Status of human papillomavirus infection after loop electrosurgical excision procedure at the National Referral Hospital, Bhutan, 2022-2023: A retrospective study.

Spinal metastases from malignant tumors represent an increasingly relevant clinical problem due to improved systemic therapies, prolonged survival, and the growing prevalence of long-term survivors with metastatic disease. The spine is not only acentral biomechanical component of the musculoskeletal system, but also protects the spinal cord and spinal nerves. Accordingly, the treatment of spinal metastases is complex and must always be embedded within an overarching oncological treatment concept. This review summarizes epidemiological and pathophysiological principles and presents contemporary indications and operative strategies for spinal metastases. The central goals of surgery are histological diagnosis, decompression of neural structures, restoration or preservation of mechanical stability, pain relief, and maintenance of neurological function and quality of life. Surgical decision-making should be interdisciplinary and should consider not only imaging findings and neurological status, but also tumor biology, radiosensitivity, systemic treatment options, prognosis, patient preference, and rehabilitation potential. Modern surgical treatment of spinal metastases has undergone aparadigm shift: maximal tumor resection is no longer routinely the primary objective; instead, the focus has shifted toward function-preserving, low-morbidity interventions embedded within amultimodal treatment strategy. Concepts such as NOMS, SINS, and the Bilsky grading system support structured decision-making. Minimally invasive procedures, percutaneous instrumentation, navigation, intraoperative three-dimensional imaging, modern implant materials, and increasingly AI-based prognostic models allow apatient-specific calibration of surgical invasiveness. The overall aim is to preserve neurological function and quality of life, control local tumor progression, and minimize treatment-delaying morbidity.

Total pancreatectomy (TP) remains a challenging procedure due to the complex postoperative management required, although recent advances have expanded the indications for this surgery. In this study, we analyzed the surgical outcomes and prognostic factors in patients who underwent TP. We retrospectively analyzed the data of patients who underwent TP at our institution between January 2013 and December 2023. Repancreatectomy of the remnant pancreas was excluded. The patient characteristics, surgical outcomes, postoperative course, and survival outcomes were evaluated, with particular attention paid to the nutritional status. The median age of the 43 patients was 68 years, and pancreatic ductal adenocarcinoma/invasive IPMC accounted for 62.8% of all cases. The 90-day mortality rate was 2.3%, and the 90-day readmission rate was 34.9%. The median overall survival was 28.8 months, with a 5-year survival rate of 38.1%. The PNI exhibited consistent prognostic significance across all 3 postoperative outpatient visits ( P =0.0191, 0.0003, and 0.0492, respectively). A low PNI (≤40) at the second postoperative outpatient visit ( HR: 42.0, P =0.0006 ) and a histologic diagnosis of pancreatic ductal adenocarcinoma/invasive IPMC ( HR: 5.27, P =0.0085 ) were identified as poor prognostic factors. Postoperative nutritional status, as measured by the PNI, was found to exert a significant influence on long-term survival after TP, with the underlying histologic diagnosis serving as another critical determinant of the postoperative outcomes. These findings highlight the importance of systematic nutritional monitoring and intervention throughout the postoperative period.

Intragraft clonal expansion of cytotoxic CD8+ and CD4+ T cells in antibody-mediated kidney transplant rejection.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an established first-line technique for sampling mediastinal and/or hilar lymphadenopathy (MHL). However, its diagnostic accuracy is constrained by the procurement of small-volume specimens, which may not reliably capture the diagnostically relevant tissue. Needle-based confocal laser endomicroscopy (nCLE) provides real-time in vivo microscopic imaging and has the potential to facilitate targeted tissue acquisition. EBUS-guided transbronchial mediastinal cryobiopsy (EBUS-TBMC) can yield larger and better-preserved specimens; however, its availability is limited. This study aims to evaluate whether nCLE-assisted EBUS-TBNA is non-inferior to EBUS-TBMC for diagnostic yield for MHL. The confocal laser endomicroscopy-assisted endobronchial ultrasound-guided needle aspiration (COLLABORATION III) trial is a prospective, multicentre, stratified, non-inferiority randomised controlled trial conducted across five centres in China. The study aims to enroll 640 adult participants presenting with unexplained MHL with a short-axis measurement ≥10 mm necessitating histopathological confirmation. Participants will be stratified based on the preprocedural likelihood of malignancy and randomised at a 1:1 ratio to undergo nCLE-assisted EBUS-TBNA or EBUS-TBMC. The primary endpoint is the overall diagnostic yield, defined as the proportion of procedures that obtain specimens sufficient for a definitive histological or cytological diagnosis, with a non-inferiority margin set at -10%. Secondary endpoints include diagnostic sensitivity for both malignant and benign conditions, rate of granuloma detection, procedure duration and incidence of adverse events. The primary analysis will be conducted on an intention-to-treat basis, supplemented by a per-protocol sensitivity analysis. Non-inferiority will be established if the difference in the diagnostic yield exceeds -10%. The study protocol was approved by the Institutional Review Board of the China-Japan Friendship Hospital (2025-KY-388). Written informed consent will be required from all participants. These findings will be disseminated through peer-reviewed journal publications and conference presentations. COLLABORATION-III was prospectively registered at ClinicalTrials.gov (ID: NCT07040670, Date: 2025-6-26).

FAST-02: Results from the second in-human prospective evaluation of single-fraction proton FLASH for symptomatic thoracic bone metastases.

Young adult women are increasingly undergoing infertility treatment; however, evidence regarding breast cancer screening in this population remains limited. Given that most women in this age group have dense breast tissue, for which mammography has limited sensitivity, breast ultrasound (US) is often used as a screening modality. A diagnosis of breast cancer during infertility treatment may affect both oncologic management and reproductive planning. This study aimed to examine the clinical relevance of breast US in women in their 30s undergoing infertility treatment at an infertility clinic. We retrospectively analyzed 1,336 women aged 30-39 years who underwent screening breast US between November 1, 2018, and June 30, 2025. Analyses were performed on a per-woman basis, including only the first screening examination for each participant. Breast composition was categorized according to the BI-RADS 5th edition Atlas. Screening outcomes-including recall rate, positive predictive value (PPV), cancer detection rate, and US findings (mass and non-mass findings)-were assessed using medical records. The continuation of infertility treatment, defined as ongoing or resumed treatment during the diagnostic evaluation period, was descriptively evaluated as part of the clinical context. Of the 1,336 women, 1,277 (95.6%) were classified as having dense breasts. A total of 140 (10.5%) women were recalled for further evaluation. In these recalled cases, 147 findings were identified, comprising 113 mass lesions (76.8%) and 34 non-mass findings (23.1%). Four breast cancers were identified, corresponding to a cancer detection rate of 0.30% and a PPV of 2.86%. Histological diagnoses included one mucinous carcinoma, two invasive carcinomas of no special type (NST), and one ductal carcinoma in situ (DCIS). Following diagnostic evaluation, 124 recalled women (88.6%) continued infertility treatment. Breast US screening in women in their 30s undergoing infertility treatment provides descriptive findings within a specific clinical setting. The observed cancer detection rate appears to be within the range reported in previous studies; however, direct comparisons are limited due to differences in study populations and clinical contexts. The clinical course following recall was described as part of the screening pathway. Further prospective and multicenter studies are required to clarify the clinical significance of breast US screening in this population.

Accurate distinction of inflammatory bowel disease (IBD) and gastrointestinal tuberculosis (GITB) on mucosal biopsies remains challenging, especially in South-East Asia. Our previous meta-analysis highlighted that mucosal basal plasmacytosis (BP) can help in identifying IBD although evidence is limited. This study was planned to evaluate the utility of mucosal BP and combined presence of BP and mucosal eosinophilia (ME) (BP+ME) in differentiating ulcerative colitis (UC), Crohn's disease (CD) and GITB using endoscopic mucosal biopsies. We retrospectively analysed 500 mucosal biopsies from patients diagnosed with UC, CD and GITB based on clinical, radiological, endoscopic findings and treatment response. Inclusion and exclusion criteria were applied, and histological evaluation was performed independently by two experienced pathologists. Presence of BP and BP+ME was systematically compared across patient groups. Of the 500 biopsies reviewed, 412 met inclusion criteria (UC: 194, CD: 68, GITB: 114, IBD-unclassified: 36). BP was significantly more prevalent in both UC and CD than in GITB. BP+ME was significantly more prevalent in mucosal biopsies from IBD than in GITB. Also, in segmental mucosal biopsies from IBD patients, BP was found significantly more in three or more biopsy fragments than in biopsies from GITB. Both BP and BP+ME demonstrated good diagnostic utility in differentiating IBD from GITB and CD from GITB (positive likelihood ratio 3.24 and 4.35, respectively). Histological identification of mucosal BP and/or BP+ME provides moderate diagnostic utility in distinguishing IBD from GITB. Identification of BP in three or more biopsy fragments further strengthens histological diagnosis of IBD.

Orofacial tumours and tumour-like lesions encompass a diverse spectrum of benign and malignant conditions. Understanding their demographic distribution is essential for early diagnosis and optimal treatment planning. This study aimed to evaluate the prevalence and histopathological spectrum of OT/TLL in a Nigerian tertiary hospital and to compare findings with reports from other regions of the country. Histopathology records of all orofacial lesions diagnosed between January 2015 and December 2024 were reviewed. Data on demographics, anatomical sites, and histological diagnoses were analyzed. Lesions were categorized as benign or malignant and Chi-square tests, logistic regression, and odds ratios were calculated using SPSS version 26. A total of 588 patients were studied. Benign lesions predominated (84.0%) and reactive follicular hyperplasia was the most common diagnosis (47.0%) peaking in childhood. Ameloblastoma (8.6%) was the leading benign odontogenic neoplasm, especially in the 10-19 age group. Malignancy rates increased progressively by odds of 9.6% with each additional year of age (OR = 1.096, 95% CI: 1.067-1.126, p < 0.001). Squamous cell carcinoma (59.6%) as the most frequent with 73.2% of cases occurring in patients aged ≥ 50 years (χ²=112.4, p < 0.0001). Benign tumours showed a slight female predominance, whereas males had significantly higher malignancy rates than females (χ²=7.82, p = 0.005) and independently conferred 86% higher odds (OR = 1.86, 95% CI: 1.16-2.98, p = 0.010). The mandible was the main site for ameloblastoma, while SCC often involved the larynx and nasopharynx. Benign orofacial lesions are highly prevalent, with reactive follicular hyperplasia being most common. Ameloblastoma and SCC represent the most significant benign and malignant neoplasms, respectively with age and male gender independent predictors of malignancy. These findings highlight the need for improved diagnostic services, oral health interventions, and strengthened cancer screening programs for early detection at high-risk sites.

Image-guided thermal ablation is a guideline-supported treatment for small renal tumors. While biopsy is recommended, the optimal timing relative to ablation remains undefined. Pre-ablation biopsy may complicate ablation through hemorrhage, impaired target visualization, and potential tumor seeding. Post-cryoablation biopsy has been described in a small cohort of patients, but reproducibility has not been established. This study evaluated the diagnostic performance and clinical outcomes of renal mass biopsy performed immediately after cryoablation in a single session. This retrospective, single-center study included patients who underwent image-guided percutaneous cryoablation followed by immediate post-ablation core needle biopsy, performed at operator discretion, between December 2018 and April 2025. After active or passive thaw and probe removal, at least two 18-gauge core biopsy samples were obtained per lesion using a coaxial needle. Specimens were formalin-fixed and reviewed by pathology. Outcomes included specimen adequacy, histopathologic diagnosis, adverse events, imaging response, and tumor recurrence or seeding. Follow-up imaging and labs were performed at 3 and 6 or 9 months, then annually. Twenty-six solid enhancing renal masses (mean size 2.5cm, range 1.4-4.7cm) in 24 patients were included. All biopsy specimens were diagnostic with histologic diagnoses including renal cell carcinoma (RCC, n = 19), oncocytoma (n = 6), and metanephric adenoma (n = 1), with RCC subtypes including clear cell, papillary, chromophobe, sarcomatoid, and mixed histology. Complications were limited to the immediate post-procedural period, with no delayed adverse events or chronic sequelae. All lesions demonstrated complete radiographic response on 3-month follow-up imaging. There were no cases of tumor recurrence or seeding observed over a median follow-up of 1,415 days. Immediate post-cryoablation renal mass biopsy is diagnostically reliable and may provide benefit in clinical practice.

To identify predictive factors of the absence of high-grade intraepithelial lesion on large loop excision of the transformation zone specimen of patients with a previous histological diagnosis of high-grade intraepithelial lesion. We conducted a multicenter retrospective study in nine hospitals. All patients treated by large loop excision of the transformation zone following histological diagnosis of high-grade intraepithelial lesion between 2015 and 2021 were included. All patients had initial diagnosis of high-grade intraepithelial lesion performed on cervical biopsy and/or endocervical curettage. Clinical, cytological, colposcopic, and high-grade intraepithelial lesion data were extracted from medical files. The primary endpoint was the absence of high-grade intraepithelial lesion on the specimen, defined either by the identification of a low-grade intraepithelial lesion only or by the absence of any intraepithelial lesion. A total of 2037 patients were included. The absence of high-grade intraepithelial lesion was identified in 191 (9.4%) patients. Three predictive factors of high-grade intraepithelial lesion absence on large loop excision of the transformation zone specimen were identified: a small abnormal transformation zone defined by cervical involvement less than or equal to one quadrant (aOR: 2.01; 95%CI: 1.47-2.75; p < 0.001), a colposcopic impression of normal cervix or minor changes (aOR: 1.73; 95%CI: 1.24-2.42; p = 0.001), and normal or low-grade or ASC-US cytology (aOR: 1.37; 95%CI: 1.00-1.87; p = 0.049). Predictive factors of high-grade intraepithelial lesion absence on large loop excision of the transformation zone specimen of patients with a histological diagnosis of high-grade intraepithelial lesion are a small abnormal transformation zone, a colposcopic impression of normal cervix or minor changes, and normal, low-grade or ASC-US cytology. Practitioners should take these three elements into account when considering large loop excision of the transformation zone treatment in women with a proven diagnosis of high-grade intraepithelial lesion.

Treatment with NovaSure® endometrial ablation is approved for patients with heavy menstrual bleeding (HMB) without evidence of malignant or premalignant lesions. This analysis addresses the rare but clinically relevant situation in which endometrial carcinoma (EC) or atypical hyperplasia (AEH) is identified histologically after endometrial ablation in premenopausal patients. Histological evaluation of hysterectomy specimens with correlation to clinical parameters in patients undergoing hysterectomy after incidental histological diagnosis of AEH or EC following NovaSure® endometrial ablation. A retrospective single-center analysis was conducted on more than 400 patients who underwent NovaSure® endometrial ablation at our center between January 2020 and February 2025. Patients with AEH or EC for whom subsequent hysterectomy specimens were available were included. Histological evaluation was performed and independently reviewed to assess residual endometrium, residual endometrial atypia or carcinoma, and ablation-related histomorphological changes. A total of 11 patients (AEH n = 8; EC n = 3) underwent subsequent hysterectomy after NovaSure® endometrial ablation. Six out of eight patients with AEH showed no residual atypia in the hysterectomy specimens (2/8 with focal residual atypia), and no residual invasive carcinoma was detected in any of the three carcinoma cases. Histopathological analysis showed pronounced postablative changes, including necrosis, fibrosis, zonation, and vascular and lymphatic alterations. This descriptive study provides a clinicopathological characterization of patients with EC or AEH who underwent hysterectomy after endometrial ablation. In these patients, no preprocedural evidence of endometrial pathology was present, and the diagnosis was established solely through routine histopathological examination of curettage specimens obtained immediately before the ablation procedure. Histological assessment revealed pronounced changes, highlighting specific diagnostic challenges and underscoring the importance of careful patient selection and thorough diagnostic evaluation before NovaSure® ablation. Within the limitations of this study, no evidence was found that prior endometrial ablation compromises oncological outcome.

Glioblastoma is an aggressive form of brain cancer and poses a challenge in treatment due to its profound heterogeneity and capacity for extensive infiltration into the brain parenchyma. Research has shown glioblastomas near the ependyma have poorer survival rates. Therefore, our aim was to identify distinct molecular features of glioblastoma invading the ependyma of lateral ventricles and neural stem cell region and the survival prognosis of these patients.A retrospective review of 170 patients with a new histologically confirmed diagnosis of glioblastoma between 2018 and 2019. Patients were excluded if they were less than 18-years-old, did not have a histological diagnosis, or had missing data. Overall survival (OS) data was analysed. Statistical analysis included Kaplan-Meier survival curves, log rank tests and Cox regression.A total of 170 patients were included (mean age 61 ± 11.3 years; 54% male). Tumours contacted the ependyma in 69 patients and did not in 101. The most common tumour locations were temporal (31%), frontal (29%), and parietal (21%) lobes. Preoperatively, 65% had a performance status of 0-1. Biopsy alone was performed in 19%, subtotal resection (STR) in 48%, and gross total resection (GTR) in 32%; GTR was more common in non-ependyma contacting tumours (40% vs. 20%). MGMT promoter was unmethylated in 64% of patients. Mean overall survival was significantly lower in patients with ependymal contact compared with non-contacting tumours (11.9 vs. 17.4 months, p = 0.004). On multivariable analysis, ependymal contact remained independently associated with poorer survival. No significant association was found between MGMT status and ependymal contact or tumour epicentre distance.Overall, our study reinforces the prognostic relevance of glioblastoma contact with the ependymal and subventricular zones. Tumours involving these regions were associated with poorer overall survival.

As the histopathology workforce continues to struggle and service demand continues to increase, it has become prudent to consider viable avenues to try to alleviate diagnostic workload burden. One such avenue is computer-based technologies (CBTs). Breast cancer (BC) is the most common malignant neoplasm in the United Kingdom and requires additional testing for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2) status at the time of histological diagnosis. This makes BC diagnostics a promising candidate for the application of an efficient CBT. However, for clinical acceptance, these technologies must prove that they work within a real-life diagnostic environment. We present a study protocol for a prospective clinical service evaluation aimed to validate a UK Conformity Assessed-marked CBT's ability to provide ER, PR, and HER2 results for invasive BCs from scanned hematoxylin and eosin-stained whole slide images. This protocol has been designed to use and mimic a preexisting digital pathology workflow within a National Health Service tertiary referral cancer center without disrupting normal patient care. Eligible cases are identified prospectively through the laboratory information management system, and their whole slide images are extracted from the clinical digital workflow. After verification of national data opt-out status and the exclusion of appropriate cases (N=400 analyzable cases), these cases are analyzed on a dedicated computer in parallel to the existing clinical workflow by a UK Conformity Assessed-marked deep learning-based CBT in a separate environment, providing results for ER, PR, and HER2 status. These results are compared to the ER, PR, and HER2 status reported on the corresponding pathology report. To evaluate the CBT's performance, a range of accepted concordance measures will be applied, including specificity, sensitivity, false-positive rate, false-negative rate, positive predictive value, and negative predictive value. Moreover, time stamps representing the duration of image analysis will also be collected. This study started in April 2025. There are no results to present, as this paper focuses on study design, and results have yet to be generated. As of March 2026, overall, 366 potentially analyzable cases have been collected. The anticipated end date of the study is May 2026 (400-case target). Results will be presented in a separate publication. This design assesses a CBT within a clinical environment while effectively eliminating any unwanted effects on patient care. This type of service evaluation provides a useful step to establish confidence in a CBT before trialing its effect on patient care. It also offers the opportunity to support interventional randomized controlled trials, health economic evaluations, and usability studies. This protocol will hopefully prove useful to others who wish to conduct a similar service evaluation at their own institution. DERR1-10.2196/76785.

Background Liver biopsy is the gold standard for histologic diagnosis of parenchymal liver disease. Endoscopic ultrasound–guided liver biopsy (EUS-LB) is increasingly being performed for tissue acquisition. However, the needle size to perform the procedure is still debated. We performed a systematic review and meta-analysis comparing outcomes and safety of two different needles, 19 gauge (G) and 22 G, for EUS-LB. Methods A comprehensive search of multiple databases was conducted to identify studies comparing 19 G and 22 G needles for liver biopsy. Studies reporting tissue adequacy, histologic diagnosis, and other relevant outcomes were included. A meta-analysis was conducted using random-effects models, and heterogeneity was assessed using standard methods. Results Our analysis of six studies revealed the superiority of 19 G needles in terms of tissue adequacy (odds ratio [OR] 7.9, 95% confidence interval [CI] 1.9–32.0, P = 0.004) and obtaining a histological diagnosis (OR 7.25, 95% CI 1.4–36.7, P = 0.02) compared to 22 G needles. Both needle sizes performed similarly in obtaining long intact core preprocessing; however, 19 G needles yielded significantly longer intact cores postprocessing. Postprocedural pain was similar between groups. Conclusion Our meta-analysis supports the preferential use of 19 G needles over 22 G needles for EUS-LB, given their superior performance in tissue adequacy and histological diagnosis with no difference in postprocedural adverse events. These findings underscore the importance of appropriate needle size in optimizing EUS-LB outcomes.

Unplanned excision refers to the resection of soft tissue sarcomas without appropriate preoperative imaging, histologic confirmation, or oncologic planning. Although the short-term oncologic risks of unplanned excisions are well described, data on long-term outcomes remain limited. After controlling for tumor grade, clinical stage, Charlson comorbidity index (CCI), and surgical margin status, is unplanned excision independently associated with (1) worse overall survival, (2) local recurrence-free survival, and (3) metastatic disease-free survival compared with planned excision? In this study of 1100 patient records initially identified by Current Procedural Terminology code query, 403 were identified as duplicate records, 253 were excluded for insufficient baseline data or lack of cancer center entry, and 48 were excluded for insufficient follow-up or not undergoing surgery at the institution, yielding 396 patients, 279 who underwent planned excision and 117 who underwent unplanned excision. We defined an unplanned excision as resection of a soft tissue mass performed without appropriate preoperative advanced imaging (such as MRI) or histologic tissue diagnosis (such as core needle biopsy), or when imaging and biopsy findings were misinterpreted as benign, leading to resection without oncologic planning. The mean ± SD age was similar between groups (planned excision 59 ± 17 years versus unplanned excision 56 ± 18 years); however, groups differed in sex distribution, CCI, clinical stage, and histologic subtype distribution, underscoring the importance of multivariable adjustment. Overall survival, local recurrence-free survival, and metastatic disease-free survival were compared using Kaplan-Meier analysis, log-rank testing, and multivariable Cox regression at 5-, 10-, and 15-year intervals. Overall survival did not differ at 5 years between patients with unplanned excisions and planned excisions (79% [95% confidence interval (CI) 68% to 87%] versus 87% [95% CI 81% to 91%]; p = 0.21), but it was lower after unplanned versus planned excision at 10 years (65% [95% CI 49% to 77%] versus 81% [95% CI 71% to 87%]; p < 0.01) and 15 years (43% [95% CI 11% to 73%] versus 74% [95% CI 58% to 85%]; p = 0.02; log-rank, p = 0.02). Metastatic disease-free survival was lower after unplanned excision at 5, 10, and 15 years, and local recurrence-free survival was worse at 10 years (unplanned excision 67% [95% CI 47% to 81%] versus planned excision 69% [95% CI 57% to 79%]; p = 0.047) and 15 years (40% [95% CI 12% to 67%] versus 69% [95% CI 57% to 79%]; p = 0.01). On multivariable analysis, unplanned excisions independently were associated with worse overall survival (HR 1.77 [95% CI 1.06 to 2.97]; p = 0.03) and local recurrence-free survival (HR 1.74 [95% CI 1.10 to 2.75]; p = 0.02). Unplanned excision of soft tissue sarcoma is associated with worse long-term overall, local recurrence-free, and metastatic disease-free survival, with differences emerging after 10 years. These findings suggest a potential role for extended oncologic surveillance beyond 5 years, particularly in patients at high risk. Further prospective studies are needed to define appropriate surveillance strategies and determine whether earlier detection improves outcomes. Level III, therapeutic study.

Primary liver cancer and colorectal liver metastases (CRLM) pose significant challenges, because of limited early diagnosis and the reliance on time-consuming frozen section analysis during surgery to confirm complete tumor resection (R0). This study investigates the potential of optical coherence tomography (OCT) combined with anomaly detection for differentiating hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (iCCA) and CRLM from normal liver parenchyma, ex-vivo. Our dataset comprises 173 OCT images sourced from 69 patients undergoing liver surgery. We leveraged pre-trained neural networks with frozen weights and statistical outlier modeling to train an anomaly detection model using only non-cancer parenchyma scans. Given the small-scale nature of the dataset and the presence of label uncertainty, a stratified cross-validation procedure was employed to robustly assess the model’s performance in accurately matching OCT scans with their corresponding histological diagnoses. This resulted in promising classification performance using a pre-trained Vision Transformer: sensitivity 80%, specificity 78%, accuracy 79%, and area under the receiving-operating-characteristic-curve (ROC-AUC) of 81%. While limited by a relatively small and noisy dataset, this study highlights the promising potential of OCT combined with anomaly detection for intraoperative liver cancer detection. This semi-supervised learning approach offers several advantages, including reduced training time and data requirements, as well as interpretable anomaly scores.

Total sacrectomy is now a standard curative procedure for primary malignant sacral tumours. Reconstruction, however, remains demanding because of the complex regional anatomy and unique biomechanical environment. Several spinopelvic reconstruction techniques have been reported, all yielding satisfactory functional outcomes. This study aims to evaluate both the clinical outcomes and the biomechanical behavior of a modified spinopelvic fixation construct, which incorporates a novel three-dimensional-printed component following total sacrectomy. We conducted a retrospective cohort study of 12 consecutive patients (4 men, 8 women; mean age 38 years, range 17-61 years) treated between 2021 and 2024. Eleven patients with primary malignant sacral tumours underwent total en-bloc sacrectomy, and one patient with a giant-cell tumour (GCT) underwent piecemeal resection. All patients received modified spinopelvic reconstruction. Tumour extent was L5-S5 in two patients with recurrent malignant peripheral nerve sheath tumour (MPNST), S1-S5 in eight patients with primary malignancies, S1-S5 in the patient with GCT, and S1-S5 with extension into pelvic zones I/IV in one patient with osteosarcoma. Operative time, oncological outcomes, functional outcomes, complications, and implant status were all reviewed. A finite-element analysis was performed to evaluate the biomechanical behaviour of the novel construct and to compare it with previously described reconstruction models. All 12 patients had a confirmed histological diagnosis before surgery. Three osteosarcoma and four malignant peripheral nerve sheath tumour (MPNST) patients received neoadjuvant and postoperative chemotherapy; one giant-cell tumour (GCT) patient was treated with denosumab. Mean operative time was 11.5h (range 7.5-15h) and mean intra-operative blood loss was 2,616ml (range 1,200-4,000ml). During follow-up, local recurrence was detected in two chordoma cases. Functionally, S1-S5 root transection caused sphincter disturbance in 11 patients; two of these also sacrificed a unilateral L5 root, yet none required colostomy or chronic catheterisation. Nine patients lost dorsiflexion strength. At the latest follow-up, 10 patients could walk independently, and 2 required assistive devices. No major perioperative complications were observed; three patients experienced wound healing complications, which were successfully managed with simple debridement, suturing, and negative pressure wound therapy. Only one overweight patient experienced unilateral iliac screw failure without further revision; the remaining 11 patients had no mechanical complications. Finite-element analysis suggested that the current reconstruction may have favorable load-bearing capacity and stability characteristics compared with previously described models. The modified spinopelvic fixation with the fifth rod and 3D-printing element represents a potential option for anterior column reconstruction after total sacrectomy, with preliminary evidence of satisfactory clinical outcomes in non-overweight patients. Finite-element analysis suggests that the construct may possess adequate stiffness and stability characteristics that could contribute to preventing pelvic-spinal collapse, though these biomechanical findings require further clinical validation. Stress values from the finite-element model indicate a theoretically low risk of implant fracture under static loading or fatigue conditions, but long-term follow-up is necessary to confirm implant durability and exclude late complications such as loosening or breakage.

The goal was to determine the incidence and risk factors of malignant transformation of oral lichen planus (OLP); oral lichenoid lesions without (OLL) or oral dysplasia with lichenoid features (ODLF). We identified a retrospective cohort of 188 patients with a pathological diagnosis of OLP, OLL, or ODLF, and a minimal 12-month follow-up. In each subgroup, we analyzed the rate of malignant transformation and performed a uni- and multivariate analysis of factors associated with malignant transformation. Diagnoses of OLL, OLP, and ODLF were made in 80.9%, 15.4%, and 3.7% of patients, respectively. The average follow-up was 51.5 months. The malignant transformation rates for OLL, OLP, and ODLF were 5.9% (n = 9), 0% (n = 0), and 42.9% (n = 3), respectively. Multivariate analysis performed on the entire cohort showed that the presence of dysplasia was significantly associated with transformation to OSCC (OR = 7.40; p = 0.01) as well as the asymmetry of lesion (OR = 8.81; p = 0.009), whereas there was a trend toward an association between plaque-like lesions and malignant transformation (p = 0.07). The risk of malignant transformation was only observed in OLL and ODLF. The presence of dysplasia is associated with a higher risk of malignant transformation. Clinical and histological diagnosis of plaque-like OLP is challenging, highlighting the need for future genomic investigations to enable a better molecular characterization of this condition.

BackgroundCerebrospinal fluid placental alkaline phosphatase (CSF-PLAP) is useful in diagnosing intracranial germinomas. However, reports on CSF-PLAP in histological subtypes other than germinoma remain limited. The primary aim of this study was to retrospectively analyze cases with histological diagnoses in which CSF-PLAP levels were measured and evaluate the sensitivity and specificity of this test using the clinically applied cutoff value of 8 pg/mL.MethodsWe retrospectively analyzed 134 patients with intracranial disease who underwent CSF-PLAP testing for diagnostic purposes and had confirmed histopathological diagnoses without receiving any adjuvant therapy before, or between CSF-PLAP measurement and surgery. The cases were categorized as true positive (TP), true negative (TN), false positive (FP), false negative, or clinical germinoma. Diagnostic accuracy was evaluated based on sensitivity, specificity, and statistical comparisons between groups.ResultsAmong the 134 analyzed cases, 30 were classified as TP, 99 as TN, and 5 as FP. Using the 8 pg/mL cutoff, CSF-PLAP testing demonstrated a sensitivity of 100% and a specificity of 95.2%. The mean CSF-PLAP level was significantly higher in the TP group than in the FP group, and the TP group participants were significantly younger than the FP group participants. No significant differences in CSF-PLAP levels or age were found between the TP and clinical germinoma groups, supporting their clinical equivalence.ConclusionsCSF-PLAP using an 8 pg/mL cutoff demonstrates high diagnostic accuracy for intracranial germinoma. Recognition of potential false-positive results and consideration of sampling site may further improve clinical interpretation of CSF-PLAP measurements.