Gland surgery最新文献

Background: Prepectoral implant-based breast reconstruction (BR) via single-port endoscopic axillary approach reduces visible scarring and incision-related complications. TILOOP mesh may improve implant support and aesthetics, but its added value remains uncertain. This study evaluated outcomes, complications, and patient satisfaction with mesh use.

Methods: A retrospective cohort of 383 patients (165 mesh vs. 218 no-mesh) undergoing immediate prepectoral BR via single-port endoscopy [2020-2022] was analyzed. Outcomes included surgical parameters, complications at 30 days/12 months, oncological results at 36 months, and Breast Reconstruction Evaluation and Satisfaction Questionnaire (BREAST-Q) satisfaction.

Results: Baseline features were balanced. The mesh group showed slightly lower mean postoperative pain scores and higher breast satisfaction scores; however, these differences did not reach statistical significance (P>0.05). Mesh use was associated with greater blood loss (98.1±62.2 vs. 91.2±42.2 mL, P<0.05) and longer hospitalization (8.4±4.1 vs. 5.6±2.8 days, P<0.05). There were no significant differences in complication rates, psychological well-being, or physical function between groups. Subgroup analysis indicated that patients with larger breast volumes tended to derive greater aesthetic and structural benefit from mesh use, though these findings should be interpreted cautiously.

Conclusions: Mesh-assisted prepectoral reconstruction demonstrated comparable safety outcomes to non-mesh reconstruction, with a trend toward reduced postoperative pain and improved breast satisfaction but without statistically significant differences. Mesh use was associated with higher blood loss and longer hospitalization. Overall, mesh application should be individualized based on breast volume, reconstructive goals, and patient-specific factors.

Background: The oncologic safety of breast-conserving surgery (BCS) compared with mastectomy in women with node-positive breast cancer remains uncertain in the modern era of systemic therapy and radiotherapy (RT). The aim of this study was to clarify the comparative survival and recurrence outcomes of BCS with RT versus mastectomy in women with pathologically confirmed node-positive breast cancer through a systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods: RCTs enrolling women with pathologically confirmed node-positive breast cancer and directly comparing BCS plus RT with mastectomy were systematically identified. Searches of PubMed, Embase, Web of Science, and Cochrane CENTRAL were conducted through May 2025, following PRISMA 2020 guidelines. Hazard ratios (HRs) for overall survival (OS), disease-free survival (DFS), and breast cancer-specific survival (BCSS), and risk ratios (RRs) for locoregional recurrence (LRR) were pooled using random-effects models. Risk of bias was assessed with the Cochrane RoB 2.0 tool, and sensitivity analyses were conducted to evaluate robustness across trial eras and locoregional treatment strategies.

Results: Ten RCTs comprising 11,714 node-positive patients were included. All BCS patients received whole-breast irradiation (WBI), and nearly all participants received systemic therapy appropriate to tumor biology. Pooled analyses showed no significant differences between BCS and mastectomy for OS [HR 0.94, 95% confidence interval (CI): 0.81-1.07], DFS (HR 1.03, 95% CI: 0.93-1.12), BCSS (HR 1.00, 95% CI: 0.81-1.18), or LRR (RR 0.98, 95% CI: 0.81-1.16). Heterogeneity was negligible (I²=0% for all endpoints). Sensitivity analyses-including exclusion of individual studies, restriction to low-risk-of-bias trials, and stratification by trial era-confirmed the stability of results. Variations in axillary surgery (sentinel lymph node biopsy vs. axillary lymph node dissection) and RT fields (WBI alone vs. WBI + regional nodal irradiation) did not modify comparative outcomes. No publication bias was detected.

Conclusions: BCS with RT provides survival and recurrence outcomes equivalent to mastectomy in women with node-positive breast cancer. These findings support BCS as a safe, patient-centered surgical option in the modern multimodality treatment era and provide a strong evidence base for harmonizing guidelines and reducing unnecessary radical surgery. Future trials incorporating molecular profiling and response-adapted strategies are warranted to refine patient selection.

Background: Category 4 breast cancer lesions with benign and malignant characteristics show substantial overlap in the Breast Imaging Reporting and Data System (BI-RADS). This study aimed to develop and validate a nomogram based on kinetic heterogeneity of the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to distinguish benign from malignant BI-RADS 4 breast lesions.

Methods: A total of 271 patients diagnosed with BI-RADS 4 breast lesions by MRI and confirmed by histopathology at the Affiliated Tumor Hospital of Nantong University between January 2018 and June 2023 were retrospectively enrolled. Patients were divided into a benign group (n=84) and a malignant group (n=187) based on postoperative pathological results. The cohort was randomly split into a training set (n=192) and a validation set (n=79) in a 7:3 ratio. Clinical risk factors and MRI features were collected and re-evaluated. Kinetic heterogeneity parameters, including volume, washout component (%), plateau component (%), persistent component (%), predominant peak, and heterogeneity, were extracted using MATLAB and SPM12 software. Statistical analyses compared clinical, imaging, and kinetic parameters between groups. Univariate and multivariate logistic regressions identified independent predictors of malignancy. Three predictive models were constructed: one based on kinetic heterogeneity, one on clinicoradiological features, and a combined model integrating both. A nomogram was developed from the combined model. Model performance was evaluated using receiver operating characteristic (ROC) curves and validated in the independent set. Decision curve analysis (DCA) and clinical impact curve (CIC) were used to assess clinical utility.

Results: Multivariate logistic regression identified peak, heterogeneity, apparent diffusion coefficient (ADC) values, time-intensity curve (TIC) type, and peritumoral edema as independent predictors of malignancy in BI-RADS 4 lesions. Among these, peak, heterogeneity, and ADC values demonstrated strong discriminatory power, with areas under the curve (AUC) of 0.793 [95% confidence interval (CI): 0.723-0.863], 0.816 (95% CI: 0.750-0.881), and 0.773 (95% CI: 0.704-0.842), respectively. The kinetic heterogeneity and clinicoradiological models achieved AUCs of 0.863 and 0.819, respectively. The combined nomogram demonstrated superior diagnostic performance (AUC 0.928 training, 0.906 validation), with high sensitivity and specificity. DCA and CIC confirmed its clinical utility.

Conclusions: The DCE-MRI kinetic heterogeneity-based nomogram is a promising tool to differentiate benign and malignant BI-RADS 4 breast lesions. Prospective external validation is warranted to confirm its potential for improving clinical decision-making and reducing unnecessary biopsies.

Background: Accurate preoperative diagnosis of benign and malignant thyroid nodules is crucial for personalized patient treatment and management. This study aimed to create a dual-source dual-energy computed tomography (DS-DECT) based nomogram model to predict the risk of malignant thyroid nodules.

Methods: A total of 263 patients (288 nodules) with thyroid nodules who underwent preoperative neck DS-DECT scans and were pathologically confirmed were included in this study. The computed tomography (CT) radiological features and DS-DECT-derived quantitative parameters of the nodules were collected. Subsequently, the thyroid nodules were randomly partitioned into a training cohort (n=201) and a validation cohort (n=87) at a ratio of 7:3. Univariate logistic regression analysis identified predictors (P<0.05), followed by least absolute shrinkage and selection operator (LASSO) logistic regression to screen features in the training cohort. Multivariate logistic regression analysis was then conducted to determine independent predictors of malignancy (P<0.05) and to construct a nomogram model for predicting malignancy risk. The performance of the model was assessed using the area under the curve (AUC), calibration curve, and decision curve analysis (DCA). The applicability of the nomogram was evaluated through internal validation.

Results: In the final stepwise multivariable logistic regression model, independent predictors of malignancy included iodine concentration in the arterial phase [IC_IAP; odds ratio (OR) =0.286; 95% confidence interval (CI): 0.140-0.517; P<0.001], normalized iodine concentration relative to the thyroid parenchyma in the arterial phase (NIC_P_IAP; OR =0.133; 95% CI: 0.033-0.417; P=0.003), effective atomic number in the venous phase (Zeff_IVP; OR =0.137; 95% CI: 0.050-0.333; P<0.001), thyroid edge interruption (OR =3.791; 95% CI: 1.599-9.491; P=0.003), and enhanced blurring (OR =3.247; 95% CI: 1.373-7.937; P=0.008). The AUCs of the nomogram model, based on these five factors, were 0.932 (95% CI: 0.898-0.963) for the training set and 0.908 (95% CI: 0.842-0.964) for the validation set. The Hosmer-Lemeshow test indicated that the nomogram model had a good fit (P>0.05), and the calibration curve was close to the standard curve. DCA showed significant net benefits from using the model.

Conclusions: The nomogram model, based on normalized multiphase quantitative DECT parameters and qualitative imaging features, serves as an effective diagnostic tool for imaging physicians to distinguish between benign and malignant nodules.

Background: Hypocalcemia is the most common complication following parathyroidectomy (PTX) in patients with primary hyperparathyroidism (PHPT). With asymptomatic PHPT cases increasingly comprising a larger proportion of clinical presentations, the association between preoperative symptom status and postoperative hypocalcemia risk remains poorly defined. This study aimed to identify risk factors for hypocalcemia after PTX in symptomatic vs. asymptomatic PHPT patients to enable individualized calcium management protocols.

Methods: A retrospective analysis was performed on patients with primary PHPT who underwent PTX between July 2012 and August 2024. A total of 478 patients were included and categorized into two groups based on symptomatic status at admission. Data regarding demographics, surgical details, and laboratory parameters were collected. Univariate and multivariate analyses were performed to identify factors associated with postoperative hypocalcemia in PHPT patients.

Results: Multivariate analysis revealed that the preoperative serum chloride/calcium (Cl/Ca) ratio [odds ratio (OR) =1.104; 95% confidence interval (CI): 1.025-1.190; P=0.009], alkaline phosphatase (OR =1.002; 95% CI: 1.001-1.003; P=0.001) and female gender (OR =0.257; 95% CI: 0.103-0.641; P=0.004) were statistically significant predictors of early postoperative hypocalcemia in the symptomatic group. In the asymptomatic group, age ≤60 years (OR =0.379; 95% CI: 0.161-0.894; P=0.03) and a higher preoperative serum Cl/Ca ratio (OR =1.335; 95% CI: 1.170-1.523; P<0.001) were identified as independent predictors of early postoperative hypocalcemia.

Conclusions: This first stratification analysis of PHPT patients by symptomatic status identified the serum Ca/Cl ratio as a common, independent predictor of post-PTX hypocalcemia in both symptomatic and asymptomatic groups. Additionally, in symptomatic patients, alkaline phosphatase levels and female gender were associated with early hypocalcemia. Conversely, for asymptomatic patients, age ≤60 years emerged as a significant predictor.

Breast cancer is the most common malignancy among women, and as survival continues to improve, increasing attention has been placed on optimizing quality of life after treatment. Breast reconstruction is an important part of this process and remains among the top five reconstructive procedures performed in the United States. Reconstruction of the nipple-areola complex (NAC) is often the final-and in many ways the most rewarding-step in the reconstructive sequence. NAC reconstruction plays a critical role in psychological recovery by helping patients regain a sense of wholeness after mastectomy. The objective of this study was to provide an overarching review on NAC reconstruction techniques, drawing from published literature and current institutional practices. A narrative review was conducted by querying PubMed using the terms ("NAC" OR "nipple-areolar complex") AND ("reconstruction" OR "tattoo") to synthesize contemporary literature on NAC reconstruction techniques including local flaps, grafts, implant devices, and tattooing. Additionally, patients who underwent NAC reconstruction at a single academic institution were reviewed and outcomes included. Local flaps are the foundation of surgical NAC reconstruction, though projection loss can vary from 40-75% depending on flap type. Adjuncts such as acellular dermal matrix (ADM), bioabsorbable scaffolds, and implant devices can improve projection durability. Tattooing techniques have advanced substantially able to deliver three dimensional results with a high patient satisfaction and minimal down time; however, pigment fading is common. NAC reconstruction is an individualized process that can be achieved using a variety of tools including flaps, implant devices, and tattooing. These techniques can be used in combination or on their own depending on patient preference and anatomy with the goal of delivering symmetry, durability, and high satisfaction.

Background: During intraoperative neuromonitoring (IONM), an evoked amplitude below 100 µV is typically regarded as loss of signal (LOS). However, after adjusting the event threshold, previously undetectable electromyographic (EMG) waveforms may become visible. This study aimed to evaluate the diagnostic and clinical significance of such subthreshold EMG waveforms.

Methods: A total of 231 patients (335 nerves at risk, NARs) who underwent thyroidectomy with IONM using either EMG endotracheal tube electrodes or adhesive skin electrodes were retrospectively reviewed. Evoked EMG parameters, including mean amplitude and latency after stimulation of the recurrent laryngeal nerve (RLN) and vagus nerve (VN), were analyzed. Preoperative and postoperative laryngoscopic examinations were performed to assess vocal fold mobility.

Results: Among the 335 NARs, twelve NARs (3.5%) demonstrated evoked EMG amplitudes below 100 µV and were confirmed as true LOS, all of which were classified as Type I (segmental) LOS. After stepwise lowering the event threshold from 100 µV to 80 and subsequently to 50 µV, biphasic EMG waveforms became detectable in 10 of these 12 cases. Although all 12 nerves exhibited immediate postoperative vocal fold paralysis, the 10 nerves with detectable low-amplitude waveforms showed complete recovery of vocal fold mobility within eight months postoperatively.

Conclusions: In cases of Type I LOS during thyroid surgery, the presence of subthreshold biphasic EMG waveforms may reflect residual neural conduction and is strongly associated with postoperative vocal fold recovery. These findings suggest that optimization of threshold settings can improve the sensitivity of IONM interpretation and assist in intraoperative prognostic assessment.

In oncologic breast reconstruction, autologous techniques have been demonstrated to provide patients with improved long-term outcomes and fewer complications than implant-based techniques, especially in the setting of adjunct therapies. While the deep inferior epigastric perforator (DIEP) flap remains the gold standard, not all patients are suitable candidates due to insufficient abdominal tissue or prior abdominal surgeries. Recent advances in microsurgical and imaging techniques, such as computed tomography angiography (CTA) for perforator mapping, have provided reconstructive surgeons with the ability to reliably harvest perforator-based flaps from various areas of the body that minimize donor site morbidity while maximizing reconstructive success. The profunda artery perforator (PAP) flap has emerged as a useful tool in the reconstructive microsurgeon's armamentarium for breast reconstruction in patients where more traditional donor sites are inappropriate or unavailable. Harvested from the posteromedial thigh, this fasciocutaneous flap preserves underlying muscle function and offers distinct advantages, including a reliable vascular pedicle and a discreetly hidden scar. This review article outlines the development of the flap, recent modifications, and relevant surgical anatomy, ultimately synthesizing current clinical outcomes to validate the PAP flap as a robust and aesthetically superior alternative for restoring natural breast contour.