Cases Of Positive Margins Research Articles

A Case Report of Superficial Solitary Fibrous Tumor in the Right Parotideomasseteric Region.

Solitary fibrous tumors (SFTs) are rare mesenchymal tumors that occur in various soft tissues and organs throughout the body. Superficial SFTs in the head and neck region are uncommon and reports of such cases are limited. An elderly Japanese woman in her 80s presented to our clinic with a smooth mass in the right parotideomasseteric region. Ultrasonography and magnetic resonance imaging revealed a well-defined subcutaneous mass measuring 20 mm. For a definitive diagnosis and treatment, surgical resection was performed under local anesthesia. Intraoperatively, a brown-colored tumor was identified beneath the skin, without surrounding tissue adhesion, and was completely excised. Immunohistochemistry, revealing the expression of STAT6, confirmed the diagnosis of SFT. Based on the SFT risk classification, this case was classified into the low-risk group, and no recurrence occurred during the 4 year postoperative period. According to the 2020 World Health Organization Classification of Soft Tissue Tumors, SFTs belong to the intermediate category with recurrence potential. In previous studies, cases of positive margins and recurrence have been reported in superficial SFTs, and SFTs may show benign features on clinical presentation but require precise surgical manipulation. Therefore, it is crucial for otolaryngologists to gain a comprehensive understanding of this tumor for appropriate treatment.

Impact of pathologic features on local recurrence in penile squamous cell carcinoma after penectomy

BackgroundPenile squamous cell carcinoma (PSCC) is a rare malignancy that may be cured in cases of local disease by resection of the primary tumor. Risk factors and patterns of local recurrence (LR) have not been well described in cases requiring partial or radical penectomy. In this study, we evaluated risk factors for LR and the impact of frozen and final margin assessment. Materials and methodsWe evaluated 119 patients with PSCC who had undergone partial or radical penectomy from 2007 to 2023. Data regarding clinical and pathologic features were collected by retrospective chart review. The primary outcome of interest was LR. Determinants of LR were analyzed by Student's t, Fisher's exact, chi-square and logistic regression analysis. Predictive statistics of frozen margin status on final margin were assessed and LR rates for subsets of frozen and final margin interaction were defined. Finally, all cases of positive margins and LR were described to highlight patterns of LR and the importance of margin status in these cases. ResultsThere were 8 (6.7%) cases of local recurrence. There were no significant predictors of LR, although a trend toward increased LR risk was observed among those with a positive final margin. Positive final margins were found in 15 (13%) cases. Frozen margin analysis was utilized in 79 cases, of which 10 (13%) were positive. The sensitivity, specificity, positive predictive value, and negative predictive value of frozen margin status for final margins were 44%, 92%, 40%, and 93%, respectively. There were no LR among cases in which frozen margin was not sent. Analysis of all cases with positive margin and/or LR identified three subsets of patients: CIS or focally positive margin resulting in either no LR or LR managed with minimal local intervention, bulky disease in which survival is determined by response to subsequent therapy rather than local recurrence, and clinically significant local recurrence requiring continued surveillance and intervention despite negative margins. ConclusionsLR is rare, even in cases of larger, proximal tumors requiring partial or radical penectomy. In this study, no statistically significant risk factors for local recurrence were identified; however, analysis of frozen and final margins provided insight into the importance of margin status and patterns of local recurrence. When feasible, visibly intra-operative negative margins are an excellent predictor of low risk for LR, and, in cases of CIS or focally positive margins, further resection to achieve negative margins is unlikely to reduce the risk of clinically significant LR. Additionally, in cases of bulky disease, the goals of resection should be focused toward palliation and next line therapy.

The Feasibility of Omitting Postoperative Radiotherapy in Japanese Patients With Ductal Carcinoma In Situ of Breast Treated With Breast-Conserving Surgery.

Background To analyze the feasibility of omitting postoperative radiotherapy (PORT) after breast-conserving surgery (BCS) in Japanese patients with ductal carcinoma in situ (DCIS). Materials and methods We retrospectively analyzed 88 patients with small pure DCIS (median diameter 1.1 cm, ≤ 4 cm) who underwent BCS with (n = 39) or without (n = 49) PORT.The primary and secondary endpoints were ipsilateral breast tumor recurrence (IBTR) and overall survival (OS), respectively, between the groups that received PORT and those that did not. Results The PORT group included a high number of margin-positive cases. The incidence of IBTR was 2.4% (95% confidence interval (CI), 0.3-15.7%) and 2.8% (95% CI, 0.4-18.2%) at five years and 5.5% (95% CI, 1.4-20.6%) and 2.8% (95% CI, 0.4-18.2%) at 10 years in patients without and with PORT, respectively (p = 0.686). In the margin-negative group, only one patient showed IBTR without RT (2.3%), whereas no patient with PORT experienced IBTR (0%). To date, there have been no regional or distant metastases; therefore, no patient has experienced breast cancer-related deaths.The OS rates were 97.7% (95% CI, 84.9-99.6%) and 100% at 10 years in patients without and with PORT, respectively (p = 0.372). Conclusion This study suggests that the omission of PORT after BCS could be a feasible option for selected Japanese patientsbut requires further investigation to identify the low-risk factor in patients who can omit PORT.

Virtual 3D Specimen Mapping in Head & Neck Oncologic Surgery.

Virtual 3D specimen mapping of oncologic surgical specimens provides a visual record of the specimen and margin sampling sites which can be utilized in a variety of cancer care settings. Our objective was to perform a retrospective review of head and neck surgical oncology cases where the specimen was mapped post-operatively and to evaluate the utility of these 3D specimen maps amongst the multidisciplinary cancer care team. A retrospective review of our 3D specimen model biorepository was performed. Surgical specimens were 3D scanned and then graphically annotated (or "mapped") during routine pathologic processing. The resulting 3D specimen maps were distributed to the multidisciplinary oncologic care team. Final margin status and any use of the 3D specimen maps were recorded. A total of 28 cases were included. Virtual 3D specimen maps were utilized by the cancer care team in 8 cases (29%), including 2 positive margin cases, 2 close margin cases, and 4 indeterminate margin cases. 3D specimen maps were used to visualize positive margin sites for pathologist-surgeon communication as a visual reference during tumor board discussions and to inform radiation treatment planning. Post-operative virtual 3D specimen mapping of oncologic specimens creates a permanent visual record of the specimen and the margins sampled and may serve as a beneficial tool for communication amongst the multidisciplinary cancer care team. 4 Laryngoscope, 134:191-197, 2024.

A systematic review of Pilomatrix carcinoma arising from the previous scar site of Pilomatrixoma.

Pilomatrix carcinoma is a rare tumor arising from the hair follicle matrix cells most commonly seen in the head and neck region. Also known as "calcified epithelial carcinoma of Melherbe," it was first reported in 1980 by Lopansri and Mihm. Since then till date to the best of our knowledge only around 125 cases were reported in literature, of which only 11 cases were reported to arise from histologically proven areas of previous pilomatrixoma which is the benign variant. One such case is being reported here along with the review of literature. A 50-year-old man presented with a swelling in the nape of his neck since 6 months, which was gradually increasing in size. He had a history of similar swelling at the same site 18 months back for which he underwent a surgery at a center outside. Final histopathology report was suggestive of pilomatrixoma with negative margin. Wide local excision of the tumor with 3 cm margin, placement of surgical clips followed by a primary closure was done. The final histopathology report is suggestive of pilomatrix carcinoma. The patient has no recurrence in 6 months follow-up. The differential diagnosis of pilomatrix carcinoma should be considered in cases of recurrent skin tumors. Wide local excision is the preferred treatment. Re-excision should be done in margin positive cases and cases where simple excision was done due to improper preoperative diagnosis. Due to the rarity of the disease, adjuvant treatment is not properly defined.

Breast-Conserving Surgery Margin Guidance Using Micro-Computed Tomography: Challenges When Imaging Radiodense Resection Specimens.

Breast-conserving surgery (BCS) is an integral component of early-stage breast cancer treatment, but costly reexcision procedures are common due to the high prevalence of cancer-positive margins on primary resections. A need exists to develop and evaluate improved methods of margin assessment to detect positive margins intraoperatively. A prospective trial was conducted through which micro-computed tomography (micro-CT) with radiological interpretation by three independent readers was evaluated for BCS margin assessment. Results were compared to standard-of-care intraoperative margin assessment (i.e., specimen palpation and radiography [abbreviated SIA]) for detecting cancer-positive margins. Six hundred margins from 100 patients were analyzed. Twenty-one margins in 14 patients were pathologically positive. On analysis at the specimen-level, SIA yielded a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 42.9%, 76.7%, 23.1%, and 89.2%, respectively. SIA correctly identified six of 14 margin-positive cases with a 23.5% falsepositive rate (FPR). Micro-CT readers achieved sensitivity, specificity, PPV, and NPV ranges of 35.7-50.0%, 55.8-68.6%, 15.6-15.8%, and 86.8-87.3%, respectively. Micro-CT readers correctly identified five to seven of 14 margin-positive cases with an FPR range of 31.4-44.2%. If micro-CT scanning had been combined with SIA, up to three additional margin-positive specimens would have been identified. Micro-CT identified a similar proportion of margin-positive cases as standard specimen palpation and radiography, but due to difficulty distinguishing between radiodense fibroglandular tissue and cancer, resulted in a higher proportion of falsepositive margin assessments.

Expression of TP53 in oral squamous cell carcinoma and its correlation with adverse histopathological features

This study aimed to evaluate the expression of TP53 in oral squamous cell carcinoma (OSCC) and to correlate its expressions with adverse histopathological features like depth of invasion (DOI), lymphovascular invasion (LVI), perineural invasion (PNI), extranodal extension (ENE), and margin status which significantly affect the prognosis. This cross-sectional study included 48 patients of OSCC who underwent surgical resection. All the histopathological adverse features such as DOI, LVI, PNI, ENE, margin status were noted. Immunohistochemical expression of TP53 was noted and a correlation of TP53 with histopathological adverse features was done. Statistical analysis was performed using SPSS software. TP53 immunopositivity was seen in 45.83% (22/48) of cases. TP53 has a statistically significant correlation with margin status (P = 0.002). Similarly, TP53 expression is more in cases with LVI (100% cases) though the value is not statistically significant. TP53 expressions are more in positive margin cases and less if the margin is >5 mm. Similarly, TP53 expression is more in cases with LVI (100% cases) though the value is not statistically significant. Few parameters that did not show the correlation of TP53 with adverse histopathological features could be attributed to a small sample size. Further studies with a large number of cases and using other ancillary molecular diagnostic techniques would throw further light on the exact alteration of TP53 in our population and their association with histopathological prognostic features.

Specimen-Based Resection Margins and Local Control during Transoral Robotic Surgery for Oropharyngeal HPV-Mediated Squamous Cell Carcinoma

Objectives: The aim of the study was to investigate the association of surgical margin conditions, including positive specimen margins revised to negative relative to local recurrence, disease-free survival, and overall survival (OS) within a cohort of HPV-mediated oropharyngeal squamous cell carcinoma (OPSCC) who underwent en bloc resection via transoral robotic surgery (TORS). Materials and Methods: Retrospective cohort of patients with untreated HPV-mediated OPSCC cT1 or T2 undergoing TORS resection between October 2014 and March 2020. The methodologic description of our interdisciplinary institutional approach, number of cut-through margins (CTMs) during intraoperative consultation, percentage of final positive margin cases, and disease-free survival and OS stratified by margin status and margin tumor-free distance is identified. Results: 135 patients with primary cT1/T2 HPV-mediated OPSCC met inclusion criteria. Twenty-eight of 135 (20.7%) specimens revealed CTM and were revised during the same operative setting. Three of 135 (2.2%) surgical cases had positive final margin status. Local control rate was 97%. On univariate analysis, margin distance did not impact OS. CTM and final positive margins had lower OS than initially negative margins (p = 0.044). Pathologic N-stage significantly impacted OS (p < 0.001). Conclusions: High local control rate and low final positive margin status confound the study of specimen margin-based techniques in HPV-mediated OPSCC resected en bloc with TORS. Pathologic N-stage may impact OS more than margin status. Larger numbers are needed to confirm differences.

Prognostic Value of Human Papillomavirus Genotyping before and after Cervical Conization for Squamous Intraepithelial Lesion

Introduction: We previously reported that preoperative human papillomavirus (HPV) type 16/18 positivity and postoperative high-risk (HR)-HPV test positivity are associated with abnormal postoperative cytology. In this study, we further examined whether preoperative and postoperative HR-HPV genotyping could predict cytological abnormalities and the risk of additional surgery. Methods: Patients who underwent cervical conization at our hospital between July 2009 and June 2018 were enrolled. HPV genotyping was performed preoperatively for all patients with HPV-positive. The association among preoperative and postoperative HR-HPV genotyping results, the cumulative risk of cytological abnormalities, and additional surgery were evaluated. The endpoint approach was used to investigate the cumulative incidence of additional surgery owing to cytological abnormalities, such as low-grade squamous intraepithelial lesion positivity and recurrence 2 years after cervical conization. Results: Positive and negative histological margins were observed in 21 and 287 of 308 cases, respectively. The cumulative incidence of abnormal cytology and additional surgery was significantly higher in margin-positive cases than that in margin-negative cases. Examination established according to the margin status demonstrated that the postoperative HR-HPV-positive group had a significantly worse prognosis than the HR-HPV-negative group. Additionally, 32 cases, wherein the same genotype detected before and after surgery, demonstrated significantly unfavorable outcomes. Fifteen patients with persistent HPV 16/18 had the worst prognosis than the other types. Conclusion: Preoperative and postoperative HR-HPV genotype tests were used to predict the cumulative incidence of abnormal cytology and additional surgery. Particularly, patients with suspected persistent HPV type 16/18 infection are at a high recurrence risk.

Short-term Outcomes of Pylorus-Preserving Gastrectomy for Early Gastric Cancer: Comparison Between Extracorporeal and Intracorporeal Gastrogastrostomy.

PurposeThis study aimed to compare the surgical and oncological outcomes between totally laparoscopic pylorus-preserving gastrectomy (TLPPG) with intracorporeal anastomosis and laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) with extracorporeal anastomosis.Materials and MethodsA retrospective analysis was performed in 258 patients with cT1N0 gastric cancer who underwent laparoscopic pylorus-preserving gastrectomy using two different anastomosis methods: TLPPG with intracorporeal anastomosis (n=88) and LAPPG with extracorporeal anastomosis (n=170). The following variables were compared between the two groups to assess the postoperative surgical and oncological outcomes: proximal and distal margins, number of resected lymph nodes (LNs) in total and in LN station 6, operation time, postoperative hospital stay, and postoperative morbidity including delayed gastric emptying (DGE).ResultsThe average length of the proximal margin was similar between the TLPPG and LAPPG groups (2.35 vs. 2.73 cm, P=0.070). Although the distal margin was significantly shorter in the TLPPG group than in the LAPPG group (3.15 vs. 4.08 cm, P=0.001), no proximal or distal resection margin-positive cases were reported in either group. The average number of resected LN was similar in both groups (36.0 vs. 33.98, P=0.229; LN station 6, 5.72 vs. 5.33, P=0.399). The operation time was shorter in the TLPPG group than in the LAPPG (200.17 vs. 220.80 minutes, P=0.001). No significant differences were observed between the two groups in terms of postoperative hospital stay (9.38 vs. 10.10 days, P=0.426) and surgical complication rate (19.3% vs. 22.9%), including DGE (8.0% vs. 11.8%, P=0.343).ConclusionsThe oncological safety and postoperative complications of TLPPG with intracorporeal anastomosis are similar to those of LAPPG with extracorporeal anastomosis.

Clinical Significance of Horizontal and Vertical Margin of En Bloc Resection for Nonmuscle Invasive Bladder Cancer.

The primary advantage of en bloc resection of bladder tumors is to provide better diagnostic accuracy. However, the clinical significance of horizontal and vertical margin has not been demonstrated. We evaluated the clinical importance of surgical margins in patients who underwent en bloc resection of bladder tumors. We retrospectively analyzed the records of 140 consecutive patients who underwent en bloc resection of bladder tumors for nonmuscle invasive bladder cancer. We analyzed perioperative and oncological outcome, and compared patient demographics and recurrence-free survival for horizontal findings. The relationship between surgical margin and second transurethral resection outcome in pT1 bladder cancer was also analyzed. Mean tumor diameter was 17.2±9.8 mm. Pathological stages were 93 cases in pTa and 47 cases in pT1. Diagnostic rates for the horizontal and vertical margins were 63% and 99%, respectively. The rates of sessile, carcinoma in situ, high grade, and pT1 tumors were significantly higher in the horizontal margin positive group (41) than in the negative group (47). There was no significant difference in 2-year recurrence-free survival based on horizontal margin findings (negative: 72.4%, positive: 75.4%, p=0.87). A second transurethral resection was performed in 31 of the 47 pT1 patients; pT1 residue was seen only in vertical margin positive cases, and 5 pTa/pTis residues at the transurethral resection scar were seen in 15 horizontal margin positive patients. Horizontal margin positive findings were not associated with recurrence-free survival, but careful assessment is warranted regarding residue at the original site. A second transurethral resection should be considered in patients with horizontal and vertical margin positive pT1 bladder cancer.

Ocular surface squamous neoplasia: outcomes following primary excision with 2 mm margin and cryotherapy.

To assess margins and the rate of local recurrence of ocular surface squamous neoplasia after excision with a 2 mm margin and cryotherapy at a single ophthalmic oncology center. (1) Conjunctival margin were assessed as positive, negative, or indeterminate margins. (2) Feasibility of repair without a graft. (3) Local recurrence. Retrospective chart review of histologically proven conjunctival intraepithelial neoplasia and invasive squamous cell carcinoma cases that underwent excision with a 2 mm margin and cryotherapy. Eighty cases met inclusion criteria for the quantitative analysis. The margin was positive in six cases (7.5%), four of which were treated with post-op topical immunotherapy/chemotherapy. Of the six positive margin cases, there was one recurrence which occurred in the patient who did not receive post-op topical adjuvant therapy, however resolved after starting topical treatment. Conjunctival repair without use of a graft was feasible in 74 (93%) cases with a mean basal diameter of 6.4 mm. Total number of local recurrence was seen in three cases (4%), which were successfully treated with adjuvant topical treatment (one positive margin case, one indeterminate margin case) or repeat resection followed by episcleral plaque brachytherapy (one negative margin case). Excision with 2 mm margin of OSSN is not associated with high rates of positive surgical margins. Even those with positive margins, when treated with adjuvant topical therapy did not develop recurrence. While achieving low rates of local recurrence, the conjunctiva is conserved, thereby minimizing the need for amniotic membrane or free conjunctival grafts for conjunctival repair.

Predictors of local recurrence and its impact on survival after glansectomy for penile cancer: time to challenge the dogma?

To identify predictive pathological factors for local recurrence (LR) and to study the impact of LR on survival in patients treated with glansectomy for penile squamous cell carcinoma (pSCC). We retrospectively studied patients treated with glansectomy at international, high-volume reference centres. We analysed histopathological predictors of LR, stratified patients into risk groups based on the number of risk factors present, and studied the impact of LR on survival outcomes using Kaplan-Meier survival analysis and stepwise Cox proportional hazards regression models. Subsequently, we performed sensitivity analyses excluding margin-positive cases, pT3 disease, and cN+ disease, or all of these factors. Across nine institutions, 897 patients were included, of whom 94 experienced LR. On multivariable analysis, presence of high-grade disease and pT3 stage were independent predictors of LR. LR-free survival rates significantly differed according to the number of risk factors present, with a hazard ratio (HR) of 1.90 (95% confidence interval [CI] 1.17-3.07; P = 0.01) for the intermediate-risk group (one risk factor) and 6.11 (95% CI 3.47-10.77; P < 0.001) for the high-risk group (two risk factors), using the low-risk group (no risk factors) as reference. Patients who experienced LR had significantly worse overall survival (OS; HR 2.89, 95% CI 2.02-4.14; P < 0.001) and cancer-specific survival (CSS; HR 5.64, 95% CI 3.45-9.22; P < 0.001). LR (HR 3.82, 95% CI 2.14-6.8; P < 0.001), lymphovascular invasion and cN status were significant predictors of decreased CSS. LR remained a strong predictor of both OS and CSS in all sensitivity analyses. Pathological T3 stage and presence of high-grade disease were independent histopathological predictors of LR after glansectomy for primary pSCC, which allowed risk stratification into three groups with significantly different risk of developing LR. Additionally, LR is related to poor OS and CSS, indicating that LR is a manifestation of underlying aggressive disease and clearly challenging the dogma of using organ-sparing surgery whenever possible since survival is unaffected by higher LR rates.

Incorporation of Limited Margin, Dose Escalated Proton Beam RT to 59.4Gy (RBE) in Children with Rhabdomyosarcoma

Local recurrence is still the most common site of failure in childhood rhabdomyosarcoma who are treated with treated with 50.4Gy conventional dose RT. We are conducting a dose escalation trial incorporating 59.4 Gy(RBE) with proton therapy (PT) for children with primary tumors >5cm to reduce the risk of local failure. We report the early outcomes for this approach from this IRB-approved prospective multi-center trial. Since December 2013, 108 patients (median age, 7.8 years) were treated with risk-based VAC (1.2gm/m2 cyclo) chemotherapy, local therapy, and for intermediate and high-risk patients, maintenance therapy for 4 cycles with Bevacizumab/Sorafenib/Cyclophosphamide. Local control (LC) consisted of surgery (upfront or delayed), margin-only adjuvant PT (36Gy(RBE)) for margin positive cases), or definitive PT (59.4Gy(RBE) >5cm, 50.4Gy(RBE) ≤5cm). The GTV was the residual visible mass at the time of PT and the CTV included a 5mm anatomically-constrained margin incorporating the initially infiltrated tissues. Acute and late toxicities were collected during and following PBRT. Eight-six patients are included in this analysis, with exclusion of patients not at LC or progression prior to LC. The 1 and 3-year cumulative incidence of LF for all patients is 1.2% (95% CI 0.1-8.2) and 3% with a median follow up of 19 months with follow-up and enrollment continuing. The CI of LF did not differ by dose group with one failure each in the no RT (20 pts), 50.4Gy (RBE) (22 pts) and 59.4Gy(RBE) (30 pts) arms. Due to the low failure rate across all groups no prognostic factors could be tested. Acute toxicity was acceptable and will be further detailed. With the incorporation of dose escalated PT in children with RMS early LF rates are low and may indicate that this therapeutic modification could improve outcome for these children with large tumors and intermediate and high-risk disease. The limited RT targeting approaches used in this trial (reduced gross tumor volume, margin only RT, 5mm CTV) also demonstrate the feasibility without compromising local control. Additional follow up is needed to confirm these promising findings.

Retrospective Cohort Analysis from a High-Volume Center of Prognostic Factors Affecting Biochemical Relapse in Patients with Encapsulated, Margin-Negative, Isolated Seminal Vesicle Invasion After Robot-Assisted Laparoscopic Prostatectomy: A Novel Study.

Purpose: Specimen pathology findings collectively impact the long-term outcomes of robot-assisted laparoscopic prostatectomy. Since seminal vesicle invasion (SVI) is an important independent predictor of biochemical recurrence (BCR), this study was designed to evaluate the influence of isolated SVI in the absence of capsular/margin invasion on BCR. Material and Methods: Pathology reports of 2009 robot-assisted laparoscopic prostatectomy specimens were analyzed retrospectively excluding capsular breach and/or margin-positive cases to include 1409 patients in the study. Factors predicting SVI and BCR in this select group of patients were assessed and statistically analyzed. Survival analysis for PSA (prostate-specific antigen) failure probability and binomial regressions for variable predictability were performed. Results: The African American race was associated with SVI (p < 0.05). PSA had a directly proportional correlation with the occurrence of SVI and BCR. SVI was found to be an independent predictor of BCR, leading to higher odds of BCR at 5 years (odds ratio [OR] 8.2, 95% confidence interval [CI] 4.5-14.6, p < 0.0001). When the seminal vesicle was invaded, the specimen Gleason grade group (SGGG; OR 1.9, 95% CI 1.02-3.7, p = 0.04), PSA (OR 1.2, 95% CI 1.01-1.4, p = 0.03), and BMI (body mass index) (OR 1.2, 95% CI 1.04-1.5, p = 0.01) predicted BCR. Seminal vesicle involvement was not found in SGGG 1. Risk stratification of significant predictors of BCR with isolated SVI identified a subgroup with BMI ≤27.9 kg/m2, PSA ≤8.6 ng/mL, and SGGG 2, which had a significantly better prognosis (p = 0.029, log-rank test). Conclusions: Seminal vesicles are infrequently involved with SGGG 1. Select groups of patients with isolated SVI who have low-grade disease with relatively lower PSA and BMI do not have an aggressive biological behavior and are unlikely to have a BCR, thereby circumventing unnecessary adjuvant therapy with its attendant side effects. The BMI significantly predicted PSA failures and should be considered as an additional risk assessment tool.

Abstract P1-20-10: The role of micro-CT in imaging breast cancer specimens

Abstract Background: The goal of breast cancer surgery is to remove all cancer with a minimum of normal tissue, but the absence of full 3-dimensional information on the surgical specimen makes this difficult to achieve. Method: Micro CT is a high resolution, X-ray, 3D imaging method, used principally in material science and industry but little used in medicine. Results: We imaged and analyzed 173 partial mastectomies by Micro-CT (129 ductal carcinomas, 14 lobular carcinomas, 28 DCIS). Imaging was simple and rapid. Size of cancer image on Micro-CT was very similar to the size of cancer at specimen dissection. Micro-CT images of surgical specimens in cassettes revealed sizes and shapes very similar to cancer later seen on the slide. Micro CT images of multicentric/multifocal cancers appeared as separate, clearly non-contiguous, masses. Additional image realization was carried out with image analysis software, with which we created a variety of three-dimensional image visualizations seen by rotation, slicing, and various degrees of transparentness, achieved by volume rendering with adjustment of opacity and maximum intensity projection imaging modified by the transfer function, making viewing through the 3D mass possible. Video can be seen at https://youtu.be/1hyNmFDidO4. Micro-CT assessment found cancer to touch edge in 134 (77%) of cases, while assessment of the microscope slides revealed positivity in 114 (66%) of cases. Cases judged by the pathologist to be margin positive were margin positive by Micro CT 93% the time. Cancer occupied 0.45% of surface area for “Micro-CT-Only-Positive Cases” but more than three times as much space, at 1.55% when both the pathologist and the Micro-CT suggested cancer at the edge. Conclusions: Micro-CT provides full 3D images of partial mastectomy specimens, allowing one to identify, in a few minutes, and thus while the patient is in OR, margin positive cases, with information on where cancer touches the edge, in a fashion more accurate than possible from the histology slides alone. Citation Format: Ankur Tiwari, Daniel DiCorpo, Kevin Hughes, James Michaelson. The role of micro-CT in imaging breast cancer specimens [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-20-10.

Clinical usefulness of high-frequency ultrasonography in the monitoring of basal cell carcinoma treatment effects.

IntroductionTo date, there has been no consensus either on the method, frequency or total duration of follow-up for patients that have developed a basal cell carcinoma (BCC).AimTo evaluate usefulness of high-frequency ultrasound in monitoring patients with BCC, particularly to detect residual disease or early recurrence.Material and methodsSeventy-eight patients with suspicious lesions of BCC were enrolled in this study. Only patients for whom histologic evaluation confirmed diagnosis of BCC (70) continued the study. The dermatoscopic and ultrasonographic observation started before the treatment. Three control examinations were performed 4, 12 and 24 weeks after the treatment.ResultsA total of 70 basal cell carcinomas were examined in this study. The presence of cancer formation was observed in the margins of removed nodular BCC in 15% (6/40), in another 25% of cases the margin of surgical removal was narrow and was < 0.2 cm (10/40). For 4 of 6 (66%) lesions, in which histopathological examination demonstrated a positive margin, hypo or heteroechogenic, irregularly shaped focal lesions were found in the ultrasonographic examination just under the entrance echo on the first follow-up visit. In 2 other cases of positive margins of the removed BCC, no signs of residual disease were observed in ultrasonographic examination. For patients with a narrow margin of healthy tissues after surgical removal, hypo or heteroechogenic foci located directly under the entrance echo were also observed in the ultrasonographic examination 4 weeks after the surgery, suggesting the presence of cancer formation. Reduction in the suspected area and scar formation were observed on the subsequent visits. It was found that the characteristic feature of residual disease presence is an enlargement of the hypoechogenic area in subsequent ultrasonographic examinations.ConclusionsThe use of high-frequency ultrasonography in the monitoring of patients after surgery can accelerate and improve the diagnosis of residual disease.

Sinonasal mucosal melanoma: A 9-year experience from a tertiary-cancer centre in South India

Sinonasal tract malignancies are uncommon, representing not more than 5% of all head and neck neoplasm. Primary sinonasal mucosal melanomas (SNMM) are rare and constitute 1% of all melanomas and about 4% of all sinonasal tumors. Mucosal melanomas are biologically distinct from cutaneous melanomas. Etiology of mucosal melanomas is still under speculation. We retrieved nine cases of SNMM from our archives over a period of 9 years from 2010 to 2018. The aim was to identify the clinical characteristics, histopathological features, disease progression, and treatment of this disease. The most common symptom was epistaxis. The mean duration of symptoms was 3 months. Nasal cavity along with maxillary sinus was the most common site. The male to female ratio was 4:5 and the mean age was 63 years. The tumors showed varying histomorphology including epithelioid, spindle cell, and undifferentiated types. Immunohistochemical studies confirmed the diagnosis with positive reactions for S100 and melanocytic markers HMB45, Melan A. Surgery was the first line of management with postoperative radiotherapy (RT) for margin positive cases. Three inoperable cases were given palliative RT. Four cases developed recurrence. Recurrences were managed with RT in most cases. Three patients died due to disease. The 1 year recurrence-free survival (RFS) rate was 44% and 2 years' RFS rate was 22%. The 5-year overall survival rate was 28%. More studies are required to understand the utility of chemotherapy and immunotherapy in treatment of this rare entity. Multi-institutional studies are needed for better understanding this rare malignancy.

The efficacy of urinary continence in patients undergoing radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis

Objective To discuss the efficacy of urinary continence in patients undergoing radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis. Methods From August 2016 to November 2018, 31 patients with prostate cancer underwent laparoscopic radical prostatectomy. The patients were 62-85 years old(mean 74.8 years), and the mean PSA score was 16.5 ng/ml(6.8-34.2 ng/ml). The pathological examination confirmed that the Gleason score was 6-9 and the prostate size was 44-83 ml. All patients underwent laparoscopic radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis. Surgical procedure: After resection of the prostate in laparoscopic radical prostatectomy, the bladder neck was sutured at 6 o'clock position to narrow the bladder neck ( tennis racquet reconstruction). The interval was 1 cm, and 2-3 needles were sutured, the distance between the neck of the bladder and the ureter was extended. The bladder neck mucosa and urethral mucosa eversion were performed. The posterior wall of the bladder neck was sutured at interval of 1 cm on both sides of the midline. After the knot was tightened, the posterior wall of the bladder was folded and bladder neck was elevated. The posterior wall of the bladder and the posterior wall of the urethra were sutured to reduce the distance between the bladder and the urethra. Finally, the bladder and urethra were anastomosed. The postoperative urinary continence recovery and the clinical effect were recorded. Results The operation time of 31 patients ranged from 80 to 210, with an average of 139.7 minutes. Intraoperative bleeding was 50-330 ml, with an average of 144.2 ml. None of the patients switched to open surgery during the operation, and there was no injury to large vessels and rectum, and no anastomotic leakage. Postoperative pathology showed 21 cases of pT2 stage, 10 cases of pT3 stage, 2 cases of positive margin, including 1 case of basal part and 1 case of apex part, both of which received medical castration therapy postoperatively.The surgical margin was positive in 2 cases (6.45%). 31 patients removed the urinary catheter in ten days after surgery. 17 cases (54.8%) recovered instantly urinary continence; 7 cases (22.6%) urinary continence in 1 month after operation; 4 cases (12.9%) urinary continence in 3 months after operation; and 3 cases (9.7%) urinary control in 6 months after operation. One case had urinary retention after removing the urinary catheter, and cathetered for 2 more weeks. After pulling out again, the urinary continence was good. Conclusions Laparoscopic radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis may be helpful for early recovery of urinary continence. Key words: Prostatectomy; Bladder neck extension; Mucosal eversion; Urinary continence

Evaluation of positive ductal margins of biliary tract cancer in intraoperative histological examination.

At present the only method available to confirm microscopic infiltration of cancer into ductal margins during surgery, is intraoperative histological examination. In the present study, the status of the surgical margins and postoperative course were evaluated to determine any correlation between remnant carcinoma and postoperative survival. All consecutive patients who underwent resection for biliary tract cancer between January 2004 and May 2012 were identified from a database. Positive margin cases were divided into two groups, invasive carcinoma and carcinoma in situ (CIS). Immunohistochemical staining targeting Ki67 and p53 for positive margins was performed. Cases of major vessel invasion were significantly increased in the positive group compared with the negative group. The recurrence rate was significantly lower in the CIS group compared with the invasive group. The survival rate was significantly increased in the CIS group compared with the invasive group. The expression levels of p53 and Ki67 were significantly increased in the invasive group compared with the CIS group. No statistical correlations were observed between the expression of p53 or Ki67 and the survival or recurrence of disease. In the positive group, resected margin status was the principal factor associated with recurrence-free survival according to Cox-regression analysis. In conclusion, the status of the resected margins in the positive group was the most important factor for postoperative survival and recurrence in cholangiocarcinoma, not immunohistochemical staining targeting Ki67 and p53.