Gland surgery最新文献

Background: With rising well-differentiated thyroid cancer (WDTC) incidence, the appropriate treatment choice remains controversial for T1 tumors <2 cm. This study analyzed differences in surgery refusal and survival outcomes between T1a (<1 cm) and T1b (1-2 cm) WDTC, examining the demographic and clinical characteristics associated with patients who decide to either undergo or refuse recommended surgery.

Methods: We studied 81,664 T1N0M0 WDTC patients in the Surveillance, Epidemiology, and End Results (SEER) registry [2000-2019]. Treatment with surgery (n=81,565) or refusal (n=99) was compared. Propensity score matching balanced groups. Cox models assessed mortality predictors.

Results: Among 81,664 patients, the overall mortality rate was 5.7% (n=4,635 deaths). Refused surgery associated with higher mortality (11.1% vs. 5.7%, P=0.03) and shorter survival times (152.05±7.43 vs. 178.62±0.17 months, P<0.001). Thyroid cancer-specific mortality rates were 2.2% for refused surgery and 0.4% with surgery (P=0.01). Refusing surgery carried over twice the mortality risk [adjusted hazards ratio (aHR) =2.15, 95% confidence interval (CI): 1.01-4.57, P=0.046]. However, for T1b patients, refusing surgery escalated mortality risk over 3-fold (aHR =3.44, 95% CI: 1.43-8.28, P=0.006), yet for T1a patients it showed no increased risk (aHR =0.41, 95% CI: 0.049-3.46, P=0.42). Other independent risk factors for mortality included older age (aHR =6.24 for ≥55 years) and prior malignancy (aHR =2.78).

Conclusions: Our study reveals notable differences in survival and mortality between T1a and T1b WDTC, underscoring the need for subtype-specific, evidence-based treatment guidelines. For T1b patients, surgery remains the standard of care with significant improvements in outcomes. In contrast, select T1a patients may benefit from active surveillance, offering comparable survival rates while potentially enhancing quality of life.

Background: Luminal B breast cancer is routinely treated with chemotherapy and endocrine therapy. However, its sensitivity to treatment remains heterogeneous; therefore, identifying patients who may most benefit remains crucial. Immune-related genes are reportedly related to the prognosis of breast cancer. The purpose of this study was to evaluate the impact of an immune-related gene signature (IRGS) in predicting the prognosis of patients with Luminal B breast cancer.

Methods: We selected patients with Luminal B breast cancer from two large datasets: 488 from the Metabric dataset (training cohort) and 250 patients from The Cancer Genome Atlas (TCGA) dataset (validation cohort). Prognostic analysis was performed to test the predictive value of IRGS, and enrichment analysis and ESTIMATE were used for deeper function analysis.

Results: A prognostic IRGS model containing 12 immune-related genes was developed. After which, we separated patients with Luminal B breast cancer into low- and high-risk groups in terms of disease-free survival (DFS) (P<0.001). Multivariate analysis identified IRGS as an independent prognostic factor. Furthermore, functional analysis showed that the 12 genes were mainly enriched in pathways related to chemotherapy response, whose expression levels showed completely opposing trends in low- and high-risk groups.

Conclusions: The novel IRGS is a satisfactory and reliable biomarker to predict the clinical outcome of patients with Luminal B breast cancer which potentially facilitating individualised management. Further studies are needed to assess the clinical potential in predicting prognosis and the treatment options for Luminal B breast cancer patients.

Background: Accurate diagnosis of breast cancer is of great importance to improve the prognosis of patients. Artificial intelligence (AI)-assisted diagnostic system for breast ultrasound is gradually being applied in the identification of benign and malignant breast lesions. This study aimed to evaluate the diagnostic performance and optimal application of AI-assisted ultrasonography for breast lesions in clinical setting.

Methods: A total of 501 consecutive patients with 679 breast lesions were prospectively included in the study. Junior and senior radiologists were asked to interpret images of lesions with and without AI assistance, respectively. Three application modes of AI were employed: AI alone, adjusted Breast Imaging Reporting and Data System (BI-RADS; incorporating BI-RADS obtained by AI into BI-RADS obtained by radiologists), and second reading mode (combining characteristic information extracted by AI to conduct a second reading so as to obtain a new BI-RADS). The diagnostic performances of these application modes were analyzed and compared.

Results: The area under the curve (AUC) of junior radiologists increased from 0.879 to 0.921 in BI-RADS_{second reading}, which was higher than that in BI-RADS_adjusted (0.901), similar to that in AI alone (0.924), and lower than that obtained by senior radiologists (0.950). Using BI-RADS category 4A as the threshold, the sensitivity of junior radiologists was found to increase from 0.83 to 0.92 (P<0.001). Furthermore, the specificity increased from 0.79 to 0.85, which was higher than those of AI alone and BI-RADS_adjusted (P<0.001). The unnecessary biopsy rate decreased by 14.70% (P=0.01). For senior radiologists, the sensitivity increased from 0.91 to 0.96 (P=0.01). Similar results were observed in the subgroup analysis of lesions ≤2 cm. For lesions >2 cm, only the specificity of junior radiologists increased from 0.39 to 0.52 (P=0.03).

Conclusions: AI-assisted ultrasound is useful for the diagnosis of breast lesions, particularly for junior radiologists and lesions ≤2 cm. The use of the second reading mode can achieve excellent diagnostic performance.

Background: A right adrenal gland may present in the form of adreno-hepatic fusion (AHF), in which the adrenal cells are interspersed among the hepatocytes without septation. This rare, naturally-occurring phenomenon may be associated with preoperative misdiagnosis. We present two cases of adrenal tumor in patients with AHF that were misdiagnosed, despite thorough preoperative work-ups. The findings emphasize the importance of suspecting adrenal tumor arising in AHF for lesions at the periphery of liver segment 7, even when located inside the liver. In addition, AHF can resemble malignant invasion on preoperative images, which further complicates the initial diagnosis.

Case description: A 44-year-old woman presented with a 3-cm fat-enriched intrahepatic tumor at the periphery of segment 7. Preoperative biopsy revealed a possible angiomyolipoma or epithelioid cell neoplasm that was negative for arginase-1 and hepatocyte markers and positive for smooth muscle actin (SMA). During liver tumorectomy, a severe adhesion to the right adrenal gland was identified. The final diagnosis was an adrenocortical neoplasm with Weiss score 2 that had arisen in AHF. A second patient, a 67-year-old man had a hypoattenuating 4-cm lesion of his right adrenal gland with irregular borders to the liver, suggesting liver invasion on computed tomography. Positron emission tomography (PET) showed a mild hypermetabolic nodule, but did not suggest malignancy. However, because adrenocortical carcinoma was suspected due invasive features, right adrenalectomy with liver tumorectomy was performed as an en bloc resection. The final diagnosis was an adrenocortical neoplasm with Weiss score 2 that had arisen in AHF. Both patients showed no further evidence of disease ≥1 year of following surgery.

Conclusions: AHF-related adrenal lesions are often associated with diagnostic challenges, potentially resulting in misdiagnosis. We presented for the first time that adrenal lesions can be SMA-positive, which complicated the initial diagnosis of the first patient. Moreover, PET scans may help differentiate such lesions from malignancy, especially when invasive features are suspected. Alongside a review of 16 similar cases in the literature, our experience with these patients underscores the importance of initially considering AHF in the differential diagnosis of adrenal tumor adjacent to the liver.

Background: Axillary lymph node metastasis (ALNM) is a significant predictor of overall patient survival; thus, precise evaluation of ALNM is essential for staging breast cancer, informing multimodal treatment strategies, and ensuring optimal patient care. This study aimed to establish a magnetic resonance imaging (MRI) scoring system for predicting extensive axillary nodal metastasis in patients with clinically node-negative breast cancer derived from preoperative breast and axillary MRI.

Methods: This study included 226 patients with clinically node-negative breast cancer who underwent preoperative breast and axillary MRI between January 1, 2010 and December 31, 2020 at King Chulalongkorn Memorial Hospital. Their clinical, radiological, and pathological features were retrospectively reviewed. MRI characteristics of breast tumors and axillary lymph nodes (LNs) were assessed. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen's Kappa coefficient of the scoring system were evaluated. The receiver operating characteristic curve was used to determine the cutoff value for the MRI scoring system to differentiate extensive ALNM from nonextensive ALNM.

Results: Of the 226 patients, 144 had cancer-free axilla, 51 had 1-2 positive metastatic LNs, and 31 had ≥3 positive metastatic LNs. Moreover, only 60 could be evaluated for the apparent diffusion coefficient (ADC) value of LNs because of size limitations. The cutoff value for the MRI scoring system with ADC was 14 (NPV =87.1% with moderately acceptable discrimination), and the cutoff value without ADC was 8 (sensitivity =77.4%; specificity =81%; PPV =39.3%; NPV =95.8% with moderately acceptable discrimination).

Conclusions: The MRI scoring system using breast and axillary LN characteristics from preoperative MRI may help predict extensive ALNM and aid axillary nodal treatment selection.

Various approaches and techniques have been developed to address parotid neoplasms over the years. This article reflects on the integration, modification, and refinement of these techniques over a decade of clinical practice. This article provides a narrative description of the evolution of a head and neck oncologic surgeon's approach to parotid neoplasms. It describes technical considerations in the preoperative, operative, and postoperative settings. Thoughtful diagnostic workup and treatment planning based on patient history and parotid tumor characteristics can assist with diagnostics, the decision of surveillance vs. surgery, operative approach, and extent of surgery. Point of care ultrasound (US) is invaluable both in the office and intraoperatively as it can be used to understand tumor characteristics, guide incision placement, and for surveillance practices. Minimally invasive approaches can be performed safely and integrated into practice with a clear understanding of parotid and facial nerve anatomy and further aided with US guidance. Furthermore, key points based on the gland compartment in which the tumor exists help influence the nerve dissection and reconstructive techniques employed. By embracing the multitude of options as they relate to diagnostic workup, surgical approach, and extent of surgery, head and neck surgeons today have the opportunity and ability to tailor unique and individualized treatment plans for parotid neoplasms.

Background: Ultrasound based radiomics prediction model can improve the differentiation ability of benign and malignant thyroid nodules to avoid overtreatment. This study evaluates the role of predictive models based on intranodular and perinodular ultrasound radiomics in distinguishing between benign and malignant thyroid nodules.

Methods: A total of 1,076 thyroid nodules were enrolled from three hospitals between 2016 and 2022, forming the training, validation and test cohorts. The clinical signature (Clinic_Sig) was developed based on clinical information and conventional morphological features of ultrasound. Expanding 1 pixel, 3 pixels, 5 pixels, 7 pixels, and 9 pixels outward from the thyroid nodule, six radiomics models were constructed using intranodular (intra) and combined radiomics (intranodular and perinodular: +p1,+p3,+p5,+p7,+p9) features. The model with the best area under the curve (AUC) was defined as radiomics signature (Rad_Sig). The combined model was constructed from Clinic_Sig and Rad_Sig. AUC and calibration curves were used to evaluate the predictive performance of the model. Decision curve analysis (DCA) was used to evaluate the clinical net benefit of the model.

Results: The intra+p1 radiomics model exhibited the highest efficacy (AUC =0.863) in the test cohort, which was combined with Clinic_Sig to construct the combined model. Compared with Clinic_Sig and Rad_Sig, the combined model showed the higher predictive performance, with AUCs of 0.942 (training), 0.894 (validation), and 0.933 (test). The calibration curve showed that the predicted probabilities of the combined model were in good agreement with the actual probabilities, and DCA indicated that it provided more net benefit than the treat-none or treat-all scheme.

Conclusions: The combined model based on clinical signatures, intranodular and perinodular ultrasound radiomics has the potential to effectively predict benign or malignant thyroid nodules.

In recent years, minimally invasive breast surgery (MIBS) has revolutionized breast cancer treatment, allowing for preservation of aesthetic outcomes while ensuring oncological safety. However, this has created a new challenge in maintaining optimal visualization and dexterity during microvascular anastomosis which is critical for successful autologous tissue reconstruction. Traditional retractors often limit maneuverability, potentially impacting the outcomes of anastomotic procedures. We describe a novel use of the Goligher self-retaining retractor in microvascular anastomosis through an inframammary fold (IMF) incision in 6 breast cancer patients who underwent endoscopic total mastectomy (ETM) with free abdominal-based flap reconstruction. After the ETM is performed via an IMF incision, the Goligher retractor is assembled to retract the tissues for optimal visualisation and exposure for microvascular anastomosis. The average ischaemic time was 37.3 minutes (range, 22-50 minutes). One case required re-exploration, no flap failure occurred and no nipple/skin ischaemia/necrosis occurred. Our surgeons reported enhanced visibility, leading to more precise suturing and reduced operative times. This may correlate with a lower incidence of complications and favorable aesthetic outcomes. Overall, the Goligher retractor presents an excellent adjunct in the field of minimally invasive mastectomy reconstruction and its integration into surgical practice may contribute to improved surgical outcomes.