Pathology
AGA Clinical Practice Update on Screening and Surveillance in High-Risk US Populations for Gastric Cancer: Expert Review
25 Dec, 2024 | 11:02h | UTCIntroduction:
This American Gastroenterological Association (AGA) Clinical Practice Update provides guidance on primary and secondary prevention strategies for gastric cancer (GC) among high-risk groups in the United States. GC disproportionately affects racial and ethnic minorities, certain first-generation immigrants from countries with elevated GC incidence, and individuals with specific hereditary syndromes or family histories of GC. Given ongoing disparities in diagnosis and outcomes, this document outlines best practices for recognizing at-risk individuals, performing high-quality endoscopic screening, and establishing surveillance protocols for gastric precancerous conditions.
Key Recommendations:
- Identify High-Risk Groups: Consider screening among first-generation immigrants from high-incidence regions, people with a family history of GC in a first-degree relative, individuals with hereditary gastrointestinal syndromes, and patients with multiple risk factors (eg, chronic Helicobacter pylori infection, smoking, diets high in salt and processed meats).
- Preferred Screening Modality: Upper endoscopy is considered the best method for detecting precancerous lesions (atrophic gastritis and intestinal metaplasia) and early malignancies. It allows direct visualization of the gastric mucosa, systematic biopsy, and accurate histologic staging.
- High-Quality Endoscopic Examination: Essential elements include high-definition endoscopes, optimal mucosal cleansing and insufflation, adequate inspection time, systematic photodocumentation, and biopsy protocols (such as the updated Sydney System) to detect and characterize precancerous changes or early cancer.
- H. pylori Eradication: Opportunistic screening for H. pylori and its eradication are key adjunctive measures in preventing GC development. Family-based testing—screening adult household members of H. pylori–positive individuals—may further reduce reinfection rates and disease progression.
- Systematic Biopsy Protocols: When atrophic gastritis or intestinal metaplasia is suspected, obtain at least five biopsies (antrum/incisura and corpus in separate containers). Any suspicious lesion should be sampled independently.
- Recognition of Metaplasia and Dysplasia: Endoscopists should be trained to accurately identify visual patterns associated with gastric intestinal metaplasia (GIM) and dysplasia. Artificial intelligence may hold promise, but current data are insufficient to recommend routine use.
- Risk Stratification and Surveillance Intervals: Patients with confirmed GIM or dysplasia, especially those with severe or extensive metaplasia, may require follow-up endoscopy every three years. Individuals with multiple risk factors or severe metaplastic changes could benefit from shorter intervals.
- Management of Dysplasia and Early GC: All dysplasia should be reviewed by an expert gastrointestinal pathologist. Visible high-grade dysplasia or early GC lesions generally warrant endoscopic submucosal dissection (ESD) at specialized centers to achieve en bloc, R0 resection and enable accurate pathology.
- Post-Resection Surveillance: Individuals with successfully resected dysplasia or early cancer need ongoing endoscopic surveillance to detect metachronous lesions. Surveillance intervals vary depending on pathology results and patient-level factors.
- De-Escalation of Screening: Discontinue screening or surveillance when the patient is no longer fit for potential endoscopic or surgical treatment.
- Equity and Sustainability: To reduce GC mortality, it is crucial to address modifiable risk factors, enhance patient access to endoscopy and skilled practitioners, and integrate research advances, especially in noninvasive biomarker development and improved endoscopic technologies.
Conclusion:
An effective US-based GC screening and surveillance program requires robust preprocedural identification of high-risk individuals, intraprocedural adherence to quality endoscopy standards, and consistent postprocedural follow-up to ensure equitable access to treatment. By refining these clinical practices and prioritizing research, meaningful reductions in GC incidence and mortality can be achieved, ultimately improving patient outcomes and addressing healthcare disparities.
Reference:
Shah SC, Wang AY, Wallace MB, Hwang JH. AGA Clinical Practice Update on Screening and Surveillance in Individuals at Increased Risk for Gastric Cancer in the United States: Expert Review. Gastroenterology. Published online December 23, 2024.
https://doi.org/10.1053/j.gastro.2024.11.001
Study Shows High Prevalence of Solid Lung Nodules in Nonsmoking Adults – Radiology
14 Aug, 2024 | 13:14h | UTCStudy Design and Population: This cohort study examined the prevalence and size distribution of solid lung nodules in a nonsmoking population from the Northern Netherlands. A total of 10,431 participants aged 45 years and older, predominantly nonsmokers, were included in the Imaging in Lifelines (ImaLife) study. The study utilized low-dose chest CT scans to detect and measure lung nodules.
Main Findings: Lung nodules were present in 42% of participants, with a higher prevalence in males (47.5%) than females (37.7%). The prevalence of clinically relevant nodules (≥100 mm³) was 11.1%, and actionable nodules (≥300 mm³) were found in 2.3% of individuals. Both prevalence and nodule size increased with age, and male participants consistently showed a higher prevalence and larger nodule sizes compared to females.
Implications for Practice: While 42% of nonsmoking adults in this Northern European cohort were found to have solid lung nodules, the incidence of lung cancer within this population is notably low. This suggests that many of the clinically relevant and even actionable nodules identified in nonsmokers are likely benign. These findings highlight the need to refine nodule management strategies for individuals at low risk of lung cancer, potentially reducing unnecessary follow-up and interventions in nonsmoking populations. Future research on lung cancer outcomes in this cohort could further inform and optimize guidelines for nodule management in low-risk groups.
Deep Learning Model Noninferior to Radiologists in Detecting Clinically Significant Prostate Cancer at MRI – Radiology
10 Aug, 2024 | 21:31h | UTCStudy Design and Population: This retrospective study evaluated the performance of a deep learning (DL) model for detecting clinically significant prostate cancer (csPCa) using multiparametric MRI (mpMRI) images from 5215 patients (5735 examinations) with a mean age of 66 years. The study included patients who underwent prostate MRI between January 2017 and December 2019 at a single academic institution. The DL model was trained on T2-weighted, diffusion-weighted, and contrast-enhanced MRI sequences, with pathologic diagnosis as the reference standard.
Main Findings: The DL model achieved an area under the receiver operating characteristic curve (AUC) of 0.89 on the internal test set and 0.86 on an external test set, demonstrating noninferiority to radiologists, who had AUCs of 0.89 and 0.84, respectively. Additionally, the combination of the DL model and radiologists improved diagnostic performance (AUC of 0.89). Gradient-weighted class activation maps (Grad-CAMs) effectively localized csPCa lesions, overlapping with true-positive cases in 92% of internal test set and 97% of external test set cases.
Implications for Practice: The DL model showed comparable performance to experienced radiologists in detecting csPCa at MRI, suggesting its potential to assist radiologists in improving diagnostic accuracy and reducing interobserver variability. Future research should focus on integrating the model into clinical workflows and assessing its impact on biopsy targeting.
Prospective Study: Enhanced detection of colorectal cancer and precancerous lesions with next-generation stool DNA testing
20 Mar, 2024 | 17:41h | UTCStudy Design and Population:
This prospective study evaluated the efficacy of a next-generation multitarget stool DNA test for colorectal cancer screening in asymptomatic adults aged 40 and older. The study encompassed 20,176 participants undergoing screening colonoscopy to determine the test’s sensitivity and specificity in detecting colorectal cancer and advanced neoplasia, including advanced precancerous lesions.
Main Findings:
The next-generation stool DNA test demonstrated a sensitivity of 93.9% for detecting colorectal cancer and a specificity of 90.6% for advanced neoplasia, significantly outperforming the fecal immunochemical test (FIT) in sensitivity for both colorectal cancer and advanced precancerous lesions. However, the test showed slightly lower specificity for advanced neoplasia compared to FIT. No adverse events were reported, indicating the test’s safety for screening purposes.
Implications for Practice:
The findings suggest that the next-generation multitarget stool DNA test offers a superior option for colorectal cancer screening, with significantly higher sensitivity for detecting cancer and advanced precancerous lesions than the currently available FIT. This advance in non-invasive screening technology could lead to earlier detection and treatment of colorectal cancer, potentially improving patient outcomes. Further research may focus on optimizing the balance between sensitivity and specificity to enhance the clinical utility of stool DNA testing.
Reference:
2023 ETA clinical practice guidelines for thyroid nodule management
12 Jul, 2023 | 13:48h | UTC
The 2023 Bethesda System for reporting thyroid cytopathology
12 Jul, 2023 | 13:46h | UTCThe 2023 Bethesda System for Reporting Thyroid Cytopathology – Thyroid
FIGO staging of endometrial cancer: 2023
29 Jun, 2023 | 13:53h | UTCFIGO staging of endometrial cancer: 2023 – Gynecology & Obstetrics
Review | Updates in immunohistochemistry for hematopoietic and lymphoid neoplasms
20 Jun, 2023 | 12:36h | UTC
ASCO Guideline Update | Human epidermal growth factor receptor 2 testing in breast cancer
14 Jun, 2023 | 14:15h | UTC
Review | Inflammatory lesions of the breast
2 Jun, 2023 | 12:10h | UTCInflammatory Lesions of the Breast – Archives of Pathology and Laboratory Medicine
Cohort Study | 5-mm margins may be adequate for T1a melanoma excision near critical structures
16 May, 2023 | 14:40h | UTCAssociation of Excision Margin Size With Local Recurrence and Survival in Patients With T1a Melanoma at Critical Structures – JAMA Dermatology (link to abstract – $ for full-text)
Commentary: Melanoma Excisions with 5 Millimeter Margins Linked to Less Risk of Local Recurrence – HCP Live
Commentary on Twitter
Study on thin melanomas (T1a) near critical anatomic sites such as the head and face showed that 5-mm surgical margins may be safe for patients and decrease reconstructive surgery and potential adverse, including scarring and mental issues. https://t.co/Mw7Ub4xMVX
— JAMA Dermatology (@JAMADerm) April 12, 2023
An update on the role of immunohistochemistry in the evaluation of pancreatic/liver/gastrointestinal luminal tract disorders
15 May, 2023 | 13:02h | UTC
2023 Rectal cancer lexicon update | Revised consensus on terminology and staging
15 May, 2023 | 12:50h | UTC
RCT | Cancer stem cell assay-guided chemotherapy improves survival of patients with recurrent glioblastoma
12 May, 2023 | 13:18h | UTCNews Release: ChemoID platform-predicted treatments lead to longer survival for glioblastoma patients – University of Cincinnati
Commentary on Twitter
Online now: Cancer stem cell assay-guided chemotherapy improves survival of patients with recurrent glioblastoma in a randomized trial https://t.co/y5GYCCgg3b
— Cell Reports Medicine (@CellRepMed) May 3, 2023
Review | Applications of artificial intelligence in breast pathology
9 May, 2023 | 14:36h | UTC
Cohort Study | Skin biopsy yields 88% sensitivity in detecting meningococcal Purpura Fulminans
5 May, 2023 | 15:15h | UTC
Review | Updated salivary gland immunohistochemistry
5 May, 2023 | 14:55h | UTCUpdated Salivary Gland Immunohistochemistry: A Review – Archives of Pathology & Laboratory Medicine
Researchers develop an AI-based method to replace chemical staining of tissue
4 May, 2023 | 13:48h | UTCNews Release: Researchers develop an AI-based method to replace chemical staining of tissue – University of Turku
Original Study: Unstained Tissue Imaging and Virtual Hematoxylin and Eosin Staining of Histologic Whole Slide Images – Laboratorial Investigation
What is acute kidney injury? A visual guide
4 Apr, 2023 | 14:02h | UTCWhat is acute kidney injury? A visual guide – Nature
Practice Guide | Acquiring tissue for advanced lung cancer diagnosis and comprehensive biomarker testing
9 Mar, 2023 | 14:04h | UTC
Gadolinium nanoparticles detected in kidney tissue of patients after MRI with gadolinium contrast, raising safety concerns
20 Feb, 2023 | 12:24h | UTCSummary: Researchers have discovered that tiny particles of the rare earth metal gadolinium can infiltrate kidney cells, potentially causing side effects. These particles, used to enhance MRI scans, were found in human and rodent specimens in a study that used electron microscopy to detect them. Gadolinium is typically tightly bound to chelating molecules in MRI contrast agents so that it can be eliminated via the kidneys, but the researchers found that some particles can leach out and build up in tissues. This raises questions about the safety of contrast agents containing gadolinium, which are used in around 50% of MRI scans, and highlights the need for further research into the risks and potential harms associated with these agents.
Commentary: Expert left ‘astounded’ by gadolinium discovery – Health Imaging
Recent advances in the classification of gynecological tract tumors: updates from the 5th edition of the WHO “Blue Book”
16 Feb, 2023 | 14:35h | UTC
Study shows non-diabetic kidney disease is prevalent among individuals with diabetes undergoing renal biopsy
15 Feb, 2023 | 15:41h | UTCCommentary: Non-Diabetic Kidney Disease Prevalent in Individuals With Type 2 Diabetes – Consultant 360
Single-arm phase 2 study | Neoadjuvant pembrolizumab in localized microsatellite instability high/deficient mismatch repair solid tumors
24 Jan, 2023 | 14:19h | UTCNeoadjuvant Pembrolizumab in Localized Microsatellite Instability High/Deficient Mismatch Repair Solid Tumors – Journal of Clinical Oncology (link to abstract – $ for full-text)
Commentary: Neoadjuvant Pembrolizumab in Localized MSI-H/dMMR Solid Tumors – The ASCO Post
Glomerulonephritis: immunopathogenesis and immunotherapy
17 Jan, 2023 | 13:12h | UTCGlomerulonephritis: immunopathogenesis and immunotherapy – Nature Reviews Immunology (if the link is paywalled, try this one)
Commentary on Twitter
A Review in @NatRevImmunol proposes a new grouping of glomerulonephritis disorders based on their underlying immunopathogenesis, with a view to improving diagnosis, mechanistic understanding and treatment of these immune-mediated kidney diseases. https://t.co/5EsGFBpU3K pic.twitter.com/KULbWS0xMz
— Nature Portfolio (@NaturePortfolio) January 15, 2023