Location Of Margin Research Articles

Fracture Resistance in Non-Vital Teeth: Absence of Interproximal Ferrule and Influence of Preparation Depth in CAD/CAM Endocrown Overlays-An In Vitro Study.

There is ample evidence to support the use of endocrowns to restore endodontic teeth. However, the influence of the position of the interproximal margins on fracture strength has not yet been studied. The aim was to determine the relationship between the apicocoronal position of the interproximal restorative margins and fracture resistance in nonvital teeth restored with CAD/CAM endocrown overlays. Forty extracted human maxillary premolars were prepared for endocrown overlay restorations without ferrule on the interproximal aspects and classified according to the position of the interproximal restoration margins in relation to the alveolar crest: 2 mm (group A), 1 mm (group B), 0.5 mm (group C), and 0 mm (group D). Fracture strength was measured using a universal testing machine applying a compressive force to the longitudinal tooth axis. Group A had a mean fracture resistance of 859.61 (±267.951) N, group B 1053.9 (±333.985) N, group C 1124.6 (±291.172) N, and group D 780.67 (±183.269) N, with statistical differences between groups. Group C had the highest values for fracture strength compared to the other groups (p < 0.05). The location of the interproximal margins appears to influence the fracture resistance of CAD/CAM endocrown overlays. A distance of 0.5 mm between the interproximal margin and the alveolar crest was associated with increased fracture resistance.

Oncologic outcomes according to the location and status of resection margin in pancreas head cancer: role of radiation therapy in R1 resection.

PurposeThe clinical significance of margin status in pancreatic head cancer is still controversial due to the nonstandardized definition of R status and pathologic reporting. This study aims to evaluate the impact of the margin status including location and the role of radiation therapy in pancreatic head cancer.MethodsA total of 314 patients who underwent curative-intent surgery for pancreatic head cancer between 2010 and 2017 were analyzed. Demographics, survival, and local recurrences were compared according to 2 definitions: 0-mm R1 as direct involvement and 1-mm R1 as close resection margin less than 1 mm. The specific margins were divided into 4 groups according to the location around the pancreas: pancreas transection, anterior surface, posterior surface, and vessel (superior mesenteric artery/superior mesenteric vein) margin.ResultsThe 0-mm R1-rate was 15.6%, and increased to 36.3% in 1-mm R1. The median overall survival rate of 0-mm R0 vs. R1 was 26 months vs. 16 months (P = 0.052) and that of 1-mm R0 vs. R1 was 27 months vs. 18 months, respectively (P = 0.016). In individual margins, posterior, anterior surface, and pancreas transection margin involvement were associated with poor outcome, and the 1 mm posterior surface involvement was an independent risk factor for disease-free survival (hazard ratio, 1.63). Adjuvant radiation therapy had oncologic benefits, especially in R1 patients (P = 0.011) compared to R0 patients (P = 0.088).ConclusionMargin status, especially 1-mm R1 status is an important predictive factor, and involved posterior surface has a clinical impact. Patients with positive margins should be considered adjuvant radiation therapy.

The Distinct Impact of TAM Infiltration on the Prognosis of Patients With Cardia and Non-Cardia Gastric Cancer and Its Association With H. pylori Infection.

BackgroundIn stage III gastric cancer (GC), the role of tumor-associated macrophages (TAMs) and Helicobacter pylori (H. pylori) infection impact tumor progression; however, the specific mechanisms remain controversial. We speculated whether this controversy is caused by differences in the location of TAM infiltration (in the core (CT) and invasive margin (MI) of primary tumors) and the topographical subsites of GC (cardia and non-cardia). Therefore, in this study, we investigated TAMs in different locations and H. pylori infection status as prognostic biomarkers for GC.MethodsImmunohistochemical staining for CD68 (pan-macrophage), CD163 (M2-like macrophage), and H. pylori in 200 samples (100 cases of cardia-GC [CGC] and 100 cases of non-cardia GC [NCGC]) was performed. We compared the number of CD68+ and CD163+ macrophages that infiltrated the CT and MI in patients with the prognosis of CGC and NCGC, respectively. In addition, we analyzed the relationship between H. pylori status and the prognosis of patients with GC in different locations, as well as the correlation with TAM infiltration.ResultsThe distribution of TAMs had distinct characteristics in CGC and NCGC, especially differences between CT and MI subtype. A Kaplan–Meier analysis showed that a high number of CD68+ macrophages that infiltrated the CT in CGC was associated with a better prognosis, whereas infiltration at the MI in NCGC indicated a poor prognosis. Furthermore, a high number of CD163+ macrophages infiltrating the MI resulted in a poor prognosis in CGC and NCGC cohorts. Considering the larger differences in the relationship between the infiltration of CD68+ macrophages at different locations and prognosis, we divided the GC cases into marginal and central GC, based on this difference. This resulted in an accurate estimation of the prognosis. Moreover, positive H. pylori status in central GC was significantly associated with a better prognosis and TAM infiltration.ConclusionTAMs in different locations and H. pylori status were identified as independent prognostic markers, with an obvious correlation between them. Therefore, it is important to clarify the impact of TAM location on the prognosis of patients with GC, which contributes to the development of potential therapeutic strategies.

LGM ice extent and deglaciation history in the Gurktal and Lavantal Alps (eastern European Alps): first constraints from 10Be surface exposure dating of glacially polished quartz veins

AbstractCompared with the western European Alps, the ice extent during the Last Glacial Maximum (LGM) and the subsequent deglaciation history of the eastern Alps east of the Tauern Window remain less well constrained. Also, considerable discrepancies exist between the mapped LGM ice margin and the ice extent predicted by ice‐sheet models. Here we present the first 10Be surface exposures ages from two regions east of the Tauern Window (the Gurktal and Lavantal Alps), which provide constraints on the LGM ice extent and the deglaciation history. Our results show that the deglaciation of the Gurktal Alps occurred between 16 and 14 ka, which agrees with the predictions from ice‐sheet models. In contrast, the 10Be ages from the Lavantal Alps located farther east are either LGM in age or predate the LGM, indicating that these regions were ice free or only partially covered by LGM ice. This finding suggests that ice‐sheet models may have overestimated the LGM ice extent in the easternmost Alps. In conclusion, our study highlights the need for more age data from the eastern Alps to refine the location of the LGM ice margin and the deglaciation history, which is also crucial for climate‐evolution and postglacial‐rebound models.

Clinical characteristics and survival analysis of colorectal cancer in China: a retrospective cohort study with 13,328 patients from southern China.

BackgroundColorectal cancer (CRC) is one of the most common cancers in China. However, detailed clinical characteristics and survival information are limited. This study aimed to investigate the potential epidemiological and clinical risk factors affecting the survival of CRC patients in southern China.MethodsPatients with primary CRC between 1994 and 2019 at the First and the Sixth Affiliated Hospitals of Sun Yat-sen University (Guangzhou, China) were included. Clinical characteristics and survival outcomes were collected from medical records. The Kaplan–Meier method was used to estimate overall survival (OS) and progression-free survival (PFS), and Cox’s proportional-hazards regression model was used to estimate hazard ratios and 95% confidence intervals.ResultsOf all 13,328 patients, 60.1% were men; the mean age was 61.3 years; 53.5% had colon cancer. Among all patients, 1,864 (14.0%) were diagnosed with stage IV disease. The 3- and 5-year OS rates were 79.90% and 71.50%, respectively, whereas the 3- and 5-year PFS rates were 70.30% and 63.90%, respectively. The median OS and PFS times were 189 and 149 months, respectively. Among 13,328 patients, 428 (14.0%) patients with poor/undifferentiated cancer suffered recurrence. In patients with stage III and stage IV diseases, the median PFS times of the patients who received chemotherapy were significantly longer than those in patients who had not received chemotherapy (stage III: 147 vs 62 months, P < 0.001; stage IV: 14 vs 9.5 months, P < 0.001).ConclusionsThis retrospective cohort study illustrates the current status of the clinical characteristics of patients with CRC in southern China. Sex, age, family history, location of cancer occurrence, differentiation status, T status, N status, M status, clinical stage, operation, and surgical margin are independent factors associated with the OS of CRC patients.

Periodontal outcomes of anterior fixed partial dentures on teeth treated with the biologically oriented preparation technique: A 6-year prospective clinical trial

Statement of problemOne of the most frequent complications in participants with fixed partial dentures (FPDs) is the apical migration of the gingival margin, which may be associated with factors such as fit, gingival margin location, or tooth preparation type. The prevalence of the complication in participants restored with FPDs prepared by using the biologically oriented preparation technique (BOPT) is unclear. PurposeThe purpose of this prospective clinical trial was to evaluate the clinical and biologic outcomes of FPDs on teeth prepared by using the BOPT, over a 6-year follow-up period. Material and methodsTooth-supported zirconia FPDs in the anterior region prepared by using the BOPT were evaluated. Each participant was monitored annually for 6 years by evaluating plaque index, probing depth, vestibular gingival thickness, and gingival margin stability. Biologic and/or mechanical complications were also recorded. Patient satisfaction was measured by using a visual analog scale (VAS). ResultsA total of 25 FPDs supported by 70 teeth in 24 participants were analyzed. Low plaque index values and stable probing depths were observed, whereas the gingival index was 0 for most of the teeth. Teeth treated by using the BOPT presented significant increase in gingival thickness, and the gingival margin was found to be stable in 100% of the treatments. FPD survival was 100%. ConclusionTooth supporting FPDs prepared by using the BOPT presented good periodontal health and gingival margin stability, without recession and with a 100% survival rate during a 6-year follow-up.

Incidence and Risk Factors for Surgical Site Infections Following Oromaxillofacial Oncologic Surgery in Dogs.

Antibiotic stewardship in veterinary medicine is essential to help prevent resistant bacterial infections. Critical evaluation into the benefits of prophylactic use of antibiotics during veterinary surgical procedures is under reported and additional investigation is warranted. The objectives of this paper were to determine the incidence of surgical site infection in dogs that underwent oromaxillofacial oncologic surgery and to identify risk factors for the development of surgical site infection. In this retrospective cohort study including 226 dogs surgically treated for oromaxillofacial tumors between January 1, 1997 and December 31, 2018, the incidence of surgical site infection was determined to be 7.5%. Univariable logistical regression models were used to evaluate potential risk factors for development of surgical site infections including signalment, tumor type, antibiotic protocol, time under anesthesia, location of surgical procedure (dental suite vs. sterile operating room), specific comorbidities, and surgical margins obtained. Anesthetic events lasting greater than 6 h were significantly associated with development of infection. Signalment, comorbidities, administration of anti-inflammatory and immunosuppressive medications, tumor type, histological margin evaluation, surgical procedure location, and antibiotic protocols were not significant contributors to development of infection. Use of antibiotic therapy in this cohort was not protective against development of infection and may not be routinely indicated for all oromaxillofacial oncologic surgeries despite common promotion of its use and the contaminated nature of the oral cavity. Anesthetic time significantly contributed towards the development of infection and use of perioperative antibiotics for surgical procedures lasting >6 h may be routinely warranted.

Differences between lung adenocarcinoma and squamous cell carcinoma in histological distribution of residual tumor after induction chemoradiotherapy

AimsTo facilitate dose planning for convergent beam radiotherapy in non-small cell lung cancer (NSCLC), tumor response and histological distribution of residual tumors after induction chemoradiotherapy (ICRT) were compared between adenocarcinoma (AD) and squamous cell carcinoma (SQ).MethodsNinety-five patients with N1–2 or T3–4 NSCLC were treated with ICRT followed by surgery; 55 had AD and 40 had SQ. For the evaluation of distribution of residual tumors, the location of the external margin of residual tumors was assessed on surgical materials as follows: radius of whole tumor (“a”); distance between the center of tumor and the external margin of residual tumor (“b”); and its location (“b/a”).ResultsOf the 55 AD cases, 8 (15%) showed pathological complete remission, which was significantly less frequent than 22 of 40 SQ cases (55%) (p < 0.001). AD showed the residual tumors at the most periphery of tumor (b/a = 1.0) more frequently than SQ, i.e., 39/55 (71%) versus 6/40 (15%), respectively (p < 0.001). Even in 65 cases other than the pathological complete remission, external margins in 47 AD cases located more periphery than those in 18 SQ cases, of which mean b/a values were 0.97 ± 0.17 and 0.70 ± 0.29, respectively (p < 0.001).ConclusionAD showed worse tumor response to ICRT than SQ. After ICRT, AD remained at the periphery of primary tumor more frequently than SQ. It seems that, also in the convergent beam radiotherapy, the periphery part of AD would be more resistant than that of SQ.

The impact of the extent and location of positive surgical margins on the risk of biochemical recurrence following radical prostatectomy in men with Gleason 7 prostate cancers.

Positive surgical margins (PSM) after radical prostatectomy (RP) have been associated with increased risk of biochemical recurrence (BCR). This is heavily influenced by other clinicopathological factors. This study aims to assess the impact of the extent and location of PSM on BCR following RP for Gleason 7 carcinoma of the prostate (CaP). All men treated with RP between 2008 and 2017 in our region for localized or locally advanced Gleason 7 CaP, were included. Clinical (age, year, preoperative prostate specific antigen) and pathological (prostate weight, positive or negative surgical margins, International Society of Urological Pathology [ISUP] grade, T stage) data were collected. PSM were subcategorised according to Extent into favourable (unifocal and <3 mm in length) or unfavourable (multifocal or ≥3 mm in length), and Location into apical only or others. The outcome was the risk of BCR which was calculated with univariable and multivariable regression models and reported as hazard ratio (HR) with 95% confidence interval (CI). The cohort constituted of 1433 men. Majority had ISUP 2 (71.2%) or localized (62%) disease. Men with PSM (n = 506) were at greater risk of BCR when compared to those with negative margins (adjusted HR = 1.52, [CI: 1.14-2.04], p = .005). Similar observation was demonstrated for both PSM location subgroups. As for the PSM extent category, only men with unfavourable PSM demonstrated an increase in BCR risk over negative margin (adjusted HR = 1.67, [CI: 1.23-2.28], p = .001). Within this study settings, PSM were generally associated with increased BCR risk. This, however, was not demonstrated in favourable PSM extent cases. Observation rather than active treatment in these men should be considered.

Evaluation of the Marginal Location and Periodontal Health in Crowns and Bridges – A Patient Preference Based Study

OBJECTIVE: The objective of this paper was to evaluate the marginal location preference and periodontal health in extra coronal restoration of anterior and posterior teeth. METHODOLOGY: In this prospective case control study, a total of 652 patients who had crown and bridge for not less than six months were included. The gingival margin location preference and reasons behind choosing a particular gingival margin was asked from the patients. Additionally, the teeth with and without restoration were also examined for periodontal health. Split mouth technique was used as unrestored, healthy contra lateral teeth in the same individual served as controls. Descriptive statistics and Chi square test were used for analysis to formulate the results. RESULTS: Ironically, 92% patients were not given a chance by their dentist to give input about margin location preference. The majority of patients preferred equi gingival margin for their anterior crowns 495 (75.92%) and supra gingival margin 586 (89.87%) for their posterior teeth, with esthetics 547 (83.89%) and hygiene 599 (91.87%) respectively being the most common reasons for selecting the particular margin location. The clinical examination revealed that supra gingival and equi gingival margins demonstrated superior gingival health indices as compared to subgingival margins CONCLUSION: This study concluded that the supra gingival and equi gingival margins demonstrated superior gingival health indices as compared to subgingival margin and in order to achieve optimal periodontal health and patient satisfaction the health professionals should wisely consider the margin location and involve the patient in treatment decisions wherever possible. KEY WORDS: Crown and Bridge, Margin location, Patient preference, Periodontal Health.

PD64-09 COMPARATIVE EVALUATION OF ONCOLOGIC OUTCOMES ACCORDING TO THE ANATOMIC LOCATION OF SURGICAL MARGIN POSITIVITY AFTER PARTIAL NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy VI (PD64)1 Sep 2021PD64-09 COMPARATIVE EVALUATION OF ONCOLOGIC OUTCOMES ACCORDING TO THE ANATOMIC LOCATION OF SURGICAL MARGIN POSITIVITY AFTER PARTIAL NEPHRECTOMY Alp T. Beksac, Soodong Kim, Umberto Carbonara, Margaret Meagher, Alessandro Tafuri, Mahmoud Abou Zeinab, Louis Lenfant, Alessandro Antonelli, Riccardo Autorino, Ithaar Derweesh, and Jihad Kaouk Alp T. BeksacAlp T. Beksac More articles by this author , Soodong KimSoodong Kim More articles by this author , Umberto CarbonaraUmberto Carbonara More articles by this author , Margaret MeagherMargaret Meagher More articles by this author , Alessandro TafuriAlessandro Tafuri More articles by this author , Mahmoud Abou ZeinabMahmoud Abou Zeinab More articles by this author , Louis LenfantLouis Lenfant More articles by this author , Alessandro AntonelliAlessandro Antonelli More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Ithaar DerweeshIthaar Derweesh More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002108.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We sought to assess if the anatomical location of positive surgical margins (PSM) can affect the oncological outcomes following partial nephrectomy (PN). METHODS: From a multi-institutional dataset, we performed a retrospective analysis of 115 patients who were found to have PSM following PN. Surgeries were performed between from January 2010 to May 2020. Patients with benign pathology, less than 6 months follow up, baseline metastatic disease, bilateral tumors, familial renal cell carcinoma, and pathological node positive disease were excluded from analysis. Patients with PSM were stratified into two groups according to the anatomical location (parenchymal invasion, sinus fat invasion). Due to uneven sample size a 1:2 matched pair analysis was performed (by cT stage) to limit confounding effect of stage on recurrence. Demographics, clinical and tumor characteristics, and poncological outcomes were compared using Chi-square, Fisher’s exact, Mann-Whitney U, and student’s t tests. Kaplan-Meier analysis performed to analyze recurrence free survival (RFS). RESULTS: Overall 84 patients were included in analysis (56 parenchymal vs. 28 sinus). Median follow-up was 25 months (IQR 11-41). Baseline characteristics were comparable between the two groups. Pathological tumor size was comparable. In the parenchymal group, more patients had multifocal PSM, whereas more patients had pT3a upstaging in the sinus group. Local recurrence rate was higher in the sinus group (17.9% vs. 10.9%, p=0.377), however this association did not reach statistical significance. Distant recurrence rate was comparable as well (5.5% vs. 7.1%, p=0.76). Kaplan-Meier analysis did not show any difference in terms of RFS (p=0.68). CONCLUSIONS: At 25 months follow up, the location of positive surgical margin did not alter distance recurrence rates following PN. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1147-e1148 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alp T. Beksac More articles by this author Soodong Kim More articles by this author Umberto Carbonara More articles by this author Margaret Meagher More articles by this author Alessandro Tafuri More articles by this author Mahmoud Abou Zeinab More articles by this author Louis Lenfant More articles by this author Alessandro Antonelli More articles by this author Riccardo Autorino More articles by this author Ithaar Derweesh More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement Loading ...

Crustal architecture and tectonic evolution of the southernmost Río de la Plata Craton and its Neoproterozoic–Paleozoic sedimentary cover: Insights from 3D litho-constrained stochastic inversion models

In the last decade, several models have been proposed to explain the location and geometry of the southern margin of the Archean–Paleoproterozoic Río de la Plata Craton. However, these topics and the regional distribution of the Neoproterozoic–Paleozoic sedimentary cover of the craton are still widely debated. This contribution presents a 3D litho-constrained gravity inversion model of the southern sector of the Río de la Plata Craton, based on the integration of geological, geophysical, and petrophysical data. The distribution of the Neoproterozoic–Paleozoic sedimentary cover of the region is reassessed considering a common and protracted geological history of the three morphotectonic units involved in the study area: the Tandilia System, the Claromecó Basin, and the Ventania System. Our results provide key information on the location and geometry of the southern margin of the Río de la Plata Craton that supports its relationship with the Neoproterozoic Brasiliano/Pan-African Orogeny and, subsequently, with the Paleozoic Terra Australis and Gondwanide orogenies. In this context, the Neoproterozoic basement of the Ventania System was dextrally transported from the Brasiliano/Pan-African Orogen during the late Ediacaran–early Cambrian and thrusted over the Río de la Plata Craton and its Neoproterozoic–early Paleozoic sedimentary cover during the Permian. Likewise, our 3D model also shed new insights into the orogenic mechanisms of deformation transfer from the North Patagonian Massif to the Ventania System. The deep crustal geometry determined for the latter suggests intraplate deformation, mainly due to the Permian reactivation of the boundary between the Río de la Plata Craton and the Brasiliano/Pan-African basement. This implies that the Ventania System was mechanically disconnected from the Permian orogenic front located further southwest in the North Patagonian Massif, thus challenging previous models of orogenic architecture for the region.

Mohs Micrographic Surgery

ABSTRACT Mohs micrographic surgery is a specialized surgical technique that involves serial excision of locally invasive, recurrent, or ill-defined skin cancers with complete histological examination of surgical margins. Originally developed by Dr. Frederic E. Mohs in the 1930s, it began as in situ tissue fixation with zinc chloride and healing by secondary intention and has evolved to fresh tissue surgical excision with subsequent reconstruction. Despite continuous advancements made in the field, the underlying principle of Mohs surgery remains the same: one surgeon acting as a pathologist to ensure complete tumor removal while minimizing the resection of healthy tissue. Mohs surgery is considered the gold standard for treatment of various cutaneous tumors and can be performed on an outpatient basis within a single day. The tumor is excised, mapped, and processed with frozen, horizontal sections for immediate histological evaluation and subsequent surgical staging in the location of a positive margin. This article serves as a review of Mohs surgery for dermatology nurses and offers an overview of the history of the procedure, clinical indications, preoperative assessments, surgical technique, reconstructive modalities, and postoperative care.

Impact of Nerve-Sparing Status on Positive Surgical Margin Location and Biochemical Recurrence in Patients with Prostate Cancer Post Radical Prostatectomy.

This study was designed to assess the relationship between nerve-sparing (NS) status, positive surgical margin (PSM) location, and biochemical recurrence (BCR) based on a multicenter, radical prostatectomy (RP) database. We retrospectively reviewed data from 726 patients who underwent RP without any neoadjuvant or adjuvant treatment between 2010 and 2014. We statistically assessed the impact of NS sides on PSM location and BCR. PSM rates were 21.9% in the 726 patients studied, 13.2% in patients with ≤pT2, and 46.8% in patients with ≥pT3. Regarding PSM locations, the anterior-apex (AA) was the most common site for PSM (43.3%). After adjusting for confounding factors, bilateral nerve sparing (BNS) had a significantly higher odds ratio of PSM than the absence of NS did (odds ratio [OR] 3.04, 95% confidence interval [CI] 1.85-4.99). In the UNS RP in patients with ≤pT2, non-AA PSM on the non-NS side was significantly higher than that on the NS side (92.9% vs. 45.5%, p = 0.009). In all patients, 5.8% experienced BCR during a median follow-up of 43.5 months. PSM was significantly associated with BCR-free survival in patients with ≤pT2 (p = 0.013), but not in patients with ≥pT3 (p = 0.185). Non-AA PSM at the non-NS side was an independent risk factor for BCR (hazard ratio [HR] 2.56, 95% confidence interval [CI] 1.12-5.85), whereas AA PSMs, including NS/non-NS sides and non-AA PSM at the NS side, were not associated with BCR-free survival. Avoidance of non-AA PSM on the non-NS side may be rather important for maintaining BCR-free survival after RP.

Surgical excision of non-melanoma skin cancer: no end in site?

Non-melanoma skin cancer (NMSC) is the most common type of cancer in the UK and Ireland, accounting for approximately 20% of all new malignancies recorded, with evidence of increasing incidence. Surgical excision is regarded as the gold standard treatment for such lesions; however, incomplete excision incurs both physical and financial strain on patients and the healthcare service. Our aim is to identify which anatomical regions of the head and neck pose greater risk of incomplete excision and raise awareness for future surgical practice. Manual data collection was carried out on all patients admitted to the OMFS department for surgical excision of NMSCs between January 2016 and December 2017. Information collected included clinical notes and MDT outcomes. NMSCs excised via Mohs surgery. All tumours incompletely excised and requiring further treatment were noted with particular emphasis on the site of the lesion within the head and neck region, and the location of the positive margin on the specimen itself. A total of 506 NMSCs were excised (307 BCC, 199 SCC). Of these, 7.8% (n=24) and 6.0% (n=12), respectively, required further treatment due to incomplete excision. The incompletely exised lesions were predominately located on the nose (13.3%), temple (15.0%), and ear (12.8%). Our results demonstrate that our department is successfully excising NMSCs with minimal cases requiring further management. This study has identified anatomical profiles posing a higher risk of incomplete removal. Alongside the conventionally challenging sites of the nose and ear, we have highlighted additional risk within the temporal region. We therefore propose that Mohs surgery or a two-stage procedure should be considered as management for the temple at future MDTs.

Cutaneous Spindle Cell Squamous Cell Carcinoma in Cats: Clinical, Histological, and Immunohistochemical Study.

This study describes the clinical and pathological characteristics of cutaneous spindle cell squamous cell carcinoma (SCSCC) in 18 cats. The average age of the cats was 11.8 ± 2.7 years, and all tumors were located in the facial skin, mainly affecting the pinna (13/18, 72%), followed by the periorbital area (4/18, 22%) and the dorsal muzzle (1/18, 6%). Tumors were composed of fusiform neoplastic cells with moderate atypia arranged in solid sheets or fascicles with foci of squamous differentiation. A panel of antibodies against cytokeratins, vimentin, S-100 protein, NSE, GFAP, Melan A, SMA, desmin, CD18, CD31, and p63 was used to help differentiate SCSCC from other spindle cell malignancies. SCSCCs expressed CK5/6 (17/18, 94%), AE1/AE3 (15/18, 83%), and p63 protein (18/18, 100%), but there was no immunolabeling for CK8/18. A role for sunlight exposure in the pathogenesis of the tumors was suggested by changes indicative of actinic keratosis, the location of the tumors in dorsal areas, and the absence of histomorphologic features of papillomavirus infection. Recurrence was not recorded in 14/18 cases (78%) during a follow-up period of 7 to 25 months. Three of 18 (17%) tumors recurred or led to humane euthanasia due to local progression, and one case (5%) had regional lymph node metastasis. Clinical outcome varied with cutaneous location, mitotic count, and invasion of surgical margins; thus, SCSCCs with a more aggressive behavior were located in the periorbital area (4/4 cases), had ≥14 mitoses in 10 high-power fields (2.37 mm2) (4/4 cases), and showed invasion of surgical margins (3/4 cases).

High-frequency (22-MHz) ultrasound for assessing the depth of basal cell carcinoma invasion.

High-frequency ultrasound (HFUS) has been studied in the diagnosis and therapeutic management of basal cell carcinoma (BCC). The accuracy of this method for location of deep margins remains unknown. This study evaluates HFUS for localization of deep surgical margins in BCC. Ultrasound images of 83 lesions from 67 patients with clinical and dermoscopic diagnosis of BCC were compared with histopathological findings. Pearson's correlation coefficient was used to assess the relationship between thickness as measured by HFUS and histopathology. A strong correlation between HFUS and histopathological measurements was identified (r=0.9744, P<.001). HFUS had sensitivity of 96%, specificity of 84%, and accuracy of 91% for measurement of deep tumor margins. Factors affecting tumor measurement on HFUS include marked basophilic degeneration of collagen, presence of peritumoral hypertrophic glands or hair follicles, fibrosis, and dense inflammatory changes related to the tumor itself or to prior procedures. High-frequency ultrasound was effective in localizing deep tumor margins in BCC. Therefore, we believe that this diagnostic imaging method is important when selecting a therapeutic approach, considering Mohs micrographic surgery, and evaluating the surgical site.

Evaluating Incidence, Location, and Predictors of Positive Surgical Margin Among Chinese Men Undergoing Robot-Assisted Radical Prostatectomy.

PurposeTo evaluate the incidence and locations of positive surgical margin (PSM) among Chinese men undergoing RARP and identify the preoperative predictors for PSM.MethodsWe retrospectively identified 393 patients who underwent RARP according to inclusion criteria by single surgeon in our hospital. PSM was defined as the presence of cancer adjacent to inked surface of the specimen and categorized into four groups based on locations: apex, posterolateral, base, and multifocal. Logistic regression analysis was performed to identify the predictors of overall and location-specific PSM.ResultsThe overall PSM rate was 133/393 (34%). The PSM rates for pT2, pT3, and pT4 stage were 63/278 (23%), 50/89 (56%), and 20/26 (77%), respectively. The estimated rates for apical, posterolateral, basal, and multifocal PSM were 8%, 4%, 7%, and 14%, respectively. In univariate analysis, overall PSM related to tPSA, f/tPSA, percentage of positive needles, and Gleason score. Multifocal PSM correlated with smoking history, drinking history, tPSA, f/tPSA, percentage of positive needles, and Gleason score. In multivariate analysis, percentage of positive needles reminded the only independent predictor for overall (OR = 10.5, 95% CI: 2.58–44.4) and basal PSM (OR = 24.0, 95% CI: 3.22–179.4). The f/tPSA (OR = 2.59, 95% CI: 2.18–5.71) and percentage of positive needles (OR = 31.0, 95% CI: 3.17–303) were independent risk factors for multifocal PSM.ConclusionThe multifocal sites were the most common location of positive surgical margin, followed by apical and basal sites among Chinese patients undergoing RARP. The percentage of positive needles was an independent predictor for overall, basal, and multifocal PSM.

Practice Patterns of Korean Urologists Regarding Positive Surgical Margins after Radical Prostatectomy: a Survey and Narrative Review.

BackgroundThere is no clear consensus on the optimal treatment with curative intent for patients with positive surgical margins (PSMs) following radical prostatectomy (RP). The aim of this study was to investigate the perceptions and treatment patterns of Korean urologists regarding the resection margin after RP.MethodsA preliminary questionnaire was prepared by analyzing various studies on resection margins after RP. Eight experienced urologists finalized the 10-item questionnaire. In July 2019, the final questionnaire was delivered via e-mail to 105 urologists in Korea who specialize in urinary cancers.ResultsWe received replies from 91 of the 105 urologists (86.7%) in our sample population. Among them, 41 respondents (45.1%) had performed more than 300 RPs and 22 (24.2%) had completed 500 or more RPs. In the question about whether they usually performed an additional biopsy beyond the main specimen, to get information about surgical margin invasion during surgery, the main opinion was that if no residual cancer was suspected, it was not performed (74.7%). For PSMs, the Gleason score of the positive site (49.5%) was judged to be a more important prognostic factor than the margin location (18.7%), multifocality (14.3%), or margin length (17.6%). In cases with PSMs after surgery, the prevailing opinion on follow-up was to measure and monitor prostate-specific antigen (PSA) levels rather than to begin immediate treatment (68.1%). Many respondents said that they considered postoperative radiologic examinations when PSA was elevated (72.2%), rather than regularly (24.4%). When patients had PSMs without extracapsular extension (pT2R1) or a negative surgical margin with extracapsular extension (pT3aR0), the response ‘does not make a difference in treatment policy’ prevailed at 65.9%. Even in patients at high risk of PSMs on preoperative radiologic screening, 84.6% of the respondents said that they did not perform neoadjuvant androgen deprivation therapy. Most respondents (75.8%) indicated that they avoided nerve-sparing RP in cases with a high risk of PSMs, but 25.7% said that they had tried nerve-sparing surgery. Additional analyses showed that urologists who had performed 300 or more prostatectomies tended to attempt more nerve-sparing procedures in patients with a high risk of PSMs than less experienced surgeons (36.6% vs. 14.0%; P = 0.012).ConclusionThe most common response was to monitor PSA levels without recommending any additional treatment when PSMs were found after RP. Through this questionnaire, we found that the perceptions and treatment patterns of Korean urologists differed considerably according to RP resection margin status. Refined research and standard practice guidelines are needed.

Influence of the adhesive strategy in the sealing ability of resin composite inlays after deep margin elevation.

BackgroundThe aim of this study was to determine the influence of the gingival margin position and the adhesive strategy selected to perform deep margin elevation (DME) in marginal sealing of resin composite inlays by a nanoleakage test. Material and Methods12 sound third molars were selected and expulsive MOD cavities for inlays were prepared. Experimental groups were established according to gingival margin location (enamel: 1 mm above cemento-enamel junction (CEJ), dentin: 1 mm below CEJ, or DME, and the adhesive strategy used to lute inlays and elevate the gingival margin. Therefore, the six experimental groups were: 1) Enamel + etch-and-rinse adhesive (ERA) Adper Scotchbond 1XT (SB1XT); 2) Dentin + SB1XT; 3) DME + SB1XT; 4) Enamel + self-etching adhesive (SEA) with enamel selective etching Clearfil SE Bond (CSE); 5) Dentin + CSE; 6) DME + CSE. Resin composite inlays were constructed (Gradia Indirect) and all luted with the same resin cement (RelyX ARC). Specimens were submitted to nanoleakage test. Results were analyzed by Kruskal-Wallis and Mann-Whitney U tests with Bonferroni correction (p<0.05). ResultsA perfect sealing ability was evidenced for experimental groups with gingival margins on enamel. Similar nanoleakage values were determined when CSE adhesive was applied regardless the gingival margin position. The highest silver nitrate infiltration was detected for elevated margins with the ERA SB1XT. ConclusionsThe SEA Clearfil SE Bond showed higher sealing ability than the ERA Adper Scotchbond 1XT when margins were located on dentin, regardless margin elevation. Gingival margins on enamel together with enamel acid etching provided an excellent sealing with both adhesive systems. Key words:Adhesion, composite inlays, gingival margin, deep margin elevation, marginal seal, nanoleakage test.