Shahida Niazi

Use of Fine-Needle Aspiration in the Evaluation of Breast Lumps

Background. A study was designed to see the role of fine needle aspiration cytology (FNAC) in palpable breast lumps. Materials and Methods. Four hundred and twenty five (425) patients came to the Department of Pathology King Edward Medical University, Lahore in four years for FNAC of their palpable breast masses from June 2006 to June 2010. FNAC diagnosis was compared with histological diagnosis to see the accuracy of fine needle aspiration cytology for neoplastic lesions. Results. There were 271/425 benign, 120/425 malignant, and 32/425 suspicious smears. Inadequate samples were repeated twice or thrice, and the degree of success was improved with consecutive repeating approaches. The frequency of inadequacy declined from 86 to 18, and 2 for first, second and third attempts, respectively. The number of repeats increased the diagnostic accuracy of aspirates which is statistically significant (P = .000). Invasive ductal carcinoma was the most commonly reported lesion with maximum incidence in the 4th, 5th, and 6th decades followed by invasive lobular carcinoma and other malignant lesions. The sensitivity, specificity, accuracy, negative predictive value, and the positive predictive value of FNAC was 98%, 100%, 98%, 100%, and 97%, respectively. Conclusion. FNAC serves as a rapid, economical, and reliable tool for the diagnosis of palpable breast lesions because the cytopathological examination of these lesions before operation or treatment serves as an important diagnostic modality.

Chemotherapeutic/chemopreventive role of retinoids in chemically induced skin carcinogenesis in albino mice

Objective  To determine the chemotherapeutic effect of retinoids on albino mouse skin.

Elevated frequency of p53 genetic mutations and AgNOR values in squamous cell carcinoma

Background:  Epidermal squamous cell carcinoma (SCC) is a common malignancy in Pakistan. We hypothesize that it is characterized by higher frequency of p53 genetic mutations and increased AgNOR values compared with squamous cell papilloma (SCP) and basal cell carcinoma (BCC).

Better Thyroid Cytopathology Reporting System May Increase the ClinicalManagement and Patients Outcome

Objective: The Bethesda System is better for Thyroid Cytopathology reporting and may increase the clinical management of Thyroid Disease. Study design: Analytical Cross sectional. Material and methods: A cross sectional study was conducted on 120 smears of thyroid swellings which were referred for fine needle aspiration to the Department of Pathology in 2011 and the Bethesda System for reporting Thyroid Cytopathology was followed in comparison to old conventional reporting system running from the last 30 years. Histopathology was used as a gold standard to compare the sensitivity of both systems. Three groups of Histopathologists were assigned three reporting systems without knowing the results of each other. The comparison was made in a meeting of 3 groups after histopathology biopsy reports were made available. Group A was assigned to report with the older system of thyroid aspiration with 7 categories, Group B reported with five classes of an older reporting system and Group C reported with the latest Bethesda Reporting System. Screening test was applied to compare the results. Results: When the results of these three systems were compared Bethesda adapted method was found to be more superior as compared to the others. Sensitivity of Group B and C is significantly high 0.051 as compared to group A (p=0.051 and 0.000)’ Sensitivity of Group C is also significantly high as compared to Group B (p=0.000). Specificity of Group B is not significant (0.326) as compared to group A. Specificity of group C is also significantly high as compared to Group A and Group B (p=0.009 and 0.002). Our findings are consistent with others who used the Bethesda Cytopathology Reporting System. Conclusions: Bethesda Cytopathology Reporting system can help with a better patient’s outcome due to proper clinical management of thyroid swellings and saves patients from unnecessary thyroid surgery.

Relationship of immunohistochemistry scores of altered p53 protein expression in relation to patient's habits and histological grades and stages of squamous cell carcinoma.

Background:  p53 mutations are etiologically associated with the development of squamous cell carcinomas (SCCs) or with exposure to specific carcinogens. The study was conducted to examine the relationship of immunohistochemistry (IHC) scores between altered p53 protein expression in relation to patient’s habits and histological grades and stages of SCC.

Prognostic Significance of New Immunohistochemistry Scoring of p53 Protein Expression in Cutaneous Squamous Cell Carcinoma of Mice

This study was conducted to investigate the prognostic value and therapeutic response of treatment modalities on p53 protein expression and AgNOR index in squamous cell carcinoma (SCC). Furthermore, based on data, we proposed a new p53 immunohistochemistry (IHC) scoring system. Sixty albino mice were given 7,12‐dimethylbenz[a]anthracine (DMBA) and 12‐O‐tetradecanoly Phorbol‐13‐acetate (TPA) to produce skin tumors. The retinoids were given after the development of tumors. p53 immunohistochemical and AgNOR staining was performed on the sections taken before and after the retinoid administration. p53 protein was expressed in 31 of the lesions (60.8%). AgNOR index was high in all 51 (100%) of the pretreated lesions. There was a marked decrease in the expression of p53 protein in 16/51 (31.4%) and AgNOR index in 36/51 (70.6%) in post‐treated mice. There was no decrease in the expression of both markers in mice harboring malignant neoplasms. p53 IHC scores were 0, I, and II in epidermal hyperplasia, papilloma, and dysplasia, respectively, while they were II, III, IV, and V in SCC in situ, well‐differentiated, moderately differentiated, and poorly differentiated SCCs, respectively. Alteration of p53 and AgNOR index occured during the development of SCC. The p53 IHC scores are directly related to the grades of malignancy. Both markers might be used as a supportive tool with routinely performed Hematoxylin and Eosin staining and may help in the diagnosis of SCC. The newly proposed p53 IHC scoring system will help histopathologists in making their differential diagnosis among benign, premalignant, and malignant lesions. It will also help the oncologists to assess the prognosis and effectiveness of their chemotherapy.

Histopathological and Immunohistochemistry Observations Based Bukhari Grading for Squamous cell carcinoma

Background: Increasing incidence of Squamous Cell Carcinoma (SCC) has emphasized the challenges of managing this condition. Traditional microscopic information often fails, especially when based on H & E methods. Immunohistochemistry (IHC) and molecular studies in combination with traditional histopathology may fill this gulf. Aims: The study was conducted to introduce new a grading system based on both histopathological and biological correlation of SCC. Settings and Design: A descriptive study included 180 cases of SCC of the skin (all regions of skin and oral mucosa). Cellular proliferation index (Ki-67 and p53 expression) was studied in SCC by immunohistochemistry (IHC). This study was carried out in the Department of Pathology from January 2006 to December 2008. Methods and Material: The clinicopathological information regarding age, sex, primary tumor site, tumor size, local recurrence, distance metastasis and follow-up status was collected for each case. Patient outcome was verified and updated through the medical records. Five micron thick (5μm) sections were cut from archival formalin fixed, paraffin embedded specimens. The first section was stained with haematoxylin and eosin (H&E) for histopathological analysis. Other sections were stained immunohistochemically with p53 and Ki-67 and then independently scored for the expression of p53 proteins and Ki-67 index. Results: SCC was designated low, intermediate, and high tirade grades based on the sum of point values assigned to each 4 scores of histological differentiation, staging, expression of p53 protein and Ki-67 index. Expression of p53 was found to be related to the Ki-67 and the scores of histology and stages of SCC. A significant correlation was found among the newly assigned grades, stages (Spearman correlation = 0.721, P value = 0.000). The grades were also significantly correlated with other prognostic factors like local invasion, lymph node and distance metastasis (Kendalls Tau-b = 0.394;p-value = 0.00). Tumor recurrence was also significantly based on grades of SCC (Kendalls Tau–b = 0.966, P value = 0.025). Conclusion: It was concluded that a new grading system is an important prognostic indicator of squamous cell carcinoma. This practical approach has potential to improve clinical evaluation of SCC in understanding the pathological as well as clinical behavior of SCC.

Abstract A31: Bukhari molecular grading for squamous cell carcinoma and its correlation with pathologic prognostic factors.

Background: Optimal patient management requires correct pathologic information regarding its prognostic value and definitive discrimination between the biological behavior of tumors. Traditional microscopic information often fails, especially when base on hematoxyllin and eosin methods. New grading system fills this void. The study was undertaken to determine the molecular grades of squamous cell carcinoma based on cumulative scores of histopathology, and proliferative activity and to see their correlation with pathological prognostic factors. Materials and Methods: Scoring for histology, Ki-67 index, and p63 immunohistochemistry was done for 180 samples of squamous cell carcinoma with different histologic grades. Data regarding pathologic prognostic factors e.g., lymph node metastasis, local invasion, distance metastasis and recurrence was also collected for each case. Spearman correlation and Kendall9s Tau-b test was used to assess association of molecular grading with pathologic prognostic factors. P Results: Three grades (low, intermediate, and high) were determined by the sum of point values assigned to each 4 scores of histological differentiation, 5 p63 immunoreactivity scores and 4 scores of Ki-67. p63 scores were found to be related to the Ki-67 in the histological scoring of SCC. A significant correlation was found between the tumor grades and pathologic prognostic factors like stages (The molecular grades and the surgical stages are highly positively correlated, i.e. Spearman correlation = 0.721, p-value = 0.000) local invasion, lymph node involvement, distance metastasis (Kendall9s Tau-b = 0.394; p-value = 0.00) and recurrence (Kendall9s Tau — b = −0.966, p-value = 0.025). Conclusion: Molecular features of the malignant cells were related to the pathological prognostic factors. New molecular grading is better in understanding the pathologic and clinical behavior of SCC at the molecular level. Citation Information: Cancer Prev Res 2010;3(12 Suppl):A31.