College of American Pathologists
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  Anatomic Abstracts





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October 2002

Fibrotic focus in invasive ductal carcinoma of the breast
The authors previously reported that invasive ductal carcinomas with fibrotic focus are associated with significantly poorer survival than IDCs without fibrotic focus. For this study, the authors prospectively investigated the effect of fibrotic focus on the outcomes of 439 patients with IDCs to confirm the prognostic significance of fibrotic focus by multivariate analysis, employing the Cox proportional hazard regression model, as compared with well-known clinicopathological parameters. They also evaluated the prognostic significance of fibrotic focus based on its characteristics. The authors demonstrated that fibrotic focus is a useful parameter for predicting tumor recurrence and initial distant organ metastasis (IDOM) in lymph node-negative IDCs (P=.024, P=.026) and IDCs positive for estrogen receptor or progesterone receptor (P=.007, P=.015), or both of the latter. Fibrotic focus of more than 8 mm in diameter was found to be an independent prognostic parameter for tumor recurrence and IDOM in lymph node-negative patients and patients with IDCs positive for estrogen receptor or progesterone receptor (P=.005, P=.018), or both. The authors concluded that fibrotic focus is an important histologic prognostic parameter for patients with IDCs of the breast.

Hasebe T, Sasaki S, Imoto S, et al. Prognostic significance of fibrotic focus in invasive ductal carcinoma of the breast: a prospective observational study. Mod Pathol. 2002;15(5):502-516.

Reprints: Dr. Atsushi Ochiai, Pathology Division, National Cancer Center Research Institute East, Kashiwanoha 6-5-1, Kashiwa, Chiba 277-8577 Japan;

Significance of an insular component in thyroid carcinoma with distant metastases
Distant metastases are rare in well-differentiated thyroid carcinoma and correlate with poor survival. Among the histologic subtypes, insular carcinoma has an intermediate prognosis that lies between well-differentiated and undifferentiated carcinoma. To assess the characteristics that could predict a worse prognosis, the authors reviewed the initial thyroid cancer slides from patients with distant metastases. For a comparative statistical analysis, they included a control group without distant metastases. Among 1,230 patients with differentiated carcinoma who were treated from 1960 to 1999, nine percent developed such metastases. This group was a mean age of 53 years and had a 73 percent rate of death. Histologic slides were available in 80 cases. The primary thyroid tumors were classified as papillary (51 cases), follicular (25), and pure insular carcinoma (four). Extrathyroidal extension was present in 47 percent of papillary carcinomas. The mean tumor size was greater than 5 cm for all histologic subtypes, and at least a vascular invasion was found in 69 percent. Fifty-four percent of these tumors had an insular component, compared with only 6.5 percent in the control group. The insular component ranged from five to 100 percent (mean, 64 percent). Statistical analysis by univariate and multivariate logistic regression confirmed that the risk of distant metastases was elevated in the presence of insular carcinoma. This study indicates that increasing age, large tumor size, vascular invasion, and extrathyroidal extension are important prognostic factors in well-differentiated carcinoma. It also demonstrates that the presence of an insular component in an otherwise differentiated carcinoma is a strong, independent factor for poor prognosis.

Decaussin M, Bernard MH, Adeleine P, et al. Thyroid carcinomas with distant metastases: a review of 111 cases with emphasis on the prognostic significance of an insular component. Am J Surg Pathol. 2002;26(8): 1107-1015.

Reprints: Nicole Berger, Dept. of Pathology, Hôpital de l'Hôtel-Dieu, 1 place de l'Hôpital, 69288 Lyon Cedex 02, France;

Value of liquid-based Pap smears without a transformation zone component
The authors evaluated whether ThinPrep Pap smears without a transformation zone component versus those with such a component were more likely to have false-negative cytology findings. The authors assessed women aged 18 to 50 years (n=4,389) who visited one of three Planned Parenthood clinics between 1997 and 2001 for ThinPrep Pap screening and polymerase chain reaction-based human papillomavirus DNA testing. Repeat cytology, colposcopy, and biopsy were offered to women with any cytologic abnormality, high-risk HPV types, and a random sample with normal Pap and negative HPV tests. Cytology and biopsy diagnoses at the colposcopy visit were reviewed according to the presence (n=3,689) or absence (n=700) of a transformation zone component at screening. Among women with normal cytology at screening, histologic detection of at least cervical intraepithelial neoplasia grade 2 (odds ratio, 1.3; 95 percent confidence interval, 0.5, 3.3) at colposcopy did not differ significantly between transformation zone-positive and zone-negative smears. Histologically confirmed cervical intraepithelial neoplasia grade 1 was detected more often among smears lacking a transformation zone component (odds ratio, 2.0; confidence interval, 1.0, 3.8). Transformation zone-negative smears were more common among older women, oral contraceptive users, those past the 14th day of their last menstrual period, and those negative for high-risk HPV types. Absence of a transformation zone component in a screening ThinPrep Pap test was not associated with missed high-grade lesions. Based on the data, the authors do not recommend repeat screening of reproductive-age women who have negative liquid-based tests and no cytologic evidence of a transformation zone component.

Baer A, et al. Liquid-based Papanicolaou smears without a transformation zone component: Should clinicians worry? Obstet Gynecol. 2002;99:1053-1059.

Dr. Laura Koutsky, University of Washington, HPV Research Group, Suite 300, 1914 N. 34th St., Seattle, WA 98103;