Prognostic markers for colorectal cancer: estimating ploidy and stroma.

Background: We report here the prognostic value of ploidy and digital tumour-stromal morphometric analyses using material from 2624 patients with early stage colorectal cancer (CRC). Patients and methods: DNA content (ploidy) and stroma-tumour fraction were estimated using automated digital imaging systems and DNA was extracted from sections of formalin-fixed paraffin-embedded (FFPE) tissue for analysis of microsatellite instability. Samples were available from 1092 patients recruited to the QUASAR 2 trial and two large observational series (Gloucester, n = 954; Oslo University Hospital, n = 578). Resultant biomarkers were analysed for prognostic impact using 5-year cancer-specific survival (CSS) as the clinical end point. Results: Ploidy and stroma-tumour fraction were significantly prognostic in a multivariate model adjusted for age, adjuvant treatment, and pathological T-stage in stage II patients, and the combination of ploidy and stroma-tumour fraction was found to stratify these patients into three clinically useful groups; 5-year CSS 90% versus 83% versus 73% [hazard ratio (HR) = 1.77 (95% confidence interval (95% CI): 1.13-2.77) and HR = 2.95 (95% CI: 1.73-5.03), P < 0.001]. Conclusion: A novel biomarker, combining estimates of ploidy and stroma-tumour fraction, sampled from FFPE tissue, identifies stage II CRC patients with low, intermediate or high risk of CRC disease specific death, and can reliably stratify clinically relevant patient sub-populations with differential risks of tumour recurrence and may support choice of adjuvant therapy for these individuals.

[Telepathology at the Norwegian Radium Hospital]. / Telepatologi ved Det Norske Radiumhospital.

BACKGROUND: The article gives an overview of the telepathology activity at the Norwegian Radium Hospital from the service was launched in 1994 and up until today. We show the development during these years and discuss telepathology in general terms. We also discuss those aspects that determine how well a telepathology service functions. MATERIAL AND METHODS: 74 frozen section slides were diagnosed by two different telepathology systems. One of these systems was used for examining its appropriateness as a tool for second opinion in pathology. A new Internet-based system was developed that provided additional functionality. RESULTS: A telepathology system with a digital camera outperforms one with an analog camera with respect to diagnostic accuracy. INTERPRETATION: Image quality determines the precision of a telepathology service. Telepathology is a feasible tool for second opinion in pathology.