Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, IL, USA.
Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, IL, USA.
Pathol Res Pract. 2022 Sep;237:154070. doi: 10.1016/j.prp.2022.154070. Epub 2022 Aug 10.
Lymph node metastasis is the most important prognostic factor for breast cancer patients. In addition to the number of nodes involved and the largest metastatic focus, extranodal extension (ENE) is also used to subclassify breast cancer patients into different risk groups. More recently, pathologists are required to report the size/extent of ENE per the new CAP guideline, as it seems to be associated with more axillary nodal burden and/or a worse prognosis. Although the definition of ENE is largely understood and agreed upon among pathologists around the world, evaluation and reporting for the size of ENE are not. To understand current practice, we conducted an international survey among pathologists who are interested in breast pathology. A total of 70 pathologists responded. The results showed that (1) 98% of the participants reported the presence or absence of ENE and 61% also reported the size of ENE in millimeter (mm). (2) There was no uniform method of measuring the size of ENE; 47% measured the largest dimension regardless of orientation, while 30% measured the largest perpendicular distance from the capsule. (3) The most common factors affecting the accuracy in diagnosis of ENE are the presence of lymphovascular invasion (LVI), lack of capsule integrity, and the presence of fatty hilar or fatty replacement of a lymph node. (4) 71% felt that the H&E stain is adequate to evaluate ENE, deeper levels and IHC analysis for vascular and cytokeratin markers can be helpful if needed. (5) 75% agreed that there is an urgent need to standardize the measurement and reporting for ENE. Our survey highlights the variation in ENE evaluation and the need for its standardization in breast cancer patients with axillary node metastasis.
淋巴结转移是乳腺癌患者最重要的预后因素。除了受累淋巴结的数量和最大转移灶外，还使用额外的淋巴结外扩散（ENE）来将乳腺癌患者分为不同的风险组。最近，根据新的 CAP 指南，病理学家被要求报告 ENE 的大小/范围，因为它似乎与更多的腋窝淋巴结负担和/或更差的预后相关。尽管 ENE 的定义在全球范围内的病理学家中得到了广泛的理解和认同，但对 ENE 大小的评估和报告并不一致。为了了解当前的实践情况，我们对有兴趣研究乳腺癌病理学的病理学家进行了一项国际调查。共有 70 名病理学家做出了回应。结果表明：（1）98%的参与者报告了 ENE 的存在或不存在，61%的参与者还以毫米（mm）报告了 ENE 的大小。（2）没有统一的方法来测量 ENE 的大小；47%的人无论方向如何都测量最大维度，而 30%的人则测量从包膜的最大垂直距离。（3）影响 ENE 诊断准确性的最常见因素是存在淋巴管血管侵犯（LVI）、包膜完整性缺失以及淋巴结存在脂肪门或脂肪替代。（4）71%的人认为 H&E 染色足以评估 ENE，如果需要，可以进行更深层次的水平和免疫组化分析，以评估血管和细胞角蛋白标志物。（5）75%的人同意迫切需要标准化评估和报告乳腺癌伴腋窝淋巴结转移患者的 ENE。我们的调查突出了 ENE 评估的变异性，以及在乳腺癌伴腋窝淋巴结转移患者中标准化评估的必要性。
