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Colling R, Indave I, Del Aguila J, Jimenez RC, Campbell F, Chechlińska M, Kowalewska M, Holdenrieder S, Trulson I, Worf K, Pollán M, Plans-Beriso E, Pérez-Gómez B, Craciun O, García-Ovejero E, Michałek IM, Maslova K, Rymkiewicz G, Didkowska J, Tan PH, Md Nasir ND, Myles N, Goldman-Lévy G, Lokuhetty D, Cree IA. A New Hierarchy of Research Evidence for Tumor Pathology: A Delphi Study to Define Levels of Evidence in Tumor Pathology. Mod Pathol 2024; 37:100357. [PMID: 37866639 DOI: 10.1016/j.modpat.2023.100357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/03/2023] [Accepted: 10/15/2023] [Indexed: 10/24/2023]
Abstract
The hierarchy of evidence is a fundamental concept in evidence-based medicine, but existing models can be challenging to apply in laboratory-based health care disciplines, such as pathology, where the types of evidence and contexts are significantly different from interventional medicine. This project aimed to define a comprehensive and complementary framework of new levels of evidence for evaluating research in tumor pathology-introducing a novel Hierarchy of Research Evidence for Tumor Pathology collaboratively designed by pathologists with help from epidemiologists, public health professionals, oncologists, and scientists, specifically tailored for use by pathologists-and to aid in the production of the World Health Organization Classification of Tumors (WCT) evidence gap maps. To achieve this, we adopted a modified Delphi approach, encompassing iterative online surveys, expert oversight, and external peer review, to establish the criteria for evidence in tumor pathology, determine the optimal structure for the new hierarchy, and ascertain the levels of confidence for each type of evidence. Over a span of 4 months and 3 survey rounds, we collected 1104 survey responses, culminating in a 3-day hybrid meeting in 2023, where a new hierarchy was unanimously agreed upon. The hierarchy is organized into 5 research theme groupings closely aligned with the subheadings of the WCT, and it consists of 5 levels of evidence-level P1 representing evidence types that merit the greatest level of confidence and level P5 reflecting the greatest risk of bias. For the first time, an international collaboration of pathology experts, supported by the International Agency for Research on Cancer, has successfully united to establish a standardized approach for evaluating evidence in tumor pathology. We intend to implement this novel Hierarchy of Research Evidence for Tumor Pathology to map the available evidence, thereby enriching and informing the WCT effectively.
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Affiliation(s)
- Richard Colling
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK; Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Iciar Indave
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Javier Del Aguila
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Ramon Cierco Jimenez
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Fiona Campbell
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Magdalena Chechlińska
- Department of Cancer Biology, Maria Sklodowska-Curie National Research Institute of Oncology (MSCI), Warsaw, Poland
| | - Magdalena Kowalewska
- Department of Molecular and Translational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology (MSCI), Warsaw, Poland
| | - Stefan Holdenrieder
- Institute of Laboratory Medicine, German Heart Centre Munich (DHM), Munich, Germany
| | - Inga Trulson
- Institute of Laboratory Medicine, German Heart Centre Munich (DHM), Munich, Germany
| | - Karolina Worf
- Institute of Laboratory Medicine, German Heart Centre Munich (DHM), Munich, Germany
| | - Marina Pollán
- National Center for Epidemiology, Instituto de Salud Carlos III (ISC III), Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Elena Plans-Beriso
- National Center for Epidemiology, Instituto de Salud Carlos III (ISC III), Madrid, Spain
| | - Beatriz Pérez-Gómez
- National Center for Epidemiology, Instituto de Salud Carlos III (ISC III), Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Oana Craciun
- National Center for Epidemiology, Instituto de Salud Carlos III (ISC III), Madrid, Spain
| | - Ester García-Ovejero
- National Center for Epidemiology, Instituto de Salud Carlos III (ISC III), Madrid, Spain
| | - Irmina Maria Michałek
- Department of Cancer Pathology, Maria Sklodowska-Curie National Research Institute of Oncology (MSCI), Warsaw, Poland
| | - Kateryna Maslova
- Department of Cancer Biology, Maria Sklodowska-Curie National Research Institute of Oncology (MSCI), Warsaw, Poland
| | - Grzegorz Rymkiewicz
- Department of Cancer Pathology, Maria Sklodowska-Curie National Research Institute of Oncology (MSCI), Warsaw, Poland
| | - Joanna Didkowska
- Polish National Cancer Registry, Department of Epidemiology and Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology (MSCI), Warsaw, Poland
| | | | | | - Nickolas Myles
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Gabrielle Goldman-Lévy
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Dilani Lokuhetty
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Ian A Cree
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
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2
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Md Nasir ND, Koh VCY, Cree IA, Ruiz BII, Del Águila J, Armon S, Fox SB, Lakhani SR, Tan PH. Phyllodes tumour evidence gaps mapped from the 5th edition of the WHO classification of tumours of the breast. Histopathology 2023; 82:704-712. [PMID: 36579383 DOI: 10.1111/his.14856] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/21/2022] [Accepted: 12/24/2022] [Indexed: 12/30/2022]
Abstract
AIMS Breast phyllodes tumours (PTs) are a rare subset of fibroepithelial neoplasms categorised into benign, borderline, and malignant grades according to the World Health Organization (WHO) Classification of Tumours (WCTs). In this report, we developed an evidence gap map (EGM) based on the literature cited in the PT chapter of the 5th edition of the breast WCT in order to identify knowledge and research gaps in PT. METHODS A framework was first established where the dimensions of the EGM were defined as categories of tumour descriptors, tumour types, and evidence levels. Citations were collected into a Microsoft Excel form and imported into EPPI-reviewer to produce the EGM. RESULTS The EGM showed that the "Histopathology" and "Pathogenesis" sections contained the most citations, the majority being of low-level evidence. The highest number of citations considered of moderate-level evidence were found in the "Histopathology" section. There was no high-level evidence cited in this chapter. The "Localisation", "Aetiology", and "Staging" sections had the fewest citations. CONCLUSION This EGM provides a visual representation of the cited literature in the PT chapter of the breast WCT, revealing the lack of high-level evidence citations. There is an uneven distribution of references, probably due to citation practices. Pockets of low-level evidence are highlighted, possibly related to referencing habits, lack of relevant research, or the belief that the information presented is standard accepted fact, without the need for specific citations. Future work needs to bridge evidence gaps and broaden citations beyond those in the latest WCT.
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Affiliation(s)
- Nur Diyana Md Nasir
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Valerie C Y Koh
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Ian A Cree
- WHO/IARC Classification of Tumours, International Agency for Research on Cancer (IARC), Lyon, France
| | - Blanca I I Ruiz
- WHO/IARC Classification of Tumours, International Agency for Research on Cancer (IARC), Lyon, France
| | - Javier Del Águila
- WHO/IARC Classification of Tumours, International Agency for Research on Cancer (IARC), Lyon, France
| | - Subasri Armon
- WHO/IARC Classification of Tumours, International Agency for Research on Cancer (IARC), Lyon, France
| | - Stephen B Fox
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sunil R Lakhani
- University of Queensland Centre for Clinical Research and Pathology, Brisbane, QLD, Australia
| | - Puay Hoon Tan
- Luma Medical Centre, Singapore, Singapore
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- KK Women's and Children's Hospital, Singapore, Singapore
- Department of Pathology, University of Western Sydney, Sydney, Australia
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3
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Indave BI, Colling R, Campbell F, Tan PH, Cree IA. Evidence-levels in pathology for informing the WHO classification of tumours. Histopathology 2022; 81:420-425. [PMID: 36089568 DOI: 10.1111/his.14648] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 03/25/2024]
Affiliation(s)
- Blanca Iciar Indave
- WHO Classification of Tumours Programme, International Agency for Research on Cancer, World Health Organisation, Lyon, France
| | - Richard Colling
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Fiona Campbell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore
| | - Ian A Cree
- WHO Classification of Tumours Programme, International Agency for Research on Cancer, World Health Organisation, Lyon, France
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Tessier-Cloutier B, Grewal JK, Jones MR, Pleasance E, Shen Y, Cai E, Dunham C, Hoang L, Horst B, Huntsman DG, Ionescu D, Karnezis AN, Lee AF, Lee CH, Lee TH, Twa DD, Mungall AJ, Mungall K, Naso JR, Ng T, Schaeffer DF, Sheffield BS, Skinnider B, Smith T, Williamson L, Zhong E, Regier DA, Laskin J, Marra MA, Gilks CB, Jones SJ, Yip S. The impact of whole genome and transcriptome analysis (WGTA) on predictive biomarker discovery and diagnostic accuracy of advanced malignancies. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2022; 8:395-407. [PMID: 35257510 PMCID: PMC9161328 DOI: 10.1002/cjp2.265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/15/2022] [Accepted: 02/04/2022] [Indexed: 12/13/2022]
Abstract
In this study, we evaluate the impact of whole genome and transcriptome analysis (WGTA) on predictive molecular profiling and histologic diagnosis in a cohort of advanced malignancies. WGTA was used to generate reports including molecular alterations and site/tissue of origin prediction. Two reviewers analyzed genomic reports, clinical history, and tumor pathology. We used National Comprehensive Cancer Network (NCCN) consensus guidelines, Food and Drug Administration (FDA) approvals, and provincially reimbursed treatments to define genomic biomarkers associated with approved targeted therapeutic options (TTOs). Tumor tissue/site of origin was reassessed for most cases using genomic analysis, including a machine learning algorithm (Supervised Cancer Origin Prediction Using Expression [SCOPE]) trained on The Cancer Genome Atlas data. WGTA was performed on 652 cases, including a range of primary tumor types/tumor sites and 15 malignant tumors of uncertain histogenesis (MTUH). At the time WGTA was performed, alterations associated with an approved TTO were identified in 39 (6%) cases; 3 of these were not identified through routine pathology workup. In seven (1%) cases, the pathology workup either failed, was not performed, or gave a different result from the WGTA. Approved TTOs identified by WGTA increased to 103 (16%) when applying 2021 guidelines. The histopathologic diagnosis was reviewed in 389 cases and agreed with the diagnostic consensus after WGTA in 94% of non‐MTUH cases (n = 374). The remainder included situations where the morphologic diagnosis was changed based on WGTA and clinical data (0.5%), or where the WGTA was non‐contributory (5%). The 15 MTUH were all diagnosed as specific tumor types by WGTA. Tumor board reviews including WGTA agreed with almost all initial predictive molecular profile and histopathologic diagnoses. WGTA was a powerful tool to assign site/tissue of origin in MTUH. Current efforts focus on improving therapeutic predictive power and decreasing cost to enhance use of WGTA data as a routine clinical test.
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Affiliation(s)
- Basile Tessier-Cloutier
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jasleen K Grewal
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - Martin R Jones
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - Erin Pleasance
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - Yaoqing Shen
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - Ellen Cai
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Chris Dunham
- Department of Pathology and Laboratory Medicine, Children's and Women's Health Centre of British Columbia, Vancouver, BC, Canada
| | - Lynn Hoang
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC, Canada
| | - Basil Horst
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC, Canada
| | - David G Huntsman
- Department of Molecular Oncology, BC Cancer, Vancouver, BC, Canada
| | - Diana Ionescu
- Department of Anatomical Pathology, BC Cancer, Vancouver, BC, Canada
| | - Anthony N Karnezis
- Department of Pathology and Laboratory Medicine, UC Davis, Sacramento, CA, USA
| | - Anna F Lee
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, Children's and Women's Health Centre of British Columbia, Vancouver, BC, Canada
| | - Cheng Han Lee
- Department of Molecular Oncology, BC Cancer, Vancouver, BC, Canada
| | - Tae Hoon Lee
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David Dw Twa
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andrew J Mungall
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - Karen Mungall
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - Julia R Naso
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tony Ng
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC, Canada
| | - David F Schaeffer
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC, Canada
| | - Brandon S Sheffield
- Department of Pathology and Laboratory Medicine, William Osler Health System, Brampton, ON, Canada
| | - Brian Skinnider
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC, Canada
| | - Tyler Smith
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC, Canada
| | - Laura Williamson
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada
| | - Ellia Zhong
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Dean A Regier
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - Janessa Laskin
- Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Marco A Marra
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - C Blake Gilks
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC, Canada
| | - Steven Jm Jones
- Canada's Michael Smith Genome Sciences Centre, Vancouver, BC, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.,Department of Molecular Biology and Biochemistry, Simon Fraser University, Vancouver, BC, Canada
| | - Stephen Yip
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, BC, Canada.,Department of Molecular Oncology, BC Cancer, Vancouver, BC, Canada
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Marchevsky AM, Diniz MA, Manzoor D, Walts AE. Prognosis in pathology: Are we "prognosticating" or only establishing correlations between independent variables and survival? A study with various analytics cautions about the overinterpretation of statistical results. Ann Diagn Pathol 2020; 46:151525. [PMID: 32353712 DOI: 10.1016/j.anndiagpath.2020.151525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/16/2020] [Indexed: 01/27/2023]
Abstract
Survival data from 225 patients with resected pulmonary typical carcinoids were analyzed with Kaplan-Meier statistics (K-M) and "deep learning" methods to illustrate the difference between establishing "correlations" and "prognostications". Cases were stratified into G1 and G2 classes using a ≤5% Ki-67% cut-point. Overall survival, number of patients at risk and 95% confidence intervals (CI) were estimated for the two classes. Seven neural network models (NN) were developed with GMDH Shell 3.8.2 and Statgraphics Centurion 18.1 software, using variable prior probabilities and different numbers of training vs testing cases. The NNs used age, sex, and pTNM, G1 and G2 as input neurons and "alive" and "dead" as output neurons. Areas under the curve (AUC) and other performance measures were evaluated for all models. Log-rank test showed a significant difference in overall survival between G1 and G2 (p < 0.001). However, 95% CI estimates showed considerable variability in survival at different time intervals. Including the number of patients at risk at different time intervals showed that most G2 patients had been censored by 100 weeks. The NN models provided variable "prognostications", with AUC ranging from 0.5 to 1 and variability in the sensitivity, specificity, and other performance measures. The results illustrate the limitations of survival statistics and NNs in predicting the prognosis of individual patients. The need for pathologists not to overinterpret the finding of significant correlations as "prognostic" or "predictive" for individual patients is discussed.
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Affiliation(s)
- Alberto M Marchevsky
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
| | - Marcio A Diniz
- Biostatistics and Bioinformatics Research Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, United States of America
| | - Daniel Manzoor
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | - Ann E Walts
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
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6
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Marchevsky AM, Khoor A, Walts AE, Nicholson AG, Zhang YZ, Roggli V, Carney J, Roden AC, Tazelaar HD, Larsen BT, LeStang N, Chirieac LR, Klebe S, Tsao MS, De Perrot M, Pierre A, Hwang DM, Hung YP, Mino-Kenudson M, Travis W, Sauter J, Beasley MB, Galateau-Sallé F. Localized malignant mesothelioma, an unusual and poorly characterized neoplasm of serosal origin: best current evidence from the literature and the International Mesothelioma Panel. Mod Pathol 2020; 33:281-296. [PMID: 31485011 PMCID: PMC10428660 DOI: 10.1038/s41379-019-0352-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/29/2019] [Accepted: 07/30/2019] [Indexed: 12/12/2022]
Abstract
Localized malignant mesotheliomas (LMM) is an uncommon and poorly recognized neoplasm. Its pathologic diagnosis is often surprising in patients with serosal/subserosal based localized tumors that are clinically suspicious for metastatic lesions or primary sarcomas. Once a tumor is diagnosed as "mesothelioma", LMM is often mistaken for diffuse malignant mesothelioma (DMM). Best currently available evidence about LMM was collected from the literature and cases diagnosed by members of the International Mesothelioma Panel (IMP). One hundred and one (101) LMM have been reported in the English literature. Patients had localized tumors with identical histopathologic features to DMM. Patients ranged in age from 6 to 82 years; 75% were men. Most (82%) of the tumors were intrathoracic. Others presented as intrahepatic, mesenteric, gastric, pancreatic, umbilical, splenic, and abdominal wall lesions. Tumors varied in size from 0.6 to 15 cm. Most patients underwent surgical resection and/or chemotherapy or radiation therapy. Median survival in a subset of patients was 29 months. Seventy two additional LMM from IMP institutions ranged in age from 28 to 95 years; 58.3% were men. Sixty tumors (83.3%) were intrathoracic, others presented in intraabdominal sites. Tumors varied in size from 1.2 to 19 cm. Median survival for 51 cases was 134 months. Best evidence was used to formulate guidelines for the diagnosis of LMM. It is important to distinguish LMM from DMM as their treatment and prognosis is different. A multidisciplinary approach is needed for the diagnosis of LMM as it shows identical histopathology and immunophenotype to DMM.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biopsy
- Child
- Diagnosis, Differential
- Evidence-Based Medicine
- Female
- Humans
- Male
- Mesothelioma, Malignant/diagnostic imaging
- Mesothelioma, Malignant/mortality
- Mesothelioma, Malignant/pathology
- Mesothelioma, Malignant/therapy
- Middle Aged
- Pleural Neoplasms/diagnostic imaging
- Pleural Neoplasms/mortality
- Pleural Neoplasms/pathology
- Pleural Neoplasms/therapy
- Predictive Value of Tests
- Prognosis
- Solitary Fibrous Tumor, Pleural/diagnostic imaging
- Solitary Fibrous Tumor, Pleural/mortality
- Solitary Fibrous Tumor, Pleural/pathology
- Solitary Fibrous Tumor, Pleural/therapy
- Tumor Burden
- Young Adult
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Affiliation(s)
| | | | - Ann E Walts
- Departments of Pathology Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Yu Zhi Zhang
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | | | | | | | | | | | | | - Sonja Klebe
- Flinders University, Adelaide, SA, Australia
| | - Ming-Sound Tsao
- University Health Network, Toronto General Hospital and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Marc De Perrot
- University Health Network, Toronto General Hospital and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Andrew Pierre
- University Health Network, Toronto General Hospital and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - David M Hwang
- University Health Network, Toronto General Hospital and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Yin P Hung
- Massachusetts General Hospital, Boston, MA, USA
| | | | - William Travis
- Sloan Kettering Memorial Cancer Center, New York, NY, USA
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7
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Marchevsky AM, Walts AE, Wick MR. Pathology in the era of "Personalized Medicine": The need to learn how to integrate multivariate immunohistochemical and "omics" data with clinicopathologic information in a clinically relevant way". Ann Diagn Pathol 2019; 43:151410. [PMID: 31689574 DOI: 10.1016/j.anndiagpath.2019.151410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/11/2019] [Indexed: 11/30/2022]
Abstract
"Personalized medicine" has been proposed as a new paradigm for patient care that, based on the integration of genomics and other "omics" data with clinical and other multidisciplinary information, promises early disease detection, improved outcomes and reduced side effects to therapies. Pathologists have become important participants in this new approach as the guardians of tissues and experts in the performance of molecular and other laboratory tests. Large amounts of new laboratory data in multiple neoplasms and other entities are being reported but there has been limited discussion about how best to evaluate the clinical significance of this information and how to integrate it into currently available diagnostic and therapeutic modalities. This article introduces a variety of epistemological problems presented by the "personalized medicine" paradigm and briefly discusses various topics that will be evaluated in further detail in future articles of this new series on Evidence-Based Pathology.
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Affiliation(s)
- Alberto M Marchevsky
- Departments of Pathology & Laboratory Medicine Cedars-Sinai Medical Center, Los Angeles CA, United States of America.
| | - Ann E Walts
- Departments of Pathology & Laboratory Medicine Cedars-Sinai Medical Center, Los Angeles CA, United States of America
| | - Mark R Wick
- University of Virginia, Charlottesville, VA, United States of America
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8
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The use of Ki-67 labeling index to grade pulmonary well-differentiated neuroendocrine neoplasms: current best evidence. Mod Pathol 2018; 31:1523-1531. [PMID: 29802361 DOI: 10.1038/s41379-018-0076-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/04/2018] [Accepted: 04/08/2018] [Indexed: 01/28/2023]
Abstract
Although Ki-67 labeling index (Ki-67%) is not a diagnostic or grading criterion in the World Health Organization classification of pulmonary carcinoid tumor, oncologists often request this test. A survey was administered at a North American Society for Neuroendocrine Tumors meeting to understand how Ki-67% is used in oncologic practices. A systematic literature review was performed to gather best evidence regarding the use of Ki-67%. Consecutive pulmonary carcinoids were stratified into pulmonary typical carcinoids with Ki-67% <5% (group A, n = 187), typical carcinoids with Ki-67% ≥5% (group B, n = 38) and atypical carcinoids irrespective of Ki-67% (group C, n = 31). Overall survival, progression-free survival, recurrence proportions and time to recurrence were compared, by group, using the log-rank test, chi-square statistics and ANOVA, respectively. Our survey confirmed that Ki-67% is frequently used by specialists caring for these patients. Ki-67% of 1-7% significantly correlated with overall survival in the literature but we found no information about Ki-67% cut-off values that would accurately distinguish pulmonary typical from atypical carcinoids or estimate the prognosis of patients stratified by World Health Organization diagnosis and Ki-67% cut-off. Overall survival was significantly different in our 3 patient groups (p < 0.001), with survival probabilities decreasing from groups A to C. Progression-free survival was significantly longer in group A than B (p < 0.007). Our results support the concept that by combining World Health Organization diagnosis and Ki-67%, pulmonary carcinoids can be stratified into 3 grades: G1 (typical carcinoids with Ki-67% <5), G2 (typical carcinoids with Ki-67% ≥5%) and G3 (atypical carcinoids) with different prognoses.
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Caswell JL, Bassel LL, Rothenburger JL, Gröne A, Sargeant JM, Beck AP, Ekman S, Gibson-Corley KN, Kuiken T, LaDouceur EEB, Meyerholz DK, Origgi FC, Posthaus H, Priestnall SL, Ressel L, Sharkey L, Teixeira LBC, Uchida K, Ward JM, Webster JD, Yamate J. Observational Study Design in Veterinary Pathology, Part 1: Study Design. Vet Pathol 2018; 55:607-621. [PMID: 30071806 DOI: 10.1177/0300985818785705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Observational studies are the basis for much of our knowledge of veterinary pathology and are highly relevant to the daily practice of pathology. However, recommendations for conducting pathology-based observational studies are not readily available. In part 1 of this series, we offer advice on planning and conducting an observational study with examples from the veterinary pathology literature. Investigators should recognize the importance of creativity, insight, and innovation in devising studies that solve problems and fill important gaps in knowledge. Studies should focus on specific and testable hypotheses, questions, or objectives. The methodology is developed to support these goals. We consider the merits and limitations of different types of analytic and descriptive studies, as well as of prospective vs retrospective enrollment. Investigators should define clear inclusion and exclusion criteria and select adequate numbers of study subjects, including careful selection of the most appropriate controls. Studies of causality must consider the temporal relationships between variables and the advantages of measuring incident cases rather than prevalent cases. Investigators must consider unique aspects of studies based on archived laboratory case material and take particular care to consider and mitigate the potential for selection bias and information bias. We close by discussing approaches to adding value and impact to observational studies. Part 2 of the series focuses on methodology and validation of methods.
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Affiliation(s)
- Jeff L Caswell
- 1 Department of Pathobiology, University of Guelph, Guelph, Ontario, Canada
| | - Laura L Bassel
- 1 Department of Pathobiology, University of Guelph, Guelph, Ontario, Canada
| | - Jamie L Rothenburger
- 2 Department of Ecosystem and Public Health, Canadian Wildlife Health Cooperative, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Gröne
- 3 Department of Pathobiology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Jan M Sargeant
- 4 Department of Population Medicine and Centre for Public Health and Zoonoses, University of Guelph, Guelph, Ontario, Canada
| | - Amanda P Beck
- 5 Albert Einstein College of Medicine, Bronx, NY, USA
| | - Stina Ekman
- 6 Department of Biomedicine and Veterinary Public Health, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Katherine N Gibson-Corley
- 7 Department of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Thijs Kuiken
- 8 Department of Viroscience, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | - David K Meyerholz
- 10 University of Iowa Carver College of Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Francesco C Origgi
- 11 Centre for Fish and Wildlife Health, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Horst Posthaus
- 12 Institute of Animal Pathology, Vetsuisse-Faculty, University of Bern, Bern, Switzerland
| | - Simon L Priestnall
- 13 Deparment Pathobiology & Population Sciences, The Royal Veterinary College, Hatfield, United Kingdom
| | - Lorenzo Ressel
- 14 Department of Veterinary Pathology and Public Health, Institute of Veterinary Science, University of Liverpool, Liverpool, United Kingdom
| | - Leslie Sharkey
- 15 Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, N. Grafton, MA, USA
| | - Leandro B C Teixeira
- 16 Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Kazuyuki Uchida
- 17 Department of Veterinary Pathology, University of Tokyo, Tokyo, Japan
| | | | | | - Jyoji Yamate
- 20 Laboratory of Veterinary Pathology, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Izumisano City, Osaka, Japan
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10
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Marchevsky AM, Wick MR. Evidence-based pathology: systematic literature reviews as the basis for guidelines and best practices. Arch Pathol Lab Med 2014; 139:394-9. [PMID: 25356986 DOI: 10.5858/arpa.2014-0106-ra] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Evidence-based medicine has been proposed as a new paradigm for the identification and evaluation of medical information. Best available evidence or data are identified and used as the basis for the diagnosis and treatment of individual patients. Evidence-based pathology has adapted basic evidence-based medicine concepts to the specific needs of pathology and laboratory medicine. OBJECTIVES To briefly review the history and basic concepts of evidence-based medicine and evidence-based pathology, describe how to perform and interpret systematic reviews, and discuss how to integrate best evidence into guidelines. DATA SOURCES PubMed (National Library of Medicine, Washington, DC) and Web of Science (Thompson Reuters, New York, New York) were used. CONCLUSIONS Evidence-based pathology provides methodology to evaluate the quality of information published in pathology journals and apply it to the diagnosis of tissue samples and other tests from individual patients. Information is gathered through the use of systematic reviews, using a method that is less biased and more comprehensive than ad hoc literature searches. Published data are classified into evidence levels to provide readers with a quick impression about the quality and probable clinical validity of available information. Best available evidence is combined with personal experience for the formulation of evidence-based, rather than opinion-based, guidelines that address specific practice needs.
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Affiliation(s)
- Alberto M Marchevsky
- From the Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California (Dr Marchevsky)
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11
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Wick MR, Marchevsky AM. Evidence-Based Principles in Pathology: Existing Problem Areas and the Development of “Quality” Practice Patterns. Arch Pathol Lab Med 2011; 135:1398-404. [DOI: 10.5858/arpa.2011-0181-sa] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Contrary to the intuitive impressions of many pathologists, several areas exist in laboratory medicine where evidence-based medicine (EBM) principles are not applied. These include aspects of both anatomic and clinical pathology. Some non-EBM practices are perpetuated by clinical “consumers” of laboratory services because of inadequate education, habit, or overreliance on empirical factors. Other faulty procedures are driven by pathologists themselves.
Objectives.—To consider (1) several selected problem areas representing non-EBM practices in laboratory medicine; such examples include ideas and techniques that concern metastatic malignancies, “targeted” oncologic therapy, general laboratory testing and data utilization, evaluation of selected coagulation defects, administration of blood products, and analysis of hepatic iron-overload syndromes; and (2) EBM principles as methods for remediation of deficiencies in hospital pathology, and implements for the construction of “quality” practices in our specialty.
Data Sources.—Current English literature relating to evidence-based principles in pathology and laboratory medicine, as well as the authors' experience.
Conclusions.—Evidence-based medicine holds the promise of optimizing laboratory services to produce “quality” practices in pathology. It will also be a key to restraining the overall cost of health care.
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12
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Kuperman M, Florence RR, Pantanowitz L, Visintainer PF, Cibas ES, Otis CN. Distinguishing benign from malignant mesothelial cells in effusions by Glut-1, EMA, and Desmin expression: An evidence-based approach. Diagn Cytopathol 2011; 41:131-40. [DOI: 10.1002/dc.21800] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 07/07/2011] [Indexed: 12/16/2022]
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