Pathologic T Descriptor of Nonmucinous Lung Adenocarcinomas Now Based on Invasive Tumor Size

Abstract Objectives The eighth edition of the American Joint Committee on Cancer staging manual now stratifies nonmucinous lung adenocarcinomas (nmLACAs) by the size of the invasive component only. This is determined by direct gross or microscopic measurement; however, a calculated invasive size based on the percentage of invasive growth patterns has been proposed as an alternative option. Methods To compare radiologic with different pathologic assessments of invasive tumor size, we retrospectively reviewed a cohort of resected nmLACAs with a part-solid appearance on computed tomography (CT) scan (n = 112). Results The median direct microscopic pathologic invasive measurements were not significantly different from the median calculated pathologic invasive measurements; however, the median CT invasive measurements were 0.26 cm larger than the median direct pathologic measurements (P < .001). Conclusions Our results show that pathologic calculated invasive tumor measurements are comparable to direct microscopic measurements of invasive tumor, thereby supporting the recommendation for use of calculated invasive tumor size by the pathologist if necessary.

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The Role of Large-Format Histopathology in Assessing Subgross Morphological Prognostic Parameters: A Single Institution Report of 1000 Consecutive Breast Cancer Cases

International Journal of Breast Cancer ◽

10.1155/2012/395415 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 10

Author(s):

Tibor Tot

Keyword(s):

Breast Cancer ◽

Tumor Size ◽

Growth Patterns ◽

Resection Margins ◽

Low Grade ◽

Large Format ◽

Disease Extent ◽

Invasive Tumor ◽

Therapeutic Decisions

Breast cancer subgross morphological parameters (disease extent, lesion distribution, and tumor size) provide significant prognostic information and guide therapeutic decisions. Modern multimodality radiological imaging can determine these parameters with increasing accuracy in most patients. Large-format histopathology preserves the spatial relationship of the tumor components and their relationship to the resection margins and has clear advantages over traditional routine pathology techniques. We report a series of 1000 consecutive breast cancer cases worked up with large-format histology with detailed radiological-pathological correlation. We confirmed that breast carcinomas often exhibit complex subgross morphology in both early and advanced stages. Half of the cases were extensive tumors and occupied a tissue space ≥40 mm in its largest dimension. Because both in situ and invasive tumor components may exhibit unifocal, multifocal, and diffuse lesion distribution, 17 different breast cancer growth patterns can be observed. Combining in situ and invasive tumor components, most cases fall into three aggregate growth patterns: unifocal (36%), multifocal (35%), and diffuse (28%). Large-format histology categories of tumor size and disease extent were concordant with radiological measurements in approximately 80% of the cases. Noncalcified, low-grade in situ foci, and invasive tumor foci <5 mm were the most frequent causes of discrepant findings.

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The IASLC Lung Cancer Staging Project: Proposals for Coding T Categories for Subsolid Nodules and Assessment of Tumor Size in Part-Solid Tumors in the Forthcoming Eighth Edition of the TNM Classification of Lung Cancer

Journal of Thoracic Oncology ◽

10.1016/j.jtho.2016.03.025 ◽

2016 ◽

Vol 11 (8) ◽

pp. 1204-1223 ◽

Cited By ~ 227

Author(s):

William D. Travis ◽

Hisao Asamura ◽

Alexander A. Bankier ◽

Mary Beth Beasley ◽

Frank Detterbeck ◽

...

Keyword(s):

Lung Cancer ◽

Solid Tumors ◽

Tumor Size ◽

Tnm Classification ◽

Cancer Staging ◽

Eighth Edition

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Prognostic Value of Tumor Size in Resected Stage IIIA-N2 Non-Small-Cell Lung Cancer

Journal of Clinical Medicine ◽

10.3390/jcm9051307 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1307 ◽

Cited By ~ 1

Author(s):

Chih-Yu Chen ◽

Bing-Ru Wu ◽

Chia-Hung Chen ◽

Wen-Chien Cheng ◽

Wei-Chun Chen ◽

...

Keyword(s):

Lung Cancer ◽

Prognostic Factors ◽

Tumor Size ◽

Small Cell ◽

Small Cell Lung ◽

Stage Iiia ◽

Pathologic Stage ◽

The Mean ◽

Eighth Edition ◽

Resected Stage

The eighth edition of the American Joint Committee on Cancer (AJCC) staging system for lung cancer was introduced in 2017 and included major revisions, especially of stage III. For the subgroup stage IIIA-N2 non-small-cell lung cancer (NSCLC), surgical resection remains controversial due to heterogeneous disease entity. The aim of this study was to evaluate the clinicopathologic features and prognostic factors of patients with completely resected stage IIIA-N2 NSCLC. We retrospectively evaluated 77 consecutive patients with pathologic stage IIIA-N2 NSCLC (AJCC eighth edition) who underwent surgical resection with curative intent in China Medical University Hospital between 2006 and 2014. Survival analysis was conducted, using the Kaplan–Meier method. Prognostic factors predicting overall survival (OS) and disease-free survival (DFS) were analyzed, using log-rank tests and multivariate Cox proportional hazards models. Of the 77 patients with pathologic stage IIIA-N2 NSCLC examined, 35 (45.5%) were diagnosed before surgery and 42 (54.5%) were diagnosed unexpectedly during surgery. The mean age of patients was 59 years, and the mean length of follow-up was 38.1 months. The overall one-, three-, and five-year OS rates were 91.9%, 61.3%, and 33.5%, respectively. Multivariate analysis showed that tumor size <3 cm (hazards ratio (HR): 0.373, p = 0.003) and video-assisted thoracoscopic surgery (VATS) approach (HR: 0.383, p = 0.014) were significant predictors for improved OS. For patients with surgically treated, pathologic stage IIIA-N2 NSCLC, tumor size <3 cm and the VATS approach seemed to be associated with better prognosis.

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The IASLC Lung Cancer Staging Project: The New Database to Inform the Eighth Edition of the TNM Classification of Lung Cancer

Journal of Thoracic Oncology ◽

10.1097/jto.0000000000000334 ◽

2014 ◽

Vol 9 (11) ◽

pp. 1618-1624 ◽

Cited By ~ 146

Author(s):

Ramón Rami-Porta ◽

Vanessa Bolejack ◽

Dorothy J. Giroux ◽

Kari Chansky ◽

John Crowley ◽

...

Keyword(s):

Lung Cancer ◽

Tnm Classification ◽

Cancer Staging ◽

Eighth Edition

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The Effect of the New Eighth Edition Breast Cancer Staging System on 100 Consecutive Patients

Journal of Clinical Medicine Research ◽

10.14740/jocmr3803 ◽

2019 ◽

Vol 11 (6) ◽

pp. 407-414 ◽

Cited By ~ 1

Author(s):

Ashley Biswal ◽

Jacqueline Erler ◽

Omar Qari ◽

Arthur A. Topilow ◽

Varsha Gupta ◽

...

Keyword(s):

Breast Cancer ◽

Staging System ◽

Cancer Staging ◽

Breast Cancer Staging ◽

Eighth Edition

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Melanoma Prognosis: Accuracy of the American Joint Committee on Cancer Staging Manual Eighth Edition

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djaa008 ◽

2020 ◽

Vol 112 (9) ◽

pp. 921-928 ◽

Cited By ~ 5

Author(s):

Shirin Bajaj ◽

Douglas Donnelly ◽

Melissa Call ◽

Paul Johannet ◽

Una Moran ◽

...

Keyword(s):

Clinical Trials ◽

Statistical Tests ◽

Area Under The Curve ◽

Cancer Staging ◽

Stage I ◽

Stage Iii ◽

Prognostic Accuracy ◽

American Joint Committee ◽

Melanoma Prognosis ◽

Eighth Edition

Abstract Background The American Joint Committee on Cancer (AJCC) maintains that the eighth edition of its Staging Manual (AJCC8) has improved accuracy compared with the seventh (AJCC7). However, there are concerns that implementation may disrupt analysis of active clinical trials for stage III patients. We used an independent cohort of melanoma patients to test the extent to which AJCC8 has improved prognostic accuracy compared with AJCC7. Methods We analyzed a cohort of 1315 prospectively enrolled patients. We assessed primary tumor and nodal classification of stage I–III patients using AJCC7 and AJCC8 to assign disease stages at diagnosis. We compared recurrence-free (RFS) and overall survival (OS) using Kaplan-Meier curves and log-rank tests. We then compared concordance indices of discriminatory prognostic ability and area under the curve of 5-year survival to predict RFS and OS. All statistical tests were two-sided. Results Stage IIC patients continued to have worse outcomes than stage IIIA patients, with a 5-year RFS of 26.5% (95% confidence interval [CI] = 12.8% to 55.1%) vs 56.0% (95% CI = 37.0% to 84.7%) by AJCC8 (P = .002). For stage I, removing mitotic index as a T classification factor decreased its prognostic value, although not statistically significantly (RFS concordance index [C-index] = 0.63, 95% CI = 0.56 to 0.69; to 0.56, 95% CI = 0.49 to 0.63, P = .07; OS C-index = 0.48, 95% CI = 0.38 to 0.58; to 0.48, 95% CI = 0.41 to 0.56, P = .90). For stage II, prognostication remained constant (RFS C-index = 0.65, 95% CI = 0.57 to 0.72; OS C-index = 0.61, 95% CI = 0.50 to 0.72), and for stage III, AJCC8 yielded statistically significantly enhanced prognostication for RFS (C-index = 0.65, 95% CI = 0.60 to 0.70; to 0.70, 95% CI = 0.66 to 0.75, P = .01). Conclusions Compared with AJCC7, we demonstrate that AJCC8 enables more accurate prognosis for patients with stage III melanoma. Restaging a large cohort of patients can enhance the analysis of active clinical trials.

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Incidental Gallbladder Cancer: A Clinicopathological Study

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz113.091 ◽

2019 ◽

Vol 152 (Supplement_1) ◽

pp. S74-S74

Author(s):

Poojaben Dhorajiya ◽

Rifat Mannan ◽

Abdelsalam Sharabi

Keyword(s):

Gallbladder Cancer ◽

Tumor Size ◽

Tumor Staging ◽

Gallbladder Disease ◽

Lymph Node Status ◽

Female Population ◽

Benign Condition ◽

Invasive Component ◽

Average Patient ◽

Incidental Gallbladder Cancer

Abstract Objectives Incidental gallbladder cancer (iGBC) is defined as gallbladder cancer (GBC) diagnosed at the time of or after cholecystectomy, performed for unsuspected benign gallbladder disease. Being rare, it is found in 0.2% to 2.9% cases of cholecystectomies performed for cholecystitis and represents approximately 40% of all GBCs. Here, we present the clinical and pathological features of iGBC diagnosed at our institute over a 10-year period. Methods The pathology reports of GBC in patients who underwent simple cholecystectomies due to sole complain of cholecystitis between 2008 and 2018 were retrieved from electronic medical records. Cases with dysplasia (without invasive component), clinically suspected gallbladder malignancy, polyp (nonincidental), or cholecystectomies performed as a part of any other procedure were excluded. Results Twenty-two cases of iGBC were diagnosed during the study period. Average patient age was 69.59 (range; 48-91) years, with a slight female (n = 12, 54.5%) predominance. Most common site was body (n = 7), followed by fundus (n = 4), neck (n = 2), and unknown (n = 9). Mean tumor size was 1.6 cm, where measurement of tumor size was possible (n = 16). Histopathological diagnoses were adenocarcinoma (n = 21) and carcinosarcoma (n = 1). The AJCC tumor staging was pT1a (n = 3), pT1b (n = 3), pT2 (n = 12), pT3 (n = 3), and unidentifiable (n = 1). Four cases were identified with N1 lymph node status. Cystic duct margin was positive in two cases. Perineural invasion was identified in three cases. Conclusion iGBC after a cholecystectomy for clinically benign condition is a rare finding. Although cholecystitis is much more frequent in female, iGBC had only a slight predominance for female population in our study. It is more common in people over 60 years of the age, which is comparable to the literature. This entity still remains a diagnostic and therapeutic challenge, and management is often more complicated in cases with advanced stage.

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