There have been a number of new advances in Surgical Pathology – okay exciting for Surgical Pathologists who are known for their exciting demeanour.
STRUCTURED OR SYNOPTIC REPORTS FOR CANCER RESECTIONS.
These are reports with a set structure or template in which all relevant features for the type of disease being reported are included. The parameters are standardised and defined.
The Synoptic Report was intended to replace the narrative report which is prone to misinterpretation and which frequently lacked specific information.
A significant number of resections have synchronous tumours or incidental non-neoplastic pathology which complicate the issue. Setting out the information for multiple cancers is a challenge that has not been well handled by Information Technology.
We have retained a hybrid format for our cancer resection reports which combines the old with the new. For uncomplicated cases, the narrative microscopic description may be dropped in favour of the Synoptic Report.
We have opted to retain the SUMMARY as Synoptic Reports can be quite lengthy. You will have noticed that our reports are “upside down”. This places the “important” stuff at the top of the report and allows us to add supplementary reports without losing the additional information down the bottom. This report format has the added advantage of the SUMMARY being on the first page viewed in our web-based report page.
A cancer biomarker is a gene alteration or abnormal protein that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention (National Institute of Health).
Helix Pathology detects an increasing number of these by immunohistochemistry and in situ hybridization or, for gene alterations, through a referral laboratory.
Some routine Cancer Biomarkers are:
Breast Cancer: Oestrogen receptor, progesterone receptor, Her2 (immunohistochemistry & ISH) & Proliferation Index (Ki67)
Lung Cancer (non-small cell): ALK (ultrasensitive), PD-L1, ROS-1, molecular analysis
Colorectal: Mismatch Repair genes, BRAF (V600E), molecular analysis
Gastro-oesophageal & gastric cancer: E-cadherin, EBV, Mismatch Repair genes, Her2
Head & neck SCC: p16
Endometrial cancer: Oestrogen receptor, progesterone receptor, p53, Mismatch Repair genes
Diffuse large B cell lymphoma: bcl-6, MUM-1, CD10, c-myc, EBV, FISH for multiple hit lymphoma +/- PD-L1
Pancreatic & GI neuroendocrine tumours: Proliferation index (Ki67)
IN SITU HYBRIDIZATION (ISH):
In situ hybridization (ISH) uses tagged DNA sequences complementary to known in vivo DNA sequences. The tag can be a chromogen (colour detected by routine microscopy – CISH) or a fluorophor (fluorescent detected by a fluorescent microscope – FISH).
ISH can be specific for a gene such as Her2, EBV, high risk HPV or an immunoglobulin light chain. Translocations specific for certain neoplasms can be identified by ISH usually FISH. Referral laboratories usually perform FISH. Multiplex FISH, in which multiple targets can be tagged, is one area which may prove useful and we have a platform that lends itself to this.
Helix Pathology is hoping to increase its scope of testing in all these areas. So, watch this space.