PREOPERATIVE DELINEATION OF DEEPLY INVASIVE CUTANEOUS TUMORS: A SYSTEMATIC REVIEW OF HIGH-PRECISION IMAGING TECHNIQUES AND OUTCOMES

A positive margin after breast conserving surgery has consistently been shown to be a significant predictor for ipsilateral breast tumor recurrence. Currently, there is no standard for intraoperative margin assessment during lumpectomy, and up to 20% of cases result in positive margins. MarginProbe is a device that provides real-time evaluation of lumpectomy margins during surgery. The aim of this study was to evaluate the impact of MarginProbe as an adjunct to standard operating procedure (SOP). Patients diagnosed with breast cancer scheduled for breast conserving surgery were consented for intraoperative use of MarginProbe. Shaved margins were excised based on margin assessment using the surgeon's SOP which included specimen radiography and gross pathologic examination, and feedback from the device. The primary endpoint was re-excision rate. Secondary endpoints included sensitivity, specificity, false-positive and negative rates. Of the 60 breast cancers, initial histologically close/positive margins were identified in 18 patients (30%). The re-excision rate in the overall cohort was 6.6%, compared to a historical re-excision rate of 8.6% (p < 0.01). Based on 360 measurement sites, MarginProbe demonstrated a sensitivity of 67% and specificity of 60%, with a positive predictive value of 16%, and of negative predictive value of 94%, which was similar to the accuracy of SOP. MarginProbe performs equally as well as specimen radiography and gross pathologic examination. In this setting where the baseline re-excision rate was low, the use of MarginProbe as an adjunct to SOP resulted in a small 2% absolute reduction in re-excision rate.

Does the Addition of Breast MRI Add Value to the Diagnostic Workup of Invasive Lobular Carcinoma?

A positive margin status after breast conserving surgery (BCS) is one of the strongest predictors for local recurrence of intraductal (DCIS) and invasive carcinoma. As much as 20-50% of patients with BCS need to undergo a second operation to receive free margins. In this study we tested the clinical performance of MarginProbe© (Dune Medical Devices, Paoli, PA, USA), a device for the intraoperative evaluation of surgical margins. A prospective clinical study was performed: The device was utilized in BCS of 150 patients treated at a single facility from November 2012 to June 2013. The re-excision rate was compared to the re-excision rate of a historical group of 172 patients treated with BCS at the same hospital without the application of the device. We analyzed whether the results of MarginProbe© are affected by the morphology, grading, size of the tumor, breast density, age, BMI or the use of marker-wires. The application of MarginProbe© resulted in an overall decreased re-excision rate of 14.6%. In the subgroup of DCIS the re-excision rate was reduced from 61.7 to 23.1%. In the subgroup of invasive lobular carcinomas the re-excision rate decreased from 37.0 to 19.0%. MarginProbe© results were not affected by grading, tumor size, breast density, age, BMI or marker-wire application. MarginProbe© detects positive margins in invasive carcinoma, DCIS as well as in invasive lobular carcinoma. The device decreases the re-excision rate after BCS significantly. It does not interfere with any of the factors we examined.

Background Research in the field of orbital imaging demonstrates that AI methods, in particular deep learning architectures, can outperform traditional manual segmentation [1–5]. Such approaches provide higher accuracy of orbital structure extraction, significantly reducing interobserver variability. Aim To evaluate and compare the performance of modern AI segmentation methods with traditional manual approaches for orbital structure extraction and volumetric analysis. Material and Methods The study is based on the analysis of scientific literature and published studies. Results Preliminary results indicate that AI segmentation methods significantly outperform traditional manual segmentation in terms of accuracy and reproducibility, reducing interobserver variability. Automated voxel counting combined with AI segmentation significantly reduces the time required for volumetric analysis, which has a positive impact on the clinical workflow. In addition, the achieved improvements contribute to more accurate diagnostics and assist in surgical planning, which confirms their clinical significance. The key success factors are: • availability of high-quality, well-annotated datasets, standardized multi-sequence imaging; • modern computing infrastructure (GPU, specialized frameworks) for training and integrating algorithms into the clinical workflow; • interdisciplinary collaboration between specialists to fine-tune the algorithms and confirm their clinical accuracy. All these components together contribute to the development of more accurate treatment strategies and potentially improve patient outcomes. Conclusion The integration of modern AI architectures (nnU-Net, Attention-Based Neural Networks) with automated voxel counting methods represents a significant breakthrough in orbital segmentation and volumetric analysis. These methods not only provide high accuracy, but also contribute to improving the quality of surgical treatment planning. Keywords: orbital measurements; segmentation; volumetric analysis; artificial intelligence; surgical planning

P102. Therapeutic mammoplasty: Use of wire localization and margin involvement

P100. Management of positive sentinel node biopsy. Audit of practice 2010–2012

Sensitivity of the intraoperative assessment of myometrial invasion in patients undergoing hysterectomy for endometrial cancer

The aim of this study was to discuss posterior petrous meningiomas--their classification, clinical manifestations, surgical treatments, and patient outcomes. A retrospective analysis was performed in 82 patients with posterior petrous meningiomas for microsurgery. According to the anatomical relationship with the posterior surface of the petrous bone and with special reference to the internal auditory canal (IAC), posterior petrous meningiomas were classified into three types: Type I, located laterally to the IAC (28 cases); Type II, located medially to the IAC, which might extend to the cavernous sinus and clivus (32 cases); and Type III, extensively attached to the posterior surface of the petrous bone, which might envelop the seventh and eighth cranial nerves (22 cases). Sixty-eight (83%) of 82 cases involved total resection. The rate of anatomical preservation of facial nerve was 97.5%, whereas the functional preservation rate was 81%. The rate of hearing preservation was 67%. All Type I tumors were completely resected, and the rate of anatomical preservation of facial nerve was 100% and functional preservation was 93%. Regarding Type II lesions, 75% of 32 cases involved total resection; the rate of anatomical preservation of facial nerve was 97% and functional preservation was 75%. For Type III lesions, 73% of 22 cases were totally resected. The rate of anatomical preservation of facial nerve in patients with this tumor type was 95%, whereas functional preservation was 73%. Clinical manifestations and surgical prognoses are different among the various types of posterior petrous meningiomas. It is more difficult for Types II and III tumors to be resected radically than Type I lesions, and postoperative functional outcomes are significantly worse accordingly. The primary principles in dealing with this disease entity include preservation of vital vascular and central nervous system structures and total resection of the tumor as much as possible.

Recurrent plexiform schwannoma involving the carotid canal

operative frozen section examination of breast lumpectomy margins was associated with a substantial reduction in the rate of reexcision. In their retrospective study, at some time after the initial lumpectomy a reexcision was performed in 48.9% of patients who did not have frozen section margin evaluation compared with only 14.9% of those in whom frozen section evaluation of the margins was performed. Further, these investigators developed a technique to overcome the methodological difficulties of attempting to cut frozen sections of fatty tissue such as margins of breast specimens. So if it is now technically feasible to obtain adequate frozen sections from lumpectomy margins and if intraoperative frozen section evaluations of these margins can reduce the need for a subsequent reexcision by almost 70%, should pathologists the world over be gearing up to routinely freeze margins of breast lumpectomy specimens? To answer this question, we must first review some fundamental data on lumpectomy margins and their association with local recurrence, and put these data into current clinical context. Various patient factors, treatment factors, and pathologic factors have been reported to be associated with an increased risk of recurrence in the ipsilateral breast (local recurrence) after breast-conserving treatment for invasive breast cancer and ductal carcinoma in situ (DCIS). Arguably the most important of these is the status of the microscopic margins of excision of the resected breast specimen. Positive margins (ie, invasive carcinoma or DCIS at an inked tissue edge) have consistently been associated with a higher risk of local recurrence than negative margins. 2

15599 Background: Robotic-assisted laparoscopic radical prostatectomy (RLRP) is increasingly being utilized for the treatment of localized prostate cancer at many centers. The main objective of RLRP is cancer control and preservation of erectile function with reduced positive surgical margin (PSM) rates. We evaluated the effect of a side-specific nerve preservation (NP)protocol which was implemented in June 2006 to help further reduce PSM rates. Methods: Between June-November 2006, 150 consecutive RLRPs were performed using select ipsilateral, NP techniques (interfascial, extrafascial and wide resection) based on pre-operative risk factors (clinical stage, biopsy Gleason score (GS), percentage of core number positive and maximal core cancer percentage). Prior to June 2006, only interfascial and wide resection were performed. The NP protocol, included ipsilateral extrafascial dissection in all patients with GS=7 with non-palpable disease. All patients with GS≤6, non-palpable disease and whose biopsy pathology demonstrated &lt;33% of ipsilateral cores positive for cancer were offered interfascial dissection. Wide resection was performed for patients with palpable disease, GS≥8 and ≥66% of all ipsilateral biopsy cores positive for cancer. Pathological outcomes were compared with the 245 consecutive RLRP cases performed prior to June 2006, where more liberal interfascial NP was performed. Results: Relative to the modified NP group, mean patient age (60 vs 59, p= 0.21), PSA (6.7 vs 6.8, p=0.77), clinical stage (p=0.93), biopsy Gleason score (p=0.51), pathologic Gleason score (p=0.32) and stage (p=0.65) were similar to the control group. Mean total number of positive cores involved with cancer were also comparable between groups (3.5 vs 3.3, p=0.31). Overall PSM rate was significantly lower in the modified NP group (12.6% vs 20.4%,p=0.04). Specific pT2-PSM rates were significantly lower (8.3% vs 15%, p=0.04) while only a trend was observed for pT3-PSM rates (34.5% vs 40.4%, p=0.60) in the modified NP group. Conclusions: Modifying ipsilateral nerve preservation for patients undergoing RLRP, based on specific pre-operative variables has significantly helped further reduce overall and pT2-specific PSM rates. No significant financial relationships to disclose.

Background. Considering decreasing age of patients with prostate cancer, increasing cancer alertness of first-line doctors as well as increased frequency of radical prostatectomies (RP), the problem of preservation of erectile function (EF) is vitally important (erectile dysfunction develops in 25–75 % of all patients who underwent surgery).The study objective is to analyze preservation of EF after RP depending on the type of endoscopic access and nerve preservation.Materials and methods. Between February of 2015 and February of 2016, in the Urology Clinic of the Sechenov University, 507 RPs were performed; the retrospective single-center study included 231 patients with localized prostate cancer. Surgery was performed with the following accesses: laparoscopic, extraperitoneal laparoscopic, and robotic. Indications for nerve preservation were formulated based on the Briganti nomogram, Partin table as well as patient’s desire to preserve EF. Further evaluation of EF was performed using the International Index of Erectile Function (IIEF5), evaluation of quality of life – using the QoL (Quality of Life) scale.Results. RP with nerve preservation was performed in 150 patients. Surgical time and blood loss did not significantly differ for surgeries with and without nerve preservation (р = 0.064 and р = 0.073 respectively). Pathomorphological examination showed that in all cases (n = 231) integrity of the prostatic capsule and negative surgical margin were achieved. Frequent significant erectile dysfunction and full loss of EF were observed in patients after RP without nerve preservation compared to the group with preserved neurovascular bundles (5.0 (0.0–10.0) points compared to 6.5 (0.8–19.0) points per the IIEF5 scale, р = 0.271): 96.2 % versus 72.2 % (p &lt;0.001). Nerve preservation significantly improved quality of life: 1.63 ± 1.16 points versus 1.88 ± 1.02 points per the QoL scale (р = 0.035).Conclusions. The best results were achieved in the robotic access group. Surgery with nerve preservation decreased frequency of EF loss. This benefit in conjunction with the radical nature of the operative intervention allows to consider RP techniques with nerve preservation as reasonable approach to erectile dysfunction prevention in patients with localized prostate cancer.

Background: A positive margin status after breast conserving surgery (BCS) is one of the strongest predictors of local recurrence of intraductal and invasive carcinoma. As much as 20-50% of all patients with BCS need to undergo a second operation in order to receive free margins. In this study we tested the clinical performance of Margin Probe (Dune Medical Devices), a novel device for intraoperative margin evaluation. Methods: A prospective clinical trial was performed: The device was applied to 150 lumpectomy specimen from consecutive patients with BCS treated during the first three months in 2013. The re-excision rate was compared to the re-excision rate of a historical group of 156 patients treated with BCS during the first three months in 2012, without the application of the device. We analyzed whether Margin Probe is affected by tumor morphology, grading, size of the tumor, breast density, age, body-mass-index or the use of wire-marker. Results: Due to the application of Margin Probe the re-excision rate decreased significantly by 51% from 39.7% to 14.6%. In the subgroup of intraductal carcinoma (DCIS) the re-excision rate was reduced about two thirds from 66.7% to 23.1%. In the subgroup of invasive lobular carcinomas the re-excision rate decreased from 37.0% to 19.0%. Margin Probe results are not affected by grading, tumor size, breast-density, age, body-mass-index or wire-marker application. Conclusion: Margin Probe is an effective tool for detection of positive margins during BCS and significantly decreases the re-excision rate. It is not limited to invasive carcinoma but also detects involved margins in DCIS as well as in invasive lobular carcinoma. It does not interfere with any of the factors we examined. Citation Format: Jens Uwe Blohmer, Julia Tanko, Ragna Voelker, Julia de Grahl, Jessica Gross. Margin Probe device is able to reduce re-excision rate of breast conserving surgery in invasive and pre-invasive breast cancer independent from any patient or tumor related factors [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-16-06.

Breast conservation therapy is controversial for ductal carcinoma in situ (DCIS) due to recently reported high recurrence rates. We believe that cytologic evaluation of lumpectomy margins improves efficiency and leads to a lower recurrence rate following lumpectomy for DCIS. A prospectively accrued database of 1255 breast cancer patients at the H. Lee Moffitt Cancer Center and Research Institute was found to have 218 patients with DCIS (17.4%). Of those 218 cases, 114 were treated with lumpectomy, axillary dissection, and radiation therapy; the remaining 104 patients were treated with mastectomy with or without reconstruction. Imprint cytology was used to evaluate all lumpectomy margins. Permanent sections and imprint cytology were reviewed by the same pathologist. All lumpectomy specimens (116 tumors in 114 patients) were evaluated. The median follow up was 57.5 months (range 2-110 months). One hundred and three patients with 104 tumors were selected on the basis of pure DCIS (with or without microinvasion), and treated with lumpectomy, axillary dissection and radiation therapy. Of the 104 tumors utilizing attempted breast conservation therapy, 7 (6.6%) required mastectomy. There were 6 recurrences (6.1%) with a median time for recurrence of 47.5 months (range 27-85 months); four recurrences were comedo and two were noncomedo at original diagnosis. The determination of lumpectomy margins in DCIS patients using imprint cytology leads to an overall recurrence rate of 6.1% with reduction in operative time, and re-excision rate. Significant recurrence rates were associated with microinvasion and multifocal tumors (28%) versus simple DCIS at 5 years. Breast conservation therapy and surgical margin determination with imprint cytology for DCIS is a cost-effective and reliable method of treatment for simple DCIS.

Patients with thoracic aortic aneurysm and dissection (TAAD) are often asymptomatic but present acutely with life threatening complications that necessitate emergency intervention. Aortic diameter measurement using computed tomography (CT) is considered the gold standard for diagnosis, surgical planning, and monitoring. However, manual measurement can create challenges in clinical workflows due to its time-consuming, labour-intensive nature and susceptibility to human error. With advancements in artificial intelligence (AI), several models have emerged in recent years for automated aortic diameter measurement. This article aims to review the performance and clinical relevance of these models in relation to clinical workflows. We performed literature searches in PubMed, Scopus, and Web of Science to identify relevant studies published between 2014 and 2024, with the focus on AI and deep learning aortic diameter measurements in screening and diagnosis of TAAD. Twenty-four studies were retrieved in the past ten years, highlighting a significant knowledge gap in the field of translational medicine. The discussion included an overview of AI-powered models for aortic diameter measurement, as well as current clinical guidelines and workflows. This article provides a thorough overview of AI and deep learning models designed for automatic aortic diameter measurement in the screening and diagnosis of thoracic aortic aneurysms (TAAs). We emphasize not only the performance of these technologies but also their clinical significance in enabling timely interventions for high-risk patients. Looking ahead, we envision a future where AI and deep learning-powered automatic aortic diameter measurement models will streamline TAAD clinical management.