Dear clinical Flow experts, we need your help! For the past months we have been trying to research the current literature and develop a more meaningful report on breast CA cases (node negative only). Well, to say the least, we are more confused than before since there still does not seem to be any significant progress from the 93 consensus report. In the past we have signed out our cases basically as good prognosis (diploid and low SPF with less than 7%), intermediate prognosis (diploid with SPF more than 7% or aneuploid with less than 12%), and poor prognosis (aneuploid with SPF of 12% or higher or hypertetraploid) according to the Kallioniemi paper of 1988. We have also verified these cutoff points for the s-phase fractions with our own laboratory data. However, I think the recent "consensus" is that SPF seems to be more important than the ploidy and more emphasis should be placed on this regarding the interpretation to the physician. So here are my questions: 1. What are the different prognostic groups? Is it really just the SPF which matters or do you still report out aneuploid as a bad prognostic factor? 2. If you do report both, which one do you weigh heavier (SPF or ploidy)? 3. Which cutoff values for the SPF are you using. We established a mean SPF of 40 diploid (paraffin-embedded) and 40 aneuploid tumors and added 2SD's to the mean as a cutoff value. For instance, for the aneuploid tumors the mean was 6.6% with +/- 2 SD's of 5.4%, so the cutoff is 12%. Is everything below 12% a low SPF and does this result put this patient in a favorable group despite the aneuploidy? 4. If ploidy matters, do the near-diploid tumors do as well as the DNA diploid tumors? We get excellent C.V.'s in our lab (between 1.8 and 3.0 and we see quite a few near-diploid ones). Is hypodiploidy and hypertetraploidy still considered worse than just plain aneuploidy? I really would appreciate your input since we are just about to delete the ploidy analysis on breast Ca from our flow menu. If we don't know exactly what it means, how is the ordering physician supposed to make sense out of it and use our data for patient treatment? We are looking forward to your reponses Andrea Illingworth Dahl-Chase Diagnostic Services/Flow Cytometry 333 State Street Bangor, Maine 04401 (207)990-4855
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