Showing papers by "Adrian C Bateman published in 2012"

Comparing virtual with conventional microscopy for the consensus diagnosis of Barrett’s neoplasia in the AspECT Barrett’s chemoprevention trial pathology audit

Abstract: Sanders D S A, Grabsch H, Harrison R, Bateman A, Going J, Goldin R, Mapstone N, Novelli M, Walker M M & Jankowski J (2012) Histopathology 61, 795–800 Comparing virtual with conventional microscopy for the consensus diagnosis of Barrett’s neoplasia in the AspECT Barrett’s chemoprevention trial pathology audit Aims: To compare the diagnostic accuracy of conventional versus virtual microscopy for the diagnosis of Barrett’s neoplasia Methods and results: Sixty-one biopsies from 35 ASPirin Esomeprazole ChemopreventionTrial (AspECT) trial patients were given a Barrett’s neoplasia score (1–5) by a panel of five pathologists using conventional microscopy Thirty-three biopsies positive for neoplasia were digitized and rescored blindly by virtual microscopy Diagnostic reliability was compared between conventional and virtual microscopy using Fleiss’ kappa There was substantial reliability of diagnostic agreement (κ = 0712) scoring the 61 biopsies and moderate agreement scoring the subgroup of 33 ‘positive’ biopsies with both conventional microscopy (κ = 0598) and virtual microscopy (κ = 0436) Inter-observer diagnostic agreement between two pathologists by virtual microscopy was substantial (κ = 076) Comparison of panel consensus neoplasia scores between conventional and virtual microscopy was almost perfect (κ = 08769) However, with virtual microscopy there was lowering of the consensus neoplasia score in nine biopsies Conclusions: Diagnostic agreement with virtual microscopy compares favourably with conventional microscopy in what is recognized to be a challenging area of diagnostic practice However, this study highlights possible limitations for this method in the primary diagnostic setting

Chronic gastric ulceration: a novel manifestation of IgG4-related disease?

Abstract: A 73-year-old woman who presented with anaemia and gastroscopy revealed a 30 mm firm ulcer with raised edges at the lesser curve of the stomach. A CT scan revealed features within the ulcer that were suspicious for malignancy. She was treated with a proton pump inhibitor and sucralfate but the ulcer failed to heal over a 1-year period. Three sets of biopsies from the ulcer edge during this time revealed benign changes only. There was no history of non-steroidal anti-inflammatory drug usage and urinary salicylate estimation was negative. The serum gastrin concentration was not raised. Her medical history included insulin-dependent diabetes mellitus and ischaemic heart disease. There was no history of a systemic inflammatory disorder. Due to the continued concern of occult malignancy she proceeded to laparotomy with partial gastrectomy, after which she made an uneventful recovery. Macroscopic examination of the resection specimen revealed a 30 mm mucosal ulcer with slightly raised edges. The adjacent gastric mucosa was macroscopically normal. …

Developing a ‘traffic light’ test with potential for rational early diagnosis of liver fibrosis and cirrhosis in the community

Abstract: Background Liver disease develops silently and presents late, with often fatal complications. Aim To develop a ‘traffic light’ test for liver disease suitable for community use that could enhance assessment of liver risk and allow rational referral of more severe disease to specialist care.

Pathological grading of regression: an International Study Group perspective

Abstract: In this issue of the Journal of Clinical Pathology , MacGregor, Maughan and Sharma1 discuss the value and utility of pathological grading of regression from an oncologist's point of view. Neoadjuvant chemoradiotherapy is now a well-accepted treatment for locally advanced rectal cancer (cT3/T4 or lymph node-positive rectal cancers). However, neoadjuvant therapy affects the histopathological reporting of resected specimens by virtue of the host response to treatment, which occurs in the majority of patients. Pathological complete responses ranging from 9% to 29% have been reported,2 ,3 but the clinical significance of ‘incomplete’ regression and, more importantly, its role in determining postoperative treatment, is not clear. Pathological complete response has been associated with good patient outcomes.4–7 However, tumour regression grade (although having prognostic value for survival and recurrence by univariate analyses) has not been established to be an independent prognostic value that is superior to ypTNM in predicting clinical outcome.6 ,7–13 On the contrary, Min et al 11 demonstrated that regression grading is a good prognostic factor in patients with lymph node negative locally advanced rectal cancer. Therefore, regression grading may be a useful parameter for monitoring patient response and also as a potential prognostic factor. Several grading systems have been proposed and used, the most popular one being the Mandard and Dworak systems.14 ,15. We, an ‘International …

A multi-centre pathologist survey on pathological processing and regression grading of colorectal cancer resection specimens treated by neoadjuvant chemoradiation

Abstract: To ascertain the approach and degree of consensus of pathologists in the handling and regression grading of colorectal cancer resection specimens treated with neoadjuvant chemoradiation, a ten-part questionnaire was circulated to 18 gastrointestinal pathologists in eight countries. The questions were specific and addressed pertinent issues related to colorectal cancer with neoadjuvant chemoradiation. There is a lack of consensus on how to handle the specimen, number of sections taken, correlation with pre- and post-operative radiological imaging, and especially, regression grading schema employed. Consensus in the form of guidelines is required so that the pathological assessment of these specimens will provide clinically relevant information for patient management, irrespective of location.

IgG4-related disease: can non-classical histopathological features or the examination of clinically uninvolved tissues be helpful in the diagnosis?

Abstract: IgG4-related disease (IgG4-RD) is an increasingly recognised inflammatory and fibrosing condition that commonly shows multisystem involvement. The disease may mimic malignancy and other inflammatory or immune-mediated disorders, but usually has a good response to corticosteroid therapy, underlining the requirement for recognition of the condition. Accurate diagnosis requires careful interpretation of varying combinations of serum IgG4 levels, radiological features and characteristic histopathological appearances within an appropriate clinical setting. The presence of 'classical' histopathological features together with an elevated tissue IgG4+ plasma cell count and IgG4 to IgG ratio is often diagnostic and at the very least can strongly support a clinicopathological diagnosis of IgG4-RD. The authors describe the most recent diagnostic criteria for IgG4-RD, especially the histopathological features. The authors then discuss the merits of examining tissues that may be more easily obtainable than those that commonly show the 'classical' histopathological features, but within which not all of these 'diagnostic' features may be present. The authors conclude that while a combination of 'classical' histopathological features and an elevated tissue IgG4+ plasma cell count is the gold standard for diagnosis, examination of tissues that show some but not all of these features can, in the appropriate context, provide useful supporting evidence for a clinicopathological diagnosis of IgG4-RD.

Colorectal cancer staging using TNM 7: is it time to use this new staging system?

Abstract: The authors audited pathological colorectal cancer staging according to tumour node metastasis (TNM) 7 and using TNM 5 as a gold standard. 144 consecutive colorectal cancer resection specimens were staged prospectively using both TNM 5 and TNM 7 criteria during routine reporting by specialist gastrointestinal pathologists within a single institution. The pN stage remained the same under both systems apart from the required subclassification of pN1 and pN2 under TNM 7. The TNM 7 pN1c category was used in only 3% of cases. All cases staged as pT4 underwent reversal of pT4 subclassification using TNM 7 compared with TNM 5. A previous study revealed stage migration from pN1 to pN2 in 32.6% of cases under TNM 7 compared with TNM 5. The difference in frequency of pN stage migration between this study and our audit suggests that the application of TNM 7 to the assessment of discontinuous/satellite tumour foci is subject to significant inter-observer variability.

Increased expression of the 5-lipoxygenase pathway and its cellular localization in Barrett's adenocarcinoma.

Abstract: Boger P C, Shutt J D, Neale J R, Wilson S J, Bateman A C, Holloway J W, Patel P & Sampson A P (2012) Histopathology 61, 509–517 Increased expression of the 5-lipoxygenase pathway and its cellular localization in Barrett’s adenocarcinoma Aims: Up-regulation of the 5-lipoxygenase (5-LOX) leukotriene pathway is evident in numerous tumour types, and has been linked to the promotion of cancer cell growth. The aim of this study was to evaluate the immunohistochemical expression of 5-LOX pathway proteins in oesophageal adenocarcinoma and its premalignant lesion, Barrett’s metaplasia. Methods and results: Tissue samples were collected at endoscopy from 16 patients with Barrett’s metaplasia and from seven with oesophageal adenocarcinoma; five proximal squamous oesophagus samples were used as controls. Immunohistochemical analyses were performed on stromal and epithelial areas with optimized concentrations of primary antibodies for 5-LOX, 5-LOX-activating protein (FLAP), and the distal enzymes leukotriene (LT) A4 hydrolase (LTA4H) and LTC4 synthase (LTC4S). the diagnosis was histologically confirmed from adjacent sections by a gastrointestinal pathologist. Striking increases in the stromal immunoexpression of 5-LOX (P = 0.041), FLAP (P = 0.038), LTA4H (P = 0.0008) and LTC4S (P = 0.036) were seen in adenocarcinoma tissue. Stromal FLAP and LTA4H immunostaining correlated with elevated neutrophil counts (P < 0.001). LTC4S was also notably overexpressed within epithelial cells in both Barrett’s metaplasia (P < 0.001) and adenocarcinoma (P < 0.01) tissue. Conclusions: Key biosynthetic enzymes of the LTB4 and LTC4 biosynthetic pathways are incrementally expressed across the spectrum of squamous, Barrett’s metaplasia and oesophageal adenocarcinoma tissues, suggesting, for the first time, a role for both LT subfamilies in disease progression.

PWE-099 Contribution of surgery and disease subtype to health related quality of life in patients with locally advanced and recurrent colorectal cancer

Abstract: Introduction Management of patients with locally advanced (LA) and locally recurrent (LR) colorectal cancer is challenging, with patients frequently requiring complex multimodality interventions. Despite increasing emphasis on evaluation of health related quality of life (HRQoL) in patients having complex interventions, HRQoL information on patients with LA and LR colorectal cancer is sparse. The aim of this study was to prospectively assess outcome measures and HRQoL in a cohort of patients with LA and LR colorectal cancer at our institution. Methods LA disease was defined as tumour requiring extended multi-visceral resection in the abdomen or pelvis to achieve an R0 resection. 45 consecutive patients were prospectively assessed over a 2-year period. Demographic, treatment, and cancer-related outcomes were recorded on all patients. Pelvic disease was staged using Leeds and Royal Marsden Hospital classification systems. HRQoL was prospectively evaluated using the EORTC generic and disease specific instruments QLQ-CR30 and QLQ-CR29. Results Median age was 69 (range 46–89) and 60% were male (27/45). There were 25 cases of LA disease and 20 LR cases. 35 patients underwent surgery while 10 patients had non-surgical palliation. R0 resection rate was 94%. HRQoL data were available on 41 patients. Median global health status was 65 (95% CI 55.5 to 74.1), physical functioning 77 (95% CI 69.9 to 84.5), and social functioning 72 (95% CI 60.3 to 83.8), which compared favourably with published EORTC reference values. Global health status and pain were significantly better in patients having surgery compared to non-surgical palliation (p Conclusion In carefully selected patients, HRQoL after radical multimodality treatment for LA and LR colorectal cancer is acceptable, and gives better results than palliation. Competing interests None declared.