Gland surgery最新文献

Background: Lateral cervical lymph node metastasis (LLNM) is a well-established prognostic factor influencing recurrence and survival in patients with papillary thyroid carcinoma (PTC). However, the accuracy of preoperative imaging examinations is limited. We have pioneered a minimally invasive technique-endoscopic thyroidectomy via sternocleidomastoid muscle posteroinferior approach (ETSPIA). This technique facilitates selective lateral neck lymph node dissection while excising thyroid lesions, effectively eradicating occult lateral cervical lymph node metastasis (OLLNM) without the need for extended incisions. This study investigates the diagnostic and therapeutic value of ETSPIA in managing OLLNM in PTC.

Methods: A retrospective analysis was conducted on the clinical data of 142 patients with primary PTC who underwent ETSPIA at Beijing Tongren Hospital from November 2022 to June 2024. All patients underwent lateral cervical lymph node exploration: intraoperative examination first targeted the medial lymph nodes of the internal jugular vein, with frozen section analysis; if positive, the external lymph nodes of the internal jugular vein were subsequently addressed. The study recorded cases of LLNM and analyzed factors influencing OLLNM.

Results: Excluding 8 patients with preoperatively detected evident LLNM via ultrasound, 33 out of 134 patients (24.6%) exhibited OLLNM. This subgroup included 19 males and 14 females, with a median age of 34 years. The tumor-node-metastasis (TNM) staging revealed 17 cases of T1a, 7 cases of T1b, 4 cases of T2, and 4 cases of T3b. The tumors were located in the thyroid upper pole in 12 cases, the middle part in 15 cases, and the lower pole in 6 cases, with 26 cases presenting with solitary tumors and 7 with multiple lesions. Extrathyroidal extension was observed in 4 cases. Over a median follow-up period of 17 months, no severe complications were reported. Univariate analysis identified male gender, younger age, tumor T stage, preoperative ultrasound indication of upper pole thyroid tumors, and extrathyroidal extension as factors associated with OLLNM (P<0.001, P=0.02, P=0.007, P<0.001, P=0.003 respectively). Multivariate regression analysis demonstrated that male gender, younger age, and preoperative ultrasound indication of upper pole thyroid tumors were independent risk factors for OLLNM in PTC (P=0.001, P=0.006, P=0.02, P=0.002, respectively).

Conclusions: As a novel minimally invasive endoscopic thyroid approach, ETSPIA allows for the excision of thyroid lesions while addressing lateral cervical metastatic lymph nodes. It demonstrates favorable cosmetic outcomes and safety, offering a viable alternative for the management of thyroid cancer.

[This corrects the article DOI: 10.21037/gs-24-130.].

Background: Ductal carcinoma in situ with microinvasion (DCISM) represents 1% of all breast cancer cases and is arguably a more aggressive subtype of ductal carcinoma in situ (DCIS). Preoperative evaluation of DCISM usually relies on core needle biopsy, and non-invasive evaluation methods are relatively limited. This study aims to explore the features of conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) in DCISM and to analyze the US and clinicopathological predictors of infiltrating components.

Methods: A retrospective collection of US, CEUS, and clinicopathologic data for DCIS and DCISM lesions was conducted from January 1, 2019 to June 30, 2022. The Breast Imaging Reporting and Data System (BI-RADS) criteria were used to evaluate breast lesions. On CEUS, the imaging features were scored using a 5-point scoring system to re-rate the BI-RADS category indicated by conventional US features. The pathological diagnosis served as the gold standard. Histopathologic features included comedo-type necrosis and pathological grade, while biomarkers included estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and the Ki-67 index. A logistic regression analysis was performed to identify the independent risk factors for DCISM. The diagnostic performance of the model was evaluated using the receiver operating characteristic (ROC) curve and calculating the area under the curve (AUC).

Results: A total of 89 women were included in the study. Of these, 66 had a pathologic diagnosis of DCIS (66 lesions, ranging in size from 0.6 to 4.9 cm), and 23 had a pathologic diagnosis of DCISM (23 lesions, ranging in size from 0.7 to 4.2 cm). Three features on conventional US (tumor size, margin, and calcification) and three enhancement features on CEUS (enhancement margin, enhancement mode, and enhancement scope) were found to be significantly different between the DCIS and DCISM lesions (P=0.03, P=0.04, P=0.02, P=0.03, P=0.03, P=0.007, respectively). Patients with DCISM were more likely to have a higher pathological grade, ER negativity, PR negativity, HER2 positivity, and a higher Ki-67 index than patients with DCIS (P<0.001, P=0.042, P=0.03, P=0.009, P=0.05, respectively). A multivariate logistic regression analysis further showed that only an enlarged enhancement scope and pathological grade were associated with DCISM. The sensitivity and specificity of this predictive model were 87.0% and 81.8%, respectively (AUC =0.89). The absence of calcifications, non-mass lesions, lack of vascularity, and the non-enlarged scope can lead to misdiagnosis of DCIS and DCISM.

Conclusions: Understanding the CEUS and clinicopathologic features of DCISM lesions may alert clinicians to the possibility of microinvasion and guide appropriate management.

Background: Age has been confirmed as a very aggressive biological factor associated with the poor prognosis of breast cancer (BC) patients. However, the understanding of young women with breast cancer (YWBC) is scarce. This study compares and evaluates the clinical characteristics and pathologic complete response (pCR) rate after neoadjuvant chemotherapy (NAC) in YWBC and older women with BC.

Methods: We retrospectively analyzed the clinicopathological data and pCR rates of 1,419 non-metastatic BC patients from the Harbin Medical University Cancer Hospital from 1 January 2012 to 31 December 2019. Patients were classified according to age (≤35 vs. >35 years old) with the clinical parameters. The chi-squared or Fisher's exact test was used to evaluate the correlation between clinicopathological variables and pCR. Any predictor variables with P<0.05 in the univariate analysis were included in the multivariate regression analysis to study the relationship between different age groups and pCR.

Results: A total of 879 patients in this study were eligible for analysis, and 71 (8.1%) female patients were ≤35 years old. Compared with elderly patients, YWBC were more likely to achieve pCR (25.4% vs. 15.6%, P=0.03) and undergo breast-conserving surgery (BCS). There was a higher proportion of clinically higher stage in the YWBC group. Patients with YWBC, clinical stage I+II, positive human epidermal growth factor receptor 2 (HER-2) expression, negative progesterone receptor (PR) expression, and KI67 >15% were more likely to achieve pCR (P<0.05).

Conclusions: Our study found that age is the main factor affecting the achievement of pCR in patients with BC. Chemotherapy is more effective in patients with YWBC. We need to pay more attention to this group and achieve individualized treatment, which will facilitate improved treatment of BC and provide new targets and blueprints for clinical therapy.

Background: There is no uniform conclusion as to whether internal or external drainage of the supporting duct is more clinically effective, especially in laparoscopic pancreaticoduodenectomy (LPD) which has not yet been reported in clinical studies. This study aimed to investigate the efficacy of external versus internal pancreatic duct drainage during LPD performed in a low-flow center at the beginning of the learning curve.

Methods: The clinical data of a total of 73 cases of patients who underwent LPD between January 2022 and June 2024 were retrospectively analyzed. Forty-eight cases performed by doctors from Jingzhou Hospital Affiliated to Yangtze University were considered as not having passed the early stages of the learning curve, and 25 cases performed by the invited team with rich LPD experience were considered as having passed the early stages of the learning curve. According to whether they had passed the early stages of the learning curve or not and the method of pancreatic duct drainage used, 73 patients were divided into the external drainage group (EDG) that did not pass the early stages of the learning curve (n=24), the internal drainage group (IDG) that did not pass the early stages of the learning curve (n=24), and the IDG that passed the early stages of the learning curve (n=25). The EDG was compared with the two IDGs in terms of complication rates and other procedure-related indicators.

Results: The total pancreatic fistulae incidence rate of the whole group was 16.4% (12/73), and the incidence of pancreatic fistulae was significantly lower in the EDG that did not pass the early stages of the learning curve (8.3%) than in the IDG that did not pass the early stages of the learning curve (33.3%), with statistically significant difference (P=0.03); the incidence of pancreatic fistulae was slightly higher in the EDG that did not pass the early stages of the learning curve (8.3%) than in the IDG that passed the early stages of the learning curve (8.0%), with statistically not significant difference (P>0.99). The incidence of biliary fistulae in the EDG that did not pass the early stages of the learning curve (0.0%) was lower than that in the IDG that did not pass the early stages of the learning curve (25.0%), and the difference was statistically significant (P=0.02). The differences in other complications between the EDG and the two IDGs were not statistically significant.

Conclusions: External pancreatic duct drainage is more helpful in reducing the incidence of postoperative pancreatic fistulae, more conducive to the safe passage of the operator through the initial stages of the LPD learning curve, more suitable for use in the development of LPD in low-volume centers.

Background: Although ultrasound (US) has been widely adopted as the preferred imaging modality for thyroid nodule evaluation, its reliability in distinguishing follicular adenomas from adenocarcinomas based on US features has been a subject of debate. The primary objective of our study was to comprehensively evaluate the efficacy of US-derived intratumoral and peritumoral radiomics in preoperatively differentiating follicular thyroid adenomas from adenocarcinomas, thereby contributing to the ongoing discussion regarding this challenging distinction.

Methods: In total, 195 patients who were pathologically diagnosed with thyroid follicular neoplasm were retrospectively enrolled in this study. Patients were randomly assigned to a training cohort and a test cohort in an 8:2 ratio to develop and evaluate the clinical model, intratumor-region model, peritumor-region model, and combined-region model. Radiomic features from both intratumoral and peritumoral regions were extracted from 2-dimensional (2D) US images, and we used the least absolute shrinkage and selection operator (LASSO) method for constructing the signature within the discovery dataset. Linear regression (LR) model was selected as the foundation for constructing both the radiomics and clinical signature. The prediction performance was evaluated by the area under receiver operating characteristic curve (AUC), sensitivity, and specificity. Decision curve analysis (DCA) was used to assess the clinical applicability of the models. Ultimately, a radiomics-clinical model was developed by integrating clinical information with radiomic features.

Results: A total of 19 radiomics features were selected to develop a radiomics model of intratumoral and peritumoral regions. Compared to the clinical model, the combined radiomics-clinical model showed higher diagnostic accuracy in distinguishing follicular thyroid carcinoma (FTC) in both the training set (AUC: 0.894 vs. 0.553) and the validation set (AUC: 0.884 vs. 0.540). A radiomics-clinical nomogram was constructed, and its clinical usefulness was validated through DCA.

Conclusions: The radiomics-clinical model that combined the intratumoral and peritumoral radiomics with clinical information had a high diagnostic performance for early identifications of FTC.

Background: Cervical lymph node metastasis in papillary thyroid carcinoma plays a crucial role in the development of surgical strategy for thyroid patients. The aim of this study was to determine the predictors of cervical lymph node metastasis based on ultrasound features of papillary thyroid carcinoma, and to develop and validate nomogram to help predict cervical lymph node metastasis.

Methods: Patients who underwent thyroid ultrasound examination in Department of Ultrasonography of The First Affiliated Hospital of Nanjing Medical University between January 1, 2021 and October 31, 2021 were selected. Patients with at least one Thyroid Imaging Reporting and Data System (TI-RADS) class 4 or higher nodule and postoperative pathologically confirmed primary papillary thyroid carcinoma with cervical lymph node metastasis were identified or not, and ultrasound image characteristics of the nodules were recorded to screen for cervical lymph node metastasis predictors. Subsequently, nomogram was developed and validated to help predict cervical lymph node metastasis.

Results: The overall echogenicity of the thyroid gland, the number of malignant nodules, nodule left-right diameter, the location of the nodules, the relationship between the nodules and the thyroid capsule, and the elasticity score of the nodules were considered to be independent predictors of papillary thyroid carcinoma related cervical lymph node metastasis; the model had a good discrimination rate.

Conclusions: We developed a nomogram to predict metastasis in the neck lymph nodes of papillary thyroid carcinoma, and the nomogram showed good performance for prediction aspects.

Background: Since 2017, switching from laparoscopic transabdominal adrenalectomy (LTA), posterior retroperitoneoscopic adrenalectomy (RPA) is used as standard procedure in this institution. Aim of this retrospective study was to compare both techniques regarding operative time, length of stay and safety of the procedures.

Methods: All patients operated in our institution for adrenal tumors were prospectively documented in the EUROCRINE-database and retrospectively analyzed. Sex, age, body mass index (BMI), indication, operative time, conversion and complication rates, hospital stay and tumor-size were analyzed by Z-score, chi-square test, t-test, Mann-Whitney U test and Pearson correlation.

Results: A total of 105 RPAs and 132 LTAs were performed in an 8-year period. No difference was seen in age, sex and tumor localization. Adenoma (n=113) and pheochromocytoma (n=64) were the most common histopathological findings. Compared to the LTA group, the RPA group had significantly shorter operative time with a median of 50 (15-380) vs. 125 (25-420) min (P<0.001) and shorter hospital stay with a median of 3 vs. 9 days (P<0.001). The decrease of the median operative time in RPA group, visualizing the learning curve of the procedure, was from 60 min (2017) to 45 min (2020). Four conversions from RPA to open adrenalectomy had to be performed due to bleeding or adhesions, whereas 9 LTA procedures had to be converted due to bleeding (n=2), unclear anatomy (n=1), adhesions (n=1), difficult access (n=1) or planned conversion (n=4).

Conclusions: RPA could be safely introduced with reduced operative times and shorter length of hospital stay compared to LTA.