Margin Assessment Research Articles

Clinical significance of intraoperative histological examination of resection margins during organ-preserving operations

Introduction. Today, resection margins are assessed in different ways, but in clinical practice, preference is given to the histological method with macro- and microscopic examination of the margins. Assessment of resection margins can be carried out not only during planned histological examination, but also during intraoperative examination.Aim. To evaluate the feasibility of intraoperative assessment of resection margins when performing organ-preserving operations in patients with primary resectable breast cancer.Materials and methods. A retrospective study analyzed data from patients with early breast cancer who underwent surgical treatment at the Blokhin National Medical Research Center of Oncology of the Ministry of Health of Russia from June 2020 to May 2022. All patients underwent mammary gland resection with or without intraoperative marginal GI of resection, with sentinel lymph node determination or regional lymphadenectomy at the first stage. Patients included in the final analysis were divided into 2 groups: the study group consisted of patients who underwent intraoperative marginal GI of resection, and the control group consisted of patients who did not undergo intraoperative marginal GI of resection. Marginal GI of resection is performed by a pathologist by measuring the distance from the tumor node to the resection margins on a macropreparation. Frozen sections were always stained with hematoxylin and eosin.Results. The 451 patients with early forms of breast cancer included in the final analysis and subjected to breast resection at the first stage were divided into 2 main groups: the study group consisted of patients (n = 310) who underwent intraoperative microscopic histological assessment of resection margins, and the control group included patients (n = 141) who did not undergo intraoperative assessment of resection margins. During intraoperative histological assessment of resection margins, patients with positive resection margins were most often observed with invasive cancer – 20.3 versus 3.9 % with intraductal cancer.Conclusion. Further research is needed to determine the factors influencing the increase in the incidence of positive resection margins and their impact on patient survival rates.

Exploring hot isostatic pressing as a thermo-mechanical treatment for additive and milled CAD-CAM screw-retained frameworks: trueness, marginal and internal gap assessments

Exploring hot isostatic pressing as a thermo-mechanical treatment for additive and milled CAD-CAM screw-retained frameworks: trueness, marginal and internal gap assessments

Oncological and Functional Outcomes After Type III Cordectomy for Early Glottic Cancer (Tis, T1a): A Retrospective Study Based on Our 10-Year Experience

Background: The recommended treatment for early glottic cancer is trans-oral laser microsurgery, with excellent oncological and functional outcomes. The aim of this study is to evaluate oncological and functional outcomes in patients who underwent monolateral type III laser cordectomy for early glottic cancer. Methods: A total of 104 patients were enrolled. Staging, histological type, grading, assessment of surgical margins, mean time of relapse, OS, DFS, and DSS were obtained. Maximum phonation time, GIRBAS score, shimmer, jitter, fundamental frequency, and Yanagihara score were evaluated. Patients were submitted to the VHI-10 questionnaire. Results: Correlations between patients with single recurrence and the anterior commissure involvement were analyzed, as well as correlations between patients with recurrence and the status of margins. Correlations between VHI-10 scores and anterior commissure involvement were analyzed. Conclusions: The recurrence rate was higher in patients with anterior commissure involvement. A significant inversely proportional association between DSS and assessment of surgical margins was observed. The distribution of VHI-10 scores differed significatively in patients with and without anterior commissure involvement. Vocal results reflected mild dysphonia.

Monitoring Dissolved Organic Carbon Concentration and Flux in the Qiantang Riverine System Using Sentinel-2 Satellite Images

Real-time monitoring of riverine-dissolved organic carbon (DOC) and its controlling factors is critical for formulating strategies regarding the river basin and marginal seas pollution prevention and control. In this study, we established a linear regression formulation that relates the permanganate index (CODMn) to the DOC concentration based on in situ measurements collected on five field surveys in 2023–2024. This regression formulation was used on a large number of data collected from automatic monitoring stations in the Qiantang River area to construct a daily quasi-in situ database of DOC concentration. By combining the quasi-in situ DOC data and Sentinel-2 measurements, an enhanced algorithm for empirical DOC estimation was developed (R2 = 0.66) using the extreme gradient boosting (XGBoost) method and its spatial and temporal variations in the Qiantang River were analyzed from 2016 to 2023. Spatially, the main stream of the Qiantang River exhibited an overall decreasing and increasing trend influenced by population density, economic development, and pollutant discharge in the basin area, and the temporal distribution of DOC was controlled by meteorological conditions. The DOC contents had the highest in summer, primarily due to high rainfall and leaching. The inter-annual variation in DOC concentration was influenced by the total annual runoff volumes, with a minimum level of 2.24 mg L−1 in 2023 and a maximum level of 2.45 mg L−1 in 2019. The monthly DOC fluxes ranged from 6.3 to 13.8 × 104 t, with the highest values coinciding with the maximum river discharge volumes in June and July. The DOC levels in the Qiantang River remained relatively high in recent years (2016–2023). This study enables the concerned stakeholders and researchers to better understand carbon transportation and its dynamics in the Qiantang River and its coastal areas.

HPB SO22 - Clinical outcomes following radical cholecystectomies, a single centre experience in review

Abstract Background Gallbladder carcinoma (GBC) is a rare disease with dismal prognosis. The majority of cases are identified at an advanced state that preclude curative approaches which would usually necessitate removal of the gallbladder with en-block wedge hepatectomy of segment 4b/5 as well as periportal lymphadenectomy. The purpose of this study was to analyze our outcomes for patients undergoing a radical cholecystectomy for suspected GBC. Method A retrospective analysis of patients who underwent radical cholecystecomies at Queen’s Medical Centre, Nottingham, UK between 1st January 2014 and October 2023 was performed. Patients with concomitant primaries, incidental GBC or completion liver resection following index cholecystectomy were excluded. Results 41 patients were eligible for analysis, those were comprised of 13 males and 28 females with a median age of 67 (IQR 57-72) years. The incidence of malignancy on histology was 31.7% (GBC n=11, metastatic renal carcinoma n=1, metastatic melanoma n=1). Cystic margin assessment by frozen section was performed in 41% of cases. In cases with confirmed gallbladder cancer, the median tumour size was 30mm, positive periportal lymph nodes were identified in two patients while R0 resection was achieved in all cases. The median length of stay following surgery was 5 days (IQR 5-7) while Clavien Dindo complication grade ≥ III were experienced in 12% ( return to theatre for leak from repaired cholecysto-duodenal fistula n=1, IR drainage of post operative collection n=3, ITU stay for cardiac arrhythmia n=1). The pathologies encountered in benign cases (n=28) were compatible with chronic cholecystitis (53.5%, n=15), concurrent chronic cholecystitis and adenomyomatosis (21.4%, n=6), xanthogranulomatous cholecystitis (10.7%, n=3), adenomyomatosis (7.1%, n=2), follicular cholecystitis (3.5%, n=1), benign GB polyps (3.5%, n=1). Conclusion Radical cholecystectomy remains the standard of care for suspected GBC however sufficient preoperative counselling is prudent given likelihood of benign disease on histology.

Intraoperative Peripheral Frozen Margin Assessment in Soft Tissue Sarcoma.

Intraoperative peripheral margin sampling in soft tissue sarcoma (STS) is a routine practice among musculoskeletal oncologists. Practice patterns are variable, and evidence to support it is lacking. Rates of peripheral margin sampling at our institution were analyzed in addition to its clinical utility and cost-effectiveness. Peripheral margin sampling patterns at a tertiary sarcoma center were retrospectively evaluated. Concordance between peripheral margins and final pathology was assessed using McNemar's test and κ Coefficient. Clinical outcomes were compared, and a cost-utility analysis was performed. A total of 179 patients were included. 66% had peripheral margins sampled of which 23% had frozen margins analyzed. Ten patients had positive margins (5.5% of all patients; 8.4% in those with margins sampled) and R1 margins on the final tumor specimen were identified in 15 patients (8.4%). There were no R2 resections. Three patients underwent repeat surgical resection (20%). Three patients with R1 resections had negative peripheral margins sampled, suggesting falsely reassuring peripheral margins. Peripheral margin sampling averaged $5000/patient. Routine peripheral margin sampling in STS resection is of questionable utility with added cost. Prospective studies are warranted to determine the optimal approach to surgical margin assessment.

Musculoskeletal Tumor Society Member Survey: Intra-Operative Peripheral Margins in Soft Tissue Sarcoma.

Routine intraoperative peripheral margin sampling is often employed by musculoskeletal surgical oncologists. Several recommendations exist regarding this practice pattern. It is unknown what the practice patterns of Musculoskeletal Tumor Society (MSTS) members are. Evidence-based data to support or refute this practice is currently lacking. We developed an anonymous survey with two primary objectives. To determine the practice patterns of active MSTS members with respect to intraoperative peripheral margin sampling and to elucidate the most common rationale for routine sampling. An anonymous survey was distributed through the MSTS to 320 active members. Results were collected with a branching logic fashion via Microsoft Forms®. Surveys were sent to 320 MSTS members in 2021. A total of 108 responses were collected. A total of 55 (51%) respondents noted that they routinely send intraoperative peripheral margins. Primary reasons for margin assessment included concerns about adequacy of margins. Members who routinely send frozen margins sent on average 4-6 specimens. There is significant variability in this practice amongst MSTS members. Given there is no evidence to support or refute this practice, Further investigation is required to determine the clinical utility of routine intraoperative peripheral margin sampling.

Endoscopic In Vivo Hyperspectral Imaging for Head and Neck Tumor Surgeries Using a Medically Approved CE-Certified Camera with Rapid Visualization During Surgery.

Background: In vivo visualization of malignant tumors remains the main challenge during head and neck cancer surgery. This can result in inadequate tumor margin assessment and incomplete tumor resection, adversely affecting patient outcomes. Hyperspectral imaging (HSI) is a promising approach to address this issue. However, its application in surgery has been limited by the lack of medically approved HSI devices compliant with MDR regulations, as well as challenges regarding the integration into the surgical workflow. Methods: In this feasibility study, we employed endoscopic HSI during surgery to visualize the tumor sites of 12 head and neck cancer patients. We optimized the HSI workflow to minimize time required during surgery and to reduce the adaptation period needed for surgeons to adjust to the new workflow. Additionally, we implemented data processing to enable real-time classification and visualization of HSI within the intraoperative setting. HSI evaluation was conducted using principal component analysis and k-means clustering, with this clustering validated through comparison with expert annotations. Results: Our complete HSI workflow requires two to three minutes, with each HSI measurement-including evaluation and visualization-taking less than 10 s, achieving an accuracy of 79%, sensitivity of 72%, and specificity of 84%. Medical personnel became proficient with the HSI system after two surgeries. Conclusions: This study presents an HSI workflow for in vivo tissue differentiation during head and neck cancer surgery, providing accurate and visually accessible results within minimal time. This approach enhances the in vivo evaluation of tumor margins, leading to more clear margins and, consequently, improved patient outcomes.

Research on static voltage stability enhancement for new energy station based on grid-forming control strategy

The advent of novel power systems has given rise to a multitude of safety and stability concerns associated with the integration of emerging energy sources and power electronic equipment. The active support of the grid-forming control strategy represents an effective solution to the voltage and frequency stability issues associated with the weak damping and low inertia inherent to high-ratio new energy systems. Firstly, a static voltage stability index based on critical impedance is proposed for assessment of the static stability margin of a new energy grid-connected system, based on the static voltage stability theory of a traditional single-unit single-load system. Secondly, an analysis is conducted of the control principle of the grid-forming control converter and its impedance characteristics. In conclusion, a method for enhancing the static voltage stability margin of grid-connected new energy stations through parameter control of grid-forming converters is presented. The simulation verification of the single-feed and multi-feed systems demonstrates the efficacy and accuracy of the methodology presented in this study.

Photodynamic therapy in the treatment of recurrent nasal cavity and paranasal sinus cancer

The purpose of the study was to evaluate the effectiveness of treatment of patients with recurrent nasal cavity and paranasal sinus cancer using photodynamic diagnosis (PDD) and photodynamic therapy (FDT).Material and Methods. The study included 40 patients with locally advanced nasal cavity and paranasal sinus cancer, who were admitted to the clinics of the Cancer Research Institute of Tomsk National Research Medical Center with disease progression or recurrence. All patients were divided into the study group (n=20) and the control group (n=20). Patients in both groups received chemotherapy combined with radiotherapy, chemotherapy combined with surgery or a combination of chemotherapy, radiotherapy and surgery. Treatment of patients included intraoperative assessment of resection margin using a laser electron spectral analyzer LESA-01 BIOSPEC. The bed of the removed tumor was examined to detect residual tumor tissues. Photodynamic therapy of the bed of the removed tumor was then performed using Photoditazine at a dose of 1 mg/kg body weight. Radiotherapy at a dose of 300–350 J per feld was given using a Latus–T apparatus, the feld diameter ranged from 1 to 2 cm. The power density varied from 0.4 W/cm2 to 0.5 W/cm2.Results. Nonparametric tests revealed a statistically signifcant difference in disease-free survival: 3.10, p=0.001 by Gehan-Wilcoxon test and 3.03, p=0,002 by Log-Rank test. When assessing overall survival, there were 10 (50.0 %) completed cases in the control group, 4 (20.0 %) in the study group, and 10 (50.0 %) and 16 (80.0 %) censored cases, respectively. Gehan-Wilcoxon test – -2.02 p=0.04. Log-Rank test –2.10 p=0.04. The results of the study showed that according to any of the criteria, there were statistically signifcant differences in survival between the control and study groups.Conclusion. Inclusion of intraoperative PDD and PDT in the treatment algorithm for nasal cavity and paranasal sinus recurrent carcinomas signifcantly increases the disease-free and overall survival of patients.

Achieving Adherence With NCCN Guidelines for Nonmelanoma Skin Cancer Regarding Peripheral and Deep En Face Margin Assessment (PDEMA).

Peripheral and deep en face margin assessment (PDEMA), formerly termed by NCCN as complete circumferential peripheral and deep margin assessment (CCPDMA), has the advantages of histologic visualization of the entire marginal surface, highly accurate resection of involved tissue, and sparing of uninvolved tissue. Owing to its highest reported cure rates, PDEMA is the NCCN-preferred treatment for dermatofibrosarcoma protuberans, high-risk basal cell carcinoma, and very-high-risk cutaneous squamous cell carcinoma. In the United States, Mohs micrographic surgery (Mohs) is the most common method of PDEMA. In Germany and some other countries, non-Mohs methods of PDEMA referred to as the Tubingen torte and muffin techniques are more widely used. The Tubingen methods of PDEMA require close communication between surgeon and pathologist. This article describes the background of both Mohs and Tubingen PDEMA, reviews what constitutes PDEMA, and provides a protocol for Tubingen PDEMA detailing critical components in a stepwise fashion using illustrative photos and diagrams. We hope to broaden understanding of the NCCN Guidelines and their rationale, align practice, and optimize patient outcomes.

A Clinically Feasible Electrode Array for 3D Intraoperative Electrical Impedance Tomography-Based Surgical Margin Assessment in Robot-Assisted Radical Prostatectomy.

A novel small form factor circular electrode array was designed specifically for electrical impedance tomography (EIT) based assessment of surgical margins during robot assisted radical prostatectomy (RARP). The electrode array consists of 33 gold-plated electrodes arranged within a 9.5 mm diameter circular footprint on the end of a surgical probe that can be introduced through a standard 12 mm laparoscopic port used during RARP. The electrode array contains 8 larger, low-contact impedance outer electrodes dedicated for current drive and an internal grid of 25 smaller electrodes for simultaneous voltage measurement. Separating electrode geometry by function is designed to improve current delivery, speed, and resolution while reducing hardware requirements. Simulations demonstrated that 1 mm diameter hemispherical prostate cancer inclusions could be localized within regions of adipose and benign prostate tissue; 1.5 mm diameter inclusions were required for localization within muscle tissue. A 2.38 mm diameter aluminum rod in 0.2 S/m saline could be localized throughout the imaging domain with a position error of less than 2.5 mm for depths from the electrode array surface of up to 1.7 mm. Ex vivo tissue experiments with a bovine model demonstrate visual congruence of muscle and adipose tissue locations between the sample and reconstructed images. Simulation and experimental results indicate good detection and location of inclusions. These results suggest the proposed electrode array design can provide sufficient accuracy in the detection and localization of prostate cancer against clinically relevant background tissues for use during RARP.

P043 Cost-effectiveness of intraoperative surgical margin assessment during radical prostatectomy

P043 Cost-effectiveness of intraoperative surgical margin assessment during radical prostatectomy

Laryngectomy Margin Assessment: A Little Help From a Template.

Laryngectomy margin assessment is an important part of patient care and can affect outcomes. There is no standard approach to grossing laryngectomy specimens, with variations in the published guidelines. A uniform approach to margin assessment may be helpful to improve patient care and future research. At the very least, sampling of all mucosal margins (arytenoid area, hypopharyngeal, and anterior epiglottis) and tracheal margin should be performed. Sampling of soft tissue margins may be delegated to the pathologist, and contingent on the tumor extent into soft tissue. If a tracheostomy is present, skin and soft tissue margins should be sampled from the stoma. This review provides a template for laryngectomy margin assessment and can be used as a guideline as to which margins should be assessed.

Autofluorescence imaging guided needle-type Raman spectroscopy system for breast tumor margin assessment.

A trajectory-tracked, near-infrared autofluorescence imaging guided, biochemical signature-projected needle-type Raman spectroscopy (TNBN-RS) system integrated on a medical cart was developed for rapid wide-field breast tissue stratification. A wide-field (10 × 10 cm2) near-infrared autofluorescence (NIRAF) imaging subsystem was developed for gross stratification of breast tissue types based on higher NIRAF intensity associated with breast cancer, followed by projection of NIRAF-identified breast tumor margins onto the tissue of interest with a compact projector. Raman spectra were further acquired from the NIRAF projected regions for confirmed margin assessment using a needle-type Raman probe equipped with color camera-based probe trajectory tracking. The trajectory of the Raman probe and the accompanying RS biochemical signature-based margin assessment were instantly projected. A unique field of view (FOV) calibration method was proposed to calibrate the TNBN-RS FOVs, resulting in a projection accuracy of <2 mm. A graphical user interface (GUI) was developed in C# for system control, real-time processing and display of NIRAF images, Raman spectra, and projection of their results. The performance of the TNBN-RS system was validated on an ex vivo breast tissue, demonstrating its potential for rapid intraoperative breast tumor margin assessment.

Interpretable diagnosis of breast lesions in ultrasound imaging using deep multi-stage reasoning

Objective.Ultrasound is the primary screening test for breast cancer. However, providing an interpretable auxiliary diagnosis of breast lesions is a challenging task. This study aims to develop an interpretable auxiliary diagnostic method to enhance usability in human-machine collaborative diagnosis.Approach.To address this issue, this study proposes the deep multi-stage reasoning method (DMSRM), which provides individual and overall breast imaging-reporting and data system (BI-RADS) assessment categories for breast lesions. In the first stage of the DMSRM, the individual BI-RADS assessment network (IBRANet) is designed to capture lesion features from breast ultrasound images. IBRANet performs individual BI-RADS assessments of breast lesions using ultrasound images, focusing on specific features such as margin, contour, echogenicity, calcification, and vascularity. In the second stage, evidence reasoning (ER) is employed to achieve uncertain information fusion and reach an overall BI-RADS assessment of the breast lesions.Main results.To evaluate the performance of DMSRM at each stage, two test sets are utilized: the first for individual BI-RADS assessment, containing 4322 ultrasound images; the second for overall BI-RADS assessment, containing 175 sets of ultrasound image pairs. In the individual BI-RADS assessment of margin, contour, echogenicity, calcification, and vascularity, IBRANet achieves accuracies of 0.9491, 0.9466, 0.9293, 0.9234, and 0.9625, respectively. In the overall BI-RADS assessment of lesions, the ER achieves an accuracy of 0.8502. Compared to independent diagnosis, the human-machine collaborative diagnosis results of three radiologists show increases in positive predictive value by 0.0158, 0.0427, and 0.0401, in sensitivity by 0.0400, 0.0600 and 0.0434, and in area under the curve by 0.0344, 0.0468, and 0.0255.Significance.This study proposes a DMSRM that enhances the transparency of the diagnostic reasoning process. Results indicate that DMSRM exhibits robust BI-RADS assessment capabilities and provides an interpretable reasoning process that better suits clinical needs.

A Comparative Evaluation of New and Used Dental Explorer Working Tips

Abstract The dental explorer medical device assists multiple functions, including marginal assessment. The working tip quality of this instrument has been previously established as a factor affecting operator judgment. However, little data exists to demonstrate the actual quality of working tips in clinical practice. The purpose of this study is to investigate and quantify if any real, measurable differences of the explorer working tip dimension exist among such instruments currently in service and compare to published medical device industry standards. Twenty new #23 dental explorer instruments from two manufacturers served as controls and sixty-three instruments in circulation at a dental school clinic were observed using light microscopy. The instruments were measured 50 micrometers from the terminus. A one-way analysis of variance (ANOVA) was performed to analyze values among groups. No statistically significant difference between the mean working tip dimension of new instruments was detected between brands. However, statistically significant differences between new and used instruments were detected regardless of brand. The range of values was 92.5–227.5 micrometers with average used instrument tip estimated over 50% wider than the average new instrument. These findings imply that other studies employing a dental explorer may be confounded if the instrument is not measured. Furthermore, the results of this study should serve as a motivating factor toward future research to update quality standards regarding the medical device with a goal of defining acceptable dimensions of the instrument working tip for certain applications in relation to clinical performance and expected outcomes.

Assessment of functional performance in self-rectifying passive crossbar arrays utilizing sneak path current

Self-rectifying memristive devices have emerged as promising contenders for low-power in-memory computing, presenting numerous advantages. However, characterizing the functional behavior of passive crossbar arrays incorporating these devices remains challenging due to sophisticated parasitic currents stemming from rich memristive dynamic behavior. Conventional methods using read margin assessments to evaluate functional behavior in passive crossbars are hindered by the voltage divider effect from the pull-up resistor. In this study, we propose a novel performance metric, Δ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\Delta$$\\end{document}SC, harnessing sneak path currents to assess functional behavior. Through the application of a pair of negative rectification factors, RFn,L\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\ ext {RF}_\ ext {n, L}$$\\end{document} and RFn,H\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\ ext {RF}_\ ext {n, H}$$\\end{document}, we comprehensively delineate dynamic rectification behavior in both positive and negative bias regimes, as well as in low-resistance state and high-resistance state, deviating from conventional metrics such as on/off ratios, nonlinearity, and rectifying factors. Notably, Δ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\Delta$$\\end{document}SC provides a quantitative evaluation of the interaction between sneak path currents and read margin, demonstrating its efficacy and addressing a pivotal research gap in the field. For instance, employing self-rectifying BiFeO3\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$_3$$\\end{document} memristive cells featuring RFn,L\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\ ext {RF}_\ ext {n, L}$$\\end{document} = 1.22E3 and RFn,H\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\ ext {RF}_\ ext {n, H}$$\\end{document} = 9.27, we showcase the successful functional performance of a passive crossbar array, achieving Δ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\Delta$$\\end{document}SC < 2.19E−2, while ensuring a read margin > 0.

Image-Guided Breast Conserving Surgery

Background: Breast-conserving surgery (BCS) has gained wide acceptance as the treatment of choice for early-stage breast cancer. One of the primary goals of BCS is to obtain tumor-free resection margins. In practice, the excision of a palpable breast carcinoma is guided by preoperative diagnostic images and the intraoperative tactile skills of the surgeon. The somewhat ‘blind’ approach of using palpation-guided surgery is known to be highly inaccurate, with studies worldwide reporting positive resection margins in up to 41% of patients. In recent years, ultrasonography has emerged as an effective guidance tool during surgery and ultrasound-guided surgery has been introduced into breast cancer surgery as a method of excising nonpalpable breast cancer. Objective: The aim of this study is comparing ultrasound-guided vs palpation-guided conservative breast surgery in obtaining tumor-free resection margins. Methods: This study was a prospective randomized controlled clinical trial where patients with early breast cancer (T1-T2) and eligible for breast conserving surgery are randomly assigned (1:1) into two arms. Arm A: included the patients who will undergo ultrasound-guided breast conserving surgery. Arm B: included the patients who will undergo the conventional palpation-guided breast conserving surgery. Results: Overall, 142 patients undergoing breast conserving surgery were enrolled: 71 were allocated to the Ultrasound-guided (US) group (Arm A) and 71 to the Palpation-guided (PG) group (Arm B). Patient and tumor characteristics were comparable between the two groups. Age, Body mass index, tumor laterality, tumor location and tumor stage were comparable in both groups and statistically insignificant. Despite that the final tumor size was comparable between both groups, IOUS significantly reduced the main specimen volume and the least negative margin width (p&lt;0.001). The median operative time was significantly longer in the US group bey around 27 min than in the PG group and this was statistically significant in favor of the PG surgery (p&lt;0.001). The involved resection margin rate was significantly higher in the PG group and thus the need for reoperation (p&lt;0.001). Conclusion: IOUS is the only method allowing a true real-time visualization and continuous control of resection margins during all phases of BCS. In our single-institution study, IOUS demonstrated clear superiority over palpation-guided surgery in both oncological and surgical outcomes except for the operative time (smaller excision volume yet, with optimum resection margins). IOUs provides much better tumor localization in small breasts with dense fibroadenosis. Since all the other available localization techniques (including palpation) limit the surgeon’s visual guidance during BCS, IOUS could be regarded as one of the most significant modern technological innovations in the field of breast cancer surgery, restoring sight to the breast surgeon. Our findings strongly suggests that the integration of IOUS in breast conserving surgery could be regarded as a highly beneficial surgical approach.

Surgical Margins of Nonmelanoma Skin Cancers in Mohs Surgery: Dermoscopy Versus Naked Eye.

Mohs micrographic surgery (MMS) offers high cure rates for nonmelanoma skin cancer (NMSC) but relies on precise margin assessment, traditionally initiated by the naked eye. Dermoscopy has emerged as a potential tool to improve margin delineation. To compare the efficacy of dermoscopic versus naked eye evaluation in marking initial MMS margins for NMSC. A multicenter, prospective study on patients with NMSC undergoing MMS was conducted. Patients were randomized into dermoscopy and naked eye groups. Statistical analysis was performed using statistical package for social sciences. A total of 127 patients were enrolled, with 63 in the naked eye group and 64 in the dermoscopy group. No significant differences in age, sex distribution, or histological subtype were found. The average number of MMS stages and accuracy of initial margins were comparable between groups. Despite its potential, the authors' study found no significant reduction in total MMS stages using dermoscopy. Novel imaging modalities or standardized dermoscopic criteria should be explored to enhance margin assessment accuracy and improve outcomes in NMSC treatment. Dermoscopic evaluation of presurgical margins does not effectively assess lateral/deep margins nor contribute to a reduction in total MMS stages. Improving the authors' understanding of presurgical margin assessment techniques can lead to better treatment outcomes for NMSC.