Pub Date : 2025-12-01DOI: 10.1016/j.amjsurg.2025.116757
Pooja Podugu , Amisha Paul , Ari Zlota , Priyash Hafiz , Tien Nguyen , Annabel Yang , Nikhil Madugula , Caleb Curry , Hope Carrane , Vanessa P. Ho , Justin Dvorak
Introduction
The utility of surveillance imaging (SI) after high-grade liver injury is unclear. We studied SI's detection rate and its association with unplanned interventions, emergency department (ED) visits, and mortality.
Methods
Adult patients with American Association for the Surgery of Trauma (AAST) grade III-V liver injury (2018–2024) were categorized by follow-up imaging: surveillance imaging (SI, no clinical change), clinically-prompted imaging (CI), or none. Outcomes included unplanned intervention, liver-related ED visits, and mortality.
Results
Among 252 patients, SI prompted intervention in 10 % of cases versus 31 % for CI. Unplanned interventions were more frequent after CI than SI (37 % vs. 18 %; p = 0.018). ED visits were marginally lower after SI versus CI (30 % vs. 43 %; p = 0.10). Mortality did not differ across groups.
Conclusions
SI identified complications in select patients and was associated with fewer unplanned interventions, marginally fewer ED visits, and no mortality difference compared to CI.
导读：监测成像（SI）在高级别肝损伤后的应用尚不清楚。我们研究了SI的检出率及其与计划外干预、急诊（ED）就诊和死亡率的关系。方法：美国创伤外科学会（AAST） III-V级肝损伤成年患者（2018-2024）按随访影像学分类：监测影像学（SI，无临床变化），临床提示影像学（CI），或无。结果包括计划外干预、肝脏相关急诊科就诊和死亡率。结果：在252例患者中，10%的病例采用SI，而31%的病例采用CI。CI后非计划干预比SI后更频繁（37%比18%；p = 0.018）。在SI和CI之后，急诊科的诊断率略低（30% vs 43%; p = 0.10）。死亡率在各组之间没有差异。结论：与CI相比，SI确定了部分患者的并发症，并且与计划外干预较少，ED就诊较少相关，且死亡率无差异。
{"title":"Assessing the utility of surveillance imaging in high-grade liver injury patients","authors":"Pooja Podugu , Amisha Paul , Ari Zlota , Priyash Hafiz , Tien Nguyen , Annabel Yang , Nikhil Madugula , Caleb Curry , Hope Carrane , Vanessa P. Ho , Justin Dvorak","doi":"10.1016/j.amjsurg.2025.116757","DOIUrl":"10.1016/j.amjsurg.2025.116757","url":null,"abstract":"<div><h3>Introduction</h3><div>The utility of surveillance imaging (SI) after high-grade liver injury is unclear. We studied SI's detection rate and its association with unplanned interventions, emergency department (ED) visits, and mortality.</div></div><div><h3>Methods</h3><div>Adult patients with American Association for the Surgery of Trauma (AAST) grade III-V liver injury (2018–2024) were categorized by follow-up imaging: surveillance imaging (SI, no clinical change), clinically-prompted imaging (CI), or none. Outcomes included unplanned intervention, liver-related ED visits, and mortality.</div></div><div><h3>Results</h3><div>Among 252 patients, SI prompted intervention in 10 % of cases versus 31 % for CI. Unplanned interventions were more frequent after CI than SI (37 % vs. 18 %; p = 0.018). ED visits were marginally lower after SI versus CI (30 % vs. 43 %; p = 0.10). Mortality did not differ across groups.</div></div><div><h3>Conclusions</h3><div>SI identified complications in select patients and was associated with fewer unplanned interventions, marginally fewer ED visits, and no mortality difference compared to CI.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116757"},"PeriodicalIF":2.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145699714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.amjsurg.2025.116756
Makena Pook , Tahereh Najafi Ghezeljeh , Hiba Elhaj , Fateme Rajabiyazdi , Saba Balvardi , Stephanie Wong , Marylise Boutros , Gerald M. Fried , Lawrence Lee , Liane S. Feldman , Julio F. Fiore Jr.
Background
Understanding surgeons’ perspectives on post-discharge opioid prescribing is crucial for optimizing pain management while mitigating opioid-related harms.
Objective
To describe the perspectives of North American general surgeons towards opioid prescribing after hospital discharge.
Methods
This qualitative study involved semi-structured interviews with 30 general surgeons in the USA and Canada. Interviews were audio-recorded, transcribed verbatim, and continued until thematic saturation. Data were analyzed using inductive thematic analysis.
Results
Three themes were derived: motives for relying on opioids, motives for opioid minimization, and strategies for tailoring analgesia. Reliance on opioids was motivated by prescribing culture, convenience, patients' expectations, apprehension towards non-opioid analgesics, and limited pain management expertise. Motivations for opioid-minimization included cultural shift, non-opioids’ effectiveness, policy, and emerging research. Strategies for tailoring prescribing included addressing patient expectations and post-discharge follow-up.
Conclusions
Barriers to evidence-based prescribing, including tradition, convenience, and lacking expertise, should be addressed to optimize analgesia and mitigate opioid-related harms.
{"title":"General surgeons’ perspectives on post-discharge opioid prescribing: A qualitative study","authors":"Makena Pook , Tahereh Najafi Ghezeljeh , Hiba Elhaj , Fateme Rajabiyazdi , Saba Balvardi , Stephanie Wong , Marylise Boutros , Gerald M. Fried , Lawrence Lee , Liane S. Feldman , Julio F. Fiore Jr.","doi":"10.1016/j.amjsurg.2025.116756","DOIUrl":"10.1016/j.amjsurg.2025.116756","url":null,"abstract":"<div><h3>Background</h3><div>Understanding surgeons’ perspectives on post-discharge opioid prescribing is crucial for optimizing pain management while mitigating opioid-related harms.</div></div><div><h3>Objective</h3><div>To describe the perspectives of North American general surgeons towards opioid prescribing after hospital discharge.</div></div><div><h3>Methods</h3><div>This qualitative study involved semi-structured interviews with 30 general surgeons in the USA and Canada. Interviews were audio-recorded, transcribed verbatim, and continued until thematic saturation. Data were analyzed using inductive thematic analysis.</div></div><div><h3>Results</h3><div>Three themes were derived: motives for relying on opioids, motives for opioid minimization, and strategies for tailoring analgesia. Reliance on opioids was motivated by prescribing culture, convenience, patients' expectations, apprehension towards non-opioid analgesics, and limited pain management expertise. Motivations for opioid-minimization included cultural shift, non-opioids’ effectiveness, policy, and emerging research. Strategies for tailoring prescribing included addressing patient expectations and post-discharge follow-up.</div></div><div><h3>Conclusions</h3><div>Barriers to evidence-based prescribing, including tradition, convenience, and lacking expertise, should be addressed to optimize analgesia and mitigate opioid-related harms.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116756"},"PeriodicalIF":2.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145699300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.amjsurg.2025.116762
Brian M. Carter
{"title":"Captioning Brought to You By … A call for operating room accessibility","authors":"Brian M. Carter","doi":"10.1016/j.amjsurg.2025.116762","DOIUrl":"10.1016/j.amjsurg.2025.116762","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116762"},"PeriodicalIF":2.7,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-28DOI: 10.1016/j.amjsurg.2025.116760
Mustafa Oruc, Tyler Cross, Salih Karahan, Anna Spivak, Metincan Erkaya, Anuradha Bhama, Scott Steele, Emre Gorgun
Background
The effect of dedicated bedside assistance on the outcomes of robotic colorectal surgery has not been clearly established. This study evaluated whether dedicated bedside assistance (DBA) improves the operative efficiency and overall surgical performance.
Method
A retrospective analysis was conducted on 148 consecutive robotic proctectomy and sigmoidectomy cases performed by a single expert colorectal surgeon between 2021 and 2024. Cases were compared based on the presence or absence of a dedicated bedside assistant. Both intraoperative metrics and postoperative outcomes were analyzed.
Results
The presence of DBA was associated with significantly reduced operation, console, and non-console times in rectal procedures, with efficiency gains observed across most clinical subgroups. Workflow improvements were also observed in sigmoid surgeries despite similar total operative durations.
Conclusion
The implementation of a DBA markedly enhances intraoperative efficiency in robotic colorectal surgery. This benefit is most pronounced in technically demanding rectal procedures, where skilled bedside support can significantly streamline workflow and reduce console time.
{"title":"Dedicated bedside assistance improves operative efficiency in robotic colorectal surgery: A retrospective comparative study","authors":"Mustafa Oruc, Tyler Cross, Salih Karahan, Anna Spivak, Metincan Erkaya, Anuradha Bhama, Scott Steele, Emre Gorgun","doi":"10.1016/j.amjsurg.2025.116760","DOIUrl":"10.1016/j.amjsurg.2025.116760","url":null,"abstract":"<div><h3>Background</h3><div>The effect of dedicated bedside assistance on the outcomes of robotic colorectal surgery has not been clearly established. This study evaluated whether dedicated bedside assistance (DBA) improves the operative efficiency and overall surgical performance.</div></div><div><h3>Method</h3><div>A retrospective analysis was conducted on 148 consecutive robotic proctectomy and sigmoidectomy cases performed by a single expert colorectal surgeon between 2021 and 2024. Cases were compared based on the presence or absence of a dedicated bedside assistant. Both intraoperative metrics and postoperative outcomes were analyzed.</div></div><div><h3>Results</h3><div>The presence of DBA was associated with significantly reduced operation, console, and non-console times in rectal procedures, with efficiency gains observed across most clinical subgroups. Workflow improvements were also observed in sigmoid surgeries despite similar total operative durations.</div></div><div><h3>Conclusion</h3><div>The implementation of a DBA markedly enhances intraoperative efficiency in robotic colorectal surgery. This benefit is most pronounced in technically demanding rectal procedures, where skilled bedside support can significantly streamline workflow and reduce console time.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116760"},"PeriodicalIF":2.7,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-27DOI: 10.1016/j.amjsurg.2025.116761
R.L. Wolansky , M.A. Kendall , T. Zander , J. Sujka , P.C. Kuo , M.S. Baker
Background
Recent randomized trials evaluating survival benefit to adjuvant chemotherapy (AC) in cholangiocarcinoma evaluate heterogeneous populations including patients with gallbladder cancer, extrahepatic, and intrahepatic cholangiocarcinoma (ICCA). The efficacy of AC in ICCA remains undefined.
Methods
We queried the National Cancer Database for patients undergoing resection of localized ICCA between 2006 and 2017. Patients receiving AC were 1:1 propensity score matched for age, sex, race, comorbidities, insurance, stage, radiation, and resection margin to those undergoing resection alone. Kaplan-Meier (KM) methods were used to compare 5-year overall survival (OS) patterns for matched cohorts.
Results
1312 patients underwent resection of ICCA; 489 (37.3 %) received AC. 411 patients undergoing AC were successfully matched to 411 undergoing surgery alone. Median OS was 40.8 months for patients treated with AC versus 32.0 months for those undergoing resection alone (p = 0.151).
Conclusions
AC offers limited potential benefit to patients with resected ICCA.
{"title":"Resected intrahepatic cholangiocarcinoma: Is adjuvant chemotherapy associated with improved overall survival?","authors":"R.L. Wolansky , M.A. Kendall , T. Zander , J. Sujka , P.C. Kuo , M.S. Baker","doi":"10.1016/j.amjsurg.2025.116761","DOIUrl":"10.1016/j.amjsurg.2025.116761","url":null,"abstract":"<div><h3>Background</h3><div>Recent randomized trials evaluating survival benefit to adjuvant chemotherapy (AC) in cholangiocarcinoma evaluate heterogeneous populations including patients with gallbladder cancer, extrahepatic, and intrahepatic cholangiocarcinoma (ICCA). The efficacy of AC in ICCA remains undefined.</div></div><div><h3>Methods</h3><div>We queried the National Cancer Database for patients undergoing resection of localized ICCA between 2006 and 2017. Patients receiving AC were 1:1 propensity score matched for age, sex, race, comorbidities, insurance, stage, radiation, and resection margin to those undergoing resection alone. Kaplan-Meier (KM) methods were used to compare 5-year overall survival (OS) patterns for matched cohorts.</div></div><div><h3>Results</h3><div>1312 patients underwent resection of ICCA; 489 (37.3 %) received AC. 411 patients undergoing AC were successfully matched to 411 undergoing surgery alone. Median OS was 40.8 months for patients treated with AC versus 32.0 months for those undergoing resection alone (p = 0.151).</div></div><div><h3>Conclusions</h3><div>AC offers limited potential benefit to patients with resected ICCA.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116761"},"PeriodicalIF":2.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-27DOI: 10.1016/j.amjsurg.2025.116759
Sarah Lyon , Abby Turza , Santhi Ganesan , Christopher R. McHenry
Background
The purpose of this study was to determine the positive predictive value (PPV) and false positive (FP) rate for the Afirma Gene Sequencing Classifier (GSC).
Methods
The GSC was analyzed in patients with indeterminate thyroid nodules (ITN). True positive (TP), FP and PPV were determined and were correlated with pathology.
Results
From June 2023–January 2025, 75 ITN were evaluated with the GSC and it was suspicious for cancer in 21 (28 %); 15 patients with 16 suspicious nodules underwent thyroidectomy. There were 7 TP and 9 FP results for a PPV of 44 %. The final pathology was papillary cancer 6 and oncocytic carcinoma 1 with TP GSC and follicular/oncocytic adenoma 4, follicular nodule 2, NIFTP 2 and Hashimoto thyroiditis 1 with FP GSC.
Conclusions
A PPV of 44 % for the GSC has implications for the extent of surgery and for reducing overtreatment of patients with ITN.
{"title":"Positive predictive value of the Afirma gene sequencing classifier for evaluation of the indeterminate thyroid nodule: An institutional experience","authors":"Sarah Lyon , Abby Turza , Santhi Ganesan , Christopher R. McHenry","doi":"10.1016/j.amjsurg.2025.116759","DOIUrl":"10.1016/j.amjsurg.2025.116759","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of this study was to determine the positive predictive value (PPV) and false positive (FP) rate for the Afirma Gene Sequencing Classifier (GSC).</div></div><div><h3>Methods</h3><div>The GSC was analyzed in patients with indeterminate thyroid nodules (ITN). True positive (TP), FP and PPV were determined and were correlated with pathology.</div></div><div><h3>Results</h3><div>From June 2023–January 2025, 75 ITN were evaluated with the GSC and it was suspicious for cancer in 21 (28 %); 15 patients with 16 suspicious nodules underwent thyroidectomy. There were 7 TP and 9 FP results for a PPV of 44 %. The final pathology was papillary cancer 6 and oncocytic carcinoma 1 with TP GSC and follicular/oncocytic adenoma 4, follicular nodule 2, NIFTP 2 and Hashimoto thyroiditis 1 with FP GSC.</div></div><div><h3>Conclusions</h3><div>A PPV of 44 % for the GSC has implications for the extent of surgery and for reducing overtreatment of patients with ITN.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116759"},"PeriodicalIF":2.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-27DOI: 10.1016/j.amjsurg.2025.116758
A. Laykova , D. Scheeres , G. Zambito , A. Banks-Venegoni
Introduction
There is a current gap in literature regarding the appropriate timing of non-emergent repair for a resolved obstructing gastric volvulus. This study aims to evaluate outcomes related to hiatal hernia repair (HHR) during the index hospitalization versus early outpatient repair, with the assumption that outpatient repair will result in better outcomes.
Methods
This study included HHR data from 2017 to 2022. The primary outcome assessed overall morbidity using the Clavien-Dindo classification among various secondary outcomes.
Results
A total of 25 patients were included. There was no difference in morbidity between groups (p = 0.66). In the outpatient group, 3 patients re-volvulized prior to repair and the LOS post repair was statistically longer in the inpatient group (2.5 days vs 1 day, p = 0.0172).
Conclusion
Our findings demonstrate that definitive HHR following resolved obstructing gastric volvulus can be safely performed during the index hospitalization, without increase in morbidity, which may be preferred for this patient population.
{"title":"Outcomes of non-obstructed gastric volvulus: Repair during the index hospitalization vs early elective setting","authors":"A. Laykova , D. Scheeres , G. Zambito , A. Banks-Venegoni","doi":"10.1016/j.amjsurg.2025.116758","DOIUrl":"10.1016/j.amjsurg.2025.116758","url":null,"abstract":"<div><h3>Introduction</h3><div>There is a current gap in literature regarding the appropriate timing of non-emergent repair for a resolved obstructing gastric volvulus. This study aims to evaluate outcomes related to hiatal hernia repair (HHR) during the index hospitalization versus early outpatient repair, with the assumption that outpatient repair will result in better outcomes.</div></div><div><h3>Methods</h3><div>This study included HHR data from 2017 to 2022. The primary outcome assessed overall morbidity using the Clavien-Dindo classification among various secondary outcomes.</div></div><div><h3>Results</h3><div>A total of 25 patients were included. There was no difference in morbidity between groups (p = 0.66). In the outpatient group, 3 patients re-volvulized prior to repair and the LOS post repair was statistically longer in the inpatient group (2.5 days vs 1 day, p = 0.0172).</div></div><div><h3>Conclusion</h3><div>Our findings demonstrate that definitive HHR following resolved obstructing gastric volvulus can be safely performed during the index hospitalization, without increase in morbidity, which may be preferred for this patient population.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"253 ","pages":"Article 116758"},"PeriodicalIF":2.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-27DOI: 10.1016/j.amjsurg.2025.116755
Niranjna Swaminathan , ZhiXing Song , Christopher Wu , Ramsha Akhund , Jessica Fazendin , Brenessa Lindeman , Herbert Chen , Andrea Gillis
Background
Molecular testing (MT) aids in reducing unnecessary thyroidectomy for indeterminate thyroid nodules, primarily due to its high negative predictive value (NPV). However, its reliability in large nodules (≥4 cm), which carry a higher malignancy risk, remains unclear.
Methods
We performed a retrospective study of patients with thyroid nodules ≥4 cm who underwent fine-needle aspiration (FNA) at a tertiary care center from 2015 to 2023. Cytology was categorized using the Bethesda system. Molecular results (Afirma GEC and GSC) were matched with surgical pathology. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was classified as malignant.
Results
A total of 231 patients were included (mean age 52 ± 16 years; 69.7 % female). The median nodule size was 5.0 cm (IQR: 4.4–5.8). Malignancy was identified in 28.1 % of cases. Malignancy rates by Bethesda category were 4.3 % (Bethesda II), 33.8 % (III), and 50.0 % (IV), all Bethesda V and VI nodules were malignant. Among 96 patients with Bethesda III or IV cytology, 79 (82.3 %) underwent MT, 30 with GEC and 47 with GSC. GEC yielded 91.7 % sensitivity, 33.3 % specificity, and NPV of 85.7 %. GSC showed 88.9 % sensitivity, 58.6 % specificity, and NPV of 89.5 %. Malignancy occurred in 40.0 % (GEC) and 38.3 % (GSC) of tested nodules. False negatives included anaplastic carcinoma, oncocytic carcinoma, and NIFTP. Mutation testing revealed malignancy in 41.4 % of BRAF-negative and 44.8 % of RET/PTC-negative patients.
Conclusion
Molecular testing in nodules ≥4 cm may underestimate malignancy risk. Clinicians should interpret benign MT results in this subgroup with caution.
{"title":"Diagnostic value of molecular testing for evaluating thyroid nodules greater than 4 centimeters","authors":"Niranjna Swaminathan , ZhiXing Song , Christopher Wu , Ramsha Akhund , Jessica Fazendin , Brenessa Lindeman , Herbert Chen , Andrea Gillis","doi":"10.1016/j.amjsurg.2025.116755","DOIUrl":"10.1016/j.amjsurg.2025.116755","url":null,"abstract":"<div><h3>Background</h3><div>Molecular testing (MT) aids in reducing unnecessary thyroidectomy for indeterminate thyroid nodules, primarily due to its high negative predictive value (NPV). However, its reliability in large nodules (≥4 cm), which carry a higher malignancy risk, remains unclear.</div></div><div><h3>Methods</h3><div>We performed a retrospective study of patients with thyroid nodules ≥4 cm who underwent fine-needle aspiration (FNA) at a tertiary care center from 2015 to 2023. Cytology was categorized using the Bethesda system. Molecular results (Afirma GEC and GSC) were matched with surgical pathology. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was classified as malignant.</div></div><div><h3>Results</h3><div>A total of 231 patients were included (mean age 52 ± 16 years; 69.7 % female). The median nodule size was 5.0 cm (IQR: 4.4–5.8). Malignancy was identified in 28.1 % of cases. Malignancy rates by Bethesda category were 4.3 % (Bethesda II), 33.8 % (III), and 50.0 % (IV), all Bethesda V and VI nodules were malignant. Among 96 patients with Bethesda III or IV cytology, 79 (82.3 %) underwent MT, 30 with GEC and 47 with GSC. GEC yielded 91.7 % sensitivity, 33.3 % specificity, and NPV of 85.7 %. GSC showed 88.9 % sensitivity, 58.6 % specificity, and NPV of 89.5 %. Malignancy occurred in 40.0 % (GEC) and 38.3 % (GSC) of tested nodules. False negatives included anaplastic carcinoma, oncocytic carcinoma, and NIFTP. Mutation testing revealed malignancy in 41.4 % of BRAF-negative and 44.8 % of RET/PTC-negative patients.</div></div><div><h3>Conclusion</h3><div>Molecular testing in nodules ≥4 cm may underestimate malignancy risk. Clinicians should interpret benign MT results in this subgroup with caution.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116755"},"PeriodicalIF":2.7,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-26DOI: 10.1016/j.amjsurg.2025.116754
Niranjna Swaminathan, Sanya Nathani, Andrea Gillis, Sophie Dream, Brenessa Lindeman, Herbert Chen, Peter J Abraham
{"title":"Diagnostic localization techniques in Primary hyperparathyroidism: Is PET Choline the new gold standard?","authors":"Niranjna Swaminathan, Sanya Nathani, Andrea Gillis, Sophie Dream, Brenessa Lindeman, Herbert Chen, Peter J Abraham","doi":"10.1016/j.amjsurg.2025.116754","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116754","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116754"},"PeriodicalIF":2.7,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145740577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-26DOI: 10.1016/j.amjsurg.2025.116753
Alexandra Savage, Rachael Caretti, Hector Caceres, Madeleine Obuya, Zhixing Song, Sanajana Balachandra, Jessica Fazendin, Brenessa Lindeman, Andrea Gillis, Sophie Dream, Herbert Chen
{"title":"Patients with primary hyperparathyroidism who required three or more parathyroidectomies: Could this be prevented?","authors":"Alexandra Savage, Rachael Caretti, Hector Caceres, Madeleine Obuya, Zhixing Song, Sanajana Balachandra, Jessica Fazendin, Brenessa Lindeman, Andrea Gillis, Sophie Dream, Herbert Chen","doi":"10.1016/j.amjsurg.2025.116753","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116753","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116753"},"PeriodicalIF":2.7,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145666748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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