Diagnostic accuracy of primary liver cancer: implications for cancer registration.

AIMS AND BACKGROUND: We evaluated some standardized criteria for classifying incident cases of liver cancer into either primary liver cancer (PLC) or unspecified liver cancer (ULC) on the basis of the diagnostic examinations performed and their results. METHODS: A pilot hospital-based study (98 cases) was carried out in Verona, northern Italy, with the main aim of assessing the feasibility of the method. The same procedures were subsequently applied in a population-based study (349 cases) in Brescia, northern Italy. RESULTS: Diagnosis was made on histologic data in 38.7% and 41.8% of the hospital based and population-based studies, respectively, with a wide variation among different hospitals. The percentage of cases classified as PLC was 78.6% in the hospital-based study and 78.8% in the population-based study. No differences in the proportion of cases attributed to PLC were found according to patients' age and sex or hospital of admission. The repeatibility of the procedure was assessed by a cross-panel review of 198 cases, and concordance was found in 91.9% of them. CONCLUSIONS: An operational method for case definition of PLC based on the results of the diagnostic examinations currently performed and some suggestions for cancer registration are proposed.

pTNM stage distribution in breast cancer: a population-based survey in northern Italy. Collaborative Group of Pathologists for Cancer Registration in Verona.

AIMS AND BACKGROUND: The role of distribution by stage at diagnosis in breast cancer has been considered in many studies, with particular regard to evaluation of prognosis, impact of screening programs and quality of care. Nevertheless, international comparisons of descriptive data can be hampered by lack of homogeneity in staging methods. The TNM is presently the most common staging system used all over the world, although some criticism have been raised recently against its pragmatic value. The present study reports a population-based survey of pathologic TNM distribution in incident cases of female breast cancer in the Verona province, a geographical area of northern Italy covered by cancer registration. METHODS: All histologically proven incident cases of breast cancer were identified in the study period 1988-1990 and classified as for tumor size and nodal involvement according to the pathological TNM criteria. The type of surgical treatment was also registered for all cases diagnosed in 1990. RESULTS: one thousand two hundreds and fifty-four invasive and in situ breast cancers were observed and pT1 cases accounted for 44.4%. Nodal involvement was present in 41.5% of invasive cancers. A surgical treatment was performed in 1213 patients (96.7%). Axillary dissection was reported in 1080 cases, 820 of them (76.6%) having 10 or more lymph nodes examined. Radical mastectomy accounted for 74% of the 458 breast cancers diagnosed in 1990 and 31.6% of the eligible cases were conservatively treated. CONCLUSIONS: Cancer registries should be encouraged to report data on stage distribution in breast cancer (and in other malignancies). This practice could improve international comparisons and give an essential contribution to studies on survival, screening programs and quality of care.

Cancer registration: a feasibility study in northern Italy. The Collaborative Group of Pathologists for Cancer Registration in Verona.

A pilot study was carried out in the province of Verona, in the north-east of Italy, in order to assess the feasibility of establishing a population-based cancer registry in the area. The quality of routinely collected data, particularly histological diagnoses and hospital discharge codes, was evaluated for the year 1988. All the histologically confirmed incident cancers observed in the pathology departments of the study area were registered and compared to the expected cases. Moreover, computerised discharge codes were tested for accuracy in identifying hospitalised patients with cancer. Finally, the sensitivity of the two sources combined was measured (90.3%). This study could provide helpful information to cancer registries which intend to assess the quality of specific sources of data both for planning and periodical evaluation purposes.

'Malignant lymphoepithelial lesions' (undifferentiated ductal carcinomas of the parotid gland). Three case reports and review of the literature.

Three cases of the so-cassed malignant lymphoepithelial lesion occurring in women are described. The authors, however, prefer to label the lesion 'undifferentiated carcinoma of the parotid'. From an accurate review of the world literature it appears that 23 cases of such lesion have been reported, 22 arising in the parotid and 1 in the submandibular gland. The malignant lymphoepithelial lesion has been mainly encountered in Eskimos and the three cases of the present report are the first to have been evidenced in Europe. The malignant lymphoepithelial lesion is discussed from the taxonomic, nosologic, pathogenetic, diagnostic and therapeutic points of view. The lesion does not seem to be of an autoimmune nature, unlike the benign lymphoepithelial lesion which is generally regarded as an autoimmune disease.