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van den Hoek Bos- DW, Tuinman MA, Hillen MA, Huijgens FL, Kurpershoek E, Calaminus G, Kaatsch P, Hagedoorn M, Lehmann V. DISCLOSING A HISTORY OF CHILDHOOD CANCER TO ROMANTIC PARTNERS. Psychooncology 2023. [PMID: 36998113 DOI: 10.1002/pon.6130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE To describe young adult childhood cancer survivors' disclosure of their cancer history (i.e., disclosure behavior, difficulty, and timing), perceived partner responses, and associations with relationship status satisfaction. METHODS German long-term survivors of childhood cancer (N=509; response rate: 31.3%, age 21-26, 59.7% female) completed a registry-based nationwide survey (embedded mixed methods design, including closed and open-ended questions) on measures about disclosure history (behavior, difficulty, and timing), partner responses, and relationship status satisfaction. Statistical (χ2 -, t-, or F-tests) and qualitative analyses were conducted. RESULTS Half of all survivors always disclosed their cancer history to romantic partners. Thereby, three themes for considering (non-)disclosure were identified: Survivors' attitudes, having integrated cancer as part of their identity, and anticipated effects on romantic relationships. About 40% indicated having no difficulties with disclosing their cancer history. The timing of disclosure varied, with most survivors disclosing after a few dates. Facilitators of disclosure were the visibility of their former illness (e.g., scars), having trust in a (potential) partner, getting older/mature, and previous positive experiences with disclosure. Few survivors (13.8%) had ever experienced negative responses from dating partners. Yet, those who had negative experiences, found it more difficult to disclose their cancer history. Survivors were overall rather satisfied with their relationship status, with partnered survivors reporting greater satisfaction than singles (Hedge's g=1.68); and particularly partnered survivors with past positive responses being most satisfied. CONCLUSIONS Young adult childhood cancer survivors appear rather open in disclosing their cancer history to (potential) romantic partners, and few experienced negative responses. Psycho-educational programs may emphasize such findings in helping to prevent fear of disclosure or avoidance of dating and disclosure among survivors. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- D W van den Hoek Bos-
- Amsterdam UMC location University of Amsterdam, department of Medical Psychology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Quality of Care program, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - M A Tuinman
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M A Hillen
- Amsterdam UMC location University of Amsterdam, department of Medical Psychology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Quality of Care program, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - F L Huijgens
- Amsterdam UMC location University of Amsterdam, department of Medical Psychology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Quality of Care program, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - E Kurpershoek
- Amsterdam UMC location University of Amsterdam, department of Medical Psychology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Quality of Care program, Amsterdam, The Netherlands
| | - G Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - P Kaatsch
- Institute of Medical Biostatistics, University Medical Center Mainz, German Childhood Cancer Registry (GCCR), Epidemiology and Informatics (IMBEI), Mainz, Germany
| | - M Hagedoorn
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - V Lehmann
- Amsterdam UMC location University of Amsterdam, department of Medical Psychology, Meibergdreef 9, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
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Sturm B, Creytens D, Smits J, Ooms AHAG, Eijken E, Kurpershoek E, Küsters-Vandevelde HVN, Wauters C, Blokx WAM, van der Laak JAWM. Computer-Aided Assessment of Melanocytic Lesions by Means of a Mitosis Algorithm. Diagnostics (Basel) 2022; 12:diagnostics12020436. [PMID: 35204526 PMCID: PMC8871065 DOI: 10.3390/diagnostics12020436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/31/2021] [Accepted: 01/14/2022] [Indexed: 11/16/2022] Open
Abstract
An increasing number of pathology laboratories are now fully digitised, using whole slide imaging (WSI) for routine diagnostics. WSI paves the road to use artificial intelligence (AI) that will play an increasing role in computer-aided diagnosis (CAD). In melanocytic skin lesions, the presence of a dermal mitosis may be an important clue for an intermediate or a malignant lesion and may indicate worse prognosis. In this study a mitosis algorithm primarily developed for breast carcinoma is applied to melanocytic skin lesions. This study aimed to assess whether the algorithm could be used in diagnosing melanocytic lesions, and to study the added value in diagnosing melanocytic lesions in a practical setting. WSI’s of a set of hematoxylin and eosin (H&E) stained slides of 99 melanocytic lesions (35 nevi, 4 intermediate melanocytic lesions, and 60 malignant melanomas, including 10 nevoid melanomas), for which a consensus diagnosis was reached by three academic pathologists, were subjected to a mitosis algorithm based on AI. Two academic and six general pathologists specialized in dermatopathology examined the WSI cases two times, first without mitosis annotations and after a washout period of at least 2 months with mitosis annotations based on the algorithm. The algorithm indicated true mitosis in lesional cells, i.e., melanocytes, and non-lesional cells, i.e., mainly keratinocytes and inflammatory cells. A high number of false positive mitosis was indicated as well, comprising melanin pigment, sebaceous glands nuclei, and spindle cell nuclei such as stromal cells and neuroid differentiated melanocytes. All but one pathologist reported more often a dermal mitosis with the mitosis algorithm, which on a regular basis, was incorrectly attributed to mitoses from mainly inflammatory cells. The overall concordance of the pathologists with the consensus diagnosis for all cases excluding nevoid melanoma (n = 89) appeared to be comparable with and without the use of AI (89% vs. 90%). However, the concordance increased by using AI in nevoid melanoma cases (n = 10) (75% vs. 68%). This study showed that in general cases, pathologists perform similarly with the aid of a mitosis algorithm developed primarily for breast cancer. In nevoid melanoma cases, pathologists perform better with the algorithm. From this study, it can be learned that pathologists need to be aware of potential pitfalls using CAD on H&E slides, e.g., misinterpreting dermal mitoses in non-melanotic cells.
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Affiliation(s)
- Bart Sturm
- Department of Pathology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
- Pathan B.V., 3045 PM Rotterdam, The Netherlands; (J.S.); (A.H.A.G.O.); (E.K.)
| | - David Creytens
- Department of Pathology, Ghent University Hospital, 9000 Ghent, Belgium;
| | - Jan Smits
- Pathan B.V., 3045 PM Rotterdam, The Netherlands; (J.S.); (A.H.A.G.O.); (E.K.)
| | | | - Erik Eijken
- Laboratory for Pathology Oost Nederland (LabPON), 7550 AM Hengelo, The Netherlands;
| | - Eline Kurpershoek
- Pathan B.V., 3045 PM Rotterdam, The Netherlands; (J.S.); (A.H.A.G.O.); (E.K.)
| | | | - Carla Wauters
- Department of Pathology, Canisius Wilhelmina Hospital, 6500 GS Nijmegen, The Netherlands; (H.V.N.K.-V.); (C.W.)
| | - Willeke A. M. Blokx
- Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands;
| | - Jeroen A. W. M. van der Laak
- Department of Pathology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
- Center for Medical Image Science and Visualization, Linköping University, 581 83 Linköping, Sweden
- Correspondence: ; Tel.: +31-638-814-869
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Van Bockstal MR, François A, Altinay S, Arnould L, Balkenhol M, Broeckx G, Burguès O, Colpaert C, Dedeurwaerdere F, Dessauvagie B, Duwel V, Floris G, Fox S, Gerosa C, Hastir D, Jaffer S, Kurpershoek E, Lacroix-Triki M, Laka A, Lambein K, MacGrogan GM, Marchio C, Martinez MDM, Nofech-Mozes S, Peeters D, Ravarino A, Reisenbichler E, Resetkova E, Sanati S, Schelfhout AM, Schelfhout V, Shaaban A, Sinke R, Stanciu-Pop CM, van Deurzen CHM, Van de Vijver KK, Van Rompuy AS, Vincent-Salomon A, Wen H, Wong S, Bouzin C, Galant C. Interobserver variability in the assessment of stromal tumor-infiltrating lymphocytes (sTILs) in triple-negative invasive breast carcinoma influences the association with pathological complete response: the IVITA study. Mod Pathol 2021; 34:2130-2140. [PMID: 34218258 PMCID: PMC8595512 DOI: 10.1038/s41379-021-00865-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 12/11/2022]
Abstract
High stromal tumor-infiltrating lymphocytes (sTILs) in triple-negative breast cancer (TNBC) are associated with pathological complete response (pCR) after neoadjuvant chemotherapy (NAC). Histopathological assessment of sTILs in TNBC biopsies is characterized by substantial interobserver variability, but it is unknown whether this affects its association with pCR. Here, we aimed to investigate the degree of interobserver variability in an international study, and its impact on the relationship between sTILs and pCR. Forty pathologists assessed sTILs as a percentage in digitalized biopsy slides, originating from 41 TNBC patients who were treated with NAC followed by surgery. Pathological response was quantified by the MD Anderson Residual Cancer Burden (RCB) score. Intraclass correlation coefficients (ICCs) were calculated per pathologist duo and Bland-Altman plots were constructed. The relation between sTILs and pCR or RCB class was investigated. The ICCs ranged from -0.376 to 0.947 (mean: 0.659), indicating substantial interobserver variability. Nevertheless, high sTILs scores were significantly associated with pCR for 36 participants (90%), and with RCB class for eight participants (20%). Post hoc sTILs cutoffs at 20% and 40% resulted in variable associations with pCR. The sTILs in TNBC with RCB-II and RCB-III were intermediate to those of RCB-0 and RCB-I, with lowest sTILs observed in RCB-I. However, the limited number of RCB-I cases precludes any definite conclusions due to lack of power, and this observation therefore requires further investigation. In conclusion, sTILs are a robust marker for pCR at the group level. However, if sTILs are to be used to guide the NAC scheme for individual patients, the observed interobserver variability might substantially affect the chance of obtaining a pCR. Future studies should determine the 'ideal' sTILs threshold, and attempt to fine-tune the patient selection for sTILs-based de-escalation of NAC regimens. At present, there is insufficient evidence for robust and reproducible sTILs-guided therapeutic decisions.
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Affiliation(s)
- Mieke R. Van Bockstal
- Department of pathology, Cliniques universitaires Saint-Luc Bruxelles, Avenue Hippocrate 10, Woluwé-Saint-Lambert 1200, Belgium
| | - Aline François
- Department of pathology, Cliniques universitaires Saint-Luc Bruxelles, Avenue Hippocrate 10, Woluwé-Saint-Lambert 1200, Belgium
| | - Serdar Altinay
- Department of Pathology, University of Health Sciences, Bakirköy Dr. Sadi Konuk Health Application and Research Center, 34147 Istanbul, Turkey
| | - Laurent Arnould
- Département de Biologie et de Pathologie des Tumeurs, Centre George-François Leclerc, 1 Rue Pr. Marion, 21000 Dijon, France
| | - Maschenka Balkenhol
- Department of Pathology, Radboud University Medical Center, PO Box 9100, 6500, HB Nijmegen, The Netherlands
| | - Glenn Broeckx
- Department of Pathology, University Hospital Antwerp, Drie Eikenstraat 655, 2650 Edegem, Belgium
| | - Octavio Burguès
- Department of Pathology, Hospital Clínico Universitario de Valencia, Av. De Blasco Ibáñez 17, 46010 València, Valencia, Spain
| | - Cecile Colpaert
- Department of Pathology, AZ Turnhout Campus Sint-Jozef, Steenweg op Merksplas 44, 2300 Turnhout, Belgium
| | | | - Benjamin Dessauvagie
- Division of Pathology and Laboratory Medicine, Medical School, The University of Western Australia, Crawley, WA 6009, Australia,Anatomical Pathology, PathWest Laboratory Medicine WA, Perth, Australia
| | - Valérie Duwel
- Department of pathology, AZ Klina Brasschaat, Augustijnslei 100, 2930 Brasschaat, Belgium
| | - Giuseppe Floris
- Department of Pathology, University Hospitals Leuven, KU Leuven – University of Leuven, Herestraat 49, 3000 Leuven, Belgium,Department of Imaging and Pathology, Laboratory of Translational Cell & Tissue Research, KU Leuven – University of Leuven, Leuven, Belgium
| | - Stephen Fox
- Department of Pathology, Peter MacCallum Cancer Center and the University of Melbourne, Melbourne, Vic 3000, Australia
| | - Clara Gerosa
- Department of Pathology, University of Cagliari, AOU San Giovanni di Dio, Via Ospedale 54, 09124 Cagliari, Italy
| | - Delfyne Hastir
- Institute of Pathology, Lausanne University Hospital, Rue du Bugnon 25, CH-1011 Lausanne, Switzerland
| | - Shabnam Jaffer
- Department of Pathology, Mount Sinai Hospital and Icahn School of Medicine, New York, New York, NY10029 USA
| | | | - Magali Lacroix-Triki
- Department of Pathology, Gustave-Roussy Cancer Campus, 114 Rue Edouard-Vaillant, 94805 Villejuif, France
| | - Andoni Laka
- Department of Pathology, Clinique Notre-Dame de Grâce (CNDG), Chaussée de Nivelles 212, 6041 Gosselies, Belgium
| | - Kathleen Lambein
- Department of Pathology, AZ St Lucas Hospital, Groenebriel 1, 9000 Ghent, Belgium
| | - Gaëtan Marie MacGrogan
- Surgical Pathology Unit, Department of Pathobiology, Institut Bergonié, F-33076 Bordeaux, France
| | - Caterina Marchio
- Department of Medical Sciences, University of Turin, 10126 Torino, Italy,Pathology Unit, FPO-IRCCS, Candiolo Cancer Institute, Candiolo, Italy
| | | | - Sharon Nofech-Mozes
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, ON M4N 3M5, Canada
| | - Dieter Peeters
- Department of Pathology, AZ St Maarten, Liersesteenweg 435, 2800 Mechelen, Belgium,Histopathology, Imaging and Quantification Unit, HistoGeneX, Sint-Bavostraat 78, 2610 Antwerp, Belgium
| | - Alberto Ravarino
- Department of Pathology, University of Cagliari, AOU San Giovanni di Dio, Via Ospedale 54, 09124 Cagliari, Italy
| | - Emily Reisenbichler
- Department of Pathology, Yale School of Medicine, Yale New Haven Hospital, 310 Cedar Street, New Haven, CT06510, United States
| | - Erika Resetkova
- The University of Texas MD Anderson Cancer Center, Houston TX77030, Texas, USA
| | - Souzan Sanati
- Department of Pathology and Lab Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Rm8612, Los Angeles, CA90048, United States
| | - Anne-Marie Schelfhout
- Department of Pathology, Onze-Lieve-Vrouwziekenhuis Aalst, Moorselbaan 164, 9300 Aalst, Belgium
| | - Vera Schelfhout
- Department of Pathology, AZ St Maarten, Liersesteenweg 435, 2800 Mechelen, Belgium
| | - Abeer Shaaban
- Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham, University of Birmingham, Birmingham B15 2GW, United Kingdom
| | - Renata Sinke
- Pathan BV, Kleiweg 500, 3045 PM Rotterdam, The Netherlands
| | - Claudia M Stanciu-Pop
- Department of Pathology, CHU UCL Namur, Site Godinne, Avenue Docteur G. Thérasse 1, 5530 Yvoir, Belgium
| | - Carolien HM van Deurzen
- Department of Pathology, Erasmus Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Koen K Van de Vijver
- Department of Pathology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Anne-Sophie Van Rompuy
- Department of Pathology, University Hospitals Leuven, KU Leuven – University of Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Anne Vincent-Salomon
- Pôle de Médicine Diagnostique & Théranostique, INSERM U934, Institut Curie, 26 Rue d’Ulm, 75248 Paris Cedex 05, France
| | - Hannah Wen
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065
| | - Serena Wong
- Department of Pathology, Yale School of Medicine, Yale New Haven Hospital, 310 Cedar Street, New Haven, CT06510, United States
| | - Caroline Bouzin
- 2IP IREC Imaging Platform, Institute of Clinical and Experimental Research (IREC), Université catholique de Louvain, Avenue Hippocrate 55, 1200 Brussels, Belgium
| | - Christine Galant
- Department of pathology, Cliniques universitaires Saint-Luc Bruxelles, Avenue Hippocrate 10, Woluwé-Saint-Lambert 1200, Belgium,Institute of Clinical and Experimental Research (IREC), Université catholique de Louvain, Avenue Hippocrate 55, 1200 Brussels, Belgium
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Sturm B, Creytens D, Cook MG, Smits J, van Dijk MCRF, Eijken E, Kurpershoek E, Küsters-Vandevelde HVN, Ooms AHAG, Wauters C, Blokx WAM, van der Laak JAWM. Validation of Whole-slide Digitally Imaged Melanocytic Lesions: Does Z-Stack Scanning Improve Diagnostic Accuracy? J Pathol Inform 2019; 10:6. [PMID: 30972225 PMCID: PMC6415522 DOI: 10.4103/jpi.jpi_46_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 12/17/2018] [Indexed: 01/21/2023] Open
Abstract
Background Accurate diagnosis of melanocytic lesions is challenging, even for expert pathologists. Nowadays, whole-slide imaging (WSI) is used for routine clinical pathology diagnosis in several laboratories. One of the limitations of WSI, as it is most often used, is the lack of a multiplanar focusing option. In this study, we aim to establish the diagnostic accuracy of WSI for melanocytic lesions and investigate the potential accuracy increase of z-stack scanning. Z-stack enables pathologists to use a software focus adjustment, comparable to the fine-focus knob of a conventional light microscope. Materials and Methods Melanocytic lesions (n = 102) were selected from our pathology archives: 35 nevi, 5 spitzoid tumors of unknown malignant potential, and 62 malignant melanomas, including 10 nevoid melanomas. All slides were scanned at a magnification comparable to use of a ×40 objective, in z-stack mode. A ground truth diagnosis was established on the glass slides by four academic dermatopathologists with a special interest in the diagnosis of melanoma. Six nonacademic surgical pathologists subspecialized in dermatopathology examined the cases by WSI. Results An expert consensus diagnosis was achieved in 99 (97%) of cases. Concordance rates between surgical pathologists and the ground truth varied between 75% and 90%, excluding nevoid melanoma cases. Concordance rates of nevoid melanoma varied between 10% and 80%. Pathologists used the software focusing option in 7%-28% of cases, which in 1 case of nevoid melanoma resulted in correcting a misdiagnosis after finding a dermal mitosis. Conclusion Diagnostic accuracy of melanocytic lesions based on glass slides and WSI is comparable with previous publications. A large variability in diagnostic accuracy of nevoid melanoma does exist. Our results show that z-stack scanning, in general, does not increase the diagnostic accuracy of melanocytic.
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Affiliation(s)
- Bart Sturm
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David Creytens
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Martin G Cook
- Department of Histopathology, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Jan Smits
- Pathan B.V., Rotterdam, The Netherlands
| | | | - Erik Eijken
- Laboratory for Pathology East Netherlands (LabPON), Hengelo, The Netherlands
| | | | | | | | - Carla Wauters
- Department of Pathology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Willeke A M Blokx
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
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