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Öğe Calculation of the Ki67 index in pancreatic neuroendocrine tumors: A comparative analysis of four counting methodologies(Nature Publishing Group, 2015) Reid, Michelle Dian; Bağcı, Pelin; Ohike, Nobuyuki; Saka, Burcu; Erbarut Seven, İpek; Dursun, Nevra; Balcı, Serdar; Gucer, Hasan; Jang, Kee-Taek; Tajiri, Takuma; Baştürk, Olca; Kong, So Yeon; Goodman, Michael; Akkaş, Gizem; Adsay, VolkanKi67 index is now an essential part of classification of pancreatic neuroendocrine tumors. However, its adaptation into daily practice has been fraught with challenges related to counting methodology. In this study, three reviewers used four counting methodologies to calculate Ki67 index in 68 well-differentiated pancreatic neuroendocrine tumors: (1) 'eye-ball' estimation, which has been advocated as reliable and is widely used; (2) automated counting by image analyzer; (3) manual eye-counting (eye under a microscope without a grid); and (4) manual count of camera-captured/printed image. Pearson's correlation (R) was used to measure pair-wise correlation among three reviewers using all four methodologies. Average level of agreement was calculated using mean of R values. The results showed that: (1) 'eye-balling' was least expensive and fastest (average time <1 min) but had poor reliability and reproducibility. (2) Automated count was the most expensive and least practical with major impact on turnaround time (limited by machine and personnel accessibility), and, more importantly, had inaccuracies in overcounting unwanted material. (3) Manual eye count had no additional cost, averaged 6 min, but proved impractical and poorly reproducible. (4) Camera-captured/printed image was most reliable, had highest reproducibility, but took longer than 'eye-balling'. In conclusion, based on its comparatively low cost/benefit ratio and reproducibility, camera-captured/printed image appears to be the most practical for calculating Ki67 index. Although automated counting is generally advertised as the gold standard for index calculation, in this study it was not as accurate or cost-effective as camera-captured/printed image and was highly operator-dependent. 'Eye-balling' produces highly inaccurate and unreliable results, and is not recommended for routine use.Öğe Field risk ("field-effect"/"field-defect") in the gallbladder and biliary tree: An under-recognized phenomenon with major implications for management and carcinogenesis(Nature Publishing Group, 2019) Reid, Michelle; Losada, Hector; Muraki, Takashi; Pehlivanoğlu, Burçin; Memiş, Bahar; Koshiol, Jill; Bağcı, Pelin; Seven, İpek Erbarut; Balcı, Serdar; Saka, Burcu; Dursun, Nevra; Jang, Keetaek; Ohike, Nobuyuki; Tajiri, Takuma; Goodman, Michael; Carlos Roa, Juan; Araya, Juan; Bellolio, Enrique; Sarmiento, Juan; Xue, Yue; Baştürk, Olca; Adsay, Volkan[Abstract Not Available]Öğe Field risk ("field-effect"/"field-defect") in the gallbladder and biliary tree: An under-recognized phenomenon with major implications for management and carcinogenesis(Nature Publishing Group, 2019) Reid, Michelle; Losada, Hector; Muraki, Takashi; Pehlivanoğlu, Burçin; Memiş, Bahar; Koshiol, Jill; Bağcı, Pelin; Seven, İpek Erbarut; Balcı, Serdar; Saka, Burcu; Dursun, Nevra; Jang, Keetaek; Ohike, Nobuyuki; Tajiri, Takuma; Goodman, Michael; Carlos Roa, Juan; Araya, Juan; Bellolio, Enrique; Sarmiento, Juan; Xue, Yue; Baştürk, Olca; Adsay, Volkan[Abstract Not Available]Öğe Substaging nodal status in ampullary carcinomas has significant prognostic value: Proposed revised staging based on an analysis of 313 well-characterized cases(Society of Surgical Oncology, 2015) Balcı, Serdar; Baştürk, Olca; Saka, Burcu; Bağcı, Pelin; Postlewait, Lauren Mc Lendon; Tajiri, Takuma; Jang, Kee-taek; Ohike, Nobuyuki; Kim, Grace Eun Hye; Krasinskas, Alyssa; Choi, Hyejeong; Sarmiento, Juan Martinez; Kooby, David; El-Rayes, Bassel; Knight, Jessica; Goodman, Michael; Akkaş, Gizem; Reid, Michelle Dian; Maithel, Shishir Kumar; Adsay, Nazmi VolkanBackground: Current nodal staging (N-staging) of ampullary carcinoma in the TNM staging system distinguishes between node-negative (N0) and node-positive (N1) disease but does not consider the metastatic lymph node (LN) number. Methods: Overall, 313 patients who underwent pancreatoduodenectomy for ampullary adenocarcinoma were categorized as N0, N1 (1–2 metastatic LNs), or N2 (?3 metastatic LNs), as proposed by Kang et al. Clinicopathological features and overall survival (OS) of the three groups were compared. Results: The median number of LNs examined was 11, and LN metastasis was present in 142 cases (45 %). When LN-positive cases were re-classified according to the proposed staging system, 82 were N1 (26 %) and 60 were N2 (19 %). There was a significant correlation between proposed N-stage and lymphovascular invasion, perineural invasion, increased tumor size (each p < 0.001), and surgical margin positivity (p = 0.001). The median OS in LN-negative cases was significantly longer than that in LN-positive cases (107.5 vs. 32 months; p < 0.001). Patients with N1 and N2 disease had median survivals of 40 and 24.5 months, respectively (p < 0.0001). In addition, 1-, 3-, and 5-year survivals were 88, 76, 62 %, respectively, for N0; 90, 55, 31.5 %, respectively, for N1; and 68, 34, 30 %, respectively for N2 (p < 0.001). Even with multivariate modeling, the association between higher proposed N stage and shorter survival persisted (hazard ratio 1.6 for N1 and 1.9 for N2; p = 0.018). Conclusions: Classification of nodal status in ampullary carcinomas based on the number of metastatic LNs has a significant prognostic value. A revised N-staging classification system should be incorporated into the TNM staging of ampullary cancers.
