The edition · Pathology
In small-bowel NETs, the mesenteric deposit's Ki67 predicted progression; the primary's did not
A Histopathology series favours staining the largest tumour deposit, Korean consensus sets out how to test pleural fluid and lavage for ctDNA, and MTAP proves an unreliable CDKN2A surrogate in peritoneal mesothelioma.
The edition in brief
In 75 jejunoileal well-differentiated neuroendocrine tumours with nodal or mesenteric spread, Ki67 measured in the largest mesenteric tumour deposit was the only index independently associated with progression (HR 1.22 per 1% increase); primary-tumour and nodal Ki67 were not, and in 68% of cases a node or deposit had a higher index than the primary. Korean consensus guidelines set out 15 recommendations for ctDNA testing on pleural effusion and bronchoalveolar lavage fluid in lung cancer, covering pre-analytical handling, validation and reporting; evidence is mostly from pleural fluid and only 21% of surveyed laboratories offered the test. In peritoneal mesothelioma, MTAP immunohistochemistry matched MTAP FISH well but agreed poorly with CDKN2A deletion (kappa 0.21), unlike pleural mesothelioma, so MTAP loss should be interpreted on its own rather than as a CDKN2A proxy at that site. Shallow whole-genome sequencing split 33 TP53-mutated multiple-classifier endometrial carcinomas into copy-number-high tumours, which carried all recurrences, and copy-number-low tumours with none. The pearl: apply the endometrial molecular classification in its fixed order.
Consensus recommendations for ctDNA testing on pleural fluid and lavage
Laboratories offering ctDNA testing on pleural fluid or lavage should validate it as a separate matrix and follow a written pre-analytical and reporting protocol.
MTAP loss does not stand in for CDKN2A deletion in peritoneal mesothelioma
In peritoneal mesothelioma, interpret MTAP loss on its own and use CDKN2A FISH when deletion status is needed.
Copy-number profiling splits TP53-mutated multiple-classifier endometrial cancers
Keep classifying multiple-classifier endometrial cancers by the current algorithm, but report TP53 detail; a copy-number-high subset may behave more aggressively.
Endometrial molecular classification has a fixed order
Apply the endometrial molecular classes in order: POLE, then mismatch repair deficiency, then p53, then no specific profile.
Small-bowel NETs: consider Ki67 on the largest mesenteric deposit
In jejunoileal NETs with mesenteric deposits, consider staining the largest deposit for Ki67 and report its index with the block it came from.
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