Median Tumor Size Research Articles

Midface Degloving Approach for Total Maxillectomy Without Orbital Exenteration: A Case Series.

Evaluate the feasibility of the midface degloving approach (MDA) in total maxillectomy without orbital exenteration (TMWOE) and reconstruction for sino-nasal neoplasms. Retrospective case series. Tertiary referral center. This single-center series included 9 consecutive sino-nasal neoplasm patients who had TMWOE using MDA, free tissue reconstruction, and orbital floor implants (April 2018-Dec 2022) assessing tumor characteristics, margins, and complications. There were 3 female and 6 male patients with a median age of 61 years. The median follow-up was 462 days. There were 7 malignant and 2 benign tumors. The median tumor size was 4.6 cm. There were 7 clear margins and 2 positive margins. Most patients underwent some combination of preoperative and or postoperative therapies. After resection, a variety of free tissue reconstruction was performed. Overall, there were no complications clearly attributable to the midface degloving approach. Flap debulking was required in one patient but no long-term complications were encountered. Midface degloving offers an alternative to the Weber-Ferguson for TMWOE and avoids facial incision while providing adequate exposure to the orbital rim. Patient selection is critical, as tumors extending laterally into the zygomatic arch and infratemporal fossa may not be accessible.

Discrepancies at clinical presentation of patients with soft tissue sarcoma according to the type of health insurance in a Brazilian population.

In Brazil, 75% of the population is covered by public health insurance (PubHIn), and the rest pay for private insurance (PrivHIn). The impact of the type of health insurance on clinical presentation of Brazilian patients diagnosed with soft tissue sarcoma (STS) is unknown. We aim to describe the clinical characteristics at diagnosis of patients with STS, stratifying them by type of health insurance, and to evaluate the symptom-diagnosis and -treatment intervals. Observational, retrospective cohort, single-center study conducted in a Brazilian cancer center that admits both private and public patients. Medical records of individuals with 18 years old or more diagnosed with selected types of STS who started treatment in our center between January 2011 and December 2019 were reviewed. Kaplan-Meier method and log-rank test were used for survival analyses. Chi-square and Mann Whitney test were used for univariate analysis. Significance was defined as a p-value <0.05. 225 patients were included: 25.3% (n=57) with PubHIn and 74.7% (n=168) with PrivHIn. Median tumor size in PrivHIn was 7 cm (0.9-45 cm) versus 10.3 cm (0.8-30.5 cm) in PubHIn (p=0.0001). Metastases were present in 8.9% of patients with PrivHIn (n=15) and in 26.3% (n=15) of those with PubHIn (p=0.002). Median symptom-diagnosis interval was 195 days in the PubHIn group and 163 days in the PrivHIn group (p=0.74). For the whole series, median age at diagnosis was 51 years (18-85 yo). Lower limbs were the most frequent location of tumors (53.8%), and 86% had histological grade 2/3. Patients with STS covered by PubHIn presented larger tumors and more metastatic disease at diagnosis, suggesting that there may be disparities in health care delivery and limited access to health resources. A better understanding of the barriers in the journey of patients with STS could improve outcomes.

Utilization of cardiopulmonary bypass at radical nephrectomy for renal cell carcinoma with tumour thrombus.

The objective of this study is to evaluate preoperative factors associated with cardiopulmonary bypass (CPB) utilization and outcomes for patients with renal cell carcinoma (RCC) and tumour thrombus (TT). Radical nephrectomy with thrombectomy is a standard treatment for patients with RCC and associated TT. Morbidity and mortality rates tend to correlate with aggressiveness of tumour and TT level. Patients undergoing radical nephrectomy with thrombectomy (2006-2023) were retrospectively identified. Inclusion criteria included RCC histology and preoperative imaging available for thrombus-level categorization based on the Mayo Clinic grading system. Logistic regression assessed predictors for utilizing CPB, and Cox regression identified factors associated with survival. A total of 72 patients with RCC and associated TT were identified. The median age was 67 years. RCC-related symptoms were present in 83%, and 28% had Levels 3 and 4 thrombi. Eleven patients (15.3%) had undergone neoadjuvant therapy, and 81% had clear-cell RCC. CPB was utilized in eight (11.1%) cases. The median tumour size was 10.5cm. Metastatic disease was greater in the CPB cohort (75% vs. 28%, p = 0.008). All cases performed on CPB were Levels 3 and 4 thrombi (100% vs. 19% in the non-CPB group, p < 0.001). CPB cases had significantly longer operative time, and hospital stays and rates of Clavien ≥ 3 complications. On multivariate analysis, metastatic disease was a predictor of CPB utilization. Median survival was 74 and 25 months in the non-CPB and CPB cohorts, respectively (p = 0.01). Pulmonary disease and metastatic disease with CPB utilization were significantly associated with worse survival on multivariate analysis. Surgical extirpation of kidney tumours with associated TT remains the standard of care among patients with locally advanced RCC. CPB can be utilized to increase the feasibility of resection for high-level thrombi. Preoperative planning and cooperation among surgical teams are key given the perioperative morbidity and mortality.

Can parenchymal volume analysis replace nuclear renal scans for split renal function before and after partial nephrectomy with warm ischemia?

Can parenchymal volume analysis replace nuclear renal scans for split renal function before and after partial nephrectomy with warm ischemia?

Auerbach's plexus invasion as a key pathological factor for predicting outcomes in ampullary carcinoma.

Auerbach's plexus invasion as a key pathological factor for predicting outcomes in ampullary carcinoma.

Who Are Suitable Patients for Omitting Breast Surgery as an Exceptional Responder in Selected Molecular Subtypes of Breast Cancer After Neoadjuvant Systemic Treatment?

Background and Objectives: Among breast cancer molecular types, HER2 positive and triple negative (TN) subtypes have the highest likelihood of pathological complete response (pCR), which is a surrogate marker for reduced recurrence and improved patient survival after neoadjuvant systemic treatment (NST). Preoperative pathological identification of these exceptional responders is a new era. Therefore, we aimed to determine the accuracy of trucut biopsy in identifying the exceptional responders in selected molecular subtypes of breast cancer patients. Materials and Methods: This two-centre, observational, single-arm, prospective, pilot study was conducted between January and September 2024. The patients with TN or HER2 positive breast cancer whose breast tumour had completely disappeared on the radiological assessment including MRI after neoadjuvant therapy were enrolled. To assess neoadjuvant treatment response, a standardised biopsy protocol was used, consisting of 10 samples from the marked tumour area per patient by 12 G core needle. Then, all patients underwent surgery. The pathological results of both postchemo-presurgical biopsy and surgical breast specimen were compared. Results: The study included 20 patients. The mean age of the patients was 47.3 years. The median tumour size at diagnosis was 23.1 mm. All biopsy results were concordant with the findings of surgical specimen. Seventeen patients had a complete response. The remaining 3 patients had residual disease. Conclusions: Along with thorough patient selection, post-chemo radiological assessment and the reliable biopsy technique are the key points in accurately predicting response to neoadjuvant treatment. If an image-guided core biopsy confirms elimination of tumour tissue at the marked tumour area with a radiological complete response on MRI after NST in breast cancer patients with selected molecular subtypes, these may be suitable patients as exceptional responders in whom we can omit breast surgery.

Application of needle electrodes in en bloc resection of single bladder tumor.

Transurethral resection of bladder tumor is associated with some limitations when used in the diagnosis and treatment of non-muscle invasive bladder cancer. This study explored the application of needle electrodes in the transurethral resection of single bladder tumor (SBT) and highlighted the advantages of en bloc resection of bladder tumors. A retrospective analysis was conducted on 79 patients with SBT treated at the Department of Urology, People's Liberation Army General Hospital, from January to December 2023. Among the patients, 64 (81.0%) were male, and 15 (19.0%) were female, with a mean age of 62.6 years. Among the patients, 68 (86.1%) had primary tumors, 11 (13.9%) had recurrent tumors, and 2 (2.5%) had SBTs following upper urothelial carcinoma radical resection. All patients underwent transurethral resection of bladder tumors using needle electrodes. All procedures were successfully completed. The mean operation time lasted 51.0 min, and the mean blood loss was 7.9 mL. The median tumor size was 2 cm. The obturator nerve block was employed in 22 (33.8%) cases. The incidence of obturator nerve reflex was 40.9% (9/22) and 23.3% (10/43) without (p = 0.139). Post-operative complications included bladder tamponade in one patient (1.3%). The accuracy of muscle invasion reporting was 89.9%. Three patients were lost to follow-up, and two patients (2.6%) suffered from recurrence at 6 months. The median follow-up time was 13 months. Needle electrode resection for SBTs was highly safe, had low complication rates, and offered accurate tumor staging, resulting in precise treatment and low postoperative recurrence.

Postauricular Approach for Enucleation of Cervical Vagal Schwannomas.

This study evaluates the outcomes of intracapsular enucleation using the retroauricular hairline incision (RAHI) approach for treating cervical vagal schwannomas. A longitudinal study was conducted on patients with cervical vagal schwannomas. Eleven patients who underwent RAHI-based enucleation were included. Preoperative imaging was performed using contrast-enhanced MRI. Postoperative evaluations assessed pain, neurological function, cosmetic outcomes, voice, and swallowing functions. Eleven patients underwent surgery. The median tumor size was 4.6 cm. The median operation time was 42 min, with minimal bleeding. Common complications were earlobe numbness (45%) and temporary vocal cord paralysis (27%), which were resolved within a year. Cosmetic satisfaction was high, with median VAS scores of nine for scars and 10 for facial deformities. No significant dysphagia was found. No recurrences were observed over a median follow-up of 79 months. Intracapsular enucleation using the RAHI approach is a safe and effective method for treating cervical vagal schwannomas.

Outcomes following laparoscopic adrenalectomy: Experience of more than two decades at a tertiary care centre.

Laparoscopic transperitoneal adrenalectomy was first described by Gagner M et al . Here, we present our experience of more than two decades of laparoscopic adrenalectomy performed in a single surgical unit at a tertiary care centre. A prospectively collected database of patients undergoing laparoscopic adrenalectomy from December 1994 to May 2020 was analysed retrospectively. The demographic profile, details of clinical workup and laboratory parameters were recorded in a pre-structured pro forma. Functional workup and anatomical imaging were performed for all the patients. Patients were taken up for surgery after adequate pre-operative optimisation using a multidisciplinary approach. All the patients were operated by a single surgical team of experienced laparoscopic surgeons. A total of 158 patients underwent laparoscopic transperitoneal adrenalectomy. The majority patients were females (64.5%). The median tumour size was 5 cm (range, 1-18 cm). The diagnosis in the majority of the patients was pheochromocytoma (56.3%). The mean operative time was 80 min (range: 45-210 min). The most common complication was bleeding in 6 (3.7%) patients, which required laparotomy. The median duration of post-operative hospital stay was 3 days (range: 1-13). There was no 30-day mortality. The mean follow-up period was 15 months (range: 6-72 months), during which two patients developed local recurrence. The advantages of laparoscopic surgery are well established and have been extensively explored for the management of adrenal lesions. A multidisciplinary approach to management, consisting of endocrinologists, surgeons and anaesthesiologists is preferred. Pre-operative evaluation, optimisation and accurate selection of patients are crucial for successful laparoscopic adrenalectomy.

Evaluation of surgical outcomes of nephron-sparing surgery in a leading hospital of an advanced nation.

To assess the efficacy of renal score grading in guiding therapy decisions, predicting perioperative outcomes, and characterising tumours following partial nephrectomy. The retrospective, single-centre study was conducted at the University College Hospital Galway, Ireland, and comprised data from January 11, 2012, to June 17, 2016, of all patients aged >18 years who underwent partial nephrectomy as part of treatment for kidney cancer. Data was analysed using SPSS 20. Of the 76 patients, 52(68.4%) were males and 24(31.6%) were females. The median age of patients was 58 years (IQR: 16). Tumours were predominantly on the right side 44(57.9%) and lower pole 36(47.4%), with a median tumour size of 2.35 cm (IQR: 1.0 cm), and renal score had a median of 5.00 (IQR: 2). Of the total, 70(92.1%) patients underwent open surgery, with complications in 6(7.9%), which were associated significantly with higher body mass index, American Society of Anaesthesiologists classification score, warm ischaemia time and tumour size (p<0.05). Recurrence correlated with tumour size and positive margins (p<0.05). Survival analysis showed a median diseasefree survival (DFS) of 30 months (IQR: 6 months). However, due to the absence of events, the median overall survival (OS) and survival estimates could not be fully calculated. The longest follow-up time was 36 months, with no recorded mortality in the cohort. For individuals with comparatively small localised renal tumours, the selection of partial nephrectomy was found to be a suitable alternative, showcasing exceptional results regarding the complication profile, recurrencefree survival and overall survival.

The Immune Contexture in Canine Anal Sac Adenocarcinoma: Immunohistochemical Quantification of Tumor-Infiltrating Lymphocytes and Tumor-Associated Macrophages with Image Analysis.

Canine anal sac gland adenocarcinomas (ASACs) are locally aggressive and highly metastatic to regional lymph nodes. Tumor-infiltrating lymphocytes (TILs) and tumor-associated macrophages (TAMs) can be effective prognostic and predictive markers in numerous human neoplasms and are increasingly investigated in dogs. The aim of this study was to characterize immune cells in canine ASACs and their relationship with tumor size, histologic metastatic status, and tumor clinical stage. Thirty ASACs with known tumor size, metastatic status, and clinical stage were immunolabeled for Iba1 (macrophages), CD20 (B cells), CD3 (T cells), and Foxp3 (regulatory T cells). With image analysis, two areas of 1 mm2 were analyzed for each case at the tumor core (TC) and invasive margin (IM) and immune cells were counted. Eighteen patients had metastasis at the time of diagnosis, of which fifteen were nodal only, and three were both distant and nodal. The median tumor size was 32.5 mm (range 11-70). The clinical stage was I in five cases, II in seven cases, III in fifteen cases, and IV in three cases. T cells and macrophages were the most abundant immune cells in all tumors. Tumor size did not influence the number or type of infiltrating immune cells. By contrast, significantly higher numbers of TC T lymphocytes were found in patients without metastasis, while significantly higher numbers of TC macrophages were found in dogs with metastasis. Immune cell infiltrate did not differ according to clinical stage. The results indicate that the tumor immune microenvironment, specifically TILs and TAMs, contribute to tumor behavior and may influence metastatic potential; in particular, high CD3 infiltration may prevent tumor progression, while increased macrophage infiltration could promote it.

Preoperative versus postoperative radiotherapy for localized soft tissue sarcoma treated with curative intent in a French tertiary center “SARCLOC”

BackgroundSoft tissue sarcomas of the extremities (E-STS) are rare and heterogeneous. Treatment combines surgery with preoperative or postoperative radiotherapy (RT) for deep, large, or high-grade tumors. We evaluate the effectiveness and toxicity in E-STS patients treated at our institution from 2015 to 2021.Materials and methodsThis retrospective, single-center study, compared clinical and therapeutic characteristics, toxicities, and surgical complications by radiotherapy type. Local recurrence-free survival (LRFS), overall survival (OS), and recurrence-free survival (RFS) were estimated using the Kaplan–Meier method.ResultsWe included 158 patients; 124 (78%) received preoperative RT. The two groups (preoperative RT vs. postoperative RT) differed significantly in terms of median tumor size (111 vs. 67.5 mm, p < 0.01), perivascular involvement (51% vs. 29%, p = 0.03), and bone contact (32% vs. 12%, p = 0.02), but not in grade (grade 2 or 3: 65% vs. 74%, p = 0.72). Median follow-up was 2.9 vs. 5.1 years. Two-year LRFS was 82% [95%CI: 74–88] for both groups; OS was 87% [95%CI: 80–92] vs. 88% [95%CI: 71–95]; and RFS was 72% [95%CI: 63–79] vs. 70% [95%CI: 52–83]. Postoperative complications were 53% vs. 35%, with wound disruption at 39% vs. 15% and infections at 29% vs. 6%. Grade 2 or higher dermatitis was 16% vs. 29%, and RT discontinuation rates were 4% vs. 12% for the two groups, respectively.ConclusionDespite poorer prognostic factors in the preoperative RT group, LRFS and OS were comparable to those in the postoperative RT group. Postoperative complications were more frequent with preoperative RT, and treatment discontinuation was more common postoperatively.

Response of mucinous breast carcinoma to neoadjuvant chemotherapy.

Mucinous breast carcinoma (MBC) is thought to be a favorable-differentiated form of invasive breast cancer and is rarely preferred for neoadjuvant chemotherapy (NAC). The study aimed to define the response of MBCs to NAC. A review was made of the demographic, clinicopathologic characteristics, management and follow-up data of 70 patients diagnosed with MBC between May 2010 and December 2020 by examining the patients' historical files and oncology records. The median age, tumor size, and follow-up period of patients were 52.9 (range: 32-87) years, 25.8 (range: 8-88) mm, and 61.5 (range: 18-143) months, respectively. Of the 70 patients, 45 had conservative surgery, 25 had a mastectomy, and 22 had axillary clearance due to a positive sentinel node biopsy or clinical axilla. Eight patients (11.4%) received NAC. Twenty-one patients (30.0%) received adjuvant chemotherapy, whereas almost all the patients received hormone therapy. The preoperative core biopsy diagnosis of four of eight patients receiving NAC was unspecified invasive breast carcinoma. NAC was used as treatment in patients who were younger, had tumors larger in diameter, had tumors with an initial higher T-stage, and especially those with clinically positive axilla, and tumors with a higher Ki-67 index. Despite these preference criteria, both the overall mastectomy and axillary clearance rates were significantly higher in these patients. Two local and five systemic recurrences were observed in the follow-up period. NAC had no significant contribution to survival. It may be concluded that NAC is not sufficiently effective in either helping to diminish the need for mastectomy by downsizing the tumor, or in preventing axillary clearance in MBCs, and no significant benefit on survival could be observed. In addition, the results may emphasize the importance of identifying the MBC subtype, and the significant association between the degree of response to NAC and the subtype.

Omission of postoperative radiotherapy after breast-conserving surgery in low-risk breast cancer.

This prospective cohort study aimed to assess whether postoperative radiotherapy could safely be omitted in women ≥ 65 years with low-risk, estrogen receptor (ER)-positive T1N0 breast cancer treated with breast-conserving surgery and adjuvant endocrine therapy. Eligible patients were women ≥ 65 years with unifocal, non-lobular, grade 1 or 2, ER-positive, pT1N0 breast cancer treated with breast-conserving surgery and endocrine therapy for five years. Patients were followed up with mammography at least annually for 10 years. The primary endpoint was local recurrence. Secondary endpoints were contralateral breast cancer, recurrence-free survival, and overall survival. The final study cohort included 601 patients with a median age of 71 years (range: 65 to 90 years) and a median tumor size of 11 mm (range: 3 to 20 mm). Median follow-up time was 119 months (interquartile range: 103 to 121 months). The cumulative incidence of local recurrence was 1.5% (95% confidence interval (CI): 0.8 to 2.8%) and 5.5% (95% CI: 3.8 to 7.6%) at 5 and 10 years, respectively. The cumulative incidence of contralateral breast cancer was 1.7% (95% CI: 0.9 to 3.0%) at 5 years and 4.5% (95% CI: 3.0 to 6.6%) at 10 years. The overall survival rate at 10 years was 83.1% (95% CI: 80.8 to 85.4%). In total, three patients (0.5%) died due to breast cancer. Our results support the possibility to omit radiotherapy after breast-conserving surgery in a well-defined subgroup of women aged ≥ 65 years with low-risk, ER-positive, pT1N0 breast cancer receiving adjuvant endocrine therapy.

Outcomes After Stereotactic Body Radiation for Hepatocellular Carcinoma in Patients With Child-Pugh A Versus Child-Pugh B/C Cirrhosis

Outcomes After Stereotactic Body Radiation for Hepatocellular Carcinoma in Patients With Child-Pugh A Versus Child-Pugh B/C Cirrhosis

Characteristics of Esophageal Squamous Cell Carcinomas Based on Circumferential Localization

ABSTRACTBackground and AimIn terms of their longitudinal positioning, esophageal squamous cell carcinoma (ESCC) commonly arises in the middle segment of the esophagus. However, limited attention has been given to the circumferential aspect. This study aimed to investigate the prevalence and characteristics of ESCC lesions resected via endoscopic submucosal dissection (ESD), taking into consideration both longitudinal and circumferential positions.MethodsWe retrospectively evaluated 193 ESD‐resected ESCC lesions and compared the occurrence rate of ESCC development and the degree of histopathological invasion across various circumferential and longitudinal positions. We scrutinized lesion characteristics by location, with a particular focus on the proportion of early‐stage small lesions in each site.ResultsRegarding lesion location, 27 were situated on the anterior wall, 62 on the left, 66 on the posterior, and 38 on the right. Among the four circumferential positions, the anterior wall group had the smallest median tumor size. Additionally, the anterior wall group had the highest proportions of lesions with invasion depths limited to the epithelial layer and sizes &lt; 10 mm, at 44.4% and 25.9%, respectively. Furthermore, a significant difference was noted among the four circumferential positions with respect to the proportion of ESCC lesions satisfying both criteria, with the highest proportion observed in the anterior wall group (p = 0.049).ConclusionsOur findings suggest that while ESCC occurrence on the anterior wall is less frequent, these lesions may present as small lesions with superficial invasion depths.

Therapeutic Outcomes in 691 Angiosarcomas of the Head and Neck-A Retrospective SEER Study.

Angiosarcomas (AS) are an aggressive subtype of head and neck tumors. Current outcome research is limited to single-surgeon and/or single-institution data. This study analyzes the Surveillance, Epidemiology, and End Results program (SEER) database data to improve outcomes of head and neck AS. In this study, the authors accessed the SEER database from 2000 to 2020 to identify patients who underwent surgical and/or nonsurgical treatment of head and neck AS. Data included demographics, diagnostic workup, tumor characteristics, treatment pathways, and therapy outcomes. The study included 691 patients (210 females, 481 males) with AS of the head and neck. The median tumor size was 40mm. Most patients (63%) underwent surgery, with surgery followed by radiation being the most common treatment combination (50%). Median survival was 16 months. Patients treated with surgery showed significantly longer survival (18mo) compared with nonsurgery cases (12mo, P<0.001). Neoadjuvant treatment significantly improved survival (28mo) compared with non-neoadjuvant cases (15mo, P=0.023). Adjuvant treatment also improved overall survival (19mo) versus nonadjuvant treatment (14mo, P<0.001). There was no significant difference between neoadjuvant and adjuvant treatment outcomes (P=0.270). Bottom of Form This study compares the outcomes of multimodal treatments, especially surgery and radiotherapy, for head and neck AS, emphasizing tailored approaches to optimize patient outcomes and extend survival. Future research should refine these strategies.

Does Preoperative Renal Tumour Biopsy Impact Trifecta Achievement in Partial Nephrectomy?

We aimed to evaluate the effect of renal tumour biopsy (RTB) on trifecta criteria achievement in patients treated with open partial nephrectomy (OPN). Patients who were diagnosed with renal cancer and underwent OPN between 2012 and 2023 were retrospectively reviewed. The RTB group consisted of patients who underwent RTB before OPN, while the non-RTB group consisted of those who did not undergo RTB. No matching method was employed since parameters such as tumour size and Padua score were comparable between the two groups. The primary outcome was trifecta achievement, defined as negative surgical margins, warm ischemia time (WIT) <25 minutes, and no complications. Secondary outcomes were the clinicopathologic and survival outcomes of both groups. There were 137 (82.03%) patients in the non-RTB group and 30 (17.96%) patients in the RTB group. The median postoperative follow-up was 45 (24-141) months. The median tumour size was 3.4 (1-7) cm and 3 (1.4-7) cm in the non-RTB group and RTB group, respectively (p=0.282). Seventy-five of the 137 (54.76%) patients in the non-RTB group and 16 of the 30 (53.3%) patients in the RTB group achieved the trifecta criteria (p=0.878). There was no statistically significant difference between the two groups in terms of metastasis-free survival (p=0.332) or overall survival (p=0.359) at 24 months. The rate of intraparenchymal lymphovascular invasion was significantly higher in the RTB group (16.6%) than in the non-RTB group (2.92%) (p=0.013). Our study indicated that trifecta achievement rates were comparable between patients who did and those who did not undergo RTB. Consequently, RTB can be safely performed in renal cancer.

Tumor Size as a Predictive Indicator for Lymph Node Metastasis in Papillary Thyroid Carcinoma: An Inverted L-Shaped Curve Analysis Based on the SEER Database.

Papillary thyroid carcinoma (PTC) frequently metastasises to lymph nodes, with lymph node metastasis (LNM) occurring with high frequency in small, early-stage tumors. The present study examines the inverse l-shaped relationship between tumor size and the likelihood of LNM in patients diagnosed with PTC. We performed a detailed retrospective cohort analysis of 48,021 cases of papillary thyroid cancer using data from the Epidemiology, and End Results (SEER) database from 1992 to 2019. Our study used various analytical methods, including logistic regression, spline curve fitting, and variable interaction assessment, to clarify the association between tumor size and LNM rates. We rigorously controlled for potential confounders such as patient age, sex, ethnicity, tumor size, extrathyroidal extension (ETE), histopathological characteristics and distant metastases. In addition, we thoroughly investigated and quantitatively assessed the relationship between adjusted tumor size measurements and the likelihood of LNM development. The median tumor size among the 48,021 patients diagnosed with PTC was 1.3 cm. Among these patients, 12,365 (25.75%) had LNM, with a median tumor size of 1.9 cm in this group. A comparative analysis shows a significant difference in tumor sizes between PTC patients who were LNM-positive and those who were LNM-negative. The relationship between tumor size and the likelihood of LNM exhibits a distinct nonlinear pattern. Specifically, below a diameter threshold of 1.978 cm, the probability of LNM significantly increases with larger tumor sizes (odds ratio [OR] = 2.363, 95% confidence Interval [CI]: 2.214-2.523). Once this threshold is surpassed, the effect of tumor size on LNM incidence levels off (OR = 1.031, 95% CI: 1.003-1.061). The results of this study confirm that tumor size significantly determines the likelihood of LNM in patients with PTC. We found an inverse l-shaped relationship between tumor size and the probability of LNM. As the tumor size increased below 1.978 cm, the likelihood of LNM increased, but not with tumor size above that threshold. These findings provide new insights into the complex relationship between tumor size and LNM in PTC.

Comparison of clinical outcomes between conventional and underwater endoscopic mucosal resection for duodenal neuroendocrine tumors.

Duodenal neuroendocrine tumors are relatively rare subepithelial tumors that arise from cells of the neuroendocrine system. Small duodenal neuroendocrine tumors can be treated endoscopically because of their low potential for metastasis. This study aimed to evaluate the clinical outcomes of conventional and underwater endoscopic mucosal resection for duodenal neuroendocrine tumors. Between March 2009 and March 2023, 15 patients with duodenal neuroendocrine tumors resected using conventional (n = 7) and underwater (n = 8) endoscopic mucosal resections were retrospectively enrolled. The median specimen size and median tumor size were 1.0 cm (interquartile range: 0.8-1.2 cm) and 0.6 cm (interquartile range: 0.4-0.6 cm), respectively. More than half of duodenal neuroendocrine tumors were located in the duodenal bulb (9/15, 60%). The en bloc and complete resection rates of both conventional and underwater endoscopic mucosal resections were 100%. Only one perforation event occurred in the conventional endoscopic mucosal resection group (14.3%). The patient with the perforation was treated with endoscopic clipping. The median follow-up period was 39.5 months (interquartile range: 19.5-57.3 months). There was no local recurrence or distant metastasis during the follow-up period. Underwater endoscopic mucosal resection is a safe and effective treatment option for small duodenal neuroendocrine tumors and is the preferred treatment option for flat-type duodenal neuroendocrine tumors.