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Sejben A, Sejben I, Budai A, Lauwers GY, Kővári B. Inflammatory Bowel Disease-Mimicking Colitis Associated With Nintedanib-Based Therapy in a Lung Cancer Patient. Int J Surg Pathol 2023; 31:1326-1328. [PMID: 36514295 DOI: 10.1177/10668969221143472] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Anita Sejben
- Department of Pathology, Faculty of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - István Sejben
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Annamária Budai
- Department of Internal Medicine, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Gregory Y Lauwers
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute and Departments of Pathology and Oncologic Sciences, University of South Florida, Tampa, FL, USA
| | - Bence Kővári
- Department of Pathology, Faculty of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute and Departments of Pathology and Oncologic Sciences, University of South Florida, Tampa, FL, USA
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Cserni B, Kilmartin D, O’Loughlin M, Andreu X, Bagó-Horváth Z, Bianchi S, Chmielik E, Figueiredo P, Floris G, Foschini MP, Kovács A, Heikkilä P, Kulka J, Laenkholm AV, Liepniece-Karele I, Marchiò C, Provenzano E, Regitnig P, Reiner A, Ryška A, Sapino A, Stovgaard ES, Quinn C, Zolota V, Webber M, Glynn SA, Bori R, Csörgő E, Oláh-Németh O, Pancsa T, Sejben A, Sejben I, Vörös A, Zombori T, Nyári T, Callagy G, Cserni G. ONEST (Observers Needed to Evaluate Subjective Tests) Analysis of Stromal Tumour-Infiltrating Lymphocytes (sTILs) in Breast Cancer and Its Limitations. Cancers (Basel) 2023; 15:cancers15041199. [PMID: 36831541 PMCID: PMC9954449 DOI: 10.3390/cancers15041199] [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: 01/20/2023] [Revised: 02/04/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Tumour-infiltrating lymphocytes (TILs) reflect antitumour immunity. Their evaluation of histopathology specimens is influenced by several factors and is subject to issues of reproducibility. ONEST (Observers Needed to Evaluate Subjective Tests) helps in determining the number of observers that would be sufficient for the reliable estimation of inter-observer agreement of TIL categorisation. This has not been explored previously in relation to TILs. ONEST analyses, using an open-source software developed by the first author, were performed on TIL quantification in breast cancers taken from two previous studies. These were one reproducibility study involving 49 breast cancers, 23 in the first circulation and 14 pathologists in the second circulation, and one study involving 100 cases and 9 pathologists. In addition to the estimates of the number of observers required, other factors influencing the results of ONEST were examined. The analyses reveal that between six and nine observers (range 2-11) are most commonly needed to give a robust estimate of reproducibility. In addition, the number and experience of observers, the distribution of values around or away from the extremes, and outliers in the classification also influence the results. Due to the simplicity and the potentially relevant information it may give, we propose ONEST to be a part of new reproducibility analyses.
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Affiliation(s)
- Bálint Cserni
- TNG Technology Consulting GmbH, Király u. 26., 1061 Budapest, Hungary
| | - Darren Kilmartin
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Mark O’Loughlin
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Xavier Andreu
- Pathology Department, Atryshealth Co., Ltd., 08039 Barcelona, Spain
| | - Zsuzsanna Bagó-Horváth
- Department of Pathology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Simonetta Bianchi
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Paulo Figueiredo
- Laboratório de Anatomia Patológica, IPO Coimbra, 3000-075 Coimbra, Portugal
| | - Giuseppe Floris
- Laboratory of Translational Cell & Tissue Research and KU Leuven, Department of Imaging and Pathology, Department of Pathology, University Hospitals Leuven, University of Leuven, Oude Market 13, 3000 Leuven, Belgium
| | - Maria Pia Foschini
- Unit of Anatomic Pathology, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bellaria Hospital, 40139 Bologna, Italy
| | - Anikó Kovács
- Department of Clinical Pathology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Päivi Heikkilä
- Department of Pathology, Helsinki University Central Hospital, 00029 Helsinki, Finland
| | - Janina Kulka
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University Budapest, Üllői út 93, 1091 Budapest, Hungary
| | - Anne-Vibeke Laenkholm
- Department of Surgical Pathology, Zealand University Hospital, 4000 Roskilde, Denmark
| | - Inta Liepniece-Karele
- Department of Pathology, Riga Stradins University, Riga East Clinical University Hospital, LV-1038 Riga, Latvia
| | - Caterina Marchiò
- Unit of Pathology, Candiolo Cancer Institute FPO-IRCCS, 10060 Candiolo, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Elena Provenzano
- Department of Histopathology, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge CB2 0QQ, UK
- National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge CB2 0QQ, UK
| | - Peter Regitnig
- Diagnostic and Research Institute of Pathology, Medical University of Graz, 8010 Graz, Austria
| | - Angelika Reiner
- Department of Pathology, Klinikum Donaustadt, 1090 Vienna, Austria
| | - Aleš Ryška
- The Fingerland Department of Pathology, Charles University Medical Faculty and University Hospital, 50003 Hradec Kralove, Czech Republic
| | - Anna Sapino
- Unit of Pathology, Candiolo Cancer Institute FPO-IRCCS, 10060 Candiolo, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | | | - Cecily Quinn
- Department of Histopathology, Irish National Breast Screening Programme, BreastCheck, St. Vincent’s University Hospital and School of Medicine, University College Dublin, D04 T6F4 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Vasiliki Zolota
- Department of Pathology, School of Medicine, University of Patras, 26504 Rion, Greece
| | - Mark Webber
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Sharon A. Glynn
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Rita Bori
- Department of Pathology, Bács-Kiskun County Teaching Hospital, 6000 Kecskemét, Hungary
| | - Erika Csörgő
- Department of Pathology, Bács-Kiskun County Teaching Hospital, 6000 Kecskemét, Hungary
| | | | - Tamás Pancsa
- Department of Pathology, University of Szeged, 6720 Szeged, Hungary
| | - Anita Sejben
- Department of Pathology, University of Szeged, 6720 Szeged, Hungary
| | - István Sejben
- Department of Pathology, Bács-Kiskun County Teaching Hospital, 6000 Kecskemét, Hungary
| | - András Vörös
- Department of Pathology, University of Szeged, 6720 Szeged, Hungary
| | - Tamás Zombori
- Department of Pathology, University of Szeged, 6720 Szeged, Hungary
| | - Tibor Nyári
- Department of Medical Physics and Informatics, University of Szeged, 6720 Szeged, Hungary
| | - Grace Callagy
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Gábor Cserni
- Department of Pathology, Bács-Kiskun County Teaching Hospital, 6000 Kecskemét, Hungary
- Department of Pathology, University of Szeged, 6720 Szeged, Hungary
- Correspondence:
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Cserni B, Bori R, Csörgő E, Oláh-Németh O, Pancsa T, Sejben A, Sejben I, Vörös A, Zombori T, Nyári T, Cserni G. ONEST (Observers Needed to Evaluate Subjective Tests) suggests four or more observers for a reliable assessment of the consistency of histological grading of invasive breast carcinoma: A reproducibility study with a retrospective view on previous studies. Pathol Res Pract 2022; 229:153718. [DOI: 10.1016/j.prp.2021.153718] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/21/2021] [Accepted: 11/25/2021] [Indexed: 11/15/2022]
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Zombori T, Kuthi L, Hortobágyi T, Csörgő E, Árgyelán J, Kocsis L, Sejben I, Kaizer L, Radics B, Sejben A, Pancsa T, Nyári GR, Baráth B, Cserni G, Iványi B, Tiszlavicz L. “Dum spiro spero”: clinicopathologic characteristics of SARS-CoV-2 infection. Orv Hetil 2021; 162:1791-1802. [PMID: 34747358 DOI: 10.1556/650.2021.32387] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/19/2021] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Bevezetés: A kórboncolás hozzájárul a súlyos akut légzőszervi szindrómát okozó koronavírus-2 (SARS-CoV-2-) fertőzés klinikopatológiai vonatkozásainak megismeréséhez. Célkitűzés: A SARS-CoV-2-fertőzöttek boncolása során gyűjtött tapasztalatok bemutatása. Módszer: Egymást követően boncolt, védőoltásban nem részesült, SARS-CoV-2-fertőzött elhunytak klinikai adatait, makro- és mikroszkópos észleleteit összegeztük; a tüdőkimetszéseket SARS-CoV-2-nukleokapszid-immunfestéssel vizsgáltuk. Eredmények: A boncolást a halálok megállapítására (n = 14), tumorgyanú (n = 9), illetve törvényi kötelezettség (n = 3) miatt végeztük. A fertőzést a klinikai észlelés vagy a boncolás során (n = 4) végzett SARS-CoV-2-nukleinsav-teszt igazolta. A tünetes betegség átlagos hossza 12,9 nap volt. 21 betegnél (medián életkor 69 év; 18 férfi) állt fenn COVID-19-pneumonia, mely 16 esetben önmagában, 4 esetben bakteriális pneumoniával vagy álhártyás colitisszel szövődve okozott halált; 1 antikoagulált pneumoniás beteg heveny retroperitonealis vérzésben halt meg. 3 betegnél a halált disszeminálódott malignus tumor, 1 betegnél coronariathrombosis, 1 mentálisan retardált betegnél pedig pulmonalis emboliás szövődmény okozta. A COVID-19-pneumoniás tüdők nehezek, tömöttek és vörösen foltozottak voltak. Szövettanilag a betegség időtartamától függően diffúz alveolaris károsodás korai exsudativ vagy későbbi proliferativ fázisa látszott atípusos pneumocytákkal; gyakori volt a microthrombosis (n = 7), a macrothrombosis (n = 5), illetve a pulmonalis embolia (n = 4). A SARS-CoV-2-immunfestés pozitívnak bizonyult az esetek 38,5%-ában, dominálóan az exsudativ fázisban. Minden elhunyt társbetegség(ek)ben szenvedett, így magasvérnyomás-betegségben (n = 17), érelmeszesedésben (n = 14), 2-es típusú diabetesben (n = 8), rosszindulatú daganatban (n = 6), krónikus obstruktív tüdőbetegségben (n = 4), elhízásban (n = 3), vesetranszplantáció utáni immunszuppresszióban (n = 3). Következtetés: Az irodalmi adatokkal összhangban, halálos COVID-19-pneumonia túlnyomóan idős, társbetegség(ek)től sújtott férfiakban alakult ki. A boncolási gyakorlatban a SARS-CoV-2-nukleokapszid-immunfestéstől a diffúz alveolaris károsodás korai fázisában várható pozitivitás. Orv Hetil. 2021; 162(45): 1791-1802. SUMMARY INTRODUCTION Autopsy is an important tool for the evaluation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Objectice: The aim of this study was to present our experience with autopsies of patients diagnosed with SARS-CoV-2 infection. METHOD Clinical data, macroscopic and microscopic findings of consecutive postmortems of non-vaccinated SARS-CoV-2 patients are summarized. Lung samples were evaluated with SARS-CoV-2 nucleocapsid immunohistochemistry. RESULTS Autopsies were performed to determine the cause of death (n = 14), suspected tumours (n = 9) or due to legal obligation (n = 3). SARS-CoV-2 infection was verified by ante mortem (n = 22) and post mortem (n = 4) polymerase chain reaction. The mean duration of symptomatic disease was 12.9 days. Of 21 patients with COVID-19 pneumonia, 16 died of respiratory failure, 4 had additional bacterial pneumonia or Clostridioides difficile infection, and 1 developed hemorrhagic complication (n = 1). Other causes of death included disseminated malignancies (n = 3), coronary thrombosis (n = 1) and pulmonary embolism (n = 1). The affected lungs were heavy and had patchy red appearance. Exudative or proliferative phases of diffuse alveolar damage (DAD) were detected with atypical pneumocytes. Microthrombosis (n = 7), macrothrombosis (n = 5) and pulmonary embolism (n = 4) were frequent. The SARS-CoV-2 immunohistochemical reaction was positive in 38.5% of cases. All patients had co-morbidities, namely, hypertension (n = 17), atherosclerosis (n = 14), diabetes (n = 8), malignancies (n = 6), chronic obstructive pulmonary diseases (n = 4), obesity (n = 3) and immunosuppression after kidney transplantation (n = 3). CONCLUSION Fatal COVID-19 pneumonia occurred mostly in elderly males with co-morbidities. In the autopsy practice, the SARS-CoV-2 nucleocapsid immunohistochemical reaction may confirm the infectious etiology in the early phase of DAD. Orv Hetil. 2021; 162(45): 1791-1802.
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Affiliation(s)
- Tamás Zombori
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725
| | - Levente Kuthi
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725
| | - Tibor Hortobágyi
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725
| | | | | | | | | | - László Kaizer
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725
| | - Bence Radics
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725
| | - Anita Sejben
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725
| | - Tamás Pancsa
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725
| | - Gergely Róbert Nyári
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725
| | - Bence Baráth
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725
| | - Gábor Cserni
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725.,2 Bács-Kiskun Megyei Oktatókórház, Kecskemét
| | - Béla Iványi
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725
| | - László Tiszlavicz
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged, Állomás u. 1., 6725
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Cserni B, Bori R, Csörgő E, Oláh-Németh O, Pancsa T, Sejben A, Sejben I, Vörös A, Zombori T, Nyári T, Cserni G. The additional value of ONEST (Observers Needed to Evaluate Subjective Tests) in assessing reproducibility of oestrogen receptor, progesterone receptor, and Ki67 classification in breast cancer. Virchows Arch 2021; 479:1101-1109. [PMID: 34415429 PMCID: PMC8724065 DOI: 10.1007/s00428-021-03172-9] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/06/2021] [Accepted: 07/25/2021] [Indexed: 11/28/2022]
Abstract
The reproducibility of assessing potential biomarkers is crucial for their implementation. ONEST (Observers Needed to Evaluate Subjective Tests) has been recently introduced as a new additive evaluation method for the assessment of reliability, by demonstrating how the number of observers impact on interobserver agreement. Oestrogen receptor (ER), progesterone receptor (PR), and Ki67 proliferation marker immunohistochemical stainings were assessed on 50 core needle biopsy and 50 excision samples from breast cancers by 9 pathologists according to daily practice. ER and PR statuses based on the percentages of stained nuclei were the most consistently assessed parameters (intraclass correlation coefficients, ICC 0.918-0.996), whereas Ki67 with 5 different theoretical or St Gallen Consensus Conference-proposed cut-off values demonstrated moderate to good reproducibility (ICC: 0.625-0.760). ONEST highlighted that consistent tests like ER and PR assessment needed only 2 or 3 observers for optimal evaluation of reproducibility, and the width between plots of the best and worst overall percent agreement values for 100 randomly selected permutations of observers was narrow. In contrast, with less consistently evaluated tests of Ki67 categorization, ONEST suggested at least 5 observers required for more trustful assessment of reliability, and the bandwidth of the best and worst plots was wider (up to 34% difference between two observers). ONEST has additional value to traditional calculations of the interobserver agreement by not only highlighting the number of observers needed to trustfully evaluate reproducibility but also by highlighting the rate of agreement with an increasing number of observers and disagreement between the better and worse ratings.
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Affiliation(s)
| | - Rita Bori
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Erika Csörgő
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | | | - Tamás Pancsa
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Anita Sejben
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - István Sejben
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - András Vörös
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Tamás Zombori
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Tibor Nyári
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Gábor Cserni
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary. .,Department of Pathology, University of Szeged, Szeged, Hungary.
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Sejben I, Som Z, Cserni G. [Sudden cardiac death due to sarcoidosis. Case report]. Orv Hetil 2017; 158:1067-1070. [PMID: 28670989 DOI: 10.1556/650.2017.30724] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Sarcoidosis is a systemic granulomatous disease of unknown aetiology, which is characterized by bilateral hilar lymphadenopathy and pulmonary disease. Clinically detected cardiac involvement occurs in 5% of sarcoid patients, although cardiac manifestations are discovered in 25% of the cases at autopsy. Sarcoid heart disease frequently causes atrioventricular block. The authors present the case of a 44-year-old man with bradycardia. On admission, second degree Mobitz II, then third degree atrioventricular block was diagnosed. Coronarography showed normal coronary arteries. 2.5 years following artificial Biotronik Entovis DR type pacemaker implantation, sudden cardiac death occurred. Autopsy revealed sarcoidosis with cardiac, pulmonary, splenic, renal and lymph node involvement. In case of young or middle-aged patients with atrioventricular block, it is best to search for other causes if the most common coronary origin can be excluded. Orv Hetil. 2017; 158(27): 1067-1070.
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Affiliation(s)
- István Sejben
- Patológiai Osztály, Bács-Kiskun Megyei Kórház Kecskemét, Nyíri út 38., 6000
| | - Zoltán Som
- Felnőtt Kardiológiai Osztály, Gottsegen György Országos Kardiológiai Intézet Budapest
| | - Gábor Cserni
- Patológiai Osztály, Bács-Kiskun Megyei Kórház Kecskemét, Nyíri út 38., 6000.,Szent-Györgyi Albert Klinikai Központ, Patológiai Intézet, Szegedi Tudományegyetem Szeged
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Cserni G, Bori R, Sejben I, Ágoston EI, Ács B, Szász AM. The Petersen prognostic index revisited in Dukes B colon cancer--Inter-institutional differences. Pathol Res Pract 2016; 212:73-6. [PMID: 26724146 DOI: 10.1016/j.prp.2015.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 03/14/2015] [Revised: 06/12/2015] [Accepted: 08/14/2015] [Indexed: 10/23/2022]
Abstract
A prognostic index (Petersen index, PI) was created for patients with pT3-4 pN0 M0 (Stage II, Dukes' B) colon cancers to distinguish between patients with better and worse outcome, and to help in recommending adjuvant chemotherapy for high risk patients in this stage. The prognostic value of the PI was evaluated in two independent retrospective series of stage II (Dukes' B) colon cancer patients. The parameters defining the PI (venous invasion, peritoneal involvement, circumferential margin involvement, perforation through the tumour) and performance of the PI were compared in two institutions. The two series of patients consisted of 127 and 87 patients. Venous invasion was more frequently detected at one of the centres (p<0.01) and tumour perforation was more frequent at the other (p<0.01). There were no significant differences in the 5-year survival estimates of all patients (p=0.19), and of either the low PI value groups (p=0.52) or that of the high PI value groups (p=0.99) between the two sites. In contrast, there were significant differences in the survival estimates between patients of the low PI category and those of the high PI category altogether (p<0.01) and in either centre. Although, it was expected that differences in the frequency of the parameters involved in the PI would influence its performance, this was not confirmed by the data. Our results suggest that using the PI may be of value in prognostic factor based therapy selection of colon carcinoma patients.
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Affiliation(s)
- Gábor Cserni
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Nyíri út 38., Kecskemét 6000, Hungary; Department of Pathology, University of Szeged, Állomás u. 2., Szeged 6725, Hungary.
| | - Rita Bori
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Nyíri út 38., Kecskemét 6000, Hungary
| | - István Sejben
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Nyíri út 38., Kecskemét 6000, Hungary
| | - Emese I Ágoston
- 1(st) Department of Surgery, Semmelweis University, Üllői út 78., Budapest 1082, Hungary
| | - Balázs Ács
- 2(nd) Department of Pathology, Semmelweis University, Üllői út 93., Budapest 1091, Hungary
| | - A Marcell Szász
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Nyíri út 38., Kecskemét 6000, Hungary; 2(nd) Department of Pathology, Semmelweis University, Üllői út 93., Budapest 1091, Hungary
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Sejben I, Kocsis L, Török L, Cserni G. Elastic staining does not assist detection of venous invasion in cutaneous melanoma. Pathol Res Pract 2015; 212:51-3. [PMID: 26639870 DOI: 10.1016/j.prp.2015.11.011] [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: 04/01/2015] [Revised: 07/03/2015] [Accepted: 11/11/2015] [Indexed: 12/01/2022]
Abstract
The aim of the present study was to determine the benefit of orcein elastic staining of primary cutaneous melanoma specimens in detecting venous invasion. Primary cutaneous melanomas in vertical growth phase were assessed for vascular invasion. All tumour blocks were stained with haematoxylin and eosin (H&E) and orcein. The cases were reviewed by two pathologists. Vascular invasion was not identified more frequently on orcein stained slides than on H&E stained ones. Elastosis and periappendiceal elastic fibres interfered with vascular invasion detection with elastic staining. Based on our study, we conclude that elastic stains such as orcein do not improve the detection rate of venous invasion in primary cutaneous melanomas.
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Affiliation(s)
- István Sejben
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Nyíri út 38, H-6000 Kecskemét, Hungary.
| | - Lajos Kocsis
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Nyíri út 38, H-6000 Kecskemét, Hungary; Department of Dermatology, Bács-Kiskun County Teaching Hospital, Nyíri út 38, H-6000 Kecskemét, Hungary
| | - László Török
- Department of Dermatology, Bács-Kiskun County Teaching Hospital, Nyíri út 38, H-6000 Kecskemét, Hungary
| | - Gábor Cserni
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Nyíri út 38, H-6000 Kecskemét, Hungary; Department of Pathology, University of Szeged, Állomás u. 2, H-6720 Szeged, Hungary
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Patyi M, Sejben I, Cserni G, Sántha B, Gaál Z, Pongrácz J, Oberna F. Retrospective health-care associated infection surveillance in oral and maxillofacial reconstructive microsurgery. Acta Microbiol Immunol Hung 2014; 61:407-16. [PMID: 25361526 DOI: 10.1556/amicr.61.2014.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/13/2023]
Abstract
In polymorbid or anaemic patients who receive preoperative radiotherapy or undergo long duration surgery involving potentially infectious sites, perioperative antibiotic prophylaxis (PAP) that is effective against normal oral bacterial flora is mandatory and plays an important role in preventing postoperative infection. In a four-year retrospective analysis, the incidence, outcome, and the efficacy of PAP were evaluated in patients treated at the Department of Oral and Maxillofacial Surgery and Otorhinolaryngology at Kecskemét Hospital. The results were compared with data from the literature to determine if the use of PAP was adequate at the Department.During the study period (between 01/09/2007 and 31/01/2011) 108 patients were evaluated. The mean duration of prophylactic antibiotic treatment was 8.3 ± 5.2 days, with cefotaxime+metronidazole being the most commonly used combination. Surgical site infection occurred in 8 patients (7.5%) in the clean-contaminated category.Our results showed that the perioperative antibiotic prophylaxis administered at our Department was efficient and effective against the oral bacterial flora of patients. Its use is recommended in head and neck microsurgery. To avoid development of antibiotic resistance and to reduce costs, it seems that the duration of antibiotic regimen for primary surgery can be reduced from 8.3 ± 5.2 days to 3 days.
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Affiliation(s)
- Márta Patyi
- 1 Bács-Kiskun County Teaching Hospital Department of Hospital Hygiene Kecskemét Hungary
| | - István Sejben
- 2 Bács-Kiskun County Teaching Hospital Department of Pathology Kecskemét Hungary
| | - Gábor Cserni
- 2 Bács-Kiskun County Teaching Hospital Department of Pathology Kecskemét Hungary
| | - Beáta Sántha
- 3 Bács-Kiskun County Teaching Hospital Department of Oral and Maxillofacial Surgery and Otorhinolaryngology Kecskemét Hungary
| | - Zoltán Gaál
- 4 Bács-Kiskun County Teaching Hospital Central Intensive Care Unit Kecskemét Hungary
| | - Júlia Pongrácz
- 5 Semmelweis University Clinical Microbiology Diagnostic Laboratory, Institute of Laboratory Medicine Budapest Hungary
| | - Ferenc Oberna
- 3 Bács-Kiskun County Teaching Hospital Department of Oral and Maxillofacial Surgery and Otorhinolaryngology Kecskemét Hungary
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Sejben I, Szabó Z, Lukács N, Loránd M, Sükösd F, Cserni G. Papillary renal cell carcinoma embedded in an oncocytoma: Case report of a rare combined tumour of the kidney. Can Urol Assoc J 2013; 7:E513-6. [PMID: 23914273 DOI: 10.5489/cuaj.414] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
An asymptomatic 1-cm large papillary renal cell carcinoma (RCC) embedded in a 3.5-cm large oncocytoma was diagnosed and removed by right nephrectomy in a 68-year-old male investigated for the abdominal symptoms associated with cholelithiasis. The papillary RCC displayed positive immunohistochemical stainings with cytokeratin 7, alpha-methylacyl-CoA racemase and vimentin and was negative for the E-cadherin and CD117 immunostains, whereas the oncocytoma part showed opposite staining patterns. No gains of chromosomes 7 and 17 or loss of chromosome Y was detected in the papillary carcinoma by fluorescent in situ hybridization with centromeric enumeration probes. This finding is in keeping with the morphologic diagnosis of type 2 papillary RCC reported to have lower rates of these characteristic chromosomal changes. The combination of papillary RCC and oncocytoma, two tumours of different postulated origin, is extremely rare. It may represent a simple coincidence, but 2 previous cases and our current one share a few features, including the intimate embedment of the papillary RCC in the oncocytoma, the small size of the RCC and the old age of the patients. This case raises the point that renal oncocytomas can contain a hidden malignant tumour.
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Affiliation(s)
- István Sejben
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
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Meretoja TJ, Audisio RA, Heikkilä PS, Bori R, Sejben I, Regitnig P, Luschin-Ebengreuth G, Zgajnar J, Perhavec A, Gazic B, Lázár G, Takács T, Kővári B, Saidan ZA, Nadeem RM, Castellano I, Sapino A, Bianchi S, Vezzosi V, Barranger E, Lousquy R, Arisio R, Foschini MP, Imoto S, Kamma H, Tvedskov TF, Jensen MB, Cserni G, Leidenius MHK. International multicenter tool to predict the risk of four or more tumor-positive axillary lymph nodes in breast cancer patients with sentinel node macrometastases. Breast Cancer Res Treat 2013; 138:817-27. [DOI: 10.1007/s10549-013-2468-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 02/25/2013] [Indexed: 01/06/2023]
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Abstract
Chronic granulomatous inflammation may develop after injectingforeign oily substances into the penis. The disorder affects mainlythe site of administration, but regional lymphadenopathy or evensystemic disease can occur. We present a 39-year-old man withpetroleum jelly-induced penile lesion and unilateral inguinal lymphadenitis mimicking incarcerated inguinal hernia. At hernioplasty no hernial sac was found, but enlarged lymph nodes suspicious for malignancy were identified. The histopathologic findings of these nodes were consistent with mineral oil granuloma. Paraffinoma of the male genitalia can cause various clinical features posing a differential diagnostic dilemma. Regional lymphadenitis may be the main clinical characteristic. Patient’s history, physical and histopathological examination are required to establish the diagnosis.
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Cserni G, Bori R, Sejben I, Vörös A, Kaiser L, Hamar S, Csörgő E, Kulka J. Unifocal, multifocal and diffuse carcinomas: A reproducibility study of breast cancer distribution. Breast 2013; 22:34-8. [DOI: 10.1016/j.breast.2012.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 05/06/2012] [Accepted: 05/14/2012] [Indexed: 11/26/2022] Open
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Meretoja TJ, Leidenius MHK, Heikkilä PS, Boross G, Sejben I, Regitnig P, Luschin-Ebengreuth G, Žgajnar J, Perhavec A, Gazic B, Lázár G, Takács T, Vörös A, Saidan ZA, Nadeem RM, Castellano I, Sapino A, Bianchi S, Vezzosi V, Barranger E, Lousquy R, Arisio R, Foschini MP, Imoto S, Kamma H, Tvedskov TF, Kroman N, Jensen MB, Audisio RA, Cserni G. International multicenter tool to predict the risk of nonsentinel node metastases in breast cancer. J Natl Cancer Inst 2012; 104:1888-96. [PMID: 23117131 DOI: 10.1093/jnci/djs455] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Axillary treatment of breast cancer patients is undergoing a paradigm shift, as completion axillary lymph node dissections (ALNDs) are being questioned in the treatment of patients with tumor-positive sentinel nodes. This study aims to develop a novel multi-institutional predictive tool to calculate patient-specific risk of residual axillary disease after tumor-positive sentinel node biopsy. METHODS Breast cancer patients with a tumor-positive sentinel node and a completion ALND from five European centers formed the original patient series (N = 1000). Statistically significant variables predicting nonsentinel node involvement were identified in logistic regression analysis. A multivariable predictive model was developed and validated by area under the receiver operating characteristics curve (AUC), first internally in 500 additional patients and then externally in 1068 patients from other centers. All statistical tests were two-sided. RESULTS Nine tumor- and sentinel node-specific variables were identified as statistically significant factors predicting nonsentinel node involvement in logistic regression analysis. A resulting predictive model applied to the internal validation series resulted in an AUC of 0.714 (95% confidence interval [CI] = 0.665 to 0.763). For the external validation series, the AUC was 0.719 (95% CI = 0.689 to 0.750). The model was well calibrated in the external validation series. CONCLUSIONS We present a novel, international, multicenter, predictive tool to assess the risk of additional axillary metastases after tumor-positive sentinel node biopsy in breast cancer. The predictive model performed well in internal and external validation but needs to be further studied in each center before application to clinical use.
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Affiliation(s)
- Tuomo J Meretoja
- Helsinki University Central Hospital, Breast Surgery Unit, PO Box 140, FI-00029 HUS, Finland.
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Sejben I, Rácz A, Svébis M, Patyi M, Cserni G. Petroleum jelly-induced penile paraffinoma with inguinal lymphadenitis mimicking incarcerated inguinal hernia. Can Urol Assoc J 2012; 6:E137-9. [PMID: 23093564 DOI: 10.5489/cuaj.11146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Chronic granulomatous inflammation may develop after injecting foreign oily substances into the penis. The disorder affects mainly the site of administration, but regional lymphadenopathy or even systemic disease can occur. We present a 39-year-old man with petroleum jelly-induced penile lesion and unilateral inguinal lymphadenitis mimicking incarcerated inguinal hernia. At hernioplasty no hernial sac was found, but enlarged lymph nodes suspicious for malignancy were identified. The histopathologic findings of these nodes were consistent with mineral oil granuloma. Paraffinoma of the male genitalia can cause various clinical features posing a differential diagnostic dilemma. Regional lymphadenitis may be the main clinical characteristic. Patient's history, physical and histopathological examination are required to establish the diagnosis.
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Affiliation(s)
- István Sejben
- Department of Surgical Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
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Abstract
AIMS To assess the reliability of nodal staging in colorectal carcinomas (CRCs) when only lymph nodes close to the tumour are recovered and examined histologically. METHODS Lymph nodes from CRC resection specimens were recovered into two fractions: one from around the tumour and the 3 cm sidelong bowel segment associated with it in the proximal and distal directions, and another from the remaining part of the resection specimen. RESULTS Of the 762 CRCs (239 right colon, 251 left colon, 257 rectum, 15 unspecified localisation) there were 393 node-negative and 369 node-positive cases. The median number of LNs examined was 18. The assessment of the LNs located in the close fraction (median 13) yielded an adequate qualitative nodal status in 756 patients (99.2%). In four cases (two rectal and two right colic), no LN metastases could be identified in the close-fraction lymph nodes, but nodes from the distant fraction contained metastases. Of the node-positive carcinomas which had at least one positive lymph node in the close fraction, 203 belonged to the pN1 category and 162 to the pN2 category of the Tumour Node Metastasis staging system. Only 14 cases (10 rectal, two right and two left colic tumours) were misclassified as pN1 (on the basis of lymph nodes recovered from the close fraction) although they were of the pN2 category. CONCLUSIONS In general, nodal status of CRCs may be adequately assessed by examining the lymph nodes from the close fraction around the tumour and the 3 cm sidelong bowel segment in both directions.
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Affiliation(s)
- Gábor Cserni
- Bács-Kiskun County Teaching Hospital, Department of Pathology, Kecskemét, Hungary.
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Pajkos G, Sejben I, Gombos K, Ember I. 818 Expression correlations of NFkB signaling and miR146 a/b miR21 and let-7 expression in primary human head and neck squamous cell carcinomas. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)71614-1] [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: 11/30/2022] Open
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Sejben I, Bori R, Cserni G. Venous invasion demonstrated by orcein staining of colorectal carcinoma specimens is associated with the development of distant metastasis. J Clin Pathol 2010; 63:575-8. [PMID: 20501452 DOI: 10.1136/jcp.2010.075846] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS To assess venous invasion (VI) and its relation to distant metastases in colorectal cancer (CRC). METHODS Primary untreated CRC cases were assessed for VI. All tumour blocks were stained with H&E and orcein. The presence of VI and nodal status were then correlated with the presence of synchronous or metachronous distant metastases. RESULTS VI was detected more frequently with the orcein stain (18% versus 71%). Eleven tumours (nine node-positive tumours, all VI positive) were associated with synchronous distant metastasis. During a median follow-up of 17 months nine further cases were diagnosed with distant metastasis (six node-positive tumours, all VI positive). The specificity and sensitivity of the presence of nodal metastasis for predicting distant metastasis were 0.56 and 0.75, respectively. The same values for orcein-detected VI were 0.39 and 1, respectively. CONCLUSIONS Elastic stains such as the orcein stain enable the detection of clinically relevant VI with greater frequency than conventionally stained histological slides. If nodal involvement is an indication for systemic chemotherapy, the data presented here suggest that VI detected by the orcein stain should also be an indication for systemic chemotherapy.
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Affiliation(s)
- István Sejben
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Nyiri ut, Hungary
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Bori R, Sejben I, Svébis M, Vajda K, Markó L, Pajkos G, Cserni G. Heterogeneity of pT3 colorectal carcinomas according to the depth of invasion. Pathol Oncol Res 2010; 15:527-32. [PMID: 19172413 DOI: 10.1007/s12253-009-9149-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2008] [Accepted: 01/08/2009] [Indexed: 12/30/2022]
Abstract
Colorectal carcinomas (CRCs) infiltrating through the muscularis propria layer without infiltration of adjacent structures, organs or the serosa-i.e. the pT3 tumors, compose the largest subset of large intestinal carcinomas treated by surgical resection. They are heterogeneous in terms of prognosis. CRCs treated by surgery in a period of 69 months were prospectively classified as pT3a tumors (invading to a maximum of 5 mm beyond the muscularis propria) and pT3b tumors (invading deeper). Their nodal status, incidence of vascular invasion and the presence or absence of distant metastases were analyzed in relation to the depth of invasion. Of the 593 CRCs primarily treated by surgery 429 were pT3 tumors. CRCs categorized as pT3a had significantly lower rates of nodal involvement (44% vs 75%), massive nodal involvement (pN2) (9% vs 39%), venous invasion (17% vs 30%) and distant metastasis (11% vs 28%) than pT3b tumors. Significant differences in these prognostic variables in pT3a and pT3b cancers were observed both for carcinomas of the colon and those of the rectum. Such differences were not obvious in further 66 ypT3 cases of rectal carcinoma receiving neoadjuvant treatment before surgery. Tumors in the pT3a category are associated with a better prognostic profile than pT3b tumors. This subdivision might be useful in both prognostication and treatment planning.
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Affiliation(s)
- Rita Bori
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Nyíri út 38., 6000, Kecskemét, Hungary.
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Cserni G, Bori R, Sejben I, Boross G, Maráz R, Svébis M, Rajtár M, Tekle Wolde E, Ambrózay É. Analysis of predictive tools for further axillary involvement in patients with sentinel lymph node positive small (≤15 mm) invasive breast cancer. Orv Hetil 2009; 150:2182-8. [DOI: 10.1556/oh.2009.28699] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Small breast cancers often require different treatment than larger ones. The frequency and predictability of further nodal involvement was evaluated in patients with positive sentinel lymph nodes and breast cancers ≤15 mm by means of 8 different predictive tools. Of 506 patients with such small tumors 138 with positive sentinel nodes underwent axillary dissection and 39 of these had non-sentinel node involvement too. The Stanford nomogram and the micrometastatic nomogram were the predictive tools identifying a small group of patients with low probability of further axillary involvement that might not require completion axillary lymph node dissection. Our data also suggest that the Tenon score can separate subsets of patients with a low and a higher risk of non-sentinel node metastasis. Predictive tools based on multivariate models can help in omitting completion axillary dissection in patients with low risk of non-sentinel lymph node metastasis based on their small tumor size.
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Affiliation(s)
- Gábor Cserni
- Bács-Kiskun Megyei Önkormányzat Kórháza Patológiai Osztály Kecskemét Nyíri út 38. 6000
| | - Rita Bori
- Bács-Kiskun Megyei Önkormányzat Kórháza Patológiai Osztály Kecskemét Nyíri út 38. 6000
| | - István Sejben
- Bács-Kiskun Megyei Önkormányzat Kórháza Patológiai Osztály Kecskemét Nyíri út 38. 6000
| | - Gábor Boross
- Bács-Kiskun Megyei Önkormányzat Kórháza Sebészeti Osztály Kecskemét
| | - Róbert Maráz
- Bács-Kiskun Megyei Önkormányzat Kórháza Sebészeti Osztály Kecskemét
| | - Mihály Svébis
- Bács-Kiskun Megyei Önkormányzat Kórháza Sebészeti Osztály Kecskemét
| | - Mária Rajtár
- Bács-Kiskun Megyei Önkormányzat Kórháza Nukleáris Medicina Osztály Kecskemét
| | - Eliza Tekle Wolde
- Bács-Kiskun Megyei Önkormányzat Kórháza Nukleáris Medicina Osztály Kecskemét
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Cserni G, Bori R, Sejben I. Vascular invasion demonstrated by elastic stain—a common phenomenon in benign granular cell tumors. Virchows Arch 2008; 454:211-5. [DOI: 10.1007/s00428-008-0702-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 11/07/2008] [Accepted: 11/11/2008] [Indexed: 12/22/2022]
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Cserni G, Bianchi S, Vezzosi V, van Diest P, van Deurzen C, Sejben I, Regitnig P, Asslaber M, Foschini MP, Sapino A, Castellano I, Callagy G, Arkoumani E, Kulka J, Wells CA. Variations in sentinel node isolated tumour cells/micrometastasis and non-sentinel node involvement rates according to different interpretations of the TNM definitions. Eur J Cancer 2008; 44:2185-91. [PMID: 18691877 DOI: 10.1016/j.ejca.2008.06.033] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 05/28/2008] [Accepted: 06/23/2008] [Indexed: 01/15/2023]
Abstract
Breast cancers with nodal isolated tumour cells (ITC) and micrometastases are categorised as node-negative and node-positive, respectively, in the tumour node metastasis (TNM) classification. Two recently published interpretations of the TNM definitions were applied to cases of low-volume sentinel lymph node (SLN) involvement and their corresponding non-SLNs for reclassification as micrometastasis or ITC. Of the 517 cases reviewed, 82 had ITC and 435 had micrometastasis on the basis of one classification, and the number of ITC increased to 207 with 310 micrometastases on the basis of the other. Approximately 24% of the cases were discordantly categorised. The rates of non-SLN metastases associated with SLN ITCs were 8.5% and 13.5%, respectively. Although the second interpretation of low-volume nodal stage categories has better reproducibility, it may underestimate the rate of non-SLN involvement. The TNM definitions of low-volume nodal metastases need to be better formulated and supplemented with visual information in the form of multiple sample images.
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Affiliation(s)
- Gábor Cserni
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Nyiri út 38, H-6000 Kecskemét, Hungary.
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