Photo of Debra L. Zynger

Debra L. Zynger

  • Associate Professor, Pathology
    The Ohio State University
  • Director, Division of Genitourinary Pathology, Pathology
    The Ohio State University
  • E401 Doan Hall

Research Interests

Urologic pathology and oncology, Breast pathology and oncology

Professional Interests

Urologic pathology, Breast pathology
  • Most Common Publication Keywords # of Pubs
  • BREAST CANCER3
  • APPARENT DIFFUSION COEFFICIENT2
  • BIOMARKER2
  • BLADDER MALIGNANCY2
  • ER2
  • HER22
  • HISTOGRAM ANALYSIS2
  • K-MEANS CLUSTERING2
  • NEOADJUVANT2
  • PR2
  • Most Common Publication Subject Categories # of Pubs
  • PATHOLOGY1
  • RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING1

Most Recent Journal Articles

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  • Hou,Yanjun; Tozbikian,Gary; Zynger,Debra,L; et al. "Using the Modified Magee Equation to Identify Patients Unlikely to Benefit From the 21-Gene Recurrence Score Assay (Oncotype DX Assay)." American journal of clinical pathology. Vol. 147, no. 6. (Jun 2017): 541-548. (Published). Hou,Yanjun; Tozbikian,Gary; Zynger,Debra,L; Li,Zaibo Using the Modified Magee Equation to Identify Patients Unlikely to Benefit From the 21-Gene Recurrence Score Assay (Oncotype DX Assay). American journal of clinical pathology Journal Article Peer-Review 28449064 10.1093/ajcp/aqx008 0002-9173 Objectives This study aimed to compare a modified Magee equation with Oncotype DX (Genomic Health, Redwood City, CA) recurrence score (RS) and identify patients who are unlikely to benefit from Oncotype DX. Methods Magee equation RS was calculated in 438 cases and correlated with Oncotype DX RS. Results The Pearson correlation coefficient ( r ) for the Magee equation and Oncotype DX RS was 0.6645 ( P ?<?.00001), and the overall agreement was 66.4%. All cases (11.6%) with a Magee equation RS?greater than?30 or?11 or less had been correctly predicted to have either high Oncotype DX RS or low Oncotype DX RS, respectively. Conclusions The modified Magee equation is able to identify up to 12% patients who are unlikely to benefit from Oncotype DX testing. Using the modified Magee equation RS on these patients would be an alternative to Oncotype DX, leading to cost savings. Breast cancer|Estrogen receptor|Magee equation|Oncotype DX|Recurrence score Links
  • Nguyen,Huyen,T; Shah,Zarine,K; Mortazavi,Amir; et al. "Non-invasive quantification of tumour heterogeneity in water diffusivity to differentiate malignant from benign tissues of urinary bladder: a phase I study." EUROPEAN RADIOLOGY. Vol. 27, no. 5. (May 2017): 2146-2152. (Published).Citation Count: 0. Nguyen,Huyen,T; Shah,Zarine,K; Mortazavi,Amir; Pohar,Kamal,S; Wei,Lai; Jia,Guang; Zynger,Debra,L; Knopp,Michael,V Non-invasive quantification of tumour heterogeneity in water diffusivity to differentiate malignant from benign tissues of urinary bladder: a phase I study EUROPEAN RADIOLOGY Journal Article Peer-Review 10.1007/s00330-016-4549-2 0938-7994 To quantify the heterogeneity of the tumour apparent diffusion coefficient (ADC) using voxel-based analysis to differentiate malignancy from benign wall thickening of the urinary bladder. Nineteen patients with histopathological findings of their cystectomy specimen were included. A data set of voxel-based ADC values was acquired for each patient's lesion. Histogram analysis was performed on each data set to calculate uniformity (U) and entropy (E). The k-means clustering of the voxel-wised ADC data set was implemented to measure mean intra-cluster distance (MICD) and largest inter-cluster distance (LICD). Subsequently, U, E, MICD, and LICD for malignant tumours were compared with those for benign lesions using a two-sample t-test. Eleven patients had pathological confirmation of malignancy and eight with benign wall thickening. Histogram analysis showed that malignant tumours had a significantly higher degree of ADC heterogeneity with lower U (P = 0.016) and higher E (P = 0.005) than benign lesions. In agreement with these findings, k-means clustering of voxel-wise ADC indicated that bladder malignancy presented with significantly higher MICD (P < 0.001) and higher LICD (P = 0.002) than benign wall thickening. The quantitative assessment of tumour diffusion heterogeneity using voxel-based ADC analysis has the potential to become a non-invasive tool to distinguish malignant from benign tissues of urinary bladder cancer. aEuro cent Heterogeneity is an intrinsic characteristic of tumoral tissue. aEuro cent Non-invasive quantification of tumour heterogeneity can provide adjunctive information to improve cancer diagnosis accuracy. aEuro cent Histogram analysis and k-means clustering can quantify tumour diffusion heterogeneity. aEuro cent The quantification helps differentiate malignant from benign urinary bladder tissue. COEFFICIENT|CANCER-DETECTION|DIAGNOSIS|PREDICTION|LESIONS|WEIGHTED MRI|K-means clustering|apparent diffusion coefficient|histogram analysis|tumour heterogeneity|bladder malignancy Radiology, Nuclear Medicine & Medical Imaging Links
  • Nguyen,Huyen,T; Shah,Zarine,K; Mortazavi,Amir; et al. "Non-invasive quantification of tumour heterogeneity in water diffusivity to differentiate malignant from benign tissues of urinary bladder: a phase I study." European radiology. Vol. 27, no. 5. (May 2017): 2146-2152. (Published). Nguyen,Huyen,T; Shah,Zarine,K; Mortazavi,Amir; Pohar,Kamal,S; Wei,Lai; Jia,Guang; Zynger,Debra,L; Knopp,Michael,V Non-invasive quantification of tumour heterogeneity in water diffusivity to differentiate malignant from benign tissues of urinary bladder: a phase I study. European radiology Journal Article Peer-Review 27553924 10.1007/s00330-016-4549-2 0938-7994 OBJECTIVES To quantify the heterogeneity of the tumour apparent diffusion coefficient (ADC) using voxel-based analysis to differentiate malignancy from benign wall thickening of the urinary bladder. METHODS Nineteen patients with histopathological findings of their cystectomy specimen were included. A data set of voxel-based ADC values was acquired for each patient's lesion. Histogram analysis was performed on each data set to calculate uniformity (U) and entropy (E). The k-means clustering of the voxel-wised ADC data set was implemented to measure mean intra-cluster distance (MICD) and largest inter-cluster distance (LICD). Subsequently, U, E, MICD, and LICD for malignant tumours were compared with those for benign lesions using a two-sample t-test. RESULTS Eleven patients had pathological confirmation of malignancy and eight with benign wall thickening. Histogram analysis showed that malignant tumours had a significantly higher degree of ADC heterogeneity with lower U (P?=?0.016) and higher E (P?=?0.005) than benign lesions. In agreement with these findings, k-means clustering of voxel-wise ADC indicated that bladder malignancy presented with significantly higher MICD (P?<?0.001) and higher LICD (P?=?0.002) than benign wall thickening. CONCLUSIONS The quantitative assessment of tumour diffusion heterogeneity using voxel-based ADC analysis has the potential to become a non-invasive tool to distinguish malignant from benign tissues of urinary bladder cancer. KEY POINTS • Heterogeneity is an intrinsic characteristic of tumoral tissue. • Non-invasive quantification of tumour heterogeneity can provide adjunctive information to improve cancer diagnosis accuracy. • Histogram analysis and k-means clustering can quantify tumour diffusion heterogeneity. • The quantification helps differentiate malignant from benign urinary bladder tissue. Apparent Diffusion Coefficient|Bladder malignancy|Histogram analysis|K-means clustering|Tumour heterogeneity Links
  • Xian,Zhaoying; Quinones,Alexander,K; Tozbikian,Gary; et al. "Breast cancer biomarkers before and after neoadjuvant chemotherapy: does repeat testing impact therapeutic management?." Human pathology. Vol. 62, (Apr 2017): 215-221. (Published). Xian,Zhaoying; Quinones,Alexander,K; Tozbikian,Gary; Zynger,Debra,L Breast cancer biomarkers before and after neoadjuvant chemotherapy: does repeat testing impact therapeutic management? Human pathology Journal Article Peer-Review 28041972 10.1016/j.humpath.2016.12.019 0046-8177 In patients treated with neoadjuvant chemotherapy (NAC), there is no consensus on retesting biomarkers within the excision specimen. Our aim was to investigate the clinical relevance of biomarker changes post-NAC at a large tertiary medical center. A retrospective search was performed to identify cases from 2012 to 2015 with needle biopsy-confirmed invasive breast carcinoma treated with NAC and subsequent excision containing residual invasive tumor. Biomarkers (estrogen receptor [ER], progesterone receptor [PR], and HER2/neu [HER2]) were performed on all pre-NAC biopsies. One hundred fifty-four NAC-treated cases were identified in which 83 (54%) had repeat testing of at least 1 biomarker on the surgical specimen. Twenty-five (30%) of 83 repeated cases demonstrated changes in pre-NAC biopsy versus post-NAC resection biomarker status. There was no impact of age or grade on biomarker status changes. Tumors that were triple negative at biopsy were more likely to remain triple negative. Clinically relevant changes were identified including the following: (1) ER negative to ER positive, 2 (3%) of 75; (2) PR negative to PR positive with ER negative both pre- and post-NAC, 2 (3%) of 73; and (3) HER2 negative to positive, 1 (1%) of 77. Four of 5 of the changes led to modifications of the adjuvant treatment regimen, including the addition of adjuvant tamoxifen, anastrazole, or trastuzumab. In summary, post-NAC biomarker repeat testing in patients with breast cancer impacts therapeutic management in a small subset of patients and therefore, repeat testing may be considered for patients that are hormone receptor and/or HER2 negative before NAC. Biomarker|Breast cancer|ER|HER2|Neoadjuvant|PR|Repeat testing Links
  • Xian,Zhaoying; Quinones,Alexander,K; Tozbikian,Gary; et al. "Breast cancer biomarkers before and after neoadjuvant chemotherapy: does repeat testing impact therapeutic management?." HUMAN PATHOLOGY. Vol. 62, (Apr 2017): 215-221. (Published).Citation Count: 0. Xian,Zhaoying; Quinones,Alexander,K; Tozbikian,Gary; Zynger,Debra,L Breast cancer biomarkers before and after neoadjuvant chemotherapy: does repeat testing impact therapeutic management? HUMAN PATHOLOGY Journal Article Peer-Review 10.1016/j.humpath.2016.12.019 0046-8177 In patients treated with neoadjuvant chemotherapy (NAC), there is no consensus on retesting biomarkers within the excision specimen. Our aim was to investigate the clinical relevance of biomarker changes post-NAC at a large tertiary medical center. A retrospective search was performed to identify cases from 2012 to 2015 with needle biopsy-confirmed invasive breast carcinoma treated with NAC and subsequent excision containing residual invasive tumor. Biomarkers (estrogen receptor [ER], progesterone receptor [PR], and HER2/neu [HER2]) were performed on all pre-NAC biopsies. One hundred fifty-four NAC-treated cases were identified in which 83 (54%) had repeat testing of at least 1 biomarker on the surgical specimen. Twenty-five (30%) of 83 repeated cases demonstrated changes in pre-NAC biopsy versus post-NAC resection biomarker status. There was no impact of age or grade on biomarker status changes. Tumors that were triple negative at biopsy were more likely to remain triple negative. Clinically relevant changes were identified including the following: (1) ER negative to ER positive, 2 (3%) of 75; (2) PR negative to PR positive with ER negative both pre- and post-NAC, 2 (3%) of 73; and (3) HER2 negative to positive, 1 (1%) of 77. Four of 5 of the changes led to modifications of the adjuvant treatment regimen, including the addition of adjuvant tamoxifen, anastrazole, or trastuzumab. In summary, post-NAC biomarker repeat testing in patients with breast cancer impacts therapeutic management in a small subset of patients and therefore, repeat testing may be considered for patients that are hormone receptor and/or HER2 negative before NAC. (C) 2017 Elsevier Inc. All rights reserved. HORMONE-RECEPTOR STATUS|CARCINOMA|ESTROGEN-RECEPTOR|AMERICAN-SOCIETY|PROGESTERONE-RECEPTOR|EXPRESSION|PROGNOSTIC VALUE|GROWTH-FACTOR RECEPTOR-2|BIOLOGICAL MARKERS|HER2/NEU STATUS|ER|her2|PR|biomarker|neoadjuvant|BREAST CANCER|repeat testing Pathology Links

Most Recent Scholarly Presentations

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  • Debra L. Zynger, Seminar Presenter. "Benign Mimickers and Variants of Prostatic Carcinoma." Presented at College of American Pathologists 2016 Annual Meeting, Peers within Field., Las Vegas, Nevada (Sep 2016) Debra L. Zynger Benign Mimickers and Variants of Prostatic Carcinoma Seminar Presenter 1 College of American Pathologists 2016 Annual Meeting International
  • Debra L. Zynger, Seminar Presenter. "Bladder Bx/TURBT Pitfalls, CIS and Tumor Variants." Presented at College of American Pathologists 2016 Annual Meeting, Peers within Field., Las Vegas, Nevada (Sep 2016) Debra L. Zynger Bladder Bx/TURBT Pitfalls, CIS and Tumor Variants Seminar Presenter 1 College of American Pathologists 2016 Annual Meeting International
  • Debra L. Zynger, Seminar Presenter. "IHC for Genitourinary Pathology: The Pathologist’s Perspective." Presented at National Society for Histotechnology 2016 Annual Meeting, Peers within Field., Long Beach, California (Sep 2016) Debra L. Zynger IHC for Genitourinary Pathology: The Pathologist’s Perspective Seminar Presenter 1 National Society for Histotechnology 2016 Annual Meeting International
  • Debra L. Zynger, Seminar Presenter. "Prostate Benign Mimickers and Variants: Pitfalls on Needle Biopsies." Presented at American Society for Clinical Pathology 2016 Annual Meeting, Peers within Field., Las Vegas, Nevada (Sep 2016) Debra L. Zynger Prostate Benign Mimickers and Variants: Pitfalls on Needle Biopsies Seminar Presenter 1 American Society for Clinical Pathology 2016 Annual Meeting International
  • Debra L. Zynger, Seminar Presenter. "Prostate Biopsy Billing." Presented at American Society for Clinical Pathology 2016 Annual Meeting, Peers within Field., Las Vegas, Nevada (Sep 2016) Debra L. Zynger Prostate Biopsy Billing Seminar Presenter 1 American Society for Clinical Pathology 2016 Annual Meeting International