Please, read this carefully.
In this study we have two series of cases so TWO circulations.
In the FIRST series/first circulation we have cases from 1 to 50. Each case has 5 jpg H&E slides named: a, b, c and d (which are at magnifications 5X, 10X, 20X, 40X, respectively) and e (which is also at 40X and this is the slide in which we should assess the DCIS nuclear grade if the diagnosis is "DCIS" or "DCIS with microinvasion" – these are the e labelled images following the a, b, c and d ones). You can access the slides at: http://www.kmk.hu/info/ewgbsp2/ You can also download the materials (slides, instructions and spreadsheet) at: http://www.kmk.hu/info/ewgbsp2/ 
 
You should fill in the accompanying spreadsheet, excel file and you should send it back to me, i.e. Gabor ( Ez az e-mail-cím a szpemrobotok elleni védelem alatt áll. Megtekintéséhez engedélyeznie kell a JavaScript használatát. and Ez az e-mail-cím a szpemrobotok elleni védelem alatt áll. Megtekintéséhez engedélyeznie kell a JavaScript használatát.). Deadline for this agreed in Neubrandenburg is 15 November. Those of you, who did the test in 2007, please ignore your previous results, and redo the series again; sorry for this (I did it myself). It would be nice, if you could record the time required for completing the 50 cases (if you do this in multiple sessions, make the addition of the session lengths), so please do it.
 
Because of previous experience with similar studies, may I just quote to you a text by our group about the definition. (This is at the end of this text – try to adhere to it as much as possible) 
 
We will start with the second series/second circulation two months after the end of the first circulation. You will receive the relevant information in due time.
 
The aim of the study is not only to assess the diagnostic reproducibility of microinvasion in H&E sections but also to see if IHC improves the diagnostic accuracy. 
In the First Circulation you should reply to the following questions (one column each in the excel file):
1. Diagnostic categories for non invasive carcinoma: DCIS or LCIS 
2. Nuclear grade for the DCIS component, when present, on the basis of the jpg image labelled “e”: H, I or L for High or Intermediate and Low, respectively 
3. DCIS growth pattern: CRI (cribriform) or PAP (papillary/micropapillary) or COM (comedo) or APO (apocrine) or MIX ( mixed) or OTH (other).
4. Presence or absence of necrosis in DCIS: Y (present) or N (absent).
5. Presence or absence of microinvasive carcinoma on the basis of H&E slides: Y (present) or N (absent). Please, note that there is no scale bar on the images so each case with definite invasion should be interpreted as a MICROINVASIVE CARCINOMA. 
6. Overall diagnosis on the basis of H&E slides: DCIS or LCIS or MIC (microinvasive carcinoma).
7. Certainty of diagnosis on the basis of H&E: please give Y (yes) if you are confident on its reporting or N (no) if you think that the case needs IHC.
 
*****
 
“Definition.
A tumour in which the dominant lesion is in-situ carcinoma (usually extensive high nuclear grade DCIS, rarely other types of DCIS or lobular intraepithelial neoplasia) but in which there are one or more clearly separate foci of infiltration of non specialized interlobular or interductal fibrous or adipose tissue, none measuring more than 1 mm (about 2 hpf) in maximum diameter. (27,28,29). This definition has been officially reported in the TNM system as pT1mic since 1997 (fifth edition)(30). It is very restrictive and tumours fulfilling the criteria are consequently rare.
 
Criteria.
 
The tumour focus/foci must invade into nonspecialized interlobular or interductal stroma (extension of the lesion beyond the confines of a ductolobular unit, development of a desmoplastic stroma). The cells deemed to be invasive must be distributed in a fashion (non-organoid pattern) that does not represent tangential sectioning of a duct or a lobular structure with in-situ carcinoma. Tangentially sectioned in-situ carcinoma foci that simulate microinvasion are distributed in the specialized periductal and intralobular stroma and usually occur as compact groups of tumour cells that have a smooth border surrounded by a circumferential layer of myoepithelial cells and stroma or a thickened basement membrane (29). At sites of microinvasive foci, tumour cells are distributed singly or as small groups that have irregular shapes reminiscent of conventional invasive carcinoma with no particular orientation (29). There is complete absence of surrounding basement membrane and myoepithelial cells: immunostains are helpful in demonstrating the presence or absence of basement membrane components (laminin and collagen type IV) or myoepithelial cells (smooth-muscle actin, calponin, smooth-muscle myosin heavy chain). Detecting microinvasion can be difficult when there is a marked periductal fibrosis or inflammation because the true boundary of the specialized periductal or lobular stroma is not clear, but immunostaining for cytokeratin may be useful to confirm the presence of separate foci of neoplastic cells embedded in periductal fibrosis or inflammation.”
 
E(C)WGBSP: Quality assurance guidelines for pathology. Wells CA (ed)
 
Download the whole package (ZIP)
 

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