Gland surgery最新文献

The options for post-mastectomy breast reconstruction have increased considerably over the past 50 years and depend on the resultant disfigurement from surgery and or radiotherapy. Radical and modified radical mastectomy were considered the acceptable treatment for breast cancer until the mid-1970's and would often be followed with post-mastectomy radiotherapy. This presented a major challenge for reconstructive surgeons because of limited surgical options, but as the approach to the management of breast cancer became less aggressive and a therapeutic dose of radiotherapy was fractionated the reconstructive ladder expanded. Where post-mastectomy skin flaps were healthy and radiotherapy was not planned, the introduction of breast implants and saline-filled expanders enabled less traumatic immediate, delayed and revisional reconstructions. Controversies continue to follow the history of implantable breast implants, but polyurethane covered implants have a historically proven advantage over silicone shelled implants, with a significant reduction in the rate of capsular contracture. An understanding of the axial vascular supply of local and regional flaps, and the vascular territories of free flaps, dramatically improved the opportunity to more closely restore breast shape and form using composites of healthy tissue. The technique for harvesting of autologous fat graft and the appropriate use of acellular dermal matrix products has further improved the outcomes. Contemporary breast cancer management has become an inter- and multi-disciplinary specialty, and reconstructive outcomes will more likely result in remarkable symmetry of size, shape and volume of the breast reconstruction. This paper describes the chronology and variety of options that became available to selected breast cancer patients for reconstruction in the United Kingdom over the course of 50 years.

Background: Previous studies have confirmed that the higher axillary lymph node metastasis rate, the worse the prognosis. This study aimed to determine the key factors associated with axillary lymph node metastasis and prognosis of T2 breast cancer, which ultimately provides a scientific basis for precise risk stratification, optimized treatment decision-making, and improved prognosis in T2 patients.

Methods: Multivariate logistic regression was used to explore the influencing factors of axillary lymph node metastasis in patients with T2 breast cancer. Univariate and multivariate Cox regression were used to explore the prognostic factors of T2 breast cancer patients, and the nomogram was used to predict the survival probability of patients. Kaplan-Meier survival curve was used to analyze the influence of influencing factors on survival.

Results: A total of 150,730 patients with T2 breast cancer were included in this study. Age ≥65 years old, and other races were protective factors for axillary lymph node metastasis, while black race, infiltrating cancer, estrogen receptor (ER)-positive, progesterone receptor (PR)-positive, luminal B subtype, human epidermal growth factor receptor-2 (HER2)-positive subtype, and triple-negative subtype were risk factors. Other race, married, right primary site, chemotherapy, ER-positive, PR-positive, HER2-positive subtype, and triple-negative subtype were protective factors for overall survival (OS) of patients with T2 breast cancer, while age ≥65 years old, black race, other marital status, stage II, stage III, axillary lymph node metastasis, and luminal B subtype were risk factors for OS of patients with T2 breast cancer. The same results were also found in the breast cancer-specific survival (BCSS) of patients with T2 breast cancer. The nomogram constructed based on these factors affecting OS and BCSS can be used as a tool to predict OS and BCSS for T2 breast cancer.

Conclusions: Black race, infiltrating cancer, ER-positive, PR-positive, luminal B subtype, HER2-positive subtype, and triple-negative subtype were independent risk factors for axillary lymph node metastasis. Old age, black race, other marital status, stage II, stage III, axillary lymph node metastasis, and luminal B subtype were risk factors for the prognosis of patients with T2 breast cancer.

Background: Breast cancer (BC) is the most prevalent malignancy among women worldwide. The development of accurate and noninvasive diagnostic methods is essential to reduce unnecessary biopsies and surgeries. This study aims to develop a dual-modal deep learning (DL) radiomics model based on B-mode ultrasound (BUS) and contrast-enhanced ultrasound (CEUS) images. The model is designed to assist radiologists in accurately differentiating benign from malignant breast lesions.

Methods: This retrospective multicenter study included 427 female patients with breast lesions from four hospitals. Traditional radiomics models were constructed using logistic regression (LR). DL radiomics models were built on a VGG-16 network pretrained on ImageNet. An integrated model was developed through early feature fusion of BUS and CEUS features. Model interpretability was assessed with Shapley Additive exPlanations (SHAP) and heatmaps generated by gradient-weighted class activation mapping (Grad-CAM). In a two-round reader study, the integrated model provided radiologists with artificial intelligence (AI) scores and heatmaps to support diagnosis. Model performance was evaluated using the area under the curve (AUC) and decision curve analysis (DCA).

Results: In the testing cohort, the integrated model achieved the highest performance, with an AUC of 0.825 [95% confidence interval (CI): 0.744-0.907]. SHAP analysis revealed that, compared with BUS features, CEUS features had a greater impact on the model's diagnostic performance. In the first round, the integrated model outperformed all the radiologists (model AUC: 0.825 vs. radiologists' AUCs: 0.701-0.824). In the second round, radiologists assisted by the integrated model demonstrated improved performance. Their AUCs ranged from 0.748 to 0.869, with ΔAUCs ranging from +0.030 to +0.058. Four radiologists outperformed the model itself.

Conclusions: The integrated model provides an effective and noninvasive approach for predicting the benignity or malignancy of breast lesions. It has a strong potential to serve as a valuable clinical tool for improving radiologists' diagnostic performance.

[This corrects the article DOI: 10.21037/gs-2025-149.].

Background: Surgical resection for benign parotid gland tumors is associated with high complication rates, and thus there is in acute need for minimally invasive alternatives. This study aimed to examine the feasibility, safety, and efficacy of ultrasound-guided microwave ablation (MWA) for benign parotid gland tumors.

Methods: A retrospective multicenter study was conducted on 13 consecutive patients clinically diagnosed with parotid gland mass and suspected parotid gland tumors from July 2013 to June 2018. All patients underwent core needle biopsy, and parotid gland tumors considered benign based on the biopsy results were treated with ultrasound-guided MWA. The ablated area of the parotid gland was evaluated through dynamic ultrasound imaging, and complications related to needle biopsy and ablative treatment were followed up, with a follow-up ultrasound performed in the third month after MWA.

Results: A total of 13 parotid gland tumors underwent core needle biopsy over 5 years. Of these, 12 were benign tumors, including six pleomorphic adenomas, four Warthin's tumors, one dermoid cyst, and one lymphoid nodular hyperplasia, all treated with MWA. Patient age ranged from 10 to 79 years (median, 60.5 years), with tumor diameters ranging from 17.8 to 49 mm (median, 26.15 mm). MWA was performed for 70-598 s (median, 155 s), with complete absorption occurring in 8-37 months (median, 23.5 months). No residual tumors or serious complications were observed after ablation.

Conclusions: Ultrasound-guided MWA can serve as a minimally invasive alternative to open surgery for the treatment of benign parotid gland tumors and involves only limited side effects and minor complications.

Background: LSM4 belongs to the LSM (Like-Sm) gene family; however, its role in triple-negative breast cancer (TNBC) progression remains mostly unclear. Consequently, this study aimed to explore the mechanistic importance of LSM4 as a regulatory element in the progression of TNBC.

Methods: The expression of LSM4 was found to be evaluated through various bioinformatics approaches. To assess the prognostic significance and predictive capacity of LSM4, we employed univariate Cox, multivariate Cox, and nomogram models. Gene Ontology (GO) techniques were utilized to pinpoint signaling pathways linked with genes that co-express LSM4. Subsequently, LSM4 expression in clinical samples and cells was confirmed using western blotting, quantitative real-time polymerase chain reaction (qPCR), and immunofluorescence staining. The functional role of LSM4 was further examined through flow cytometry and transwell assays. Additionally, we explored the possible interaction between LSM4 and ECT2 using a combination of bioinformatics analysis and western blot assays. Rescue experiments demonstrated that the mechanism by which LSM4 enhances TNBC cell proliferation, migration, and invasion involves the AKT/PI3K signaling pathway.

Results: Our research demonstrated a notable increase in LSM4 expression in samples TNBC when contrasted with normal samples, and LSM4 has been recognized as a possible prognostic indicator for individuals diagnosed with TNBC. Mechanistically, the tumor-promoting influence of LSM4 on TNBC cell proliferation, migration, and invasion has been demonstrated to be enhanced by the PI3K/AKT pathway. Furthermore, our findings indicate that LSM4 can regulate the migration and invasion of TNBC cells through ECT2.

Conclusions: Our findings indicate that LSM4 can play a crucial role in TNBC progression, underscoring its potential as a therapeutic target in TNBC.

Background: With the continuous development of robotic-assisted surgery and the increasing experience in thyroid surgery, robotic-assisted thyroidectomy has become one of the common methods for treating thyroid tumors. Its advantages lie in the unique three-dimensional (3D) vision and the technology based on precise simulation, which help surgeons eliminate hand tremors, making the operation more precise and flexible. This approach enhances the thoroughness of thyroid surgery and has high prospects in the field of thyroid surgery. In the present research, bibliometric analysis was applied to examine and condense scientific publications from nearly 15 years, with the goal of fostering better understanding.

Methods: Included in this analysis were 666 publications from 2008 to 2023, retrieved systematically from the Web of Science (WoS) database. General characteristics were summarized, developmental structures and research frontiers were examined, and CiteSpace was applied for result evaluation and visualization.

Results: The results contained 666 publications, and the total number of citations for these works was 12,500. For the volume of published literatures, the top 5 countries/regions were South Korea, USA, China, Italy, and Germany. When considering literature centrality, the top 5 countries/regions were Thailand, Italy, Belgium, England, and Scotland. Ten institutions each produced over 20 publications. All top 10 institutions had a centrality score of 0.19 or above, a result that points to relatively intensive research in this domain and ample collaboration between institutions. Researchers from South Korea were the most prominent among authors with high publication and citation rates. Journals like Surgical Endoscopy and Other Interventional Techniques, World Journal of Surgery, Head & Neck: Journal for the Sciences and Specialties of the Head and Neck, and Thyroid had more significant influence in this field. Keyword analysis revealed that the main research focuses are thyroid cancer, endoscopic thyroidectomy, and the surgical method for robot-assisted thyroidectomy.

Conclusions: A comprehensive assessment of global research productivity, collaboration patterns, and research hotspots related to robot-assisted thyroidectomy is presented in this bibliometric study, which serves to direct future research efforts toward endoscopic thyroidectomy.

In the neck dissection procedures for head and neck squamous cell carcinoma (HNSCC), the submandibular gland (SMG) is frequently and routinely removed. However, is the sacrifice of the SMG truly indispensable? We have analyzed this issue from multiple viewpoints. Anatomically, there are no lymph nodes (LNs) within the gland, thus eliminating the risk of cancer metastasizing to the SMG via LNs. From a pathological perspective, apart from cases in which the primary tumor tissue directly invades or adjacent LNs have extracapsular invasion, the probability of the SMG being affected by cancer is extremely low. In terms of patient survival rate, preserving the SMG during surgery does not exert a substantial impact on this critical metric. Preserving the SMG can assist in maintaining its secretory function. Nevertheless, the precise preservation of the SMG presents challenges. In addition to requiring greater data assistance, this idea may lengthen the procedure and raise the bar for surgeon skill. Although difficulties persisting, the significance of this perspective is far-reaching. The preservation of the SMG represents further exploration by clinicians in the realm of functional neck dissection. On the premise of ensuring safety, we endeavor to preserve more functional structures and reduce the resection scope, focusing not only on enabling patients with HNSCC to survive but also on guaranteeing their quality of life in the long term after treatment. Finally, we have proposed development directions and future prospects for this field, hoping to inspire fellow scholars. This study aims to analyze the necessity of performing SMG resection in head and neck cancer surgery, evaluate the evidence for SMG preservation (encompassing anatomical, pathological, survival, and functional aspects), discuss relevant controversies, and propose future research directions to provide guidance for clinical practice.