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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.

The previous study used the definitions from the 6th edition of the TNM classification of breast cancers and found a less then optimal reproducibility of these diagnostic categories even after discussion and common interpretation of the definitions.

With the publication of the 7th edition, the study is/was repeated with the cases being mixed and relabelled. The cases of the repeated study are downloadable / accessible from here.

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:
  1. "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);
  2. A number follows the "A", this is the case number (0<51, as there are 50 cases);
  3. 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);
  4. 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:
  1. ITC: isolated tumour cells(s),
  2. MIC: micrometastasis
  3. 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)
Use TNM 7th edition definitions for distinctions: p434 and p449-451 of the attached document downloadable from the Springer homepage.

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:
  1. pN0: not a metastasis and not isolated tumour cells;
  2. pN0(i+): not a metastasis, but isolated tumour cells;
  3. pN1mi: micrometastasis;
  4. 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)
and
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).

Please send the original (readable electronic or hard copy as you prefer) report form to me, and keep a copy for yourself. Deadline is 30 June 2010. (Gabor Cserni, Bacs-Kiskun County Hospital, Nyiri ut 38., H-6000 Kecskemet, Hungary, Fax 00-36-76-481219 with my name clearly indicated, as this is a central fax; Ez az e-mail-cím a szpemrobotok elleni védelem alatt áll. Megtekintéséhez engedélyeznie kell a JavaScript használatát. )

Questionnaires evaluating the practice of Ki-67 evaluation:


Download Questionnaire A.
Download Questionnaire B.

Cases' Images:



A1AL
A1AL
A1BM
A1BM
A2AM
A2AM
A2BH
A2BH
A3AM
A3AM
A3BH
A3BH
A4AM
A4AM
A4BH
A4BH
A5AM
A5AM
A5BH
A5BH
A6AM
A6AM
A6BH
A6BH
A7AM
A7AM
A7BH
A7BH
A8AM
A8AM
A8BH
A8BH
A8CH
A8CH
A9AM
A9AM
A9BH
A9BH
A10AM
A10AM
A10BH
A10BH
A11AM
A11AM
A11BH
A11BH
A12AM
A12AM
A12BH
A12BH
A13AM
A13AM
A14AM
A14AM
A14BH
A14BH
A15AM
A15AM
A15BH
A15BH
A16AM
A16AM
A16BH
A16BH
A17AM
A17AM
A17BH
A17BH
A18AM
A18AM
A18BH
A18BH
A18CH
A18CH
A19AM
A19AM
A19BH
A19BH
A19CH
A19CH
A20AH
A20AH
A21AH
A21AH
A22AH
A22AH
A22BH
A22BH
A23AM
A23AM
A23BH
A23BH
A23CH
A23CH
A23DH
A23DH
A24AM
A24AM
A24BH
A24BH
A25AM
A25AM
A25BH
A25BH
A25CH
A25CH
A26AM
A26AM
A26BH
A26BH
A27AM
A27AM
A27BH
A27BH
A28AH
A28AH
A29AM
A29AM
A29BH
A29BH
A30AM
A30AM
A30BH
A30BH
A31AM
A31AM
A32AM
A32AM
A32BH
A32BH
A33AM
A33AM
A33BH
A33BH
A34AH
A34AH
A35AH
A35AH
A36AM
A36AM
A36BH
A36BH
A37AL
A37AL
A37BM
A37BM
A37CH
A37CH
A38AL
A38AL
A38BM
A38BM
A38CH
A38CH
A38DH
A38DH
A39AM
A39AM
A39BH
A39BH
A40AM
A40AM
A40BH
A40BH
A41AM
A41AM
A41BH
A41BH
A42AM
A42AM
A42BH
A42BH
A42CH
A42CH
A43AL
A43AL
A43BM
A43BM
A44AH
A44AH
A45AL
A45AL
A45BM
A45BM
A45CM
A45CM
A45DH
A45DH
A46AM
A46AM
A46BH
A46BH
A47AM
A47AM
A47BH
A47BH
A47CH
A47CH
A48AM
A48AM
A48BH
A48BH
A49AM
A49AM
A49BH
A49BH
A50AM
A50AM
A50BH
A50BH

 

Downloadable Contents

Read Me
DOCX DOC RTF ODT PDF

Report
XLSX XLS ODS

TNM 7th edition - Breast
Downloadable Sample pages 4
LINK

All Documents (With Pictures)
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