Avoiding Spinal Cord Conundrums.

BreathBC is a multicenter prospective observational cohort study aimed at comparing metabolic profiles from exhaled breath of patients with breast cancer (BC) and malignancy-free controls. The study accounts for the novelty and complexity of breath analysis, with a particular emphasis on the standardization of each step in the process. Women with primary BC without distant metastasis, women carriers of germline BRCA1/2 pathogenic variants and controls were consecutively recruited in two clinical independent cohorts and two technical validation cohorts. Breath samples were collected and linked to clinical breast status, personal, medical and lifestyle data that were retrieved using a questionnaire focused on factors potentially affecting breath analysis. Among 1010 participants, a group of 846 subjects, compliant with criteria of recruitment and sampling of the study, were preliminarily characterized. The mean age was 61 years for patients with BC and 58 years for controls, with 71% of women in post-menopause. The control group included 48% of participants with benign disease. Hypertension was the main age-related morbidity observed in 28% of participants and 10% were smokers. Among patients with BC, 15% had in situ disease and 85% an invasive cancer whose sub-typing presented a high prevalence of luminal subtypes, in agreement with the consecutive recruitment.Future activities will be focused on data analysis of breathomics data and on technical enhancement of prototypes used for sampling and instrumental analysis.

Benign uterine diseases remain among the leading causes of surgical interventions in women of reproductive age. A forty-year cumulative clinical experience (1986—2026) demonstrates that the effectiveness of reconstructive and uterus-preserving surgery for adenomyosis, uterine fibroids, and combined forms of pathology is determined not only by the radical removal of pathological lesions, but primarily by the accuracy of defining the extent of surgery and by preservation of the functional integrity of the residual myometrium. At all stages in the evolution of surgical approaches—from early methods of quantitative assessment of lesion extent to modern navigation-assisted procedures—the principle of precision has remained the key condition for achieving a balance between surgical radicality, procedural safety, and preservation of the patient’s reproductive potential. The integration of artificial intelligence (AI), three-dimensional modeling, and intraoperative navigation does not replace the surgeon’s clinical judgment but rather represents its technological extension, enabling more objective delineation of pathological boundaries, optimization of resection volume, and improvement of the reconstructive stage, taking into account the functional characteristics of the residual myometrium and endometrium. Modern operative gynecology is focused not only on eliminating disease but also on maximizing the anatomical and functional preservation of the uterus, particularly in women who have not yet realized their reproductive plans. In this context, uterus-preserving approaches based on the integration of AI technologies and high-precision surgical energy modalities are becoming especially relevant for achieving highly precise interventions. This paper systematizes current evidence on the application of AI in diagnostics, preoperative modeling, and intraoperative navigation of surgical interventions for uterine fibroids and adenomyosis. The capabilities of machine learning and radiomics algorithms in the analysis of ultrasound and magnetic resonance images, automated lesion segmentation, three-dimensional uterine modeling, and personalization of surgical strategy are reviewed. AI support contributes to increased preoperative diagnostic accuracy and optimization of the extent of uterus-preserving surgery based on three-dimensional imaging, with the goal of maximizing preservation of the anatomical and functional integrity of the residual myometrium and endometrium. A separate section is devoted to novel surgical energy-based technologies, including radiofrequency and microwave ablation, as well as high-intensity focused ultrasound (HIFU). Their biophysical mechanisms, clinical effectiveness, safety, and early reproductive outcome data are discussed. The combination of image-guided technologies with AI algorithms is emphasized as a foundation for the transition to precision surgery. Thus, the integration of artificial intelligence and high-precision energy-based methods represents a promising direction in the development of operative gynecology, aimed at optimizing uterus-preserving interventions, reducing surgical trauma, and improving functional and reproductive outcomes in patients with benign uterine diseases.

Solid pancreatic serous cystadenoma (SCA) may present as a hypervascular mass and mimic nonfunctioning pancreatic neuroendocrine tumour (NF-pNET), potentially leading to pancreatic resection for benign disease. We synthesized the available evidence on this diagnostic pitfall. A PRISMA 2020-aligned systematic review searched MEDLINE, Embase, and Web of Science (1 January 2000-1 December 2025). We included comparative cohorts of pathology-proven SCA versus NF-pNET reporting CT/MRI discriminative features and case reports/series of pathology-proven SCA preoperatively interpreted as NF-pNET. Comparative cohorts and case reports/series were synthesized separately; no meta-analysis was performed. Thirty-five publications were included: four retrospective single-center comparative cohorts (50 SCA and 89 NF-pNET patients) and 31 case reports/series (39 SCA patients). In comparative cohorts, unenhanced CT attenuation was consistently lower in SCA than in NF-pNET (18.5-29.6 vs. 38.8-48.4 HU), with study-specific ROC-derived cutoffs in the low 30-HU range; attenuation ratios performed similarly. Diffusion-weighted MRI showed higher ADC values in SCA, with reported study-specific cutoffs of > 1.36 × 10- 3 mm2/s and > 1.99 × 10- 3 mm2/s. In case reports/series, arterial hyperenhancement occurred in 32/33 (97.0%), 68Ga-DOTA-peptide uptake in 17/39 (43.6%), and EUS-guided sampling was diagnostic in 9/17 (52.9%). NF-pNET-mimicking SCA is an uncommon but clinically consequential benign mimic. In the available retrospective comparative cohorts of resected, pathology-proven lesions, lower unenhanced CT attenuation (and attenuation ratios) and higher DWI-ADC values consistently favored SCA over NF-pNET, whereas arterial hyperenhancement and positive somatostatin receptor imaging uptake were not specific. These findings may support cautious multiparametric assessment in selected hypervascular solid-appearing pancreatic lesions, but should not be applied as definitive diagnostic thresholds without external validation.

Introduction. Basal cell carcinoma is the most common malignant cutaneous neoplasm and accounts for most non-melanoma skin cancers. Despite its low metastatic potential, it may exhibit locally aggressive behavior, particularly in high-risk anatomical regions such as the nose and in aggressive histological subtypes, including the micronodular variant. Involvement of the nasal ala represents a significant therapeutic challenge, as management must integrate the principles of complete oncologic resection with optimal functional and aesthetic reconstruction. In this context, local flaps represent a valuable reconstructive option, and the bilobed flap remains a reliable technique for small to medium-sized nasal defects due to its versatility, favorable tissue match, and ability to achieve reconstruction in a single surgical stage. Objective. To describe the diagnostic approach, surgical management, and immediate reconstruction of a micronodular basal cell carcinoma located on the left nasal ala, as well as to highlight the utility of the bilobed flap as a reconstructive option for nasal defects following oncologic resection. Materials and Methods. A 54-year-old female patient is presented, with a history of systemic arterial hypertension, chronic occasional tobacco use, and prior superficial parotidectomy for benign disease, who presented with a dermal lesion on the left nasal ala of one year’s duration with progressive growth. On physical examination, a nodular lesion measuring approximately 1 cm was identified, with poorly defined borders, pigmentation, and central ulceration, without evidence of deep tissue invasion. An incisional biopsy was performed on October 10, 2025, yielding a histopathological diagnosis of ulcerated, pigmented micronodular basal cell carcinoma. Given the high-risk histological subtype and the anatomical location, surgical treatment was indicated. A wide three-dimensional excision with 1 cm safety margins was performed, followed by immediate reconstruction using a bilobed flap designed according to nasal subunit principles. The procedure was completed without complications, and the flap demonstrated adequate viability in the immediate postoperative period. Results. During the surgical procedure, an exophytic nodular lesion measuring approximately 1 cm in diameter was identified on the left nasal ala. A wide three-dimensional excision was performed, with adequate circumferential and deep margins to ensure optimal oncologic control. The resulting defect was immediately reconstructed using a bilobed flap, allowing coverage with local tissue of similar characteristics, appropriate redistribution of tension, and preservation of the nasal contour. In the immediate postoperative period, the patient remained hemodynamically stable, with a Glasgow Coma Scale score of 15, fully oriented, without evidence of active bleeding, and with adequate flap viability, with no immediate complications. Conclusions. Micronodular basal cell carcinoma located on the nasal ala represents a high-risk entity due to both its anatomical location and its infiltrative histological pattern, requiring a surgical approach with strict adherence to oncologic principles. Wide three-dimensional excision followed by immediate reconstruction using a bilobed flap constitutes a safe and effective option in selected cases, as it allows adequate tumor control while achieving functional and aesthetic restoration in a single surgical stage. In this context, the bilobed flap remains a valuable reconstructive tool in facial plastic surgery, particularly for small to medium-sized defects of the distal nasal third.

Papillary carcinoma arising in a thyroglossal duct cyst is rare and often indistinguishable from benign disease. We report a male patient with progressive cyst changes leading to diagnosis and successful Sistrunk-based management, highlighting the need for close, appropriate imaging and individualized treatment in midline neck masses.

Background: Thyroid disorders represent a significant spectrum of endocrine diseases globally. This study aimed to evaluate demographic, surgical, and histopathological trends of thyroidectomies at the National Hospital of Sri Lanka (NHSL) from 2017 to 2023.Methods: This retrospective cohort study analyzed 2,580 thyroidectomy cases performed at NHSL between January 2017 and December 2023. Data were extracted from electronic and paper-based patient records, including demographic characteristics, surgical procedures, and histopathological findings. Statistical analysis was performed using chi-square tests and regression analysis.Results: The cohort comprised 2,580 patients (84.7% female, mean age 47.7 years). Total thyroidectomy was the most common procedure (82.0%). Malignancy was identified in 24.5% of cases, with papillary carcinoma (18.2%) being the most common. Male gender was significantly associated with malignancy (32.6% vs 23.0%, p<0.001). Parathyroid glands were identified in 7.0% of specimens, and lymph nodes in 11.9% overall (29.3% in malignant cases).Conclusion: This study represents the largest single-center audit of thyroid surgery in Sri Lanka. The findings highlight the predominance of benign disease, the significant association of male gender with malignancy, and opportunities for improving surgical quality indicators including parathyroid preservation and lymph node assessment.

Artificial intelligence for surgical management of benign esophageal disease: scoping review and evidence mapping.

The utilisation of transoral robotic surgery (TORS) has grown in popularity over recent years with wide applications for both benign and malignant disease. It is important to recognise that the introduction of robotic surgery inserts a new variable into an already error-prone healthcare service that has a high preventable adverse event rate. Surgical safety checklists (SSC) have been well established in recent years and demonstrated to improve outcomes and reduce complications. This study aims to introduce a novel SSC designed for use specifically in operating theatres for cases using TORS. A modified Delphi process was utilised to define consensus for a proposed TORS specific SSC. An initial iteration was devised using a literature search. Experts with significant TORS experience rated each proposed item for potential inclusion using a Likert scale. The process was repeated until consensus was reached for all items. Two rounds were completed with seven experts agreeing on various items to be included in the TORS specific SSC. This novel surgical safety checklist is the first developed specifically for use with TORS. It has been designed using robust Delphi methodology with several TORS experts from high-volume centres across the UK. The aim of the TORS SSC is to be used alongside the WHO SSC and requires ideally long-term and multi-centre adoption in order to validate its implementation.

Papillary thyroid cancer (PTC) is the most common form of thyroid malignancy, with an incidence that has been steadily rising globally. Early and accurate diagnosis remains crucial for effective treatment and improved outcomes. MicroRNAs (miRNAs), small non-coding RNA molecules that regulate gene expression, have emerged as promising biomarkers in cancer research due to their stability and accessibility in serum. In this pilot study we compared the expression of 84 consistently reported, malignancy-associated serum miRNAs in patients with PTC (PTC group) and benign thyroid disease (Control group) as potential PTC markers. A focused panel containing primer assays for 84 human miRNAs that are consistently reported in the literature as being detectable and differentially expressed in serum in various organ-specific cancers was used to measure miRNA levels in serum samples from PTC (n = 8) and benign thyroid disease (n = 6) patients prior to thyroidectomy. Among the 84 miRNAs analyzed, a panel of ten miRNAs showed numerical trends of differential expression between the two groups, including three upregulated (hsa-miR-150-5p, hsa-miR-21-5p, hsa-miR-23a-3p) and seven downregulated miRNAs (hsa-miR-17-5p, hsa-miR-17-3p, hsa-miR-200c-3p, hsa-miR-296-5p, hsa-miR-574-3p, hsa-miR-885-5p, hsa-miR-130-3p). The serum expression levels of hsa-miR-23a-3p were markedly elevated in patients with malignant nodules compared with those with benign lesions, while hsa-miR-574-3p was significantly downregulated in the PTC group. These findings warrant further investigation of hsa-miR-23a-3p and hsa-miR-574-3p in larger cohorts of patients with PTC to validate their potential clinical relevance.

Multiparametric MRI (mpMRI) and ^68Ga-PSMA PET/CT are widely used for prostate cancer (PCa) diagnosis but remain limited by false positives and modest specificity, particularly in distinguishing benign prostate diseases (BPDs) and clinically significant PCa (csPCa). Existing studies often rely on small, single-center cohorts with limited generalizability. This study aimed to develop and externally validate a multimodal radiomics model integrating PET/CT and mpMRI for automated PCa diagnosis, and to evaluate the impact of prostate VOI delineation strategies. A total of 488 patients with suspected PCa who underwent both ^68Ga-PSMA PET/CT and mpMRI (T2 and DWI) followed by biopsy were retrospectively enrolled from two centers (366 for model development and ten-fold internal validation; 41 for external validation cohort 1; 81 for external validation cohort 2). Radiomics features were extracted from both modalities, and six classical machine learning classifiers (LR, SVM, Random Forest, Extra Trees, XGBoost, LightGBM) were trained for three tasks: (1) csPCa diagnosis, (2) overall PCa detection, and (3) comparison between expert-drawn and deep learning generated prostate VOIs. Model performance was assessed using AUC, sensitivity, specificity, accuracy, PPV, and NPV. Among 407 patients, 137 had BPD, 25 had clinically insignificant PCa, and 250 had csPCa. The multimodal PET/mpMRI radiomics model achieved the best performance with LightGBM (AUC = 0.91 internally; 0.825 externally). Automatically segmented VOIs achieved comparable diagnostic accuracy to expert annotations, with AUC differences within 3-8%. The proposed multimodal PET/CT and mpMRI ML-based model enables accurate risk stratification for prostate cancer, with strong external generalizability. Automated prostate segmentation provides comparable diagnostic performance to expert manual delineation, facilitating clinical scalability.

Location and Socioeconomic Vulnerability on Access and Early Outcomes in Benign Foregut Surgery.

Extracellular vesicles (EVs) have emerged as promising circulating biomarkers for diverse pathologies, yet clinical adoption remains limited due to inter-patient variability in blood EV concentrations, which introduces inconsistent biomarker signals and reduces diagnostic reliability. To address this, we developed an in-situ dopamine polymerization method for precise glycan density quantification on EVs expressing a specific membrane protein. EV membrane proteins were labeled using streptavidin-horseradish peroxidase-conjugated aptamers, while surface lipids and glycans were simultaneously tagged with fluorescent cholesterol and lectin, respectively. Controlled dopamine polymerization spatially restricted fluorescence quenching to EV membranes, enabling glycan density calculation via attenuation profiles of cholesterol- and lectin-bound fluorophores. The method was miniaturized into a microfluidic platform for rapid (< 1h), wash-free point-of-care analysis. In 47 clinical specimens (16 patients with acute myeloid leukemia, 15 patients with benign hematological diseases, and 16 healthy donors), glycan density normalization reduced inter-patient variability compared to absolute measurements. Multi-lectin analysis of CD133+ EV glycan density achieved superior diagnostic accuracy (AUC = 0.904) in distinguishing acute myeloid leukemia from benign hematological diseases, outperforming direct glycan quantification. By integrating surface biophysical normalization, this platform enhances EV biomarker consistency, providing a rapid, blood-based diagnostic tool with clinical translatability for acute myeloid leukemia.

Weakly and semi-supervised segmentation of uterus using coarse annotations in MRI

Robotic ureteric reimplantation for benign disease in a tertiary UK centre: safe and effective.

Significant disparities in access to minimally invasive surgery (MIS) exist worldwide. This opinion piece reviews the global burden of gynecologic diseases, the economic implications of MIS implementation, and the current state of MIS in low- and middle-income countries (LMICs). Women in LMICs experience a higher burden of benign gynecologic diseases compared to women in high-income countries. Unfortunately, due to barriers in healthcare/surgical infrastructure and limited MIS training among physicians in LMICs, MIS options remain limited. Open surgery, which has major repercussions for the health, quality of life, and financial stability of patients and the economic security of healthcare systems, remains the surgical standard of care in many countries. Some LMICs have demonstrated promising results in the implementation of laparoscopy, but this requires investment in infrastructure and personnel alongside meaningful collaboration with policymakers and industry leaders. Training partnerships are a critical component to elevate the international standard of surgical care for women. This article summarizes current barriers to the implementation of MIS and offers insights to overcome these obstacles on a global scale. National governments, industries, international surgical societies, and individual surgeons all play a role in achieving global surgical equity.

Short-term outcomes of laparoscopic versus open major hepatectomy for benign liver disease: an international bicentric study.

Ovarian cancer is a leading cause of mortality among women globally. This study aimed to evaluate the diagnostic value of CA-125, HE4, and the ROMA index in identifying ovarian cancer in patients in Bangladesh. This case-control study was conducted at the National Institute of Cancer Research and Hospital (NICRH) in 50 patients with histologically confirmed epithelial ovarian cancer, 25 patients with benign ovarian diseases, and 25 healthy controls. Women with prior chemotherapy or hormonal therapy, non-epithelial ovarian cancer, bilateral oophorectomy, pregnancy, or serious systemic illness were excluded. Serum CA-125 and HE4 levels were measured using Chemiluminescence Immunoassay (CLIA), and the ROMA index was calculated. Receiver Operating Characteristic (ROC) analysis was performed to assess diagnostic performance. The mean ages of participants were 52.5-years for ovarian cancer patients, 38.2-years for those with benign diseases, and 45.0-years for healthy controls. The median serum levels of HE4, CA-125, and ROMA index were significantly higher in ovarian cancer patients compared to controls. ROC analysis revealed AUCs of 0.95 for ROMA, 0.92 for HE4, and 0.88 for CA-125 in differentiating cancer from healthy controls, and 0.93 for ROMA, 0.94 for HE4, and 0.60 for CA-125 in differentiating cancer from benign ovarian diseases. ROMA and HE4 significantly distinguished ovarian cancer from benign conditions (p < 0.001), while CA-125 did not (p = 0.165). In this study, the ROMA index appeared to perform better than HE4 and CA-125, though findings should be interpreted cautiously, considering the limited statistical power.

ABSTRACT Cancer‐derived extracellular vesicle (EV) nanoparticles carry important biomarkers but are difficult to recover from plasma, making EV‐based diagnostics a challenge for clinical settings. Here, we demonstrate nanoparticle‐based detection of pancreatic cancer using dielectrophoresis (DEP) nanoparticle recovery technology, which purifies nanoparticles from undiluted plasma and quantifies associated biomarkers. We combined both nanoparticle recovery and biomarker quantification on a single device by simultaneously collecting cell‐free DNA nanoparticles and EVs followed by on‐chip biomarker fluorescent staining for DNA and Glypican‐1. Using a blinded cohort, these biomarkers differentiated pancreatic cancer from benign pancreatic diseases, including cysts, pancreatitis, and precancerous low‐grade intraductal papillary mucinous neoplasm (IPMN) lesions, with a sensitivity of 0.92, a specificity of 0.83, and an AUC of 0.93. The AUC increased to 0.97 for patients over 50 years old. This is higher than the standard invasive endoscopic ultrasound‐guided fine needle aspiration tissue biopsy procedure (AUC 0.79). This study is among the first demonstrating a combined threshold of DNA and protein levels that can distinguish pancreatic cancer from its precursor IPMN lesions. We also demonstrated the detection of early‐stage pancreatic cancer and high‐grade in situ precancerous lesions. This DEP‐based technique shows that multiple types of cancer‐derived nanoparticles can be quickly and easily recovered from plasma making it promising for future clinical diagnostics.

High-grade serous ovarian cancer (HGSOC) is the most lethal gynecological malignancy. Pre- and post-operative, non-invasive biomarkers for reliable treatment outcome prediction, (minimal) residual disease detection, and prognosis are not yet established in clinical practice for these patients. This prospective study quantified circulating tumor cells (CTCs) in 7.5 ml peripheral blood in 56 women with FIGO stages IIIC and IV HGSOC before and after primary cytoreductive surgery and in 9 women with benign ovarian disease. Clinical outcomes were assessed during the median follow-up of 35.4 months. CTCs were detected in 48.2% (27/56) of patients pre-operatively and in 46.4% (26/56) post-operatively, but not in benign controls. Pre-operative CTCs were associated with suboptimal cytoreductive surgery (OR = 15.6, 95% CI: 2.97-127.0, p = 0.0031), worse platinum response (p = 0.0173), lymph node metastases (p = 0.0151), and shorter progression-free (p = 0.0045) and overall survival (p = 0.0241). Post-operative CTC-augmented residual tumor was significantly associated with worse OS (p = 0.047). In multivariable analyses, pre-operative CTCs remained an independent surrogate marker for incomplete debulking, platinum resistance, and poor survival in HGSOC. Therefore, the quantification of CTCs in HGSOC pre- and post-operatively may be used to guide treatment selection, reduce surgical morbidity, improve the healthcare provider's resource allocation and planning, and enhance patient counseling.