Gland surgery最新文献

{"title":"Influencing factors and prediction model of ultrasound-based false-negative central lymph node metastasis in localized papillary thyroid carcinoma.","authors":"Ningning Ren, Xiaoyi Ren, Xingsong Tian","doi":"10.21037/gs-2026-1-0129","DOIUrl":"10.21037/gs-2026-1-0129","url":null,"abstract":"<p><strong>Background: </strong>Patients with papillary thyroid cancer (PTC) exhibited a high false-negative rate for central lymph nodes (CLNs), with unknown influencing factors and predictive models. This study aimed to identify risk factors for false-negative CLN findings in a cohort study and to develop a predictive model to support clinical decision-making.</p><p><strong>Methods: </strong>This cohort study included patients admitted to the Breast and Thyroid Surgery Department of Shandong Provincial Hospital, China, between January 2013 and December 2023. All patients included in the study were confirmed to papillary thyroid cancer (TC) based on postoperative paraffin-embedded pathology. False-negative CLNs refers to metastasis undetected by preoperative ultrasound but confirmed postoperatively by pathology. Logistic regression, forest graph and nomogram were used to calculate and display statistical difference between influencing factors and the false-negative rate of CLNs.</p><p><strong>Results: </strong>A total of 5,614 patients with papillary TC [44.19±11.14 years, 4,469 women (79.6%)] were analyzed. Logistic regression analysis showed that gender [odds ratio (OR): 1.832, 95% confidence interval (CI): 1.570-2.137, P<0.001], chronic disease (OR: 0.655, 95% CI: 0.552-0.778, P<0.001), diameter of malignant thyroid nodules under ultrasound (OR: 1.816, 95% CI: 1.511-2.182, P<0.001), diameter of CLNs under ultrasound (OR: 1.404, 95% CI: 1.074-1.836, P=0.01), enlargement of lateral lymph nodes (LLNs) under ultrasound (OR: 1.550, 95% CI: 1.213-1.980, P<0.001), diameter of LLN under ultrasound (OR: 0.645, 95% CI: 0.435-0.956, P=0.03) were statistically significant preoperative influencing factors.</p><p><strong>Conclusions: </strong>This cohort study indicated that the false-negative rate of CLNs was quite common. Personalized preventive CLN dissection was suggested.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"231"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944709","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":"Highly cosmetic and safe breast-conserving surgery using a wave-like periareolar incision with sub-nipple and extensive subcutaneous dissection: a retrospective cohort study.","authors":"Shohei Shikata, Takamichi Yokoe, Tomoe Kameyama, Haruka Yagishita, Aiko Nagayama, Tomoko Seki, Maiko Takahashi, Tetsu Hayashida","doi":"10.21037/gs-2026-0299","DOIUrl":"10.21037/gs-2026-0299","url":null,"abstract":"<p><strong>Background: </strong>In breast-conserving surgery (BCS), tumor-surface incision often results in visible scarring, skin contracture, and nipple deviation. While various oncoplastic-BCSs (OBCSs) have been developed, many remain invasive and non-standardized. We developed a novel OBCS, namely, the Keio-BCS (K-BCS), utilizing a linear or wave-like periareolar incision combined with sub-nipple and extensive subcutaneous dissection, aiming for superior cosmetic outcomes across diverse patient and tumor characteristics. We aimed to compare cosmetic and surgical outcomes between K-BCS and tumor-surface incision surgery.</p><p><strong>Methods: </strong>We retrospectively analyzed 195 patients who underwent BCS between January 1, 2021 and December 31, 2023 (K-BCS group, n=127; tumor-surface incision group, n=68). Cosmetic outcomes, objectively evaluated using BCCT.core software, were categorized as excellent, good, fair, or poor. Subgroup and logistic regression analyses were conducted for evaluation of 'excellent' outcome. Complication rates and the frequency of positive or close surgical margins (<2 mm) were also evaluated.</p><p><strong>Results: </strong>The K-BCS group showed significantly better cosmetic outcomes than the tumor-surface incision group (excellent, 57% <i>vs.</i> 34%; good, 37% <i>vs.</i> 47%; fair, 5% <i>vs.</i> 16%; poor, 1% <i>vs.</i> 3%, respectively; P=0.002). Superior results with K-BCS were consistent across all subgroups. Multivariate analysis confirmed K-BCS as an independent factor associated with 'excellent' evaluation [odds ratio (OR) =2.58; 95% confidence interval (CI): 1.26-5.32; P=0.009]. No significant differences were observed in complication rates or margin status.</p><p><strong>Conclusions: </strong>As a promising, reproducible OBCS approach, K-BCS yielded superior esthetic outcomes across various patients and tumor characteristics while maintaining oncologic and surgical safety.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"212"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944732","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":"Survival outcomes after breast-conserving surgery with radiotherapy versus mastectomy in apocrine carcinoma of the breast: a Surveillance, Epidemiology, and End Results-based retrospective cohort study with time-dependent analysis.","authors":"Chenglong Pan, Qian He, Bailing Wu, Guoqing Pan","doi":"10.21037/gs-2026-0220","DOIUrl":"10.21037/gs-2026-0220","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Apocrine carcinoma (AC) of the breast is a rare subtype of breast cancer, with distinct biological features, often characterized by hormone receptor negativity and androgen receptor positivity. Because its behavior may differ from conventional triple-negative breast cancer, local treatment selection remains clinically important. Evidence comparing breast-conserving surgery combined with radiotherapy (BCS + RT) and mastectomy (MAST) remains limited. This study evaluated the survival impact of RT after BCS and compared BCS + RT with MAST, with attention to time-dependent effects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients with AC of the breast diagnosed between 2010 and 2022 were identified from the Surveillance, Epidemiology, and End Results (SEER) database using International Classification of Diseases for Oncology, Third Edition (ICD-O-3) code 8401/3. Patients with documented surgery type and available survival information were included; those with missing surgery type or follow-up information were excluded. Two cohorts were constructed: one compared BCS alone with BCS + RT, and the second cohort compared BCS + RT with MAST in early-stage, breast-conservation-eligible patients. Covariates included age, race/ethnicity, marital status, tumor grade, stage, tumor size, chemotherapy status, breast subtype, and axillary level I-II nodal burden. Follow-up was calculated from diagnosis to death or last follow-up. Overall survival (OS) and breast cancer-specific survival (BCSS) were analyzed using Cox and Fine-Gray models. Stabilized inverse probability of treatment weighting (IPTW) based on the full eligible cohort was used as the primary propensity score-based adjustment method, and propensity score matching (PSM) was performed as a sensitivity analysis. Landmark, continuous landmark, and restricted mean survival time (RMST) analyses were performed. A single-center cohort was included for descriptive clinicopathological supplementation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 1,199 patients were included, comprising 202 treated with BCS, 469 with BCS + RT, 400 with MAST, and 128 with MAST + RT. Most patients were aged ≥50 years, and 84.2% had stage I-II disease. The BCS + RT group had more early-stage and node-negative patients, whereas the MAST + RT group showed greater axillary nodal burden and higher-risk features. Among patients undergoing BCS, RT was associated with improved OS after IPTW adjustment [hazard ratio (HR) =0.608, 95% confidence interval (CI): 0.415-0.889], whereas its effect on BCSS was not statistically significant. In early-stage, breast-conservation-eligible patients, BCS + RT and MAST showed comparable long-term OS and BCSS after adjustment (IPTW HR for OS =0.785, P=0.20). Time-dependent analyses showed that the survival benefit of BCS + RT was mainly observed within 3 years (HR =0.377) and diminished over time.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;RT was associated with improved OS among patients u","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"225"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944781","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":"Local recurrence in nipple-sparing mastectomy without intraoperative radiotherapy (IORT) in breast cancer.","authors":"Prakasit Chirappapha, Wassa Watanakun, Sarunthorn Lapkittichot, Panuwat Lertsithichai, Ronnarat Suvikapakornkul, Thongchai Sukarayothin, Monchai Leesombatpaiboon, Yodying Wasuthit, Rutchanee Prasitmonthol, Lakkana Adireklarpwong","doi":"10.21037/gs-2026-0272","DOIUrl":"10.21037/gs-2026-0272","url":null,"abstract":"<p><strong>Background: </strong>Nipple-sparing mastectomy (NSM) is increasingly used in breast cancer treatment. Concerns remain about residual tissue beneath the nipple-areolar complex (NAC) and the risk of locoregional recurrence (LRR). This study aimed to evaluate recurrence in NSM patients with or without radiation therapy (RT) and to assess the role of RT.</p><p><strong>Methods: </strong>Retrospective review of patients with ductal carcinoma in situ (DCIS) or invasive breast cancer who underwent NSM with immediate reconstruction without intraoperative radiotherapy (IORT) from January 2007 to July 2021. LRR was the primary outcome; secondary outcomes included overall survival (OS), disease-free survival (DFS), and factors associated with outcomes and RT use.</p><p><strong>Results: </strong>A total of 148 NSMs were analyzed, including 116 invasive cancers and 33 DCIS cases. The mean age was 43 years, most patients were premenopausal (80%), T1 to T2 (94%), node-negative (64%), and estrogen receptor (ER) positive (82%). Positive margins occurred in 10 patients (7%). Chemotherapy was administered to 91 (68%), hormonal therapy to 118 (83%), and trastuzumab to half of 21 human epidermal growth factor receptor 2 (HER2) positive patients. Whole breast RT was given to 42 patients (28%). After a median follow-up of 72 months, 9 patients (6%) experienced LRR. RT did not significantly affect recurrence or survival. Ten-year OS was 100% <i>vs.</i> 94.7% (P=0.08) and DFS was 88.2% <i>vs.</i> 97.6% (P=0.24) for patients without and with RT, respectively.</p><p><strong>Conclusions: </strong>NSM without IORT is safe, and selective RT guided by tumor, nodal, and margin status achieves low LRR, even in higher-risk patients.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"227"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929888","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":"Understanding pancreatic reconstruction after pancreatoduodenectomy: lessons in technique and biology.","authors":"Naveen Manisundaram, Derek J Erstad","doi":"10.21037/gs-2026-1-0116","DOIUrl":"10.21037/gs-2026-1-0116","url":null,"abstract":"","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"243"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944309","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":"Clinical, microbial, and experimental features associated with Grade C postoperative pancreatic fistula and pancreaticojejunostomy disruption.","authors":"Qingquan Tan, Yichen Li, Jie Yang, Zuowei Wu, Ziheng Guo, Xing Wang, Zhenjiang Zheng, Yonghua Chen, Xubao Liu, Chunlu Tan","doi":"10.21037/gs-2026-0336","DOIUrl":"10.21037/gs-2026-0336","url":null,"abstract":"<p><strong>Background: </strong>Most postoperative pancreatic leaks after pancreatoduodenectomy (PD) remain clinically insignificant biochemical leaks, whereas a minority progress to life-threatening Grade C postoperative pancreatic fistula (POPF). The biological events underlying this progression remain poorly understood. We investigated the clinical, microbial, and immunological mechanisms associated with severe POPF progression.</p><p><strong>Methods: </strong>Of 642 consecutive patients assessed between March 2022 and March 2024, 74 were excluded and 568 were included in the clinical cohort. Risk factors for Grade C POPF were evaluated using univariable analysis and Firth penalized multivariable logistic regression. For translational analyses, peritoneal fluid from 20 patients with biochemical leak and 20 patients with Grade C POPF underwent 16S ribosomal RNA (rRNA) sequencing and multiplex cytokine profiling. Human pancreatic tissues from two Grade C POPF patients and three histologically normal controls were evaluated descriptively. Experimental evaluation used a rat model combining pancreatic and intestinal fistulas to simulate enteric contamination relevant to pancreaticojejunostomy leakage.</p><p><strong>Results: </strong>Among 568 included patients, 20 (3.5%) developed Grade C POPF. Pancreaticojejunostomy disruption occurred in 13 of 20 Grade C patients and 17 of 548 non-Grade C patients (65.0% <i>vs.</i> 3.1%, P<0.001). In Firth penalized multivariable logistic regression, disruption remained strongly associated with Grade C POPF [odds ratio (OR) 21.84, 95% confidence interval (CI): 7.12-72.63, P<0.001]. Compared with biochemical leak, Grade C POPF was associated with lower peritoneal microbial diversity, differential representation of several genera, and higher concentrations of interferon-gamma (IFN-γ), interleukin-6 (IL-6), interleukin-1 alpha (IL-1α), interleukin-1 beta (IL-1β), and tumor necrosis factor-alpha (TNF-α). The small human tissue series descriptively showed inflammatory injury and CD68⁺ iNOS⁺ macrophage accumulation. In rats, pancreatic leakage plus enteric contamination aggravated pancreatic injury and inflammation; antibiotic treatment attenuated these findings but could not isolate microbiota depletion from direct antibacterial or anti-inflammatory effects.</p><p><strong>Conclusions: </strong>Grade C POPF was strongly associated with pancreaticojejunostomy disruption and was accompanied by peritoneal microbial and inflammatory differences compared with biochemical leak. The animal model simulated key features of pancreaticojejunostomy leakage and supports the possibility that enteric contamination contributes to inflammatory aggravation.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"211"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561602/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944305","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":"Utility of intercostal artery perforator flap in granulomatous lobular mastitis: a single-center retrospective study.","authors":"Zi-Ying Wang, Quan-Feng Shao, Wei Liang, Yuan-Yuan Li, Jiao Xue, Bei Zhu, Shu-Yang Xu, Lin Zheng, Wei-Xian Chen","doi":"10.21037/gs-2026-0168","DOIUrl":"10.21037/gs-2026-0168","url":null,"abstract":"<p><strong>Background: </strong>Determining a procedure to fill operation defects, maintain breast shape, and conceal surgical incisions remains a challenge for breast surgeons in treating granulomatous lobular mastitis (GLM). The intercostal artery perforator (ICAP) flap is a volume replacement technique in breast-conserving surgery. This study aimed to describe the feasibility, safety, and patient-reported outcomes of extended mass resection and breast defect reconstruction with an ICAP flap in selected GLM patients.</p><p><strong>Methods: </strong>We retrospectively analyzed the data of 108 GLM patients treated surgically between January 2022 and May 2024 at our center. Patients were divided into three groups according to the actual surgical strategy received in routine clinical practice. The no reconstruction group was considered the main clinical comparator for the flap reconstruction group, whereas the no resection group was retained as an exploratory real-world reference group.</p><p><strong>Results: </strong>A total of 43 patients underwent extended mass resection and defect reconstruction with an ICAP flap (flap reconstruction group), 37 patients underwent extended mass resection without breast defect reconstruction (no reconstruction group), and 28 patients continued with abscess drainage or fistula removal without mass resection (no resection group). The flap reconstruction group showed longer surgery times and drainage removal times, as well as more blood loss and drainage volumes, than the other groups (P<0.001). There were no significant differences in postoperative complications among the three groups (P>0.05). Compared with the no reconstruction group, the flap reconstruction group showed better patient-reported cosmetic change and higher satisfaction scores (P<0.001). No recurrence was observed in the flap reconstruction group during 1-year follow-up; however, this exploratory finding should be interpreted cautiously.</p><p><strong>Conclusions: </strong>Extended mass resection and breast defect reconstruction with an ICAP flap appears to be a feasible and safe option for selected GLM patients requiring resection, with potential advantages in maintaining breast appearance and improving patient-reported satisfaction. The observed recurrence difference should be interpreted cautiously because of the retrospective design, limited sample size, and short follow-up.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"221"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944469","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":"High-volume central node metastasis.","authors":"Ashok R Shaha","doi":"10.21037/gs-2026-0400","DOIUrl":"10.21037/gs-2026-0400","url":null,"abstract":"","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"207"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944659","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 a predictive model for thyroid nodule malignancy risk based on intralesional and perilesional ultrasound radiomic features.","authors":"Wanying Liu, Ziran Zhang, Li Ling, Ying Zhao, Jiale Wu, Yongquan Chu","doi":"10.21037/gs-2026-0143","DOIUrl":"10.21037/gs-2026-0143","url":null,"abstract":"<p><strong>Background: </strong>Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) 4a/b thyroid nodules present substantial clinical diagnostic challenges due to wide malignancy risk variation. This study aimed to develop a multimodal integrated predictive model that combines intralesional and perilesional radiomic features with clinical characteristics, and to systematically evaluate its clinical utility in predicting malignancy among thyroid nodules (TNs) classified as C-TIRADS 4a/b.</p><p><strong>Methods: </strong>A retrospective cohort of 147 patients with TNs who underwent thyroid ultrasound and subsequent ultrasound-guided fine-needle aspiration biopsy (US-FNAB) at Jiaxing Maternal and Child Health Care Hospital between August 2023 and September 2025 was enrolled. Participants were randomly allocated in a 7:3 ratio into training (n=102) and validation (n=45) cohorts. ITK-SNAP software was employed to delineate intralesional regions of interest (ROIs), with perilesional ROIs generated through a 2-mm outward expansion. The PyRadiomics module was utilized to extract radiomic features from horizontal intralesional, longitudinal intralesional, and integrated horizontal and longitudinal intra- and perilesional regions. Based on the selected features, three machine learning algorithms-logistic regression (LR), decision tree, and light gradient boosting machine-were implemented to develop radiomics models and clinical-radiomics combined models. Model performance was assessed using receiver operating characteristic curves, calibration curves, and decision curve analysis (DCA), with interpretability analysis conducted using the Shapley additive explanations framework.</p><p><strong>Results: </strong>Multivariate LR analysis identified microcalcification, aspect ratio >1, and irregular shape as independent predictors of malignant TNs. The clinical-radiomics combined model demonstrated superior performance in the validation cohort, achieving an area under the curve of 0.866 [95% confidence interval (CI): 0.728-0.970] using the LR algorithm, with an accuracy of 84.4%, sensitivity of 91.3%, and specificity of 77.3%. DCA confirmed that the clinical-radiomics combined model provided the highest net clinical benefit across a wide range of threshold probabilities. SHAP analysis indicated that the combined intralesional-perilesional radiomics scores contributed most substantially to model predictions, highlighting the critical importance of radiomic features.</p><p><strong>Conclusions: </strong>This study successfully developed a multimodal integrated predictive model combining intralesional and perilesional radiomic features with clinical characteristics. The model demonstrated excellent diagnostic performance in differentiating benign from malignant TNs classified as C-TIRADS 4a/b, providing clinicians with a convenient, non-invasive, and highly effective auxiliary diagnostic tool to support clinical decision-making.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"218"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944623","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":"Contrast-enhanced ultrasound for differentiating benign from malignant Breast Imaging Reporting and Data System 4a breast lesions: a prospective diagnostic accuracy study.","authors":"Liping Fan, Na Yuan, Fang Qi, Wentao Qu, Jinhui Zhang, Xiaomei Tian, Yaning Kang","doi":"10.21037/gs-2026-0315","DOIUrl":"10.21037/gs-2026-0315","url":null,"abstract":"<p><strong>Background: </strong>Breast Imaging Reporting and Data System (BI-RADS) 4a breast lesions are considered low suspicion for malignancy (2-10%), yet current guidelines recommend biopsy for definitive diagnosis, leading to a high rate of unnecessary invasive procedures. Contrast-enhanced ultrasound (CEUS) provides real-time microvascular perfusion information that may improve risk stratification in this indeterminate category. This study aimed to evaluate the diagnostic performance of CEUS in differentiating benign from malignant BI-RADS 4a lesions, with a focus on its potential to reduce avoidable biopsies.</p><p><strong>Methods: </strong>In this prospective diagnostic study, consecutive patients with BI-RADS 4a lesions identified on conventional ultrasound underwent CEUS examination using a sulfur-hexafluoride microbubble contrast agent. CEUS cine loops were independently reviewed by two blinded readers. Lesions were classified as CEUS-positive (suspicious for malignancy) if they exhibited ≥2 predefined malignant perfusion features (e.g., heterogeneous hyper-enhancement, centripetal filling, perfusion defects, fast wash-in/wash-out). Histopathology from biopsy or surgery served as the reference standard. Diagnostic accuracy metrics-sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the receiver operating characteristic curve (AUC)-were calculated.</p><p><strong>Results: </strong>A total of 149 BI-RADS 4a lesions were included. Histopathology revealed 129 benign and 20 malignant/high-risk lesions. CEUS demonstrated a sensitivity of 85.0% [95% confidence interval (CI): 62.1-96.8%], specificity of 89.9% (95% CI: 83.3-94.6%), PPV of 47.2% (32.9-62.0%), and NPV of 98.2% (95% CI: 93.8-99.6%). The overall accuracy was 89.3% (95% CI: 83.2-93.7%), with an AUC of 0.88 (95% CI: 0.81-0.94). Malignant lesions showed significantly higher frequencies of heterogeneous hyper-enhancement, centripetal perfusion, perfusion defects, and fast wash-in/wash-out kinetics (all P<0.001). Inter-observer agreement for CEUS classification was substantial (κ=0.76).</p><p><strong>Conclusions: </strong>CEUS exhibits high diagnostic performance, especially a high NPV, in the evaluation of BI-RADS 4a breast lesions. It can reliably identify a subset of lesions with a very low probability of malignancy, suggesting that CEUS may help identify a subset of patients in whom immediate biopsy could be considered for deferral within a shared decision-making framework, though prospective validation in larger cohorts is needed. These findings support the integration of CEUS as a valuable adjunctive triage tool to reduce unnecessary biopsies in low-suspicion breast lesions.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"235"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944595","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}