Grossing and reporting of colorectal cancer resection specimens: An evidence-based approach.

Appropriate management of the patient with colorectal carcinoma depends on obtaining key prognostic and predictive information from the resection specimen. These include the quality of surgery, extent of lymph nodal clearance, presence of nodal disease, vascular invasion, residual disease post neoadjuvant treatment, and completeness of resection. A meticulous and structured approach to dissection of the resection specimen and subsequent histological examination by the pathologist is crucial in providing this information to the treating clinician. A good macroscopic examination also serves to audit the quality of other services including radiology, surgery, and oncology. This article attempts to review dissection and reporting guidelines with an evidence-based approach and hopes to guide pathologists to understand the basis behind the recommended protocols.

Does Interim PET Scan After 2 Cycles of ABVD Predict Outcome in Hodgkin Lymphoma? Real-World Evidence.

PURPOSE: Escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) improves overall survival (OS) in patients with Hodgkin lymphoma (HL) relative to ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) therapy. However, the associated higher cost and toxicity discourage clinicians from prescribing it. Identifying high-risk patients and administering escalated BEACOPP remains an effective strategy. We assessed the significance of interim positron emission tomography (iPET) scan after 2 cycles (iPET2) in identifying this high-risk subset. PATIENTS AND METHODS: This cohort study used secondary data from 12 tertiary care centers in South India gathered over 10 years (2008-2018). OS, event-free survival (EFS), determinants of EFS, and complete response (CR) in iPET2 were assessed. RESULTS: The study included 409 patients with HL (mean age, 34.5 years; male/female ratio, 1.4:1). The median duration of follow-up was 2.8 years. Of 409 patients, 63% underwent PET-based staging and 37% underwent computerized tomography (CT) staging. Stage IV (28.9%) and bone involvement (9.2%) were seen more often with PET than with CT staging (9.2% and 2%, respectively). Among 171 patients with iPET2 results, 24% did not achieve CR, and no factors were significantly associated. The 5-year EFS and OS rates of the entire cohort were 78% and 97%, respectively. The 5-year EFS and OS rates of patients with CR on iPET2 were 90% and 99%, respectively, whereas these were 65% and 100%, respectively, for patients not achieving CR. On univariable analysis, sex, stage, and iPET2 response significantly predicted inferior EFS. On multivariate analysis, only iPET2 response significantly predicted EFS (P < .000). CONCLUSION: Our study supports the use of PET for staging and iPET2 for response assessment. Nonachievement of CR on iPET2 indicates unfavorable outcome, and such patients may benefit from more intensive treatment.

Microvessel Density (MVD) in Locally Advanced Breast Cancer

Background: The aim of this study was to evaluate microvessel density (MVD) by expression of CD31 and CLEC14A in core biopsies from previously untreated patients with locally advanced breast cancer (LABC) and assess its prognostic significance. Methods: MVD was evaluated in core needle biopsies (n = 92), collected prior to any treatment, from patients who were diagnosed with locally advanced breast cancer (LABC). Immunohistochemistry for expression of CD31 and CLEC14A were performed on these tumours. The median duration of follow-up was 9.3 years. The effect of prognostic factors on disease free survival (DFS) and overall survival (OS) was assessed using a Log rank test and Cox regression model. Results: The clinical factors such as age, clinical nodal stage, stage and pathological nodal status were found to be significant in predicting overall survival by multivariate analysis (P<0.05). Out of 92, 52 tumours had blood vessels expressing CD31, whereas in the remainder, there was no expression. The mean and median MVD of CD31 in 92 tumours was 38 and 5.5 respectively, and it was not a significant factor for predicting disease free survival or overall survival. When we considered the tumours (n=52) which expressed CD31, patients who had very high MVD (>100), had inferior progression free survival and overall survival (P=0.5). There was no expression of CLEC14A in any of the core needle biopsies whereas it was expressed in specimens from mastectomy from the same patient. Conclusion: This is the first report of MVD in LABC prior to any treatment. The results suggest angiogenesis could be a prognostic factor in LABC.