宫颈病变冷刀锥切术后切缘阳性及病变残留的危险因素分析北大核心

目的:研究因宫颈病变行冷刀锥切术后切缘阳性及病变残留的危险因素。方法:回顾性分析2018年09月至2021年04月在山西医科大学第二医院妇科行宫颈冷刀锥切术经病理组织学诊断为HSIL及MIC的429例患者的临床资料,采用单因素分析及多因素Logistic回归分析年龄、绝经状态、孕次、产次、同房出血、不规则出血、家族肿瘤史、HR-HPV感染种类、HPV16/18感染、TCT检测结果、转化区类型、宫颈管搔刮术(endocervical curettage,ECC)结果、病变级别、是否累及腺体与宫颈冷刀锥切术后切缘阳性是否相关。同时,对79例进一步行子宫切除术者分析切缘阳性及上述相关因素与术后病变残留的关系。结果:术后切缘阳性与TCT检测结果、转化区类型、病变级别、是否累及腺体、ECC结果有关(P<0.05),其中MIC、累及腺体、3型转化区及ECC阳性是宫颈冷刀锥切术后切缘阳性的独立危险因素(P<0.05)。此外,宫颈病变残留与切缘状态及病变级别有关(P=0.001;P=0.038),切缘阳性是子宫切除术后病变残留的独立危险因素(P=0.002)。结论:重视宫颈冷刀锥切术后切缘阳性的危险因素,指导临床个体化干预,是降低切缘阳性和病变残留的重要措施。     

A prospective comparison study for predicting circumferential resection margin between preoperative MRI and whole mount sections in mid-rectal cancer: Significance of different scan planes

Aim

The aim of this study is to evaluate the accuracy of preoperative magnetic resonance imaging (MRI) in the prediction of circumferential resection margin (CRM) and to determine whether each different MRI scan plane provides an accurate CRM assessment.

Method

Fifty-seven consecutive patients with mid-rectal cancer were enrolled prospectively. The CRM measurement from each MRI plane according to tumor location was compared with CRM measurement on whole-mount sections with the definition of threatened CRM as 2 mm in distance. The difference in performance among the sagittal, axial and oblique MR images was analyzed by using receiver operating characteristic (ROC) curves (A_z).

Results

For anterior tumors (n = 17), the A_z of the sagittal, axial and oblique MR planes were 0.66, 0.83 and 0.79, respectively. For lateral tumors (n = 17), the A_z of the sagittal, axial and oblique MR planes were 0.53, 0.66 and 0.78, respectively. For posterior tumors (n = 23), the A_z of the sagittal, axial and oblique MR planes were 0.76, 0.82 and 0.97, respectively.

Conclusions

MRI provides an accurate prediction of preoperative CRM. There exist differences in diagnostic accuracy according to each different scan plane of MRI and tumor location within the rectum.     

Post-therapy pathologic stage and survival in patients with pancreatic ductal adenocarcinoma treated with neoadjuvant chemoradiation

BACKGROUND:

Neoadjuvant chemoradiation before surgery is an emerging treatment modality for pancreatic ductal adenocarcinoma (PDAC). However, analysis of prognostic factors is limited for patients with PDAC treated with neoadjuvant chemoradiation and pancreaticoduodenectomy (PD).

METHODS:

The study population was comprised of 240 consecutive patients with PDAC who received neoadjuvant chemoradiation and PD and was compared with 60 patients who had no neoadjuvant therapy between 1999 and 2007. Clinicopathologic features were correlated with disease‐free survival (DFS) and overall survival (OS).

RESULTS:

Among the 240 treated patients, the 1‐year and 3‐year DFS rates were 52% and 32%, with a median DFS of 15.1 months. The 1‐year and 3‐year OS rates were 95% and 47%, with a median OS of 33.5 months. By univariate analysis, DFS was associated with age, post‐therapy tumor stage (ypT), lymph node status (ypN), number of positive lymph nodes, and American Joint Committee on Cancer (AJCC) stage, whereas OS was associated with intraoperative blood loss, margin status, ypT, ypN, number of positive lymph nodes, and AJCC stage. By multivariate analysis, DFS was independently associated with age, number of positive lymph nodes, and AJCC stage, and OS was independently associated with differentiation, margin status, number of positive lymph nodes, and AJCC stage. In addition, the treated patients had better OS and lower frequency of lymph node metastasis than those who had no neoadjuvant therapy.

CONCLUSIONS:

In patients with PDAC who received neoadjuvant chemoradiation and subsequent PD, post‐therapy pathologic AJCC stage and number of positive lymph nodes are independent prognostic factors. Cancer 2012. © 2011 American Cancer Society.     

Classification of R1 resections for pancreatic cancer: the prognostic relevance of tumour involvement within 1 mm of a resection margin

Aims:  The current Royal College of Pathologists guidelines for pancreatoduodenectomy specimen reporting recommend that microscopic evidence of tumour within 1 mm of a resection margin (RM) should be classified as R1. No clinical evidence exists to justify this classification. The aim of this study was to identify the proportion of pancreatoduodenectomy specimens in which 'equivocal' RMs are present (tumour involvement within 1 mm of, but not directly reaching, one or more resection margins) and whether the survival of these patients was similar to that of patients with 'unequivocal' RM involvement.
Methods and results:  Patients with histologically confirmed pancreatic ductal adenocarcinoma undergoing pancreatoduodenectomy between 1997 and 2007 ( n  = 163) were identified from a prospective database. One hundred and twenty-eight cases (79%) were classified as R1. Of these, 57 (45% of all R1 cases) were based on 'equivocal' margin involvement. There was no significant difference in overall survival between equivocal and unequivocal R1 resections (log rank, P  = 0.102). All R1 resections had a poorer survival on univariate (log rank, P  = 0.013), but not multivariate, analysis (Cox, P  = 0.132).
Conclusions:  Our results indicate that cases with microscopic tumour involvement within 1 mm of a resection margin should be considered synonymous with incomplete excision for resected pancreatic cancer.     

螺旋CT在术前预测直肠癌环周切缘受累的价值

目的 观察螺旋CT检查在术前预测进展期直肠癌环周切缘受累的准确性.方法 39例病理证实直肠癌病人,以空气作为肠腔内对比剂进行螺旋CT扫描,按全直肠系膜切除术原则进行手术,将CT扫描与病理组织学检查结果 进行比较.结果 螺旋CT准确判断出肿瘤在直肠系膜间隙内侵犯的深度.8例环周切缘阳性的病人均可见直肠系膜内明显的肿瘤浸润,7例病人通过螺旋CT准确判断出环周切缘受累.预测环周切缘受累灵敏度为87.5%(7/8),特异度为93.3%(29/31),准确度为92.3%(36/39),阳性预测值为77.8%(7/9),阴性预测值为96.7%(29/30).结论 术前螺旋CT检查可准确预测肿瘤环周切缘状态.     

Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy

BACKGROUND: Patients receiving breast conservation therapy have a lifelong risk of local recurrence. To minimize this risk, surgeons have explored various approaches to examining the surgical margins of the resection specimen. If tumor cells are found at the margin, there is a high probability that residual tumor remains in the surgical cavity. This review examines published reports about standard and innovative approaches to assessing surgical margins, the clinical significance of margin size, and risk factors for positive margins. METHODS: Published literature abstracted in Medline was reviewed using the Gateway site from the National Library of Medicine. CONCLUSIONS: It is still not clear whether obtaining a radical margin will decrease the rate of local recurrence after breast conserving surgery. What is clear is that it is absolutely unacceptable to have tumor cells directly at the cut edge of the excised specimen, regardless of the type of post-surgical adjuvant therapy.     

Discrepancies in frozen section mucosal margin tissue in laryngeal squamous cell carcinoma

BACKGROUND: Head and neck surgeons commonly request frozen sections. Practice patterns vary from laboratory to laboratory on how the tissue is used in performing the frozen section. Some pathologists wish to see all the material submitted by consuming it completely during frozen section, whereas others reserve some for permanent section. We wished to determine whether knowledge of margin status was initially inaccurate because of reserving tissue for permanent section. METHODS: Sixty-five laryngectomies (total and partial) with margin assessment enhanced by frozen section evaluation were studied. Forty-five laryngectomy specimens, generating 249 frozen sections in which a permanent section was prepared from tissue remaining from frozen section examination, were studied. RESULTS: Five of the 249 frozen sections contained a discrepancy between the frozen section and permanent section because of insufficient leveling of the frozen section block. These five discrepancies were called negative on frozen section, but permanent section revealed dysplasia (two cases of mild dysplasia, one case with moderate dysplasia, and one case with severe dysplasia) or carcinoma in situ (one case). Twenty laryngectomies in which the frozen section tissue was consumed at the time of frozen section generated 103 frozen sections. In eight of the frozen sections involving six cases, the diagnostic tissue was not present on one or two of the frozen section levels examined. CONCLUSIONS: We conclude that in examining margins for laryngeal squamous cell carcinoma the frozen section tissue should be completely sampled by examining several levels at the time of frozen section. This requires consuming or exhausting the frozen section tissue rather than reserving any remaining frozen tissue for a paraffin-embedded permanent section.     

Atypical lipomatous tumors of the face: a controversial issue

We reviewed the topic of atypical lipomatous tumors including definition, diagnosis and management, with special emphasis on head and neck location and to report on the management of a rare case located in the temporalis muscle. Atypical lipomatous tumors/well-differentiated liposarcomas (ALT/WDLS) are rarely reported in the head and neck. Their behavior dictates a complete resection. Resection with a safety margin is sometimes needed according to the histological characteristics. Tumors located to the masticator space can be accessed through a mucosal approach achieving relative safety to the facial nerve. ALT constitute a group of tumors of a borderline behavior. Their management can be affected by some histological criteria and by their location in the head and neck region where vital structures can be affected.