Mesothelin is a surface glycoprotein overexpressed in several solid tumors and a known immunotherapy target. While present on blast cells in acute myeloid leukemia (AML), its role in acute lymphoblastic leukemia (ALL) remains unclear. This study evaluated mesothelin expression in 181 newly diagnosed acute leukemia cases using immunohistochemistry (IHC) on bone marrow biopsies and ELISA on plasma samples. Mesothelin was expressed in 31% of pediatric and 15% of adult AML cases (n=65), with no significant differences among AML subtypes. It was absent or rare in ALL (n=51) and undetectable in normal bone marrow. In AML, mesothelin was detected in 49% of CD38⁺, 60% of CD64⁺, 62.5% of KMT2A-rearranged, and 69% of core binding factor AML [83% with inv(16)/ t (16;16) , 57% with t (8;21) ]. It was largely absent in cases with NPM1 (87.5%), GATA2, and DNMT3A mutations. Expression correlated significantly with age, CD38, CD64, and mutations in NPM1, GATA2, DNMT3A, and KDM6A. No significant association was found between mesothelin expression and 5-year overall or event-free survival, measurable residual disease, remission, or relapse. In ALL, 83.3% of T-ALL and 85% of B-ALL cases showed no expression. However, mesothelin correlated with CD11c, PHF6, and CBLC mutations in ALL. Soluble mesothelin was present in 17.6% of AML and 2.7% of ALL cases (all adults), but not in healthy individuals. In AML, it correlated with CD33 expression and inv(16)/ t (16;16) . In conclusion, mesothelin is rare in ALL but enriched in specific AML subtypes and not prognostic for survival.

The ability to escape immune surveillance is a hallmark of malignancy. Programmed death ligand 1 (PD-L1) facilitates tumor progression by binding to the immune inhibitory receptor known as programmed cell death protein 1 (PD1) on immune cells, resulting in suppression of the cytotoxic T lymphocyte function. The degree of PD-L1 expression may have a prognostic value in some cancer types, and it may vary according to the genetic makeup and the ethnicity of patients. The expression level of PD-L1 in 63 cases of primary head and neck squamous cell carcinoma (HNSCC) tumor tissues was evaluated using immunohistochemistry (IHC). Also, PD-L1 association with various clinicopathologic characteristics and overall survival was studied. The positive expression rate of PD-L1 in HNSCC was 85.7%, 60.3%, and 52.3% of the total number of cases using combined positive score (CPS) ≥ 1, CPS ≥ 5, and CPS ≥ 20 cutoff values, respectively. Statistical analysis revealed no significant relationship between the expression of PD-L1 protein and clinicopathological features except for tobacco use using a cutoff CPS ≥ 20. The log-rank chi-square results showed that PD-L1 was not a significant factor affecting the 4-year overall survival of HNSCC patients. Also, the overall survival rate was not significantly affected by the patient's age, tumor differentiation, tumor size, and lymphovascular invasion. However, survival curves demonstrated lower overall survival in HNSCC female patients, disease recurrence, and positive perineural invasion. Our findings showed relatively high PDL-1 expression in most HNSCC patients. No significant association was found between PD-L1 protein expression and overall survival.

Background:Invasive lobular carcinoma (ILC) accounts for approximately 10% of invasive breast carcinomas and is the most common special subtype. Most ILCs express estrogen receptors (ERs) and progesterone receptors (PRs) but typically lack ERBB2 (human epidermal growth factor receptor 2 (HER2)) overexpression. HER2-positive ILC is rare, understudied, and often linked to aggressive clinical and histopathologic features. This study aimed to examine the clinicopathologic characteristics of HER2-positive ILC to ensure proper classification and management. Methods:A retrospective review was conducted on 48 cases, including 28 HER2-positive ILC and 20 pleomorphic invasive lobular carcinoma (p-ILC) cases without HER2 overexpression. Histological features assessed included nuclear pleomorphism, signet ring cell morphology, and apocrine features. Hormone receptor status and clinical outcomes were also analyzed. Results:All HER2-positive ILC cases exhibited at least one pleomorphic histological feature. Hormone receptor positivity was lower in HER2-positive ILC compared to p-ILC without HER2 overexpression. However, overall survival did not significantly differ between the two groups. Conclusion:HER2 overexpression in ILC is frequently associated with pleomorphic features. p-ILC, regardless of HER2 status, portends a worse prognosis. Identifying these features in HER2-positive ILC and classifying them as pleomorphic lobular carcinoma, a more aggressive ILC variant, is crucial for closer patient follow-up.

BackgroundInformation regarding the use of digital pathology (DP) in developing countries is limited. Additionally, the knowledge and attitudes/perceptions of pathologists are mainly unknown. In this study, we aim to assess the knowledge and attitudes of Jordanian pathologists on DP and artificial intelligence (AI).MethodsA digital survey consisting of 32 questions was constructed using Google Forms and sent to practicing pathologists across all sectors in Jordan. The results were analyzed using descriptive statistics.ResultsForty pathologists representing university hospitals, the Ministry of Health, the Royal Medical Services (RMS), and the private sector (PS) participated in the study. 69.2% of participants had average/above-average knowledge of DP. 77.8% of participants without scanners were interested in obtaining one if funds were available, and 85% were likely or very likely to use it for diagnostic purposes. In comparison, 92.5% were very likely to use it for consultation. Cases diagnosed using DP represent 10%. 85% of participants expressed interest in attending sessions at a national congress on DP, and 37.5% currently use AI platforms. Approximately 65% of people with DP didn't follow any guidelines. Seventy-one percent and twenty-nine percent of the guidelines used were from the College of American Pathologists (CAP) and the Royal College of Pathologists (RCP), respectively. At the same time, all pathologists believed the Jordanian Pathologists Society should develop its guidelines. 76.9% thought that a lack of funds was the primary obstacle to adopting DP. In comparison, a lack of infrastructure and experience ranked second, with 40% indicating a lack of interest or a preference for glass slides as obstacles. As for the primary use of DP, 86.8%, 73.7%, 63.2%, 50%, 44.7%, and 44.7% would use it for consultation, education, research, diagnosis, archiving cases, and tumor boards, respectively.ConclusionsAlthough digital pathology and slide scanners are limited in Jordan, most pathologists are willing to adopt their use, provided that the significant challenges of a lack of funding and inadequate infrastructure are addressed. The primary uses of DP in Jordan seem to be related to consultations and research.

Background: Cytomegalovirus (CMV) infection can lead to significant morbidity and mortality in pediatric hematopoietic stem cell transplant recipients. Early detection of CMV infection is crucial for managing its impact. Aim: This study aims to evaluate the effectiveness of QuantiFERON-CMV ® (QF-CMV) and QuantiFERON-Monitor ® (QFM) tests in predicting CMV infection and graft-versus-host disease (GvHD) in pediatric hematopoietic stem cell transplant recipients to enhance patient outcomes and support personalized prevention strategies. Methods: The QF-CMV and QFM tests were used to predict CMV pp65 antigen and GvHD in 24 pediatric hematopoietic stem cell transplant recipients. Results: Data showed that positive CMV antigenemia (CMV-Ag) increased the risk of GvHD by 21.2%. QF-CMV and QFM were associated with CMV-Ag, with QF-CMV inversely predicting GvHD. Lymphocyte and neutrophil counts were positively linked to both tests. Conclusion: The findings suggest that QF-CMV and QFM tests could predict GvHD and CMV infection risk and help identify high-risk patients, contributing to personalized prevention strategies and improving CMV treatment. Despite the small sample size, this study is an essential proof of concept due to the unique patient population of pediatric bone marrow stem cell transplant recipients. Further multicenter studies are needed to validate these results.

Background:The 21-gene recurrence score (Oncotype DX) guides adjuvant chemotherapy decisions in early-stage estrogen receptor (ER)-positive, human epidermal growth factor receptor-2 (HER2)-negative breast cancer. However, its high cost and limited availability motivate the development of simplified predictive models using routinely reported pathology parameters. The aim of this study was to develop and validate a practical, rule-based algorithm that predicts Oncotype DX recurrence score (RS) category using only histologic grade and progesterone receptor (PR) expression percentage. Methods:This retrospective study included 528 patients with ER+/HER2- early breast cancer who underwent Oncotype DX testing. Cases were randomly assigned to a learning (n = 377) and validation (n = 151) set. Univariate analysis and receiver operating characteristics (ROC) curves were used to determine PR% cut-offs within each histologic grade to stratify patients into low-risk (RS ≤ 25) or high-risk (RS > 25) categories. A stepwise algorithm was derived from these parameters and tested in the validation cohort. Results:Histologic grade and PR% were significantly associated with RS. Grade 1 tumors were uniformly low-risk regardless of PR%. In grade 2, PR ≥ 60% achieved 100% sensitivity for low RS; in grade 3, PR < 40% achieved 100% sensitivity for high risk. The algorithm confidently stratified ∼ 65% of cases. In the validation set, the model showed 87.5% sensitivity, 100% specificity, 100% positive predictive value (PPV), 99% negative predictive value (NPV), and 99% overall accuracy. Conclusion:This simplified algorithm accurately predicts Oncotype DX RS category using only histologic grade and PR%. It enables confident risk stratification in most patients without molecular testing, offering a low-cost, practical tool for clinical decision-making, particularly in resource-limited settings.

Recent advances in the field of immuno-oncology have brought transformative changes in the management of cancer patients. The immune profile of tumours has been found to have key value in predicting disease prognosis and treatment response in various cancers. Multiplex immunohistochemistry and immunofluorescence have emerged as potent tools for the simultaneous detection of multiple protein biomarkers in a single tissue section, thereby expanding opportunities for molecular and immune profiling while preserving tissue samples. By establishing the phenotype of individual tumour cells when distributed within a mixed cell population, the identification of clinically relevant biomarkers with high-throughput multiplex immunophenotyping of tumour samples has great potential to guide appropriate treatment choices. Moreover, the emergence of novel multi-marker imaging approaches can now provide unprecedented insights into the tumour microenvironment, including the potential interplay between various cell types. However, there are significant challenges to widespread integration of these technologies in daily research and clinical practice. This review addresses the challenges and potential solutions within a structured framework of action from a regulatory and clinical trial perspective. New developments within the field of immunophenotyping using multiplexed tissue imaging platforms and associated digital pathology are also described, with a specific focus on translational implications across different subtypes of cancer. © 2024 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.

Abstract Background: Because of the diagnosis at an earlier stage, and the wider availability of more effective therapies, treatment outcomes of patients with breast cancer are getting much better resulting in an increasing proportion of patients surviving their disease, however, a significant percentage of patients with early-stage disease at initial diagnosis may eventually relapse. Residual tumor cells can remain dormant for many years before causing tumor recurrence. Physical examination and mammography are strongly recommended in surveillance guidelines, but data on routine blood tests or imaging is lacking. The revolution made in recent years, following the approval of novel targeted and immunotherapy agents, may have better outcome if started earlier in the disease course with the lowest tumor burden and in patients with good performance status and adequate organs’ function. Additionally, early detection of oligometastatic disease can give a chance for cure for a subset of these patients. Levels of CA15.3 and CEA are used in decision making in the metastatic setting but their role in surveillance is still controversial. We aim to investigate whether serial measurement of tumor markers, when it correlates with tumor bulk (conditional), can detect early asymptomatic recurrence among subset of patients with high-risk early-stage breast cancer. Methods: Patients with high-risk early-stage breast cancer were invited to participate. High-risk features include any of the following: large tumor size (T3/4), grade-3, node-positive, triple-negative, HER2-positive or hormone receptor (HR)-negative disease. Patients were considered eligible if they have elevated CA15.3 and/or CEA at baseline, that subsequently normalize 6 weeks after surgical resection; upfront or following neoadjuvant chemotherapy. Serial testing of the elevated CA15.3 and/or CEA is done every 2 months thereafter, samples are cryopreserved and will not be processed until disease relapse. As such results will not be used for clinical decisions. The study is still ongoing, we here present an interim analysis evaluating the correlation between certain tumor characteristics and elevated serum marker(s) levels. Results: Since the launch of the study, 367 patients deemed high-risk by the above criteria, accepted to participate. Abnormal baseline CA15.3 and/or CEA was found in 110 (30%); 65 (18%) patients had elevated CA 15.3 while elevated CEA was found in 45 (12%) patients. Abnormal CA 15.3 was found in 27% of cases with T3/4 disease compared with 13% in T1/2 disease (p=0.001), and in 21% of node positive disease versus 7% in node negative disease (p=0.002), in 9% of HR negative disease versus 20% in HR-positive (P=0.038). Tumor grade and HER2 status were not associated with significant difference. Regarding CEA, abnormal levels were detected in 24% of HER2-positive disease compared to 5% of HER2-negative disease (P< 0.0001). Other tumor features were not associated with significant difference. Conclusions: Only a third of patients with high-risk early-stage breast cancer had high level of serum tumor markers at initial diagnosis and thus such markers may correlate with tumor presence. Large tumors (T3/4) and node positive disease were associated with high CA15.3 but not CEA. HER2-stutus and tumor grade had no effect on CA15.3 level, while HER2 positive disease correlated well with high CEA. Citation Format: Sarah Edaily, Baha' Sharaf, Maher Sughayer, Lina Yousef, Hala Abu-Fares, Sarah Abdel-Razeq, Hala Abu-Jaish, Mahmoud Abunasser, Suhaib Khater, Anas Zayed, Osama El Khatib, Rahaf Rahal, Hazem Abdulelah, Maria Shraim, Hikmat Abdel-Razeq. Conditional Use of Serial Serum Tumor Markers CA 15.3 and CEA as Predictors of Disease Relapse in Patients with High-Risk Early-Stage Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-03-03.

COVID-19 continues to impact healthcare workers (HCWs), making it crucial to investigate vaccine response rates. This study examined HCWs’ humoral and cellular immunological responses to COVID-19 booster dosages. We enrolled thirty-four vaccinated HCWs. Twelve received a booster. Post-immunization, the participants’ anti-COVID-19 IgG antibodies and IFN-γ secretion were assessed. The median second immunization response time was 406.5 days. Eighteen of twenty-two (81.8%) experienced breakthrough infections after the second vaccination, whereas ten out of twelve individuals who received booster doses had breakthrough infections (83.3%). Six of thirty-four HCWs (17.6%) had no breakthrough infections. Booster-injection recipients had a median antibody titer of 19,592 AU/mL, compared to 7513.55 AU/mL. HCWs with breakthrough infections exhibited a median antibody titer of 13,271.9 AU/mL, compared to 7770.65 AU/mL for those without infections. Breakthrough-infection and booster-injection groups had a slightly higher median T-cell response to antigens 1, 2, and 3. SARS-CoV-2 antibody titer and T-cell responsiveness were positively associated. HCWs sustain cellular and humoral immunity for over 10 months. Irrespective of the type of vaccine, booster injections enhance these immune responses. The results of our research are consistent with previous studies, and a multicenter investigation could validate the findings.

Background: Recruitment of low risk blood donors can be challenging. Efforts should be made to increase the level of awareness and positive attitude towards blood donation. An essential step to achieve this is obtaining comprehensive data about the current situation of awareness, knowledge and attitudes of the population towards blood donation. Methods/materials: The present study was conducted at two blood donation centres in Amman, Jordan, during 2021. A total of 536 whole blood donors were included. Data regarding their demographic characteristics, blood donation history as well as their knowledge and attitudes regarding blood donation were collected by a questionnaire. Results: Four hundred ninety participants (91.4%) were males, whereas only 46 participants (8.6%) were females. Ninety seven subjects (18.1%) were first time donors, whereas 431 subjects (81.9%) had previous donations. The participants’ median score in the knowledge section was 19.0 points (range 5–25 points). Based on a cut-off of 15 out of 28: 84% of the participants were knowledgeable. Similarly 97% of the participants had a positive attitude based on a cut-off of 17 out of 32 points. Multivariate analysis revealed that high knowledge score was significantly associated with study major and employment status, whereas a positive attitude was significantly associated with a higher income. More than half of first time donors stated lack of awareness as being the reason for not donating blood before. Conclusion: Measures to improve awareness, knowledge and attitudes towards blood donation should be implemented in order to meet the increasing demand for blood and blood components. Targeted campaigns, correction of some misconceptions and using different motivations are suggested.

Abstract Introduction/Objective Human epidermal growth factor receptor 2 (HER2/neu) is a well-established therapeutic target in breast and gastric cancers. Currently HER2 expression is being considered in other solid tumors including colorectal cancer (CRC). We aimed to investigate HER2 expression in CRC among Jordanians and its association with clinicopathological variables. Methods/Case Report Formalin-fixed, paraffin-embedded tissue blocks of 69 CRC cases were retrieved with their clinicopathological data. Tissue microarray (TMA) were constructed and immunostained using anti-HER2/neu 4B5 monoclonal antibody (Ventana, Tucson, AZ). HER2 scoring was performed by two experienced pathologists using the HERACLES criteria (HER2 positivity: cases of (3+) in ≥10% of cells and FISH-positive equivocal cases). Fisher’s exact/Chi-square test was used to investigate the association between HER2 s and clinicopathological data such as age, gender, histological differentiation, node and metastasis (NM) stage, and tumor site. Survival analysis was evaluated using Kaplan–Meier curves. Results (if a Case Study enter NA) Any degree (score) of HER2/neu expression was seen in 43.5 % of the cases. In 25 (36.2%), 4 (5.8%) and 1 (1.5%) the HER2 score was 1+, 2+ and 3+ respectively. The rest of the cases, 39 (56.5%) were scored as 0. Two of the four cases with a score (2+) required ISH testing to confirm amplification which was not performed. No significant association was found between HER2/neu expression and clinicopathological parameters or with survival. However, survival analysis showed that combined 2+/ 3+ group tend to have worse overall (OS) and event -free survival than the (0/1+) group. Conclusion The prevalence of HER2 overexpression in CRC is low among Jordanian patients, with only 1.5% of the study sample exhibiting definite HER2 overexpression. This rate is lower than the 3-5% rate reported in general, however the small sample size and lack of FISH confirmation might have contributed to this low rate. There was a trend towards worse OS and EFS in HER2 positive cases

Background and Objectives: Human papillomavirus (HPV) was previously investigated in lung cancer with wide inter-geographic discrepancies. p16INK4a has been used as a surrogate for detecting high-risk HPV (HR-HPV) in some cancer types. This study assessed the evidence of HPV in non-small-cell lung cancer (NSCLC) among Jordanian patients, investigated the expression of p16INK4a, and evaluated its prognostic value and association with HPV status. Materials and Methods: The archived samples of 100 patients were used. HPV DNA detection was performed by real-time polymerase chain reaction (RT-PCR). p16INK4a expression was assessed by immunohistochemistry (IHC). The Eighth American Joint Committee on Cancer protocol (AJCC) of head and neck cancer criteria were applied to evaluate p16INK4a positivity considering a moderate/strong nuclear/cytoplasmic expression intensity with a distribution in ≥75% of cells as positive. Results: HPV DNA was detected in 5% of NSCLC cases. Three positive cases showed HR-HPV subtypes (16, 18, 52), and two cases showed the probable HR-HPV 26 subtype. p16INK4a expression was positive in 20 (20%) NSCLC cases. None of the HPV-positive tumors were positive for p16INK4a expression. A statistically significant association was identified between p16INK4a expression and the pathological stage (p = 0.029) but not with other variables. No survival impact of p16INK4a expression was detected in NSCLC cases as a group; however, it showed a statistically significant association with overall survival (OS) in squamous cell carcinoma (SqCC) cases (p = 0.033). Conclusions: This is the first study to assess HPV and p16INK4a expression in a Jordanian population. HPV positivity is rare in NSCLC among a Jordanian subpopulation. P16 INK4a reliability as a surrogate marker for HPV infection in lung cancer must be revisited.

Pathologists use certain terminologies to communicate uncertainty in pathology reports. The message conveyed in pathology reports may be interpreted differently by clinicians leading to possible miscommunication. We aimed to compare the interpretation and impact of uncertainty phrases between pathologists and clinicians. A survey with examples of uncertain diagnoses containing ("suspicious for", "indefinite for", "favor", "cannot exclude", "suggestive of", "compatible with", "cannot rule out", "highly suspicious for" and "consistent with") was sent to pathologists and clinicians. For each diagnosis, participants assigned a level of certainty from 1 to 10 and were asked whether they would recommend treatment based on such phraseology. Thirty-six responses (from 7 pathologists, 10 surgeons, 8 pediatric oncologists, 8 medical oncologists, 2 radiation oncologists and 1 diagnostic radiologist) were received. Pathologists had a narrower range of uncertainty compared to clinicians. Wide variation between both groups was seen for all phrases except "compatible with" and "highly suspicious for". 'Indefinite for' showed the lowest mean of certainty (4.67 for pathologists; 4.00 for clinicians) whereas 'consistent with' had the highest (8.83 for pathologists and 9.38 for clinicians). There was a significant difference in the degree of certainty between both groups for "compatible with" (7.83 for pathologists and 9.06 for clinicians, p = .009). For treatment decisions, pathologists and clinicians agreed on initiating treatment when "consistent with" and "compatible with" were used and gave variable responses for the other terms. They proposed opposing treatment recommendations for "favor". Pathologists and clinicians varied in interpretation of uncertainty phrases which may impact treatment.

Introduction:Thymus is a primary lymphoid organ which has an important role in humoral and cellular immunity. It can be a site for various neoplasms including thymomas.Case presentation:The authors report a case of a 55-year-old patient presenting with weight loss, night sweats and sensation of heat. After thorough evaluation his histopathology analysis revealed the rare presence of Hodgkin lymphoma in a background of type B2 thymoma.Discussion:Thymoma is one of the well-known thymic tumors that is encountered in clinical practice. It has diverse associations with other autoimmune diseases and malignancies. The concurrent diagnosis of thymoma with thymic Hodgkin lymphoma is extremely rare.Conclusion:Although this association is very rare, it is crucial to distinguish between thymic Hodgkin lymphoma and thymoma and manage them appropriately.

Background Breast cancer, particularly triple-negative breast cancer (TNBC), poses a significant global health burden. Chemotherapy was the mainstay treatment for TNBC patients until immunotherapy was introduced. Studies indicate a noteworthy prevalence (0.2% to 18.6%) of mismatch repair protein (MMRP) deficiency in TNBC, with recent research highlighting the potential of immunotherapy for MMRP-deficient metastatic breast cancer. This study aims to identify MMRP deficiency in TNBC patients using immunohistochemistry. Methods A retrospective cohort study design was used and included TNBC patients treated between 2015 and 2021 at King Hussein Cancer Center. Immunohistochemistry was conducted to assess MMRP expression Results Among 152 patients, 14 (9.2%) exhibited deficient MMR (dMMR). Loss of PMS2 expression was observed in 13 patients, 5 of whom showed loss of MLH1 expression. Loss of MSH6 and MSH2 expression was observed in one patient. The median follow-up duration was 44 (3–102) months. Despite the higher survival rate (80.8%, 5 years) of dMMR patients than of proficient MMR patients (62.3%), overall survival did not significantly differ between the two groups. Conclusion Approximately 9% of TNBC patients exhibit dMMR. dMMR could be used to predict outcomes and identify patients with TNBC who may benefit from immunotherapy.

OBJECTIVES: To evaluate the effect of procalcitonin-guided management on the duration of antibiotic therapy in critically ill cancer patients with sepsis. DESIGN: Randomized, controlled, single-blinded trial. SETTING: A comprehensive multidisciplinary cancer hospital in Jordan. PATIENTS: Adults with cancer treated in the ICU who were started on antibiotics for suspected infection, met the SEPSIS-3 criteria, and were expected to stay in the ICU greater than or equal to 48 hours. INTERVENTIONS: Patients were randomized to the procalcitonin-guided or standard care (SC) arms. All patients had procalcitonin measured daily, up to 5 days or until ICU discharge or death. For the procalcitonin arm, a procalcitonin-guided algorithm was provided to guide antibiotic management, but clinicians were allowed to override the algorithm, if clinically indicated. In the SC arm, ICU clinicians were blinded to the procalcitonin levels. MEASUREMENTS AND MAIN RESULTS: Primary outcome was time to antibiotic cessation. We also evaluated the number of antibiotic-free days at 28 days, hospital discharge, or death, whichever came first, and antibiotic defined daily doses (DDDs). We enrolled 77 patients in the procalcitonin arm and 76 in the SC arm. Mean age was 58 ± 14 (sd) years, 67% were males, 74% had solid tumors, and 13% were neutropenic. Median (interquartile range [IQR]) Sequential Organ Failure Assessment scores were 7 (6–10) and 7 (5–9) and procalcitonin concentrations (ng/mL) at baseline were 3.4 (0.8–16) and 3.4 (0.5–26), in the procalcitonin and SC arms, respectively. There was no difference in the median (IQR) time to antibiotic cessation in the procalcitonin and SC arms, 8 (4–11) and 8 (5–13), respectively (p = 0.463). Median (IQR) number of antibiotic-free days were 20 (17–24) and 20 (16–23), (p = 0.484) and total DDDs were 1541.4 and 2050.4 in the procalcitonin and SC arms, respectively. CONCLUSIONS: In critically ill cancer patients with sepsis, procalcitonin-guided management did not reduce the duration of antibiotic treatment.

Background: One of the most frequently used methods for quantifying PD-L1 (programmed cell death-ligand 1) expression in tumor tissue is IHC (immunohistochemistry). This may predict the patient's response to anti-PD1/PD-L1 therapy in cancer. Methods: ImageJ software was used to score IHC-stained sections for PD-L1 and compare the results with the conventional manual method. Results: In diffuse large B cell lymphoma, no significant difference between the scores obtained by the conventional method and ImageJ scores obtained using the option “RGB” or “Brightness/Contrast.” On the other hand, a significant difference was found between the conventional and HSB scoring methods. ImageJ faced some challenges in analyzing head and neck squamous cell carcinoma tissues because of tissue heterogenicity. A significant difference was found between the conventional and ImageJ scores using HSB or RGB but not with the “Brightness/Contrast” option. Scores obtained by ImageJ analysis after taking images using 20 × objective lens gave significantly higher readings compared to 40 × magnification. A significant difference between camera-captured images’ scores and scanner whole slide images’ scores was observed. Conclusion: ImageJ can be used to score homogeneous tissues. In the case of highly heterogeneous tissues, it is advised to use the conventional method rather than ImageJ scoring.