Bacs Kiskun County Teaching Hospital

Kecskemét, Hungary

Bacs Kiskun County Teaching Hospital

Kecskemét, Hungary
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Van Diest P.J.,University Utrecht | Van Deurzen C.H.M.,Erasmus Medical Center | Cserni G.,Bacs Kiskun County Teaching Hospital
Breast Disease | Year: 2010

The goal for the pathologist when dealing with sentinel nodes (SNs) of breast cancer patients is not to find all metastases, but to find clinically relevant metastases: those associated with further metastases beyond the SN, necessitating further locoregional treatment, or indicating an adverse prognosis, necessitating adjuvant systemic therapy. Pathology examination of the SN has to be done more with more attention than usual and can be done pre-operatively, post-operatively, but also intra-operatively to allow immediate axillary lymph node dissection when necessary. There are several means for pre-operative, intra-operative and post-operative SN pathological evaluation. These include fine needle aspiration cytology, gross examination, imprint cytology, frozen section analysis, histopathological investigation by step sectioning, immunohistochemistry, and molecular analysis. In this paper, we provide an up to date discussion on the virtues and flaws of these different methods to find SN metastases, and provide recommendations on the optimal pathology protocol for breast cancer SNs. © 2010 - IOS Press and the authors. All rights reserved.

Maraz R.,Bacs Kiskun County Teaching Hospital | Boross G.,Bacs Kiskun County Teaching Hospital | Pap-Szekeres J.,Bacs Kiskun County Teaching Hospital | Rajtar M.,Bacs Kiskun County Teaching Hospital | And 3 more authors.
Pathology and Oncology Research | Year: 2014

Axillary sentinel node (A-SN) biopsy is a standard procedure in breast cancer surgery. Sampling of intenal mammary sentinel nodes (IM-SN) is not performed routinly, although it is also considered an important prognostic factor of breast cancer. The role of this latter procedure was investigated in cases of IM-SN visualized on lymphoscintigraphy. Between January 2001 and June 2012 1542 patients with clinically node negative operable primary breast cancer had sentinel node biopsy (SNB). Both axillary and IM-SN were sampled (whenever detected), based on lymphoscintigraphy, intraoperative gamma probe detection and blu dye mapping. Lymphoscintigraphy showed IM-SN in 83 cases. IM-SN biopsy (IM-SNB) was succesfull in 77 patients (93%). A total of 86 IM-SNs were removed. IM-SN involvement was identified in 14 cases, representing 18% of patients who underwent IM-SNB. This included macrometastases (MAC) in 5 cases, micrometastases (MIC) in 2 cases, isolated tumor cells (ITC) in 7 cases. No significant differences were found between patients with and without IM-SN involvement in terms of age, tumor location, tumor size, axillary involvement, tumor grade or estrogen receptor status. The IM-SN involvement has lead to new therapeutic indications in 2 cases (2.6%), both of them due to MAC in the IM-SN: in 1 case change in chemotherapy and in 1 case change in radiotherapy, with the addition of iradiation of the internal mammary chain. Based on this series and information from the literature, we conclude that the indication for an IM-SNB procedure is very limited and its routine use should not be recommended. © Arányi Lajos Foundation 2013.

Cserni G.,Bacs Kiskun County Teaching Hospital | Cserni G.,University of Szeged | Bezsenyi I.,Bacs Kiskun County Teaching Hospital | Marko L.,Bacs Kiskun County Teaching Hospital
Pathology and Oncology Research | Year: 2013

The optimal locoregional treatment of patients diagnosed with sentinel node (SN) micrometastasis is controversial. A previously reported and validated nomogram was used to calculate the risk of non-SN metastasis in patients with SN micrometastasis over a period of 2 years. Patients were given detailed information about the risk, consequences and treatment options of non-SN involvement, the risk and potential complications of unnecessary completion axillary lymph node dissection (ALND), the imperfectness of the nomogram, and other factors that may influence their selection of further treatment. They also received a questionnaire to monitor factors influencing their decisions. Of the 25 patients participating in the study, 10 have opted for ALND. The only factor that seemed to influence their choice was fear from disease recurrence. Giving detailed information to SN micrometastatic patients is a patient-centered alternative to current recommendations on performing ALND in all such patients or omitting ALND in all of them. © 2012 Arányi Lajos Foundation.

Voros A.,University of Szeged | Csorgo E.,University of Szeged | Nyari T.,University of Szeged | Cserni G.,University of Szeged | Cserni G.,Bacs Kiskun County Teaching Hospital
Pathobiology | Year: 2013

Objective: The Ki-67 proliferation index has received an important role in treatment tailoring and molecular classification of estrogen receptor-positive breast carcinomas. The aim was to analyze the reproducibility of assessing proliferation on the basis of Ki-67 immunohistochemistry. Methods: Thirty core biopsy samples of breast cancer patients were analyzed after immunostaining with B56, SP6 and MIB-1 monoclonal Ki-67 antibodies. All samples were evaluated twice and independently by 3 pathologists, with each observer performing his daily routine practice. The ratio of Ki-67-positive cells was estimated with 5% accuracy. Correlation was calculated for the results of each investigator for all pairs of antibodies and for the results of each antibody for all pairs of investigators. Ki-67 scores were divided into categories of either 4 quarters or into 3 groups reflecting the St. Gallen consensus recommendations with 15 and 30% as cutoff values. The reproducibility of classifying the tumors into these categories was assessed with κ statistics. Results: Altogether, 540 evaluations were made. Good to excellent correlation (Spearman's and Pearson's coefficient range 0.74-0.92 and 0.73-0.93, respectively) was noted for the pairwise comparison of antibodies by observer and of observers by antibody. The inter- and intraobserver reproducibility of the Ki-67 score classification into equal quarters (1-25, 26-50, 51-75 and 76-100%) or into 3 categories with cutoffs at 15 and 30% was fair to poor in the middle categories, but moderate to substantial in the low and high ranges. Interobserver differences in practice potentially impacted on less consistent classification. Conclusion: Our results indicate that the three different Ki-67 antibodies tested do not substantially influence the reproducibility of the estimated proliferation rates. Although reproducibility is better in the clinically more relevant distinction of high versus low proliferation, without standardization, the current practice of Ki-67 assessment in many laboratories does not allow proper and consistent therapeutic decision-making. Copyright © 2012 S. Karger AG, Basel.

Sejben I.,Bacs Kiskun County Teaching Hospital | Bori R.,Bacs Kiskun County Teaching Hospital | Cserni G.,Bacs Kiskun County Teaching Hospital
Journal of Clinical Pathology | Year: 2010

Aims: To assess venous invasion (VI) and its relation to distant metastases in colorectal cancer (CRC). Methods: Primary untreated CRC cases were assessed for VI. All tumour blocks were stained with H&E and orcein. The presence of VI and nodal status were then correlated with the presence of synchronous or metachronous distant metastases. Results: VI was detected more frequently with the orcein stain (18% versus 71%). Eleven tumours (nine node-positive tumours, all VI positive) were associated with synchronous distant metastasis. During a median follow-up of 17 months nine further cases were diagnosed with distant metastasis (six node-positive tumours, all VI positive). The specificity and sensitivity of the presence of nodal metastasis for predicting distant metastasis were 0.56 and 0.75, respectively. The same values for orcein-detected VI were 0.39 and 1, respectively. Conclusions: Elastic stains such as the orcein stain enable the detection of clinically relevant VI with greater frequency than conventionally stained histological slides. If nodal involvement is an indication for systemic chemotherapy, the data presented here suggest that VI detected by the orcein stain should also be an indication for systemic chemotherapy.

Cserni G.,Bacs Kiskun County Teaching Hospital
Journal of Clinical Pathology | Year: 2012

One-step nucleic acid amplification (OSNA) is a novel method introduced for the lymph node staging of breast cancer and has been tested in multiple series. The present review summarises current literature and concerns related to the new method. The results of this automated molecular assay based on the quantification of cytokeratin 19 mRNA show a 96% concordance rate with detailed histopathology complemented with immunohistochemistry when alternative slices of the same lymph node are used for the two tests. The low false-negative rate makes OSNA suitable for the intraoperative evaluation of sentinel lymph nodes. The false-positive rate also seems very low. Most discordant cases are explainable by low volume metastases (micrometastases), which may be missing from the material submitted for one test, but not from the different part used for the other test. It is tempting to change the gold standard for comparisons between the methods, and if this is done, histology seems to come out as a weaker test for the identification of metastases. OSNA detects more low volume nodal involvement, but it is uncertain whether these require further axillary treatment, and this will be a subject for future investigations. Therefore, it is also uncertain whether the advantage of OSNA of detecting practically all metastases due to complete sampling of lymph node tissue is clinically more important than the exclusion of metastases greater than micrometastasis that can be reliably done by intraoperative microscopy followed by permanent section histology.

Kovari B.,University of Szeged | Rusz O.,University of Szeged | Schally A.V.,University of Miami | Kahan Z.,University of Szeged | And 2 more authors.
APMIS | Year: 2014

Different classes of breast cancers were explored for their positivity for growth hormone-releasing hormone receptors (GHRH-R) in this pilot study, as no systematic evaluation of such tumors has been performed to date. Seventy-two small primary breast carcinomas were evaluated for GHRH-R expression by immunohistochemistry using a polyclonal antibody and a cutoff value of 10% staining. GHRH-R positivity was detected in 58% of all cases, 20/23 (87%) of invasive lobular carcinomas (ILC) and 22/46 (48%) of invasive ductal carcinomas (IDC). GHRH-R positivity was more frequent in grade 2 tumors (86%), as compared to grade 1 (18%) or grade 3 (47%) cancers. GHRH-R expression was not associated with mitotic scores, the Ki-67 labeling indices or nodal status. IDCs with casting-type calcifications on the mammogram showed positivity for GHRH-R in 9/12 (75%) cases. Most importantly, apocrine epithelium, and all 10 apocrine carcinomas added later to the study were GHRH-R-positive. These preliminary results suggest a greater than average GHRH-R expression in ILCs and IDCs associated with casting-type calcifications on the mammogram. Apocrine carcinomas seem uniformly positive for GHRH-R. Whether these findings could indicate a potential role of GHRH-antagonists in targeted treatment of these types of breast cancer requires further studies. © 2014 APMIS.

Cserni G.,Bacs Kiskun County Teaching Hospital | Cserni G.,University of Szeged
APMIS | Year: 2012

Two cases of apocrine papillary lesions are presented, in which myoepithelial cells were not visualized on hematoxylin and eosin-stained slides. A complex sclerosing papillary lesion did not exhibit myoepithelial cells on p63 and CD10 immunostaining, although a thin rim of myoepithelial cell cytoplasm was revealed by smooth muscle actin, calponin, and S100 immunostains. In the other lesion, without sclerosis, myoepithelium was not detected in the central papillary cores or at the periphery of the cystic wall on hematoxylin and eosin-stained sections or with any of the myoepithelial markers tested, although two small wall areas did display the presence of myoepithelium. These two cases strengthen the view that the lack of myoepithelium alone in apocrine lesions cannot be equated with malignancy. As recent literature reports have demonstrated that myoepithelial cells may be missing from benign apocrine changes and proliferations of different types, a reconsideration of the diagnostic criteria of the malignancy of such lesions appears essential. © 2011 The Author. APMIS © 2011 APMIS.

Cserni G.,Bacs Kiskun County Teaching Hospital
Memo - Magazine of European Medical Oncology | Year: 2011

Summary: The TNM is the most widely used staging system for malignant disease. Its seventh edition has been updated in several respects, but there still remain controversial issues requiring further improvement. The current review highlights the items related to early breast cancer. It deals separately with contradictions found in the online resources, those related to the different categories, the stages, grade and finally it places the TNM in the milieu of biological markers often used to tailor individual patient treatment. Although TNM has lost its nearly unique role in assessing patient risk and in selecting systemic therapy for breast cancer, it is still of importance in reflecting the anatomic extent of disease in a categorical way, selecting surgical treatment and comparing similar tumours of different extent. © 2011 Springer-Verlag.

Cserni G.,Bacs Kiskun County Teaching Hospital | Cserni G.,University of Szeged | Maraz R.,Bacs Kiskun County Teaching Hospital
Pathology and Oncology Research | Year: 2015

Whether an axillary lymph node dissection (ALND) is needed for breast cancer patients with minimal sentinel lymph node (SLN) involvement is arguable despite recent data supporting the omission of axillary clearance in these patients. Data on disease recurrence of 111 patients with SLN involvement and no ALND were analysed. Patients with minimal SLN involvement were assessed for their risk of non-SLN metastasis by means of several nomograms. The series included patients with isolated tumour cells (n = 76), micrmetastasis (n = 33) and macrometastasis (n = 2) who were followed for a median of 37 months (range 12–148 months). Six patients died, 3 of disease and 3 of unrelated causes. Eight further patients had breast cancer related events: 1 local breast recurrence and seven distant metastases. No axillary regional recurrence was detected. Disease related events were not associated with the risk of non-SLN metastasis. The presented data suggest that omitting ALND in patients with low volume SLN metastasis may be a safe procedure, and support the observation that systemic disease recurrence may not be associated with axillary recurrence or the risk of NSLN involvement predicted by nomograms. © 2015, Arányi Lajos Foundation.

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