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Morphometry in predicting survival in breast cancer
ABSTRACTS
6 Ll';4G CHANGES llq HYPEKTROPHIC CARDIOMYOPATHY, WITH EMPHASIS ON THE PULXONARY VASCL'LATURE
.
K. Chetty". A.G. Rose, P.J. C o m e r f o r d , D.A. Taylor. Departments of Anatomical Pathology and Cardiology, Ilniversity o f Cape Town and Grootr Schuur Hospital. Cape Town, South Africa. An autopsy analysis of the lung findings i n 13 cases ( i f hypertrophic cardiornyopathy (ttC?l) was undertaken wlth p a r c i c u l r r attention being focused on the pulmonary vessels.. Five of the 13 cases showed histopathological features of pulmonary veno-occlusive disease (PVOD). Furthermore. 4 of the 5 patients had severe pulmonary arterial hypertension, not a s c r i b a b l e to a simple back pressure effect of a failing Left ventricle. Other f i n d i n g s included: pulmonary oedema, congestion, bronchopneumonia ( 2 cases) and tuberculosis ( 2 cases). I t is felt that t h i s c o - e x i . s t e n c e i s more than merely a chance association. However, t h e s x a c t aetiological link i s n o t clear. Presenter: Dr Kunjan Chetty, Pathology Department, Bendigo and Northern District Base Hospital. Bendigo, V i c tor ia 3550.
.
SIMULTANEOUS MEASUREMENT OF NUCLEAR DNA CONTENT AND NUCLEAR MORPHOMETRY IN PARAFFIN SECTIONS OF PRIMARY BREAST TUMOURS USlNG VIDEO IMAGE ANALYSIS. D. Charalambous*. R. Stillwell. P. Smart. J. RQ& Department ot Anatomical Pathology, St Vincents Hospital, Melbourne and The University of Melbourne, 3065, and Goulburn Valley Base Hospital. Shepparton.
DNA aneuploidy has been shown to be prognostically significant in female breast cancer. Traditionally, pbidy studies have been carried out using flow cytometiy. With the development of video image analysis systems a method has become available whereby ploidy can be determined on paraffin sections. Simultaneous assessment of mean nuclear area for each tumour is possible and the potentialfor investigation of other parameters such as shape is also available. Simultaneous measurements of nuclear DNA content and mean nuclear area were performed on Feulgen stained, routinely paraffin processed tissue sections of 18 primary breast carcinomas retrieved from the archives of Goulburn Valley Base Hospital, Shepparton. Measurements were made using an MD30 video image analysis System, and data was recorded in pixels. 01 the 18 turnours assessed, 4 were diploid, 4 hyperdiploid and 10 aneuploid. The diploid tumour mean nuclear size ranged from 117.42183.57. while the hyperdiploid turnours had a range of 180.55-211.49, and the aneuploid turnours ranged from 80.23-278.64. Diploid and hyperdiploid tumurs show a tight range of values, while aneupbid turnours appear to have a wide variation in mean nuclear area. Although the sample size is small, there appears to be a pattern Of inter-relationship between these two indices emerging which warrants further investigation. Presenter: D. Charalambous, Dept. Anat. Path, SVH, Melbourne
MORPHOMETRY IN PREDICFING SURVIVALIN BREAST CANCER.
' INFLAMMATORY '
CELLS I N CORONARY PARAGANGLIA - ARE THEY SIGNIFICANT?
I.G. C h a r l t o n , R . A . Williams*, & J . Rode
Pathology Departments, Wangaratta D i s t r i c t Base H o s p i t a l Wangaratta, V i c t o r i a . St. Vincent's H o s p i t a l , Melbourne, V i c t o r i a . The normal histological appearance of coronary p a r a g a n g l i a (CP) is n o t w e l l documented. The small s i z e of t h e s t r u c t u r e s may h a v e d e t e r r e d p o t e n t i a l i n v e s t i g a t o r s from u n d e r t a k i n g s t u d i e s i n t o t h e i r a p p e a r a n c e , b o t h u n d e r normal p h y s i o l o g i c a l c o n d i t i o n s and i n a s s o c i a t i o n w i t h d i s e a s e p r o c e s s e s . I n a b r i e f i . n t r o d u c t o r y s t u d y , w e h a v e examined t h e a p p e a r a n c e of CP i n f i v e p e r s o n s who d i e d s u d d e n l y . Two were known to have pathological disorders (prolonged QT and b i l e d u c t c a r c i n o m a ) a n d t h e r e m a i n i n g t h r e e were a p p a r e n t l y h e a l t h y , d e a t h b e i n g d u e t o trauma and m y o c a r d i a l i n f a r c t i o n . CP were f o u n d i n all cases. An i n t e r e s t i n g and u n e x p e c t e d f i n d i n g w a s t h e p r e s e n c e of mast c e l l s and l y m p h o c y t e s i n a n d a r o u n d CP from a l l cases. It was previously t h o u g h t t h e p r e s e n c e of t h e s e c e l l s in a s s o c i a t i o n w i t h CP m i g h t l e a d t o e l e c t r i c a l i n s t a b i l i t y of the heart, resulting i n sudden & e a t h . The same c e l l s p r e s e n t i n CP of p a t i e n t s d y i n g a s a r e s u l t of trauma raises some d o u b t s a b o u t t h i s o b s e r v a t i o n , and l e a d s u s t o q u e s t i o n whether t h e y might p l a y a r e g u l a t o r y neurohormonal r o l e i n t h e CP o r a r e t h e y p r e s e n t a s a r e s u l t o f a g e r e l a t e d c h a n g e s . F u r t h e r i n v e s t i g a t i o n is r e q u i r e d t o answer these questions. P r e s e n t e r : Dr R i c h a r d Williams, P a t h o l o g y Department, WDBH.
D. LM.Tay., R.W. Brown', P.S.Bhathal., *Dept ofhatomical Pathology, The Royal Melbourne Hospital Vic 3050 and 'Melbourne Pathology, Collingwood.
To assess thevalueofmorphometryinpredictingprognosisofpatientswithinvasi~ breast cancer (BC) 102 patients with infitrating ductal and infiltrating lobular cancers were selected for study from the 5 ps up to 1979. Of these 46 died, 39 from BC and 7 from other causes. Among the cellular and nuclear features measured were mitotic activity index (MAI); cellularity index; N/C ratio; nuclear longest axis, shortest ads,area,perimeter, size, shape factor; and nucleolar area, perimeter and area to perimeter ratio. Two systems for histological grading of invasive BC were compared, the NSABP method and our modification of the WHO system. The number of axillarylymph nodes involved was also noted. The statisticallysignificant values for the 3 Cox Regression analyses (CRA) are shown below.
2
VARIABLES
Positive nodes > 3
MitoseJlOOO nuclei Modified WHO histo-grade (3.40) NSABP histo-grade (2.W 4.79
10.14 4.93 (1.40)
CF& 1: time to all deaths. CRA 2: time to B C - s p e F deaths. CRA 3 disease-free interval. ( ) not significant x1 = 3.84
6.22 (0.89) 10.461
Of all the morphometric data mitoseJ1000 cells achieved the highest statistical signiIicancein separatingsurvivorskom non-survivors and was also the single most important feature in both the NSABP grading method and our modified WHO histological grading scores. Of the 3 pressions, the BC-specific death regression (CRA-2) was considered the best (x2=29.4, p 3 or 5 3 will be useful in identifying and dassifying more accurately groups of patients of differing prognosis after the present learning set has been enlarged and tested against a new group of patients (test set) and subjected to statistical evaluation of the accuracy and sensitivity of the classificationrule.
6 Ll';4G CHANGES llq HYPEKTROPHIC CARDIOMYOPATHY, WITH EMPHASIS ON THE PULXONARY VASCL'LATURE
.
K. Chetty". A.G. Rose, P.J. C o m e r f o r d , D.A. Taylor. Departments of Anatomical Pathology and Cardiology, Ilniversity o f Cape Town and Grootr Schuur Hospital. Cape Town, South Africa. An autopsy analysis of the lung findings i n 13 cases ( i f hypertrophic cardiornyopathy (ttC?l) was undertaken wlth p a r c i c u l r r attention being focused on the pulmonary vessels.. Five of the 13 cases showed histopathological features of pulmonary veno-occlusive disease (PVOD). Furthermore. 4 of the 5 patients had severe pulmonary arterial hypertension, not a s c r i b a b l e to a simple back pressure effect of a failing Left ventricle. Other f i n d i n g s included: pulmonary oedema, congestion, bronchopneumonia ( 2 cases) and tuberculosis ( 2 cases). I t is felt that t h i s c o - e x i . s t e n c e i s more than merely a chance association. However, t h e s x a c t aetiological link i s n o t clear. Presenter: Dr Kunjan Chetty, Pathology Department, Bendigo and Northern District Base Hospital. Bendigo, V i c tor ia 3550.
.
SIMULTANEOUS MEASUREMENT OF NUCLEAR DNA CONTENT AND NUCLEAR MORPHOMETRY IN PARAFFIN SECTIONS OF PRIMARY BREAST TUMOURS USlNG VIDEO IMAGE ANALYSIS. D. Charalambous*. R. Stillwell. P. Smart. J. RQ& Department ot Anatomical Pathology, St Vincents Hospital, Melbourne and The University of Melbourne, 3065, and Goulburn Valley Base Hospital. Shepparton.
DNA aneuploidy has been shown to be prognostically significant in female breast cancer. Traditionally, pbidy studies have been carried out using flow cytometiy. With the development of video image analysis systems a method has become available whereby ploidy can be determined on paraffin sections. Simultaneous assessment of mean nuclear area for each tumour is possible and the potentialfor investigation of other parameters such as shape is also available. Simultaneous measurements of nuclear DNA content and mean nuclear area were performed on Feulgen stained, routinely paraffin processed tissue sections of 18 primary breast carcinomas retrieved from the archives of Goulburn Valley Base Hospital, Shepparton. Measurements were made using an MD30 video image analysis System, and data was recorded in pixels. 01 the 18 turnours assessed, 4 were diploid, 4 hyperdiploid and 10 aneuploid. The diploid tumour mean nuclear size ranged from 117.42183.57. while the hyperdiploid turnours had a range of 180.55-211.49, and the aneuploid turnours ranged from 80.23-278.64. Diploid and hyperdiploid tumurs show a tight range of values, while aneupbid turnours appear to have a wide variation in mean nuclear area. Although the sample size is small, there appears to be a pattern Of inter-relationship between these two indices emerging which warrants further investigation. Presenter: D. Charalambous, Dept. Anat. Path, SVH, Melbourne
MORPHOMETRY IN PREDICFING SURVIVALIN BREAST CANCER.
' INFLAMMATORY '
CELLS I N CORONARY PARAGANGLIA - ARE THEY SIGNIFICANT?
I.G. C h a r l t o n , R . A . Williams*, & J . Rode
Pathology Departments, Wangaratta D i s t r i c t Base H o s p i t a l Wangaratta, V i c t o r i a . St. Vincent's H o s p i t a l , Melbourne, V i c t o r i a . The normal histological appearance of coronary p a r a g a n g l i a (CP) is n o t w e l l documented. The small s i z e of t h e s t r u c t u r e s may h a v e d e t e r r e d p o t e n t i a l i n v e s t i g a t o r s from u n d e r t a k i n g s t u d i e s i n t o t h e i r a p p e a r a n c e , b o t h u n d e r normal p h y s i o l o g i c a l c o n d i t i o n s and i n a s s o c i a t i o n w i t h d i s e a s e p r o c e s s e s . I n a b r i e f i . n t r o d u c t o r y s t u d y , w e h a v e examined t h e a p p e a r a n c e of CP i n f i v e p e r s o n s who d i e d s u d d e n l y . Two were known to have pathological disorders (prolonged QT and b i l e d u c t c a r c i n o m a ) a n d t h e r e m a i n i n g t h r e e were a p p a r e n t l y h e a l t h y , d e a t h b e i n g d u e t o trauma and m y o c a r d i a l i n f a r c t i o n . CP were f o u n d i n all cases. An i n t e r e s t i n g and u n e x p e c t e d f i n d i n g w a s t h e p r e s e n c e of mast c e l l s and l y m p h o c y t e s i n a n d a r o u n d CP from a l l cases. It was previously t h o u g h t t h e p r e s e n c e of t h e s e c e l l s in a s s o c i a t i o n w i t h CP m i g h t l e a d t o e l e c t r i c a l i n s t a b i l i t y of the heart, resulting i n sudden & e a t h . The same c e l l s p r e s e n t i n CP of p a t i e n t s d y i n g a s a r e s u l t of trauma raises some d o u b t s a b o u t t h i s o b s e r v a t i o n , and l e a d s u s t o q u e s t i o n whether t h e y might p l a y a r e g u l a t o r y neurohormonal r o l e i n t h e CP o r a r e t h e y p r e s e n t a s a r e s u l t o f a g e r e l a t e d c h a n g e s . F u r t h e r i n v e s t i g a t i o n is r e q u i r e d t o answer these questions. P r e s e n t e r : Dr R i c h a r d Williams, P a t h o l o g y Department, WDBH.
D. LM.Tay., R.W. Brown', P.S.Bhathal., *Dept ofhatomical Pathology, The Royal Melbourne Hospital Vic 3050 and 'Melbourne Pathology, Collingwood.
To assess thevalueofmorphometryinpredictingprognosisofpatientswithinvasi~ breast cancer (BC) 102 patients with infitrating ductal and infiltrating lobular cancers were selected for study from the 5 ps up to 1979. Of these 46 died, 39 from BC and 7 from other causes. Among the cellular and nuclear features measured were mitotic activity index (MAI); cellularity index; N/C ratio; nuclear longest axis, shortest ads,area,perimeter, size, shape factor; and nucleolar area, perimeter and area to perimeter ratio. Two systems for histological grading of invasive BC were compared, the NSABP method and our modification of the WHO system. The number of axillarylymph nodes involved was also noted. The statisticallysignificant values for the 3 Cox Regression analyses (CRA) are shown below.
2
VARIABLES
Positive nodes > 3
MitoseJlOOO nuclei Modified WHO histo-grade (3.40) NSABP histo-grade (2.W 4.79
10.14 4.93 (1.40)
CF& 1: time to all deaths. CRA 2: time to B C - s p e F deaths. CRA 3 disease-free interval. ( ) not significant x1 = 3.84
6.22 (0.89) 10.461
Of all the morphometric data mitoseJ1000 cells achieved the highest statistical signiIicancein separatingsurvivorskom non-survivors and was also the single most important feature in both the NSABP grading method and our modified WHO histological grading scores. Of the 3 pressions, the BC-specific death regression (CRA-2) was considered the best (x2=29.4, p