Coronal Serial Sequential Sampling of Breast Specimen in the Assessment of the Extent of Ductal Carcinoma In Situ
Notice bibliographique
Résumé
To the Editor.—We read with interest the articles of Dadmanesh et al1 and Grin et al.2 As pointed out by the authors, the extent of ductal carcinoma in situ (DCIS) is an important prognostic factor for local recurrence after segmental resection. As noted, the method of measurement based on the mammographic findings is often inaccurate. Measuring directly from the slide is appropriate if the lesion is present in its entirety on a single slide. This is usually not the case, however, and there is as yet no standard method for measuring the extent of disease in more extensive lesions. The authors compared the number of involved blocks method with the “gold standard” method, in which specimens were serially sectioned perpendicular to the long axis of the specimen and then submitted in toto. Sectioning breast mastectomy and segmental specimens using this technique tends to divide the region of DCIS involvement into multiple segments. We believe this makes the measurement of the size of DCIS more difficult and prone to error.As reported in our previous studies, we have had occasion to examine breast specimens (both mastectomy and segmental resection) by coronal sectioning (ie, parallel to the chest wall).3–6 In this technique, each sequential section had a thickness of 5 mm and resulted in the largest surface possible per slice. The grossly suspicious regions of these large coronal sections were submitted for microscopic examination by dividing the area in a grid pattern. When cut this way, the tissue blocks were also in the coronal plane. The assembled glass slides from each plane of coronal section will likely represent the largest section of DCIS in that plane of section. When no gross lesion is discernable, the sampling of multiple regions without destroying the anatomic relationship of the remaining tissue is possible when the sections are large and intact. This facilitates revisiting the gross specimen to take additional samples from regions of microscopic involvement.Ductal carcinoma in situ is a preinvasive malignant lesion typically involving the one major duct and its branches, as demonstrated by a 3-dimensional study.3 The process most often involves the duct system by continuous or discontinuous spread (with skipped areas of uninvolved duct) along the duct and its attributor branches and acini. Occasionally, DCIS involves more than one duct system, thought to be due to either true multicentric origins or via spread to the nipple skin and secondary extension into other duct system.We believe that coronal serial sequential sampling offers the following advantages:With respect to the superficial and deep resection margins not visualized in a coronal plane, serial sections perpendicular to the inked resection margins of all suspicious areas should be taken.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,022 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,003 | 0,003 |
| Science ouverte | 0,003 | 0,001 |
| Intégrité de la recherche | 0,007 | 0,008 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,003 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».