Positive Recurrence Research Articles

Safety of intrabiliary radiofrequency ablation in cases of residual and recurrent neoplasia after endoscopic papillectomy

Background and Aims Intrabiliary radiofrequency ablation (IB-RFA) is a therapeutic option for cases of positive margins or recurrence after endoscopic papillectomy (EP) for superficial neoplasia. We report our experience concerning safety and efficiency of IB-RFA. Patients and methods Single tertiary center retrospective study. All patients who underwent IB-RFA indicated in cases of residual or recurrent neoplasia after EP were included. We assessed morbidity (< 30 days) and late complication (> 30 days). Secondary outcomes were clinical success and late recurrence (absence of recurrence at the papillectomy site 12months after IB-RFA and beyond, respectively). Results: Twenty-five patients were included and underwent IB-RFA for deep positive margins (20/25, 80%) and relapse (5/25, 20%), 40 sessions were delivered. Morbidity rate was 8% (2/24) (one pancreatitis, one bleeding).Acute pancreatitis was significantly more common in the absence of pancreatic stenting (0% vs. 22%, p=0.046). One patient for whom pancreatic stenting failed died from acute severe pancreatitis in the first month (mortality rate = 4%). Late complications occurred in 12/24 patients (50%) concerning only biliary stricture, all managed endoscopically without sequelae. The clinical success rate was 92% (22/24), and late recurrence occurred in 2/24 patients (8%). Conclusions: IB-RFA is relatively safe and efficient in cases of residual or recurrent neoplasia after EP and is an alternative to surgery in well-selected cases. Biliary stricture occur frequently (50%) but are managed endoscopically without sequelae in all cases. In case of pancreatic stenting failure and because of the risk of severe acute pancreatitis potentially lethal, IB-RFA should be postpone.

Preoperative Ultrasound-Guided Marking, Mammogram, and Peroperative Use of Image Intensifier: A Cost-Effective Technique in Clipped Non-Palpable Breast Cancer Lesions to Achieve Adequate Surgical Margins.

To measure the effectiveness of localisation and removal of impalpable target lesions without compromising patient safety in a resource-limited setup using preoperative ultrasound and mammography with peroperative use of C-arm image intensifier. Descriptive study. Place and Duration of the Study: Department of Breast Surgery, Ittefaq Hospital (Trust), Lahore, Pakistan, from 25th October 2011 to 17th February 2023. All the breast cancer patients who achieved complete clinical response after neoadjuvant systemic treatment and underwent breast conservation surgery during the study period were included. Tumour / clip localisation was done using preoperative ultrasound or image-guided marking, a 2-view mammogram in all cases and the use of an image intensifier to confirm the presence of clips in the excised specimen. The primary outcome was the accurate localisation and removal of the index lesion, while the secondary outcome included the reoperation rate for positive margins and early local recurrence. Data from 144 patients were reviewed. Successful localisation was done in all the patients; only one patient had a positive margin for ductal carcinoma-in situ (DCIS), achieving a 99.3% clear margin rate. Local recurrence within two years after primary operation was seen in one patient only. Conclusion: By a combined approach of preoperative ultrasound-guided marking, a 2-view mammogram, and the use of image intensifier, successful localisation of an impalpable breast lesion is possible without compromising oncological and aesthetic principles. Breast conservation surgery, Localisation, Non-palpable, Margins, Image intensifier.

Preoperative Ultrasound-Guided Marking, Mammogram, and Peroperative Use of Image Intensifier: A Cost-Effective Technique in Clipped Non-Palpable Breast Cancer Lesions to Achieve Adequate Surgical Margins.

To measure the effectiveness of localisation and removal of impalpable target lesions without compromising patient safety in a resource-limited setup using preoperative ultrasound and mammography with peroperative use of C-arm image intensifier. Descriptive study. Place and Duration of the Study: Department of Breast Surgery, Ittefaq Hospital (Trust), Lahore, Pakistan, from 25th October 2011 to 17th February 2023. All the breast cancer patients who achieved complete clinical response after neoadjuvant systemic treatment and underwent breast conservation surgery during the study period were included. Tumour / clip localisation was done using preoperative ultrasound or image-guided marking, a 2-view mammogram in all cases and the use of an image intensifier to confirm the presence of clips in the excised specimen. The primary outcome was the accurate localisation and removal of the index lesion, while the secondary outcome included the reoperation rate for positive margins and early local recurrence. Data from 144 patients were reviewed. Successful localisation was done in all the patients; only one patient had a positive margin for ductal carcinoma-in situ (DCIS), achieving a 99.3% clear margin rate. Local recurrence within two years after primary operation was seen in one patient only. Conclusion: By a combined approach of preoperative ultrasound-guided marking, a 2-view mammogram, and the use of image intensifier, successful localisation of an impalpable breast lesion is possible without compromising oncological and aesthetic principles. Breast conservation surgery, Localisation, Non-palpable, Margins, Image intensifier.

ThP1.8 - Margin re-excision after Wise pattern or Vertical scar therapeutic mammoplasty for early breast cancer - a single institution 4-year review

Abstract Introduction Therapeutic mammoplasty is a technique which facilitates large volume cancer excisions whilst maintaining breast cosmesis in patients with breast cancer. The aim of this audit was to evaluate the rates of positive margins and cancer recurrence in this cohort and determine any risk factors for requiring margin re-excision. Methods All patients undergoing therapeutic mammoplasty using a Wise-pattern or vertical scar technique for the treatment of breast cancer over a 4-year period (November 2019- October 2023) were included. Data was collected on patient demographics, tumour characteristics, re-excision rates and cancer recurrence. Results Of a total of 61 patients who underwent therapeutic mammoplasty, 10 (16.4%) required margin re-excision. DCIS alone was present at the margin in the majority (70%). Re-excision specimens contained further cancer in 4/10, of which 2 had clear new margins, one required further re-excision and one underwent completion mastectomy. Half of those who required re-excision had a cancer that was either mammographically occult or was non-concordant with the pre-operative imaging on final histology in terms of extent and/or focality. There was one case only of in-breast recurrence, in a patient who had not previously required margin re-excision. Conclusions Therapeutic mammoplasty is an oncologically safe technique and in the vast majority of patients the breast can continue to be preserved even when margins are close or involved. Patients undergoing therapeutic mammoplasty who have mammographically occult tumours may be at higher risk of margin re-excision even with the addition of MRI imaging.

Predictors of distant metastatic recurrence in intermediate-risk papillary thyroid carcinoma.

Patients with intermediate-risk papillary thyroid carcinoma (PTC) have a favorable prognosis with standard treatment of total thyroidectomy (TT) and adjuvant radioactive iodine therapy (RAIT). However, the benefits of TT or adjuvant RAIT remain undetermined, and they are often omitted in Japan. We investigated risk factors for life-threatening distant recurrence in patients with intermediate-risk PTC who are optimal candidates for adjuvant RAIT. Outcomes without RAIT were retrospectively examined in 4030 intermediate-risk conventional PTC cases underwent initial surgery from 2005 to 22 (IRB approval 20200709-1). Lobectomy (LT) and TT was performed in 11.5% and 88.5%, respectively. Recurrent laryngeal nerve paralysis and hypoparathyroidism was less commonly observed in LT (1.3% and 0%) than TT (2.4% and 3.5 %). Fifty-six cases (1.4%) had distant recurrence. Recurrence-free survival rates at 10years was 93.5%. There was no significant difference in recurrence rate between LT and TT. Age ≥55, cN1b, and tumor diameter >30mm significantly associated with distant recurrence. There was a strong relationship between the number of positive risk factors and recurrence; the distant recurrence rate in cases of 0, 1, 2, and 3 positive factors was 0.3% (4/1203), 1.3% (25/1889), 2.7% (23/830) and 7.1% (4/52) (HR 6.46 (2.34-17.86), Log-rank <0.001). For intermediate-risk conventional PTC, there is no difference in prognosis even if LT was selectively conducted. However, in patients with risk factors for distant metastatic recurrence, such as age ≥55years, cN1b, and tumor size >30mm, adjuvant RAIT was considered eligible.

Reviewing the recurrence rates in stage I-III HR or ER positive breast cancer in obese patients given multi-modal weight loss plan post-treatment with aromatase inhibitors.

15 Background: Aromatase inhibitors (AIs) in the treatment of endocrine recepter positive breast cancer stages I-III, poses significant challenges in the management of obesity. Obesity is not only associated with an increased risk of breast cancer incidence but also with higher rates of cancer recurrence and poorer treatment outcomes. Moreover, the use of AIs, while effective in reducing estrogen levels and preventing ER or HR positive breast cancer recurrence, may exacerbate weight gain and metabolic disturbances in obese individuals. Weight management strategies have experienced increased attention in breast cancer survivors in recent years, especially overweight or obese individuals. Novel data makes it possible to infer that obesity management activities and multimodal programs that incorporate dietary counseling and physical activity can reduce recurrence rates. Methods: Participants in this study were individuals with Stage I-III endocrine receptor positive breast cancer who had completed adjuvant therapy and had a BMI in the 40s or 50s, increasing risk of recurrence. Eligible patients were identified based on the start date for endocrine therapy. High-risk patients were then assigned to either the intervention or control group. Those in the intervention group received access to a dietician, along with informational pamphlets on physiology and weight loss strategies. Additionally, they were offered discounts to certain gyms or provided free access to fitness facilities. Both intervention and control groups were briefed about the study, with those in the intervention group encouraged to utilize the provided resources for weight management. Results: The evidence from our study will underscore the potential benefits of multimodal weight loss interventions in overweight or obese breast cancer survivors, particularly in improving anthropometric outcomes and enhancing overall quality of life. Conclusions: While the studies included in our analysis demonstrated reductions in body weight, BMI, and waist circumference, as well as improvements in quality of life measures, there remains a notable gap in understanding the impact of these interventions on breast cancer recurrence rates, especially in the context of endocrine-positive breast cancer treated with Aromatase Inhibitors (AIs).

Postoperative outcomes of minimally invasive versus conventional nipple-sparing mastectomy with prosthesis breast reconstruction in breast cancer: a meta-analysis.

Breast cancer is the most common malignant tumor worldwide, and mastectomy remains the primary strategy for treating early stage breast cancer. However, the complication rates, surgical variables, and oncologic safety of minimally invasive nipple-sparing mastectomy (MINSM) have not been fully addressed. We systematically searched PubMed, Web of Science, Embase, and the Cochrane Library for randomized-controlled trials (RCTs) and non-RCTs that compared MINSM with conventional nipple-sparing mastectomy (CNSM), both followed by Prosthesis Breast Reconstruction (PBR). The main outcomes observed included overall complications, (Grade III) complications, skin and nipple necrosis, wound dehiscence, infection, seroma, hematoma, implant loss, and oncologic safety (positive margins and recurrence). Secondary outcomes included operation time, blood loss, hospital stay, cost-effectiveness, and patient satisfaction. Binary and continuous variables were compared using odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI). A total of 10 studies involving 2,166 patients were included. There were no statistically significant differences between MINSM and CNSM in terms of skin necrosis, wound dehiscence, infection, seroma, hematoma, implant loss, or oncologic safety. However, MINSM significantly reduced overall complications (OR = 0. 74, 95% CI [0. 58, 0. 94], p = 0. 01) and (Grade III) complications (OR = 0. 47, 95% CI [0. 31, 0. 71], p = 0. 0003). Nipple necrosis events were also significantly reduced in the MINSM group (OR = 0. 49, 95% CI [0. 30, 0. 80], p = 0. 005). Patient satisfaction improved notably in the MINSM group. Additionally, compared with the CNSM group, the MINSM group had longer operating times (MD = 46. 88, 95% CI [19. 55, 74. 21], p = 0. 0008) and hospital stays (MD = 1. 39, 95% CI [0. 65, 2. 12], p < 0. 001), while intraoperative blood loss was significantly reduced (MD = -29. 05, 95% CI [-36. 20, -21. 90], p < 0. 001). Compared with CNSM, MINSM offers advantages in reducing complications and intraoperative blood loss, as well as improving aesthetic outcomes and patient satisfaction. Therefore, MINSM may become a viable option for breast surgery. Nevertheless, a long-term evaluation of the oncologic safety of this approach is necessary to ensure its efficacy and safety for patients.

Sinusoidal oscillator parametrically forced to robust hyperchaotic states: the lumpkin case

The objective of this paper is to showcase the capability of the conventional circuit structure known as the Lumpkin oscillator, widely employed in practical applications, to operate in robust chaotic or hyperchaotic steady states. Through numerical analysis, we demonstrate that the generated signals exhibit a significant level of unpredictability and randomness, as evidenced by positive Lyapunov exponents, approximate entropy, recurrence plots, and other indicators of complex dynamics. We establish the structural stability of strange attractors through design and practical construction of a flow-equivalent fourth-order chaotic oscillator, followed by experimental measurements. The oscilloscope screenshots captured align well with the plane projections of the approximate solutions derived from the underlying mathematical models.

PD-L1 and PD-L2 Expression in Different Tumor Stages and Types of Malignant Salivary Gland Neoplasms: A Single-center Experience.

There is a limited amount of data on the role of programmed cell death ligand (PD-L) -1 and PD-L2 in salivary gland carcinomas. We aimed to evaluate the prognostic value of PD-L1 and PD-L2 expressions, which are closely related to immune mechanisms, with respect to salivary gland tumor types and stages. Data from patients with salivary gland masses surgically removed between 2006 and 2021, diagnosed with a malignant salivary gland neoplasm, were retrospectively analyzed. Immunoreactivity for PD-L1 and PD-L2 was performed on resection materials. The mean age of 90 patients was 52.1±18.8 and 46.7% were male. Overall, 55.6% of patients were diagnosed with adenoid cystic carcinoma (ACC), 23.3% with mucoepidermoid carcinoma (MEC), 16.7% with acinic cell carcinoma (AciCC), 3.3% with ductal carcinoma (DC), and 1 patient with pleomorphic adenoma ex carcinoma (PA-ex-CA). In all, 52% of ACC, 12% of AciCC, 24% of MEC, and 12% of DC cases were at stage IV. The tumor diameter, frequencies of lymphovascular invasion, metastasis, positive surgical margin, recurrence, and mortality rates of patients at stages III and IV were significantly larger than those at stages I and II ( P <0.05). The percentages of tumor cell score (TCS) and immune cell score (ICS) for PD-L1 were significantly higher among patients with MEC compared with those with other types of tumors ( P =0.0011). However, the percentages of combined score (CS) for PD-L1 and tumor cell score for PD-L2 were comparable among tumor types ( P >0.05). No significant difference was found in these scores for PD-L1 between tumor stages ( P >0.05), but for PD-L2, all patients at stage I had TCS <1% for PD-L2, while all patients at stages II and III, and 92% of patients at stage IV had TCS ≥1% ( P <0.0001). High expression of PD-L1 was mostly observed in MEC cases ( P =0.0016), while all patients with AciCC had a low PD-L1 expression level ( P =0.0206). The mean tumor diameter, rate of lymphovascular invasion, perineural invasion, metastasis, positive surgical margin, recurrence, type of treatment, mortality, and TILs ratio did not differ significantly according to PD-L1 expression level ( P >0.05). The percentage of tumor-infiltrating lymphocytes was comparable among negative and positive PD-L1 scores according to both 1% and 5% threshold values ( P >0.05). High PD-L1 expression is rare in AciCC, while PD-L1 expression is high in MEC. Our findings underline the importance of future screening for PD-L1 and PD-L2 before patients undergoing immunotherapies in all salivary gland tumors.

Effects of stochastic perturbations on a phytoplankton allelopathy competitive system

In this paper, we investigate stochastic models of two species competitive phytoplankton system with allelopathic interaction. We construct stochastic models from deterministic models by introducing three different stochastic perturbations to the equations. For the first model, we prove that this model is asymptotically stable in probability at three different equilibrium points. It is also shown that the system is positively recurrent under some conditions. For the second model, we study the extinction, existence of positive recurrence and global asymptotic stability under some sufficient conditions. For the last system, almost sufficient and necessary conditions for global asymptotic stability, the existence of positive recurrence and extinction of each population are established. In addition, using a suitable stochastic Lyapunov method, we prove that there is a unique solution to three models, we also discuss the ultimate boundedness of the three stochastic systems. Moreover, some numerical simulations are introduced to illustrate our mathematical results. We show that stochastic models still retain the desirable stability of their deterministic counterparts if stochastic perturbations are relatively small.

Abstract PO2-23-01: Selective cavity margin shaving: effective method to maintain balance between cosmesis and negative margin in breast conserving surgery

Abstract Background: Breast conserving surgery (BCS), which became the mainstay of breast cancer surgery, both cosmesis and margin negativity are significant issues. Firstly, it is well known that negative resection margin is crucial for reducing local recurrence after BCS. Therefore, there has been numerous attempts to secure negative margin, such as specimen mammography, frozen section margin analysis, and cavity margin shaving. Regarding cosmesis, wider excision to secure negative margin could disrupt cosmesis especially in Asian patients with relatively smaller breast, and minimizing excision volume is necessary for optimal cosmetic outcome. Our center adopted the concept of selective cavity margin shaving (SCMS) to achieve negative margin while optimizing cosmetic result. Method: 606 female patients with non-metastatic, unilateral breast cancer were prospectively collected and underwent BCS with SCMS from October, 2012 to December, 2020. The medical record was retrospectively reviewed, and we assessed positive margin rate and local recurrence. During BCS, the surgeon excised gross margin of 1~2cm around the cancer, and assessed the proximity of the margin through gross examination. If sufficient margin was not obtained, cavity shaving was performed in the close margin, while shaving from retrieved specimen was conducted on the sufficient margin side. Additionally, circumferential margin frozen analysis was carried out, and further excision was performed until a negative margin was achieved or when only focal DCIS involvement remained. Result: The mean ± SD age of the patients was 52.47 ± 9.92 years and mean follow-up period was 59.98 ± 26.59 months. 56 patients (9.24%) received neoadjuvant chemotherapy. 123 patients (20.29%) got positive margin for invasive cancer or DCIS in frozen section margin analysis and 97 patients (16.01%) underwent intraoperative re-excision. There was discordance between frozen and permanent section margin analysis in 48 patients (7.92%), and 7 patients (1.16%) underwent post-operative re-excision operation. Local recurrence occurred in 11 patients (1.82%), which is significantly lower compared to previously reported outcomes after BCS. Presence of lympho-vascular invasion, neoadjuvant chemotherapy, and margin involvement of invasive cancer in permanent section analysis were strongly related with local recurrence. Conclusion: In conclusion, SCMS and frozen section margin analysis demonstrated low positive margin rate and reduced re-excision rate. The local recurrence was also lower compared to conventionally reported rate after BCS. Selective cavity margin shaving is an oncologically safer and effective surgical method with minimized cosmetic deformity. Table 1. Baseline patient characteristics Table2. Univariate and multivariate analysis of factors associated with local recurrence Table2. Univariate and multivariate analysis of factors associated with local recurrence by Cox proportional hazard model. Citation Format: Dabin Kim, Zisun Kim, Sung Mo Hur, Cheol wan Lim. Selective cavity margin shaving: effective method to maintain balance between cosmesis and negative margin in breast conserving surgery [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-23-01.

The Epidemiology of Newly Recognized Causes of Drug-Induced Liver Injury: An Update.

The incidence and prevalence of drug-induced liver injury appear to be increasing globally, for example, with the introduction of checkpoint inhibitors. Several reviews have been published in the last decade on the epidemiology of DILI, both among hospitalized patients and in the general population, as well as from retrospective and prospective studies on DILI. Most of these reviews have not focused on newly recognized agents that have recently changed the landscape of DILI. Apart from liver injury associated with antibiotics, oncological agents, particularly checkpoint inhibitors, are increasingly being recognized as causing liver injury. The type of liver injury associated with these agents is not idiosyncratic but rather an indirect type of injury. Furthermore, recently, COVID-19 vaccines and green tea extract have been found to lead to liver injury. Checkpoint inhibitors have revolutionized the treatment of many malignancies, such as malignant melanoma, lung cancer, and renal cancer. Via the activation of T cells, they can increase immune activity against malignant cells, but at the same time, they can decrease immune tolerance and therefore lead to immune-related adverse effects in many organs. The most common adverse effect in clinical practice is liver injury. A recent prospective study demonstrated an 8% frequency of DILI due to the use of checkpoint inhibitors among patients with malignant melanoma and renal cancer. This rate is much higher than observed with drugs, leading to idiosyncratic liver injury. Shortly after the implementation of the worldwide vaccination program against COVID-19, several case reports were published on suspected vaccination-induced autoimmune-like hepatitis occurring shortly after the vaccination. At first, these reports were met with skepticism, but currently, around 100 reports have been published, and cases of positive recurrence have been reported. The clinical, biochemical, immunological, and histological features are indistinguishable from classic autoimmune hepatitis (AIH). These reactions are very similar to drug-induced autoimmune-like hepatitis (DI-ALH) due to drugs such as nitrofurantoin, minocycline, and infliximab, which do not relapse after a short course of corticosteroids, which is the general rule in classic autoimmune hepatitis (AIH). Green tea extract has been found to be a well-documented cause of acute hepatocellular liver injury with jaundice. A strong HLA association has been reported, showing a high prevalence of HLA-B*35:01 among patients suffering from green tea-induced liver injury. Overall, 3% of patients recruited in the DILIN study were supplemented with green tea extract as one of the ingredients. In a prospective population-based study from Iceland, green tea was implicated in approximately 8% of patients with DILI.

The effect of harmonization on the variability of PET radiomic features extracted using various segmentation methods

PurposeThis study aimed to examine the robustness of positron emission tomography (PET) radiomic features extracted via different segmentation methods before and after ComBat harmonization in patients with non-small cell lung cancer (NSCLC).MethodsWe included 120 patients (positive recurrence = 46 and negative recurrence = 74) referred for PET scanning as a routine part of their care. All patients had a biopsy-proven NSCLC. Nine segmentation methods were applied to each image, including manual delineation, K-means (KM), watershed, fuzzy-C-mean, region-growing, local active contour (LAC), and iterative thresholding (IT) with 40, 45, and 50% thresholds. Diverse image discretizations, both without a filter and with different wavelet decompositions, were applied to PET images. Overall, 6741 radiomic features were extracted from each image (749 radiomic features from each segmented area). Non-parametric empirical Bayes (NPEB) ComBat harmonization was used to harmonize the features. Linear Support Vector Classifier (LinearSVC) with L1 regularization For feature selection and Support Vector Machine classifier (SVM) with fivefold nested cross-validation was performed using StratifiedKFold with ‘n_splits’ set to 5 to predict recurrence in NSCLC patients and assess the impact of ComBat harmonization on the outcome.ResultsFrom 749 extracted radiomic features, 206 (27%) and 389 (51%) features showed excellent reliability (ICC ≥ 0.90) against segmentation method variation before and after NPEB ComBat harmonization, respectively. Among all, 39 features demonstrated poor reliability, which declined to 10 after ComBat harmonization. The 64 fixed bin widths (without any filter) and wavelets (LLL)-based radiomic features set achieved the best performance in terms of robustness against diverse segmentation techniques before and after ComBat harmonization. The first-order and GLRLM and also first-order and NGTDM feature families showed the largest number of robust features before and after ComBat harmonization, respectively. In terms of predicting recurrence in NSCLC, our findings indicate that using ComBat harmonization can significantly enhance machine learning outcomes, particularly improving the accuracy of watershed segmentation, which initially had fewer reliable features than manual contouring. Following the application of ComBat harmonization, the majority of cases saw substantial increase in sensitivity and specificity.ConclusionRadiomic features are vulnerable to different segmentation methods. ComBat harmonization might be considered a solution to overcome the poor reliability of radiomic features.

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.

Oncoplastic breast-conserving surgery (OBCS) vs. mastectomy with reconstruction: a comparison of outcomes in an underserved population.

Oncoplastic breast-conserving surgery (OBCS) has demonstrated superior cosmetic outcomes to traditional breast-conserving surgery (BCS) while maintaining oncologic safety. While prior studies have compared OBCS to mastectomy, there is a scarcity of literature on the impact of social determinants of health on outcomes. Furthermore, although traditionally tumors larger than 5 cm and multifocal disease were treated with mastectomy, the literature has now shown OBCS to be safe in treating such disease. As a result, patients with large or multifocal tumors could be eligible for both mastectomy and OBCS, which prompts the need for comparison between the two. Thus, the aim of our study was to compare OBCS and mastectomy with reconstruction using BREAST-Q and oncologic outcome measures, as well as stratify these outcomes based on race, ethnicity, and body mass index (BMI). A retrospective chart review was performed for 57 patients treated with OBCS and 204 patients treated with mastectomy with reconstruction from 2015 to 2021. Variables including age, race, ethnicity, BMI, insurance status, surgery type, pathology, recurrence, and complications were recorded. Patient-reported outcomes (PROs) were recorded using BREAST-Q pre- and post-operatively. Despite having a higher BMI (P<0.001), OBCS yielded higher "satisfaction with breast" and "satisfaction with outcome" than mastectomy (P=0.02 and P=0.02, respectively). When stratified by race, there were no statistical differences in the PROs between the two surgeries for Hispanic nor African American patients. OBCS had a significantly lower rate of infection and fewer additional surgeries than mastectomy (P=0.004 and P<0.001, respectively). There were no differences in positive margin rate or recurrence rate between the groups. In our study, OBCS yielded better PROs than mastectomy while maintaining oncologic safety and resulting in fewer surgeries and complications. These excellent outcomes in a majority non-Caucasian cohort support the utilization of OBCS for underserved, minority populations. Larger studies evaluating PROs in diverse and uninsured groups are needed to reinforce these conclusions.

Margin quality analysis for wedge resection of lung cancer and construction of a predictive model.

Insufficient pulmonary wedge resection margin is associated with malignant positive margins and high local recurrence risk for lung cancer. This study aimed to identify the risk factors of insufficient or guideline discordant resection margin distance and establish a predictive model to preoperatively estimate the risk of discordant margin for individual patient. Guideline discordant resection margin was defined as ratio of resection margin distance to tumor size less than one. Patients who had pulmonary malignancies and underwent wedge resection between April 2014 and February 2023 were enrolled and stratified by quality of resection margin. Multivariable logistic regression analysis was employed to identify risk factors of guideline discordant margin and a predictive model was developed. Data from March 2023 to January 2024 were collected for internal validation. A total of 530 patients were included. The incidence of guideline discordant wedge resection margin was 37.2%. Longer tumor's max distance to pleura and larger tumor size were variables associated with increased risk and included in the final model. Preoperative localization and right-side surgery were protective variables in the predictive model. A nomogram was built based on the predictive model. The model showed satisfying predictive performance with a concordance index of 0.720 for the predictive model, and 0.761 for internal validation. The goodness-if-fit tests were non-significant for both model development and internal validation data set. The preoperative predictive model and nomogram show good predictive performance to estimate the risk of guideline discordant wedge resection margin. Individualized surgical plans or preoperative nodule localization can be made for high-risk patients.

EPIDEMIOLOGICALRISK FACTORS OF RECURRENCE OF LUMBAR INTERVERTEBRAL DISC HERNIATION AFTER PRIMARY DISCECTOMY (LITERATURE REVIEW)

Primary discectomy for a lumbar intervertebral disc herniated (LDH) is usually accompanied by a rapid regression of clinical symptoms, however, in 5–15 % of cases, an X-ray positive recurrence of the hernia with corresponding orthopedic disorders is registered, which leads to repeated surgical intervention. Objective. Determination of risk factors for recurrence of LDH and their frequency under the conditions of various methods of primary discectomy based on a scientific analysis of the relevant literature. Methods. The material of the research is articles containing the definition of risk factors for the recurrence of a LDH after primary discectomy, for the period 2013–2023 in PubMed, Google Scholar, Medline databases using medical subject headings and keywords «recurrent lumbar disc herniation, surgical interventions, percutaneous endoscopic lumbar discectomy, microdiscectomy, laminectomy, discectomy, spondylodesis». The research method is a systematic review of relevant literature sources. Results. Early and long-term results of primary discectomy for intervertebral disc herniation using decompression (open discectomy, microendoscopic discectomy, percutaneous discectomy, laminectomy, minidiscectomy, endoscopic discectomy) and decompression-stabilization (discectomy combined with spondylodesis) techniques are traced in the literature. The most successful were: 1 year after the operation — endoscopic discectomy (12.4 % of reoperations) and spondylodesis (11.8 %); 10 years after the operation — laminectomy (14 %) and spondylodesis (10 %). The highest rates of revision discectomy: 1 year after the operation — laminectomy (18.6 %); 10 years after surgery — open discectomy and endoscopic discectomy — 16 % each. Conclusions. Recurrent intervertebral disc herniation is an early complication of primary discectomy, the frequency of which varies depending on the surgical technique and the timing of the postoperative period. The most reliable risk factors are male gender, age younger than 50 years, diabetes mellitus, and smoking.

On the Positive Recurrence of Finite Regenerative Stochastic Models

We consider a general approach to establish the positive recurrence (stability) of regenerative stochastic systems. The approach is based on the renewal theory and a characterization of the remaining renewal time of the embedded renewal process generated by regeneration. We discuss how this analysis is simplified for some classes of the stochastic systems. The general approach is then illustrated by the stability analysis of a k-out-of-n repairable system containing n unreliable components with exponential lifetimes. Then we extend the stability analysis to the system with non-exponential lifetimes.

Near-Infrared Fluorescence Imaging with Indocyanine Green for Robot-Assisted Partial Nephrectomy: A Systematic Review and Meta-Analysis

Background: We aimed to analyze the influence of near-infrared fluorescence (NIRF) using indocyanine green (ICG) with standard robot-assisted partial nephrectomy (RAPN) in patients with a kidney tumor (KT). Methods: We performed a literature search on 12 September 2023 through PubMed, EMBASE, and Scopus. The analysis included observational studies that examined the perioperative and long-term outcomes of patients with a KT who underwent RAPN with NIRF. Results: Overall, eight prospective studies, involving 535 patients, were eligible for this meta-analysis, with 212 participants in the ICG group and 323 in the No ICG group. For warm ischemia time, the ICG group showed a lower duration (weighted Mean difference (WMD) = −2.05, 95% confidence interval (CI) = −3.30–−0.80, p = 0.011). The postoperative eGFR also favored the ICG group (WMD = 7.67, 95% CI = 2.88–12.46, p = 0.002). No difference emerged for the other perioperative outcomes between the two groups. In terms of oncological radicality, the positive surgical margins and tumor recurrence rates were similar among the two groups. Conclusions: Our meta-analysis showed that NIRF with ICG during RAPN yields a favorable impact on functional outcomes, whereas it exerts no such influence on oncological aspects. Therefore, NIRF should be adopted when preserving nephron function is a paramount concern.

On Positive Recurrence of the Mn/GI/1/∞ Model

Positive recurrence for a single-server queueing system is established under generalized service intensity conditions, without the assumption of the existence of a service density distribution function, but with a certain integral type lower bound as a sufficient condition. Positive recurrence implies the existence of the invariant distribution and a guaranteed slow convergence to it in the total variation metric.