Dr David Millan CONSULTANT PATHOLOGIST SCOTTISH GYNAECOLOGICAL - - PowerPoint PPT Presentation

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Dr David Millan CONSULTANT PATHOLOGIST SCOTTISH GYNAECOLOGICAL - - PowerPoint PPT Presentation

May 18, 2023 259 likes •449 views

Gynecologic Cancer InterGroup Translational Research Brainstorming October 2016 Lisbon Dr David Millan CONSULTANT PATHOLOGIST SCOTTISH GYNAECOLOGICAL CANCER GROUP Representative of the GCIG Pathology

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Dr David Millan

CONSULTANT PATHOLOGIST SCOTTISH GYNAECOLOGICAL CANCER GROUP Representative of the GCIG Pathology Liaison group




Gynecologic Cancer InterGroup
 Translational Research Brainstorming
 October 2016 Lisbon


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SLIDE 2

DESIGN OF GOOD STUDIES

START WITH A PATHOLOGICAL DEFINITION OF THE DISEASE UNDER STUDY




Gynecologic Cancer InterGroup
 Translational Research Brainstorming
 October 2016 Lisbon


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SLIDE 3

How important are pathological criteria?




Gynecologic Cancer InterGroup
 Translational Research Brainstorming
 October 2016 Lisbon


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Kommoss papers Ovarian tumours 2013 – specialist review- 6.8% patients had a major diagnostic ,clinically relevant discrepancy in comparison to the initial diagnosis 2016-change in definition of disease 2002 vs. 2014 46% cases changed histotype.




Gynecologic Cancer InterGroup
 Translational Research Brainstorming
 October 2016 Lisbon


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SLIDE 5

PATHOLOGY

TISSUE DISSECTION PROTOCOLS ARE ALSO ESSENTIAL SURGICAL TRIALS poor quality of surgical trials in cervical cancer




Gynecologic Cancer InterGroup
 Translational Research Brainstorming
 October 2016 Lisbon


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SLIDE 6

MANY TRIALS ARE DEVALUED OR INVALIDATED BY THE POOR QUALITY OF THEIR PATHOLOGICAL DEFINITION AND EVALUATION




Gynecologic Cancer InterGroup
 Translational Research Brainstorming
 October 2016 Lisbon


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SLIDE 7

How can we improve?

  • Trial specific pathology manual.
  • Definition of acceptable and applicable

diagnostic criteria

  • Histopathological features
  • Molecular profiling
  • Review-various mechanisms




Gynecologic Cancer InterGroup
 Translational Research Brainstorming
 October 2016 Lisbon


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SLIDE 8

THE PATHOLOGY MANUAL
 IS CONTRUCTED BY ALL THE 
 PATHOLOGISTS
 WORKING WITH THE PARTICIPATING TRIAL GROUPS
 
 JGOG- CCC Trial




Gynecologic Cancer InterGroup
 Translational Research Brainstorming
 October 2016 Lisbon


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SLIDE 9

Clear Cell Cytoplasm

Higher power view of CCC in which numerous enlarged, hyperchromatic, atypical and bizarre nuclei are easily identified.

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True yolk sac tumor in a young patient. Note classical Schiller-Duval bodies and prominent clear cells.

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TRIALS PATHOLOGY

  • Stringency of definitions
  • In ‘TRIAL’ terms pragmatism is needed in

diagnostic criteria

  • WHAT IS REASONABLE, OBVIOUS ,

ACCEPTABLE.

  • Determined by participating representative

and together with participating pathologists from the active trial groups.




Gynecologic Cancer InterGroup
 Translational Research Brainstorming
 October 2016 Lisbon


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GCIG PATHOLOGY QUALITY

  • REFLECTION OF THE TRIAL PATHOLOGY MANUAL AND ITS CLARITY

OF DIRECTION

  • RECOGNITION OF INTERNATIONAL ISSUES
  • ESSENTIAL HARMONISATION REQUIREMENT
  • IT RESOURCES
  • POTENTIAL FOR SHARING




Gynecologic Cancer InterGroup
 Translational Research Brainstorming
 October 2016 Lisbon


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PATHOLOGY REVIEW

  • DIFFERENT MODELS –slides and images
  • SHARING ….
  • TRIAL AND FUNDING DEPENDENT
  • INCORPORATION INTO TRIAL DESIGN AND

COSTING




Gynecologic Cancer InterGroup
 Translational Research Brainstorming
 October 2016 Lisbon


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Pathology Review

  • Part of standard diagnostic process e.g..

French system regional and national , U.K. MDT process.

  • Trial specific case review- diagnostic

criteria may be more stringent

  • International Review
  • Managing discrepancies




Gynecologic Cancer InterGroup
 Translational Research Brainstorming
 October 2016 Lisbon


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SLIDE 15

Once we have agreed that we are all studying the same disease entity and its stage




Gynecologic Cancer InterGroup
 Translational Research Brainstorming
 October 2016 Lisbon


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TRANSLATIONAL STUDIES

  • TRIAL DESIGN AND ETHICS
  • TISSUE COLLECTION
  • PATHOLOGICAL INVOLVEMENNT
  • STANDARDISATION
  • COLLABORATIVE STUDIES ,
  • AUTHORSHIP RIGHTS




Gynecologic Cancer InterGroup
 Translational Research Brainstorming
 October 2016 Lisbon


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SLIDE 17

Who has the tissue?




Gynecologic Cancer InterGroup
 Translational Research Brainstorming
 October 2016 Lisbon


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The Pathologist !




Gynecologic Cancer InterGroup
 Translational Research Brainstorming
 October 2016 Lisbon