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Summary We have recently demonstrated an association between distant metastasis and the expression of the extracellular matrix glycoprotein tenascin-C (Tn-C) in the invasion border of small axillary node-negative breast carcinomas. Our purpose was to assess the relationship between the expression of Tn-C in the tumour invasion border and several histopathological and biological variables and to compare their usefulness in predicting local and distant disease recurrences. The original patient group consisted of 143 women with axillary node-negative breast cancer (one bilateral) treated with breast-conserving surgery and post-operative radiotherapy, and followed for a median of 8 years. Because of the small number of recurrences an additional group of 15 similarly treated women with recurrent breast cancer was also studied. The size of the tumour, its histology, including a possible intraductal component, and grade were re-evaluated. The expression of erbB-2, p53, Ki-67 and Tn-C was evaluated by immunohistochemistry. Ploidy and S-phase fraction (SPF) were assessed by flow cytometry. The only statistically significant prognostic factor for local recurrence was Tn-C expression in the invasion border. For metastasis Ki-67 positivity, tumour size and Tn-C expression in the invasion border were statistically significant, but Ki-67 positivity was the only independent prognostic factor. Tn-C expression in the invasion border was associated with a higher proliferation rate measured by Ki-67 and SPF, which is consistent with the suggested growth-promoting activity of Tn-C. Tn-C may be a useful marker in selecting patients for adjuvant therapies to reduce the rate of both local and distant cancer recurrences.

A European Federation of Cytology Societies (EFCS) working party of 28 members from 14 European countries met at the European Congress of Cytology in Lisbon in September 2009, with two observers from the USA, to discuss the need for standardising thyroid FNA nomenclature in the light of the National Institute of Cancer (NCI) recommendations resulting from the State of the Science conference in Bethesda in 2007. The data were obtained through two questionnaires sent by email and a transcript of the live discussion at the congress, which is presented in full. The surveys and discussion showed that there were currently no national terminologies for reporting thyroid FNA in the different European countries except in Italy and the UK. Personal, 'local', surgical pathology and descriptive terminologies were in use. All but one of the working party members agreed that thyroid FNA reporting should be standardised. Whilst almost a third would adopt the NCI Bethesda terminology, which offers the advantages of a 'risk of cancer' correlation and is linked to clinical recommendations, more than half favoured a translation of local terminology as the first step towards a unified nomenclature, as has been done recently in the UK. There was some disagreement about the use of: a) the six-tiered as opposed to four or five-tiered systems, b) the use of an indeterminate category and c) the 'follicular neoplasm' category, which was felt by some participants not to be different from the 'suspicious of malignancy' category. The conclusions will be passed to the different national societies of cytology for discussion, who will be asked to map their local terminologies to the Bethesda classification, observe its acceptance by clinicians and audit its correlation with outcome.

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Tenascin ( l n)is an extracellular matrix glycoprotein transiently expressed in epithelial-mesenchymal interaction areas during embryogenesis. Tn is expressed in a limited manner in adult tissues but emerges during wound healing and tumorigenesis. We have studied Tn expression by immunohistochemistry in I37 small node-negative breast cancers treated with breastconserving surgery and post-operative radiotherapy during [1985][1986][1987][1988][1989]. None of the patients had undergone any adjuvant hormonal therapy or chemotherapy. Stromal Tn expression itself could not predict distant metastasis. However, Tn staining in the area of the invasion border seemed to be a strong predictor of distant metastasis, with an estimated 5-year metastasis-free survival (MFS) of 85% in Tn-positive cases compared to 98% in Tn-negative ones. The prognostic impact of Tn in the invasion border on MFS was stronger than that of tumour size and grade. This staining appears to be a useful adjunct for the estimation of breast-cancer metastasis.o 1996 Wiley-Liss, Tnc.Tenascin (Tn) is a large glycoprotein of the extracellular matrix transiently expressed in various tissues during embryogenesis and growth. It is also expressed in wound healing and tumour stroma (Chiquet-Ehrismann et al., 1995; Erickson, 1993;Koukoulis et al., 1991). In adult human tissues, Tn is variably present in the basement membrane region of some epithelia and in smooth-muscle cells (Koukoulis et al., 1991). Tn was originally thought to be a stromal marker of malignancy in breast cancer (Mackie et al., 1987). Later studies have, however, demonstrated that Tn is expressed in benign breast hyperplasia, dysplasia and benign tumours but also that it is enhanced in intraductal and infiltrating carcinomas (Ferguson et al., 1990; Howeedy et al., 1990; Moch et al., 1993).Breast cancer (BC) has a favourable prognosis in its early phases. Adjuvant chemo-or hormonal therapy can improve the prognosis and is generally used in patients with axillary lymph-node metastases. Of the node-negative patients, 10-30% develop distant metastases. The increasing number of options for treatment of BC has made the prognostic evaluation of the disease important. Despite numerous prognostic factors, there is still a need for strong prognostic markers in node-negative BC for selection of those patients who might benefit from adjuvant therapy (EBCTCG, 1992).In this study we have examined the distribution of Tn in clinical material of invasive early BC. The presence and intensity of periductal and stromal Tn immunoreactivity was noted in both invasive and intraductal areas. We also paid attention to possible Tn expression in areas of the invasion border and inflammation, when present, and correlated the different patterns of Tn reactivity with the development of distant metastases. MATERIAL AND METHODS Patients and specimensThe 136 patients with 137 node-negative BCs were collected retrospectively from 2 surgical clinics in Helsinki: the 4th Department of Surgery of Helsinki University Central Hospit...

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Intraoperative examination of sentinel lymph nodes enables breast surgery, axillary staging, and treatment in the same operation in a substantial proportion of breast cancer patients. Hospital costs as well as workload in the pathology laboratory may be reduced, limiting the intraoperative assessment to the two first retrieved nodes.

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