Showing papers by "George L. Mutter published in 2017"
TL;DR: Obesity may be associated with greater endometrial tumor expression of ER and PR, and adding either marker does not appear to improve mortality prediction beyond the standard predictors, while body mass index might explain some of the biological variation amongendometrial tumors.
Abstract: Background: Endometrial tumors arise from a hormonally responsive tissue. Defining subtypes by hormone receptor expression might better inform etiology and prediction of patient outcomes. We evaluated the potential role of tumor estrogen receptor (ER) and progesterone receptor (PR) expression to define endometrial cancer subtypes.Methods: We measured semi-continuous ER and PR protein expression in tissue specimens from 360 endometrial primary tumors from the Nurses' Health Study. To explore the impact of different definitions of marker positivity, we dichotomized ER and PR expression at different cut points in increments of 5% positive cells. Logistic regression was used to estimate associations between endometrial cancer risk factors, such as body mass index, with dichotomous ER or PR status. Reclassification statistics were used to assess whether adding dichotomous ER or PR status to standard prognostic factors of stage, grade, and histologic type would improve endometrial cancer-specific mortality prediction.Results: Compared with not being obese, obesity increased the odds of having an ER-positive tumor at cut points of 0% to 20% [maximum OR, 2.92; 95% confidence interval (CI), 1.34-6.33] as well as the odds of having a PR-positive tumor at cut points of 70% to 90% (maximum OR, 2.53; 95% CI, 1.36-4.68). Adding dichotomous tumor ER or PR status to the panel of standard predictors did not improve both model discrimination and calibration.Conclusions: Obesity may be associated with greater endometrial tumor expression of ER and PR. Adding either marker does not appear to improve mortality prediction beyond the standard predictors.Impact: Body mass index might explain some of the biological variation among endometrial tumors. Cancer Epidemiol Biomarkers Prev; 26(5); 727-35. ©2017 AACR.
40 citations
TL;DR: This data indicates that pre- and post-menopausal women who have had vaginal or laparoscopic mesh placement surgery are more likely to have a positive immune response to chemotherapy than those who do not have a history of either disease.
Abstract: Authors Teri A. Longacre, MD, FCAP* Department of Pathology, Stanford Medicine, Stanford, CA Russell Broaddus, MD, PhD Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX Linus T. Chuang, MD Department of Obstetrics, Gynecology and Reproductive Science, Hess Center for Science and Medicine, Sinai Medical Center, New York, NY Michael B. Cohen, MD, FCAP Department of Pathology, Huntsman Cancer Hospital, Salt Lake City, UT Patricia Salter Jamieson, CTR University of Alabama at Birmingham, Birmingham, AL Elke A Jarboe, MD Department of Pathology, University of Utah, Salt Lake City, UT George L. Mutter, MD, FCAP Department of Pathology, Brigham and Women’s Hospital, Boston, MA Christopher N. Otis, MD, FCAP Department of Pathology, Baystate Medical Center, Springfield, MA Richard Zaino, MD, FCAP Department of Pathology, Penn State Hershey Medical Center, Hershey, PA
23 citations
TL;DR: Each pathologist had different diagnostic tendencies which were affected not only by histopathology and marker studies, but also by the patient management tendencies of the gynecologist that the pathologist worked with.
Abstract: Objective: Inter-observer differences in the diagnosis of HPV related cervical lesions are problematic and response of gynecologists to these diagnostic entities is non-standardized. This study evaluated the diagnostic reproducibility of "cervical intraepithelial neoplasia" (CIN) and "squamous intraepithelial lesion" (SIL) diagnoses. Material and Method: 19 pathologists evaluated 66 cases once using H & E slides and once with immunohistochemical studies (p16, Ki-67 and Pro-ExC). Management response to diagnoses was evaluated amongst 12 gynecologists. Pathologists and gynecologists were also given a questionnaire about how additional information like smear results and age modify diagnosis and management. Results: We show moderate interobserver diagnostic reproducibility amongst pathologists. The overall kappa value was 0.50 and 0.59 using the CIN and SIL classifications respectively. Impact of immunohistochemical evaluation on interpretation of cases differed and there was lack of statistically significant improvement of interobserver diagnostic reproducibility with the addition of immunohistochemistry. We saw that choice of treatment methods amongst gynecologists varied and overall concordance was only fair to moderate. The CIN2 diagnostic category was seen to have the lowest percentage agreement amongst both pathologists and gynecologists. We showed that pathologists had diagnostic "styles" and gynecologists had management "styles". Conclusion: In summary each pathologist had different diagnostic tendencies which were affected not only by histopathology and marker studies, but also by the patient management tendencies of the gynecologist that the pathologist worked with. The two-tiered modified Bethesda system improved diagnostic agreement. We concluded that immunohistochemistry should be used only to resolve problems in select cases and not for every case.
2 citations