ABSTRACT
BACKGROUND: Signet ring cell (SRC) carcinoma is defined as an adenocarcinoma in which >50% of the total operative specimen consists of isolated or small groups of malignant cells containing intracytoplasmic mucins (hSRCs). We previously demonstrated that hSRCs are a predictor of poor prognosis with specific tumoral characteristics suggesting the need for a dedicated therapeutic strategy before surgery. However diagnostic accuracy and prognostic value of SRCs on pretreatment biopsies (bSRCs) is unknown. The aim of the study was to determine if bSRCs can accurately predict hSRCs and survival. METHODS: A retrospective analysis was performed among 254 patients with an adenocarcinoma. We performed pretreatment endoscopic biopsies and histopathologic analysis of the surgical specimen. Pretreatment endoscopic biopsy results were compared with definitive pathologic results and were correlated with long-term survival. RESULTS: From 254 patients enrolled, 96 had bSRCs (37.8%), and 101 (39.8%) had hSRCs. Pretreatment biopsy results were correct in 89 of 101 patients with hSRC (sensitivity 88.1%) and in 146 of 153 with histologic non-SRCs (hNSRCs) (specificity 95.4%). The positive and negative predictive values for the biopsies were 92.7, and 92.4%, respectively, with an overall accuracy of 92.5%. When compared to the biopsy results, non-SRCs (bNSRCs), bSRCs were associated with poorer survival and were identified as an independent factor for poor prognosis (hazard ratio 1.89 with 95% confidence interval 1.35 to 2.64, P < 0.001). CONCLUSIONS: The presence of signet ring cells in samples obtained from routine pretreatment endoscopic biopsies accurately predicts SRC histology and poor prognosis. The specific therapeutic strategy can consequently be considered from the initial diagnosis.
Subject(s)
Biopsy , Carcinoma, Signet Ring Cell/pathology , Gastroscopy , Preoperative Care , Stomach Neoplasms/pathology , Aged , Carcinoma, Signet Ring Cell/mortality , Carcinoma, Signet Ring Cell/surgery , Female , Follow-Up Studies , Gastrectomy , Humans , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Staging , Predictive Value of Tests , Prognosis , Retrospective Studies , Stomach Neoplasms/mortality , Stomach Neoplasms/surgery , Survival Analysis , Survival RateABSTRACT
Breast cancer in pregnancy is an uncommon situation but poses dilemmas for patients and their physicians. There is a paucity of prospective studies regarding diagnosis and treatment of breast cancer during pregnancy. Women diagnosed with breast cancer during pregnancy have similar disease characteristics to age-matched controls. Current evidence suggests that diagnosis may be carried out with limitations regarding staging. Surgical treatment may be performed as for non-pregnant women. Radiotherapy and endocrine or antibody treatment should be postponed until after delivery. Chemotherapy is allowed after the first trimester. Physicians should be aggressive in the workup of breast symptoms in the pregnant population to expedite diagnosis and allow multidisciplinary treatment without delay.
