The European Working Group for Breast Screening Pathology (EWGBSP) used a series of digital images in order to assess the reproducibility of the distinction between the Tumour Node Metastasis (TNM) categories of isolated tumour cells (ITC) and micrometastasis in lymph nodes.
Please, read this carefully:
The files are all of the screen-acceptable 1MegaPixel type, with as small compression as possible.
The .jpg filenames are composed of 4 consecutive elements:
- "A" for starting the case (all files have this element without exception; most softwares would put teh cases in increasing order because a letter precedes the case identifying / labelling number);
- A number follows the "A", this is the case number (0<51, as there are 50 cases);
- A single letter ("A" to "D") follows the number (as several pictures were (might have been) taken from one case, these make the distinction between them – "A" is always for a lower magnification);
- Another letter for the magnification: "L": low power (x40), "M": medium power (x100), "H": high power (x400). You have a scale on the images, use a blank paper with a segment of equal size or a ruler to turn this scale to any directions wanted.
There is an Excel spreadsheet (REPORT.XLS in MS Office 2003 version) attached, and this may help you in replying. You can print it out and fill it in. (This may be the best way, because Excel may fill in cells for you automatically if you mistype the first letter… this is why I preferred 3 letter answers everywhere. This may also help to read less nice handwriting.)
These are the columns in the spreadsheet:
A: Case ID for identification of the cases. (The number in parenthesis gives you the number of images available for the given case: generally BUT NOT ALWAYS 2)
B: Give a diagnostic category for the whole case (all the images of the cases together)
You have to rate each case as one single entity (eg: Case “n” [Cn] is a micrometastasis, with one focus…etc) and you do NOT have to report the parts of a given case separately (eg: CnAM is a micrometastasis but CnBH is an isolated tumour cell...etc)
Chose from the 3 categories available and use only these 3 options when filling in this column:
- ITC: isolated tumour cells(s),
- MIC: micrometastasis
- OTH: anything else (other: e.g. if you consider this is a macrometastasis, artifact, not a metastasis...; remember the study is centred on the distinction between micrometastasis and isolated tumour cells)
C: If other then what?: If you indicated OTH in column “B”, please give what you think the picture shows.
D: Single focus or Multiple?: Specify whether you think that the case has a single focus of whatever type, or whether it has multiple foci of whatever type. (In the second case, categorize the whole lesion on the basis of the largest lesion). Use only one of the 2 categories available: SIN: single; MUL: multiple
E: If Multiple how many?: If you indicated MUL in column D, you should give a number here (the number of foci you think on the given case, OR repeat MUL, if there are two many foci to count, or the foci are >4.
F: pN what?: Give the pN category of the pTNM (7th edition) you consider adequate for this type of nodal involvement. Possibilities:
- pN0: not a metastasis and not isolated tumour cells;
- pN0(i+): not a metastasis, but isolated tumour cells;
- pN1mi: micrometastasis;
- pN1a: (macro)metastasis, i.e. greater than 2 mm.
G: Self confidence: Please give Y (yes) if you think that the case is straight forward, and you are absolutely confident on its reporting or N (no) if you think that the case is somewhat controversial, and you are somewhat uncertain of you diagnosis / classification.
H: Comment: Any comments you feel necessary for later discussion.
Therefore you have to fill in:
all cells of column B (ITC, MIC or OTH), column F (pN0, pN0(i+), pN1mi or pN1a) column D (SIN or MUL) and column G (Y or N)
selected cells of column C (all after B=OTH), column E (all after D=MUL; a number, or MUL again) and column H (up to you).
Questionnaires evaluating the practice of Ki-67 evaluation:
Download Questionnaire A.
Download Questionnaire B.