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Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Daniela Penz, MD, and coauthors reported data from a national database of patients who underwent screening colonoscopy for detection of colorectal cancer (CRC) or precursor lesions in a single European country. The study cohort included 296,170 patients with data collected over a 6-year interval (2012–2018) and contained 11,103 patients aged 50 years or less.
The outcomes of interest were prevalence of adenomas and advanced adenomas, as well as the rates of colorectal cancer. Among the patients aged 50 years or less, 1,166 had adenomas and 389 had advanced adenomas. The number needed to detect an adenoma was nine and to detect an advanced adenoma was 26. The risk for adenoma presence in patients aged 40–44 years was 14.2% for males and 8.1% for females.
Over the study interval, the rate of colorectal cancer and the incidence of adenomas increased in male patients aged 50 years or less but decreased in females and in older patients. The authors concluded that these findings confirm an increasing CRC risk in younger patients, especially male patients, and support development of targeted CRC screening programs for this group.
Intraoperative Fluorescence Guidance Has Potential Value for Breast Cancer Lumpectomy Surgery
Survival after breast-conserving surgery is equivalent to survival after mastectomy, but local recurrence due to incomplete removal of tumor tissue is associated with increased mortality risk—with one excess cancer death for every four local recurrences. Currently, residual tumor tissue is assessed with pathological examination of shaved margins of the cavity created by tumor resection. Discovery of residual tumor necessitates a second surgical procedure.
Available evidence shows that false negative margins are common with local recurrence being diagnosed in 15%–35% of patients. This study reported a prospective trial (n = 406) that sought to determine the value of intravenous pegulicianine (pFGS) imaging to detect residual tumor in biopsy cavities following local resection of breast tumors.
The data showed that pFGS imaging was effective for identification of residual tumor and reduced the risk of second surgeries, but positive imaging resulted in removal of an additional 10 cm2 of tissue, raising concerns about the effect on cosmesis.
The authors concluded that pFGS imaging has potential value for patients undergoing breast conserving surgery for malignancy. In the editorial that accompanied the article, Lauren Turza, MD, and Craig Shriver, MD, FACS, agreed with this conclusion but encouraged additional research with patient reported outcomes to determine the effect of this technique on cosmetic outcomes.
Review Article Describes Emerging Imaging Technologies for Parathyroid Gland Identification and Vascular Assessment in Thyroid Surgery
This review of available evidence by an expert panel of endocrine surgeons was designed to determine the strengths and limitations of near infrared autofluorescence (NIRAF) for identification of parathyroid glands during thyroid surgical procedures. Evidence relevant to use of NIRAF combined with indocyanine green (ICG) labeling for evaluation of vascularization and perfusion of parathyroid glands that were preserved was also reviewed.
Accuracy of identification and adequacy of perfusion were determined and studies that assessed postoperative parathyroid function and hypoparathyroidism-related morbidity and mortality were included in the review. The data analysis showed that NIRAF identified parathyroid glands with 90%–97% sensitivity and accuracy. Use of NIRAF was shown to reduce unintended removal of parathyroid glands and documentation of adequate parathyroid gland perfusion with addition of ICG was associated with reduced risk of postoperative hypocalcemia although outcomes were variable in the studies reviewed.
The authors concluded that NIRAF and NIRAF+ICG usage should be supported in combination with sound surgical judgment. They encouraged additional research to develop intraoperative scoring systems that can predict postoperative outcomes. Clear guidance for implementation of these imaging protocols is provided and surgeons are encouraged to review the entire content of the article.
