Histopathology
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Review Meta Analysis
Prognostic value of tumour budding in oesophageal cancer: a meta-analysis.
Recently, tumour budding (TB) has been suggested as a strong prognostic marker in oesophageal cancer. The aim of this systematic review is to test the prognostic value of TB in oesophageal cancer by a meta-analysis of previously published studies. We systematically reviewed the literature related to TB by using the bibliographic databases of Scopus, PubMed, and Web of Science. ⋯ The meta-analysis of eligible studies revealed that TB is a significant prognosticator for overall survival in oesophageal cancer, with a risk ratio (RR) of 2.97 [95% confidence interval (CI) 1.81-4.85; P = 0.0023] in univariate analysis, and with an RR of 2.07 (95% CI 1.22-3.52; P = 0.017) in multivariate analysis. We conclude that a high TB score is a promising prognostic marker of poor survival in oesophageal cancer. Because of its simplicity, reproducibility and high predictive power, TB is strongly recommended to be included in the routine pathology report of oesophageal cancer.
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Review Meta Analysis
Prognostic value of tumour budding in oesophageal cancer: a meta-analysis.
Recently, tumour budding (TB) has been suggested as a strong prognostic marker in oesophageal cancer. The aim of this systematic review is to test the prognostic value of TB in oesophageal cancer by a meta-analysis of previously published studies. We systematically reviewed the literature related to TB by using the bibliographic databases of Scopus, PubMed, and Web of Science. ⋯ The meta-analysis of eligible studies revealed that TB is a significant prognosticator for overall survival in oesophageal cancer, with a risk ratio (RR) of 2.97 [95% confidence interval (CI) 1.81-4.85; P = 0.0023] in univariate analysis, and with an RR of 2.07 (95% CI 1.22-3.52; P = 0.017) in multivariate analysis. We conclude that a high TB score is a promising prognostic marker of poor survival in oesophageal cancer. Because of its simplicity, reproducibility and high predictive power, TB is strongly recommended to be included in the routine pathology report of oesophageal cancer.
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Health care is a high-risk industry, with most documented adverse incidents being associated with 'human factors' including cognitive and social skills termed 'non-technical skills'. Non-technical skills complement the diagnostic and specialist skills and professional attributes required by medical practitioners, including histopathologists, and can enhance the quality of practice and delivery of health-care services and thus contribute to patient safety. This review aims to introduce histopathologists to non-technical skills and how these pertain to everyday histopathological practice. ⋯ The generic non-technical skills are defined as situation awareness, decision-making, communication, teamwork, leadership, managing stress and coping with fatigue. Example scenarios from histopathology are presented and the contributions to outcomes made by non-technical skills are explained. Consideration of these specific non-technical skills as a component in histopathology training may benefit practitioners as well as assuring patient safety.
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An acute exacerbation is the development of acute lung injury, usually resulting in acute respiratory distress syndrome, in a patient with a pre-existing fibrosing interstitial pneumonia. By definition, acute exacerbations are not caused by infection, heart failure, aspiration or drug reaction. Most patients with acute exacerbations have underlying usual interstitial pneumonia, either idiopathic or in association with a connective tissue disease, but the same process has been reported in patients with fibrotic non-specific interstitial pneumonia, fibrotic hypersensitivity pneumonitis, desquamative interstitial pneumonia and asbestosis. ⋯ Biopsies may be extremely confusing, because the acute injury pattern can completely obscure the underlying disease; a useful clue is that diffuse alveolar damage and organizing pneumonia should not be associated with old dense fibrosis and peripheral honeycomb change. Consultation with radiology can also be extremely helpful, because the fibrosing disease may be evident on old or concurrent computed tomography scans. The aetiology of acute exacerbations is unknown, and the prognosis is poor; however, some patients survive with high-dose steroid therapy.
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The concept of fibrosis with emphysema is confused by the existence of two very different clinical/pathological scenarios: first, cases in which a diffuse fibrosing interstitial pneumonia, most commonly usual interstitial pneumonia (UIP), occurs in a patient with emphysema. This combination is largely of clinical interest because of its effects on pulmonary function and pulmonary hypertension, but can produce unusual appearances in surgical lung biopsies when the fibrotic areas are wrapped around emphysematous spaces. However, the underlying morphology of emphysema and UIP or other interstitial lung disease remains unchanged. ⋯ These lesions have been called 'respiratory bronchiolitis' (RB), 'respiratory bronchiolitis-interstitial lung disease' (RB-ILD), 'airspace enlargement with fibrosis', 'RB-ILD with fibrosis' and 'clinically occult interstitial fibrosis in smokers', but are probably all the same entity. Such changes are associated only rarely with the physiological or radiological features of an interstitial lung disease. Care should be taken when describing these lesions in biopsies so as not to give the impression that a diffuse interstitial lung disease is present.