PubMed Health⌕ Search

Biomedical subjects

G Cserni

Publications and source records attributed to G Cserni.

At least 19 recordsLinked to original sources
PubMed2006

The value of cytokeratin immunohistochemistry in the evaluation of axillary sentinel lymph nodes in patients with lobular breast carcinoma.

BACKGROUND: Cytokeratin immunohistochemistry (IHC) reveals a higher rate of occult lymph node metastases among lobular carcinomas than among ductal breast cancers. IHC is widely used but is seldom recommended for the evaluation of sentinel lymph nodes in breast cancer patients. OBJECTIVE: To assess the value of cytokeratin IHC for the detection of metastases in sentinel lymph nodes of patients with invasive lobular carcinoma. METHODS: The value of IHC, the types of metastasis found by this method, and the involvement of non-sentinel lymph nodes were analysed in a multi-institutional cohort of 449 patients with lobular breast carcinoma, staged by sentinel lymph node biopsy and routine assessment of the sentinel lymph nodes by IHC when multilevel haematoxylin and eosin staining revealed no metastasis. RESULTS: 189 patients (42%) had some type of sentinel node involvement, the frequency of this increasing with increasing tumour size. IHC was needed for identification of 65 of these cases: 17 of 19 isolated tumour cells, 40 of 64 micrometastases, and 8 of 106 larger metastases were detected by this means. Non-sentinel-node involvement was noted in 66 of 161 cases undergoing axillary dissection. Although isolated tumour cells were not associated with further lymph node involvement, sentinel node positivity detected by IHC was associated with further nodal metastases in 12 of 50 cases (0.24), a proportion that is higher than previously reported for breast cancer in general. CONCLUSIONS: IHC is recommended for the evaluation of sentinel nodes from patients with lobular breast carcinoma, as the micrometastases or larger metastases demonstrated by this method are often associated with a further metastatic nodal load.

Axilla↗
PubMed2005

Discriminating between micrometastases and isolated tumor cells in a regional and institutional setting.

The reproducibility of diagnosing isolated tumor cells (ITC) and micrometastases has been recently tested by expert breast pathologists, but might be different in a community setting. Digital images of 50 cases of low volume nodal involvement were circulated among pathologists from the Piedmont region (Italy) and from the Helios Medical Center in Berlin. Participants were asked to categorize the lesions into micrometastasis, ITC or others. The test was performed on the basis of a previous consensus statement. Kappa statistics were used for the assessment of interobserver variability. The kappa values for the consistency of categorizing cases were 0.47 and 0.57 for the regional and the institutional tests, respectively. Our study suggests that the reproducibility of diagnosing micrometastases and ITC in a community setting may reach that of experts, but is in the moderate range, and this may interfere with studies trying to solve the prognostic significance of these diagnostic categories.

Breast Neoplasms↗
PubMed2005

Evaluation of sentinel lymph nodes in breast cancer.

Sentinel lymph node biopsy is an accurate method for the detection of axillary metastases in cases of breast carcinoma and is of value as a replacement for axillary dissection. There is variation, however, in the methods and protocols used for the histopathological evaluation of sentinel lymph nodes, standardisation of which will be required if results of sentinel lymph node analysis are to be used to stratify patients into prognostic groups. The significance of micrometastases, isolated tumour cells (ITCs) and the value of immunohistochemistry are also matters for further definition. In this Expert Opinion we present reviews from two authors, providing American and European perspectives on the approach to sentinel lymph node evaluation.

Breast Neoplasms↗
PubMed2005

A new concept for esophageal resection--prevascularization: an experimental study.

We aim to elaborate upon a basically new animal model for esophageal resection. A total of 17 operations on 10 dogs were performed in order to develop a model in which resection of the cervical part of the esophagus involves two steps. The first step comprises omental flap transplantation from the abdomen to the cervical region by a microsurgical method, this omental flap improving the blood supply to the organ (prevascularization). The second step is segmental resection of the esophagus 14 days later. Of the five transplanted grafts, four still survived one week after the operation; for technical reasons, one flap had thrombotized. In the two long-term survival cases with esophageal resection after prevascularizastion, there were no major complications: the resections were successful, and the omental flap 'grew into' the tissue structure of the esophagus, assisting the healing of the anastomosis. Segmental resection of the cervical part of the esophagus was performed successfully via a new type of operation on dogs.

Anastomosis, Surgical↗
PubMed2004

Consistency of staining and reporting of oestrogen receptor immunocytochemistry within the European Union--an inter-laboratory study.

To assess the variability of oestrogen receptor (ER) testing using immunocytochemistry, centrally stained and unstained slides from breast cancers were circulated to the members of the European Working Group for Breast Screening Pathology, who were asked to report on both slides. The results showed that there was almost complete concordance among readers (kappa=0.95) in ER-negative tumours on the stained slide and excellent concordance among readers (kappa=0.82) on the slides stained in each individual laboratory. Tumours showing strong positivity were reasonably well assessed (kappa=0.57 and 0.4, respectively), but there was less concordance in tumours with moderate and low levels of ER, especially when these were heterogeneous in their staining. Because of the variation, the Working Group recommends that laboratories performing these stains should take part in a external quality assurance scheme for immunocytochemistry, should include a tumour with low ER levels as a weak positive control and should audit the percentage positive tumours in their laboratory against the accepted norms annually. The Quick score method of receptor assessment may also have too many categories for good concordance, and grouping of these into fewer categories may remove some of the variation among laboratories.

Breast Neoplasms↗
PubMed2004

Meta-analysis of non-sentinel node metastases associated with micrometastatic sentinel nodes in breast cancer.

BACKGROUND: The need for further axillary treatment in patients with breast cancer with low-volume sentinel node (SN) involvement (micrometastases or smaller) is controversial. METHODS: Twenty-five studies reporting on non-SN involvement associated with low-volume SN involvement were identified using Medline and a meta-analysis was performed. RESULTS: The weighted mean estimate for the incidence of non-SN metastases after low-volume SN involvement is around 20 per cent, whereas this incidence is around 9 per cent if the SN involvement is detected by immunohistochemistry (IHC) alone. Subset analyses suggest that studies with axillary dissection after any type of SN involvement result in somewhat higher estimates than studies allowing omission of axillary clearance, as do studies with more detailed histological evaluation of the SN compared with those with a less intensive histological protocol. Higher-quality papers yield lower pooled estimates than lower-quality papers. CONCLUSION: The risk of non-SN metastasis with a low-volume metastasis in the SN is around 10-15 per cent, depending on the method of detection of SN involvement. This should be taken into account when assessing the risk of omission of axillary dissection after a positive SN biopsy yielding micrometastatic or immunohistochemically positive SNs.

Breast↗
PubMed2004

PM-SCL autoantibody positive scleroderma with polymyositis (mechanic's hand: clinical aid in the diagnosis).

This report concerns a 56-year-old-woman presenting PM-SCL autoantibody positive scleroderma with dermatomyositis (scleromyositis) and concomitant interstitial lung fibrosis. The recently observed overlapping syndrome is characterized by the presence of specific autoantibodies, HLA-type association and benign course. A new skin symptom ("mechanic's hands") predicts the disease, in particular the interstitial lung pathology, which is its most relevant internal manifestation.

Autoantibodies↗
PubMed2004

Discrepancies in current practice of pathological evaluation of sentinel lymph nodes in breast cancer. Results of a questionnaire based survey by the European Working Group for Breast Screening Pathology.

AIMS: To evaluate aspects of the current practice of sentinel lymph node (SLN) pathology in breast cancer via a questionnaire based survey, to recognise major issues that the European guidelines for mammography screening should address in the next revision. METHODS: A questionnaire was circulated by mail or electronically by the authors in their respective countries. Replies from pathology units dealing with SLN specimens were evaluated further. RESULTS: Of the 382 respondents, 240 European pathology units were dealing with SLN specimens. Sixty per cent of these units carried out intraoperative assessment, most commonly consisting of frozen sections. Most units slice larger SLNs into pieces and only 12% assess these slices on a single haematoxylin and eosin (HE) stained slide. Seventy one per cent of the units routinely use immunohistochemistry in all cases negative by HE. The terms micrometastasis, submicrometastasis, and isolated tumour cells (ITCs) are used in 93%, 22%, and 71% of units, respectively, but have a rather heterogeneous interpretation. Molecular SLN staging was reported by only 10 units (4%). Most institutions have their own guidelines for SLN processing, but some countries also have well recognised national guidelines. CONCLUSIONS: Pathological examination of SLNs throughout Europe varies considerably and is not standardised. The European guidelines should focus on standardising examination. They should recommend techniques that identify metastases > 2 mm as a minimum standard. Uniform reporting of additional findings may also be important, because micrometastases and ITCs may in the future be shown to have clinical relevance.

Biomarkers, Tumor↗
PubMed2004

A model for determining the optimum histology of sentinel lymph nodes in breast cancer.

AIMS: To create and use a geometrical model for sentinel lymph node (SLN) histopathology in breast cancer. METHODS: The model involves a spherical metastasis randomly situated in an SLN. Two extreme situations are taken as the starting points. In one of these, the metastasis is seen in its largest dimension, whereas in the other it is only just visible, approximating 0 mm in size. Intermediate positions are analysed, with different metastasis sizes and different distances between the levels assessed by histology. RESULTS: The findings suggest that sections taken 1 mm apart afford a reasonable means of identifying almost all metastases measuring > 2 mm (referred to as macrometastases here). For nearly all micrometastases to be identified correctly according to the current TNM definitions (that is, metastases > 0.2 mm), a step sectioning protocol with levels of 250 microm or 200 microm would be adequate. CONCLUSIONS: SLNs are the most likely sites of nodal metastasis. Macrometastases are of recognised prognostic relevance so that all should be identified, preferably correctly as macrometastases; an assessment of levels 1 mm apart appears satisfactory and sufficient for this aim. SLNs also offer an ideal method for the study of the significance of micrometastases; for this, step sections separated by 200 or 250 microm are a good choice.

Breast Neoplasms↗
PubMed2003

Pathological work-up of sentinel lymph nodes in breast cancer. Review of current data to be considered for the formulation of guidelines.

Controversies and inconsistencies regarding the pathological work-up of sentinel lymph nodes (SNs) led the European Working Group for Breast Screening Pathology (EWGBSP) to review published data and current evidence that can promote the formulation of European guidelines for the pathological work-up of SNs. After an evaluation of the accuracy of SN biopsy as a staging procedure, the yields of different sectioning methods and the immunohistochemical detection of metastatic cells are reviewed. Currently published data do not allow the significance of micrometastases or isolated tumour cells to be established, but it is suggested that approximately 18% of the cases may be associated with further nodal (non-SN) metastases, i.e. approximately 2% of all patients initially staged by SN biopsy. The methods for the intraoperative and molecular assessment of SNs are also surveyed.

Breast Neoplasms↗
PubMed2003

Nodal staging of colorectal carcinomas and sentinel nodes.

This review surveys the staging systems used for the classification of colorectal carcinomas, including the TNM system, and focuses on the assessment of the nodal stage of the disease. It reviews the quantitative requirements for a regional metastatic work up, and some qualitative features of lymph nodes that may help in the selection of positive and negative lymph nodes. Identification of the sentinel lymph nodes (those lymph nodes that have direct drainage from the primary tumour site) is one such qualitative feature that is claimed to allow the upstaging of colorectal carcinomas via an oriented, enhanced pathological work up. Current evidence in favour of a change in the requisite of assessing as may lymph nodes as is possible, and concentrating the efforts on only a selected number of lymph nodes, is weak.

Colorectal Neoplasms↗
PubMed2003

Effect of increasing the surface sampled by imprint cytology on the intraoperative assessment of axillary sentinel lymph nodes in breast cancer patients.

As axillary sentinel nodes predict the nodal status and may allow dissection of the axilla on a selective basis we assessed the effects of increasing the surface sampled during intraoperative imprint cytology. Sentinel nodes from 110 patients identified with Patent blue and/or the high radioactivity due to the uptake of 99m-Tc-labeled colloidal albumin were analyzed via hematoxylin and eosin-stained touch preparations. Imprint cytology was performed either on bisected nodes (Protocol One; n = 55) or on sentinel nodes sliced into multiple pieces at 2- to 3-mm intervals (Protocol Two; n = 55). The sentinel nodes were submitted in toto to permanent step sectioning and immunostaining for cytokeratins. There were equal numbers of patients with involved nodes in the two groups assessed. With Protocols One and Two the imprints had sensitivities of 52 and 61 per cent, negative predictive values of 74 and 78 per cent, and false negative rates of 47 and 39 per cent, respectively. No macrometastasis missed by Protocol Two was absent from the surface sampled. These data suggest that increasing the surface sampled improves the proportion of involved sentinel nodes detected intraoperatively by imprint cytology, but a number of metastatic nodes still remain undetected by this method. The sampling of multiple surfaces is encouraged for a more accurate intraoperative assessment.

Axilla↗
PubMed2002

The potential therapeutic effect of sentinel lymphadenectomy.

Sentinel lymph node (SLN) biopsy in a minimally invasive staging procedure for early breast cancer patients that is currently being investigated in many institutional and multi-institutional studies. Its main perspectives are the omission of axillary dissection in sentinel lymph node-negative patients and an improved staging as a result of more intensive histopathological methods for the detection of nodal involvement. The hypothesis presented in this article suggests that sentinel lymphadenectomy may also serve as a therapeutic intervention in some patients. The background for this comes from historical studies before the general use of systemic adjuvant treatment, which suggest that some node-positive breast cancer patients seem to be curable by locoregional treatment alone. Recent studies show that many patients have nodal metastases limited to the SLNs, where (considering the sigmoid growth model of solid tumours) small metastases may grow faster than larger ones. Large metastases are associated with worse prognosis. It is suggested that, in consequence of its expected therapeutic effects, sentinel lymphadenectomy, i.e. the removal of the lymph nodes most likely to harbour metastases, should be preferred to the omission of axillary dissection, or any other surgical staging procedure based on predictive models of nodal involvement derived from primary tumour characteristics.

Axilla↗
PubMed2002

Metastasis of pulmonary adenocarcinoma in right sylvian secretory meningioma.

We report a secretory meningioma with metastasis from a pulmonary adenocarcinoma in a 48-year-old woman. Secretory meningioma can simulate metastatic disease both clinically and pathologically. Secretory meningioma and tumour-to-tumour metastasis are each rare, and we believe this to be the first report of their coincidence.

Adenocarcinoma↗
PubMed2002

Complete sectioning of axillary sentinel nodes in patients with breast cancer. Analysis of two different step sectioning and immunohistochemistry protocols in 246 patients.

AIMS: To evaluate two detailed step sectioning protocols for sentinel lymph nodes (SLNs). METHODS: After vital dye or combined dye and radiocolloid guided biopsy, SLNs were fixed in formalin and embedded in paraffin wax. In protocol A, SLNs from 123 patients were sectioned in steps of 50-100 micro m, whereas in protocol B, SLNs from 123 patients were sectioned at steps of 250 micro m. Epithelial marker immunohistochemistry (IHC) was performed on multiple levels in cases with negative haematoxylin and eosin findings. RESULTS: In groups A and B, 74 and 47 patients were found to have tumour cells in their axillary SLNs, and 19 (28%) and 18 (19%) patients, respectively, were upstaged as compared with the standard histological assessment. Nodal involvement detected by deeper sections was often micrometastatic or in isolated tumour cells CONCLUSIONS: Serial sectioning and IHC are recommended for the evaluation of SLNs. The optimal extent of the histopathological work up should be studied further.

Axilla↗
PubMed2002

Tumour histological grade may progress between primary and recurrent invasive mammary carcinoma.

AIMS: To assess the constancy of the histological grade of invasive breast carcinomas by comparing primary tumours with their axillary metastases and local or regional recurrences. METHODS: Eighty four recurrent invasive breast carcinomas with a primary tumour or previous recurrence were available for histological review from the period 1980 to 2000. These and any further recurrences were graded by one observer. RESULTS: Nine, 24, and 51 tumours with grades 1, 2, and 3, respectively, recurred. Grade 1, 2, and 3 tumours recurred within a median time of 88, 42, and 23 months, respectively. The intraobserver reproducibility of the histological grade was good (kappa = 0.66), and the grades of the primary tumours and their axillary metastases or next recurrence also exhibited good agreement. However, when further (second to sixth) recurrences were included in the analysis, the agreement between the grade of the tumours and their last recurrence was only moderate (kappa = 0.48). Only two of the nine grade 1 and 15 of the 24 grade 2 tumours retained their grade in their last recurrence. CONCLUSIONS: Low grade carcinomas require a longer follow up. These long term data support the possibility of a transition from low grade invasive breast carcinomas to higher grade tumours. It is suggested that low grade (well differentiated) breast carcinomas are not a single entity: some may progress to high grade tumours, whereas others appear not to progress.

Adult↗
PubMed2002

The influence of nodal size on the staging of colorectal carcinomas.

AIMS: The reliable identification of node negative colorectal carcinomas (CRCs) has often been linked to the histological examination of a minimum number of lymph nodes. The sizes of the lymph nodes, their metastatic status, and their number were investigated to establish whether these parameters are related, and whether their relation could help in determining the adequacy of staging. METHODS: One thousand three hundred and thirty four negative lymph nodes, 189 metastatic lymph nodes, and 43 pericolonic/perirectal tumour deposits measuring > or = 3 mm from 60 node positive and from 63 node negative patients with CRC were assessed for size. RESULTS: The mean size (SD) of these structures was 4.5 (2.7) mm. The lymph nodes were significantly larger in the CRCs with metastatic nodes (4.7 v 4.3 mm). Involved nodes were significantly larger than negative nodes (6.3 v 4.2 mm), despite the fact that the largest node was < or = 5 mm in one third of node positive CRCs. The examination of the seven largest nodes could have adequately staged 97% of node positive CRCs and 98% of all CRCs. CONCLUSIONS: The nodal staging of CRCs is dependent not only on the number of lymph nodes investigated, but also on qualitative features of the lymph nodes assessed, including their size. Lymph nodes are not equivalent and any study neglecting this fact will give grounds for error in the recommendation of a minimum number of nodes for the reliable determination of node negative CRCs. Although pathologists should aim to recover all nodes, a negative nodal status based on only seven nodes can be reliable.

Aged↗