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Pat Whitworth, Steven Schonholz, Rogsbert Phillips, Yara Robertson, Antonio Ruiz, Susan Winchester, Cathy Graham, Jean Simpson, Chloe Wernecke
BACKGROUND: Aiming to minimize overtreatment of high-risk breast lesions (HRLs), including atypical ductal hyperplasia, and small breast cancers, including ductal carcinoma in situ (DCIS), we investigated a minimally invasive (MI) approach to definitive diagnosis and management of these conditions. METHODS: In the prospective Intact Percutaneous Excision registry study, women aged 31-86 years had removal of small invasive cancers, DCIS, or HRLs using image-guided 12-20 mm radiofrequency basket capture (MI excision)...
February 12, 2019: Annals of Surgical Oncology
Kelsey Gray, Reed Ayabe, Andrew Shover, Ashkan Moazzez, Junko Ozao-Choy, Christine Dauphine
The rate of positive margins after breast conserving surgery (BCS) can be as high as 50 per cent, and optimal techniques for reducing rates of positive margins are presently debated. Our institution has previously demonstrated low rates of margin re-excision using a standardized approach to intraoperative selective margin excision for patients undergoing BCS. We hypothesized that this approach can be used for patients with ductal carcinoma In Situ (DCIS) and can yield similar rates when compared with invasive cancer...
October 1, 2018: American Surgeon
Elizabeth H Bruenderman, Neal Bhutiani, Megan K Mercer, Kelly M McMasters, Mary Ann G Sanders, Nico Lás Ajkay
BACKGROUND: Microcalcifications associated with ductal carcinoma in situ (DCIS-AMC) close to lumpectomy margins could be used as a surrogate for margin involvement and aid in decreasing margin re-excision. We sought to evaluate the histologic factors of DCIS-AMC near lumpectomy margins. METHODS: Women with DCIS treated with breast-conserving surgery (BCS) who had DCIS-AMC on surgical specimens were identified. Pathology slides were reviewed to determine the distance of DCIS-AMC from each margin (six per specimen) and the distance of DCIS from each margin (ie, margin status)...
February 11, 2019: Journal of Surgical Oncology
Weisi Xie, Ye Chen, Yu Wang, Linpeng Wei, Chengbo Yin, Adam K Glaser, Mark E Fauver, Eric J Seibel, Suzanne M Dintzis, Joshua C Vaughan, Nicholas P Reder, Jonathan T C Liu
Intraoperative assessment of breast surgical margins will be of value for reducing the rate of re-excision surgeries for lumpectomy patients. While frozen-section histology is used for intraoperative guidance of certain cancers, it provides limited sampling of the margin surface (typically <1  %   of the margin) and is inferior to gold-standard histology, especially for fatty tissues that do not freeze well, such as breast specimens. Microscopy with ultraviolet surface excitation (MUSE) is a nondestructive superficial optical-sectioning technique that has the potential to enable rapid, high-resolution examination of excised margin surfaces...
February 2019: Journal of Biomedical Optics
Jasmin M Schaefer, Connor W Barth, Scott C Davis, Summer L Gibbs
Intraoperative margin assessment is imperative to cancer cure but is a continued challenge to successful surgery. Breast conserving surgery is a relevant example, where a cosmetically improved outcome is gained over mastectomy, but re-excision is required in >25  %   of cases due to positive or closely involved margins. Clinical translation of margin assessment modalities that must directly contact the patient or required administered contrast agents are time consuming and costly to move from bench to bedside...
February 2019: Journal of Biomedical Optics
Caleb M Schadel, Craig W Anderson, Angela C Chi, Martin B Steed
A perineurioma (PN) is a rare benign peripheral nerve sheath tumor derived from perineurial cells. Based on clinical and pathologic features, PNs can be classified into 2 major subtypes: intraneural PN (IPN) and the more common extraneural PN (EPN). EPNs and IPNs are extremely rare in the oral cavity, and there have been only 38 reported cases (21 EPNs, 17 IPNs). In the present case, a 20-year-old man presented with a painless left dorsal tongue mass. Excisional biopsy examination indicated a diagnosis of EPN based on microscopic examination with immunohistochemical analysis...
February 2019: Journal of Oral and Maxillofacial Surgery
Chelsea R Horwood, Valerie Grignol, Samantha Lahey, Vishnu Pemmaraju, Andrew Schafer, Alicia M Terando, Doreen M Agnese
The aim of this study was to compare wire localization (WL) and radioactive seed localization (RSL) for nonpalpable breast lesions with regard to margin status, re-excision rate, procedure length, and complications related to localization. A retrospective review of the electronic health records at a single institution was performed. There was no difference in re-excision rate, margin positivity, volume of tissue removed, and complication rate for RSL vs WL (P = 0.9934, P = 0.9934, P = 0.6645, and P = 0...
January 31, 2019: Breast Journal
Katerina Kaczmarski, Peiqi Wang, Richard Gilmore, Heidi N Overton, David M Euhus, Lisa K Jacobs, Mehran Habibi, Melissa Camp, Matthew J Weiss, Martin A Makary
BACKGROUND: To better understand re-excision practice patterns following breast-conserving therapy (BCT), we evaluated variation in surgeon-specific re-excision rates and associated factors. STUDY DESIGN: We performed a retrospective analysis using Medicare claims from 2012-2018 to identify patients undergoing BCT and subsequent breast resection procedures within 12 months. We compared rates before and after the 2014 "no tumor on ink" consensus guideline...
January 28, 2019: Journal of the American College of Surgeons
Maggie L DiNome, Amy M Kusske, Deanna J Attai, Cheryce P Fischer, Anne C Hoyt
PURPOSE: Use of a wire to localize a non-palpable breast lesion for surgery is standard but archaic. We sought to evaluate a new radiofrequency localization system (RFLS) as an effective, non-radioactive alternative to the wire. METHODS: Patients who required surgical excision of a non-palpable breast lesion were consented for the study. Patients underwent localization with a radiofrequency Tag and surgical removal guided by the handheld LOCalizer probe. The primary study endpoint was successful placement and retrieval of the Tag, and secondary endpoints included marker migration; days prior to surgery of Tag insertion; patient, radiologist, and surgeon experience; distance of Tag from skin; and positive margin and re-excision rates for cancer...
January 28, 2019: Breast Cancer Research and Treatment
Maureen P McEvoy, Jeffrey Landercasper, Himani R Naik, Sheldon Feldman
In 2015, the American Society of Breast Surgeons (ASBrS) convened a multidisciplinary consensus conference, the Collaborative Attempt to Lower Lumpectomy Reoperation Rates (CALLER). The CALLER conference endorsed a "toolbox" of multiple processes of care for which there was evidence that they were associated with fewer reoperations. We present an update of the toolbox taking into consideration the latest advances in decreasing re excision rates. In this review, we performed a comprehensive review of the literature from 2015-2018 using search terms for each tool...
December 2018: Gland Surgery
Uzma Jalali, Alhad Dhebri, Eszter Karip, Roger Hunt
A 43-year-old woman with a positive family history of breast cancer presented with a painless lump in her left axilla for 2 years. Clinical diagnosis was a left axillary sebaceous cyst as the lump was inseparable from the skin. The lesion was excised under local anaesthesia and reported as breast tissue widely infiltrated by an invasive ductal carcinoma (grade 2). The malignancy was not involving the epidermis but <1 mm away from deeper margins. Re-excision of the deeper tissue with an axillary sentinel lymph nodes biopsy was performed and deep margins were reported to be tumour-free with no nodal involvement...
January 24, 2019: BMJ Case Reports
Robert Anthony Keenan, Aisling U Nic An Riogh, Andrea Stroiescu, Adrian Fuentes, Joan Heneghan, Ivor M Cullen, Padraig J Daly
Paratesticular soft tissue tumours are remarkably rare entities, with malignant subtypes accounting for approximately 30%. Due to the paucity of cases, a consensus on the best treatment has not yet been reached, presenting a diagnostic and therapeutic challenge for clinicians. Although rare, three such cases presented to the care of our institution serving a population of approximately 400,000 in the space of 13 months. These were three gentlemen, aged 54, 82 and 86 years old, presenting with left sided testicular swellings...
January 2019: Therapeutic Advances in Urology
Steven A Ovadia, Seth A Spector, Seth R Thaller
INTRODUCTION: With increasing health care expenses and limited resources, it is important to evaluate potential means of reducing cost while maintaining efficacy and safety. The purpose of our study was to compare the cost and outcomes of surgical excision of nonmelanoma skin cancer (NMSC) in the operating room versus an outpatient procedure clinic. METHODS: A retrospective review of patients undergoing excision of biopsy-confirmed NMSC at the Miami Veterans Affairs Hospital between December 1, 2015, and December 1, 2016, was completed...
January 9, 2019: Annals of Plastic Surgery
Karin Hellerhoff, Lorenz Birnbacher, Anikó Sztrókay-Gaul, Susanne Grandl, Sigrid Auweter, Marian Willner, Mathias Marschner, Doris Mayr, Maximilian F Reiser, Franz Pfeiffer, Julia Herzen
BACKGROUND: The extent of intraductal carcinoma in situ (DCIS) is commonly underestimated due to the discontinuous growth and lack of microcalcifications. Specimen radiography has been established to reduce the rate of re-excision. However, the predictive value for margin assessment with conventional specimen radiography for DCIS is low. In this study we assessed the potential of grating-based phase-contrast computed tomography (GBPC-CT) at conventional X-ray sources for specimen tomography of DCIS containing samples...
2019: PloS One
Georgi Tchernev, Ivanka Temelkova
BACKGROUND: Drug-induced carcinogenesis is a matter of huge popularity and the subject of in-depth research over the last few years. According to the literature, dopamine agonists and acetylsalicylic acid fall into the list of drugs likely to potentiate the development of cutaneous melanoma. However, according to recent data, widely used angiotensin receptor blockers (ARBs) for the treatment of arterial hypertension, also carry a risk of malignancy development. The content of probable carcinogens, such as NDMA or NDEA in the drug valsartan (ARBs), causes the product to be withdrawn from the market...
December 20, 2018: Open Access Macedonian Journal of Medical Sciences
Georgi Tchernev, Ilia Lozev, Ivan Pidakev, Ivanka Temelkova
BACKGROUND: One of the features characterising cutaneous SCC as high-risk is lymphovascular infiltration. The diffuse lymphangitic spread of carcinogenic cells is defined as the so-called lymphangitis carcinomatosa. In some cases, it is the only and first sign to alert the presence of an underlying malignancy. Therefore, biopsy in patients with clinical data on lymphangiosis carcinomatosa is of paramount importance. CASE REPORT: We present a 77-year-old man with a progressively growing tumour formation in the area of the right shoulder, clinically suspected for SCC...
December 20, 2018: Open Access Macedonian Journal of Medical Sciences
Georgi Tchernev, Ivanka Temelkova
BACKGROUND: The American Joint Committee on Cancer (AJCC) offers a two-stage, often insufficient or so-called variable model of cutaneous melanoma treatment. This model starts with primary excision and an initial operational safety margin of 0.5 cm in all directions, followed by a re-excision with an additional field of operational security, determined by histologically established tumor thickness (with or without removal of SLN). We present a brand new method of melanoma surgery, the so-called One Step melanoma surgery (OSMS), in which cutaneous melanomas (regardless of their thickness) could be removed by single surgical intervention...
December 20, 2018: Open Access Macedonian Journal of Medical Sciences
A Bouchard-Fortier, N N Baxter, R Sutradhar, K Fernandes, X Camacho, P Graham, M L Quan
Background and Objectives: Contralateral prophylactic mastectomy (cpm) has been increasingly common among women with unilateral invasive breast cancer (ibca) even though the data that support it are limited. Using a population-based cohort, the objectives of the present study were to describe factors predictive of cpm in young women (≤35 years) with ibca and to evaluate the impact of the procedure on mortality. Methods: All women diagnosed during 1994-2003 and treated with cpm were identified from the Ontario Cancer Registry...
December 2018: Current Oncology
Inka Treskova, Ondrej Hes, Vlastimil Bursa
RATIONALE: Testosterone is important for the development of secondary sexual characteristics in female-to-male transsexuals. On the contrary, it can increase the risk of breast cancer. PATIENT CONCERNS: We present a rare case of breast cancer in female-to-male transsexual patient after long-term hormonal therapy. DIAGNOSIS: Breast cancer in female-to-male transsexual patient. INTERVENTIONS: The patient underwent mastectomy and chemotherapy...
December 2018: Medicine (Baltimore)
Alexandra Banks, Gerald Coronado, Robert Zimmerman, Geeta Iyengar, Dennis R Holmes
BACKGROUND: A prospective randomized controlled trial has established the efficacy of targeted intraoperative radiotherapy (TARGIT) in the management of invasive breast cancer treated with breast-conserving surgery (BCS). The purpose of this analysis is to evaluate the efficacy of TARGIT in the management of ductal carcinoma in situ (DCIS). METHODS: A prospective nonrandomized trial was designed to evaluate the success of TARGIT in the management of DCIS, as measured by a low risk of requiring additional surgery or radiotherapy and an acceptable local recurrence rate (LRR)...
December 27, 2018: Journal of Surgical Oncology
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