Rex Bentley

Overview:

Outcome-based research on pathology of endometrial carcinoma, including prognostic significance of histologic features of endometrial carcinoma, variants of endometrial carcinoma, definitions of atypia and well-differentiated carcinoma, and collaborative studies of oncogenes and tumor suppressor genes in endometrial carcinoma.

Endometrial pathology, especially as it relates to molecular/genetic alterations in neoplasms.

Ovarian pathology, especially as it relates to molecular and genetic alterations in neoplasms.

Improving accuracy of radiographic screening for breast cancer, by careful patho-radiographic correlation and study of improved imaging techniques (especially ultrasound).

Use of electron microscopy as a diagnostic and research technique.

Objective measures of pathology resident performance.

Positions:

Professor of Pathology

Pathology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1986

Harvard University

Resident, Pathology

Duke University

Chief Resident, Pathology

Duke University

Associate, Pathology

Duke University

Fellow, Surgical Pathology, Pathology

Duke University

Grants:

Erythropoietin Receptors in Breast Cancer

Administered By
Medicine, Hematology
Awarded By
National Institutes of Health
Role
Investigator
Start Date
End Date

CDC PO- IUGR Study

Administered By
Obstetrics and Gynecology
Awarded By
Centers for Disease Control and Prevention
Role
Pathologist
Start Date
End Date

Role Of Type-C Retroviral Antigens In Autoimmunity

Administered By
Pathology
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Publications:

ASO Visual Abstract: Limited Reporting of Histopathologic Details in a Multi-Institutional Academic Cohort of Phyllodes Tumors: Time for Standardization.

Authors
Rosenberger, LH; Quintana, LM; Thomas, SM; Nimbkar, SN; Hieken, TJ; Ludwig, KK; Jacobs, LK; Miller, ME; Gallagher, KK; Wong, J; Neuman, HB; Tseng, J; Hassinger, TE; King, TA; Jakub, JW; Bentley, RC; Schnitt, SJ
MLA Citation
Rosenberger, Laura H., et al. “ASO Visual Abstract: Limited Reporting of Histopathologic Details in a Multi-Institutional Academic Cohort of Phyllodes Tumors: Time for Standardization.Ann Surg Oncol, June 2021. Pubmed, doi:10.1245/s10434-021-10159-y.
URI
https://scholars.duke.edu/individual/pub1484307
PMID
34061280
Source
pubmed
Published In
Annals of Surgical Oncology
Published Date
DOI
10.1245/s10434-021-10159-y

Limited Reporting of Histopathologic Details in a Multi-Institutional Academic Cohort of Phyllodes Tumors: Time for Standardization.

<h4>Background</h4>Phyllodes tumors are rare fibroepithelial neoplasms that are classified by tiered histopathologic features. While there are protocols for the reporting of cancer specimens, no standardized reporting protocol exists for phyllodes.<h4>Methods</h4>We performed an 11-institution contemporary review of phyllodes tumors. Granular histopathologic details were recorded, including the features specifically considered for phyllodes grade classification.<h4>Results</h4>Of 550 patients, median tumor size was 3.0 cm, 68.9% (n = 379) of tumors were benign, 19.6% (n = 108) were borderline, and 10.5% (n = 58) were malignant. All cases reported the final tumor size and grade classification. Complete pathologic reporting of all histopathologic features was present in 15.3% (n = 84) of cases, while an additional 35.6% (n = 196) were missing only one or two features in the report. Individual details regarding the degree of stromal cellularity was not reported in 53.5% (n = 294) of cases, degree of stromal atypia in 58.0% (n = 319) of cases, presence of stromal overgrowth in 56.2% (n = 309) of cases, stromal cell mitoses in 37.5% (n = 206) of cases, and tumor border in 54.2% (n = 298) of cases. The final margin status (negative vs. positive) was omitted in only 0.9% of cases, and the final negative margin width was specifically reported in 73.8% of cases. Reporting of details was similar across all sites.<h4>Conclusion</h4>In this academic cohort of phyllodes tumors, one or more histopathologic features were frequently omitted from the pathology report. While all features were considered by the pathologist for grading, this limited reporting reflects a lack of reporting consensus. We recommend that standardized reporting in the form of a synoptic-style cancer protocol be implemented for phyllodes tumors, similar to other rare tumors.
Authors
Rosenberger, LH; Quintana, LM; Thomas, SM; Nimbkar, SN; Hieken, TJ; Ludwig, KK; Jacobs, LK; Miller, ME; Gallagher, KK; Wong, J; Neuman, HB; Tseng, J; Hassinger, TE; King, TA; Jakub, JW; Bentley, RC; Schnitt, SJ
MLA Citation
Rosenberger, Laura H., et al. “Limited Reporting of Histopathologic Details in a Multi-Institutional Academic Cohort of Phyllodes Tumors: Time for Standardization.Annals of Surgical Oncology, vol. 28, no. 12, Nov. 2021, pp. 7404–09. Epmc, doi:10.1245/s10434-021-10118-7.
URI
https://scholars.duke.edu/individual/pub1482788
PMID
33990927
Source
epmc
Published In
Annals of Surgical Oncology
Volume
28
Published Date
Start Page
7404
End Page
7409
DOI
10.1245/s10434-021-10118-7

Communicating Certainty in Pathology Reports: Interpretation Differences Among Staff Pathologists, Clinicians, and Residents in a Multicenter Study.

CONTEXT.—: Pathology reports are the main modality in which results are communicated to other physicians. For various reasons, the diagnosis may be qualified on a spectrum of uncertainty. OBJECTIVE.—: To examine how communication of uncertainty is an unexamined source of possible medical error. No study to our knowledge has examined pathology reports across multiple institutions. This study seeks to identify commonly used phrases of diagnostic uncertainty and their interpreted meanings by surgical pathologists and clinicians. DESIGN.—: Anonymous surveys were completed at 3 major US academic institutions by 18 practicing staff pathologists, 12 pathology residents, 53 staff clinicians, and 50 resident/allied health professional clinicians at 5 standard tumor boards. All participants rated percentage certainty associated with 7 diagnostic terms. Pathologists answered 2 questions related to the ability to clarify a diagnosis using a comment and comfort wording pathology reports. Clinicians answered questions on how often they read a pathology report comment, if they found the comment helpful, and how comfortable they were in reading pathology reports. RESULTS.—: A wide range in percentage certainty was found for each of the 7 diagnostic phrases. Both staff and resident clinicians and residents showed wide variability in interpreting the phrases. Twenty-five of 50 staff clinicians (52%) were very comfortable reading a pathology report, whereas only 4 of 53 resident clinicians (8%) were very comfortable reading a pathology report. Twenty-four of 53 staff clinicians (63%) reported always reading the comment, yet only 20 of 53 (27%) always found the comment helpful. The phrases "diagnostic of" and "consistent with" had the strongest agreement in meaning. The weakest agreement was between "suspicious for" and "compatible with." CONCLUSIONS.—: Efforts to standardize diagnostic terms may improve communication.
Authors
Gibson, BA; McKinnon, E; Bentley, RC; Mohlman, J; Witt, BL; Yang, EJ; Geisler, D; DeFrances, M
MLA Citation
Gibson, Blake A., et al. “Communicating Certainty in Pathology Reports: Interpretation Differences Among Staff Pathologists, Clinicians, and Residents in a Multicenter Study.Arch Pathol Lab Med, Oct. 2021. Pubmed, doi:10.5858/arpa.2020-0761-OA.
URI
https://scholars.duke.edu/individual/pub1499656
PMID
34669920
Source
pubmed
Published In
Arch Pathol Lab Med
Published Date
DOI
10.5858/arpa.2020-0761-OA

Association between PEG3 DNA methylation and high-grade cervical intraepithelial neoplasia.

BACKGROUND: Epigenetic mechanisms are hypothesized to contribute substantially to the progression of cervical intraepithelial neoplasia (CIN) to cervical cancer, although empirical data are limited. METHODS: Women (n = 419) were enrolled at colposcopic evaluation at Duke Medical Center in Durham, North Carolina. Human papillomavirus (HPV) was genotyped by HPV linear array and CIN grade was ascertained by biopsy pathologic review. DNA methylation was measured at differentially methylated regions (DMRs) regulating genomic imprinting of the IGF2/H19, IGF2AS, MESTIT1/MEST, MEG3, PLAGL1/HYMAI, KvDMR and PEG10, PEG3 imprinted domains, using Sequenom-EpiTYPER assays. Logistic regression models were used to evaluate the associations between HPV infection, DMR methylation and CIN risk overall and by race. RESULTS: Of the 419 participants, 20 had CIN3+, 52 had CIN2, and 347 had ≤ CIN1 (CIN1 and negative histology). The median participant age was 28.6 (IQR:11.6) and 40% were African American. Overall, we found no statistically significant association between altered methylation in selected DMRs and CIN2+ compared to ≤CIN1. Similarly, there was no significant association between DMR methylation and CIN3+ compared to ≤CIN2. Restricting the outcome to CIN2+ cases that were HR-HPV positive and p16 staining positive, we found a significant association with PEG3 DMR methylation (OR: 1.56 95% CI: 1.03-2.36). CONCLUSIONS: While the small number of high-grade CIN cases limit inferences, our findings suggest an association between altered DNA methylation at regulatory regions of PEG3 and high grade CIN in high-risk HPV positive cases.
Authors
Bosire, C; Vidal, AC; Smith, JS; Jima, D; Huang, Z; Skaar, D; Valea, F; Bentley, R; Gradison, M; Yarnall, KSH; Ford, A; Overcash, F; Murphy, SK; Hoyo, C
MLA Citation
Bosire, Claire, et al. “Association between PEG3 DNA methylation and high-grade cervical intraepithelial neoplasia.Infect Agent Cancer, vol. 16, no. 1, June 2021, p. 42. Pubmed, doi:10.1186/s13027-021-00382-3.
URI
https://scholars.duke.edu/individual/pub1485714
PMID
34120615
Source
pubmed
Published In
Infectious Agents and Cancer
Volume
16
Published Date
Start Page
42
DOI
10.1186/s13027-021-00382-3

Epithelioid Hyalinizing Sarcoma With MGA-NUTM1 Fusion.

OBJECTIVES: Soft tissue sarcomas are a group of tumors derived from the mesenchymal origin. Historically, they have been classified according to morphologic and immunohistochemical characteristics. The advent of multiplexed next-generation sequencing (NGS), specifically RNA sequencing, has modified the classification of such tumors and others by determining categorization based on molecular alterations. The NUTM1 rearrangement, previously thought to be present only in carcinomas, has recently been reported in poorly differentiated high-grade sarcomas of the soft tissue. We present the first reported case of an epithelioid hyalinizing sarcoma harboring the MGA-NUTM1 fusion in an acral site. METHODS: Histopathologic, immunohistochemical, and molecular testing were performed on resection tissue. RESULTS: Histologically, the tumor showed an epithelioid morphology with prominent background hyalinization. Immunohistochemically, the tumor expressed CD99 and nuclear NUT-1. By NGS the tumor harbors MGA-NUTM1 fusion. CONCLUSIONS: Our findings support more extensive use of NGS for accurate sarcoma classification and identification of potential therapeutic targets. Furthermore, they corroborate the fact that NUTM1-rearranged soft tissue tumors represent a spectrum of heterogeneous morphologic entities. This case also highlights the utility of NUT-1 immunohistochemical study as a possible screening tool for NUTM1-fused sarcomas.
Authors
Underwood, CIM; Cardona, DM; Bentley, RC; Shen, G; Feng, X; Jour, G; Al-Rohil, RN
MLA Citation
Underwood, Caroline I. M., et al. “Epithelioid Hyalinizing Sarcoma With MGA-NUTM1 Fusion.Am J Clin Pathol, vol. 154, no. 6, Nov. 2020, pp. 859–66. Pubmed, doi:10.1093/ajcp/aqaa113.
URI
https://scholars.duke.edu/individual/pub1459499
PMID
32880623
Source
pubmed
Published In
Am J Clin Pathol
Volume
154
Published Date
Start Page
859
End Page
866
DOI
10.1093/ajcp/aqaa113