Intraoperative Evaluation of Lumpectomy Margins by Imprint Cytology With Histologic Correlation

2002 ◽  
Vol 126 (7) ◽  
pp. 846-848 ◽  
Author(s):  
Andrew J. Creager ◽  
Jo Ann Shaw ◽  
Peter R. Young ◽  
Kim R. Geisinger
Keyword(s):  
Predictive Value ◽  
Community Hospital ◽  
Frozen Section ◽  
Breast Conservation ◽  
Hospital Setting ◽  
Breast Conservation Therapy ◽  
Imprint Cytology ◽  
Recurrence Rates ◽  
Cytologic Examination ◽  
Initial Surgery

Abstract Background.—Several well-controlled studies have demonstrated significantly increased local recurrence rates in patients with low-stage breast carcinoma treated with breast conservation therapy in whom focally positive margins were not reexcised. Imprint cytology is a rapid technique for evaluating surgical margins intraoperatively, thus allowing reexcisions to be performed during the initial surgery. The large majority of studies on the use of intraoperative imprint cytologic examination of breast conservation therapy margins have been performed at university-based academic centers. Objective.—To evaluate the utility of intraoperative imprint cytologic evaluation of breast conservation therapy margins in a community hospital setting. Methods.—We retrospectively reviewed the intraoperative imprint cytology margins of 141 lumpectomy specimens that had been obtained from 137 patients between May 1997 and May 2001. Results.—We evaluated 758 separate margins. On a patient basis, the sensitivity was 80%, the specificity was 85%, the positive predictive value was 40%, the negative predictive value was 97%, and the overall accuracy was 85%. There were no cytologically unsatisfactory margins. Conclusions.—Imprint cytology is an accurate, simple, rapid, and cost-effective method for determining the margin status of breast conservation therapy specimens intraoperatively in the community hospital setting. This method allows a survey of the entire surface area of the lumpectomy specimen, which is not practical using frozen section evaluation.

Operative Decision-Making for Follicular Thyroid Lesions: A Community Hospital System Experience

2011 ◽  
Vol 77 (4) ◽  
pp. 443-446 ◽  
Author(s):  
Kevin Grannan ◽  
Jonathan Snyder ◽  
Sarah Mcdonough ◽  
Amy Engel ◽  
James Farnum
Keyword(s):  
Decision Making ◽  
Community Hospital ◽  
Frozen Section ◽  
Needle Aspiration ◽  
Frozen Sections ◽  
Indication For Surgery ◽  
Hospital System ◽  
Reoperative Surgery ◽  
Intraoperative Frozen Section ◽  
Initial Surgery

Follicular neoplasms of the thyroid are a frequent indication for surgery of the thyroid gland. We evaluated the use of frozen sections on intraoperative decision-making, possible avoidance of reoperative surgery, and histologic findings in a retrospective cohort. A database was created of all thyroid operations from 2001 to 2007. Data collected included age, gender, preoperative cytology, indication for surgery, surgeon, intraoperative decision-making, and histologic findings. Of the 723 thyroidectomies, 203 were performed for follicular neoplasms diagnosed by fine needle aspiration. Of these, 135 had cytology reports available within our electronic medical record; 44 per cent (59 of 135) of these patients had an intraoperative frozen section. Only two of 59 (3.4%) were positive for carcinoma, both of which were papillary carcinomas. One was interpreted as “suspicious” for carcinoma by the pathologist. In these three cases, the surgeon proceeded with total thyroidectomy at the time of initial surgery. The results of frozen section altered the operation in only three of 59 cases (5.1%). Intraoperative frozen section rarely impacts the conduct of thyroidectomy for follicular neoplasms.

Determinants of outcome in elderly patients with positive sentinel lymph nodes

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 614-614
Author(s):  
M. Gemignani ◽  
A. Karam ◽  
M. Hsu ◽  
S. Patil ◽  
M. Stempel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Elderly Patients ◽  
Lymph Nodes ◽  
Frozen Section ◽  
Breast Conservation ◽  
Multivariate Logistic Regression Analysis ◽  
Disease Free Survival ◽  
Standard Of Care ◽  
Breast Conservation Therapy ◽  
Sentinel Lymph Nodes

614 Background: Older women are less likely to receive standard of care treatment for breast cancer. This undertreatment may be linked to the perception that elderly patients (pts) may not tolerate or derive benefit from treatment that is often viewed as “too toxic.” Methods: From July 1997 to July 2003, 1,470 pts with invasive cancer with positive sentinel lymph nodes (PSLN) by intraoperative frozen section or final pathologic exam by hematoxylin-eosin and/or immunohistochemistry (IHC). We examined sociodemographic, pathologic, and therapeutic variables that affected the outcome of elderly pts ≥70 years old. A comorbidity score was assigned using Adult Comorbidity Evaluation-27 system. Chi-square, Fisher's exact Wilcoxon tests, and multivariate logistic regression analysis were used. Results: The median age was 53 years (range 21–89) and median tumor size 1.6 cm (range 0.1–11). 1,265 (86.1%) pts were <70 years old and 205 (13.9%) pts were ≥70 years old. 183 (12.5%) pts had IHC only PSLN, 1,021 (69.5%) had 1–3 PSLN, and 266 (18%) ≥4 PSLN. Breast conservation therapy (BCT) was performed in 59.7% of pts. Elderly pts were more likely to have moderate to severe comorbidities (46% vs. 11%, p < 0.0001) and BCT (67% vs. 59%, p = 0.026), compared to pts <70 years old. Elderly pts were less likely to undergo completion ALND (73% vs. 89%, p < 0.0001), adjuvant chemotherapy (43% vs. 90%, p < 0.0001) and radiotherapy following BCT (82% vs. 90%) compared to pts <70 years old. The 5-year disease-free survival (DFS) was not significantly different for elderly pts compared to non-elderly pts (87.7% vs. 91.9%, p = 0.21), on the other hand the 5-year overall survival was significantly worse for elderly pts (80.4% vs. 93.2%, p < 0.0001), a difference that was mainly due to a significantly higher 5-year cumulative incidence of death due to other causes (13.2% vs. 1.9%, p < 0.0001). On multivariate analysis, ER or PR positive status, IHC only PSLN and T1 tumors were the only factors independently associated with improved odds of 5-year DFS. Conclusions: Tumor rather than patient factors were the primary determinants of breast cancer outcomes in our cohort of node positive breast cancer pts. Elderly breast cancer pts with an estimated life expectancy beyond 5 years should receive the same standard of care therapy as their younger counterparts. No significant financial relationships to disclose.

scholarly journals Comparative Study of Imprint Cytology and Frozen Section in the Intraoperative Diagnosis of Thyroid Lesions

1970 ◽  
Vol 24 (1) ◽  
pp. 12-15 ◽  
Author(s):  
Sukumar Shaha ◽  
AJE Nahar Rahman
Keyword(s):  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Frozen Section ◽  
Cost Effective ◽  
Imprint Cytology ◽  
Intraoperative Diagnosis ◽  
Fresh Specimen ◽  
Sensitivity Specificity ◽  
Thyroid Lesions

 Imprint cytology can provide a useful adjunct to the frozen section diagnosis and may be used safely in the intraoperative diagnosis of thyroid nodules, especially in the centres where frozen section facilities are not available. This study was conducted to compare imprint cytology and frozen section in terms of diagnostic accuracy, sensitivity, specificity, positive predictive value and to assess the value of imprint cytology in the intraoperative diagnosis of thyroid lesions. A total of 57 consecutive patients were enrolled in the study. All of the patients underwent frozen section in the department of pathology, BSMMU, Dhaka. Imprints were taken from the fresh specimen sent for frozen section from departments of otolaryngology and surgery of BSMMU. Imprint slides were stained with rapid H & E staining method. Then the tissues were submitted for frozen section by standard method. In this study, diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of imprint cytology were 81.25%, 66.66%, 82.59%, 87.12% respectively. Frozen section revealed the diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive as 88.46%, 72.72%, 100%, 100%, 83.33% respectively. Imprint cytology was found to be comparable with frozen section in diagnostic accuracy and sensitivity. Since imprint cytology is a simple and cost-effective procedure it can be used as an alternative to frozen section in hospitals where frozen section facilities are not available. Key Words: Imprint cytology, frozen section, intraoperative diagnosis of thyroid lesions  doi: 10.3329/bjpath.v24i1.2876 Bangladesh J Pathol 24 (1) : 12-15   

scholarly journals 2157. Evaluation of the Utility of the MRSA Nasal PCR Assay in a Community Healthcare System

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S732-S732
Author(s):  
Athena L V Hobbs ◽  
Stephen Turner ◽  
Bhavyata Parag ◽  
Katherine M Shea ◽  
Nathan Seligson
Keyword(s):  
Healthcare System ◽  
Predictive Value ◽  
Community Hospital ◽  
Hospital Setting ◽  
Pcr Assay ◽  
Hospital System ◽  
Noninvasive Test ◽  
Community Healthcare ◽  
Pcr Assays ◽  
Rule Out

Abstract Background The MRSA nasal PCR assay is a rapid, noninvasive test that has demonstrated a strong negative predictive value (NPV), as high as 99%, for ruling out MRSA pneumonia. These findings are based primarily on literature from large academic centers, which have evaluated both the positive predictive value (PPV) and NPV of MRSA nasal PCR assays. Investigators sought to assess the NPV of the MRSA nasal PCR assay to rule out MRSA pneumonia within a community healthcare system. To the best of our knowledge, this is the largest study from a community hospital and the only study from a community healthcare system for the utilization of a nasal PCR assay to rule out MRSA pneumonia. Methods This is a multicenter, retrospective study of adult patients with both an MRSA nasal PCR assay and positive respiratory culture (sputum, bronchoalveolar lavage, or endotracheal aspirate). Data were collected from September 2014 through August 2015 at three community hospitals (bed size ranging from 328 to 706) across two states within a healthcare system. The study was approved by the Baptist Memorial Hospital Institutional Review Board. PPV and NPV 95% confidence intervals (95% CI) were calculated as previously described in the literature. Results A total of 808 patients were included in the analysis across the three hospitals. The total incidence of MRSA in positive sputum samples was 14.9% across the three facilities. Our study demonstrated an overall NPV of 95.1% (93.2, 96.6%) and a PPV of 65.9% (95% CI 57.2, 73.9%). The high NPV was retained despite unit type, resulting in 94.9% (95% CI 92.7, 96.6%), 96.3% (95% CI 90.8, 99.0%), and 94.7% (95% CI 74.0, 99.9%) for the intensive care units (ICU), medical-surgical units, and the emergency department, respectively (Table 1). Conclusion We concluded that the high NPV of a negative MRSA nasal PCR assay to rule out MRSA pneumonia persisted within a community hospital system. With the results of our study, we plan to utilize institution-specific data along with previously published literature to encourage earlier discontinuation of anti-MRSA antibiotics in patients being treated for pneumonia with negative MRSA nasal PCR assays. Our study demonstrates the validity of the assay in the large community hospital setting with similar findings to studies at large academic institutions. Disclosures All authors: No reported disclosures.

Risk factors in breast-conservation therapy.

1994 ◽  
Vol 12 (4) ◽  
pp. 653-660 ◽  
Author(s):  
J Borger ◽  
H Kemperman ◽  
A Hart ◽  
H Peterse ◽  
J van Dongen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Local Recurrence ◽  
Predictive Factors ◽  
Vascular Invasion ◽  
Breast Conservation ◽  
Breast Conservation Therapy ◽  
Recurrence Rates ◽  
Margin Involvement ◽  
Increased Risk ◽  
Breast Recurrence

PURPOSE To identify clinical and pathologic factors associated with an increased risk of local recurrence following breast-conservation therapy (BCT) to assess the safety of this procedure for all subgroups of patients. PATIENTS AND METHODS The study population consisted of 1,026 patients with clinical stage I and II breast cancer treated between 1979 and 1988 at the Netherlands Cancer Institute. The BCT regimen consisted of local excision and axillary lymph node dissection (ALND) followed by whole-breast irradiation to a total dose of 50 Gy in 2-Gy fractions and boost irradiation (mostly by iridium implant) of 15 to 25 Gy. RESULTS With a median follow-up duration of 66 months, the actuarial breast recurrence rate was 4% at 5 years, counting all breast recurrences. Univariate analysis showed seven factors to be associated with an increased risk of local recurrence; age, residual tumor at reexcision, histologic tumor type, presence of any carcinoma-in-situ component, vascular invasion, microscopic margin involvement, and whole-breast radiation dose. Three factors remained independently significant after proportional hazard regression analysis: age, margin involvement, and the presence of vascular invasion. When the analysis was repeated, but counting only those breast recurrences that occurred before regional or distant failures, only young age and vascular invasion were independent predictive factors. In the third analysis, factors predicting the necessity of local salvage treatment were analyzed. In this analysis, the possible bias in the former analysis caused by censoring actuarial methods was avoided. The results were the same as in the second analysis, showing young age and vascular invasion as the only independent predictive factors. Breast recurrence rates were 6% for patients less than 40 years of age and 8% for patients with tumors showing vascular invasion. In the absence of risk factors, the breast recurrence rate is only 1% at 5 years. CONCLUSION Slightly higher recurrence rates were found in patients less than 40 years of age and in patients with tumors showing vascular invasion. The role of margin involvement is uncertain.

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