Biomedical subjects

F A Langley

Publications and source records attributed to F A Langley.

At least 19 recordsLinked to original sources

PubMed1991

The completeness and accuracy of health authority and cancer registry records according to a study of ovarian neoplasms.

The completeness and accuracy of Hospital Activity Analysis (HAA) and Regional Cancer Registry (RCR) records were investigated in a series of 868 histologically reviewed cases in which primary ovarian neoplasms had been diagnosed according to one or more of seven data sources including HAA and RCR. All the women concerned were residents of Manchester and Salford who had presented in 1979-83 aged 15 years or more. The histological review confirmed the diagnosis of ovarian neoplasia in 829 of these women and excluded it in 39. Among the 829 confirmed cases, 333 were malignant or of borderline malignancy and therefore eligible for registration with the RCR, and 496 were benign. Only 611 (74%) of the 829 cases were listed as ovarian neoplasms or cysts in HAA records of hospital admissions from the study area during the study period, and the HAA diagnosis was incorrect in 40% of the 611 listed cases. Among the 333 borderline or malignant cases, only 241 (72%) appeared among the RCR's registrations of ovarian neoplasms for the study period and area. The RCR record of histological diagnosis was inaccurate in over 20% of these 241 registered cases, although most of the inaccuracies did not affect whether the neoplasm was classified as borderline or malignant. Five per cent of the cases listed as ovarian neoplasms in the HAA file and 15% of those listed as registrable ovarian neoplasms by the RCR should not have been so listed. The findings highlight the limitations of these routine health information systems, both as sources of cases for research and as National Health Service management tools.

Adolescent↗

PubMed1988

Malignant lymphoma presenting as an ovarian tumour: a clinicopathological analysis of 34 cases.

The clinicopathological features of 34 patients with malignant lymphoma or leukaemia where the initial presentation was as an ovarian tumour are described. Nineteen patients died, usually within 1 year of diagnosis, whilst 15 survived, some for long periods. Factors indicating a poor prognosis were rapid onset of abdominal symptoms, the presence of systemic symptoms, bilateral ovarian tumours, advanced stage and a histological pattern other than that of a B-cell lymphoma. For staging purposes the Ann Arbor method appeared a more sensitive prognostic indicator than did the FIGO staging system. It is suggested that primary malignant lymphomas of the ovary are extremely rare and that for therapeutic purposes all lymphomas of the ovary should be regarded as local manifestations of systemic disease.

Acute Disease↗

PubMed1987

The prognostic variability of ovarian tumor grading by different pathologists.

In a multicenter ovarian tumor study, it was shown that there are considerable differences between different pathologists when grading the same ovarian tumors. The question arises whether these differences in grading also reflect prognostic differences. To investigate this, the survival curves of the various tumor grades assigned to the same tumors by four different pathologists were investigated. The results of the present study indicate that tumor grade was strongly correlated with the prognosis, although there were considerable variations in the survival curves and in the five year survival of patients of the same grade assessed by the different pathologists. Five-year survival varied from 82 to 100% in the borderline tumors, from 49 to 80% in the well, and from 21 to 48% in the moderately differentiated tumor groups. Only the poorly differentiated cancers showed less variation. Similar interobserver differences were found in the histological typing and (strictly predefined) malignancy grades. The intraobserver variation, which was also tested after a 6-month interval, was somewhat lower, but was still present for each of the pathologists. These data clearly indicate the necessity for objective, sharply defined, reproducible criteria rather than subjective grades.

Cell Differentiation↗

PubMed1986

Morphometric data to FIGO stage and histological type and grade for prognosis of ovarian tumours.

The prognostic value of using histological typing, grading, and morphology, in addition to clinical staging, was assessed in 98 cases of invasive ovarian cancer of the common epithelial types (serous, mucinous, and endometrial). All of these cases had at least five years of follow up. When regression analysis was used, the International Federation of Gynaecology and Obstetrics' (FIGO) staging system was the best indicator for prognosis. Analysis of a combination of morphometric features was the second best indicator, being especially useful for the those patients with stage I disease. Variables that indicated a relatively poor prognostic outcome were mitotic index above 30; volume percentage epithelium above 65%; shortest nuclear axis above a mean of 1 X 1 micrometers. Histological typing of ovarian tumours was of limited value; mucinous tumours have a somewhat better prognosis than serous tumours, but the prognostic value of typing alone was found to be limited. Qualitative histological grading was useful, but the prognostic value of morphometric grading was better. Measurement of morphological features with an interactive computer program is simple and can be done by a pathologist or a technician: in future it is likely that such automated systems of measurement will improve the objectivity of tissue analysis.

Cell Nucleus↗

PubMed1986

Grading ovarian tumors. Evaluation of decision making by different pathologists.

Although grading of ovarian tumors is widely performed, the criteria for each grade are not well defined; as a result, pathologists tend to establish their own criteria without, however, assessing the actual predictive value of the criteria. In order to investigate this relationship, four gynecologic pathologists independently reviewed and carefully graded as benign, borderline or malignant (grade I, II or III) 40 "common" epithelial tumors of the ovary, without reference to clinical, prognostic or other findings. Intermediate grades were allowed. Subsequently, a subjective grading form was completed for each case; the form contained questions regarding the histologic and cytologic features. The sets of features with the biggest correlation with the tumor grades differed among the pathologists. This may indicate that the observers use different features in their grading processes. Moreover, the pathologist with the highest number (five) of significant microscopic features in the multivariate model had the lowest coefficient of correlation between his tumor grade and his feature set. The correlation coefficients for the other pathologists were quite similar, although the features used (no more than two or three) varied. The participants in the study felt that the methodologic approach had an educational value for them. Further investigations are required to evaluate whether the differences in the underlying decision making process also result in frank disagreement in ovarian tumor grading.

Carcinoma↗

PubMed1986

Interpathologist and intrapathologist disagreement in ovarian tumor grading and typing.

In order to evaluate possible differences in the typing and grading of ovarian tumors, four different gynecologic pathologists independently evaluated slides from 198 patients. Histologic typing was done using the WHO recommendations, and the tumors were graded as benign, borderline or malignant (well, moderately or poorly differentiated). All of the slides were assessed twice by each pathologist (with approximately a 12-month time interval) in a "blind" fashion (i.e., without any knowledge about stage, treatment and clinical outcome). In addition to assessing interobserver agreement, the intraobserver consistency was evaluated by comparing the first and second assessments of the same pathologist. Histologic grading showed the best correlation between observers' results; however, the level of agreement was low. Complete agreement was rare, both in the first and second assessments (18.7% and 32.8%, respectively). Complete disagreement was rare, but occurred, both in the first and second assessments. Agreement in histologic typing was rather good after panel discussions; further analysis of the data revealed that the lack of agreement could not be attributed to any one of the pathologists in particular. The intraobserver agreement in grading and typing the same tumor differed. The number of cases with more than one grade difference between the first and second assessments varied from 0.5% to 3.2% between the different pathologists. Complete consistency was also varied: 87%, 78%, 64% and 62%. Histologic typing in general was less consistent, although some pathologists were better than others. The results indicate the need for objective criteria for grading ovarian tumors.

Carcinoma↗

PubMed1985

The prognostic value of morphometry in ovarian epithelial tumors of borderline malignancy.

A fully "blind" morphometric analysis was made of 20 ovarian epithelial tumors; 18 of these were of borderline malignancy, one was a well-differentiated adenocarcinoma and one had been categorized as "borderline? malignant?" Morphometry correctly identified the adenocarcinoma, which had proved fatal, and the two tumors of borderline malignancy that had directly led to the patients' deaths, as having a "poor" prognosis. One tumor thought to have a "poor" prognosis was associated with long-term survival, but the patient had received chemotherapy. All the patients whose tumors were morphometrically graded as having a "good" prognosis were alive and tumor-free at intervals ranging from 4 to 14 years. It is concluded that the predictive prognostic power of morphometry, when applied to ovarian epithelial tumors of borderline malignancy, is greater than that of unaided light microscopy.

Adenocarcinoma, Mucinous↗

PubMed1985

The outlook for women with borderline epithelial tumours of the ovary.

Seventy-two women with borderline epithelial tumours of the ovary have been followed up for between 3 and 9 years. Patients with disease confined to one or both ovaries had a good prognosis, irrespective of histological type. When extra-ovarian spread was present at the time of diagnosis, neither the histological type nor the amount of residual tumour predicted the long-term outcome in individual patients.

Adult↗

PubMed1985

The use of ROC curves in histopathologic decision making.

The applicability of receiver operator characteristic (ROC) curves to histopathology is presented in three examples, along with a basic discussion of some properties of ROC curves. One major application is in the attempt to define stages in diseases that show a continuous spectrum of histologic patterns, in which the uncertainty of boundary points and the overlap of features makes such definition difficult. Construction and analysis of ROC curves may help to identify the features with the greatest utility, as, for example, in the grading of mucinous carcinomas of the ovary. ROC curves can also be used to assess diagnostic differences between histopathologists, whether they are using different criteria or the same criteria but with different weightings, as, for example, in cervical premalignancy or borderline ovarian tumors.

Adenocarcinoma, Mucinous↗

PubMed1984

Ovarian clear cell adenofibromatous tumors. Benign, of low malignant potential, and associated with invasive clear cell carcinoma.

The authors have studied 17 cases of ovarian clear cell tumors having an adenofibromatous pattern and classified them on a histologic basis into three categories: benign, of low malignant potential, and associated with invasive clear cell carcinoma. Clear cell adenofibroma is characterized by orderly tubules and glands lined by uniform epithelium with little or no nuclear atypia set in an abundant stroma with an interlacing pattern resembling ovarian stroma. Clear cell adenofibromatous tumors of low malignant potential had a similar stroma, but exhibited moderate to marked degrees of epithelial proliferation and atypia. In the third category there were cases of invasive clear cell carcinoma in which a distinct portion of the tumor met the criteria for clear cell adenofibroma, or clear cell adenofibromatous tumor of low malignant potential. Cases of invasive clear cell carcinoma exhibiting a desmoplastic reaction or a diffuse fibrous stroma, but lacking typical adenofibromatous areas, were not included in this study. The benign and low malignant potential tumors showed no clinical evidence of aggressive behavior, whereas those associated with invasive clear cell carcinoma often did. Although there have been no recurrences in our small group of patients with tumors of low malignant potential, the histologic similarity of the epithelium in these tumors to that seen in invasive carcinomas justifies such a categorization. Further studies of larger series using the proposed classification should yield more information concerning the biologic behavior of these types of clear cell adenofibromatous tumors.

Adenocarcinoma↗

PubMed1984

Quantitative methods in diagnostic gynaecological pathology.

In gynaecological pathology it is often useful to analyse the histological pattern quantitatively. To enable the results to be generally useful certain criteria should be fulfilled--the observations should be reproducible by other pathologists in a consistent manner and should be able to be validated. Some methods of assessing the relevant features of a section, such as pattern grading, are very subjective and do not readily conform to these criteria. Mitosis counting is perhaps somewhat more objective than pattern grading but there is considerable overlap in the counts as one moves along the clinical grade, say from benign to malignant, making it necessary to analyse other features in parallel. Using stereological methods of pattern analysis, many features of the histological pictures can be analysed simultaneously with a high degree of objectivity and accuracy. Significant features of the pattern can then be identified by discriminant multivariate analysis.

DNA, Neoplasm↗

PubMed1982

Disagreement of histopathological diagnosis of different pathologists in ovarian tumors-with some theoretical considerations.

Microscopical sections of forty-nine ovarian tumors have been assessed as benign, borderline or malignant by four different pathologists, who were unaware of the FIGO stage and clinical follow-up of each patient and each others' diagnosis. There was absolute agreement in 37 cases (75.5%), and disagreement in 12 cases (24.5%). The majority of the disagreements involved borderline-malignant differences. If one of the pathologists did disagree with the other three (in 9 cases, or 18%), there is no correlation between disagreement and histopathological experience. In three cases (6.5%) two pathologists did disagree with the other two. It is concluded that in pathology, objective reproducible and if possible, quantitative techniques should be used instead of subjective grading methods. The probability of the diagnosis should be expressed in a numerical way.

Diagnosis, Differential↗

PubMed1981

Yolk sac and allied tumours of the ovary.

A review is presented of the histological appearances of 38 yolk sac tumours of the ovary and four so-called embryonal carcinomas together with the associated clinical features. It is suggested that these neoplasms belong to a single taxonomic group of embryonal ovarian tumours differing only in the concomitant types of differentiation. One yolk sac tumour occurred in an individual of 46 XY chromosome constitution and another in a patient with a gonadoblastoma in the contralateral ovary. The value of post-operative serial assays of serum AFP is stressed.

Adolescent↗

PubMed1979

A report of the histological features in 12 cases of gonadoblastoma.

This report deals with 12 cases of gonadoblastoma submitted to the Ovarian Tumour Panel of the Royal College of Obstetricians and Gynaecologists. These tumours are found in children and young adults. Children may present with obvious genital malformation, retarded growth or precocious puberty. In adults the main compliant is amenorrhoea but sometimes there is associated masculinization. Histologically the gonadoblastoma has a distinctive structure, easily recognized in most instances. The most important feature is the instability of the germ cells in these tumours. Nine of these cases showed an associated dysgerminoma, bilateral in 4. In any cases of suspected gonadal dysgenesis presumptive evidence of diagnosis is suggested by the presence of a Y chromosome, raised gonadotrophin output and pelvic calcification on X-ray examination. At operation, streak tissue on both sides must be removed since these tumours are frequently microscopic in size. For the same reason the tissue removed should be serially sectioned.

Adolescent↗

PubMed1979

Foetal remnants in the uterus and their relation to other uterine heterotopia.

Foetal remnants were found in uterine curettings obtained from three women complaining of irregular vaginal bleeding. These findings are discussed in relation to other cases in the literature in which heterotopic tissues have been found in curettings and also for the light they throw on the origin of the so-called uterine teratomas.

Abortion, Incomplete↗

PubMed1979

Discrepancies in the histological diagnosis of hydatidiform mole.

Sections of tissue from 256 patients on which a histological diagnosis of hydatidiform mole had been made were reviewed by a visiting pathologist. There was agreement between the reporting pathologists and the visiting pathologist in only 55.1 per cent of cases, a less severe diagnosis was made by the visiting pathologist in 42.2 per cent of cases. The disagreement was as high as 66.6 per cent with pathologists who rarely worked in the gynaecological field. This study casts serious doubt on the consistency of the histological diagnosis of hydatidiform mole made in any one laboratory and between different laboratories. It is suggested that in epidemiological studies the diagnosis should be made by a panel of pathologists using strict histological criteria and in an individual laboratory diagnosis should be made or confirmed by a pathologist experienced in gynaecological pathology.

Diagnostic Errors↗

PubMed1978

Quality control in histopathology and diagnostic cytology.

The need for quality control in diagnostic histopathology and cytology is analysed together with a discussion of previously reported experience in this field. The philosophical and mathematical inferences of this type of exercise are debated also in relationship to personally observed experiences in respect of uterine cervical cytology and histology. The desirability of methods of monitoring of diagnostic quality and of obtaining quality improvement are emphasized and suggestions made regarding the techniques most suited to these objectives.

Carcinoma in Situ↗

PubMed1977

Histological discrimination of malignancy in mucinous ovarian tumours.

Eight histological features were measured quantitatively in a group of 77 ovarian mucinous carcinomas and a group of 28 benign mucinous cystomas. These were compared with the duration of survival of the patients and the clinical staging of the tumours. Using the method of discriminant function analysis it was possible to identify a group of tumours of 'borderline malignancy'. Although single histological features were inadequate indicators of prognosis a combination of three features proved fairly accurate.

Adenocarcinoma, Mucinous↗