Gland surgery最新文献

{"title":"Malignant risk prediction of cystic-solid thyroid nodules using a comprehensive model integrating clinical and ultrasound features, ultrasound radiomics, and deep transfer learning.","authors":"Rongwei Liu, Haiyuan Li, Changwen Liu, Jinbo Peng, Ruizhi Gao, Hong Yang, Yun He","doi":"10.21037/gs-2024-551","DOIUrl":"10.21037/gs-2024-551","url":null,"abstract":"<p><strong>Background: </strong>The risk of malignancy in cystic-solid thyroid nodules (CSTN) varies greatly and may be underestimated. This study aimed to explore the value of a comprehensive model that integrates deep transfer learning (DTL), ultrasound radiomics, and clinical, and ultrasound features in predicting the risk of malignancy of CSTN.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 278 patients with CSTN confirmed by pathology from the First Affiliated Hospital of Guangxi Medical University from January 2023 to December 2023. Radiomics features were manually extracted from ultrasound images, and DTL features were extracted using deep learning networks. The least absolute shrinkage and selection operator (LASSO) regression was utilized to select non-zero coefficient features from radiomics and DTL features. The comprehensive model nomogram was constructed using a logistic regression algorithm that integrates clinical, ultrasound features, deep learning, and radiomics features. The predictive performance was assessed using the receiver operating characteristic (ROC) curve and the area under the curve (AUC), calibration curves, and decision curves. Subsequently, DeLong testing was performed for comparative analysis of the AUC, with parameter estimates including a 95% confidence interval (CI), and a P value of less than 0.05 was considered statistically significant.</p><p><strong>Results: </strong>The AUC of each model was compared, revealing that the comprehensive model outperformed the individual models in predicting the malignancy risk of CSTN, demonstrating good predictive performance with sensitivity and specificity of 87.50% and 82.90%, respectively. Additionally, the AUC of the comprehensive model in the testing set was 0.913 (95% CI: 0.844-0.982), which was higher than the radiomics model (0.913 <i>vs.</i> 0.898, P=0.67), and the DTL model (0.913 <i>vs.</i> 0.848, P=0.38). In the training set, the AUC was 0.973 (95% CI: 0.949-0.997), outperforming the radiomics model (0.973 <i>vs.</i> 0.926, P=0.09) and the DTL model (0.973 <i>vs.</i> 0.943, P=0.01).</p><p><strong>Conclusions: </strong>The novel comprehensive model based on ultrasound demonstrates excellent performance in predicting the malignancy risk of CSTN, providing clinicians with a preoperative non-invasive screening method to predict the malignancy risk of CSTN.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"584-596"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127438","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 web-based predictive model for secondary skin infections in breast cancer patients undergoing reconstruction.","authors":"Xuni Xu, Wanying Chen, Gaoyi Wang, Yaqin Zhou, Wenkai Pan, Yu Zhou, Wei Zhang","doi":"10.21037/gs-24-470","DOIUrl":"10.21037/gs-24-470","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer (BC) is one of the most common malignancies in women worldwide, with surgical interventions such as mastectomy and implant-based reconstruction playing a key role in management. While implant-based reconstruction offers immediate breast contour restoration, complications such as infection, capsular contracture, and implant failure are influenced by patient-specific factors, including age, body mass index (BMI), smoking, and adjuvant therapies like radiation. This study aimed to develop a predictive model for postoperative skin infections to enhance personalized risk assessment and optimize surgical outcomes in BC patients.</p><p><strong>Methods: </strong>This retrospective study included 166 Chinese female patients with BC who underwent unilateral mastectomy followed by implant-based reconstruction. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for postoperative skin infections. A nomogram was constructed based on significant variables, with its accuracy assessed using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).</p><p><strong>Results: </strong>The 166 patients were divided into training and validation cohorts (6:4). Univariate analysis identified BMI, chemotherapy, radiotherapy, and prosthesis thickness as significant factors for postoperative skin infections. Multivariate analysis confirmed BMI, chemotherapy, and prosthesis thickness as independent risk factors. The predictive model demonstrated strong performance, with area under the curve (AUC) values of 0.87 and 0.812 for the training and validation cohorts, respectively. Calibration curves showed good agreement between predicted and observed outcomes, and DCA confirmed the model's clinical utility. A web-based calculator was developed to estimate infection risk (https://kevinpan.shinyapps.io/InfectionStatus/).</p><p><strong>Conclusions: </strong>BMI, prosthesis thickness, and chemotherapy are key factors influencing the risk of postoperative skin infections in BC patients undergoing implant-based reconstruction. The predictive model developed in this study provides a valuable tool for clinicians to assess risk and personalize treatment plans. Further studies with larger cohorts are needed to validate and refine the model for broader clinical use.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"699-713"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127377","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":"Dose-dense adjuvant chemotherapy for high-risk early breast cancer: its role in the era of personalised oncology.","authors":"Constantinos Savva, Ramsey Cutress, Ellen Copson","doi":"10.21037/gs-2025-72","DOIUrl":"10.21037/gs-2025-72","url":null,"abstract":"","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"791-796"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127379","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":"Correlation study of tumor-infiltrating lymphocytes (TILs) and subtypes analysis before and after neoadjuvant chemotherapy in triple-negative breast cancer.","authors":"Yan Zhao, Si-Juan Jiang, Jin-Lu Wang, Zong-Yu Xie, Xin Jin","doi":"10.21037/gs-2024-537","DOIUrl":"10.21037/gs-2024-537","url":null,"abstract":"<p><strong>Background: </strong>In recent years, neoadjuvant chemotherapy (NACT) has become an increasingly important treatment for triple-negative breast cancer (TNBC). As the most immunogenic subtype of breast cancer, it is imperative to comprehensively study the immune microenvironment of TNBC and the effects of NACT on it. Our study aims to address this need and provide valuable insights for the development of effective postoperative adjuvant treatment strategies.</p><p><strong>Methods: </strong>Samples were taken prior to and following NACT with docetaxel, epirubicin, and cyclophosphamide (TEC) from 71 TNBC patients who were included in this trial. We examined the clinicopathological alterations in patients before and after NACT treatment, assessed the impact of stromal tumor-infiltrating lymphocytes (sTILs) and immune biomarkers [CD8, CD4, CD3, FOXP3, CD20, CD163, programmed cell death ligand 1 (PD-L1)] on the efficacy of neoadjuvant therapy, and identified changes in NACT-induced immune subsets and specific immune biomarkers.</p><p><strong>Results: </strong>Our study revealed that tumor size, histological grade, Ki-67 status, and sTILs content in baseline clinical features, as well as CD3, CD4, and CD8 content before NACT, showed significant differences between pathological complete response (pCR) and non-pCR patients (P<0.05). The expression of sTILs and PD-L1 in residual lesions after NACT was found to be higher than before NACT. Univariate analysis indicated that the levels of sTILs, CD3, CD4, and CD8 immune subsets before NACT were correlated with pCR. Importantly, multivariate regression analysis demonstrated that sTILs and CD8 immune subsets before NACT served as independent predictors of TNBC neoadjuvant therapy (P<0.05), providing crucial insights into the individualized management of TNBC.</p><p><strong>Conclusions: </strong>The findings of this study suggest that increasing sTILs and CD8 can significantly enhance the neoadjuvant efficacy of TNBC. Furthermore, the addition of CD3 and CD8 immune subsets can substantially improve the efficacy of TNBC neoadjuvant prediction. The detection of relevant immune markers after neoadjuvant therapy holds great promise in providing more comprehensive and accurate prognostic and therapeutic information for TNBC patients.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"628-645"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127321","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":"Critical appraisal of the 2 mm threshold in ductal carcinoma in situ: methodological concerns in meta-analysis of margin width and local recurrence risk.","authors":"Mariam Rizk, Muharrem Oner, Kefah Mokbel","doi":"10.21037/gs-2025-108","DOIUrl":"10.21037/gs-2025-108","url":null,"abstract":"","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"771-775"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127322","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":"Development and validation of an intratumoral-peritumoral deep transfer learning fusion model for differentiating BI-RADS 3-4 breast nodules.","authors":"Lin Shi, Xinpeng Liu, Jinyu Lai, Feng Lu, Liping Gu, Lichang Zhong","doi":"10.21037/gs-24-457","DOIUrl":"10.21037/gs-24-457","url":null,"abstract":"<p><strong>Background: </strong>The Breast Imaging Reporting and Data System (BI-RADS) 3-4 breast nodules present a diagnostic challenge, as some benign lesions lead to unnecessary biopsies. Traditional imaging modalities like mammography and ultrasound often yield false positives due to limited specificity. While radiomics and machine learning show potential for improving accuracy, most studies focus on intratumoral features, neglecting the diagnostic value of peritumoral regions (PTRs). This study aimed to develop a non-invasive tool integrating intratumoral and peritumoral deep transfer learning (DTL) features to enhance risk stratification.</p><p><strong>Methods: </strong>Clinical data (age, tumor size), ultrasound images, and parameters [calcification, color Doppler flow imaging (CDFI), BI-RADS] were retrospectively collected from 555 patients with BI-RADS 3-4 nodules confirmed by pathology at two Shanghai medical centers. Patients from Center 1 (Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine) were split into training (n=291) and internal validation sets (n=125) at a 7:3 ratio, while those from Center 2 (Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine) formed an external validation set (n=139). Radiomics features from intratumoral and PTRs (5, 10, 20 voxels) were extracted using PyRadiomics, and DTL features were derived using a pre-trained ResNet-18 network. Combined features from DTL, radiomics, and clinical data were selected via least absolute shrinkage and selection operator (LASSO) regression. Machine learning models, including logistic regression (LR), random forest (RF), naive Bayes, K-nearest neighbors (KNN), and light gradient boosting machine (LightGBM), were constructed and compared using metrics like area under the curve (AUC). Ultrasound physicians independently reviewed images, and their performance was compared with the models.</p><p><strong>Results: </strong>The cohort included 555 female patients (mean age: 48.11±14.83 years), with 72.07% of nodules lacking calcifications and 61.08% without CDFI signals. The naive Bayes model based on intratumoral and 10-voxel peritumoral DTL features performed best. In the training set, it achieved an AUC of 0.911 (accuracy: 0.852, sensitivity: 0.852, specificity: 0.852). In the internal and external validation sets, AUCs were 0.909 and 0.910, respectively, outperforming physicians' AUCs of 0.722 and 0.745. The model also surpassed physicians in accuracy, sensitivity, specificity, and efficiency.</p><p><strong>Conclusions: </strong>The DTL feature model integrating intratumoral and PTRs effectively predicts BI-RADS 3-4 nodule malignancy, outperforming ultrasound physicians. It aids in reducing unnecessary biopsies and improving treatment decisions.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"658-669"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127338","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":"Intra-parotid lymph node metastasis in primary parotid gland cancer: a narrative review of its significance, anatomic distribution, and therapeutic implications.","authors":"Jeon Yeob Jang, Han-Sin Jeong","doi":"10.21037/gs-2024-575","DOIUrl":"10.21037/gs-2024-575","url":null,"abstract":"<p><strong>Background and objective: </strong>Intra-parotid lymph node metastasis (LNM) has been proven to be an independent predictor of worse prognosis in patients with primary parotid gland cancer (PGC) as well as cervical LNM. However, the anatomic information or distribution of intra-parotid LNM within the parotid glands and its clinical significance remain largely unexplored. In this narrative review summarizing the relevant literature, we sought to answer the sub-site distribution of intra-parotid LNM in PGC, and suggest therapeutic implications.</p><p><strong>Methods: </strong>A comprehensive review of the literature was conducted by searching the PubMed and Web of Science databases. Manuscripts offering objective data on the incidence, subsite distribution, and prognostic significances of intra-parotid LNM were selected for inclusion in this review.</p><p><strong>Key content and findings: </strong>Overall, the rate of intra-parotid LNM appears to be greater than 40% in high-grade PGC but not in low-grade PGC. As for the lymph node (LN) distribution in the normal parotid gland, the majority (>80%) of LNs in the parotid glands are located in the superficial lobe, while the deep lobe contains just one LN on average. The European Salivary Gland Society (ESGS) classification system of the parotid gland sub-site is straightforward and can be applied to confirm intra-parotid LNM. Taking into consideration the intra-parotid LNM location, most intra-parotid LNMs from PGC are observed in the superficial parotid LNs, while metastasis to the deep parotid LNs seems to compose less than 10% of cases.</p><p><strong>Conclusions: </strong>The rate of intra-parotid LNM in the parotid deep lobe is not high enough to justify total parotidectomy in all PGC cases. In some PGC cases, a more selective approach preserving a portion of the deep parotid gland with a low risk of intra-parotid LNM might be an alternative to total parotidectomy.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"761-770"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127470","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":"Risking arm lymphedema in more than a hundred patients to benefit one patient-is it worth it?","authors":"Geok Hoon Lim, Yoon-Sim Yap, Rui Jun Lim, Lester Chee Hao Leong","doi":"10.21037/gs-2025-34","DOIUrl":"10.21037/gs-2025-34","url":null,"abstract":"","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"781-784"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127489","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":"Fluorescent intraoperative tissue angiography during breast reduction: a single institution, single surgeon study evaluating decrease in complication rates with acquired proficiency.","authors":"Jillian A Smith, Scott Sylvester, Daniel Norez, William D Kelly, Hugues Touze, Kristina M Crawford, Brian G Celso, John D Murray","doi":"10.21037/gs-2024-532","DOIUrl":"10.21037/gs-2024-532","url":null,"abstract":"<p><strong>Background: </strong>Fluorescent intraoperative tissue angiography (FITA) provides real-time perfusion analysis that predicts which tissues will progress to postoperative ischemic necrosis. This technology helps guide the surgeon to resect the at-risk tissues preemptively. The purpose of our study was to evaluate whether clinical outcomes are affected by the level of experience with FITA for superomedial-pedicle breast reduction (SBR).</p><p><strong>Methods: </strong>A retrospective, sequential series of 50 patients who underwent single-surgeon bilateral reduction mammaplasty using FITA (SPY Elite, Stryker, Kalamazoo, MI, USA) between April 2015 and September 2020 were included in the study. Two groups from the series were formed: the first three years with 25 patients (Group A) and the last three years with 25 patients (Group B). Operative data included FITA perfusion indices (medial breast, lateral breast, and nipple-areolar complex) and resection weight. Post-operative complications such as return to operating room (RTOR), and skin or nipple loss were reported.</p><p><strong>Results: </strong>Two statistically significant changes were observed: superomedial perfusion indices increased (right breast P<0.001, left breast P=0.02) and resection weights decreased (right breast P=0.044, left breast P=0.007). While the number of observed complications (nipple sensation, minor skin loss, RTOR), decreased in Group B compared to Group A, the difference was not statistically significant (P=0.62). The rate of minor skin or nipple loss was reduced by 57% in Group B versus Group A).</p><p><strong>Conclusions: </strong>FITA may help guide the preservation of perforators in the breast reduction pedicle. Though doing so did not reveal any statistical reduction in the number of complications in our study. These findings require further investigation for definitive conclusions.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"611-617"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127392","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":"Oncoplastic breast-conserving surgery: advancing oncological outcomes and aesthetic standards in breast cancer treatment.","authors":"Umar Wazir, Kefah Mokbel","doi":"10.21037/gs-2024-572","DOIUrl":"10.21037/gs-2024-572","url":null,"abstract":"","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"797-799"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127410","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}