RESUMO
INTRODUCTION: Breast conserving surgery (BCS) aims to remove a breast cancer completely and obtain clear margins. Complete excision is essential to reduce the risk of local recurrence. The ClearEdge™ (CE) imaging device examines margins of excised breast tissue intra-operatively. The aim of this study was to investigate the potential of the device in detecting margin involvement in patients having BCS. METHODS: In Phase-1 58 patients underwent BCS and had 334 margins assessed by the device. In Phase-2 the device was used in 63 patients having BCS and 335 margins were assessed. Patients with margins considered close or involved by the CE device were re-excised. RESULTS: The margin assessment accuracies in Phase-1 and Phase-2 compared to permanent section pathology were very similar: sensitivity (84.3% and 87.3%), specificity (81.9% and 75.6%), positive predictive value (67.2% and 63.6%), and negative predictive value (92.2% and 92.4%). The false positive rate (18.1% and 24.4%) and false negative rate (15.7% and 12.7%) were low in both phases. In Phase-2 re-excision rate was 37%, but in the 54 where the CE device was used appropriately the re-excision rate was 17%. Had all surgeons interpreted all images appropriately and re-excised margins detected as abnormal by the device in Phase-2 then the re-excision rate would have been 7%. CONCLUSION: This study shows that the CE device has potential to reduce re-excision after BCS and further randomized studies of its value are warranted.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Lobular/diagnóstico por imagem , Espectroscopia Dielétrica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/complicações , Carcinoma Ductal de Mama/cirurgia , Carcinoma Intraductal não Infiltrante/complicações , Carcinoma Intraductal não Infiltrante/cirurgia , Carcinoma Lobular/cirurgia , Espectroscopia Dielétrica/instrumentação , Feminino , Humanos , Período Intraoperatório , Masculino , Margens de Excisão , Mastectomia Segmentar , Pessoa de Meia-Idade , Neoplasia Residual , Valor Preditivo dos TestesAssuntos
Ocupações em Saúde/economia , Apoio à Pesquisa como Assunto/legislação & jurisprudência , Educação de Pós-Graduação , Ocupações em Saúde/educação , Humanos , National Institutes of Health (U.S.) , Apoio ao Desenvolvimento de Recursos Humanos/legislação & jurisprudência , Estados Unidos , United States Health Resources and Services AdministrationRESUMO
To begin to characterize the health needs of the growing number of refugees from Central America, we compiled the results of examinations for ova and parasites of a single stool specimen of each of 128 children of Central American and Mexican background who entered our health center during a four-month period. Among the 96 children who were born in Central America or Mexico, there was a 65% prevalence of parasitic infestation. Pathogens were found in 46% and multiple pathogens in 14%. Among the 32 American-born children there was a 13% prevalence of parasitic infection, but no pathogens were found. There was no correlation between symptoms and the presence of parasites. Screening Central American immigrant children for intestinal parasites is a high-yield procedure and should be part of their routine health care.
