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Aims: To evaluate aspects of the current practice of sentinel lymph node (SLN) pathology in breast cancer via a questionnaire based survey, to recognise major issues that the European guidelines for mammography screening should address in the next revision. Methods: A questionnaire was circulated by mail or electronically by the authors in their respective countries. Replies from pathology units dealing with SLN specimens were evaluated further. Results: Of the 382 respondents, 240 European pathology units were dealing with SLN specimens. Sixty per cent of these units carried out intraoperative assessment, most commonly consisting of frozen sections. Most units slice larger SLNs into pieces and only 12% assess these slices on a single haematoxylin and eosin (HE) stained slide. Seventy one per cent of the units routinely use immunohistochemistry in all cases negative by HE. The terms micrometastasis, submicrometastasis, and isolated tumour cells (ITCs) are used in 93%, 22%, and 71% of units, respectively, but have a rather heterogeneous interpretation. Molecular SLN staging was reported by only 10 units (4%). Most institutions have their own guidelines for SLN processing, but some countries also have well recognised national guidelines. Conclusions: Pathological examination of SLNs throughout Europe varies considerably and is not standardised. The European guidelines should focus on standardising examination. They should recommend techniques that identify metastases . 2 mm as a minimum standard. Uniform reporting of additional findings may also be important, because micrometastases and ITCs may in the future be shown to have clinical relevance.

To assess the variability of oestrogen receptor (ER) testing using immunocytochemistry, centrally stained and unstained slides from breast cancers were circulated to the members of the European Working Group for Breast Screening Pathology, who were asked to report on both slides. The results showed that there was almost complete concordance among readers (kappa=0.95) in ER-negative tumours on the stained slide and excellent concordance among readers (kappa=0.82) on the slides stained in each individual laboratory. Tumours showing strong positivity were reasonably well assessed (kappa=0.57 and 0.4, respectively), but there was less concordance in tumours with moderate and low levels of ER, especially when these were heterogeneous in their staining. Because of the variation, the Working Group recommends that laboratories performing these stains should take part in a external quality assurance scheme for immunocytochemistry, should include a tumour with low ER levels as a weak positive control and should audit the percentage positive tumours in their laboratory against the accepted norms annually. The Quick score method of receptor assessment may also have too many categories for good concordance, and grouping of these into fewer categories may remove some of the variation among laboratories.

The declining sizes of breast tumours (< or = 10 mm), especially from radiologically detected lesions and sometimes without a macroscopic correlate, create new limitations and changing indications in the histopathological interpretation. Considering the performance of new diagnostic methods (i.e. large core needle biopsies), frozen sections of surgical specimens should not be the primary diagnostic procedure for breast lesions and should be performed only after other preoperative methods have failed.

Aim:Non-melanoma skin cancer (NMSC) of the lower legs is a challenge to treat. Surgery can be difficult given the challenged blood supply.Radiotherapy (RT) is a controversial treatment modality and some radiation oncologists (ROs) will not offer definitive treatment for lesions below the knee for fear of creating a radiation-induced ulcer. This study is a retrospective audit of a single RO’s treatment of lower leg NMSCs. The aim is to evaluate the efficacy of RT in gaining local control of these lesions. The aim is also to document the development of late side effects following RT, including radiation-induced ulcers and their treatment. Referral growth over time was also investigated. Methods:Electronic medical records were searched for patients with lower leg NMSCs treated by the RO between January 2009 and December 2019 at three locations in Sydney, Australia (St Vincent’s Hospital, Mater Hospital, and Macquarie University Hospital). Patient, tumour, treatment, and outcome factors were collected and analysed.Referrals over time were recorded. Results:111 lesions arising in 56 patients were identified. There was even distribution of sex and the mean age was 82 (range 57–95). There were 78 cutaneous squamous cell carcinomas (cSCCs) and 23 basal cell carcinomas (BCC). Median lesion size was 2 centimetres (range 1–10cm). The most common RT modality used was electrons (91 [82%]), followed by superficial RT (SXRT) (20 [18%]). Median duration of follow-up was 4 months (range 0–117 months). Of the 77 lesions treated with curative intent, cure was achieved in 74 (96%) lesions. 2 cSCCs and 1 BCC recurred, with a median time to recurrence of 24 months. 15 (14%) lesions developed a radiation-induced ulcer following RT. Median duration of therapy required for these ulcers was 5 months (range 1–55 months), with conservative treatment being the most common therapy used. Referrals increased from 8 in the 2008-2011 period to 26 in the 2016-2019 period. Conclusion: This study showed RT treatment of lower leg NMSCs achieves local control of lesions with an acceptably low rate of radiation-induced ulcers, thus supporting the use of this modality for this patient population. Referrals grew over time which may reflect growing referrer knowledge and confidence in definitive RT below the knee.