A European consensus conference on endometrial carcinoma was held in 2014 to produce multidisciplinary evidence-based guidelines on selected questions. Given the large body of literature on the management of endometrial carcinoma published since 2014, the European Society of Gynaecological Oncology (ESGO), the European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Society of Pathology (ESP) jointly decided to update these evidence-based guidelines and to cover new topics in order to improve the quality of care for women with endometrial carcinoma across Europe and worldwide. ESGO/ESTRO/ESP nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of endometrial carcinoma (27 experts across Europe). To ensure that the guidelines are evidence-based, the literature published since 2014, identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 191 independent international practitioners in cancer care delivery and patient representatives. The guidelines comprehensively cover endometrial carcinoma staging, definition of prognostic risk groups integrating molecular markers, pre- and intra-operative work-up, fertility preservation, management for early, advanced, metastatic, and recurrent disease and palliative treatment. Principles of radiotherapy and pathological evaluation are also defined.
- MeSH
- biopsie normy MeSH
- diagnostické techniky molekulární normy MeSH
- hodnocení rizik MeSH
- karcinom genetika patologie terapie MeSH
- lékařská onkologie normy MeSH
- lidé MeSH
- medicína založená na důkazech normy MeSH
- nádorové biomarkery genetika MeSH
- nádory endometria genetika patologie terapie MeSH
- prediktivní hodnota testů MeSH
- rizikové faktory MeSH
- staging nádorů normy MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- konsensus - konference MeSH
- směrnice pro lékařskou praxi MeSH
- systematický přehled MeSH
CONTEXT.—: Ultrastaging of sentinel lymph nodes (SLNs) is a crucial aspect in the approach to SLN processing. No consensual protocol for pathologic ultrastaging has been approved by international societies to date. OBJECTIVE.—: To provide a review of the ultrastaging protocol and all its aspects related to the processing of SLNs in patients with cervical cancer. DATA SOURCES.—: In total, 127 publications reporting data from 9085 cases were identified in the literature. In 24% of studies, the information about SLN processing is entirely missing. No ultrastaging protocol was used in 7% of publications. When described, the differences in all aspects of SLN processing among the studies and institutions are substantial. This includes grossing of the SLN, which is not completely sliced and processed in almost 20% of studies. The reported protocols varied in all aspects of SLN processing, including the thickness of slices (range, 1-5 mm), the number of levels (range, 0-cut out until no tissue left), distance between the levels (range, 40-1000 μm), and number of sections per level (range, 1-5). CONCLUSIONS.—: We found substantial differences in protocols used for SLN pathologic ultrastaging, which can impact sensitivity for detection of micrometastases and even small macrometastases. Since the involvement of pelvic lymph nodes is the most important negative prognostic factor, such profound discrepancies influence the referral of patients to adjuvant radiotherapy and could potentially cause treatment failure. It is urgent that international societies agree on a consensual protocol before SLN biopsy without pelvic lymphadenectomy is introduced into routine clinical practice.
AIMS: Pathological evaluation of lymphadenectomy specimens plays a pivotal role in accurate lymph node (LN) staging. Guidelines standardising the gross handling and reporting of pelvic LN dissection (PLND) in prostate (PCa) and bladder (BCa) cancer are currently lacking. This study aimed to establish current practice patterns of PLND evaluation among pathologists. METHODS AND RESULTS: A web-based survey was circulated to all members of the European Network of Uropathology (ENUP), comprising 29 questions focusing on the macroscopic handling, LN enumeration and reporting of PLND in PCa and BCa. Two hundred and eighty responses were received from pathologists throughout 23 countries. Only LNs palpable at grossing were submitted by 58%, while 39% routinely embedded the entire specimen. Average LN yield from PLND was ≥10 LNs in 56% and <10 LNs in 44%. Serial section(s) and immunohistochemistry were routinely performed on LN blocks by 42% and <1% of respondents, respectively. To designate a LN microscopically, 91% required a capsule/subcapsular sinus. In pN+ cases, 72% reported the size of the largest metastatic deposit and 94% reported extranodal extension. Isolated tumour cells were interpreted as pN1 by 77%. Deposits identified in fat without associated lymphoid tissue were reported as tumour deposits (pN0) by 36% and replaced LNs (pN+) by 27%. LNs identified in periprostatic fat were included in the PLND LN count by 69%. CONCLUSION: This study highlights variations in practice with respect to the gross sampling and microscopic evaluation of PLND in urological malignancies. A consensus protocol may provide a framework for more consistent and standardised reporting of PLND specimens.
- MeSH
- chirurgická patologie metody normy MeSH
- internet MeSH
- lidé MeSH
- lymfadenektomie * MeSH
- lymfatické metastázy * diagnóza patologie MeSH
- nádory močového měchýře * patologie MeSH
- nádory prostaty * patologie MeSH
- odběr biologického vzorku metody normy MeSH
- průzkumy a dotazníky MeSH
- staging nádorů metody normy MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
- MeSH
- analýza přežití MeSH
- bronchogenní karcinom klasifikace MeSH
- lidé MeSH
- lymfatické uzliny diagnostické zobrazování patologie MeSH
- mediastinoskopie metody přístrojové vybavení MeSH
- mediastinum diagnostické zobrazování patologie MeSH
- nemalobuněčný karcinom plic * diagnostické zobrazování klasifikace patologie MeSH
- staging nádorů metody normy přístrojové vybavení MeSH
- stupeň nádoru metody přístrojové vybavení MeSH
- Check Tag
- lidé MeSH
CONTEXT: In the management of urothelial carcinoma, determination of the pathological grade aims at stratifying tumours into different prognostic groups to allow evaluation of treatment results, and optimise patient management. This article reviews the principles behind different grading systems for urothelial bladder carcinoma discussing their reproducibility and prognostic value. OBJECTIVE: This paper aims to show the evolution of the World Health Organisation (WHO) grading system, discussing their reproducibility and prognostic value, and evaluating which classification system best predicts disease recurrence and progression. The most optimal classification system is robust, reproducible, and transparent with comprehensive data on interobserver and intraobserver variability. The WHO published an updated tumour classification in 2016, which presents a step forward, but its performance will need validation in clinical studies. EVIDENCE ACQUISITION: Medline and EMBASE were searched using the key terms WHO 1973, WHO/International Society of Urological Pathology 1998, WHO 2004, WHO 2016, histology, reproducibility, and prognostic value, in the time frame 1973 to May 2016. The references list of relevant papers was also consulted, resulting in the selection of 48 papers. EVIDENCE SYNTHESIS: There are still inherent limitations in all available tumour classification systems. The WHO 1973 presents considerable ambiguity for classification of the G2 tumour group and grading of the G1/2 and G2/3 groups. The 2004 WHO classification introduced the concept of low-grade and high-grade tumours, as well as the papillary urothelial neoplasm of low malignant potential category which is retained in the 2016 classification. Furthermore, while molecular markers are available that have been shown to contribute to a more accurate histological grading of urothelial carcinomas, thereby improving selection of treatment for a given patient, these are not (yet) part of standard clinical practice. CONCLUSIONS: The prognosis of patients diagnosed with urothelial carcinoma greatly depends on correct histological grading of the tumour. There is still limited data regarding intraobserver and interobserver variability differences between the WHO 1973 and 2004 classification systems. Additionally, reproducibility remains a concern: histological differences between the various types of tumour may be subtle and there is still no consensus amongst pathologists. The recent WHO 2016 classification presents a further improvement on the 2004 classification, but until further data becomes available, the European Association of Urology currently recommends the use of both WHO 1973 and WHO 2004/2016 classifications. PATIENT SUMMARY: Bladder cancer, when treated in time, has a good prognosis. However, selection of the most optimal treatment is largely dependent on the information your doctor will receive from the pathologist following evaluation of the tissue resected from the bladder. It is therefore important that the classification system that the pathologist uses to grade the tissue is transparent and clear for both urologists and pathologists. A reliable classification system will ensure that aggressive tumours are not misinterpreted, and less aggressive cancer is not overtreated.
The new WHO 2016 classification of renal neoplasia encounters the new entity called "clear cell papillary renal cell carcinoma" (ccpRCC). The ccpRCC has been long included as a subtype of clear cell RCC histotype and it actually ranges from 2 to 9% in different routinely available cohort of renal carcinomas. Of important note, ccpRCC does not show any recurrences or metastases or lymph-node invasion and the outcome is always good. We reviewed twenty-four publications with available follow-up for patients (no. 362) affected by clear cell papillary RCCs/renal adenomatoid tumours and notably ccpRCC harbors an indolent clinical behavior after a mean of 38 months (3,5 years) of follow-up. This paper reviews the histological, molecular and clinical features characterizing ccpRCC, with the goal of focusing the knowledge of the benign fashion of this new tumour entity, supporting the idea of a new renal cell adenoma recruited morphologically from ex conventional clear cell RCC tumours.
- MeSH
- adenom patologie MeSH
- karcinom z renálních buněk klasifikace patologie MeSH
- lidé MeSH
- nádory ledvin klasifikace patologie MeSH
- papilární karcinom patologie MeSH
- staging nádorů normy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
x
x
- MeSH
- adenokarcinom diagnóza chirurgie terapie MeSH
- adjuvantní chemoterapie metody využití MeSH
- chemoradioterapie metody využití MeSH
- duktální karcinom pankreatu * diagnóza epidemiologie chirurgie MeSH
- endokrinní chirurgické výkony * metody trendy využití MeSH
- lidé MeSH
- metaanalýza jako téma MeSH
- metastázy nádorů diagnóza farmakoterapie terapie MeSH
- neoadjuvantní terapie metody trendy využití MeSH
- prognóza * MeSH
- staging nádorů metody normy využití MeSH
- statistika jako téma MeSH
- stupeň nádoru metody trendy využití MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
Brachyterapie karcinomu prostaty patří mezi standardní léčebné metody lokalizovaného karcinomu prostaty společně s radikální prostatektomií a zevní radioterapií. Brachyterapie ve srovnání s ostatními metodami zevní radioterapie je nejlepší pro dodání vysoké dávky záření do prostaty a nejšetrnější k okolí. Pro svoji velmi nízkou morbiditu patří stále k velmi aktuálním a oblíbeným metodám léčby. Mezinárodní doporučení pro indikaci a optimální výběr pacientů jsou stále doplňována a zpřesňována.
Along with radical prostatectomy and external radiotherapy, brachytherapy for prostate cancer is among the standard treatmentmethods for localized prostate cancer. When compared with the other methods of external radiotherapy, brachytherapy is bestfor the delivery of a high radiation dose to the prostate while sparing the surrounding tissues. Because of its very low morbidityrates, it still remains a current and popular treatment modality. International guidelines for indication and optimal patient selectionare being constantly supplemented and refined.
- MeSH
- brachyterapie * metody trendy využití MeSH
- celková dávka radioterapie * normy MeSH
- dávka záření MeSH
- karcinom radioterapie MeSH
- lidé MeSH
- nádory prostaty * radioterapie MeSH
- prostatektomie metody trendy využití MeSH
- prostatický specifický antigen izolace a purifikace krev normy MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- staging nádorů klasifikace normy využití MeSH
- statistika jako téma MeSH
- stupeň nádoru klasifikace normy využití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Sarkomy měkkých tkání jsou úzká heterogenní skupina nádorů, která se vyznačuje obtížnou diagnostikou a značně individuální terapií zahrnující kombinaci předoperační a pooperační chemoterapie, radioterapie a chirurgického zákroku. Základní a často rozhodující pro další osud nemocného je dostatečný radikální chirurgický resekční či amputační výkon, který musí zasahovat i do zdravé tkáně. Proto doporučujeme při každém vážném podezření na maligní měkkotkáňový tumor odeslat pacienta ke konzultaci do onkologického centra zabývajícího se komplexní terapií muskuloskeletálních tumorů.
Soft tissue sarcomas are a narrow, heterogeneous group of tumours, which is characterized by their difficult diagnosis and substantially individualized therapies comprising a combination of preoperative and postoperative chemotherapy, radiotherapy and surgery. A fundamental and often decisive factor for the fate of the patient is adequate surgical resection or radical amputation performance that must reach into healthy tissue. Therefore we recommend that every patient with a serious suspicion of a malignant soft tissue sarcomas is sent for consultation to an oncology centre dealing with complex therapy of musculoskeletal tumours.
- MeSH
- lidé MeSH
- lokální recidiva nádoru diagnóza prevence a kontrola MeSH
- magnetická rezonanční tomografie metody normy MeSH
- nádory z pojivové a měkké tkáně farmakoterapie chirurgie patologie MeSH
- ortopedické výkony metody normy MeSH
- pooperační péče metody MeSH
- prognóza MeSH
- sarkom * farmakoterapie chirurgie patologie MeSH
- staging nádorů normy MeSH
- stupeň nádoru MeSH
- ultrasonografie metody normy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Staging a restaging nemalobuněčného karcinomu plic levého horního laloku představuje separátní multidisciplinární výzvu v široké problematice diagnostiky a terapie tohoto závažného onemocnění. Neoadjuvantní terapie je etablovanou terapeutickou metodou v multimodální terapii nemalobuněčného karcinomu plic s předoperačně prokázaným uzlinovým postižením mediastinálního kompartmentu. Autonomie lymfatické drenáže levého horního laloku způsobuje, že nádorové buňky tvoří primární lymfatické metastázy v oblasti uzlin aorto-pulmonálního okna. Tyto lymfatické uzliny jsou rovněž součástí uzlinového kompartmentu mezihrudí. Jsou však lokalizovány mimo dosahu konvenčních stagingových metod. Proto i přes negativní mediastinoskopii a počítačovou tomografii může být intraoperačně prokázáno N2 postižení v oblasti A-P okna. Zavedení invazivního stagingu při suponované pozitivitě uzlin A-P okna by mohlo mít pro selektovanou skupinu pacientů terapeutický benefit ve smyslu primární indukční terapie před chirurgickou resekcí. Přehledová práce autorů si klade za cíl poukázat na problematiku stagingu a restagingu nemalobuněčného karcinomu plic levého horního laloku v intencích revidovaných doporučení Evropské společnosti hrudní chirurgie a našich zkušeností.
Staging and re-staging of non-small cell lung carcinoma of the left upper lobe represents a multidisciplinary challenge for diagnostics and therapy of this serious disease. Neoadjuvant therapy is an established therapeutic approach for multimodal therapy of non-small cell lung carcinoma with pre-surgery diagnosed nodal spreading into the mediastinal compartment. The autonomy of lymphatic drainage of the upper left lobe causes that the cancer cells produce primary lymphatic metastases in the aorta-pulmonary (A-P) window area. These lymphatic nodes are also a part of nodal compartment of the mediastinum. However, they are localized beyond the reach of the conventional staging methods. Therefore, even in spite of negative mediastinoscopy and CT, N2 spreading into the A-P window area can be proven intra-operationally. Establishment of invasive staging during suspected positivity of the A-P window nodes might be of therapeutic benefit for selected patients, in terms of primary induction therapy prior to surgical resection. The aim of this review is to pinpoint and highlight the known issues with staging and re-staging of non-small cell lung carcinoma of the upper left lobe based on revised guidelines of the European Association of Thoracic Surgery and our experience.
- Klíčová slova
- levý horní plicní lalok, aortopulmonální okno, reevaluace stagingu nodálního statusu,
- MeSH
- biopsie metody využití MeSH
- chirurgie plic metody využití MeSH
- diagnostické zobrazování metody normy využití MeSH
- kombinovaná terapie metody normy využití MeSH
- lidé MeSH
- metastázy nádorů diagnóza terapie MeSH
- nádory plic diagnóza etiologie terapie MeSH
- nemalobuněčný karcinom plic * diagnóza chirurgie terapie MeSH
- neoadjuvantní terapie metody normy využití MeSH
- přežití po terapii bez příznaků nemoci MeSH
- směrnice pro lékařskou praxi jako téma normy MeSH
- staging nádorů * metody normy využití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
