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Frank Traub, Anthony M Griffin, Jay S Wunder, Peter C Ferguson
BACKGROUND: Soft-tissue sarcomas (STSs) are a heterogeneous group of malignant tumors that can be difficult to treat. This is particularly true after incomplete or unplanned excisions and especially for patients with American Joint Committee on Cancer stage III tumors, who are at high risk for relapse. Numerous studies have shown that an inadequate sarcoma excision is associated with a worse prognosis. However, other reports have suggested an improved prognosis for patients with an initial unplanned excision and subsequent re-excision in comparison with patients who undergo planned primary surgery...
October 15, 2018: Cancer
Alison Laws, Mantaj S Brar, Antoine Bouchard-Fortier, Brad Leong, May Lynn Quan
BACKGROUND AND OBJECTIVES: Using a 2 mm margin criteria, we evaluated the effect of intra-operative margin assessment on margin status and re-excisions following breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS). METHODS: We identified patients undergoing BCS for DCIS from a prospective, population-based database. Multivariable logistic regression was used to determine the effect of specimen mammography, ultrasound and macroscopic assessment by a pathologist on margins and re-excision rates...
October 7, 2018: Journal of Surgical Oncology
Mina M G Youssef, Alfred Namour, Omar Z Youssef, Ahmed Morsi
Oncoplastic surgery (OPS) has emerged as a new approach for extending breast conserving surgery (BCS) possibilities, reducing both mastectomy and re-excision rates, while avoiding breast deformities. OPS is based upon the integration of plastic surgery techniques for immediate reshaping after wide excision for breast cancer. This is a prospective feasibility cohort study of oncoplastic breast surgery after neoadjuvant chemotherapy that was carried at the National Cancer Institute, Cairo University and included 70 patients...
September 2018: Indian Journal of Surgical Oncology
Astrid Botty Van Den Bruele, Bharti Jasra, Carmen Smotherman, Marie Crandall, Laila Samiian
BACKGROUND: Re-excision rates after breast conservation surgery are reported to be 20%-40%. Inaccuracies with specimen orientation may affect margin assessment. This study examined whether the addition of surgeon performed intraoperative inking of the lumpectomy specimen after adoption of margin guidelines would be cost-effective. METHODS: A retrospective review of a prospective surgical database was performed from 2009 to 2017. Patients with initial lumpectomy and a preoperative diagnosis of invasive breast carcinoma or ductal carcinoma in situ (DCIS) were included...
November 2018: Journal of Surgical Research
Jun-Ying Chen, Yi-Jie Huang, Liu-Lu Zhang, Ci-Qiu Yang, Kun Wang
Purpose: The use of oncoplastic reconstruction for breast-conserving surgery (BCS) extends benefits beyond merely minimizing poor cosmetic results. However, the feasibility and oncological safety of oncoplastic surgery (OPS) are controversial. Methods: This meta-analysis aimed to compare the short-term and long-term oncological outcomes of BCS alone and BCS plus OPS. Relevant studies published before July 2017 in the Embase, the Cochrane Library, PubMed, and Web of Science databases were screened and collected...
September 2018: Journal of Breast Cancer
Giuseppe Giudice, Giorgio Favia, Angela Tempesta, Luisa Limongelli, Michelangelo Vestita
From 2005 to 2010, 20 consecutive patients with fully manifested neurofibromatosis type 1 (NF1) underwent elective neurofibroma resection at our institution (Departments of Plastic Surgery and of Odontostomatology). Specimens were photographed under optical microscope and confocal laser scanning microscopy (CLSM) with ultra-high accuracy of detail, including depth of field. Patients were followed up for a minimum of 4 years and up to a maximum of 12 years, postsurgery. While all nonrecurring lesions showed intense fluorescence, six of the seven lesions with absence of fluorescence under CLSM recurred at a mean of 5...
2018: Dermatology Research and Practice
Jennifer Marchetti Cautela, Alice Mannocci, Camilla Reggiani, Flavia Persechino, Federica Ferrari, Elena Rossi, Erika Passini, Pierantonio Bellini, Marco Meleti, Sara Wertzberger Rowan, Cristina Magnoni
The rising incidence of Non Melanoma Skin Cancers (NMSC) leads to a high number of surgical procedures worldwide. The strict compliance with international guidelines with regard to excisional margins may help decrease the number of re-excision procedures and reduce the risk of NMSC recurrence. The aim of this study was to investigate the prevalence of excisional margins as recommended by the European Academy of Dermatology and Venereology (EADV) and the European Dermatology Forum (EDF) guidelines, and the factors (demographic or clinical) that influence surgeons' compliance with these guidelines...
2018: PloS One
Batul H Al-Zubeidy, Hannah Weiss, Seema A Khan
The local therapy of breast cancer continues to evolve toward less surgery. Breast conservation is firmly in place, with recent trends toward decreased rates of re-excision. Axillary dissection is becoming a rare operation and is being replaced by sentinel node biopsy. The switch to sentinel node biopsy occurred first in patients with pathologically tumor-free nodes, and later in patients with limited nodal disease. Sentinel node biopsy is now also widely used in patients with pathologically positive nodes who receive neoadjuvant chemotherapy...
September 2018: Clinical Advances in Hematology & Oncology: H&O
David M McClatchy, Rebecca A Zuurbier, Wendy A Wells, Keith D Paulsen, Brian W Pogue
BACKGROUND: Roughly 23% of breast conserving surgery (BCS) patients undergo a second re-excision procedure due to pathologically positive surgical margins. We investigated the feasibility and potential value of micro-Computed Tomography (micro-CT) as a surgical margin guidance tool during BCS. METHODS: A cohort of 32 BCS specimens was prospectively imaged with a pre-clinical micro-CT system upon arrival in the surgical pathology laboratory. Reconstructed micro-CT scans were evaluated retrospectively by an experienced breast radiologist, who provided binary determinations whether lesions extended to the specimen margin...
September 17, 2018: Breast Cancer Research and Treatment
Zackariah Clement, William McLeay, Clive Hoffmann, Peter Shin, Munir Chowdhry, Michael Eaton
BACKGROUND: Positive margins after Breast conserving surgery (BCS) for breast cancer can result in local recurrence (LR) requiring further surgery. This can lead to unnecessary patient anxiety, poor prognosis and impose additional economic burden to our health system. The aim of this study is to assess the rate of re-excision for positive margins after BCS using the sector resection technique. METHODS: This single centre retrospective cohort study included all women who underwent BCS using sector resection between the years of 2012 and 2016...
August 31, 2018: Breast Disease
Hai-Lin Park, Young Chan Pyo, Ka Young Kim, Jong Seob Park, Ji-Eun Shin, Hye-Rin Kim, Bora Yang, Ji-Young Kim, Jeong Yun Shim, Eun-Ah Shin, Song-Mi Noh
BACKGROUND/AIM: Recently, the development of ultrasonography (US)-guided vacuum-assisted breast biopsy (VABB) has enabled the excision of benign breast tumors with normal surrounding breast tissues; thus, complete excision is possible without residual tumor tissue. We sought to identify the clinicopathological characteristics and recurrence rates of benign phyllodes tumors diagnosed by US-guided VABB. PATIENTS AND METHODS: Data from 11,221 US-guided VABBs performed at the Gangnam Cha Medical Center over 12 years were analyzed...
September 2018: Anticancer Research
Meijiao Zhou, Prakash Peddi, Quyen D Chu
BACKGROUND/AIM: A re-excision for positive margin(s) following a lumpectomy for invasive breast cancer is a standard recommendation. However, for elderly women with stage I estrogen receptor-positive (ER+) tumors, who may be at higher surgical risk, whether radiation therapy without re-excision will be adequate is not known. PATIENTS AND METHODS: We evaluated a cohort of 53,950 women aged ≥70 years with Stage I, ER+ breast cancer who had lumpectomy and anti-hormone therapy diagnosed between 2004 and 2011 in the National Cancer Data Base...
September 2018: Anticancer Research
Khayal Gasimli, Martina Straussner, Iryna Schmeil, Thomas Karn, Ria Winkelmann, Sven Becker, Ahmed El-Balat
BACKGROUND: hTFM in primary vulvar cancer is an important prognostic factor. Ideally, a diameter of > 8 mm should be achieved after primary surgery. The role of VIN III persistence after primary surgery in vulvar cancer is still unclear. The main objective of the current study was to study the role of residual VIN III re-excision and compare differences in disease-free survival among patients with different hTFM and in primary vulvar cancer. METHODS: Forty-two patients with residual adjacent VIN III after primary surgery for vulvar cancer which were operated between 2000 and 2016 in our clinic were enrolled in this retrospective study...
September 6, 2018: Archives of Gynecology and Obstetrics
Grace Oh, Clara R Farley, Alexandra G Lopez-Aguiar, Maria C Russell, Keith A Delman, Michael C Lowe
The significance and management of melanoma in situ (MIS) at the margin of excision of invasive melanoma is debated. Patients undergoing excision of invasive melanoma from 2000 to 2016 with MIS at the margin were identified. A cohort without MIS was matched for age, gender, location, and Breslow depth. Thirty-two patients with 33 cases of MIS at the margin were identified. Melanoma was located on the head/neck (66.7%), extremities (24.2%), and trunk (9.1%). Median Breslow depth was 1.0 mm (range 0.25-10.80)...
August 1, 2018: American Surgeon
Lindsay A McGrath, Adam Meeney, Zanna I Currie, Hardeep Singh Mudhar, Jennifer H Tan
AIMS: The aim is to study staged periocular basal cell carcinoma (BCC) excision in a tertiary oculoplastic referral centre in Sheffield, UK. In particular, we examined patients with close or positive margins and no tumour seen on re-excision to identify demographics and tumour characteristics in this population. METHODS: A retrospective review of medical records of 437 cases of staged periocular BCC excisions over a 10-year period (2007-2017) was carried out. Patients had surgical excision with 3 mm clinically clear margins...
September 4, 2018: British Journal of Ophthalmology
R L O'Connell, E Baker, A Trickey, T Rattay, L Whisker, R D Macmillan, S Potter
BACKGROUND: Therapeutic mammaplasty, which combines breast reduction and mastopexy techniques with tumour excision, may extend the boundaries of breast-conserving surgery and improve outcomes for patients, but current practice is unknown and high-quality outcome data are lacking. This prospective multicentre cohort study aimed to explore the practice and short-term outcomes of the technique. METHODS: Consecutive patients undergoing therapeutic mammaplasty at participating centres between 1 September 2016 and 30 June 2017 were recruited to the study...
August 22, 2018: British Journal of Surgery
Hung-Wen Lai, Ren-Hung Huang, Yu-Ting Wu, Chih-Jung Chen, Shou-Tung Chen, Ying-Jen Lin, Dar-Ren Chen, Chih-Wei Lee, Hwa-Koon Wu, Hui-Yu Lin, Shou-Jen Kuo
BACKGROUND: To evaluate whether clinicopathologic factors are related to surgical margin involvement, reoperation, and residual cancer in primary operable breast cancer. METHODS: Identification of patients at increased risk for positive surgical margins may enhance clinical preoperative decision-making and lower the reoperation rate. In this retrospective study, we analyzed the factors associated with positive surgical margins, the need for re-excision, and residual cancer detection in re-excised specimens in a cohort of 2050 women who underwent either breast-conserving surgery (BCS) or mastectomy for primary operable breast cancer...
August 1, 2018: European Journal of Surgical Oncology
Georgi Tchernev, Ivanka Temelkova
BACKGROUND: Innovations in medicine are often due to the simplicity of a certain activity, interaction, even counteraction, or a mistake leading to a subsequent final optimal outcome. Innovations could also be due to conclusions based on targeted clinical or sporadic, as well as completely random observations. The genius of an approach or statement is often based on the "iron logic", which in turn is based on irrefutable data or facts. These are often observations or results from actions that happen right before our eyes and provide advantages or prerequisites for the better future development of things (in this case, disease) concerning certain groups of people (in these case-patients)...
July 20, 2018: Open Access Macedonian Journal of Medical Sciences
Tien Anh N Tran, Konstantinos Linos, Francine B de Abreu, John Andrew Carlson
Malignant melanoma (MM) may display highly variable phenotypic diversity, sometimes associated with loss of immunohistochemical melanocytic markers and acquisition of nonmelanocytic lineage of differentiation. Primary cutaneous MM with rhabdomyosarcomatous differentiation is extremely rare with only 5 reported cases in the literature. To date, a chronological progression of a MM to rhabdomyosarcoma has not been conclusively documented. A 96-year-old man underwent a re-excision of an "atypical fibroxanthoma" of the forearm, which revealed a small lentigo maligna melanoma associated with a dominant dermal high-grade spindle cell nodule admixed with a population of malignant polygonal epithelioid cells...
August 6, 2018: American Journal of Dermatopathology
Angelena Crown, Lauren G Scovel, Flavio G Rocha, Elliot J Scott, Debra G Wechter, Janie W Grumley
BACKGROUND: Oncoplastic breast conserving surgery (OBCS) integrates plastic surgery techniques in the resection of breast cancer and lowers the rate of re-excision while improving breast cosmesis. The goal of this study is to compare the surgical site complication rate of OBCS with that of standard BCS. METHODS: A single institution chart review evaluated all patients undergoing BCS for treatment of breast cancer. Patients treated from January 2009 to December 2010, prior to adoption of oncoplastic techniques, were identified as the standard surgery (SS) group...
June 19, 2018: American Journal of Surgery
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