Clear Margins Research Articles

Technoeconomic evaluation of post-combustion carbon capture technologies on-board a medium range tanker

The international maritime organization has recently set targets and timelines for reducing global greenhouse gas emissions from the maritime industry, which currently stand at 1.1 Gt/year and make 3 % of the global emissions. Reducing emissions by increasing engine efficacy is the immediate target, but there is a limit to how much this path can achieve. Onboard post-combustion carbon capture and concentration in large marine vessels is emerging as an interim approach to reduce maritime emissions until large-scale deployment of low/zero emission fuels become viable. In this paper, we evaluate three carbon capture technologies (chemical absorption using either aqueous MEA or aqueous NH3 as the solvent, cryogenic separation, and membrane separation) for a medium-range tanker for two fuels, namely heavy fuel oil and liquefied natural gas. The capture cost per tonne of CO2 (recovery>90 %, purity>95 %) was considered as the assessment criterion, with simultaneous evaluation of other aspects such as energy and space demands. The simulations were carried out using MATLAB and ASPEN V12. For rate-based models, the adjustable parameters for the model were tuned using pilot plant data. Additionally, options for hot and cold energy integration were also assessed and implemented. Based on the reference ship conditions and assessment criteria, the simulation studies show that amine-based absorption is the best prospect for on-board capture by a clear margin.

Resection margins, lymph node harvest and 3 year survival in open and laparoscopic colorectal cancer surgery; a prospective cohort study

IntroductionLaparoscopic colorectal cancer surgery has been gaining popularity in the last decade. However, there are concerns about adequate lymph node dissection and safe resection margins in laparoscopic colorectal cancer surgery. This study was aimed at comparing the lymph node (LN) clearance and surgical resection margins and 3-year survival for open and laparoscopic colorectal cancer surgery.MethodA pre-tested interviewer administered questionnaire was used to assess the adoption of the laparoscopic approach by Sri Lankan surgeons. Data was collected prospectively from patients who underwent open or laparoscopic colorectal cancer surgery at the University Surgical Unit of the National Hospital of Sri Lanka from April 2016 to May 2019. The histopathology records were analysed to determine the longitudinal and circumferential resection margins(CRM) and the number of lymph nodes harvested. The resection margins were classified as positive or negative. The total number of LN examined was evaluated. Presence of local recurrence and liver metastasis was determined by contrast enhanced CT scan during 3-years of follow up. Chi square, T test and z test for proportions were used to compare CRM, LN harvest and survival rates between the groups.ResultsOf the surgeons interviewed only 11 (18.4%) performed laparoscopic colorectal cancer surgery. A total of 137 patients (83 males and 54 females) were studied. Eighty-one procedures were laparoscopic and 56 procedures were open. All patients had clear longitudinal resection margins. Seventy-eight patients in the laparoscopic group (96%) and 51 patients (91%) in the open group had clear CRM (p > 0.05). A total of 2188 LNs (mean 15.9) were resected in all procedures. Six-hundred-eighty-nine lymph nodes were removed during open procedures (mean 12.3, SD 0.4) and 1499 (mean 18.5, SD 0.6) were removed during laparoscopy (p < 0.05). At 3 years follow-up the disease-free survival in the laparoscopic and open colon cancer patients was 27/41 (65.8%) and 16/29 (55.1%) respectively (p = 0.35). Disease free survival in the laparoscopic and open rectal cancer patients was 23/38 (60.5%) and 13/25 (52.0%) respectively (p = 0.40). Four patients were lost during follow-up.Discussion and conclusionCRM was comparable in the two groups. Laparoscopic group had a significantly higher LN harvest. Three-year survival rates were similar in the two groups. Acceptable results can be obtained with laparoscopic colorectal cancer surgery.

Tunneled Island Flaps for the Reconstruction of Nasal Defects: A 21-Case Series

(1) Background: The reconstruction of cutaneous defects following surgical procedures in the nasal pyramid presents a challenge due to the limited amount of available tissue. In cases of larger defects, skin from adjacent units is used. Traditionally, two-stage surgical flaps have been employed for reconstructing these defects. Tunnelized island flaps allow for the one-stage surgical reconstruction of nasal pyramid defects, using tissue from the forehead or cheek for the flap. (2) Methods: Descriptive retrospective study of 21 consecutive patients who underwent surgery for defects on the nasal pyramid using tunnelized island flaps. (3) Results: Surgical reconstruction was performed in 21 patients with basal cell carcinomas, 14 of them using the melolabial island flap and 7 using the paramedian forehead island flap. In all cases except one, clear histological margins were obtained. Immediate complications were mild and minor. It is worth noting the trapdoor effect complication, which improved over time in most cases, resulting in a satisfactory cosmetic outcome. No tumor recurrences were observed during an average follow-up period of 17.7 months. (4) Conclusions: Tunnelized island flaps allow for single-stage reconstruction of nasal pyramid defects, yielding excellent cosmetic results by utilizing adjacent skin. This procedure demands a certain level of skill but is associated with minimal complications, making it a valuable alternative in reconstructive dermatological surgery.

Towards Adaptive Information Fusion in Graph Convolutional Networks

Graph Convolutional Networks (GCNs) have gained great popularity in tackling various analytic tasks on graph and network data. However, some recent studies raise concerns about whether GCNs can optimally integrate node features and topological structures in a complex graph. In this paper, we first present an experimental investigation. Surprisingly, our experimental results clearly show that the capability of the state-of-the-art GCNs in fusing node features and topological structures is distant from optimal or even satisfactory. The weakness may severely hinder the capability of GCNs in some classification tasks, since GCNs may not be able to adaptively learn some deep correlation information between topological structures and node features. Can we remedy the weakness and design a new type of GCNs that can retain the advantages of the state-of-the-art GCNs and, at the same time, enhance the capability of fusing topological structures and node features substantially? We tackle the challenge and propose an <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">A</b> daptive <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">M</b> ulti-channel <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">G</b> raph <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">C</b> onvolutional <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">N</b> etwork for semi-supervised classification ( <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">AM-GCN</b> ). The central idea is that we extract the specific and common embeddings from node features, topological structures, and their combinations simultaneously, and use the attention mechanism to learn adaptive importance weights of the embeddings. However, considering that the input topology and feature structure in AM-GCN are still predefined and fixed, once the properties of graph structures are not consistent with tasks, the fusion performance of AM-GCN will be hindered from the beginning. Therefore, we need to adjust the structure and further propose the <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">L</b> abel <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">P</b> ropagation guided <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">M</b> ulti-channel <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">G</b> raph <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">C</b> onvolutional <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">N</b> etwork ( <bold xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">LPM-GCN</b> ). LPM-GCN introduces edge weights learning on both topology and feature spaces to improve structural homophily, which can better promote the fusion process of graph convolutional networks. Our extensive experiments on benchmark data sets clearly show that our proposed models extract the most correlated information from both node features and topological structures substantially, and improves the classification accuracy with a clear margin.

Abstract A037: Prostate Specific Membrane Antigen Targeted Photodynamic Therapy Agent for the Treatment of Breast Cancer

Abstract Introduction: Breast cancer (BCa) is a solid cancer where 65% of all BCa cases, women with stages 1-3 of BCa undergoing Breast Conserving Surgery (BCS) as the primary form of treatment with incomplete resections occurring in 20-60% of BCS leading to repeat procedures[1]. Local recurrence, an indication of “surgically missed” cancerous tissues, occurs in 5-16% of patients with clean margins [1], indicating regions of tumor not resected during analysis of excised tissues. This demonstrates an unmet clinical need for technologies to identify and destroy cancerous tissues in the margins of BCa specimens. Prostate Specific Membrane Antigen (PSMA) is known to be overexpressed in prostate cancer and on the neovasculature of many solid human tumors, including breast tumors [2]. Photodynamic therapy (PDT) is a minimally invasive phototherapy used in the treatment of cancers and other diseases. Previously, we combined a potent Photodynamic Therapy (PDT) agent and highly selective PSMA ligand invented in our lab, to develop a theranostic agent to selectively identify and destroy prostate cancer (PCa) [3]. We have characterized PSMA expression in BCa tumor neovascualture in our novel syngeneic mouse model and show how PSMA-1-Pc413 is an effective strategy in visualizing and treating BCa tumors. Methods: 20 female BALB/c mice were inoculated with 10,000 4T1 – i.e., metastatic mouse cancer cell line – via injection into the mammary pads to create a syngeneic mouse model. We allowed the tumors to grow till an average of 50mm3. Mice were randomly separated into 3 treatment groups based on PSMA-1-Pc413 and PDT irradiation dose, a combination of 0.75mg/kg or 1.0mg/kg at 100Jcm−2 or 150Jcm−2. A 4th control group that received PBS irradiated with 150jcm−2 of light. PSMA-1-Pc413 was injected via tail vein and fluorescence images were taken till 24hr. 24hours post-injection, we irradiated the tumors at the given dose with a 672 nm laser. Tumor growth was tracked via calipers. The endpoint was 28days after treatment. Mice were euthanized, and their lung nodules quantified through counting. Results: Fluorescence images of a representative mouse from the group show positive accumulation of probe within the tumor which was subsequently bleached after PDT treatment, signified by a dark area. Compared to our control group, we see a significant reduction in tumor growth rate with all 5 mice in each of the treatment groups surviving longer than the control group. Groups that received a higher dose of agent and irradiation showed further improved response. Additionally, after euthanizing animals 4 weeks after PDT treatment and quantifying lung nodules we can see a significant decrease in lung metastases which contributes to improved survival outcomes. Conclusions: From the results provided that PSMA can be used as an in vivo target for treating Breast Cancer and that our PSMA-1-Pc413 agent is effective in non-prostatic cancer models. Even a single dose of PDT with our agent has significant impact in reducing tumor growth rate and lung metastases formation. Citation Format: Aditi A Shirke, Xinning Wang, James P Basilion. Prostate Specific Membrane Antigen Targeted Photodynamic Therapy Agent for the Treatment of Breast Cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor Immunology and Immunotherapy; 2023 Oct 1-4; Toronto, Ontario, Canada. Philadelphia (PA): AACR; Cancer Immunol Res 2023;11(12 Suppl):Abstract nr A037.

Learning Degradation-Robust Spatiotemporal Frequency-Transformer for Video Super-Resolution.

Video Super-Resolution (VSR) aims to restore high-resolution (HR) videos from low-resolution (LR) videos. Existing VSR techniques usually recover HR frames by extracting pertinent textures from nearby frames with known degradation processes. Despite significant progress, grand challenges remain to effectively extract and transmit high-quality textures from high-degraded low-quality sequences, such as blur, additive noises, and compression artifacts. This work proposes a novel degradation-robust Frequency-Transformer (FTVSR++) for handling low-quality videos that carry out self-attention in a combined space-time-frequency domain. First, video frames are split into patches and each patch is transformed into spectral maps in which each channel represents a frequency band. It permits a fine-grained self-attention on each frequency band so that real visual texture can be distinguished from artifacts. Second, a novel dual frequency attention (DFA) mechanism is proposed to capture the global and local frequency relations, which can handle different complicated degradation processes in real-world scenarios. Third, we explore different self-attention schemes for video processing in the frequency domain and discover that a "divided attention" which conducts joint space-frequency attention before applying temporal-frequency attention, leads to the best video enhancement quality. Extensive experiments on three widely-used VSR datasets show that FTVSR++ outperforms state-of-the-art methods on different low-quality videos with clear visual margins. Code and pre-trained models are available at https://github.com/researchmm/FTVSR.

A Systematic Review and Meta-Analysis of Mapping Biopsy for Primary Extramammary Paget's Disease in Reducing Recurrence Following Surgical Excision.

To examine the association between the performance of mapping biopsies and surgical outcomes postexcision of extramammary Paget's disease (EMPD). Primary EMPD is a rare entity associated with poorly defined surgical margins and difficult-to-access sites of lesions. Surgical resection with clear margins remains the preferred management method. The use of mapping biopsies might be beneficial, particularly in lowering disease recurrence. Available literature was reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology before a fixed-effect meta-analysis was performed to identify the presence of a correlation between performing mapping biopsies and positive margins on permanent sections as well as disease-free survival. Additional study results not included in the quantitative assessment were qualitatively assessed and reported. A total of 12 studies were shortlisted for final analysis. 294 patients who underwent mapping biopsies and 48 patients who did not undergo mapping biopsies were included in the assessment. Forest plot analysis revealed a pooled rate ratio of 0.50 (95% CI, 0.32-0.77) in the prevalence of positive margins in patients with mapping biopsies performed as compared to patients without. The pooled rate ratio of the prevalence of disease-free survival in patients with mapping biopsies performed as compared to patients without was 1.38 (95% CI, 1.03-1.84). Qualitative assessment of the remaining selected studies revealed equivocal results. Mapping biopsies are able to improve EMPD surgical excision outcomes but given the rarity of the disease and heterogeneity of mapping biopsy procedures, further confirmation with randomized controlled trials or a larger patient pool is necessary.

Malignant proliferating trichilemmal tumor in male: A rare case entity with diagnostic dilemma

Abstract Trichilemmal tumor is a rare hair follicle tumor that is, thought to occur from a malignant transformation of a benign trichilemmoma. The tumor develops from the outer root sheath of the hair follicle. The patient underwent a wide local excision with 1 cm clear margin. The defect was covered by split thick skin graft harvested from ipsilateral thigh after consulting the plastic surgery department. Trichilemmal cyst can be misdiagnosed as other cutaneous lesions. Like in our case, initial FNAC was suggestive of a epidermoid cyst but post excision Histopathological examination gave us the real picture of a trichilemmal tumor. Recurrent tumors are very rare and can get misdiagnosed as squamous cell carcinoma. Malignant proliferating trichilemmal tumors are rare cutaneous tumors that are very rare in males. These tumors can be misdiagnosed as squamous cell carcinoma and require external stimuli for malignant conversion from benign counterparts. Wide local excision is sufficient for treatment.

Extraskeletal Osteosarcoma with Extensive Gastrointestinal Tract Involvement

Abstract Introduction/Objective Extraskeletal osteosarcoma (ESOS) is a rare aggressive mesenchymal tumor that originates from soft tissues or visceral organs, differentiating it from primary bone osteosarcoma. ESOS represents less than 5% of all osteosarcomas and less than 1% of soft tissue sarcomas. Primary ESOS in the gastrointestinal tract (GIT) is exceedingly uncommon, with a low incidence rate Methods/Case Report A 70 year-old-man with a history of hypertension, Myasthenia Gravis, hypothyroidism (status post total thyroidectomy), and skin cancer presented to the clinic with a chief complaint of abdominal fullness of 4 months duration. Primary work-up revealed anemia (Hemoglobin 7 g/dl) and peripheral blood smear was suggestive of bone marrow infiltration. Evaluation with upper gastrointestinal endoscopy and ultrasound demonstrated regular mucosal folds of the stomach with a solid-cystic lesion between the body of the pancreas and the posterior aspect of the stomach. The patient underwent a fine needle biopsy showing a spindle cell lesion with positive immunohistochemistry (IHC) for Smooth Muscle Actin (SMA), beta-Catenin, CD34, and negative for panCK, DOG-1, and CD117; suggestive of leiomyoma. The patient underwent a total gastrectomy, distal pancreatectomy, and splenectomy. Examination of the specimen confirmed a high-grade malignant spindle cell lesion with numerous associated osteoclast-like multinucleated giant cells, and focal areas consistent with osteoid changes. The IHC was requested and the cells were positive for WT1 and Muscle Specific Actin, SATB2, and Ki-67&amp;gt;90% whereas the cells were negative for SMA, Myo-D1, Myogenin, S100, SOX10, MART1, CD34, CD31, and Calretinin. Also, the genetic analysis for MDM2 was negative. These findings confirmed the diagnosis of ESOS with abdominal visceral involvement (stomach, pancreas, and omentum) Results (if a Case Study enter NA) NA Conclusion ESOS is an extremely rare condition that demands a comprehensive evaluation involving clinical, radiological, histopathological, and immunohistochemical analyses to establish an accurate diagnosis. Distinguishing ESOS from primary bone osteosarcoma is vital due to the different treatment strategies. Additionally, ESOS requires a unique therapeutic approach compared to more prevalent gastrointestinal sarcomas like GIST or leiomyosarcoma. The mainstay of ESOS treatment entails complete surgical resection of the tumor with clear margins, accompanied by adjuvant chemotherapy. Ensuring precise diagnosis is of utmost importance to provide suitable and effective treatment

Clinical characteristics and treatment outcomes of angiosarcoma of the head and neck: A 17-year single-centre experience

Angiosarcomas in the head and neck region are aggressive tumours associated with high local recurrence and metastatic rates. We present our 17-year experience at the North of England Bone and Soft Tissue Tumour Service. A retrospective review of our prospectively maintained database was undertaken, looking for patients diagnosed with angiosarcomas affecting the head and neck. Data were gathered using a pre-defined proforma to include demographics, histological characteristics, treatment modalities, adjuvant therapies, local recurrence, distant spread, and disease-specific survival. A total of 23 patients (17 males, 6 females) were identified, with a mean age of 76 years at presentation. Fourteen presented with scalp lesions, whereas the remainder arose on the face. Eighteen patients underwent resection with curative intent, whereas three received palliative radiotherapy and two received comfort-based care only. Of the patients undergoing surgery, 12 had local flap reconstruction and 6 underwent free tissue transfer. Clear resection margins were obtained in nine cases (50%). Fourteen patients (78%) presented with local recurrence after surgery, and 11 (61%) developed distant metastases. The median disease-specific survival time for patients treated with curative intent was 38 months. Eight patients had mapping biopsies ahead of their resection; however, complete resection was achieved in only two cases. Angiosarcomas of the head and neck are associated with a poor prognosis, with most patients rapidly developing local recurrence, resulting in adverse clinical outcomes. Mapping biopsies do not demonstrate a clear advantage for achieving complete surgical resection. A radical surgical approach is warranted, given the aggressiveness of the pathology. However, there remains no consensus on optimal surgical management; we recommend further synthesising studies to determine the most appropriate treatment pathway.

Immediate diagnosis of cutaneous metastases with optical coherence tomography, line‐field confocal optical coherence tomography and dermoscopy: A case series

AbstractBackgroundCutaneous metastases (CM) are a frequent finding in the follow‐up of malignant tumours.ObjectivesCM were examined with dermoscopy, optical coherence tomography (OCT), dynamic OCT and line‐field confocal OCT (LC‐OCT) to describe common findings.MethodsIn the University Hospital Carl Gustav Carus Dresden, Germany, 18 patients with 61 CM were examined with dermoscopy. CM (n = 43, 31 melanoma metastases, two metastases of renal carcinoma, five metastases of cutaneous squamous cell carcinoma and five metastases of pleomorphic dermal sarcoma) were examined with OCT (VivoSight® Michelson Diagnostics). Additional 18 melanoma metastases were examined with LC‐OCT (deepLive™; Damae Medical).ResultsCM were localized on the head, trunk, neck and limbs. Dermoscopy patterns were angioma‐like, nevus‐like nonglobular, nevus‐like globular, blue nevus‐like and unspecific. CM showed an ulceration, hyperkeratosis with increased entrance signal and disturbed architecture of the epidermis in OCT. In deeper metastases, the dermoepidermal junction (DEJ) was normal; in most cases it was disturbed. CM were visible as subepidermal hyporeflective roundish area, with septae, with either clear margin and shadowing or blurred margin. DOCT showed dot, coiled, serpiginous and branched vessels; there was a disarray in size and distribution and vessels were converging on the centre of the metastasis. In LC‐OCT, CM showed enhanced entrance signal and disturbed architecture of a thinned epidermis, ulceration, atypical honeycomb or cobblestone pattern as well as a broken DEJ. In the dermis, a hyporeflective roundish area with clusters of hyporeflective cells with septae, clear margin and clefting or blurred margin was visible; the hyporeflective area was surrounded by bundles of connective tissue. Subepidermal vessels differentiated in size and distribution. Inflammatory, dendritic and pagetoid cells were visible.ConclusionsOCT and LC‐OCT may be useful tools for immediate diagnosis, localization of CM and monitoring under treatment in addition to conventional methods like ultrasound and histopathology.

Management of periocular keratinocyte carcinomas with Mohs micrographic surgery and predictors of complex reconstruction: a retrospective study

BackgroundSkin cancer is the most frequent cancer worldwide and the most frequent periocular tumor. Keratinocyte Carcinomas (KC) located in periorificial areas, such as periocular tumors, are considered high-risk tumors. Mohs Micrographic Surgery (MMS) is considered the first line for the treatment of high-risk KC, providing a lower recurrence rate than conventional wide excision. ObjectiveTo describe the clinical-pathological features of periocular KC treated with MMS in a tertiary university center in Chile. MethodsA single-center, retrospective study of patients with KC located on the periocular area, that underwent MMS between 2017‒2022. MMS details were recorded. ResultsOne hundred thirteen patients with periocular carcinomas were included. The mean age was 59 ± 13 years; 52% were women. The most frequent location was the medial canthus (53%), followed by the lower eyelid (30.1%). The most frequent BCC histology was the nodular variant (59.3%). Regarding MMS, the average number of stages was 1.5 ± 0.7, and 54% of the cases required only 1 stage to achieve clear margins. To date, no recurrence has been reported. Tumors larger than 8.5 mm in largest diameter or 43.5 mm2 were more likely to require complex reconstruction. Study limitationsRetrospective design and a relatively low number of patients in the SCC group. Possible selection bias, as larger or more complex cases, may have been referred to oculoplastic surgeons directly. ConclusionThe present study confirms the role of MMS for the treatment of periocular KCs. Periocular KCs larger than 8.5 mm might require complex reconstruction. These results can be used to counsel patients during pre-surgical visits.

To study the clinical course and management of recurrent OSSN in HIV positive patient in Eastern Uttar Pradesh

We present a case of recurrent OSSN in HIV positive individual and its successful management. Patient presented to us with slow growing painless greyish mass in temporal area in interpalpebral region. He was diagnosed with HIV 2 years back and was on HAART regimen. He underwent excision for a similar looking mass in same eye 2 years back at the same time he was diagnosed with HIV. On local examination, a greyish white raised nodular gelatinous mass with feeder vessel was seen. It did not involve cornea and took up staining with rose bengal stain. complete excision biopsy using no-touch technique with a margin clearance of 4 mm followed by mitomycin-C and the remaining conjunctival defect closed with amniotic membrane graft was done. Histopathology confirmed OSSN. No recurrence was seen at 2-year follow-up.HIV shows a strong relation with OSSN and also with recurrent disease. Histopathology should always be done in interpalpebral mass excision in HIV positive patients as the recurrence rate is higher with more aggressive tumour.

Paradigm Change for Intraoperative Surgical Margin Assessment for Oral Squamous Cell Carcinoma.

Achieving clear surgical margins is one of the primary surgical goals in treating oral squamous cell carcinoma (OSCC) and thus aiming to improve overall and disease-specific survival. Therefore, we developed the Goal-Oriented Assessment for Intraoperative Margin ('GAIM') protocol, a novel intraoperative approach for margin assessment, and present here our 5-year experience and outcomes. 'GAIM' is a 7-step procedure comprising systematic ruler-aided resection of labeled tumor-bed margins, frozen section (FS) co-produced by both pathologists and operating surgeons, and immediate extension of resection according to FS findings. Data from all patients operated using the 'GAIM' protocol at a single tertiary center between 2018 to 2022 were analyzed, including margin status on FS and final pathology (FP) records, recurrence, and mortality. A total of 196 patients were included, 56.6% (n = 111) stages I-II, and 43.4% (n = 85) stages III-IV. Using the 'GAIM' protocol, we achieved an overall 94.4% of clean and revised clean surgical margins. Patients with a 2-year and longer follow-up (n = 141) had local recurrence in 3.5% when both FS and final margins were clean, 8.1% when FP margins were clean, and 16.7% with close/positive final margins. The proposed 'GAIM' protocol is a novel, effective, reproducible, and safe approach for margin evaluation that can be systematically applied. It can increase the rate of final clean surgical margins and potentially improve patients' outcomes. 3 Laryngoscope, 134:1725-1732, 2024.

Polarization-Diversity Optical Coherence Tomography Assessment of Choroidal Nevi.

The purpose of this study was to demonstrate the utility of polarization-diversity optical coherence tomography (PD-OCT), a noninvasive imaging technique with melanin-specific contrast, in the quantitative and qualitative assessment of choroidal nevi. Nevi were imaged with a custom-built 55-degree field-of-view (FOV) 400 kHz PD-OCT system. Imaging features on PD-OCT were compared to those on fundus photography, auto-fluorescence, ultrasound, and non-PD-OCT images. Lesions were manually segmented for size measurement and metrics for objective assessment of melanin distributions were calculated, including degree of polarization uniformity (DOPU), attenuation coefficient, and melanin occupancy rate (MOR). We imaged 17 patients (mean age = 69.5 years, range = 37-90) with 11 pigmented, 3 non-pigmented, and 3 mixed pigmentation nevi. Nevi with full margin acquisition had an average longest basal diameter of 5.1mm (range = 2.99-8.72mm) and average height of 0.72mm (range = 0.37mm-2.09mm). PD-OCT provided clear contrast of choroidal melanin content, distribution, and delineation of nevus margins for melanotic nevi. Pigmented nevi were found to have lower DOPU, higher attenuation coefficient, and higher MOR than non-pigmented lesions. Melanin content on PD-OCT was consistent with pigmentation on fundus in 15 of 17 nevi (88%). PD-OCT allows objective assessment of choroidal nevi melanin content and distribution. In addition, melanin-specific contrast by PD-OCT enables clear nevus margin delineation and may improve serial growth surveillance. Further investigation is needed to determine the clinical significance and prognostic value of melanin characterization by PD-OCT in the evaluation of choroidal nevi.

CLASSICA: Validating artificial intelligence in classifying cancer in real time during surgery.

Treatment pathways for significant rectal polyps differ depending on the underlying pathology, but pre-excision profiling is imperfect. It has been demonstrated that differences in fluorescence perfusion signals following injection of indocyanine green (ICG) can be analysed mathematically and, with the assistance of artificial intelligence (AI), used to classify tumours endoscopically as benign or malignant. This study aims to validate this method of characterization across multiple clinical sites regarding its generalizability, usability and accuracy while developing clinical-grade software to enable it to become a useful method. The CLASSICA study is a prospective, unblinded multicentre European observational study aimed to validate the use of AI analysis of ICG fluorescence for intra-operative tissue characterization. Six hundred patients undergoing transanal endoscopic evaluation of significant rectal polyps and tumours will be enrolled in at least five clinical sites across the European Union over a 4-year period. Video recordings will be analysed regarding dynamic fluorescence patterns centrally as software is developed to enable analysis with automatic classification to happen locally. AI-based classification and subsequently guided intervention will be compared with the current standard of care including biopsies, final specimen pathology and patient outcomes. CLASSICA will validate the use of AI in the analysis of ICG fluorescence for the purposes of classifying significant rectal polyps and tumours endoscopically. Follow-on studies will compare AI-guided targeted biopsy or, indeed, AI characterization alone with traditional biopsy and AI-guided local excision versus traditional excision with regard to marginal clearance and recurrence.

Analyzing factors associated with the receipt of surgery in clear cell sarcoma.

447 Background: Clear cell sarcoma (CCS) is a ultrarare soft tissue sarcoma, which is highly aggressive and associated with a poor prognosis. CCS is histologically characterized by clear cells, representative of intracellular glycogen accumulation. Primary tumors commonly arise from tendinous sheaths or aponeuroses in the upper and lower extremities—the most common site being around the ankles. Average age at diagnosis is 25 years old. 5-year survival is between 40 and 60%. CCS is the result of fusion gene EWSR1/ATF1. Multimodal therapy, including wide surgical excision with radiotherapy, is often used to treat CCS. Chemotherapy may be used if patients are not eligible for surgery. No significant study has analyzed the factors which predict the utilization of wide surgical excision. This study aims to describe the factors involved in the receipt of this surgery. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with CCS from 2004 to 2020 using histology codes 9044 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square, and Logistic Regression tests were performed, and data were analyzed using SPSS version 27. Statistical significance was set at α = 0.05. Results: 669 patients with CCS formed the initial sample. Of these patients, 466 patients (69.7%) received a surgical procedure of the primary site. Additionally, 14 patients (2.09%) received radiation and 69 patients (10.31%) received adjuvant chemotherapy. The receipt of surgery was associated with a marked increase in median survival ( 91.5 months vs. 8.525 months; p&lt;0.05). Surgical resection with clear margins was achieved in 409 patients (61.14%), of whom experienced improved survival compared to patients with residual tumor burden. Each additional year of age in a patient conferred a 2.4% decrease in likelihood of the patient receiving surgery. Lower stage disease was significantly more likely to be treated surgically (OR 11.4; p&lt;0.001), while stage IV disease and abdominal primary site tumors were associated with lower rates of surgery. Facility type (academic vs. nonacademic), insurance, or distance travelled for care had no effect on rates of surgery. Conclusions: As a significant portion of CCS patients receive surgical treatment, this study confirms that tumor resection is associated with increased overall survival of patients with CCS. Improved survival with surgery correlates with clear surgical margins and full tumor resection. It appears that patients are more likely to be treated surgically if their disease is of lower stage. Patients with abdominal primary site tumors or stage IV disease are less likely to receive surgery. This research serves as the beginning of developing standardized treatment plans for CCS patients. Further studies are needed to better understand the factors involved in receiving surgery and other treatment modalities as part of CCS treatment.

Semantic-Aware Graph Matching Mechanism for Multi-Label Image Recognition

Multi-label image recognition aims to predict a set of labels that present in an image. The key to deal with such problem is to mine the associations between image contents and labels, and further obtain the correct assignments between images and their labels. In this paper, we treat each image as a bag of instances, and formulate the task of multi-label image recognition as an instance-label matching selection problem. To model such problem, we propose an innovative Semantic-aware Graph Matching framework for Multi-Label image recognition (ML-SGM), in which Graph Matching mechanism is introduced owing to its good performance of excavating the instance and label relationship. The framework explicitly establishes category correlations and instance-label correspondences by modeling the relation among content-aware (instance) and semantic-aware (label) category representations, to facilitate multi-label image understanding and reduce the dependency of large amounts of training samples for each category. Specifically, we first construct an instance spatial graph and a label semantic graph respectively and then incorporate them into a constructed assignment graph by connecting each instance to all labels. Subsequently, the graph network block is adopted to aggregate and update all nodes and edges state on the assignment graph to form structured representations for each instance and label. Our network finally derives a prediction score for each instance-label correspondence and optimizes such correspondence with a weighted cross-entropy loss. Empirical results conducted on generic multi-label image recognition demonstrate the superiority of our proposed method. Moreover, the proposed method also shows advantages in multi-label recognition with partial labels and multi-label few-shot learning, as well as outperforms current state-of-the-art methods with a clear margin. Our code is available at https://github.com/yananwu0510/ML-SGM.

High Level Sacral Bone Resection for Locally Recurrent Rectal Cancer.

Locally recurrent rectal cancer (LRRC) involving the upper sacrum is generally considered a contraindication for curative surgery. In the surgical management of LRRC, sacrectomy is frequently performed to secure clear resection margins. Nonetheless, the indications for high sacrectomy remain controversial due to potential postoperative complications, questions about radicality, and the increased complexity of the operation. Furthermore, comprehensive studies addressing this issue are notably absent. This study aimed to assess the feasibility, safety, and surgical prognosis in high sacrectomy for LRRC. All patients with LRRC who required concomitant sacrectomy, but did not include the inferior margin of the second sacral vertebra, between 2003 and 2014, were reviewed retrospectively. Eight patients with a median age of 59 years were included in this study. The proximal resection line for sacral bone resection was the central part of the S1 vertebra in one patient, lower edge of the S1 vertebra in six patients, and central part of the S2 vertebra in one patient. Negative margin resection was achieved in five out of the eight patients. The median operative time was 922 min, and the median operative blood loss volume was 6,370 ml. Major complications included pelvic abscess (n=5), ileus (n=1), and pulmonary vein embolism (n=1), none of which proved fatal during the postoperative period. Both the 5-year local re-recurrence-free survival rate and the 5-year distant metastasis-free survival rate were 50% (4/8). High sacrectomy is safe and feasible to achieve negative margins in patients with LRRC.

Eyelid and conjunctival mast cell tumors: A retrospective study of 26 dogs and 8 cats.

The objective of the study was to describe clinical and histologic characteristics of eyelid (LMCT) and conjunctival (CMCT) mast cell tumors in dogs and cats presented to a referral clinic in Germany. Medical records were reviewed to identify dogs and cats diagnosed with LMCTs or CMCTs between 2006 and 2020. LMCT were diagnosed in 31 patients and were cutaneous (n = 28; 20 dogs and 8 cats) or subcutaneous (three dogs). Five cases involved the mucocutaneous junction (four dogs, one cat). CMCTs occurred only in dogs (n = 3). At the time of presentation two of the four canine LMCT cases involving the mucocutaneous junction had metastasized to a mandibular lymph node. When applying the Kiupel system, both these cases were categorized as high grade. 85.7% (18/21) of the canine (19 cutaneous and 2 subcutaneous) LMCT and all CMCT cases were categorized as Kiupel low grade. No local recurrences occurred in all LMCT cases in which clean surgical margins were obtained (n = 18, mean surgical margin width: dogs 9.4 mm, cats 3.8 mm). Two cats (2/4) and four dogs (4/7) with questionable or incomplete surgical margins experienced local recurrences (mean time to recurrence of 180 and 637 days in dogs and cats, respectively). Recurrence of low-grade LMCTs and CMCTs following excision with clean margins is rare. Tumors involving the mucocutaneous junction may be of higher grade and prone to lymphatic metastasis.