Background
Concern persists regarding percutaneous core needle biopsy (CNB) of a potentially malignant lesion of the retroperitoneum due to the perceived risk of immediate complications and adverse ...oncologic outcomes, including needle tract seeding (NTS).
Objective
The aim of this study was to evaluate the incidence of (1) early complications and (2) NTS following CNB of suspected retroperitoneal sarcoma (RPS).
Methods
Patients who underwent CNB of an RP mass with pre-biopsy suspicion of sarcoma were identified from a prospective database at two centers: (1) Princess Margaret Cancer Centre/Mount Sinai Hospital, Toronto (2009–2015); and (2) The Ottawa Hospital (1999–2015). Early complications, including bleeding, pain, infection, and organ injury, were recorded. Instances of NTS were identified from long-term follow-up of patients who underwent resection of primary RPS at these two centers after initial CNB (1996–2013).
Results
Of 358 percutaneous CNBs of suspected RPS performed over the study period, 7 (2.0%) resulted in minor bleeding with no transfusion, 3 (0.8%) resulted in significant pain, 1 (0.3%) resulted in unplanned admission to hospital for observation, and 1 (0.3%) resulted in a pneumothorax. There were no infections. In 203 patients who underwent resection of RPS following CNB, crude cumulative local recurrence was 24% at 5 years. At a median follow-up of 44 months, there was one case of NTS (approximately 0.5%).
Conclusion
This large bi-institutional experience with CNB of an RP mass demonstrates that both the early complication rate and the incidence of NTS are very low. Physicians and patients can be reassured that the benefits of CNB in diagnosing sarcoma and determining its histologic subtype and grade far outweigh the risks.
Many catalyst materials have been tried to synthesize ultra-long carbon nanotubes (CNTs) by extending catalyst lifetime and delaying growth termination. We propose a time-controlled, variable ...composition iron-molybdenum catalyst system, where the diffusion of molybdenum (as a thin layer reservoir) is mediated by the alumina underlayer, to reach and to slowly alloy with the Fe catalyst on the surface during the thermal process. This technique enhanced both the catalytic activity and the catalytic lifetime to grow CNT carpets with heights up 5 mm, compared to a maximum of approximately 1.5 mm for a regular sample (without Mo reservoir). Moreover, the CNT height increased with the thickness of the Mo thin layer reservoir for thicknesses from 10 nm to 30 nm. We discuss this new growth mechanism using high resolution transmission microscopy (HRTEM) images of cross-section lamellas and Rutherford Back Scattering (RBS) analysis to show the increasing alloying of Mo with Fe. Overall, the proposed technique of mediated diffusion of Mo to the surface with subsequent progressive alloying with the Fe catalyst, besides enhancing CNT height, could allow the one-step synthesis of CNT carpets with regions of different heights based on patterning these regions with different thicknesses of the Mo reservoir during sample preparation.
The use of a thin layer of molybdenum delays growth termination leading to up to 5X taller CNT carpets.
Une revue, un outil de pensée libreCette nouvelle livraison de L’Année du Maghreb arrive dans un contexte tendu, intellectuellement et politiquement. Face aux transformations néo-managériales de ...l’enseignement supérieur et de la recherche, il est de plus en plus difficile aujourd’hui de maintenir une revue académique, tant l’académie est mise à rude épreuve : nos tâches sont nombreuses, notre temps de travail fragmenté et nos engagements nécessairement multiples. L’Année du Maghreb, comme bi...
Appropriate surveillance of patients with melanoma treated with curative intent is vital to improve patient outcomes. A systematic review was conducted to capture locoregional recurrence and ...metastatic disease, and to evaluate the effectiveness of various surveillance strategies.
MEDLINE, EMBASE, PubMed, Cochrane Database of Systematic Reviews, and National Cancer Institute Clinical Trials Database were searched. Randomized controlled trials (RCTs) and comparative studies reporting at least one patient-related outcome were included. Exclusion criteria included: published in non-English or recruited >20 % or an uncertain percentage of non-target patients without conducting a subgroup analysis for the target patients. This review was registered at PROSPERO (CRD42021246482).
Among 17,978 publications from the literature search, one RCT and five non-randomized comparative studies were included and comprised 4016 patients. The aggregate evidence certainty was low for the RCT and very low for the comparative studies, as assessed by the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. For patients with stage IA–IIC melanoma, a reduced follow-up schedule with clinical follow-up strategies alone may be safe and cost-effective. For stage IIC–IIIC patients, at least two serial PET/CT or whole-body CT and brain MRI imaging within a median follow-up of 31.2 months may detect 50 % of recurrences that lead to additional management, such as surgery. PET/CT may have a higher positive predictive value and lower false positive rate compared with CT alone in detecting recurrence in stage I–III patients.
Surveillance protocols should be based on individual risk of recurrence and established best practices when formulating follow-up strategies, as suggested by the studies reviewed. Future high-quality studies are needed to clarify the frequency of imaging follow-up strategies, especially in patients with high-risk stage II melanoma.
•The first journal publication of a systematic review on surveillance in melanoma.•A reduced follow-up schedule may be feasible for stage IA–IIC melanoma.•Annual/biannual CT/PET-CT may be suitable in stage IIIA-D as clinically indicated.•Established individual risk of recurrence is the key to surveillance protocols.
AbstractObjectiveTo determine the efficacy and safety of extended duration perioperative thromboprophylaxis by low molecular weight heparin when assessing disease-free survival in patients undergoing ...resection for colorectal cancer.DesignMulticentre, open label, randomised controlled trial.Settings12 hospitals in Quebec and Ontario, Canada, between 25 October 2011 and 31 December 2020.Participants614 adults (age ≥18 years) were eligible with pathologically confirmed invasive adenocarcinoma of the colon or rectum, no evidence of metastatic disease, a haemoglobin concentration of ≥8 g/dL, and were scheduled to undergo surgical resection.InterventionsRandom assignment to extended duration thromboprophylaxis using daily subcutaneous tinzaparin at 4500 IU, beginning at decision to operate and continuing for 56 days postoperatively, compared with in-patient postoperative thromboprophylaxis only.Main outcome measuresPrimary outcome was disease-free survival at three years, defined as survival without locoregional recurrence, distant metastases, second primary (same cancer), second primary (other cancer), or death. Secondary outcomes included venous thromboembolism, postoperative major bleeding complications, and five year overall survival. Analyses were done in the intention-to-treat population.ResultsThe trial stopped recruitment prematurely after the interim analysis for futility. The primary outcome occurred in 235 (77%) of 307 patients in the extended duration group and in 243 (79%) of 307 patients in the in-hospital thromboprophylaxis group (hazard ratio 1.1, 95% confidence interval 0.90 to 1.33; P=0.4). Postoperative venous thromboembolism occurred in five patients (2%) in the extended duration group and in four patients (1%) in the in-hospital thromboprophylaxis group (P=0.8). Major surgery related bleeding in the first postoperative week was reported in one person (<1%) in the extended duration and in six people (2%) in the in-hospital thromboprophylaxis group (P=0.1). No difference was noted for overall survival at five years in 272 (89%) patients in the extended duration group and 280 (91%) patients in the in-hospital thromboprophylaxis group (hazard ratio 1.12; 95% confidence interval 0.72 to 1.76; P=0.1).ConclusionsExtended duration to perioperative anticoagulation with tinzaparin did not improve disease-free survival or overall survival in patients with colorectal cancer undergoing surgical resection compared with in-patient postoperative thromboprophylaxis alone. The incidences of venous thromboembolism and postoperative major bleeding were low and similar between groups.Trial registrationClinicalTrials.gov NCT01455831.
Background
Consideration of sentinel lymph node biopsy (SLNB) is recommended for patients with T1b melanomas and T1a melanomas with high-risk features; however, the proportion of patients with ...actionable results is low. We aimed to identify factors predicting SLNB positivity in T1 melanomas by examining a multi-institutional international population.
Methods
Data were extracted on patients with T1 cutaneous melanoma who underwent SLNB between 2005 and 2018 at five tertiary centers in Europe and Canada. Univariable and multivariable logistic regression analyses were performed to identify predictors of SLNB positivity.
Results
Overall, 676 patients were analyzed. Most patients had one or more high-risk features: Breslow thickness 0.8–1 mm in 78.1% of patients, ulceration in 8.3%, mitotic rate > 1/mm
2
in 42.5%, Clark’s level ≥ 4 in 34.3%, lymphovascular invasion in 1.4%, nodular histology in 2.9%, and absence of tumor-infiltrating lymphocytes in 14.4%. Fifty-three patients (7.8%) had a positive SLNB. Breslow thickness and mitotic rate independently predicted SLNB positivity. The odds of positive SLNB increased by 50% for each 0.1 mm increase in thickness past 0.7 mm (95% confidence interval CI 1.05–2.13) and by 22% for each mitosis per mm
2
(95% CI 1.06–1.41). Patients who had one excised node (vs. two or more) were three times less likely to have a positive SLNB (3.6% vs. 9.6%; odds ratio 2.9 1.3–7.7).
Conclusions
Our international multi-institutional data confirm that Breslow thickness and mitotic rate independently predict SLNB positivity in patients with T1 melanoma. Even within this highly selected population, the number needed to diagnose is 13:1 (7.8%), indicating that more work is required to identify additional predictors of sentinel node positivity.
There is a global rise in skin cancer incidence, resulting in an increase in patient care needs and healthcare costs. To optimize health care planning, costs, and patient care, Ontario Health ...developed a provincial skin cancer plan to streamline the quality of care. We conducted a systematic review and a grey literature search to evaluate the definitions and management of skin cancer within other jurisdictions, as well as a provincial survey of skin cancer care practices, to identify care gaps. The systematic review did not identify any published comprehensive skin cancer management plans. The grey literature search revealed skin cancer plans in isolated regions of the United Kingdom (U.K.), National Institute for Health and Care Excellence (NICE) guidelines for skin cancer quality indicators and regional skin cancer biopsy clinics, and wait time guidelines in Australia and the U.K. With the input of the Ontario Cancer Advisory Committee (CAC), unique definitions for complex and non-complex skin cancers and the appropriate cancer services were created. A provincial survey of skin cancer care yielded 44 responses and demonstrated gaps in biopsy access. A skin cancer pathway map was created and a recommendation was made for regional skin cancer biopsy clinics. We have created unique definitions for complex and non-complex skin cancer and a skin cancer pathways map, which will allow for the implementation of both process and performance metrics to address identified gaps in care.
Background
Surgery is the mainstay of treatment for retroperitoneal sarcoma (RPS), but local recurrence is common. Biologic behavior and recurrence patterns differ significantly among histologic ...types of RPS, with implications for management. The Transatlantic Australasian RPS Working Group (TARPSWG) published a consensus approach to primary RPS, and to complement this, one for recurrent RPS in 2016. Since then, additional studies have been published, and collaborative discussion is ongoing to address the clinical challenges of local recurrence in RPS.
Methods
An extensive literature search was performed, and the previous consensus statements for recurrent RPS were updated after review by TARPSWG members. The search included the most common RPS histologic types: liposarcoma, leiomyosarcoma, solitary fibrous tumor, undifferentiated pleomorphic sarcoma, and malignant peripheral nerve sheath tumor.
Results
Recurrent RPS management was evaluated from diagnosis to follow-up evaluation. For appropriately selected patients, resection is safe. Nomograms currently are available to help predict outcome after resection. These and other new findings have been combined with expert recommendations to provide 36 statements, each of which is attributed a level of evidence and grade of recommendation. In this updated document, more emphasis is placed on histologic type and clarification of the intent for surgical treatment, either curative or palliative. Overall, the fundamental tenet of optimal care for patients with recurrent RPS remains individualized treatment after multidisciplinary discussion by an experienced team with expertise in RPS.
Conclusions
Updated consensus recommendations are provided to help guide decision-making for treatment of locally recurrent RPS and better selection of patients who would potentially benefit from surgery.
À partir de sources administratives, de témoignages littéraires et scientifiques, cet article étudie la mise en place d'une industrie viticole en Tunisie, sous le protectorat français, et son impact ...sur les populations. Le vin produit en Tunisie est en grande majorité exporté à l'étranger, ce qui donne ainsi une vitrine au protectorat français en Tunisie, des revenus supplémentaires et permet d'asseoir la domination coloniale. En parallèle, le commerce et la consommation d'alcool par les indigènes tunisiens sont strictement interdits à partir de 1917. L'administration souhaite faire respecter l'interdit religieux musulman de consommation d'alcool, mais renforce ainsi les représentations coloniales sur les coutumes des indigènes. Malgré ces interdits, le vin est une synapse entre la société des colons et la société colonisée. Par les ventes de vin clandestines, ou par les représentations autour des consommations de chacun le vin est un moyen de renégocier ou réaffirmer l'autorité coloniale. Reprinted by permission of Sage Publications
À partir de sources administratives, de témoignages littéraires et scientifiques, cet article étudie la mise en place d’une industrie viticole en Tunisie, sous le protectorat français, et son impact ...sur les populations. Le vin produit en Tunisie est en grande majorité exporté à l’étranger, ce qui donne ainsi une vitrine au protectorat français en Tunisie, des revenus supplémentaires et permet d’asseoir la domination coloniale. En parallèle, le commerce et la consommation d’alcool par les indigènes tunisiens sont strictement interdits à partir de 1917. L’administration souhaite faire respecter l’interdit religieux musulman de consommation d’alcool, mais renforce ainsi les représentations coloniales sur les coutumes des indigènes. Malgré ces interdits, le vin est une synapse entre la société des colons et la société colonisée. Par les ventes de vin clandestines, ou par les représentations autour des consommations de chacun le vin est un moyen de renégocier ou réaffirmer l’autorité coloniale.
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