96. Jahrestagung der Deutschen Gesellschaft für Pathologie e. V ...

SO-022
Specialized pathology review in patients with ovarian cancer:
highly recommended to assure adequate treatment.
Results from a prospective study
S . Kommoss 1 , J . Pfisterer 2 , A . Reuss 3 , A . du Bois 4 , J . Diebold 5 , S . Hautmann 6 , D .
Schmidt 7 , F . Kommoss 7 , for the AGO study group 8
1 University of British Columbia, Department of Pathology, Vancouver, Canada,
2 Klinikum Solingen, Dept of Gynecology, Solingen, 3 Philipps-Universität
Marburg, Koordinierungszentrum für klinische Studien, Marburg, 4 Kliniken
Essen Mitte (KEM), Dept Gynecology & Gyn .Oncology, 5 Luzerner Kantonsspital,
Institute of Pathology, Luzern, Switzerland, 6 Institute of Pathology,
Allgäu-Oberschwaben, Wangen i . A ., 7 Institute of Pathology, A 2 , 2 , Mannheim,
8 AGO study group, Wiesbaden
Aims. In view of retrospective findings on second opinion pathology in
ovarian cancer it seems certain, that a considerable number of ovarian
borderline tumors (BOTs) or metastatic non-ovarian primaries are being
erroneously diagnosed as ovarian carcinomas. If BOTs are misdiagnosed
as cancer, patients may not only suffer from non-beneficial morbidity
at unnecessary high cost but may have to cope with an incorrect diagnosis
of cancer for the rest of their lives. In cases of metastatic disease
mistaken for an ovarian primary, more adequate therapeutic modalities
may be withheld from some patients. Finally, clinical trials may be biased
through disregarding of histological inclusion criteria. We hypothesized
that 5% of all patients in clinical trials of ovarian carcinomas have lesions
other than epithelial ovarian cancer. This is the first such study with a
prospective approach.
Methods. Patients who were enrolled into a chemotherapy trial of ovarian
carcinoma were asked to consent to a translational subprotocol. Contributing
pathologists were asked to submit all original slides as well as
paraffin material. Specialized central pathology review of all cases was
performed by two experienced gynecopathologists. In cases of clinically
relevant diagnostic discrepancies, the contributing pathologist was contacted.
If a given discrepancy could not be resolved, a panel of experts
was available for clarification.
Results. 454 patients with an outside diagnosis of ovarian epithelial
cancer were recruited. In 6.8% (n=31), a major diagnostic discrepancy
of potential clinical relevance was found. Most frequently (n=15), serous
BOTs had been misdiagnosed as invasive cancer. Ovarian metastases
constituted the second most frequent misdiagnosis (n=12). As minor discrepancies,
a divergent histological typing of ovarian carcinomas was
found in 28.2% (n=128).
Conclusions. This study clearly shows that central pathology review by
experienced gynecopathologists is highly recommendable if overtreatment
with chemotherapy of patients with BOTs and inadequate treatment
of patients with ovarian metastases is to be avoided in the future.
Specialized pathology review should become standard procedure in study
protocols prior to randomization. In order to further optimize the
quality of care, a high throughput infrastructure for specialized pathology
review will have to be established. The authors propose a internetbased
ovarian cancer network, capable of providing specialized second
opinion pathology within 10 working days.
SO-023
Development of a consortial database with pathological and
clinical data for fresh frozen breast cancer specimen
P . Bronsert1 , E . Stickeler2 , S . Schmid1 , K . Aumann1 , F . Haller3 , C . Röcken4 ,
N . Arnold5 , C . Mundhenke5 , F . Fend6 , A . Stäbler6 , T . Fehm7 , U . Vogel6 ,
M . Werner1 , O . Opitz8 1Albert-Ludwigs-University Freiburg, Institute of Pathology, Freiburg,
2Albert-Ludwigs-University Freiburg, Department of Obstetrics and
Gynecology, Freiburg, 3Friedrich-Alexander-University Erlangen-Nürnberg,
Institute of Pathology, Erlangen, 4Christian-Albrechts-University, Institute of
Pathology, Kiel, 5Christian-Albrechts-University, Department of Gynecology
and Obstetrics, Kiel, 6Eberhard Karls University Tübingen, Institute of
Pathology, Tübingen, 7Eberhard Karls University Tübingen, Department of
Gynecology and Obstetrics, Tübingen, 8Albert-Ludwigs-University Freiburg,
Tumour Center Ludwig Heilmeyer, Freiburg
Aims. Over the past two decades biomedical research technology in
tumor banking has enabled significant advances in the molecular characterization
of cancers, especially in research projects. Essential for the
functioning of a high quality tumor bank is a standardized implementation
of clinical and pathological information of tumor tissue. Each specific
specimen cohort reflects certain quality characteristics of a tumor
bank database and has to be handled in a certain manner. By combining
three independent breast cancer biobanks with two different disciplines
per facility together, it has to be assured, that each attendant is working
with synchronized and harmonized standard operating procedures
(SOP) and datasets.
Methods. At all three attended facilities rules of internal procedure were
defined, a Shared Resources Advisory was established, SOPs were partially
new elaborated, harmonized and synchronized. Minimal obligate
and facultative breast-cancer-specific, datasets for pathological and clinical
diagnoses were established. A periodically updated, secured database
with an automated combination of all consortial data was developed. A
web page for public presentation and research access was designed. To
attest effective consortial operation, tissue micro arrays (TMA) of a well
specified, facility research related, patient cohort were established, sectioned
and send to each facility where immunohistochemical staining
was performed. The results will be published in a consortial publication.
Results. From 2001 to 2011, the consortial breast cancer tissue bank contains
3400 fresh frozen, prospectively collected and immunohistochemically
classified breast cancer samples from all three facilities. Nearly
half of the patients were diagnosed with a ductal carcinoma in situ. The
median age was 61 years. The common pT category was pT1c (n=1063),
the most frequently pN category was pN0 (1693) followed by pN2 (n=197),
pN1 (194) and pN3 (82). 1113 patients were ER and/or PR and/or HER2/
neu positive. After written request, access for researchers to the consortial
internet accessible breast cancer database can be granted.
Conclusions. A well planed clinicopathological, IT linked infrastructure
is the fundament of a consortial database and the basic principle for multicentric
translational research.
Der Pathologe · Supplement 1 · 2012 |
67