Pattern of distribution and prognostic value of angiogenesis in pancreatic duct carcinoma: a semiquantitative immunohistochemical study of 45 patients

In specimens obtained from resected pancreata, the intratumoral microvessel density (IMD), the proliferation rate of the neoplastic parenchymal cells, and their p53 protein expression were assessed. The sources of errors were great in the measurements of the IMD. This statement can be illustrated by the finding that when the IMD was calculated by manual counting in five areas of intense neovascularization (hot spot regions), using x200 and x400 magnifications, the numbers of microvessels per square millimeter were 65+/-23 and 106+/-8, respectively, which reflects a significant difference. Two patterns of microvessel distribution could be identified: one with hot spots only in the stroma (n = 19) and one in which the hot spots were located in areas of neoplastic parenchyma (including its stroma) (n = 26). The IMD was significantly greater in the latter group. There was no general correlation of neoplastic disease with the IMD. However, when a scoring system was used to assess the angiogenesis, hot spots in areas of neoplastic parenchyma were associated with a greater proliferation rate of the tumor cells, and with a short length of survival of the patients from their neoplastic disease.

Aspects of percutaneous fine-needle aspiration biopsy in the diagnosis of pancreatic carcinoma

BACKGROUND

Morphologic verification of malignancy is usually a prerequisite before initiating nonsurgical therapy for pancreatic carcinoma. Fine-needle biopsy has been widely used, but the method has also been criticized because of inadequate sampling material and the risk of intra-abdominal seeding.

METHODS

Cytologic material from 334 patients with suspected pancreatic malignancy was evaluated with regard to the sensitivity, specificity, and overall accuracy of the technique. The outcome (positive versus negative yield of cancer cells) was also entered in a Cox bivariate regression analysis and tested against multiple prognostic variables.

RESULTS

In all, 270 patients had malignant disease, which was verified cytologically in 187. The sensitivity, specificity, and accuracy were 69%, 100%, and 75%, respectively. Statistically significant prognostic factors with regard to patient survival time were type of therapy (P <0.001), tumor location (P <0.001), jaundice (P <0.001), pain (P <0.001), and palpable mass (P <0.05).

CONCLUSION

Fine-needle aspiration biopsy is still found to be a safe and feasible method for diagnosing pancreatic cancer, providing the requisite diagnostic information before initiating nonsurgical therapy.

Prognostic significance of Ki-67 antigen and p53 protein expression in pancreatic duct carcinoma: a study of the monoclonal antibodies MIB-1 and DO-7 in formalin-fixed paraffin-embedded tumour material

Formalin-fixed paraffin-embedded material from 57 patients in whom curative resection of pancreatic carcinoma had been attempted was analysed by an immunohistochemical procedure to estimate proliferation and p53 protein expression. Using the monoclonal antibody (MAb) MIB-1, which recognizes a Ki-67 epitope, the proliferating cell index (PCI, percentage of immunoreactive tumour nuclei) and proliferating cell area (PCA, percentage of immunoreactive tumour nuclear area) were calculated using an interactive image analysis system and were compared with semiquantitative scoring of stainability. MAb DO-7, which recognizes both wild- and mutant-type p53 protein, was used to assess p53 expression in the same material. MIB-1 stainings were of high quality in 53 tumours. The median PCI was 29.7% (range 0.5-82.1%) and the median PCA was 10.6% (range 0.0-36.5%). There was a close correlation between PCI and PCA (P < 0.0001). PCI and PCA values were in conformity with the semiquantitative scoring (P < 0.0001). The p53 immunohistochemical stainings were successful in 48 tumours and the protein was expressed in 22 (46%). High PCI values (> 45%, n = 14) correlated with shorter survival time (P < 0.01). PCA (P < 0.05) and the expression of p53 protein (P < 0.001) were independent prognostic variables.

Combined use of nuclear morphometry and DNA ploidy as prognostic indicators in nonresectable adenocarcinoma of the pancreas

The introduction of combined modality treatment has only marginally affected the prognosis in nonresectable pancreatic carcinoma. Evaluation of easily accessible prognostic variables could be of clinical importance when selecting patients for proper therapy. DNA ploidy and morphometric variables were chosen as prognostic markers and assessed on cytologic material obtained by fine-needle aspiration biopsy (FNAB) from 128 patients with pancreatic carcinoma. The nuclear DNA content was measured by image cytometry. Patients were categorized as short-term (< or = 6 mo) and long-term survivors (> 6 mo). Ninety-eight of 116 nonresectable patients were possible to evaluate. There were significant differences between short- and long-term survivors with regard to DNA ploidy (p < 0.01) and the morphonuclear variable anisokaryosis (p < 0.001). In patients with either DNA aneuploid tumors or anisokaryosis > or = 0.6, the survival time was 6 mo or less in 85 and 93%, respectively. When both these criteria were fulfilled, only 5% survived for more than 6 mo. Thus, DNA ploidy and morphometry, separately or in combination, may provide prognostic information in nonresectable pancreatic carcinoma.

Prognostic significance of DNA ploidy in pancreatic carcinoma

The nuclear DNA content was assessed by image cytometry on cytologic specimens obtained with fine-needle aspiration biopsy in 96 patients with pancreatic duct carcinoma. Twenty-two of these patients had pancreaticoduodenal resection. According to DNA analysis there were 27 (28%) diploid, 17 (18%) tetraploid, and 52 (54%) aneuploid tumors. The corresponding patient median survival times were 8, 5, and 4 months, respectively. Resectable tumors were more often DNA diploid (10 of 22) than nonresectable tumors (17 of 74) (p < 0.05). A Cox multivariate regression analysis demonstrated that surgical resection (p < 0.001) and diploid DNA pattern (p < 0.05) were factors associated with longer patient survival time. Although the difference in survival time was small, the data indicate that DNA diploid tumors represent a less aggressive subset of pancreatic carcinoma.

Morphometric characteristics in adenocarcinoma of the pancreas and chronic pancreatitis

BACKGROUND

Morphometric analysis whereby size and form of cellular nuclei are transformed into quantities has previously been shown to be a valuable adjunct to the histopathologic differential diagnosis between chronic pancreatitis and pancreatic carcinoma. The present study aims to assess the clinical value of morphometry performed on cytologic material from benign and malignant pancreatic lesions.

METHODS

Cytologic specimens from 100 patients with the diagnosis of pancreatic carcinoma and 15 patients with chronic pancreatitis were evaluated by interactive morphometry using a digital image analyzer system.

RESULTS

There were significant differences (p < 0.001) for all morphometric variables between the malignant and benign groups (mean area p 50, 135.41 microns 2 versus 69.66 microns 2; anisokaryosis, 0.74 versus 0.41; and polymorphism, 0.13 versus 0.09).

CONCLUSIONS

Morphometry may be used as a complementary tool in the cytologic diagnosis of pancreatic carcinoma.