Interpretation of PD-L1 expression in gastric cancer: summary of a consensus meeting of Korean gastrointestinal pathologists.

Nivolumab plus chemotherapy in the first-line setting has demonstrated clinical efficacy in patients with human epidermal growth factor receptor 2-negative advanced or metastatic gastric cancer, and is currently indicated as a standard treatment. Programmed death-ligand 1 (PD-L1) expression is an important biomarker for predicting response to anti-programmed death 1/PD-L1 agents in several solid tumors, including gastric cancer. In the CheckMate-649 trial, significant clinical improvements were observed in patients with PD-L1 combined positive score (CPS) ≥ 5, determined using the 28-8 pharmDx assay. Accordingly, an accurate interpretation of PD-L1 CPS, especially at a cutoff of 5, is important. The CPS method evaluates both immune and tumor cells and provides a comprehensive assessment of PD-L1 expression in the tumor microenvironment of gastric cancer. However, CPS evaluation has several limitations, one of which is poor interobserver concordance among pathologists. Despite these limitations, clinical indications relying on PD-L1 CPS are increasing. In response, Korean gastrointestinal pathologists held a consensus meeting for the interpretation of PD-L1 CPS in gastric cancer. Eleven pathologists reviewed 20 PD-L1 slides with a CPS cutoff close to 5, stained with the 28-8 pharmDx assay, and determined the consensus scores. The issues observed in discrepant cases were discussed. In this review, we present cases of gastric cancer with consensus PD-L1 CPS. In addition, we briefly touch upon current practices and clinical issues associated with assays used for the assessment of PD-L1 expression in gastric cancer.

A Nationwide Study on HER2-low Breast Cancer in South Korea: Its Incidence of 2022 Real World Data and the Importance of Immunohistochemical Staining Protocols.

Purpose: Notable effectiveness of trastuzumab deruxtecan (T-DXd) in patients with HER2-low advanced breast cancer (BC) has focused pathologists' attention. We studied the incidence and clinicopathologic characteristics of HER2-low BC, and the effects of immunohistochemistry (IHC) associated factors on HER2 IHC results. Materials and Methods: The Breast Pathology Study Group of the Korean Society of Pathologists conducted a nationwide study using real-world data on HER2 status generated between January 2022 and December 2022. Information on HER2 IHC protocols at each participating institution was also collected. Results: Total 11,416 patients from twenty-five institutions included in this study. Of these patients, 40.7% (range: 6.0%-76.3%) were classified as HER2-zero, 41.7% (range: 10.5%-69.1%) as HER2-low, and 17.5% (range: 6.7%-34.0%) as HER2-positive. HER2-low tumors were associated with positive ER and PR statuses (p<0.001 and p<0.001, respectively). Antigen retrieval times (≥ 36 min vs. < 36 min) and antibody incubation times (≥ 12 min vs. < 12 min) affected on the frequency of HER2 IHC 1+ BC at institutions using the PATHWAY HER2 (4B5) IHC assay and BenchMark XT or Ultra staining instruments. Furthermore, discordant results between core needle biopsy (CNB) and subsequent resection specimen HER2 statuses were observed in 24.1% (787/3259) of the patients. Conclusion: The overall incidence of HER2-low BC in South Korea concurs with those reported in previously published studies. Significant inter-institutional differences in HER2 IHC protocols were observed, and it may have impact on HER2-low status. Thus, we recommend standardizing HER2 IHC conditions to ensure precise patient selection for targeted therapy.

Automated Diagnosis of Cervical Intraepithelial Neoplasia in Histology Images via Deep Learning.

Artificial intelligence has enabled the automated diagnosis of several cancer types. We aimed to develop and validate deep learning models that automatically classify cervical intraepithelial neoplasia (CIN) based on histological images. Microscopic images of CIN3, CIN2, CIN1, and non-neoplasm were obtained. The performances of two pre-trained convolutional neural network (CNN) models adopting DenseNet-161 and EfficientNet-B7 architectures were evaluated and compared with those of pathologists. The dataset comprised 1106 images from 588 patients; images of 10% of patients were included in the test dataset. The mean accuracies for the four-class classification were 88.5% (95% confidence interval [CI], 86.3-90.6%) by DenseNet-161 and 89.5% (95% CI, 83.3-95.7%) by EfficientNet-B7, which were similar to human performance (93.2% and 89.7%). The mean per-class area under the receiver operating characteristic curve values by EfficientNet-B7 were 0.996, 0.990, 0.971, and 0.956 in the non-neoplasm, CIN3, CIN1, and CIN2 groups, respectively. The class activation map detected the diagnostic area for CIN lesions. In the three-class classification of CIN2 and CIN3 as one group, the mean accuracies of DenseNet-161 and EfficientNet-B7 increased to 91.4% (95% CI, 88.8-94.0%), and 92.6% (95% CI, 90.4-94.9%), respectively. CNN-based deep learning is a promising tool for diagnosing CIN lesions on digital histological images.

Colonic mucosal immune activity in irritable bowel syndrome: comparison with healthy controls and patients with ulcerative colitis.

BACKGROUND AND AIM: Mucosal immune activity may participate in irritable bowel syndrome (IBS) pathogenesis. Mast- and T cell numbers from patients with IBS or ulcerative colitis (UC) and healthy controls were determined. METHODS: Between November 2007 and May 2012, patients with diarrhea-predominant IBS (D-IBS, n = 83), 49 patients with UC, and 25 healthy controls were recruited. Of the UC group, 28 were in remission and 21 had mildly active UC. Biopsies from each colon segment were subjected to immunohistochemical analysis. The mast cells, intraepithelial lymphocytes (IELs), and lamina proprial lymphocytes (LPLs) were counted. RESULTS: Compared to the healthy controls, the patients with D-IBS, UC in remission, and mildly active UC had significantly higher mean colorectal mucosal mast-cell, IEL, and LPL counts. Comparison with the colon segments (ascending, transverse, descending, and sigmoid segments) that had once been involved in UC (in the patients with remission) revealed that the D-IBS colons had similar immune-cell counts. However, they had significantly fewer immune cells than the colon segments that presently showed involvement in the patients with mildly-activated UC. The mast-cell and IEL counts were similar in the D-IBS rectums and once-involved UC rectums but significantly higher in the presently-involved UC rectums. However, both the once-involved and presently-involved UC rectums had significantly higher LPL counts than the D-IBS rectums. CONCLUSIONS: Patients with D-IBS had significantly higher colonic mucosal immune-cell counts than healthy controls but had similar counts to patients with UC in remission. The symptoms in both conditions may originate from low-grade inflammation in the colonic mucosa.

A case of acute myocarditis as the initial presentation of Crohn's disease.

We experienced a case of acute myocarditis as the initial presentation of Crohn's disease. A 19-year-old woman was admitted with impaired consciousness, shock, and respiratory failure. She had suffered from frequent diarrhea and abdominal pain for several years. Cardiac troponin I and creatine kinase-MB fraction levels were elevated to 5.32 and 16.66 ng/mL, respectively. A 12-lead electrocardiogram showed sinus tachycardia, and a chest radiograph revealed interstitial pulmonary edema. An echocardiogram showed dilated ventricles with akinesia of the basal to apical inferoseptal, anteroseptal, anterior, and inferior left ventricular walls and severely impaired systolic function. Intensive care with inotropic support was effective, and her clinical condition gradually improved. Two weeks later, a colonoscopy revealed ulceration with stenosis in the terminal ileum and multiple aphthous ulcers in the rectum. A biopsy of the rectum revealed non-caseating granulomatous inflammation. She was diagnosed with Crohn's disease presenting with acute myocarditis.

Carcinoma ex pleomorphic adenoma of the salivary glands: distinct clinicopathologic features and immunoprofiles between subgroups according to cellular differentiation.

In carcinoma ex pleomorphic adenoma (CXPA), pleomorphic adenoma (PA) and diverse carcinoma components showing luminal (ductal) or non-luminal (myoepithelial) differentiation coexist. To elucidate the clinicopathological implications of cellular differentiation in CXPA and the potential role of p53, vascular endothelial growth factor (VEGF), c-erbB-2, c-kit, and glucose transporter 1 (Glut-1) in carcinogenesis, we analyzed 11 CXPAs with luminal differentiation (CXPAs-LD) and 6 CXPAs with non-luminal differentiation (CXPAs-NLD) and compared protein expressions in residual PAs and carcinomas by immunohistochemistry. Among the CXPAs-LD, 5 were invasive and 8 were histologically high-grade tumors. The 5-year survival rate was 72.7%. P53, c-erbB-2, VEGF, and Glut-1 were more immunoreactive in carcinoma components than in PAs (P = 0.008, 0.004, 0.002, and 0.024, respectively); c-erbB-2 overexpression was associated with high histological grade (P = 0.024). Carcinoma components frequently lacked c-kit expression (P = 0.009). CXPAs-NLD were all low-grade and invasive with a larger mean tumor size (5.2 cm) than CXPAs-LD (3.3 cm) (P = 0.040). The patients remained disease-free without significant immunohistochemical expression. The immunoprofiles and clinical course of CXPA differed according to cellular differentiation. Therefore, it is important to report the histological subtype and to assess potential biomarkers in diagnostic and therapeutic trials.

The effects of barrier materials on reduction of pericardial adhesion formation in rabbits: a comparative study of a hyaluronan-based solution and a temperature sensitive poloxamer solution/gel material.

OBJECTIVE: This study was performed to examine the efficacy and safety of a hyaluronan solution (Guardix-SL) and a temperature sensitive poloxamer solution/gel material (Guardix-SG) on the prevention of pericardial adhesion in rabbits. METHODS: A total of 60 rabbits were divided into three groups according to material applied after epicardial abrasion: the control group (group CO), the Guardix SL group (group SL), and the Guardix SG group (group SG). The ejection fraction and the presence of pericardial effusion were evaluated by echocardiograms at the immediate postoperative period and 2 wk after the surgery. The adhesion was evaluated macroscopically and microscopically 2 wk after the surgery. RESULTS: In the group SG, mild pericardial effusions were observed only at the immediate postoperative period in 10 out of 20 rabbits with an insignificant reduction of the ejection fraction. Group CO had a significantly higher macroscopic adhesion and fibrosis score than did groups SL and SG (P < 0.001), and group SL had a significantly higher adhesion score than did group SG (P = 0.045). Inflammation score and the expression of anti-macrophage antibody in group CO were higher than those in groups SL and SG, although the differences were not significant. CONCLUSIONS: Guardix-SL and Guardix-SG effectively reduced the adhesion formation, and Guardix-SG is more effective than Guardix-SL for preventing adhesion. However, Guardix-SG showed a potential disadvantage of decreasing the ejection fraction, although this was statistically insignificant. Further study to verify the appropriate dosage to maximize the therapeutic effect without decreasing the heart function is needed.

An assessment of the effects of a hyaluronan-based solution on reduction of postsurgical adhesion formation in rats: a comparative study of hyaluronan-based solution and two film barriers.

BACKGROUND: Intra-abdominal application of anti-adhesive barriers may reduce the extent and severity of postoperative adhesions. This study was designed to compare the effectiveness of a sprayable liquid barrier (a mixed solution of sodium hyaluronate and carboxymethylcellulose) with two conventional sheets. METHODS: Eighty male Sprague Dawley rats underwent laparotomy with subsequent multiple intestinal wall abrasions and abdominal wall injury. Afterwards, sodium hyaluronate and carboxymethylcellulose (HA-CMC) solutions were intraperitoneally sprayed or a film barrier of either oxidized regenerated cellulose (ORC) or polylactic acid (PA) was placed under the incision. At postoperative d 21, the rats underwent relaparotomy and complete adhesiolysis. Three investigators, who were blind to the group assignment, scored the extent of adhesion formation and resected specimens for histologic examination of fibrosis and inflammation. Expression profiles of parameters as mediators (macrophages [CD68]) in cellular inflammation response were analyzed. RESULTS: Mean adhesion scores in rats that received HA-CMC solution (7.6±2.3) and ORC membrane (8.1±2.2) were lower than in rats that received PA film (10.7±2.5) and the control group (11.2±2.6) (P<0.05 for each comparison). In addition, there were significantly fewer adhesions located between large and small intestine in the HA-CMC solution group than in the control and each of the film barrier groups (P<0.05 for each comparison). CONCLUSIONS: This study suggests that both HA-CMC solution and ORC membrane decrease the overall incidence of postoperative adhesions. However, the mixed solution of HA-CMC appeared to be superior to ORC membrane because this sprayable solution is easy to use and suitable for site-specific adhesion prevention after multifocal bowel trauma.

Fine needle aspiration biopsy for the diagnosis of thymoma metastatic to the breast: a case report.

BACKGROUND: Extrathoracic metastases of thymomas are extremely rare, with only 9 documented cases in the cytologic literature, and a thymoma metastasis to the breast has not been reported before. Here we report the cytologic findings on fine needle aspiration biopsy (FNAB) for the diagnosis of a case of thymoma metastatic to the breast. CASE: A 73-year-old woman presented with a palpable mass in the right breast. A sonogram revealed a discrete, hypoechoic nodule in the upper inner quadrant of the breast. She had a history of mediastinal thymoma 2 years earlier, which was treated with chemotherapy because of inoperability. FNAB was performed: the cytologic specimen showed epithelial cell clusters with a few entrapped lymphocytes, suggestive of metastatic thymoma. However, the differential diagnosis also included a primary malignancy such as poorly differentiated ductal carcinoma or medullary carcinoma of the breast. Excisional biopsy with additional immunohistochemical staining confirmed the thymoma metastasis. CONCLUSION: An FNAB-based diagnosis of this rare entity can be an appropriate, simple and minimally invasive procedure in the right clinical setting and with the appropriate patient history.

A case of isolated invasive Aspergillus colitis presenting with hematochezia in a nonneutropenic patient with colon cancer.

Gastrointestinal invasive aspergillosis is often reported as part of a disseminated infection, and rarely as an isolated organ infection. Isolated invasive Aspergillus colitis is very rare, being observed only in patients with hematological malignancy and neutropenia. We encountered an unusual case of isolated invasive Aspergillus colitis presenting with hematochezia in a nonneutropenic patient with colon cancer. Fungal hyphae with surrounding inflammatory cells and mucosal necrosis were observed during the histological examination of a biopsy sample obtained at endoscopy. This case indicates that isolated invasive Aspergillus colitis may develop in a variable context of immunosuppression.

Sentinel lymph node identification with radiopharmaceuticals in patients with breast cancer: a comparison of 99mTc-tin colloid and 99mTc-phytate efficiency.

Sentinel lymph node biopsy with lymphoscintigraphy has become the standard method for the detection of axillary lymph node metastasis in breast cancer patients. However, there is no standardized radiopharmaceutical. For the detection of axillary lymph node metastasis by lymphoscintigraphy and sentinel node biopsy in patients with breast cancer, we compared the results between subareolar injection of (99m)Tc-tin colloid and injection of (99m)Tc-phytate. This study included 516 breast cancer patients who underwent surgery between 2001 and 2010. Among the 516 patients, (99m)Tc-tin colloid (37-185 MBq) was administered to 412 patients by subareolar injection, and (99m)Tc-phytate (37-185 MBq) was injected in 104 patients. Lymphoscintigraphy was performed with the patients in the supine position, and sentinel node identification was performed by hand-held gamma probe during surgery. Among 412 patients with (99m)Tc-tin colloid, the sentinel node was identified by lymphoscintigraphy in 364 cases (88.3%) and by a gamma probe in 369 cases (89.6%). Among 104 patients with (99m)Tc-phytate, 101 cases (97.1%) were identified by lymphoscintigraphy and 101 cases (97.1%) were identified by a gamma probe. The identification rates by lymphoscintigraphy and gamma probe were superior with (99m)Tc-phytate, as compared with (99m)Tc-tin colloid, with a statistically significant difference (P < 0.05 for both methods). (99m)Tc-phytate is a better choice than (99m)Tc-tin colloid for identification of the sentinel node in breast cancer patients.

Killian-Jamieson diverticulum mimicking a suspicious thyroid nodule: sonographic diagnosis.

Killian-Jamieson diverticulum is a rare form of pharyngoesophageal diverticula emerging in the anterolateral wall of the cervical esophagus. We present a case of Killian-Jamieson diverticulum that mimicked a thyroid nodule on sonography (US), and for which a US-guided fine-needle aspiration (FNA) was performed. The possibility of Killian-Jamieson diverticulum should be considered when a thyroid nodule is seen adjacent to the esophagus even without US change during/after swallowing.

Comparison of ex vivo and in vivo injection of blue dye in sentinel lymph node mapping for colorectal cancer.

BACKGROUND: The technique of sentinel lymph node (SLN) mapping in patients with colorectal cancer varies between reports, and the optimal method has not been established. The purpose of this study was to determine the optimal injection technique for SLN mapping. METHODS: Sixty-nine consecutive patients who underwent curative surgery for colorectal cancer were enrolled. The SLNs was identified intraoperatively by subserosal blue dye injection (in vivo) or by submucosal injection after standard colectomy (ex vivo). If negative by conventional hematoxylin and eosin staining analysis, all lymph nodes, SLNs and non-SLNs, were subjected to further analysis by multi-level section and immunohistochemical examination. RESULTS: The in vivo and ex vivo injected groups were similar in demographic character, tumor size, and histological grade. The mean number of SLNs identified was 2.3 in the in vivo group and 2.6 in the ex vivo group (p = 0.192). The detection rate of SLNs by blue dye injection was somewhat higher in the ex vivo group than in the in vivo group: 90.6 vs. 81.1% (p = 0.219). The false-negative rate was 23.5% for the in vivo group and 13.3% for the ex vivo group (p = 0.392). The upstaging rate, which was 18.5% overall, was similar in both groups (p = 0.538). CONCLUSIONS: These findings suggest that ex vivo blue dye injection is an effective alternative to in vivo injection for identifying SLNs in patients with colorectal cancer. Because of its simplicity and applicability in routine clinical settings, further investigation of the ex vivo mapping technique is warranted.

The prognostic value of hypoxia markers in T2-staged oral tongue cancer.

Tumor hypoxia is associated with poorer outcome in patients with head and neck carcinomas, but little is known about hypoxia biomarkers in oral tongue cancer. We evaluated whether hypoxia biomarkers and clinicopathologic variables were prognostic predictors in patients with T2-staged squamous cell carcinoma (SCC) of the oral tongue. Tissue microarrays were constructed from formalin-fixed tumor blocks of 43 patients with T2-staged tongue SCCs treated by surgical resection and neck dissection. Tissue samples were stained with monoclonal antibodies to hypoxia-inducible factor (HIF)-1alpha, HIF-2alpha, carbonic anhydrase (CA)-9, glucose transporter (GLUT)-1, and erythropoietin receptor (EPOR). Locoregional control and survival rates were calculated by the Kaplan-Meier method, and prognostic factors were calculated from uni- and multivariate analyses. Tumor thickness was correlated with expression of CA-9 and GLUT-1 and nodal classification was correlated with GLUT-1 expression. The nodal metastasis rate was 51%, and the 5-year locoregional control and disease-specific survival (DSS) rates were 59% and 69%, respectively. Univariate analysis showed that HIF-1alpha and EPOR expression were significantly related to DSS. Multivariate analysis showed that EPOR expression was an independent predictor of DSS (P=0.030). EPOR expression may be an independent predictor for DSS in patients with T2-staged SCC of the oral tongue.

Peritoneal mesotheliomas: clinicopathologic features, CT findings, and differential diagnosis.

OBJECTIVE: The objective of our study was to illustrate various CT findings of peritoneal mesotheliomas, to review their clinicopathologic features, and to discuss the differential diagnoses. CONCLUSION: The clinicopathologic features of peritoneal mesotheliomas vary among the subtypes such as malignant mesotheliomas, cystic mesotheliomas, and well-differentiated papillary mesotheliomas, and accordingly, there is a spectrum of CT appearances.

Patients with ERCC1-negative locally advanced esophageal cancers may benefit from preoperative chemoradiotherapy.

PURPOSE: To assess the significance of excision repair cross-complementation group 1 (ERCC1) expression as a predictive marker, we analyzed the effects of preoperative chemoradiotherapy on survival relative to ERCC1 status in patients with locally advanced operable esophageal cancer. EXPERIMENTAL DESIGN: Paraffin-embedded pretreatment tumor specimens, collected by endoscopic biopsy from patients treated with surgery alone or with preoperative chemoradiotherapy followed by surgery, were immunohistochemically assayed for ERCC1 expression. RESULTS: Of the 175 patients, 152 biopsy specimens were available for immunohistochemical analysis. Based on a median ERCC1 expression score of 1, we divided the samples into ERCC1-positive (score >1; 71 patients, 47%) and ERCC1-negative (score

Prognostic values of pathologic findings and hypoxia markers in 21 patients with salivary duct carcinoma.

BACKGROUND: Salivary duct carcinoma (SDC) is associated with aggressive clinical behavior. METHODS: We examined the prognostic values of clinicopathologic variables and hypoxia biomarker expression in 21 patients with SDC treated by resection with/without neck dissection and radiotherapy. Tissue microarrays constructed from tumor blocks were stained with monoclonal antibodies to hypoxia-inducible factor (HIF)-1alpha, HIF-2alpha, carbonic anhydrase-9, glucose transporter-1, and erythropoietin receptor. Locoregional control and survival rates were calculated by the Kaplan-Meier method and prognostic factors were calculated from uni- and multivariate analyses. RESULTS: The cervical nodal metastasis rate was 67% at initial diagnosis and the distant metastasis rate was 71% during follow-up. The only significant predictor of distant metastasis was nodal metastasis (P = 0.006). Actuarial 5-year locoregional control, distant metastasis-free survival, and overall survival rates were 57%, 40%, and 44%. Multivariate analysis showed that lymphovascular and perineural invasion and radiotherapy were independent predictors of overall survival (P < 0.025). None of the hypoxia biomarkers, however, was a significant predictor of locoregional control, distant metastasis, or survival. CONCLUSIONS: Lymphovascular and perineural invasion, but not hypoxia biomarkers, were significant prognostic factors for patients with SDC.

Papillary lesions of the breast diagnosed at percutaneous sonographically guided biopsy: comparison of sonographic features and biopsy methods.

OBJECTIVE: The objective of our study was to retrospectively assess the potential role of sonographic features and biopsy in the management of patients with papillary lesions diagnosed at percutaneous sonographically guided biopsy. MATERIALS AND METHODS: Surgical or sonographic follow-up (> or = 2 years) was available in 123 women (age range, 21-75 years; mean age, 47 years) with 124 papillary lesions diagnosed at sonographically guided core needle or vacuum-assisted biopsy during a 7-year period. Surgical excision results or follow-up sonograms with no change at the 2-year follow-up served as the reference standard. We reviewed the sonographic features, biopsy results, and surgical or sonographic follow-up. Statistical analysis was performed using the Fisher's exact test for the difference of sonographic features. RESULTS: Cancer incidence per BI-RADS category was as follows: category 3, zero (0%) of 21; category 4a, 14 (17%) of 85; category 4b, four (36%) of 11; category 4c, one (20%) of five; and category 5, one (50%) of two. On sonography, two features distinguishing benign from malignant papillary lesions were echo pattern and margins of masses. Core needle biopsy gave a sensitivity of 28% and specificity of 100%, whereas both sensitivity and specificity were 100% with vacuum-assisted biopsy. Of 117 lesions with benign biopsy results, upgrade to malignancy or high-risk lesion was found in 17% of benign papillomas, 24% of atypical papillomas, and 0% of multiple papillomas. CONCLUSION: Vacuum-assisted biopsy was more accurate than core needle biopsy in diagnosing papillary lesions, and both sonographic features and core needle biopsy were not sufficiently accurate. Therefore, surgical excision should be performed for the accurate diagnosis of papillary lesions.

Screening-detected and symptomatic ductal carcinoma in situ: differences in the sonographic and pathologic features.

OBJECTIVE: The purpose of our study was to retrospectively compare the sonographic and pathologic features of screening-detected and symptomatic ductal carcinoma in situ (DCIS). MATERIALS AND METHODS: Of 5,790 cases diagnosed as breast cancer at our institution between January 1998 and December 2005, 528 (9.1%) cases were DCIS. We found 106 screening-detected and 125 symptomatic DCIS lesions in 226 patients (age range, 20-77 years; mean age, 47.8 years) who underwent preoperative whole-breast sonography and mammography. Three radiologists reviewed the sonographic features of these 231 cases of DCIS by consensus according to Breast Imaging Reporting and Data System (BI-RADS). The pathologic features were also reviewed. Statistical comparisons were performed using the chi-square test, the Fisher's exact test, and the Mann-Whitney U test. RESULTS: On sonography, masses (p < 0.001) and associated ductal change (p = 0.019) were more common in symptomatic than in asymptomatic patients. Associated microcalcifications and posterior shadowing were more frequently found in screening-detected than in symptomatic DCIS (p < 0.001). On mammography, microcalcifications were more common in screening-detected than in symptomatic DCIS, and masses were more common in symptomatic than in screening-detected DCIS (p < 0.001). No significant differences were seen in the pathologic features of the two groups. CONCLUSION: Our results showed that differences exist in the sonographic features of screening-detected and symptomatic DCIS. Recognition of the many and varied sonographic appearances of DCIS might be helpful to decrease the false-negative rate of bilateral whole-breast sonography and to detect symptomatic mammographically occult DCIS when we use sonography to supplement mammography.

ERCC1 predicting chemoradiation resistance and poor outcome in oesophageal cancer.

We assessed whether expression of excision repair cross-complementation group 1 (ERCC1) and/or thymidylate synthase (TS) can predict clinical outcome after preoperative chemoradiotherapy (CRT) in patients with localised oesophageal cancer. Paraffin-embedded pretreatment tumour specimens collected by endoscopic biopsy from patients treated with preoperative CRT (5-fluorouracil/cisplatin or capecitabine/cisplatin plus radiation) were analysed by immunohistochemical assay. Between March 1993 and June 2005, 129 patients were treated with preoperative CRT followed by surgery; of these, 108 biopsy specimens were available for analysis, and 40% and 35% were positive for ERCC1 and TS, respectively. Patients with ERCC1-negative (p<0.001) or TS-negative (p=0.04) tumours were significantly more likely to achieve pathologic major response. In multivariate analysis, ERCC1 was the only independent variable predicting pathologic response (p<0.001). Patients with ERCC1-negative tumours showed tendencies toward prolonged overall survival (p=0.10) and event free survival (p=0.08). Prospective studies are required to determine the benefit of preoperative CRT in ERCC1-negative tumours.