Margin distance and other clinico-pathologic prognostic factors in vulvar carcinoma: a multivariate analysis

OBJECTIVES: To determine the importance of margin status and other prognostic factors associated with the recurrence and survival of patients with squamous cell vulvar carcinoma. METHODS: Data were analyzed using Kaplan-Meier methods and Cox proportional hazards regression. All slides were re-reviewed by two gynecologic pathologists. RESULTS: Ninety patients (median age: 69) were treated for vulvar carcinoma from 1984 to 2002, including 28 FIGO stage I, 20 stage II, 26 stage III and 16 with stage IV disease. Sixty-three (70%) patients underwent complete radical vulvectomies and 27 (30%) had modified radical vulvectomies. Nineteen (20%) patients received adjuvant radiotherapy. Five-year disease-specific survival rates were 100%, 100%, 86% and 29% for stages I-IV, respectively. None of the 30 patients with a pathologic margin distance >8 mm had local recurrence. Of the 53 women with tumor-free pathologic margin of <8 mm, 12 (23%) had a local recurrence. Moreover, women with >2 positive groin nodes had significantly higher recurrence risk compared to those with <2 metastatic groin nodes (p<0.001). On multivariate analysis, positive groin nodes and margin distance were important prognostic factors for recurrence. Moreover, stage, tumor size, margin distance, and depth of invasion were significant independent predictors for disease-specific survival. The median follow-up was 58 months (range: 2-188). CONCLUSIONS: Pathologic margin distance is an important predictor of local vulvar recurrence. Our data suggest that a > or =8-mm pathologic margin clearance leads to a high rate of loco-regional control.     

前牙唇侧齐龈肩台EMAX铸瓷全冠修复后唇侧牙周状况的评价

目的评价前牙唇侧齐龈肩台EMAX铸瓷全冠修复后唇侧牙周状况。方法对120颗前牙预备唇侧齐龈肩台,行EMAX铸瓷全冠修复。在修复前,修复后6个月,修复后1年和修复后2年分别采集唇侧龈沟液,测定龈沟液（gingivalcrevicular fluid,GCF）髓过氧化物酶（myeloperoxidase,MPO）的含量,同时记录唇侧牙周的牙龈指数（gingival index,GI）和牙周探诊深度（Pocket depths PD）。结果前牙EMAX铸瓷全冠在修复后6个月,修复后1年,修复后2年和修复前相比,牙龈指数GI、牙周探诊深度PD和龈沟液髓过氧化物酶MPO均无显著性差异（P〉0.05）。结论前牙EMAX铸瓷全冠修复体在临床上可获得理想的美学效果和边缘适应性,修复后2年唇侧牙周状况良好。     

Locust bean gum safety in neonates and young infants: An integrated review of the toxicological database and clinical evidence

Locust bean gum (LBG) is a galactomannan polysaccharide used as thickener in infant formulas with the therapeutic aim to treat uncomplicated gastroesophageal reflux (GER). Since its use in young infants below 12 weeks of age is not explicitly covered by the current scientific concept of the derivation of health based guidance values, the present integrated safety review aimed to compile all the relevant preclinical toxicological studies and to combine them with substantial evidence gathered from the clinical paediatric use as part of the weight of evidence supporting the safety in young infants below 12 weeks of age. LBG was demonstrated to have very low toxicity in preclinical studies mainly resulting from its indigestible nature leading to negligible systemic bioavailability and only possibly influencing tolerance. A standard therapeutic level of 0.5 g/100 mL in thickened infant formula is shown to confer a sufficiently protective Margin of Safety. LBG was not associated with any adverse toxic or nutritional effects in healthy term infants, while there are limited case-reports of possible adverse effects in preterms receiving the thickener inappropriately. Altogether, it can be concluded that LBG is safe for its intended therapeutic use in term-born infants to treat uncomplicated regurgitation from birth onwards.     

Surgical treatment of basal cell carcinoma: an algorithm based on the literature

Although basal cell carcinoma can be effectively managed through surgical excision,the most suitable surgical margins have not yet been fully determined. Furthermore,micrographic surgery is not readily available in many places around the world. Areview of the literature regarding the surgical treatment of basal cell carcinoma wasconducted in order to develop an algorithm for the surgical treatment of basal cellcarcinoma that could help the choice of surgical technique and safety margins,considering the major factors that affect cure rates. Through this review, it wasfound that surgical margins of 4mm seem to be suitable for small, primary,well-defined basal cell carcinomas, although some good results can be achieved withsmaller margins and the use of margin control surgical techniques. For treatment ofhigh-risk and recurrent tumors, margins of 5-6 mm or margin control of the surgicalexcision is required. Previous treatment, histological subtype, site and size of thelesion should be considered in surgical planning because these factors have beenproven to affect cure rates. Thus, considering these factors, the algorithm can be auseful tool, especially for places where micrographic surgery is not widelyavailable.     

The impact of additional margin coagulation with radiofrequency in liver resections with subcentimetric margin: can we improve the oncological results? A propensity score matching study

BackgroundWhereas the usefulness of radiofrequency (RF) energy as haemostatic method in liver surgery has become well established in the last decades, its intentional application on resection margins with the aim of reducing local recurrence is still debatable. Our goal was to compare the impact of an additional application of RF energy on the top of the resection surface, namely additional margin coagulation (AMC), on local recurrence (LR) when subjected to a subcentimeter margin.MethodsWe retrospectively analyzed 185 patients out of a whole cohort of 283 patients who underwent radical hepatic resection with subcentimetric margin. After propensity score adjustment, patients were classified into two balanced groups according to whether RF was applied or not.ResultsNo significant differences were observed within groups in baseline characteristics after PSM adjustment. The LR rate was significantly higher in the Control than AMC Group: 12 patients (14.5%) vs. 4 patients (4.8%) (p = 0.039). The estimated 1, 3, and 5-year LR-free survival rates of patients in the Control and AMC Group were: 93.5%, 86.0%, 81.0% and 98.8%, 97.2%, 91.9%, respectively (p = 0.049). Univariate Cox analyses indicated that the use of the RF applicator was significantly associated with lower LR (HR = 0.29, 95% confidence interval 0.093–0.906, p = 0.033). The Control Group showed smaller coagulation widths than the AMC group (p < 0.001).ConclusionsAn additional application of RF on the top of the resection surface is associated with less local hepatic recurrence than the use of conventional techniques.     

Intraoperative Margin Assessment in Early Oral Squamous Cell Carcinoma

The surgical method of margin sampling affects local control, pathologists’ approach to margin sampling, and clarity of pathology reports. Studies have shown that exclusive reliance on tumor bed margins is associated with worse local control and should be avoided. En bloc resections and margins obtained from the resection specimen remain the “gold standard.” Successful surgical treatment of early carcinomas of the oral cavity relies on close cooperation between surgeons and pathologists on issues of specimen orientation and margin sampling.     

Digital breast tomosynthesis versus full-field digital mammography—Which modality provides more accurate prediction of margin status in specimen radiography?

ObjectivesTo evaluate the reliability of tumor margin assessment in specimen radiography (SR) using digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) in comparison to postoperative histopathology margin status as the gold standard.MethodsAfter ethics committee approval, 102 consecutive patients who underwent breast conservative surgery for nonpalpable proven breast cancer were prospectively included. All patients underwent ultrasound/mammography-guided wire localization of their lesions. After excision, each specimen was marked for orientation and imaged using FFDM and DBT. Two blinded radiologists (R1, R2) independently analyzed images acquired with both modalities. Readers identified in which direction the lesion was closest to the specimen margin and to measure the margin width. Their findings were compared with the final histopathological analysis. True positive margin status was defined as a margin measuring <1 mm for invasive cancer and 5 mm for ductal carcinoma in situ (DCIS) at imaging and pathology.ResultsFor FFDM, correct margin direction was identified in 45 cases (44%) by R1 and in 37 cases (36%) by R2. For DBT, 69 cases (68%) were correctly identified by R1 and 70 cases (69%) by R2. Overall accuracy was 40% for FFDM and 69% for DBT; the difference was statistically significant (p < 0.0001). Sensitivity in terms of correct assessment of margin status was significantly better for DBT than FFDM (77% versus 62%).ConclusionSR using DBT is significantly superior to FFDM regarding identification of the closest margin and sensitivity in assessment of margin status.