Section Margin Research Articles

Preanalytical Phase Tumor Contaminants in Intraoperative Margins From Transoral Robotic Surgeries.

Tumor contaminants were incidentally noted in frozen section margins of oropharyngeal squamous cell carcinoma. To estimate the frequency of tumor contaminants in frozen section slides of patients who underwent surgery for pharyngeal cancer, and to characterize the surgical and pathologic context of these incidents. A retrospective search was conducted to identify pharyngeal resections from 2016 to 2022. Surgical pathology, operative reports, and frozen section slides were reviewed. Preanalytical phase tumor contaminants were defined as tumor contaminants that occurred in frozen section slides with or without occurrence in permanent slides. Eighty-one pharyngeal resections with intraoperative tumor bed margins for squamous cell carcinoma were identified. These included 308 tumor bed margins represented in 641 slides. Preanalytical contaminants occurred among 9 patients (11.1% of all and 21.4% of robotic surgeries) and in 3.8% of the 308 intraoperative tumor bed margins. A statistically significant association was found between contaminants and larger tumor size (Student t test, P = .04) and surgical approach (robotic versus open oropharyngectomy: Fisher exact test, P < .001). All patients with contaminants had intraoperative tumor disruption. Two frozen section deferrals (0.6%) and 2 discrepancies with final diagnosis (0.6%) attributed to contaminants were identified; however, clinical or surgical management was not affected in any patient. Preanalytical contaminants may cause confusion in intraoperative margin assessment. They are more likely to occur in margins of nonkeratinizing squamous cell carcinoma resected by transoral robotic surgery if there is intraoperative tumor disruption. Rarely, preanalytical contaminants lead to frozen section deferral or discrepancy with final diagnosis.

Effect of Heat Exchange Area Margins on Thermal Characteristics of the Heat Exchange System in the Pressurized Water Test Loop during Fuel Assembly Irradiation

The performance of heat exchangers in the pressurized water test loop is a critical factor in ensuring the achievement of irradiation parameters for fuel assemblies and the safety of experimental operations. The effect of the heat exchange area margin on the heat exchangers in the pressurized water test loop for the fuel assembly during the steady-state irradiation is analyzed. Additionally, optimization methods for determining the margin of heat exchange area and corresponding design strategies are further investigated. It shows that the effect of the heat exchange area margin on the heat exchange power is less affected by the inlet temperature of the primary water and is primarily influenced by the flow rate of the primary water. A decrease in the flow rate of the primary water reduces the compensatory effect of the cooling section on power and enhances the weakening effect of the regeneration section on power. Meanwhile, the correspondence between the margin of the regeneration section and the cooling section, established based on design conditions, can be applicable when there are changes in the inlet temperature of the primary water, but it is not suitable when there are changes in the flow rate of the primary water. When the flow rate of the primary water decreases, the cooling section margin required to compensate for the decrease in power caused by the regeneration section margin will increase significantly. In addition, short-circuiting the heat exchange tubes in the regeneration section can effectively enhance the heat transfer capability. Furthermore, setting the heat exchange area margins of the regeneration and cooling sections to zero can serve as a termination condition for iterative calculations in the verification of regenerative heat exchangers under off-design conditions.

The utility of intraoperative marrow margin frozen section in extremity bone sarcoma resection.

Intraoperative frozen section analysis is commonly used to evaluate marrow margins during extremity bone sarcoma resections, but its efficacy in the era of magnetic resonance imaging is debated. This study aimed to compare the accuracy of intraoperative frozen section assessment with final pathology, assess its correlation with gross intraoperative margin assessment, and evaluate its impact on surgical decision making. Consecutive patients undergoing extremity bone sarcoma resections from 2010 to 2022 at a single sarcoma center were included. Intraoperative frozen section and gross margin assessments were compared to final pathology using positive predictive values (PPV) and negative predictive values (NPV). Changes in surgical decisions due to positive intraoperative margins were recorded. Of 166 intraoperative frozen section marrow margins, four were indeterminant/positive, with two false positive/indeterminant findings and two false negatives compared to final pathology. Gross intraoperative assessment had no false positives and two false negatives. Frozen section analysis yielded a PPV of 50% (95% confidence interval [CI]: 16%-84%) and NPV of 98.8% (95% CI: 97%-100%), while gross assessment had a PPV of 100% (95% CI: 16%-100%) and NPV of 98.8% (95% CI: 97%-100%). Positive frozen section margins led to additional resections in three of four cases. Intraoperative frozen section analysis did not offer added clinical value beyond gross margin assessment in extremity bone sarcoma resections. It exhibited a low PPV and led to unnecessary additional resections. Gross intraoperative assessment proved adequate for margin evaluation, potentially saving time and resources.

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.

Myxofibrosarcoma: Outcomes, Prognostic Factors, and Role of Neoadjuvant Radiation Therapy

IntroductionMyxofibrosarcoma (MFS) is a subtype of soft tissue sarcoma with a highly infiltrative growth pattern that leads to a higher risk of inadvertent positive surgical margins and local relapse. Poorly defined tumor margins also pose a challenge for radiotherapy (RT) planning, in terms of treatment volumes and administration of pre- versus post-operative RT. This study aims to evaluate local control and patterns of recurrence in MFS patients treated with neoadjuvant RT followed by definitive surgical excision. Materials and methodsMultiple institutional databases were retrospectively searched for patients diagnosed with MFS between 2013-2021, who were exclusively treated with pre-operative radiotherapy followed by definitive surgery at our institution. The endpoints of the study were defined as local tumor recurrence (LR), distant metastasis (DM), or death from the date of definitive surgery. Results49 patients met the inclusion criteria and were included in the final study. The median age at diagnosis was 67 years, and 71% were male. The tumor was superficially located in 63% of patients and the mean tumor size at presentation was 7.8 cm. All patients received neoadjuvant RT and completed their planned course of treatment. Neoadjuvant chemotherapy was administered in 22% of patients. Inadvertent excision (IE) prior to definitive treatment was performed in 25 patients (51%), 84% of which had superficially located tumors.All margins were assessed using frozen section analysis at the time of definitive surgery, and 100% of patients had negative surgical margins, with 25% having no residual tumor. With a median follow-up of 4.7 years, a 5-year local control (LC) rate was 87%, and 5-year overall survival (OS) was 98%. Tumor depth was associated with DM (p <0.01). ConclusionDespite the infiltrative nature of MFS, preoperative RT followed by definitive surgical excision, especially in the setting of a reliable frozen section margin analysis, is associated with excellent local control.

Recurrence rates of periocular basal cell carcinoma following intra-operative en-face frozen section margin controlled excision.

To report the margin control process and rate of recurrence of periocular basal cell carcinomas (BCCs) managed by en-face, frozen section margin controlled (FSC), excision by a single surgeon with a 3-year follow-up. A retrospective analysis of all histopathologically proven cases of periocular BCC who underwent surgical excision with intra-operative, en-face, FSC, excision by a single surgeon from 2015 to 2019 was performed. Patients with less than 3-year follow-up were offered a virtual appointment to determine possible recurrence. A total of 88 BCC excisions from 86 patients were reviewed. Minimum 3-year follow-up data is available for 73 patients. The most common location and histological subtype was the lower eyelid and nodular BCC, respectively (47% and 83% of cases). Primary BCC (pBCC) comprised 98% (86/88) of cases and recurrent BCC (rBCC) comprised 2% (2/88) of cases. Negative frozen section margins were achieved in 93% (82/88) of excisions on the day of surgery. The overall recurrence rate during this time was 1.4% (1/73) at minimum 3years. Periocular BCC can be managed effectively by en-face, FSC, excision, with a high cure rate and low recurrence rate comparable to alternative excision techniques such as Moh's micrographic surgery. Advantages of en-face excision include same-day excision and reconstruction and reduced theatre time. Primary nodular BCCs with clear margins can be considered for early discharge with advice to self-monitor.

Is there concordance between the Cellvizio system and pathology in determining microscopic inflammation at the ileal resection margins in Crohn's ileal disease? The CELLVICROHN study

BackgroundCrohn's disease is an inflammatory bowel disease for which surgery is required in approximately 80% of cases. However, surgery does not cure Crohn's disease. The type of surgery is important, as there are intraoperative risk factors for recurrence, including microscopic inflammation at the resection margins. This point is crucial, as a too large resection may result in short bowel syndrome and a too short resection (microscopic inflammation at the resection site) a higher risk of postoperative recurrence (75% vs 46% at 18 months). Based on the results of a randomised control trial, surgeons are encouraged to perform a limited resection (2 cm from macroscopic Crohn's disease). However, such a macroscopically non-inflamed resection margin may show microscopic inflammation (up to 80%). Thus, it would be useful to evaluate whether there is microscopic inflammation at the resection margin. Moreover, there is an increasing interest in the role of the mesentery in recurrence, which is still unclear. Thus, it would be informative to also clarify the border between inflamed and non-inflamed mesentery. Cellvizio is a type of confocal laser endomicroscopy system that provides the possibility to obtain high-magnification in-vivo images of the gut epithelium. This allows real-time examination of the gastrointestinal mucosa at the cellular and subcellular level. Cellvizio has never been used during surgery for Crohn's disease. PurposeThe aim of this study is to evaluate the intraoperative use of Cellvizio to determine the optimal ileal resection margins in Crohn's disease. Primary outcomeThe primary outcome is the concordance between the evaluation of microscopic inflammation at the ileal resection margin by the Cellvizio system and pathology. Secondary outcomesThe secondary outcomes are the concordance between the Cellvizio system and pathology in evaluating inflammation of the serosa (transmural inflammation) and mesentery and the length of the ileum (in cm) between the surgical margin and the theoretical resection site to have a resection margin free of microscopic inflammation as determined by the Cellvizio system (for the mucosa and serosa). Study designThis is a prospective, single centre, interventional study. Eligibility criteriainclusion criteria: Patients who require an ileocecal resection for Crohn's disease, regardless of the phenotype. exclusion criteria: Patients who are under 18 years of age, are pregnant or breastfeeding, have had an ileocolic resection for a surgical recurrence of Crohn's disease, have had emergency surgery for peritonitis, and those who have a contra indication for fluoresceine injection or severe allergy to any drug. Arm number or label and arm typeThis is a single-arm study. InterventionsDuring surgery an intravenous injection of fluoresceine will be performed. The surgeon will then evaluate the ileal section margins of the mucosa, serosa, and mesentery to evaluate whether the section margin shows microscopic inflammation. The surgeon will then evaluate (in cm) the length between this section margin and the theorical section margin to be within non-inflamed tissue of the mucosa, serosa, and mesentery. The data will be recorded during surgery, blind from the pathological analysis. The pathological analysis will also be performed blind from the Cellvizio data. A video collection will be performed anonymously. Number of participants41 patients Statistical analysisWe assume an estimated Kappa coefficient of 90%, a lower bound of 70%, and a frequency of microscopic inflammation at the ileal resection margin of 70%. Given this hypothesis and an alpha risk of 5%, the inclusion of 41 patients will be necessary.

'Stealth' Prostate Tumors.

The aim of this study was to determine the false negative rates of prebiopsy magnetic resonance imaging (MRI) and MRI-ultrasound (US) 12-core systematic prostate biopsy (PBx) by analyzing radical prostatectomy specimens. This retrospective study included 3600 prostate cancer (PCa) patients who underwent robot-assisted laparoscopic radical prostatectomy. Based on comparison of lobe-specific data on final pathology with preoperative biopsy and imaging data, the study population was subdivided into group I-contralateral (CL) benign PBx (n = 983), group II-CL and/or bilateral (BL) non-suspicious mpMRI (n = 2223) and group III-CL benign PBx + non-suspicious mpMRI (n = 688). This population was studied for the presence of PCa, clinically significant PCa (csPCa), extracapsular extension (ECE) (pathological stage pT3), positive frozen section and final positive surgical margin (PSM) in the CL lobe. Descriptive statistics were performed. In subgroups I, II and III, PCa was respectively detected in 21.5%, 37.7% and 19.5% of cases, and csPCa in 11.3%, 16.3% and 10.3% of cases. CL pT3 disease was seen in 4.5%, 4% and 5.5%, and CL surgical margins and/or frozen section analysis were positive in 6%, 7% and 5% of cases in subgroups I, II and III, respectively. There are still significant rates of false negatives in the standard care diagnostics of PCa. Further strategies are required to improve the accuracy of diagnosis and determination of tumor location.

Either High or Low Risk: The Acinar Score at the Resection Margin Dichotomizes the Risk Spectrum of Pancreas-specific Complications After Pancreatoduodenectomy.

Pancreatic acinar content (Ac) has been associated with pancreas-specific complications after pancreatoduodenectomy. The aim of this study was to improve the prediction ability of intraoperative risk stratification by integrating the pancreatic acinar score. A training and validation cohort underwent pancreatoduodenectomy with a subsequent histologic assessment of pancreatic section margins for Ac, fibrosis (Fc), and fat. Intraoperative risk stratification (pancreatic texture, duct diameter) and pancreas-specific complications (postoperative hyperamylasemia [POH], postpancreatectomy acute pancreatitis [PPAP], pancreatic fistula [POPF]) were classified according to ISGPS definitions. In the validation cohort (n= 373), the association of pancreas-specific complications with higher Ac and lower Fc was replicated (all P <0.001). In the entire cohort (n= 761), the ISGPS classification allocated 275 (36%) patients into intermediate-risk classes B (POH 32%/PPAP 3%/POPF 17%) and C (POH 36%/PPAP 9%/POPF 33%). Using the acinar score (Ac ≥60% and/or Fc ≤10%), intermediate-risk patients could be dichotomized into a low-risk (POH 5%/PPAP 1%/POPF 6%) and a high-risk (POH 51%/PPAP 9%/POPF 38%) group (all P <0.001). The acinar score AUC for POPF prediction was 0.70 in the ISGPS intermediate-risk classes. Overall, 239 (31%) patients were relocated into the high-risk group from lower ISGPS risk classes using the acinar score. The risk of pancreas-specific complications appears to be dichotomous-either high or low-according to the acinar score, a tool to better target the application of mitigation strategies in cases of intermediate macroscopic features.

Permanent section margin concordance after Mohs micrographic surgery with immunohistochemistry for invasive melanoma and melanoma in situ: A retrospective dual-center analysis

Mohs Micrographic Surgery (MMS) for melanoma practices vary among dermatologic surgeons. The implementation of immunohistochemical staining in MMS for melanoma mitigates challenges associated with slide interpretation, however the reliability of Melanoma antigen recognized by T cells 1 (MART-1), the preferred immunostain for melanoma, has yet to be compared to permanent section pathology. To assess concordance rates of MART-1 frozen sections and permanent section pathologic interpretation of melanoma treated with MMS. A dual center retrospective analysis was conducted to collect concordance and demographic data. Chi square tests were performed for group comparisons of categorical variables. Of the 379 permanent sections sent, 367 were concordant with frozen section pathology for an overall concordance rate of 96.8%. Cases were stratified into indeterminately concordant and indisputably concordant. 22 (6%) of cases were indeterminately concordant whereas 345 (94.0%) of cases were indisputably concordant. The concordance rate is derived from a comparison of adjacent tissue margins, an inevitable consequence of utilizing two techniques. To the author's knowledge, this study represents the largest investigation examining concordance rates of MART-1 frozen sections in Mohs for melanoma. High concordance disputes the ongoing need for additional permanent margins when using MART-1 in routine cases.

Retrospective Cohort Study of Practical Applications of Paramagnetic Seed Localisation in Breast Carcinoma and Other Malignancies.

(1) Background: Paramagnetic seeds are a safe alternative for the wire-guided localisation of non-palpable breast lesions, but can also be applied for non-breast lesions. This study presents the experience with a paramagnetic seed, MagSeed® (Endomagnetics Ltd., Cambridge, UK, CE-registered and FDA-cleared), in an academic and non-academic breast centre. (2) Methods: Multicentre, retrospective analysis of 374 consecutive patients who underwent surgery after paramagnetic seed localisation (MSL) between 2018 and 2020. Indications for localisation included non-palpable breast lesions (n = 356), lymph nodes (n = 15) or soft tissue lesions (n = 3). The primary outcome was feasibility and the rate of positive section margins. The secondary outcome was predictive factors for positive section margins. (3) Results: The accurate excision of high-risk breast lesions, lymph nodes and soft tissue lesions was seen in 91.07% (n = 56). Positive section margins were observed in 7.86% (n = 25) after breast conserving surgery for invasive or ductal carcinoma in situ (DCIS) (n = 318). Invasive breast cancer associated with DCIS (p = 0.043) and the size of DCIS (p &lt; 0.001) were significantly correlated with the positive section margins. (4) Conclusion: This study confirms the feasibility of MSL, as well as the higher risk for positive margins in cases of breast carcinoma with associated DCIS. Soft tissue lesions and lymph nodes associated with other malignancies, e.g., melanoma, can also be localised with paramagnetic seeds. This offers perspectives for future applications, such as the de-escalation of axillary treatment in breast cancer.

Section Margin Allocation Method for Renewable Energy Power Generation Clusters Considering the Randomness of Source and Load Power

It is difficult to adapt the traditional section margin distribution method to the power system with a high proportion of renewable energy generation (REG). This paper proposes a section margin allocation method of REG clusters considering the randomness of source and load power. Firstly, the probability density function of the predicted REG power error is estimated, the probability that REG stations meet the output command after the section margin distribution is calculated, and the output realization probability of each REG station is discussed. The typical operation mode set of the REG cluster is then obtained by clustering the REG stations according to the operation history, and the load rise space of the REG cluster under each typical operation mode is calculated. Considering the randomness of REG power and its load power, the section margin is allocated to each REG station in the REG cluster so as to ensure that each REG station reaches the highest output probability. On the premise of ensuring the safe and stable operation of the grid, this method facilitates the management of REG clusters and the accommodation capacity of the power system for REG. Simulations of the power system of IEEE 39 nodes verify the rationality and validity of the section margin allocation method.

Utilizing 3D head and neck specimen scanning for intraoperative margin discussions: Proof of concept of our novel approach.

The current standard of documenting and communicating frozen section margin results is inefficient. We present a novel method of generating 3D digital models of gross tumor specimens to more clearly visualize histopathological margin results. Fifty-five head and neck specimens were scanned and virtually "inked" using 3D software. These 3D specimen maps were displayed in the operating room to provide the surgeon with a real-time specimen-to-defect relationship by which further resections could be guided. Margin results were reported within an average of 34 min using the proposed workflow. The scanner rendered accurate models of specimens that exceeded 3.0 × 3.0 × 3.0cm. Critical specimen features to consider were size, color, textural complexity, and the presence of discernible anatomic landmarks. Optical 3D scanning technology can improve the quality of head and neck margin documentation and the efficiency with which results are communicated between the pathologist and surgeon.

Xenophobic attitudes and representations in Social Media during Covid-19 pandemic in India

Social media activity was reported to have significantly increased during the pandemic period as most of the daily routines transformed into the digital space. On the verge of this new normality of the post-pandemic, exploring virtual space would contribute in analysing and shaping the future digital media discourse. This paper attempted to explore the politics of representation in digital space using Foucauldian theories of power and discipline. A qualitative exploration of the xenophobic attitudes and representation was conducted on 123 young adults to understand how health concerns associated with the pandemic influenced social representations and marginalization of certain social sections and how participants recognized and understood their contribution to this group polarization. Thematic analysis of participant opinions indicated a significant change in polarization and attitude towards out-groups following the pandemic outbreak. The existing hierarchical homogenization and polarization of the marginalized moderated by polarized political affinities were found to be translated into digital space intensifying xenophobic attitudes.&#x0D; Keywords: Xenophobia, covid-19 pandemic, marginalization, social media representation.

Recurrence Patterns After Hepatectomy With Very Narrow Resection Margins for Hepatocellular Carcinoma.

BackgroundThe extent of hepatic resection In HCC depends on the remnant liver reserve or the proximity of the tumor to major vessels. In this study, we evaluated the effects of very close resection margins on postoperative recurrence.MethodsConsecutive LR for HCC between 2003 and 2009 were studied. Patients were divided into groups with very narrow (≤1 mm) or wider (>1 mm) resection margins. Propensity score matching (PSM) was used to balance demographic, surgical, and pathological factors.Results983 patients were included in the study. After PSM, 173 patients were analyzed in each group. 5-year tumor recurrence and survival rates were comparable. Most recurrences were multiple intrahepatic. Section margin recurrences were similar in both groups. By multivariate analysis, tumor size >5 cm was associated with a very narrow resection margin, whereas low platelet count and tumor macrovascular invasion were significant factors related to tumor recurrence.ConclusionsPatients with very narrow surgical margins showed outcomes comparable to those with wider surgical margins. Most recurrences were multiple intrahepatic and associated with the degree of portal hypertension and adverse tumor biology. Although wide surgical margins should be aimed whenever possible, a narrow tumor-free margin resection still represents an effective therapeutic strategy.

Role of Theatricality in Samuel Fyzee-Rahamin's Play Daughter of Ind

This study aims at investigating the theatrical aspects of SamuelFyzee-Rahamin’s play text Daughter of Ind. The playwright's theatricality comprises of a variety of distancing devices that are artistically positioned to realize the intended sociopolitical goals. To pop up the spectacle dimension of the said text, various situations, episodes, and personages are shrewdly juxtaposed against each other. This phenomenon inevitably necessitates the sense of urgency, immediacy, and the unfolding of the dialogic filters. A paradigm of analogies is introduced intentionally to complement and reinforce the dialectical configurations. Histrionic expressions and actions push the characters and the discourses towards the stagy world of acting. Theatrical imagery, the intervention of supernatural elements, the polyphony of competitive ideologies, and the narrational voice are the other features of theatricality that smartly challenge the coercive structures like patriarchy,colonialism, and the marginalization of the weak sections of the Indian society.Naivety is a common technique used by political dramatists to successfully enlist the attention of the audience. A theoretical framework for this study consists of postmodern theories on theater, especially Wladimir Krysinski’sessay Changed Textual Signs in Modern Theatricality.

Inter-Correlations Between Various High-Risk Pathological Factors in Resected Buccal Mucosal Squamous Cell Carcinoma

<h3>Purpose/Objective(s)</h3> While exploring histopathological high-risk factors for squamous cell oral cancer most studies have included oral tongue as major subsite in their patient population. Buccal mucosal squamous cell carcinoma (BMSCC) being rare in developed countries is a less studied site in this regard. Hence most of the knowledge we have about high-risk factors of BMSCC is extrapolated from oral tongue carcinoma. The objective of this study was to explore inter-correlations between various pathological high-risk factors found in resected specimen of BMSCC. <h3>Materials/Methods</h3> It was a retrospective analysis in which we reviewed the final histopathology of surgical specimen of 150 patients with BMSCC who had undergone upfront surgical resection followed by adjuvant therapy. Various high-risk factors studied were pT Stage, pN Stage, depth of invasion (DOI), grade, perineural invasion (PNI), lymphovascular invasion (LVI), tumor thickness (TT), worst pattern of invasion (WPOI), and extranodal extension (ENE). Inter-correlations were performed between various pathological factors using Spearman's correlation test. <h3>Results</h3> Inter-correlation between various factors were found and shown in Table. <h3>Conclusion</h3> pT stage showed significant positive correlation with pN stage, TT, DOI, PNI, nodal deposit size and with ENE. pN stage showed significant positive correlation with pT stage, PNI, LVI, WPOI and ENE. PNI showed significant positive correlation with pT stage, pN stage, nodal deposit size, ENE, LVI, DOI, TT, WPOI. LVI showed significant positive correlation with PNI, WPOI, pN stage, nodal deposit size and ENE. DOI showed significant positive correlation with pT stage, PNI, TT. TT showed significant positive correlation with pT stage, PNI and DOI. WPOI showed significant positive correlation with pN stage, frozen section margin, PNI, LVI and ENE. ENE showed significant positive correlation with pT stage, pN stage, PNI, LVI and WPOI. Grade, configuration and margin status of the tumor showed no significant association with any of the histopathologic variable. Many of these correlations are not shown in oral tongue cancer in most studies. Hence, it is appropriate that intercorrelation between these factors in BMSCC should be dealt differently than in oral tongue cancer. BMSCC may have different biology than oral tongue cancer.

English

BACKGROUND A key technique that is used by the pathologists during intraoperative consultation is frozen section evaluation. It is very important for the surgeons to know if the surgical margin is clear of malignant cells and the status of dysplasia during oncosurgery. There should be concordance between the frozen section margin and paraffin-embedded section. The purpose of the study was to evaluate and validate the accuracy of frozen section surgical margin status in oral squamous cell carcinoma (OSCC) among 2 observers. METHODS A total of 25 histologically diagnosed OSCC cases from April 2018 to April 2019 were included in the study. A total of 122 surgical margin slides (61 frozen sections and paraffin-embedded slides) were retrieved. The interobserver agreement of frozen section margin status with paraffin-embedded was analyzed. RESULTS Interobserver agreement in frozen section margin was 73.80 % with a kappa value of 0.048 (slight) and P-value 0.344. The interobserver agreement for paraffinembedded margin was 93.40 % with a kappa value of 0.572 (moderate) and P-value 0.005. The concordance between frozen and paraffin section by observer 1 was 85.20 % and by observer 2 was 95.10 %. CONCLUSIONS The rate of discordant will get reduced by accurate sampling along with better communication between pathologist and surgeon and at times of uncertainty, a second pathologist’s opinion can be considered for re-evaluating the interpretations. KEY WORDS Frozen Section Margin Status, Interobserver, Paraffin Embedded Margin Status, OSCC

PD61-07 NEUROVASCULAR STRUCTURE-ADJACENT FROZEN-SECTION EXAMINATION (NEUROSAFE) ROBOTIC ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY: OUTCOMES FROM 500 CONSECUTIVE CASES IN THE UK

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy V (PD61)1 Sep 2021PD61-07 NEUROVASCULAR STRUCTURE-ADJACENT FROZEN-SECTION EXAMINATION (NEUROSAFE) ROBOTIC ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY: OUTCOMES FROM 500 CONSECUTIVE CASES IN THE UK Jonathan Noël, Neil Spencer, Siya Lodhia, Seiver Karim, Surina Taneja, Darius Moghanchizadeh, Arvind Nayak, Ashwin Tamhankar, Rajiv Swamy, Samita Agarwal, Ashish Narula, Tim Lane, Jim Adshead, and Nikhil Vasdev Jonathan NoëlJonathan Noël More articles by this author , Neil SpencerNeil Spencer More articles by this author , Siya LodhiaSiya Lodhia More articles by this author , Seiver KarimSeiver Karim More articles by this author , Surina TanejaSurina Taneja More articles by this author , Darius MoghanchizadehDarius Moghanchizadeh More articles by this author , Arvind NayakArvind Nayak More articles by this author , Ashwin TamhankarAshwin Tamhankar More articles by this author , Rajiv SwamyRajiv Swamy More articles by this author , Samita AgarwalSamita Agarwal More articles by this author , Ashish NarulaAshish Narula More articles by this author , Tim LaneTim Lane More articles by this author , Jim AdsheadJim Adshead More articles by this author , and Nikhil VasdevNikhil Vasdev More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002098.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To report the United Kingdom’s largest single centre experience of robotically assisted laparoscopic radical prostatectomies (RALP), using the neurovascular structure -adjacent frozen-section (NeuroSAFE) technique. We describe its’ efficacy on histopathological and functional outcomes, to aid units in their early stages of adoption of this technique. METHODS: We prospectively collected data from November 2012 – December 2019 on 520 patients who underwent RALP with NeuroSAFE at our Institution. Exclusion criteria was pre-operative indication to perform an extra-fascial nerve spare or wide local excision prostatectomy, including salvage RALP. Our Institution’s database was analysed for false positive frozen section (FS) margins as confirmed on paraffin histopathological analysis; console and FS report time; functional outcomes of potency, continence, surgical margins and biochemical recurrence (BCR). RESULTS: The median (range) of operative console time of our NeuroSAFE RALPs was 145 (90–300) minutes. The mean time of FS processing to report was 35 minutes. In our cohort, positive FS was seen in 30.7% (160/520) of patients, with a confirmatory paraffin analysis in 91.8% of cases (147/160). The neurovascular bundles (NVBs) that underwent secondary resection, contained tumour in 26.8% (43/160) of cases. 77.5% T2, 22.3% T3 cancer was found on final prostate specimen analysis. Biochemical recurrence (BCR) was 6.7% (35/520), of which FS was positive in 40% (14/35) of those cases. Bilateral nerve spare (NS) RALP was statistically significant for potency, over wide excision due to positive FS. There was insufficient evidence of a statistically significant association of urinary incontinence and positive surgical margin rates according to NS or NVB resection. CONCLUSIONS: Our mid to long term results of NeuroSAFE RALP describes acceptable functional outcomes. NeuroSAFE enables intra operative confirmation of the oncologic safety of a NS procedure. Patients with a positive FS on NeuroSAFE can be converted to a negative surgical margin (NSM) by wide resection of the NVB. This spared 1 in 4 men from positive margins posterolaterally in our series. No other technique has been externally validated to offer intraoperative ‘real time’ feedback on the oncologic safety of NS RALP. Limitations are the absence of a matched contemporary cohort of NS RALP without NeuroSAFE in our centre; three surgeons with variable NVB preservation techniques and three Uro-pathologists. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1069-e1069 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan Noël More articles by this author Neil Spencer More articles by this author Siya Lodhia More articles by this author Seiver Karim More articles by this author Surina Taneja More articles by this author Darius Moghanchizadeh More articles by this author Arvind Nayak More articles by this author Ashwin Tamhankar More articles by this author Rajiv Swamy More articles by this author Samita Agarwal More articles by this author Ashish Narula More articles by this author Tim Lane More articles by this author Jim Adshead More articles by this author Nikhil Vasdev More articles by this author Expand All Advertisement Loading ...

Resource Control and Secessionist Movements in Nigeria: Implications for National Unity and Development

The geographical entity called Nigeria came into existence on January 1, 1914, when the then Northern and Southern protectorates were merged. Since then, successive governments in the country have been trying to unite the diverse elements that make up the country, all to no avail. From the North and South, there have been called for the dismemberment of the country due to the failure of successive administrations to address the national questions. It is against this backdrop that this paper examines the issues confronting Nigeria’s unity and suggests a way forward. The paper is anchored on elite and frustration-aggression theories and relies on secondary sources of data. The paper contended that injustice, high-handedness, and marginalization of certain sections or regions of the country in the governance of the country accounted for resource control and secessionist movements in the country. The paper suggests justice and inclusiveness of all sections of the country in the affairs of the state, among others.