Background: Accurate orientation of resected breast specimens is essential for proper pathological evaluation and margin assessment. Misorientation may compromise analysis, lead to imprecise re-excisions, and increase the risk of local recurrence. This study aims to evaluate a novel specimen plate designed to maintain consistent tissue orientation and compares its effectiveness to traditional suture marking. Methods: In a single-center, prospective, randomized two-arm trial, 56 specimens were oriented with the new plate and 54 with conventional sutures. Outcomes included intraoperative imaging interpretation, specimen handling, and pathological assessment, with a focus on orientation accuracy and margin evaluation. Results: The specimen plate significantly reduced misorientation (p < 0.01) and improved interpretation during intraoperative imaging. Pathologists reported greater ease in identifying direction and tumor-free zones, leading to a more accurate margin assessment. Non-R0 resections requiring re-excision were fewer with the specimen plate (8.9%) compared to suture marking (22.2%). Conclusions: The newly developed specimen plate can offer a reliable solution for improving specimen orientation in breast cancer surgery; however, further validation in multicenter studies is needed to confirm its applicability across diverse surgical settings. By ensuring consistent orientation and enhancing diagnostic interpretation, it may help reduce re-excisions and improve patient safety.

Background: The incidence of non-palpable breast cancer is increasing due to widespread screening and neo-adjuvant therapies. Among the available tumor localization techniques, radio-guided occult lesion localization (ROLL) has largely replaced wire-guided localization (WGL). The aim of this study was to compare the ROLL and WGL techniques in terms of the effectiveness of isotopic marking of axillary sentinel lymph nodes and to assess patient perspectives along with surgeon and radiologist preferences. Methods: A single-center, prospective, randomized study enrolled 110 patients with non-palpable breast lesions (56 ROLL, 54 WGL). Breast type, tumor volume, location, histological and radiological features, and localization/surgical duration were evaluated in the context of sentinel lymph node marking using isotope (technetium-99m-labeled human serum albumin) and blue dye. Statistical analysis was performed with significance set at p < 0.05 and strong significance at p < 0.01. Results: A single-center, prospective, randomized study enrolled 110 patients with non-palpable breast lesions (56 ROLL, 54 WGL). Breast type, tumor volume, location, histological and radiological features, and localization/surgical duration were evaluated in the context of sentinel lymph node marking using isotope (technetium-99m-labeled human serum albumin) and blue dye. Statistical analysis was performed with significance set at p < 0.05 and strong significance at p < 0.01. Conclusions: While ROLL provided advantages in terms of patient comfort and logistical simplicity, WGL was superior for axillary sentinel lymph node marking, particularly in inner quadrant tumors, suggesting that WGL may be preferred in these cases.

Accurate specimen marking is crucial during breast cancer surgery to avoid misorientation, which can lead to inadequate re-excision and tumor recurrence. We studied the marking methods at various breast cancer centers to create a tool that would prevent specimen misorientation. An online questionnaire was used to survey marking procedures at major breast cancer centers in Hungary, and a tool was developed using a troubleshooting method. Twelve out of twenty units responded (60%). Nine use an institutionally standardized marking system. Less than half of the surgical teams found specimen mammograms to be unambiguous. In more than 70% of departments, pathologists were uncertain about breast specimen orientation. Ambiguous marking methods caused orientation errors in half of the cases, while unclear marking directions caused the rest. Most pathologists (85%) and surgeons (75%) believed that coronal plane specimen mammography would help solve the problem. A plastic specimen plate has been developed to anchor breast tissue to a coronal breast scheme as seen in mammography images, providing clear localization information throughout the surgical process. There is a lack of standardization in breast specimen orientation and marking in Hungary. An optimized orientation toolkit is being developed to ensure consistent interpretation of specimen mammograms by surgeons and pathologists.

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Background Various surgical protocols suggest the need for chest cavity exploration during surgical stabilization of rib fractures (SSRF) in the presence of a hemothorax (HTX). The aim of this study is to determine the outcome of patients who underwent SSRF with blind HTX evacuation vs. HTX washout under visual inspection. Methods This is a retrospective analysis of prospectively collected data from the Chest Injury International Database (CIID), a data repository of the Chest Wall Injury Society (CWIS) contributing members. Two cohorts were created: group VATS (SSRF with Video-Assisted Thoracic Surgery (VATS)) and group IOPI (SSRF with blind intra-operative pleural irrigation (IOPI)). The primary endpoint was chest tube days after SSRF. Secondary endpoints were pneumonia, mortality, Intensive Care Unit length of stay (ICULOS), hospital length of stay (HLOS), 30-day readmission, and mechanical ventilation days. Results A total of 276 patients were included (VATS n = 129; IOPI n = 147). Chest tube duration was shorter in the VATS group (VATS: 0[0−2], IOPI: 3[2−5]; p ' 0.001), while hospital length of stay was shorter in the IOPI group (VATS: 10.5[7−15], IOPI 7[5−10]; p ' 0.001). Mechanical ventilation was more frequent in the VATS group (VATS: n = 83/129, IOPI: n = 21/147; p ' 0.001), whereas ventilation duration was longer in the IOPI group (VATS: 1[1], IOPI: 4[2−10]; p ' 0.001). Mortality (p = 0.417), pneumonia (p = 0.842), readmission (p = 0.107), and ICU length of stay among ICU-admitted patients (p = 0.953) did not differ between groups. After adjustment for injury severity and pulmonary contusion burden, VATS remained independently associated with shorter chest tube duration, whereas hemothorax evacuation technique was not independently associated with hospital or ICU length of stay. Conclusion The use of VATS during SSRF was associated with shorter chest tube duration, and this association remained significant after adjustment for injury severity and pulmonary contusion burden. However, broader clinical outcomes were comparable between techniques. Level of evidence Therapeutic / Care Management; Level IV.