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(Coordinator : P. Kern)
Minutes of the meeting in Lisbon, hotel Barcelona, October 7, 1997, 18.30-19.30
Participants :S. Bresson-Hadni, P. Kern, S. Kurz, C. Macpherson, R. Piarroux, S. Reuter, D. Vuitton.
Informed, but could not participate : H. Wen, N. Sato.
The purpose of the meeting was to discuss the proposal of the PIM-classification and of a staging scheme for alveolar echinococcosis.
1.The PIM-classification:
This classification proposed last year by S. Bresson-Hadni, P. Kern and D. Vuitton is of similar design to the TNM-system for hepato-cellular carcinoma. Thus, it is to apply at the time of first diagnosis.Three categories of this classification were discussed :
P: the parasitic mass
I: the involvement of adjacent organs
M: distant metastasis
In parallel to the TNM-classification it was proposed to add a suffix such as i PIM, for incomplete data, mainly because of inoperable lesions, if the patient is classified without operation and histology.
For metastases, the following procedures (cerebral CT and chest X-ray) have to be performed, as they are essential at the time of first diagnosis and should be included into the classification. The parameter X means, that there was insufficient information about metastasis.
Finally, it was found necessary to give detailed instructions for the use of this classification.
2. STAGING-proposal
This staging, in addition to the PIM-classification, will be applied to the patient after each visit during the course of the disease.
It was designed by S. Bresson, P. Kern and D. Vuitton last year, and was now presented and discussed.Different opinions on the purpose of this staging were debated ;
Who will fill in the questionnaire (general practitioner or registration center)?
Should the current staging be simplified ?
The following data are required for follow-up :The term "additional parameters" was changed during the discussion into "evaluated parameters".
This means, collecting some further information about :
Thus, the staging would offer a documented and standardized follow-up.Each registration center will collect this data and give its judgment about the case. It will be concluded by a
General Evaluation of the disease, which divides the patients into the following three groups.
A : cure from AE
B : stability or regression
C : progression, continuous sequelae or patients with liver transplantation
3. Presentation of data from Besançon and Ulm
The two schemes were already applied to patients in Ulm and Besançon.At the moment, the number of patients evaluated is too small to draw conclusions. It was discussed to regroup patients, who are divided into the different PIM-types, and then analyze the data.S/ Kurz was invited to come for a second visit to Besançon to enlarge the French data.
Encl : PIM-classification, staging.
WHO Informal Working Group (Network-Standardization)
CLASSIFICATION OF ALVEOLAR ECHINOCOCCOSISAT DIAGNOSIS : P.I.M.
PARASITE LOCATION IN THE LIVER : P
P 0 : - no detectable tumor in the liver
P 1 : - single lesion involving ( 2 segments, without intrahepatic vascular or biliary involvement
P 2 : - single lesion ( 2 segments, with intrahepatic vascular or biliary involvement - or single lesion involving 3 or 4 segments, without intrahepatic vascular or biliary involvement
P 3 : - single lesion involving 3 to 5 segments, with intrahepatic vascular or biliary involvement - or multiple lesions, without intrahepatic vascular or biliary involvement(
P 4 : - single lesion involving 6 to 8 segments - or multiple lesions, with intrahepatic vascular or biliary involvement
2. INVOLVEMENT OF ADJACENT ORGANS : I
[diaphragm, lung, pleura, pericardium, heart, gastric and duodenal wall, adrenal glands, peritoneum, retroperitoneum, parietal wall (muscles, skin, bone), pancreas, gallbladder, inferior vena cava, extrahepatic portal vein and bile duct, common hepatic artery, regional lymph nodes, liver ligaments].
X : not evaluated
0 : no regional involvement (see list)
1 : regional involvement of only one contiguous organ or tissue
2 : regional involvement of several organs or tissues ((1)
3. METASTASES : M
[characterizing distant parasitic tumors : lung, distant lymph nodes, spleen, CNS, orbital, bone, skin, muscle, distant peritoneum and retroperitoneum].
X : not completely evaluated
0 : no metastases (negative chest X-ray and negative CT-scan or MR imaging)
1 : one metastasis in only one organ
2 : more than one metastasis within one distant organ (see list)
3 : one or several metastases in several different organs
4. CLASSIFIED WITH OPERATION/HISTOLOGY
i : for incomplete data
CLASSIFICATION : ___________ P I M ( Modified after the meeting in Lisbon, November 7, 1997
Editor's note : The picture from the paper versione of Echinonews will be added as soon as possible )
