Gland surgery最新文献

{"title":"Evaluating the role of sentinel lymph node biopsy in cT1-2N0M0 breast cancer: a SEER-based study.","authors":"Zheng Xu, Guidong Chen, Binxiao Cao, Mianhao Zhang, Pengcheng Ruan","doi":"10.21037/gs-2025-171","DOIUrl":"10.21037/gs-2025-171","url":null,"abstract":"<p><strong>Background: </strong>Axillary lymph node staging is vital in breast cancer (BC) management. Sentinel lymph node biopsy (SLNB) reduces complications compared to axillary lymph node dissection (ALND). Recent trials suggest omitting SLNB may be feasible for early-stage patients. This study uses the Surveillance, Epidemiology, and End Results (SEER) database to validate these findings for cT1-2N0M0 patients and explores the relationship between tumor T staging and SLNB.</p><p><strong>Methods: </strong>We selected BC patients with cT1-2N0M0 stage who underwent breast-conserving surgery (BCS) or BCS + SLNB from the SEER database based on the inclusion and exclusion criteria. Propensity score matching (PSM) was used to balance baseline differences between the two groups. Cox regression analysis was performed to identify independent risk factors for these patients, and Kaplan-Meier (KM) analysis was used to assess survival differences in overall survival (OS) and breast cancer-specific survival (BCSS) between the BCS and BCS + SLNB groups.</p><p><strong>Results: </strong>This study included 1,470 BC patients, with 215 undergoing BCS and 1,255 undergoing BCS + SLNB. The BCS group had less aggressive tumors and was older on average. Cox regression analysis of patients' OS and BCSS showed that SLNB was not an independent risk factor for patients. Before PSM, SLNB was associated with improved OS in patients; however, after PSM, this statistical difference disappeared. Subgroup analysis by T staging also indicated no impact of SLNB on OS or BCSS, supporting the feasibility of omitting SLNB for clinically node-negative (cN0) patients.</p><p><strong>Conclusions: </strong>This study, using the SEER database, found that SLNB did not impact the prognosis of cT1-2N0M0 BC patients, regardless of T stage. This supports previous findings that these patients may avoid axillary surgery without compromising outcomes.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 8","pages":"1585-1598"},"PeriodicalIF":1.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064337","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":"Multimodal model enhances qualitative diagnosis of hypervascular thyroid nodules: integrating radiomics and deep learning features based on B-mode and PDI images.","authors":"Wen Wen, Tingrui Zhang, Haina Zhao, Jingyan Liu, Heng Jiang, Yushuang He, Zekun Jiang","doi":"10.21037/gs-2025-183","DOIUrl":"10.21037/gs-2025-183","url":null,"abstract":"<p><strong>Background: </strong>Facing challenges in differentiating benign/malignant hypervascular thyroid nodules due to overlapping ultrasound features and limited vascular characterization, this study developed multimodal machine learning models integrating B-mode and power Doppler imaging (PDI) features.</p><p><strong>Methods: </strong>A retrospective cohort of 315 patients with pathologically confirmed hypervascular thyroid nodules (Adler grade 2/3) was divided into training (n=220) and test (n=95) sets. Multimodal ultrasound images were processed using a deep learning-based segmentation model and red-channel thresholding method, followed by radiomics feature extraction (1,910 features via PyRadiomics) and deep learning feature derivation (1,000 ResNet-derived features). Feature selection employed analysis of variance (ANOVA) F-tests, yielding hybrid feature sets. Five machine learning algorithms, including random forest, logistic regression, support vector machine (SVM), eXtreme Gradient Boosting (XGBoost), and Tabular Prior-data Fitted Network (TABPFN), were trained and validated. A fused model integrated optimal B-mode and PDI SVM models. Performance was assessed via area under the curve (AUC), accuracy, precision, recall, and SHapley Additive exPlanations (SHAP) analysis. Clinical trial registration number: ChinCTR2100049742.</p><p><strong>Results: </strong>SVM outperformed other models in single-modality analyses: B-mode SVM achieved an AUC of 0.89 (accuracy: 0.84; recall: 0.94), while PDI SVM attained an AUC of 0.86 (accuracy: 0.82; recall: 0.97). The combined model demonstrated near-perfect training performance (AUC: 1.00; accuracy: 0.96) but moderated in testing (AUC: 0.89; accuracy: 0.78), indicating potential overfitting. Radiomics features dominated feature importance, including Logarithm_firstorder_Energy (B-mode) and squareroot_firstorder_Minimum (PDI). The fused model showed superior recall (0.95) and F1-score (0.86) compared to single modalities, highlighting complementary diagnostic value.</p><p><strong>Conclusions: </strong>Multimodal ultrasound fusion models, particularly SVM-based frameworks, enhance diagnostic accuracy for hypervascular thyroid nodules by synergizing morphological and vascular features. Despite challenges in generalizability, the integration of radiomics and deep learning features offers clinically reliable tools to reduce invasive biopsies.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 8","pages":"1558-1571"},"PeriodicalIF":1.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064357","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":"Identification and validation of a novel lymph node metastasis-related model for papillary thyroid carcinoma to predict the prognosis.","authors":"Chao-Ran Xie, Xi-Wei Zhang, Qi Chen, Li-Feng Zhao, Kai-Ming Huang, Yong Wang, Xing Yu","doi":"10.21037/gs-2025-102","DOIUrl":"10.21037/gs-2025-102","url":null,"abstract":"<p><strong>Background: </strong>Papillary thyroid carcinoma (PTC) is a common malignancy with a good prognosis, but lymph node metastasis (LNM) is associated with a poor prognosis for patients. This study aimed to construct an LNM-related risk model and identify hub genes that could predict the prognosis of PTC.</p><p><strong>Methods: </strong>Gene expression and clinical information were obtained from The Cancer Genome Atlas (TCGA). Cox analysis was used to select hub genes and construct a risk model. The model was validated through receiver operator characteristic (ROC) curve. Nomogram was constructed for clinical application. Survival analysis was performed by the Kaplan-Meier (K-M) curve. Methylation of hub genes and drug sensitivity were calculated in Gene Set Cancer Analysis (GSCA). The expression levels of four hub genes and their effect on the malignant features of PTC were further validated through cell experiments.</p><p><strong>Results: </strong>A risk model was constructed by four hub genes <i>ATP2C2</i>, <i>CXCL5</i>, <i>IL11</i>, and <i>TREM1</i>. ROC curve showed that the AUC of the risk model for PTC prognosis at 3-, 5-, and 10-year was 0.91, 0.88, and 0.92, respectively. The nomogram indicated that risk score was more important than some clinical characteristics. High-risk group exhibited lower immune infiltration levels. In PTC, four hub genes might function as oncogenes, but <i>ATP2C2</i> was lowly expressed in tumors and patients with LNM. Additionally, <i>ATP2C2</i> overexpression promoted PTC cell migration, invasion, and LNM-related protein expression levels, while knockdown of <i>CXCL5</i>, <i>IL11</i>, and <i>TREM1</i> inhibited PTC cells' malignant features.</p><p><strong>Conclusions: </strong>We constructed an LNM-related risk model based on four hub genes, and targeting these key genes can benefit patients from immunotherapy or chemotherapy.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 8","pages":"1456-1472"},"PeriodicalIF":1.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064285","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":"Clinicopathological characteristics and outcomes of phyllodes tumors in a tertiary care center: a retrospective study.","authors":"Louae Malaika, Abdulrahman A Alamoudi, Ghader Jamjoum, Nora Trabulsi, Ali Samkari, Rana Ajabnoor, Shadi Alahmadi, Hessa Aljhdali, Bayan Z Hafiz","doi":"10.21037/gs-2025-153","DOIUrl":"10.21037/gs-2025-153","url":null,"abstract":"<p><strong>Background: </strong>Phyllodes tumors (PTs) are rare breast tumors that account for less than 1% of all breast tumors worldwide. According to the World Health Organization (WHO), PTs can be classified as benign, borderline, or malignant based on their microscopic features. Currently, surgical excision with a clear margin is the standard treatment for PTs. The aim of this study is to investigate the clinicopathological characteristics of PTs at a tertiary care hospital to explore their association with recurrence and other clinical outcomes.</p><p><strong>Methods: </strong>This study was conducted at King Abdulaziz University Hospital, a tertiary care hospital in Jeddah, Saudi Arabia, between 2015 and 2024. We retrospectively collected and analyzed data to identify the outcomes of PTs in relation to their pathological characteristics. The data included demographics, clinical presentation, radiological features, surgery type, and histopathological features.</p><p><strong>Results: </strong>Thirty-seven patients with PT (12 benign, 14 borderline, and 11 malignant) were included. The mean age was 43.7 years, and the average tumor size was 9 cm. According to our analyzed data, 7 (18.9%) of the patients had local recurrence and systemic after surgery: one benign, two borderline, and four malignant. Focal infiltrative margin type was significantly correlated with recurrence rate (P=0.01).</p><p><strong>Conclusions: </strong>We conclude that PT with focal infiltration has a higher risk for recurrence of the tumor. Margin status and stromal cellularity do not correlate with the recurrence rate. A multi-center study with a larger sample size is recommended to reach more accurate results.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 8","pages":"1510-1518"},"PeriodicalIF":1.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064321","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":"Factors influencing the efficacy of neoadjuvant chemotherapy for HER-2-low early-stage breast cancer and a predictive model for pathological complete response.","authors":"Shuai Duan, Dilimulati Aisimutula, Yiyang Wang, Binjie Zheng, Chenming Guo","doi":"10.21037/gs-2025-7","DOIUrl":"10.21037/gs-2025-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;At present, human epidermal growth factor receptor 2 (HER-2)-low and HER-2-zero breast cancer (BC) are still classified into a single category, which simplifies targeting in the selection of neoadjuvant chemotherapy (NAC) regimens. Moreover, no studies have reported the factors influencing pathological complete response (pCR) after NAC for HER-2-low early-stage breast cancer (eBC) and constructed predictive models. This study aimed to clarify the tumor heterogeneity of these two types of eBC to provide a research basis for subsequent clinical classification and diagnosis. Moreover, a prediction model was constructed to provide a basis for the selection of the initial treatment plan for HER-2-low eBC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study retrospectively included 212 patients with HER-2-low and HER-2-zero eBC treated with NAC and surgery from April 2013 to March 2024. The differences in the effects of NAC were compared at the imaging and pathological levels via Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and the Miller-Payne assessment criteria, and the clinical and core needle biopsy histopathological (CNB) features were analyzed to clarify the influencing factors. Moreover, the clinical and pathological factors influencing pCR after NAC for HER-2-low eBC were analyzed via univariate analysis and multifactorial binary logistic regression. A nomogram prediction model was constructed based on the independent influencing factors, diagnostic calibration curves were used for the goodness-of-fit test, and the performance of the prediction model was evaluated via receiver operating characteristic (ROC) curve analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;HER-2-low eBC was associated with worse responsiveness to NAC at both the imaging and pathologic levels (P&lt;0.05) and were significantly associated with estrogen receptor (ER)-positive status (P=0.03), progesterone receptor (PR)-positive status (P=0.04), and a low expression of Ki-67 (P=0.045). Univariate analysis indicated that a maximum tumor diameter &gt;3 cm (P=0.04), positive axillary lymph nodes through puncture (P=0.001), fewer chemotherapeutic cycles (P=0.002), pathological grading I or II through puncture (P=0.04), ER-positive status (P=0.001), PR-positive status (P&lt;0.001), low expression of Ki-67 (P=0.04), androgen receptor (AR)-positive status (P&lt;0.001), and tumor invasion (P=0.002) were all unfavorable factors influencing pCR after NAC of HER-2-low eBC. Multifactorial analysis found that a maximum tumor diameter &gt;3 cm [odds ratio (OR): 0.088; 95% confidence interval (CI): 0.015-0.529; P=0.008], positive axillary lymph nodes through puncture (OR: 18.677; 95% CI: 3.028-115.201; P=0.002), and fewer chemotherapeutic cycles (OR: 0.337; 95% CI: 0.148-0.764; P=0.009) were independent unfavorable factors. The area under the ROC of the nomogram prediction model for pCR after NAC for HER-2-low eBC was 0.861 (95% CI: 0.785-0.936), with a sensitivity of ","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 8","pages":"1418-1432"},"PeriodicalIF":1.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064297","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":"Single-incision robotic nipple-sparing mastectomy with immediate breast reconstruction: a comprehensive surgical technique and strategy.","authors":"Ze Huang, Zuxiao Chen, Xiaoyan Fu, Zongyan Li, Zhijie Wu, Qiwen Liu, Lina Wei, Bingfeng Chen, Chan Qiu, Haiyan Li","doi":"10.21037/gs-2025-151","DOIUrl":"10.21037/gs-2025-151","url":null,"abstract":"<p><p>With the increasing application of robotic surgical systems in various surgical fields and the progressive refinement of endoscopic breast surgery, robotic breast surgery has been actively explored and implemented. Robotic surgical platforms offer several advantages, including enhanced flexibility, three-dimensional magnified visualization, high-resolution imaging, and tremor elimination, thereby improving surgical stability and precision, particularly in confined surgical spaces. Given that the breast lacks a natural cavity, robotic surgical systems exhibit a high degree of adaptability for breast surgery. In 2015, Toesca <i>et al.</i> first reported robotic nipple-sparing mastectomy (R-NSM) with immediate breast reconstruction (IBR), which has since become a mainstream approach in robotic-assisted breast surgery. Existing studies have consistently demonstrated that R-NSM with IBR is a safe and feasible procedure, achieving good aesthetic outcomes, high patient satisfaction, and a low complication rate. However, as R-NSM with IBR is still in its nascent stages, particularly, single-incision R-NSM with IBR, the procedure involves intricate and complex surgical steps. The adoption of this novel technology imposes higher requirements on surgical precision, further increasing the procedural complexity. Standardized protocols and systematic workflows for this procedure are yet to be established. In this study, we provide a comprehensive step-by-step description of the entire surgical process of single-incision R-NSM with IBR through an instructional video and text.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 8","pages":"1612-1621"},"PeriodicalIF":1.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064302","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":"Visualizing research trends and collaboration networks in surgery: a case study of bilateral axillo-breast approach surgery [2007-2024].","authors":"Inho Lee, Sung Heuk Kim, Gahgene Gweon, Hyeong Won Yu, Su-Jin Kim, Young Jun Chai, June Young Choi, Kyu Eun Lee","doi":"10.21037/gs-2025-167","DOIUrl":"10.21037/gs-2025-167","url":null,"abstract":"<p><strong>Background: </strong>Bilateral axillo-breast approach (BABA) offers a remote-access technique for thyroidectomy that maintains the advantages of conventional surgery while eliminating visible neck scarring. Despite its increasing global adoption, no comprehensive bibliometric analysis has been conducted to examine the academic progression of BABA. This study evaluates publication trends, citation networks, and keyword patterns in BABA-related literature over the past 18 years.</p><p><strong>Methods: </strong>A bibliometric analysis was conducted using data from PubMed and Web of Science (WoS) covering the period before 2024. Articles were retrieved using search terms related to BABA. Citation networks, co-authorships, and keyword clusters were visualized using bibliometric tools such as VOSviewer and CiteSpace. Following data cleaning and standardization, articles were included in the analysis.</p><p><strong>Results: </strong>This study analyzed 170 publications related to the BABA technique and visualized research trends and the status of global collaboration networks through annual publication trends, co-citation analysis, keyword analysis, citation relationships among countries and institutions, as well as author and journal analyses. South Korea published the largest number of articles (106, 62.4%), followed by China (37, 21.8%) and the United States (19, 11.2%). In addition, articles were published by authors from various other countries. Additionally, keyword analysis revealed \"robotic thyroidectomy\" and \"endoscopic thyroidectomy\" as major recurring themes, with a marked increase in frequency since 2010, indicating a steady rise in academic interest in the BABA technique.</p><p><strong>Conclusions: </strong>According to 18 years of bibliometric analysis, research on the BABA surgical technique has expanded significantly, accompanied by growing academic interest and widespread global adoption. Studies related to BABA have been actively conducted in South Korea, the United States, and China, with researchers from other countries increasingly showing interest and beginning to implement the technique in clinical practice. These findings suggest the potential for even broader global adoption of the BABA approach in the future.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 8","pages":"1572-1584"},"PeriodicalIF":1.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064359","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":"Intraoperative applications of artificial intelligence for augmented parathyroid gland recognition: a narrative review.","authors":"Alexis Korman, Kepal N Patel","doi":"10.21037/gs-2025-165","DOIUrl":"10.21037/gs-2025-165","url":null,"abstract":"<p><strong>Background and objective: </strong>Intraoperative parathyroid gland recognition is a key step during thyroidectomy to decrease the risk of postoperative hypocalcemia and during parathyroidectomy to distinguish normal and abnormal glands. Current methods for intraoperative identification rely largely upon visual identification. Recent investigation of methods such as near-infrared (NIR) autofluorescence and indocyanine green (ICG) for enhanced recognition have demonstrated steep learning curves. Artificial intelligence (AI) augmentation of all methods of parathyroid gland identification may improve intraoperative recognition rates and ultimately decrease rates of postoperative hypoparathyroidism. This narrative review aims to summarize the status of intraoperative application of AI for parathyroid gland recognition.</p><p><strong>Methods: </strong>A systematic, comprehensive literature search was conducted using the search terms \"artificial intelligence\", \"deep learning\", \"surgery\", \"parathyroid gland\", and \"parathyroid glands\". Inclusion criteria included articles in English with the majority of the article devoted to intraoperative applications of AI on parathyroid gland recognition. Eleven studies were identified and included.</p><p><strong>Key content and findings: </strong>Eight studies focused on utilizing AI intraoperatively to identify parathyroid glands from surrounding tissues. Three studies focused on using AI to predict abnormal from normal parathyroid glands. Five studies used NIR autofluorescence, two studies used visual recognition during open thyroidectomy, two studies used visual recognition during endoscopic thyroidectomy, one study used NIR autofluorescence with ICG angiography, and one study used coaxial dual-red-green-blue/near-infrared (dual-RGB/NIR) imaging system to identify parathyroid glands. Recall and precision scores for the models ranged from 50-95% and 72-94%, respectively. Four studies compared model performance with that of senior and junior surgeons and found that the models outperformed junior surgeons while performing comparably to senior surgeons.</p><p><strong>Conclusions: </strong>AI augmentation of intraoperative parathyroid gland recognition demonstrates adequate accuracy results across a range of parathyroid gland recognition methods. Although these models are not currently available for widespread commercial use, the eventual integration into clinical practice may allow for enhanced intraoperative recognition of parathyroid glands, particularly in lower volume centers and for junior level surgeons.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 8","pages":"1622-1633"},"PeriodicalIF":1.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064354","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":"Targeted axillary dissection in breast cancer patients with metastatic nodal disease: a prospective study on localization techniques and oncological outcomes.","authors":"Geok Hoon Lim, Aisha Masoud Al Shukairi, Yien Sien Lee, Sze Yiun Teo, Zhiyan Yan, Qing Ting Tan, Mihir Gudi, Ruey Pyng Ng, Fuh Yong Wong","doi":"10.21037/gs-2025-166","DOIUrl":"10.21037/gs-2025-166","url":null,"abstract":"<p><strong>Background: </strong>Neoadjuvant chemotherapy followed by targeted axillary dissection (TAD) has been proposed as an alternative to axillary lymph node dissection (ALND) in breast cancer patients with metastatic nodal disease. However, there is lack of standardization of TAD technique. This study aimed to prospectively evaluate the effectiveness of various localization techniques in TAD and assess the oncological outcomes of TAD alone versus ALND.</p><p><strong>Methods: </strong>Breast cancer patients with histologically proven nodal metastasis (T1-4N1-2M0) and neoadjuvant chemotherapy were included. Patients were divided into three groups: TAD-alone, TAD with ALND, and upfront ALND. Localization techniques used during TAD were assessed and oncological outcomes were compared between the TAD alone and ALND groups. This study was registered with ClinicalTrials.gov (identifier: NCT03878017).</p><p><strong>Results: </strong>One hundred and twenty-three patients, of which 18, 18, 87 underwent TAD alone, TAD with ALND and upfront ALND respectively, were included. All localization techniques, such as skin marking, Savi Scout and radio-guided occult lesion localization (ROLL) resulted in 100% retrieval of the marked node. Single-agent sentinel node localization during TAD was feasible. After a median follow-up of 13 and 23 months for the TAD-alone and ALND groups respectively, there were no significant differences in their oncological outcomes.</p><p><strong>Conclusions: </strong>Various localization techniques, including the less studied skin marking and ROLL, were effective in TAD. During TAD, single agent may be used for sentinel node localization. TAD alone did not have inferior oncologic outcomes on short term follow-up and may replace ALND in patients with complete nodal pathological response after neoadjuvant chemotherapy. Our findings need validation in larger studies with longer follow-up.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 8","pages":"1529-1538"},"PeriodicalIF":1.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064423","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":"Marital status, race/ethnicity, and outcomes in well-differentiated thyroid cancer in the elderly.","authors":"Ryan C Higgins, David C Moffatt, Christopher S Hollenbeak, David Goldenberg","doi":"10.21037/gs-2025-113","DOIUrl":"10.21037/gs-2025-113","url":null,"abstract":"<p><strong>Background: </strong>There is limited research examining the effect of marital status on outcomes for patients with well-differentiated thyroid carcinoma, particularly among patients ≥55 years of age and by race/ethnicity. This study aimed to better characterize the interplay between age, race, and marital status in the treatment and prognosis for patients with well-differentiated thyroid carcinoma.</p><p><strong>Methods: </strong>A retrospective, observational study of 12,779 patients ≥55 years of age with well-differentiated thyroid carcinoma was conducted using the Surveillance, Epidemiology, and End Results registry from January 1, 1988 to December 31, 2013. Marital status was classified as married, single, separated/divorced, widowed, and \"other\". Race/ethnicity was classified as White non-Hispanic, Black non-Hispanic, Hispanic, Asian and \"other\". Disease-specific survival was analyzed controlling for patient, disease, and treatment characteristics. A secondary analysis of overall survival, defined as death from any cause, was performed. Survival analyses were performed focusing on effects for marital status and race/ethnicity.</p><p><strong>Results: </strong>Widowed status, increasing age, male sex, distant stage, local excision, and external beam radiation were associated with significantly worse disease-specific survival. When compared to their married counterparts, widowed patients ≥65 years of age and widowed Black non-Hispanic patients both had significantly worse overall survival, while widowed White non-Hispanic patients had significantly worse overall and disease-specific survival.</p><p><strong>Conclusions: </strong>Our study elucidates the impact of widowed marital status and race/ethnicity have on mortality amongst older patients with well-differentiated thyroid carcinoma.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 8","pages":"1599-1611"},"PeriodicalIF":1.6,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064360","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}