Gland surgery最新文献

{"title":"Optimization of fat grafting to attenuate radiation damage: a narrative review.","authors":"Amy Skarsfeldt, Katharina S Berryman, Kento Takaya, Ivy J Stejskal, Kellen Chen, Geoffrey C Gurtner","doi":"10.21037/gs-2026-0230","DOIUrl":"10.21037/gs-2026-0230","url":null,"abstract":"<p><strong>Background and objective: </strong>Radiation-induced fibrosis (RIF) remains a progressive complication of cancer therapy that compromises tissue quality and reconstructive outcomes. Autologous fat grafting (AFG) has emerged as a regenerative strategy to mitigate radiation damage. However, clinical outcomes remain variable, and efforts to enhance outcomes have largely focused on improving graft survival, angiogenesis, and reduction of fibrotic remodeling. This review aims to highlight recent advances in fat grafting to resolve fibrosis and new evidence for closely related adverse conditions.</p><p><strong>Methods: </strong>In this narrative review, an overview of existing knowledge and recent research in the use of fat grafting to attenuate RIF is presented. The article is based on a literature search in PubMed with the keywords \"fat graft\" and \"adipose\" in addition to the senior authors' clinical experience in breast reconstruction.</p><p><strong>Key content and findings: </strong>Research continues to evaluate specific adipose-derived stem cell (ADSC) populations to improve graft survival with limited progress towards clinical application. In addition, several pharmacological strategies combined with AFG have been evaluated in murine models to mitigate RIF and improve fat graft outcomes. Emerging data on decellularized adipose matrix (DAM) shows promise and may be ideal for patients with insufficient adipose tissue. Given the ADSC population variability between donors, research studies could benefit from analyzing the adipose tissue as this remains poorly characterized. Most strategies involved in AFG enrichment involve procedures that would require Good Manufacturing Practice (GMP) handling or use of medicines outside of their indications, which would be considered burdensome in a clinical setting.</p><p><strong>Conclusions: </strong>This review examines current cellular therapy, pharmacologic treatments, and prophylactic strategies aimed at enhancing fat graft survival and discusses applications beyond attenuating fibrosis with specific indications focused on resolving secondary lymphedema, neuropathic pain, and wound healing with promising though limited clinical evidence.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"237"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944784","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 clinical relevance of LODDS for post-mastectomy radiotherapy in T1-2N1M0 breast cancer: a real-world propensity score-weighted analysis using the SEER database.","authors":"Yifan Li, Zitong Yang, Zi Ou, Yuanbo Xue, Yufeng Tian, Aojin Li, Jiandong Wang","doi":"10.21037/gs-2026-0343","DOIUrl":"10.21037/gs-2026-0343","url":null,"abstract":"<p><strong>Background: </strong>The benefit of postmastectomy radiotherapy (PMRT) in patients with T1-2N1M0 breast cancer remains heterogeneous. This study evaluated whether the log odds of positive lymph nodes (LODDS) could stratify PMRT-associated survival benefit in this population.</p><p><strong>Methods: </strong>This study was designed as a retrospective observational cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) database. Patients with T1-2N1M0 breast cancer who underwent mastectomy between 2010 and 2018 were identified from the SEER database. LODDS was calculated as log [(positive lymph nodes + 0.5)/(negative lymph nodes + 0.5)] and categorized into low, intermediate, and high groups. Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics. Breast cancer-specific survival (BCSS) and overall survival (OS) were analyzed using Kaplan-Meier curves and Cox regression models.</p><p><strong>Results: </strong>A total of 28,864 patients were included, of whom 12,481 received PMRT and 16,383 did not. After IPTW, baseline characteristics were well balanced. PMRT was associated with improved BCSS [hazard ratio =0.776, 95% confidence interval (CI): 0.723-0.833, P<0.001] and OS (hazard ratio =0.800, 95% CI: 0.759-0.844, P<0.001). The association between PMRT and BCSS differed by LODDS group (P for interaction =0.048). PMRT was not significantly associated with improved BCSS in the low LODDS group (hazard ratio =0.895, 95% CI: 0.779-1.028, P=0.12), but was associated with improved BCSS in the intermediate and high LODDS groups (P<0.001).</p><p><strong>Conclusions: </strong>PMRT was associated with improved survival in patients with T1-T2N1M0 breast cancer after mastectomy, especially among those with intermediate or high LODDS. LODDS may help refine PMRT decision-making beyond N stage alone.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"208"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944013","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 prediction model for lateral lymph node metastasis in papillary thyroid carcinoma.","authors":"Zhenxing Peng, Jialong Wu, Junwei Huang, Xiaohong Chen","doi":"10.21037/gs-2026-0236","DOIUrl":"10.21037/gs-2026-0236","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Lateral lymph node metastasis (LLNM) is a critical determinant of surgical extent and a significant risk factor for locoregional recurrence and decreased survival in papillary thyroid carcinoma (PTC). However, accurate preoperative prediction of LLNM remains challenging due to the limited sensitivity of conventional ultrasound, which often leads to either unnecessary prophylactic lateral neck dissection or inadequate surgical management. This study aimed to develop and validate a nomogram incorporating preoperative clinical and ultrasound features to improve individualized LLNM risk prediction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this multicenter retrospective study, we included 1,195 consecutive PTC patients who underwent thyroid surgery at three centers (Beijing Tongren Hospital, Beijing Shijitan Hospital, and Qinhuangdao First Hospital) from January 2017 to June 2021.All patients had histopathologically confirmed PTC, and the reference standard for LLNM diagnosis was histopathological examination of dissected lateral neck lymph nodes. Patients with incomplete clinical or pathological data, a history of prior thyroid or neck surgery, other thyroid cancer subtypes, other malignancies, or preoperative thyroid function-related medication were excluded. Of the total patients, there were 1,080 were randomly split into a training cohort (n=756) and an internal validation cohort (n=324). An independent cohort of 115 patients was used for external validation. Candidate predictors including clinicodemographic and ultrasound features were screened via univariate analysis using Chi-squared or Wilcoxon rank-sum tests. Variables with P&lt;0.05 in univariate analysis were entered into a multivariate logistic regression with backward stepwise selection to identify independent factors. Model performance was evaluated using area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The independent risk factors for LLNM were Hashimoto's thyroiditis (HT), tumor location (upper pole), size, multifocality, capsular invasion, extrathyroidal extension (ETE), and ≥5 central lymph node metastases (CLNM). The model achieved AUCs of 0.88, 0.89, and 0.82 in the training, internal validation, and external validation cohorts, respectively. The model demonstrated sensitivity of 84.2%, 81.6%, and 73.1%, and specificity of 90.1%, 88.9%, and 84.3% in the training, internal validation, and external validation cohorts, respectively. Calibration was good, and DCA showed net clinical benefit across a wide range of risk thresholds.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This nomogram, integrating readily available preoperative clinical and ultrasound features, demonstrates promising accuracy for stratifying LLNM risk in PTC patients. However, given the limited sample size of the external validation cohort (n=115; 26 events), these results should be interpreted with caut","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"229"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing postoperative thyroid-stimulating hormone suppression therapy in low-risk papillary thyroid cancer after lobectomy.","authors":"Bingbin Dong, Shuguang Xiao, Zheng Wang, Yabing Wang","doi":"10.21037/gs-2026-0244","DOIUrl":"10.21037/gs-2026-0244","url":null,"abstract":"<p><strong>Background: </strong>Thyroid-stimulating hormone (TSH) suppression therapy remains an important treatment option for patients with low-risk differentiated thyroid cancer (DTC). This study aimed to analyze the potential influencing factors affecting TSH suppression outcomes in patients with postoperative low-risk papillary thyroid cancer (PTC).</p><p><strong>Methods: </strong>A total of 223 low-risk PTC patients were enrolled in this single-center cross-sectional study between September 2024 and February 2025. Based on the TSH level measured at 4-6 months post-lobectomy, the patients were divided into three groups: an excessive TSH suppression group (TSH <0.5 mU/L), optimal TSH suppression group (TSH 0.5-2.0 mU/L), and insufficient TSH suppression group (TSH >2.0 mU/L). The clinicopathological data of the patients, including demographic, clinical laboratory, pathological, and lifestyle characteristics, were analyzed to investigate the factors influencing TSH suppression therapy.</p><p><strong>Results: </strong>There were no statistically significant differences in age, marital status, preoperative free triiodothyronine (FT3), free thyroxine (FT4), thyroglobulin antibody (TG-Ab), thyroid peroxidase antibody (TPO-Ab), thyroglobulin (Tg) level, longest tumor diameter, lesion site, central lymph node metastasis, Hashimoto's thyroiditis, <i>BRAF</i> V600E mutation, levothyroxine intake habits, dietary habits, or sleep habits among the three groups (all P>0.05). The distributions of sex, body mass index (BMI), comorbidities, preoperative TSH levels, multifocal lesions, levothyroxine dose, physical activity, and sedentary time differed significantly among the three groups (all P<0.05). Multivariate logistic regression analyses demonstrated that excessive TSH suppression was significantly associated with female sex, a higher levothyroxine dose (≥1.6 µg/kg/day), lower preoperative TSH levels, lower physical activity, and higher sedentary time. Conversely, insufficient TSH suppression was independently associated with higher BMI and lower levothyroxine dose (<1.6 µg/kg/day).</p><p><strong>Conclusions: </strong>A complex interplay exists among demographic, clinical, and lifestyle factors in postoperative TSH management. Prospective studies with objective lifestyle measurements are needed to confirm these associations before clinical implementation.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"234"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944569","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 internal validation of a multimodal MRI-FNAC radiomics-pathomics model for predicting cervical lymph node metastasis in papillary thyroid carcinoma.","authors":"Jing Wan, Lunyou Zhang, Zhiqin Zhou, Zhu You, Yi Qiu","doi":"10.21037/gs-2026-0241","DOIUrl":"10.21037/gs-2026-0241","url":null,"abstract":"<p><strong>Background: </strong>Cervical lymph node metastasis (CLNM) occurs in 40-60% of papillary thyroid carcinoma (PTC) cases and critically affects surgical planning and prognosis. Current preoperative assessment relies mainly on ultrasound and ultrasound-guided fine-needle aspiration cytology (FNAC), which have limited sensitivity and a high false-negative rate. These shortcomings frequently lead to either missed metastases or unnecessary prophylactic neck dissection with risks of recurrent laryngeal nerve injury and hypoparathyroidism. Therefore, more accurate non-invasive preoperative prediction tools are urgently needed. This study aimed to develop and internally validate a multimodal magnetic resonance imaging (MRI)-FNAC radiomics-pathomics model based on deep learning features for predicting CLNM in patients with PTC.</p><p><strong>Methods: </strong>We retrospectively enrolled 128 PTC patients who underwent thyroidectomy and neck dissection (78 with CLNM, 50 without). Patients were randomly split into training (n=90) and test (n=38) sets at a 7:3 ratio. Deep features were extracted from preoperative MRI using a pretrained ResNet-50 model and from FNAC hematoxylin and eosin (H&E) images. Six machine learning algorithms were applied to develop models based on MRI radiomics, pathomics, and multimodal fusion features. Performance was evaluated using area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), decision curve analysis (DCA), DeLong test, and calibration metrics (Brier score and Hosmer-Lemeshow test).</p><p><strong>Results: </strong>The cohort had a mean age of 48.82±10.02 years (71.1% female). No significant differences were found between CLNM-positive and -negative groups in age, sex, or tumor diameter, whereas multifocality and extrathyroidal extension were more prevalent in the CLNM-positive group. In the test set, the multimodal k-nearest neighbors (KNN) model achieved the highest AUC of 0.872 (95% confidence interval: 0.778-0.955). DeLong tests confirmed its superiority over the best pathomics-only model (P=0.046) and the best MRI-only model (P=0.003). The multimodal model also demonstrated the best calibration (Brier score 0.1059; Hosmer-Lemeshow P=0.72) and superior clinical net benefit on DCA.</p><p><strong>Conclusions: </strong>The multimodal MRI-FNAC radiomics-pathomics model showed promising performance for predicting CLNM in PTC. However, external validation in larger multicenter cohorts is required before clinical implementation.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"217"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944648","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 SEER-derived prognostic nomogram for non-metastatic Asian breast cancer patients.","authors":"Fei Xu, Yu-Ling Zhang, Jin-Mei Cheng, Heng-Wen Sun, Sha-Sha Du, Xin Hua","doi":"10.21037/gs-2026-0203","DOIUrl":"10.21037/gs-2026-0203","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer (BC) is the most prevalent cancer among American women. Asian Americans are confronting a rapidly increasing incidence, facing unique challenges within the healthcare system that contribute to disparities in cancer outcomes. This study aimed to develop and validate a prognostic nomogram for predicting long-term survival in Asian BC patients utilizing the Surveillance, Epidemiology, and End Results (SEER) database.</p><p><strong>Methods: </strong>Asian female BC patients diagnosed between 2000 and 2021 were identified from the SEER database. Following the application of inclusion and exclusion criteria, 38,269 patients were included and randomly divided into training (70%) and validation (30%) cohorts. Univariate and multivariate Cox regression analyses were conducted to identify independent prognostic factors, which were incorporated into a nomogram. The model's discriminative ability, calibration, and clinical utility were evaluated.</p><p><strong>Results: </strong>Independent predictors of overall survival included age, tumor grade, marital status, T stage, N stage, subtype, radiotherapy, and chemotherapy. The nomogram demonstrated strong discriminative performance, with concordance indices of 0.794 and 0.811 in the training and validation cohorts, respectively, demonstrating better discriminative performance than the traditional tumor-node-metastasis (TNM) staging system. Calibration plots and decision curve analysis confirmed excellent calibration and clinical applicability.</p><p><strong>Conclusions: </strong>This study presents a prognostic nomogram developed and validated exclusively in a large cohort of non-metastatic Asian American BC patients from the SEER database, incorporating modern molecular subtypes to improve prognostic stratification for this understudied population. By integrating readily available clinicopathological factors, the nomogram provides personalized survival forecasts, serving as a valuable tool for individualized management in this unique population. Further external validation and refinements are warranted to enhance its clinical utility.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"214"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944604","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 endoscopic-assisted triple-plane technique: a technical refinement for complete autologous prosthesis coverage in subpectoral implant-based breast reconstruction.","authors":"Wenfei He, Yue He, Mingzhi Xia, Zhihua Liu, Zhaoyang Zhu, Zhaoyun Wu, Zhijie Gao, Xiaobo Hu","doi":"10.21037/gs-2026-0224","DOIUrl":"10.21037/gs-2026-0224","url":null,"abstract":"<p><p>The triple-plane technique offers complete autologous prosthesis coverage in subpectoral breast reconstruction without requiring mesh. Its integration with endoscopic assistance allows for precise dissection through a concealed incision. Achieving complete implant coverage without mesh in subpectoral reconstruction remains a technical challenge. This study evaluates the feasibility and early outcomes of this novel endoscopic-assisted triple-plane technique. In this prospective case series, we describe and evaluate an integrated approach utilizing a single axillary incision under endoscopic visualization to dissect three anatomical planes: the subpectoral plane (pectoralis major, A-plane), the serratus anterior fascia (B-plane), and the deep superficial fascia (C-plane). These layers are combined to create a mesh-free pocket ensuring complete autologous prosthesis coverage. In our preliminary series, the procedure was successfully performed in 89 patients. The mean operative time was 90.28±14.95 minutes, with an average blood loss of 44.21±13.40 mL. The mean incision length was 5.47±0.52 cm, and the average hospital stay was 7.56±1.78 days. Postoperative breast appearance was rated as excellent in 86 patients (96.63%) and good in 3 patients (3.37%). All patients reported high satisfaction, with BREAST-Q (a validated patient-reported outcome measure for breast surgery) scores ranging from 80 to 100 and a mean score of 87.28. No major perioperative complications, such as prosthesis loss or total flap necrosis, were recorded. The endoscopic-assisted triple-plane technique is a safe and reproducible mesh-free method that combines the benefits of complete autologous coverage with the advantages of minimally invasive surgery. This integrated approach appears to be a promising refinement for subpectoral breast reconstruction, supported by favorable early aesthetic outcomes and high patient satisfaction. These preliminary findings warrant further validation in comparative studies with larger sample sizes and longer follow-up.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 7","pages":"200"},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720361","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":"Anatomical mastectomy: where oncologic precision meets reconstructive surgery.","authors":"Lorenzo Scardina, Marzia Salgarello, Gianluca Franceschini","doi":"10.21037/gs-2026-0273","DOIUrl":"10.21037/gs-2026-0273","url":null,"abstract":"","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 7","pages":"182"},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725190","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 transportability, calibration drift, and local updating of a B-mode ultrasound radiomics-clinical prediction model for occult high-volume central lymph node metastasis in cN0 papillary thyroid carcinoma: development, temporal validation, and external validation.","authors":"Ziwei Zhang, Cailing Lin, Jing Ning, Xiaochen Liu, Chenshan Dong, Hang Ling","doi":"10.21037/gs-2026-0217","DOIUrl":"10.21037/gs-2026-0217","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Occult high-volume central lymph node metastasis (CLNM) can remain undetected in clinically node-negative papillary thyroid carcinoma (cN0 PTC), yet nodal burden influences preoperative counseling and recurrence-oriented risk stratification. For clinical implementation, a preoperative radiomics-based risk estimate must remain transportable, locally calibrated, and interpretable after transfer to another center. This study evaluated the clinical transportability, calibration drift, threshold consequences, and local updating of a B-mode ultrasound radiomics-clinical prediction model for occult high-volume CLNM.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This three-center retrospective model-development, validation, and updating study used the source workbook containing 957 cN0 PTC patients. The endpoint was occult high-volume CLNM, defined as more than five metastatic central lymph nodes on postoperative pathology. Candidate predictors were restricted to preoperative clinical-ultrasound variables and a prespecified B-mode radiomics score. Clinical-only, B-mode score-only, and clinical plus B-mode score models were compared in the development cohort; the clinical plus B-mode score model was treated as the locked primary implementation model because it preserved routine clinical interpretability while incorporating the quantitative image signal. The locked model was evaluated in a temporal Center 1 cohort (n=210), Center 2 (n=139), and Center 3 (n=119). Discrimination, Brier score, calibration, fixed-threshold classification, decision curve analysis, threshold consequences, and post hoc intercept-only recalibration were assessed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;High-volume CLNM was present in 399 of 957 patients (41.7%). Event rates were 44.8%, 45.2%, 41.0%, and 23.5% in the development, temporal validation, Center 2, and Center 3 cohorts. Development-cohort comparisons showed larger tumors, higher B-mode radiomics scores, higher Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) subclass, and richer vascularity among endpoint-positive patients. The B-mode score accounted for most discrimination. Compared with the B-mode score-only model, adding clinical-ultrasound variables changed the area under the receiver operating characteristic curve (AUC) by +0.015 in development, +0.008 in temporal validation, -0.009 in Center 2, and -0.029 in Center 3. The locked clinical plus B-mode score model had AUC values of 0.823, 0.874, 0.866, and 0.870, respectively. Mean predicted risk aligned with observed risk in the development, temporal validation, and Center 2 cohorts but overestimated risk in Center 3 (36.4% predicted &lt;i&gt;vs.&lt;/i&gt; 23.5% observed; calibration intercept, -0.902). At the locked threshold of 0.565, Center 3 retained specificity of 0.857 and negative predictive value (NPV) of 0.897, while intercept-only updating reduced the Center 3 Brier score from 0.138 to 0.121.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The locked radiomi","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 7","pages":"195"},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148726095","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":"Cross-sectional study and clinical prediction of post-thyroidectomy discomfort.","authors":"Jin Du, Zhaohua Shen, Yang Song, Xiaonan Huang, Fanfu Fang, Chenlu Ding, Qiuxia Ni, Yan Guo, Hengyu Li, Junyi Shi, Jing Chen, Zhiping Huang, Chaoqian Liu","doi":"10.21037/gs-2026-0208","DOIUrl":"10.21037/gs-2026-0208","url":null,"abstract":"<p><strong>Background: </strong>Thyroid lobectomy may result in various postoperative adverse symptoms, which are closely associated with patient satisfaction and recovery outcomes. The aim of this study was to investigate the incidence of discomfort symptoms in postoperative patients following thyroid lobectomy and to develop a predictive model for early identification of patients at high risk of postoperative pain and vomiting, which would be helpful in implementing preventive management.</p><p><strong>Methods: </strong>We enrolled a total of 532 patients hospitalised for thyroid lobectomy under general anaesthesia between October 2024 and March 2025, and assessed patients' postoperative discomfort symptoms by means of a questionnaire. Risk factors were identified by multivariate logistic regression and nomograms were created, followed by performance assessment and clinical utility assessment of nomograms.</p><p><strong>Results: </strong>The most common complications after thyroidectomy include pain in the incision, pharyngeal symptoms (sore throat, dysphagia, cough, etc.) and sleep disturbance. The postoperative pain frequency prediction model incorporated five correlates: thyroxine (T4), thyroglobulin antibody (TGAb), lymph node metastasis, age, and body mass index (BMI), the postoperative pain level prediction model incorporated three correlates: thyroid peroxidase antibody (TPOAb), BMI, and nodal benign or malignant status, and the postoperative vomiting prediction model incorporated four correlates: TGAb, sex, nodal diameter, and nalbuphine use.</p><p><strong>Conclusions: </strong>The established nomogram may help accurately identify high-risk patients for post-thyroidectomy pain and postoperative nausea and vomiting (PONV), facilitating the timely provision of personalized pain and vomiting management strategies.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 7","pages":"184"},"PeriodicalIF":1.9,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13462817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720312","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}