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Determine the long-term outcome and need for additional therapy after pulmonary endarterectomy (PEA) for segmental chronic thromboembolic pulmonary hypertension.Retrospective analysis of a prospective cohort of 401 consecutive Canadian patients undergoing PEA between August 2005 and March 2020 in Toronto. The outcome of segmental disease defined as Jamieson type 3 was compared with more proximal disease defined as Jamieson type 1 and 2. The cohort was divided into 3 intervals to analyze the trend over time: 2005-2010, 2011-2015, and 2016-2020.Type 3 disease accounted for 41% of patients undergoing PEA durig 2016-2020 compared with 7% in 2006-2010. Total pulmonary vascular resistance improved by 505 ± 485 dynes/s/cmPEA achieved excellent early and long-term results in segmental chronic thromboembolic pulmonary hypertension. However, patients with segmental disease are at increased risk of requiring additional therapy after PEA and should be carefully monitored.

Objectives: To assess the benefits associated with radioactive seed localization (RSL) in comparison to conventional wire localization (WL) for nonpalpable breast lesions. Methods: Radioactive seed localization was initiated at our institution in July 2013. Retrospective review of all WL performed between June 2012 and July 2013 (2013) and all RSL performed during June 2015 and July 2016 (2016). Patients who received neoadjuvant therapy or did not undergo their planned surgeries and WL performed in 2016 were excluded. The following data were collected: final pathology, resection margins for malignant lesions, time to surgery, seed migration, and number of localized lumpectomies performed by each surgeon. Results: A total of 292 WL procedures (288 women) in 2013 and 194 RSL procedures (186 women) in 2016 were eligible for the study. All WLs were inserted the day of surgery. Mean time from RSL insertion to surgery was 4.0 ± 2.8 days (range: 1-17 days). There was no difference in specimen size for malignant lesions (6.8 ± 2.8 cm for WL and 6.9 ± 2.9 cm for RSL; P = .5). Specimen radiographs were obtained in 233 (80%) of 292 WL compared to 194 (100%) of 194 RSL ( P < .001). For malignant lesions, positive margins were present in 34 (17.2%) of 198 with WL compared to 15 (10.3%) of 146 with RSL ( P < .001). Close margins (≤1 mm) were present in 31 (15.6%) of 198 with WL compared to 1 (0.6%) of 146 with RSL ( P < .001). The seed fell out of the specimen during surgery in 6 (3.1%) of 194. No seed loss was recorded. The surgeons (n = 4) who transitioned to RSL increased the number of surgeries per month from a mean of 4.4 ± 2.6 in 2013 to 6.9 ± 3.5 in 2016, equivalent to a 41% increase ( P = .003). Conclusions: The use of RSL, as compared to conventional WL, resulted in a reduction in the number of pathologically involved surgical margins and was associated with an increased number of surgeries. Furthermore, RSL can be performed up to 14 days prior to surgery, which may improve scheduling flexibility in the radiology department.

Background With advances in mammographic screening techniques, it has become easier to detect nonpalpable breast lesions at an early stage. Pre-surgical localization of lesions by radioactive seed localization (RSL) has several benefits over conventional wire localization (WL) in guiding breast conserving surgery. In this study, we compared WL and RSL, focusing on the relationship between the techniques and in-breast recurrence or margin positivity. Methods This study included 1083 patients with nonpalpable breast lesions who underwent breast conserving surgery between 2010 and 2015. The patients were classified into WL and RSL groups. Results Margin positivity and in-breast recurrence rates did not differ significantly between the WL and RSL groups (P = 0.368 and P = 0.167, respectively). Multivariate analysis showed that tumor grade (OR: 5.016; 95% CI: 1.53–23.059) was significantly associated with margin positivity in patients undergoing RSL. Tumor size was significantly associated with in-breast recurrence in both the WL group (OR: 2.299; 95% CI: 1.561–3.411) and RSL group (OR: 2.998; 95% CI: 1.128–8.043). Conclusion As the method of tumor localization did not influence margin positivity or in-breast recurrence, either WL or RSL appear to be appropriate for breast conserving surgery. Given the advantages of RSL, including the ability to perform this technique days to weeks before surgery, we propose that high-volume breast centers consider adopting this localization method.