Imaging-Assisted Large-Format Breast Pathology: Program Rationale and Development in a Nonprofit Health System in the United States

Tucker, F. Lee

doi:10.1155/2012/171792

Cited by 19 publications

(23 citation statements)

References 54 publications

(56 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although pathology is considered to be the ‘gold standard', a variety of potential errors in pathologic measurement have been identified (Lagios, 2005; Provencher et al , 2012; Tucker, 2012), meaning that discrepancies with pathology may occur even when residual tumour size is accurately assessed before surgery. For example, pathologic diameters are likely to be overestimated when measured from a combination of tumour fragments, or excised and re-excised specimens (Lagios, 2005).…”

Section: Discussionmentioning

confidence: 99%

“…For example, pathologic diameters are likely to be overestimated when measured from a combination of tumour fragments, or excised and re-excised specimens (Lagios, 2005). There may also be errors in orientating intact specimens so that tumour diameters on imaging and pathology are measured in the same plane (Provencher et al , 2012), particularly if three-dimensional imaging data are unavailable to the pathologist (Weatherall et al , 2001; Tucker, 2012); this could result in pathologic measurements underestimating the longest diameter for irregularly shaped tumours (Lagios, 2005). There also exists the possibility that the process of removal, preparation or measurement of the pathologic specimen may shrink, expand or otherwise distort tumour dimensions (Pritt and Weaver, 2005; Pritt et al , 2005; Behjatnia et al , 2010; Provencher et al , 2012).…”

Section: Discussionmentioning

confidence: 99%

“…Underestimation may also occur owing to partial volume effects (Lobbes et al , 2012). Furthermore, the inherently pliable nature of breast tissue means that tumour dimensions may vary, depending on patient positioning (Tucker, 2012). …”

mentioning

confidence: 99%

See 2 more Smart Citations

Meta-analysis of agreement between MRI and pathologic breast tumour size after neoadjuvant chemotherapy

et al. 2013

View full text Add to dashboard Cite

Background:Magnetic resonance imaging (MRI) has been proposed to guide breast cancer surgery by measuring residual tumour after neoadjuvant chemotherapy. This study-level meta-analysis examines MRI's agreement with pathology, compares MRI with alternative tests and investigates consistency between different measures of agreement.Methods:A systematic literature search was undertaken. Mean differences (MDs) in tumour size between MRI or comparator tests and pathology were pooled by assuming a fixed effect. Limits of agreement (LOA) were estimated from a pooled variance by assuming equal variance of the differences across studies.Results:Data were extracted from 19 studies (958 patients). The pooled MD between MRI and pathology from six studies was 0.1 cm (95% LOA: −4.2 to 4.4 cm). Similar overestimation for MRI (MD: 0.1 cm) and ultrasound (US) (MD: 0.1 cm) was observed, with comparable LOA (two studies). Overestimation was lower for MRI (MD: 0.1 cm) than mammography (MD: 0.4 cm; two studies). Overestimation by MRI (MD: 0.1 cm) was smaller than underestimation by clinical examination (MD: −0.3 cm). The LOA for mammography and clinical examination were wider than that for MRI. Percentage agreement between MRI and pathology was greater than that of comparator tests (six studies). The range of Pearson's/Spearman's correlations was wide (0.21–0.92; 16 studies). Inconsistencies between MDs, percentage agreement and correlations were common.Conclusion:Magnetic resonance imaging appears to slightly overestimate pathologic size, but measurement errors may be large enough to be clinically significant. Comparable performance by US was observed, but agreement with pathology was poorer for mammography and clinical examination. Percentage agreement can provide supplementary information to MDs and LOA, but Pearson's/Spearman's correlation does not provide evidence of agreement and should be avoided. Further comparisons of MRI and other tests using the recommended methods are warranted.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Meta-analysis of agreement between MRI and pathologic breast tumour size after neoadjuvant chemotherapy

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Tot [25] calculated the costs of LS in daily practice and compared them with those obtained from conventional blocks, demonstrating that LS costs do not substantially differ from those of accurate conventional blocking. Tucker [26] calculated the cost of LS in a breast care centre and concluded that the LS costs increase from 6.02 USD in cases of lumpectomies to 18.58 USD in cases of mastectomies which was regarded relatively inexpensive and balanced by a better staging and more accurate evaluation of resection margins [26]. As a consequence additional surgical procedures were lowered in number, which led to a decrease of the overall cost of each single patient's treatment [26].…”

Section: Methodsmentioning

confidence: 99%

“…The method to obtain LS has been previously described in several papers [27], as well as it is described by Tucker [26] in the present issue.…”

Section: Methodsmentioning

confidence: 99%

The Value of Large Sections in Surgical Pathology

Foschini

Baldovini

Ishikawa

et al. 2012

International Journal of Breast Cancer

View full text Add to dashboard Cite

Large format sections (LS) first have been introduced in breast pathology more than a century ago. Since then, they constituted for longtime a research tool to better understand breast microanatomy and the relationship between radiological images and pathological features. Similarly LS have been used to study neoplastic, inflammatory, and degenerative diseases affecting various organs, as brain, lung, gastrointentinal tract, bone, urinary tract, prostate, and placenta. Currently LS are mostly applied to diagnostic routine to better stage tumours such as prostate and breast carcinomas or to correlate radiologic imaging to gross specimens. The purpose of the present paper is to review the historical background and the basis of the applications of LS in surgical pathology, with special emphasis on breast tumours.

show abstract

Molecular phenotype of the foci in multifocal invasive breast carcinomas: Intertumoral heterogeneity is related to shorter survival and may influence the choice of therapy

Pekár

Gere

Tarján

et al. 2013

Cancer

View full text Add to dashboard Cite

BACKGROUND Multiple synchronous, ipsilateral, invasive foci of breast carcinomas are frequent and are associated with a poorer prognosis. Few studies have investigated the prognostic and therapeutic implications of heterogeneity of such foci. METHODS The authors reviewed the tumor type, grade, and size of all invasive foci in a series of 110 multifocal breast carcinomas documented on large‐format slides. Molecular phenotype was determined by immunohistochemistry in tissue microarray blocks using 3 classification systems. The survival of patients who had tumors with microscopic (tumor type and/or grade) heterogeneity and of those who had tumors with phenotypic heterogeneity was compared with the survival of patients who had multifocal homogeneous tumors using Kaplan‐Meier curves. The hazard ratio of dying from breast cancer was also calculated. RESULTS Intertumoral heterogeneity in tumor type and grade was detected in 16 of 110 tumors (14.6%) and in 6 of 110 tumors (5.5%), respectively. The molecular phenotype of invasive tumor foci within the same breast differed in 10% to 12.7% of patients (11‐14 of 110 tumors), depending on the classification system used. Patients who had phenotypically heterogeneous, multifocal cancers had a greater risk of dying from disease (HR=2.879; 95%CI=1.084−7.649; P = .034) and had significantly shorter survival (P = .016). Phenotypic differences were most common in patients who had tumors that were homogeneous in terms of tumor type (11 of 18 tumors) and histology grade (14 of 18 tumors). Phenotyping additional tumor foci had the potential to influence the therapeutic decisions in up to 8 patients. CONCLUSIONS Phenotyping more than 1 invasive focus of multifocal breast carcinomas only if the individual foci deviate microscopically appears to be insufficient, because phenotypic intertumoral heterogeneity may be observed in microscopically identical foci and has potential prognostic and therapeutic consequences. Cancer 2014;120:26–34. © 2013 American Cancer Society.

show abstract

Imaging-Assisted Large-Format Breast Pathology: Program Rationale and Development in a Nonprofit Health System in the United States

Cited by 19 publications

References 54 publications

Meta-analysis of agreement between MRI and pathologic breast tumour size after neoadjuvant chemotherapy

Meta-analysis of agreement between MRI and pathologic breast tumour size after neoadjuvant chemotherapy

The Value of Large Sections in Surgical Pathology

Molecular phenotype of the foci in multifocal invasive breast carcinomas: Intertumoral heterogeneity is related to shorter survival and may influence the choice of therapy

Contact Info

Product

Resources

About