Gland surgery最新文献

Background: Oral steroids are recommended as the first-line treatment for idiopathic granulomatous mastitis (IGM), but frequently induce significant side effects. Topical steroid therapy has recently emerged as a potential alternative for IGM, however current evidence regarding the efficacy of topical steroids remains scarce, primarily derived from small case series and retrospective reports. This prospective, observational cohort study evaluated the outcomes of patients with IGM treated with topical steroids.

Methods: From January 2022 to October 2024, 76 patients diagnosed with IGM and treated with topical steroid therapy at West China Hospital were prospectively included in the study. Inclusion criteria comprised adult females with histologically confirmed IGM who were treatment-naive. At baseline, we recorded demographic data, clinical manifestations, as well as lesion size and location. Clinical evaluations incorporating both physical examination (PE) and ultrasonographic findings were performed biweekly to assess treatment response. Primary outcomes included symptom resolution, lesion size reduction, recurrence rates, and treatment-related adverse events. Follow-up was conducted at 1, 3, and 6 months, and every 6 months thereafter.

Results: The median age at IGM diagnosis was 33.2 years. Clinical presentations included unilateral breast masses in nearly all cases (97.5%), with 75% of lesions measuring 2-5 cm in diameter. Breast pain was reported by 67.1% of patients; 64.3% (45/70) of patients responded to topical steroid therapy, with a complete remission (CR) rate of 32.9%. The median time to CR was 60 days. The presence of a breast abscess was associated with significantly reduced response to the treatment (P=0.009). During a median follow-up of 63 days, only 4 patients (8.9%) experienced recurrence. Adverse effects were limited to local issues (e.g., erythema, skin atrophy) with no systemic side effects reported.

Conclusions: Topical steroids represent a feasible alternative to oral steroids for select IGM patients, particularly due to their reduced risk of systemic adverse effects. When a breast abscess develops, other intervention should be undertaken promptly.

Background: Parathyroid carcinoma (PC) is a rare endocrine malignancy, and its preoperative diagnosis remains challenging. This study aimed to evaluate the differential diagnostic value of complete blood count (CBC) parameters for parathyroid tumors.

Methods: A total of 68 patients with PC and 340 patients with parathyroid adenoma (PA) were enrolled in this retrospective study. Preoperative CBC results and follow-up data concerning patient outcomes were collected. Logistic regression (LR), machine learning, and Cox regression models were constructed to investigate the diagnostic and prognostic value of CBC parameters.

Results: In the PC group, the white blood cell (WBC) count, monocyte (MON) count, neutrophil (NEU) count, basophil percentage (BAS%), neutrophil percentage (NEU%), and neutrophil-to-lymphocyte ratio (NLR) in peripheral blood samples were significantly higher than those in the PA group (P<0.05). In contrast, the red blood cell (RBC) count, hematocrit (HCT), basophil (BAS) count, lymphocyte percentage (LYM%), mean platelet volume (MPV), eosinophil percentage (EOS%), and lymphocyte-to-monocyte ratio (LMR) were significantly lower in the PC group (P<0.05). The diagnostic factors for PC were RBC count [odds ratio (OR) 0.443; 95% confidence interval (CI): 0.243-0.809], BAS count (OR 0.000; 95% CI: 0.000-0.001), BAS% (OR 12.314; 95% CI: 3.567-42.514), EOS% (OR 0.732; 95% CI: 0.571-0.937), and NEU count (OR 1.445; 95% CI: 1.139-1.833) (P<0.05). The area under the curve (AUC) was 0.870. When these features were combined with clinical features, the AUC of the model increased to 0.946. For patients with PC, high mean corpuscular hemoglobin concentration (MCHC) (P=0.02), parafibromin staining loss (P=0.003), and high parathyroid hormone (PTH) (P=0.02) were independent risk factors for recurrence.

Conclusions: CBC parameters may be useful adjunct markers for the differential diagnosis of PC. They can improve the diagnostic efficiency of clinical parameters for PC.

Background: The external branch of the superior laryngeal nerve (EBSLN) is susceptible to iatrogenic injury during thyroidectomy, which may lead to voice impairment. While intraoperative neuromonitoring (IONM) has been established for recurrent laryngeal nerve (RLN) protection, its application for identifying and preserving the EBSLN in gasless unilateral subclavian approach endoscopic thyroid surgery remains technically challenging and poorly documented. This study aims to evaluate the feasibility and safety of IONM for EBSLN exploration in this specific approach.

Methods: In this retrospective cohort study, we analyzed 48 patients with papillary thyroid carcinoma who underwent modified gasless unilateral subclavian endoscopic hemithyroidectomy with central compartment dissection between October 2023 and June 2024. Feasibility was assessed by EBSLN identification rate, dissection time, and total operative time. Safety was evaluated by incidence of EBSLN-related complications, other surgical complications, and conversion rates.

Results: The cohort included 39 females and 9 males, with a mean age of 35.4±10.4 years (19-59 years). The EBSLN was successfully identified in 46 cases (95.8%). Mean operative time was 115.6±25.1 minutes (60-165 minutes), with mean EBSLN dissection time of 3.4±1.0 minutes (2-6 minutes). Mean tumor size was 7.0±2.7 mm (3-16 mm). The mean number of harvested central compartment lymph nodes was 9.1±4.4 (3-21). The mean length of postoperative hospital stay was 2.9±0.7 days (2-5 days). All procedures were completed endoscopically without conversion. No EBSLN injuries, permanent RLN palsies, hemorrhages, or infections occurred.

Conclusions: IONM enables high-rate identification and safe preservation of the EBSLN in gasless subclavian endoscopic thyroid surgery. These findings support the integration of this technique into clinical practice to minimize EBSLN injury and improve functional outcomes in patients undergoing endoscopic thyroidectomy.

Background: As diverse gender identities and sexual orientations gain increasing recognition and acceptance worldwide, the demand for gender-affirming procedures has risen. Among these procedures, chest contouring surgery is the most common and often the first undertaken by transgender men. Goals of this procedure is to remove breast tissue, excess skin and relocate the nipple-areolar complex (NAC) while aesthetically placing surgical scar. The accurate placement of the NAC in masculine chest wall contouring surgery is a critical step in achieving a natural appearance. This study aims to identify the optimal intraoperative NAC position relative to the pectoralis major muscle, yet no standard method exists.

Methods: A descriptive cross-sectional study. Thirty-eight healthy male volunteers (76 breasts) with normal chest anatomy were examined for surface anatomical parameters and underwent ultrasound to measure distances from the (I) lateral border and (II) inferior border of the pectoralis major muscle to the nipple. These distances were measured by ultrasound from perpendicular point on skin to nipple in supine position with 90-degree shoulder abduction. The relationship between the NAC and the pectoralis major muscle was analyzed to develop a reproducible and practical intraoperative technique for locating the NAC.

Results: The mean age of participants was 29.5 years, with an average body mass index (BMI) of 22 kg/m². The NAC demonstrated a consistent relationship with the pectoralis major muscle, positioned on average 5.49 cm from the lateral border and 4 cm from the inferior border of the pectoralis major muscle. The ratio of inter-nipple distance to chest circumference and the ratio of clavicle-to-nipple distance to suprasternal notch-to-umbilicus distance were 0.23 and 0.42, respectively. These ratios were independent of weight, height, or BMI. The male areola was in oval shape for 87.5% of the subjects, with average horizontal and vertical dimensions of 2.47 and 1.9 cm, respectively. The male nipple had an average diameter of 5 mm and height of 1.8 mm, regardless of the body figure.

Conclusions: The consistent anatomical relationship between the NAC and the pectoralis major muscle provides a reliable, reproducible method for NAC positioning in chest masculinization surgery. These findings can guide nipple creation and areolar grafting techniques, improving surgical precision and aesthetic outcomes.

Background: Enlargement of cervical lymph nodes (CLNs) is a common clinical response to lesions in the neck as well as in other parts of the body. Accurate qualitative diagnosis of lymph nodes can provide important reference information for clinical decision-making. While histopathological diagnosis remains the gold standard for differentiating benign from malignant CLNs, it is an invasive procedure. Ultrasonography serves as a non-invasive imaging modality widely employed in clinical practice for the preoperative evaluation and qualitative assessment of CLNs; however, its diagnostic accuracy is operator-dependent. In this study, we investigated ultrasound image features between benign and malignant CLNs and developed deep learning (DL) models for the qualitative diagnosis of CLNs.

Methods: Patients with pathologically confirmed CLNs via ultrasound-guided biopsy from January 2020 to December 2023 were retrospectively included. The gold standard was histopathological diagnosis. Ultrasound features of CLNs were documented, and their value in differentiating benign from malignant CLNs was assessed using univariate analysis. DL models were developed to qualitatively diagnose the benign and malignant CLNs. Model performance was evaluated using receiver operating characteristic curves, accuracy curves, recall curves, and loss curves.

Results: A total of 3,014 CLNs from 2,697 patients were included in this study, with 1,489 classified as benign cases and 1,525 as malignant cases. Almost all DL models demonstrated satisfactory performance in qualitative diagnosis of CLNs, achieving area under the curve (AUC) values ranging from 0.56 to 0.81, with the VGG16 model exhibiting the best performance with an AUC of 0.81 [95% confidence interval (CI): 0.77-0.86], accuracy of 0.73, sensitivity of 0.71, and specificity of 0.74. In comparison to ultrasonography, the VGG16, ResNet101, and ResNet50 models showed significantly superior predictive performance (P<0.05).

Conclusions: DL models utilizing ultrasound images demonstrated promising performance in the qualitative diagnosis of CLNs. This approach enhanced the diagnostic accuracy of preoperative ultrasound assessment, thereby allowing a subset of patients to avoid unnecessary biopsies and optimizing clinical decision-making.

Background: Pleomorphic adenoma (PA) is the most common benign tumor of the salivary glands, but rarely shows extensive oncocytic metaplasia. Extensive oncocytic metaplasia within PA is rarely encountered and may closely mimic malignant neoplasms, creating significant diagnostic challenges for clinicians and pathologists. This uncommon histologic variant can potentially influence clinical decision-making processes and subsequent patient management strategies.

Case description: A 54-year-old male presented with a painless, slowly enlarging mass in the left parotid gland, which had persisted for two years. Imaging studies revealed a poorly demarcated 2.6 cm mass involving both the superficial and deep lobes of the parotid gland. Fine needle aspiration biopsy suggested oncocytic changes within PA. The patient underwent total parotidectomy with preservation of the facial nerve and reconstruction using an artificial dermal matrix. Histopathological analysis confirmed PA with extensive oncocytic metaplasia and negative surgical margins. Postoperatively, the patient experienced transient weakness of the buccal branch of the facial nerve, which resolved completely within 15 days. No recurrence was observed during the 12-month follow-up period.

Conclusions: Recognition of this oncocytic variant of PA requires a multidisciplinary diagnostic approach to avoid misdiagnosis and overtreatment. Total parotidectomy with facial nerve preservation provides favorable functional and oncologic outcomes. Awareness of this rare variant and proper diagnostic evaluation are essential for optimal patient management.

Background: Insufficient iodine intake is a global health issue, causing goiter in about 2.2 billion people, with a prevalence of 15.8%. Thyroid surgeries, although necessary, can lead to serious complications like recurrent laryngeal nerve (RLN) injury. This study aims to identify leading countries, institutions, and keywords related to thyroid surgery and RLN injury to guide future research and clinical practice.

Methods: A search in the Scopus database on May 7, 2024, resulted in 1,440 publications from 346 sources, analyzed using the Bibliometrix R-package.

Results: The analysis shows an upward trend in publications. The USA leads with 730 publications, followed by China (n=660) and Italy (n=388). Kaohsiung Medical University Hospital has the highest publication count (n=103), followed by Harvard Medical School (n=60). China provided the most research grants (n=100), followed by the USA (n=46). Extensive collaborations are noted, especially between the USA, China, Italy, and Korea. The World Journal of Surgery published the most articles (n=67), while the International Journal of Surgery had the highest impact factor (15.3). Prominent authors include Dionigi G with 49 articles and Wu CW. with forty. The keywords "thyroidectomy" and "recurrent laryngeal nerve" were frequently used from 1974 to 2024.

Conclusions: This bibliometric analysis underscores the increasing global research focus on RLN injury in thyroidectomy, highlighting the need for enhanced surgical techniques, international collaboration, and standardized practices to improve patient outcomes.

Background: Accurate preoperative identification of pectoralis major fascia (PMF) invasion in breast cancer is essential to guide surgical planning, particularly when considering fascia preservation to reduce reconstructive complications. However, no validated preoperative tool currently exists for assessing PMF invasion risk. This study aimed to develop and internally validate a nomogram based on preoperative magnetic resonance imaging (MRI) parameters to predict the risk of PMF invasion in breast cancer patients.

Methods: We retrospectively analyzed data from 235 breast cancer patients who underwent surgery between January 2019 and February 2022. Postoperative paraffin pathology served as the gold standard for diagnosing PMF invasion. MRI-based variables included tumor location, axillary lymph node metastasis, carbohydrate antigen (CA)-153 levels, tumor diameter, the shortest distance from tumor to PMF in contrast-enhanced MRI (D1), the distance from the posterior edge of the gland to PMF in lipid-suppressed MRI (D2), and the D1/D2 ratio. Patients were randomly split into training and validation cohorts (2:1). Logistic regression identified predictors used to construct a nomogram, evaluated by receiver operating characteristic (ROC) analysis, calibration curve, and decision curve analysis (DCA).

Results: PMF invasion was present in 16 out of 235 patients (6.8%). Significant differences in D1, D2, and D1/D2 were found between invasion and non-invasion groups. Logistic regression identified D2 [P=0.012, odds ratio (OR) =0.091, 95% confidence interval (CI): 0.014-0.585] and D1/D2 (P=0.007, OR =0.217, 95% CI: 0.071-0.664) as independent predictors. The nomogram yielded an area under the curve (AUC) of 0.81 in the training set and 0.87 in the validation set, with good calibration and clinical utility.

Conclusions: This study presents a preliminary nomogram based on MRI-derived features for preoperative prediction of PMF invasion in breast cancer. While internally validated, the model's utility is limited by the small number of invasion cases and retrospective design. Further prospective studies with larger cohorts are necessary to confirm clinical applicability.

Background: Primary aldosteronism (PA) is a prevalent cause of endocrine hypertension. While unilateral PA (UPA) is potentially curable by adrenalectomy, complete clinical success (CCS) rates vary significantly. Using international Primary Aldosteronism Surgical Outcomes (PASO) criteria, this study aimed to identify preoperative factors influencing clinical outcomes following minimally invasive adrenalectomy (MIA) for UPA to optimize postoperative management.

Methods: We retrospectively analyzed the clinical data of 206 patients who underwent MIA for UPA between January 2018 and January 2023 at our hospital. The PASO criteria were used to assess the clinical outcomes. We comparatively analyzed between-group differences and influencing factors in the CCS and incomplete clinical success (ICS) groups (partial and no success).

Results: Statistically significant differences existed between the two groups in pathological type, body mass index (BMI), duration of hypertension, preoperative systolic and diastolic blood pressure, and preoperative potassium (P all <0.05), whereas there were no statistically significant differences in gender, age, tumor location, maximum tumor diameter, surgical method, and preoperative aldosterone to renin ratio (ARR). Univariate logistic regression analysis showed that unilateral adrenal hyperplasia (UAH), BMI, duration of hypertension, preoperative systolic and diastolic blood pressure, and preoperative potassium were associated with the clinical outcomes (P all <0.05). Multivariate logistic regression analysis showed that UAH [odds ratio (OR) =3.920, P=0.04], BMI (OR =1.486, P<0.001), duration of hypertension (OR =1.156, P<0.001), and preoperative systolic blood pressure (OR =1.280, P<0.001) were independent risk factors for ICS. The overall clinical success rate was 85.93%.

Conclusions: Patients with UAH, high BMI, preoperative systolic blood pressure, and long duration of hypertension should be followed up for a long period.