Gland surgery最新文献

{"title":"A nomogram for predicting the central lymph node metastasis in double primary carcinoma involving thyroid carcinoma.","authors":"Lei Tang, Jing Shen","doi":"10.21037/gs-2025-206","DOIUrl":"10.21037/gs-2025-206","url":null,"abstract":"<p><strong>Background: </strong>Although the incidence of double primary carcinoma (DPC) involving thyroid carcinoma is clinically significant, current literature lacks sufficient investigation of this population, particularly regarding central lymph node metastasis (CLNM) patterns. Accurate preoperative prediction in CLNM is crucial for optimal surgical planning and decision-making. This study aimed to investigate the influential factors of CLNM in DPC involving thyroid carcinoma and develop a nomogram for the prediction in CLNM.</p><p><strong>Methods: </strong>A retrospective analysis of 62 cases with DPC involving thyroid carcinoma from January 2021 to May 2025 was performed. All patients presented with complete clinical data and underwent postoperative follow-up. Univariable and multivariable logistic regression analyses were used to identify the factors affecting CLNM. Based on the regression results, a nomogram model was constructed and internally validated using k-fold cross-validation. The C-index value, the calibration curve and the Hosmer-Lemeshow test were used to evaluate the performance of the model.</p><p><strong>Results: </strong>Analyses revealed that tumor size, tumor site, blood group and thyroglobulin (TG) were influential factors of CLNM in DPC involving thyroid carcinoma (P<0.05). These factors were incorporated into the construction of the nomogram [C-index =0.892, 95% confidence interval (CI): 0.878-0.906]. The sensitivity and specificity of the model were 75.0% and 91.3%. The k-fold cross-validation method (k=5) validated the high accuracy of the model (C-index =0.893). The model presented superior predictive power with a Hosmer-Lemeshow goodness-of-fit test value of χ²=11.348, P=0.18.</p><p><strong>Conclusions: </strong>Tumor size ≥0.95 cm and TG ≥15.62 mg/L were risk factors of CLNM in the DPC patients involving thyroid carcinoma. Meanwhile, lower tumor location in the thyroid and type B blood were risk factors of CLNM. The proposed nomogram could be a reliable tool for accurate prediction in CLNM. Additionally, our study showed that multifocal lung carcinoma patients always tended to have a higher rate of multifocality in thyroid carcinoma.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 8","pages":"1549-1557"},"PeriodicalIF":1.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Value of dynamic contrast-enhanced ultrasound in predicting cervical lymph node metastasis in papillary thyroid carcinoma patients with Hashimoto's thyroiditis.","authors":"","doi":"10.21037/gs-2025b-2","DOIUrl":"10.21037/gs-2025b-2","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.21037/gs-2024-510.].</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 8","pages":"1634-1635"},"PeriodicalIF":1.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate lymphatic reconstruction (ILR) for prevention of secondary lymphedema after breast cancer surgery: a systematic review and meta‑analysis.","authors":"Zhiting He, Lijuan Zhang, Shanshan Huang, Yi Xie, Yu Qiu, Linyu Wu, Xinhua Xie","doi":"10.21037/gs-2025-40","DOIUrl":"10.21037/gs-2025-40","url":null,"abstract":"<p><strong>Background: </strong>The most common chronic complication following breast cancer surgery is breast cancer-related lymphedema (BCRL). Lymphovenous anastomosis (LVA) is a surgical treatment for lymphedema, but it could not cure lymphedema. Immediate lymphatic reconstruction (ILR) has been shown in early studies to reduce the risk of BCRL. The objective of this study is to detail the impact of ILR on the incidence of BCRL and to summarize the current opportunities and challenges of ILR.</p><p><strong>Methods: </strong>We performed a systematic review through September 2024 of the Web of Science, Embase, and PubMed databases. There were cohort studies that documented the incidence of BCRL having undergone ILR. BCRL occurrences between the ILR and no ILR group were compared using a comparative meta-analysis of five studies. Additionally, a single percentage meta-analysis was conducted using 12 papers that documented the events of BCRL after ILR.</p><p><strong>Results: </strong>The 12 papers included all met the criteria for analysis. The incidence of BCRL in the no ILR group was higher than that in the ILR group, according to a comparative meta-analysis, and there was a statistically significant difference [odds ratio (OR): 0.14; 95% confidence interval (CI): 0.08-0.24; P<0.001]. Besides, the incidence of BCRL of the IRL group was 8.6% (95% CI: 6-12%), according to a meta-analysis of single percentages. The results of the subgroup analysis showed that follow-up time of less than 1 year or more than 1 year after ILR was not significantly associated with the incidence of BCRL (P=0.40).</p><p><strong>Conclusions: </strong>There is a definite indication that ILR is beneficial in preventing BCRL. This might be a helpful intervention for improving the quality of life of breast cancer survivors.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 8","pages":"1539-1548"},"PeriodicalIF":1.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reevaluating regional nodal irradiation after nodal pathologic complete response to neoadjuvant chemotherapy: toward individualized de-escalation.","authors":"Janhavi Venkataraman, Kefah Mokbel","doi":"10.21037/gs-2025-240","DOIUrl":"10.21037/gs-2025-240","url":null,"abstract":"","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 8","pages":"1415-1417"},"PeriodicalIF":1.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A dynamic nomogram and risk stratification system for predicting cancer-specific survival in patients with locally advanced differentiated thyroid cancer: a population-based study.","authors":"Jie Yuan, Zhirong Li, Likuan Tu, Yijia Cao, Qing Li, Fan Li","doi":"10.21037/gs-2025-111","DOIUrl":"10.21037/gs-2025-111","url":null,"abstract":"<p><strong>Background: </strong>Locally advanced differentiated thyroid cancer (LADTC) refers to a severe stage of differentiated thyroid cancer (DTC) with a relatively poor prognosis. This study aimed to construct a dynamic nomogram and risk stratification system to predict cancer-specific survival (CSS) in patients with LADTC.</p><p><strong>Methods: </strong>A total of 4,856 patients diagnosed with LADTC from 2004 to 2020 were included from the Surveillance, Epidemiology, and End Results database. Least absolute shrinkage and selection operator (LASSO) and Cox regression analyses were utilized to identify variables and construct the dynamic nomogram. The performance of the nomogram was assessed using the concordance index (C-index), time-dependent receiver operating characteristic (ROC) curve, area under the curve (AUC), and calibration plot, while decision curve analysis (DCA) was conducted to evaluate clinical benefits. The improvement of the nomogram in comparison to the American Joint Committee on Cancer (AJCC) staging system was evaluated using the C-index, net reclassification index (NRI), and integrated discrimination improvement (IDI). A risk stratification system was established according to the total score of each patient in the nomogram.</p><p><strong>Results: </strong>Eight variables were identified to construct the nomogram. The C-index, time-dependent ROC curve, AUC, calibration plot, and DCA demonstrated the strong performance and clinical benefits of the nomogram. The C-index, NRI, and IDI indicated that the nomogram outperformed the AJCC staging system in prognostic prediction. The risk stratification system demonstrated the favorable ability to categorize patients with LADTC.</p><p><strong>Conclusions: </strong>A dynamic nomogram and risk stratification system were constructed and validated to assist clinicians in evaluating prognostic risk and devising personalized treatment strategies for patients with LADTC.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 8","pages":"1497-1509"},"PeriodicalIF":1.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The postoperative outcomes and oncological safety of free dermal fat graft for breast reconstruction.","authors":"Zuyan Huang, Bo Li, Chenmeng Long, Guiyi Wei, Liujing Zhu","doi":"10.21037/gs-2025-109","DOIUrl":"10.21037/gs-2025-109","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer treatment has evolved to focus on not only eradicating the disease but also enhancing the quality of life (QoL) for patients. Free dermal fat graft (FDFG) is used for immediate breast reconstruction (IBR), an emerging technique with the potential for enhanced aesthetic outcomes and improved patient satisfaction. However, concerns remain regarding complications and oncological safety. This study aims to assess the clinical effect, aesthetic outcomes, and oncological safety of FDFG compared to traditional breast-conserving surgery (TBCS) in patients with early-stage breast cancer.</p><p><strong>Methods: </strong>In this retrospective study, data from a total of 106 breast cancer patients were collected with 52 in the FDFG group and 54 in the TBCS group. Follow-up evaluations occurred at six months, one and three years after the surgery, encompassing physical examinations, imaging studies, and tumor markers for monitoring the recurrence or metastasis. The cosmetic outcomes were based on the Breast Cancer Patient-Reported Outcomes Questionnaire (BREAST-Q).</p><p><strong>Results: </strong>Despite longer operation time, more severe intraoperative bleeding, and greater postoperative drainage volumes in the FDFG group, the complication rates did not differ significantly between the groups. FDFG patients reported significantly higher scores in satisfaction with the breasts and psychosocial well-being in the BREAST-Q survey. There were no significant differences in survival rates, local recurrence rates, regional recurrence rates, or distant metastasis rates. Serum tumor markers decreased postoperatively, with no significant difference observed between the two groups.</p><p><strong>Conclusions: </strong>In this retrospective study, the short-term cosmetic outcome of FDFG was superior to that of TBCS, and patient satisfaction was higher. There was no significant difference in survival, local recurrence, nor distant metastasis. Nevertheless, further prospective studies are necessary to validate these findings regarding oncological safety.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 8","pages":"1433-1443"},"PeriodicalIF":1.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between preoperative body mass index and postoperative short-term outcomes in patients undergoing pancreaticoduodenectomy: a multicenter study.","authors":"Judong Li, Ting Niu, Xiaowei Deng, Minghui Zheng, Xunan Mao, Ligang Shi, Guang Yang, Xing Liang, Meng Ji, Zhiping Fu, Liang Tang, Danlei Chen, Anan Liu, Wei Wu, Xiaoyong Wang, Lijun Hu, Xinliang Lv, Chenghao Shao","doi":"10.21037/gs-2025-158","DOIUrl":"10.21037/gs-2025-158","url":null,"abstract":"<p><strong>Background: </strong>Pancreaticoduodenectomy (PD) is regarded as a highly complex procedures with high morbidity. This study aims to investigate the association between preoperative body mass index (BMI) and postoperative short-term outcomes in patients after PD.</p><p><strong>Methods: </strong>Patients enrolled in this multicenter study were categorized into three groups based on preoperative BMI: low-BMI group (BMI <18.5 kg/m²), normal-BMI group (18.5≤ BMI <25.0 kg/m²), and high-BMI group (BMI ≥25.0 kg/m²). The baseline characteristics, intraoperative variables, and short-term postoperative outcomes of the patients were compared. Univariable and multivariable analyses were conducted to identify the risk factors for mortality and morbidity following PD.</p><p><strong>Results: </strong>Among the 658 patients, 64 (9.7%), 475 (72.2%), and 119 (18.1%) were low-BMI, normal-BMI, and high-BMI, respectively. Compared with normal-BMI group, the mortality and morbidity were significantly higher in the low-BMI group (6.3% <i>vs.</i> 1.5%, P<i>=</i>0.03; 64.1% <i>vs.</i> 49.3%, P<0.001) and high-BMI group (5.0% <i>vs.</i> 1.5%, P<i>=</i>0.03; 67.2% <i>vs.</i> 49.3%, P<0.001). Multivariable analyses revealed that both low-BMI and high-BMI were independently associated with increased mortality [odds ratio (OR) 4.220, 95% confidence interval (CI): 1.133-15.712, P<i>=</i>0.03, and OR 4.046, 95% CI: 1.262-12.976, P<i>=</i>0.02] and overall morbidity (OR 2.084, 95% CI: 1.135-3.827, P<i>=</i>0.02, and OR 2.364, 95% CI: 1.462-3.822, P<i><</i>0.001). Similar results were also observed for the incidence of clinically relevant postoperative pancreatic fistula (CR-POPF).</p><p><strong>Conclusions: </strong>Patients with low-BMI and high-BMI had elevated postoperative mortality and morbidity, as well as an increased risk of CR-POPF following PD.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 8","pages":"1483-1496"},"PeriodicalIF":1.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative study of layered breast defect reconstruction and traditional surgery in the treatment of plasma cell mastitis: a single-center study.","authors":"Hong Xu, Hao Zheng, Xilite Dabu, Lihua Hou, Lihua Xue, Yajing Wang, Shan Miao, Zhongyuan Xia, Xiaoguang Shi","doi":"10.21037/gs-2025-99","DOIUrl":"10.21037/gs-2025-99","url":null,"abstract":"<p><strong>Background: </strong>Plasma cell mastitis (PCM) is a chronic inflammatory breast disease that presents challenges in achieving both effective disease control and satisfactory cosmetic outcomes. Layered breast defect reconstruction (LBDR) is a technique that may reduce recurrence and improve breast aesthetics. This study aimed to evaluate the clinical value of LBDR compared to traditional surgical repair in PCM patients.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 90 female PCM patients treated at the Third Medical Center of Chinese PLA General Hospital between 2002 and 2018. Patients with histologically confirmed PCM who underwent surgical treatment and completed at least 3 years of follow-up were included. Based on the surgical technique, patients were divided into two groups: traditional surgery (n=24) and LBDR (n=66). Baseline clinical characteristics-including age, body mass index (BMI), disease duration, and comorbidities-were collected and compared between groups. The primary outcomes were postoperative recurrence and aesthetic satisfaction. Secondary outcomes included operative time, intraoperative blood loss, and complication rates. Logistic regression was used to identify independent predictors of favorable outcomes.</p><p><strong>Results: </strong>The two groups were generally comparable in baseline characteristics, including BMI, smoking history, breastfeeding history, and clinical symptoms (all P>0.05). However, patients in the LBDR group were significantly older (P=0.003), and lesion locations differed between groups (P=0.02). Compared to traditional surgery, LBDR significantly reduced the recurrence rate (4.55% <i>vs.</i> 45.83%, P<0.001) and improved aesthetic satisfaction (100% <i>vs.</i> 8.33%, P<0.001). Multivariate logistic regression analysis identified LBDR as an independent protective factor for favorable breast appearance [odds ratio (OR) =0.00, 95% confidence interval (CI): 0.00-0.03, P=0.001] and reduced recurrence (OR =0.06, 95% CI: 0.01-0.25, P<0.001). Although LBDR involved a longer operative time, there were no significant differences in intraoperative bleeding nor postoperative complications.</p><p><strong>Conclusions: </strong>LBDR may provide favorable oncologic and cosmetic outcomes in selected PCM patients without increasing perioperative risks. However, given the retrospective, non-randomized design, further prospective studies are needed to validate these findings.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 8","pages":"1473-1482"},"PeriodicalIF":1.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the effectiveness of near-infrared autofluorescence (NIRAF) imaging combined with immunocolloidal gold technique (ICGT) in identifying and protecting parathyroid glands during thyroid cancer surgery.","authors":"Weijie Tao, Ran Duan, Ying Gao, Jinmiao Wang, Shoujun Wang, Jie Hao, Ming Gao","doi":"10.21037/gs-2025-118","DOIUrl":"10.21037/gs-2025-118","url":null,"abstract":"<p><strong>Background: </strong>The hypocalcemia and hypoparathyroidism due to parathyroid damage during thyroid cancer surgery seriously affect the quality of life of patients. Although contemporary scholars have implemented different technologies, demonstrating improved intraoperative outcomes, there is still a lack of reliable real-time recognition technology. The aim of this study is to assess the efficacy of near-infrared autofluorescence (NIRAF) imaging combined with immunocolloidal gold technique (ICGT) in identifying and protecting parathyroid glands (PTGs) during thyroid cancer surgery.</p><p><strong>Methods: </strong>This retrospective cohort study evaluated 62 thyroid cancer patients undergoing total thyroidectomy with bilateral central lymph node dissection (CLND) by the same surgical team (January-December 2023). Cohort allocation was based on intraoperative identification methods: the observation group (n=34) received NIRAF and ICGT, while the control group (n=28) underwent standard visual assessment. Primary endpoints included (I) intraoperative parathyroid detection quantitation; (II) rates of <i>in situ</i> gland preservation <i>vs.</i> autotransplantation; and (III) incidence of unintended parathyroid resection. Secondary outcomes assessed postoperative biochemical profiles [parathyroid hormone (PTH) and calcium levels at 24/72 h] and surgical complications. All statistical comparisons were performed with SPSS version 27.0.</p><p><strong>Results: </strong>Intraoperative analysis demonstrated superior glandular preservation in the NIRAF-ICGT cohort, with 128/132 (97.0%) PTGs maintained <i>in situ</i> versus 83/97 (85.6%) in conventional controls (P<0.001). Transplantations differed significantly between groups (4 <i>vs.</i> 14 cases, P=0.009). Although accidental resection rates showed non-significant disparity (1 <i>vs.</i> 5 glands, P>0.05), immediate postoperative metrics revealed substantial physiological advantages. Biochemical monitoring at 24 h postoperatively showed higher calcium levels in the observation group (2.11±0.13 <i>vs.</i> 1.94±0.10 mmol/L, P<0.001), paralleled by elevated PTH values {16.88 [interquartile range (IQR) 4.97] <i>vs.</i> 10.50 [3.70] pg/mL, P<0.001}. These differentials persisted through postoperative day 3: calcium concentrations (2.17±0.77 <i>vs.</i> 2.08±0.11 mmol/L, P<0.001) and PTH levels [25.38 (IQR 3.38) <i>vs.</i> 14.32 (IQR 2.08) pg/mL, P<0.001]. Clinically, the observation group exhibited reduced hypocalcemia incidence (12 <i>vs.</i> 18 cases) and lower transient hypoparathyroidism rates (10 <i>vs.</i> 16 case), both P<0.05.</p><p><strong>Conclusions: </strong>Compared to traditional visual recognition, the NIRAF-ICGT integrated technology can help surgeons better identify and protect parathyroid function during thyroid cancer surgery.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 8","pages":"1519-1528"},"PeriodicalIF":1.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved diagnostic value of whole-lesion histogram and texture analyses on multiparametric breast MRI for papillary neoplasms with non-mass enhancement.","authors":"Xinyue Li, Qiuyi Fu, Kun Sun, Fuhua Yan, Weimin Chai","doi":"10.21037/gs-2025-128","DOIUrl":"10.21037/gs-2025-128","url":null,"abstract":"<p><strong>Background: </strong>Differentiating between benign and malignant entities remains a complex aspect in the diagnosis of breast papillary neoplasms. This study aimed to assess if analyzing whole-lesion histograms and texture features on multiparametric magnetic resonance imaging (MRI) can enhance the diagnostic accuracy of breast papillary neoplasms presenting as non-mass enhancement (NME).</p><p><strong>Methods: </strong>In this retrospective analysis, 98 female patients with 98 papillary neoplasms exhibiting NME on dynamic contrast-enhanced (DCE) MRI were enrolled. Two radiologists independently assessed all lesions and later established a consensus on morphological features based on the Breast Imaging Reporting and Data System (BI-RADS) criteria. Quantitative histogram and texture metrics were extracted from four MRI sequences: diffusion-weighted imaging (DWI) with b values of 50 and 1,000 s/mm², apparent diffusion coefficient (ADC) map, and contrast-enhanced T1-weighted subtraction (SUB) magnetic resonance (MR) images. The least absolute shrinkage and selection operator (LASSO) was applied to feature selection. A multivariable logistic regression model was developed using stepwise covariate selection. Diagnostic efficacy was assessed via receiver operating characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>According to BI-RADS, benign and malignant papillary neoplasms with NME differed significantly in the amount of fibroglandular tissue (FGT), distribution, and time-intensity curve (TIC) pattern (P=0.04, 0.008, <0.001, respectively), yielding an area under the ROC curve (AUC) of 0.792 (sensitivity 67.4%, specificity 84.6%). Quantitative analysis revealed differences in the ADC_{standard deviation (SD)}, ADC_{5th percentile}, ADC_{differential entropy (diff-entropy)}, ADC_contrast, DWI_b50-SD, DWI_b800-mean, and SUB MR_{95th percentile} (P=0.009, 0.01, 0.001, 0.01, 0.001, 0.002, 0.02, respectively), achieving an AUC of 0.908 (sensitivity 82.6%, specificity 88.5%). The AUC of the quantitative model outperformed that of the qualitative model (P<0.001). The AUC of the quantitative model for distinguishing malignant NME papillary neoplasms from benign NME papillary neoplasms in the internal validation set was 0.941, with a sensitivity of 90.4%, and a specificity of 87.0%.</p><p><strong>Conclusions: </strong>Compared to the qualitative BI-RADS assessment, quantitative analysis of whole-lesion histogram and texture on multiparametric MRI is proven to be more effective in distinguishing between benign and malignant papillary breast neoplasms with NME, in order to avoid overtreatment.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 8","pages":"1444-1455"},"PeriodicalIF":1.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}