Archana A. Randale

Abstract

Introduction: Breast cancer has been ranked number one cancer among the Indian females surpassing the incidence of cervical cancer. Multiple clinico-pathological-molecular prognostic factors are available in decision making about potentially suitable treatment options for breast cancer. Among all, Nottingham Prognostic Index (NPI) is the most powerful integrated index. Present study aimed to evaluate the significance of NPI in prognosis of operable breast cancer patients. Materials and Methods: This longitudinal (Descriptive) study was carried on 60 female patients of operable breast carcinoma at tertiary care centre in central India. Results: Two patients from good prognostic group (NPI3.4) (30%) had metastasis to bone & CNS. F rom moderate prognostic group ((NPI 3.4 - 5.4) (50%) , one patient had recurrence at previous surgical scar site and 3 patients had metastasis to liver, lung and supraclavicular lymph node each. However the worst outcome was found in patients from poor prognostic group (NPI > 5.4) (10%). Five patients from poor prognostic group had metastasis in liver, bone, CNS and lung with two patients had simultaneous metastasis in liver & bone. Four patients from poor prognostic group had death within two and half year s of primary diagnosis. Out of 60 patients, 34 patients had a follow up of more than 1000 days, so were included in statistical analysis of survival based on Cox Proportional Hazard Model. Among 7 variables, NPI was found to be statistically most significant with p value 0.001 Conclusion: Estimation of NPI is the powerful and reproducible index for assessing prognosis in patients with operable breast cancer in advanced resources deprived institute. Main strength of NPI lies in the fact that it is based on relatively simple data which can be provided in routine histopathology report of carcinoma breast. Keywords: Operable breast cancer, Nottingham prognostic index (NPI), Utility in outcome.

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Abstract

Introduction: The colonoscopy along with mucosal biopsy interpretation forms a prime diagnostic tool in work of patients with lesional diversity of colorectal region. The study was conduted to evaluate the histomorphological spectrum of colorectal lesions on colonoscopic biopsies and correlate the microscopy (histomorphology) with colonoscopic diagnosis offered. Materials and Methods: The material consisted of 168 colonoscopic biopsies which were submitted to the Department of Pathology, Govt. Medical College & Superspeciality Hospital, Nagpur during the period of Jan 2014 –Dec 2016. The histopathological classification of these lesions was based on WHO. Statistical analysis was done by Open Epi Info software. Result: Out of 168 colonoscopicbiopsies, 116 were non-neoplastic and 52 were neoplastic. A higher frequency of colonic diseases occur in males with male: female ratio -1.4:1 and the age range was between 2yrs to 92 yrs. Among the non-neoplastic lesions, ulcerative colitis was most common diagnosis, with frequent age group involved was 41- 50 yrs. Uncommon but interesting lesions like amoebic colitis (2 cases), pseudo membranous colitis(1 case), Melanosis coli (1 case) & congestive colopathy (1 case) were also found. Hyper plastic polyp & retention polyps were most common in non-neoplastic category while villous adenoma with dysplasia’s was most common in neoplastic polyps. Among the neoplastic lesions, conventional adenocarcinoma was the commonest subtype with rectum as the most common site. Conclusion: Colonoscopy & Microscopy are the two sides of the coin which can be used effectively together not only in diagnosis &treatment of colorectal lesions but alsosurveillance of inflammatory bowel disease. As 48% of overall malignant lesions occurred in less than 50yrs of age, due importance should be given to colonoscopic screening to detect early colorectal neoplasm. Keywords: Colonoscopy, Colorectal carcinoma, Dysplasia, Microscopy (histomrphology), Ulcerative colitis, Villous adenoma.

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