BACKGROUND AND AIM: Traditionally lumpectomy as a part of breast-conserving surgery (BCS) is performed by palpation-guided method leading to positive margins and large excision volumes. There is no evidence suggesting that wide margin excisions decrease intra-breast tumour recurrence. Various perioperative techniques are used for margin assessment. We aimed to compare three commonly used techniques, i.e., ultrasound-guided surgery, palpation-guided surgery and cavity shaving for attaining negative margins and estimating the extent of healthy breast tissue resection. METHOD: A prospective comparative study was performed on 90 patients who underwent breast conservation surgery for early breast cancer between August 2018 and June 2019. Tumour excision with a minimum of 1 cm margin was done either using ultrasound, palpation or cavity shaving. Histopathological evaluation was done to assess the margin status and excess amount of resected normal breast tissue. Calculated resection ratio (CRR) defining the excess amount of the resected breast tissue was achieved by dividing the total resection volume (TRV) by optimal resection volume (ORV). The time taken for excision was also recorded. RESULTS: Histopathology of all 90 patients (30 in each group) revealed a negative resection margin in 93.3% of 30 patients in palpation-guided surgery group and 100% in both ultrasound-guided surgery and cavity shaving groups. Two patients (6.7%) from the cavity shaving group had positive margins on initial lumpectomy but shave margins were negative. TRV was significantly less in the ultrasound-guided surgery group compared to the palpation-guided surgery group and cavity shaving group (76.9 cm3, 94.7 cm3 and 126.3 cm3 respectively; p < 0.0051). CRR was 1.2 in ultrasound group compared to 1.9 in palpation group and 2.1 in cavity shave group which was also statistically significant (p < 0.0001). Excision time was significantly less (p < 0.001) in palpation-guided surgery group (13.8 min) compared to cavity shaving group (15.1 min) and ultrasound-guided group (19.4 min). CONCLUSION: Ultrasound-guided surgery is more accurate in attaining negative margins with the removal of least amount of healthy breast tissue compared to palpation-guided surgery and cavity shaving.

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Purpose: This study was done to assess the efficacy of powered endoscopic dacryocystorhinostomy (DCR) with creation of a large bony ostium exposing fundus of the sac and primary mucosal anastomosis. Methods: The study involved prospective interventional case series with short perioperative follow up. Operative and postoperative data were prospectively collected on 42 patients (15 men and 27 women; mean age, 62.4 years; range 14-91 years) who presented to a lacrimal clinic with epiphora and obstruction of the nasolacrimal system and who consecutively underwent either primary or revision powered endoscopic DCR. All surgeries were done by the same surgeon by standardized surgical technique. Follow-up evaluation included symptom evaluation and endoscopic assessment of the newly created ostium with fluorescein testing at each postoperative visit. Results: The only surgical complication was one case of sub cutaneous emphysema. Thirty nine of the 42 DCRs had anatomically patent naso lacrimal duct after a mean follow-up of 12 months (standard deviation = 5 months), yielding a success rate of 95.7%. Out of three failures, two had closed ostium because of improper use of medications, one patient had granulation tissue at the ostium. Two patients with a patent ostium had functional block and continued to have some symptoms. Conclusion: Powered endoscopic DCR with full sac exposure and primary mucosal apposition has a success rate comparable to that achieved with external DCR.

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