Gland surgery最新文献

Background: Lateral lymph node metastasis (LLNM) and skip lymph node metastasis (SLNM) in papillary thyroid carcinoma (PTC) are generally unpredictable, especially in adolescents and young adults (AYAs). This study aims to investigate the risk factors associated with LLNM and skip SLNM in AYAs with PTC.

Methods: This retrospective analysis was performed on the medical records of AYAs with PTC who underwent total or near-total thyroidectomy or lobectomy, along with central lymph node dissection (CLND) and lateral lymph node dissection (LLND) at The First Affiliated Hospital of Soochow University from January 2017 to December 2023. Variables identified as significant in the univariate analysis were further assessed using multivariate analysis. Continuous variables deemed significant were analyzed using receiver operating characteristic (ROC) curve analysis to establish optimal cut-off values. Logistic regression analysis was then employed to identify independent risk factors for LLNM and SLNM in AYAs with PTC.

Results: Among the 545 AYAs with PTC, 480 individuals (88.1%) exhibited LLNM, with 54 of these 480 patients (11.3%) demonstrating SLNM. Univariate and multivariate analyses identified the diameter of the largest tumor [P<0.001, odds ratio (OR) =2.768, 95% confidence interval (CI): 1.544-4.962] and the number of central lymph node metastasis (CLNM) (P=0.001, OR =3.888, 95% CI: 1.701-8.888) as independent predictors for LLNM. Furthermore, the number of LLNM (P=0.007, OR =0.295, 95% CI: 0.122-0.712) was identified as an independent factor for SLNM. ROC curve analysis determined that the optimal cut-off values for the diameter of the largest tumor, the number of CLNM, and the CLNM/ CLND ratio as risk factors for LLNM in AYAs with PTC were 1.1 cm, 3, and 0.3, respectively. Similarly, the optimal cut-off values for the diameter of the largest tumor, the number of LLNM, and the LLNM/LLND ratio for predicting SLNM were 1.2 cm, 5, and 0.2, respectively.

Conclusions: This study demonstrated that the diameter of the largest tumor greater than 1.1 cm and a number of CLNM equal to or greater than 3 were independent risk factors for LLNM in AYAs with PTC. Additionally, a number of LLNM equal to or less than 5 was identified as a risk factor for SLNM.

Background: Large benign thyroid nodules (BTNs) (≥4 cm) are often situated in close proximity to critical tissues, posing unique challenges for treatment. Microwave ablation (MWA), known for its ability to generate consistently higher intratumoral temperatures, has emerged as a promising non-surgical alternative. This study aimed to assess the efficacy and safety of MWA when treating patients harboring large BTNs, and explore the strategy for protecting against recurrent laryngeal nerve (RLN) injury.

Methods: A retrospective analysis of 205 patients with BTNs who underwent MWA was conducted. Clinical and ultrasound (US) analyses were performed at 1, 6, and 12 months post-ablation. The volume reduction rate (VRR), associated factors, and complications were analyzed.

Results: For patients in this cohort, the respective mean nodule diameter and volume were 46.56±7.66 mm and 22.91±15.23 mL. Of the 205 nodules, 59 were solid, and 146 were predominantly solid. At 12 months, the mean VRR was 82.54%, with a technical efficacy rate of 93.66%. Multivariate analysis revealed that VRR was significantly associated with nodule composition at 6 months but not at 12 months. Eighteen cases necessitated repeat ablation owing to difficulties in maintaining an effective isolating fluid width, with this issue being attributable to high levels of tension between the thyroid nodule and the tracheoesophageal groove. One patient developed transient hoarseness, that was fully resolved within 1 month after ablation.

Conclusions: MWA can be safely and effectively used to treat large BTNs. Secondary ablation is a crucial strategy for mitigating RLN injury when isolating fluid is insufficient.

Background: Radiofrequency ablation (RFA) has emerged as an effective, minimally invasive treatment option for benign thyroid nodules. However, safety in patients with cardiac implantable electronic devices (CIEDs) such as implantable cardioverter defibrillators (ICDs), permanent pacemakers (PPMs), and implantable cardiac monitors (ICMs) is unclear, given theoretical risks of electromagnetic interference (EMI). As the use of both RFA and CIEDs continues to increase, establishing evidence-based safety guidance for this population is essential. This study aimed to evaluate the safety of RFA for benign thyroid nodules in patients with CIEDs.

Methods: This retrospective study included 7 patients with a history of ICDs, ICMs, or PPMs and benign thyroid nodules who underwent RFA. All CIEDs were interrogated both before and after the procedure. A magnet was placed over ICDs, and electrocardiogram (ECG) monitoring was performed to detect arrhythmias or mode switching. Outcomes included the incidence of post-RFA complications, including possible cardiac implant malfunctions and volume reduction rate (VRR) at 6 months.

Results: The mean age of the patients was 72.1±12.5 years, with 71.4% of the patients being female. The mean VRR at 6 months was 73.8%±24.9%. No peri-procedural complications occurred, and no patient demonstrated clinically significant EMI, inappropriate sensing or pacing, arrhythmias, device resets, or structural lead damage. All patients tolerated the procedure without adverse events.

Conclusions: RFA appears to be a safe and effective treatment for benign thyroid nodules in patients with a history of ICDs, ICMs, and PPMs. Our experience demonstrated the safety of RFA and supported its utility in this high-risk population when performing these procedures with appropriate monitoring.

Background: Papillary thyroid carcinoma (PTC) is the most common malignant tumor of the endocrine system, with its incidence increasing annually worldwide. Currently, despite the adoption of various treatment modalities, tumor invasion and metastasis constitute critical factors affecting the long-term survival of PTC patients. Adipocytes participate in regulating the malignant biological characteristics of tumor cells. However, the role of adipocytes in PTC carcinogenesis and progression remains poorly understood. Therefore, this study aims to investigate the role of adipocytes in PTC metastasis.

Methods: 3T3L1-D cells were treated with differentiation medium to induce differentiation into adipocytes. PTC cells were cultured with adipocytes, and the PTC cell invasion ability was examined by transwell assay. The associated mechanisms were further investigated.

Results: Here, we found that the surrounding adipocytes could promote the invasion capacity of PTC cells via FATP2/TR4 signaling, and the inhibition of FATP2 or TR4 expression could reverse the invasion capacity of PTC cells. Furthermore, the preclinical investigation demonstrated that targeting this newly identified signaling with lipofermata (a FATP2-specific inhibitor) suppressed PTC progression.

Conclusions: Together, these findings suggest that adipocytes in the PTC microenvironment may function via FATP2/TR4 signaling to regulate PTC progression, and targeting this newly identified adipocyte/FATP2/TR4 signaling axis may facilitate the development of novel therapeutic strategies for PTC.

Background: Cancer-related lymphedema (CRL) seriously affects patients' quality of life. Many practice guidelines emphasize the importance of early prevention. However, a significant gap exists between these guidelines and clinical practice. This study aimed to understand the current status of lymphedema management in Chinese hospitals and to provide a basis for promoting standardized practices in lymphedema care.

Methods: A cross-sectional survey was conducted from September to November 2024 using a self-designed questionnaire on lymphedema management. A convenience sample of 45 hospitals nationwide was surveyed.

Results: The survey revealed that 60% of hospitals had established outpatient clinics for lymphedema, while 46.7% routinely implemented manual lymphatic drainage. Additionally, 68.9% of hospitals performed routine high-risk screening or preoperative assessments for lymphedema. Regarding treatment management, the application rate of complete decongestive therapy (CDT) was 88.9%, but 42.2% of hospitals lacked a standardized fee system. Concerning personnel training, 37.8% of hospitals had not conducted lymphedema training.

Conclusions: Challenges in lymphedema management in Chinese hospitals include the limited implementation of standardized care protocols, incomplete fee systems for treatments, and the low coverage of specialized training. Efforts should focus on enhancing medical staff training, establishing standardized care pathways, and improving technical fee structures to advance the standardized development of lymphedema care.

Background: Mucoepidermoid carcinoma (MEC) is a malignant tumor primarily composed of epidermoid, mucous, and intermediate cells. While it predominantly occurs in the salivary glands, MEC can also develop in the lungs, esophagus, breast, and thymus. Thymic MEC is rare, accounting for 2-3% of primary thymic malignancies. The primary clinical characteristic is incidental discovery in asymptomatic individuals. Due to the rarity of thymic MEC, much of the literature consists of case reports, and no standardized treatment protocol exists. Surgical resection is the primary treatment for MEC.

Case description: This report presents a case of thymic MEC identified incidentally during a routine physical examination in an asymptomatic patient. Chest computed tomography (CT) revealed a well-defined, rounded cystic-solid mass measuring approximately 61 mm × 32 mm in the right anterior mediastinum, with mild enhancement. Following comprehensive assessment to rule out surgical contraindications, the mass was resected. Postoperative pathology indicated a low-grade primary MEC, positive for epithelial membrane antigen (EMA), cytokeratin (CK)19, p63, CK7, cluster of differentiation (CD)5, and mucicarmine/Alcian blue (AB)-periodic acid-Schiff (PAS) staining. Ki-67 was ~5%, and fluorescence in situ hybridization (FISH) analysis confirmed mastermind-like transcriptional coactivator 2 (MAML2) gene rearrangement. The patient received no additional treatment.

Conclusions: This report details a rare case of thymic MEC. The diagnosis required pathology and molecular testing. MAML2 rearrangement suggests a better prognosis; further research is needed to elucidate its pathogenesis and improve its treatment.

Background: Step-down therapy is becoming a critical approach in the treatment of breast cancer in a localized setting. The applicability of sentinel lymph node biopsy (SLNB) in patients with clinically node-negative (cN0) breast cancer following neoadjuvant chemotherapy (NACT) is still a topic of controversy. The objective of this study was to compare a variety of machine learning algorithms to determine the most effective model for predicting sentinel lymph node (SLN) metastasis in cN0 breast cancer following NACT.

Methods: A total of 221 patients with cN0 breast cancer who underwent standardized NACT combined with SLNB at the Affiliated Hospital of Southwest Medical University from January 2017 to January 2025 were included in this retrospective study. Predictive models for the risk of SLN metastasis were created using four machine learning algorithms. The clinical net benefit was compared through decision curve analysis (DCA), and the diagnostic performance was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. SHapley Additive exPlanations (SHAP) was also implemented to evaluate the model that demonstrated the most optimal performance.

Results: The SLN-negative group contained 186 cases (84.2%), while the SLN-positive group contained 35 cases (15.8%). The logistic regression (LR) model demonstrated superior performance in comparison to the other models in the testing set. The sensitivity, specificity, accuracy, F1 values, and AUC were, respectively, 0.448, 0.947, 0.864, 0.508, and 0.889 [95% confidence interval (CI): 0.886-0.892]. It yielded the greatest net benefit across the majority of threshold ranges in the testing set. The main predictors identified by SHAP analysis were radiological complete response (rCR), lymphovascular invasion, and axillary nodes on ultrasonography.

Conclusions: The LR model developed in this study demonstrates high specificity and can reliably identify patients without SLN metastasis, thereby supporting the exemption of SLNB in low-risk patients with cN0 breast cancer following NACT.