Oncologic Outcomes of a Novel Mapping Biopsy Technique Before Surgical Excision in the Management of Extramammary Paget Disease
Abstract
Objective To analyze oncologic outcomes of patients with extramammary Paget disease (EMPD) undergoing a
novel mapping biopsy before tumor excision (WLE).
Methods We analyzed 19 consecutive patients with EMPD treated with biopsy and/or surgical excision at Moffitt
Cancer Center from 2013 to 2021. Biopsy technique, patient demographics, pathology, and oncologic outcomes were
analyzed.
Results In total, 19 patients were included in the analysis. Median age at diagnosis was 72. No patients were
diagnosed with secondary malignancy during mandatory workup. Of the 17 patients receiving novel mapping biopsy,
8/17 had at least one positive core biopsy site, with a mean of 7% positivity of the total core sites (4/60). Mapping
biopsy positive sites helped shape perimeters for wide local excision (WLE) for patients opting for surgical treatment.
Although an extensive mapping biopsy was performed, WLE margins were positive in 11/17 patients. Although
positive pathologic margins following surgical excision were prominent, only one patient experienced recurrence of
EMPD during a median follow-up period of 38 months.
Conclusions We have demonstrated a standardized mapping biopsy before surgical excision in the management of
EMPD in men. Despite extensive mapping biopsies, positive surgical margin rates are high, and this may reflect the
occult nature of the disease process. Close follow-up is warranted in patients regardless of margin status, but those
with positive surgical margins may benefit from more aggressive regimens.
Introduction
The Société International d'Urologie (SIU), which owns and publishes the Société International d'Urologie Journal (SIUJ), does not require authors of papers published in the journal to transfer copyright. Instead, we ask authors to grant an exclusive licence that allows us to publish the article in SIUJ (and any derivative or related products or publications) and that allows us to sub-license such rights and exploit all subsidiary rights.
Authors retain the right to use their own articles for their own non-commercial purposes without seeking explicit permission from SIU.
The SIUJ publication licence expressly defines “non-commercial” as “not primarily intended for or directed towards commercial advantage or monetary compensation.” Although no activity is completely disconnected from commercial activity, the following are generally considered to be non-commercial uses:
- Reproduction of a reasonable number (no more than 100) of print copies of the published paper for personal use (e.g., sharing with colleagues, including in grant applications).
- Posting a copy of the published version of the paper on the author’s own or their institution’s website. The article must be accompanied by this statement: ‘This article has been published in the SIUJ: [full citation; link]’.
- Inclusion of the paper in a course pack, with a maximum of 100 copies to be used in the author’s institution. The copies must include the following acknowledgement: ‘This article has been published in the SIUJ: [full citation; link].’
As the distinction between commercial and non-commercial is not always clear, authors are strongly advised to seek permission from SIU for any use that may be considered to have a commercial aspect.
We ask the corresponding author to read the terms of the licence and then to grant this exclusive licence on behalf of all authors by indicating agreement to the following statement:
The corresponding author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence on a worldwide basis to the SIU and its licensees to permit this article (if accepted) to be published in the SIUJ and any other SIU products and publications and to exploit all subsidiary rights, as set out in our licence agreement.
Review and Decision
Most submissions will be reviewed by a senior editor within 2 weeks. Many manuscripts will be rejected at this point for a variety of reasons, including subject matter outside the scope of the SIUJ, flawed design, discredited or outdated methodology, poor organization or presentation, failure to conform to ethical requirements, and apparent plagiarism.The remaining manuscripts will be sent for peer review. The SIUJ uses a single-blind process: reviewers know the identity of the authors, but the authors are not told who has reviewed their manuscript, and SIUJ ensures that potentially identifying information is removed from comments sent to them. Reviewers are asked to make their recommendations within 10 days, after which a senior/specialist editor will consider their comments and recommend provisional acceptance dependent on satisfactory revision, acceptance without revision, or rejection. Authors should receive a final decision within 4 to 6 weeks of submission.
