Variations in cancer centers' use of cytology for the diagnosis of small cell lung carcinoma in the National Cancer Data Base

Influence of preanalytical variables on performance of delta-like protein 3 (DLL3) predictive immunohistochemistry

DLL3 might become a predictive immunohistochemical marker in small cell carcinoma of the lung (SCLC). We investigated the influence of pre-analytical handling of samples on the performance of DLL3 immunohistochemistry (IHC) using DLL3 SP347 ready to use assay (Ventana). DLL3 positive cell lines were subjected to different experimental conditions mimicking the pre-analytical variation in daily clinical practice. Formalin fixation of 24 h led to the most optimal results of DLL3 IHC. Longstanding fixation in Cytolyt, methanol-based fixative for cytology samples, but also decalcification using a mix of formic- and hydrochloracid resulted in decreased DLL3 staining. Postponed staining of blanc slides for 3 months also decreased DLL3 IHC. Postponed fixation of the SCLC cell lines did not influence the performance of DLL3 IHC, although this might be different in the tissues than in the cell lines. In conclusion, different pre-analytical variables decrease the performance of DLL3 IHC. These findings are essential for implementing novel predictive immunohistochemical biomarkers in daily pathology practice.

Electrochemical biosensors for the detection of lung cancer biomarkers: A review

Cancer is one of the most widespread challenges and important diseases, which has the highest mortality rate. Lung cancer is the most common type of cancer, so that about 25% of all cancer deaths are related to the lung cancer. The lung cancer is classified as two different types with different treatment methodology: the small cell lung carcinoma and nonsmall cell lung carcinoma are two categories of the lung cancer. Since the lung cancer is often in the latent period in its early stages, therefore, early diagnosis of lung cancer has many challenges. Hence, there is a need for sensitive and reliable tools for preclinical diagnosis of lung cancer. Therefore, many detection methods have been employed for early detection of lung cancer. As lung cancer tumors growth in the body, the cancerous cells release numerous DNA, proteins, and metabolites as special biomarkers of the lung cancer. The levels of these biomarkers show the stages of the lung cancer. Therefore, detection of the biomarkers can be used for screening and clinical diagnosis of the lung cancer. There are numerous biomarkers for the lung cancer such as EGFR, CEA, CYFRA 21-1, ENO1, NSE, CA 19-9, CA 125 and VEGF. Nowadays, electrochemical methods are very attractive and useful in the lung cancer detections. So, in this paper, the recent advances and improvements (2010-2018) in the electrochemical detection of the lung cancer biomarkers have been reviewed.

Trends in Diagnosis of Gleason Score 2 Through 4 Prostate Cancer in the National Cancer Database, 1990–2013

Context.—

The incidence of prostate cancer with Gleason scores 2 through 4 has been decreasing for decades, largely because of evolving criteria for Gleason scores, including the 2005 International Society of Urological Pathology recommendation that scores of 2 through 4 should rarely, if ever, be diagnosed based on needle biopsy. Whether trends in assigning Gleason scores 2 through 4 vary by facility type and patient characteristics is unknown.

Objective.—

To assess trends in prostate cancer grading among various categories of treatment facilities.

Design.—

Analyses of National Cancer Database records from 1990 through 2013 for 434 612 prostate cancers diagnosed by core needle biopsy, including multivariable regression for 106 331 patients with clinical T1c disease diagnosed from 2004 through 2013.

Results.—

The proportion of prostate core needle biopsies with Gleason scores 2 through 4 declined from 11 476 of 53 850 (21.3%) (1990–1994) to 96 of 43 566 (0.2%) (2010–2013). The proportions of American Joint Committee on Cancer category T1c needle biopsies assigned Gleason scores 2 through 4 were 416 of 12 796 (3.3%) and 9 of 7194 (0.1%) during 2004 and 2013, respectively. Declines occurred earliest at National Cancer Institute–designated programs and latest at community programs. A multivariable logistic model adjusting for patient demographic and clinical variables and restricted to T1c cancers diagnosed in needle biopsies from 2004 through 2013 showed that facility type is independently associated with the likelihood of cancers in such specimens being assigned Gleason scores of 2 through 4, with community centers having a statistically significant odds ratio of 5.99 relative to National Cancer Institute–designated centers.

Conclusions.—

These results strongly suggest differences in Gleason grading by pathologists practicing in different facility categories and variations in their promptness of adopting International Society of Urological Pathology recommendations.

Trends and Predictors of Chemotherapy Use among Thyroid Cancer Patients in the National Cancer Database (2004-2013)

BACKGROUND/AIM

Beginning in 2011, the Food and Drug Administration (FDA) approved the use of multikinase inhibitors (MKIs) for medullary thyroid cancers (MTCs), and in 2013 MKIs were approved for metastatic differentiated thyroid cancers (DTCs). However, little is known about the use of chemotherapy in thyroid cancer patients. Thus, the goal of our study was to describe patterns of chemotherapy use, including MKIs, among DTC and MTC patients in the National Cancer Database (NCDB).

METHODS

Chemotherapy use, along with other treatment types (surgery and radiation), was assessed between 2004 and 2013. The primary predictor was the year of diagnosis (2004-2010 and 2011-2013), based on the FDA's approval of chemotherapy for MTC (2011). Baseline use of MKIs in DTCs in 2013 was also examined. Multivariable logistic regression was used to estimate odds ratios (OR) and 95% CI of receipt of chemotherapy.

RESULTS

Overall, 199,654 patients were included in our analytic sample with 194,667 nonmetastatic DTCs, 1,633 metastatic DTCs, and 3,354 MTCs. Among MTCs, chemotherapy use significantly increased from 3.1% in 2004-2010 to 5.0% in 2011-2013 (p = 0.018) in unadjusted and adjusted (OR = 1.54, 95% CI: 1.00, 2.36) analyses. In metastatic DTCs, 4.9% of patients received chemotherapy in 2013, which was not significantly higher than in previous years (p = 0.755).

CONCLUSIONS

Overall, chemotherapy use among MTCs increased marginally following the FDA's approval of MKIs in 2011, although their use remains very low. MKIs were infrequently used in metastatic DTCs in 2013. Future studies examining patterns of chemotherapy in thyroid cancer patients are warranted.

Variations in cancer centers' use of cytology for the diagnosis of unresectable pancreatic cancer in the National Cancer Data Base

BACKGROUND

Cytology is an accurate, safe, cost-effective, and guideline-recommended method for pancreatic cancer diagnosis, particularly for unresectable disease. However, to the authors' knowledge, the frequency and determinants of its use have not been described to date. The current study examined patterns of cytological diagnosis among patients with unresectable pancreatic cancer by treatment facility type and by patient characteristics.

METHODS

The prevalence of definitive cytological diagnosis (cytology only, without confirmatory histology) versus histological diagnosis (with or without accompanying cytology) was examined in National Cancer Data Base records of 13,657 patients diagnosed with unresectable (American Joint Committee on Cancer stages III and IV) pancreatic cancer in 2011 and 2012 who did not undergo surgical treatment (mode of diagnosis could not be ascertained for surgical patients). Associations between definitive cytological diagnosis and patient and facility characteristics were assessed using multivariable marginal logistic regression models and expressed as odds ratios (OR) and 95% confidence intervals (95% CIs).

RESULTS

Overall, 26.8% of unresectable pancreatic cancer cases were definitively diagnosed with cytology. The prevalence of cytological diagnosis ranged from 16.5% in community cancer programs and 22.6% in comprehensive community cancer programs to 31.3% in academic/teaching/research cancer programs and 43.2% in National Cancer Institute-designated cancer programs (P<.001). Compared with patients diagnosed in National Cancer Institute-designated cancer programs, those from community cancer programs (OR, 0.29; 95% CI, 0.20-0.42), comprehensive community cancer programs (OR, 0.42; 95% CI, 0.31-0.59), and academic/teaching/research cancer programs (OR, 0.60; 95% CI, 0.43-0.84) had lower odds of being diagnosed with cytology.

CONCLUSIONS

Greater than 25% of unresectable pancreatic cancers were diagnosed definitively with cytology, with wide variation in its use by facility type, suggesting opportunities for quality improvement interventions that increase the use of cytology. Cancer Cytopathol 2016;124:791-800. © 2016 American Cancer Society.