An audit of residual cancer burden reproducibility in a <scp>UK</scp> context

Naidoo, Khimara; Parham, David M.; Pinder, Sarah

doi:10.1111/his.13054

Cited by 17 publications

(18 citation statements)

References 18 publications

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“…The lower the score, the lower the risk of distant recurrence. The score has been shown to be highly reproducible, even in the 'routine' diagnostic setting (31,32).…”

Section: Assessment Of Amount Of Residual Diseasementioning

confidence: 99%

The importance of histological assessment after neoadjuvant therapy and the need for standardisation

Naidoo

Pinder

2018

Clinical Radiology

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Neoadjuvant therapy is increasingly being recognised as a management option for patients with primary invasive breast carcinoma; this may take the form of primary endocrine treatment or primary chemotherapy. Surgical specimens from women treated with neoadjuvant treatments, particularly primary chemotherapy, may cause a challenge for the histopathologist in handling and interpretation and have, in the past, been sampled, evaluated, and reported in a non-standardised way. This limits comparison between clinical trials and potentially provides clinicians and patients with suboptimal prognostic information. We describe here some of the difficulties faced and the recommendations and standards now applied.

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“…The lower the score, the lower the risk of distant recurrence. The score has been shown to be highly reproducible, even in the 'routine' diagnostic setting (31,32).…”

Section: Assessment Of Amount Of Residual Diseasementioning

confidence: 99%

The importance of histological assessment after neoadjuvant therapy and the need for standardisation

Naidoo

Pinder

2018

Clinical Radiology

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“…Currently, tumor burden is manually estimated by pathologists on hematoxylin and eosin (H&E) stained slides, the quality and reliability of which might be impaired by inter‐observer variability which potentially affects pCR and prognostic power assessment in NAT trials . This procedure is also qualitative and time‐consuming in the current practice .…”

Section: Introductionmentioning

confidence: 99%

Automatic cellularity assessment from post‐treated breast surgical specimens

et al. 2017

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Neoadjuvant treatment (NAT) of breast cancer (BCa) is an option for patients with the locally advanced disease. It has been compared with standard adjuvant therapy with the aim of improving prognosis and surgical outcome. Moreover, the response of the tumor to the therapy provides useful information for patient management. The pathological examination of the tissue sections after surgery is the gold-standard to estimate the residual tumor and the assessment of cellularity is an important component of tumor burden assessment. In the current clinical practice, tumor cellularity is manually estimated by pathologists on hematoxylin and eosin (H&E) stained slides, the quality, and reliability of which might be impaired by inter-observer variability which potentially affects prognostic power assessment in NAT trials. This procedure is also qualitative and time-consuming. In this paper, we describe a method of automatically assessing cellularity. A pipeline to automatically segment nuclei figures and estimate residual cancer cellularity from within patches and whole slide images (WSIs) of BCa was developed. We have compared the performance of our proposed pipeline in estimating residual cancer cellularity with that of two expert pathologists. We found an intra-class agreement coefficient (ICC) of 0.89 (95% CI of [0.70, 0.95]) between pathologists, 0.74 (95% CI of [0.70, 0.77]) between pathologist #1 and proposed method, and 0.75 (95% CI of [0.71, 0.79]) between pathologist #2 and proposed method. We have also successfully applied our proposed technique on a WSI to locate areas with high concentration of residual cancer. The main advantage of our approach is that it is fully automatic and can be used to find areas with high cellularity in WSIs. This provides a first step in developing an automatic technique for post-NAT tumor response assessment from pathology slides.

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“…As one of the developed scores for the evaluation of pCR, the RCB has demonstrated reliable reproducibility, a wide range of significant prognostic pathological elements, and prognostic power across various breast cancer subtypes and chemotherapy regimens. 24,[27][28][29][30][31][32] There are several advantages of the RCB score compared to other methods. The RCB score is based on the mathematical model and, as opposite to other methods segregating response into groups, RCB is an exact deliverable with a precisely calculated score.…”

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confidence: 99%

Validation of Residual Cancer Burden as Prognostic Factor for Breast Cancer Patients After Neoadjuvant Therapy

et al. 2019

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Background. Assessing the residual cancer burden (RCB) predictive performance, the potential subgroup effects, and time-dependent impact on breast cancer patients who underwent neoadjuvant therapy in a developer's independent cohort is essential for its usage in clinical routine. Methods. Between 2011 and 2016, the RCB scores of 184 female breast cancer patients were prospectively collected, and subsequent clinicopathological and follow-up data were obtained retrospectively. Recurrence-free survival (RFS), overall survival (OS), as well as subgroup analysis, and time-dependent variables were calculated with multivariate, complex, or linear statistical models. Results. A total of 184 patients (HER2 33%, TNBC 27%), with a mean follow-up time of 4 years, treated with neoadjuvant systemic therapy (92% anthracycline-taxane based) were analyzed revealing 43 events (38 recurrences, 28 deaths). High RCB scores were associated with recurrence (median index: 2.34 vs. 1.39 points, rank-sum p \ 0.0001), decreased RFS (hazard ratio [HR] = 1.80, 95% confidence interval [CI] 1.44-2.24, p \ 0.0001) and reduced OS (HR 1.96, 95% CI 1.49-2.59, p \ 0.0001). The RCB score showed proportionality of hazards (interaction HR with linear follow-up time = 1.00, p = 0.896) and good discriminating power (Harrell's c index 0.7). Conclusions. Our results confirm the RCB score as externally valid prognostic marker and being independent of molecular subtype for RFS and OS in a clinical setting.

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An audit of residual cancer burden reproducibility in a UK context

Abstract: These data suggest that the RCB score is reproducible in a UK context. Further data comparing it to other quantification systems is required, however, before any superiority can be established.

Cited by 17 publications

References 18 publications

The importance of histological assessment after neoadjuvant therapy and the need for standardisation

The importance of histological assessment after neoadjuvant therapy and the need for standardisation

Automatic cellularity assessment from post‐treated breast surgical specimens

Validation of Residual Cancer Burden as Prognostic Factor for Breast Cancer Patients After Neoadjuvant Therapy

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