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AimThe earlier detection of breast cancer through mammographic screening has resulted in a shift in stage distribution with patients who are node-positive tending to present with a lower number of positive lymph nodes (LN). This study aims to assess the prognostic value of absolute number of positive nodes in the pN1 TNM stage (1–3 positive LN) and whether the prognostic value of the number of nodes in this clinically important stage justifies its consideration in management decisions.MethodsThis study is based on a large and well-characterised consecutive series of operable breast cancer (3491 cases), treated according to standard protocols in a single institution, with a long-term follow-up.ResultsLN stages and the absolute number of LN are associated with both breast cancer specific survival (BCSS) and distant metastasis free survival (DMFS). In the pN1 stage, patients with three positive LN (14% of pN1) show shorter BCSS (HR=1.9, (95% CI 1.3 to 2.6)) and shorter DMFS (HR=2.2, (95% CI 1.6 to 2.9)) when compared with one and/or two positive nodes. This effect is noted in the whole series as well as in different subgroups based on tumour size (pT1c and pT2), histological grade (grade 2 and 3), vascular invasion and oestrogen receptor status (both positive and negative). Multivariable analyses showed that three positive LN, compared with one and two positive LN, are an independent predictor of shorter BCSS and DMFS.ConclusionThe number of LN in the pN1 stage yielded potentially informative risk assignments with three positive LN providing an independent predictor of poorer outcome. [ABSTRACT FROM AUTHOR]

Background and aimsIncident reporting (IR) refers to systematic documentation of adverse incidents to facilitate their appropriate investigation and institution of corrective or remedial actions, and provide data to identify risk trends for recurrent problems. Minimisation of errors and reduction in process variation is recognised as an important goal of quality management and is an essential part of continuous quality improvement. Published data on the role IR plays in cellular pathology remains scanty.MethodsIn this study, the authors collected and analysed all incidents and adverse events reported in their department over a 2-year period.Results584 incidents were reported (0.5% of all cases processed). The majority (59%) occurred in the pre-analytical phase of the laboratory process with 23% in the analytical and 18% in the post-analytical phases. Booking-in and specimen labelling-related incidents were the largest single group (56% of all incidents), prompting further root cause analysis, but no other obvious patterns or trends were identified, and most incidents were followed by corrective actions on an individual basis. Most incidents (79%) posed potential harm, as opposed to causing actual harm to the service or patients. Only 78 cases (14%) posed a major risk to patients, such as specimen loss or mix-up, whereas 27% were associated with moderate risk and 59% with minor or insignificant risk.ConclusionMajor risk incidents are relatively rare in the cellular pathology laboratory. IR should be included as an important component of a risk management strategy and clinical governance framework. [ABSTRACT FROM AUTHOR]

BACKGROUND: Fatty liver disease (FLD), of either alcoholic (AFLD) or non-alcoholic (NAFLD) aetiologies, is characterised histologically by features that are lobulocentric that typically affect zone 3, in contrast with portal-based inflammation characteristics of other forms of chronic liver disease. AIM: The authors aimed to determine the prevalence and significance of portal inflammation in a cohort of adults diagnosed as having AFLD and NAFLD. METHODS: From a histology database, the authors identified 160 patients with biopsy proven AFLD and 214 with NAFLD diagnosed between 1991 and 2001. All liver biopsies were reviewed by one pathologist to evaluate various histological features. RESULTS: More than a mild degree of portal inflammation was found in 47% of AFLD compared with 30% in NAFLD subgroup. A higher degree of portal inflammation in AFLD was associated with a higher mean corpuscular volume, gamma glutamyl transferase (GGT) and alkaline phosphatase, and a lower platelet count and albumin, whereas in NAFLD this was associated with age, presence of diabetes, hypertension, body mass index (BMI), higher fasting blood glucose, cholesterol, alanine transaminase, GGT and ferritin. On regression analysis, portal inflammation was associated with the severity of steatosis (p=0.005), presence of ballooning (p=0.030) in NAFLD and severity of fibrosis in both AFLD and NAFLD (p<0.001). CONCLUSIONS: Portal inflammation is a common component of histological spectrum of both AFLD and NAFLD. In both conditions portal inflammation is associated with clinical and histological features suggestive of advanced disease. [ABSTRACT FROM AUTHOR]

Triple‐negative breast cancer (estrogen receptor‐negative, progesterone receptor‐negative, and HER2‐negative) is a high risk breast cancer that lacks the benefit of specific therapy that targets these proteins.In this study, the authors examined a large and well characterized series of invasive breast carcinoma (n = 1944) with a long‐term clinical follow‐up (median, 56 months) by using tissue microarray. The series were also stained with concurrent immunohistochemical prognostic panels (estrogen receptor, progesterone receptor, HER‐2, androgen receptor, epidermal growth factor receptor (EGFR), P‐cadherin, E‐cadherin, and basal (CK5/6, CK14), and p53), to characterize this specific subgroup of breast cancer and to identify prognostic markers that can identify tumors with more aggressive behavior.Of informative cases, 16.3% were of the triple‐negative phenotype. The majority of these tumors were grade 3, ductal/no‐specific‐type carcinomas. There were positive associations with larger size, pushing margins, poorer Nottingham Prognostic Index, development of recurrence and distant metastasis, and poorer outcome. In addition, associations were found with loss of expression of androgen receptor and E‐cadherin, and positive expression of basal cytokeratins (basal phenotype), P‐cadherin, p53, and EGFR. In all tumors, tumor size, lymph node stage, and androgen receptor were the most useful prognostic markers. In the lymph node‐positive subgroup, both size and androgen receptor retained their prognostic significance. However, in the lymph node‐negative tumors, basal phenotype was the sole prognostic marker identified in this subgroup. Other parameters including age, histological grade, tumor size, vascular invasion or other biomarkers included in the current study were not significant.The authors concluded that assessment of androgen receptor and basal phenotype, in addition to the established pathologic variables, mainly lymph node status and tumor size, can be used to select high‐risk and low‐risk patients at the time of primary surgery and can provide valuable information on treatment options in these triple‐negative tumors. Cancer 2007. © 2006 American Cancer Society [ABSTRACT FROM AUTHOR]