Touch prep (TP) cytology as a tool for determining pulmonary parenchymal resection margin status

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 18095-18095
Author(s):  
K. M. Brown ◽  
J. Flaherty ◽  
V. Ciocca ◽  
H. Ehya ◽  
W. Scott ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Wedge Resection ◽  
Accurate Determination ◽  
Lung Lesion ◽  
Margin Status ◽  
Resection Margins ◽  
Logrank Test ◽  
Lung Cancers ◽  
Promising Tool ◽  
Metastatic Lung

18095 Background: Accurate determination of parenchymal resection margins is critical in excision of primary and metastatic lung cancers. Complete microscopic examination of the entire margin is difficult and may not give timely results. Staple-line excision may compromise the accuracy of histologic margin exam (HME). TP offers a novel method to obtain pulmonary parenchymal margin status intraoperatively. Methods: Patients undergoing wedge resection for a known malignant lung lesion were studied prospectively. At the time of resection, the specimen stapled margin underwent TP on 3 glass slides for cytological analysis. The presence or absence of malignant cells on TP was correlated to final HME. Local recurrence and overall survival by TP and HME status were compared using logrank test. Results: Thirty specimens from 29 patients were studied between December 2002 and April 2006. Fifteen specimens (50%) were right- sided; 9/29 patients (31%) were male. Median age was 66 years (range 28 - 81). Histologies included non-small cell lung cancer (NSCLC) in 22 (73%), and metastases from colorectal cancer (4/30, 13%), sarcoma (2/20, 7%), and breast (1/30, 3%). All TP negative specimens had negative HME. TP was positive in 10 of 30 (33%) specimens, 6 of which had negative HME. These included 4 NSCLC and metastases from sarcoma (1) and colon (1). Mean margin distance was 4 ± 1.7 mm for TP/HME negative specimens, 0.5 ± 0 mm for TP/HME positive specimens, and 5 ± 1.7 mm for TP positive/HME negative patients. There was no difference in time to local recurrence between patients with positive margins by TP vs HME (18.6 and 18.63 months), or in TP and HME negative patients (30.1 and 30.6 months). Conclusion: TP analysis of lung parenchymal margins is safe and feasible. A negative TP is highly predictive of negative HME. Factors contributing to false-positive TP remain unresolved. Multi-institutional prospective studies are indicated for further characterization of this promising tool. No significant financial relationships to disclose.

scholarly journals Surgical Treatment of Local Recurrence After Stereotactic Body Radiotherapy for Primary and Metastatic Lung Cancers

2010 ◽  
Vol 5 (12) ◽  
pp. 2003-2007 ◽  
Author(s):  
Shinya Neri ◽  
Yutaka Takahashi ◽  
Takuya Terashi ◽  
Hiroshi Hamakawa ◽  
Keisuke Tomii ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Local Recurrence ◽  
Stereotactic Body Radiotherapy ◽  
Lung Cancers ◽  
Metastatic Lung

scholarly journals Performance of Intraoperative Assessment of Resection Margins in Oral Cancer Surgery: A Review of Literature

2021 ◽  
Vol 11 ◽  
Author(s):  
Elisa M. Barroso ◽  
Yassine Aaboubout ◽  
Lisette C. van der Sar ◽  
Hetty Mast ◽  
Aniel Sewnaik ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Oral Cancer ◽  
Local Recurrence ◽  
Sensitivity And Specificity ◽  
Clinical Relevance ◽  
Cancer Surgery ◽  
Margin Status ◽  
Resection Margins ◽  
Intraoperative Assessment ◽  
Average Accuracy

IntroductionAchieving adequate resection margins during oral cancer surgery is important to improve patient prognosis. Surgeons have the delicate task of achieving an adequate resection and safeguarding satisfactory remaining function and acceptable physical appearance, while relying on visual inspection, palpation, and preoperative imaging. Intraoperative assessment of resection margins (IOARM) is a multidisciplinary effort, which can guide towards adequate resections. Different forms of IOARM are currently used, but it is unknown how accurate these methods are in predicting margin status. Therefore, this review aims to investigate: 1) the IOARM methods currently used during oral cancer surgery, 2) their performance, and 3) their clinical relevance.MethodsA literature search was performed in the following databases: Embase, Medline, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar (from inception to January 23, 2020). IOARM performance was assessed in terms of accuracy, sensitivity, and specificity in predicting margin status, and the reduction of inadequate margins. Clinical relevance (i.e., overall survival, local recurrence, regional recurrence, local recurrence-free survival, disease-specific survival, adjuvant therapy) was recorded if available.ResultsEighteen studies were included in the review, of which 10 for soft tissue and 8 for bone. For soft tissue, defect-driven IOARM-studies showed the average accuracy, sensitivity, and specificity of 90.9%, 47.6%, and 84.4%, and specimen-driven IOARM-studies showed, 91.5%, 68.4%, and 96.7%, respectively. For bone, specimen-driven IOARM-studies performed better than defect-driven, with an average accuracy, sensitivity, and specificity of 96.6%, 81.8%, and 98%, respectively. For both, soft tissue and bone, IOARM positively impacts patient outcome.ConclusionIOARM improves margin-status, especially the specimen-driven IOARM has higher performance compared to defect-driven IOARM. However, this conclusion is limited by the low number of studies reporting performance results for defect-driven IOARM. The current methods suffer from inherent disadvantages, namely their subjective character and the fact that only a small part of the resection surface can be assessed in a short time span, causing sampling errors. Therefore, a solution should be sought in the field of objective techniques that can rapidly assess the whole resection surface.

scholarly journals Radiation-Associated Angiosarcoma of the Breast and Chest Wall Treated with Thermography-Controlled, Contactless wIRA-Hyperthermia and Hypofractionated Re-Irradiation

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3911
Author(s):  
Markus Notter ◽  
Emanuel Stutz ◽  
Andreas R. Thomsen ◽  
Peter Vaupel
Keyword(s):  
Local Recurrence ◽  
Background Radiation ◽  
Definitive Treatment ◽  
Resection Margins ◽  
Recurrence Rates ◽  
Rate Dependent ◽  
Angiosarcoma Of The Breast ◽  
Positive Resection Margins ◽  
Locally Recurrent ◽  
Tumor Extent

Background: Radiation-associated angiosarcoma of the breast (RAASB) is a rare, challenging disease, with surgery being the accepted basic therapeutic approach. In contrast, the role of adjuvant and systemic therapies is a subject of some controversy. Local recurrence rates reported in the literature are mostly heterogeneous and are highly dependent on the extent of surgery. In cases of locally recurrent or unresectable RAASB, prognosis is very poor. Methods: We retrospectively report on 10 consecutive RAASB patients, most of them presenting with locally recurrent or unresectable RAASB, which were treated with thermography-controlled water-filtered infrared-A (wIRA) superficial hyperthermia (HT) immediately followed by re-irradiation (re-RT). Patients with RAASB were graded based on their tumor extent before onset of radiotherapy (RT). Results: We recorded a local control (LC) rate dependent on tumor extent ranging from a high LC rate of 100% (two of two patients) in the adjuvant setting with an R0 or R2 resection to a limited LC rate of 33% (one of three patients) in patients with inoperable, macroscopic tumor lesions. Conclusion: Combined HT and re-RT should be considered as an option (a) for adjuvant treatment of RAASB, especially in cases with positive resection margins and after surgery of local recurrence (LR), and (b) for definitive treatment of unresectable RAASB.

scholarly journals Significant up-regulation of a novel gene, CLCP1, in a highly metastatic lung cancer subline as well as in lung cancers in vivo

Oncogene ◽  
2002 ◽  
Vol 21 (18) ◽  
pp. 2822-2828 ◽  
Author(s):  
Katsumi Koshikawa ◽  
Hirotaka Osada ◽  
Ken-ichi Kozaki ◽  
Hiroyuki Konishi ◽  
Akira Masuda ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Metastatic Lung Cancer ◽  
Lung Cancers ◽  
Novel Gene ◽  
Metastatic Lung

scholarly journals Mutational analysis of multiple lung cancers: Discrimination between primary and metastatic lung cancers by genomic profile

Oncotarget ◽  
2017 ◽  
Vol 8 (19) ◽  
pp. 31133-31143 ◽  
Author(s):  
Taichiro Goto ◽  
Yosuke Hirotsu ◽  
Hitoshi Mochizuki ◽  
Takahiro Nakagomi ◽  
Daichi Shikata ◽  
...  
Keyword(s):  
Mutational Analysis ◽  
Genomic Profile ◽  
Lung Cancers ◽  
Metastatic Lung

scholarly journals Suspected Pulmonary Metastasis of Actinic Cutaneous Squamous Cell Carcinoma

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Monet E. Meter ◽  
David J. Nye ◽  
Christian R. Galvez
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Actinic Keratosis ◽  
Uv Light ◽  
Light Exposure ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Lung Lesion ◽  
The Right

Introduction. It is rare for actinic or squamous cell carcinoma (SCC) in situ to metastasize. Case Presentation. A 67-year-old male had a significant medical history including severe psoriatic arthritis treated with UVB, methotrexate, and rapamycin. He had twenty-five different skin excisions of actinic keratosis four of which were invasive SCC. Our patient developed shortness of breath necessitating a visit to the emergency department. A CT scan of his chest revealed a mass in the right lower lung. A subsequent biopsy of the mass revealed well-differentiated SCC. He underwent thoracoscopic surgery with wedge resection of the lung lesion. Discussion. Actinic keratosis (AK) is considered precancerous and associated with UV exposure. It exists as a continuum of progression with low potential for malignancy. The majority of invasive SCCs are associated with malignant progression of AK, but only 5–10% of AKs will progress to malignant potential. Conclusion. In this case, a new finding of lung SCC in the setting of multiple invasive actinic cutaneous SCC associated with a history of extensive UV light exposure and immunosuppression supports a metastatic explanation for lung cancer.

scholarly journals Using cfRNA as a tool to evaluate clinical treatment outcomes in patients with metastatic lung cancers and other tumors

2021 ◽  
Author(s):  
Luis E. Raez ◽  
Kathleen Danenberg ◽  
Daniel Sumarriva ◽  
Joshua Usher ◽  
Jacob Sands ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Gene Expression ◽  
Response To Therapy ◽  
Liquid Biopsies ◽  
Blood Samples ◽  
Lung Cancers ◽  
Metastatic Lung ◽  
Clinical Responses ◽  
Pre Treatment ◽  
Actin Expression

Aim: We report an exploratory analysis of cfRNA as a biomarker to monitor clinical responses in non-small cell lung cancer (NSCLC), breast cancer, and colorectal cancer (CRC). An analysis of cfRNA as a method for measuring PD-L1 expression with comparison to clinical responses was also performed in the NSCLC cohort. Methods: Blood samples were collected from 127 patients with metastatic disease that were undergoing therapy, 52 with NSCLC, 50 with breast cancer, and 25 with CRC. cfRNA was purified from fractionated plasma, and following reverse transcription (RT), total cfRNA and gene expression of PD-L1were analyzed by real-time polymerase chain reaction (qPCR) using beta-actin expression as a surrogate for relative amounts of cfDNA and cfRNA. For the concordance study of liquid biopsies and tissue biopsies, the isolated RNA was analyzed by RNAseq for the expressions of 13 genes. We had to close the study early due to a lack of follow-up during the Covid-19 pandemic. Results: We collected a total of 373 blood samples. Mean cfRNA PCR signals after RT were about 50-fold higher than those of cfDNA. cfRNA was detected in all patients, while cfDNA was detected in 88% of them. A high concordance was found for the expression levels of 13 genes between blood and solid tumor tissue. Changes in cfRNA levels followed over the course of treatments were associated with response to therapy, increasing in progressive disease (PD) and falling when a partial response (PR) occurred. The expression of PD-L1 over time in patients treated with immunotherapy decreased with PR but increased with PD. Pre-treatment levels of PD-L1 were predictive of response in patients treated with immunotherapy. Conclusion: Changes in cfRNA correlate with clinical response to the therapy. Total cfRNA may be useful in predicting clinical outcomes. PD-L1 gene expression may provide a biomarker to predict response to PD-L1 inhibition.

Resection Status Does Not Impact Recurrence in Well-Differentiated Liposarcoma of the Extremity

2021 ◽  
pp. 000313482110545
Author(s):  
Chelsea R. Olson ◽  
Lorena P. Suarez-Kelly ◽  
Cecilia G. Ethun ◽  
Rita D. Shelby ◽  
Peter Y. Yu ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Resection Margins ◽  
R0 Resection ◽  
Low Grade ◽  
Incomplete Resection ◽  
R1 Resection ◽  
Increased Risk ◽  
Clinicopathologic Factors ◽  
Resection Margin Status ◽  
Well Differentiated

Background Well-differentiated liposarcoma (WDLPS) is a low-grade soft tissue sarcoma with a propensity for local recurrence. The necessity of obtaining microscopically free surgical margins (R0) to minimize local recurrence is not clear. This study evaluates recurrence-free survival (RFS) of extremity WDLPS in relation to resection margin status. Methods A retrospective review of adult patients with primary extremity WDLPS at seven US institutions from 2000 to 2016 was performed. Patients with recurrent tumors or incomplete resection (R2) were excluded. Clinicopathologic factors were analyzed to assess impact on local RFS. Results 97 patients with primary extremity WDLPS were identified. The majority of patients had deep, lower extremity tumors. Mean tumor size was 18.2±8.9cm. Patients were treated with either radical (76.3%) or excisional (23.7%) resections; 64% had R0 and 36% had microscopically positive (R1) resection margins. Ten patients received radiation therapy with no difference in receipt of radiation between R0 vs R1 groups. Thirteen patients (13%) developed a local recurrence with no difference in RFS between R0 vs R1 resection. Five-year RFS was 59.5% for R0 vs 85.2% for R1. Only one patient died of disease after developing dedifferentiation and distant metastasis despite originally having an R0 resection. Discussion In this large multi-institutional study of surgical resection of extremity WDLPS, microscopically positive margins were not associated with an increased risk of recurrence. Positive microscopic margin resection for extremity WDLPS may yield similar rates of local control while avoiding a radical approach to obtain microscopically negative margins.

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