PMC10693364 DOI: 10.4103/ijnm.ijnm_183_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/20/2022] [Accepted: 12/24/2022] [Indexed: 12/05/2023] Open
Abstract
Aims The aim of this study was to evaluate the role of 18F-2-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) scan in the detection of axillary lymph node (ALN) involvement and comparison with sentinel lymph node biopsy (SLNB) in operable early-stage breast cancer (EBC). Settings and Design It is a retrospective analysis of staging PET-CT scan of EBC. Methods A total of 128 patients with histopathologically proven breast cancer (BC) were included in the study. Preoperative mammography supplemented with ultrasonography and staging 18F-FDG PET-CT scan was done for all patients. Surgery was done within 30 (mean ± standard deviation = 13.8 ± 10.5) days of staging. SLNB was performed in patients without PET-positive ALNs. All patients with positive sentinel nodes and PET-positive ALNs underwent axillary lymph node dissection (ALND). Statistical Analysis Used The comparison between categorical variables was made by Chi-square/Fisher's exact test as applicable. For continuous variables comparisons, Student's t-test and one-way analysis of variance tests were used. Results Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PET-CT scan for detection of ALN involvement were 41.7%, 93.2%, 92.1%, and 45.6%, respectively. Sensitivity, specificity, PPV, and NPV of mammography were 84.5%, 54.5%, 78.0%, and 68.6%, respectively. Sixteen out of 46 (34.7%) patients with negative ALNs in PET-CT scan finally showed involvement in histopathology report after SLNB resulting in upstage of the disease. The size of tumor deposits in sentinel nodes was significantly smaller than PET-positive ALNs (P = 0.01). Our observations correlate with the results of earlier studies published in the literature. Conclusions 18F-FDG PET-CT scan cannot substitute SLNB for ALN screening in EBC. The limitations are most marked in smaller and micrometastatic tumor deposits in ALNs and may be attributed to limitations of PET resolution. However, PET-positive nodes showed good specificity for disease involvement in our study. Therefore, ALND can safely be performed by omitting SLNB in such cases.
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Affiliation(s)
- Raju Gupta
- Department of Nuclear Medicine, Tata Medical Center, Kolkata, West Bengal, India
| | - Jayanta Das
- Department of Nuclear Medicine, Tata Medical Center, Kolkata, West Bengal, India
| | - Sayantani Sinha
- Department of Nuclear Medicine, Tata Medical Center, Kolkata, West Bengal, India
| | - Sanjit Agarwal
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata, West Bengal, India
| | - Abhisekh Sharma
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata, West Bengal, India
| | - Rosina Ahmed
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata, West Bengal, India
| | - Aditi Chanda
- Department of Radiodiagnosis, Tata Medical Center, Kolkata, West Bengal, India
| | - Indu Arun
- Department of Histopathology, Tata Medical Center, Kolkata, West Bengal, India
| | - Soumendranath Ray
- Department of Nuclear Medicine, Tata Medical Center, Kolkata, West Bengal, India
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Agrawal SK, Patel D, Shenoy P, Ahmed R, Arun I, Chatterjee S. Oncologic safety of breast conservation following NACT in women with locally advanced breast cancer. Ecancermedicalscience 2023; 17:1554. [PMID: 37377681 PMCID: PMC10292858 DOI: 10.3332/ecancer.2023.1554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Breast conservation surgery (BCS) is the accepted standard of treatment for early breast cancer, with evidence from randomized controlled and population-based studies. The oncological outcome of BCS in locally advanced breast cancer (LABC) is mainly available from retrospective series with a small sample size and a shorter follow-up duration. Methods A retrospective observational study of 411 non-metastatic LABC patients who received neoadjuvant chemotherapy (NACT) followed by surgery from 2011 to 2016. We retrieved the data from a prospectively maintained database and electronic medical records. Survival data were analyzed by Kaplan-Meier curves and Cox regression using Statistical Package for the Social Sciences 25 and STATA 14. Results 146/411 (35.5%) women had BCS with a margin positivity rate of 3.42%. With a median follow-up of 64 months (IQR 61, 66), the local relapse rate was 8.9% in BCS and 8.3% after mastectomy. The estimated 5-year locoregional recurrence-free survival (LRFS), recurrence-free survival (RFS), distant disease-free survival (DDFS) and overall survival (OS) rates of BCS were 86.9%, 63.9%, 71% and 79.3%, and 90.1%, 57.9%, 58.3% and 71.5% in the mastectomy group. On univariate analysis, BCS showed superior survival outcomes compared to mastectomy (unadjusted HR (95% CI) for RFS: 0.70 (0.50-1), DDFS: 0.57 (0.39-0.84), OS: 0.58 (0.36-0.93)). After adjusting for age, cT stage, cN stage, poorer chemotherapy response (ypT0/is, N0) and radiotherapy, BCS and mastectomy groups were found comparable in terms of LRFS (HR: 1.1, 0.53-2.3), DDFS (HR: 0.67, 0.45-1.01), RFS (HR: 0.80, 0.55-1.17) and OS (HR: 0.69, 0.41-1.14). Conclusion BCS is technically feasible in LABC patients. LABC patients who respond well to NACT can be offered BCS without compromising survival outcomes.
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Affiliation(s)
| | - Dimple Patel
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India
| | - Pradyumn Shenoy
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India
| | - Rosina Ahmed
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India
| | - Indu Arun
- Department on Oncopathology, Tata Medical Center, Kolkata 700156, India
| | - Sanjoy Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata 700156, India
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Radhakrishnan VS, Pincha R, Raina V, Garg JK, Nag A, Bhave SJ, Achari R, Dey D, Arun I, Lateef Z, Vinarkar SS, Parihar M, Sen S, Mishra DK, Chandy M, Nair R. Salvage Using Polatuzumab Vedotin Based Therapy in Relapsed Refractory Large B-Cell Lymphomas: Early Experience from a Real-World Middle-Income Setting Using Named-Patient Compassionate Access Program. Indian J Hematol Blood Transfus 2022; 39:1-5. [PMID: 36590655 PMCID: PMC9790077 DOI: 10.1007/s12288-022-01619-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 12/19/2022] [Indexed: 12/26/2022] Open
Abstract
Polatuzumab vedotin is a novel immunotherapy antibody-drug conjugate targeting CD79b. It has been used in relapsed/refractory (R/R) large B-cell lymphomas since its FDA approval in 2019. Presently, this drug is unaffordable or unavailable for patients in Lower-Middle Income Countries (LMIC) like India. This is a retrospective study of adult (> 18 years) patients with R/R large B-cell lymphoma failing two prior lines of therapy, who received Polatuzumab based salvage therapy on a compassionate or named-patient access program. Between May 2019 and April 2022, 10 patients received Polatuzumab vedotin, and 9 were evaluable. The most common regimen used was Polatuzumab-Bendamustine-Rituximab. Out of 43 infusions administered, the adverse event profile was manageable [One grade-2 infusion reaction, 4 patients developed grade 3-4 hematological toxicity and none had grade 3-4 non-hematological toxicities]. Ten infusions were administered in the day care service. After a median of 4.5 cycles (range 1-8), 4 patients achieved CR, 2 had partial response (PR), and 3 had progressive disease (PD). With a median follow up of 491 days (range 8-1048 days), four patients are alive (three in CR and one in PR), three patients have died and three patients were lost to follow up. Early real-world experience from a LMIC setting demonstrates feasibility and a favourable safety profile of Polatuzumab vedotin based approach, along with encouraging response rates in a subset of patients.
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Affiliation(s)
- V. S. Radhakrishnan
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - R. Pincha
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - V. Raina
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - J. K. Garg
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - A. Nag
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - S. J. Bhave
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - R. Achari
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - D. Dey
- Department of Histopathology, Tata Medical Center, Kolkata, India
| | - I. Arun
- Department of Histopathology, Tata Medical Center, Kolkata, India
| | - Z. Lateef
- Department of Histopathology, Tata Medical Center, Kolkata, India
| | - S. S. Vinarkar
- Department of Laboratory Hematology, Cytogenetics and Molecular Pathology, Tata Medical Center, Kolkata, India
| | - M. Parihar
- Department of Laboratory Hematology, Cytogenetics and Molecular Pathology, Tata Medical Center, Kolkata, India
| | - S. Sen
- Department of Radiology, Tata Medical Center, Kolkata, India
| | - D. K. Mishra
- Department of Laboratory Hematology, Cytogenetics and Molecular Pathology, Tata Medical Center, Kolkata, India
| | - M. Chandy
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
| | - R. Nair
- Department of Clinical Hematology Oncology and HCT, Tata Medical Center, Newtown, Kolkata, 700160 India
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Arun I, Roy P, Jain PV, Hameed S, Manikantan K, Arun P. Subcategorization of Perineural Invasion and Its Impact on Survival in Patients with Oral Squamous Cell Carcinoma. Head Neck Pathol 2022:10.1007/s12105-022-01512-y. [PMID: 36480091 DOI: 10.1007/s12105-022-01512-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Perineural invasion (PNI) is recognized as a poor prognostic factor in oral squamous cell carcinoma (OSCC). However, the prognostic significance of further histologic subcategorization of PNI is inconclusive. In this study, we determined the prognostic relevance of histologic subcategories of PNI and their correlation with the presence of other clinical and pathological parameters METHODS: This is a retrospective study of 207 homogeneously treated OSCC patients with histologically documented PNI from a single center. Univariate and multivariate survival outcomes, namely, local recurrence-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) of patients with various subcategories of PNI,namely- number of foci, size of the involved nerve, extratumoral or intratumoral extent, and intraneural or perineural location-were determined. RESULTS Within the histologic subcategories of PNI, tongue primary and presence of lymph node metastasis correlated significantly with the number of nerves involved with PNI. Larger size of involved nerve correlated with advanced tumor stage. Number of foci, extent, and location of PNI were not prognostically significant except size of the involved nerve which showed an inverse correlation with disease outcome as involvement of larger nerves displayed better outcomes in terms of DFS and LRFS but not of OS on multivariate analysis. Addition of adjuvant chemotherapy to radiotherapy emerged as a significant predictor of improved LRFS, DFS, and OS. CONCLUSIONS Histologic subcategorization of PNI did not have prognostic relevance in our study. Involvement of even small nerves was associated with poor prognosis. Addition of chemoradiation was seen to improve prognosis.
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Affiliation(s)
- Indu Arun
- Department of Pathology, Tata Medical Center, Newtown, Kolkata, 700160, India
| | - Paromita Roy
- Department of Pathology, Tata Medical Center, Newtown, Kolkata, 700160, India
| | - Prateek Vijay Jain
- Department of Head and Neck Surgical Oncology, Tata Medical Center, Newtown, Kolkata, West Bengal, 700160, India
| | - Shahin Hameed
- Department of Pathology, Tata Medical Center, Newtown, Kolkata, 700160, India
| | - Kapila Manikantan
- Department of Head and Neck Surgical Oncology, Tata Medical Center, Newtown, Kolkata, West Bengal, 700160, India
| | - Pattatheyil Arun
- Department of Head and Neck Surgical Oncology, Tata Medical Center, Newtown, Kolkata, West Bengal, 700160, India.
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Acs B, Leung SCY, Kidwell KM, Arun I, Augulis R, Badve SS, Bai Y, Bane AL, Bartlett JMS, Bayani J, Bigras G, Blank A, Buikema H, Chang MC, Dietz RL, Dodson A, Fineberg S, Focke CM, Gao D, Gown AM, Gutierrez C, Hartman J, Kos Z, Lænkholm AV, Laurinavicius A, Levenson RM, Mahboubi-Ardakani R, Mastropasqua MG, Nofech-Mozes S, Osborne CK, Penault-Llorca FM, Piper T, Quintayo MA, Rau TT, Reinhard S, Robertson S, Salgado R, Sugie T, van der Vegt B, Viale G, Zabaglo LA, Hayes DF, Dowsett M, Nielsen TO, Rimm DL. Systematically higher Ki67 scores on core biopsy samples compared to corresponding resection specimen in breast cancer: a multi-operator and multi-institutional study. Mod Pathol 2022; 35:1362-1369. [PMID: 35729220 PMCID: PMC9514990 DOI: 10.1038/s41379-022-01104-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/11/2022] [Accepted: 05/05/2022] [Indexed: 02/06/2023]
Abstract
Ki67 has potential clinical importance in breast cancer but has yet to see broad acceptance due to inter-laboratory variability. Here we tested an open source and calibrated automated digital image analysis (DIA) platform to: (i) investigate the comparability of Ki67 measurement across corresponding core biopsy and resection specimen cases, and (ii) assess section to section differences in Ki67 scoring. Two sets of 60 previously stained slides containing 30 core-cut biopsy and 30 corresponding resection specimens from 30 estrogen receptor-positive breast cancer patients were sent to 17 participating labs for automated assessment of average Ki67 expression. The blocks were centrally cut and immunohistochemically (IHC) stained for Ki67 (MIB-1 antibody). The QuPath platform was used to evaluate tumoral Ki67 expression. Calibration of the DIA method was performed as in published studies. A guideline for building an automated Ki67 scoring algorithm was sent to participating labs. Very high correlation and no systematic error (p = 0.08) was found between consecutive Ki67 IHC sections. Ki67 scores were higher for core biopsy slides compared to paired whole sections from resections (p ≤ 0.001; median difference: 5.31%). The systematic discrepancy between core biopsy and corresponding whole sections was likely due to pre-analytical factors (tissue handling, fixation). Therefore, Ki67 IHC should be tested on core biopsy samples to best reflect the biological status of the tumor.
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Affiliation(s)
- Balazs Acs
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden.
| | | | - Kelley M Kidwell
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Indu Arun
- Tata Medical Center, Kolkata, West Bengal, India
| | - Renaldas Augulis
- Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Sunil S Badve
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Yalai Bai
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Anita L Bane
- Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - John M S Bartlett
- Ontario Institute for Cancer Research, Toronto, ON, Canada
- Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom
| | - Jane Bayani
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Gilbert Bigras
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Annika Blank
- Institute of Pathology, University of Bern, Bern, Switzerland
- Institute of Pathology, Triemli Hospital Zurich, Zurich, Switzerland
| | - Henk Buikema
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin C Chang
- Department of Pathology & Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Robin L Dietz
- Department of Pathology, Olive View-UCLA Medical Center, Los Angeles, CA, USA
| | - Andrew Dodson
- UK NEQAS for Immunocytochemistry and In-Situ Hybridisation, London, United Kingdom
| | - Susan Fineberg
- Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | - Cornelia M Focke
- Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany
| | - Dongxia Gao
- University of British Columbia, Vancouver, BC, Canada
| | | | - Carolina Gutierrez
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Johan Hartman
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Zuzana Kos
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anne-Vibeke Lænkholm
- Department of Surgical Pathology, Zealand University Hospital, Roskilde, Denmark
| | - Arvydas Laurinavicius
- Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Richard M Levenson
- Department of Medical Pathology and Laboratory Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | - Rustin Mahboubi-Ardakani
- Department of Medical Pathology and Laboratory Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | | | - Sharon Nofech-Mozes
- University of Toronto Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - C Kent Osborne
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Frédérique M Penault-Llorca
- Imagerie Moléculaire et Stratégies Théranostiques, UMR1240, Université Clermont Auvergne, INSERM, Clermont-Ferrand, France
- Service de Pathologie, Centre Jean PERRIN, Clermont-Ferrand, France
| | - Tammy Piper
- Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom
| | | | - Tilman T Rau
- Institute of Pathology, University of Bern, Bern, Switzerland
- Institute of Pathology, Heinrich Heine University and University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Stefan Reinhard
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Stephanie Robertson
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Roberto Salgado
- Department of Pathology, GZA-ZNA, Antwerp, Belgium
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | | | - Bert van der Vegt
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Giuseppe Viale
- European Institute of Oncology, Milan, Italy
- European Institute of Oncology IRCCS, and University of Milan, Milan, Italy
| | - Lila A Zabaglo
- The Institute of Cancer Research, London, United Kingdom
| | - Daniel F Hayes
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Mitch Dowsett
- The Institute of Cancer Research, London, United Kingdom
| | | | - David L Rimm
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.
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Guntiboina VA, Radhakrishnan VS, Kumar J, Bhave SJ, Vinarkar S, Das J, Arun I, Mishra DK, Chandy M, Nair R. Peripheral T-Cell Lymphoma, Hemophagocytic Lymphohistiocytosis, and XIAP Gene Mutations: Getting the Treatment Right! Clin Lymphoma Myeloma Leuk 2022; 22:780-784. [PMID: 35697635 DOI: 10.1016/j.clml.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/23/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Affiliation(s)
| | | | - Jeevan Kumar
- Clinical Hematology Oncology and HCT, Tata Medical Center, Kolkata, India
| | - Saurabh J Bhave
- Clinical Hematology Oncology and HCT, Tata Medical Center, Kolkata, India
| | - Sushant Vinarkar
- Laboratory Hematology and Molecular Pathology, Tata Medical Center, Kolkata, India
| | - Jayanta Das
- Nuclear Medicine, Tata Medical Center, Kolkata, India
| | - Indu Arun
- Histopathology, Tata Medical Center, Kolkata, India
| | - Deepak Kumar Mishra
- Laboratory Hematology and Molecular Pathology, Tata Medical Center, Kolkata, India
| | - Mammen Chandy
- Clinical Hematology Oncology and HCT, Tata Medical Center, Kolkata, India
| | - Reena Nair
- Clinical Hematology Oncology and HCT, Tata Medical Center, Kolkata, India
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8
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Dey D, Lali BS, Roy P, Midha D, Arun I, Zameer L, Bardia A, Mukherjee G. Impact of review of histopathology specimens at a tertiary oncology hospital in Eastern India – lessons learnt. Ecancermedicalscience 2022; 16:1441. [PMID: 36200017 PMCID: PMC9470176 DOI: 10.3332/ecancer.2022.1441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Debdeep Dey
- Department of Oncopathology, Tata Medical Center, 14, MAR(E-W), DH Block(Newtown), Action Area I, Newtown, Kolkata, West Bengal 700160, India
| | - Bhagat Singh Lali
- Department of Oncopathology, Tata Medical Center, 14, MAR(E-W), DH Block(Newtown), Action Area I, Newtown, Kolkata, West Bengal 700160, India
| | - Paromita Roy
- Department of Oncopathology, Tata Medical Center, 14, MAR(E-W), DH Block(Newtown), Action Area I, Newtown, Kolkata, West Bengal 700160, India
| | - Divya Midha
- Department of Oncopathology, Tata Medical Center, 14, MAR(E-W), DH Block(Newtown), Action Area I, Newtown, Kolkata, West Bengal 700160, India
| | - Indu Arun
- Department of Oncopathology, Tata Medical Center, 14, MAR(E-W), DH Block(Newtown), Action Area I, Newtown, Kolkata, West Bengal 700160, India
| | - Lateef Zameer
- Department of Oncopathology, Tata Medical Center, 14, MAR(E-W), DH Block(Newtown), Action Area I, Newtown, Kolkata, West Bengal 700160, India
| | - Anand Bardia
- Department of Oncopathology, Tata Medical Center, 14, MAR(E-W), DH Block(Newtown), Action Area I, Newtown, Kolkata, West Bengal 700160, India
| | - Geetashree Mukherjee
- Department of Oncopathology, Tata Medical Center, 14, MAR(E-W), DH Block(Newtown), Action Area I, Newtown, Kolkata, West Bengal 700160, India
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Agrawal SK, Sharma H, Priya N, Saji AP, Phom HD, Sharma A, Arun I, Das J, Chandra A, Ahmed R. Diagnostic performance and survival outcome following sentinel lymph node biopsy in breast cancer patients from a tertiary cancer centre in India. Ecancermedicalscience 2022; 16:1398. [PMID: 35919228 PMCID: PMC9300403 DOI: 10.3332/ecancer.2022.1398] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Indexed: 11/06/2022] Open
Abstract
Background Sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection (ALND) for axillary staging in early node-negative breast cancer (BC) patients in developed countries. However, in resource-constrained developing countries, adoption of SLNB is slow due to logistic issues and lack of outcome data from non-screened BC cohort. Therefore, we aim to report diagnostic performance, surgical morbidity and survival outcome of SLNB in BC patients from a tertiary care cancer centre in India. Methodology 1,521 consecutive early node-negative T1-3N0 BC patients having SLNB from 2011 to 2020 were included in the study. Data were retrieved from the institutional Redcap database and electronic medical records. Analysis was done using Stata14. Results SLNB was done by dual dye (methylene blue (MB) + radioisotope (RI)/indo cyanine green (ICG)) in 57.7%, MB only in 39.3%, and RI alone in 3% of patients. The identification rate (IR) and SLNB positivity rate were 96% and 27.7%, respectively. IR was highest (98%) with MB + ICG and lowest (94%) with MB alone SLNB. UltraSonoGraphy guided fine needle aspiration cytology of radiological suspicious nodes has significantly reduced the SLNB positivity rate from 34.6% to 26.4% (p < 0.01). One patient had skin necrosis, and 16 had persistent blue staining of the skin in the MB injection site. All were managed conservatively. The lymphedema rate was significantly higher (5.2%) in the ALND versus 0.5% in the SLNB alone patients (p < 0.05). In a median follow up of 27 months, the axillary recurrence rate was 0.04% (4/1,023), and false-negative rate was 0.9% in SLNB negative patients. There were 35 recurrences and 25 deaths in SLNB negative patients, with 10 years predicted disease-free survival of 81% (95% CI 66% to 89%) and overall survival of 79% (95% CI 59% to 90%). Conclusions SLNB should be offered as an axillary staging procedure to all eligible BC patients from developing countries to avoid the morbidity associated with ALND. Fluorescent dye can be used as an alternative for RI in a resource-constrained setup.
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Affiliation(s)
| | - Himanshu Sharma
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India
| | - Noopur Priya
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India
| | - Anoop P Saji
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India
| | - Hamyung Denchu Phom
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India
| | - Abhishek Sharma
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India
| | - Indu Arun
- Department of Histopathology, Tata Medical Center, Kolkata 700156, India
| | - Jayanta Das
- Department of Nuclear Medicine, Tata Medical Center, Kolkata 700156, India
| | - Aditi Chandra
- Department of Radiology, Tata Medical Center, Kolkata 700156, India
| | - Rosina Ahmed
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata 700156, India
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Shrestha G, Roy P, Arun I, Chatterjee A, Biswas G. Dedifferentiated chordoma, a case report. J Pathol Nep 2022. [DOI: 10.3126/jpn.v12i1.42213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Dedifferentiated chordoma is a rare variant of chordoma, exhibiting simultaneous presence of conventional chordoma and component of high grade sarcoma. It occurs either de novo or in the form of high grade transformation of a conventional chordoma in a setting of recurrence or radiotherapy induced changes. Despite similar clinical manifestations, it shows significantly poorer survival among all variants of chordomas, making an accurate diagnosis important. We, herein, report a case of large chordoma in a 65 years old female, arising de novo in sacrum, where dedifferentiated component was present only focally, highlighting the importance of adequate grossing.
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Radhakrishnan VS, Bajaj R, Raina V, Kumar J, Bhave SJ, Sukumaran Nair RK, Nag A, Arun I, Zameer L, Dey D, Arora N, Parihar M, Das J, Achari RB, Mishra DK, Chandy M, Nair R. Relapsed Refractory Hodgkin Lymphoma and Brentuximab Vedotin-Bendamustine Combination Therapy as a Bridge to Transplantation: Real-World Evidence From a Middle-Income Setting and Literature Review. Front Oncol 2022; 11:796270. [PMID: 35127505 PMCID: PMC8814627 DOI: 10.3389/fonc.2021.796270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Despite high cure rates with standard treatment, 30% patients with Hodgkin lymphoma develop relapsed or refractory (R/R) disease. Salvage therapy followed by autologous hematopoietic cell transplantation (HCT) is considered standard of care. Brentuximab Vedotin (Bv) in combination with Bendamustine (B) has been tested in the salvage setting with promising results. Materials and Methodology We conducted a single centre retrospective chart review of patients who received BBv salvage therapy to determine its activity and safety in patients with R/R classical Hodgkin lymphoma (HL). Between May 2011- December 2019, 179 patients were diagnosed with R/R HL. Results Thirty patients received BBv [median age: 30 (15-59) years, females (n=15)]. Primary refractory disease in 19 patients (63%), and 26 patients (87%) had advanced stage at treatment. Most patients received BBv after 2 prior lines of therapy [n=16 (53%)]. The median number of cycles of BBv were 3 (1-6). The number of BBv cycles delivered as outpatient was 63%. The most common Grade III/IV hematological adverse event was neutropenia [n=21, (70%)], while grade III/IV non-hematological toxicities included infections in 4 (13%), neuropathy in 4(13%), skin rash in 2 (7%), GI toxicities in 3 (10%) and liver dysfunction in 2 (7%) patients. The ORR and CR rates were 79% and 62%, respectively. Seventeen patients (57%) underwent an autologous HCT and 8 (26%) underwent an Allogeneic HCT (all haploidentical). The median follow up time from BBv administration was 12 months. Six patients died: 2 = disease progression, and 4 = non-relapse causes (Infection and sepsis = 2, GVHD=2). In addition to this, one patient progressed soon after HCT and another patient relapsed 22 months post HCT. Three year Overall survival (OS) and Event free survival (EFS) probability post-BBv treatment was 75% and 58%, respectively. OS and EFS analysis based on response (viz., CMR) to BBv demonstrated that patients in CMR had better survival probability [93% (p=0.0022) 3yr-OS and 72% (p=0.038) 3yr-EFS probability]. Conclusions BBv is an active and well-tolerated salvage treatment for patients with R/R HL, even in refractory and advanced settings. In middle-income settings, cost constraints and access determine patient uptake of this regimen.
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Affiliation(s)
- Vivek S. Radhakrishnan
- Clinical Haematology Oncology and Haematopoietic Cell Transplantation (HCT), Tata Medical Center, Kolkata, India
- *Correspondence: Vivek S. Radhakrishnan, ; orcid.org/0000-0001-9484-5669
| | - Rajat Bajaj
- Clinical Haematology Oncology and Haematopoietic Cell Transplantation (HCT), Tata Medical Center, Kolkata, India
| | - Vasundhara Raina
- Clinical Haematology Oncology and Haematopoietic Cell Transplantation (HCT), Tata Medical Center, Kolkata, India
| | - Jeevan Kumar
- Clinical Haematology Oncology and Haematopoietic Cell Transplantation (HCT), Tata Medical Center, Kolkata, India
| | - Saurabh J. Bhave
- Clinical Haematology Oncology and Haematopoietic Cell Transplantation (HCT), Tata Medical Center, Kolkata, India
| | | | - Arijit Nag
- Clinical Haematology Oncology and Haematopoietic Cell Transplantation (HCT), Tata Medical Center, Kolkata, India
| | - Indu Arun
- Histopathology, Tata Medical Center, Kolkata, India
| | | | - Debdeep Dey
- Histopathology, Tata Medical Center, Kolkata, India
| | - Neeraj Arora
- Laboratory Haematology Cytogenetics and Molecular Pathology, Tata Medical Center, Kolkata, India
| | - Mayur Parihar
- Laboratory Haematology Cytogenetics and Molecular Pathology, Tata Medical Center, Kolkata, India
| | - Jayanta Das
- Nuclear Medicine, Tata Medical Center, Kolkata, India
| | | | - Deepak K. Mishra
- Laboratory Haematology Cytogenetics and Molecular Pathology, Tata Medical Center, Kolkata, India
| | - Mammen Chandy
- Clinical Haematology Oncology and Haematopoietic Cell Transplantation (HCT), Tata Medical Center, Kolkata, India
| | - Reena Nair
- Clinical Haematology Oncology and Haematopoietic Cell Transplantation (HCT), Tata Medical Center, Kolkata, India
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12
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El Bairi K, Haynes HR, Blackley E, Fineberg S, Shear J, Turner S, de Freitas JR, Sur D, Amendola LC, Gharib M, Kallala A, Arun I, Azmoudeh-Ardalan F, Fujimoto L, Sua LF, Liu SW, Lien HC, Kirtani P, Balancin M, El Attar H, Guleria P, Yang W, Shash E, Chen IC, Bautista V, Do Prado Moura JF, Rapoport BL, Castaneda C, Spengler E, Acosta-Haab G, Frahm I, Sanchez J, Castillo M, Bouchmaa N, Md Zin RR, Shui R, Onyuma T, Yang W, Husain Z, Willard-Gallo K, Coosemans A, Perez EA, Provenzano E, Ericsson PG, Richardet E, Mehrotra R, Sarancone S, Ehinger A, Rimm DL, Bartlett JMS, Viale G, Denkert C, Hida AI, Sotiriou C, Loibl S, Hewitt SM, Badve S, Symmans WF, Kim RS, Pruneri G, Goel S, Francis PA, Inurrigarro G, Yamaguchi R, Garcia-Rivello H, Horlings H, Afqir S, Salgado R, Adams S, Kok M, Dieci MV, Michiels S, Demaria S, Loi S. The tale of TILs in breast cancer: A report from The International Immuno-Oncology Biomarker Working Group. NPJ Breast Cancer 2021; 7:150. [PMID: 34853355 PMCID: PMC8636568 DOI: 10.1038/s41523-021-00346-1] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 09/28/2021] [Indexed: 02/08/2023] Open
Abstract
The advent of immune-checkpoint inhibitors (ICI) in modern oncology has significantly improved survival in several cancer settings. A subgroup of women with breast cancer (BC) has immunogenic infiltration of lymphocytes with expression of programmed death-ligand 1 (PD-L1). These patients may potentially benefit from ICI targeting the programmed death 1 (PD-1)/PD-L1 signaling axis. The use of tumor-infiltrating lymphocytes (TILs) as predictive and prognostic biomarkers has been under intense examination. Emerging data suggest that TILs are associated with response to both cytotoxic treatments and immunotherapy, particularly for patients with triple-negative BC. In this review from The International Immuno-Oncology Biomarker Working Group, we discuss (a) the biological understanding of TILs, (b) their analytical and clinical validity and efforts toward the clinical utility in BC, and (c) the current status of PD-L1 and TIL testing across different continents, including experiences from low-to-middle-income countries, incorporating also the view of a patient advocate. This information will help set the stage for future approaches to optimize the understanding and clinical utilization of TIL analysis in patients with BC.
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Affiliation(s)
- Khalid El Bairi
- Department of Medical Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.
| | - Harry R Haynes
- Department of Cellular Pathology, Great Western Hospital, Swindon, UK
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Elizabeth Blackley
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Susan Fineberg
- Department of Pathology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jeffrey Shear
- Chief Information Officer, WISS & Company, LLP and President J. Shear Consulting, LLC-Ardsley, Ardsley, NY, USA
| | | | - Juliana Ribeiro de Freitas
- Department of Pathology and Legal Medicine, Medical School of the Federal University of Bahia, Salvador, Brazil
| | - Daniel Sur
- Department of Medical Oncology, University of Medicine "I. Hatieganu", Cluj Napoca, Romania
| | | | - Masoumeh Gharib
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Indu Arun
- Department of Histopathology, Tata Medical Center, Kolkata, India
| | - Farid Azmoudeh-Ardalan
- Department of Pathology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Luciana Fujimoto
- Pathology and Legal Medicine, Amazon Federal University, Belém, Brazil
| | - Luz F Sua
- Department of Pathology and Laboratory Medicine, Fundacion Valle del Lili, and Faculty of Health Sciences, Universidad ICESI, Cali, Colombia
| | | | - Huang-Chun Lien
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Pawan Kirtani
- Department of Histopathology, Manipal Hospitals Dwarka, New Delhi, India
| | - Marcelo Balancin
- Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Prerna Guleria
- Army Hospital Research and Referral, Delhi Cantt, New Delhi, India
| | | | - Emad Shash
- Breast Cancer Comprehensive Center, National Cancer Institute, Cairo University, Cairo, Egypt
| | - I-Chun Chen
- Department of Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Veronica Bautista
- Department of Pathology, Breast Cancer Center FUCAM, Mexico City, Mexico
| | | | - Bernardo L Rapoport
- The Medical Oncology Centre of Rosebank, Johannesburg, South Africa
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, corner Doctor Savage Road and Bophelo Road, Pretoria, 0002, South Africa
| | - Carlos Castaneda
- Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplásicas, Lima, 15038, Peru
- Faculty of Health Sciences, Universidad Cientifica del Sur, Lima, Peru
| | - Eunice Spengler
- Departmento de Patologia, Hospital Universitario Austral, Pilar, Argentina
| | - Gabriela Acosta-Haab
- Department of Pathology, Hospital de Oncología Maria Curie, Buenos Aires, Argentina
| | - Isabel Frahm
- Department of Pathology, Sanatorio Mater Dei, Buenos Aires, Argentina
| | - Joselyn Sanchez
- Department of Research, Instituto Nacional de Enfermedades Neoplasicas, Lima, 15038, Peru
| | - Miluska Castillo
- Department of Research, Instituto Nacional de Enfermedades Neoplasicas, Lima, 15038, Peru
| | - Najat Bouchmaa
- Institute of Biological Sciences, Mohammed VI Polytechnic University (UM6P), 43 150, Ben-Guerir, Morocco
| | - Reena R Md Zin
- Department of Pathology, Faculty of Medicine, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Ruohong Shui
- Department of Pathology, Fudan University Cancer Center, Shanghai, China
| | | | - Wentao Yang
- Department of Pathology, Fudan University Cancer Center, Shanghai, China
| | | | - Karen Willard-Gallo
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - An Coosemans
- Laboratory of Tumour Immunology and Immunotherapy, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Edith A Perez
- Department of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Elena Provenzano
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Paula Gonzalez Ericsson
- Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eduardo Richardet
- Clinical Oncology Unit, Instituto Oncológico Córdoba, Córdoba, Argentina
| | - Ravi Mehrotra
- India Cancer Research Consortium-ICMR, Department of Health Research, New Delhi, India
| | - Sandra Sarancone
- Department of Pathology, Laboratorio QUANTUM, Rosario, Argentina
| | - Anna Ehinger
- Department of Clinical Genetics and Pathology, Skåne University Hospital, Lund University, Lund, Sweden
| | - David L Rimm
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - John M S Bartlett
- Diagnostic Development, Ontario Institute for Cancer Research, Toronto, Canada
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Giuseppe Viale
- Department of Pathology, Istituto Europeo di Oncologia IRCCS, and University of Milan, Milan, Italy
| | - Carsten Denkert
- Institute of Pathology, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg and Philipps-Universität Marburg, Marburg, Germany
| | - Akira I Hida
- Department of Pathology, Matsuyama Shimin Hospital, Matsuyama, Japan
| | - Christos Sotiriou
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Stephen M Hewitt
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Sunil Badve
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, USA
| | - William Fraser Symmans
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Rim S Kim
- National Surgical Adjuvant Breast and Bowel Project (NSABP)/NRG Oncology, Pittsburgh, PA, USA
| | - Giancarlo Pruneri
- Department of Pathology, RCCS Fondazione Istituto Nazionale Tumori and University of Milan, School of Medicine, Milan, Italy
| | - Shom Goel
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Prudence A Francis
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
- Medical Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Rin Yamaguchi
- Department of Pathology and Laboratory Medicine, Kurume University Medical Center, Kurume, Fukuoka, Japan
| | - Hernan Garcia-Rivello
- Servicio de Anatomía Patológica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Hugo Horlings
- Division of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Said Afqir
- Department of Medical Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco
| | - Roberto Salgado
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium
| | - Sylvia Adams
- Perlmutter Cancer Center, New York University Medical School, New York, NY, USA
| | - Marleen Kok
- Divisions of Medical Oncology, Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Stefan Michiels
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, Inserm, University Paris-Saclay, labeled Ligue Contre le Cancer, Villejuif, France
| | - Sandra Demaria
- Department of Radiation Oncology, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sherene Loi
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
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Arun P, Arun I, Jain P, Manikantan K, Sharan R. Determinants of prognosis in patients with oral squamous cell carcinoma metastasizing to a single cervical lymph node. Oral Oncol 2021; 123:105586. [PMID: 34710734 DOI: 10.1016/j.oraloncology.2021.105586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/17/2021] [Accepted: 10/15/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Metastasis in a single lymph node without adverse tumour factors and perineural invasion has been assigned to a lower risk category by the ASCO recommendations of 2019. We analyzed patients with a single positive node with a view to identifying high risk features and their impact on prognosis within this subgroup. MATERIALS AND METHODS The study retrospectively analyzed 707 patients with OSCC. Descriptive statistics were used to compare distribution of clinicopathologic risk features between 323 N0 and 121 single node positive (Ns) patients. The Ns group was further analyzed for the impact of clinicopathologic factors on disease free (DFS) and overall survival (OS) using univariate and multivariate models. RESULTS The Ns group exhibited greater depth of invasion compared to the N0 group and significantly higher proportion of lymphovascular invasion (LVI), perineural invasion (PNI) and poorly differentiated tumors. Within the Ns group, primary tumor localised to the gingivobuccal subsite (HR 2.55, 1.18-5.52 95%CI, p = 0.02) and PNI (HR 2.55, 1.14-5.62, 95%CI p = 0.02) exhibited poor DFS. PNI also contributed to poor OS (HR 2.86, 1.27-6.47 95%CI, p = 0.01). Uninvolved margins (HR 0.46, 0.22-0.96 95%CI, p = 0.04) and chemoradiation (HR 0.18,0.05-0.68 95% CI, p = 0.01) improved OS. CONCLUSION Significant differences are noted in the prevalence of pathologic risk factors between the single node positive and node negative groups. Within the single node positive group, tumour factors like the gingivobuccal subsite, PNI and margin positivity impacted survival. Among nodal factors, deposit size of 12 mm or more and presence of ENE are pointers to poor prognosis. These patients would benefit from adjuvant treatment.
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Affiliation(s)
- Pattatheyil Arun
- Head and Neck Surgical Oncology, Tata Medical Center, Newtown, Kolkata 700160, India.
| | - Indu Arun
- Department of Histopathology, Tata Medical Center, Newtown, Kolkata 700160, India
| | - Prateek Jain
- Head and Neck Surgical Oncology, Tata Medical Center, Newtown, Kolkata 700160, India
| | - Kapila Manikantan
- Head and Neck Surgical Oncology, Tata Medical Center, Newtown, Kolkata 700160, India
| | - Rajeev Sharan
- Head and Neck Surgical Oncology, Tata Medical Center, Newtown, Kolkata 700160, India
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14
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Mallick I, Roy P, Saha S, Arun I, Arun P, Sharan R, Manikantan K, Jain P, Zameer L, Chatterjee S. PO-0952 A dynamically updating individualized survival prediction modelling tool for oral cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07403-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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Agrawal SK, Hashlamoun I, Karki B, Sharma A, Arun I, Ahmed R. Diagnostic Performance of Indocyanine Green Plus Methylene Blue Versus Radioisotope Plus Methylene Blue Dye Method for Sentinel Lymph Node Biopsy in Node-Negative Early Breast Cancer. JCO Glob Oncol 2021; 6:1225-1231. [PMID: 32749861 PMCID: PMC7456319 DOI: 10.1200/go.20.00165] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Sentinel lymph node biopsy (SLNB) by dual-dye method (radioisotope plus blue) is the gold standard for axillary staging in patients with breast cancer, but in developing countries, logistic issues and financial constraint play a vital role. Recently, indocyanine green (ICG) has emerged as an alternative to radioisotope (technetium-99 [Tc-99]) for SLNB in breast cancer. This study compared the diagnostic performance of Tc-99 plus methylene blue (MB) dye versus ICG + MB dye SLNB. METHODS Two hundred seven patients with early breast cancer (T1-3N0) were included in the study from 2017 to 2019. SLNB was done either with Tc-99 + MB or with ICG + MB as per availability of radioisotope. SLN identification rate (IR), SLN positivity rate, and metastatic SLN counts were compared between the 2 groups. RESULTS IR was 199 (96%) of 207. IR was 95% in Tc-99 + MB compared with 97% with ICG + MB. The mean number of SLNs identified were 3.17 (standard deviation [SD], 1.84), with > 1 SLN identified in 87% patients by Tc-99 + MB. SLN was positive in 31.3% of patients with a metastatic SLN count of 0.37 (SD, 0.76). With ICG + MB, the number of SLNs was 2.73 (SD, 1.55), with > 1 SLN identified in 79% of patients. Twenty-eight percent of patients had positive SLNs, with a metastatic SLN count of 0.41 (SD, 0.77). A sharp decline in the availability of Tc-99 was observed, with 58% of patients in 2014 and only 12% of patients in 2018. CONCLUSION ICG is equivalent to Tc-99 for SLNB in early breast cancer and has a good potential to be adopted by surgeons in resource-constrained setups.
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Affiliation(s)
- Sanjit Kumar Agrawal
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata, West Bengal, India
| | - Izideen Hashlamoun
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata, West Bengal, India
| | - Banira Karki
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata, West Bengal, India
| | - Abhishek Sharma
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata, West Bengal, India
| | - Indu Arun
- Department of Histopathology, Tata Medical Center, Kolkata, West Bengal, India
| | - Rosina Ahmed
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata, West Bengal, India
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Arun I, Venkatesh S, Ahmed R, Agrawal SK, Leung SCY. Reliability of Ki67 visual scoring app compared to eyeball estimate and digital image analysis and its prognostic significance in hormone receptor-positive breast cancer. APMIS 2021; 129:489-502. [PMID: 34053140 DOI: 10.1111/apm.13156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 05/03/2021] [Indexed: 12/31/2022]
Abstract
We analysed the reproducibility of Ki67 labelling index (LI) between two scorers using the International Ki67 Working Group (IKWG) global methods on an Android application (APP), correlated the APP and eyeball estimate (EBE) with digital image analysis (DIA) scores and determined the prognostic significance of Ki67LI. Global weighted (GW) and global unweighted (GUW) Ki67 app scores of hormone receptor-positive and HER2 (human epidermal growth factor receptor 2)-negative breast cancer patients were obtained. Reproducibility of Ki67LI between 2 scorers and correlation of APP and EBE scores with DIA scores were performed. The prognostic significance of APP scores and its correlation with other clinico-pathologic variables were evaluated. The intra-class correlation coefficient (ICC) between 2 scorers showed excellent reliability with both GW and GUW methods. ICC between DIA and APP scores was significantly greater than DIA versus EBE. The three categories of APP scores based on median value and cut points of 10%, 18% and 38% were significantly associated with poor DFS. On multivariate analysis, significant association between Ki67LI, tumour size, nodal involvement and DFS was noted. Our study shows that the visual Ki67 scoring app is effective in bringing consistency to KI67LI and APP scores showed significant correlation with DFS.
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Affiliation(s)
- Indu Arun
- Department of Pathology, Tata Medical Center, Newtown, Kolkata, India
| | - Saranya Venkatesh
- Department of Pathology, Tata Medical Center, Newtown, Kolkata, India
| | - Rosina Ahmed
- Department of Breast Oncosurgery, Tata Medical Center, Newtown, Kolkata, India
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Sarker C, Radhakrishnan VS, Mandal P, Kumar J, Bhave S, Achari R, Dey D, Arun I, Latif Z, Arora N, Mishra D, Chandy M, Nair R. Outcomes of diffuse large B-cell lymphoma in elderly patients-real-world experience from a middle-income country setting. Ecancermedicalscience 2021; 15:1242. [PMID: 34267798 PMCID: PMC8241458 DOI: 10.3332/ecancer.2021.1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Indexed: 11/17/2022] Open
Abstract
Background Diffuse large B-cell lymphoma (DLBCL) is the commonest subtype of lymphoma in the elderly and poses unique challenges in this group of patients. There is a need for more information on real-world outcomes across economic disparities. Methods Electronic Medical Record of 3,087 lymphomas (>18 years) were evaluated retrospectively, of which 842 (27%) patients were ≥65 years. Two hundred and twelve patients who were ≥65 years received first line treatment for DLBCL between May 2011 and Dec 2016. Demography, clinical features, associated co-morbidities, first line treatment outcomes and hospital costs were analysed. Patients were followed up till March 2020. Results The median age at presentation was 71 years. Gender ratio was 2.5:1. 38% patients presented with early-stage disease, 37% with low and low-intermediate International prognostic index, 49% with nodal disease. One or more co-morbidities were present in 58%. The commonest extra nodal site was gastro-intestinal (29%). Two-thirds of the patients presented with non-Germinal centre B subtype. The overall response (OR) to treatment was 72.5%. Patients who received anthracycline-based therapy (n = 124) and rituximab-based therapy (n = 159) had a median progression free survival (PFS), not reached and 47.0 months, respectively, versus 10 months and 7.9 months, respectively, for patients receiving non-anthracycline and non-rituximab therapies. At a median follow-up of 24 months, the 5-year overall survival and PFS are 44% and 41%, respectively, for the entire cohort. Conclusions DLBCL is a curable lymphoma in elderly patients with standard anthracycline and rituximab-based therapies. Improvement in outcomes largely depends on social and financial support to complete the scheduled treatments.
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Affiliation(s)
- Chandrayee Sarker
- Department of Clinical Hematology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
| | - Vivek S Radhakrishnan
- Department of Clinical Hematology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India.,https://orcid.org/0000-0001-9484-5669
| | - Payal Mandal
- Department of Clinical Hematology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
| | - Jeevan Kumar
- Department of Clinical Hematology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
| | - Saurabh Bhave
- Department of Clinical Hematology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
| | - Rimpa Achari
- Department of Radiation Oncology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
| | - Debdeep Dey
- Department of Pathology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
| | - Indu Arun
- Department of Pathology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
| | - Zameer Latif
- Department of Pathology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
| | - Neeraj Arora
- Department of Hemato Pathology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
| | - Deepak Mishra
- Department of Hemato Pathology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
| | - Mammen Chandy
- Department of Clinical Hematology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
| | - Reena Nair
- Department of Clinical Hematology, Tata Medical Center, 14 Main Arterial Road (EW), Newtown, Kolkata 700160, India
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Ghosh J, Ganguly S, Dabkara D, Biswas B, Chatterjee A, Mukhopadhyay S, Banerjee S, Sen S, Arun I. Pancreatic adenocarcinoma with primary tumor calcification and calcified liver metastasis: Report of a rare case and review of literature. Indian J Med Paediatr Oncol 2021. [DOI: 10.4103/ijmpo.ijmpo_102_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractCalcification is a feature of benign pancreatic diseases such as chronic calcific pancreatitis (CCP) or benign pancreatic tumors such as solid and papillary epithelial neoplasm of the pancreas and serous cystadenoma. The presence of calcification in a primary malignant pancreatic tumor is uncommon except for neuroendocrine tumors of the pancreas. Calcification in adenocarcinoma of the pancreas involving the primary tumor as well as the metastasis resulting thereof is extremely rare in the absence of CCP. To our knowledge, this is the first report of a case of primary adenocarcinoma of the pancreas that presented with calcification of the primary tumor as well as the metastatic liver nodules, accompanied by hypercalcemia.
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Affiliation(s)
- Joydeep Ghosh
- Department of Medical Oncology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
| | - Deepak Dabkara
- Department of Medical Oncology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
| | - Arghya Chatterjee
- Department of Radiology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
| | - Sumit Mukhopadhyay
- Department of Radiology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
| | - Sudeep Banerjee
- Department of Surgical Oncology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
| | - Saugata Sen
- Department of Radiology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
| | - Indu Arun
- Department of Pathology, Tata Medical Center, Newtown, Kolkata, West Bengal, India
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19
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Arun I, Maity N, Hameed S, Jain PV, Manikantan K, Sharan R, Arun P. Reply to Letter to the Editor regarding "Lymph node characteristics and their prognostic significance in oral squamous cell carcinoma". Head Neck 2021; 43:2556. [PMID: 33964180 DOI: 10.1002/hed.26711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 04/08/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Indu Arun
- Department of Pathology, Tata Medical Center, Newtown, Kolkata, India
| | - Namrata Maity
- Department of Pathology, Tata Medical Center, Newtown, Kolkata, India
| | - Shahin Hameed
- Department of Pathology, Tata Medical Center, Newtown, Kolkata, India
| | - Prateek Vijay Jain
- Department of Head and Neck Surgical Oncology, Tata Medical Center, Newtown, Kolkata, India
| | - Kapila Manikantan
- Department of Head and Neck Surgical Oncology, Tata Medical Center, Newtown, Kolkata, India
| | - Rajeev Sharan
- Department of Head and Neck Surgical Oncology, Tata Medical Center, Newtown, Kolkata, India
| | - Pattatheyil Arun
- Department of Head and Neck Surgical Oncology, Tata Medical Center, Newtown, Kolkata, India
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20
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Ghosh J, Arun I, Ganguly A, Ganguly S. Cutaneous metastases in a patient with adenocarcinoma of the stomach. Indian J Dermatol Venereol Leprol 2021; 87:699-701. [PMID: 34114411 DOI: 10.25259/ijdvl_657_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 01/01/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Joydeep Ghosh
- Department of Medical Oncology, Tata Medical Center, Newtown, Kolkata, India
| | - Indu Arun
- Department of Pathology Tata Medical Center, Newtown, Kolkata, India
| | | | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Newtown, Kolkata, India
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21
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Kathrotiya M, Radhakrishnan VS, Bhave SJ, Kumar J, Roychowdhury M, Arun I, Das J, Chandy M, Nair R. Relapsed plasmablastic lymphoma in a HIV-negative patient: Pushing the envelope. Clin Case Rep 2021; 9:873-877. [PMID: 33598263 PMCID: PMC7869339 DOI: 10.1002/ccr3.3673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/05/2020] [Accepted: 11/24/2020] [Indexed: 11/22/2022] Open
Abstract
This case emphasizes that, with the availability of novel immunotherapy agents (Daratumumab), and repurposed use of bortezomib, a patient with HIV-negative relapsed PBL can be treated successfully and consolidated with an allogeneic haploidentical hematopoietic cell transplantation.
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Affiliation(s)
| | | | - Saurabh J Bhave
- Clinical Haematology Oncology and HCTTata Medical CenterKolkataIndia
| | - Jeevan Kumar
- Clinical Haematology Oncology and HCTTata Medical CenterKolkataIndia
| | - Mita Roychowdhury
- Clinical Haematology Oncology and HCTTata Medical CenterKolkataIndia
| | - Indu Arun
- PathologyTata Medical CenterKolkataIndia
| | - Jayanta Das
- Nuclear MedicineTata Medical CenterKolkataIndia
| | - Mammen Chandy
- Clinical Haematology Oncology and HCTTata Medical CenterKolkataIndia
| | - Reena Nair
- Clinical Haematology Oncology and HCTTata Medical CenterKolkataIndia
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22
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Roy P, Mallick I, Arun I, Zameer L, Dey D, Singh A, Chatterjee S, Jain P, Manikantan K, Sharan R, Pattatheyil A. Nodal yield and topography of nodal metastases from oral cavity squamous cell carcinoma - An audit of 1004 cases undergoing primary surgical resection. Oral Oncol 2020; 113:105115. [PMID: 33341004 DOI: 10.1016/j.oraloncology.2020.105115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Nodal metastasis is an important prognostic factor in oral squamous cell carcinoma (OSCC). Detailed topographic study of metastasis can guide surgical and adjuvant radiation treatment protocols. METHODS Retrospective analysis of distribution of nodal spread was done by auditing pathology records of 1004 patients who underwent primary surgical management at our center. RESULTS The median nodal yield was 41 (range of 9-166) nodes, per patient. Metastasis was present in 42.9% patients, of which 52.3% demonstrated extranodal extension. Reclassification by AJCC8 criteria resulted in up-staging in 35.6% patients (pN1, pN2a, pN2b, pN2c, pN3a and pN3b in 13.1%, 3.7%, 6.9%, 0.9%, 0%, 18.1% respectively). Ipsilateral levels Ib and IIa were involved in a quarter of patients each, while IIb, IV and V were involved in < 4%, 3% and 1% of patients, respectively. Contralateral nodal metastasis was present in 5.4%. Skip metastases to level IV were 2.2% and 1.2% for tongue and gingivobuccal primaries. Tongue primaries had a lower likelihood of involving level Ib, but higher of level IIa and III, compared to gingivobuccal primaries, and a lower likelihood of extranodal extension. Primary site did not influence nodal metastasis to levels IIb, IV or V, but other factors like lymphovascular invasion, pT stage and margin status had an influence. CONCLUSION This large series with high nodal yield, shows low level of metastasis to level IIb, IV and V, which can help modify future guidelines for extent of surgery and avoid targeted adjuvant radiation to specific levels.
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Affiliation(s)
- Paromita Roy
- Oncopathology, Tata Medical Center, Kolkata, India.
| | | | - Indu Arun
- Oncopathology, Tata Medical Center, Kolkata, India
| | | | - Debdeep Dey
- Oncopathology, Tata Medical Center, Kolkata, India
| | - Angad Singh
- Oncopathology, Tata Medical Center, Kolkata, India
| | | | - Prateek Jain
- Head and Neck Surgery, Tata Medical Center, Kolkata, India
| | | | - Rajeev Sharan
- Head and Neck Surgery, Tata Medical Center, Kolkata, India
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23
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Arun I, Maity N, Hameed S, Jain PV, Manikantan K, Sharan R, Arun P. Lymph node characteristics and their prognostic significance in oral squamous cell carcinoma. Head Neck 2020; 43:520-533. [PMID: 33021340 DOI: 10.1002/hed.26499] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/10/2020] [Accepted: 09/24/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The prognostic significance of various histopathologic lymph node-based biomarkers in oral squamous cell carcinoma (OSCC) needs further evaluation. METHODS Retrospective analysis of 212 OSCC patients with regional metastasis to determine the association of extranodal extension (ENE), extent of ENE, size of metastatic deposit, lymph node yield (LNY), lymph node ratio (LNR), and topography of involvement with survival outcomes. RESULTS The presence of ENE, larger nodal deposit, higher pN stage, lymph nodes in the lower levels, and patients who did not receive adjuvant treatment had poor disease-free survival (DFS). In addition, more positive nodes and high LNR showed worse overall survival (OS). ENE beyond 5 mm resulted in poorer outcomes. Larger sizes of metastatic deposit predisposed to ENE. Multivariate analyses showed only lower level of neck involvement to affect both DFS and OS. CONCLUSIONS Lymph node metastasis to lower levels and other lymph node characteristics affect prognosis and must be considered in the evolution of staging systems for OSCC.
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Affiliation(s)
- Indu Arun
- Department of Pathology, Tata Medical Center, Kolkata, West Bengal, India
| | - Namrata Maity
- Department of Pathology, Tata Medical Center, Kolkata, West Bengal, India
| | - Shahin Hameed
- Department of Pathology, Tata Medical Center, Kolkata, West Bengal, India
| | - Prateek Vijay Jain
- Department of Head and Neck Surgical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Kapila Manikantan
- Department of Head and Neck Surgical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Rajeev Sharan
- Department of Head and Neck Surgical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Pattatheyil Arun
- Department of Head and Neck Surgical Oncology, Tata Medical Center, Kolkata, West Bengal, India
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24
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Tewary S, Arun I, Ahmed R, Chatterjee S, Mukhopadhyay S. AutoIHC-Analyzer: computer-assisted microscopy for automated membrane extraction/scoring in HER2 molecular markers. J Microsc 2020; 281:87-96. [PMID: 32803890 DOI: 10.1111/jmi.12955] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 11/30/2022]
Abstract
Human epidermal growth factor receptor 2 (HER2) is one of the widely used Immunohistochemical (IHC) markers for prognostic evaluation amongst the patient of breast cancer. Accurate quantification of cell membrane is essential for HER2 scoring in therapeutic decision making. In modern laboratory practice, expert pathologist visually assesses the HER2-stained tissue sample under the bright field microscope for cell membrane assessment. This manual assessment is time consuming, tedious and quite often results in interobserver variability. Further, the burden of increasing number of patients is a challenge for the pathologists. To address these challenges, there is an urgent need with a rapid HER2 cell membrane extraction method. The proposed study aims at developing an automated IHC scoring system, termed as AutoIHC-Analyzer, for automated cell membrane extraction followed by HER2 molecular expression assessment from stained tissue images. A series of image processing approaches have been used to automatically extract the stained cells and membrane region, followed by automatic assessment of complete and broken membrane. Finally, a set of features are used to automatically classify the tissue under observation for the quantitative scoring as 0/1+, 2+ and 3+. In a set of surgically extracted cases of HER2-stained tissues, obtained from collaborative hospital for the testing and validation of the proposed approach AutoIHC-Analyzer and publicly available open source ImmunoMembrane software are compared for 90 set of randomly acquired images with the scores by expert pathologist where significant correlation is observed [(r = 0.9448; p < 0.001) and (r = 0.8521; p < 0.001)] respectively. The output shows promising quantification in automated scoring. LAY DESCRIPTION: In cancer prognosis amongst the patient of breast cancer, human epidermal growth factor receptor 2 (HER2) is used as Immunohistochemical (IHC) biomarker. The correct assessment of HER2 leads to the therapeutic decision making. In regular practice, the stained tissue sample is observed under a bright microscope and the expert pathologists score the sample as negative (0/1+), equivocal (2+) and positive (3+) case. The scoring is based on the standard guidelines relating the complete and broken cell membrane as well as intensity of staining in the membrane boundary. Such evaluation is time consuming, tedious and quite often results in interobserver variability. To assist in rapid HER2 cell membrane assessment, the proposed study aims at developing an automated IHC scoring system, termed as AutoIHC-Analyzer, for automated cell membrane extraction followed by HER2 molecular expression assessment from stained tissue images. The input image is preprocessed using modified white patch and CMYK and RGB colour space were used in extracting the haematoxylin (negatively stained cells) and diaminobenzidine (DAB) stain observed in the tumour cell membrane. Segmentation and postprocessing are applied to create the masks for each of the stain channels. The membrane mask is then quantified as complete or broken using skeletonisation and morphological operations. Six set of features were assessed for the classification from a set of 180 training images. These features are: complete to broken membrane ratio, amount of stain using area of Blue and Saturation channels to the image size, DAB to haematoxylin ratio from segmented masks and average R, G and B from five largest blobs in segmented DAB-masked image. These features are then used in training the SVM classifier with Gaussian kernel using 5-fold cross-validation. The accuracy in the training sample is found to be 88.3%. The model is then used for 90 set of unknown test sample images and the final labelling of stained cells and HER2 scores (as 0/1+, 2+ and 3+) are compared with the ground truth, that is expert pathologists' score from the collaborative hospital. The test sample images were also fed to ImmunoMembrane software for a comparative assessment. The results from the proposed AutoIHC-Analyzer and ImmunoMembrane software were compared with the expert pathologists' score where significant agreement using Pearson's correlation coefficient [(r = 0.9448; p < 0.001) and (r = 0.8521; p < 0.001) respectively] is observed. The results from AutoIHC-Analyzer show promising quantitative assessment of HER2 scoring.
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Affiliation(s)
- Suman Tewary
- School of Medical Science & Technology, IIT Kharagpur, Kharagpur, West Bengal, India.,Computational Instrumentation Division, CSIR-CSIO, Chandigarh, India
| | - Indu Arun
- Tata Medical Center, New Town, Rajarhat, Kolkata, West Bengal, India
| | - Rosina Ahmed
- Tata Medical Center, New Town, Rajarhat, Kolkata, West Bengal, India
| | - Sanjoy Chatterjee
- Tata Medical Center, New Town, Rajarhat, Kolkata, West Bengal, India
| | - Sudipta Mukhopadhyay
- Electronics and Electrical Communication Engineering, IIT Kharagpur, Kharagpur, West Bengal, India
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25
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Acs B, Leung SC, Kidwell KM, Arun I, Augulis R, Badve SS, Bai Y, Bane AL, Bartlett JM, Bayani J, Bigras G, Blank A, Borgquist S, Buikema H, Chang MC, Dietz RL, Dodson A, Ehinger A, Fineberg S, Focke CM, Gao D, Gown AM, Gutierrez C, Hartman J, Hugh JC, Kos Z, Lænkholm AV, Laurinavicius A, Levenson RM, Mahboubi-Ardakani R, Mastropasqua MG, Moriya T, Nofech-Mozes S, Osborne CK, Pantanowitz L, Penault-Llorca FM, Piper T, Quintayo MA, Rau TT, Reinhard S, Robertson S, Sakatani T, Salgado R, Spears M, Starczynski J, Sugie T, van der Vegt B, Viale G, Virk S, Zabaglo LA, Hayes DF, Dowsett M, Nielsen TO, Rimm DL. Abstract P5-02-01: Analytical validation and prognostic potential of an automated digital scoring protocol for Ki67: An International Ki67 Working Group study. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p5-02-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The nuclear proliferation biomarker Ki67 has multiple potential roles in breast cancer, including aiding decisions based on prognosis, but has unacceptable between-laboratory variability. Here we tested an open source and calibrated automated digital image analysis (DIA) platform to: (i) Assess inter-laboratory reproducibility of automated Ki67 measurement among 17 participating labs and compare those with standardized pathologist-based visual scoring. (ii) Investigate the comparability of Ki67 measurement across corresponding core biopsy and whole section cases. (iii) Test prognostic potential of the built Ki67 scoring algorithms on an independent cohort.
Methods: Two sets of 60 previously stained slides containing 30 core-cut biopsy and 30 corresponding whole tumor sections from 30 ER+ breast cancer cases were sent to 17 participating labs for automated assessment of average Ki67 expression. The blocks were centrally cut and stained for Ki67 using the Mib-1 antibody. The QuPath (open-source software) DIA platform was used to evaluate tumoral Ki67 expression. Calibration of the DIA method was performed in our previous study (Acs et al, Lab Invest 2019). A detailed guideline for building an automated Ki67 scoring algorithm was sent to the participating labs. Visual scoring of average Ki67 expression was performed by pathologists according to published standardized methods (Leung et al, NPJ Br Cancer 2016; Leung et al, Histopath 2019). Locked down DIA Ki67 scoring algorithms were applied to a validation cohort: 222 breast cancer cases from the Karolinska University Hospital in whole section format. Sufficient reproducibility to declare analytical validity was defined as an Intra Class Correlation (ICC) with lower limit of 95% credible interval (CI) >0.80. Markov Chain Monte Carlo routines for generalized linear mixed models were used to estimate ICCs and calculate corresponding CIs.
Results: The same-section ICC was 0.902 (CI: 0.852-0.949) across 17 labs using calibrated DIA platform on core biopsy slides and 0.845 (CI: 0.778-0.912) on whole sections. The different-section ICC across the 17 labs was 0.873 (CI: 0.806-0.932) scoring on core biopsy slides and 0.777 (CI: 0.670-0.874) on whole sections. The pathologist-based visual Ki67 scoring showed ICC of 0.860 for all comparisons, respectively (CI: 0.795-0.927). Similar to what was observed for visual Ki67 scoring, the DIA scores are higher for core biopsy slides compared to paired whole sections (p≤0.001; median difference: 5.31%; IQR: 11.50%). Ki67 scores of all locked down DIA algorithms correlates significantly (p≤0.023) with outcome on the validation cohort (observed hazard ratios range: 2.518-2.922).
Conclusions: Automated Ki67 evaluation using a calibrated, open-source DIA platform (QuPath) met the pre-specified criterion of success on core biopsies but not on whole sections in the multi-institutional setting. The systematic discrepancy between core biopsy and corresponding whole sections was likely due to pre-analytical factors (tissue handling, fixation) and intratumor heterogeneity. We found that different algorithms built according to calibrated DIA methods had similar prognostic potential. Assessment of clinical utility is planned.
Citation Format: Balazs Acs, Samuel C.Y. Leung, Kelley M. Kidwell, Indu Arun, Renaldas Augulis, Sunil S. Badve, Yalai Bai, Anita L. Bane, John M.S. Bartlett, Jane Bayani, Gilbert Bigras, Annika Blank, Signe Borgquist, Henk Buikema, Martin C. Chang, Robin L. Dietz, Andrew Dodson, Anna Ehinger, Susan Fineberg, Cornelia M. Focke, Dongxia Gao, Allen M. Gown, Carolina Gutierrez, Johan Hartman, Judith C. Hugh, Zuzana Kos, Anne-Vibeke Lænkholm, Arvydas Laurinavicius, Richard M. Levenson, Rustin Mahboubi-Ardakani, Mauro G. Mastropasqua, Takuya Moriya, Sharon Nofech-Mozes, C. Kent Osborne, Liron Pantanowitz, Frédérique M. Penault-Llorca, Tammy Piper, Mary Anne Quintayo, Tilman T. Rau, Stefan Reinhard, Stephanie Robertson, Takashi Sakatani, Roberto Salgado, Melanie Spears, Jane Starczynski, Tomoharu Sugie, Bert van der Vegt, Giuseppe Viale, Shakeel Virk, Lila A. Zabaglo, Daniel F. Hayes, Mitch Dowsett, Torsten O. Nielsen, David L. Rimm, International Ki67 in Breast Cancer Working Group, BIG-NABCG. Analytical validation and prognostic potential of an automated digital scoring protocol for Ki67: An International Ki67 Working Group study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-02-01.
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Affiliation(s)
- Balazs Acs
- 1Department of Pathology, Yale University School of Medicine, New Haven, CT
| | | | - Kelley M. Kidwell
- 3Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Indu Arun
- 4Tata Medical Center, Kolkata, India
| | - Renaldas Augulis
- 5Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Sunil S. Badve
- 6Indiana University Simon Cancer Center, Indianapolis, IN
| | - Yalai Bai
- 1Department of Pathology, Yale University School of Medicine, New Haven, CT
| | - Anita L. Bane
- 7Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada
| | | | - Jane Bayani
- 8Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Gilbert Bigras
- 9Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Annika Blank
- 10Universität Bern Institut für Pathologie, Murtenstrasse, Switzerland
| | | | - Henk Buikema
- 12University Medical Center Groningen, Groningen, Netherlands
| | - Martin C. Chang
- 13Department of Pathology & Laboratory Medicine, University of Vermont Medical Center, Burlington, VT
| | - Robin L. Dietz
- 14Department of Pathology, University of Pittsburgh, Pittsburgh, PA
| | - Andrew Dodson
- 15UK NEQAS for Immunocytochemistry and In-Situ Hybridisation, London, United Kingdom
| | | | - Susan Fineberg
- 16Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY
| | | | - Dongxia Gao
- 2University of British Columbia, Vancouver, BC, Canada
| | | | - Carolina Gutierrez
- 19Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
| | | | | | - Zuzana Kos
- 22University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Anne-Vibeke Lænkholm
- 23Department of Surgical Pathology, Zealand University Hospital, Slagelse, Denmark
| | - Arvydas Laurinavicius
- 5Vilnius University Faculty of Medicine and National Center of Pathology, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Richard M. Levenson
- 24Department of Medical Pathology and Laboratory Medicine, University of California Davis Medical Center, Sacramento, CA
| | - Rustin Mahboubi-Ardakani
- 24Department of Medical Pathology and Laboratory Medicine, University of California Davis Medical Center, Sacramento, CA
| | | | | | - Sharon Nofech-Mozes
- 27University of Toronto Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - C. Kent Osborne
- 19Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
| | | | | | - Tammy Piper
- 29Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom
| | | | - Tilman T. Rau
- 10Universität Bern Institut für Pathologie, Murtenstrasse, Switzerland
| | - Stefan Reinhard
- 10Universität Bern Institut für Pathologie, Murtenstrasse, Switzerland
| | | | | | | | - Melanie Spears
- 8Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Jane Starczynski
- 32Birmingham Heart of England, National Health Service, Birmingham, United Kingdom
| | | | | | | | - Shakeel Virk
- 35Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
| | | | | | - Mitch Dowsett
- 36The Institute of Cancer Research, London, United Kingdom
| | | | - David L. Rimm
- 1Department of Pathology, Yale University School of Medicine, New Haven, CT
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Arun I, Hameed S. Clear cell carcinoma of salivary gland - A diagnostic challenge. Indian J Med Res 2020; 152:S215-S216. [PMID: 35345215 PMCID: PMC8257225 DOI: 10.4103/ijmr.ijmr_2349_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Das A, Bhave SJ, Pal B, Arun I, Goel G, Bhattacharya S, Sen S, Das J, Bhattacharyya P. Brucellosis Complicated by Kikuchi-Fujimoto Disease and Doxycycline-Induced Intracranial Hypertension. Indian J Pediatr 2019; 86:1063-1064. [PMID: 30945234 DOI: 10.1007/s12098-019-02937-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 03/18/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Anirban Das
- Department of Pediatric Hematology-Oncology, Tata Medical Centre, 14 Major Arterial Road (EW), Rajarhat, Kolkata, 700160, India.
| | | | - Bikramjit Pal
- Department of Ophthalmology, Tata Medical Centre, Kolkata, India
| | - Indu Arun
- Department Histopathology, Tata Medical Centre, Kolkata, India
| | - Gaurav Goel
- Department of Microbiology, Tata Medical Centre, Kolkata, India
| | | | - Saugata Sen
- Department of Radiology, Tata Medical Centre, Kolkata, India
| | - Jayanta Das
- Department of Nuclear Medicine, Tata Medical Centre, Kolkata, India
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Rai S, Arun I, Jindal D, Gangopadhyay S, Tapadia R, Bhaumik J. Serous Borderline Tumour of the Fallopian Tube: A Case Report. Indian J Gynecol Oncolog 2019. [DOI: 10.1007/s40944-019-0304-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Leung SCY, Nielsen TO, Zabaglo LA, Arun I, Badve SS, Bane AL, Bartlett JMS, Borgquist S, Chang MC, Dodson A, Ehinger A, Fineberg S, Focke CM, Gao D, Gown AM, Gutierrez C, Hugh JC, Kos Z, Laenkholm AV, Mastropasqua MG, Moriya T, Nofech-Mozes S, Osborne CK, Penault-Llorca FM, Piper T, Sakatani T, Salgado R, Starczynski J, Sugie T, van der Vegt B, Viale G, Hayes DF, McShane LM, Dowsett M. Analytical validation of a standardised scoring protocol for Ki67 immunohistochemistry on breast cancer excision whole sections: an international multicentre collaboration. Histopathology 2019; 75:225-235. [PMID: 31017314 DOI: 10.1111/his.13880] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/19/2019] [Indexed: 01/12/2023]
Abstract
AIMS The nuclear proliferation marker Ki67 assayed by immunohistochemistry has multiple potential uses in breast cancer, but an unacceptable level of interlaboratory variability has hampered its clinical utility. The International Ki67 in Breast Cancer Working Group has undertaken a systematic programme to determine whether Ki67 measurement can be analytically validated and standardised among laboratories. This study addresses whether acceptable scoring reproducibility can be achieved on excision whole sections. METHODS AND RESULTS Adjacent sections from 30 primary ER+ breast cancers were centrally stained for Ki67 and sections were circulated among 23 pathologists in 12 countries. All pathologists scored Ki67 by two methods: (i) global: four fields of 100 tumour cells each were selected to reflect observed heterogeneity in nuclear staining; (ii) hot-spot: the field with highest apparent Ki67 index was selected and up to 500 cells scored. The intraclass correlation coefficient (ICC) for the global method [confidence interval (CI) = 0.87; 95% CI = 0.799-0.93] marginally met the prespecified success criterion (lower 95% CI ≥ 0.8), while the ICC for the hot-spot method (0.83; 95% CI = 0.74-0.90) did not. Visually, interobserver concordance in location of selected hot-spots varies between cases. The median times for scoring were 9 and 6 min for global and hot-spot methods, respectively. CONCLUSIONS The global scoring method demonstrates adequate reproducibility to warrant next steps towards evaluation for technical and clinical validity in appropriate cohorts of cases. The time taken for scoring by either method is practical using counting software we are making publicly available. Establishment of external quality assessment schemes is likely to improve the reproducibility between laboratories further.
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Affiliation(s)
| | | | | | | | - Sunil S Badve
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - Anita L Bane
- Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - John M S Bartlett
- Ontario Institute for Cancer Research, Toronto, ON, Canada.,Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
| | - Signe Borgquist
- Division of Oncology and Pathology, Department of Clinical Science, Lund University, Lund, Sweden
| | - Martin C Chang
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA
| | - Andrew Dodson
- Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, UK
| | - Anna Ehinger
- Department of Clinical Genetics and Pathology, Skane University Hospital, Lund University, Lund, Sweden
| | - Susan Fineberg
- Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Dongxia Gao
- University of British Columbia, Vancouver, BC, Canada
| | | | - Carolina Gutierrez
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | | | - Zuzana Kos
- University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | | | | | | | - Sharon Nofech-Mozes
- University of Toronto Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - C Kent Osborne
- Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | | | - Tammy Piper
- Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
| | | | - Roberto Salgado
- Department of Pathology, GZA-ZNA, Antwerp, Belgium.,Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jane Starczynski
- Birmingham Heart of England, National Health Service, Birmingham, UK
| | | | | | - Giuseppe Viale
- European Institute of Oncology, Milan, Italy.,University of Milan, Milan, Italy
| | - Daniel F Hayes
- University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
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Nayak SS, Roy P, Arora N, Arun I, Roy MK, Banerjee S, Mallick I, Mallath MK. Prevalence estimation of microsatellite instability in colorectal cancers using tissue microarray based methods - A tertiary care center experience. INDIAN J PATHOL MICR 2019; 61:520-525. [PMID: 30303141 DOI: 10.4103/ijpm.ijpm_430_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aim Microsatellite instability (MSI) pathway is known to be implicated in carcinogenesis of 15% colorectal carcinomas (CRC), including 2%-3% of cases of Lynch syndrome, as per western literature. MSI status has important prognostic and therapeutic implications. The prevalence of MSI in Indian CRC patients is unknown. We aimed to determine the prevalence by studying 231 consecutive unselected cases of CRC. Methods Tissue microarrays using duplicate cores per case for 141 cases, and whole tissue sections for 90 cases, were used. Immunohistochemistry with four mismatch repair (MMR) markers - MLH1, MSH2, MSH6, and PMS2 was performed. Molecular analysis for MSI status was performed in 18 randomly selected cases. Correlation with various clinical and histopathological features was done using univariate and multivariate analysis. Results Loss of MMR immunohistochemical (IHC) was seen in 53/231 cases, i.e. 22.94% (95% confidence interval 17.52%-28.36%). MLH1-PMS2 dual loss comprised 13.9%, MSH2-MSH6 7.4%, and isolated PMS2 loss in 1.73% of cases. Univariate analysis showed significant association with age (<60 years), right-sided tumor location, histologic type, high grade, the presence of severe intratumoral lymphocytic (ITL) and peri-tumoral lymphocytic response, and N0 nodal stage. On multivariate analysis, independent variables were age < 60 years, right-sided location, and severe ITL. Molecular testing for MSI corroborated with the IHC results. Conclusion The study results show a slightly higher prevalence of MSI-H phenotype, compared to Western literature, stressing the need for more widespread testing for better clinical management and identification of possible hereditary colon cancer syndrome.
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Affiliation(s)
| | - Paromita Roy
- Department of Pathology, Tata Medical Centre, Kolkata, West Bengal, India
| | - Neeraj Arora
- Department of Laboratory Medicine and Molecular Genetics, Tata Medical Centre, Kolkata, West Bengal, India
| | - Indu Arun
- Department of Pathology, Tata Medical Centre, Kolkata, West Bengal, India
| | - Manas Kumar Roy
- Department of Surgical Oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - Sudeep Banerjee
- Department of Surgical Oncology, Tata Medical Centre, Kolkata, West Bengal, India
| | - Indranil Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Mohandas K Mallath
- Department of GI Medicine, Tata Medical Center, Kolkata, West Bengal, India
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Patel AK, Vipparthi K, Thatikonda V, Arun I, Bhattacharjee S, Sharan R, Arun P, Singh S. A subtype of cancer-associated fibroblasts with lower expression of alpha-smooth muscle actin suppresses stemness through BMP4 in oral carcinoma. Oncogenesis 2018; 7:78. [PMID: 30287850 PMCID: PMC6172238 DOI: 10.1038/s41389-018-0087-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/02/2018] [Accepted: 09/04/2018] [Indexed: 12/11/2022] Open
Abstract
Cancer-associated fibroblasts (CAFs) demonstrate the characteristics of myofibroblast differentiation by often expressing the ultrastructure of alpha-smooth muscle actin (αSMA). However, heterogeneity among cancer-associated fibroblasts (CAFs), with respect to αSMA expression, has been demonstrated in several clinical studies of oral cancer. Like normal stem cells, stem-like cancer cells (SLCCs) are also regulated extrinsically by its microenvironment; therefore, we postulated that the heterogeneous oral-CAFs would differently regulate oral-SLCCs. Using transcriptomics, we clearly demonstrated that the gene expression differences between oral tumor-derived CAFs were indeed the molecular basis of heterogeneity. This also grouped these CAFs in two distinct clusters, which were named as C1 and C2. Interestingly, the oral-CAFs belonging to C1 or C2 clusters showed low or high αSMA-score, respectively. Our data with tumor tissues and in vitro co-culture experiments interestingly demonstrated a negative correlation between αSMA-score and cell proliferation, whereas, the frequency of oral-SLCCs was significantly positively correlated with αSMA-score. The oral-CAF-subtype with lower score for αSMA (C1-type CAFs) was more supportive for cell proliferation but suppressive for the self-renewal growth of oral-SLCCs. Further, we found the determining role of BMP4 in C1-type CAFs-mediated suppression of self-renewal of oral-SLCCs. Overall, we have discovered an unexplored interaction between CAFs with lower-αSMA expression and SLCCs in oral tumors and provided the first evidence about the involvement of CAF-expressed BMP4 in regulation of self-renewal of oral-SLCCs.
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Affiliation(s)
| | | | - Venu Thatikonda
- National Institute of Biomedical Genomics, Kalyani, India.,German Cancer Research Center, Heidelberg, Germany
| | | | | | | | | | - Sandeep Singh
- National Institute of Biomedical Genomics, Kalyani, India.
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32
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Choraria A, Agrawal S, Arun I, Chatterjee S, Ahmed R. Sentinel and Non-Sentinel Lymph Node Metastasis Prediction and Validation of the MSKCC Nomograms for Indian Breast Cancer Patients. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.22900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Sentinel lymph node (SLN) biopsy accurately stages the axilla, but is time consuming and resource intensive. Nomograms and scoring systems have been developed, based on clinical and pathologic data available before surgery, to attempt to predict the likelihood of lymph node metastasis before surgery. As the management of the axilla in patients with low nodal burden changes, it is also important to predict whether there will be further axillary disease in patients with a positive SLN. Aim: To explore the risk factors for SLN and non-SLN metastasis in Indian women with breast cancer, by analysis of clinical and pathologic data. To assess the validity and clinical utility of two MSKCC nomograms that predicts axillary lymph node status for Western patients. Methods: Clinical data, and pathologic data available from core biopsy, for a consecutive series of women having SLNB was analyzed, and was plotted on two MSKCC nomograms. Univariate analysis was done by χ2 and Fischer exact tests and multivariate analysis was done by logistic regression method. A receiver-operating characteristic (ROC) curve was drawn and predictive accuracy was assessed by calculating the area under the ROC curve (AUC). Results: 34% (89 out of 256) of our patients had SLN positivity. When correlated with SLN metastasis by univariate analysis, LVI (χ2 = 80, P ≤ 0.001), PNI (χ2 = 13.36, P ≤ 0.001), ER+ (χ2 = 6.85, P = 0.009), PR+ (χ2 = 7.1, P = 0.008) and age ( P = 0.03) were significant. However, multivariate analysis showed that age (OR=1.04, P = 0.007) and LVI (OR=0.07, P ≤ 0.001) were identified as independent predictors for SLN metastasis. The area under the ROC curve was 0.772 and it fairly correlated with MSKCC nomogram. Patients with MSKCC scores lower than 38% had a frequency of SLN metastasis of 7.7% (5/65) and this cut-off could be used as a guide for not doing frozen section analysis in this subgroup. Further axillary dissection showed 41% (38 out of 92) had non-sentinel nodes positive. When correlated with non-SLN metastasis by univariate analysis, LVI (χ2 = 8.8, P = 0.003), PNI (χ2 = 6.85, P = 0.009), and extracapsular extension (χ2 = 4.18, P = 0.04) were significant. Number of SLN negative ( P = 0.01), SLN ratio (number of SLN positive/total number of SLN removed) ( P = 0.01) and size of SLN metastasis ( P = 0.002) were significant. However, multivariate analysis showed that only size of SLN metastasis (OR=0.845, P = 0.02) was identified as independent predictor for non-SLN metastasis. The area under the ROC curve was 0.66 and it poorly correlated with MSKCC nomogram. Conclusion: The MSKCC nomogram can provide a fairly accurate prediction of the probability of SLN metastasis, but is not for non-SLN metastasis. An institutional nomogram for non-SLN metastasis, including additional factors such as size of SLN metastasis, may improve prediction.
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Dutta A, Arun P, Roy P, Arun I. Cytological diagnosis of follicular dendritic cell sarcoma: A case report and review of literature. Cytopathology 2018; 29:461-467. [PMID: 29683532 DOI: 10.1111/cyt.12558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 12/18/2022]
Affiliation(s)
- A. Dutta
- Department of Pathology; Tata Medical Center; Kolkata West Bengal India
| | - P. Arun
- Department of Head and Neck Surgery; Tata Medical Center; Kolkata West Bengal India
| | - P. Roy
- Department of Pathology; Tata Medical Center; Kolkata West Bengal India
| | - I. Arun
- Department of Pathology; Tata Medical Center; Kolkata West Bengal India
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Chatterjee S, Ahmed R, Chakraborty S, Datta S, Ganguly S, Ghosh J, Das J, Saha M, Das A, Arun I, Ray S. Palliative radiotherapy (RT) to the breast using a novel hypofractionated radiotherapy regime: Results of the HYPORT phase I/II study (CTRI/2015/12/006407). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e12613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Jayanta Das
- Tata Medical Center, Kolkata, Kolkata, India
| | | | - Avipsa Das
- Tata Medical Center, Kolkata, Kolkata, India
| | - Indu Arun
- Tata Medical Center, Kolkata, Kolkata, India
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Manickam A, Nallathambi C, Sharan R, Manikantan K, Chatterjee S, Mallick I, Roy P, Zameer M, Arun I, Pattetheyil A. EP-1145: Does Carcinoma Tongue Differ From Gingivobuccal Sulcus? Analysis of Clinicopathology and Outcomes. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31455-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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36
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Nielsen TO, Leung SCY, Zabaglo LA, Arun I, Badve SS, Bane AL, Bartlet JMS, Borgquist S, Chang MC, Dodson A, Ehinger A, Fineberg S, Focke CM, Gao D, Gown AM, Gutierrez C, Hugh JC, Kos Z, Lænkholm AV, Mastropasqua MG, Moriya T, Nofech-Mozes S, Osborne CK, Penault-Llorca FM, Piper T, Sakatani T, Salgado R, Starczynski J, Sugie T, van der Vegt B, Viale G, Hayes DF, McShane LM, Dowsett M. Abstract P2-03-01: Analytical validation of a standardized scoring protocol for Ki67 assessed on breast excision whole sections: An international multicenter collaboration. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-03-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Aims: (i) Determine whether between-observer reproducibility for Ki67 when assessed on whole sections according to a standardized scoring protocol is adequate for clinical application. (ii) Compare between-observer reproducibility of Ki67 scores assessed on hot-spots to scores using a global method that averages across a tissue section.
Background: The nuclear proliferation biomarker Ki67 has multiple potential roles in breast cancer, including aiding decisions based on prognosis, but unacceptable levels of between-laboratory variability have been observed. The International Ki67 in Breast Cancer Working Group has undertaken a systematic program to determine whether Ki67 measurement can be analytically validated and standardized across labs. In phase 1, variability in visual interpretation was identified as an important source of variability. Phases 2 and 3a showed that adherence to defined scoring methods substantially improved reproducibility in scoring tissue microarrays and core-cut biopsies. We now assess whether acceptable reproducibility can be achieved on whole sections.
Methods: Adjacent sections from 30 primary ER+ breast cancers were centrally stained for Ki67 to assemble 4 sets of 30 stained tumor sections, circulated around 23 labs in 12 countries. Ki67 was scored by 2 methods by all labs: (a) global: 4 fields of 100 tumor cells each were selected to reflect observed heterogeneity in nuclear staining (b) hot-spot: the field with highest Ki67 percentage of tumor cells with nuclear staining was selected and up to 500 cells scored. Ki67 scores were log2-transformed for statistical analyses and back-transformed for presentation. The primary objective was to assess whether either method could achieve an intraclass correlation coefficient (ICC) significantly greater than 0.8, considered substantial to almost-perfect reproducibility. Secondary objectives were to assess which method had highest observed ICC and to assess whether observers identified the same “hot-spots”.
Results: ICC for the global method was 0.87 (95%CI: 0.799-0.93), marginally meeting the prespecified success criterion. The ICC for the hot-spot method was 0.83 (95%CI: 0.74-0.90) and had a CI extending below the success criterion. Across the 23 labs, geometric mean value of the 30 scores ranged from 8.5 to 19.6 for the global method and from 12.8 to 30.3 for the hot-spot method. The overall mean (95% CI) of these values was 12.9 (11.9-14.0) and 20.9 (19.1-22.8), respectively. Visually, between-laboratory agreement in location of selected hot-spot varies between cases. The median times for scoring were 9 and 6 minutes for global and hot-spot methods respectively.
Conclusions: The global method marginally met the prespecified criterion of success; it should now be evaluated for clinical validity in appropriate cohorts of cases. The hot-spot method was observed to have slightly less reproducibility between labs. The time taken for scoring by either method is practical using counting software we are making publicly available. Establishment of external quality assessment schemes is likely to improve the reproducibility between labs further.
(Supported by a grant from the Breast Cancer Research Foundation)
Citation Format: Nielsen TO, Leung SCY, Zabaglo LA, Arun I, Badve SS, Bane AL, Bartlet JMS, Borgquist S, Chang MC, Dodson A, Ehinger A, Fineberg S, Focke CM, Gao D, Gown AM, Gutierrez C, Hugh JC, Kos Z, Lænkholm A-V, Mastropasqua MG, Moriya T, Nofech-Mozes S, Osborne CK, Penault-Llorca FM, Piper T, Sakatani T, Salgado R, Starczynski J, Sugie T, van der Vegt B, Viale G, Hayes DF, McShane LM, Dowsett M. Analytical validation of a standardized scoring protocol for Ki67 assessed on breast excision whole sections: An international multicenter collaboration [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-03-01.
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Affiliation(s)
- TO Nielsen
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - SCY Leung
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - LA Zabaglo
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - I Arun
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - SS Badve
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - AL Bane
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - JMS Bartlet
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - S Borgquist
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - MC Chang
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - A Dodson
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - A Ehinger
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - S Fineberg
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - CM Focke
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - D Gao
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - AM Gown
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - C Gutierrez
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - JC Hugh
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - Z Kos
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - A-V Lænkholm
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - MG Mastropasqua
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - T Moriya
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - S Nofech-Mozes
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - CK Osborne
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - FM Penault-Llorca
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - T Piper
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - T Sakatani
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - R Salgado
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - J Starczynski
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - T Sugie
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - B van der Vegt
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - G Viale
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - DF Hayes
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - LM McShane
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - M Dowsett
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
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Pal R, Bhaumik J, Arun I. Endodermal Sinus Tumour of the Uterine Cervix: A Case Report. Indian J Gynecol Oncolog 2017. [DOI: 10.1007/s40944-017-0130-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Agrawal SK, Shenoy SS, Nalawade N, Datta SS, Roy S, Chatterjee S, Arun I, Ahmed R. Quality Indicators for Sentinel Lymph Node Biopsy in Breast Cancer: Applicability and Clinical Relevance in a Non-screened Population. Indian J Surg Oncol 2017; 9:312-317. [PMID: 30287989 DOI: 10.1007/s13193-017-0695-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 08/14/2017] [Indexed: 11/25/2022] Open
Abstract
Quality Indicators for Sentinel Lymph Node Biopsy in Breast Cancer: Applicability and Clinical Relevance in a Non-screened Population: sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection (ALND) as standard of care for management of early breast cancer. This study assessed our SLNB program against 11 published quality indicators (QIs). All breast cancer patients who underwent SLNB in our centre from June 2013-Dec 2015 were included. Clinical, pathological and follow-up data were extracted from the institutional REDCap data system. Analysis was done with SPSS 23. Following validation, 234 patients had SLNB, always performed along with primary surgery. Identification rate was 95.3% and > 1 SLN was identified in 72% of patients. SLNB positivity was 33%, of these, 100% underwent ALND. Overall 91% of QI eligible patients underwent SLNB. No ineligible patients (T4) underwent SLNB. For the patients who had radio colloid, injection criteria were met for 100%. Pathological evaluation and reporting criteria were met for 100% of patients. There were no axillary recurrences in a median follow-up of 2 years. 7.6% patients had SLN negative on frozen section but positive on final histology. 7.2% of patients with clinical negative nodes had pN2 disease in final histopathology report after surgery. Sixty percent of patients who had completion ALND had only positive SLN. This study supports the applicability of published QI of SLNB in a non-screened cohort of early breast cancer patients. Although QI were useful, modification based on patient characteristics and resource availability may be needed. These indicators can be used as audit tools to improve the overall accuracy of the procedure.
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Affiliation(s)
| | | | - Nikhil Nalawade
- 1Department of Breast Oncosurgery, Tata Medical Center, Kolkata, India
| | | | - Soumendranath Roy
- 3Department of Nuclear Medicine, Tata Medical Center, Kolkata, India
| | - Sanjoy Chatterjee
- 4Department of Clinical Oncology, Tata Medical Center, Kolkata, India
| | - Indu Arun
- 5Department of Pathology, Tata Medical Center, Kolkata, India
| | - Rosina Ahmed
- 1Department of Breast Oncosurgery, Tata Medical Center, Kolkata, India
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Tewary S, Arun I, Ahmed R, Chatterjee S, Chakraborty C. AutoIHC-scoring: a machine learning framework for automated Allred scoring of molecular expression in ER- and PR-stained breast cancer tissue. J Microsc 2017; 268:172-185. [PMID: 28613390 DOI: 10.1111/jmi.12596] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/18/2017] [Accepted: 05/29/2017] [Indexed: 12/11/2022]
Abstract
In prognostic evaluation of breast cancer Immunohistochemical (IHC) markers namely, oestrogen receptor (ER) and progesterone receptor (PR) are widely used. The expert pathologist investigates qualitatively the stained tissue slide under microscope to provide the Allred score; which is clinically used for therapeutic decision making. Such qualitative judgment is time-consuming, tedious and more often suffers from interobserver variability. As a result, it leads to imprecise IHC score for ER and PR. To overcome this, there is an urgent need of developing a reliable and efficient IHC quantifier for high throughput decision making. In view of this, our study aims at developing an automated IHC profiler for quantitative assessment of ER and PR molecular expression from stained tissue images. We propose here to use CMYK colour space for positively and negatively stained cell extraction for proportion score. Also colour features are used for quantitative assessment of intensity scoring among the positively stained cells. Five different machine learning models namely artificial neural network, Naïve Bayes, K-nearest neighbours, decision tree and random forest are considered for learning the colour features using average red, green and blue pixel values of positively stained cell patches. Fifty cases of ER- and PR-stained tissues have been evaluated for validation with the expert pathologist's score. All five models perform adequately where random forest shows the best correlation with the expert's score (Pearson's correlation coefficient = 0.9192). In the proposed approach the average variation of diaminobenzidine (DAB) to nuclear area from the expert's score is found to be 7.58%, as compared to 27.83% for state-of-the-art ImmunoRatio software.
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Affiliation(s)
- S Tewary
- School of Medical Science & Technology, IIT Kharagpur, West Bengal, India
| | - I Arun
- Tata Medical Center, New Town, Rajarhat, Kolkata, West Bengal, India
| | - R Ahmed
- Tata Medical Center, New Town, Rajarhat, Kolkata, West Bengal, India
| | - S Chatterjee
- Tata Medical Center, New Town, Rajarhat, Kolkata, West Bengal, India
| | - C Chakraborty
- School of Medical Science & Technology, IIT Kharagpur, West Bengal, India
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Mungle T, Tewary S, Das DK, Arun I, Basak B, Agarwal S, Ahmed R, Chatterjee S, Chakraborty C. MRF-ANN: a machine learning approach for automated ER scoring of breast cancer immunohistochemical images. J Microsc 2017; 267:117-129. [PMID: 28319275 DOI: 10.1111/jmi.12552] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 02/03/2017] [Accepted: 02/14/2017] [Indexed: 11/27/2022]
Abstract
Molecular pathology, especially immunohistochemistry, plays an important role in evaluating hormone receptor status along with diagnosis of breast cancer. Time-consumption and inter-/intraobserver variability are major hindrances for evaluating the receptor score. In view of this, the paper proposes an automated Allred Scoring methodology for estrogen receptor (ER). White balancing is used to normalize the colour image taking into consideration colour variation during staining in different labs. Markov random field model with expectation-maximization optimization is employed to segment the ER cells. The proposed segmentation methodology is found to have F-measure 0.95. Artificial neural network is subsequently used to obtain intensity-based score for ER cells, from pixel colour intensity features. Simultaneously, proportion score - percentage of ER positive cells is computed via cell counting. The final ER score is computed by adding intensity and proportion scores - a standard Allred scoring system followed by pathologists. The classification accuracy for classification of cells by classifier in terms of F-measure is 0.9626. The problem of subjective interobserver ability is addressed by quantifying ER score from two expert pathologist and proposed methodology. The intraclass correlation achieved is greater than 0.90. The study has potential advantage of assisting pathologist in decision making over manual procedure and could evolve as a part of automated decision support system with other receptor scoring/analysis procedure.
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Affiliation(s)
- T Mungle
- School of Medical Science & Technology, IIT Kharagpur, West Bengal, India
| | - S Tewary
- School of Medical Science & Technology, IIT Kharagpur, West Bengal, India
| | - D K Das
- School of Medical Science & Technology, IIT Kharagpur, West Bengal, India
| | - I Arun
- Tata Medical Center, Kolkata, West Bengal, India
| | - B Basak
- Tata Medical Center, Kolkata, West Bengal, India
| | - S Agarwal
- Tata Medical Center, Kolkata, West Bengal, India
| | - R Ahmed
- Tata Medical Center, Kolkata, West Bengal, India
| | - S Chatterjee
- Tata Medical Center, Kolkata, West Bengal, India
| | - C Chakraborty
- School of Medical Science & Technology, IIT Kharagpur, West Bengal, India
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Choraria A, Agrawal S, Arun I, Chatterjee S, Ahmed R. Predicting Sentinel and Non-sentinel Lymph Node Metastasis – are MSKCC Nomograms Valid for Non-screened Breast Cancer Patients? Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2016.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Roy P, Arun I, Mallick I, Banerjee S, Roy M. The Importance of Lymph Node Yield and the Lymph Node Ratio after Neoadjuvant Chemoradiation in Rectal Cancer. Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2016.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mungle T, Tewary S, Arun I, Basak B, Agarwal S, Ahmed R, Chatterjee S, Maity AK, Chakraborty C. Automated characterization and counting of Ki-67 protein for breast cancer prognosis: A quantitative immunohistochemistry approach. Comput Methods Programs Biomed 2017; 139:149-161. [PMID: 28187885 DOI: 10.1016/j.cmpb.2016.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 10/21/2016] [Accepted: 11/03/2016] [Indexed: 06/06/2023]
Abstract
Ki-67 protein expression plays an important role in predicting the proliferative status of tumour cells and deciding the future course of therapy in breast cancer. Immunohistochemical (IHC) determination of Ki-67 score or labelling index, by estimating the fraction of Ki67 positively stained tumour cells, is the most widely practiced method to assess tumour proliferation (Dowsett et al. 2011). Accurate manual counting of these cells (specifically nuclei) due to complex and dense distribution of cells, therefore, becomes critical and presents a major challenge to pathologists. In this paper, we suggest a hybrid clustering algorithm to quantify the proliferative index of breast cancer cells based on automated counting of Ki-67 nuclei. The proposed methodology initially pre-processes the IHC images of Ki-67 stained slides of breast cancer. The RGB images are converted to grey, L*a*b*, HSI, YCbCr, YIQ and XYZ colour space. All the stained cells are then characterized by two stage segmentation process. Fuzzy C-means quantifies all the stained cells as one cluster. The blue channel of the first stage output is given as input to k-means algorithm, which provides separate cluster for Ki-67 positive and negative cells. The count of positive and negative nuclei is used to calculate the F-measure for each colour space. A comparative study of our work with the expert opinion is studied to evaluate the error rate. The positive and negative nuclei detection results for all colour spaces are compared with the ground truth for validation and F-measure is calculated. The F-measure for L*a*b* colour space (0.8847) provides the best statistical result as compared to grey, HSI, YCbCr, YIQ and XYZ colour space. Further, a study is carried out to count nuclei manually and automatically from the proposed algorithm with an average error rate of 6.84% which is significant. The study provides an automated count of positive and negative nuclei using L*a*b*colour space and hybrid segmentation technique. Computerized evaluation of proliferation index can aid pathologist in assessing breast cancer severity. The proposed methodology, further, has the potential advantage of saving time and assisting in decision making over the present manual procedure and could evolve as an assistive pathological decision support system.
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Affiliation(s)
- Tushar Mungle
- School of Medical Science & Technology, IIT Kharagpur, Kharagpur, West Bengal, India
| | - Suman Tewary
- School of Medical Science & Technology, IIT Kharagpur, Kharagpur, West Bengal, India
| | - Indu Arun
- Tata Medical Center, New Town, Rajarhat, Kolkata, West Bengal, India
| | - Bijan Basak
- Tata Medical Center, New Town, Rajarhat, Kolkata, West Bengal, India
| | - Sanjit Agarwal
- Tata Medical Center, New Town, Rajarhat, Kolkata, West Bengal, India
| | - Rosina Ahmed
- Tata Medical Center, New Town, Rajarhat, Kolkata, West Bengal, India
| | - Sanjoy Chatterjee
- Tata Medical Center, New Town, Rajarhat, Kolkata, West Bengal, India
| | - Asok Kumar Maity
- Midnapur Medical College and Hospital, Midnapur, West Bengal, India
| | - Chandan Chakraborty
- School of Medical Science & Technology, IIT Kharagpur, Kharagpur, West Bengal, India.
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Arun I, Roy P, Arora N, Bhave SJ, Nair R, Chandy M. PAX-5 Positivity in Anaplastic Lymphoma Kinase-Negative Anaplastic Large Cell Lymphoma: A Case Report and Review of Literature. Int J Surg Pathol 2016; 25:333-338. [PMID: 28013563 DOI: 10.1177/1066896916683447] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma (ALCL) is a subtype of T-cell lymphomas that may mimic several other malignancies morphologically. With the help of immunohistochemistry, most cases of ALCL can be diagnosed on the basis of expression of T-cell lineage associated antigens. However, aberrations in the expression of immunohistochemical markers pose diagnostic challenges. The morphological and immunophenotypic features of ALCL show considerable overlap with classical Hodgkin lymphoma (CHL), which is a B-cell lymphoma. The 2008 World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues suggests that staining for the B-cell transcription factor, paired box 5 (PAX-5), is helpful in differentiating between them, as it is weakly positive in most CHL and should be negative in ALCL. We report a rare case of ALK-negative ALCL, which was positive for PAX-5 and CD15, mimicking CHL by immunohistochemistry, resulting in a diagnostic dilemma.
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Affiliation(s)
- Indu Arun
- 1 Tata Medical Center, Kolkata, West Bengal, India
| | - Paromita Roy
- 1 Tata Medical Center, Kolkata, West Bengal, India
| | - Neeraj Arora
- 1 Tata Medical Center, Kolkata, West Bengal, India
| | | | - Reena Nair
- 1 Tata Medical Center, Kolkata, West Bengal, India
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Chatterjee S, Arun I, Agrawal S, Arunsingh M, Mallick I, Ahmed R. Immunohistochemistry Heterogeneity in Reported Breast Cancer Demographics From India: Triple-Negative Breast Cancer Rates Could Be Lower Than Suggested in Pooled Meta-Analysis. J Glob Oncol 2016; 3:180-181. [PMID: 28717757 PMCID: PMC5493280 DOI: 10.1200/jgo.2016.006635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chatterjee S, Arunsingh M, Agrawal S, Dabkara D, Mahata A, Arun I, Shrimali RK, Achari R, Mallick I, Ahmed R. Outcomes Following a Moderately Hypofractionated Adjuvant Radiation (START B Type) Schedule for Breast Cancer in an Unscreened Non-Caucasian Population. Clin Oncol (R Coll Radiol) 2016; 28:e165-72. [PMID: 27369459 DOI: 10.1016/j.clon.2016.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 01/01/2023]
Abstract
AIMS Breast cancer is the most common cancer in women. Western data have confirmed hypofractionated radiation therapy to be safe and effective in the adjuvant radiation therapy of breast cancers. We report the disease-related outcomes in a non-Caucasian, unscreened population treated with hypofractionated radiation. MATERIALS AND METHODS Unselected case notes of patients presenting to a tertiary cancer centre between June 2011 and December 2013 were reviewed from the electronic hospital case records. Patients with a diagnosis of non-metastatic invasive non-sarcomatous breast cancer were identified. Demographic information, oestrogen receptor (ER), progesterone receptor (PR), HER2 status, pathological tumour, nodal stage at diagnosis and outcomes of treatment, including systemic therapies, surgery and hypofractionated radiation, were documented. Local recurrence rates, disease-free survival (DFS) and overall survival were calculated. RESULTS Overall 925 patents were identified, median age 53.0 years (interquartile range 45-61), 330 of whom had neoadjuvant chemotherapy. The median follow-up time was 22.6 months and 23.5 months for overall and neoadjuvant chemotherapy groups, respectively. ER, PR and HER2 status was available in 788 patients, 77.2% of whom were ER/PR positive, 14.7% had triple negative disease, while 9.5% were HER2 rich. Overall, 34.2% (113 patients) underwent breast conservation surgery; 744 (80.4%) patients were treated with systemic chemotherapy and 878 (94.9%) patients received adjuvant radiation therapy, of whom 407 (44.0%) received supraclavicular-fossa radiotherapy. Overall survival, DFS and locoregional recurrence-free survival (LRRFS) for the overall group were 93%, 86.9% and 97.1%, respectively. LRRFS in the breast conservation surgery versus mastectomy groups were 99% versus 95.5% (P=0.003), with more node-positive patients in the mastectomy group. Stage N0/1 had better LRRFS compared with N2/2 (99.1% versus 95.7%); 94.3% versus 82.3%; P=0.005, 0.000. Grade 3 (53.8%) tumours had worse overall survival compared with grade 1 or grade 2 disease (89.6% versus 100% and 96.4%; P<0.001) although the LRRFS was not significantly different between the groups (98.9% versus 97.8%; P=0.37). There was no difference in LRRFS based on molecular subtypes. CONCLUSION Local recurrence rates following hypofractionated radiation in our population were comparable with those reported by the START trialists and were found to be safe in the medium term for patients irrespective of breast conservation surgery/mastectomy or radiotherapy to the supraclavicular field. Molecular group frequencies were comparable with Western populations but did not affect LRRFS.
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Affiliation(s)
- S Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India.
| | - M Arunsingh
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - S Agrawal
- Department of Surgical Oncology, Tata Medical Center, Kolkata, India
| | - D Dabkara
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
| | - A Mahata
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - I Arun
- Department of Pathology, Tata Medical Center, Kolkata, India
| | - R K Shrimali
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - R Achari
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - I Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - R Ahmed
- Department of Surgical Oncology, Tata Medical Center, Kolkata, India
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Leung SCY, Nielsen TO, Zabaglo L, Arun I, Badve SS, Bane AL, Bartlett JMS, Borgquist S, Chang MC, Dodson A, Enos RA, Fineberg S, Focke CM, Gao D, Gown AM, Grabau D, Gutierrez C, Hugh JC, Kos Z, Lænkholm AV, Lin MG, Mastropasqua MG, Moriya T, Nofech-Mozes S, Osborne CK, Penault-Llorca FM, Piper T, Sakatani T, Salgado R, Starczynski J, Viale G, Hayes DF, McShane LM, Dowsett M. Analytical validation of a standardized scoring protocol for Ki67: phase 3 of an international multicenter collaboration. NPJ Breast Cancer 2016; 2:16014. [PMID: 28721378 PMCID: PMC5515324 DOI: 10.1038/npjbcancer.2016.14] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/22/2016] [Accepted: 04/01/2016] [Indexed: 11/09/2022] Open
Abstract
Pathological analysis of the nuclear proliferation biomarker Ki67 has multiple potential roles in breast and other cancers. However, clinical utility of the immunohistochemical (IHC) assay for Ki67 immunohistochemistry has been hampered by unacceptable between-laboratory analytical variability. The International Ki67 Working Group has conducted a series of studies aiming to decrease this variability and improve the evaluation of Ki67. This study tries to assess whether acceptable performance can be achieved on prestained core-cut biopsies using a standardized scoring method. Sections from 30 primary ER+ breast cancer core biopsies were centrally stained for Ki67 and circulated among 22 laboratories in 11 countries. Each laboratory scored Ki67 using three methods: (1) global (4 fields of 100 cells each); (2) weighted global (same as global but weighted by estimated percentages of total area); and (3) hot-spot (single field of 500 cells). The intraclass correlation coefficient (ICC), a measure of interlaboratory agreement, for the unweighted global method (0.87; 95% credible interval (CI): 0.81–0.93) met the prespecified success criterion for scoring reproducibility, whereas that for the weighted global (0.87; 95% CI: 0.7999–0.93) and hot-spot methods (0.84; 95% CI: 0.77–0.92) marginally failed to do so. The unweighted global assessment of Ki67 IHC analysis on core biopsies met the prespecified criterion of success for scoring reproducibility. A few cases still showed large scoring discrepancies. Establishment of external quality assessment schemes is likely to improve the agreement between laboratories further. Additional evaluations are needed to assess staining variability and clinical validity in appropriate cohorts of samples.
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Affiliation(s)
- Samuel C Y Leung
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Torsten O Nielsen
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lila Zabaglo
- Academic Department of Biochemistry, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | - Indu Arun
- Department of Pathology, Tata Medical Center, Kolkata, West Bengal, India
| | - Sunil S Badve
- Department of Pathology and Laboratory Medicine, Indiana University Simon Cancer Center, Indianapolis, Indiana, USA
| | - Anita L Bane
- Department of Pathology and Molecular Medicine, Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - John M S Bartlett
- Transformative Pathology, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Signe Borgquist
- Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Martin C Chang
- Department of Pathology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Andrew Dodson
- Academic Department of Biochemistry, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | | | - Susan Fineberg
- Department of Pathology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, USA
| | - Cornelia M Focke
- Department of Pathology, Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany
| | - Dongxia Gao
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allen M Gown
- PhenoPath Laboratories, Seattle, Washington, USA
| | - Dorthe Grabau
- Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Carolina Gutierrez
- Lester and Sue Smith Breast Center and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Judith C Hugh
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Zuzana Kos
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Ming-Gang Lin
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Mauro G Mastropasqua
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Takuya Moriya
- Department of Pathology, Kawasaki Medical School, Kurashiki, Okayama Prefecture, Japan
| | - Sharon Nofech-Mozes
- Department of Laboratory Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - C Kent Osborne
- Lester and Sue Smith Breast Center and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | | | - Tammy Piper
- Biomarkers & Companion Diagnostics Group, Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom
| | - Takashi Sakatani
- Department of Pathology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Roberto Salgado
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Brussels, Belgium
| | - Jane Starczynski
- Department of Cellular Pathology, Birmingham Heart of England, National Health Service, Birmingham, United Kingdom
| | - Giuseppe Viale
- Division of Pathology and Laboratory Medicine, European Institute of Oncology and University of Milan, Milan, Italy
| | - Daniel F Hayes
- Breast Oncology Program, Department of Internal Medicine, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan, USA
| | - Lisa M McShane
- Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland, USA
| | - Mitch Dowsett
- Academic Department of Biochemistry, Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
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Arora N, Mehta A, Ravichandran S, Arun I, Achari RB, Chakrapani A, Bhave SJ, Chandy M, Nair R. NK/T Cell Lymphoma: A Tertiary Centre Experience. Indian J Hematol Blood Transfus 2016; 33:69-73. [PMID: 28194059 DOI: 10.1007/s12288-016-0675-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 03/31/2016] [Indexed: 11/25/2022] Open
Abstract
Extranodal NK/T-cell lymphoma (ENKTL), nasal type, is a rare type of non-Hodgkin lymphoma that is commonly seen in East Asian countries and is associated with Epstein-Barr virus infection. This is a retrospective study where we describe nine cases of ENKTL; nasal type diagnosed and treated at our center over a period of 2 years. These cases were analyzed retrospectively for clinical presentation (age, sex, site of involvement), immunophenotype, treatment, response and toxicity profile. Sino-nasal symptoms (blocked nose, headache, epistaxis, regurgitation) were the most common presenting complaints (n = 8). Almost 67 % (n = 6/9) of the cases were referred from Bhutan. Necrosis and angiocentricity were the commonest histological features. Depending on the stage of the disease patient were initially treated with chemotherapy (SMILE/CHOP) and Radiotherapy (IFRT). We describe our experience of management of ENKTL, where we observe that Bhutan could be endemic region for this rare tumour.
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Affiliation(s)
- Neeraj Arora
- Department of Laboratory Haematology & Molecular Genetics, Tata Medical Center, Kolkata, India
| | - Arpan Mehta
- Department of Laboratory Haematology & Molecular Genetics, Tata Medical Center, Kolkata, India
| | | | - Indu Arun
- Department of Pathology, Tata Medical Center, Kolkata, India
| | - Rimpa Basu Achari
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - Anupam Chakrapani
- Department of Clinical Haematology, Tata Medical Center, Kolkata, India
| | | | - Mammen Chandy
- Department of Clinical Haematology, Tata Medical Center, Kolkata, India
| | - Reena Nair
- Department of Clinical Haematology, Tata Medical Center, Kolkata, India
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Sancheti S, Menon S, Mukherjee S, Arun I. Clear cell renal cell carcinoma with hemangioblastoma-like features: A recently described pattern with unusual immunohistochemical profile. INDIAN J PATHOL MICR 2016; 58:354-5. [PMID: 26275263 DOI: 10.4103/0377-4929.162898] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The diagnosis of clear cell renal cell carcinoma may sometimes pose challenges because of the presence of uncharacteristic morphology, varied immunophenotypic patterns and due to lack of molecular or genetic determinants. More often, the morphological variations can be easily overlooked in routine practice and a more common diagnosis is usually put forward. Solid, acinar and alveolar are the common patterns described in the literature. We report a recently described pattern of clear cell renal cell carcinoma which has hemangioblastoma-like morphology and an unusual immunoprofile. In our case, the tumor showed a diffuse hemangioblastoma-like pattern and diffuse positivity for Alpha-inhibin on immunohistochemistry. A thorough literature search, extensive sampling and an expanded immunohistochemistry panel revealed a clear cell renal cell carcinoma component. Presence of renal vein thrombosis and focal necrosis were other helpful features in discerning the malignant nature of tumor.
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Affiliation(s)
| | | | | | - Indu Arun
- Department of Pathology, Tata Medical Center, Kolkata, West Bengal, India
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