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Thyroid : Official Journal of the... Sep 2016Invasive disease is a poor prognostic factor for patients with differentiated thyroid cancer (DTC). Uncontrolled central neck disease is a common cause of distressing... (Review)
Review
BACKGROUND
Invasive disease is a poor prognostic factor for patients with differentiated thyroid cancer (DTC). Uncontrolled central neck disease is a common cause of distressing death for patients presenting in this manner. Advances in assessment and management of such cases have led to significant improvements in outcome for this patient group. This article reviews the patterns of invasion and a contemporary approach to investigation and treatment of patients with invasive DTC.
SUMMARY
Aerodigestive tract invasion is reported in around 10% of case series of DTC. Assessment should include not only clinical history and physical examination with endoscopy as indicated, but ultrasound and contrast-enhanced cross-sectional imaging. Further studies including positron emission tomography should be considered, particularly in recurrent cases that are radioactive iodine (RAI) resistant. Both the patient and the extent of disease should be carefully assessed prior to embarking on surgery. The aim of surgery is to resect all gross disease. When minimal visceral invasion is encountered early, "shave" procedures are recommended. In the setting of transmural invasion of the airway or esophagus, however, full thickness excision is required. For intermediate cases in which invasion of the viscera has penetrated the superficial layers but is not evident in the submucosa, opinion is divided. Early reports recommended an aggressive approach. More recently authors have tended to recommend less aggressive resections with postoperative adjuvant therapies. The role of external beam radiotherapy continues to evolve in DTC with support for its use in patients considered to have RAI-resistant tumors.
CONCLUSIONS
Patients with invasive DTC require a multidisciplinary approach to investigation and treatment. With detailed assessment, appropriate surgery, and adjuvant therapy when indicated, this patient group can expect durable control of central neck disease, despite the aggressive nature of their primary tumors.
Topics: Humans; Prognosis; Radiotherapy, Adjuvant; Thyroid Neoplasms; Thyroidectomy
PubMed: 27480110
DOI: 10.1089/thy.2016.0064 -
Australian Journal of General Practice Jun 2024General practitioners manage a significant proportion of inflammatory and neoplastic skin conditions on a daily basis. Various surgical techniques can be employed to aid...
BACKGROUND
General practitioners manage a significant proportion of inflammatory and neoplastic skin conditions on a daily basis. Various surgical techniques can be employed to aid in diagnosis, including punch biopsies, shave biopsy, shave excision, incisional biopsy, curettage and formal excision with closure. Requiring minimal equipment, shave procedures are quick to perform, produce good cosmetic outcomes and minimise costs.
OBJECTIVE
Our aim is to discuss shave procedures in detail and highlight the difference between shave biopsies and shave excisions, as well as the role they each have in diagnosing an array of benign, inflammatory and malignant skin conditions, including melanocytic lesions.
DISCUSSION
Shave procedures performed on suitable lesions by trained practitioners can be used for sampling or removing suspect lesions. Where the intent is complete removal, margin involvement is rare given good lesion selection and technique.
Topics: Humans; General Practice; Biopsy; Skin Diseases
PubMed: 38840380
DOI: 10.31128/AJGP-06-23-6872 -
American Family Physician Jan 2012Cutaneous malignant melanoma accounts for 3 to 5 percent of all skin cancers and is responsible for approximately 75 percent of all deaths from skin cancer. Persons with... (Review)
Review
Cutaneous malignant melanoma accounts for 3 to 5 percent of all skin cancers and is responsible for approximately 75 percent of all deaths from skin cancer. Persons with an increased number of moles, dysplastic (also called atypical) nevi, or a family history of the disease are at increased risk compared with the general population. An important tool to assist in the evaluation of potential melanomas for patients and health care professionals is the ABCDE mnemonic, which takes into account asymmetry, border irregularities, color variation, diameter, and evolution. Any suspicious pigmented lesion should be biopsied. Appropriate methods of biopsy can vary, and include deep shave, punch, and excisional biopsy. Regardless of the procedure selected, it is essential that the size of the specimen be adequate to determine the histologic depth of lesion penetration, which is known as the Breslow depth. The Breslow depth is the most important prognostic parameter in evaluating the primary tumor. Because early detection and treatment can lead to identification of thinner lesions, which may increase survival, it is critical that physicians be comfortable with evaluating suspicious pigmented lesions and providing treatment or referral as necessary.
Topics: Biopsy; Dermoscopy; Humans; Incidence; Melanoma; Neoplasm Staging; Nevus; Practice Guidelines as Topic; Primary Health Care; Skin; Skin Neoplasms; United States
PubMed: 22335216
DOI: No ID Found -
Fertility and Sterility Dec 2022To present different approaches used in the surgical management of diaphragmatic endometriosis using the Davinci Robotic system.
OBJECTIVE
To present different approaches used in the surgical management of diaphragmatic endometriosis using the Davinci Robotic system.
DESIGN
A video article presenting patient positioning, port placement, and surgical techniques used in robotic excision of diaphragmatic endometriosis with concomitant pelvic disease.
SETTING
Endometriosis center.
PATIENT(S)
Patients undergoing excision of diaphragmatic endometriosis.
INTERVENTION(S)
Systematic robotic approach to excise diaphragmatic lesions depending on the depth of invasion.
MAIN OUTCOME MEASURES(S)
The advantages and disadvantages of the lithotomy and the lateral decubitus approach were reviewed. Ports placements are illustrated according to the chosen approach. Diaphragmatic peritoneal stripping, diaphragmatic shaving, and diaphragmatic excision are different techniques used according to the depth of invasion.
RESULTS(S)
N/A.
CONCLUSION(S)
The choice of approach between the lithotomy position and the left lateral decubitus position depend on the extent of the diaphragmatic disease and the presence of concomitant pelvic lesions. Despite the lack of high-quality evidence, the advantages of the robotic system may improve the outcomes in such difficult cases in comparison with conventional laparoscopy.
Topics: Female; Humans; Endometriosis; Diaphragm; Laparoscopy; Muscular Diseases; Pelvis; Robotic Surgical Procedures
PubMed: 36369182
DOI: 10.1016/j.fertnstert.2022.09.019 -
Dermatology Online Journal Dec 2019Dermatologists around the world widely utilize skin biopsies, which can be performed using shave, punch, incisional, or excisional techniques [1]. The punch biopsy...
Dermatologists around the world widely utilize skin biopsies, which can be performed using shave, punch, incisional, or excisional techniques [1]. The punch biopsy allows a dermatologist to obtain a full-thickness skin sample. The post-biopsy wound heals by primary closure or second intention [2]. Some suspicious lesions may be located at the body parts that are difficult to access.
Topics: Biopsy; Humans; Skin
PubMed: 32045172
DOI: No ID Found -
Cost Effectiveness and Resource... Sep 2023In an effort to minimize positive margins and subsequent re-excision after breast conserving surgery (BCS), many providers and facilities have implemented either a Full...
BACKGROUND
In an effort to minimize positive margins and subsequent re-excision after breast conserving surgery (BCS), many providers and facilities have implemented either a Full Cavity Shave (FCS) approach or adding the MarginProbe Radiofrequency Spectroscopy System.
OBJECTIVE
We sought to create a functioning Pro-Forma for use by facilities and payers to evaluate and compare the cost savings of implementing FCS or MarginProbe based on personalized variable inputs.
METHODS
A decision tree demonstrating three possible surgical pathways, BCS, BCS + FCS, and BCS + MarginProbe was developed with clinical inputs for re-excision rate, mastectomy as 2nd surgery, rate of reconstruction, and rate of 3rd surgery derived by a literature review. A surgical pathway cost formula was created using the decision tree and financial inputs derived by utilizing the nation's largest database of privately billed health insurance claims and Medicare claims data (fairhealth.org). Using the surgical pathway formula and financial inputs, a customizable Pro-Forma was created for immediate cost savings analysis of BCS + FCS and BCS + Marginprobe using variable inputs. Costs are from the perspective of third-party payers.
RESULTS
Utilizing MarginProbe to reduce re-excisions for positive margins can be associated with better cost-savings than FCS due to the increased pathology processing costs by using an FCS approach. The reduction in re-excision provided by both FCS and MarginProbe offset their increased expense to various degrees with cost savings of each method improving as baseline re-excisions rates increase, until ultimately each may become cost-neutral or cost-prohibitive when compared to BCS alone. Our data suggest that in the privately insured population, MarginProbe provides a cost-savings over BCS alone when baseline re-excision rates are over 20% and that FCS becomes cost-saving when baseline re-excision rates are over 29%. For Medicare patients, MarginProbe provides a cost-savings when baseline re-excision rates exceed 34%, and FCS becomes cost-saving for re-excision rates over 52%. Our Pro-Forma allows an individual provider or institution to evaluate the cost savings of the FCS approach and/or utilization of the MarginProbe device such that the additional cost or cost-savings of utilizing one or both of these methods can be quickly calculated based on their facility's volume and baseline re-excision rate.
CONCLUSIONS
Our data suggest that utilizing either an FCS approach or the MarginProbe radiofrequency spectroscopy system may be a cost-saving solution to reducing the rate of re-excisions depending on a facility or practice's surgical volume and baseline re-excision rate. The degree to which each of these interventions provides an added cost or cost-savings to healthcare payers can be evaluated by utilizing the Pro-Forma outlined herein with customizable variable inputs.
PubMed: 37716980
DOI: 10.1186/s12962-023-00477-1 -
Data in Brief Dec 2021Densely labelled segmentation data for digital pathology images is costly to produce but is invaluable to training effective machine learning models. We make available...
Densely labelled segmentation data for digital pathology images is costly to produce but is invaluable to training effective machine learning models. We make available 290 hand-annotated histopathology tissue sections of the 3 most common skin cancers; basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and intraepidermal carcinoma (IEC). These non-melanoma skin cancers constitute over 90% of all skin cancer diagnoses and hence this dataset gives an opportunity to the scientific community to benchmark analytic methodologies on a significant portion of the dermatopathology workflow. The data represents typical cases of the three cancer types (not requiring a differential diagnosis) across shave, punch and excision biopsy contexts. Each image is accompanied with a segmentation mask which characterizes the section into 12 tissue types, specifically: keratin, epidermis, papillary dermis, reticular dermis, hypodermis, inflammation, glands, hair follicles and background, as well as BCC, SCC and IEC. Included also are cancer margin measurements to work towards automated assessment of surgical margin clearance and tumour invasion. This leaves open many opportunities for researchers to utilize or extend the dataset, building upon recent work on image analysis problems in skin cancer (Thomas et al., 2021).
PubMed: 34877372
DOI: 10.1016/j.dib.2021.107587 -
International Journal of Surgical... 2013Breast-conserving surgery (BCS) is the treatment of choice for early breast cancer. The adequacy of surgical margins (SM) is a crucial issue for adjusting the volume of... (Review)
Review
Breast-conserving surgery (BCS) is the treatment of choice for early breast cancer. The adequacy of surgical margins (SM) is a crucial issue for adjusting the volume of excision and for avoiding local recurrences, although the precise definition of an adequate margins width remains controversial. Moreover, other factors such as the biological behaviour of the tumor and subsequent proper systemic therapies may influence the local recurrence rate (LRR). However, a successful BCS requires preoperative localization techniques or margin assessment techniques. Carbon marking, wire-guided, biopsy clips, radio-guided, ultrasound-guided, frozen section analysis, imprint cytology, and cavity shave margins are commonly used, but from the literature review, no single technique proved to be better among the various ones. Thus, an association of two or more methods could result in a decrease in rates of involved margins. Each institute should adopt its most congenial techniques, based on the senologic equipe experience, skills, and technologies.
Topics: Biomarkers, Tumor; Breast Neoplasms; Carcinoma, Intraductal, Noninfiltrating; Female; Humans; Intraoperative Care; Mastectomy, Segmental; Neoplasm Recurrence, Local; Plastic Surgery Procedures
PubMed: 23986868
DOI: 10.1155/2013/793819 -
Journal of Cutaneous and Aesthetic... 2020The razor blade has been used by dermatologists as an alternative tool for performing shave excision and biopsy owing to its superior sharpness and flexibility. It is...
The razor blade has been used by dermatologists as an alternative tool for performing shave excision and biopsy owing to its superior sharpness and flexibility. It is inexpensive and freely available but the bare blade design carries the risk of accidental injury to the operator and patient. We describe an easy modification of the razor blade for better grip, control, and safety in obtaining cutaneous shave specimens.
PubMed: 33209008
DOI: 10.4103/JCAS.JCAS_191_19 -
Cureus Apr 2024A 72-year-old male with a history of systemic hypertension, asthma, chronic obstructive pulmonary disease (COPD), and hyperlipidemia presents with diffuse patches of...
A 72-year-old male with a history of systemic hypertension, asthma, chronic obstructive pulmonary disease (COPD), and hyperlipidemia presents with diffuse patches of cutaneous depigmentation. A shave biopsy of different regions of depigmented skin indicated vitiligo. The patient was prescribed Opzelura (ruxolitinib) 1.5% topical cream as well as tacrolimus 0.1% topical ointment for vitiligo. He also had a history of prostate cancer. A prostate biopsy revealed three sites of prostatic adenocarcinoma with a Gleason score of 6 and a Prostate Imaging-Reporting and Data System (PI-RADS) score of 2. The patient remained in active surveillance for prostate cancer without treatment, due to its low severity. A subsequent biopsy five years later revealed a decrease in prostate cancer prevalence, with cancer present in only one core and at a lower severity. The purpose of this case presentation is to discuss possible links between vitiligo and prostate cancer, as well as their shared mechanisms and pathways.
PubMed: 38817459
DOI: 10.7759/cureus.59349