scholarly journals MarginProbe Radiofrequency Spectroscopy with Intraoperative Pathology Assessment: Synergistic, or Redundant?

2021 ◽  
Author(s):  
Fred Qafiti ◽  
Christina Layton ◽  
Kerry-Ann McDonald
Keyword(s):  
Tumor Size ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Breast Conserving Surgery ◽  
Invasive Cancer ◽  
Relative Reduction ◽  
Consensus Guideline ◽  
Positive Margins ◽  
Incremental Value

Abstract Background:Published MarginProbe (MP) data reports ≥50% reduction in positive lumpectomy margins. Standard of care (SOC) in our facility uses intraoperative pathologic gross assessment for invasive cancer. We sought to determine if adjunctive use of MP would provide incremental value over gross assessment alone. Methods:This is a single-site, single-surgeon retrospective chart review of 86 consecutive lumpectomies with MP from 12/2018–11/2019. Margins were considered positive using SSO/ASTRO “no ink on tumor” consensus guideline for invasive cancer, and SSO/ASTRO/ASCO consensus guideline of 2mm or greater for pure DCIS. Significance was measured using Fisher’s exact two-tailed test.Results:76 patients (7 bilateral, 3 unilateral/multi-focal) yielded 86 lumpectomies for inclusion. Mean age was 69.8 and mean tumor size was 1.09cm. 68 invasive cancers were assessed using adjunct MP and gross assessment while 18 DCIS cases utilized MP only. Among all cases, gross assessment alone reduced positive margins from 27.9% to 19.8% (29.2% relative reduction, p=0.28). Utilizing both modalities in tandem, positive margins decreased from 27.9% to 9.3% (66.7% relative reduction, p<0.01) representing a 46.9% relative reduction versus gross assessment alone. Main specimen tissue volume was 27.1cc. After gross assessment and MarginProbe evaluation, there was additional excised volume that averaged 2.9 cc. Total averaged excised volume was 33 cc. This compares to the reported 40-60 cc average in multiple studies.Conclusion:Adjunctive use of MP with gross assessment maximizes reduction of positive margins during breast conserving surgery while minimizing impact on specimen volumes.

Predictors of residual disease after breast-conserving surgery.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 168-168
Author(s):  
Sanjay Aneja ◽  
Donald R. Lannin ◽  
Brigid K. Killelea ◽  
Nina Ruth Horowitz ◽  
Anees B. Chagpar
Keyword(s):  
Tumor Size ◽  
Lymphovascular Invasion ◽  
Residual Disease ◽  
Breast Conserving Surgery ◽  
Invasive Disease ◽  
Invasive Cancer ◽  
Outcome Variable ◽  
Routine Practice ◽  
Breast Cancers

168 Background: Locoregional failure after breast conserving surgery (BCS) is often due to undetected residual disease, and the risk of such residual disease frequently guides management. We sought to determine clinical and pathologic factors correlating with the finding of residual invasive cancer and/or DCIS in patients undergoing BCS. Methods: We performed a retrospective cohort study for all invasive and in situ breast cancer treated with BCS at a single institution in 2009. The main outcome variable of interest was residual disease determined by pathologic examinations of cavity shave margins or reexcision. Chart review and statistical analyses were performed to evaluate clinical and pathological factors correlating with residual DCIS or invasive cancer. Results: 256 in situ or invasive breast cancers were treated with BCS in 2009. Of these, 207 (80.9%) underwent additional resection either for close margins or as routine practice. These formed the cohort of interest for this study. 39 patients (18.8%) had residual DCIS and 22 (10.6%) had residual invasive disease. Age, race, histology, ER, PR, her-2-neu and margin distance for invasive disease did not predict the finding of residual DCIS nor invasive cancer. Lymphovascular invasion, while not predicting residual DCIS, was correlated with the finding of residual invasive disease (28.0% vs. 7.9%, p=0.007). Margin distance for DCIS was not predictive of residual invasive cancer but was predictive of residual DCIS. 33.8% of lesions with DCIS margins <1mm were associated with residual DCIS, while 3.4% of those with DCIS margins >5mm were associated with residual in situ disease (p=0.002). Increasing tumor size for invasive and in situ disease were associated with residual DCIS (median 19.5 vs. 13.0 mm, p=0.001 and 22.5 vs. 15.0 mm, p<0.001, respectively); however, neither size component was associated with residual invasive disease. Conclusions: While margin distance and tumor size are associated with residual DCIS in patients undergoing BCS, these are not correlated with residual invasive disease. Conversely, the finding of lymphovascular invasion predicts residual invasive cancer, but not DCIS. These factors may aid in risk stratification of patients and guide postoperative management.

A retrospective chart review of a symptom-triggered alcohol withdrawal protocol versus previous standard of care at a veterans hospital

2013 ◽  
Vol 3 (4) ◽  
pp. 174-179
Author(s):  
Katy L. Zeier ◽  
Robert Connell ◽  
William Resch ◽  
Stephen Todd Hanson ◽  
Christopher J. Thomas
Keyword(s):  
Hospital Stay ◽  
Alcohol Withdrawal ◽  
Chart Review ◽  
Rating Scale ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
The Body ◽  
Fixed Dose ◽  
Medication Regimen

Alcohol is a commonly abused substance, and it is important that healthcare facilities properly manage alcohol withdrawal. Studies have found that the most efficient way to manage alcohol withdrawal is to use a symptom-triggered approach and only administer medications if symptoms surpass a specific threshold determined by a clinician administered rating scale. Alternatively, a standard fixed-dose medication regimen can be utilized. This study assessed if a new symptom-triggered protocol, utilizing the Clinical Institute Withdrawal for Alcohol, Revised (CIWA-Ar) scale for the assessment of symptoms, resulted in the anticipated patient outcomes of decreased length of hospital stay, less benzodiazepine administered per patient, and a shorter administration time from first dose of benzodiazepine given to last dose, when compared to the previous standard of care. A retrospective chart review was performed for 70 patients who had been treated for alcohol withdrawal. Patients who were treated with the symptom-triggered protocol had a decreased length of hospital stay when compared to the previous standard of care (−2.62 days, p = 0.0054). Both secondary efficacy outcomes were also statistically significant in favor of the symptom-triggered group. This retrospective chart review adds to the body of evidence supporting the use of symptom-triggered protocols as opposed to fixed-dose protocols in the management of alcohol withdrawal.

The margins effect: Residual tumor after breast conserving surgery

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 11045-11045
Author(s):  
A. Meirovitz ◽  
H. S. Rennert ◽  
T. Peretz ◽  
A. Salmon ◽  
G. Rennert
Keyword(s):  
Breast Cancer ◽  
Ductal Carcinoma ◽  
Residual Tumor ◽  
Breast Conserving Surgery ◽  
Invasive Cancer ◽  
Partial Breast Irradiation ◽  
Pathology Report ◽  
Full Data ◽  
Positive Margins ◽  
Malignant Breast

11045 Background: Resection of breast cancer with good surgical margins is one of the fundamental aspects of breast conserving surgery. Most studies have shown that women with positive margins after breast conserving surgery (BCS) fared worse compared to those with negative margins, regardless of chemotherapy or radiation therapy. Nowadays, when partial breast irradiation is gaining popularity, understanding the natural history of positive or close margins is particularly important. We studied the surgical process in a large cohort of Israeli women with breast cancer to estimate the frequency of tumor margin involvement in the primary and subsequent surgical procedure. Methods: The National Israeli Breast Cancer Detection Programs has been monitoring the detection process of all new cases of breast cancer in Israel since 1996. Full data on tumor histology and surgical procedures, including indication of margins in the pathology report were available for 16,925 malignant breast tumors. Margins were classified as positive margins (PM), close (= 2mm) (CM) or negative margins (greater then 2mm)(NM). Results: BCS was identified in 14,815 women with invasive cancer and 2,110 with pure ductal carcinoma in situ (DCIS). Only 7,751 (52.3%) of the 14,815 women with invasive cancer had NM, while 2,868 (19.4%) had CM and 4,196 (28.3%) had PM. Among those with PM, 2,276 (54.6%) had a re-operation within 6 months from the index surgery and 1,265 (55.6%) of them were found to be malignant; 58% of them were invasive cancers and 42% DCIS. Among the invasives on re-operation, 24.4% still had PM and another 12.1% had CM while among the DCIS 14.4% had PM and 17.6% had CM. Of the 717 women with DCIS and positive margins at first surgery, 67.9% had a second operation. Of them, 59.8% had malignancy, 8.8% of them invasive. Overall 10.6% of all invasive cancers and 3.7% of all DCIS had PM on relumpectomy within 6 month regardless of initial margin status. Conclusions: A relatively high proportion of all women undergoing BCS were found to have positive or close margins, even after re-operations. If a failure to reach clean margins is a reflection of an aggressive tumor phenotype, special attention should be given to these patients and treatment should be adjusted accordingly. No significant financial relationships to disclose.

Can Selective Image-Guided Intraoperative Margin Resection Improve Re-Excision Rates after Lumpectomy in Ductal Carcinoma In Situ of the Breast?

2018 ◽  
Vol 84 (10) ◽  
pp. 1580-1583
Author(s):  
Kelsey Gray ◽  
Reed Ayabe ◽  
Andrew Shover ◽  
Ashkan Moazzez ◽  
Junko Ozao-Choy ◽  
...  
Keyword(s):  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Conserving Surgery ◽  
Lesion Size ◽  
Invasive Cancer ◽  
Positive Margins ◽  
Cancer Group ◽  
Significant Difference

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. We performed a retrospective analysis of women with breast cancer who underwent BCS from January 2012 through July 2016 using our institution's standardized approach to selective margin resection. Of the 152 patients who underwent BCS, there were 30 (20%) with DCIS and 122 (80%) with invasive cancer. There was no statistically significant difference in re-excision rates for DCIS (13.3%) and invasive cancer (13.1%). Notably, the DCIS group had a larger mean lesion size ( P = 0.00009); however, the lesion was visible on ultrasound more often in the invasive cancer group ( P = 0.007). This standardized approach to intraoperative selective margin excision can produce similar rates of margin re-excision for DCIS and invasive cancer and may be a viable option for lowering re-excision rates for patients with DCIS.

scholarly journals Time to Stable Dose of Psychostimulants in Pediatric Patients With ADHD

2020 ◽  
Vol 25 (3) ◽  
pp. 228-234
Author(s):  
Selena R. Pasadyn ◽  
Kimberly Giuliano ◽  
Deanna LaBianca ◽  
Michael Manos
Keyword(s):  
Chart Review ◽  
Extended Release ◽  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Stable Dose ◽  
Stimulant Use ◽  
Hyperactivity Disorder ◽  
The Impact ◽  
Medication Switching

OBJECTIVES The prevalence of attention-deficit/hyperactivity disorder (ADHD) is increasing and psychostimulants are the pharmacological standard of care. Patients benefit most when there is efficient titration to a stable dose of medication as defined by maintaining that same dose for 6 months. The aims of this study were to describe time to stable dose in a cohort of children with ADHD and examine the impact of demographic factors. METHODS A list of pediatric patients with a diagnosis of ADHD in the electronic health record was generated, and a retrospective chart review of stimulant use was conducted on 500 patients randomly selected from 2010 to 2015 who met inclusion criteria. Time to stable dosing and its association with demographic characteristics were assessed. RESULTS Patients were predominantly male (72%), white (81%), and privately insured (67%). Fifty-five percent of patients achieved a stable dose of medication on first attempt; therefore, the median time to stable dosing for the cohort was 0 days with the interquartile range being 0 to 133.8 days. There was significant increase in time to stable dose for patients younger than 10 years compared with those ≥10 years of age (p = 0.01). Time to stable dose was not significantly associated with race (p = 0.13), sex (p = 0.72), type of insurance (p = 0.56), or formulation being immediate or extended release (p = 0.56). CONCLUSIONS Many patients had long titration periods when trying to reach a stable dose. Given that medication switching can be challenging for patients and families, more frequent contact with providers during titration may be necessary.

Comparison of care patterns for hospitalized immune-related adverse events (irAEs) between melanoma patients on combination immune checkpoint inhibitor (ICI) therapy versus ICI monotherapy.

2019 ◽  
Vol 37 (8_suppl) ◽  
pp. 85-85
Author(s):  
RuiQui Chen ◽  
Elliot Charles Smith ◽  
Sze Wah Samuel Chan ◽  
Katrina Hueniken ◽  
M. Catherine Brown ◽  
...  
Keyword(s):  
Chart Review ◽  
Immune Checkpoint Inhibitor ◽  
Average Length ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Readmission Rates ◽  
Admission Rates ◽  
Average Length Of Stay ◽  
Care Patterns ◽  
Melanoma Patients

85 Background: Prior clinical trials in melanoma have demonstrated higher rates of irAEs from combination ICI therapy compared to monotherapy. However, this has not been well studied in the real-world where patients often have greater co-morbidities and less organ reserve. We aim to compare irAEs hospitalizations for melanoma patients on combination vs monotherapy ICIs. Methods: We performed a single centre retrospective chart review (Princess Margaret Cancer Centre, Toronto, ON) for all melanoma patients receiving ICI as standard of care (2012-2017) admitted with irAEs. Data collected include demographics, investigations, management and outcomes of hospitalizations. Descriptive analyses were performed to characterize hospitalizations and compare between ICI combination vs monotherapy groups. Results: Among 381 melanoma patients identified on standard of care ICI, 41 (11%) were admitted for irAE. Among those admitted, 10% received monotherapy with nivolumab, 22% pembrolizumab, 39% ipilimumab and 29% combination ICI. Admission rates were higher among patients receiving combination ICI compared to monotherapy (20% vs 8% p = 0.003). Prevalence of the most common irAEs were similar between combination and monotherapy groups: colitis (58% vs 59%), pneumonitis (8% vs 14%) and hepatitis (8% vs 10%). Less than half received invasive diagnostic tests (i.e, endoscopy) (42% combination vs 35% monotherapy, p = 0.50) with 3 (60%) and 5 (50%) confirming irAEs, respectively. Rates of infliximab use were similar between the combination and monotherapy group (25% vs 21%, p = 0.70). Average length of stay was shorter for patients on combination ICI compared to monotherapy (5 days vs 15 days, p = 0.08). irAE readmission rates were similar between patients receiving combination ICI compared to monotherapy (20% vs 17%, p = 0.65). Conclusions: Despite higher admission rates among patients receiving combination ICI, there was a trend towards shorter hospitalizations. Other outcomes including diagnoses, investigations and management were not significantly different between patients receiving combination vs ICI monotherapy.

scholarly journals Risk factors for positive resection margins of breast cancer tumorectomy specimen following breast-conserving surgery

2017 ◽  
Vol 32 (2) ◽  
Author(s):  
Niko Heiss ◽  
Valentin Rousson ◽  
Assia Ifticene-Treboux ◽  
Hans-Anton Lehr ◽  
Jean-François Delaloye
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Breast Conserving Surgery ◽  
Surgical Margins ◽  
Invasive Cancer ◽  
Surgical Experience ◽  
Positive Surgical Margins ◽  
Positive Margins ◽  
Significant Difference ◽  
Excision Rate

AbstractBackgroundThe aim of the study was to identify risk factors for positive surgical margins in breast-conserving surgery for breast cancer and to evaluate the influence of surgical experience in obtaining complete resection.MethodsAll lumpectomies for invasive breast carcinoma and ductal carcinoma in situ (DCIS) between April 2008 and March 2010 were selected from the database of a single institution. Re-excision rates for positive margins as well as patient and histopathologic tumor characteristics were analyzed. Surgical experience was staged by pairs made of Resident plus Specialist or Consultant. Two periods were defined. During period A, the majority of operations were performed by Residents under supervision of Specialist or Consultant. During period B, only palpable tumors were operated by Residents.ResultsThe global re-excision rate was 27% (50 of 183 patients). The presence of DCIS increased the risk for positive margins: 60% (nine of 15 patients) in the case of sole DCIS compared to 26% (41 of 160 patients) for invasive cancer (p = 0.005) and 35% (42 of 120 patients) in the case of peritumoral DCIS compared to 11% (seven of 62 patients) in the case of sole invasive cancer (p = 0.001). Re-excision rate decreased from 36% (23 of 64 patients) during period A to 23% (27 of 119 patients) during period B (p = 0.055). There was no significant difference between the surgical pairs.ConclusionIn our study, DCIS was the only risk factor for positive surgical margins. Breast-conserving surgery for non-palpable tumors should be performed by Specialists, however, palpable tumors can be safely operated by Residents under supervision.

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