Gland surgery最新文献

Background: Breast cancer is a complex disease encompassing multiple phenotypic and genetic subtypes. The biomarker status of primary and recurrent lesions may be dissimilar, and changes in biomarker status may inform clinical decision-making. The expression of biomarkers between primary breast cancers and loco-regional recurrences lacked large sample studies. This study aimed to investigate the discordance in the status of specific biomarkers between primary breast cancers and loco-regional recurrences, while also exploring the associated clinical and pathological characteristics of the affected patients.

Methods: A retrospective review was conducted on the medical records of 112 female patients with a confirmed pathological diagnosis of breast cancer who experienced loco-regional recurrence between July 2005 and March 2018 at Peking Union Medical College Hospital. Comprehensive data regarding primary and recurrent tumor characteristics, surgical interventions, history of systemic therapy, presence and management of loco-regional recurrences, as well as disease-free survival (DFS) and overall survival (OS), were systematically recorded and subsequently subjected to comparative analysis.

Results: The study revealed disparities in the expression of individual biomarkers between primary breast cancers and loco-regional recurrences, with discordance rates exhibiting variation across breast cancer subtypes. Specifically, the overall discordance rates were as follows: 9.8% for estrogen receptor (ER) expression, 15.2% for PR expression, 7.6% for human epidermal growth factor receptor-2 (HER2) expression, and 20.6% for the Ki-67 index (21 out of 102 cases). Luminal A tumors exhibited the highest discordance rate at 81.8%, while triple negative (TN) tumors displayed the lowest at 9.1%. Furthermore, a statistically significant association was identified between DFS and the subtype of primary breast cancer (P=0.002).

Conclusions: The study shows that there exists discordance in the expression of individual biomarkers between primary breast cancers and loco-regional recurrences. The discordance rate was found to be highest among luminal A tumors and lowest for TN tumors. Additionally, patients with HER2 and TN primary breast tumors exhibited the shortest DFS. Based on these findings, the study recommends the implementation of biomarker testing for recurrent breast cancers as a valuable strategy to inform and guide decisions regarding the selection of rescue chemotherapy, endocrine therapy, and targeted therapy.

Background: Thyroid cancer is one of the most common endocrine tumors and preoperative diagnosis of thyroid follicular neoplasm (FN) is challenging. Commonly used examination methods have difficulty in distinguishing thyroid cancer from other follicular lesions. At the same time, with the recently released World Health Organization (WHO) guidelines, the risk classification of FNs of the thyroid is a new enlightenment for clinicians in the diagnosis and treatment. Therefore, we conducted this study to help identify malignant tumors, determine the appropriate extent of surgery, and reduce unnecessary surgical resection.

Methods: We performed this retrospective cohort study between January 2015 and December 2023. According to the inclusion and exclusion criteria, 192 patients were finally included for subsequent analysis. Clinical and pathological characteristics, examination test results, and surgical information were collected to explore factors that aid decision making. Categorical variables were compared using Pearson's Chi-squared test or Fisher's exact-test and continuous variables were analyzed using the Mann-Whitney U-test. Ordinal logistic regression was carried out to appraise the relative risks of malignancy.

Results: There were 192 patients included and analyzed in this study. Significant differences were observed between the three groups regarding tumor size, interval to surgery, nodule components, and several sonographic features. Ordinal logistic regression analysis demonstrated that taller than wide [odds ratio (OR) =3.219], irregular margins (OR =4.118), hypoechogenicity (OR =2.134) and calcifications (OR =2.144) were independent risk factors for malignancy. Furthermore, noteworthy case series, such as patients with incidentally discovered papillary microcarcinoma and postoperative pathologically confirmed follicular thyroid carcinoma were also documented.

Conclusions: Patients with a cytological diagnosis of FN with ultrasound features of taller than wide, irregular margins, hypoechogenicity, and calcifications might be at high risk for malignancy and should be treated with caution. In the future, a multi-factor risk assessment diagnostic prediction model should be established and applied.

Background: The management of thyroid nodules diagnosed as Bethesda III by fine-needle aspiration presents certain challenges, and there is an urgent need for a non-invasive and accurate method for early identification of the benign or malignant nature of Bethesda III nodules. Our objective is to develop and validate a clinical-radiomics nomogram based on preoperative ultrasound (US) images and clinical features, for predicting the malignancy of thyroid nodules with indeterminate cytology (Bethesda III).

Methods: Between June 2017 and June 2022, we conducted a retrospective study on 274 patients with surgically confirmed indeterminate cytology (Bethesda III) across two separate medical centers in Shanghai. The training and internal validation sets were comprised of 136 and 58 patients, respectively, all sourced from Shanghai's Sixth People's Hospital. To facilitate external test, a further 80 patients were selected from Tinglin Hospital. Utilizing preoperative US data, we obtained imaging markers for radiomic features. After feature selection, we developed a comprehensive diagnostic model to evaluate the predictive value for Bethesda III benign and malignant cases. The model's diagnostic accuracy, calibration, and clinical applicability were systematically assessed.

Results: The results showed that the prediction model, which integrated US radiomics, and clinical risk features, exhibited superior stability in distinguishing between benign and malignant indeterminate thyroid nodules (Bethesda III). In the external test set, the area under the curve (AUC) was 0.824 [95% confidence interval (CI): 0.718-0.929], and the accuracy, sensitivity, specificity, precision, and recall were 0.775, 0.731, 0.796, 0.633, and 0.731, respectively.

Conclusions: An integrated model, utilizing US radiomics and clinical risk features, effectively discriminates between benign and malignant indeterminate thyroid nodules (Bethesda III), thereby minimizing the need for unnecessary diagnostic surgeries and subsequent complications.

Background: Secretory carcinoma (SC) represents a relatively new and less recognized subtype of salivary gland cancer among clinicians. The objective of our study was to shed light on this rare entity by providing an in-depth analysis of the clinical presentation, pathological characteristics, and treatment outcomes of five patients diagnosed with SC. We also sought to contribute to the understanding of the diagnostic criteria and prognostic factors associated with SC.

Case description: The patients, treated at Guangdong Provincial People's Hospital, were aged between 33 and 40 years, with an average age of 33 years. Notably, none of the patients reported pain or noticed a mass initially; however, the mass became progressively larger over time. Diagnostic imaging, such as magnetic resonance imaging (MRI), led to the classification of four cases as benign and one as a low-grade malignancy. We meticulously documented the diagnostic and treatment journey of these patients, including the clinical data, histopathological findings, and subsequent treatment responses.

Conclusions: Our findings suggest that SC is associated with a favorable prognosis. Nevertheless, the clinical presentation of SC lacks distinct features, necessitating a comprehensive approach that includes immunohistochemistry (IHC) and genetic testing for an accurate diagnosis. This study underscores the importance of recognizing SC as a distinct pathological entity to ensure appropriate patient management and improve outcomes.

Background: Cushing syndrome increases morbidity and mortality, which is mainly caused by cardiovascular disorders. This study reports the cardiovascular risk outcomes at 3, 6, and 12 months after unilateral laparoscopic adrenalectomy in cortisol-secreting adrenal tumor and to identify the preoperative parameters predicting the resolution of cardiovascular risk factors after surgery.

Methods: All clinical data of patients with unilateral cortisol-secreting adrenal tumors who underwent laparoscopic adrenalectomy in King Chulalongkorn Memorial Hospital between 2001-2022 were retrospectively reviewed. Analyzed baseline parameters included age, gender, body mass index (BMI), tumor size, and laterality. Systolic and diastolic blood pressure (DBP), fasting blood sugar (FBS), hemoglobin A1C (HbA1C), lipid profiles, and serum cortisol level were evaluated before surgery and at 3, 6, 12 months postoperatively. The resolution rate and predictive factors of hypertension (HT), diabetes, and dyslipidemia after surgery were analyzed.

Results: Forty-five patients were included in this study. The mean [standard deviation (SD)] age was 44.2 (14.7) years. The mean (SD) BMI was 25.9 (5.4) kg/m². The mean (SD) tumor size was 3.1 (1.0) cm. Most of the patients were female (97.8%). After surgery, the resolution rate of HT, dyslipidemia, and obesity were significantly improved after 3 months (P<0.001, P=0.01, and 0.02 respectively). Diabetes mellitus (DM) significantly improved at 1 year after surgery (P<0.001). From multivariable analysis, the significant predictive factors for the resolution of HT were age [odds ratio (OR) 0.95; 95% confidence interval (CI): 0.91-0.99, P=0.01], BMI (OR 0.85; 95% CI: 0.77-0.95, P=0.003) and systolic blood pressure (SBP) (OR 0.97; 95% CI: 0.94-1, P=0.03). Preoperative serum cortisol was the significant predictive factor for the improvement of diabetes (OR 1.12; 95% CI: 1.01-1.25, P=0.04) and serum cholesterol was the predictive factor for the improvement of dyslipidemia (OR 0.97; 95% CI: 0.96-0.99, P=0.003) after surgery.

Conclusions: Adrenalectomy significantly improves the cardiovascular risk factors in cortisol-secreting adrenal adenoma.

Background: Primary thyroid lymphoma (PTL) is a rare malignancy of the thyroid gland that poses significant clinical challenges due to its rarity and the varied therapeutic approaches it demands. Although recent years have seen an increasing focus on PTL, there is a notable lack of bibliometric analyses that consolidate the evolving research within this field. This study aims to analyze and highlight the research hotspots and trend changes in PTL, elucidating their clinical implications and guiding future research.

Methods: We conducted a systematic bibliometric analysis of literature on PTL published from 2000 to 2023. This involved a structured search in the Web of Science Core Collection, using medical subject headings (MeSH) from the MeSH database to refine and eliminate duplicates, forming a precise search formula. Relevant publications were limited to English-language articles and reviews, which were then processed and analyzed using CiteSpace (6.2.R4) for visualization. The analysis, performed with CiteSpace software, facilitated the visualization of trends and hotspots in PTL research by mapping citation networks and identifying key themes and influential works.

Results: Our search yielded 281 literature records on PTL, demonstrating a curvilinear upward trend in publications over the years. The majority of publications originated from China, with the most influential contributions coming from the United States. Hirokawa Mitsuyoshi and Derringer Ga were identified as the most prolific and most co-cited authors, respectively. Keyword and co-citation analyses indicated a growing interest in clinicopathological features, treatment modalities, survival outcomes of different PTL subtypes, risk factors, complementary diagnostic techniques, and immunotherapeutic approaches.

Conclusions: This bibliometric analysis underscores the significant clinical relevance of understanding the pathologies, diagnostic challenges, and treatment strategies for PTL. The identified research hotspots, particularly in pathological typing, diagnosis and treatment modalities, gene expression profiles, targeted therapies, clinical trials, and survival rates, highlight critical areas requiring continued research focus. These insights have pivotal implications for improving patient outcomes and advancing the clinical management of PTL.

Background: An increasing body of studies indicates that prophylactic abdominal drainage may not be necessary following left pancreatectomy (LP), despite its common use in clinical practice. This meta-analysis seeks to offer a definitive recommendation regarding the necessity of drainage after LP by examining and contrasting postoperative outcomes in patients who did and did not undergo drainage.

Methods: An extensive literature search was conducted to compare the outcomes of no-drainage and drainage after LP from inception to July 2024 on PubMed, MEDLINE, Embase, Web of Science, and the Cochrane Library. Fixed-effect models or random effects were selected based on heterogeneity, and pooled odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated.

Results: A total of 10 studies with 3,505 patients were included, comprising two randomized controlled trials (RCTs) and eight observational clinical studies (OCS). There was no difference in major morbidity (Clavien-Dindo score ≥III) between the no-drainage and drainage groups (RCTs: OR =0.79; 95% CI: 0.54-1.15; P=0.22). However, the incidence of postoperative pancreatic fistula with grade B and C (POPF B/C) was lower (RCTs: OR =0.47; 95% CI: 0.30-0.73, P<0.001), and the length of hospital stay was shorter in the no-drainage group.. In RCTs, interventional drainage, reoperation, readmission, and mortality rates did not differ between the two groups.

Conclusions: No-drainage is completely safe and has a lower rate of POPF B/C compared to abdominal drainage after LP. Therefore, a no drainage policy should be implemented after LP.

Background: As the most prevalent histological type of thyroid cancer, the prognosis of papillary thyroid cancer (PTC) is closely related to cervical lymph node metastasis (LNM), particularly in the case of lateral LNM (LLNM). The patterns of cervical LNM in PTC remain inconclusive. We aim to assess the risk factors for LLNM and extranodal extension (ENE) at different lateral levels in N1b PTC patients.

Methods: A total of 486 PTC patients with pathologically diagnosed N1b, who underwent thyroidectomy with central and lateral neck lymph node dissection at our hospital between January 2019 and December 2021, were retrospectively retrieved. The metastatic status of different lateral levels was recorded. Further correlation analysis was conducted.

Results: Based on the correlation analysis, binary logistic regression analysis indicated that upper location [odds ratio (OR) =3.067; P<0.001; 95% confidence interval (CI): 2.075-4.534] and central LNM-ENE (CLNM-ENE) (OR =2.036; P=0.04; 95% CI: 1.044-3.970) are predictive factors for level II metastasis. Additionally, upper location (OR =2.106; P<0.001; 95% CI: 1.404-3.159) and CLNM (OR =2.664; P<0.001; 95% CI: 1.681-4.222) were found to be predictive factors for level III metastasis. LLNM at level IV was closely associated only with CLNM. Level III-ENE (OR =2.347; P=0.03; 95% CI: 1.065-5.176) was found to be highly correlated with level V metastasis. As for ENE, level III-ENE was found to be a risk factor for ENE in all other levels (II, IV, V), while ENE in the other lateral cervical regions also increased the risk for level III.

Conclusions: Despite some uncertainties, LLNM remains closely associated with the upper location of PTC. Meanwhile, level III functions as the hub of the lateral neck, with level III-ENE increasing the risk of LLNM in level V, and significantly raising the probability of ENE in other lateral cervical regions. LLNM have its inherent patterns, as evidenced in the study, but also have a degree of unpredictability, therefore an accurate preoperative assessment is essential.

Background: The distribution and morphology of mass microvessels could affect the diagnostic accuracy of breast cancer (BC). The aim of our study was to compare the value of contrast-enhanced ultrasound and micro-flow imaging (CEUS-MFI), contrast-enhanced ultrasound (CEUS), and color Doppler flow imaging (CDFI) in the assessment of mass microvasculature.

Methods: A total of 106 patients with 106 breast masses categorized as Breast Imaging Reporting and Data System (BI-RADS) category 4 were enrolled in our prospective study. CEUS-MFI, CEUS and conventional CDFI were used to estimate the microvascular morphology and distribution types of breast lesions, respectively. Pathological results were considered the gold standard.

Results: CEUS-MFI technique applied in microvascular morphology and distribution types resulted in a higher resolution in breast lesions than the CEUS and CDFI techniques. The sensitivity, specificity, and accuracy of CEUS-MFI were 94.4%, 85.3%, and 91.5%, respectively. The sensitivity, specificity, and accuracy of CEUS were 88.9%, 82.4%, and 86.8%, respectively. The sensitivity, specificity, and accuracy of the CDFI were 61.1%, 76.5% and 66.0%, respectively. There were significant differences in accuracy between the CEUS-MFI and CEUS (P=0.01). There were significant differences in accuracy between the CEUS-MFI and CDFI (P<0.001).

Conclusions: This study supports CEUS-MFI is a new and promising imaging method for visualizing microvasculature in breast masses. CEUS-MFI improves the diagnostic capacity for BC.