Rafael Cano

Diagnosis of the sentinel lymph node in breast cancer: a reproducible molecular method: a multicentric Spanish study

Bernet L, Cano R, Martinez M, Dueñas B, Matias‐Guiu X, Morell L, Palacios J, Rezola R, Robles‐Frias M, Ruiz I, Velasco A, Vieites B, Sevilla F, Torro J, Medrano J & Ballester B
(2011) Histopathology 58, 863–869
Diagnosis of the sentinel lymph node in breast cancer: a reproducible molecular method: a multicentric Spanish study

Prevalence of nonpolypoid colorectal neoplasms in symptomatic patients scheduled for colonoscopy: a study with total colonic chromoscopy.

Objectives: (i) To determine the prevalence of nonpolypoid colorectal neoplasms (NP-CRNs) in a prospective cohort of patients of a Mediterranean area; (ii) to compare the characteristics of NP-CRNs with those of polypoid adenomas, focusing on the rate of high-grade dysplasia (HGD) and carcinoma; (iii) to evaluate the characteristics of patients harboring NP-CRNs versus patients with protruding adenomas (P-CRNs). Patients and Methods: A prospective, cross-sectional observational study was made in which consecutive unselected patients were scheduled for colonoscopy and pancolonic chromoendoscopy. The Paris Classification of Superficial Neoplastic Lesions was used to classify the detected lesions, and the revised Vienna criteria were applied to describe the grade of dysplasia. All examinations were performed by the same endoscopist, and all samples were reviewed by the same pathologist. Results: A total of 290 patients were included, and 613 neoplasms were detected—26% of them being NP-CRNs. The prevalence of NP-CRNs was 34.1% [95% confidence interval (CI): 28.8%-39.7%]. The proportion of HGD or carcinoma in NP-CRNs was 2.5% (95% CI: 0.8%-5.9%), versus 2.9% in P-CRNs (95% CI: 1.6%-4.7%). Size larger than 10 mm [odds ratio: 22.7 (95% CI: 5.2-99.2)] and a pedunculated morphology [odds ratio: 5.7 (95% CI: 1.3-24.3)] were related to the presence of HGD or carcinoma. A relationship between increased size and HGD or carcinoma was found for all morphologies. Patients harboring only NP-CRNs and patients harboring only P-CRNs were similar for all the variables collected. Conclusions: NP-CRNs have a high prevalence in our region, but show a proportion of HGD and carcinoma similar to that seen in P-CRNs. No patient variable is predictive of the presence of a NP-CRN.

Metastatic sentinel node and axillary lymphadenectomy revisited.

Complete axillary lymph node dissection (ALND) is an integral part of the surgical treatment for breast carcinoma in spite of carrying a high morbidity and frequent secondary side effects.

Elaboration of a nomogram to predict nonsentinel node status in breast cancer patients with positive sentinel node, intraoperatively assessed with one step nucleic amplification: Retrospective and validation phase

BackgroundTumor-positive sentinel lymph node (SLN) biopsy results in a risk of non sentinel node metastases in micro- and macro-metastases ranging from 20 to 50%, respectively. Therefore, most patients underwent unnecessary axillary lymph node dissections. We have previously developed a mathematical model for predicting patient-specific risk of non sentinel node (NSN) metastases based on 2460 patients. The study reports the results of the validation phase where a total of 1945 patients were enrolled, aimed at identifying a tool that gives the possibility to the surgeon to choose intraoperatively whether to perform or not axillary lymph node dissection (ALND).MethodsThe following parameters were recorded: Clinical: hospital, age, medical record number; Bio pathological: Tumor (T) size stratified in quartiles, grading (G), histologic type, lymphatic/vascular invasion (LVI), ER-PR status, Ki 67, molecular classification (Luminal A, Luminal B, HER-2 Like, Triple negative); Sentinel and non-sentinel node related: Number of NSNs removed, number of positive NSNs, cytokeratin 19 (CK19) mRNA copy number of positive sentinel nodes stratified in quartiles. A total of 1945 patients were included in the database. All patient data were provided by the authors of this paper.ResultsThe discrimination of the model quantified with the area under the receiver operating characteristics (ROC) curve (AUC), was 0.65 and 0.71 in the validation and retrospective phase, respectively. The calibration determines the distance between predicted outcome and actual outcome. The mean difference between predicted/observed was 2.3 and 6.3% in the retrospective and in the validation phase, respectively. The two values are quite similar and as a result we can conclude that the nomogram effectiveness was validated. Moreover, the ROC curve identified in the risk category of 31% of positive NSNs, the best compromise between false negative and positive rates i.e. when ALND is unnecessary (<31%) or recommended (>31%).ConclusionsThe results of the study confirm that OSNA nomogram may help surgeons make an intraoperative decision on whether to perform ALND or not in case of positive sentinel nodes, and the patient to accept this decision based on a reliable estimation on the true percentage of NSN involvement. The use of this nomogram achieves two main gools: 1) the choice of the right treatment during the operation, 2) to avoid for the patient a second surgery procedure.

Ultrastructural Pathology of Anaplastic and Grade II Ependymomas reveals Distinctive Ciliary Structures – Electron Microscopy Redux

ABSTRACT Ependymoma tumors likely derive from the ependymal cells lining the CNS ventricular system. In grade II ependymomas, tumor cells resemble typical ependymocytes, while anaplastic ependymomas are poorly differentiated. We studied three grade II and one anaplastic ependymoma, focusing on the ciliary structures. To unambiguously characterize the ultrastructure and number of cilia, we performed electron microscopy serial section analysis of individual cells. Differentiated ependymomas contained large basal bodies and up to three cilia, and lacked centrioles. Anaplastic ependymoma cells showed instead two perpendicularly oriented centrioles and lacked cilia or basal bodies. These findings could contribute to understand the mechanisms of ependymoma aggressiveness.