The edition · Pathology
A cutoff-free invasive-front marker beat tumour budding for node risk in pT1 colorectal cancer
In 2,611 pT1 cancers from six Chinese centres, any non-glandular tumour focus at the front predicted nodal metastasis more consistently than budding or poorly differentiated clusters. Also: upgrade after vacuum biopsy of B3 breast lesions, MTAP by IHC versus NGS, the histology of CDK4/6 inhibitor liver injury, and confocal margins in Mohs surgery.
The edition in brief
A multicentre Chinese study of 2,611 resected pT1 colorectal cancers defined peritumoral malignant cellular foci as any non-glandular focus of one or more tumour cells at the invasive front. Unlike tumour budding and poorly differentiated clusters, it was independently associated with lymph node metastasis in both training and validation cohorts, and more strongly with apical (D3) nodes. Guidelines still use budding; this is a candidate to record, not yet to replace it. A meta-analysis found 11.2% of B3 breast lesions diagnosed on vacuum-assisted biopsy were upgraded to malignancy, with very low certainty. In 105 lung cancers, MTAP immunohistochemistry agreed with NGS in 97.3% after quality control, and IHC was more sensitive when tumour content was low. Seven biopsied cases of CDK4/6 inhibitor liver injury, mostly ribociclib, showed zone 3 confluent necrosis and lymphocytic cholangitis, and all resolved after withdrawal. Ex vivo fluorescence confocal microscopy matched conventional histology on 96.4% of Mohs margins. The pearl covers fixation time for breast biomarker testing.
About one in nine B3 lesions on vacuum biopsy is upgraded to malignancy
Report B3 lesions by specific type and atypia status, because the overall upgrade risk of about 11% hides a wide range.
MTAP loss in lung cancer: IHC and NGS largely agree
Use MTAP immunohistochemistry as a reliable alternative to NGS, particularly when tumour content is low.
What CDK4/6 inhibitor liver injury looks like on biopsy
Consider CDK4/6 inhibitor injury when a breast cancer patient's liver biopsy shows zone 3 necrosis with lymphocytic cholangitis.
Confocal microscopy agreed with histology on Mohs margins
Consider ex vivo confocal microscopy a credible option for Mohs margins where the equipment and trained readers exist.
Breast biomarkers need six to 72 hours in formalin
Fix breast specimens for six to 72 hours in neutral buffered formalin, and record the times, before trusting a negative biomarker.
Any non-glandular focus at the front predicted nodes in pT1 colorectal cancer
Keep reporting budding, and consider noting any non-glandular tumour foci at the invasive front of pT1 colorectal cancer as an added risk marker.
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