Borderline ovarian tumor frozen section diagnoses with features suspicious of invasive cancer:a retrospective study

Abstract Background A frozen section diagnosis of a borderline ovarian tumor with suspicious features of invasive carcinoma (“at least borderline” or synonymous descriptions) presents us with the dilemma of whether or not to perform a full ovarian cancer staging procedure. Quantification of this dilemma may help us with the issue of this clinical decision. The present study assessed and compared both the prevalence of straightforward borderline and “at least borderline” frozen section diagnoses and the proportion of these women with a final histopathological diagnosis of invasive carcinoma, with a special interest in histologic subtypes. Methods A retrospective cohort study was performed in three hospitals in The Netherlands. All women that underwent ovarian surgery with perioperative frozen section evaluation in one of these hospitals between January 2007 and July 2018 were identified and included in case of a borderline or “at least borderline” frozen section diagnosis and a borderline ovarian tumor or invasive carcinoma as a final diagnosis. Results A total of 223 women were included, of which 41 women (18.4%) were diagnosed with “at least borderline” at frozen section. Thirteen of forty-one women (31.7%) following “at least borderline” frozen section diagnosis and 14 of 182 women (7.7%) following a straightforward borderline frozen section diagnosis were diagnosed with invasive carcinoma at paraffin section evaluation (p < 0.001). When compared to straightforward borderline frozen section diagnoses, the proportion of women diagnosed with invasive carcinoma increased from 3.1 to 35.7% for serous tumors (p = 0.001), 10.0 to 21.7% for mucinous tumors (p = 0.129) and 50.0 to 75.0% (p = 0.452) in case of other histologic subtypes following an “at least borderline” frozen section diagnosis. Conclusions Overall, when compared to women with a decisive borderline frozen section diagnosis, women diagnosed with “at least borderline” frozen section diagnoses were found to have a higher chance of carcinoma upon final diagnosis (7.7% vs 31.7%). Especially in the serous subtype, full staging during initial surgery might be considered after preoperative consent to prevent a second surgical procedure or chemotherapy in unstaged women. Further studies are needed to evaluate whether additional sampling in case of an “at least borderline” diagnosis may decrease the risk of surgical over-treatment

Frozen section diagnosis of borderline ovarian tumors with suspicious features of invasive cancer is a devil's dilemma for the surgeon:A systematic review and meta-analysis

Introduction Frozen section diagnoses of borderline ovarian tumors are not always straightforward and a borderline frozen section diagnosis with suspicious features of invasive carcinoma (reported as "at least borderline" or synonymous descriptions) presents us with the dilemma of whether or not to perform a full surgical staging procedure. By performing a systematic review and meta-analysis, the prevalence of straightforward borderline and "at least borderline" frozen section diagnoses, as well as proportion of patients with a final diagnosis of invasive carcinoma in these cases, were assessed and compared, as quantification of this dilemma may help us with the issue of this clinical decision. Material and methods PubMed, EMBASE and Cochrane library databases were searched and studies discussing "at least borderline" frozen section diagnoses were included in the review. Numbers of specific frozen section diagnoses and subsequent final histological diagnoses were extracted and pooled analysis was performed to compare the proportion of patients diagnosed with invasive carcinoma following borderline and "at least borderline" frozen section diagnoses, presented as risk ratio and risk difference with 95% confidence intervals (95% CI). Results Of 4940 screened records, eight studies were considered eligible for quantitative analysis. A total of 921 women was identified and 230 (25.0%) of these women were diagnosed with "at least borderline" ovarian tumor at the time of frozen section. Final histological diagnoses were reported in five studies, including 61 women with an "at least borderline" diagnosis and 290 women with a straightforward borderline frozen section diagnosis. Twenty-five of 61 women (41.0%) of the "at least borderline" group had invasive cancer at final diagnosis, compared with 28 of 290 women (9.7%) of the straightforward borderline frozen section group (risk difference -0.34, 95% CI -0.53 to -0.15; relative risk 0.25, 95% CI 0.13-0.50). Conclusions Women diagnosed with "at least borderline" frozen section diagnoses were found to have a higher chance of carcinoma upon final diagnosis when compared with women with a straightforward borderline frozen section diagnosis (41.0% vs 9.7%). Especially in the serous subtype, and after preoperative consent, full staging during initial surgery might be considered in these cases to prevent a second surgical procedure

A guide for managing patients with stage I NSCLC: Deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 2: Systematic review of evidence regarding resection extent in generally healthy patients

Background: Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options (lobectomy, segmentectomy, wedge, stereotactic body radiotherapy, thermal ablation), weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods: A PubMed systematic review from 2000-2021 of outcomes after lobectomy, segmentectomy and wedge resection in generally healthy patients is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons with at least some adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved. Results: In healthy patients there is no short-term benefit to sublobar resection Conclusions: A systematic, comprehensive summary of evidence regarding resection extent in healthy patients with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation on which to build a framework for individualized clinical decision-making

A guide for managing patients with stage I NSCLC: Deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 3: Systematic review of evidence regarding surgery in compromised patients or specific tumors

Background: Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options [lobectomy, segmentectomy, wedge, stereotactic body radiotherapy (SBRT), thermal ablation], weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods: A PubMed systematic review from 2000-2021 of outcomes after lobectomy, segmentectomy and wedge resection in older patients, patients with limited pulmonary reserve and favorable tumors is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons (NRCs) with adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved. Results: In older patients, perioperative mortality is minimally altered by resection extent and only slightly affected by increasing age; sublobar resection may slightly decrease morbidity. Long-term outcomes are worse after lesser resection; the difference is slightly attenuated with increasing age. Reported short-term outcomes are quite acceptable in (selected) patients with severely limited pulmonary reserve, not clearly altered by resection extent but substantially improved by a minimally invasive approach. Quality-of-life (QOL) and impact on pulmonary function hasn\u27t been well studied, but there appears to be little difference by resection extent in older or compromised patients. Patient selection is paramount but not well defined. Ground-glass and screen-detected tumors exhibit favorable long-term outcomes regardless of resection extent; however solid tumors \u3c1 cm are not a reliably favorable group. Conclusions: A systematic, comprehensive summary of evidence regarding resection extent in compromised patients and favorable tumors with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation for a framework for individualized decision-making

A guide for managing patients with stage I NSCLC: Deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 4: Systematic review of evidence involving SBRT and ablation

Background: Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options [lobectomy, segmentectomy, wedge, stereotactic body radiotherapy (SBRT), thermal ablation], weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods: A PubMed systematic review from 2000-2021 of outcomes after SBRT or thermal ablation Results: Short-term outcomes are meaningfully better after SBRT than resection. SBRT doesn\u27t affect quality-of-life (QOL), on average pulmonary function is not altered, but a minority of patients may experience gradual late toxicity. Adjusted non-randomized comparisons demonstrate a clinically relevant detriment in long-term outcomes after SBRT Conclusions: A systematic, comprehensive summary of evidence regarding Stereotactic Body Radiotherapy or thermal ablatio

Faunal community consequence of interspecific bark trait dissimilarity in early-stage decomposing logs

Dead tree trunks have significant ecosystem functions related to biodiversity and biogeochemical cycles. When lying on the soil surface, they are colonized by an array of invertebrate fauna, but what determines their community composition is still unclear. We apply community assembly theory to colonization of tree logs by invertebrates. During early decomposition, the attached bark is critically important as an environment filter for community assembly through habitat provision. Specifically, we hypothesized that the more dissimilar bark traits were between tree species, the more their faunal community compositions would differ. We tested this hypothesis by investigating the effects of bark traits on the invertebrate communities in the early-decomposing logs of 11 common, temperate tree species placed in the ‘common garden’ experiment LOGLIFE. Bark traits included bark looseness, fissure index, outer bark thickness, ratio of inner to outer bark thickness, punch resistance, water storage capacity and bark pH. The predominant faunal groups studied were Annelida, Isopoda, Chilopoda, Diplopoda, Diptera and Coleoptera. Our results showed (i) strong interspecific differences in bark traits, (ii) that bark traits related to environmental buffering had profound effects on the abundance of specific invertebrate groups, and (iii) the higher the overall bark trait dissimilarity between tree species, the more dissimilar these tree species were in faunal community composition, and the higher was the joint invertebrate family richness. A suite of bark traits together has fundamental afterlife effects on invertebrate community assembly, strongly filtering the colonizing invertebrates in early-decomposing logs, driving variation in their community composition and diversity. Our findings indicate that bark trait dissimilarity among tree species in forest stands is likely a better indicator of early-phase dead trunk fauna diversity than tree species diversity per se. A lay summary is available for this article.</p

Scans for signatures of selection in Russian cattle breed genomes reveal new candidate genes for environmental adaptation and acclimation

Domestication and selective breeding has resulted in over 1000 extant cattle breeds. Many of these breeds do not excel in important traits but are adapted to local environments. These adaptations are a valuable source of genetic material for efforts to improve commercial breeds. As a step toward this goal we identified candidate regions to be under selection in genomes of nine Russian native cattle breeds adapted to survive in harsh climates. After comparing our data to other breeds of European and Asian origins we found known and novel candidate genes that could potentially be related to domestication, economically important traits and environmental adaptations in cattle. The Russian cattle breed genomes contained regions under putative selection with genes that may be related to adaptations to harsh environments (e.g., AQP5, RAD50, and RETREG1). We found genomic signatures of selective sweeps near key genes related to economically important traits, such as the milk production (e.g., DGAT1, ABCG2), growth (e.g., XKR4), and reproduction (e.g., CSF2). Our data point to candidate genes which should be included in future studies attempting to identify genes to improve the extant breeds and facilitate generation of commercial breeds that fit better into the environments of Russia and other countries with similar climates

Resonant Structure of τ→3ππ0ντ\tau\to 3\pi\pi^{0}\nu_{\tau} and τ→ωπντ\tau\to \omega\pi\nu_{\tau} Decays

The resonant structure of the four pion final state in the decay $\tau \to 3\pi\pi^0\nu_\tau$ is analyzed using 4.27 million $\tau^+\tau^-$ pairs collected by the CLEO II experiment. We search for second class currents in the decay $\tau \to \omega\pi\nu_\tau$ using spin-parity analysis and establish an upper limit on the non-vector current contribution. The mass and width of the $\rho'$ resonance are extracted from a fit to the $\tau \to \omega\pi\nu_\tau$ spectral function. A partial wave analysis of the resonant structure of the $\tau \to 3\pi\pi^0\nu_\tau$ decay is performed; the spectral decomposition of the four pion system is dominated by the $\omega\pi$ and $a_1 \pi$ final states.Comment: 34 pages postscript, also available through http://w4.lns.cornell.edu/public/CLN

Spontaneous fluctuations in a magnetic Fe/Gd skyrmion lattice

Magnetic skyrmions are topological spin textures that exhibit classical or quantum quasiparticle behavior. A substantial amount of research has occurred in this field, both because of their unique electromagnetic properties and potential application for future nonvolatile memory storage applications, as well as fundamental questions on their topology and unique magnetic phases. Here, we investigate the fluctuation properties of a magnetic Fe/Gd skyrmion lattice, using short-pulsed x rays. We first measure spontaneous fluctuations of the skyrmion lattice phase and find an inherent, collective mode showing an underdamped oscillation with a relaxation of a couple of nanoseconds. Further observations track the response towards the continuous phase transition and a critical-like slowing down of fluctuations is observed well before the critical point. These results suggest that the skyrmion lattice phase never fully freezes into a static crystal. This constant state of fluctuation indicates that the physics of topological magnetic phases may have more in common with high-temperature superconductors with disorder

Study of 3-prong Hadronic τ\tau Decays with Charged Kaons

Using a sample of 4.7/fb integrated luminosity accumulated with the CLEO-II detector at the Cornell Electron Storage Ring (CESR), we have measured the branching fractions of the tau lepton into $K^- h^+ \pi^- \nu_\tau$ and $K^- K^+ \pi^- \nu_\tau$ relative to $h^- h^+ h^- \nu_\tau; K^- h^+ \pi^- \pi^0\nu_\tau$ and $K^- K^+ \pi^- \pi^0\nu_\tau$ relative to $h^- h^+ h^- \pi^0 \nu_\tau$. The relative branching fractions are: (5.16+-0.20+-0.50)*$10^{-2}$, (1.52+-0.14+-0.29)*$10^{-2}$, (2.54+-0.44+-0.39)*$10^{-2}$ and $<0.0154$ at 95% C.L., respectively. Coupled with additional experimental information, we use our results to extract information on the structure of three-prong tau decays to charged kaons.Comment: 16 pages postscript file also available through http://w4.lns.cornell.edu/public/CLN