Assigning site of origin in non-uterine high-grade serous cancers: Bridging the gap between research and clinical practice
Notice bibliographique
Résumé
Background and aims: In research studies it is now evident that the majority of high-grade serous ovarian cancers (HGSC) starts in the fallopian tube. However, this is not reflected in clinical practice. The criteria for assigning tubal origin used in research studies rely on identifying serous tubal intraepithelial carcinoma (STIC), or tubal mucosa involvement (TMI) in fallopian tubes examined in toto (examined in 2-mm section). The clinical criteria currently used recommended by the FIGO (International Federation of Gynecology and Obstetrics) and WHO (World Heath Organization) are based on the location of the dominant tumour mass. Recently, a consensus proposal based on research criteria has been put forward by a group of academic pathologists for adoption in clinical practice. However, there are concrete difficulties in applying research criteria to clinical practice. The reason for this is that routinely examining the fallopian tubes in toto is perceived as difficult to implement, STIC is difficult to standardize, and TMI has been challenged as a reliable criterion. This study aims to bridge the gap between research studies and clinical practice by evaluating what is currently done in clinical practice in comparison to the new recommendations relating to correct assignment of fallopian tube primary. This is done by examining all consecutive cases reported as ovarian, primary peritoneal, tubal cancer in a tertiary care gynecologic oncology center over a seven-year period. Therefore, the specific aim of this study is to evaluate which of the criteria proposed is already in use at our institution, and which is not and should be implemented. Methods: Retrospective analysis of all surgical pathology reports signed out as cancer of the ovary, peritoneum or fallopian tubes at a publically funded cancer centre relating to cytoreductive surgeries performed between January 2007 and December 2013. Surgical pathology reports were examined to identify pragmatic criteria for clinical adoption. Results: During the study period of 277 cases, 215 (125 HGSC and 90 non-HGSCs) had fallopian tubes examined in toto, which represents 91% of the cases. The primary was assigned as ovary, peritoneum, fallopian tube, tubo-ovarian and uncertain in 48%, 17.6%, 19.2%, 8.8%, and 6.4% respectively of HGSC cases vs. 95.6%, 1.1%, 3.3%, 0%, and 0% respectively of non-HGSCs. (STIC) was seen only in 12.8% of HGSC and TMI in 56%. If TMI was used systematically as a criterion to assign tubal origin, the assigned primaries would be: 29.6% primary ovarian cancers, 11.2% primary peritoneal, 56 % tubal and 3.2% uncertain. We then compared the frequency of TMI in HGSC vs non-HGSCs and we found that only five cases of non-HGSCs had TMI. Discussion: These results suggest that all components of the proposed criteria, examination of the tubes in toto, identification of STIC and TMI, is already being done. However, it was not used to assign site of origin. Therefore, the proposed criteria appear to be implementable. Conclusion: Examination of the fallopian tubes in toto and meticulous reporting of TMI appear feasible in clinical practice and may help bridge the gap between research and clinical practice. Increasing the proportion of HGSC cases attributed to tubal primary and correctly assigning site of origin of HGSC is of clinical importance because it has implications for screening and early detection.Key words: fallopian tube cancer, STIC, tubal mucosa, origin of HGSC
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 | 0,044 | 0,125 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,005 | 0,005 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,004 | 0,004 |
| Science ouverte | 0,003 | 0,004 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
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 ».