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Evaluation of implementation of sentinel node biopsy in Australia

Sat, 31 Dec 2011 13:30:00 GMT

Title: Evaluation of implementation of sentinel node biopsy in Australia Author: Morris, Trenna; Wetzig, Neil R.; Sinclair, Sue; Kollias, James; Zorbas, Helen Abstract: BACKGROUND: Sentinel node biopsy (SNB) has been a major change in surgical technique for the management of early breast cancer. In June 2008, the National Breast and Ovarian Cancer Centre (NBOCC) released evidence-based guidelines for the use of SNB in Australia. During 2010, NBOCC undertook a cohort study to identify the extent to which clinical practice in Australia reflected the recommendations for use of SNB in the 6 months after release of the guidelines. METHODS: Records obtained from four datasets, Royal Australasian College of Surgeons National Breast Cancer Audit, New South Wales Central Cancer Registry, Victorian Cancer Registry and Medicare Benefits Schedule records, were analysed to determine the extent to which the four key guideline recommendations had been implemented. This was supplemented by an audit of written SNB protocols of a sample of pathology laboratories in Australia. RESULTS: Across all cohorts, between 78 and 83% of women in Australia with tumours < 3 cm had an SNB. Data were not available to indicate whether nodes were clinically negative. The likelihood of women having an SNB decreased outside the metropolitan regions, for women treated as public patients compared with private patients and as the size of the tumour increased. In 90% of procedures both preoperative lymphoscintigraphy with isotope and blue dye were used. CONCLUSION: The findings from the study confirm that best practice recommendations from the NBOCC guidelines for SNB were largely being implemented for women with early breast cancer in Australia within 6 months of their release.

A comparison of primary oesophageal squamous epithelial cells with HET-1A in organotypic culture

Thu, 31 Dec 2009 13:30:00 GMT

Title: A comparison of primary oesophageal squamous epithelial cells with HET-1A in organotypic culture Author: Underwood, Timothy; Derouet, Mathieu F.; White, Michael J.; Noble, Fergus; Moutasim, Karwan A.; Smith, Eric; Drew, Paul Anthony; Thomas, Gareth J.; Primrose, John N.; Blaydes, Jeremy P. Abstract: Background Information. Carcinoma of the oesophagus is the sixth leading cause of cancer death in the western world and is associated with a 5-year survival of less than 15%. Recent evidence suggests that stromal-epithelial interactions are fundamental in carcinogenesis. The advent of co-culture techniques permits the investigation of cross-talk between the stroma and epithelium in a physiological setting. We have characterized a histologically representative oesophageal organotypic model and have used it to compare the most commonly used squamous oesophageal cell line, HET-1A, with primary oesophageal squamous cells for use in studies of the oesophageal epithelium in vitro. Results. When grown in an organotypic culture with normal fibroblasts, the oesophageal carcinoma cell lines OE21 (squamous) and OE19 (adenocarcinoma) morphologically resembled the tumour of origin with evidence of stromal invasion and mucus production, respectively. However, HET-1A cells, which were derived from normal squamous oesophageal cells, appeared dysplastic and failed to display evidence of squamous differentiation. By comparison with primary oesophageal epithelial cells, the HET-1A cells were highly proliferative and did not express the epithelial markers E-cadherin or CK5/6 (casein kinase 5/6), or the stratified epithelial marker Delta Np63, but did express the mesenchymal markers vimentin and N-cadherin. Conclusion. Studies of epithelial carcinogenesis will benefit from culture systems which allow manipulation of the stromal and epithelial layers independently. We have developed an organotypic culture using primary oesophageal squamous cells and fibroblasts in which a stratified epithelium with a proliferative basal layer that stains strongly for Delta Np63 develops. This model will be suitable for the study of the molecular events in the development of Barrett's oesophagus. The most commonly used normal oesophageal squamous cell line, HET-1A, does not have the characteristics of normal oesophageal squamous cells and should not be used in models of the normal oesophageal epithelium. Until more representative cell lines are available, future studies in oesophageal cancer will be reliant on the availability and manipulation of primary tissue.

Isolated tumor cells in esophageal cancer: Implications for the surgeon and the pathologist

Thu, 31 Dec 2009 13:30:00 GMT

Title: Isolated tumor cells in esophageal cancer: Implications for the surgeon and the pathologist Author: Thompson, Sarah Kathryn; Ruszkiewicz, Andrew R.; Jamieson, Glyn Garfield; Sullivan, Thomas Richard; Devitt, Peter Geoffrey Abstract: Introduction: Studies suggest that up to 56% of node-negative patients have tumor deposits in their lymph nodes that are missed by routine pathologic examination. However, few studies differentiate between isolated tumor cells and micrometastases using reproducible criteria, and their prognostic significance has not been established. Methods: We identified 119 patients who had undergone surgical resection for esophageal cancer between 1997 and 2007, and who were classified as node-negative. Relevant paraffin blocks were identified, and 3 additional levels, each 250 µm apart, were cut of all lymph nodes. Isolated tumor cells and micrometastases were defined according to size criteria but additional data and characteristics were recorded. Two slides were made at each level (1 for hematoxylin and eosin, 1 for immunohistochemistry). Results were correlated with survival. Results: One patient was found to have a metastasis (>2 mm), 8 patients (7%) had micrometastases, and 22 patients (18%) had isolated tumor cells. The 5-year survival rates were 60% for patients who remained nodenegative, 33% for patients with isolated tumor cells, 40% for patients with micrometastases, and 0 for the patient with a metastasis (P=0.02). A significant difference was found between node-negative patients versus patients whose lymph nodes contained isolated tumor cells (P=0.014). Most tumor deposits (71%) were identified on the first additional section. Conclusions: Our results suggest that isolated tumor cells are as important as micrometastases in determining survival in patients with esophageal cancer. This has important implications in the retrieval and pathologic analysis of lymph nodes.

The impact of neurotrauma on society: an international perspective

Sun, 31 Dec 2006 13:30:00 GMT

Title: The impact of neurotrauma on society: an international perspective Author: Reilly, Peter Lawrence