Literatura académica sobre el tema "Excision margins"
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Artículos de revistas sobre el tema "Excision margins"
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Subhas, Gokulakkrishna, Asha J. Shah, Aditya Gupta, Jonathan Cook, Linda Dubay, Sumet Silapaswan, Ramachandra Kolachalam et al. "Review of Third and Fourth Re-Excision for Narrow or Positive Margins of Invasive and Intraductal Carcinoma". International Surgery 96, n.º 1 (1 de enero de 2011): 18–20. http://dx.doi.org/10.9738/1340.1.
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Abstract The trend in breast surgery has shifted toward breast conservation. We reviewed our third and fourth breast re-excision cases, with an analysis of various factors used in making this decision. A retrospective analysis identified 585 patients who underwent re-excision surgery for positive or close margins of invasive carcinoma or ductal carcinoma in situ (DCIS). Of these patients 75 (13%) and 17 (3%) underwent third and fourth re-excisions, respectively. The indication for a third re-excision was the presence of positive and/or close (≤1 mm) margins for invasive carcinoma or DCIS in 72/75 patients. A third re-excision was done 31 days (range 8–123 days) after the second re-excision. Re-excision of margins was done in 45 (60%) patients, whereas 30 (40%) patients underwent mastectomy. Residual tumor mandated a fourth re-excision in 17 patients, which was done 45 days (range 14–87 days) after the third surgery. Re-excision of margins was done in 6 patients, whereas 11 patients underwent mastectomy. Involved or close margins with DCIS were the most common indication for re-excision, accounting for 61/75 (82%) of third and 16/17 (94%) of fourth re-excisions. Histopathology revealed that 28/75 (37%) of third and 7/17 (41%) of fourth re-excision patients had no residual tumor. In conclusion, the majority of re-excisions was done for margins <1 mm. Lower rates of re-excision were noted in well-differentiated invasive carcinomas. A close or involved DCIS margin was more likely to lead to a third and even a fourth re-excision. The absence of residual tumors in 40% of patients undergoing third and fourth re-excisions calls for a review of margin guidelines for breast re-excision.
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Ozmen, V., S. Ozkan Gurdal, M. Muslumanoglu, A. Igci, S. S. Tuzlali, B. Ozcinar, E. Canbay, M. Kecer y T. Dagoglu. "Predictive factor for residual tumor after lumpectomy for close margins". Journal of Clinical Oncology 27, n.º 15_suppl (20 de mayo de 2009): e11538-e11538. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e11538.
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e11538 Background: It is critical to obtain clear margins to minimize local recurrence after breast conserving surgery(BCS). When re-excisions are performed, there is often no residual disease in the new specimen, calling into question the need for re-excision(s) or mastectomy. The aim of the present study was to identify factors predicting a histologically positive re-excision specimen. Methods: Our prospective breast cancer database was queried for all invasive breast cancer patients who underwent a re-excision lumpectomy for either close or positive margins after an attempt at BCS. Close margins are defined as ≤ 2 mm for invasive carcinoma and presence of ductal carcinoma in situ(DCIS). Clinicopathologic features were correlated with the presence of residual disease in the re-excision specimen. Results: Between February 1997 and August 2008, 2054 patients with early breast cancer underwent surgical treatment in our breast unit. 939(45.7%) of them had BCS. In 543 patients(26.4%), re-excision required due to close margins on the permanent section analysis of their initial surgical specimens. 186 patients(34.3%) had previous excisional biopsy in other clinics. Median age of 543 patients was 50 years. In 290 patients(53.4%), mastectomy was performed due to positive surgical margin or poor cosmetic results. There were no residual tumors in re-excision(65.6 %) or mastectomy(42.4%) specimens of patients. The factors associated with tumor positive re-excision specimen were, age ≤50 years(p=0.044), lymphovascular invasion (p=0.029), multifocality(p<0.001), tumor size >2cm(p=0.008), presence of DCIS(p=0.018), focal margin positivity(p<0.001), DCIS at resection margin(p=0.008) and node positivity (p<0.001). Conclusions: Most of our patients with early breast cancer had unnecessary re-excisions or mastectomy to obtain clear surgical margins. In subset group of patients, re-excision or mastectomy may not be required. No significant financial relationships to disclose.
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Semple, Harriet K. y Marc J. Langbart. "Margin of error: accuracy of estimated excision margins by surgical experience". Australasian Journal of Plastic Surgery 5, n.º 1 (31 de marzo de 2022): 13–16. http://dx.doi.org/10.34239/ajops.v5n1.257.
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Guidelines for recommended margins for common lesions are well documented. While it is recommended that all margins be measured prior to excision, time pressures, lack of equipment or clinician confidence may result in margins that are estimated rather than formally measured. This increases the risk of involved margins and need for re-excision to prevent recurrence. We reviewed the estimated margins of common excisions and compared these between groups of different surgical experience. We found that while accuracy generally improves with surgical experience, margins are largely underestimated by all groups. We hope to encourage the use of formally measured margins in all lesion excisions.
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O’Connell, L., S. Walsh, D. Evoy, A. O’Doherty, C. Quinn, J. Rothwell, J. Geraghty, EW McDermott y R. Prichard. "The approach to an isolated close anterior margin in breast conserving surgery". Annals of The Royal College of Surgeons of England 101, n.º 4 (abril de 2019): 268–72. http://dx.doi.org/10.1308/rcsann.2019.0017.
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Introduction Although close radial margins after breast-conserving surgery routinely undergo re-excision, appropriate management of patients with close anterior margins remains a topic of controversy. An increasing body of literature suggests that re-excision of close anterior margins yields low rates of residual malignancy and may only be necessary in selected patients. The aim of this study was to examine the management of close anterior margins after breast conserving surgery in a single institution and to analyse the rate of residual disease in re-excised anterior margins. Methods All patients having breast conserving surgery at St Vincent’s University Hospital from January 2008 to December 2012 were reviewed retrospectively. Data collected included patient demographics, tumour characteristics, margin positivity, re-excision rates and definitive histology of the re-excision specimens. A close margin was defined as les than 2 mm. Results A total of 930 patients were included with an average age of 65 years (range 29–94 years). Of these, 121 (13%) had a close anterior margin. Further re-excison of the anterior margin was carried out in 37 patients (30.6%) and a further 16 (13.2%) proceeded to mastectomy. Residual disease was found in 18.5% (7/36) of those who underwent re-excision and 7/16 (43.75%) of those who underwent mastectomy. Overall, 11.57% (14/121) of patients with close anterior margins were subsequently found to have residual disease. Conclusion The low yield of residual disease in re-excised anterior margins specimens supports the concept that routine re-excision of close anterior margins is not necessary. Further research is required to definitively assess its influence on the risk of local recurrence.
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Ghosh, S., S. Duvvi, P. Goodyear, E. Reddy y A. Kumar. "Evaluation of surgeons' marking of excision margins for superficial facial skin cancer lesions". Journal of Laryngology & Otology 123, n.º 2 (19 de mayo de 2008): 195–98. http://dx.doi.org/10.1017/s0022215108002612.
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AbstractIntroduction:We established a series of exercises that evaluated surgeons' marking of excision margins, and we sought to identify factors influencing such marking.Methods:Twenty-four participants were asked to draw preset margins (3, 4, 5, 8 or 10 mm) on a series of life-size images representing noncosmetically and cosmetically sensitive facial sites, and also to draw circles of set diameters (3, 5 and 8 mm) on white paper. Margins were measured with vernier callipers calibrated to 0.05 mm.Results:In the small margin (3 mm) and noncosmetically sensitive exercises, the mean margins drawn were greater than required. When a 10 mm margin was required in cosmetically sensitive areas and nonsensitive areas, the margin was consistently underestimated in the former group by all participants (p < 0.05).Conclusion:Surgeons marking facial lesions for excision should use a measurement of scale, in order to eliminate the inherent tendency to underestimate the margin required for large excisions and for cosmetically sensitive areas.
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Sebastian, Mary L., Alice Marie Police, Stephanie Akbari y Beth Anglin. "Combined experience at three breast centers with routine use of an intraoperative margin assessment device including comparison to historical re-excision rates." Journal of Clinical Oncology 32, n.º 26_suppl (10 de septiembre de 2014): 79. http://dx.doi.org/10.1200/jco.2014.32.26_suppl.79.
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79 Background: Historically there has been a high rate of surgical interventions to obtain clear margins for breast cancer patients undergoing breast conserving local therapy. This study is the first compellation of data among three breast centers to assess the impact of an intraoperative margin assessment tool (MarginProbe) on re-excision rates. This device has been approved for clinical use in the United States since 2013. We present groups of consecutive patients in each of these breast centers – before and after the implementation of routine intraoperative use of the margin assessment device during lumpectomy procedures. Methods: Lesions were localized by standard methods. The intraoperative margin assessment device was used on all circumferential margins of the main specimen, but not on any additional shavings. A positive reading by the device led to an additional shaving of the corresponding cavity location. Specimens were also imaged intra-operatively by X-ray, and additional shavings were taken if needed based on clinical assessment. We established the historical re-excision rates of each surgeon on a consecutive set of patients in a corresponding period just before we began using the device. Results: In total, 165 patients were treated in three institutions up until April 2014. Sixteen patients (9.7%, 16/165) required re-excision. Historical re-excision rates corresponding to periods of use before the intraoperative margin assessment device was put into use were 25.8% (48/186). The re-excision rate was reduced by 62% (P<0.0001). Six re-excisions were due to a positive shaving which was not measured by the device. Conclusions: Use of an intraoperative margin assessment device contributes to achieving clear margins and reducing re-excision procedures. As in some cases positive margins were found on shavings, future studies of interest may include an analysis of the effect of using the device on the shavings intra-operatively.
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Lupu, Mihai, Vlad Mihai Voiculescu, Ana Caruntu, Tiberiu Tebeica y Constantin Caruntu. "Preoperative Evaluation through Dermoscopy and Reflectance Confocal Microscopy of the Lateral Excision Margins for Primary Basal Cell Carcinoma". Diagnostics 11, n.º 1 (14 de enero de 2021): 120. http://dx.doi.org/10.3390/diagnostics11010120.
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Complete removal of malignant skin lesions with minimal impact on the aesthetic and functional aspects is the ideal of every dermatologic surgeon. Incomplete surgical excisions and tumor recurrences of basal cell carcinomas (BCC) commonly occur due to the subclinical extension of tumor lateral margins. Presently, the lateral excision margins for BCC cannot be objectively assessed preoperatively, dermoscopy proving to be relatively inefficient in this respect. The question is whether BCC lateral excision margins can be precisely determined preoperatively through the use of complementary non-invasive imaging techniques such as dermoscopy and reflectance confocal microscopy (RCM), thus permitting the complete removal of the lesion in a single stage, estimation of the post-excisional defect, and planning an appropriate reconstruction, especially in medical centers where Mohs micrographic surgery is not available. We present the results of a prospective, histopathologically controlled study designed to determine the feasibility of preoperative, non-invasive, in vivo evaluation of the lateral excision margins for primary basal cell carcinoma, through dermoscopy and RCM.
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Ross, M. "Margins of excision". Melanoma Research 3, n.º 1 (marzo de 1993): 9. http://dx.doi.org/10.1097/00008390-199303000-00020.
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Batsakis, John G. "Surgical Excision Margins". Advances in Anatomic Pathology 6, n.º 3 (mayo de 1999): 140–48. http://dx.doi.org/10.1097/00125480-199905000-00002.
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Schnabel, Freya Ruth, Shira Schwartz, Deirdre Kiely y Jennifer Chun. "Improving breast-conserving surgery: A focus on margins." Journal of Clinical Oncology 31, n.º 31_suppl (1 de noviembre de 2013): 127. http://dx.doi.org/10.1200/jco.2013.31.31_suppl.127.
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127 Background: Inadequate lumpectomy margins are associated with an increased risk of ipsilateral recurrence in patients undergoing breast conserving surgery for cancer. Multiple procedures are often required to achieve acceptable margins, increasing the burden to the patient and the health care system, and potentially delaying other adjuvant treatments. A novel device for intraoperative assessment of lumpectomy margins (MarginProbe) has been associated with a 25% reduction in the rate of positive margins at the conclusion of primary lumpectomy surgery. Our aim was to establish a baseline re-excision rate among surgeons and to initiate a follow up study to assess the impact of incorporating this new technology for intraoperative margin assessment. Methods: The NYU Langone Medical Center Breast Cancer Database was queried for patients who underwent breast conserving surgery including ≥ 1 re-excision procedure from 1/2010-1/2013. Variables of interest included re-excision rates, stage of disease, and additional margins taken at primary lumpectomy surgery. Statistical analyses included descriptive analyses and Pearson’s Chi-Square. Results: During the study period 957 patients had breast conserving surgery and 229 required ≥ 1 re-excision procedures (24%). Re-excision rates varied widely among surgeons (10-36%). Stage 0 disease (ductal carcinoma in situ) was associated with an increased frequency of re-excisions (p<0.0001). These parameters will be re-evaluated in patients undergoing breast conserving surgery with adjunctive intraoperative use of the MarginProbe device. Re-excision rates and the accuracy of intraoperative assessment of lumpectomy margins will be compared with the historical cohort. Conclusions: The necessity for multiple surgical procedures to complete breast conserving surgery results in an added burden to the patient and the health care system. Improved intraoperative assessment of lumpectomy margins represents an opportunity to improve the quality of breast cancer surgery. A critical analysis of the impact of a new device on re-excision rates will be important to understand its potential benefit to the conduct of breast conserving surgery.
Tesis sobre el tema "Excision margins"
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Nashidengo, Pueya Mekondjo. "Five-year review of breast-conserving therapy (BCT) for breast carcinoma: Surgical margins, re-excision and local recurrence in a single tertiary center". Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/24506.
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Background: Breast cancer burden is on the increase in the developing world. Breast-conserving therapy (BCT) is prescribed for early breast cancer. It is the wide local excision of the tumour usually followed by radiation treatment to the breast. It is the mainstay treatment for carefully selected patients with early breast cancer presenting to the Groote Schuur Hospital's Oncology and Endocrine Surgical unit, Cape Town South Africa. There has not been a formal audit to review the outcomes of BCT in the unit. Objectives: The objective of this study is to determine and analyse the excision margins for all the wide local excisions and the re-excision and local recurrence rates during the study period. Methods: This is a histopathological and oncology records review of the patients that have undergone BCT in the unit from the 1st of January 2006 until the 31st of December 2010. The University of Cape Town's Faculty of Health Sciences Human Research Ethics Committee granted approval. Data points accrued included patient age, pathological tumour size and nodal status, histological tumour type, oestrogen receptor status, presence of lymphovascular invasion, volume of specimen excised, margin status, management of involved or close margins, completeness of radiotherapy, ipsilateral breast recurrence rate and total duration of follow up. Results: A total of 192 patients had BCT during the study period. The mean age is 53 years (range 25 to 84 years). A median of 229.5 cm3 volume of specimen was excised (range 4 cm3 to 10530 cm3). Infiltrating ductal carcinoma was the commonest histological type at 79.1%. 42.7% were pT1 tumours, 49.0% pT2 tumours and 2.6 % pT3. The resection margin status are: positive margins rate of 15.1%, 8.3 % close margin (≤ 1 mm), 35.9% 1 – 5 mm, 23.4% 6 – 10 mm and > 10 mm 17.2%. An overall of 26 (13.5%) patients underwent a repeat surgical procedure. 16 (8.3%) had re-excision and 10 (5.2%) had a mastectomy. Residual tumour was present in 50% of the re-excisions and 63.6% of mastectomies. As per category of the resection margins, 68.9% of patients with positive margins had repeat surgery (48.3% re-excision and 20.6% mastectomy). 31.1% of patients with positive margins did not have repeat surgery despite the indication due to advanced age, loss to follow up or residual tumour on the deep chest wall margin. 80.8% patients completed radiotherapy treatment post breast-conserving surgery. At a median follow up of 60 months (range 1 to 108 months), a total of 11 (6.8%) patients had ipsilateral breast local recurrence. Median time to recurrence is 39 months (range 12 to 106 months). Conclusion: Positive and close margin re-excision and local recurrence rates in our unit are acceptable and comparable to other units in South Africa and internationally.
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Milan, Ranisavljević. "Дијагностичка вредност мобилне дигиталне радиографије у процени позитивности ресекционих хируршких маргина код карцинома дојке". Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2020. https://www.cris.uns.ac.rs/record.jsf?recordId=114074&source=NDLTD&language=en.
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Karcinom dojke predstavlja najčešću malignu neoplazmu među ženskom populacijom, a poštedna terapija dojke, preferirani je model lečenja bolesnica u ranom stadijumu bolesti. Smatra se da je optimalna hirurška resekciona margina 2 mm. Opisano je mnogo metoda koje služe za intraoperativnu proveru suficijentnosti resekcione hirurške margine i sve one imaju svoje prednosti i mane. Ciljevi ove studije bili su da se utvrdi, da li postoji statistički značajna razlika u određivanju širine negativne resekcione hirurške margine izražene u milimetrima pri operacijama karcinoma dojke upotrebom palpatorne metode i intraoperativne mobilne radiografije, poređenjem nalaza merenja hiruga sa većim i manjim iskustvom u hirurgiji karcinoma dojke kao i nalaza radiologa u odnosu na patohistološku ex tempore analizu. Istraživanje je sprovedeno kao retrospektivno–prospektivna studija na Klinici za operativnu onkologiju, Instituta za onkologiju Vojvodine i obuhvatilo je 150 bolesnica kod kojih je preoperativno dijagnostikovan karcinom dojke. Kriterijum za uključenje u studiju bilo je izvođenje poštedne operacije dojke sa ili bez disekcije ipsilaterale aksile, dok su iz studije isključene bolesnice kod kojih nije bilo moguće izvesti poštednu operaciju dojke, one sa radiološki potvrđenom diseminovanom bolešću, kao i bolesnice koje su ranije operisane zbog karcinoma iste dojke. Kod svih 150 ekstirpiranih karcinoma dojke urađena je procena širine resekcione hirurške margine intraoperativno palpatornom metodom, zatim na aparatu za mobilnu digitalnu radiografiju, te radiogram analiziran od strane iskusnog i manje iskusnog hiruga u hirurgiji karcinoma dojke, kao i radiologa te upoređen sa nalazom ex tempore patohistološke analize. Definitivna širina resekcione hirurške margine potvrđena je na parafinskim patohistološkim preparatima. Srednja vrednost praćenja bolesnica, postoperativno, iznosila je 100,97 nedelja. Najveći broj bolesnica pripadao je starijoj životnoj dobi (56,67%). Preoperativna lokalizacija klinički nepalpabilnih tumora u dojci urađena je kod 52 (34,67%) bolesnice. Najčešće se tumor prezentovao kao solitarni fokus sa okolnim ognjištima in situ karcinoma (72, 48%), dok je najčešći histološki subtip bio duktalni invazivni karcinom dojke (112 (74,67%)). Najveći broj operacija dojke okarakterisan je kao kvadrantektomija (85 (56,67)), dok je najučestalija operacija aksile bilo određivanje limfnog čvora stražara (119 (79,33%). Analizom rada aparata za mobilnu digitalnu radiografiju došli smo do saznanja da nema statistički značajne razlike u oceni kvaliteta radiograma i širine resekcione hirurške margine merene na aparatu za mobilnu digitalnu radiografiju između iskusnog hirurga i radiologa. Statistički značajna razlika nije uočena ni pri merenju širine resekcione hirurške margine izražene u milimetrima na aparatu za mobilnu digitalnu radiografiju od strane iskusnog hirurga i radiologa u odnosu na ex tempore patohistološku analizu, dok je ista uočena nakon definitivne patohistološke analize. Šansa doresekcije tkiva dojke nakon merenja na aparatu za mobilnu digitalnu radiografiju je 1,4 puta veća nego nakon patohistološke ex tempore analize. Lokalni recidiv javio se kod jedne pacijentkinje tokom perioda praćenja. Ne postoji statistički značajna razlika u određivanju širine resekcione hirurške margine izražene u milimetrima upotrebom aparata za mobilnu digitalnu radiografiju od strane iskusnog hirurga i radiologa u odnosu na patohistološku ex tempore analizu, dok ista postoji nakon analize radiograma od strane manje iskusnog hirurga. Palpatorna metoda se ne može smatrati sigurnom metodom u određivanju širine hirurške resekcione margine. Ne postoji statistički značajna razlika u broju doresekcije tkiva dojke između hirurga sa različitim hirurškim iskustvom.Breast cancer is the most common malignant neoplasm in the female population, and conservative breast therapy is the preferred treatment model for patients in early stages of the disease. The optimal surgical resection margin, from healthy breast tissue around the primary tumor is 2 mm. Many methods have been described that serve to check the resection margin during breast conservative surgery and all of them have their advantages and disadvantages. The aim of this study was to determine whether there was a statistically significant difference in the determination of the width of the negative resection margin expressed in millimeters in breast cancer surgery using palpatory method and intraoperative mobile specimen radiography, comparing the findings of measuring of surgeons with greater and lesser experience in breast cancer surgery as well as the findings of the radiologist in relation to histopathological ex tempore and definitive histopathological analysis. The study was conducted as a retrospective - prospective study at the Clinic for Operative Oncology, Oncology Institute of Vojvodina and included 150 patients who were preoperatively diagnosed with breast cancer. The criterion for inclusion in the study was the opportunity to perform breast conservative surgery with or without complete axillary lymph node dissection. Patients that were treated with breast amputation, those with radiological confirmed disseminated disease, as well as patients previously operated from cancer were excluded from the study. For all 150 extirpated breast cancers, an estimate of the width of the resection surgical margin was performed intraoperatively with a palpatory method, followed by measuring on device for mobile specimen digital radiography, and a radiogram was analyzed by an experienced and less experienced surgeon in breast cancer surgery, as well as by a radiologist and compared with an ex tempore histopathological analysis. The definitive width of the resection surgical margin was confirmed on histopathological preparations. The mean follow-up, postoperatively, was 100.97 weeks. The majority of patients belonged to the elderly age (56.67%). Preoperative localization of clinically impalpable breast tumors was performed in 52 (34.67%) patients. Most often the tumor was presented as a solitary focus with surrounding foci of in situ cancer (72, 48%), while the most common histological subtype was invasive ductal breast cancer (112 (74.67%)). The majority of breast operations were characterized like quadrantectomy (85 (56.67)), while the most frequent axillary surgery was the determination of the sentinel lymph node (119 (79.33%). No significant difference was observed in the evaluation of radiography quality and the width of the resection surgical margin measured on the mobile digital radiography device between the experienced surgeon and the radiologist. No statistically significant difference was observed in the measurement of the width of the resection surgical margin expressed in millimeters on the mobile digital radiography device by the experienced surgeon and radiologist versus ex tempore histopathological analysis, while the statistical difference was observed after definite histopathological analysis. The chance of breast tissue reexcision after measurement on a mobile digital radiography device is 1.4 times higher than after histopathological ex tempore analysis. Local relapse occurred in one patient during the follow-up period. There is no statistically significant difference in the determination of the width of the resection surgical margin expressed in millimeters using a mobile digital radiography device by an experienced surgeon in breast cancer surgery and radiologist with respect to histopathological ex tempore analysis. However, the statistical difference exists after radiogram analysis by a less experienced surgeon. The palpatory method cannot be considered as a safe method in determining the width of a surgical resection margin. There is no statistically significant difference in the number of breast tissue additional resections between surgeons with different surgical experience.
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Roussel, Lucas. "Diagnostiquer le cancer de l'ovaire grâce à la technologie SpiderMass". Electronic Thesis or Diss., Université de Lille (2022-....), 2023. https://pepite-depot.univ-lille.fr/ToutIDP/EDBSL/2023/2023ULILS121.pdf.
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Les cancers de l'ovaire (OC) sont les cancers gynécologiques les plus mortels, entraînant plus de 200 000 décès chaque année dans le monde. Le diagnostic de ces cancers reste difficile et un diagnostic tardif entraîne un retard de prise en charge du patient réduisant alors ses chances de survie. Pour répondre à ce besoin clinique, nous avons développé un outil de diagnostic et pronostic en temps réel : le SpiderMass. Dans un premier temps, pour permettre un diagnostic précoce et une action préventive, nous nous sommes intéressés à l'origine du sous-type d'OC le plus agressif : le cancer séreux de haut grade (HGSOC). Suite à la découverte de marqueurs lipidiques et protéiques spécifiques des lésions pré-néoplasiques de la fimbria, nous avons mis en évidence les mécanismes sous-jacents liés à ces lésions et avons confirmé qu'elles étaient à l'origine du HGSOC. Dans un second temps, nous avons étudié l'ensemble des signatures moléculaires lipidiques spécifiques des différents sous-types d'OC afin de bâtir un modèle de classification via la technologie SpiderMass. Ce modèle, associant à la fois les données moléculaires et les données morphologiques des patients, a été capable de reconnaître l'ensemble des sous-types en temps réel ex vivo. Nous avons également développé un nouveau modèle d'imagerie par spectrométrie de masse permettant la visualisation directe des différentes cellules immunitaires au sein de tissus. Cela permet de fournir un diagnostic précis des différents types de cancer de l'ovaire et d'y associer un pronostic, étant donné que la survie du patient est étroitement liée à l'infiltration de cellules immunitaires au sein de la tumeur. Nous avons démontré que ce modèle d'imagerie est applicable à plusieurs types de cancer, incluant le cancer de l'ovaire et le glioblastome. Associé à ces modèles novateurs, le SpiderMass guide le chirurgien pendant l'opération pour réduire les marges d'exérèse et apporte un diagnostic et un pronostic fiable pour proposer le meilleur traitement au patientOvarian cancer (OC) is the deadliest gynecological cancer, causing over 200,000 deaths worldwide every year. Diagnosis of OC is extremely difficult and late diagnosis leads to delays in patient management thus reducing the chances of survival. Against this backdrop, we have developed a real-time diagnostic and prognostic tool: SpiderMass. Initially, to enable early diagnosis and preventive action, we focused on the origin of the most aggressive OC subtype: high-grade serous cancer (HGSOC). Following the discovery of lipid and protein markers specific to pre-neoplastic lesions of the fimbria, we highlighted the underlying mechanisms linked to these lesions and confirmed that they were at the origin of HGSOC. Secondly, we studied all the lipid molecular signatures specific to the different OC subtypes to build a classification model using SpiderMass technology for diagnostic. This model, combining both molecular and patient morphological data, was able to recognize all subtypes in real time ex vivo. We have also developed a new mass spectrometry imaging model enabling direct visualization of different immune cells within tissues. This model provides an accurate diagnosis of the different types of ovarian cancer, and can associate a prognosis with them, given that patient survival is closely linked to the infiltration of immune cells within the tumor. We have demonstrated that this imaging model is applicable to several types of cancer, including ovarian cancer and glioblastoma. Combined with these innovative models, SpiderMass guides the surgeon during the operation to reduce excision margins and provides a reliable diagnosis and prognosis to propose the best treatment to the patient
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Addae, Haleema. "The impact of positive margins and crypt involvement in excisional procedures of the cervix on recurrence rates of premalignant diseases of the cervix". Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33427.
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BACKGROUND Recurrent disease after cervical excisional procedures has been linked to many factors. We aim to determine if positive margins and crypt involvement increased the rate of recurrence of premalignant disease in patients who had excisional procedures. METHODS In this retrospective review of the colposcopy database, patient records and pathology database, women who had cervical excisional procedures at the Groote Schuur Hospital colposcopy clinic in 2010 were followed up until 2015. Recurrence was based on high grade cytology or histology at follow up. Chi-square tests were used to compare recurrence rates. RESULTS Two hundred and seventy women were included in the final analysis. 130 women had CIN 3 and 94 had CIN 2 at the excisional procedure. Eighty five (31.5%) had endo-margin involvement, 46 (17%) had ecto-margin involvement, and 24 (8.9%) had dual margin involvement. Two hundred and thirteen (79.2%) had crypt involvement. Recurrence occurred in 30 (19.4%) of the 155 patients we had follow up data on. Of those that recurred, 19 (P<0.001) had positive endo-margin involvement, 10 (P=0.007) had ecto-margin involvement, 9 (P< <0.001) had dual margin involvement, and 28 (P=0.058) had crypt involvement. 155 women (43%) were lost to follow-up CONCLUSION Positive margins at excisional procedure of the cervix have a statistically significant increased risk of recurrence of pre-malignant disease. There was a trend towards recurrence of disease in those who have crypt involvement. In limited resource setting follow up protocols can be adjusted so that women without margin involvement can be seen at longer intervals.
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Henriques, Valéria José Gonçalves. "Margem cirúrgica no melanoma: Que evidência?" Master's thesis, 2021. http://hdl.handle.net/10316/98308.
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Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de MedicinaIntrodução: O melanoma cutâneo é uma neoplasia maligna com origem nos melanócitos. Ocorre com maior frequência em caucasianos de pele clara e com dificuldade em bronzear. O tratamento de primeira linha é a excisão cirúrgica da lesão com margens de segurança que variam de acordo com o índice de Breslow. Com este trabalho pretende-se perceber se será mesmo necessário adaptar a abordagem cirúrgica ou se, pelo contrário, todos os melanomas poderão ser excisados com a mesma margem de segurança, independentemente da sua espessura.Materiais e Métodos: Para o desenvolvimento desta revisão bibliográfica, foi feita uma pesquisa na PubMed com as chaves de pesquisa “malignant melanoma narrow wide” e “malignant melanoma 1cm 2cm” e, restringindo-se os resultados aos últimos 10 anos, selecionaram-se 9 artigos para análise pormenorizada. Além disso, foram incluídas guidelines e outros artigos pertinentes. Desenvolvimento: De acordo com a maioria dos estudos, a margem periférica de 2 cm não traz vantagens, quando comparada com a margem de 1 cm. De destacar que, quando se aplica uma margem de 2 cm, é mais frequente a necessidade de recorrer a reconstruções e a necrose dos retalhos/perda de enxerto ocorre também com maior frequência. Em relação à margem profunda, constata-se que quanto mais profunda for a remoção, melhor será o prognóstico dos doentes. No entanto, a fáscia muscular deverá ser mantida.Conclusão: Todos os melanomas cutâneos deverão ser removidos, em profundidade, até à fáscia muscular. Perifericamente, aplicar uma margem de segurança de 1 cm será suficiente nos melanomas até 4 mm. Quando a espessura for superior, sugere-se uma margem de 2 cm.
Introduction: The cutaneous melanoma is a malignant neoplasm originating from melanocytes. It occurs more frequently in Caucasians with fair skin and with difficulty in tanning. The first-line treatment is a surgical excision of the lesion with safety margins that vary according to the Breslow index. This work aims at understanding whether it will be necessary to adapt the surgical approach to each patient or whether all patients can be excised with the same margin, regardless of the thickness of the malignant lesion.Material and Methods: For carrying-out of this bibliographic review, a search was made at PubMed with the search keys “malignant melanoma narrow wide” and “malignant melanoma 1cm 2cm”. After restricting the results to articles published in the last 10 years, 9 articles were selected for further analysis. In addition, guidelines and other relevant articles have been included.Results: According to most studies, an excision surgery with a peripheral safety margin of 2 cm does not bring advantages when compared to the same surgery with a peripheral safety margin of 1 cm. It should be noted that when a margin of 2 cm is applied, necrosis/graft loss is more frequent, and reconstruction is more often necessary. Regarding the deep margin, it appears that the deeper the removal, the better the prognosis of patients. However, the muscular fascia should be maintained. Conclusion: All cutaneous melanomas must be removed in depth up to the muscular fascia. Peripherally, applying a safety margin of 1 cm will be sufficient for melanomas up to 4 mm. Whenever the thickness is greater than 4 mm, a margin of 2 cm is suggested.
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Noel, Carolyn Joyce. "Excision margins in human immunodeficiency virus seropositive women undergoing large loop excision of the transformation zone for cervical dysplasia". Thesis, 2015. http://hdl.handle.net/10539/18505.
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Department of Obstetrics and Gynaecology
University of the Witwatersrand
Johannesburg
February 2015
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Masters in Medicine, in the branch of Obstetrics and Gynaecology.HIV accelerates the development of cervical cancer by up to15 years. South Africa is currently in the midst of an HIV epidemic. With limited facilities for colposcopy it is vital to identify risk factors within the HIV positive population resulting in positive margins after Large Loop Excision of the Transformation Zone (LLETZ) and persistence of cytological abnormalities on follow-up Pap smears. Objective: The primary objective was to determine the patient risk factors, pre and during colposcopy and LLETZ biopsy, which resulted in the histological involvement of margins of the LLETZ biopsy and persistent cervical dysplasia on follow-up Pap smears. Secondary objectives included determining follow up rate of patients at the clinic as well as the correlation between the original Pap smear cytology grade and the histological grade found on histology of the LLETZ biopsy. Methods: A retrospective review of the files of HIV seropositive patients was done at the colposcopy clinic at Charlotte Maxeke Johannesburg Academic Hospital after the roll out of antiretroviral treatment for the period 1 April 2004 to 31 October 2012. Patients with abnormal pap smears during this time were referred to the colposcopy clinic where a colposcopy and LLETZ biopsies were done. Demographic and clinical data in regards to age, gravidity, contraception, CD4 count, antiretroviral usage, and referral time was collected. Data from the clinical description of the colposcopy and histology of the LLETZ biopsy was also collected. Patients followed up again after 6 months when a repeat pap smear was done. The results of these Pap smears were also collected. Data was then analysed and variate and multivariate logistical regression was used to find statistically significant correlations. Results: A total of 480 files were found to have complete clinical records. One hundred and sixty eight (42.71%) patients had both endo and ectocervical margins clear. Predictive factors for the involvement of endocervical margins was the doctor performing the procedure (p-value <0.01) cytology of the original Pap smear (p value <0.01) and the grade of histological abnormality found at time of LLETZ (p-value <0.01). The statistically significant predictive factors for ectocervical margin involvement was the visualization of the transformation zone at colposcopy (p-value <0.01), the size of lesion found at colposcopy (p-value <0.01), the use of combined oral contraceptive pill (OCP) (p-value 0.02) and the histological grade of abnormality found on the LLETZ biopsy. Age, parity, CD4 count, use of antiretroviral drugs, length of time from Pap smear to colposcopy and use of contraception other than OCP were not found to be statistically significant in our sample population for the involvement of either endo or ectocervical margins. Statistically significant risk factors for the recurrence of intraepithelial lesions on follow up Pap smear was having both endo and ectocervical margin involvement on histology (p-value 0.01) The Ectocervical margin alone was found to have a p-value of <0.01. Abnormal cytology on follow up Pap smear was found in 58.69% of patients. The follow up rate at the clinic was 46.04%. Correlation of cytological grade and histological grade of cervical intraepithelial neoplasm in our sample population was found to be adequate (p-value <0.01). Conclusion: Incomplete incision of the intraepithelial lesion was found to be a significant risk factor for the recurrence of cytological abnormality in patients undergoing LLETZ biopsy. Identifying patients at increased risk for recurrence is important to ensure close follow up in this patient population.
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Chang, Chih-chia y 張志嘉. "3D US imaging in margin evaluation for malignant breast tumor excision using Mammotome". Thesis, 2002. http://ndltd.ncl.edu.tw/handle/21209706983904264104.
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碩士國立中正大學
資訊工程研究所
90
In this paper, we use the 3D ultrasound dataset for evaluating the malignant breast tumor contour and the excision margin after the surgical operation called Mammotome. And the result can help the physician evaluating the surgical outcome. The 3D ultrasound dataset is composed of a series of 2D images, however, the traditional 2D image segmentation methods can’t extract reasonable contour due to the characteristics of ultrasound — noises and speckles. We proposed a modified edge-based segmentation method for finding the contour in this paper. By using anisotropic diffusion, the noises and speckles in ultrasound image can be removed while the most edge information is reserved. Further more, applying the stick detection for enhancing the edge. Finally, using range image and edge connection method to extract the good tumor contour and excision margin. The physician can observe that if the tumor is fully removed or is still residual by calculating these two margins. The purpose of this study is to provide the inspection of the tumor removal situation. If a small malignant tumor can be removed completely by Mammotome under the help by the proposed method, then the cosmetic result will be further improved in the breast conserving surgery.
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曾姿綺. "3D snake for US in margin evaluation for malignant breast tumor excision using mammotome". Thesis, 2002. http://ndltd.ncl.edu.tw/handle/95264239380961050796.
Texto completoLibros sobre el tema "Excision margins"
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Glynn Bolitho, D. Tumours and hand reconstruction. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199550647.003.006012.
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♦ Hand tumours are common♦ The vast majority are benign♦ Soft tissue – commonest Giant cell tumour of tendon sheath. Treatment marginal excision♦ Bone – commonest – Enchondroma. Treatment – leave if incidental or currette +/− bone grafting♦ Malignant – need full work up with detailed clinical examination, investigation, and planning in a multidisciplinary meeting♦ Treatment is wide/radical excision often with partial amputation +/− plastic surgical reconstruction.
Capítulos de libros sobre el tema "Excision margins"
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Ferrari, Marco, Nausica Montalto y Piero Nicolai. "Novel Approaches in Surgical Management: How to Assess Surgical Margins". En Critical Issues in Head and Neck Oncology, 95–110. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-63234-2_7.
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AbstractThe concept of surgical margins was born a long time ago but still lacks a univocal and sound understanding. The current biological rationale behind the recommendations on margins management relies on two pillars: (1) the observation that groups of cancer cells can leave the macroscopic tumor and disseminate throughout adjacent tissues with different degrees of aggressiveness; (2) the belief that removal of all (or most of) cancer cells can cure the patient. However, this background is undermined by some pieces of evidence. For instance, it has been proven that tissues surrounding cancer often bear precancerous traits, which means that cutting through non-cancerous tissues does not equate to cut through healthy tissues. The head and neck exquisitely poses a number of challenges in the achievement of negative margins, with special reference to anatomical complexity, high density in relevant structures, and unique histological heterogeneity of cancers. Currently, intraoperative margins evaluation relies on surgeons’ sight, palpation, ability to map tumor extension on imaging, and knowledge of anatomy, with some optical imaging technologies aiding the delineation of the mucosal margins of excision. Frozen sections are currently used to intraoperatively evaluate margins, yet with debate on whether and how this practice should be performed. Future perspectives on improvement of margins control are threefold: research is oriented towards refinements of understanding of cancers local progression, implementation of technologies to intraoperatively render tumor extension, and employment of optical imaging modalities capable of detecting foci of residual tumor in the surgical bed.
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Gareau, Daniel S., Kishwer Nehal y Milind Rajadhyaksha. "Confocal Mosaicing Microscopy in Skin Excisions: Feasibility of Cancer Margin Screening at the Bedside to Guide Mohs Surgery". En Reflectance Confocal Microscopy for Skin Diseases, 449–54. Berlin, Heidelberg: Springer Berlin Heidelberg, 2011. http://dx.doi.org/10.1007/978-3-642-21997-9_33.
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Cody, Hiram. "Re-Excision of Margins". En Atlas of Procedures in Breast Cancer Surgery, 57–62. CRC Press, 2005. http://dx.doi.org/10.3109/9780203491645-9.
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Tsabazis, Nikolaos, Anastasia Vatopoulou y Angelos Daniilidis. "Non-Free Surgical Margins After LLETZ-LEEP". En Handbook of Research on Oncological and Endoscopical Dilemmas in Modern Gynecological Clinical Practice, 129–38. IGI Global, 2021. http://dx.doi.org/10.4018/978-1-7998-4213-2.ch010.
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Large Loop Excision of the Transformation Zone (LLETZ) is thought to be the treatment of choice for the high-grade precancerous lesions. The cone is also the “gold standard” specimen for the diagnosis of the underlying cervical disease once it includes the entire area of carcinogenesis for the squamous epithelium (transformation zone). In most research studies, therapeutic success after conization is a term generally assigned for disease clearance, that is, absence of residual high grade/CIN2+ histology by the end of a reasonable follow-up period, aiming at risk reduction for future recurrence and development of invasion. Conversely, positive cone margins as a reflection of an incomplete excision may, to some extent, represent a negative prognostic factor. Therefore, margin status may also be regarded as an indicator for the quality of a clinical service. The chapter summarizes all current evidence regarding optimal treatment of positive margins after LEEP.
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Gruber, Elizabeth A. "Excision Margins in High-Risk Malignant Melanoma". En 50 Landmark Papers every Oral & Maxillofacial Surgeon Should Know, 201–6. CRC Press, 2020. http://dx.doi.org/10.1201/9780429288036-37.
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Scase, Tim. "What your pathologist does with your sample and how they assess margins of tumour excision". En BSAVA Congress Proceedings 2018, 208. British Small Animal Veterinary Association, 2018. http://dx.doi.org/10.22233/9781910443590.28.1.
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Angus, Bill. "Literature: Liminal Ground in Early Modern Drama". En A History of Crossroads in Early Modern Culture, 129–53. Edinburgh University Press, 2022. http://dx.doi.org/10.3366/edinburgh/9781474499828.003.0006.
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In Shakespeare’s lifetime and long after, to live as a traitor or to die in suicide meant, in burial, to be treated as refuse. It is probable that Shakespeare knew at least five such people, disposed of in a ceremony whose elements were, as described in the last chapter, the night, the crossroads, and the stake. Although he largely avoids depicting subjects like imprisonment and execution, the question of outcast burial nevertheless emerges in hints and allusions found in the plays, like the shadowy revenants of unquiet thoughts. Contrastingly, George Peele is the one dramatist of the era who depicts a crossroads explicitly onstage, in his The Old Wives Tale. Peele’s treatment of the subject is varied, but comedically light. This chapter argues that the delinquent crossroads are inscribed here in what de Certeau calls a ‘procedure of delimitation’ which has the function of ‘founding and articulating spaces’. The placing of a body at a boundary like a crossroads is to write it into the margins of a story as a part of the defining frame. Refusing this interment may be to refuse this influence of the marginal, but on the dramatic stage this has a way of returning despite its excision from the script.
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"Marginal Excision". En Encyclopedia of Cancer, 2168. Berlin, Heidelberg: Springer Berlin Heidelberg, 2011. http://dx.doi.org/10.1007/978-3-642-16483-5_3538.
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Kersten, Robert C. "Management of Periocular Neoplasms". En Surgery of the Eyelid, Lacrimal System, and Orbit. Oxford University Press, 2011. http://dx.doi.org/10.1093/oso/9780195340211.003.0007.
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Epithelial malignancy of the eyelid is a common problem, representing about 14% of skin cancers in the head and neck region. The goals when treating any skin cancer are complete elimination of the tumor and minimal sacrifice of normal adjacent tissues. These concepts are of paramount importance when treating periocular epithelial malignancies because of the complex nature of the periocular tissues and their critical function in protecting the underlying globe, as well as the increased risk that recurrent tumor in this area poses. Many modalities have been advocated, by a variety of medical practitioners, for the treatment of epithelial malignancies in the periocular region. There are two key considerations in selecting a treatment for skin cancers. The first is that the selected modality must be capable of eradicating all tumor cells to which it is applied. The second is that some mechanism must exist to ensure that it is applied to all the existing tumor cells. Because tumors of the lid margins and canthi often exhibit slender strands and shoots of cancer cells that may infiltrate beyond the clinically apparent borders of the neoplasm, appropriate monitoring to ensure that the treatment modality reaches all of the cancer cells is essential. Numerous studies have demonstrated that clinical judgment of tumor margins is inadequate, significantly underestimating the area of microscopic tumor involvement. The introduction of frozen-section control to document adequacy of tumor excision marked a major advancement in the treatment of eyelid malignancies and now represents the standard of care. Any treatment modality that does not use microscopic monitoring of tumor margins must instead encompass a wider area of adjacent normal tissue in hopes that any microscopic extensions of tumor will fall within this area. The purpose of this chapter is to explore alternative methods of periocular cancer treatment. Mohs micrographic technique is a refinement of frozen-section control of tumor borders that, by mapping tumor planes, allows a three-dimensional evaluation of tumor margins rather than the two-dimensional examination provided by routine frozen section. The modality was initiated by Frederick E. Mohs, MD, in 1936.
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Bernardino, C. Robert. "Reconstruction of Canthal Defects". En Surgery of the Eyelid, Lacrimal System, and Orbit. Oxford University Press, 2011. http://dx.doi.org/10.1093/oso/9780195340211.003.0010.
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Reconstruction of the medial and lateral canthal region can be quite challenging because in these two regions, soft tissue (canthal tendons) interacts directly with bony tissue to determine the location and function of the eyelids. Poor knowledge of the anatomy in these regions or poor surgical technique and planning can lead to poorly functioning eyelids in both opening and closing as well as associated lacrimal drainage and pump deficiency and aesthetic asymmetry. Tissue loss in these regions can be from many causes, including trauma, inflammation, and neoplasia. When dealing with malignant neoplasia, it is particularly important to ensure that surgical margins are free of tumor prior to reconstruction. Particularly in the medial canthus, incompletely excised lesions can spread deep into the orbit, into the periocular sinuses (ethmoid and maxillary), and down the nasolacrimal system. Therefore, excision with margin control (Mohs, frozen, or permanent sections) is warranted. When a tumor is heading toward the orbit, this author recommends margin control with permanent fixed tissue to ensure proper diagnosis. When tumor cannot be cleared with this technique an exenteration is offered. Repair of the canthal regions involves first repairing deep structures and any bony defects with autologous or synthetic materials, followed by resuspending eyelid structures to a location analogous to their native location. If remnants of the canthal tendon are present, it can be sutured to periosteum, or sutured or wired to bone through drilled pilot holes. Other techniques may involve using titanium miniplates to fixate the soft tissue to bone. If canthal tendon is not present, periosteum of the orbital rim can be fashioned into a flap simulating a canthal tendon, or the tarsus of the eyelid can be split with one arm forming a new canthal tendon. No matter what technique is used, care must be taken to ensure the tendon or tendon substitute is fixed into the orbit, deeper than the orbital rim; failure to do so will cause the eyelids to function poorly. Once deeper structures are restored, repair of the soft tissue must be undertaken.
Actas de conferencias sobre el tema "Excision margins"
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Rounds, Cody C., Jaron de Wit, Jasper Vonk, Floris Voskuil, Max J. H. Witjes y Kenneth M. Tichauer. "Margin status assessment using a ratio-metric angular domain fluorescent imaging approach in patients with head and neck squamous cell carcinoma". En Optical Molecular Probes, Imaging and Drug Delivery. Washington, D.C.: Optica Publishing Group, 2023. http://dx.doi.org/10.1364/omp.2023.ow3e.3.
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Many head and neck squamous cell carcinoma surgical patients are left with residual tumor post excision surgery (inadequate margins). We present an imaging strategy capable of rapid margin status assessment to reduce overall surgical burden.
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El-Helou, Etienne, Claudia Stanciu-Pop, Michel Moreau, Marie Chintinne, Nicolas Sirtaine, Denis Larsimont, Isabelle Veys y Catalin Florin Pop. "MACROSCOPIC EVALUATION OF THE PATHOLOGICAL MARGIN IN PATIENTS WITH BREAST CANCER DURING BREAST-CONSERVING SURGERY". En Brazilian Breast Cancer Symposium 2022. Mastology, 2022. http://dx.doi.org/10.29289/259453942022v32s2059.
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Objective: Nearly 1/5 of women with breast cancer (BC) treated by breast-conserving surgery (BCS) require reoperation due to positive margins on final pathology. In our hospital practice, intraoperative macroscopic pathological margin evaluation (IMPME) of all lumpectomy specimens is routine. The objectives of the study were to assess the accuracy of the IMPME in a large study population of BC patients treated by BCS. Methods: Patients treated by BCS from 2015 to 2017 for invasive BC were included in a retrospective analysis. The diagnostic accuracy of IMPME in predicting margin involvement was calculated by determining its sensitivity (Se), specificity (Sp), negative predictive value (NPV), and false-negative rate (FNR). Results: In all, 543 women with 562 BCS were analyzed. There were 30 (5.5%) patients with multiple BC tumors and 17 (3.1%) patients with bilateral BC. Among them, 460 (81.7%) were invasive ductal carcinomas and 79 (14%) invasive lobular carcinomas. According to intrinsic subtype classification, 504 (89.7%) were luminal tumors, 44 (7.8%) were triple-negative tumors, and 14 (2.7%) were HER2-enriched breast tumors. The mean pathological tumor size was 12.2 mm (range: 1.5–40 mm). With a cutoff value of ≤1 mm for positive margin status with IMPME, the Se, Sp, NPV, and FNR were 65.9% (29/44), 66% (342/518), 95.8% (342/357), and 4% (15/357), respectively. There were 34.2% (192/562) BCS with intraoperative re-excision after IMPME examination. The secondary re-excision rate for final positive margins after BCS was 6.6% (37/562). Conclusion: In this study population, IMPME is not sensitive and specific enough to discriminate between negative and positive margins during BCS. Nevertheless, its NPV seems sufficiently accurate to exclude the presence of residual breast tumor tissue on the surgical specimen of patients treated with BCS, which represents an effective technique for evaluating the intraoperative margin in BC patients.
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Mullen, R., EJ Macaskill, A. Khalil, E. Elseedawy, DC Brown, AC Lee, C. Purdie, L. Jordan y AM Thompson. "P3-12-04: Involved Anterior Margins after Breast Conserving Surgery: Is Re-Excision Required?" En Abstracts: Thirty-Fourth Annual CTRC‐AACR San Antonio Breast Cancer Symposium‐‐ Dec 6‐10, 2011; San Antonio, TX. American Association for Cancer Research, 2011. http://dx.doi.org/10.1158/0008-5472.sabcs11-p3-12-04.
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Belluco, Rosana Zabulon Feijó, Melissa de Andrade Baqueiro, Vitória Vasconcelos de Lara Resende, Flávio Lúcio Vasconcelos y Jefferson Lessa Soares de Macedo. "EXTENSIVE DERMATOFIBROSARCOMA PROTUBERANS IN THE CHEST AND BREAST: A CASE REPORT". En XXIV Congresso Brasileiro de Mastologia. Mastology, 2022. http://dx.doi.org/10.29289/259453942022v32s1033.
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Dermatofibrosarcoma protuberans (DP) is a neoplasm of the deep layer of the dermis and subcutaneous tissue. It presents a rare incidence and constitutes 0.1% of the malignant tumors. It has local aggressive behavior with slow tumor growth, low metastasis rates of around 5%, but has high rates of local recurrence after surgical excision. The diagnosis is histopathological through biopsy of the lesion, and the fluorescence in situ hybridization (FISH) method can help in selected cases by detecting possible chromosomal rearrangements in the tissue. Physical examination, magnetic resonance imaging, and computed tomography may be helpful in assessing the area of tumor extension. The treatment of choice is resections with 3-cm wide margins or Mohs micrographic surgery. The prognosis is directly related to the correct excision of the compromised margins. A woman, 51 years old, presented with a raised, brownish, irregular, 13×8 cm multinodular lesion attached to the overlying skin, in the epigastric region, which extended to the left hypochondrium and lower quadrants of the left breast, without local symptoms or lymph node enlargement. She reported the appearance of a small nodular skin lesion at the site 10 years ago and reports continuous growth of the nodule, with the involvement of the adjacent skin and the left breast starting 5 years ago, after the formation of a hypertrophic scar due to two previous local resections of the initial lesion. Mammography showed a nodule of cutaneous origin in the lower inner quadrant of the left breast, which may correspond to keloids — BIRADS 2. Breast ultrasound showed a solid, echogenic nodule measuring 1.6×1.2 cm in the left breast at 8 am; 2.5 cm from the nipple — suggestive of lipoma, and at 7 am, nodule measuring 2.4×1.6 cm that penetrates the breast parenchyma — BIRADS 3. The lesion was diagnosed as dermatofibrosarcoma on histopathological examination of a skin fragment. The patient underwent resection of the lesion with a safety margin by the mastology team and primary reconstruction using a thigh graft by the plastic surgery team. A surgical specimen was sent for anatomopathological examination that presented a result compatible with a previous biopsy, reiterating the diagnosis of DP, and with peripheral and deep surgical margins free of neoplastic involvement; evolved without postoperative complications or restriction of range of motion; and referred to radiotherapy to assess the need for additional treatment.
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El-Helou, Etienne, Manar Zaiter, Pauline Delrue, Ahmad Awada, Isabelle Veys y Catalin-Florin Pop. "INCIDENTAL FINDING OF SOLITARY FIBROUS TUMOR OF MALE BREAST". En Brazilian Breast Cancer Symposium 2022. Mastology, 2022. http://dx.doi.org/10.29289/259453942022v32s2087.
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Myofibroblastoma (MFB), also known as a solitary fibrous tumor of the breast, is a rare sporadic benign tumor composed of spindle-shaped tumor cells with myoblast differentiation. The most typical presentation is a painless unilateral mass that is not connected to any surrounding structure and seldom surpasses 3 cm in size and should be evaluated by using the triple-assessment approach. They have several subtypes, and a definite diagnosis can only be confirmed safely after surgery using immunohistochemistry. Surgical excision serves an essential diagnostic and therapeutic purpose; MFB has a favorable prognosis even when excision margins are positive, and local recurrence is extremely rare. The following is the case of a 73-year-old man who presented with a dry cough. An MFB was discovered by chance during the investigative workup and referred to our department. The patient’s presentation, imaging, and histological samples all supported the diagnosis, and he had surgical resection without incident. We present the second case of an incidental finding of breast MFB and urge clinicians to consider this differential diagnosis.
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Pereira, Antonio Cesar, Rogerio Bizinoto Ferreira, Delio Marques Conde, Alexandre Marchiori Xavier de Jesus, Ana Beatriz Marinho de Jesus Teixeira, Sebastião Alves Pinto y Sergi Vidal Sicart. "OCCULT LESIONS LOCALIZATION AND “IN VIVO” MARGINS EVALUATION OF BREAST CARCINOMA DETECTED BY NEW HYBRID TECHNIQUE USING RADIOFLUORESCENCE—A PILOT STUDY". En Abstracts from the Brazilian Breast Cancer Symposium - BBCS 2021. Mastology, 2021. http://dx.doi.org/10.29289/259453942021v31s2019.
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This pilot study presents a new technique of hybrid marking of non-palpable breast lesion with surgical margins evaluation “in vivo,” which we referred to as FLuorescence And Seed for Hybrid Intraoperative Evaluation (FLASHIE). Seven women, with one lesion each, were submitted to a previous implantation of 125-iodine seed in the center of the suspected area and then were injected with indocyanine green (ICG). During surgery, an optonuclear probe was used to detect gamma radiation and fluorescence. Gamma detection mode was used to locate lesions, and then fluorescence mode, to analyze the ICG concentration, which allowed distinguishing a benign tumor and six malignant lesions. These lesions were confirmed by conventional pathological and immunohistochemical analysis. In the malignant positive cases, fluorescence was also used for the orientation of the excision of the tissue in order to obtain more adequate surgical margins. This new promising technique may prevent the persistence of post-surgery tumor residues.
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Shipp, Dustin, Emad Rakha, Alexey Koloydenko, Douglas Macmillan, Ian Ellis y Ioan Notingher. "Intra-operative Assessment of Excision margins During Breast Conserving Surgery by Integrated Raman Microscopy and Auto-fluorescence Imaging". En Clinical and Translational Biophotonics. Washington, D.C.: OSA, 2018. http://dx.doi.org/10.1364/translational.2018.ctu4b.5.
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Razvi, K., K. Rothnie, T. Speed y S. Clark. "EP1085 Surgical margins of large loop excision of the transformation zone: histological comparison with patient characteristics and colposcopists' experience". En ESGO Annual Meeting Abstracts. BMJ Publishing Group Ltd, 2019. http://dx.doi.org/10.1136/ijgc-2019-esgo.1127.
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Roh, Ju-Won, Jongseung Kim, Grace J. Lee y Min-Jeong Kim. "220 Lugol’s solution reduces positive margins and residual disease after the large loop excision of the transformation zone (LLETZ)". En ESGO 2024 Congress Abstracts. BMJ Publishing Group Ltd, 2024. http://dx.doi.org/10.1136/ijgc-2024-esgo.140.
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Santos, Mayra de Oliveira, Patrícia Bittencourt Marques Lauria, Isadora Maria de Oliveira Santos, Maxlânio Azevedo Borges, Cristiana Buzelin Nunes, Jane Braga da Silva y Clécio Ênio Murta de Lucena. "CONSERVATIVE SURGERY IN ADENOID CYSTIC CARCINOMA: A CASE REPORT". En Brazilian Breast Cancer Symposium 2022. Mastology, 2022. http://dx.doi.org/10.29289/259453942022v32s2090.
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Objectives: Adenoid cystic carcinoma of the breast (CACM) is uncommon, comprising less than 0.1% of breast carcinomas. In the literature, many authors argue that local control is achieved through mastectomy, especially in high-grade histological tumors. We report a case of CACM treated with conservative surgery at the Mastology Service of Hospital das Clínicas da UFMG. Methods: ASG, a 62-year-old, female patient presented with a 2-cm palpable nodule on the left breast, with the following mammographic representation: isodense nodule in the upper lateral quadrant, obscured contours, measuring 20 mm. She underwent a diagnostic sectorectomy and was diagnosed with basaloid solid-type CACM, grade 3, triple-negative phenotype, measuring 1.5 cm, with compromised lateral and anterior margins. She underwent a new sectorectomy and sentinel lymph node biopsy, with no invasive neoplasm in the sample and four sentinel lymph nodes, all free of metastasis. Subsequently, she underwent radiotherapy. On biopsy, CACM, grade 2, triple-negative phenotype was diagnosed. She was treated with conservative surgery and radiotherapy. Results: Follow-up with no signs of local recurrence or distant metastasis at one-year follow-up. Conclusion: Although most adenoid cystic carcinomas present with the basal-like, triple-negative phenotype, these tumors are generally of low histological grade and present an indolent biological behavior. Based on these clinical characteristics, the most recent studies have demonstrated the effectiveness of treatment with a complete excision of the tumor with wide margins and the addition of radiotherapy.