Metastatic lymph nodes in hilar cholangiocarcinoma: does size matter?

AIM: To determine the diagnostic efficacy of the size criteria for the detection of metastatic lymph nodes (LN) in patients with hilar cholangiocarcinoma (HCCA). INTRODUCTION: LN metastasis is one of the most significant independent prognostic factors in patients with HCCA. Presently, in spite of the well known lack of sensitivity and specificity, one of the most used clinical criteria for nodal metastases is LN size. METHODS: Pathological slides of 147 patients who had undergone exploration for HCCA were assessed. The size (maximum and short axis diameter) of each single node was retrieved from the pathology report or measured from a section on the glass slide using a stereo microscope and a calibrated ruler integrated in the software. When a metastatic lesion was detected, the proportion of the lesion in relation to LN size was estimated. RESULTS: Out of 147 patients, 645 LN were retrieved and measured. In all, 106 nodes (16%) showed evidence of metastasis. The proportion of positive nodes was 8% in nodes <5 mm and 37% in nodes >30 mm. Ten per cent of LN smaller than 10 mm were positive, whereas only 23% of LN larger than 10 mm were metastastically involved. No clear cut-off point could be found. Similar results were found for the short axis diameter. In 50% of positive LN, the metastatic lesion accounted for 10% or less of the LN size. CONCLUSION: No cut-off point could be determined for accurately predicting nodal involvement. Therefore, imaging studies should not rely on LN size when assessing nodal involvement.

Validation of tissue microarray technology in squamous cell carcinoma of the esophagus.

Tissue microarray (TMA) technology has been developed to facilitate high-throughput immunohistochemical and in situ hybridization analysis of tissues by inserting small tissue biopsy cores into a single paraffin block. Several studies have revealed novel prognostic biomarkers in esophageal squamous cell carcinoma (ESCC) by means of TMA technology, although this technique has not yet been validated for these tumors. Because representativeness of the donor tissue cores may be a disadvantage compared to full sections, the aim of this study was to assess if TMA technology provides representative immunohistochemical results in ESCC. A TMA was constructed containing triplicate cores of 108 formalin-fixed, paraffin-embedded squamous cell carcinomas of the esophagus. The agreement in the differentiation grade and immunohistochemical staining scores of CK5/6, CK14, E-cadherin, Ki-67, and p53 between TMA cores and a subset of 64 randomly selected donor paraffin blocks was determined using kappa statistics. The concurrence between TMA cores and donor blocks was moderate for Ki-67 (kappa = 0.42) and E-cadherin (kappa = 0.47), substantial for differentiation grade (kappa = 0.65) and CK14 (kappa = 0.71), and almost perfect for p53 (kappa = 0.86) and CK5/6 (kappa = 0.93). TMA technology appears to be a valid method for immunohistochemical analysis of molecular markers in ESCC provided that the staining pattern in the tumor is homogeneous.

Dynamic clonal equilibrium and predetermined cancer risk in Barrett's oesophagus.

Surveillance of Barrett's oesophagus allows us to study the evolutionary dynamics of a human neoplasm over time. Here we use multicolour fluorescence in situ hybridization on brush cytology specimens, from two time points with a median interval of 37 months in 195 non-dysplastic Barrett's patients, and a third time point in a subset of 90 patients at a median interval of 36 months, to study clonal evolution at single-cell resolution. Baseline genetic diversity predicts progression and remains in a stable dynamic equilibrium over time. Clonal expansions are rare, being detected once every 36.8 patient years, and growing at an average rate of 1.58 cm(2) (95% CI: 0.09-4.06) per year, often involving the p16 locus. This suggests a lack of strong clonal selection in Barrett's and that the malignant potential of 'benign' Barrett's lesions is predetermined, with important implications for surveillance programs.

Agreement between endoscopic and histological gastric atrophy scores.

BACKGROUND: This study was conducted to investigate the strength of agreement between the endoscopic atrophic border (EAB) and the histological score for atrophy. METHODS: A series of 298 dyspeptic Japanese patients underwent upper endoscopy. The grade of gastric atrophy was estimated according to the EAB. Antral and corpus biopsy specimens were taken and were evaluated semiquantitatively according to the updated Sydney classification system, including the score for atrophy. The StatExact software package was used to calculate the weighted kappa statistics. RESULTS: The strength of agreement between the endoscopic atrophy score (EAB) and the histological atrophy score was good, with a weighted kappa value of 0.51 (95% confidence interval, 0.44-0.59). CONCLUSIONS: The strength of agreement between the endoscopic and histological atrophy scores is not worse than the interobserver histological agreement between two pathologists. It is worthwhile to carry out further research on the use of the EAB to identify and score gastric atrophy.