Gland surgery最新文献

{"title":"Erratum: Lysyl oxidase promotes anaplastic thyroid carcinoma cell proliferation and metastasis mediated via BMP1.","authors":"","doi":"10.21037/gs-2025b-1","DOIUrl":"10.21037/gs-2025b-1","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.21037/gs-21-908.].</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"800-802"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127384","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 development and validation of biomarkers-based scoring systems for predicting early recurrence in patients with borderline resectable pancreatic cancer undergoing resection after neoadjuvant therapy.","authors":"Hang He, Cai-Feng Zou, Yong-Jian Jiang, Feng Yang, Yang Di, Ji Li, Chen Jin, De-Liang Fu","doi":"10.21037/gs-2024-500","DOIUrl":"10.21037/gs-2024-500","url":null,"abstract":"<p><strong>Background: </strong>Neoadjuvant therapy (NAT) is a key component of the treatment strategy for borderline resectable pancreatic cancer (BRPC). However, early recurrence (ER) frequently occurs, leading to a poor prognosis. Effective approaches for ER risk stratification in patients with BRPC undergoing NAT have not been well established currently. This study aimed to develop biomarker-based perioperative scoring systems to predict ER in patients with BRPC who underwent resection after NAT.</p><p><strong>Methods: </strong>Patients with BRPC who underwent radical resection following NAT at our institute between 2018 and 2023 were retrospectively enrolled. Serum biochemical marker tests and imaging examinations were performed to evaluate recurrence. Perioperative biochemical and clinicopathological parameters were analyzed. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors for recurrence and to construct nomograms for ER prediction. Internal validation was conducted using the bootstrapping method. The accuracy in predicting ER was evaluated using receiver operating characteristic curve analysis. Survival analysis was performed using the Kaplan-Meier survival plots and log-rank test.</p><p><strong>Results: </strong>A total of 194 patients were enrolled. Recurrence occurred in 69.0% of all patients, and 61.1% of all recurrences were found within 6 months postoperatively. A preoperative scoring system was developed based on preoperative carbohydrate antigen 19-9 (CA19-9) and CA125 levels to predict ER [area under the curve (AUC), 0.700; 95% confidence interval (95% CI): 0.614-0.786] with 86.4% specificity and 48.7% sensitivity (cut-off value was 0.35886). Patients with a post-NAT prognostic score (PNPS) ≥0.35886 exhibited significantly poorer recurrence-free survival (RFS) (P<0.001) and overall survival (OS) (P<0.001) than those with a PNPS <0.35886. A postoperative scoring system based on the postoperative CA19-9 response was established to predict ER (AUC, 0.785; 95% CI: 0.705-0.866) with 65.4% specificity and 80.8% sensitivity (cut-off value was 0.43949). Patients with a postoperative prognostic score (PPS) ≥0.43949 exhibited poorer RFS (P<0.001) and OS (P<0.001) than those with a PPS <0.43949. For patients with normal CA19-9 levels after NAT, PNPS ≥0.35886 or PPS ≥0.43949 indicated a poor prognosis after surgery. For patients without normal CA19-9 levels after NAT, PNPS <0.35886 or PPS <0.43949 was associated with a favorable prognosis after surgery.</p><p><strong>Conclusions: </strong>The preoperative and postoperative scoring systems provide risk stratification for ER in patients with BRPC undergoing NAT. This may provide references to clinicians in identifying suitable candidates and optimal timing for surgery during NAT, and administering tailored adjuvant therapy (AT) after surgery.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"670-686"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127542","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 role of robot-assisted mastectomy: promise, challenges, and evidence gaps.","authors":"Mariam Rizk, Kefah Mokbel","doi":"10.21037/gs-2025-16","DOIUrl":"10.21037/gs-2025-16","url":null,"abstract":"","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"579-583"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127544","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 multivariable risk model based on clinicopathological characteristics, mammography, and MRI imaging features for predicting axillary lymph node metastasis in patients with upgraded ductal carcinoma <i>in situ</i>.","authors":"Min-Yi Cheng, Can-Gui Wu, Ying-Yi Lin, Jia-Chen Zou, Dong-Qing Wang, Bruce G Haffty, Kun Wang","doi":"10.21037/gs-2025-89","DOIUrl":"10.21037/gs-2025-89","url":null,"abstract":"<p><strong>Background: </strong>Axillary surgical staging is required for patients with upgraded ductal carcinoma in situ (DCIS) (DCIS is diagnosed on core biopsy with invasive cancer found on pathology after complete surgical excision), which may lead to complications in axillary surgery. At present, there is no reliable and accurate method for predicting axillary lymph node metastasis (ALNM) in patients with upgraded DCIS; however, such a method could prevent unnecessary axillary surgical interventions from being performed. In this study, we aimed to construct a non-invasive model for predicting ALNM in DCIS patients based on clinicopathological characteristics, mammography (MG) features, and magnetic resonance imaging (MRI) features.</p><p><strong>Methods: </strong>Between February 2018 and June 2020, 326 patients with upgraded DCIS were enrolled in this retrospective analysis. These patients were randomly divided into the training cohort (80%) and validation cohort (20%). Univariate and multivariable regression analyses were conducted to identify the candidate pathological features, which then used to develop a clinicopathological model. The features of the 2-mm, 4-mm, and 6-mm intratumoral and peritumoral regions (T-PTR) were extracted to develop the MRI radiomics model, and two deep learning classification models were developed based on the medial-lateral oblique (MLO) and craniocaudal (CC) views of the MG. A fusion model was then established that combined these sub-models. The receiver operating characteristic (ROC) curve, area under the curve (AUC), and other indicators were used to evaluate the performance of these models.</p><p><strong>Results: </strong>The clinicopathological characteristics of the two cohorts were basically balanced. The AUC values of the clinicopathological model were 0.675 and 0.690 in the training and validation cohorts, respectively. The model based on the T-PTR of MRI showed promising predictive ability. Among the three MRI models, the T-PTR (4 mm) model showed the best predictivity both in the training (AUC =0.885) and validation cohorts (AUC =0.843). The AUC values for the deep learning models of the MG CC and MLO positions all exceeded 0.7, indicating reliable predictive performance. The fusion model that combined the three methods significantly improved the accuracy and robustness of ALNM prediction. In both the training (AUC =0.975) and validation (AUC =0.877) cohorts, the fusion model showed excellent performance.</p><p><strong>Conclusions: </strong>We developed a fusion model that combined clinicopathological characteristics, MRI T-PTR (4 mm) radiomics, and MG-based deep learning. Our combined model showed promising performance in predicting ALNM in patients with upgraded DCIS.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"738-753"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127305","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":"Liquid biopsy in breast cancer: a practical guide for surgeons.","authors":"Janhavi Venkataraman, Timothy Crook, Kefah Mokbel","doi":"10.21037/gs-2025-11","DOIUrl":"10.21037/gs-2025-11","url":null,"abstract":"<p><p>Breast cancer remains a global health challenge, requiring innovative strategies for early detection, diagnosis, treatment monitoring, and recurrence detection. Liquid biopsy-leveraging circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), microRNAs (miRNAs), exosomes, immune-based biomarkers, and tumor-educated platelets (TEPs)-has emerged as a promising tool to address these needs. CTCs and ctDNA provide critical insights into tumor heterogeneity, therapeutic targets, and resistance mechanisms, while miRNAs, exosomes, and other non-CTC-based markers reflect the tumor microenvironment and offer potential biomarkers for disease progression. Importantly, liquid biopsy offers distinct advantages in early detection and precise diagnosis, as well as in identifying therapeutic resistance in real time, allowing clinicians to adapt treatment strategies effectively. The non-invasive nature of liquid biopsy further enables real-time tumor monitoring, paving the way for personalized treatment approaches. However, several challenges hinder its routine clinical adoption, including technical complexity, economic constraints, and variations in detection sensitivity due to low biomarker abundance. Additionally, a lack of standardization in methodology and interpretation limits its widespread application. Rigorous standardization and clinical validation are essential to address these barriers, ensuring equitable access across diverse healthcare settings and transforming breast cancer care for millions worldwide. Future directions include integrating artificial intelligence and multi-omic approaches to enhance diagnostic accuracy and clinical utility.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"754-760"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127429","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":"Serum thyroid-stimulating hormone as a diagnostic marker for cancer in atypia of undetermined significance/follicular lesion of undetermined significance nodules.","authors":"Saad M Alqahtani, Bassam A Altalhi, Shehata F Shehata, Yousef S Alalawi, Saif S Al-Sobhi","doi":"10.21037/gs-2024-520","DOIUrl":"10.21037/gs-2024-520","url":null,"abstract":"<p><strong>Background: </strong>Several studies have assessed the efficacy of thyroid-stimulating hormone (TSH) as a diagnostic marker of thyroid cancer (TC), with inconsistent findings. However, few studies have investigated its role in indeterminate thyroid nodules (TNs), particularly in those with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS). The objective of this study was to evaluate preoperative TSH levels as a diagnostic marker for cancer in AUS/FLUS nodules.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients who underwent thyroidectomy with a primary cytological diagnosis of AUS/FLUS. The association between preoperative TSH levels and the final anatomopathological diagnosis (benign <i>vs.</i> differentiated TC) was examined.</p><p><strong>Results: </strong>The analysis included 109 patients. The median TSH level was higher in patients with malignant nodules (2.32 mIU/L) than in those with benign pathology (1.60 mIU/L) (P=0.04). Receiver operating characteristic (ROC) curve analysis revealed that the TSH level was a potential indicator for the coexistence of thyroid malignancy, with a significant area under the curve of 0.61 (P=0.04). The optimal diagnostic cutoff point for TSH levels was ≥3.06 mIU/L.</p><p><strong>Conclusions: </strong>This study demonstrated that TSH levels are an acceptable and useful marker to rule in rather than rule out TC in AUS/FLUS nodules.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"618-627"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127491","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":"Recent changes in surgical outcomes and preoperative biliary drainage with the increased use of neoadjuvant chemotherapy in pancreatic cancer patients undergoing pancreatoduodenectomy: a single-center retrospective study.","authors":"Naoya Imamura, Atsushi Nanashima, Yuki Tsuchimochi, Takeomi Hamada, Hiroshi Kawakami, Masahide Hiyoshi","doi":"10.21037/gs-2024-507","DOIUrl":"10.21037/gs-2024-507","url":null,"abstract":"<p><strong>Background: </strong>Neoadjuvant chemotherapy (NAC) has been increasingly used in recent years in patients with pancreatic ductal adenocarcinoma (PDAC). This has forced a change in the practice of preoperative biliary drainage (PBD) is performed in PDAC patients scheduled for pancreatoduodenectomy (PD). What has changed in the NAC era and what is the appropriate method of PBD? To address this question, this study retrospectively reviewed the surgical outcomes and details of PBD in NAC and upfront surgery (US) patients.</p><p><strong>Methods: </strong>The study included consecutive PDAC patients who underwent PD from 2013 to 2021 during the transition from US to NAC, when outcomes were comparable. Clinical factors such as patient background, preoperative examination, surgical procedure, and postoperative complications were compared between the NAC group (40 patients) and the US group (59 patients), and details of PBD such as PBD procedure and adverse events were compared between the NAC and US groups who received PBD (27 NAC patients, 33 US patients). In the comparison test between groups, Fisher's exact test and Mann-Whitney <i>U</i> test were mainly used. In addition, the outcomes and patency periods of each of the 128 PBD procedures were examined for the 60 patients who underwent PBD. The log-rank test was performed using the Kaplan-Meier method to compare patency period by PBD procedure.</p><p><strong>Results: </strong>There were no differences in patient background between the NAC and US groups. Compared with the US group, the NAC group had higher preoperative albumin (ALB) levels and less blood loss, but there was no difference of postoperative complications (NAC <i>vs.</i> US, 35% <i>vs.</i> 46%, respectively, P=0.29). With respect to PBD, the NAC group had more initial metallic stent (MS) placement (NAC <i>vs.</i> US, 52% <i>vs.</i> 15%, respectively, P=0.009), and fewer PBD-related adverse events (NAC <i>vs.</i> US, 33% <i>vs.</i> 61%, respectively, P=0.04). In a comparison of outcomes by drainage method, the duration of patency was significantly longer with MS placement than plastic stent (PS) placement (median days of patency, MS <i>vs.</i> PS, 68 <i>vs.</i> 15 days, respectively, P<0.001). However, MS placement and PS placement were equally likely to require a delay in the surgical schedule due to PBD-related adverse events (MS <i>vs.</i> PS, 6% <i>vs.</i> 6%, respectively, P>0.99).</p><p><strong>Conclusions: </strong>Prolonged PBD with NAC did not adversely affect surgical outcomes. MS placement provides a long patency period and is currently useful in PBD for PDAC patients undergoing PD after NAC, which requires a prolonged preoperative period. However, MS placement also has adverse events, and further studies are needed.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 4","pages":"714-725"},"PeriodicalIF":1.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127416","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":"Prevalence of Hashimoto's thyroiditis in papillary thyroid cancer and its association with aggressive characteristics.","authors":"Zi-Fang Xu, Huan Ge, Neng Tang, Zi-En Qin, Hai-Long Tan","doi":"10.21037/gs-24-445","DOIUrl":"https://doi.org/10.21037/gs-24-445","url":null,"abstract":"<p><strong>Background: </strong>Hashimoto's thyroiditis (HT) has been associated with papillary thyroid cancer (PTC), yet whether the clinicopathological features of PTC are affected by HT remains unknown. The purpose of this study was to investigate the association of HT with clinicopathological features of PTC.</p><p><strong>Methods: </strong>We conducted a multicenter cross-sectional study to retrospectively evaluate the association of HT with clinicopathological features of PTC in the central provinces of China. The association between HT with clinicopathological features of PTC (including pathological HT and clinical HT) was evaluated by logistic regression analysis.</p><p><strong>Results: </strong>A total of 15,305 patients with PTC were enrolled to this study, with a median age of 42 years at diagnosis, including 11,465 women (74.9%) and 3,840 men (25.1%). The overall prevalence of HT in PTC patients was 22.9% (3,505/15,305). Compared with PTC patients without HT, pathological HT was a potential protective factor for several aggressive characteristics of PTC, including <i>BRAF^V600E</i> mutation (P<0.001), extrathyroidal extension (P=0.04), larger primary tumor size (P<0.001), advanced primary tumor stage (P<0.001), and the number of metastatic lymph nodes >5 (P=0.006), whereas this effect was not observed in clinical HT except for the <i>BRAF^V600E</i> mutation and bilateral tumors (P<0.001 for both). Notably, both pathological (P<0.001) and clinical HT (P=0.04) are potential risk factors for multifocal tumors.</p><p><strong>Conclusions: </strong>PTC patients often have concomitant HT. Some potential links between the 2 entities are present. Pathological HT is a potential protective factor for some aggressive characteristics of PTC, whereas this effect does not present in clinical HT, which has guiding significance for clinical treatment decision-making.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 3","pages":"451-461"},"PeriodicalIF":1.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12004320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014451","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":"Nomograms for predicting cervical central lymph node metastases and high-volume cervical central lymph node metastases in papillary thyroid carcinoma.","authors":"Xindong Huang, Xiaoxiong Gan, Jianhua Feng, Wensong Cai, Bo Xu","doi":"10.21037/gs-24-237","DOIUrl":"https://doi.org/10.21037/gs-24-237","url":null,"abstract":"<p><strong>Background: </strong>Cervical central lymph node metastasis (CLNM) is a known risk factor for recurrent thyroid cancer (TC), and cervical high-volume central lymph node metastases (HVCLNM) are associated with higher recurrence rates and shorter disease-specific survival. The status of CLNM is critical in determining surgical strategies for papillary thyroid carcinoma (PTC). We developed two separate nomograms to predict the probability of CLNM and HVCLNM.</p><p><strong>Methods: </strong>We retrospectively analyzed 590 PTC patients who underwent total thyroidectomy or lobectomy with central lymph node dissection (CLND) between January 2020 and May 2023. Univariate and multivariate analyses were conducted to identify risk factors associated with CLNM and HVCLNM. The nomograms were internally validated using bootstrapping and evaluated on a temporal validation cohort.</p><p><strong>Results: </strong>Between January 2020 and May 2023, 1,019 patients were screened, 590 (57.9%) were eligible, and they were divided into development (n=353) and validation (n=237) cohorts. HVCLNM was present in 41 patients (11.6%). The variables with the strongest predictive value for CLNM were younger age (P<0.001), male sex (P=0.045), tumor size (P<0.001), and tumor multifocality (P=0.001). The strongest predictors for HVCLNM were younger age (P=0.001), tumor size (P<0.001), bilateral lesions (P=0.005), and preoperative serum thyroid peroxidase antibody (TPOAb) ≤14.95 IU/mL (P=0.01). The area under the curve (AUC) for the CLNM model was 0.75, with similar results achieved in internal validation (0.74) and external validation (0.68). The AUC for the HVCLNM model was 0.80, with similar values in internal validation (0.79) and external validation (0.79). Both models demonstrated good calibration, with predictions closely aligning with observed outcomes.</p><p><strong>Conclusions: </strong>Based on the quantified risk stratification offered by our nomograms, clinicians can engage in comprehensive preoperative discussions with PTC patients. Prophylactic CLND and strict postoperative evaluation may be recommended for patients with high nomogram scores.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 3","pages":"421-435"},"PeriodicalIF":1.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12004298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008367","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 diagnostic value of real-time ultrasound elastography and contrast-enhanced ultrasound in BI-RADS 4A breast lesions.","authors":"Yindi Zhu, Li Jiang, Yue-Nan Chen, Mingyue Wang, Tina J Hieken, Mei-Fang Pan, Dian Zhang","doi":"10.21037/gs-2025-93","DOIUrl":"https://doi.org/10.21037/gs-2025-93","url":null,"abstract":"<p><strong>Background: </strong>The Breast Imaging-Reporting and Data System (BI-RADS) is the primary system for classifying clinical breast lesions. Most early lesions identified via ultrasound are classified as BI-RADS 4A or lower. Although the vast majority of BI-RADS 4A lesions are benign, those lesions still have the possibility of malignancy in clinical practice, which is a controversial and noteworthy issue. This study aimed to assess the diagnostic value of real-time ultrasound elastography (UE) and contrast-enhanced ultrasound (CEUS) in evaluating BI-RADS 4A breast lesions.</p><p><strong>Methods: </strong>A retrospective analysis was conducted of the UE and CEUS data of 52 BI-RADS 4A breast lesions from 52 patients between January 2020 and March 2023. All diagnoses were confirmed by surgical pathology. Lesion characteristics, including the margins, echogenicity, size, microcalcifications, blood flow patterns, UE scores, and CEUS features, were analyzed. CEUS scores were based on a five-point system, and the area under the curve (AUC) was calculated using MedCalc version 19.0.4.</p><p><strong>Results: </strong>Based on the postoperative pathology, of the 52 lesions, 27 were benign and 25 were malignant. Compared to those with benign lesions, the patients with malignant lesions were older and had larger lesions (P<0.05). Features such as irregular morphology, indistinct margins, increased blood flow, and calcifications were more common in the malignant lesions than the benign lesions (P<0.05). The malignant lesions also had a higher prevalence of inhomogeneous enhancement, vasa vasorum, irregular enhanced morphology, and crab claw-like signs on CEUS than the benign lesions (P<0.05). The diagnostic accuracy of both the UE and CEUS individually was 76.9%, while the diagnostic accuracy of the UE and CEUS combined reached 80.8%. The AUCs of UE, CEUS, and the UE and CEUS combined were 0.761, 0.773, and 0.813, respectively.</p><p><strong>Conclusions: </strong>UE and CEUS have significant diagnostic value for BI-RADS 4A breast lesions. Combining these techniques improves diagnostic accuracy and can help reduce unnecessary biopsies.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"14 3","pages":"488-497"},"PeriodicalIF":1.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12004297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019010","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}