Gland surgery最新文献

Background: Precise identification of papillary thyroid carcinoma (PTC) is crucial in clinical practice to prevent unnecessary treatment. This research aimed to combine metabolic function parameters and inflammatory markers to establish a multimodal diagnostic model using the Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) for enhancing risk evaluation and improving clinical decision-making for PTC.

Methods: A total of 314 patients with thyroid nodules were retrospectively enrolled, consisting of 193 cases of PTC and 121 cases of benign thyroid nodules (BTNs). These participants were randomly divided into a training set with 222 cases and a validation set with 92 cases at a ratio of 7:3. Univariate analysis and multivariate logistic regression were utilized to identify independent predictors for PTC diagnosis, leading to the creation of prediction models, including both baseline models and an integrated model. The discriminative ability of the integrated model was assessed using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Subsequently, the diagnostic performance of the integrated model was compared with that of the baseline model. The calibration of the integrated model was evaluated using calibration curves in combination with the Hosmer-Lemeshow test.

Results: Multivariate logistic regression identified C-TIRADS high-risk classification, body mass index (BMI), thyroid stimulating hormone (TSH), lymphocyte-to-monocyte ratio (LMR), age, and thyroglobulin (Tg) as independent predictors of PTC diagnosis. The integrated model exhibited significantly higher diagnostic efficiency compared to the baseline model in the training set (AUC: 0.903 vs. 0.827, 0.878, 0.874, P<0.05). However, there was no statistically significant difference between the model and the baseline model in the validation set (AUC: 0.845 vs. 0.816, 0.837, 0.829, P>0.05). The calibration curve demonstrated a high level of consistency between the predicted probability of the integrated model and the actual risk probability (Hosmer-Lemeshow test P>0.05).

Conclusions: The integrated model based on C-TIRADS classification combined with metabolic function parameters and inflammatory indicators has good efficacy in risk assessment of PTC, and can provide an objective quantitative tool for individual diagnostic evaluation and treatment decisions.

Background: Ductal carcinoma in situ (DCIS) cases diagnosed by ultrasound-guided core needle biopsy (US-CNB) carry a risk of postoperative upstaging to invasive breast carcinoma, complicating clinical management. This study aimed to investigate clinicopathological and ultrasound (US) predictors for postoperative upstaging and to develop a nomogram for individualized risk prediction.

Methods: A total of 240 patients with 246 DCIS lesions diagnosed by US-CNB were enrolled in this retrospective study from May 2013 to January 2025. Clinicopathological and US features were compared using the Student's t-test for continuous variables and the Chi-squared or Fisher's exact test for categorical variables. Multivariate logistic regression identified predictors of upstaging to DCIS with invasive components (DCIS-IC). A nomogram was developed and internally validated. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC-ROC) with 1,000 bootstrap replicates. Calibration was evaluated through calibration curves and the Hosmer-Lemeshow (H-L) test, and clinical utility was examined using decision curve analysis (DCA).

Results: Among all the lesions, 161 (65.4%) were diagnosed as pure DCIS, while 85 (34.6%) were upstaged to DCIS-IC, including 37 (15.0% of total) with microinvasive carcinoma. Age [per 1-year increase, odds ratio (OR) =1.04; 95% confidence interval (CI): 1.01-1.06; P=0.01], Ki-67 >20% (OR =2.56; 95% CI: 1.35-4.86; P=0.004), and suspicious axillary lymph node (ALN) on US (OR =3.00; 95% CI: 1.07-8.45; P=0.04) were independent predictors of postoperative upstaging to DCIS-IC. The nomogram showed moderate discrimination with an apparent area under the curve (AUC) of 0.72 (95% CI: 0.65-0.78), which was internally validated as 0.70 (95% CI: 0.66-0.72) using 1,000 bootstrap replicates. It demonstrated good calibration (H-L test, P=0.86). The DCA showed that the nomogram provided net benefit across a threshold probability range of 20% to 88% compared to default strategies. Although larger tumor size (>1 cm; P=0.02) and non-circumscribed mass margins (P=0.03) were associated with upstaging in univariate analysis, they were not retained as independent predictors in the multivariate model.

Conclusions: The nomogram incorporating age, Ki-67, and suspicious ALN on US effectively predicts DCIS upstaging risk in cases diagnosed by US-CNB and may assist in clinical decision-making. US characteristics (size >1 cm, non-circumscribed mass margins) may provide supplementary information but require further validation.

Background and objective: Venous thromboembolism (VTE) remains a leading cause of preventable morbidity and mortality in surgical patients, with individuals undergoing abdominal-based free flap breast reconstruction representing a particularly high-risk group. Despite the widespread use of risk assessment tools such as the Caprini Risk Assessment Model (RAM), prophylaxis strategies remain inconsistent across institutions. This literature review aims to synthesize current literature on VTE incidence, risk stratification, and chemoprophylaxis in abdominal-based free flap breast reconstruction to identify best practices and areas for future research.

Methods: A narrative review of the literature was performed, focusing on studies evaluating VTE incidence, prevention strategies, and outcomes in patients undergoing abdominal-based autologous breast reconstruction. Emphasis was placed on risk stratification models, pharmacologic and mechanical prophylaxis, and the timing, dosing, and duration of anticoagulation regimens.

Key content and findings: Validated tools such as the Caprini RAM effectively stratify surgical patients by VTE risk; however, specific recommendations for abdominal-based reconstruction are lacking. Extended-duration prophylaxis appears beneficial in high-risk patients, with recent studies supporting preoperative initiation. Despite concerns about flap loss or hematoma, evidence suggests that appropriately dosed chemoprophylaxis does not significantly increase complications. Oral agents like apixaban show promise for improving adherence without increased bleeding risk. The majority of VTE events occur after discharge, supporting the rationale for outpatient prophylaxis. Future directions include machine learning-enhanced risk prediction and multicenter trials to standardize prophylaxis.

Conclusions: Patients undergoing abdominal-based breast reconstruction face substantial VTE risk, and tailored chemoprophylaxis is essential. While current evidence supports individualized risk-based strategies, practice variability underscores the need for a standardized chemoprophylaxis algorithm. Future prospective studies are critical to establish optimal prophylaxis regimens, timing, and duration in this high-risk surgical population.

The success of pancreaticojejunostomy (PJ) critically depends on achieving optimal pancreatic juice drainage. Clinical evidence demonstrates that internal stent placement is highly safe and effective in reducing postoperative complications associated with PJ. However, recent clinical observations have raised concerns regarding potential complications following pancreatic duct stent placement, including intestinal wall perforation caused by the stent. This study aims to describe the design and step-by-step use of a bulb-tipped internal pancreatic duct stent during PJ and to report short-term postoperative outcomes in a consecutive single center series (January 2021-January 2023). The clinical data of 33 patients who underwent PJ with the improved tube from January 2021 to January 2023 were reviewed. General information (gender, age, underlying disease), operation-related information (intraoperative blood loss, postoperative complications, postoperative hospital stay, prognosis) and postoperative diagnosis were retrospectively analyzed. All patients, with a median age of 60 (range, 46-75) years, 18 males and 15 females, underwent PJ successfully, and the improved duct stent was successfully placed during the operation. The median intraoperative blood loss was 100 (range, 50-700) mL. Postoperative complications were observed in 16 patients (48.5%). Among them, a total of 5 patients (15.2%) experienced Grade B/C postoperative pancreatic fistula (POPF). The specific types of complications were as follows: Grade A POPF (n=11, accounting for 33.3%), Grade B POPF [n=4, accounting for 12.1%; among which there were 3 cases of delayed gastric emptying (DGE) and 1 case of surgical site infection], and Grade C POPF (n=1, accounting for 3.0%). Notably, no stent-related complications occurred (0%; 95% confidence interval: 0.0-10.6%). The median postoperative hospitalization was 15 (range, 12-38) days. Among the 31 patients (93.9%) who completed the 3-month follow-up, two cases (6.1%) were lost to follow-up. Preliminary findings suggest that the optimized pancreatic duct stent exhibits favorable early-stage safety in current clinical applications. No stent-related complications were detected within this cohort. As further research progresses, this improved medical device holds promise for demonstrating broader clinical utility and substantial potential in enhancing patient treatment efficacy.

Background: Varying patterns of angiogenesis are observed across molecular subtypes of breast cancer (BC). This study aimed to develop and validate machine learning (ML) models for identifying molecular subtypes of BC using contrast-enhanced ultrasound (CEUS) and superb microvascular imaging (SMI).

Methods: In this prospective study, 191 BC patients with 193 lesions were enrolled. Clinical data, CEUS parameters, and SMI features were collected; recursive feature elimination was applied for feature selection. Random forest (RF), support vector machine (SVM), and logistic regression (LR) were trained to distinguish molecular subtypes, and their diagnostic performances were compared. Model interpretability was achieved using SHapley Additive exPlanations (SHAP).

Results: BC lesions were randomly assigned to training (n=135) and test (n=58) cohorts in a 7:3 ratio. Fivefold cross-validation with five repetitions was utilized for hyperparameter tuning. SVM effectively distinguished luminal subtypes, achieving area under the curves (AUCs) of 0.955 [95% confidence interval (CI): 0.914-0.996] for training and 0.874 (95% CI: 0.769-0.979) for testing. RF outperformed other models for human epidermal growth factor receptor 2 (HER2)-overexpressed subtype, with AUC of 0.944 (95% CI: 0.902-0.986) and 0.872 (95% CI: 0.768-0.975) in training and test cohorts, respectively. LR excelled in differentiating triple-negative breast cancer (TNBC), yielding AUC of 0.846 (95% CI: 0.758-0.933) and 0.824 (95% CI: 0.704-0.943).

Conclusions: Incorporating CEUS and SMI features into an ML approach may enhance the diagnostic capacity for distinguishing molecular subtypes of BC.

Background: Thyroid cancer (THCA) is a rapidly increasing endocrine malignancy. This study aims to explore alkaline phosphatase (ALPL) as a potential prognostic biomarker and therapeutic target, focusing on its role in tumor progression and immune infiltration.

Methods: We utilized RNA sequencing (RNA-Seq) data from The Cancer Genome Atlas (TCGA) to investigate the role of ALPL in THCA. Comprehensive analyses included differential gene expression, survival outcomes, immune cell infiltration, and RNA methylation correlations. Functional assays such as cell counting kit-8, colony formation, Transwell migration/invasion, 5-ethynyl-2'-deoxyuridine (EdU) staining, and flow cytometry were conducted to evaluate the effects of ALPL knockdown in THCA cell lines. At the same time, we constructed a nomogram.

Results: Our study identified ALPL as a key biomarker in THCA through TCGA analysis. The expression of ALPL was significantly elevated in tumor tissues and correlated with worse overall survival (OS). Moreover, we verified the expression of ALPL in patients with THCA. Functional assays showed that ALPL knockdown inhibited proliferation by 40-50%, reduced migration and invasion by 35-45%, and diminished clonogenic potential. Flow cytometry revealed a 2-fold increase in apoptosis. ALPL was also linked to immune infiltration, RNA methylation, and vascular endothelial growth factor (VEGF)/calcium signaling pathways, highlighting its role in tumor progression and potential as a therapeutic target. The nomogram that we constructed showed high value in predicting prognosis.

Conclusions: ALPL is a key biomarker in THCA, driving tumor progression and poor outcomes through its roles in proliferation, invasion, and immune modulation. These findings support its potential as a diagnostic and prognostic marker.

Background: Currently, the incidence of ductal carcinoma in situ (DCIS) is gradually increasing. Considering its overall favorable prognosis, some studies have explored exempting patients from surgery for potentially low-risk patients. This retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database investigates whether omitting surgery and administering only local radiotherapy (RT) affects the prognosis of patients.

Methods: A total of 2,363 patients with DCIS who did not receive surgery were identified from the SEER database. Propensity score matching (PSM) and Kaplan-Meier method were applied to analyze the impact of RT alone. Cox regression analyses and competitive risk models were used to examine factors related to the progression of DCIS to invasive cancer.

Results: After PSM, there were 194 patients in each of the RT and non-RT groups. Overall survival (OS) at 10 years (93.17% RT vs. 78.09% non-RT, P=0.001), breast cancer-specific survival (BCSS) at 10 years (99.45% RT vs. 90.50% non-RT, P<0.001), and invasive breast cancer progression (iBCP) at 10 years (4.23% RT vs. 13.35% non-RT, P<0.001) were statistically different between the two groups. Specific characteristics like upper outer quadrant location, certain histological types, and hormone receptor-positive status, were associated with survival benefits from RT alone.

Conclusions: Based on the study of the SEER database, we found that RT alone can effectively improve patient outcomes, with a relatively low 10-year iBCP rate. Factors such as histological type, tumor size, histological grade, and hormone receptor status can influence the survival benefits and risk of RT alone for invasive breast cancer.

Background: Chyle leakage, a rare but serious complication of neck lymph node dissection, occurs in 2-8% of cases and can lead to severe outcomes such as electrolyte imbalances and infection. The 2022 Chinese expert consensus on the prevention and treatment of chyle leakage after neck dissection for thyroid cancer aimed to standardize management. This study evaluated the consensus's impact on chyle leakage incidence and management in patients undergoing lateral neck lymph node dissection for papillary thyroid carcinoma (PTC).

Methods: This retrospective study analyzed 360 patients who underwent lateral neck lymph node dissection for PTC between May 2020 and December 2023. Patients were divided into pre-consensus (n=231) and post-consensus (n=129) groups. The post-consensus group received standardized preventive measures, including meticulous ligation, local adhesives, and intraoperative techniques. Data on baseline characteristics, chyle leakage incidence, and treatment outcomes were compared. Statistical analyses were performed using SPSS version 27, with a P value <0.05 considered significant.

Results: The overall chyle leakage rate was 4.8% (20/399 dissections), with a significant reduction in the post-consensus group (1.6% vs. 7.8%, P=0.01). Left-sided dissections were associated with a higher incidence of chyle leakage (80.0% vs. 20.0%, P=0.01). Conservative management, including continuous drainage, local compression, and fat-free diets, was successful in 80% of cases. Surgical intervention was required in 4 cases, all from the pre-consensus group. The use of local adhesives, introduced post-consensus, demonstrated efficacy in reducing drainage volume.

Conclusions: The implementation of the Chinese expert consensus significantly reduced the incidence of chyle leakage in patients undergoing lateral neck lymph node dissection for PTC. Systematic prevention and management strategies, including standardized surgical techniques and conservative treatments, are crucial in minimizing this complication. Further multicenter prospective studies are warranted to validate these findings and refine consensus recommendations.

Background: Papillary thyroid carcinoma (PTC) generally has a favorable prognosis; however, recurrence occurs in up to 30% of cases following initial management. Re-recurrence presents additional clinical challenges, making it crucial to distinguish between persistent disease and true recurrence in order to optimize management strategies and improve patient outcomes. Despite its significance, studies focusing on the risk factors for re-recurrence in PTC are limited. This study aimed to identify the risk factors for re-recurrence in PTC patients who underwent total thyroidectomy and central neck dissection, with or without lateral neck dissection, as the initial operation.

Methods: A retrospective review was conducted on the medical records of 158 PTC patients who underwent reoperation for recurrence at a single institution between February 2006 and October 2020. Predictive factors for re-recurrence were identified using Cox proportional hazards models and Kaplan-Meier survival analyses.

Results: During a median follow-up of 101.3 months after reoperation, re-recurrence occurred in 27 (17.1%) patients. Univariate analysis revealed that initial T4 stage (P=0.006), initial lymph node ratio >0.7 (P=0.049), and unstimulated thyroglobulin (Tg) ≥1 ng/mL (P=0.02) were significantly associated with worse recurrence-free survival after reoperation. In multivariate analysis, T4a stage [vs. T1-T3b; hazard ratio (HR), 2.782; 95% confidence interval (CI): 1.201-6.447; P=0.02] and unstimulated maximal Tg ≥1 ng/mL after reoperation (vs. <1 ng/mL; HR, 2.427; 95% CI: 1.054-5.588; P=0.04) were strong predictors of re-recurrence.

Conclusions: Short-term follow-up with appropriate imaging modalities is necessary for patients with T4a stage disease and for those who had elevated Tg levels after the first reoperation due to PTC.