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Query: UMLS:C0009676 (confusion)
 21,692 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Errors in clinical staging of bladder carcinoma occur in about 50 per cent of patients. Sources of error include (1) a variable assortment of diagnostic studies performed, (2) inexactitudes inherent in the diagnostic measures employed, (3) insufficient corroboration by surgical and pathologic staging, (4) the lack of a satisfactory means for detecting micrometastases, and (5) a generalized confusion regarding the multiple classifications available for clinical staging. More precise clinical staging will be influential in treatment decision-making and in prognosis. Minimum requirements for clinical staging of the primary tumor currently include complete examination, excretory urography, cystoscopy, bimanual examination under anesthesia, and transurethral resection or biopsy. Polycystography, triple contrast cystograpy and arteriography may be helpful occasionally to document muscle invasion. Pedal lymphangiography and lymphography can in selected cases be helpful in detecting otherwise silent nodal involvement in spite of its inability to demonstrate many primary or regional lymph nodes. Familiarity with the above diagnostic options and the advantages and limitations of each is essential for each physician caring for a patient with bladder carcinoma. Conversion to TNM classification for bladder carcinoma that is similar to that of the UICC seems appropriate (1) because of its more rational approach to extent of involement by primary tumor, lymph node and distant sites, and (2) in order for our western hemisphere urologists to communicate better with our colleagues from around the globe. Such a system is now under consideration by a subcommittee of the American Joint Committee on Staging and End Result Reporting.
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PMID:Pitfalls in clinical staging of bladder tumors. 82 29

A chronological overview of the various staging systems for colorectal cancer is presented in an effort to demonstrate the reason for the current state of confusion. The Dukes 1932 system is considered to be the gold standard because of its simplicity and accuracy and is the system most often referred to in the literature. Number of positive nodes and depth of invasion are two variables that have been found to be predictors of survival. In the future, other prognostic factors such as nuclear morphology, flow cytometric characteristics, histological grade, and vascular or lymphatic invasion may also be entered into the staging equation. Use of the TNM system at this time is recommended since it most completely describes appropriate prognostic factors and allows conversion of other staging systems into a common format. Future modifications could logically evolve from the TNM system.
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PMID:Staging of colorectal cancer. 161 69

Proper classification of colorectal cancer has been critical in determining prognosis. Dukes' staging and its modifications have created considerable confusion. The TNM system has never been widely accepted because of its complexity. The Australian clinico-pathological staging (ACPS) system corresponds closely to Dukes' A, B, C-classification, but it differs from Dukes' in separating a stage D for incurable metastatic disease. Evaluating the compatibility of these 3 different staging systems, a survival analysis is presented of a group of 800 non-selected patients, resected in curative or palliative intention and compiled from the cancer registry of St. Gall-Appenzell. The prognostic importance of accurate staging for colorectal cancer is confirmed. No matter which system is used, in order to give realistic statements it must be based on tumor penetration, lymph node involvement and distant metastasis.
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PMID:Colorectal cancer: the relationship of staging to survival. A cancer registry study of 800 cases in St. Gallen-Appenzell. 371 27

At present, three major manuals for gastric cancer study are in use, the General rules of the Japanese Research Society (JRS), the TNM classification of the UICC, and the TNM classification of the American Joint Committee (AJC). Differences between these systems have produced considerable confusion and rendered comparison between different reports very difficult. In order to produce an internationally unified system of staging, a meeting was held in December 1984 in Hawaii between experts in gastric cancer representing the UICC, the AJC, and the JRS. A new TNM classification and staging was proposed at the meeting and was approved by the UICC, the AJC, and the JRS in 1985. In this paper, the background and evolution of the new classification are described, and end results of surgical treatment staged by this system are presented.
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PMID:[Improvement of Japanese general rules and the TNM classification of stomach cancer--a proposal for a new stage-grouping]. 378 67

Two major TNM classification systems are currently in use for staging cancer of the head and neck region, i.e. UICC and AJC. This causes confusion when attempting to exchange information and evaluate treatment results between Australia and certain overseas centres. The two systems are described and the effect of any differences on altering survival data is assessed by reviewing 234 cases of squamous carcinoma of the larynx, hypopharynx, oropharynx and oral cavity. The direct correlation between the two systems is established. Shortcomings of the systems are demonstrated and important variables not included in either TNM system are discussed.
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PMID:Head and neck cancer staging systems: a comparison between UICC and AJC. 386 80

Two major TNM classification systems are currently in use for staging cancer of the head and neck region, i.e. AJC and UICC. This results in confusion when attempting to evaluate treatment results and exchange information between overseas centres. The actual differences between these systems are described. The effect on 2 year survival is assessed by reviewing 898 cases of squamous carcinomas of the nasopharynx, larynx, oropharynx, hypopharynx and oral cavity. The direct correlation between the 2 systems is established suggesting that head and neck oncologists may communicate accurately, thus allowing optimal treatment for the patient to be selected. Shortcomings of the systems are presented and other important variables not included in either current TNM systems are discussed.
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PMID:Staging systems for cancer of the head and neck region--comparison between AJC and UICC. 664 Sep 95

The Authors try to show the possibility to combine radical excision with minimal invasiveness in the surgery of penile cancer. The focal point of every therapeutic decision is correct clinical staging. Unfortunately there's some confusion in the two international staging systems (TNM and Jackson's classification). In fact it's not clear the anatomical difference between epithelioma of the glans infiltrating corpus spongiosum and subcoronary epithelioma of the shaft infiltrating the corpora cavernosa. It's obvious that the infiltration of the corpora cavernosa is a far more aggressive oncological manifestation than that of tumour infiltrating the corpus spongiosum. So we consider Jackson's classification more congenial. In terms of surgery this anatomical independence makes it easy to consider the corpora cavernosa as a distinct entity, so they remain perfectly functional when separated from the glandulo-spongio-urethral unit with its vasculo-nervous bundle. This makes conservation of the erectile function, when clinical staging show us that the tumour is not infiltrating the corpora cavernosa. The Authors show their results, which seem to be rather good.
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PMID:[Erectile function and ablative surgery of penile tumors]. 801 24

Recently, the 1999/2004 World Health Organization (WHO) classification of adenocarcinoma became less useful from a clinical standpoint as most adenocarcinomas belonged to the mixed subtype and the term bronchioloalveolar carcinoma (BAC) gave rise to much confusion among clinicians. For these reasons a new adenocarcinoma classification was introduced in 2011 by a joint working group of the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS), and European Respiratory Society (ERS). This represents an international, multidisciplinary effort joining pathologists, molecular biologists, pulmonary physicians, thoracic oncologists, radiologists, and thoracic surgeons. Currently, a distinction is made between pre-invasive lesions, minimally invasive and invasive lesions. The confusing term BAC is not used anymore and new subcategories include adenocarcinoma in situ and minimally invasive adenocarcinoma. Several aspects of this classification are discussed with main emphasis on its correlation with imaging techniques and its impact on diagnosis, treatment and prognosis. On chest computed tomography (CT) a distinction is made between solid and subsolid nodules, the latter comprising ground glass opacities (GGO), and partly solid lesions. Several studies incorporating CT and positron emission tomographic (PET) data show a good imaging-pathologic correlation. With the implementation of screening programs early lung cancer has become a hotly debated topic and sublobar resection is currently reconsidered for early lesions without lymph node involvement. This new classification will also have an impact on the TNM classification. Thoracic surgeons will continue to play a major role in the application, evaluation and further refinement of this new adenocarcinoma classification.
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PMID:Pathologic classification of adenocarcinoma of lung. 2400 16

Size (the "T" in the TNM System) of invasive breast carcinoma is a proven independent prognostic factor; however, its accurate determination can be challenging. The purpose of this review is to discuss the complexities inherent in determining "T"-including those encountered in the clinical measurement ("cT", ie, physical and radiologic assessment) as well as pathologic determination (pT) of invasive breast carcinomas. Pathologic estimation of tumor size, macroscopic, as well as microscopic, can be problematic due to the complexity of multiple situations, seeming confusion regarding staging guidelines, and interobserver variation in interpretation. Additional problematic scenarios in determination of "T" include those incurred in excisions performed after the performance of needle core biopsies, and in cases wherein there are multiple foci of invasive carcinoma, as well as in carcinomas status post-neoadjuvant chemotherapy. It can also be difficult to determine "T" in certain types of invasive carcinoma, particularly those of the lobular type. In this communication, some of the complexities and challenges in determing "T" are discussed, and modest suggestions are offered to assist in optimizing such assessments.
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PMID:Complexities and challenges in the pathologic assessment of size (T) of invasive breast carcinoma. 2529 11

Distal urethral carcinomas are very rare and are similar in their pathology and behaviour to tumours of the glans penis and foreskin. Similarly they are associated with penile intraepithelial neoplasia (PeIN) of both differentiated and undifferentiated types. Current management is mainly surgical, but increasingly involves specialist penile-preserving techniques. Handling and dissection of the specimens is broadly the same as other primary penile tumours. The prognosis of distal urethral lesions is believed to be worse than penile tumours and better than prostatic urethral tumours, but the evidence is sparse. The staging system for urethral tumours does not distinguish between proximal and distal, apart from prostatic urethra, and has led to much confusion in the literature. Although the subtypes of tumours seen in the distal urethra are the same as those on the glans and foreskin, there is an increased proportion of basaloid squamous carcinoma and malignant melanoma whereas the majority of tumours seen in the proximal and prostatic urethra are of urothelial origin. In future, distal urethral tumours should be separately designated with site-specific staging/TNM and reporting system and pathologically classified in the same way as penile and foreskin tumours. Ultimately, this will improve the quality of data and produce evidence to inform management.
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PMID:Clinicopathological features of carcinoma of the distal penile urethra. 2565 27


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