Aims and Scope Gland Surgery (Gland Surg; GS, Print ISSN 2227-684X; Online ISSN 2227-8575), launched in May 2012, is an open access, peer-reviewed journal. Published quarterly from May 2012 to Dec. 2014 and bimonthly from Jan. 2015 to Dec. 2020, GS now follows a monthly publication model. GS has been indexed by PubMed/PubMed Central (PMC) and Web of Science [Science Citation Indexed Expanded (SCIE)]. Its latest impact factor (2025 citation year) is 1.9. As a monthly published journal, it aims at providing cutting-edge findings and practical information on diagnosis, prevention, and treatment of gland diseases, such as breast, thyroid, adrenal, pancreas surgery and other related fields. Dedicated to the understanding and treatment of gland diseases, this multidisciplinary periodical publishes articles that describe basic, translational and clinical research of gland disease from a range of fields as biomarkers, imaging, pathology, biology and interventional radiology etc. Readers can expect to gain new insights into diagnosis, therapeutic approaches and prognosis of gland diseases. The journal is proud of the quality and content, which is further enhanced by a hands-on approach by its editorial team. Its international readership is reflected in the prestigious Editorial Board supported by numerous experts worldwide. It aims to advance and improve education in surgery and to diffuse knowledge on new and improved methods of teaching and practising surgery in all its branches. The journal features original articles, case reports, cutting-edge reviews, surgical techniques and visualized surgery, thus representing a source of valuable, novel information for clinical and basic researchers alike. The entire submission and review process are managed through OJS, an electronic system to increase efficiency and ensure that submitted papers can be published within a short turnaround period. GS is published by AME Publishing Company, with support from Wolters Kluwer (the journal content will be made available on Wolters Kluwer Health’s Lippincott and Ovid platforms). 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Example of statements in published articles: https://actr.amegroups.org/article/view/8875; https://med.amegroups.org/article/view/8358/html. Contact with Editorial Office Suki Tang, Corresponding Editor, Gland Surgery Email: editor@glandsurgery.org Publisher Information GS is published by AME Publishing Company. Address: Hong Kong branch office: Flat/RM C 16F, Kings Wing Plaza 1, NO. 3 on Kwan Street, Shatin, NT, Hong Kong, China. Updated on July 10, 2026
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
Background: 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. Methods: 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. Results: 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). Conclusions: 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.
Evaluation of the efficacy and safety of breast augmentation using implants combined with autologous fat grafting: a retrospective study of 219 cases
Background: Hybrid breast augmentation—silicone gel implant placement combined with autologous fat grafting—is increasingly used in women with a thin soft-tissue envelope, yet large series from centers outside the groups that first described the technique remain limited. We evaluated the volumetric efficacy, safety, and aesthetic outcomes of hybrid augmentation, and examined whether the size gain explained patient-reported satisfaction. Methods: We retrospectively reviewed 219 women who underwent primary hybrid breast augmentation, with complete 12-month follow-up. Outcomes were the change in breast circumference, patient-reported satisfaction (BREAST-Q Augmentation module, version 2.0; Satisfaction with Breasts domain, scored 0–100), a surgeon-rated aesthetic score, and postoperative complications. Data were analyzed in SPSS version 26.0 using paired t-tests, Fisher’s exact test, univariate logistic regression, and Pearson correlation. Results: Breast circumference increased by a mean of 12.6±1.3 cm at 6 months and remained augmented at 12 months (mean gain 10.3±2.5 cm; both P<0.001). BREAST-Q satisfaction rose from a preoperative baseline of 54.4±5.9 to 80.9±5.7 at 6 months and 82.2±5.4 at 12 months (mean improvement +27.8 at 12 months; 95% confidence interval: 26.9–28.8; P<0.001), and surgeon aesthetic scores were consistently high. The overall complication rate was low (5.9%; 13/219); all events were minor, and no Baker grade IV capsular contracture occurred. Patient satisfaction was not explained by the magnitude of the size gain: BREAST-Q was not associated with the increase in circumference at either time point (r=0.05 at 6 months and r=0.06 at 12 months; both P>0.3). No complication occurred among the 33 patients with a smoking history (P=0.23), and body mass index (BMI) was not associated with complications (odds ratio 1.02; P=0.92). Conclusions: Hybrid breast augmentation provided substantial and durable enlargement with a low, exclusively minor complication profile in thin-tissue patients. Because satisfaction was largely independent of the degree of size increase, these findings support prioritizing soft-tissue quality and natural contour over volume alone. In the absence of an implant-only comparison group, these findings characterize outcomes after hybrid augmentation rather than establishing its superiority or the independent contribution of fat grafting.
Integrating delta radiomics and changes in multimodal ultrasound features for predicting response to neoadjuvant chemotherapy in breast cancer
Background: XXXXXXXXXXXX. 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 neoadjuvant chemotherapy (NAC) response in breast cancer, and to preliminarily assess the association between shrinkage patterns and IHC characteristics. Methods: 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. Results: 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. Conclusions: 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.
Clinical, microbial, and experimental features associated with Grade C postoperative pancreatic fistula and pancreaticojejunostomy disruption
Background: 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. Methods: 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. Results: 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% vs. 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. Conclusions: 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.
Highly cosmetic and safe breast-conserving surgery using a wave-like periareolar incision with sub-nipple and extensive subcutaneous dissection: a retrospective cohort study
Background: 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. Methods: 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. Results: The K-BCS group showed significantly better cosmetic outcomes than the tumor-surface incision group (excellent, 57% vs. 34%; good, 37% vs. 47%; fair, 5% vs. 16%; poor, 1% vs. 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. Conclusions: As a promising, reproducible OBCS approach, K-BCS yielded superior esthetic outcomes across various patients and tumor characteristics while maintaining oncologic and surgical safety.
Predictive model for increased postoperative drainage volume in patients with papillary thyroid carcinoma: a retrospective cohort study
Background: 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. Methods: 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. Results: 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. Conclusions: 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 management and recovery in patients with PTC. Nevertheless, these findings warrant further confirmation through large-scale, multicentre external validation studies before clinical implementation.
Development and validation of a SEER-derived prognostic nomogram for non-metastatic Asian breast cancer patients
Background: 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. Methods: 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. Results: 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. Conclusions: 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.
Endoscopic nipple-sparing mastectomy with immediate breast reconstruction and sentinel lymph node biopsy for early-stage breast cancer: a prospective case series
Background: 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. Methods: 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. Results: 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 ycT0), 47/130 (36.1%) cT1N0, 31/130 (23.8%) cT2N0, 7/130 (5.4%) cT1N1, 14/130 (10.8%) cT2N1, and 4/130 (3.1%) cT3N0. 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±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. Conclusions: 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. Endoscopic surgery is associated with minimal scarring, reduced postoperative pain, and shorter hospital stays, which may facilitate early recovery and improve therapeutic outcomes in breast cancer management. Patient-reported outcomes suggested consistently high levels of patient satisfaction with the reconstructed breast contour.
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
Background: 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. Methods: 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). Results: 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. Conclusions: 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.
Development and internal validation of a multimodal MRI-FNAC radiomics-pathomics model for predicting cervical lymph node metastasis in papillary thyroid carcinoma
Background: 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. Methods: 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). Results: 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. Conclusions: 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.
Development and validation of a predictive model for thyroid nodule malignancy risk based on intralesional and perilesional ultrasound radiomic features
Background: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX. 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 Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) 4a/b. Methods: 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. Results: 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. Conclusions: 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.
Evolution of parathyroid pathology identification during concomitant thyroid surgery
Background: 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. Methods: Retrospective cohort study of patients undergoing thyroid surgery at Emory University from 1999 to 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. Results: 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. Conclusions: 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.
Global research trends and thematic evolution of imaging-guided localization in breast cancer surgery: a bibliometric analysis
Background: 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. Methods: 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). Results: 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. Conclusions: 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.
Utility of intercostal artery perforator flap in granulomatous lobular mastitis: a single-center retrospective study
Background: 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. Methods: 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. Results: 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. Conclusions: 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.
Development and validation of a SEER-based prognostic nomogram for overall survival in elderly Asian American women with breast cancer
Background: Breast cancer is the most common malignancy among Asian American women. Although Asian American patients as a group often have favorable survival outcomes, elderly Asian American women may face distinct prognostic challenges. General prognostic models for breast cancer may have reduced accuracy in elderly Asian American women, who have distinct tumor biology, treatment patterns, and social contexts. No population-specific prognostic nomogram exists for this understudied intersectional group. The present study aimed to establish and validate a prognostic nomogram to predict overall survival (OS) in elderly Asian American breast cancer patients. Methods: Cases were identified via the International Classification of Diseases for Oncology, 3rd edition (ICD-O-3) morphology and topography codes in Surveillance, Epidemiology, and End Results (SEER) [2000–2021], and Asian ethnicity was defined per SEER race/ethnicity classification. The median follow-up time was 50 months. Patients were randomly split into training (70%) and validation (30%) cohorts. Of 109,317 Asian female patients initially identified from the SEER database, 11,968 eligible patients aged ≥65 years with stage I–III primary breast cancer were included after applying exclusion criteria for secondary tumors, missing data, and other ineligible conditions. Univariable and multivariable Cox regression identified independent prognostic factors, which were incorporated into a nomogram predicting 1-, 3-, and 5-year OS probabilities. The nomogram’s performance was evaluated using calibration, time-dependent receiver operating characteristic (tROC) curves, concordance index (C-index), and decision curve analysis (DCA). Results: Most patients had stage I disease (69.0%), hormone receptor (HR)+/human epidermal growth factor receptor 2 (HER2)− subtype (81.4%), and were aged 65–74 years (68.0%). A total of 11,968 individuals were enrolled, with 8,380 patients in the training cohort and 3,588 in the validation cohort. The nomogram incorporated age, tumor grade, marital status, tumor-node-metastasis (TNM) stage, molecular subtype, surgery, and radiotherapy. It demonstrated moderate-to-good discriminative ability, with C-indices of 0.779 and 0.763 in the training and validation cohorts, respectively, outperforming the traditional TNM staging system. Calibration plots showed strong agreement between predicted and observed survival. tROC curves and DCA confirmed the nomogram’s superior predictive accuracy and clinical utility over TNM staging. Conclusions: This nomogram provides a tailored risk stratification tool to support clinical decision-making for elderly Asian American breast cancer patients. External validation is required to confirm its generalizability before clinical implementation.
Development and internal validation of a nomogram for predicting the initial response to radioactive iodine therapy in differentiated thyroid cancer with concurrent Hashimoto’s thyroiditis
Background: Differentiated thyroid cancer (DTC) frequently coexists with Hashimoto’s thyroiditis (HT), and HT may influence the response to radioactive iodine (RAI) therapy. This study aims to establish and validate a clinical predictive model for the response to initial RAI therapy in patients with DTC complicated by HT, thereby providing a personalized tool for optimizing clinical decision-making. Methods: A total of 461 patients with DTC and HT were included in the study. Variable selection was conducted using least absolute shrinkage and selection operator (LASSO) regression, followed by the construction of a predictive nomogram based on multivariable binary logistic regression. Model performance was evaluated through receiver operating characteristic (ROC) curve analysis, calibration curve analysis, and decision curve analysis (DCA). Results: Among the 461 patients, 235 achieved an excellent response (ER), while 226 experienced a non-ER (NER). Utilizing five predictors identified by LASSO—N stage, tumor multifocality, lymph node metastasis rate, stimulated thyroglobulin (sTg), and thyroglobulin antibody (TgAb)—a binary logistic regression model and corresponding nomogram were developed. The model demonstrated an area under the ROC curve (AUC) of 0.864 in the training set and 0.882 in the validation set for predicting NER. Moreover, calibration curve analysis and DCA indicated acceptable agreement between predicted and observed outcomes, as well as potential clinical net benefit across a range of threshold probabilities, suggesting that the model may be useful for individualized risk stratification. Conclusions: This study successfully developed and internally validated a clinical prediction model for assessing the response to initial RAI therapy in patients with DTC complicated by HT. The model may serve as a reliable reference for personalized clinical decision-making.
Preoperative prediction of extrathyroidal extension in papillary thyroid carcinoma: a nomogram integrating dual-plane ultrasound-based radiomics and clinical features
Background: Extrathyroidal extension (ETE) is an important prognostic factor in papillary thyroid carcinoma (PTC) that directly influences surgical decision-making, yet its accurate preoperative assessment by conventional ultrasound remains challenging. This study aimed to establish a nomogram integrating dual-plane (transverse and longitudinal combined) ultrasound radiomics and clinical features for the preoperative prediction of ETE in PTC. Methods: A retrospective study was conducted on 483 patients with surgically confirmed PTC at our institution between January 2020 and December 2023 as the training cohort, and an additional 103 patients treated between January 2024 and June 2024 as the independent validation cohort. Radiomics features were extracted from transverse and longitudinal plane ultrasound images. The least absolute shrinkage and selection operator (LASSO) with five-fold cross-validation was applied for feature selection. Independent clinical predictors were identified by univariate and multivariate logistic regression analyses. A model integrating radiomics and clinical predictors for predicting ETE in PTC was constructed and presented as a nomogram. Results: The combined model exhibited superior predictive performance, with areas under the receiver operating characteristic (ROC) curve (AUCs) of 0.880 in the training cohort and 0.858 in the independent validation cohort, and significantly outperformed both the clinical model and radiomics model alone (all P<0.05). The dual-plane radiomics strategy provided incremental value compared with single-plane models. Maximum tumor diameter and nodule-capsule contact were identified as independent clinical predictors (both P<0.05). Calibration curves and decision curve analysis (DCA) further verified the favorable consistency and clinical utility of the combined nomogram. Conclusions: The nomogram integrating dual-plane ultrasound radiomics and clinical features provides a reliable, noninvasive tool for preoperative prediction of ETE in PTC, assisting in individualized risk stratification and clinical decision-making.
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
Background: 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. Methods: 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. Results: 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. Conclusions: RT was associated with improved OS among patients undergoing BCS. In selected early-stage patients eligible for breast conservation, BCS + RT achieved survival outcomes comparable to MAST, suggesting that BCS + RT can be considered a reasonable survival-based local treatment option when breast preservation is clinically desired in this rare subtype. Clinicians may use these findings to support shared decision-making with early-stage AC patients who prioritize breast conservation.
The impact of menstrual cycle on the safety of elective thyroid surgery
Background: The potential impact of the menstrual cycle on perioperative bleeding and surgical outcomes remains a topic of debate, yet limited evidence exists specifically for thyroid surgery in women of reproductive age. This study aimed to investigate the influence of menstrual cycle phase on the safety of routine thyroid surgery in women of reproductive age to provide evidence-based guidance for optimal surgical timing. Methods: This retrospective descriptive study involved 318 women of reproductive age with regular menstrual cycles who underwent thyroid surgery. Patients were stratified by surgical extent into unilateral thyroid lobectomy and total thyroidectomy groups. Based on their menstrual cycle phase at the time of thyroid surgery, patients were further categorized into menstrual, follicular, and luteal phase groups. Clinical data were collected and analyzed to compare surgical safety outcomes across the different menstrual phases. Results: Baseline characteristics were largely comparable among the menstrual phase groups. While triiodothyronine levels, white blood cell counts, and absolute monocyte counts differed significantly among the menstrual phase groups (P<0.05), all values remained within the normal clinical reference ranges. In the total thyroidectomy group, 24-hour postoperative drainage volumes differed significantly across the menstrual phases (P<0.05). However, the absolute magnitude of this difference was small (median: 40 mL for all three groups), and no other intraoperative or postoperative variables differed significantly among groups (P>0.05). Multivariate analysis identified operative time as the sole independent risk factor for increased 24-hour postoperative drainage volume (β=1.33, 95% confidence interval: 0.61–2.06, P<0.001); notably, menstrual phase was not an independent predictor. Conclusions: The menstrual cycle phase does not exert a clinically significant impact on the safety of routine thyroid surgery in women of reproductive age. These findings support that, under standard perioperative conditions including strict aseptic technique and meticulous surgical execution, performing thyroid surgery during menstruation is both safe and feasible.
Local recurrence in nipple-sparing mastectomy without intraoperative radiotherapy (IORT) in breast cancer
Background: 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. Methods: 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. Results: 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% vs. 94.7% (P=0.08) and DFS was 88.2% vs. 97.6% (P=0.24) for patients without and with RT, respectively. Conclusions: NSM without IORT is safe, and selective RT guided by tumor, nodal, and margin status achieves low LRR, even in higher-risk patients.
Risk factors and nomogram for predicting central lymph node metastasis in papillary thyroid carcinoma based on gasless transaxillary endoscopic thyroidectomy
Background: Gasless transaxillary endoscopic thyroidectomy (GTET) offers superior cosmetic outcomes for patients with unilateral papillary thyroid carcinoma (PTC). Accurate preoperative prediction of central lymph node metastasis (CLNM) risk is crucial for determining the extent of central lymph node dissection in this minimally invasive approach. This study aims to develop and validate a nomogram for predicting CLNM in patients with PTC undergoing GTET. Methods: A total of 377 PTC patients who underwent GTET in the past four years were included, comprising 260 patients without CLNM and 117 patients with CLNM. Independent risk factors were identified via least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analyses to construct a nomogram model. Internal validation was performed using bootstrap resampling. Model discrimination, calibration, and clinical utility were evaluated using receiver operating characteristic (ROC) curves, the concordance index (C-index), calibration curves, and decision curve analysis (DCA). Results: Younger age, prolonged operative time, larger tumor diameter, a greater number of dissected lymph nodes, and higher preoperative free thyroxine (FT4) levels were identified as independent risk factors for CLNM. The model yielded a C-index of 0.797 [95% confidence interval (CI): 0.758–0.847], which remained robust at 0.787 (95% CI: 0.740–0.834) following bootstrap validation. The calibration curve demonstrated high concordance between predicted probabilities and actual incidences. Furthermore, the DCA curve indicated that the model offers a favorable clinical net benefit across a threshold probability range of 5% to 80%. Conclusions: This study presents a predictive model for evaluating CLNM risk in PTC patients undergoing GTET. This tool facilitates the advancement and broader adoption of this surgical approach and provides an objective rationale for clinical decision-making regarding central lymph node dissection within this surgical context.
Development and validation of a multivariable prediction model for lateral lymph node metastasis in papillary thyroid carcinoma
Background: 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. Methods: 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<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). Results: 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. Conclusions: 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 caution. Further large-scale, multicenter validation is warranted before routine clinical application. The model may serve as a useful adjunct in preoperative decision-making and personalized management.
The prognostic value of central excised lymph node count in N1a papillary thyroid cancer: a population-based study
Background: 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. Methods: 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. Results: 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. Conclusions: 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.
Influencing factors and prediction model of ultrasound-based false-negative central lymph node metastasis in localized papillary thyroid carcinoma
Background: 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. Methods: 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. Results: 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. Conclusions: This cohort study indicated that the false-negative rate of CLNs was quite common. Personalized preventive CLN dissection was suggested.
Ultrasound radiomics for preoperative prediction of high axillary nodal burden in node-positive breast cancer: comparison of intratumoral and peritumoral features with external validation
Background: 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. Methods: 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. Results: 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. Conclusions: 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.
Comparison of perioperative outcomes between gasless transaxillary endoscopic thyroidectomy and conventional open thyroidectomy for papillary thyroid carcinoma: a retrospective study
Background: 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. Methods: 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. Results: 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]. Conclusions: 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.
Factors influencing postoperative thyroid-stimulating hormone suppression therapy in low-risk papillary thyroid cancer after lobectomy
Background: 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). Methods: 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. Results: 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, BRAF 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). Conclusions: 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.
Contrast-enhanced ultrasound for differentiating benign from malignant Breast Imaging Reporting and Data System 4a breast lesions: a prospective diagnostic accuracy study
Background: 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. Methods: 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. Results: 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). Conclusions: 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.
Nipple-areolar complex neurotization in implant-based breast reconstruction: a narrative review
Background and Objective: Nipple-sparing mastectomy with implant-based breast reconstruction preserves the visible nipple-areolar complex (NAC) but commonly disrupts protective, tactile, thermal, and erogenous sensation. Clinical interest has expanded, while donor selection, recipient targeting, bridge choice, implant-pocket constraints, outcome measurement, and candidacy remain unsettled. This narrative review addresses when native nerve preservation or reconstruction is anatomically credible, how implant-specific constraints affect operative planning, what the available outcomes support, and when selective non-use is appropriate. Methods: PubMed was the primary indexed database; Google Scholar and reference chaining were supplementary discovery methods. English-language, peer-reviewed sources relevant to predefined clinical questions were considered from database inception through 15 May 2026. Publications used for substantive claims were assessed in full text. Evidence was organized by directness and synthesized narratively according to study design, consistency, applicability, outcome methodology, and follow-up. No formal risk-of-bias instrument, quantitative pooling, dual independent systematic-review screening, or duplicate extraction was performed. Key Content and Findings: The direct evidence consists predominantly of technical reports and small single-center observational cohorts, with limited comparative and randomized evidence. Follow-up is generally short, sensory instruments and testing zones are inconsistent, and many reports do not provide denominators for planned, attempted, modified, or abandoned neurotization. The T3-T5 lateral intercostal corridor, particularly T4, is the principal donor region; safely preservable superficial branches may remain in continuity when oncologic resection and flap perfusion are uncompromised. Implant base width, donor length, route feasibility, and coaptation sequencing are supported technical considerations, whereas validated thresholds for acellular dermal matrix or capsule interfaces, compression, tissue expansion, route vascularity, or protected slack are absent. Subareolar stumps, retroareolar or subdermal NAC fields, posterior areolar tissue, and nipple-base targets have been used, without evidence of target superiority. Processed allograft has the strongest implant-based precedent, while direct repair, branch elongation, and autograft are anatomy-dependent alternatives; comparative biological and economic superiority is unestablished. Conclusions: NAC neurotization is selectively feasible and may improve sensation, but the evidence is heterogeneous and insufficient for firm technique or patient-selection recommendations. The proposed conditional framework supports clinical reasoning and transparent reporting; it is not a validated guideline.
Optimization of fat grafting to attenuate radiation damage: a narrative review
Background and Objective: 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. Methods: 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. Key Content and Findings: 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. Conclusions: 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.
Robotic nipple-sparing mastectomy after periareolar incision: a surgical technical approach to subareolar dissection in a previously operated field
Nipple-sparing mastectomy (NSM) after a prior periareolar incision is technically demanding because fibrosis, altered tissue planes, and possible vascular compromise around the nipple-areola complex (NAC) may increase the difficulty of subareolar dissection. Although robotic nipple-sparing mastectomy (R-NSM) has been reported as a minimally invasive option, its specific role in re-operative subareolar fields remains uncertain. This surgical technical report describes R-NSM performed with the da Vinci Xi system in a 51-year-old woman who previously underwent diagnostic lumpectomy through a periareolar incision for atypical ductal hyperplasia, followed by an indication for additional resection after ductal carcinoma in situ with microinvasion was identified. A 3.5-cm mid-axillary incision was used for access with a GelPOINT Mini platform. The key technical elements were lateral access without reopening the periareolar incision, low-pressure CO2 insufflation, hydrodissection, maintenance of uniform flap thickness, limited use of bipolar energy, and cold scissors dissection immediately beneath the NAC under magnified three-dimensional visualization. The retroareolar margin was confirmed intraoperatively by frozen section. The total operative time was 248 min, and console time was 71 min. No intraoperative complications occurred. The postoperative course was uneventful, the patient was discharged on postoperative day 7, no nipple or skin necrosis was observed, and final surgical margins were negative. This case suggests that R-NSM may facilitate controlled subareolar dissection in selected patients with prior periareolar surgery. However, this single-case report does not demonstrate superiority over open or endoscopic approaches, and the absence of objective perfusion assessment precludes conclusions regarding NAC vascular preservation.
Thyroid metastasis from lung adenocarcinoma: diagnostic pitfalls and individualized management in a six-patient case series and literature review
Background: Clinically recognized thyroid metastasis from lung adenocarcinoma is rare and may mimic a primary thyroid malignancy because imaging, cytologic, and immunophenotypic findings overlap. We aimed to characterize the diagnostic pitfalls, management, and outcomes of 6 consecutive patients and to define the limited circumstances in which thyroid-directed treatment may be reasonable. Case Description: Six patients with pathologically confirmed thyroid metastasis from lung adenocarcinoma were treated at an academic tertiary cancer hospital between September 2018 and September 2023. The cohort included 4 men and 2 women, with a mean age of 57 years. Of the 6 patients included in this case series, 2 underwent surgical resection after their primary lung lesions were identified. One of these 2 patients experienced postoperative recurrence with subsequent bone metastasis, and the other developed multiple intrapulmonary metastases and thyroid metastasis after surgery. The remaining 4 patients already had advanced-stage disease at initial detection and were not eligible for surgery, so they received systemic anti-tumor therapy. Thyroid metastasis was detected in all 6 cases during tumor staging or post-treatment follow-up. At the time of examination, 5 patients had no specific clinical symptoms, while 1 patient presented with a palpable neck mass. All patients underwent neck ultrasound and computed tomography (CT) scanning. The diagnosis was confirmed by ultrasound-guided fine-needle aspiration biopsy in 5 patients (Cases 1 and 3–6). In the remaining patient (Case 2), cytological findings were suggestive of primary medullary thyroid carcinoma, and the diagnosis of metastatic lung adenocarcinoma was established by postoperative histopathology following thyroidectomy, which was also performed to prevent local functional impairment. As of the data cutoff date, 1 patient was still alive with disease, 4 patients died from metastatic disease, and 1 patient was lost to follow-up. Conclusions: A new thyroid lesion in a patient with current or previous lung adenocarcinoma should prompt consideration of metastatic disease and tissue confirmation with a focused immunohistochemical panel. Systemic therapy remains the main treatment for most patients. Thyroidectomy should not be routine and may be considered only after multidisciplinary assessment for truly isolated/oligometastatic disease amenable to complete local control or for imminent airway, swallowing, or laryngeal morbidity. No survival benefit from surgery can be inferred from this small series.
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
Background: 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 in situ (DCIS). Case Description: 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 in situ 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. Conclusions: 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.
Airway stenosis following immediate bilateral recurrent laryngeal nerve reconstruction: report of two cases successfully treated with laser submucosal intermediate transverse resection of the arytenoid cartilage
Background: While the usefulness of immediate intraoperative reconstruction of the unilateral recurrent laryngeal nerve (RLN) has been reported, there are few reports of bilateral reconstruction. Furthermore, detailed evaluation of laryngeal function before and after surgical treatment for airway compromise caused by bilateral RLN paralysis remains limited. This report aimed to highlight a preventable complication of immediate bilateral RLN reconstruction and a salvage treatment option. Case Description: We report two women who underwent immediate bilateral RLN reconstruction during surgery for benign thyroid tumors at another hospital and subsequently developed airway stenosis. Both patients underwent intraoperative tracheostomy and were referred to our institution for tracheostomy closure. Laryngeal electromyography revealed thyroarytenoid muscle activity during inspiration and reduced activity during phonation, indicating nerve misinnervation. Respiratory, swallowing, and voice functions were evaluated before and after surgery. The laser submucosal intermediate transverse resection of the arytenoid cartilage (LSITRA) technique was performed to enlarge the posterior glottis. In both cases, respiratory function improved after surgery, tracheostomies were successfully closed, and no restenosis was observed during more than 1 year of follow-up after decannulation. Conclusions: LSITRA was effective for treating airway stenosis caused by bilateral RLN paralysis, with minimal adverse effects on voice and swallowing function. Although immediate RLN reconstruction is effective for unilateral nerve injury, bilateral reconstruction should be avoided because misinnervation may result in airway compromise. In benign thyroid disease, a two-stage surgical approach should be considered when loss of signal is detected on one side.
Malignant melanoma presenting as a thyroid mass with synchronous retroperitoneal metastases in a 55-year-old male: a case report
Background: Malignant melanoma (MM) is an aggressive tumor characterized by a high tendency for early metastasis. Although most cases have identifiable primary sites, melanoma of unknown primary (MUP) presents as metastatic disease without detectable primary lesions. MM presenting as a thyroid mass with concurrent metastasis to the spleen-kidney interspace is extremely rare, and the occult nature of the primary lesion also poses a significant diagnostic challenge, often leading to confusion with aggressive primary thyroid malignancies. Case Description: A 55-year-old male with an unremarkable medical history presented with a 3-month history of a rapidly enlarging, painless left neck mass. Physical examination revealed a firm 5-cm mass in the left thyroid lobe and a similarly sized palpable mass in the right supraclavicular region. No suspicious lesions were noted on the skin or mucous membranes. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) identified multifocal hypermetabolic lesions involving the left thyroid lobe, right supraclavicular fossa, and splenorenal recess. To improve surgical precision, patient-specific three-dimensional (3D) printing technology was used preoperatively to depict the spatial relationship between the cervical masses and adjacent neurovascular structures. The patient subsequently underwent total thyroidectomy, cervical lymph node dissection, and resection of the retroperitoneal lesion. Postoperative histopathological examination confirmed metastatic melanoma at all sites, and molecular analysis identified the BRAF V600E mutation. The patient successfully initiated targeted therapy with dabrafenib and trametinib and remains stable during follow-up. Conclusions: Advanced melanoma should be included in the differential diagnosis of rapidly expanding, atypical thyroid masses, even in the complete absence of a known primary lesion. Clinicians must utilize fine-needle aspiration cytology and a targeted immunohistochemical panel to differentiate metastatic melanoma from primary anaplastic or medullary thyroid carcinomas early. Whole-body 18F-FDG PET/CT is crucial for detecting occult systemic metastases, while patient-specific 3D printing provides substantial practical value for complex head-and-neck operative planning.
Understanding pancreatic reconstruction after pancreatoduodenectomy: lessons in technique and biology
When and how can in-hospital deaths following pancreaticoduodenectomy be prevented?