Coronal Serial Sequential Sampling of Breast Specimen in the Assessment of the Extent of Ductal Carcinoma In Situ
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.022 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.007 | 0.008 |
| Insufficient payload (model declined to judge) | 0.003 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".