Gland surgery最新文献

Background: Adenoid cystic carcinoma of the breast (ADCC) is a rare histologic subtype of breast cancer. Currently, there are no universally accepted guidelines for the treatment of ADCC. This study aimed to evaluate the association between adjuvant radiotherapy (RT) and the survival outcomes, including overall survival (OS) and breast cancer-specific survival (BCSS), of patients with non-metastatic (M0) ADCC following breast-conserving therapy (BCT).

Methods: We identified patients diagnosed with breast ADCC between 2000 and 2021 using the Surveillance, Epidemiology, and End Results (SEER) database. The inclusion criteria were as follows: (I) an International Classification of Diseases for Oncology-3 histology code of 8200/3; (II) complete clinicopathological data; (III) diagnosis at the M0 stage; (IV) documented tumor size; and (V) recorded details of the surgical approach. The exclusion criteria included a lack of surgical treatment, an unknown surgical status, diagnosis at the distant metastasis (M1) or unknown metastasis status (Mx) stage, and/or an unknown tumor size. The following prognostic variables were evaluated: age, race, tumor size, nodal status, type of surgery, and receptor status [estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2)]. Follow-up adhered to the SEER protocols with a focus on OS and BCSS. Kaplan-Meier analysis and multivariable Cox proportional hazards models were used to compare the RT and non-RT groups, adjusting for clinicopathological covariates.

Results: A total of 716 patients with ADCC were included in the study, of whom, 350 (48.9%) received RT and 366 (51.1%) did not receive RT. There were no significant differences between the two groups in terms of age, sex, race, primary tumor (T) stage, nodal status, and chemotherapy (CT) (all P>0.05). Overall, the patients who received RT showed significantly improved OS compared to those who did not receive RT (P=0.002). Subgroup analyses revealed that RT was associated with improved OS in patients undergoing BCT (P=0.001), particularly in those with tumors >10 mm (P=0.002), but not in those with tumors ≤10 mm (P=0.22) or those treated with mastectomy (P=0.75). No significant RT benefit was observed in terms of BCSS in the overall cohort (P=0.10).

Conclusions: Adjuvant RT did not improve the OS and BCSS of the M0 ADCC patients with tumors ≤10 mm who had undergone BCT. Therefore, adjuvant RT may not be necessary for M0 ADCC patients with tumors ≤10 mm who have undergone BCT.

Background: The profunda artery perforator (PAP) flap is a versatile autologous tissue option for breast reconstruction, offering a secondary option when the traditional abdominal-based flaps are not available. This study aims to systematically evaluate the use of the PAP flap in autologous breast reconstruction (ABR) by analyzing patient characteristics, flap parameters, surgical outcomes, and patient-reported satisfaction.

Methods: We conducted a systematic review of databases for studies the use of the PAP flap within ABR, namely, measures of patient characteristics, flap profile, surgical measures, and surgical/satisfaction outcomes. We excluded cadaveric, non-breast, and secondary research studies.

Results: A total of 30 studies were included in our systematic review. Mean pooled values and (standard deviations) reported in the studies were as follows: age of patients was 48.16 (3.51) years; body mass index (BMI) was 24.20 (1.87) kg/m²; PAP pedicle length was 9.87 (1.14) cm; flap weight was 311.93 (61.51) g; number of perforators per flap was 1.60 (0.15); ischemia time was 53.71 (8.96) min; operative time was 389.89 (99.21) min; and length of stay was 3.42 (3.67) days. Mean pooled rates and standard deviations reported in the included studies were as follows: donor site complication rate was 14.89% (9.94%); flap complication rate was 11.63% (9.75%); unplanned return to operating room (OR) rate was 6.17% (6.31%); and total flap loss/failure rate was 1.61% (1.52%). BREAST-Q results were provided by three studies and were also analyzed. Subgroup analysis of transverse PAP (tPAP; 14 studies) versus vertical PAP (vPAP; 8 studies) yielded a non-inferiority of the vPAP in all measured results. However, rare complications, such as compartment syndrome and lymphedema, were only reported in studies examining non-traditional, extended PAP flaps.

Conclusions: The PAP flap is a well-studied, continually refined option for ABR. Its use is dependent on surgeon experience and patient profile. The classic tPAP and newer vPAP display similar outcomes and can be utilized on an individualized, case-by-case basis. Relatively novel PAP flap variants, such as extended and fleur-de-PAP, require further study before they can be recommended as possible options in ABR.

Background: The use of acellular dermal matrix (ADM) in prepectoral implant-based breast reconstruction has become increasingly widespread, aiming to enhance prosthetic support, reduce capsular contracture, and improve aesthetic outcomes. However, ADM remains a subject of debate due to its elevated cost and concerns regarding surgical morbidity. Current evidence is largely derived from retrospective, non-randomized studies, which limits the overall strength of available data. This study aims to clarify its clinical utility by conducting a meta-analysis of postoperative complications and a systematic review.

Methods: A systematic review was conducted according to PRISMA guidelines, including observational studies comparing outcomes of prepectoral reconstruction with and without ADM. Postoperative complications were analyzed using risk ratios (RRs) with 95% confidence intervals (CIs). A random-effects model was used for outcomes with substantial heterogeneity (I²>50%); otherwise, a fixed-effect model was applied.

Results: Nine studies involving 1,455 patients met inclusion criteria. No statistically significant differences were found in most complications: reoperation (RR: 1.02; 95% CI: 0.52-1.98; P=0.91), capsular contracture (RR: 0.72; 95% CI: 0.19-2.75; P=0.49), dehiscence (RR: 0.97; 95% CI: 0.40-2.35; P=0.93), hematoma (RR: 0.98; 95% CI: 0.29-3.28; P=0.96), implant removal (RR: 0.74; 95% CI: 0.46-1.20; P=0.16), infection (RR: 0.73; 95% CI: 0.51-1.05; P=0.07), necrosis (RR: 1.27; 95% CI: 0.64-2.53; P=0.41), rippling (RR: 0.54; 95% CI: 0.01-37.58; P=0.59), and seroma (RR: 0.81; 95% CI: 0.65-1.02; P=0.07). However, a subgroup analysis by reconstructive technique revealed notably higher rates of seroma (14.04% vs. 4.26%) and infection (12.62% vs. 0.74%) in tissue expander (TE)-based reconstruction compared to direct-to-implant (DTI) procedures.

Conclusions: Prepectoral reconstruction with and without ADM shows similar complication rates. While ADM may offer structural and aesthetic benefits in selected patients, it also increases costs and may carry added risk. Because all included studies were retrospective and non-randomized, the level of evidence remains limited. These findings highlight the need for future prospective randomized trials to better define the role of ADM in clinical practice.

Background: Primary thyroid leiomyosarcoma (TLS) is an exceptionally rare malignant tumor, with fewer than 50 cases reported in the literature worldwide. In this case, the thyroid lesion was initially misdiagnosed as a benign nodule based on ultrasound and fine-needle aspiration (FNA), and treated with microwave ablation. However, the mass continued to enlarge.

Case description: A 69-year-old female patient was re-evaluated due to progressive enlargement of the thyroid lesion. Core needle biopsy revealed a spindle cell neoplasm. Immunohistochemistry showed positivity for smooth muscle actin (SMA), desmin, calponin, and p53. Given the presence of airway compression symptoms and the patient's strong desire for surgery, the clinical team developed an active surgical plan and performed resection of the thyroid and involved adjacent tissues to relieve local compression and control disease progression. Postoperative histopathological examination confirmed high-grade TLS, with evidence of invasion into the recurrent laryngeal nerve and internal jugular vein. High-throughput sequencing identified coexisting mutations in neurofibromin 1 (NF1) and BCL6 corepressor like 1 (BCORL1), along with alterations in tumor protein p53 (TP53) and the telomerase reverse transcriptase (TERT) promoter region. Two months after R0 resection, the patient developed cervical recurrence and distant metastases involving the lungs, liver, bones, and mediastinum. In May 2025, the patient initiated intravenous chemotherapy consisting of pegylated liposomal doxorubicin and ifosfamide. The treatment response is currently being monitored during follow-up.

Conclusions: When TLS initially presents with benign-appearing ultrasound and FNA findings, misdiagnosis may easily occur. This case highlights the importance of early integration of histopathological and molecular evaluation for progressive thyroid lesions. The co-occurrence of NF1 and BCORL1 mutations, along with TP53 and TERT promoter alterations, may underlie the tumor's aggressive biological behavior and supports the incorporation of molecular subtyping strategies in TLS management.

Background: The preoperative differential diagnosis of follicular thyroid neoplasms remains a major challenge in clinical practice. This study aimed to analyze the differences in ultrasonic characteristics between follicular thyroid carcinoma (FTC) and follicular thyroid adenoma (FTA), and establish a ultrasound-based risk stratification system (RSS) for follicular thyroid neoplasms.

Methods: This was a retrospective multi-center study. Data from patients who underwent surgical treatment and were definitively diagnosed with FTC or FTA based on postoperative pathology at each center between 2017 and 2024 were included. The subjects were randomly divided into a training set and a validation set at a ratio of 8:2. In the training cohort, an RSS tailored for follicular neoplasms (termed predictive score for follicular tumors, F-Score) was developed based on the multivariate logistic regression analysis. The diagnostic performance of the F-Score was subsequently assessed in the validation cohort, and compared with the commonly used Thyroid Imaging Reporting and Data Systems (TIRADSs).

Results: A total of 448 patients were included in this study. Multivariate logistic regression analysis showed that hypo/markedly hypoechoic, calcifications (any type), ill-defined/irregular margins, uneven/absent halo, and heterogeneous echotexture were independent risk factors for FTC (all P values <0.05). In the training set and the validation set, the area under the curve (AUC) of the F-Score for differentiating follicular neoplasms was 0.878 [95% confidence interval (CI): 0.842-0.914] and 0.871 (95% CI: 0.789-0.930), respectively. In both cohorts, the AUCs of F-Score were significantly higher than that of the TIRADS published by the American College of Radiology and the Chinese TIRADS (both P<0.01). Additionally, it performed significantly better than the follicular TIRADS (P=0.03) in the validation set.

Conclusions: The ultrasound-based RSS can effectively differentiate between FTC and FTA, providing an excellent approach for the preoperative diagnosis of follicular thyroid neoplasms.

The options for post-mastectomy breast reconstruction have increased considerably over the past 50 years and depend on the resultant disfigurement from surgery and or radiotherapy. Radical and modified radical mastectomy were considered the acceptable treatment for breast cancer until the mid-1970's and would often be followed with post-mastectomy radiotherapy. This presented a major challenge for reconstructive surgeons because of limited surgical options, but as the approach to the management of breast cancer became less aggressive and a therapeutic dose of radiotherapy was fractionated the reconstructive ladder expanded. Where post-mastectomy skin flaps were healthy and radiotherapy was not planned, the introduction of breast implants and saline-filled expanders enabled less traumatic immediate, delayed and revisional reconstructions. Controversies continue to follow the history of implantable breast implants, but polyurethane covered implants have a historically proven advantage over silicone shelled implants, with a significant reduction in the rate of capsular contracture. An understanding of the axial vascular supply of local and regional flaps, and the vascular territories of free flaps, dramatically improved the opportunity to more closely restore breast shape and form using composites of healthy tissue. The technique for harvesting of autologous fat graft and the appropriate use of acellular dermal matrix products has further improved the outcomes. Contemporary breast cancer management has become an inter- and multi-disciplinary specialty, and reconstructive outcomes will more likely result in remarkable symmetry of size, shape and volume of the breast reconstruction. This paper describes the chronology and variety of options that became available to selected breast cancer patients for reconstruction in the United Kingdom over the course of 50 years.

Background: Previous studies have confirmed that the higher axillary lymph node metastasis rate, the worse the prognosis. This study aimed to determine the key factors associated with axillary lymph node metastasis and prognosis of T2 breast cancer, which ultimately provides a scientific basis for precise risk stratification, optimized treatment decision-making, and improved prognosis in T2 patients.

Methods: Multivariate logistic regression was used to explore the influencing factors of axillary lymph node metastasis in patients with T2 breast cancer. Univariate and multivariate Cox regression were used to explore the prognostic factors of T2 breast cancer patients, and the nomogram was used to predict the survival probability of patients. Kaplan-Meier survival curve was used to analyze the influence of influencing factors on survival.

Results: A total of 150,730 patients with T2 breast cancer were included in this study. Age ≥65 years old, and other races were protective factors for axillary lymph node metastasis, while black race, infiltrating cancer, estrogen receptor (ER)-positive, progesterone receptor (PR)-positive, luminal B subtype, human epidermal growth factor receptor-2 (HER2)-positive subtype, and triple-negative subtype were risk factors. Other race, married, right primary site, chemotherapy, ER-positive, PR-positive, HER2-positive subtype, and triple-negative subtype were protective factors for overall survival (OS) of patients with T2 breast cancer, while age ≥65 years old, black race, other marital status, stage II, stage III, axillary lymph node metastasis, and luminal B subtype were risk factors for OS of patients with T2 breast cancer. The same results were also found in the breast cancer-specific survival (BCSS) of patients with T2 breast cancer. The nomogram constructed based on these factors affecting OS and BCSS can be used as a tool to predict OS and BCSS for T2 breast cancer.

Conclusions: Black race, infiltrating cancer, ER-positive, PR-positive, luminal B subtype, HER2-positive subtype, and triple-negative subtype were independent risk factors for axillary lymph node metastasis. Old age, black race, other marital status, stage II, stage III, axillary lymph node metastasis, and luminal B subtype were risk factors for the prognosis of patients with T2 breast cancer.

Background: Breast cancer (BC) is the most prevalent malignancy among women worldwide. The development of accurate and noninvasive diagnostic methods is essential to reduce unnecessary biopsies and surgeries. This study aims to develop a dual-modal deep learning (DL) radiomics model based on B-mode ultrasound (BUS) and contrast-enhanced ultrasound (CEUS) images. The model is designed to assist radiologists in accurately differentiating benign from malignant breast lesions.

Methods: This retrospective multicenter study included 427 female patients with breast lesions from four hospitals. Traditional radiomics models were constructed using logistic regression (LR). DL radiomics models were built on a VGG-16 network pretrained on ImageNet. An integrated model was developed through early feature fusion of BUS and CEUS features. Model interpretability was assessed with Shapley Additive exPlanations (SHAP) and heatmaps generated by gradient-weighted class activation mapping (Grad-CAM). In a two-round reader study, the integrated model provided radiologists with artificial intelligence (AI) scores and heatmaps to support diagnosis. Model performance was evaluated using the area under the curve (AUC) and decision curve analysis (DCA).

Results: In the testing cohort, the integrated model achieved the highest performance, with an AUC of 0.825 [95% confidence interval (CI): 0.744-0.907]. SHAP analysis revealed that, compared with BUS features, CEUS features had a greater impact on the model's diagnostic performance. In the first round, the integrated model outperformed all the radiologists (model AUC: 0.825 vs. radiologists' AUCs: 0.701-0.824). In the second round, radiologists assisted by the integrated model demonstrated improved performance. Their AUCs ranged from 0.748 to 0.869, with ΔAUCs ranging from +0.030 to +0.058. Four radiologists outperformed the model itself.

Conclusions: The integrated model provides an effective and noninvasive approach for predicting the benignity or malignancy of breast lesions. It has a strong potential to serve as a valuable clinical tool for improving radiologists' diagnostic performance.

[This corrects the article DOI: 10.21037/gs-2025-149.].

Background: Surgical resection for benign parotid gland tumors is associated with high complication rates, and thus there is in acute need for minimally invasive alternatives. This study aimed to examine the feasibility, safety, and efficacy of ultrasound-guided microwave ablation (MWA) for benign parotid gland tumors.

Methods: A retrospective multicenter study was conducted on 13 consecutive patients clinically diagnosed with parotid gland mass and suspected parotid gland tumors from July 2013 to June 2018. All patients underwent core needle biopsy, and parotid gland tumors considered benign based on the biopsy results were treated with ultrasound-guided MWA. The ablated area of the parotid gland was evaluated through dynamic ultrasound imaging, and complications related to needle biopsy and ablative treatment were followed up, with a follow-up ultrasound performed in the third month after MWA.

Results: A total of 13 parotid gland tumors underwent core needle biopsy over 5 years. Of these, 12 were benign tumors, including six pleomorphic adenomas, four Warthin's tumors, one dermoid cyst, and one lymphoid nodular hyperplasia, all treated with MWA. Patient age ranged from 10 to 79 years (median, 60.5 years), with tumor diameters ranging from 17.8 to 49 mm (median, 26.15 mm). MWA was performed for 70-598 s (median, 155 s), with complete absorption occurring in 8-37 months (median, 23.5 months). No residual tumors or serious complications were observed after ablation.

Conclusions: Ultrasound-guided MWA can serve as a minimally invasive alternative to open surgery for the treatment of benign parotid gland tumors and involves only limited side effects and minor complications.