Recent trends in incidence of nonmelanoma skin cancers in the East of Scotland, 1992-2003.

BACKGROUND: Historically, ascertainment of nonmelanoma skin cancer (NMSC) by cancer registries in the U.K. has been shown to be incomplete in several studies. However, recent evidence suggesting that almost all clinically diagnosed NMSCs are verified histologically, coupled with the increasing availability of electronic histopathology data to cancer registries, raises the possibility that this situation may have improved. OBJECTIVES: To assess recent trends in incidence of the main types of NMSC and carcinoma in situ (CIS) of the skin in Scotland. METHODS: The study was restricted to selected health board areas in the East of Scotland for which pathology data have been used routinely to support cancer registration since the early 1990s. Incident cases of squamous cell carcinoma (SCC) of the skin, CIS of the skin, and first ever basal cell carcinoma (BCC) were extracted from the Scottish Cancer Registry covering the period of diagnosis 1992-2003. Sex-specific, age-standardized and age-specific incidence rates were calculated for four consecutive 3-year periods of diagnosis. Estimated annual percentage changes (EAPCs) in incidence were calculated by Poisson regression modelling, with adjustment for age. The percentage distribution of SCC, BCC and CIS of the skin by anatomical site and sex was calculated for the period of diagnosis 1997-2003. RESULTS: The crude incidence of SCC for the period 1995-97 was 34.7 per 100,000, comparable with the best existing Scottish estimate of 32.2 derived from a prospective survey in Glasgow during March 1995. Age-adjusted rates of SCC, first ever BCC, and CIS of the skin have all increased significantly in both sexes between 1992 and 2003 (all P < 0.001), with EAPCs ranging in magnitude from +1.4% (first ever BCC in males) to +5.1% (CIS in males). The majority of lesions arose on the head and neck area, with the exception of CIS, which in females was more commonly located on the limbs. CONCLUSIONS: Ascertainment of NMSC has probably improved since the advent and use of electronic pathology data. Ongoing increases in age-adjusted incidence, combined with ageing of the population, will have major implications for the clinical workload associated with NMSC for the foreseeable future.

The impact of involvement of biomedical scientists in specimen dissection and selection of blocks for histopathology: a study of time benefits and specimen handling quality in Ayrshire and Arran area laboratory.

AIMS: To assess possible time benefits of specimen dissection by biomedical scientists (BMSs) and the quality of specimen handling by BMSs, in a department where BMSs trim those specimens requiring simple descriptions, from which standard blocks are taken. METHODS: Specimen handling by BMSs and consultant pathologists was compared. Time taken for each specimen trimmed was recorded prospectively. To determine specimen handling quality, adherence to dissection standard operating procedures (SOPs) was assessed by recording retrospectively whether or not each action in the SOP had been performed. Information on subsequently required extra levels or blocks was recorded. RESULTS: Analysis of data from 672 specimens trimmed by consultants showed that any given action in the SOPs was performed on average on 60.2% of applicable/assessable specimens; for 660 similar specimens trimmed by BMSs, each action was performed on average on 80.1% of specimens. Of the specimens where data on extra blocks were recorded, extra blocks were required in 3% of those trimmed by pathologists and in 4% of those trimmed by BMSs. Extra levels were required in 12% of those trimmed by pathologists and in 16% of those trimmed by BMSs. BMS trimming saves 16 hours of consultant time each month. The difference between pathologists and BMSs in time for each specimen trimmed is negligible. CONCLUSIONS: The advantages of increased adherence to trimming SOPs and saving consultant time outweigh the relatively small number of extra blocks and levels required when BMSs trim. There is no reduction in quality of dissection.

Observer variability in the histopathological reporting of needle biopsy specimens of the prostate.

The Scottish Pathology Consistency Group has in previous studies examined the consistency of histopathological reporting of biopsies from the cervix, bladder, bronchus, and rectum. In the current study, consisting of 100 needle biopsy specimens of the prostate, a single hematoxylin-eosin (H&E) slide from each case was circulated in batches of 10 to the 12 pathologists, who filled in a simple proforma. This had two sections: a diagnostic category (benign; suspicious or malignant) along with a standard Gleason score for those regarded as malignant. The majority diagnosis of the 100 cases was benign, 53; suspicious, 1; and malignant, 46. The Kappa value for benign cases versus others was 0.86 and for malignant cases versus others was 0.91. Analysis of the data on Gleason scores showed a value of 0.54 when cases were divided into two categories (2 to 6 v 7 to 10) and 0.41 when three categories were used (2 to 4; 5 to 6; 7 to 10). Although not initially part of the design of the study, the majority diagnosis was compared with the original reported diagnosis. In a small subset, examination of further levels, basal cell antibody staining, along with further clinical information, was obtained. With this added information, it appears that there were probably 52 benign and 48 malignant cases. Of the 48 malignant cases, the group majority diagnosis was malignant, 46; suspicious, 1; and benign, 1. The original reported diagnosis was 56 benign, 1 suspicious, and 43 malignant. The group therefore appeared to perform better than the original reporting pathologists. When compared with the results of our previous studies, this study has shown that the diagnosis of carcinoma of the prostate on a needle biopsy is robust.

Benefits and limitations of pathology databases to cancer registries.

In order to assess the benefits and limitations of pathology databases to cancer registries, computerised pathology records of malignant neoplasms diagnosed during 1992 were obtained for a defined area of Scotland for which pathology data were not routinely being used for cancer registration. Apparently 'missed' cancer registrations were identified by computerised probability matching with cancer registration records and their eligibility for registration was determined by reference to medical records, or when these were unavailable, by reference to the text of the original pathology report in conjunction with the local Community Health Index (to establish residency at the time of diagnosis). Misclassifications of site or incidence year were not regarded as 'missed' cases. Of 218 apparently 'missed' cancer registrations identified from computerised pathology records, 133 (5.7% of the revised total number of registrations for the study area in 1992) should have been registered. A further 14 cases were already registered but with misclassified site, morphology and/or behaviour codes. Ascertainment of cases by the Scottish Cancer Registration Scheme seems to be high for most sites. Pathology databases represent a useful additional source of cases but the fact that 71 apparently 'missed' cases were found to be ineligible for registration as independent primary malignant neoplasms suggests that unverified computerised pathology data should not be used uncritically nor independently for cancer registration purposes.

Observer variability in histopathological reporting of non-small cell lung carcinoma on bronchial biopsy specimens.

AIMS: To evaluate the ability of histopathologists to sub-classify non-small cell lung carcinomas on bronchial biopsy material using the current World Health Organisation (WHO) classification. METHODS: Twelve histopathologists each reviewed 100 randomly selected bronchial biopsy specimens which had originally been reported as showing non-small cell lung carcinoma. For each case, two sections were circulated, one stained by haematoxylin and eosin and the other by a standard method for mucin (alcian blue/periodic acid Schiff). The participants were allowed to indicate their degree of confidence in their classification of each case. A standard proforma was completed and the results were analysed using kappa statistics. RESULTS: Where the participants were confident in their classification, they were actually quite good at sub-classifying the non-small cell carcinoma sections (kappa = 0.71, standard error = 0.058). Overall, however, the results were only fair (kappa = 0.39, standard error = 0.034). CONCLUSIONS: The majority of non-small cell lung carcinomas can be correctly categorised on adequate bronchial biopsy material. Where a confident diagnosis was made, both squamous carcinoma (kappa = 0.73) and adenocarcinoma (kappa = 0.83) were well recognised.

Coincidental occurrence of primary hyperparathyroidism and cancer-associated hypercalcaemia in a middle-aged man.

Primary hyperparathyroidism (PHPT) is found not uncommonly in patients with cancer. In this report, however, we describe a patient where both humoral hypercalcaemia of malignancy and PHPT were present coincidentally. A 47-year-old man was found to have PHPT due to parathyroid hyperplasia. Serum parathyroid hormone (PTH) levels, which were elevated before parathyroidectomy, were undetectable post-operatively; however, hypercalcaemia persisted. Nephrogenous cyclic adenosine monophosphate was elevated along with this undetectable PTH, indicative of the presence of a PTH-like factor in the serum. This was confirmed by the finding of an elevated level of PTH-related protein (PTHrP) in plasma (9.1 pmol/l, normal < 2.6 pmol/l). Secondary carcinoma was identified in a lesion in the region of the manubrium sternii. This stained positively for PTHrP by immunocytochemistry and PTHrP messenger RNA was detected by in-situ hybridization. This case illustrates the value of sensitive PTH assays in distinguishing PHPT from other causes of hypercalcaemia and also shows the importance of considering primary hyperparathyroidism in the differential diagnosis of the patient with cancer and hypercalcaemia.

A new type of lethal short-limbed dwarfism.

Details are presented of a most unusual osteo-chondrodysplasia which presents with lethal neonatal short-limbed dwarfism, defective ossification and nodular calcification within cartilage. The features resemble one case previously described in the literature. We wish to present a new type of lethal short-limbed dwarfism which has presented in one family. Three affected infants have been born to unaffected parents who are first cousins. The third affected infant is reported in detail and the radiological signs of all three sibs are summarised in Table 1. There are also two healthy children, a boy and a girl, born at term.

Neonatal septal deviations.

In a review of 1000 consecutive neonates of all races, nasal septal deformity was identified in 29, an incident of 2.9%; significantly fewer cases were found in negroid babies (0.1 greater than P greater than 0.05). Ten cases (35%) underwent manipulation of the deviated septum. Six-monthly review revealed that symptoms associated with the septal deformity are rare. In 7 (44%) of the 16 cases not manipulated, the septum straightened spontaneously during the first few months of life. The appearance of the deviation is not of a dislocation of the caudal edge of the cartilage but a smooth concavity. In vitro compression of the neonatal nasal cavity reproduced this C-shaped deformity, but only temporarily. Histological serial sections of 6 postmortem nasal cavities showed that the high laminae of the vomer prevent any caudal dislocation of the septal cartilage.