Cases Of Positive Margins Research Articles

Clinical significance of preservation of bladder neck by sling suspension technique at seminal vesicle for urinary continence in laparoscopic radical prostatectomy

Objective To investigate the clinical significance of urinary continence after laparoscopic radical prostatectomy with the technique of preserving bladder neck with sling suspension technique by the seminal vesicle. Methods Sixty-eight patients’ clinical data from January 2014 to December 2016 in our hospital who underwent laparoscopic radical prostatectomy were retrospectively analyzed. 35 cases with sling suspension(experimental group). Preoperative Gleason score ≤6, 11 cases; Gleason score 7, 15 cases; Gleason score ≥8, 9 cases. Stage T1 1 cases, stage T2 28 cases, and T3a 6 cases .The traditional method of bladder neck group(control group) contained 33 cases.Preoperative Gleason score ≤6, 9 cases; Gleason score 7, 14 cases; Gleason score ≥8, 10 cases. Stage T1 2 cases, stage T2 29 cases, and T3a 2 cases. The mean ages[(64.3±4.3)years old and (62.6±3.8)years old], BMI[(22.85±1.69)kg/m2 and (22.15±1.32)kg/m2], prostate volume[(45.93±9.08)ml and (44.12±6.85)ml], preoperative PSA[(18.76±5.43)ng/ml and (21.18±6.55)ng/ml], preoperative Gleason of the two groups were not statistically different (both P>0.05). All patients had no urinary incontinence.All the surgery was done by the same senior surgeon. The continence status was assessed at 1 month, 2 month, 3 month, and 6 month after operation. The operation time, bleeding volume, urinary leakage rate, the length of hospital stay, and positive margin between the two groups were compared. Urinary continence was assessed by daily urinary pad volume: 0-1 /d for urinary continence was normal, 2-3/d for mild urinary incontinence, and >3/d for severe urinary incontinence. Results 68 cases were operated successfully. There was no conversions to open surgery.1 month, 2 month, 3 month and 6 month after operations, the continence rates of the experimental group were 57.1%(20/35), 77.1%(27/35), 85.7%(30/35), 97.14%(34/35), respectively. The control group’s continence rates were 36.4%(12/35), 54.5%(18/35), 75.8%(25/35), 93.9%(31/35), respectively. At 1 month and 2 month after surgery, there was a statistically significant difference in urinary continence between the two groups (P=0.047 and P=0.040), and there was no significant difference in urinary continence between the two groups at 3 and 6 month (P=0.274 and P=0.523). There were 3 cases and 4 cases of positive margins in the experimental group and the control group, with no statistical significance(P=0.705). Conclusions Technique of preservation of bladder neck by sling suspension technique at seminal vesicle may improve the recovery of early postoperative urinary continence, and does not increase the rate of positive margin. Key words: Laparoscopic radical prostatectomy; Sling suspension by seminal vesicle; Preservation of bladder neck; Urinary continence

Recurrence rate of lateral margin-positive cases after en bloc endoscopic submucosal dissection of colorectal neoplasia.

We aimed to evaluate the recurrence rate of colorectal neoplasia showing histologic lateral margin involvement after en bloc endoscopic submucosal dissection (ESD). We reviewed 527 colorectal lesions that were removed by en bloc ESD from 2005 to 2013 and followed by endoscopy. Based on the postprocedural pathologic reports, the lesions were categorized as follows: lesions with clear deep and positive lateral margins (n = 63) and lesions with R0 resection (n = 299). The tumor size was 45.7 ± 21.1mm in the lateral margin-positive group and 30.6 ± 15.1 in the R0 group (P < 0.001). Procedure time was longer in the lateral margin-positive group than in the R0 group (94.3 ± 75.1 vs. 54.1 ± 48.9min; P <0.001). Lateral margin positivity was associated with ESD time ≥ 120min in the multivariate analysis. Compared with 0-I morphology, LST-G was significantly associated with the lateral margin positivity. The volume of ESD experience in endoscopists may also be associated with the lateral margin positivity. Histologic reassessment of the specimen suggested that 32.2% of lateral margin-positive cases based on the initial pathology report were false-positive lateral margin involvement. The 5-year cumulative recurrence rate was 0.6% in the R0 group and 5% in the margin-positive group (P = 0.198). The local recurrence rate was not higher in lateral margin-positive cases than in R0 resection cases if the colorectal epithelial neoplasia was removed in an en bloc manner using ESD. Meticulous pathologic interpretation may reduce unnecessarily frequent surveillance after en bloc ESD.

18F-fluorodeoxyglucose specimen-positron emission mammography delineates tumour extension in breast-conserving surgery: Preliminary results.

We aimed to determine whether high-resolution specimen-positron emission mammography (PEM) using fluorodeoxyglucose (18F-FDG) can reveal extension of breast cancer in breast-conserving surgery (BCS), and assess the safety of radiation exposure to medical staff. Sixteen patients underwent positron emission tomography, and then BCS with intraoperative frozen section analysis on the same day. Resected specimens with remaining 18F-FDG accumulation were scanned by high-resolution PEM. At least 1 day after surgery, tumour extension was evaluated by three independent experienced readers and by binarized images from the specimen-PEM data. Intraoperative exposure of medical staff to 18F-FDG was measured. Specimen-PEM evaluations of binarized images and the three investigators detected all (100 %, 12/12) invasive lesions and 94.4 % (17/18) of in situ lesions using both methods. The positive predictive value of the accumulated lesions was 74.4 % (29/39) for the binarized images and 82.9 % (29/35) for the three investigators. Analysis of intraoperative frozen sections detected 100 % (2/2) of the margin-positive cases, also detected by both specimen-PEM evaluation methods with no false-positive margin cases. The mean exposure of the medical staff to 18F was 18 μSv. Specimen-PEM detected invasive and in situ lesions with high accuracy and allowable radiation exposure. • Specimen-PEM detected invasive and in situ lesions with high accuracy. • Specimen-PEM predicted complete resection with the same accuracy as frozen section analysis. • Breast-conserving surgery after fluorodeoxyglucose injection was performed with low medical staff exposure.

Effect of nano carbon tattooing on the lesion localization in the early colon cancer for additional surgical procedure after endoscopic resection

To explore the effect of nano carbon tattooing on the lesion localization in the early colon cancer for additional surgical procedure after endoscopic resection. Thirty-five patients with early colon cancer accepted additional surgical procedures after endoscopic resection in Fuzhou General Hospital of PLA from May 2014 to November 2016. All the patients underwent nano carbon tattooing before the end of endoscopic resection: 0.1 ml carbon nanoparticles suspension was respectively injected into the normal intestinal submucosa from 1 cm outside the 4 sites (upper, lower, left and right) of the lesion border by colonoscopy, marking the original lesion location and guiding the subsequent additional surgery. Data of these 35 cases were summarized. All the 35 cases, including 22 males and 13 females, with a mean age of 46.5 years(range 35-70), completed the endoscopic disposable carbon nano marking, and the mean operative time was 7.5 minutes(range 5-10). No bleeding, no perforation and no adverse reaction occurred. Four to 21(10±3.5) days after endoscopic resection, the patients received the additional surgery as a result of pathological specimens of endoscopic resection in 10 cases of vascular invasion, 7 cases of severe submucosal infiltration, 7 cases of more than grade G2 in tumor budding, 6 cases of poorly differentiated adenocarcinoma and undifferentiated carcinoma, and 5 cases of positive margin. All the patients underwent laparoscopic surgery. The mean time of intraoperative detection and lesion location was 3.0 minutes(range 1-5). All tattooings were clearly visible under the naked eye. The colon wedge resection were performed in 5 cases, colon segment resection in 14 cases, and radical resection of colon cancer in 16 cases. The operative time was 45 to 180(120±30) min, and the blood loss was 50 ~ 200(50±15) ml. There was no intraoperative complications. The first gas passage time was 12 to 48(24±8) h. The postoperative hospital stay was 10 to 3(6.5±2.5) d. There was no postoperative complication and no perioperative mortality. Nano carbon tattooing is helpful for the accurate location of primary lesions in the additional surgical operation after endoscopic resection of early colon cancer, and it can improve the safety and precision of surgical procedures, especially for laparoscopic surgery.

Risk-Adjusted Margin Positivity Rate as a Surgical Quality Metric for Non-Small Cell Lung Cancer

Incomplete lung cancer resection connotes poor prognosis; the incidence varies with patient demographic, clinical, and institutional factors. We sought to develop a valid, survival impactful, facility-based surgical quality metric that adjusts for related patient demographic and clinical characteristics. Facilities performing resections for patients diagnosed with stage I to IIIA non-small cell lung cancer in the National Cancer Data Base between 2004 and 2011 were identified. Multivariate logistic regression modeling was used to estimate the expected number of margin-positive cases by adjusting for patient risk mix and calculate the observed-to-expected ratio for each facility. Facilities were categorized as outperformers (observed-to-expected ratio less than 1, p < 0.05), nonoutliers (p > 0.05), and underperformers (observed-to-expected ratio greater than 1, p < 0.05); and their characteristics across performance categories were compared by χ2 tests. Multivariate Cox proportional hazard analyses were conducted, adjusting for patient demographic and clinical characteristics. A total of 96,324 patients underwent surgery at 809 facilities. The overall observed margin-positive rate was 4.4%. Sixty-one facilities (8%) were outperformers, 644 (80%) were nonoutliers, and 104 (13%) were underperformers. One third (36%) of National Cancer Institute-designated facilities, 13% of academic comprehensive cancer programs, 5% of comprehensive community cancer programs, and 13% of "other" facilities achieved outperforming status but no community cancer programs did. Interestingly, 9% of National Cancer Institute-designated facilities and 11% of academic comprehensive cancer program facilities were underperformers. Adjusting for patient demographic and clinical characteristics, outperformers had a 5-year all-cause hazard ratio of 0.88 (95% confidence interval: 0.85 to 0.91, p < 0.0001) compared with nonoutliers, and 0.80 (95% confidence interval: 0.77 to 0.84, p < 0.0001) compared with underperformers. Facility performance in lung cancer surgery can be captured by the risk-adjusted margin-positivity rate, potentially providing a valid quality improvement metric.

Incisal margin condition after LEEP for cervical intraepithelial neoplasia patients and prognosis.

The aim of the study was to examine the relationship between incisal condition after loop electrosurgical excision procedure (LEEP) operation for cervical intraepithelial neoplasia (CIN) patients and prognosis. A study of high-risk incisal margin positive cases was also performed. We compared the differences in the prognosis of the 1-year follow-up visit in the 120 CIN patients admitted to the hospital during the period from April 2013 to April 2014. A total of 43 cases of positive incisal margin (35.8%), and 77 negative cases were included in the study. The differences in age, course of disease, and CIN level between the two groups showed no statistical significance (P>0.05). In the positive group, the positive ratio was significantly higher than that of the negative group (P<0.05). The positive incisal margin showed a significant positive correlation with human papillomavirus (HPV) positivity (r=0.327, P=0.035). The condition of most patients with positive incisal margin and HPV was critical, which was followed by positive incisal margin and negative HPV. The patients with the best prognosis were those with significant negative incisal margin as well as HPV (P<0.05). In conclusion, the positive incisal margin after LEEP operation was associated with relapse of the disease. Thus, considering the HPV test into consideration is valuable for the prognosis of the disease.

舌扁平上皮癌に対するヨード2回染色法の有用性の検討

We examined the usefulness of a double-staining method using iodine solutions of different concentrations for the excision of T1, T2 squamous cell carcinomas （SCCs） of the tongue. We studied 127 patients who were given a diagnosis of T1, T2 SCCs of the tongue at Maxillofacial Surgery, Tokyo Medical and Dental University from 2000 through 2010. The patients were classified into 2 groups. One group, consisting of 89 cases, underwent staining once with 3% iodine solution （single-staining group: Group I）. The other group, consisting of 38 cases, underwent staining with 3% iodine solution and then with 5% iodine solution （double-staining group: Group II）. The excision margin of the lesion was designed to be about 10 mm outside of the border of the unstained areas （USAs） and stained areas （SAs）. Then the lesion was excised. In addition, the borders of the SAs and USAs were examined, and any recurrence after excision was noted. The type of lesion, type of epithelial dysplasia at the surgical margin, and recurrence rate were compared between the two groups. Local recurrence and the presence of epithelial dysplasia at the surgical margin in SCCs cases were seen in 12/127 cases （9.4%） and 58/127 cases （45.7%）, respectively. The numbers of the surgical marginpositive cases were 47/89 cases （52.8%） in Group I and 11/38 （28.9%） in Group II. The rate of SCC recurrence was significantly lower in Group II than in Group I （p=0.01）. The number of cases with local recurrence was 12/89 （13.5%） in Group I, but 0/38 （0%） in Group II. These results suggest that the double-iodine-staining method indicated the border of epithelial dysplasia more clearly than the single-staining method. Therefore,the double-iodine-staining method is useful for determining the excision margin of SCCs of the tongue.

Survival outcomes of schirrhus gastric cancer treated by multidisciplinary treatments: Putative impact on prognosis by DCS NAC.

128 Background: Among gastric cancer, schirrhus exhibited the poorest prognosis, and many patients die even after curative resection due to recurrence. Although progress of multidisciplinary treatments of advanced gastric cancer is outstanding, recent clinical outcome is obscure by such intensive treatments. Methods: Among the 5,664 gastric cancer patients who underwent gastrectomy between 1971 and 2013 in the Kitasato University Hospital, 287 of shirrhus gastric cancer were included (5%). We divided the total periods into early (1971-2004) and late period (2005-2013), and compared their prognosis. Multivariate proportional hazard model was applied to the significant univariate prognostic factors (p&lt;0.05), and identified independent prognostic factors (IPFs). Finally we compared the IPFs in terms of periods, and discuss the most appropriate treatments. Results: (1) Five-year survival rate was 13% and 31% in the early and late periods, respectively (p=0.0010). Between the periods, there were significant differences of pT (p=0.013), CY (p&lt;0.0001), and Margin status (p=0.041). (2) Univariate prognostic factors were age (p=0.032), pT (p=0.0009), pN (p&lt;0.0001), P (p=0.0033), CY (p=0.0002), and Margin status (p&lt;0.0001). Multivariate proportional hazard model elucidated IPFs of pN (pN0-2 vs pN3a-X, p&lt;0.0001) and Margin status (positive vs negative, p=0.0003). If the 2 factors were combined, patients with pN0-2 plus margin negative showed much better survival (about 40% of 5-year OS) than otherwise cases (below 10%)(p&lt;0.0001). (3) Comparison of the IPFs between early and late periods, margin positive cases were significantly less infrequent in the late period. This may be aggressive application of neoadjuvant chemotherapy of DCS (Docetaxel/CDDP/S1). Conclusions: Due to recent progress of multidisciplinary treatments of preoperative aggressive chemotherapy and surgery with curative intent for negative margin for schirrhus gastric cancer, its 5-year survival was dramatically improved. pN0-2 patients were promising for reasonable prognosis if negative margin is secured, so intraoperative diagnosis must be urgently developed.

Pathological Evaluation of Nipple-Sparing Mastectomies with Emphasis on Occult Nipple Involvement: The Weill-Cornell Experience with 325 Cases

Nipple-sparing mastectomy (NSM) is an increasingly utilized surgical option in managing breast carcinoma; however, data on malignant involvement of a separately submitted nipple margin are scant. Consecutive NSM, including those performed for therapeutic and prophylactic purposes, over a 4-year period (2007-2011), were studied. A separately submitted nipple margin was evaluated by permanent H&E preparations and via frozen section evaluation whenever requested. 325 consecutive NSM specimens, 208 (64%) therapeutic-NSM, and 117 (36%) prophylactic-NSM were studied. All nipples were clinically unremarkable. 86% (179/208) of nipple margins from therapeutic-NSM and 100% (117/117) from prophylactic-NSM showed no histopathologic abnormality. 14% (29/208) of nipple margins from therapeutic-NSM and no nipple margin from prophylactic-NSM showed malignancy. Frozen section evaluation was performed in 188/325 NSM (58%) with a sensitivity of 64% and specificity of 99%. Central tumor location and stage N2/N3 lymph node status were significantly associated with nipple margin positivity (χ(2) ≤ 0.05). Subsequent nipple resection was performed in 69% (20/29) of nipple margin-positive cases with residual malignancy found in 40% (8/20, including three cases of invasive carcinoma). In a mean follow-up of 33 months, one invasive carcinoma recurred in the "saved" nipple, 36 months after therapeutic-NSM. 14% (29/208) of nipple margins in therapeutic-NSM and no nipple margin (0/117) in prophylactic-NSM showed malignancy. Central tumor location and N2/N3 stage were significantly associated with nipple margin positivity (χ(2) ≤ 0.05).

When is local excision appropriate for “early” rectal cancer?

Local excision is increasingly performed for “early stage” rectal cancer in the US; however, local recurrence after local excision has become a controversial issue in Western countries. Local recurrence is considered to originate based on the type of tumor and procedure performed, and in surgical margin-positive cases. This review focuses on the inclusion criteria of “early” rectal cancers for local excision from the Western and Japanese points of view. “Early” rectal cancer is defined as T1 cancer in the rectum. Only the tumor grade and depth of invasion are the “high risk” factors which can be evaluated before treatment. T1 cancers with sm1 or submucosal invasion <1,000 μm are considered to be “low risk” tumors with less than 3.2 % nodal involvement, and are considered to be candidates for local excision as the sole curative surgery. Tumors with a poor tumor grade should be excluded from local excision. Digital examination, endoscopy or proctoscopy with biopsy, a barium enema study and endorectal ultrasonography are useful for identifying “low risk” or excluding “high risk” factors preoperatively for a comprehensive diagnosis. The selection of an initial local treatment modality is also considered to be important according to the analysis of the nodal involvement rate after initial local treatment and after radical surgery.

Utility of Intraoperative Frozen Section During Robot-Assisted Partial Nephrectomy: A Single Institution Experience

Intraoperative frozen section (FS) analysis has been regarded as a paramount tool for immediate evaluation of tumor margin status during partial nephrectomy procedures. The aim of this study was to assess the utility of FS during robot-assisted partial nephrectomy (RAPN). A retrospective review of our Institutional Review Board-approved prospectively maintained minimally invasive partial nephrectomy database yielded 342 consecutive RAPN procedures from June 2007 to September 2011. Of these, the initial 128 cases underwent FS evaluation, whereas the following 214 cases did not. Patient demographics, perioperative outcomes, and final pathology results were analyzed and compared between the two groups. Body mass index, Charleson Comorbidity Index, tumor size, renal score, preoperative creatinine level, and estimated glomerular filtration rate (eGFR) were similar between both groups. Operative time was significantly longer in the no-FS group (193 vs 180 min; P=0.04). Warm ischemia time (median 19 vs 19 min), estimated blood loss (150 vs 200 mL), postoperative creatinine level (1.0 vs 1.1 mg/dL), and postoperative eGFR (75.6 vs 75.9) were similar between the no-FS group and FS group, respectively. Complications occurred in 32 (15.0%) and 31 (24.2%) cases in no-FS and FS, respectively (P=0.06). Final pathology results demonstrated seven cases of positive margins, 1 (1%), in the FS group and 6 (3%) in the no-FS group (P=0.19). Of the cases with positive margins at final pathology analysis, a R.E.N.A.L. score of 3/3 was found on closeness to renal sinus. Overall, three intraoperative positive margins were noted in the FS group (2.3%): One patient underwent radical nephrectomy and one reresection; one case was managed with observation only. Routine application of FS analysis during RAPN seems to provide a limited benefit. FS might be advisable for tumors with sinus invasion because they seem to carry a higher likelihood of positive surgical margin at final pathology determination.

Clinical Outcome of Fibromatosis of the Head and Neck Region

Background and ObjectivesZZFibromatosis is an uncommon soft tissue mass lesion that can occur in all anatomic sites. Fibromatoses arising in the head and neck region comprises of approximately 5% of all fibromatoses, which is associated with an infiltrative growth pattern and thus results in difficulty in complete excision. The authors investigate the clinical characteris tics of head and neck fibromatoses. Subjects and MethodZZSix cases of head and neck fibromatoses were analyzed from 1989 to 2011. The imaging and pathologicfindings, surgical management, and clinicaloutcomes were evaluated. ResultsZZPainless mass effect was the most common symptom. The accuracy of diagnostic tools including computed tomography, magnetic resonance imaging and fine needle aspiration biopsy were under 50%. Recurrence was observed in two patients who had undergone surgical excision during follow-up. Salvage surgery was performed in these patients. ConclusionZZThe aggressive excision of head and neck fibromatosis cannot be achieved easi ly. Vigilant follow-up with or without conservative surgical excision results in good disease control. Radiotherapy can be applied for inoperable or margin positive cases considering age or performance of patient.� Korean J Otorhinolaryngol-Head Neck Surg 2013;56:144-8 Key WordsZZFibromatosis ㆍHead and neck.

未治療高リスク限局性前立腺癌における根治的前立腺全摘除術および拡大骨盤内リンパ節郭清の治療成績

We assessed the outcome after radical prostatectomy and extended pelvic lymphadenectomy in patients with untreated high-risk clinically localized prostate cancer, retrospectively. Between 2001 and 2010, 89 patients for untreated high-risk clinically localized prostate cancer on the risk classification as defined by D'Amico, underwent retropubic radical prostatectomy and extended pelvic lymphadenectomy. Boundaries of the pelvic lymph node dissection field divided into external iliac vessels, obturator fossa, and internal iliac vessels. We investigated mainly the postoperative outcome of 84 patients without any adjuvant therapies. PSA recurrence-free survival among the pretreatment variables was estimated using Kaplan-Meier plots, and the statistical significance was determined by log rank test. In 89 high-risk patients, 32.7% had pT3-pT4 tumors, 16.9% positive surgical margin, 6.7% positive lymph node metastases and 30.3% Gleason score 8-10 at the pathological examination. A median of 13 nodes (mean 14.0, range 9-25 nodes) were removed per patient. In 96.6% cases, postoperative PSA values decreased less than 0.2 ng/ml. The median observation period after operation was 1,819 days. Median PSA recurrence-free survival rates, overall survival and cancer cause-specific survival rates at 5 year, in 84 high-risk patients without any adjuvant therapies, were 73.8%, 100% and 100%, respectively. Median PSA recurrence-free survival rates according to pathological T stage and surgical margin status were statistically significant, but that according to preoperative 3 factors (clinical T stage, Gleason score at biopsy, preoperative PSA values) were statistically insignificant. Moreover, that according to both the number of positive preoperative 3 factors (1 vs. 2 positive factors) and the number of removed lymph nodes (< or =13 vs. > or = 14), were statistically insignificant. The median PSA recurrence-free survival rates at 5 year for positive margin cases were 0%. Radical prostatectomy and extended pelvic lymphadenectomy is feasible in patients with high-risk clinically localized prostate cancer. We suggest that both wide resection and extended pelvic lymphadenectomy may improve the postoperative outcome for high-risk clinically localized prostate cancer.

Early breast cancer with positive margins: excellent local control with an upfront brachytherapy boost

Standard breast conservation therapy consists of lumpectomy and whole breast radiation with boost. The effectiveness of radiation in cases of positive margins is controversial. Two potential treatment-related factors are time to initiation of radiation and localization of the boost. Here, we examine long-term outcomes of positive margin cases treated with an upfront interstitial brachytherapy boost. This particular treatment arrangement may reduce those treatment-related effects on local control. Historically, a low dose interstitial implant was a common boost technique. One approach administered the boost before external beam. A review of 521 cases treated at our institution was conducted. Patients were selected for this study if they received an upfront brachytherapy boost and had close or positive margins. Forty-four breast cancers were identified. Median follow-up of survivors was 11.3 years (8.1-21.7). Implant was performed at lumpectomy (12) or axillary dissection (32). Margin statuses were: focal carcinoma at ink (37), multifocal carcinoma at ink (1), carcinoma <1 mm from ink (2), and DCIS at ink (4). Median tumor size was 1.2 cm (0.5-3.5 cm). Ten patients had nodal involvement. Total median dose was 60 Gy (58.6-65.3 Gy). Median boost dose was 15 Gy (12-20.3 Gy). Lumpectomy to boost interval was median of 3 weeks (0-10.8). No ipsilateral breast recurrences or second primaries were identified. Four developed contralateral breast cancer. Eleven are deceased, four from breast cancer-all from metastasis. 12-year Kaplan-Meier estimates were: overall survival 78 ± 7 %, cause specific survival 93 ± 4 %, and recurrence-free survival 82 ± 6 %. Univariate analysis identified nodal disease as significant for cause specific survival (log rank p = 0.005). No ipsilateral breast recurrences were found. Early administered radiation and accurate boost localization were identified as suspected treatment-related factors for local recurrence. When these two treatment-related factors are minimized, long-term local control rates do not suffer.

Outcome of repeat loop electrosurgical excision procedure or hysterectomy of cervical intraepithelial neoplasia of cervix: Is repeat procedure necessary in margin positive cases?

Outcome of repeat loop electrosurgical excision procedure or hysterectomy of cervical intraepithelial neoplasia of cervix: Is repeat procedure necessary in margin positive cases?

The value of triple antibody (34βE12 + p63 + AMACR) cocktail stain in radical prostatectomy specimens with crushed surgical margins

BackgroundTriple antibody cocktail immunohistochemical staining is routinely used as an ancillary method to establish a diagnosis of prostate cancer in biopsies with small foci of atypical glands. Crush artefact can...

Prediction, based on resection margins, of long-term outcome of cervical intraepithelial neoplasia 3 treated by Shimodaira-Taniguchi conization

The aim of the present study was to analyze the long-term outcome of cervical intraepithelial neoplasia 3 (CIN 3) after treatment with the Shimodaira-Taniguchi conization procedure, based on the status of the resection margins. In the Osaka University Hospital, conization using the Shimodaira-Taniguchi procedure has been routinely performed for CIN 3. Medical records of patients during the period from 2001 to 2008, whose post-conization diagnosis was CIN 3, were retrospectively analyzed for outcome versus margin status. During the median follow-up period of 565 days (range 34-3,013), CIN disease was again detected in 14 of 243 patients; it was found in 7 patients among 198 margin-negative cases, and in 7 patients among 45 margin-positive cases. There was a significant difference in the reappearance rate demonstrated between the cases with positive and negative margins (p = 0.0018). Among the patients whose first follow-up post-conization cytology was normal, recurrence-free probability was significantly higher in margin-negative cases than in margin-positive ones (hazard ratio, 5.19; 95% CI, 1.175-22.994; p = 0.0041). For the first time, we demonstrate that after treatment of CIN 3 lesions by Shimodaira-Taniguchi conization the status of the resection margin was a significant predictor for long-term outcome.

Quantitative comparison of surgical margin histology following excision with traditional electrosurgery and a low‐thermal‐injury dissection device

This study is the first to examine in vivo the effect of thermal injury in breast conservation pathology in a direct comparison of traditional electrosurgery and an alternative low-thermal-injury device. A prospective study of 20 consecutive subjects with biopsy-proven invasive ductal carcinoma (IDC) tumors 1 cm was conducted. Following excision, incisions were made into the tumor with the two devices. Thermal injury depth, margin distance, tissue type, and histological effect were compared on the same breast tissue cut with each excision instrument. A probability evaluation of close and positive margin cases for the true tumor margins was conducted. Compared to traditional electrosurgery, the low-thermal-injury instrument reduced collagen denaturation depth from 435 to 102 µm (77%), fused tissue depth from 262 to 87 µm (67%), and distortion depth from 1,132 to 774 µm (30%). Based on analysis of the close subset of the true margins, using the traditional electrosurgical device in place of the low-thermal-injury device would have resulted in 48% of the close margin samples being negatively converted to false-positive, and in 11% converting from close to false-negative. The methodology of this work may be readily applied to larger, more definitive studies.

Outcomes of Node-Negative Breast Cancer 5 Centimeters and Larger Treated With and Without Postmastectomy Radiotherapy

The role of adjuvant postmastectomy radiotherapy (PMRT) remains controversial for the rare presentation of pT3pN0cM0 breast cancer. The present analysis examined locoregional recurrence (LRR) and breast cancer-specific survival (BCSS) in pT2 = 5.0-cm and pT3 >5.0-cm tumors treated with mastectomy, stratified by PMRT use. Between January 1, 1989 and December 31, 2000, the British Columbia provincial database yielded 100 node-negative patients with tumors ≥ 5 cm of 19,846 nonmetastatic breast cancer patients (0.5%). Of these 100 patients, 44 (44%) had received adjuvant PMRT. The PMRT group contained significantly more pT3 >5-cm cases (p = 0.001) and margin-positive cases (p = .03). With a median follow-up of 10 years, the cumulative 10-year LRR rate was 2.3% (95% confidence interval, 0.2-10.5) in the PMRT group vs. 8.9% (95% confidence interval, 3.2-18.2) in the no-PMRT group (p = .2). Regarding LRR in the no-PMRT group, all patients had Grade 3 histologic features (LRR 17%, 5 of 29) and had not received hormonal therapy (LRR 15%, 5 of 34). The 10-year breast cancer-specific survival rate was 85.8% (95% confidence interval 71.0-93.4) in the PMRT group vs. 74.6% (95% confidence interval 59.9-84.5) in the no-PMRT group (p = .2). On multivariate analysis, adjusted for the prognostic and predictive variables, PMRT did not significantly improve the LRR or breast cancer-specific survival rates. The present study demonstrated a low LRR rate for node-negative breast cancer ≥ 5 cm. Our results indicate that PMRT should be considered for Grade 3 histologic features and patients not undergoing hormonal therapy.

Total-Circumference Intraoperative Frozen Section Analysis Reduces Margin-Positive Rate in Breast-Conservation Surgery

One problem existing in breast-conservation surgery is ipsilateral breast tumour recurrence, and one of its major risk factors is surgical margin positivity. We therefore investigated whether total-circumference surgical margin examination can reduce surgical margin-positive rates. A total of 122 cases were examined after BCS was performed between March 2004 and March 2006. After partial mastectomy, specimens were taken from the remnant breast side along the total-circumference of the mammary gland (width, approximately 5 mm). Intraoperative frozen section analysis was performed for those specimens. Margin-positive cases were defined as those showing malignancy within <or=5 mm of the final margin as revealed by final diagnosis. If intraoperative frozen section analysis had not been performed, 33 cases (27%) would have been diagnosed as margin-positive. However, it reduced the number of margin-positive cases to 12 (9.8%), and final margin-positivity rates were thus significantly reduced (P < 0.001). As for the accuracy of intraoperative frozen section analysis, sensitivity was 78.6%, specificity was 100%, correct diagnosis rate was 95.1%, positive predictive value was 100% and negative predictive value was 94.0%. False-negatives were caused by the detection of malignancy as revealed in permanent specimens. Margin-positive sites were not limited to the nipple and distal (peripheral) sites, with equivalent margin-positive cases found laterally. Total-circumference surgical margin examination by IFSA for BCS significantly reduced margin-positive rates from 27% to 9.8%.