Permanent Sections Research Articles

Surgical margins and outcomes for eyelid melanoma: a systematic review and meta-analysis.

No randomized trials exist to inform the peripheral surgical margins or depth of wide excision for eyelid melanoma. We performed a meta-analysis examining surgical margins and Breslow depth for eyelid melanomas. A systematic review was performed in August 2022 using PubMed, Cochrane, and Medline databases (1/1/1990 to 8/1/2022). Inclusion criteria included studies reporting surgical treatment of primary cutaneous melanomas of the eyelid with reported surgical margins. Ten articles were included. The studies were examined by surgical margin size (group 1: ≤ 0.5cm; group 2 > 0.5cm and ≤ 1.5cm) and Breslow depth (group 1: ≤ 1mm; group 2: > 1mm). The odds ratio (OR) for local recurrence was 2.55 [95% CI 0.36-18.12], p = 0.18; regional metastasis was 0.70 [95% CI 0.00-23671.71], p = 0.48; and distant metastasis was 2.47 [95% CI 0.00-1687.43], p = 0.66. When examining by Breslow depth, the OR for local recurrence was 0.53 [95% CI 0.14-1.94], p = 0.34; regional metastasis was 0.14 [0.00-176.12], p = 0.54; and the OR for distant metastasis was 0.24 [95% CI 0.01-8.73], p = 0.46. There was a trend toward higher likelihood of recurrence and metastasis in the ≤ 0.5cm group. Similarly, there is a trend toward higher likelihood of recurrence and metastasis with Breslow depth > 1mm. A surgical margin of at least 0.5cm and achievement of negative margins via permanent sections or MMS are likely needed to prevent adverse outcomes. En face sectioning may be a superior method of histological processing for eyelid melanoma.

Diagnostic accuracy of intraoperative frozen section for margin evaluation of oral cavity squamous cell carcinoma

ObjectivesIntraoperative frozen-section evaluation is a valuable technique for detecting positive margins intraoperatively for oral squamous cell carcinoma. We conducted this study to determine the diagnostic accuracy of frozen section in detecting margin status and the effect of tumor grade and stage on diagnostic accuracy.ResultsA total of 251 biopsy-proven cases of oral squamous cell carcinoma were included in this study. The tissue specimen resected during surgery was sent to the laboratory for frozen section evaluation. The frozen section results were then compared with the permanent section results to determine the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy. The mean age of the patients included in the study was 51.65 ± 10.03 years, with male predominance (55.4%). The overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of frozen section were 88.81%, 94.84%, 95.20%, 88.10%, and 91.63%, respectively. We conclude that frozen section is a useful technique in determining the margin status intraoperatively in oral cancers, with high diagnostic accuracy. Moreover, certain clinical parameters such as age, gender, disease duration, and tumor stage and grade appear to affect the diagnostic accuracy of frozen section.

Postoperative permanent section evaluation of Mohs micrographic surgery debulk specimens does not result in upstaging of cutaneous squamous cell carcinoma compared to stage at the completion of surgery: A retrospective case series

BackgroundMohs micrographic surgery (MMS) is used for the treatment of high-risk cutaneous squamous cell carcinoma (cSCC). MMS examines the surgical margins in real time and does not commonly examine the central component of the tumor. ObjectiveTo determine if debulk specimens provide additional details relevant to tumor staging not gained from routine MMS. MethodsA retrospective chart review of debulk specimens taken during MMS for cSCC was conducted. Dermatopathology reports were analyzed and tumors were staged using Brigham and Women's Hospital (BWH) and American Joint Committee on Cancer’s 8th edition (AJCC8) staging systems. ResultsPermanent section evaluation of debulk specimens did not result in clinically meaningful information for staging that could not be gained from MMS layers or initial biopsy analysis. LimitationsA single institution, and the small sample size of 39 tumors. ConclusionsEvaluation of debulk specimens during MMS may not always be an effective use of time or healthcare resources.

Полемика о русском анекдоте в 1805 г.

The paper views a literary debate of the early 19th century that has not yet received the due attention of specialists. The 1800s see emerging interest in original anecdotes that show the virtue and wit of Russians. The journal Drug Prosveshcheniia, which represents one of the influential literary factions of the time, the politically and stylistically conservative “Archaists” led by Alexander Shishkov, makes “Russian anecdote” a permanent section since its first issue. In 1805, the Russian anecdote becomes the object of a literary controversy. The discussion is initiated by a publication in the May issue of Drug Prosveshcheniia. It is followed by polemical replies of Severnyi Vestnik in June, Zhurnal dlia Pol’zy i Udovol’stviia in July, and Zhurnal Rossiiskoi Slovesnosti in September. The present paper traces the course of this discussion, deciphers the sub-texts, and analyses the participants’ positions. The research shows that the subject of the dispute is the nature of the anecdote as a genre. The discussion helps to outline the range of issues of its understanding: this includes the subject matter, volume, and style. During the polemics, the paradigm of genre variants is determined. In addition, this dispute acts as part of the polemic about language between the supporters of A.S. Shishkov and N.M. Karamzin, which intensifies in the summer of 1805. The article clarifies the positions of the parties on the material of this genre, demonstrating the diversity of opinions that cannot be reduced to two polar viewpoints.

PISCI KAO SARADNICI DETINjSTVA U POLA STOLEĆA DUGOM PROMIŠLjANjU O KNjIŽEVNOSTI ZA DECU: KONTEKSTI I VRSTE PRILOGA

In the past half a century, dozens of female and male writers have published their papers in the journal Childhood, among them were texts belonging to the field of critical and theoretical reading of literature for children. Suggesting several open fields for further research of everything the phrase “writers as critics” entails, this paper gives and overview of contextual frames and types of contributions from this group of associates. Regardless whether they were intentionally written for this journal, whether they were included in the themes and thematic blocks, permanent or temporary sections, whether they are experiments, studies, essays, demonstrations, comments, reflections, interviews, translations – all texts from the abovementioned corpus are regarded as equally valuable, and even crucial in the creation of the structural diversity and dynamic of Childhood.

A Retrospective Analysis of Diagnostic Accuracy of Frozen Sections Compared to Permanent Sections: A 5 Years Study in A Single Tertiary Care Hospital In South Delhi

Introduction: Intraoperative frozen section pathology consultation has long been applied to verify/categorize a lesion, evaluate surgical margins, determine the organ of origin, and assess tissue adequacy for further diagnostic studies. Correlation of intraoperative frozen section diagnosis with final diagnosis can be an important component of an institution’s quality assurance process. The aim of this study was to evaluate the concordance and discordance between frozen section and histopathology diagnosis and to assess the reliability and challenges associated with this rapid diagnostic method. Materials and Methods: A retrospective review of all intraoperative consultation in the Frozen Section and Histopathology Department of Pathology, Hamdard Institute of Medical Sciences and Research and Hospital, New Delhi from 1st January 2018 to 31st December 2022 was performed. During this five-year study period, a total of 185 patients from surgical departments underwent intraoperative consultation. The final diagnosis from the surgical pathology report was compared to the intraoperative consultation diagnosis. Results: Frozen section diagnoses were evaluated on all the 185 cases, with 88 cases identified as positive for malignancy and 97 cases as negative for malignancy. On subsequent histopathology paraffin sections, 92 cases were positive and 93 negative for malignancy. The comparison revealed an approximate result concordance of 97.0% and a discordance of 3.0%. Conclusion: Frozen section intraoperative consultation is a reliable rapid method for patient diagnosis and management. Monitoring diagnostic accuracy of intraoperative consultation provides substantial information towards the causes of the errors. Our study suggests that more accurate sampling, and knowledge about clinical history and presentation can reduce the limitation and increase the diagnostic accuracy thus avoiding technical errors and reducing result discordance.

3D Specimen Scanning and Mapping in Musculoskeletal Oncology: A Feasibility Study.

Surgical resection is the primary treatment for bone and soft tissue tumors. Negative margin status is a key factor in prognosis. Given the three-dimensional (3D) anatomic complexity of musculoskeletal tumor specimens, communication of margin results between surgeons and pathologists is challenging. We sought to perform ex vivo 3D scanning of musculoskeletal oncology specimens to enhance communication between surgeons and pathologists. Immediately after surgical resection, 3D scanning of the fresh specimen is performed prior to frozen section analysis. During pathologic grossing, whether frozen or permanent, margin sampling sites are annotated on the virtual 3D model using computer-aided design (CAD) software. 3D scanning was performed in seven cases (six soft tissue, one bone), with specimen mapping on six cases. Intraoperative 3D scanning and mapping was performed in one case in which the location of margin sampling was shown virtually in real-time to the operating surgeon to help achieve a negative margin. In six cases, the 3D model was used to communicate final permanent section analysis. Soft tissue, cartilage, and bone (including lytic lesions within bone) showed acceptable resolution. Virtual 3D scanning and specimen mapping is feasible and may allow for enhanced documentation and communication. This protocol provides useful information for anatomically complex musculoskeletal tumor specimens. Future studies will evaluate the effect of the protocol on positive margin rates, likelihood that a re-resection contains additional malignancy, and exploration of targeted adjuvant radiation protocols using a patient-specific 3D specimen map.

Intraoperative pathologic diagnosis of central nervous system lymphomas: A comparison of frozen and permanent section diagnoses, and the significance of preoperative imaging

BackgroundCentral nervous system (CNS) lymphomas, either primary or secondary in origin, are rare malignant tumors affecting the brain, spinal cord, or leptomeninges. Diagnosis of CNS lymphomas is complicated by their diverse clinical presentations, radiological features, and histopathological characteristics. Although frozen section (FS) analysis is commonly employed for various CNS tumors, its role and accuracy in CNS lymphoma diagnosis are less explored. In this study, we conducted a comparative analysis to assess the impact of knowledge of preoperative imaging on enhancing the accuracy of FS diagnosis in CNS lymphomas. MethodsData collection involved a retrospective review of CNS lymphoma patients from January 2009 to August 2021. Patients who underwent intraoperative consultation were included, excluding those with prior cortisone treatment. The dataset incorporated patient demographics, classification as primary or secondary lymphoma, radiological preliminary diagnoses, FS diagnosis, and permanent section diagnosis. We employed various archived materials, including FSs, touch imprint slides, crush cytology slides, H&E-stained sections, and immunohistochemical stains, and re-evaluated all slides for diagnostic validation. ResultsOur study included 25 patients, of whom 60 % were female and had a mean age of 56.5 years. Preoperative radiology data were available for 80 % of cases, with preliminary diagnoses commonly including lymphoma and/or metastasis. Intraoperative consultation results indicated lymphoma in 18 (72 %) patients, with discordance observed in 28 % of cases when compared to permanent section diagnoses. Most permanent section diagnoses were diffuse large B-cell lymphomas (92 %), with the remainder being T-cell non-Hodgkin lymphoma (4 %) and follicular lymphoma (4 %). Intraoperative misdiagnoses were significantly associated with the absence of knowledge of preoperative imaging. ConclusionOur study demonstrates the reliability of FS diagnosis for CNS lymphomas during surgery, with a favorable complete concordance rate of 72 % when compared to permanent diagnoses. Importantly, lack of knowledge of preoperative imaging significantly impaired diagnostic accuracy in FS, emphasizing the need for close collaboration between pathologists and radiologists.

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

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

Accuracy of prior cytology versus intraoperative consultation in predicting the final diagnosis of thyroid specimens

Abstract Introduction/Objective The aim of this study was to assess the accuracy of preoperative cytology and the additional contribution of intraoperative frozen section in predicting the final diagnosis of thyroid surgical specimens. Methods/Case Report A retrospective search was conducted for cases that underwent pre-surgical cytology of thyroid surgical specimens received from January 2017 to June 2022. A total of 99 cases were evaluated which were grouped into six categories according to the Bethesda system. The cytology results were compared with the corresponding frozen section and permanent section diagnoses. Indeterminate and discordant cases were further evaluated with molecular tests. Results (if a Case Study enter NA) Among the 99 cases, preoperative cytologic diagnoses were as follows: 1 was nondiagnostic, 9 were benign, 7 were AUS/FLUS, 3 were FN/SFN, 7 were suspicious for malignancy, and 72 were malignant. Using Bethesda categories V and VI as cytology “positive” cases and Bethesda category II as cytology “negative” cases, the sensitivity and specificity of cytology were 99% and 100%, respectively. The positive predictive value was 100%. The negative predictive value was 89%, which was affected by sampling error. Intraoperative frozen section was performed on 31 cases. In 4 indeterminate cytology cases (Bethesda III, IV), frozen section diagnosis was benign in 1 (confirmed on final) and remained indeterminate in 3 cases (3 benign on final). All 3 dual indeterminate cases showed a follicular pattern; molecular tests were predictive of the final diagnosis in these cases. All 21 malignant frozen section diagnoses had positive cytology. Conclusion Cytology has high sensitivity and specificity, making it a valuable preoperative tool in thyroid surgery. Practically, intraoperative frozen section has limited value in thyroid nodules classified as Bethesda categories V and VI. Additional evaluation may be helpful for cases classified as uncertain Bethesda categories. For follicular patterned lesions, frozen section may have less value.

Case of Metastatic Atypical Meningioma to Lung: Utility of Cytological Preparations for Intraoperative Diagnosis

Abstract Introduction/Objective Meningiomas are the most common primary intracranial and intraspinal tumors. They are typically benign with an indolent behavior but can metastasize extracranially to the skin, bone, lymph node and liver. Lung metastasis is exceptionally rare, and the diagnosis can be challenging, especially during intraoperative diagnosis without ancillary studies. We describe a metastatic atypical meningioma to the lung for which intraoperative cytology facilitated the diagnosis and guided management. Methods/Case Report A 53-year-old woman with a history of left frontal atypical meningioma and multiple surgical resections for recurrences at outside hospitals, presented with an incidental left lung nodule. A lung wedge resection was performed and submitted for intraoperative diagnosis. Gross examination revealed a well-circumscribed, tan- white, and rubbery subpleural nodule. Cytological preparations— Diff-Quik and H&E stains—and frozen section were prepared. Cytologically, the nodule displayed cohesive distinctive papillary whorls of uniform eosinophilic cells with indistinct cell membranes, round to oval nuclei with central nucleoli and intranuclear pseudoinclusions. The frozen section exhibited similar cytological features, few identifiable whorls and predominantly solid sheets of tumor cells typical of non-small cell carcinoma. Based primarily on the cytological findings, the intraoperative diagnosis was a neoplasm with papillary growth pattern, and a metastasis was favored based on the whorled pattern and clinical history; no further resection was performed. Permanent sections displayed mitoses and no necrosis. Immunohistochemical analysis revealed positivity for somatostatin receptor 2a, progesterone receptor, and EMA (focal); no staining was seen with pancytokeratin, TTF-1, or p40. A diagnosis of atypical meningioma, WHO grade 2, was rendered. Subsequently, an atypical cranial and temporalis muscle meningioma at the site of the prior craniotomy bone flap was resected and had an identical molecular profile (1p36 deletion) to that in the lung, further supporting metastasis to the lung. Results (if a Case Study enter NA) NA Conclusion This case illustrates a rare presentation of metastatic atypical meningioma and highlights the distinctive intraoperative utility of cytology preparations—architectural and cytological details—for diagnosis and appropriate management. Cytology preparations can be a valuable tool and complement frozen sections, in which certain morphological features may be less obvious or confounded by freezing artifact.

NIMG-54. CONFOCAL FLUORESCENCE ENDOMICROSCOPY: A PROSPECTIVE MULTI-CENTERED, ASSESSOR BLINDED PILOT STUDY FOR THE DIAGNOSIS OF BRAIN TUMORS

Abstract Frozen section analysis remains the gold standard for intraoperative diagnosis during brain tumor surgeries; however, it is associated with extensive time consumption and the potential for freezing artifacts. In recent years, confocal laser endomicroscopy (CLE) has been actively studied as a promising alternative to address these limitations of frozen section analysis. In this prospective, multi-centered, assessor-blinded pilot study, our aim was to evaluate the diagnostic effectiveness of cCeLL - Ex vivo, a second-generation CLE model, compared to frozen section analysis for brain tumor diagnosis. We enrolled a total of 55 patients with newly diagnosed brain tumors between October 2022 and December 2022. Biopsy samples were obtained during surgical resection, and each tissue sample was divided into three smaller samples for permanent section analysis, frozen section analysis, and imaging acquisition using cCeLL - Ex vivo. The efficacy of both frozen section analysis and cCeLL - Ex vivo was assessed by comparing their diagnoses to the results from permanent section analysis. The diagnostic accuracy of cCeLL - Ex vivo was slightly higher than that of frozen section analysis, with accuracies of 89.2% and 86.5%, respectively. Both methods demonstrated a sensitivity of 92.2%. Notably, cCeLL - Ex vivo exhibited a higher specificity of 70% compared to frozen section analysis, which had a specificity of 50%. Additionally, the mean time from sample preparation to diagnosis was significantly shorter in cCeLL - Ex vivo (13 min 17 sec) compared to frozen section analysis (28 min 28 sec). These results indicate the promising potential of cCeLL - Ex vivo as a complementary tool for intraoperative diagnosis of brain tumors. Future studies are expected to provide more evidence regarding the potential clinical utility of CLEs in clinical settings.

Ductal Carcinoma Arising in a Squamous Epithelial Inclusion Cyst within an Axillary Lymph Node: A Challenging Nodal Metastasis

Introduction. Assessment of axillary lymph nodes in breast carcinoma is an important part of staging to guide appropriate clinical management. Lymph node inclusions of different types, including nevoid, squamous, and glandular, are rare but have been reported in multiple different anatomic locations including the axilla. These can result in diagnostic challenges and pose risks of misdiagnoses. Rarely, malignancies may arise intrinsic to otherwise incidental benign nodal inclusions. Case Presentation. We report a case of ductal carcinoma diagnosed within a squamous epithelial inclusion cyst within an axillary lymph node in a patient with pure ductal carcinoma in situ (DCIS) of the ipsilateral right breast. To our knowledge, this is the fifth report in the literature of breast carcinoma confirmed within an axillary inclusion in a patient with pure DCIS. Evaluation of the primary DCIS and lymph node inclusions, by routine and immunohistochemical stains, was performed for assessment. Discussion. The presence of lymph node inclusions can pose a challenge in assessment of benignity and malignancy, on frozen and permanent histologic sections. Pathologists should carefully evaluate lymph node inclusions to ensure that intrinsic malignancies are not missed within rare otherwise benign appearing incidental epithelial rests.

Utility and diagnostic accuracy of intraoperative frozen sections in hepato-pancreato-biliary surgical pathology.

Hepato-pancreato-biliary (HPB) surgeries are one of the most challenging and complex procedures. Intraoperative frozen section (IFS) diagnosis plays a pivotal role in management decisions. Comprehensive large cohort studies evaluating utility of IFS in HPB malignancies are lacking. This study aimed to evaluate the accuracy of frozen section analysis and to analyse discrepancies and impact of IFS on the surgical decisions. This was a retrospective study of IFS received for the HPB specimens between years 2009 and 2021. The results were compared to the permanent sections to evaluate diagnostic accuracy, sensitivity and specificity. Indications, disagreements and impact on the surgical management were analysed. A total of 1008 specimens were evaluated: bile duct margin (279; 27.7%), gallbladder (203; 20.1%), liver lesions (125 cases; 12.4%), lymph nodes (147; 14.6%), pancreatic margin (120; 11.9%) and deposits (134; 13.3%). IFS were diagnosed as negative for malignancy (805; 79.9%), positive for dysplasia (8; 0.8%), suspicious for malignancy (6; 0.6%) and positive for malignancy (189; 18.8%). The overall diagnostic accuracy was 98.4%, and the discordant rate was 1.6%. The sensitivity, specificity, positive predictive value and negative predictive value were 94.7%, 99.4%, 97.5% and 98.6% respectively. The most important reason of discordant results was technical, followed by interpretational and sampling errors. The study demonstrates high diagnostic accuracy (98.4%) of IFS in a large dataset of HPB specimens. This comprehensive analysis apprises of the indications, errors and the impact of IFS diagnosis on subsequent HPB surgical management.

Reconsidering the Role of Frozen Section in Sentinel Lymph Node Biopsy for Mastectomy Patients

IntroductionAxillary lymph node dissection was recommended for mastectomy patients with more than two nodal metastases from sentinel lymph node biopsy. Conventionally, intraoperative frozen section was sent routinely to reduce the need for second-stage axillary lymph node dissection; however, recent global trend has seen decreasing usage of the intraoperative analyses. This pilot study conducted in Thailand aimed to evaluate the role of intraoperative frozen section of sentinel lymph node biopsy in early-stage breast cancer patients who underwent mastectomy. MethodsA 5-y retrospective study of 1773 patients was conducted in Thailand. The inclusion criteria were early-stage breast cancer patients with either radiologically negative nodes, or radiographically borderline nodes found to be negative on fine needle aspiration who underwent mastectomy and sentinel lymph node biopsy. Reoperations were indicated when three or more nodal metastases were detected on the pathological analysis. The reoperation rate prevented by frozen section and the reoperation rate needed for those with permanent section alone were reported. ResultsAmong 265 patients, 202 patients underwent concomitant intraoperative frozen section while the remaining 63 patients underwent permanent section alone. Six patients (3.0%) from the frozen section group and one patient (1.6%) from the permanent section group were found with more than two nodal metastases. Despite using intraoperative frozen sections, only one patient from each group required reoperation. There was no significant difference in the number of patients requiring reoperation between the frozen section group and the permanent section group. ConclusionsOur study provides strong evidence to all surgeons that in early breast cancer patients undergoing mastectomy, sentinel lymph node biopsy with permanent section analysis alone may not lower the standard of care compared to using additional intraoperative frozen section analysis. Adopting this practice may lead to decreased operation costs, operative time, and anesthetic side effects.

Recurrence of Basal Cell Carcinoma Treated with Surgical Excision and Histopathological Analysis with Frozen Section Technique with Complete Margin Control (CMC-FS): A 15-Year Experience of a Reference Center.

Basal cell carcinoma (BCC) is the most common type of eyelid malignancy and it is considered to be dangerous due to its proximity to functionally essential organs. Early diagnosis and complete excision of the primary lesion are crucial to prevent infiltration and metastasis. The study aims to evaluate the extent of recurrence in subjects affected by BCC of the upper third of the face treated with surgical eradication and the frozen section technique with complete margin control (CMC-FS), in comparison with the gold standard Mohs micrographic surgery (MMS). The study included 111 patients with 111 biopsy-proven eyelid BCCs. On clinical examination, all lesions were removed with 2 mm margins clinically free of neoplasm. Prior to reconstruction, CMC-FS analysis of all surgical margins was performed on each tumor for histopathologic confirmation. Subsequently, all margins were presented for the permanent paraffin sections. There were 69 primary carcinomas and 42 secondary carcinomas among the 111 samples. No recurrence occurred in 109 tumors followed-up for at least 5 years, with a total recurrence rate of 1.8%. The median time between lesion excision and diagnosis of recurrence was 20 months. at 5-year follow-up, CMC-FS guided excision of BCCs of the eyelids resulted in recurrence rates equivalent to MMS. Intraoperative microscopic control of all margins reduced the recurrence rate of the upper third of the facial BCCs, correlating with easier reconstruction with better esthetic and functional outcome.

THE UKRAINIAN LANGUAGE TEACHING METHODOLOGY ISSUES ON THE PAGES OF THE EUROPEAN JOURNAL “STUDIA UCRAINICA VARSOVIENSIA” (2013–2022: DEDICATED TO THE TENTH ANNIVERSARY)

The paper discusses a relevant topic for the Ukrainian linguistic didactics – a critical review of the articles published in the Polish journal «Studia Ucrainica Varsoviensia» for the 2013–2022 period (ten issues), and is dedicated to the journal’s anniversary. The analysis shows that the journal under consideration contains (1) scientific papers, (2) reviews, (3) informative reviews of events related to the issue of teaching Ukrainian as a foreign language. However, the publications are irregular in nature. Scientific researches aspectually present the material on some important issues of teaching Ukrainian as a foreign language. They run about (1) the formation of a phraseological minimum for all learning levels: this problem is extremely difficult and has not been resolved so far; (2) the specifics of the textual learning material selection taking into account its stylistic propriety and compliance with the learning level; (3) presentation of new concepts for compiling textbooks, manuals and learners’ dictionaries; (4) it is very positive that the scientific periodical focuses as well upon the presentation of the department’s activities reviews in relation to various forms and methods of working with foreign students, and new textbooks and dictionaries are promoted. Undoubtedly, the fact of publishing new didactic literature reviews deserves approval, but the reviews should contain more critical material, comments and wishes, and not be limited to retelling the content and indicating the advantages of the analyzed literature, i. e. perform an exclusively promoting function. Demands on expert reviewers are increasing in today’s world. A good start for the journal is the publication of reporting information on events that aim at teaching Ukrainian as a foreign language through short-term courses: the experience of organizing such events must be widely spread, promoting the positive points and drawing attention to the shortcomings. It is desirable that the editorial staff should introduce permanent sections in the journals related to the problems of teaching Ukrainian as a foreign language, exchange of experiences, discussions, since not every issue contains relevant articles or reviews that could also be alternative, which would definitely have a positive effect. Key words: linguistic didactics, Ukrainian as a foreign language, textbook, manual, learner’s dictionary, review, journal “Studia Ucrainica Varsoviensia”.

Preoperative staging of uterine cancer: can transvaginal ultrasonography play a role?

Preoperative staging of uterine cancer has recently been implied as an important contribution to an accurate selection of low-risk cases, ultimately avoiding unnecessary lymph node debulking. The aim of this study was to evaluate the validity of transvaginal ultrasonography (TVS) in preoperative staging of uterine cancer in comparison to pelvic magnetic resonance imaging (MRI) and permanent section. We conducted a prospective longitudinal multicenter trial between 2017 and 2018. Inclusion criteria comprised cases of endometrial neoplasia histologically confirmed or strong imaging suspicion, candidates for elective surgery as primary treatment. Proportions of Agreement (PA), kappa statistic (K), sensitivity, specificity and accuracy were calculated with 95% confidence intervals (95%CI). Eighty-two patients were eligible for the study, presenting a mean age of 68 years (standard deviation 11). In what concerns the TVS evaluation of myometrial invasion, the subjective and objective methods of Gordon and Karlsson presented a sensitivity of 79%, 79% and 67% [95%CI 63-91; 63-91; 50-81], a specificity of 65%, 58% and 79% [95%CI 49-79; 42-73; 64-89] and an overall accuracy of 72%, 68% and 73% [95%CI 61-81; 57-78; 63-82]. MRI presented respectively a sensitivity, specificity and overall accuracy of 92%, 70% and 82% [95%CI 77-98; 52-85; 71-90]. Regarding cervical involvement, the sensitivity was respectively 31%, 50% and 67% [95%CI 9-61; 21-79; 35-90] for the subjective method, objective TVS and MRI, and the specificity was 98%, 90% and 100% [95%CI 92-100; 77-97; 94;100]. Agreement between TVS and MRI was superior in the assessment of cervical invasion, with PA ranging from 0.82 to 0.93 and K from 0.45 to 0.58, in comparison to myometrial invasion with PA ranging from 0.68 to 0.73 and K from 0.31 to 0.50. Considering the assessment of cervical involvement, as MRI showed a specificity of 100% it is not possible to increase the specificity. However, it was possible to increase the sensitivity, considering the combination of TVS with objective approach and MRI. TVS may have a promising role as a tool for preoperative staging of endometrial carcinoma, presenting a performance that approximates to MRI, with a higher agreement in the assessment of cervical invasion.

O077 Accuracy of intraoperative techniques for margin assessment in breast cancer surgery

Abstract Introduction There are a wide variety of intraoperative techniques available in breast surgery to achieve low rates for positive margins of excision. The objective of this systematic review was to determine the diagnostic accuracy of intraoperative breast margin assessment techniques, establishing a benchmark against which novel techniques may be compared. Methods A systematic search of the literature was conducted to identify studies assessing the diagnostic accuracy of intraoperative margin assessment (IOMA) techniques. Only clinical studies with raw diagnostic accuracy data as compared with final permanent section histopathology were included in the meta-analysis. A bivariate model for diagnostic meta-analysis was used to determine overall pooled sensitivity and specificity for each technique. Results Sixty-two studies were included for meta-analysis. The majority of studies evaluated specimen radiography (n= 20), frozen section (n= 14) and cytology (n= 13). Other techniques such as intraoperative ultrasound (n= 7), optical spectroscopy (n= 5), margin probe (n= 3) and micro-CT (n= 3) were less commonly evaluated. Frozen section, optical spectroscopy and cytology had the greatest diagnostic accuracy with sensitivities of 80%, 89% and 88%, respectively, and specificities of 97%, 94% and 93%, respectively. Conclusion Pooled data indicate that optical spectroscopy, cytology and frozen section have the greatest diagnostic accuracy of currently available IOMA techniques. However, long turnaround time for results and their resource intensive nature has prevented widespread adoption of these methods. The aim of emerging technologies is to challenge the diagnostic accuracy of these established techniques, while improving speed, cost and usability.

Reducing the Use of Frozen Section for Sentinel Node Biopsy in Breast Carcinoma: Feasibility and Outcome.

Sentinel lymph node biopsy (SLNB) is a standard practice for staging the axilla in breast cancer. Initially, intraoperative frozen section (FS) examination was used but was time-consuming and often provided false-negative results. Delayed permanent section (PS) analysis is currently performed; FS-SLNB is maintained for selected high-risk cases. The aim of this study was to evaluate the feasibility of this approach. All patients with breast cancer with clinically negative lymph nodes undergoing SLNB at our institution from 2004 to 2020 were analyzed, comparing operative time, re-operation rate and clinical outcome in terms of regional lymphatic recurrence-free and overall survival by type of SLNB (FS vs. PS). FS-SLNB comprised 100% of the procedures in 2004 and 18.2% at the end of the study period. The use of PS-SLNB instead of FS-SLNB was associated with a significantly reduced rate of axillary dissection (AD): 4.4% vs. 27.2, respectively (p<0.001). There was no significant difference in re-operation rate for AD: 3.9% vs. 6.9%, respectively (p=0.20). The use of PS-SLNB significantly reduced the operative time (mean=51 minutes) (p<0.001). After a mean follow-up of 70.9 months (range=16-180 months) there were no differences in regional lymphatic recurrence free or overall survival. The reduced use of FS-SLNB resulted in a significantly lower rate of AD, and significant operative time and costs savings, without any increase in the reoperation rate and lymphatic recurrences. Therefore, this approach is feasible, safe and beneficial, both for patients and healthcare services.