Indian Journal of Surgical Oncology最新文献

BETHESDA (Bethesda System for Reporting Thyroid Cytopathology) 3 cytology results of thyroid nodules are indeterminate, making it difficult to make a treatment decision. This study aimed to determine the predictive utility of preoperative hemogram parameters and the BRAF molecular test in predicting malignancy in patients with Bethesda 3 cytology. This study examined patients who received total thyroidectomy/lobectomy as a result of Bethesda 3 cytology. The study patients were categorized into two groups based on the nature of their thyroidectomy pathology, either malignant or benign. Group B refers to benign cases, while Group M refers to malignant cases. The age and gender of all patients included in the study were recorded. The Mean Platelet Volume (MPV), Neutrophil/lymphocyte Ratio (NLR), Platelet/Lymphocyte Ratio (PLR), and Lymphocyte/Monocyte Ratio (LMR) were calculated and documented in their preoperative hemograms. Molecular testing for the BRAF gene was conducted on 21 patients in Group M. This study revealed no statistically significant difference between the two groups regarding preoperative mean platelet volume (MPV) values (p = 0.963). A negative, considerable, and statistically significant association was seen in Group M between the average tumor size and the mean LMR value in patients having FTC (R.p = -0.975-0.005). The mean LMR value of patients with tumor size ≤ 10 mm in Group M was significantly higher than in Group B (p = 0.040). According to the results obtained in our study, LMR elevation in ≤ 10 mm Bethesda 3 cytology may be of limited help to clinicians in making biopsy decisions in the presence of risk criteria specified in the ATA guideline. Since the positivity rate of the BRAFV600E molecular test was determined to be very low, it was concluded that the BRAF v600E molecular test study alone was not sufficient to predict malignancy and was not cost-effective.

To assess the role of contrast enhanced mammography (CEM) as compared to conventional digital mammography (DM) in pre-operative evaluation for multifocal/multicentric breast carcinoma (BC). This prospective study was done on 35 females after obtaining approval from the institute ethics committee. DM and CEM were performed in standard craniocaudal (CC) and mediolateral oblique (MLO) positions and the findings were recorded as per the 5th edition of ACR-BIRADS lexicon. The findings included background parenchymal density and enhancement; presence of mass (size, shape, margin, density, enhancement features); presence of any satellite lesions or additional lesions on DM/CEM and its enhancement characteristics; any non-mass enhancement and associated findings. Sampling of the additional findings was done for equivocal radiology. The mean age was 45 years (26-76 years) and the mean size of index lesion was 3.44 cm (+ / - 1.25 cm) on DM. Presence of intraductal extension was seen in 5 patients (14.3%) on DM, whereas CEM could delineate it in 11 patients (31.4%). In addition, CEM showed better detection rate of multifocal disease (42.9% vs 65.7%), multicentric disease (17.1% vs 31.4%), and synchronous breast lesion (2.9% vs 5.7%). The accuracy and precision of tumour size measurement, multifocality and multicentricity were higher with CEM as compared to DM. Therefore, CEM may be a good alternative modality to assess the multifocality, multicentricity and disease extent in the preoperative setting and for those with limited access or contraindication to MRI.

Cancer diagnostic probe stations (CDP) are expensive, and they are better used in patients with suspicious findings in initial mammography. For the first time, this study investigated the compatibility of suspicious findings observed in mammograms of patients before surgery with CDP findings based on pathology findings as the gold standard. This prospective study was conducted on 26 patients with breast cancer candidates for conservative surgery with suspicious findings in the initial mammography, who were referred to our institute between April 2024 and September 2024. Ultrasound and mammography findings before surgery, frozen findings, CDP during surgery, and pathology results of patients were collected using a checklist. A breast fellowship and a radiologist, with the guidance of the positions and hourly codes of the Quadrants of Breasts, classified the position of suspicious findings in CDP and mammography. The concordance rate between the two methods was evaluated with the Kappa coefficient. Based on mammography findings, 9 (36.4%) suspicious findings were observed in the lateral, 8 (30.8%) in the medial, and 5 (19.2%) in the interior of the breast. These results were confirmed in the CDP findings. Based on the pathology findings, 7 cases of lesions were of invasive type (4 IDC and 3 ILC), while the frozen results were free in all cases. The degree of concordance and correlation between mammography and CDP findings was 96.2%. Mammography findings were almost completely consistent with intraoperative CDP findings. Suppose there are suspicious findings in the mammography of patients who are candidates for conservative breast surgery. In that case, CDP can be used intraoperatively for these slight distortions of the surrounding tumor tissue to reduce recurrence and cost and increase patient survival.

Androgen deprivation therapy (ADT) is the mainstay in the management of metastatic prostate cancer (PCa). There is a concern regarding the cardiovascular effects of ADT. Despite a reported incidence of major adverse cardiac event (MACE) in up to 6%, some Asian studies show no significant change. We aimed to find the cardiovascular effects of ADT in Indian men with PCa. In this prospective cohort study, men who underwent treatment for PCa from January 2022 to January 2023 were included. The ADT arm comprised patients with locally advanced and metastatic PCa who received ADT. The control arm included localized PCa patients who underwent radical prostatectomy without any ADT treatment. The primary outcomes were the incidence of MACE, changes in the Framingham risk score (FRS), ECG, and echocardiography at 1 year. Secondary outcomes were changes in the body mass index (BMI), waist-hip ratio, lipid profile, glycaemic parameters, and ankle brachial pressure index at 1 year. Forty cases and 23 controls were analyzed. There were three (7.5%) MACE in the ADT group at 1 year with no events in the control group. The ADT group had a significant increase in the mean FRS (2.54 ± 4.45 vs 0.67 ± 2.13; p = 0.021), weight (2.83 ± 2.97 vs. 0.94 ± 1.8 kg; p = 0.004), BMI (0.9 ± 1.08 vs. 0.32 ± 0.66 kg/m²; p = 0.016), and HbA1c (0.54 ± 1.64 vs. 0.18 ± 1.08%; p = 0.023) compared to controls. A total of 7.5% of patients who received ADT developed MACE at 1 year. FRS, BMI, and HbA1c increased with ADT. Rigorous follow-up for cardiovascular and metabolic effects is essential in patients who receive ADT.

Hepatoblastoma is a common malignant liver tumor in children with a peak incidence in the first two years. Its previous mortality was reported to be 24%, but refinements in risk stratification, advances in chemotherapy and application of protocol-based therapy, including surgery, have resulted in improving long-term outcomes. We describe our experience of treating children with hepatoblastoma who underwent surgery using the new treatment guidelines between January 2013 and December 2020. During the aforementioned period, 6 patients with hepatoblastoma (4 male and 2 female) were treated in our unit with median age at presentation being 15 (range 6-36) months. One patient was PRETEXT stage I, three were stage II, and two were stage III. All of them received chemotherapy prior to surgical resection as per the SIOPEL-3 and SIOPEL-4 protocols varying between 2 and 4 cycles, following which size reduction in the tumors was noted and the surgical procedures included right hepatectomy in three patients, non-anatomical hepatic resection in one, left lateral hepatectomy in one, and left hepatectomy in one. The mean duration of surgery was 205 (range 115-300) min, and the mean blood loss was 50 (range 20-150) ml. There was no operative mortality, following which all patients then had adjuvant chemotherapy and are now alive with a median follow-up of 40.6 (18-104) months. The management of hepatoblastoma has changed significantly following the incorporation of recent updates from international groups into clinical practice. With the use of risk stratification, preoperative and adjuvant chemotherapy, and surgical excision, the overall and event-free survival has improved, reiterating the value of a multidisciplinary approach toward the treatment of this disease.

Staging of positive axilla that showed negativity after neo-adjuvant chemotherapy is a subject of controversy. In this situation, sentinel node biopsy is debatable due to high false negative rates. This study evaluates the feasibility of axillary targeted surgery after lymph node charcoal tattooing for clinically positive nodes prior to neo-adjuvant chemotherapy. This study included 30 cases of breast cancer with clinically suspicious axillary nodes who were planned for neo-adjuvant chemotherapy. They underwent fine needle biopsy from the suspicious node with simultaneous injection of carbon suspension. After therapy, those who showed negativity on repeat ultrasound had exploration with excision of the tattooed and the sentinel node. Axillary lymph node dissection was performed if any of both was pathologically involved. A total of 30 patients were carbon-labelled before systemic therapy. Twenty-one were included in the final analysis, while 9 patients were excluded. Carbon-tattooed lymph node was in 28/30 patients (93.3%). In patients who had targeted dissection, the charcoaled and sentinel nodes were the same in 19/21 patients (90.4%), and in this group, 15/21 patients had positive targeted dissection, and we proceeded to axillary dissection in 4 patients who showed positive nodes. Targeted LN was not the sentinel node in two patients; in both, all nodes were negative. Carbon tattooing of axillary lymph nodes provides a safe, cheap, and reliable alternative to marker clips without the need for image guidance to locate the marked node which provides an excellent alternative in low-resource countries with the advantage of durable tissue staining.

Newer systemic treatments are driving us towards axillary conservation to reduce morbidity and enhance quality of life without oncological compromise in breast cancer (BC) patients. It is important to identify which patients might benefit from a more conservative approach to the axilla by studying the neoadjuvant chemotherapy (NACT) responses in different subgroups. The aim of the study is to evaluate real-world pathological response rates in breast cancer patients in accordance with latest NACT regimes and also to identify the subsets ideal for axillary de-escalation. This single-centre study at Sri Shankara Cancer Hospital and Research Centre, Bangalore, reviewed a prospectively maintained database from January 2023 to May 2024 including all non-metastatic BC patients undergoing surgery after recommended NACT. A total of 224 patients were included for analysis. Pathological complete response (PCR) was achieved by 31.69% (71/224), with 55.3% (124/224) achieving axillary PCR (APCR) and 35.26% (79/224) achieving breast PCR (BPCR). According to subtypes, 65.11% PCR was observed in Her2 subtype, followed by 44.2% in the triple positive, 24.4% in triple negative and 10% in hormone receptor positive. Among patients with cN0 disease, 91.3% (21/23) had APCR, while 63.2% (91/144) of cN1 patients were down-staged to ypN0 and only 17.9% (7/39) of cN2 down-staged to cN0. Combining the Her2-positive and triple-positive groups, 96.2% (51/53) of patients with BPCR had APCR. Pre NACT clinical nodal stage, ER and Her2 neu status can predict APCR with sensitivity of 74.0% with CI of 95% and specificity of 69.0% with CI of 95%. Our study suggests that HER2-positive and triple-positive patients with cN0 and cN1 converted to cN0 are potential candidates for de-escalation of axillary surgery.

Solitary fibrous tumor (SFT) associated with hypoglycemia is termed Doege-Potter syndrome (DPS). It may be found in almost any site of the body, but most predominantly in the intra-thoracic region, and is a rare differential diagnosis of recurrent hypoglycemia. A 73-year-old, hypertensive, non-diabetic man presented with recurrent hypoglycemic episodes, and examination revealed diminished breath sounds in the right lower lung fields. Investigations demonstrated that the patient had a mass lesion in the right thorax. Excision of the mass lesion produced biopsy samples, and the histopathological examination of the tissue was suggestive of SFT. Patients with recurrent hypoglycemia must always be screened and treated for DPS. SFTs with non-insulin-induced hypoglycemia (NICTH) are likely to be malignant. Early diagnosis and a multidisciplinary approach are pivotal in the management of the disease. Complete surgical excision of the mass lesion is the standard of care for SFTs with DPS.

Immunoglobulin G4-related disease (IgG4-RD) is a systemic fibro-inflammatory condition first recognized in 2001, primarily associated with autoimmune pancreatitis, and later identified in various organ systems. The peculiar tendency to form tumefactive lesions mimics infiltrative malignancy, leading to misdiagnosis and inappropriate treatment. Involvement of the urinary tract and its presentation to urologists remain uncommon, with only a limited number of published case reports. We report our experience with IgG4-RD, elucidating the clinical presentations, diagnostic dilemmas, and subsequent management of four patients. Each case was initially presented as a diagnostic challenge, necessitating multidisciplinary discussion. Presentations included renal pelvic masses (unilateral and bilateral), a suprarenal mass, and a retroperitoneal mass causing bilateral hydroureteronephrosis. In all cases, initial imaging raised the suspicion of malignancy, prompting aggressive surgical interventions, including nephroureterectomy, nephrectomy, and partial nephrectomy. Subsequent histopathological evaluation confirmed the diagnosis of IgG4-related disease. IgG4-RD in the urinary tract is uncommon often mimicking malignancy. Early suspicion and minimally invasive biopsy for accurate tissue diagnosis, along with multidisciplinary evaluation, is crucial for diagnosing IgG4-related disease involving the urinary tract and avoiding unnecessary extirpative surgery.