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Objective:To study the risk factors of positive surgical margins in patients with advanced hilar cholangiocarcinoma (HCCA) undergoing curative-intent resection with the aim to provide references for clinical decision-making.Methods:The clinical pathological data of 126 patients with advanced HCCA who underwent curative-intent resection at the Chinese PLA General Hospital from January 2011 to December 2014 was retrospective analyzed. There were 78 males and 48 females, with an average age of 55 years. The patients were divided into two groups: the resection margin positive group (positive for residual tumor at any surgical margin, n=29) and the negative resection margin group ( n=97). Multivariate logistic regression analysis, in reference to the results of univariate analysis, was applied to the relevant variables to study independent risk factors of positive resection margin. Receiver operating characteristic (ROC) curves were drawn to evaluate the independent and joint predictive values of the relevant indicators. Results:Univariate analysis showed vascular involvement, tumor diameter volume ≥20.94 cm 3, plasma fibrinogen ≥3.36 g/L, and DRR≤0.61 were associated with positive resection margins (all P<0.05). A history of cholecystectomy was potentially associated with positive resection margins ( P<0.1). These variables were included in the multivariate logistic regression analysis which showed vascular involvement ( OR=4.134, 95% CI: 1.545-11.060, P=0.005), tumor size ≥ 20.94 cm 3 ( OR=2.926, 95% CI: 1.107-7.733, P=0.030) and DRR≤0.61 ( OR=3.170, 95% CI: 1.126-8.928, P=0.029) were independent risk factors of positive margins after curative resection in patients with advanced HCCA. ROC curve analysis was used to evaluate the impact of the combination of the above variables in predicting positive surgical margins. Sensitivity and specificity were calculated to be 86.2% and 65.7% respectively, and the area under the curve was 0.771. Conclusion:Vascular involvement, tumor size ≥20.94 cm 3 and DRR≤0.61 were independent risk factors of positive surfical margins in patients with advanced HCCA undergoing curative-intent resection. The combination of the above predictive indicators provided some references for treatment decisions.
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Objective@#To investigate the value of preoperative dynamic contrast-enhanced MRI in reducing the rate of tumor-positive resection margins after breast conserving surgery in patients with early non-mass breast carcinoma.@*Methods@#Seventy-two patients with early non-mass breast carcinoma received ultrasonographic and mammographic examination and subsequently underwent dynamic contrast-enhanced MRI examination before breast conserving surgery. The control group consisted of 74 patients who had early non-mass breast carcinoma. They only received ultrasonographic and mammographic examination and didn′t undergo contrast-enhanced MRI examination. The comparison of the rate of tumor-positive resection margins between two groups was performed. The MRI findings that had the significant influence on the rate of tumor-positive resection margins were analyzed using Logistic regression model.@*Results@#In 28 patients (28/72, 38.9%), dynamic contrast-enhanced MRI could correct or supplement the ultrasonographic and mammographic findings and resulted in the reasonable change of surgical program. The preoperative MRI examination group (n=30) had lower rate of tumor-positive resection margins than control group for invasive ductal carcinoma (23.3% vs 40.0%, P=0.02), but there was no significant difference (21.4% vs 26.9%, P=0.10) between two groups for ductal carcinoma in situ (n=28). The preoperative MRI examination group (n=14) had lower rate of tumor-positive resection margins than control group for the other pathologic types of breast carcinoma (14.3% vs 38.9%, P=0.02). The statistical analysis on the basis of Logistic regression model showed that some main MRI findings, including change surrounding the tumor, distance between tumor and nipple and tumor size, had the significant influence on the rate of tumor-positive resection margins.@*Conclusion@#Preoperative dynamic contrast-enhanced MRI significantly increased the accuracy of resection margins evaluation, and greatly reduced the rate of tumor-positive resection margins after breast conserving surgery in patients with early non-mass breast carcinoma.
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La biopsia por congelación es un método que se emplea en la consulta intraoperatoria ya que los resultados se obtienen rápidamente, permite la diferenciación entre una lesión benignao maligna, y el estudio de los márgenes quirúrgicos con una exactitud diagnóstica superior al 90%en la mayoría de los casos; sin embargo, la biopsia por congelación presenta algunas limitantes, entre ellas, la alteración de la citología y la arquitectura, los artefactos y su bajo desempeño en algunos procesos neoplásicos, por lo cual es un instrumento para el manejo de los pacientes sin reemplazar la biopsia convencional. El objetivo de este módulo es revisar la utilidad clínica y laslimitaciones de la biopsia por congelación en muestras de aparato genital femenino, riñón, vejiga,tracto gastrointestinal, peritoneo, hígado, vesícula biliar, páncreas y piel. Además, se describe brevemente la técnica y se compara con la de la biopsia convencional.
Frozen section biopsy is a method used for intraoperative consultation because resultsare rapidly obtained, enables the differentiation between a benign and malignant lesion and theanalysis of resection margins, helps with the diagnosis of some neoplasms with a diagnostic accuracyof 90%. Nevertheless, frozen biopsy has several limitations, such as cytological and architectural distortion, artifacts, and its low performance in some specific neoplasms, which explain whyfrozen section biopsy is a tool for patient care that does not replace the conventional biopsy. The aim of this module is to review the clinical utility and the disadvantages of frozen section biopsy inspecimens from the female genital tract, kidney, bladder, gastrointestinal tract, peritoneum, liver, gallbladder, pancreas and skin. Additionally, a brief description of the technique and differenceswith conventional biopsy are included.
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Humans , Biopsy , Freezing , Frozen SectionsABSTRACT
PURPOSE: To evaluate the possibility that laparoscopic procedure could perform surgeries keeping the principle of oncologic surgery. METHODS: From July 1993 to June 1996, thrity patients undergone laparoscopic assisted colon and rectal resections (LR) for malignant disease at Yeungman university hospital. Margins of resection and lymph nodes (LNs) recovered were compared with those of thirty stage matched open resection cases (OR, n=30) retrospectively. There was no operative mortality in both group. Operative techniques used in LR vs OR were colectomy, 5:6; anterior resection, 6:5; low anterior resection, 11:12 and abdominoperineal resection, 8:7. Parameters were analgesic use, duration of postoperative ileus, operative time, hospital stay, margins of rescetion, lymph node yield (LNs), and recurrence. RESULTS: Patients who underwent LR had less pain, a shorter period of postoperative ileus and hospital stay than patients who underwent OR. But, the length of operative time was greater for patients undergoing LR. Mean lymph node yield in the laparoscopic group was 16 compared with 18.1 in the open group (P=0.560). Average margins of resection in LR vs OR were 13.9 cm vs 14.1 cm proximally (P=0.823), 3.6 cm vs 5.2 cm distally (P=0.498). In no case did the margins contain tumor. There was no statistical significance in dissected LNs and the length of both resection margins in both groups. Recurrence was similar in both groups. CONCLUSIONS: In this study, there is no evidence that laparoscopic technique is inadequate in following the cancer surgery principle.