Gland surgery最新文献

{"title":"Late breast cancer recurrence concurrent with silicone breast implant rupture 17 years after mastectomy and immediate implant-based reconstruction in a 53-year-old woman: a case report.","authors":"Mohan Liu, Yuming Chong, Qiang Sun, Feng Mao","doi":"10.21037/gs-2026-0305","DOIUrl":"10.21037/gs-2026-0305","url":null,"abstract":"<p><strong>Background: </strong>Late locoregional breast cancer recurrence and silicone implant rupture can produce similar cutaneous and periprosthetic abnormalities. However, positron emission tomography-computed tomography (PET/CT) may mask the true malignant tumor due to implant-related inflammation, resulting in false-negative results. Cases where breast cancer recurrence and silicone implant rupture coexist have rarely been reported. We report histologically confirmed recurrence with silicone implant rupture 17 years after mastectomy and immediate implant-based reconstruction for ductal carcinoma <i>in situ</i> (DCIS).</p><p><strong>Case description: </strong>A 53-year-old woman presented a 4-month history of progressive peri-areolar skin lesions 17 years after right mastectomy and immediate implant-based reconstruction. The lesions initially appeared in the medial peri-areolar region and subsequently extended toward the nipple, with erythema, ulceration, and crusting. Ultrasonography demonstrated skin and subcutaneous oedema, increased vascularity, multiple hypoechoic periprosthetic lesions, and implant capsule discontinuity. PET/CT showed mildly increased peri-areolar uptake [maximum standardized uptake value (SUVmax), 5.2] but no discrete hypermetabolic mass or regional nodal involvement; the findings were interpreted as implant rupture-related inflammation. No pre-operative biopsy or magnetic resonance imaging (MRI) was performed. The patient underwent excision of the nipple-areolar complex (NAC) and involved peri-areolar skin, partial capsulectomy, and implant removal. Intraoperative frozen section confirmed malignancy; implant rupture was identified after capsulotomy. Final histopathological examination revealed a 3.4 cm × 2.5 cm × 2.0 cm, histologic grade 2 invasive ductal carcinoma with multifocal epidermal and subdermal invasion, Paget disease of the nipple, and carcinoma involving the fibrous capsule wall. The tumour was estrogen receptor (ER) positive, progesterone receptor (PR) negative, human epidermal growth factor receptor 2 (HER2) negative by fluorescence <i>in situ</i> hybridization, and had a Ki-67 index of 10%. All peri-areolar lesions represented malignant infiltration, with no silicone granuloma identified. Postoperative treatment would comprise four cycles of anthracycline-taxane chemotherapy, locoregional radiotherapy, and long-term endocrine therapy. The wound healed without complication until the last follow-up in May 2026.</p><p><strong>Conclusions: </strong>In implant-reconstructed breasts, late-onset skin changes, capsular abnormalities, or new periprosthetic masses warrant timely tissue diagnosis, even when PET/CT does not demonstrate a discrete malignant focus or suggests implant-related inflammation. Imaging findings alone may not reliably distinguish implant rupture-associated changes from locoregional breast cancer recurrence.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"240"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929844","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 prognostic value of central excised lymph node count in N1a papillary thyroid cancer: a population-based study.","authors":"Weijian Li, Wenxin Zhang, Jianlan Yue, Hui Wang, Jinyan Chai, Jian Tan, Qiang Jia, Ruiguo Zhang","doi":"10.21037/gs-2026-0240","DOIUrl":"10.21037/gs-2026-0240","url":null,"abstract":"<p><strong>Background: </strong>The optimal number of excised lymph nodes (ELNs) during central-compartment neck dissection for papillary thyroid cancer (PTC) remains unclear. This study aimed to investigate the association between central ELN count and overall survival (OS) in PTC patients with N1a disease.</p><p><strong>Methods: </strong>Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015, encompassing a total of 10,445 patients with N1a PTC. Restricted cubic splines (RCSs) were used to characterize the relationship between ELN count and OS. Multivariate Cox proportional hazards models and sensitivity analyses were employed to assess the association.</p><p><strong>Results: </strong>Among the 10,445 patients, the RCS revealed an L-shaped association between the number of ELNs and OS (P for non-linearity <0.05), with a threshold identified at 5 ELNs. Below this threshold, each additional ELN was associated with a 15% decrease in the risk of death [hazard ratio (HR), 0.85, 95% confidence interval (CI): 0.76-0.95]. However, no significant survival benefit was observed when ELN count exceeded 5 (HR, 1.00; 95% CI: 0.97-1.04). Sensitivity analyses confirmed similar correlations between the ELN count and OS.</p><p><strong>Conclusions: </strong>Our study revealed an L-shaped association between central ELNs and OS in N1a PTC patients, suggesting ELN count serves as a prognostic indicator and a threshold of 5 ELNs may optimize survival outcomes. Further validation is required to address potential biases, including unmeasured confounders inherent in retrospective data.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"230"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944235","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 simple four-variable nomogram integrating age, ACR-TIRADS, BRAF V600E and Bethesda cytology for predicting occult central lymph node metastasis in papillary thyroid microcarcinoma: a preoperative risk-stratification tool.","authors":"Bin Cao, Gao Fei, Si-Cong Zhou, Yiwen Ding, Leilei Liu","doi":"10.21037/gs-2026-0352","DOIUrl":"10.21037/gs-2026-0352","url":null,"abstract":"<p><strong>Background: </strong>Predicting occult central lymph node metastasis (CLNM) in papillary thyroid microcarcinoma (PTMC) is important for individualized surgical planning and risk-stratified decision-making, particularly in younger patients. This study aimed to develop and internally validate a simple four-variable nomogram integrating age, American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS), BRAF V600E status, and Bethesda cytology for preoperative prediction of occult CLNM in PTMC.</p><p><strong>Methods: </strong>We retrospectively analyzed 130 PTMC patients (≤10 mm on pre-operative ultrasound) who underwent thyroidectomy with central lymph node dissection (CLND) at a single Chinese tertiary center (March 2020-December 2022). A four-variable logistic-regression nomogram (Model E) was developed integrating age, ACR-TIRADS category, BRAF V600E mutation status (from fine-needle aspiration), and Bethesda cytological classification. Internal validation used 5-fold stratified cross-validation. Calibration was assessed by the Hosmer-Lemeshow test and calibration curves; clinical utility by decision curve analysis (DCA).</p><p><strong>Results: </strong>CLNM was confirmed in 73/130 patients (56.2%). The 5-fold cross-validated area under the receiver operating characteristic curve (AUC) was 0.686, with acceptable calibration (Brier score 0.215; Hosmer-Lemeshow P=0.43). DCA demonstrated positive net clinical benefit across threshold probabilities of 0.31-0.95. Pre-specified but exploratory subgroup analyses suggested higher apparent discrimination in patients younger than 45 years (n=60; bootstrap median AUC 0.760, 95% CI: 0.574-0.888) and in BRAF wild-type cases (n=35; 0.864, 95% CI: 0.705-0.977), although CIs were wide and overlapping. In this PTMC cohort, BRAF V600E was not independently associated with CLNM; an inverse point estimate was observed but did not reach statistical significance and should be regarded as exploratory.</p><p><strong>Conclusions: </strong>This simple, four-variable nomogram provides clinically useful pre-operative CLNM risk assessment in PTMC, particularly in younger and BRAF wild-type patients-subgroups in which preoperative risk stratification is most challenging. External multi-center validation is the necessary next step.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"216"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944320","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":"Integrating delta radiomics and changes in multimodal ultrasound features for predicting response to neoadjuvant chemotherapy in breast cancer.","authors":"Jingchao Chen, Kangjian Wang, Ming He, Haolin Shen, Hong Chen","doi":"10.21037/gs-2026-0342","DOIUrl":"10.21037/gs-2026-0342","url":null,"abstract":"<p><strong>Background: </strong>To evaluate whether a multimodal, noninvasive approach can enable early prediction of response to neoadjuvant chemotherapy (NAC) in patients with breast cancer. This study aimed to develop and validate a model combining delta radiomics features (RFs), immunohistochemical (IHC) markers, tumor shrinkage patterns, and multimodal ultrasound (US) changes for early and noninvasive prediction of NAC response in breast cancer, and to preliminarily assess the association between shrinkage patterns and IHC characteristics.</p><p><strong>Methods: </strong>A total of 101 patients with breast cancer treated with NAC were included. US examinations performed before treatment and at mid-treatment were used to assess multimodal imaging changes, tumor shrinkage patterns, and radiomics alterations. Delta-RFs were derived from the two time points, and a delta radiomics score (delta Rad-score) was built using reproducible features selected by intraclass correlation coefficient (ICC) and least absolute shrinkage and selection operator (LASSO). Clinicopathological variables and US changes were further combined to develop three models, including a delta-radiomics model, an US-IHC model, and an integrated model. Model discrimination was quantified using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy. SHapley Additive exPlanations (SHAP) analysis was further performed to explain model predictions.</p><p><strong>Results: </strong>Progesterone receptor (PR) status, shrinkage pattern, change in maximum tumor diameter, and change in enhancement area were independently associated with major histopathological response (MHR), and three delta-RFs were retained to construct the delta Rad-score. The combined model achieved the highest discrimination in both the training (AUC, 0.949) and validation (AUC, 0.911) cohorts, outperforming the delta-radiomics model (AUC, 0.751 and 0.670) and showing performance comparable to the US-IHC model (AUC, 0.941 and 0.893). It also yielded the lowest Brier scores (0.092 and 0.143), together with favorable calibration and net clinical benefit on decision curve analysis.</p><p><strong>Conclusions: </strong>Integrating delta radiomics with changes in multimodal US features enables accurate, noninvasive, mid-treatment prediction of NAC response in breast cancer, potentially supporting earlier identification of poor responders and timely therapeutic adjustment.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"210"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944668","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":"Predictive model for increased postoperative drainage volume in patients with papillary thyroid carcinoma: a retrospective cohort study.","authors":"Weiben Ji, Ti Zhang, Mingzhen Chen, Yue Hu, Jianzhong Shi, Chunlan He, Shikun Ma","doi":"10.21037/gs-2026-0358","DOIUrl":"10.21037/gs-2026-0358","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Papillary thyroid carcinoma (PTC) is the predominant type of thyroid cancer, with a rapidly increasing incidence worldwide. Surgery is the cornerstone of treatment for PTC. Postoperative placement of a negative-pressure drainage tube is commonly performed to prevent hematoma, seroma, and chyle leak. However, the timing for drain removal relies largely on the surgeon's own clinical judgment. There is no reliable model to help identify patients who face a higher risk of increased postoperative drainage output volume (DOV). Excessive DOV may lead to a prolonged hospital stay, increased patient discomfort, and a higher risk of infection. Therefore, we aim to develop a reliable predictive tool for postoperative DOV in patients with PTC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study enrolled 171 patients with PTC who underwent surgery between July 2024 and May 2026. These patients were randomly assigned to training (n=120) and validation (n=51) cohorts in a 7:3 ratio. Univariable and multivariable logistic regression analyses were performed in the training cohort to identify independent risk factors for postoperative DOV in patients with PTC. A nomogram was constructed based on the independent risk factors. Receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were utilized to assess the predictive performance of the nomogram.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Patients were divided into high-output (HO, n=60) and low-output (LO, n=60) groups based on the median postoperative DOV. Univariable analysis revealed statistically significant differences between the groups in surgical time, number of tumors, number of central lymph node (LN) metastases (LNM), total number of LNs dissected, total number of LNM, scope of surgery, thyroid capsular invasion, and Hashimoto's thyroiditis (HT). Multivariable logistic regression analysis revealed that the total number of LNs dissected [odds ratio (OR) =1.125, 95% confidence interval (CI): 1.022-1.239, P=0.02], scope of surgery (OR =6.544, 95% CI: 1.445-29.64, P=0.02), and thyroid capsular invasion (OR =6.507, 95% CI: 1.63-25.975, P=0.008) were independent risk factors for increased postoperative DOV. The nomogram constructed based on these independent risk factors showed good discrimination in the internal validation cohort, with an area under the ROC curve (AUC) of 0.823 (95% CI: 0.746-0.901) in the training cohort and 0.849 (95% CI: 0.737-0.960) in the validation cohort. The calibration curve showed good agreement between the nomogram-predicted outcomes and the observed outcomes. DCA further confirmed its favorable clinical utility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;We developed and validated a nomogram that integrates the total number of LNs dissected, scope of surgery, and thyroid capsular invasion. This model effectively predicts the likelihood of increased postoperative DOV and provides clinically useful guidance for drain m","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"213"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944852","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":"Ultrasound radiomics for preoperative prediction of high axillary nodal burden in node-positive breast cancer: comparison of intratumoral and peritumoral features with external validation.","authors":"Hao Ye, Shaopan Cai, Jiaxuan Ye, Weipeng Li, Zhirong Xu, Danhong Cai","doi":"10.21037/gs-2026-0226","DOIUrl":"10.21037/gs-2026-0226","url":null,"abstract":"<p><strong>Background: </strong>Accurate preoperative assessment of axillary nodal burden is important for individualized axillary management, but conventional ultrasound and needle biopsy have limited ability to characterize the overall nodal burden. This study aimed to develop and externally validate ultrasound radiomics models for preoperative prediction of high axillary nodal burden in node-positive breast cancer and to compare the value of intratumoral and peritumoral features.</p><p><strong>Methods: </strong>This retrospective dual-center study included 404 patients with pathologically confirmed breast cancer and axillary lymph node metastasis, including 294 patients in the training cohort and 110 in the external validation cohort. Axillary nodal burden was categorized as low burden (1-2 metastatic lymph nodes) or high burden (≥3 metastatic lymph nodes) according to postoperative pathology. Intratumoral and 3-mm peritumoral ultrasound radiomics features were extracted. To avoid information leakage, the training and validation cohorts were separated before preprocessing and model development. Six prespecified models were developed in the training cohort and independently evaluated in the external validation cohort.</p><p><strong>Results: </strong>Cortical thickening, hilum status, and ultrasound-reported axillary lymph node status were independent clinical predictors of high nodal burden. In external validation, all models showed limited discrimination, with areas under the receiver operating characteristic curve (AUCs) ranging from 0.585 to 0.621. The intratumoral radiomics model achieved the numerically highest validation AUC of 0.621, with a sensitivity of 0.762 and specificity of 0.382, followed by the combined models (AUC =0.613), clinical model (AUC =0.597), and peritumoral model (AUC =0.585). Bootstrap comparisons showed no significant differences between models. Calibration performance was suboptimal in the external validation cohort.</p><p><strong>Conclusions: </strong>Under a leakage-free external validation framework, ultrasound radiomics showed limited but exploratory value for predicting high axillary nodal burden in node-positive breast cancer. The current models should not be used as standalone tools for axillary management.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"232"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944164","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":"Comparison of perioperative outcomes between gasless transaxillary endoscopic thyroidectomy and conventional open thyroidectomy for papillary thyroid carcinoma: a retrospective study.","authors":"Yesheng Zhang, Yongcan Xu, Yiheng Yang, Xiaoxin Gu, Neng Lou, Guochao Ye","doi":"10.21037/gs-2026-0209","DOIUrl":"10.21037/gs-2026-0209","url":null,"abstract":"<p><strong>Background: </strong>Papillary thyroid carcinoma (PTC) is the most common subtype of differentiated thyroid carcinoma. Gasless transaxillary endoscopic thyroidectomy (GUA) has been increasingly used because of its cosmetic advantages, but its perioperative outcomes compared with conventional open thyroidectomy (COT), particularly across different body mass index (BMI) categories, remain unclear. This study aimed to compare perioperative outcomes between GUA and COT and to explore the association between BMI and relevant perioperative indicators in patients with PTC.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included 411 patients who underwent thyroid surgery at Huzhou Central Hospital between October 1, 2023 and October 1, 2024 and were pathologically confirmed as PTC. Patients were divided into the GUA group and the COT group according to surgical approach. According to the BMI criteria for Asian populations, patients were classified as underweight, normal weight, or overweight/obese. Clinical and perioperative data were collected and analyzed using Statistical Package for the Social Sciences (SPSS) version 27.0. Intergroup comparisons, correlation analyses, and multivariable binary logistic regression analyses were performed.</p><p><strong>Results: </strong>Among the 411 patients, 144 underwent GUA and 267 underwent COT. In both the normal-weight and overweight groups, operative time was significantly longer in the GUA group than in the COT group. In all BMI subgroups, postoperative drainage volume was significantly higher in the GUA group. In the normal-weight and overweight groups, the number of lymph nodes retrieved was significantly lower and hospitalization costs were significantly higher in the GUA group. Common postoperative complications were infrequent and comparable between the two groups across BMI strata, while cosmetic satisfaction tended to be higher after GUA. BMI showed only weak correlations with most perioperative indicators; however, in overweight patients, BMI was positively correlated with nodule size. Nodule size was independently associated with pathological N stage [odds ratio (OR) =1.097, 95% confidence interval (CI): 1.031-1.169, P=0.004].</p><p><strong>Conclusions: </strong>Compared with COT, GUA was associated with longer operative time, greater postoperative drainage volume, higher costs, and fewer retrieved lymph nodes, but showed a comparable short-term safety profile in carefully selected patients. BMI was not an independent predictor of pathological N stage, but its association with nodule size in overweight patients suggests a possible relationship between body habitus and tumor burden. BMI, tumor characteristics, safety, cosmetic expectations, and medical cost should be considered when selecting the surgical approach for low-risk PTC.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"233"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944540","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":"Global research trends and thematic evolution of imaging-guided localization in breast cancer surgery: a bibliometric analysis.","authors":"Haodong Guo, Yue Wang, Li Zhao, Jinjing Tang, Yumeng Zhang, Haixia Yu, Yunyan Li, Dechun Li","doi":"10.21037/gs-2026-0319","DOIUrl":"10.21037/gs-2026-0319","url":null,"abstract":"<p><strong>Background: </strong>Imaging-guided localization has become an essential component of contemporary breast cancer surgery, particularly with the increasing detection of nonpalpable lesions and the widespread use of neoadjuvant chemotherapy. Over the past two decades, diverse imaging modalities and localization techniques have been developed; however, the global research landscape, thematic evolution, and collaborative structure of this field have not been comprehensively evaluated. Therefore, this study aimed to perform a comprehensive bibliometric analysis of imaging-guided localization in breast cancer surgery.</p><p><strong>Methods: </strong>On November 15, 2025, the Web of Science Core Collection (WoSCC) was searched to retrieve relevant publications. Following eligibility screening, articles concerning imaging-guided localization and surgical management of breast cancer published between 2000 and 2025 were incorporated. Bibliometric indicators, collaboration networks, citation patterns, and keyword co-occurrence were analyzed using VOSviewer (version 1.6.20) and the Bibliometrix package (version 5.1.1) in R (version 4.3.3).</p><p><strong>Results: </strong>A total of 366 eligible publications were included in the analysis. The annual number of publications increased steadily after 2011, indicating growing research interest; however, the average citation rate per article showed a declining trend in recent years. Country-level analysis revealed a highly centralized collaboration network, with the United States occupying a dominant position in terms of publication output, citation impact, and international connectivity. Keyword co-occurrence analysis demonstrated a clear thematic shift from traditional wire-guided localization and basic imaging techniques toward advanced imaging-guided, precision-oriented surgical approaches, particularly in the context of neoadjuvant chemotherapy. Highly cited studies were predominantly clinical investigations demonstrating the impact of imaging guidance on surgical precision and margin control.</p><p><strong>Conclusions: </strong>This bibliometric analysis delineates the evolving research landscape of imaging-guided localization in breast cancer surgery, highlighting a transition from feasibility-focused techniques to precision-driven, clinically integrated strategies. While technological innovation has accelerated, the uneven distribution of citation impact suggests a gap between emerging localization methods and evidence consolidation. These findings underscore the need for rigorous comparative studies and international collaboration to support the translation of imaging-guided innovations into standardized clinical practice.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"220"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944581","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":"Evolution of parathyroid pathology identification during concomitant thyroid surgery.","authors":"Tucker Bettis, Logan D Glosser, Neil Saunders, Thomas Yamashita, Loreski Collado, Quynh Tran, Anee Jackson, Collin Weber, Jyotirmay Sharma, Snehal G Patel","doi":"10.21037/gs-2026-0326","DOIUrl":"10.21037/gs-2026-0326","url":null,"abstract":"<p><strong>Background: </strong>Concomitant thyroid and parathyroid disease is well described, but published series usually report a single combined prevalence and do not separate the mode by which parathyroid pathology is detected at thyroid surgery. We describe the evolution of these patterns at a single academic center.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients undergoing thyroid surgery at Emory University from January 1999 to December 2025 (parent cohort, n=10,871). Patients with parathyroid pathology found at the same operation were identified by manual chart review (n=128) and reconciled against the institutional research dataset, yielding 125 patients after exclusions. Each patient was classified into a surgical-intent pathway: planned preoperative diagnosis, intraoperative discovery, or incidental pathology finding. Differences in pathway distribution across eras were evaluated descriptively and with Pearson chi-square testing. Exploratory analyses are reported in the supplement.</p><p><strong>Results: </strong>Among 125 patients (76% female; median age 60 years), the surgical-intent pathway was planned in 96 (76.8%), intraoperative discovery in 22 (17.6%), and incidental pathology finding in 7 (5.6%). The planned pathway rose from 29 of 45 cases (64%) in 1999-2009 to 31 of 32 (97%) in 2020-2025, while intraoperative or incidental findings decreased from 16 of 45 (36%) to 1 of 32 (3%). Coexisting thyroid malignancy was present in 35 of 125 patients (28%); of these, 31 (89% of thyroid neoplasms) were papillary thyroid carcinoma, median tumor size was 0.8 [interquartile range (IQR), 0.4-1.1] cm, and 19 (54%) were T1a.</p><p><strong>Conclusions: </strong>At this institution, parathyroid pathology detected during concomitant thyroid surgery shifted from intraoperative or incidental discovery toward planned preoperative identification over a 27-year period. Most coexisting malignancies were small, low-stage papillary carcinomas. The 28% rate reflects a selected combined-operation cohort and should not be generalized to all primary hyperparathyroidism patients.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"219"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944624","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":"Endoscopic nipple-sparing mastectomy with immediate breast reconstruction and sentinel lymph node biopsy for early-stage breast cancer: a prospective case series.","authors":"Khanh Quang Huynh, Viet Hoang Nguyen, Toan Duc Nguyen, Chi Ngoc Anh Pham, Thuy Thi Ngoc Nguyen, Anh Tuan Le","doi":"10.21037/gs-2026-0287","DOIUrl":"10.21037/gs-2026-0287","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Minimally invasive breast reconstruction is a surgical approach in contemporary breast cancer management that not only restores the breast following nipple-sparing mastectomy but also improves aesthetic outcomes through smaller incisions, reduces postoperative pain, and shortens hospital stay, thereby improving clinical outcomes. Breast reconstruction using submuscular implants or latissimus dorsi (LD) flaps via a transaxillary approach is a feasible technique that is increasingly adopted in contemporary surgical practice. Following 19 months of clinical experience, we report an endoscopic nipple-sparing mastectomy (E-NSM) technique. When combined with submuscular implants or LD flaps, this approach may be suitable for young patients with minimal ptosis or those undergoing bilateral procedures. E-NSM technique aims to optimize aesthetic symmetry for unilateral or bilateral breast reconstruction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study reports a case series of patients with early-stage breast cancer treated with E-NSM and immediate reconstruction using submuscular implants with polypropylene mesh reinforcement or LD flaps coverage. The study was conducted at the Department of Breast, Cho Ray Hospital. Patients were enrolled between January 2023 and July 2024, with follow-up continuing through March 2026.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 130 patients with early-stage breast cancer were enrolled, with a mean age of 44.9±6.3 years (range, 30-63). The distribution of clinical stages in the study population was as follows: 27/130 (20.8%) stage 0 cases (including 26 cTis and 1 ycT&lt;sub&gt;0&lt;/sub&gt;), 47/130 (36.1%) cT&lt;sub&gt;1&lt;/sub&gt;N&lt;sub&gt;0&lt;/sub&gt;, 31/130 (23.8%) cT&lt;sub&gt;2&lt;/sub&gt;N&lt;sub&gt;0&lt;/sub&gt;, 7/130 (5.4%) cT&lt;sub&gt;1&lt;/sub&gt;N&lt;sub&gt;1&lt;/sub&gt;, 14/130 (10.8%) cT&lt;sub&gt;2&lt;/sub&gt;N&lt;sub&gt;1&lt;/sub&gt;, and 4/130 (3.1%) cT&lt;sub&gt;3&lt;/sub&gt;N&lt;sub&gt;0&lt;/sub&gt;. Neoadjuvant chemotherapy was administered to 23/130 patients (17.7%). Implant-based breast reconstruction was performed in 15.4% of cases, and the latissimus dorsi flap in 84.6%. Mean operative time was 209.0±16.5 minutes. Surgical outcomes were generally favorable. Postoperative nipple ischemia occurred in two cases (1.5%), both of which resolved after two weeks of follow-up, with no other complications identified. Patients reported minimal postoperative pain and high satisfaction with the reconstructed breasts. All patients were managed through a multidisciplinary team approach and were followed for a mean duration of 32 months (range, 20-38 months). No local recurrence or distant metastasis was observed during the follow-up period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this study, E-NSM combined with sentinel lymph node biopsy and immediate breast reconstruction proved to be a feasible approach, offering favorable cosmetic outcomes. By potentially reducing the physical and psychological impact associated with traditional mastectomy, this technique may contribute to improved patient quality of life. ","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"215"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944626","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}