Common use of Pathology Clause in Contracts

Pathology. We included 136 patients: 103 with IDC (76%) and 33 with ILC (24%). The mean patient age was 53.5 years in the IDC group and 55.8 years in the ILC group. In the IDC group 29 patients were treated with a ▇▇▇- pectomy and 74 with a mastectomy; and, respectively, 11 and 22 in the ILC group. Table 1 shows the overall distribution of the pathologically evaluated parame- ters. We did not observe differences in the distribution of tumor stages according to the TNM classification between the IDC and the ILC group. Nevertheless, lobular cancers were overall slightly larger than ▇▇▇- ▇▇▇ carcinomas, were more often multifocal and/or multicentric, had a different distribution of tumor grade and had an overall lower mitotic activity index (MAI). Typically, IDC were associated with concurrent ductal carcinoma in situ (DCIS). Some DCIS was seen in 60 of 103 cases, and in 39 cases an extensive DCIS component (that is, DCIS more than focal outside the tumor) was present. Only 9 of 33 ILC were associated with some concurrent DCIS and 3 of cases showed extensive DCIS. ILC were, however, usually accompa- ▇▇▇▇ by lobular carcinoma in situ (LCIS), which was present in 31 of 33 cases and was extensive in 22. In IDC, LCIS was rare, 21 cases had a small LCIS com- ponent and only 2 showed extensive LCIS. ~ = We did not observe any difference in the distribution of ve; hence, the relative fraction of the extravascular extracellular space does not differ between IDC and ILC. However, the distribution of Ktrans ( permeability surface area) was significantly different between the IDC and ILC groups. The mean Ktrans was higher in the IDC group than in the ILC group (1.2 versus 0.9 min—1, P 0.01), which was mainly caused by focal areas of much higher Ktrans in IDC than in ILC. Table 1 Distribution of Pathology Parameters Characteristic IDC ILC value N 103 (76) 33 (24) Mean patient age 53.5 55.7 0.4 Unifocal 63 (61) 13 (39) 0.03 Multifocal/multicentric 40 (39) 20 (61) Size of largest focus (mean (cm)) 2.2 3.0 0.05 ER— 16 (15) 1 (3) 0.07 ER+ 87 (85) 32 (97) PR— 32 (31) 6 (18) 0.15 PR+ 71 (69) 27 (82) a Her2/Neu— 53 (88) 7 (12) 22 (92) 2 (8) 0.70 Grade Ib 19 (19) 6 (20) 0.02 Grade IIb 35 (35) 20 (67) Grade IIIb 45 (45) 4 (13) MAI (mean) 22.9 7.7 0.03 Her2/Neu+a aMissing in 52 cases: 43 IDC and 9 ILC. bMissing in 7 cases: 4 IDC and 3 ILC. ER = Estrogen Receptor expression, PR = Progesteron Receptor expression MAI = Mitotic Activity Index, Numbers between parenthesis repre- sent percentages. Table 2 Distribution of Pharmacodynamic Parameters Parameter Percentile IDC ILC P value Ktrans (min—1) 50 0.97 0.74 0.11 75 1.86 1.3 0.01 90 2.8 1.9 <0.001 Ve (%) 50 29 29 0.99 75 43 42 0.84 90 56 54 0.74 Median Ktrans values were not significantly different between groups. Increasing percentile scores showed, however, increasing differences between the IDC and ILC groups, as shown in Table 2. In short, the most enhancing voxels per tumor in the IDC group showed a significantly higher perme- ability surface area than the most enhancing voxels per tumor in the ILC group. Visual assessment of the relative enhancement versus time curve revealed that wash-out was more common in the IDC group than the ILC group (87/103 versus 16/33; P < 0.01), but this difference was no longer present when evaluating the most malignant curve that was automatically selected by CADstream’s ‘‘vol- umes’’ option (Table 3). In other words, in most tumors at least one small area can be detected with a type 3 enhancement curve, regardless of the histologi- cal origin. = Maximum relative enhancement was not different between IDC and ILC, nor was the fraction of voxels that showed rapid initial enhancement (at least 100% at the first postcontrast high spatial resolution acqui- sition) (56 versus 58%; P 0.6). The distribution of relative enhancement versus time curves in the segmented volumes differed between tumors in the IDC and ILC groups. A type III curve (wash-out) was seen in less than 10% of all segmented voxels in 31/103 IDC and 21/33 ILC (P < 0.01). More- over the fraction of voxels that showed continuous enhancement was also lower in the IDC group than in the ILC group (51% versus 61%; P = 0.03).