Enhancing clinical decision support with genomic tools in breast cancer: A Scottish perspective

INTRODUCTION

The Oncotype DX Breast RS test has been adopted in Scotland and has been the subject of a large population-based study by a Scottish Consensus Group to assess the uptake of the recurrence score (RS), evaluate co-variates associated with the RS and to analyse the effect it may have had on clinical practice.

MATERIALS & METHODS

Pan-Scotland study between August 2018-August 2021 evaluating 833 patients who had a RS test performed as part of their diagnostic pathway. Data was extracted retrospectively from electronic records and analysis conducted to describe change in chemotherapy administration (by direct comparison with conventional risk assessment tools), and univariate/multivariate analysis to assess relationship between covariates and the RS.

RESULTS

Chemotherapy treatment was strongly influenced by the RS (p < 0.001). Only 30 % of patients received chemotherapy treatment in the intermediate and high risk PREDICT groups, where chemotherapy is considered. Additionally, 55.5 % of patients with a high risk PREDICT had a low RS and did not receive chemotherapy. There were 17 % of patients with a low risk PREDICT but high RS who received chemotherapy. Multivariate regression analysis showed the progesterone receptor Allred score (PR score) to be a strong independent predictor of the RS, with a negative PR score being associated with high RS (OR 4.49, p < 0.001). Increasing grade was also associated with high RS (OR 3.81, p < 0.001). Classic lobular pathology was associated with a low RS in comparison to other tumour pathology (p < 0.01). Nodal disease was associated with a lower RS (p = 0.012) on univariate analysis, with menopausal status (p = 0.43) not influencing the RS on univariate or multivariate analysis.

CONCLUSIONS

Genomic assays offer the potential for risk-stratified decision making regarding the use of chemotherapy. They can help reduce unnecessary chemotherapy treatment and identify a subgroup of patients with more adverse genomic tumour biology. A recent publication by Health Improvement Scotland (HIS) has updated guidance on use of the RS test for NHS Scotland. It suggests to limit its use to the intermediate risk PREDICT group. Our study shows the impact of the RS test in the low and high risk PREDICT groups. The implementation across Scotland has resulted in a notable shift in practice, leading to a significant reduction in chemotherapy administration in the setting of high risk PREDICT scores returning low risk RS. There has also been utility for the test in the low risk PREDICT group to detect a small subgroup with a high RS. We have found the PR score to have a strong independent association with high risk RS. This finding was not evaluated by the key RS test papers, and the potential prognostic information provided by the PR score as a surrogate biomarker is an outstanding question that requires more research to validate.

Abstract P5-07-15: Breast cancer estrogen receptor scoring in tissue microarrays: Specialist breast pathologist versus automation

Rationale: Tissue microarrays (TMAs) have become a valuable resource for biomarker expression in translational research. Immunohistochemical (IHC) assessment of TMAs is the principal method for analyzing protein expression in large numbers of patient samples efficient with conservation of tissue. However, manual IHC assessment of TMAs remains a challenging and laborious task. With advances in image analysis, computer generated analyses of TMAs have the potential to lessen the burden of expert pathologist review. Computerized ER scoring relies on tumor localization.

Aim: The objective of this study was to compare the effectiveness of a locally developed automated invasive tumor location system with the skills of specialist breast pathologists.

Methods: In this study, tumor localization for estrogen receptor (ER) scoring was evaluated comparing computer- generated segmentation masks with those of two specialist breast pathologists. Automated tumor localization was achieved using a novel image analysis algorithm, which labeled compact groups of pixels called superpixels. Machine learning techniques were adopted to model color, shape and textural properties of superpixels in a rotation invariant manner, suitable for histopathology images. The resulting automatically and manually-obtained segmentation masks were used to obtain IHC scores for thirty-two ER stained invasive breast cancer TMA samples using FDA-approved IHC scoring software.

Results: Pixel-level comparisons showed lower agreement between automated and manual segmentation masks (κ = 0.84) than between pathologists' masks (κ = 0.91). However, this had little impact on computed IHC scores (Allred method; κ = 0.91, Quickscore method; κ = 0.92).

Conclusion: The automated system provides sufficiently consistent measurements for standardized IHC analysis of nuclear staining in TMAs from large clinical trials.

Citation Format: Jordan LB, Akbar S, Purdie CA, Thompson AM, McKenna SJ. Breast cancer estrogen receptor scoring in tissue microarrays: Specialist breast pathologist versus automation. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-07-15.

Magnetic resonance imaging texture analysis classification of primary breast cancer

OBJECTIVES

Patient-tailored treatments for breast cancer are based on histological and immunohistochemical (IHC) subtypes. Magnetic Resonance Imaging (MRI) texture analysis (TA) may be useful in non-invasive lesion subtype classification.

METHODS

Women with newly diagnosed primary breast cancer underwent pre-treatment dynamic contrast-enhanced breast MRI. TA was performed using co-occurrence matrix (COM) features, by creating a model on retrospective training data, then prospectively applying to a test set. Analyses were blinded to breast pathology. Subtype classifications were performed using a cross-validated k-nearest-neighbour (k = 3) technique, with accuracy relative to pathology assessed and receiver operator curve (AUROC) calculated. Mann-Whitney U and Kruskal-Wallis tests were used to assess raw entropy feature values.

RESULTS

Histological subtype classifications were similar across training (n = 148 cancers) and test sets (n = 73 lesions) using all COM features (training: 75%, AUROC = 0.816; test: 72.5%, AUROC = 0.823). Entropy features were significantly different between lobular and ductal cancers (p < 0.001; Mann-Whitney U). IHC classifications using COM features were also similar for training and test data (training: 57.2%, AUROC = 0.754; test: 57.0%, AUROC = 0.750). Hormone receptor positive and negative cancers demonstrated significantly different entropy features. Entropy features alone were unable to create a robust classification model.

CONCLUSION

Textural differences on contrast-enhanced MR images may reflect underlying lesion subtypes, which merits testing against treatment response.

KEY POINTS

• MR-derived entropy features, representing heterogeneity, provide important information on tissue composition. • Entropy features can differentiate between histological and immunohistochemical subtypes of breast cancer. • Differing entropy features between breast cancer subtypes implies differences in lesion heterogeneity. • Texture analysis of breast cancer potentially provides added information for decision making.

The prognostic significance of tumour-stroma ratio in oestrogen receptor-positive breast cancer

Background:

A high percentage of stroma predicts poor survival in triple-negative breast cancers but is diminished in studies of unselected cases. We determined the prognostic significance of tumour–stroma ratio (TSR) in oestrogen receptor (ER)-positive male and female breast carcinomas.

Methods:

TSR was measured in haematoxylin and eosin-stained tissue sections (118 female and 62 male). Relationship of TSR (cutoff 49%) to overall survival (OS) and relapse-free survival (RFS) was analysed.

Results:

Tumours with ⩾49% stroma were associated with better survival in female (OS P=0.008, HR=0.2–0.7; RFS P=0.006, HR=0.1–0.6) and male breast cancer (OS P=0.005, HR=0.05–0.6; RFS P=0.01, HR=0.87–5.6), confirmed in multivariate analysis.

Conclusions:

High stromal content was related to better survival in ER-positive breast cancers across both genders, contrasting data in triple-negative breast cancer and highlighting the importance of considering ER status when interpreting the prognostic value of TSR.

Abstract P4-15-01: Integrin avb6 is a therapeutic target for high-risk breast cancer and enhances trastuzumab efficacy

The integrin avβ6 promotes migration, invasion and survival of cancer cells, but the biological relevance has yet to be ascertained in breast cancer. Our immunhistochemical analysis of over 2000 breast cancers has revealed that high expression of the protein for the integrin subunit beta6 (β6) is associated with very poor survival (HR = 1.99, P = 2.9×10-6) and increased metastases to distant sites (P = 0·02). This correlation was confirmed at the mRNA level via bioinformatic analysis of the 2000 women in the METABRIC cohort. Furthermore, co-expression of HER2 gave a significantly worse prognosis (HR = 3.43, P = 4×10-12), which we investigated further.

We report from in vitro studies that HER2-driven invasion is mediated by αvβ6 in an Akt2-dependent manner. Using the well-tolerated αvβ6-blocking antibody 264RAD in vivo we show that antibody-blockade of this integrin suppressed growth of BT-474 and MCF-7/HER2-18 human breast cancer xenografts similarly to trastuzumab alone (P&lt;0.001), the antibody used for treating HER2-positive cancers (both 10mg/kg, bi-weekly). Moreover, when 264RAD was co-administered it significantly enhanced the ability of trastuzumab to suppress BT-474 tumor growth with a reduction in mean tumor volume of 94.8%+/-1.18% compared to 70.8%+/-5.98% observed with trastuzumab alone (P&lt;0.0001) after 2 weeks treatment. This trend was reproduced even in the MCF-7/HER2-18 trastuzumab-resistant breast cancer tumors where a 76.24%+/-10.15% reduction was observed with combination therapy (P&lt;0.0001) compared with only 44.62%+/-10.43% (P = 0.0006) and 46.6%+/-14.71% (P = 0.0004) reductions in final volume with 264RAD and trastuzumab respectively. The combination therapy was so effective it almost eradicated 100mm3 BT-474 tumors and completely eliminated small (10-20mm3) MCF-7/HER2-18 tumors.

264RAD or trastuzumab prolonged survival to a similar degree (14.3% and 33.33% treated mice alive after 100d, respectively, no significant difference) but again, when both drugs were combined 85.7% of mice were alive after 100d, a highly significant response compared with PBS (P&lt;0.0001) or monotherapies (264RAD: P&lt;0.0001, trastuzumab: P&lt;0.0001). Post-therapy biochemistry revealed residual tumors expressed significantly reduced αvβ6, HER2, HER3 and downstream signaling molecules including Akt2 and Smad2, essentially a much lower ‘grade’ tumour.

Since 70% of women treated with trastuzumab either have, or develop resistance, we suggest combined targeting of αvβ6 and HER2 could provide an important novel therapy for thousands of women with breast cancer. In fact, over 39,000 American women annually (NIH statistics) will develop HER2+ breast cancers for which no specific therapies exist. Our data shows that in excess of 40% of these women with trastuzumab-resistant disease are also likely to express high levels of αvβ6.

Our data also suggest that routine determination of the level of expression of αvβ6 on breast cancers would be a valuable clinical tool as it identifies novel high-risk groups of women that require enhanced therapeutic intervention.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-15-01.

What are the characteristics of breast cancers misclassified as benign by quantitative ultrasound shear wave elastography?

OBJECTIVES

Shear wave elastography (SWE) is a promising adjunct to greyscale ultrasound in differentiating benign from malignant breast masses. The purpose of this study was to characterise breast cancers which are not stiff on quantitative SWE, to elucidate potential sources of error in clinical application of SWE to evaluation of breast masses.

METHODS

Three hundred and two consecutive patients examined by SWE who underwent immediate surgery for breast cancer were included. Characteristics of 280 lesions with suspicious SWE values (mean stiffness >50 kPa) were compared with 22 lesions with benign SWE values (<50 kPa). Statistical significance of the differences was assessed using non-parametric goodness-of-fit tests.

RESULTS

Pure ductal carcinoma in situ (DCIS) masses were more often soft on SWE than masses representing invasive breast cancer. Invasive cancers that were soft were more frequently: histological grade 1, tubular subtype, ≤10 mm invasive size and detected at screening mammography. No significant differences were found with respect to the presence of invasive lobular cancer, vascular invasion, hormone and HER-2 receptor status. Lymph node positivity was less common in soft cancers.

CONCLUSION

Malignant breast masses classified as benign by quantitative SWE tend to have better prognostic features than those correctly classified as malignant.

KEY POINTS

• Over 90 % of cancers assessable with ultrasound have a mean stiffness >50 kPa. • 'Soft' invasive cancers are frequently small (≤10 mm), low grade and screen-detected. • Pure DCIS masses are more often soft than invasive cancers (>40 %). • Large symptomatic masses are better evaluated with SWE than small clinically occult lesions. • When assessing small lesions, 'softness' should not raise the threshold for biopsy.

Abstract PD03-02: Evidence for the anti-cancer action of metformin mediated via tumor AMPK, Akt and Ki67, in a preoperative window of opportunity trial

Background: Metformin reduces the overall risk of cancer incidence by 31%, improves cancer-related mortality and enhances response to neoadjuvant chemotherapy in type 2-diabetics receiving metformin. There is evidence that metformin works through activation of Adenosine Monophosphate Protein Kinase (AMPK), an energy-sensing kinase that maintains cellular energy homeostasis. In a pre-operative window-of-opportunity randomized trial we have demonstrated that metformin significantly reduces proliferation and blunts the insulin response in primary operable breast cancer. This study further analysed cancer tissue from the trial to dissect the molecular mechanisms involved.

Methodology: Non-diabetic women with operable invasive breast cancer were randomised to receive pre-operative metformin or no drug. Forty seven patients had core biopsy at diagnosis then were randomized to metformin (metformin 500mg o.d. for 1 week increased to 1g b.d for a further week continued to surgery) or no drug, and 2 weeks later had core biopsy at surgery. Insulin receptor, phospho-AMPK (pAMPK), phospho-Akt (pAkt) and Ki67 immunohistochemistry was performed on formalin-fixed paraffin-embedded cores and scored blinded to treatment. Paired t-test was used for analysis.

Results: Significant up-regulation of pAMPK (p = 0.04) and down-regulation of pAkt (p = 0.04) in metformin treated patients was demonstrated compared to the control group. No change in insulin receptor expression was identified but, as previously reported, there was a fall in ki67. Changes were independent of Body Mass Index. Seven patients (7/24) receiving metformin withdrew because of gastro-intestinal upset and were excluded from the immunohistochemical analyses.

Conclusion: These findings suggest that metformin works in vivo in breast cancer patients via up-regulation of tumor pAMPK and down-regulation of pAkt and proliferation. Since down-regulation of pAMPK is a feature of breast cancer, this suggests mechanistic evidence for the therapeutic effect of metformin.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr PD03-02.

P4-02-06: Progesterone Receptor Expression Predicts Poor Outcome in Estrogen Receptor Positive, Lymph Node Negative Breast Cancer – A Population Based Study

Background: Estrogen receptor (ER) positive, lymph node (LN) negative breast cancer usually carries a good prognosis; endocrine therapy is often the only adjuvant treatment. However, a small proportion of such patients do badly (possibly representing those with luminal B cancers identified by gene expression profiling). A clinically applicable method for identifying this subgroup of poor prognosis ER+, LN- patients is required to offer them more intensive adjuvant therapy.

Material and methods: A consecutive, unselected series of 1072 new, operable breast cancer patients diagnosed between 2000 and 2004 was studied for ER and progesterone receptor (PR) expression, HER2 status and standard pathological and demographic parameters. ER and PR expression were scored on immunohistochemistry (IHC) on preoperative, diagnostic core biopsies using the “Quickscore” method. This ensured optimal fixation and tissue processing avoiding the variable fixation of resection specimens and the well-described sampling error of tissue micro-array (TMA) methodologies. PR expression is frequently heterogeneous resulting in false negative scores in at least 12% of cases by TMA analysis. HER2 status was assessed using IHC with dual color FISH for cases scoring 2+. Adjuvant therapy was prescribed using standard protocols; all patients with ER+ disease received adjuvant endocrine therapy. Follow up data were obtained from the oncology database, and the registrar of deaths for the date and cause of death. All deaths not attributable to breast cancer were censored at the date of death. Accordingly, the primary end-point was breast cancer-specific overall survival. Survival analysis was carried out by Kaplan-Meier survival curves analysed by the Log-Rank test. Multivariate analysis was carried out using Cox's regression.

Results: Overall, PR- cancers had a worse prognosis than PR+ (p&lt;10−12, Hazard Ratio 3.40), even in the ER+ (p=0.006, HR 1.86), LN- (p=10−8, HR=5.33) and LN+ (p=10−11, HR=3.26) sub-groups. In the ER+ LN- group, the absence of PR expression predicted worse prognosis (88% vs 96% 8 year survival, p=0.0003) with a hazard ratio of 3.75. This is considerably more significant than Ki67 IHC scoring reported for a similar group of patients in other studies (HR 2.22). Multivariate analysis demonstrated that PR expression was an independent prognostic variable second only to LN status and more powerful than ER.

Discussion: Patients with ER+, LN-, PR- breast cancers have a significantly worse prognosis than those with ER+, LN-, PR+ cancers. Unlike Ki67, PR IHC uses a simple, cost effective, standard methodology (as for ER) and should identify patients who may require chemotherapy in addition to endocrine therapy in this group of otherwise good prognosis patients.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-02-06.

Increased mortality in HER2 positive, oestrogen receptor positive invasive breast cancer: a population-based study

BACKGROUND

This study assessed the impact of human epidermal growth factor receptor 2 (HER2) status on the outcomes in an unselected population of breast cancer patients who did not receive HER2-targeted therapy.

METHODS

HER2 status by immunohistochemistry and fluorescence in situ hybridisation was compared with clinicopathological data, overall survival (OS) and disease-free survival (DFS) for all patients presenting with breast cancer over 3 years.

RESULTS

In 865 patients (median follow up 6.02 years), HER2 positivity was identified in 13.3% of all cancers and was associated with higher tumour grade (P<10(-8)), lymphovascular invasion (P<0.001) and axillary nodal metastasis (P=0.003). There was a negative association with oestrogen-receptor (ER) and progesterone-receptor expression (P<10(-8)), but the majority (57%) of HER2+tumours were ER+HER2 positivity was associated with poorer OS (P=0.0046) and DFS (P=0.0001) confined to the lymph node-positive (LN+) and ER+ subgroups.

CONCLUSION

HER2-positive cancers were less common in this population-based cohort than most selected series. The association of HER2 positivity with poor prognosis was confined to the ER+ and LN+ subgroups. The survival deficit for the 7.5% of patients with ER+/HER2+ cancer compared with ER+/HER2- patients points to a significant subgroup of women who may not (currently) be considered for HER2-directed therapy.

Female-type fibrocystic disease with papillary hyperplasia in a male breast

Fibrocystic disease is a common benign finding in the female breast and often presents as a palpable mass. It is much less commonly found in the male breast. A case is reported of a young man with female-type fibrocystic disease associated with papillary hyperplasia in the right breast.

Pathology of the cervix: recent developments

In the UK, cervical carcinoma is still the eleventh most common cause of cancer in women--it comprises 2% of all female cancers, and accounts for 927 deaths in 2002 alone. The most effective treatments to date are surgery in the form of loop excision of the transformation zone (LLETZ) for pre-invasive disease, LLETZ or simple hysterectomy with laparoscopic pelvic lymphadenectomy for International Federation of Gynecology and Obstetrics (FIGO) Stages IA1 and IA2 microinvasive carcinomas, and Wertheim's hysterectomy or Coelio-Schauta for FIGO Stage IB disease along with concurrent chemoradiotherapy in patents with at least FIGO Stage IB disease. However, radical trachelectomy, which involves a radical excision of the cervix with simultaneous laparoscopic or extraperitoneal lymphadenectomy, may be used selectively in patients with up to FIGO Stage IB1 cancers, as this may preserve fertility in younger women. This paper briefly discusses the role of human papilloma viruses (HPV) and human immunodeficiency virus (HIV) in the development of cervical pre-cancer, and some of the improvements in the techniques used in the cervical carcinoma screening programme. In addition, the diagnosis, staging, spread and prognostic factors involved in invasive cervical carcinoma are mentioned. We will also discuss the role of immunohistochemistry in the diagnosis of invasive cervical carcinoma and recent advances in the molecular pathology of cervical carcinomas.

Incidence trends in house fire fatalities in eastern Scotland

Fatal house fires occur more frequently in Scotland than elsewhere in Great Britain.(1,2) Over the last few years several educational campaigns were initiated to instruct the public in the risk factors associated with such fire fatalities and to promote the installation of functional domestic smoke detectors. An epidemiological survey of house fire deaths in the Lothian and Borders region of Scotland over the first half of the present decade, was carried out to evaluate any changing incidence trends by comparison with a survey of the fatalities from the first half of the previous decade. The impact of such campaigns in reducing house fires appears to be limited.

Cervical implant from villoglandular endometrial adenocarcinoma masquerading as cervical villoglandular adenocarcinoma

This is an unusual presentation of a rare subtype of endometrial adenocarcinoma (villoglandular papillary carcinoma, VGPC) in a 71-year-old woman, which was initially diagnosed on cervical biopsy as being primary cervical VGPC. Loop excision failed to show any evidence of residual disease. Subsequent hysterectomy revealed a localized villoglandular carcinoma involving the uterine fundus and invading the inner one-third of the myometrium, the background endometrium was atrophic. The remaining cervix contained a focus of papillary forming endometrial type adenocarcinoma involving the surface epithelium and the superficial subepithelial glands. In conclusion, VGPC of cervix occurs mainly in young women and can be treated conservatively, pathologists should be cautious in making such a diagnosis in a postmenopausal woman before ruling out a primary endometrial origin.

Cotyledonoid hydropic intravenous leiomyomatosis: a new variant leiomyoma

AIMS

We present the histopathological findings of a series of six cases of a benign uterine smooth muscle tumour with an unusual growth pattern.

METHODS AND RESULTS

All cases have the appearances of the recently described dissecting (cotyledonoid) leiomyoma. In addition, three of these lesions demonstrate the features of intravenous leiomyomatosis with varying degrees of hydropic degeneration.

CONCLUSIONS

This combination of phenotypes has not previously been described within the literature; therefore we propose that these are classified as examples of 'cotyledonoid hydropic intravenous leiomyomatosis', a new variant of unconventional leiomyoma.

Clinicopathological study of the pattern and significance of cervical involvement in cases of endometrial adenocarcinoma

The pattern of cervical involvement in 107 endometrial adenocarcinomas was assessed. The cervix was involved in 29%, higher than noted in previous studies. In 40.6%, the lesion was confined to surface endocervical epithelium only; the remainder had cervical stromal involvement. In the majority only small areas within the circumference of the cervix were affected, indicating a need for adequate tissue sampling. In some cases, malignant epithelium was found as a "migrant" within the endocervical canal, entrapped within cervical mucus or applied to surface epithelium, supporting the concept that endometrial cancer spreads by surface contiguity or implantation rather than by deep tissue planes or via lymphatic channels. Our findings reinforce the view that high-grade lesions and histological subtypes such as uterine serous papillary carcinoma are associated with a later presentation, higher stage and poorer prognosis. We have identified atypical changes in endocervical epithelium that may be misinterpreted as cervical involvement, particularly in the form of atypical reserve cell hyperplasia with a micropapillary pattern that may reflect a reaction to the presence of tumor. It is our assertion that the presence of tumor "migrants", and not endocervical surface atypia, is an indicator of increased probability of cervical involvement by endometrial adenocarcinoma (P = 0.015).

Uterine serous papillary carcinoma: histopathologic changes within the female genital tract

The histopathologic features of 25 patients with uterine serous papillary carcinoma (USPC) were presented, with particular emphasis on the changes seen in the remaining müllerian epithelium. The mean age at presentation was 68.9 years; 52% of patients were stage III at the time of presentation and 40% died of their disease within 24 months of diagnosis. Histologic assessment revealed: 1) pure serous carcinoma in 56% of patients and mixed differentiation of serous and endometrioid in the remainder; 2) malignant epithelium reminiscent of that of USPC and akin to carcinoma in situ, frequently seen in the remaining endometrium, cervix, and, less commonly, the fallopian tube; 3) residual endometrium that, when identified (11/25 cases), was atrophic in all cases; 4) various types of cervical involvement in 17 cases (68%); 5) tumor within the fallopian tube in three cases (12%); and 6) carcinoma with in situ-like features in five cases (20%). In conclusion, it appears that USPC is frequently associated with malignant epithelial changes (as with carcinoma in situ) in the remaining müllerian epithelium. This finding suggests either a field change or, more likely, a transepithelial tumor spread. The latter theory is preferable, because this type of spread is frequently seen on serosal surfaces in cases of serous ovarian carcinoma. Uterine serous papillary carcinoma is, therefore, biologically more akin to its ovarian counterpart.

Three-dimensional forward-viewing intravascular ultrasound imaging of human arteries in vitro

The aim of this work was to investigate the suitability of a novel forward-viewing intravascular ultrasound (IVUS) technique for three-dimensional imaging of severely stenosed or totally occluded vessels, where the conventional side-viewing IVUS systems are of limited use. A stiff 3.8 mm diameter forward-viewing catheter was manufactured to scan a 72 degrees sector ahead of its tip. Conical volume data were acquired by rotating the catheter over 180 degrees by means of a motorised mechanical system. Operating at 30 MHz, the catheter was integrated with an IVUS scanner and a radiofrequency data acquisition system. Postmortem carotid and femoral arteries were scanned in vitro. Correlation of the reconstructed images with histology demonstrated the ability of this forward-viewing IVUS system to visualise healthy lumens, bifurcations, thickened atherosclerotic walls and, most importantly, severe and complete vessel occlusions. A rotating-sector forward-viewing IVUS system is suitable for anatomical assessment of severely diseased vessels in three dimensions.

Uterine serous papillary carcinoma: Histopathologic changes within the female genital tract

Abstract.

Jordan LB, Abdul-Kader M, Al-Nafussi A. Uterine serous papillary carcinoma: Histopathologic changes within the female genital tract.

The histopathologic features of 25 patients with uterine serous papillary carcinoma (USPC) were presented, with particular emphasis on the changes seen in the remaining müllerian epithelium. The mean age at presentation was 68.9 years; 52% of patients were stage III at the time of presentation and 40% died of their disease within 24 months of diagnosis. Histologic assessment revealed: 1) pure serous carcinoma in 56% of patients and mixed differentiation of serous and endometrioid in the remainder; 2) malignant epithelium reminiscent of that of USPC and akin to carcinoma in situ, frequently seen in the remaining endometrium, cervix, and, less commonly, the fallopian tube; 3) residual endometrium that, when identified (11/25 cases), was atrophic in all cases; 4) various types of cervical involvement in 17 cases (68%) ; 5) tumor within the fallopian tube in three cases (12%); and 6) carcinoma with in situ-like features in five cases (20%). In conclusion, it appears that USPC is frequently associated with malignant epithelial changes (as with carcinoma in situ) in the remaining müllerian epithelium. This finding suggests either a field change or, more likely, a transepithelial tumor spread. The latter theory is preferable, because this type of spread is frequently seen on serosal surfaces in cases of serous ovarian carcinoma. Uterine serous papillary carcinoma is, therefore, biologically more akin to its ovarian counterpart.