Surgical Specimen Volume Research Articles

Abstract PO5-03-01: Clinical outcomes of breast-conserving surgery under local anesthesia versus general anesthesia for breast malignancies

Abstract Clinical outcomes of breast-conserving surgery under local anesthesia versus general anesthesia for breast malignancies Hwajeong Lee, Hyunjong Jo, Eunhye Kang, Ji-Jung Jung, Ik Beom Shin, Jin Young Byeon, Changjin Lim, Hong-Kyu Kim, Hyeong-Gon Moon, Wonshik Han, Han-Byoel Lee Purpose With the increase in the incidence and proportion of stage I and in situ breast cancer, there is a growing trend for de-escalation of surgery. Several ongoing trials are evaluating the omission of sentinel lymph node biopsy (SLNB), including the SOUND trial, which showed no difference in disease-free survival. Breast-conserving surgery (BCS) under local anesthesia (LA) could be performed when no axillary surgery is necessary and could potentially reduce the physical and psychological burden on patients caused by surgery compared to BCS under general anesthesia (GA). We aim to compare the clinical outcomes between BCS under LA versus GA in patients who did not require SLNB. Methods We retrospectively collected and analyzed data from 116 patients who received BCS under LA from January 2021 to June 2023 and 260 patients who received BCS under GA in 2022. Clinical tumor size, pathologic tumor size (both including in situ carcinoma), surgical specimen volume, resection margin (RM) positivity, re-excision rate, operation time, and length of hospital stay were compared. Result There was no difference between LA and GA in terms of age, BMI, and proportion of in situ cancer. The LA group had a higher proportion of tumors with clinical tumor size ≤ 2cm. The LA group had a higher RM positive rate (11.2 vs. 5.4%, p=0.043) and re-excision rate (12.9 vs 3.5%, p < 0.001). According to tumor size, the higher RM positivity was only observed in clinical tumor size >1cm & ≤ 2cm group (p=0.039). In patients whose clinical tumor size ≤ 2cm was upgraded to pathologic tumor size > 2cm, there was no difference in RM positivity between the two groups (5/18 [27.8%] vs. 4/34 [11.8%], p=0.247). A smaller surgical specimen volume was excised under LA (22.01 ± 14.11 vs 65.67 ± 48.43 cm3, p < 0.001). The overall operation time (64±16 vs 73±22 min, p < 0.001) and hospital stay (1 ± 0 vs 4 ± 1 days, p < 0.001) was shorter in the LA group Conclusion Breast-conserving surgery under LA showed a higher RM positive rate, of which most were in patients with discordance in clinical and pathologic tumor size. Although this resulted in a higher re-excision rate, the smaller surgical specimen volume, shorter operation time, and hospital stay for BCS under LA could positively impact patient recovery and quality of life. The benefits of LA should be considered when evaluating the de-escalation of surgery for breast malignancies. Citation Format: Hawjeong Lee, Hyunjong Jo, Eunhye Kang, Ji-Jung Jung, Ik Beom Shin, Jin Young Byeon, Changjin Lim, Hong-Kyu Kim, Hyeong-Gon Moon, Wonshik Han, Han-Byoel Lee. Clinical outcomes of breast-conserving surgery under local anesthesia versus general anesthesia for breast malignancies [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 PO5-03-01.

The effect of preoperative embolization rate on surgical outcomes for carotid paraganglioma resection.

Preoperative embolization of paragangliomas decreases tumor volume and reduces intraoperative blood loss. This study aimed to evaluate the effect of the rate of devascularization achieved by preoperative embolization of carotid body tumors on surgical outcomes. Patients with carotid body tumors who underwent preoperative transarterial embolization between 2013 and 2024 were included in this retrospective study. The Shamblin classification of all patients was carried out using radiological imaging. Devascularization rates obtained after the embolization of carotid body tumors were determined from angiographic images. Patients were divided into two groups: near-complete embolization (devascularization rate >90%) and incomplete embolization (devascularization rate <90%). Hemoglobin loss was calculated with blood tests before and immediately after surgery. Tumor volume loss was calculated by preoperative radiological tumor volume and postoperative surgical specimen volume. Hemoglobin loss, tumor volume loss, and postoperative complication rates of the two groups were compared. A total of 31 patients with carotid body tumors who underwent surgery were included in the study. Near-complete embolization was achieved in 21 patients (67.74%), while incomplete embolization was achieved in 10 patients (32.25%). Shamblin classification was statistically similar (p>0.05) between the two groups. The vascular complication rate in the near-complete embolization group was significantly lower than in the incomplete embolization group (p=0.027). However, no significant difference was observed in neurological complication rates, hemoglobin loss, and tumor volume loss parameters between the two groups (p>0.05). The preoperative devascularization rate should be at least 90% to minimize the risk of vascular complications.

BIOL-24. USING NEEDLE WASH SPECIMEN AFTER STEREOTACTIC BIOPSY TO DEVELOP PDOX MODELS OF DIPG AND DIFFUSE MIDLINE GLIOMAS

Abstract Obtaining viable tissue remains a major barrier for lab-based studies, especially in brain tumors deemed surgically unresectable such as diffuse midline gliomas. Surgical biopsy is performed for those tumors invested in deep and vital brain structures however, biopsied specimens are usually of small volume without additional tissue for research after clinical testing. To overcome the barrier of limited surgical specimen volume, we partnered with neurosurgeons to develop a protocol which procures viable cells from discarded biopsy needle after stereotactic biopsies to develop patient-derived orthotopic xenograft (PDOX) models. After procurement of surgical specimen and prior to disposal of biopsy needle, each stereotactic biopsy needle was washed with FBS media twice. Wash solution was collected and immediately transported on ice to the research lab. Cell number was counted for in vitro culture and for orthotropic in vivo tumor implantation. To date, 29 samples of biopsy needle washes have been obtained including 12 diffuse midline gliomas of the brain stem, 8 supratentorial diffuse midline gliomas, and 3 pineal region tumors with harvested cell number from no visible cells to 5.3 million cells (median 1 million). 14 tumors have been orthotopically implanted into matched locations of immunodeficient mouse brains. Tumor formation was confirmed in 4 out of 15 (28.5%), including 2 brain stem tumors, 1 infiltrating astrocytoma, and 1 midline glioma, after implantation of cell numbers as low as 12,500. 3 models were successfully sub-transplanted to passages II and III. Histological examination confirmed the replication of key pathological features of the originating patient tumors. In conclusion, we have developed a novel protocol to procure clinical specimen by using wash solution of stereotactic brain tumor biopsy needles for surgically unresectable tumors. Our work demonstrates a new possibility for clinical sample acquisition and tumor modeling, opening new frontiers in the field of pediatric brain tumor research.

Breast Anthropometry: Values and Application in Breast Surgery for Vietnamese Women.

Objectives:Breast surgery requires a high aesthetic outcome and should be individualized according to anthropometric breast and body characteristics. This study aimed to measure the anthropometric parameters and volume of Vietnamese female breasts and their application in breast surgery. Subjects and Methods:A cross-sectional descriptive study enrolled 240 women treated at Vietnam National Cancer Hospital aged 18 to 78 years old. The measurements were obtained with the patient sitting upright in the anatomic position based on key landmarks and breast volume was also assessed. Differences in breast anthropometric measurements and breast volume were compared between groups of age, BMI, and the number of children. The correlation between breast volume calculated by anthropometric method and surgical specimen volume was evaluated to determine the accuracy of this method. Results:The mean values of the right and left breast volumes are less statistically different. Mean breast volume of the right breast and left breast were 396.1±182.3ml and 399.4±182.2ml, respectively. The proportion of breast ptosis increased with age (p=0.027), Body mass index (p<0.0001), and the number of children (p=0.004). The most important factor affecting the size and shape of the breast was body mass index (BMI). Mastectomy specimen volume and breast volume calculated by the anthropometric method are highly correlated with r=0.966. Conclusions:The results of this study should be applied in clinical practice in breast surgery for Vietnamese women.

The INTEND 1 randomized controlled trial of duct endoscopy as an indicator of margin excision in breast conservation surgery.

With early detection, breast conservation surgery with adequate surgical margins is the standard of care. The aim of this study was to evaluate the use of pre-operative duct endoscopy (DE) to target surgical resection, improve adequate margins and reduce re-excision operations. Women with DCIS, stage I and II breast cancer suitable for breast conservation were randomized to DE-assisted wide local excision versus standard wide local excision (without DE). The primary endpoint was margin re-excision rates between the two groups. Secondary end points were: (i) volume differences of the surgical specimen; (ii) whether an extensive in situ component (EIC) influenced successful DE-guided resection. 78 women were randomized: 44 patients to no-DE and 34 patients to the DE group. The median age was 59 (49-65) and 56 (48-64) years in the two groups respectively with mean follow-up of 9.1 (4.2-11.1) years. There were 23 positive findings in 17 women in 30 successful DE procedures (17/30 = 56.7%). The surgical specimen volume, no-DE (17 [IQR 10-29] cm3) and DE 20 [IQR 12-28] cm3), did not differ, p = 0.377. The overall re-excision rate was 20/78 (26%), 9 (20%) and 11 (32% in the no-DE and DE groups, respectively, p = 0.233. This randomized clinical trial was limited by incomplete accrual. DE did not contribute to improved margin excision rates whether a target lesion was visualized or not. The presence of EIC did not improve efficacy of DE.

The Effect of Intraoperative Radiotherapy on Healing and Complications After Sacrectomy and Immediate Reconstruction.

Sacropelvic resection is the treatment of choice for pelvic bone tumors and can be associated with intraoperative electron radiotherapy (IOERT) to optimize local control of the disease. Reconstruction with flaps also is essential to avoid pelvic complications. There is scarcity of publications evaluating outcomes of reconstructive procedures associated with IOERT. A prospective study in 53 patients between 2005 and 2018 was performed. Thirty-four patients received IOERT (group I [GI]) and 19 did not (GII). We examined demographic characteristics, tumor pathology, type of resection and volume of surgical specimen, timing of surgery, IOERT doses, postoperative stay, and complications. We used it for reconstruction rectus abdominis, gluteal, omental and gracilis, superior gluteal artery perforator flap, and free flaps. Colonic adenocarcinoma and chordoma were the most frequent tumors. The median (interquartile range) IOERT dose was 1250 (1000-1250) cGy; operating time was 10.15 (8.6-14.0) hours versus 6.0 (5.0-13.0) hours, hospital stay was 37 (21.2-63.0) days versus 26.0 (12.0-60.0) days, and volume of surgical specimen was 480.5 (88.7-1488.0) mL versus 400 (220.0-6700.0) mL in GI and GII, respectively. Operating time was significantly longer in GI (P < 0.03). There were significant positive correlations between operating time, hospital stay, and volume of surgical specimen. Main complications were exudative wounds (50% vs 31.5%), wound dehiscence (41.1% vs 31.5%), and seroma (29.4% vs 26.3%) in GI and GII, respectively. Complications were similar to previous studies with or without radiotherapy. Under a reconstructive approach, IOERT did not harm flap survival nor increased pelvic complications when compared with similar cases without IOERT.

A Validation Study of Liver Volumetry Estimation by a Semiautomated Software in Patients Undergoing Hepatic Resections

AbstractPurpose The purpose of this study was to validate the use of a semiautomated software for liver volumetry preoperatively by comparing it with the volume of resected specimen in patients undergoing hepatic resections.Materials and Methods This is a single-center retrospective study of patients who underwent estimation of future liver remnant (FLR) using Myrian XP-Liver which is a semiautomated software for hepatectomy. The estimated resection volume, which is the sum of volume of normal liver to be resected and tumor volume, was compared with actual specimen weight to calculate the accuracy of the software. The statistical analysis was performed with SPSS software version 24.Results Data on FLR estimation using the semiautomated software was available for 200 out of 388 patients who underwent formal hepatic resections. The median resected volume of surgical specimen was 650 mL (interquartile range [IQR] 364–950), while the median estimated volume using the Myrian software was 617 mL (IQR 362–979). There was significant correlation between estimated resection volume calculated using the semiautomated method and actual specimen weight (p-value &lt; 0.0001) with the Spearman’s correlation value of 0.956.Conclusion The estimated volume of liver to be resected as calculated by the semiautomated software was accurate and correlated significantly with the volume of resected specimen, and hence, the estimation of FLR volume may likely correlate with the true postoperative residual liver volume. In addition, the software-based liver segmentation, FLR estimation, and color-coded three-dimensional images provide a clear road map to the surgeon to facilitate safe resection.

Correlation between clinical grading of adenoid or tonsil hypertrophy and adenoid or tonsil volume post adenotonsillectomy: a prospective cohort study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Measuring adenoid or tonsil volume in surgically removed specimens is likely the most accurate method for quantifying adenotonsillar hypertrophy severity which may predict the extent of surgery to curtail post tonsillectomy haemorrhage a potential lethal complication.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; All patients with adenoid or tonsil hypertrophy were graded clinically while the objective grading by volumetric saline displacement in accordance with Archimedes’ principle; between August 1, 2017 to July 31, 2019 at the Jos University Teaching Hospital, Plateau State, Nigeria. Data analysis was by the SPSS version 21.0 Chicago IL, USA. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The study had 96 participants with a M:F=1.7:1. Age range was 9 months to 51 years, median was 3 yrs, mean was 9.5 yrs±15.5 yrs with 83 (86.5%) who were ≤18 yrs. Main features of this study, no. of patients in snoring was 83 (86.5%), nasal obstruction 71 (74.0%), rhinorrhoea 32 (33.3%), noisy breathing 23 (24.0%), dysphagia- 18 (18.8%), mouth breathing 18 (18.8%). Grading of this study was 78 (81.2%) were Brodsky grade III &amp;amp; IV while 72 (75.0%) had ANR of ≥0.5. Blood loss was range 10 ml to 250 ml, median 35 ml, mean 52.7±46.9 ml while 51 (63.0%) had blood loss of ≤50 ml. Volume of surgical specimen of adenoid; range 0.20-4.50 ml, mean 1.56±0.83 ml while tonsil; (Rt)-range 1.00-12.50 ml, mean 3.18±1.97 ml. There was a positive correlation between adenoid or tonsil grade and volume at 99% CI; (r)=0.409, (p=0.000) and grade (mean) 3.11±0.78, volume (mean) 3.18±1.96.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study establishes a positive correlation between clinical grading of adenoid or tonsil and volume with a certain level of accuracy which may predict extent of surgery to avoid post tonsillectomy hemorrhage, a life-threatening/lethal complication from excessive, partial or suboptimal surgery commonly.&lt;/p&gt;

Definition of Tumor Bed Boost in Oncoplastic Breast Surgery: An Understanding and Approach

IntroductionDefinition of the tumor bed (TB) is currently guided by intraoperatively placed metal clips. However, this traditional planning method may not be sufficient for tumor cavity defect refilled with modern oncoplastic breast surgery. We explored the impact of a close cooperation between surgeon and oncologist on the accuracy of TB contouring after partial breast reconstruction with chest wall perforator flaps (CWPF). Patients and MethodsA retrospective review of patients who received radiotherapy after CWPF was performed. TB and boost volume were defined by the surgeon, considering clips and the typical radiologic appearance of the flap, and by a radiation oncologist, and results were compared with the surgical specimen volume (SPV). The boost volume was marked as 5 mm penumbral ring thickness of native breast tissue wall around the replaced flap (nonbreast tissue). ResultsThere were no significant differences between SPV and surgeon-defined TB values. Conversely, the radiation oncologist–defined values were significantly smaller than the actual SPV. If a ring-shaped TB boost was delivered, this would have allowed a potential reduction of irradiated tissue of 127.6%. ConclusionTB definition solely by surgical clips may be prone to inaccuracy in case of volume replacement oncoplastic breast surgery. Our approach of combining the clips with the redefinition of the flap on computed tomographic scan may provide more accurate TB definition. Although an ideal ring-shaped boost might be difficult to reproduce in practice, it introduces a new paradigm: a lower radiation dose inside TB is tolerable, if not desirable, at least in CWPF.

18F]Fluorocholine Uptake of Parathyroid Adenoma Is Correlated with Parathyroid Hormone Level.

The aim of the study was to investigate the relationship between [18F]fluoromethyl-dimethyl-2-hydroxyethylammonium ([18F]FCh) positron emission tomography (PET) parameters, laboratory parameters, and postoperative histopathological results in patients with primary hyperparathyroidism (pHPT) due to parathyroid adenomas. This retrospective study was conducted in 52 patients with biochemically proven pHPT. [18F]FCh-PET parameters (maximum standardized uptake value: SUVmax) in early phase (after 2min) and late phase (after 50min), metabolic volume, and adenoma-to-background ratio (ABR), preoperative laboratory results (PTH and serum calcium concentration), and postoperative histopathology (location, size, volume, and weight of adenoma) were assessed. Relationship of PET parameters, laboratory parameters, and histopathological parameters was assessed using the Mann-Whitney U test and Spearman correlation coefficient. MRI characteristics of parathyroid adenomas were also analyzed. The majority of patients underwent a PET/MR scan, 42 patients (80.7%); 10 patients (19.3%) underwent PET/CT. We found a strong positive correlation between late-phase SUVmax and preoperative PTH level (r = 0.768, p < 0.001) and between late-phase ABR and preoperative PTH level (r = 0.680, p < 0.001). The surgical specimen volume was positively correlated with the PET/MR lesion volume (r = 0.659, p < 0.001). No significant association was observed between other [18F]FCh-PET parameters, laboratory parameters, and histopathological findings. Cystic adenomas were larger than non-cystic adenomas (p = 0.048). [18F]FCh uptake of parathyroid adenomas is strongly correlated with preoperative PTH serum concentration. Therefore, the preoperative PTH level might potentially be able to predict success of [18F]FCh-PET imaging in hyperparathyroidism, with higher lesion-to-background ratios being expected in patients with high PTH. PET/MR is accurate in estimating the volume of parathyroid adenomas.

Comparative Evaluation of Iodine-125 Radioactive Seed Localization and Wire Localization for Resection of Breast Lesions

PurposeRadioactive seed localization (RSL) uses a titanium seed labeled with iodine-125 energy for surgery of nonpalpable breast lesions. RSL facilitates radiology–surgery scheduling and allows for improved oncoplasty compared with wire localization (WL). The purpose of this work was to compare the 2 techniques. MethodsWe performed a retrospective study of all breast lesions operated with RSL between February 2013 and March 2015 at our university institution, and compared with an equivalent number of surgeries performed with a single WL. Imaging and pathology reports were reviewed for information on guidance mode, accuracy of targeting, nature of excised lesion, size and volume of surgical specimen, status of margins, and reinterventions. ResultsA total of 254 lesions (247 women) were excised with RSL and compared with 257 lesions (244 women) whose surgery was guided by WL. Both groups were comparable in lesion pathology, guidance mode for RSL or WL positioning, and accuracy of targeting (98% correct). Mean delay between biopsy and surgery was 84 days for RSL versus 103 after WL (P = .04). No differences were noted after RSL or WL for surgical specimen mean weight, largest diameter, and volume excised. For malignancies, the rate of positive margins was comparable (2.8%-3%), with 5 of 10 women in the RSL group who underwent a second surgery displaying residual malignancy compared with 3 of 9 women in the WL group. ConclusionsRSL is safe and accurate, and has comparable surgical endpoints to WL. Because RSL offers flexible scheduling and facilitated oncoplasty, RSL may replace WL for resection of nonpalpable single breast lesions.

Ecografía transrectal y tacto rectal en la estimación del volumen prostático. Aplicación a la práctica clínica

ObjectiveTo compare the accuracy of rectal examination and transrectal ultrasound for classifying patients for endoscopic resection or retro-pubic prostatectomy. Material and methodsA retrospective analysis was performed on a total of 133 patients who underwent radical prostatectomy for prostate cancer, collecting data on the ultrasound prostatic volume, the volume of the surgical specimen, and prostate size in digital rectal examination.Patients that had previously undergone prostatic transrectal resection, taking androgen treatment, and who had received radiotherapy, were excluded.Digital rectal examination and ultrasound prostatic volume were divided into 2 categories (I-II and III-IV, and <70 and >70 cc, respectively).To analyse the accuracy of both tests, the areas under the ROC (receiver operating characteristic) curve were compared, using the volume of the surgical specimen as the reference standard.The differences between the 2 methods were analysed using the Hanley-McNeil test. ResultsIn approximately 90% of cases, the volume of most of the pieces was <70 cc, prostate size in digital rectal examination was I-II, and using ultrasound the volume was <70 cc.The association between prostate volume estimated by digital rectal examination and volume of surgical specimen achieved an area under the curve of 0.69 (P=.03), whilst it was 0.77 (P=.001) between transrectal ultrasound and volume of surgical specimen. The differences between the 2 methods were not statistically significant (P=.38). ConclusionsOur study results show that the transrectal ultrasound does not significantly increase the classification capacity of digital rectal examination.

Additional Cavity Shaving at the Time of Breast-Conserving Surgery Enhances Accuracy of Margin Status Examination.

We addressed the impact of separate cavity margin excision (shaving) during breast-conserving surgery (BCS) for breast cancer on specimen volume, tumor margin clearance, re-excision rate, local recurrence and survival. A retrospective case-matched study was performed on 298 women with stage 0-III breast cancer; 179 patients received shaving (shaving+lumpectomy group; SLG) and 119 patients did not (lumpectomy group; LG). The two groups had similar baseline characteristics. The median volume of surgical specimen was 131.9cc in the SLG versus 134.8cc in the LG (p=0.81), and surgical margins were tumor-free in 90.7% of cases in the LG versus 92.7% in the SLG (87.1% before shaving) (p=0.69). The re-excision rate was 14.3% in the LG versus 10.6% in the SLG (p=0.44). In the SLG, shaving spared 10 (5.6%) patients from reoperation (positive lumpectomy margins but tumor-free shaving margins) (p=0.11), and only 2/19 (10.5%) patients in the SLG had tumor-free response at histological examination of re-excised margins compared with 10/17 (58.8%) cases in the LG (p=0.004). Tumor in shavings was found in 44/156 (28.2%) patients having tumor-free lumpectomy margins. At multivariate analysis, distance of tumor from lumpectomy margins, tumor multifocality, receptor status, and tumor size were related to tumor persistence in shavings. Median follow-up was 27months (range 23-35), and two patients had tumor relapse in the SLG versus none in the LG (p=0.16). Overall survival was 100% in both groups. Shaving does not significantly decrease the re-excision rate but provides wider clear margins in most procedures. It ensures more accurate margin examination and decreases false-positive margin rate, without any increase in removed breast-tissue volume.

Multimodality Image-based Target and Normal Structure Delineation for Dose Painting of Pancreatic Cancer

LC volume reduction. The mean LC maximum depths based on CT1 and CT2 were 6.4 1.3 cm and 5.2 1.3 cm, respectively (p Z 0.0002). Volume encompassed by the boost plan prescription isodose surface (V100%) was reduced in 18/20 (90%) patients after re-planning. V100% was 183.6 142.0 cc based on CT2 plans and 320.6 236.6 cc based on CT1 boost plans (p Z 0.008). While all 20 patients (100%) required a photon mini-tangential boost technique based on CT1, 8 patients (40%) became eligible for electron boost treatment after re-simulation. These 8 patients had a 2.7-fold greater absolute reduction in the mean V100% compared to patients treated with mini-tangents. This difference in mean V100% reduction was further pronounced, 4.5-fold, in 10 patients who experienced an increased LC volume on CT1 relative to pathologic surgical specimen volume. Large CT1 LC volume correlated with an increased reduction in CT2 LC maximum depth (Pearson correlation coefficient Z 0.42, p Z 0.066), and an increased reduction in V100% (Pearson correlation coefficient Z 0.63, p Z 0.003). Conclusions: In breast cancer patients with large lumpectomy cavities and maximum lumpectomy cavity depths >5 cm on initial CT simulation, tumor bed boost planning based on a newly acquired CT toward the end of the whole breast irradiation course is associated with significant treatment volume reduction and may result in a change of treatment technique. This has the potential to improve cosmesis, a clinically important outcome in breast-conserving therapy. Author Disclosure: N. Kovalchuk: None. K.K. Reddy: None. H. Bohrs: None. M.M. Qureshi: None. M.T. Truong: None. A.E. Hirsch: None. J. Willins: None. L.A. Kachnic: None.

Interfraction accumulation of seroma during accelerated partial breast irradiation: Preliminary results of a prospective study

PurposeTo quantify and characterize the process of seroma accumulation during accelerated partial breast irradiation using multicatheter balloon brachytherapy. Materials and MethodsTwenty-two patients were treated using the Contura Multilumen brachytherapy catheter to a dose of 34Gy in 10 fractions over 5 treatment days. Serial aspirations of the vacuum port of the catheter were performed at the time of CT simulation and before each treatment. Volume and characteristics of fluid drawn were recorded. Univariate analysis was performed to evaluate various factors predictive of seroma formation. ResultsMedian patient age was 59.5 years, body mass index was 31, and volume of surgical specimen was 62.4cm3. Median time from breast conservation surgery to placement of Contura catheter was 18.5 days. Pericatheter seroma, typically scant with a median volume of 0.75mL, was noted in 91% of patients at CT simulation. A total of 203 aspirations were performed with a median-aspirated seroma volume of 4.05mL. There was no significant correlation between the volume of seroma and histology (invasive vs. in situ), quadrant of location, body mass index, reexcision or reoperation, days from breast conservation surgery to balloon placement, or the volume of specimen removed. Radiation treatment factors, including balloon volume, balloon to skin distance, and planning target volume evaluation, also did not correlate with aspirated seroma. ConclusionsInterfraction seroma accumulation has a variable pattern of development with no discernible predictors of occurrence. Routine pretreatment aspirations via vacuum port may potentially improve dosimetric reproducibility for a minority of patients.

Transrectal Ultrasound versus Magnetic Resonance Imaging in the Estimation of Prostate Volume as Compared with Radical Prostatectomy Specimens

Introduction: There are relatively few studies that compare the use of transrectal ultrasound (TRUS) to magnetic resonance imaging (MRI) to estimate the prostate volume. In this study, we compared the prostate volumes measured with MRI and TRUS with a surgical specimen volume. Patients and Methods: Seventy-three patients underwent TRUS examination of the prostate prior to radical prostatectomy. All specimens were weighed and measured when freshly excised. The corresponding volume measurements calculated using TRUS and MRI were compared retrospectively with the measured volumes of freshly excised prostate. Results: The volume measured with TRUS and MRI was linearly related to the radical prostatectomy volume. The estimated increase in the prostate volumes measured with TRUS and MRI per specimen volume was 0.9508 and 0.9331 by regression analysis, respectively. If the prostate volumes were <35 cm³, the prostate volumes measured with MRI overestimated the specimen volumes. If the prostate volumes were >35 cm³, the prostate volumes measured with MRI underestimated the specimen volumes. The classic ellipsoid formula was adequate for determining the prostate volume. Conclusions: In this study, MRI and TRUS gave different volumes. MRI is more accurate than TRUS for determining the prostate volume. However, because TRUS is inexpensive, noninvasive, and almost as accurate as MRI, it should be the preferred method for measuring the prostate volume.

The influence of preoperative core biopsy on specimen volume in breast conserving therapy for breast cancer patients

795 Background: Preoperative core biopsy gives us important information on suspect lesions of the breast before surgery. Operative Management depends on this information. We wanted to know if preoperative core biopsy influences the specimen volume in breast cancer surgery Methods: Surgical specimens of 366 patients were analyzed retrospectively who underwent breast conserving surgery for breast cancer at the Department of Special Gynaecology -University Clinics of Vienna - throughout 1994 to 1998. All specimens were measured 3 dimensional macroscopically before frozen dissection. Results: 249 patients didn't undergo preoperative core biopsy which resulted in an average specimen volume of 135 cm3. Those 117 patients who received core biopsy before surgery had an average specimen volume of 182 cm3. This shows statistical significance (p=0,004). Tumour size was well balanced in both groups. Conclusions: Preoperative core biopsy influences surgical specimen volume in breast cancer patients who undergo breast conserving therapy. Average specimen volume increases significantly if the surgeon gets his information before surgery. We conclude that preoperative core biopsy should be performed in every suspect breast lesion before surgery in order to achieve more local disease control. No significant financial relationships to disclose.

Osteoporosis occurring during potassium thiocyanate therapy for hypertensive disease: Hinchey, J. J., Hines, E. A., and Ghormely, R. K.: Proc. Staff Meet., Mayo Clin. 22:275 (July 9), 1947

To quantify and characterize the process of seroma accumulation during accelerated partial breast irradiation using multicatheter balloon brachytherapy.Twenty-two patients were treated using the Contura Multilumen brachytherapy catheter to a dose of 34 Gy in 10 fractions over 5 treatment days. Serial aspirations of the vacuum port of the catheter were performed at the time of CT simulation and before each treatment. Volume and characteristics of fluid drawn were recorded. Univariate analysis was performed to evaluate various factors predictive of seroma formation.Median patient age was 59.5 years, body mass index was 31, and volume of surgical specimen was 62.4 cm3. Median time from breast conservation surgery to placement of Contura catheter was 18.5 days. Pericatheter seroma, typically scant with a median volume of 0.75 mL, was noted in 91% of patients at CT simulation. A total of 203 aspirations were performed with a median-aspirated seroma volume of 4.05 mL. There was no significant correlation between the volume of seroma and histology (invasive vs. in situ), quadrant of location, body mass index, reexcision or reoperation, days from breast conservation surgery to balloon placement, or the volume of specimen removed. Radiation treatment factors, including balloon volume, balloon to skin distance, and planning target volume evaluation, also did not correlate with aspirated seroma.Interfraction seroma accumulation has a variable pattern of development with no discernible predictors of occurrence. Routine pretreatment aspirations via vacuum port may potentially improve dosimetric reproducibility for a minority of patients.