Surgery open science最新文献_第3页

Clinical and financial outcomes associated with gastrointestinal complications among patients with type B aortic dissection B型主动脉夹层患者胃肠道并发症的临床和经济预后

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2025-10-23 DOI: 10.1016/j.sopen.2025.10.006

Troy N. Coaston MSCR , Amulya Vadlakonda MD , Esteban Aguayo MD , Zihan Gao MHSc , Syed Shaheer Ali , Oh Jin Kwon MD , Peyman Benharash MD

Background

Gastrointestinal complications (GIC) are an uncommon but serious sequelae of type B aortic dissection (TBAD), potentially contributing to increased mortality and healthcare resource utilization. Limited studies have characterized these complications among TBAD patients. The present work sought to evaluate the clinical and financial implications of GIC and identifies factors associated with their development.

Methods

All hospitalizations entailing a primary diagnosis of TBAD were identified in the 2016–2020 Nationwide Readmissions Database. Patients were stratified into those who developed GIC and those who did not. Outcomes included in-hospital mortality, length of stay (LOS), hospitalization costs, and the need for abdominal surgery. Multivariable logistic and linear regressions were employed to assess associations between patient, facility, and treatment factors with clinical and financial outcomes.

Results

Of 24,927 TBAD hospitalizations, 2.5 % developed GIC, and 24.0 % of these cases required an abdominal procedure. Patients with GIC were younger (median 61 vs. 67 years; p < 0.001), more commonly male (67.4 vs. 56.6 %; p < 0.001), and more likely to have Medicaid insurance (20.9 vs. 12.5 %; p < 0.001). GIC were independently associated with increased odds of in-hospital mortality (adjusted odds ratio 4.54; 95 % CI 3.41–6.04), greater LOS (β 5.80 days; 95 % CI 3.88–7.72), and increased costs (β $41,000; 95 % CI $31000–51,000).

Conclusions

GIC in TBAD patients was associated with substantial clinical and financial burdens. Further study of early identification and targeted interventions is warranted to mitigate these complications and optimize resource utilization in this high-risk population.

背景：胃肠道并发症（GIC）是B型主动脉夹层（TBAD）的一种罕见但严重的后遗症，可能导致死亡率和医疗资源利用率的增加。有限的研究描述了TBAD患者的这些并发症。目前的工作旨在评估GIC的临床和财务影响，并确定与其发展相关的因素。方法在2016-2020年全国再入院数据库中确定所有初步诊断为TBAD的住院病例。患者被分为有GIC的和没有GIC的两组。结果包括住院死亡率、住院时间（LOS）、住院费用和腹部手术的需要。采用多变量逻辑回归和线性回归来评估患者、设施和治疗因素与临床和财务结果之间的关系。结果在24,927例TBAD住院患者中，2.5%发展为GIC，其中24.0%需要腹部手术。GIC患者更年轻（中位年龄61岁vs. 67岁；p < 0.001），更常见的是男性（67.4% vs. 56.6%; p < 0.001），更有可能拥有医疗补助保险（20.9% vs. 12.5%; p < 0.001）。GIC与住院死亡率增加的几率（校正优势比4.54;95% CI 3.41-6.04）、更大的LOS （β 5.80天；95% CI 3.88-7.72）和成本增加（β 41,000美元；95% CI 31,000 - 51,000美元）独立相关。结论TBAD患者的gic与巨大的临床和经济负担相关。有必要进一步研究早期识别和有针对性的干预措施，以减轻这些并发症，并优化这一高危人群的资源利用。

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引用次数: 0

Liquid biopsies for risk stratification of intraductal papillary mucinous neoplasms 导管内乳头状黏液性肿瘤危险分层的液体活检

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2025-10-14 DOI: 10.1016/j.sopen.2025.10.003

Nicolas Jorek , Ingmar F. Rompen , Louisa Bolm , Thomas Hank , Martin Loos , Christoph W. Michalski , Nerma Crnovrsanin

引用次数: 0

Association of tracheostomy timing with outcomes following traumatic brain injury 创伤性脑损伤后气管切开术时机与预后的关系

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2025-10-09 DOI: 10.1016/j.sopen.2025.10.001

Syed Shaheer Ali , Troy Coaston , Konmal Ali , Giselle Porter , Esteban Aguayo , Areti Tillou , Peyman Benharash , Galinos Barmparas , on behalf of the Academic Trauma Research Consortium (ATRIUM)

Introduction

The optimal timing for tracheostomy among patients with traumatic brain injury (TBI) remains controversial. Earlier tracheostomy is hypothesized to reduce sedation requirements and allow for earlier mobility. We examined the association of tracheostomy timing with clinical endpoints among a national cohort of TBI patients.

Methods

All adult patients (≥18 years) with TBI, defined as head abbreviated injury scale ≥3, undergoing tracheostomy were identified in the 2018 to 2021 Trauma Quality Improvement Program (TQIP) database. Patients were stratified into groups labeled Early (≤10 days) and Delayed (>10 days) using the median day of tracheostomy initiation of the study cohort. Multivariable regression models were developed to assess the association between tracheostomy timing and outcomes including in-hospital mortality, pneumonia, and total ventilator days.

Results

Of 24,517 patients, 51.1 % underwent tracheostomy within 10 days of admission (Early). Compared to Delayed, Early were more commonly younger (42 [28–59] vs 48 years [31–63]; p < 0.001) and privately insured (42.9 vs 41.1 %, p < 0.001). Following multivariable adjustment, factors associated with increased likelihood of early tracheostomy included penetrating trauma (AOR 1.53, 95 % CI 1.37–1.72; ref.: Blunt) and severe facial injury (AOR 1.55, 95 % CI 1.39–1.72.) While early tracheostomy did not alter mortality (AOR 1.10, 95 % CI 0.99–1.24), patients had reduced pneumonia (AOR 0.66, 95 % CI 0.62–0.21) and reduced ventilator days (β −7.05 days, 95 % CI -7.35- -6.75).

Conclusion

Early tracheostomy is associated with reduced complications without altering mortality. These findings suggest the safety and potential benefits of early tracheostomy. Further prospective studies are warranted to explore the underlying mechanisms.

Two sentence summary

Although the optimal timing for tracheostomy among patients with traumatic brain injury remains controversial, previous literature has shown timely tracheostomy to reduce sedation requirements and allow for earlier mobility. Our findings found early tracheostomy to be linked with reduced time on the ventilator, length of stay, and risk of complications.

外伤性脑损伤（TBI）患者气管切开术的最佳时机仍然存在争议。假设早期气管切开术可以减少镇静需求并允许早期活动。我们在全国TBI患者队列中研究了气管切开术时机与临床终点的关系。方法将2018 - 2021年创伤质量改善计划（TQIP）数据库中所有接受气管切开术的成年TBI患者（≥18岁），定义为头部简略损伤评分≥3分。按照研究队列开始气管造口术的中位天数，将患者分为早期（≤10天）和延迟（≤10天）两组。建立了多变量回归模型来评估气管切开术时间与住院死亡率、肺炎和呼吸机总天数等结果之间的关系。结果24,517例患者中，51.1%在入院10天内（早期）行气管切开术。与Delayed相比，Early更年轻（42岁[28-59]vs 48岁[31-63]；p < 0.001）和私人保险（42.9% vs 41.1%, p < 0.001）。多变量调整后，与早期气管造口术可能性增加相关的因素包括穿透性创伤（AOR 1.53, 95% CI 1.37-1.72；参考文献：Blunt）和严重面部损伤（AOR 1.55, 95% CI 1.39-1.72）。虽然早期气管切开术没有改变死亡率（AOR 1.10, 95% CI 0.99-1.24），但患者肺炎发生率降低（AOR 0.66, 95% CI 0.62-0.21），呼吸机使用天数减少（β - 7.05天，95% CI -7.35- -6.75）。结论早期气管切开术可减少并发症，但不影响死亡率。这些发现提示早期气管切开术的安全性和潜在益处。进一步的前瞻性研究是必要的，以探索潜在的机制。尽管外伤性脑损伤患者气管切开术的最佳时机仍然存在争议，但先前的文献表明，及时气管切开术可以减少镇静需求，并允许早期活动。我们的研究发现，早期气管切开术与减少呼吸机使用时间、住院时间和并发症风险有关。

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引用次数: 0

The association of malnutrition with clinical and financial outcomes of traumatic injuries in older adults: A national retrospective analysis 营养不良与老年人创伤性损伤的临床和财务结果的关联：一项全国回顾性分析

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2025-09-17 DOI: 10.1016/j.sopen.2025.09.008

Troy N. Coaston MSCR , Konmal Ali BS , Amulya Vadlakonda MD , Deep J. Mehta , Sara Sakowitz MD, MPH , Dariush Yalzadeh BS , Areti Tillou MD , Peyman Benharash MD , on behalf of the Academic Trauma Research Consortium (ATRIUM)

Background

Malnutrition is an often underrecognized condition among older adults and carries significant relevance among patients hospitalized with traumatic injuries. The present study aimed to evaluate the association of malnutrition with clinical and financial outcomes among older adult patients admitted with external trauma.

Study design

This was a retrospective cohort study of the 2016–2021 National Inpatient Sample including older adults (≥65 years) hospitalized with traumatic injuries. Patients were stratified by nutritional status (Malnourished and Non-Malnourished). Risk-adjusted logistic and linear regression models were constructed to evaluate the association of malnutrition with outcomes including inpatient mortality, clinical complications, and hospitalization costs.

Results

Of 6,587,907 older adults admitted with traumatic injuries, 7.5 % had malnutrition. The prevalence of malnutrition rose from 5.8 % to 8.6 % over the study period (nptrend<0.001). Patients with malnutrition were more commonly of the lowest income quartile (25.5 vs 24.5 %), non-White (19.4 vs 16.9 %), and male (41.3 vs 39.1 %, all p < 0.001). Following risk-adjustment, malnutrition was linked with increased odds of inpatient mortality (Adjusted Odds Ratio [AOR] 1.92, 95 % Confidence Interval [CI] 1.86–1.98) and infectious complications (AOR 2.30, 95 % CI 2.25–2.35) as well as greater inpatient costs (β + $7400, 95 % CI $7100-7600).

Conclusion

Malnutrition among older adults is associated with poorer clinical outcomes and increased financial burden. Rising prevalence and significant disparities underscore the need for increased screening and culturally relevant nutritional interventions to promote quality, equity, and sustainability in trauma care.

背景：营养不良在老年人中是一种常被忽视的疾病，在创伤性损伤住院患者中具有重要的相关性。本研究旨在评估老年外伤患者营养不良与临床和财务结果的关系。这是一项2016-2021年全国住院患者样本的回顾性队列研究，包括因创伤性损伤住院的老年人（≥65岁）。根据营养状况（营养不良和非营养不良）对患者进行分层。构建风险校正logistic和线性回归模型来评估营养不良与住院死亡率、临床并发症和住院费用等结果的关系。结果6587907例老年人外伤住院患者中，营养不良占7.5%。在研究期间，营养不良发生率从5.8%上升到8.6% （nptrend<0.001）。营养不良的患者更常见于最低收入四分位数（25.5%对24.5%）、非白人（19.4%对16.9%）和男性（41.3%对39.1%，均p <； 0.001）。风险调整后，营养不良与住院死亡率增加（调整优势比[AOR] 1.92, 95%可信区间[CI] 1.86-1.98）和感染并发症（AOR 2.30, 95% CI 2.25-2.35）以及住院费用增加（β + $7400, 95% CI $7100-7600）有关。结论老年人营养不良与临床预后差、经济负担增加有关。不断上升的患病率和显著的差异强调需要增加筛查和与文化相关的营养干预措施，以促进创伤护理的质量、公平性和可持续性。

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引用次数: 0

HOW I DO IT: Breaking boundaries in surgical education by delivering expert feedback to residents anytime and anywhere. The LAPPCLINIC project. 我怎么做：通过随时随地向住院医生提供专家反馈，打破外科教育的界限。LAPPCLINIC项目。

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2025-09-12 DOI: 10.1016/j.sopen.2025.09.007

Diego Sanhueza R. MD , Cristián Jarry T. MD, MSc , Julián Varas C. MD, MSc

Objective

To describe LAPPCLINIC, an innovative web-based platform designed to enhance surgical education through remote and asynchronous feedback by video-analysis of residents' own surgical procedures.

Design

We provide a detailed description of the platform workflow, highlighting key features for enhancing surgical education.

Setting

An ongoing multicenter study involving seven surgical residency programs across Chile.

Participants

First-year surgical residents from seven different Chilean programs, with feedback provided by five surgeons, experienced in surgical education, who are beyond their learning curves in laparoscopic cholecystectomy and trained in structured quality-feedback delivery.

Conclusion

LAPPCLINIC implementation has shown strong resident acceptance and significantly higher evaluation of feedback quality compared to traditional OR-based teaching.

目的介绍一种创新的基于网络的平台LAPPCLINIC，该平台旨在通过对住院医生自身手术过程的视频分析，通过远程和异步反馈来加强外科教育。我们提供了平台工作流程的详细描述，突出了加强外科教育的关键功能。一项正在进行的多中心研究涉及智利的七个外科住院医师项目。参与者：来自智利7个不同项目的第一年外科住院医师，由5名外科医生提供反馈，他们在外科教育方面经验丰富，在腹腔镜胆囊切除术方面超出了他们的学习曲线，并接受了结构化质量反馈交付的培训。结论与传统的基于手术室的教学相比，实施lappclinic的住院医师接受度高，反馈质量评价显著提高。

引用次数: 0

Why Transanal Opening of Intersphincteric Space (TROPIS) is effective in high complex anal fistula? 为什么经肛门括约肌间隙开放术（TROPIS）治疗高度复杂肛瘘有效？

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2025-09-12 DOI: 10.1016/j.sopen.2025.09.005

Pankaj Garg

引用次数: 0

Association of operative approach with adverse events following hepatic resections 肝切除术后手术入路与不良事件的关系

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2025-09-08 DOI: 10.1016/j.sopen.2025.09.004

Arjun Chaturvedi , Esteban Aguayo , Oh. Jin Kwon , Kevin Tabibian , Barzin Badiee , Saad Mallick , Daniel Tabibian , Peyman Benharash

Background

Despite growing use of minimally invasive surgery (MIS) for hepatocellular carcinoma (HCC), contemporary national data contrasting MIS with open hepatectomy are sparse.

Methods

Adults (≥18 y) undergoing hepatectomy for HCC in the American College of Surgeons National Surgical Quality Improvement Program (2015–2022) were studied. MIS (laparoscopic or robotic) resections were compared with open operations. Entropy balancing harmonized covariates, and multivariable logistic or linear models produced adjusted odds ratios (AOR) for major adverse events (MAE; composite of mortality and serious complications), liver-specific complications, and 30-day readmission.

Results

Among 5832 hepatectomies, 27.0 % were MIS, rising from 18.8 % in 2015 to 36.1 % in 2022 (p < 0.001). After adjustment, MIS was associated with markedly lower odds of MAE (AOR 0.36, 95 % CI 0.29–0.46), postoperative liver failure (AOR 0.34, 0.20–0.58), bile leak (AOR 0.49, 0.28–0.89), need for invasive intervention (AOR 0.29, 0.18–0.47), and 30-day readmission (AOR 0.61, 0.44–0.86). In the subset undergoing major resections, MIS retained protective associations for MAE (AOR 0.26, 0.15–0.46) and readmission (AOR 0.28, 0.11–0.80).

Conclusions

In a large, contemporary U.S. cohort, MIS hepatectomy was independently associated with fewer perioperative complications, liver-specific adverse events, and readmissions compared with open surgery—even for major resections. These findings support continued expansion of minimally invasive hepatectomy and targeted training to extend its benefits to appropriately selected patients with resectable HCC.

背景：尽管微创手术（MIS）在肝细胞癌（HCC）治疗中的应用越来越多，但目前国内对比微创手术与开放肝切除术的数据很少。方法研究美国外科医师学会国家手术质量改进计划（2015-2022）中接受HCC肝切除术的成人（≥18岁）。MIS（腹腔镜或机器人）切除与开放手术比较。熵平衡协调协变量，多变量逻辑或线性模型产生了主要不良事件（MAE；死亡率和严重并发症的组合）、肝脏特异性并发症和30天再入院的调整优势比（AOR）。结果5832例肝切除术中，MIS占27.0%，由2015年的18.8%上升至2022年的36.1% （p < 0.001）。调整后，MIS与MAE （AOR 0.36, 95% CI 0.29 - 0.46）、术后肝衰竭（AOR 0.34, 0.20-0.58）、胆漏（AOR 0.49, 0.28-0.89）、需要侵入性干预（AOR 0.29, 0.18-0.47）和30天再入院（AOR 0.61, 0.44-0.86）的发生率显著降低相关。在接受主要切除术的亚组中，MIS保留了MAE （AOR 0.26, 0.15-0.46）和再住院（AOR 0.28, 0.11-0.80）的保护性关联。结论：在一项大型的美国当代队列研究中，与开放式手术相比，MIS肝切除术的围手术期并发症、肝脏特异性不良事件和再入院率均较低，即使是大切除手术。这些发现支持继续扩大微创肝切除术和有针对性的培训，以扩大其对适当选择的可切除HCC患者的益处。

{"title":"Association of operative approach with adverse events following hepatic resections","authors":"Arjun Chaturvedi , Esteban Aguayo , Oh. Jin Kwon , Kevin Tabibian , Barzin Badiee , Saad Mallick , Daniel Tabibian , Peyman Benharash","doi":"10.1016/j.sopen.2025.09.004","DOIUrl":"10.1016/j.sopen.2025.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Despite growing use of minimally invasive surgery (MIS) for hepatocellular carcinoma (HCC), contemporary national data contrasting MIS with open hepatectomy are sparse.</div></div><div><h3>Methods</h3><div>Adults (≥18 y) undergoing hepatectomy for HCC in the American College of Surgeons National Surgical Quality Improvement Program (2015–2022) were studied. MIS (laparoscopic or robotic) resections were compared with open operations. Entropy balancing harmonized covariates, and multivariable logistic or linear models produced adjusted odds ratios (AOR) for major adverse events (MAE; composite of mortality and serious complications), liver-specific complications, and 30-day readmission.</div></div><div><h3>Results</h3><div>Among 5832 hepatectomies, 27.0 % were MIS, rising from 18.8 % in 2015 to 36.1 % in 2022 (<em>p</em> < 0.001). After adjustment, MIS was associated with markedly lower odds of MAE (AOR 0.36, 95 % CI 0.29–0.46), postoperative liver failure (AOR 0.34, 0.20–0.58), bile leak (AOR 0.49, 0.28–0.89), need for invasive intervention (AOR 0.29, 0.18–0.47), and 30-day readmission (AOR 0.61, 0.44–0.86). In the subset undergoing major resections, MIS retained protective associations for MAE (AOR 0.26, 0.15–0.46) and readmission (AOR 0.28, 0.11–0.80).</div></div><div><h3>Conclusions</h3><div>In a large, contemporary U.S. cohort, MIS hepatectomy was independently associated with fewer perioperative complications, liver-specific adverse events, and readmissions compared with open surgery—even for major resections. These findings support continued expansion of minimally invasive hepatectomy and targeted training to extend its benefits to appropriately selected patients with resectable HCC.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"28 ","pages":"Pages 1-6"},"PeriodicalIF":1.7,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A 9 year retrospective review of motorcycle accidents at a level 1 trauma center in Riyadh 对利雅得一级创伤中心摩托车事故的9年回顾性审查

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2025-09-01 DOI: 10.1016/j.sopen.2025.09.006

Hussam Alhathlol , Khalid Alsikhan , Turki Alharbi , Ibrahim Alsamaani , Ali Alhathloul , Rifan Alyami

Introduction

Motorcycle accidents are a significant cause of morbidity and mortality worldwide, with an increasing trend observed in Saudi Arabia. These accidents often result in severe injuries, leading to long-term disability or death, highlighting the need for better understanding and management in trauma centers. These findings highlight the vulnerability of motorcyclists on the roads and underscore the critical need to address motorcycle safety in order to reduce the burden of road traffic accidents.

Methods

This retrospective study assessed the rate, injury patterns, and outcomes of motorcycle accidents at King Abdulaziz Medical City (KAMC) in Riyadh, a level 1 trauma center, from January 2016 to December 2024. A total of 415 adult patients were included, with data on demographics, injury types, and treatment outcomes collected from hospital records. Multivariable logistic regression was performed to identify predictors of intensive care unit (ICU) admission, intubation, and surgical intervention.

Results

The cohort consisted predominantly of young males (84.1 %), with the highest incidence observed in the 18–35 age group. Common injuries included fractures (86.7 %), brain injuries/bleeding (38.1 %), and cut/open wounds (27.5 %). Although the incidence peaked in 2023, no statistically significant trend was observed over the study period. Moreover, a surgical intervention was required in 69.9 % of the cases, with 28.2 % experiencing long-term disability, which was defined based on discharge disposition and documented rehabilitation needs Factors significantly associated with ICU admission and intubation included head injuries, chest injuries, and facial trauma.

Conclusion

Motorcycle accidents continue to pose a significant public health challenge in Saudi Arabia, with young male motorcyclists being the most vulnerable group. The high incidence of fractures and brain injuries emphasizes the importance of improving safety measures to reduce the severity of injuries.

摩托车事故是世界范围内发病率和死亡率的重要原因，在沙特阿拉伯观察到增加的趋势。这些事故往往造成严重伤害，导致长期残疾或死亡，突出表明创伤中心需要更好地了解和管理这一问题。这些调查结果突出了摩托车手在道路上的脆弱性，并强调迫切需要解决摩托车安全问题，以减轻道路交通事故的负担。方法本回顾性研究评估2016年1月至2024年12月在利雅得一级创伤中心阿卜杜勒阿齐兹国王医疗城（KAMC）摩托车事故的发生率、伤害模式和结局。总共纳入了415名成年患者，从医院记录中收集了人口统计学、损伤类型和治疗结果的数据。采用多变量logistic回归来确定重症监护病房（ICU）入院、插管和手术干预的预测因素。结果该队列以年轻男性为主（84.1%），18-35岁年龄组发病率最高。常见的损伤包括骨折（86.7%）、脑损伤/出血（38.1%）和割伤/开放性伤口（27.5%）。虽然发病率在2023年达到顶峰，但在研究期间没有观察到统计学上显著的趋势。此外，69.9%的病例需要手术干预，28.2%的病例经历了长期残疾，这是根据出院处置和记录的康复需求来定义的，与ICU入院和插管显著相关的因素包括头部损伤、胸部损伤和面部创伤。结论摩托车事故继续对沙特阿拉伯的公共卫生构成重大挑战，年轻男性摩托车手是最脆弱的群体。骨折和脑损伤的高发生率强调了改善安全措施以降低损伤严重程度的重要性。

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引用次数: 0

Predictive value of ultrasound BIRADS in conjunction with cytological and histopathological outcomes in breast disease management 超声BIRADS结合细胞学和组织病理学结果在乳腺疾病管理中的预测价值

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2025-09-01 DOI: 10.1016/j.sopen.2025.08.005

Hussein Hadi Jaber , Qutaiba Abd El-Razaq Muner

Background

Breast cancer represents the leading cause of cancer-related mortality among Iraqi women (19.5 % of female cancers). Ultrasound BI-RADS classification integrated with tissue sampling requires population-specific validation for optimal diagnostic accuracy.

Objective

To evaluate the diagnostic accuracy of ultrasound BI-RADS classification when correlated with cytological and histopathological findings in predicting malignancy risk among Iraqi women.

Methods

A prospective cross-sectional analytical study was conducted from February 2024 to February 2025 at two tertiary care teaching hospitals with specialized breast units in Baghdad, Iraq. One hundred sixty women aged ≥18 years with breast lesions classified as BI-RADS 3–5 underwent ultrasound evaluation, fine needle aspiration cytology (FNAC), and core needle biopsy (CNB) or surgical excision when indicated. Both participating radiologists completed formal BI-RADS training workshops by the Iraqi Radiological Society in 2023. Diagnostic performance metrics were calculated using histopathological confirmation as the reference standard.

Results

Mean participant age was 48.2 ± 9.7 years. BI-RADS distribution included: category 3 (25.0 %), 4A (18.8 %), 4B (12.5 %), 4C (12.5 %), and 5 (31.2 %). Overall malignancy rate was 40.0 %, varying by BI-RADS category: 2.5 % (category 3), 10.0 % (4A), 25.0 % (4B), 55.0 % (4C), and 88.0 % (category 5). ROC analysis demonstrated good discriminative ability (AUC = 0.85, 95 % CI: 0.79–0.91). At the optimal threshold (BI-RADS ≥4A), sensitivity was 98.4 % and specificity 40.6 %. Inter-modality agreement showed substantial concordance between FNAC and histopathology (κ = 0.76) and almost perfect agreement between CNB and histopathology (κ = 0.92). The integration of BI-RADS with tissue sampling demonstrated a 35–40 % reduction in unnecessary biopsies.

Conclusions

Ultrasound BI-RADS classification demonstrates good diagnostic performance in the Iraqi population, with increasing malignancy rates corresponding to higher BI-RADS categories. The integration of BI-RADS with tissue sampling techniques provides reliable diagnostic accuracy for breast disease management in resource-limited settings.

背景乳腺癌是伊拉克妇女癌症相关死亡的主要原因（占女性癌症的19.5%）。超声BI-RADS分类与组织采样集成需要人群特异性验证，以获得最佳诊断准确性。目的评价超声BI-RADS分型与细胞学和组织病理学结果在预测伊拉克妇女恶性肿瘤风险中的诊断准确性。方法于2024年2月至2025年2月在伊拉克巴格达两所设有乳腺专科的三级护理教学医院进行前瞻性横断面分析研究。160名年龄≥18岁、乳腺病变分类为BI-RADS 3-5的女性接受了超声评估、细针穿刺细胞学（FNAC）和核心针活检（CNB）或手术切除。两位参与的放射科医生于2023年完成了由伊拉克放射学会举办的正式BI-RADS培训讲习班。以组织病理学确认为参考标准计算诊断性能指标。结果患者平均年龄为48.2±9.7岁。BI-RADS分布包括：第3类（25.0%）、第4A类（18.8%）、第4B类（12.5%）、第4C类（12.5%）和第5类（31.2%）。总体恶性肿瘤发生率为40.0%，根据BI-RADS分类不同：2.5%（3类）、10.0% （4A类）、25.0% （4B类）、55.0% （4C类）和88.0%（5类）。ROC分析显示有良好的判别能力（AUC = 0.85, 95% CI: 0.79 ~ 0.91）。在最佳阈值（BI-RADS≥4A）下，敏感性为98.4%，特异性为40.6%。FNAC与组织病理学基本一致（κ = 0.76）， CNB与组织病理学基本一致（κ = 0.92）。BI-RADS与组织取样的结合表明，不必要的活组织检查减少了35 - 40%。结论超声BI-RADS分型在伊拉克人群中具有较好的诊断效果，BI-RADS分型越高，恶性肿瘤发生率越高。BI-RADS与组织采样技术的整合为资源有限的乳腺疾病管理提供了可靠的诊断准确性。

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引用次数: 0

Editorial Board Page 编委会页面

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2025-09-01 DOI: 10.1016/S2589-8450(25)00084-3

引用次数: 0