Sentinel lymph node biopsy (SLNB) is the standard staging procedure in cutaneous melanoma of the head and neck, but current guidelines are extrapolated from non-head and neck studies. Existing risk models lack specificity for this region. Using the National Cancer Database, we developed and internally validated a nomogram and web-based calculator to estimate SLNB positivity specifically in head and neck cutaneous melanoma. We conducted a retrospective cohort study using the NCDB, including patients with cutaneous melanoma of the head and neck. The inclusion criteria were patients with clinical node-negative, early-stage melanoma who underwent SLNB between 2004 and 2021. Demographic, clinical, and pathologic features were compared using chi-squared testing, and multivariable logistic regression identified independent predictors of SLNB positivity. Significant factors were incorporated into a nomogram and interactive risk calculator. We included 14,058 clinical N0, M0 cutaneous head and neck melanoma patients who underwent SLNB. Of these, 2182 (15.5%) had a positive SLNB. In multivariable analysis, age, head and neck sublocation, histologic subtype, mitotic rate, Breslow thickness, lymphovascular invasion, and ulceration were identified as independent predictors of SLNB positivity. A nomogram based on these variables was developed. The model demonstrated good discrimination with a C-index of 0.724 (95% CI, 0.712-0.735). This study provides a predictive tool that allows head and neck surgeons to estimate the risk of SLNB positivity in individual patients, enabling more personalized surgical decision-making in early-stage head and neck melanoma.

Staged proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the standard surgical treatment for medically refractory pediatric ulcerative colitis (UC). This study aimed to compare the surgical outcomes of 2-stage and 3-stage IPAA in children of similar disease severity. We queried the NSQIP-Pediatric database (2016-2023) to identify patients under 18 years with UC undergoing IPAA. Patients undergoing IPAA with concurrent colectomy were classified as having a 2-stage procedure, while those undergoing IPAA alone, following a prior colectomy, were classified as having a 3-stage procedure. The primary outcome was a composite of major complications within 30 days, including mortality, organ/space infection, progressive renal insufficiency, systemic sepsis, and intra-abdominal reoperation. The treatment groups were matched using 1:1 propensity score matching to adjust for baseline differences in disease severity. A total of 479 patients met the inclusion criteria (330 underwent 3-stage and 149 underwent 2-stage procedures). The proportion of patients undergoing each approach remained stable over the study period (P = .693). At the time of pouch creation, the 2-stage group had significantly higher rates of steroid use (22.8% vs 14.5%), leukocytosis (21.9% vs 7.1%), and hypoalbuminemia (mean 4.0 vs 4.2 g/dL). After matching, 137 patient pairs were included. There was no significant difference in major complication rates between groups (OR, 1.38; 95% CI, 0.63-3.09). This study demonstrated that surgical outcomes following pouch creation were similar in a matched cohort of children undergoing 2- or 3-stage IPAA, supporting the use of a 2-stage approach in certain patients with limited disease.

Mast cell tumours (MCTs) are common in dogs. Treatment options include surgery, radiation therapy, and cytotoxic chemotherapy; however, in cases of inoperable or metastatic tumours, tyrosine kinase inhibitors (TKIs) can be used. Imatinib mesylate has been used in the treatment of solid tumours in both human and veterinary medicine. Previous studies have shown some efficacy in dogs with MCTs; however, additional data are needed to better define the optimal dosage, toxicity profile, and clinical outcomes associated with its use. Dogs with a cytological or histopathological diagnosis of mucosal, cutaneous or subcutaneous MCTs were included. Medical records from 2017 to 2024 were reviewed for clinical presentation, results of staging procedures, diagnostic tests, and treatment. Inclusion required the presence of macroscopic disease and administration of imatinib, either as a sole treatment or in combination with surgery. Thirty-five cases were included, all receiving medical treatment with or without surgical excision. Imatinib was administered as first-line treatment in 8 dogs (22.8%) and as a rescue treatment in 27 dogs (77.1%), achieving an overall clinical benefit, including complete response, partial response, and stable disease of 77%. Median progression-free survival was 37 days (range 13-770 days), while the overall median survival time (MST) was 270 days (range 83-1396 days). Following imatinib treatment, the MST was 105 days (range 22-1145 days). Gastrointestinal and haematological adverse events were recorded in 2 (5.7%) and 3 (8.6%) dogs, respectively, and were self-limiting. Imatinib treatment was generally well tolerated, with measurable clinical responses observed and only a limited spectrum of toxicities. Further studies are warranted to better characterise its safety and efficacy in dogs with MCTs.

Previous studies reported low [18F] fluorodeoxyglucose ([18F]FDG) PET uptake in estrogen receptor-positive breast tumours, potentially missing detection of distant metastases. This study assessed the proportion of estrogen receptor-positive hypometabolic tumours, clinical factors influencing [18F]FDG uptake, and the prognostic impact. Baseline [18F]FDG PET/computed tomography (CT) and [18F]FDG PET/MRI exams of female patients diagnosed with estrogen receptor-positive locally advanced (cT3-4N0 or cT1-4N+), metastatic, or recurrent breast cancer between 2013-2022 were retrospectively collected. Different thresholds of maximum standardised uptake value (SUVmax) and tumour-to-background ratio (TBR; SUVmax tumour/SUVmax background) were applied to determine the proportion of hypometabolic [18F]FDG PET exams. Logistic regression and survival analysis were performed. 119 patients underwent [18F]FDG PET/CT and 31 [18F]FDG PET/MRI. The proportion of hypometabolic tumours for SUVmax thresholds 2.0, 2.5, 3.0, TBR of contralateral breast less than or equal to 1, and TBR of liver less than or equal to 1 was 8.4, 15.1, 21.8, 5.1, and 28.6%, respectively for [18F]FDG PET/CT and 16.1, 19.4, 29.0, 6.9, and 35.5% for [18F]FDG PET/MRI. Clinically tumour status (cT-status), histology type, and tumour grade were associated with the presence of a hypometabolic tumour. No PET-derived variables were associated with recurrence-free survival. A considerable proportion of estrogen receptor-positive breast tumours showed low SUVmax, indicating potential suboptimal staging on [18F]FDG PET. In patients with lower cT-status, lobular histology and low-grade estrogen receptor-positive tumour, [18F]FDG PET may be less reliable as staging procedure. Further research is necessary to determine the optimal metabolic threshold for defining a hypometabolic tumour.

3-Stage vs 2-Stage Redo Ileal Pouch-Anal Anastomosis: Setting the Stage for Successful Pouch Salvage.

Abstract Introduction In breast cancer patients converting from clinically positive (cN+) to negative (ycN0) lymph node status after neoadjuvant chemotherapy (NACT), surgical staging by axillary lymph node dissection (ALND) is increasingly replaced by less invasive procedures like targeted axillary dissection (TAD) or sentinel lymph node biopsy (SLNB), possibly followed by completion ALND or regional radiotherapy if positive. Prospective data comparing oncologic safety of different procedures as a primary approach after NACT are currently scarce. We report 3-year axillary recurrence-free survival (ARFS) as the first primary endpoint analysis of the AXSANA/EUBREAST 3(R) study (NCT04373655, www.eubreast.org/axsana), initiated by the European Breast Cancer Research Association of Surgical Trialists (EUBREAST e.V.). Methods In an international multicenter cohort study, patients with cN+ breast cancer who receive at least four cycles of NACT and convert to ycN0 are eligible. Axillary staging after NACT is performed according to institutional routine. Grouping of patients was based on the primary staging procedure, not on final axillary surgery, e.g., completion ALND following a positive SLNB was classified as SLNB. Co-primary endpoints are ARFS, invasive breast cancer-specific survival (iBCSS), and patient-reported quality of life. Data entry is systematically monitored. Less extensive axillary staging procedures as first surgery after NACT (TAD, SLNB, targeted lymph node biopsy (TLNB)) are considered non-inferior to staging by ALND if the lower bound of a two-sided 90% confidence interval (CI) around 3-year ARFS exceeds 97%. 750 patients were required per group (TAD/SLNB/TLNB vs ALND). Results From June 2020 to April 2025, 6,474 patients (26 countries, 288 study sites) were enrolled, 2,632 of whom had completed surgery by December 31, 2023 and were selected for analysis. Primary staging procedure was ALND in 799 patients (30.4%) and less invasive procedures (419 SLNB, 1399 TAD, 15 TLNB) in 1,833 (69.6%). Nodal complete pathological response was reported in 1,345 patients (51.1%): 423 (31.4%) after ALND and 922 (68.6%) after TAD/SLNB/TLNB. 2489 patients (94.6%) received post-NACT nodal radiotherapy: 759 (95.0%) after ALND and 1730 (94.4%) after TAD/SLNB/TLNB. After a median follow-up of 2.0 years (range, 0.01-4.5), 15 axillary recurrences occurred after TAD/SLNB/TLNB and 4 after ALND (4.2 vs 2.5 events/1000 person-years, p=0.351). 3-year ARFS was 99.2% (95% CI 98.2-100.0) after ALND and 98.8% (95% CI 98.1-99.5) after TAD/SLNB/TLNB. For TAD/SLNB/TLNB, the lower bound of a 90% CI was 98.2%. After SLNB, 1 axillary recurrence occurred and 14 after TAD (1.2 vs 5.1 events/1000 person-years, p=0.132). Results were similar upon controlling for clinicopathological risk factors and neoadjuvant treatment or exclusion of 143 patients without radiotherapy. iBCSS at 3 years was 85.7% (95% CI 82.6-89.0) for ALND and 88.2% (95% CI 86.0-90.3) for TAD/SLNB/TLNB. Conclusion In patients who convert from clinically node-positive to node-negative breast cancer, the AXSANA study showed that less invasive surgical staging procedures are associated with a low axillary recurrence rate, not inferior to ALND after 3 years, regardless of initial tumor stage or subtype. These findings reinforce efforts to minimize surgical morbidity without compromising oncologic outcomes. Citation Format: T. Kühn, M. Banys-Paluchowski, N. Ditsch, E. Stickeler, M. Hauptmann, J. Schroth, G. Karadeniz Cakmak, M. Hahn, M. Thill, T. Reimer, S. Fröhlich, E. Schmidt, M. Lux, H. Kolberg, I. Rubio, M. Gasparri, M. Kontos, E. Bonci, L. Niinikoski, D. Murawa, D. Pinto, F. Peintinger, E. Schlichting, H. Nina, H. Valiyeva, M. Vanhoeij, L. Rebaza, B. Aktas Sezen, K. Jursik, G. Kadayaprath, L. Dostalek, A. Kothari, A. Perhavec, T. Ivanov, D. Zippel, S. Thongvitokomarn, B. Adamczyk, M. Gurleyik, D. Watermann, M. Porpiglia, S. Grasshoff, S. Loibl, D. Krug, A. Lebeau, R. Di Micco, O. Gentilini, J. de Boniface, S. Hartmann, AXSANA study group.. More versus less invasive axillary surgical staging procedures in breast cancer patients converting from a clinically node-positive to a clinically node-negative stage through neoadjuvant chemotherapy - primary endpoint analysis of the international prospective multicenter AXSANA/EUBREAST 3(R)study [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr GS2-01.

Abstract Background: Breast cancer (BC) treatment is increasingly complex, with a strong need for coordinated decision-making among specialists within multidisciplinary teams (MDTs). Despite their critical role in optimizing patient care, limited data exist on the structure and functioning of BC MDTs in Portugal. To address this gap, the PRISMA study collected both qualitative and quantitative data to characterize the organization, composition, and operational practices of BC MDT meetings across various regions and healthcare sectors nationwide. Methods: A mixed-methods approach was used to analyze multidisciplinary team practices from January 2022 to June 2023. For qualitative data, a Delphi methodology was applied through a questionnaire developed from a systematic literature review. Sixty-four Portuguese specialists involved in BC MDT meetings during this period were invited to participate. Two rounds of anonymous online voting were conducted from October 2024 to December 2024, using a five-point Linkert scale; consensus was defined as ≥ 80% concordance among responses. For the quantitative data, retrospective aggregated information from MDT meetings were collected. Results: Forty-six specialists from 13 Portuguese centers participated in the Delphi panel, including representatives from 3 cancer institutes, 3 university hospitals, and 9 general hospitals, encompassing the private (3 centers) and public (10 centers) healthcare sectors. Ten centers also participated in the quantitative phase of the study, where MDT meetings have been held for an average of 18 years. During the study period, each center held an average of 88 meetings, with each meeting lasting approximately 2.3 hours. Most teams had 5-10 members (70%), including medical oncologists (100%), breast surgeons (100%), radiologists (90%), radiation oncologists (90%), pathologists (70%), and oncology nurses (60%). Additional medical and other specialties represented in at least one center included gynecology, nuclear medicine, social service, geriatrics, and data managers. These findings were validated by the Delphi panel, which underscored the role of specialized MDTs with core and supplementary members. During the study period, most meetings were conducted in a hybrid format (60%), with presential (40%) and virtual (30%) formats also reported. On average, 15 cases were discussed per meeting, totaling approximately 767 annually. Of these, on average 45 cases were revised, mainly due to missing prior information (70%). Experts participating in the Delphi panel considered MDT meetings crucial for delivering evidence-based, personalized treatment and minimizing patient care disparities. Key challenges identified included time constraints, delays in diagnosis and staging procedures, and staff shortages. Conclusions: MDT meetings are well established in Portuguese centers and align with international recommendations. This study, through a mixed-methods approach, identified both strengths and operational challenges in MDT practices. Experts emphasize their critical role in ensuring evidence-based, patient-centered care. Findings support efforts to standardize and strengthen MDT functioning to ensure high-quality breast cancer care nationwide. Citation Format: G. Sousa, A. M. Ferreira, I. Pereira, C. Abreu, D. Simão, F. Machado, G. Fernandes, R. A. Leonor, J. Fougo, M. C. Nogueira, P. H. Meireles, J. Abreu Sousa, P. F. Cortes. Multidisciplinary Team Decision-Making in Breast Cancer: Real-World Insights from the PRISMA Study [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-11-05.

Abstract Background: Axillary nodal status is an important prognostic factor in early breast cancer (eBC), guiding systemic treatment and postoperative radiotherapy. As axillary surgery does not significantly affect BC mortality itself, it is considered as a staging procedure in clinically node-negative (cN0) patients (pts). The Intergroup-Sentinel-Mamma (INSEMA) trial investigated the avoidance of sentinel lymph node biopsy (SLNB) in cN0 pts (Rando1) or the omission of completion axillary lymph node dissection (cALND) in pN1a(sn) pts (Rando2). The analysis of the first randomization demonstrated non-inferiority of omitting SLNB in cN0 patients undergoing breast-conserving surgery (BCS) concerning invasive disease-free survival (iDFS), meeting the trial's primary endpoint. Here we report the analysis of the second randomization. Study Design: The INSEMA trial was conducted between 2015 and 2019 in Germany and Austria. The first randomization of this prospective trial compared no axillary surgery with SLNB in pts with invasive eBC (tumor size ≤ 5 cm; c/iN0) scheduled for BCS, including postoperative whole-breast irradiation (WBI). This randomization was carried out in a 4:1 allocation (SLNB vs. no SLNB). Pts with 1-3 macrometastases in the SLNB arm underwent a second randomization in a 1:1 ratio, to either SLNB alone or cALND. The aim was to assess whether SLNB alone is non-inferior to cALND in terms of iDFS. The analysis of Rando2 was based on the per-protocol (PP) set. Due to fewer SLNB-positive patients than expected, the iDFS analysis for the second randomization was downgraded from a co-primary to a key secondary outcome following protocol amendment #5 (December 2018). The non-inferiority margin was defined as 5-year iDFS > 76.5% (hazard ratio (HR) < 1.271) for SLNB alone, compared to an expected 5-year iDFS of 81% for the cALND arm. Results: 485 pts were recruited for Rando2 (intention-to-treat (ITT) set: N=243 with cALND vs. N=242 with SLNB alone). After excluding 99 pts (mainly due to axillary surgery performed not per randomized arm), 386 pts (cALND: N=169, SLNB alone: N=217) were included in the PP set. The median follow-up (FU) is 74.2 months. The cALND cohort is characterized by higher rates for postoperative chemotherapy (39.8% vs. 33.6%, p=0.239), conventionally fractionated WBI (87.0% vs. 75.1%, p=0.004), tumor bed boost (88.8% vs. 80.6%, p=0.035), and regional nodal irradiation (36.0% vs. 20.6%, p=0.019) compared to the SLNB alone cohort. Analysis in the PP set was unable to demonstrate non-inferiority for SLNB alone compared to cALND, with an HR of 1.6]9 (95% CI: 0.98-2.94). Estimated 5-year iDFS rates are 86.6% (81.0%-90.7%) in the SLNB alone arm and 93.8% (88.7%-96.6%) in the cALND arm (log-rank p=0.058). Estimated 5-year overall survival (OS) rates are 94.9% (90.6%-97.2%) in the SLNB alone arm and 96.2% (91.7%-98.3%) in the cALND arm (log-rank p=0.663). Among the ITT set, there was also no difference in iDFS between the arms, with an HR of 1.26 (0.80-1.99) for SLNB alone compared to cALND. Estimated 5-year iDFS rates (ITT set) are 86.0% (80.6%-90.0%) with SLNB alone and 89.3% (84.3%-92.8%) with cALND, respectively (log-rank p=0.314). Locoregional recurrences (LRR) were infrequent, with 5-year cumulative incidence rates of 1.1% vs. 0.0% (p=0.405) in the SLNB alone arm compared to cALND. The safety analysis demonstrates that patients who underwent SLNB alone benefited in terms of lymphedema rate, arm mobility, and reduced arm and shoulder pain. Conclusion: No significant differences were observed between SLNB alone vs. cALND in both subsets (PP, ITT) for iDFS, OS, and LRR. These findings after a 6-year FU are representative of cN0 pts with positive SLNB and BCS; the 10-year FU data will be presented in 2029. Citation Format: T. Reimer, A. Stachs, K. Veselinovic, T. Kühn, J. Heil, S. Polata, F. Marmé, E. K. Trapp, T. Müller, G. Hildebrandt, D. Krug, B. Ataseven, R. Reitsamer, S. Ruth, H. Strittmatter, C. Denkert, I. Bekes, N. Stahl, D. Zahm, M. Thill, M. Golatta, J. Holtschmidt, M. Knauer, V. Nekljudova, S. Loibl, B. Gerber. Axillary surgery in breast cancer patients with one to three sentinel node macrometastases and breast-conserving therapy: Secondary results of the INSEMA trial [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr GS2-02.

Abstract Background: Axillary sentinel lymph node biopsy (SLNB) is the standard procedure for axillary staging in patients with clinically node-negative (cN0) early breast cancer (BC). Neoadjuvant chemotherapy (NACT) achieves a pathologic complete response (pCR) in 30-50% of patients with biopsy-confirmed N1 disease. Targeted axillary dissection (TAD) has been shown to reduce false-negative rates in clinically node-positive (cN+) patients following NACT. While triple-negative breast cancer (TNBC) and HER2-positive BC exhibit high response rates to NACT (potentially leading to ypN0 status), the feasibility and safety of SLNB after NACT in cN0 patients with TNBC or HER2-positive BC remain insufficiently established by high-quality evidence. Objective: This study aimed to evaluate the feasibility of SLNB following NACT in patients with clinically node-negative TNBC and HER2-positive early BC, and to assess the oncologic safety of omitting axillary lymph node dissection (ALND) in SLNB-negative patients via long-term follow-up. Methods: A prospective single-arm trial was conducted on 404 patients with primary early breast cancer (BC, cT1b-2N0M0, age ≤70 years) who were enrolled and received neoadjuvant chemotherapy (NACT) at Peking University Cancer Hospital from October 2017 to May 2023. Inclusion criteria were: histologically confirmed invasive carcinoma, indication for chemotherapy, and eligibility for SLNB before NACT (including cases with suspicious lymph nodes but negative results on fine-needle aspiration [FNA] or core needle biopsy [CNB]). Exclusion criteria included: history of prior malignancies, contraindications to chemotherapy, prior axillary surgery, or refusal of NACT, evaluation, or study participation. Tumor subtypes were categorized as HER2-negative/hormone receptor < 10% (n=147) and HER2-positive (n=242). NACT regimens were heterogeneous, including protocols such as TCbH(P) and ddEC-T±H(P). SLNB was performed using a technetium-99m-labeled tracer. Results: The success rate of SLNB was 95.63% (95% confidence interval [CI]: 93.60%-97.66%). Among 372 successful SLNB cases (median number of lymph nodes retrieved: 2, range: 1-10), 9 patients had positive SLNs, with a SLN-positive rate of 2.42% (95% CI: 0.86%-3.98%). Univariate analysis showed that ultrasound (US) T response, magnetic resonance imaging (MRI) T response, number of NACT cycles, Ki-67 expression level, and breast tumor pCR were factors influencing lymph node status (p < 0.5). Multivariate analysis identified US T response as an independent significant factor (p=0.041). During a median follow-up of 43 months (range: 6-85 months), 1 patient developed ipsilateral axillary recurrence, with an ipsilateral axillary recurrence rate of 0.28% (95% CI: 0.05%-1.54%) among 363 SLN-negative patients who did not undergo ALND. Conclusion: SLNB following NACT in patients with clinically node-negative TNBC and HER2-positive early BC shows high success rates and low positivity rates. Omitting ALND in SLN-negative patients appears feasible, with a low risk of axillary recurrence, indicating potential oncologic safety. However, longer follow-up durations and larger-scale studies are required to validate the long-term outcomes of this approach. Citation Format: Q. Zheng, X. Wang, Y. He, W. Cao, Y. Yang, C. Gu, L. Wang, X. Wang, J. Li, T. Ouyang, Z. Fan. Axillary Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy in Clinically Node-Negative Early Breast Cancer: Feasibility and Safety in Triple-Negative and HER2-Positive Breast Cancer Subtypes [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS2-05-12.

To compare postoperative auditory outcomes after cochlear implantation (CI) between patients with chronic otitis media (COM) and those with noninflammatory sensorineural hearing loss (SNHL) and to evaluate the impact of labyrinthitis and duration of deafness. We retrospectively analyzed 33 postlingual COM cases and 70 age- and sex-matched SNHL controls. Pre- and postoperative audiologic tests were obtained, and preoperative computed tomography and magnetic resonance imaging were reviewed for labyrinthitis. The surgical status and stage (single- or 2-stage procedure) of cases with COM cases were documented. Postoperative aided thresholds and word recognition scores (WRS) did not differ significantly between the groups. Complete bone conduction scale-out was more frequent in the SNHL group (P = .003). Labyrinthitis, found in 3 patients with COM (9.1%), was associated with a significantly lower WRS (P = .007 vs SNHL; P = .024 vs COM without labyrinthitis). In contrast to the SNHL group, patients with COM maintained stable WRS even with long-term deafness (>20 years). CI in COM yields auditory outcomes comparable to non-COM cases. In the absence of labyrinthitis, patients with COM showed preserved speech performance despite long-standing deafness, suggesting preserved cochlear/neural integrity. Preoperative imaging is valuable for detecting labyrinthitis, which predicts poorer postoperative results.

Introduction: The quest for an ideal substitute material for substitution urethroplasty is ongoing. While buccal mucosa graft (BMG) has gained prominence, penile skin graft (PSG) remains a valuable, historically significant option, particularly in settings with limited resources or specific contraindications to oral mucosa harvesting. This study aims to evaluate the outcomes and rationale for PSG in anterior urethral reconstruction. Methods: A retrospective analysis was conducted on 20 consecutive male patients who underwent single-stage anterior urethroplasty using a free penile skin graft between 2022 and 2025. Strictures were of various etiologies, including failed hypospadias repair (n=10), idiopathic (n=8), and post-TURP (n=2). The primary surgical technique was a dorsal onlay graft (n=18), with dorsal inlay used in two cases. Success was defined as the absence of obstructive symptoms and no need for subsequent intervention. Patients were followed for a minimum of 6 months. Results: The overall success rate was 90% (18/20 patients). The mean patient age was 35 years (range: 5-75). One patient developed a urethrocutaneous fistula, and one case was considered a failure requiring re-intervention. No significant graft loss, donor site morbidity, or new-onset chordee was reported. Conclusion: Penile skin graft urethroplasty is a reliable and effective single- stage procedure for anterior urethral strictures, demonstrating a high success rate comparable to other graft materials. Its unique histologic properties, surgical practicality, and avoidance of oral morbidity make it a vital component of the reconstructive urologist's armamentarium, especially in selected patients where BMG may be unsuitable or unavailable.

Introduction: This study aimed to evaluate the harms and oncological benefits of pelvic lymph node dissection (PLND) during radical prostatectomy (RP) in prostate cancer patients at risk for regional lymph node invasion. Methods: Patients with cN0M0 prostate cancer who underwent RP between January 2013 and February 2023 were included. Patients were categorized into two groups: 334 patients who underwent RP with PLND (group A) and 161 without PLND (group B). Perioperative and oncologic outcomes were assessed, and multivariate analysis identified independent prognostic factors. Inverse probability of treatment weighting (IPTW) was applied to account for baseline differences. Results: Group A had more advanced disease, longer operation times, and higher complication rates, with 58.3% of complications related to PLND. After a median follow-up of 56 months, there were no significant differences in 4-year biochemical recurrence-free survival (BRFS) (68.9% vs. 75.4%), metastasis-free survival, or overall survival between the groups. Positive surgical margins and tumor grade were independent risk factors for biochemical recurrence, while PLND was not. Cox regression in the IPTW-adjusted cohort confirmed no significant impact of PLND on BRFS (HR: 0.70, p = 0.09). Conclusion: PLND during RP increases postoperative complications without improving short-term oncologic outcomes, serving mainly as a staging procedure to inform management.

Robotic-assisted para-aortic and pelvic sentinel lymph node dissection as a second stage procedure in early ovarian cancer – video presentation

Sentinel lymph node biopsy (SLNB) is the standard procedure for axillary staging in early-stage breast cancer patients, however, it remains an invasive procedure. The aim of this study is to construct a multicenter, multimodal predictive model based on contrast-enhanced ultrasound (CEUS) and grayscale ultrasound (GSUS) imaging of sentinel lymph nodes (SLNs) in breast cancer patients. The model seeks to preoperatively assess the risk of SLN metastasis in a non-invasive manner, thereby enabling the exemption of unnecessary SLNB for eligible patients. In this multicenter, multimodal ultrasound radiomics study, eligible breast cancer patients from three medical centers, respectively, the Sichuan Provincial People's Hospital, Yunnan Provincial Cancer Hospital, and Fujian Provincial Cancer Hospital in China, were consecutively enrolled between January 2019 to February 2024, and between February 2024 to July 2024. The enrolled patients had pathologically confirmed breast cancer and underwent CEUS and GSUS imaging of their SLNs. The patients were divided into the following groups: training cohort (n = 763), validation cohort (n = 132), internal independent test cohort (n = 298), prospective internal test cohort 1 (n = 75), prospective external test cohort 2 (n = 51), and prospective external test cohort 3 (n = 55). A deep dual-modal fusion network (DDFN) model was developed to preoperatively predict lymph node metastasis by integrating features from both CEUS and GSUS images of the SLNs. The predictive performance of different models across the test cohorts was evaluated by negative predictive value (NPV), specificity, the area under the ROC curve (AUC), and accuracy. The DDFN demonstrated superior performance for SLN metastasis prediction compared to single-modality models. In the internal test cohort (n = 298), the DDFN model achieved a NPV of 0.973 (95% CI: 0.956-0.987), which was significantly higher than those of the GSUS model (NPV = 0.941, P = 0.032) and the CEUS model (NPV = 0.958, P = 0.041). The DDFN model also attained the highest AUC of 0.912, significantly outperforming the GSUS model (AUC = 0.782, P = 0.0046) and the CEUS model (AUC = 0.890, P = 0.039). Furthermore, the DDFN model exhibited excellent specificity (0.987), indicating its robustness in accurately distinguishing metastatic and non-metastatic SLNs. This strong performance was consistently maintained across three prospective multicenter test cohorts. The DDFN model yielded NPVs exceeding 0.9 in all cohorts (cohort 1: 0.933; cohort 2: 0.917; cohort 3: 0.909), which were statistically superior to the single-modality models in most comparisons. The AUC values of the DDFN model in the prospective cohorts (0.893, 0.866, and 0.862, respectively) remained high and generally surpassed those of the single-modality approaches. The DDFN model, integrating CEUS and GSUS images, enables preoperative evaluation of SLNs. This method holds promise for assessing axillary lymph nodes (ALNs) preoperatively, identifying patients without SLN metastasis, and exempting them from unnecessary axillary staging surgery. The study was funded by Key research and development (R&D) projects of Sichuan Science and Technology Department [item 2023YFS0263].

Accuracy and clinical value of intraoperative frozen section assessment in endometrial carcinoma.

Accurate staging of bladder cancer is critical for guiding clinical management, particularly the distinction between non-muscle-invasive (T1) and muscle-invasive (T2-T4) disease. Although MRI offers superior soft-tissue contrast, image interpretation remains opera-tor-dependent and subject to inter-observer variability. This study proposes an automated deep learning framework for MRI-based bladder cancer staging to support standardized radio-logical interpretation. A sequential AI-based pipeline was developed, integrating hybrid tumor segmentation using YOLOv11 for lesion detection and DeepLabV3 for boundary refinement, followed by three deep learning classifiers (VGG19, ResNet50, and Vision Transformer) for MRI-based stage prediction. A total of 416 T2-weighted MRI images with radiology-derived stage labels (T1-T4) were included, with data augmentation applied during training. Model performance was evaluated using accuracy, precision, recall, F1-score, and multi-class AUC. Performance un-certainty was characterized using patient-level bootstrap confidence intervals under a fixed training and evaluation pipeline. All evaluated models demonstrated high and broadly comparable discriminative performance for MRI-based bladder cancer staging within the present dataset, with high point estimates of accuracy and AUC, particularly for differentiating non-muscle-invasive from muscle-invasive disease. Calibration analysis characterized the probabilistic behavior of predicted stage probabilities under the current experimental setting. The proposed framework demonstrates the feasibility of automated MRI-based bladder cancer staging derived from radiological reference labels and supports the potential of deep learning for stand-ardizing and reproducing MRI-based staging procedures. Rather than serving as an independent clinical decision-support system, the framework is intended as a methodological and work-flow-oriented tool for automated staging consistency. Further validation using multi-center datasets, patient-level data splitting prior to augmentation, pathology-confirmed reference stand-ards, and explainable AI techniques is required to establish generalizability and clinical relevance.

Splenic hemangiosarcoma (SHSA) is an aggressive neoplasm of dogs characterized by high metastatic rate and short survival time. Although staging and treatment are well established prognostic factors, the implication of specific metastatic sites remains unclear. Describe the frequency and distribution of metastatic site at diagnosis in dogs with SHSA and evaluate the potential prognostic role of different metastatic locations. Sixty-six dogs with histologically confirmed SHSA. Retrospective, multicenter, descriptive study of dogs with SHSA treated by splenectomy. Data collected included demographics, clinical stage, and site of metastasis at diagnosis and at death, staging procedures, histopathology results, treatment protocols, and outcome. Survival analysis was conducted using Kaplan-Meier and Cox proportional hazards models. At diagnosis, three dogs were stage I (5%), 35 stage II (53%), and 28 stage III (42%). Overall median tumor-specific survival (TSS) was 132days. Stage III disease and hepatic metastases were associated with significantly decreased survival (P<.001). Dogs with liver metastasis that received anthracycline-based chemotherapy had longer survival compared with dogs that received metronomic therapy (255 vs 65days, P=.02). Muscular and pulmonary metastases did not correlate with worse outcomes. Stage and treatment were confirmed as prognostic factors, with patients in stage III and patients having received surgery alone having a worse prognosis. Although current staging classifies all metastatic disease as stage III, metastatic site may have variable impact on survival and should be considered when devising treatment strategy.

Background: Head and neck (H&N) cutaneous melanomas have poorer outcomes than melanomas at other sites, yet sentinel lymph node biopsy (SLNB)—a key prognostic tool in clinically node-negative disease—is less frequently performed, particularly outside tertiary centers. We evaluated the feasibility and prognostic relevance of SLNB in a medium-volume regional institution. Methods: We retrospectively reviewed patients with primary H&N cutaneous melanoma who underwent SLNB at the Department of Oral and Maxillofacial Surgery, University of Szeged, between 2010 and 2022. Clinicopathological features, nodal outcomes, recurrence patterns, recurrence-free survival (RFS), and overall survival (OS) were analyzed using Kaplan–Meier methods and univariate Cox regression. Results: Thirty-eight patients underwent SLNB, with a 100% sentinel lymph node identification rate and no major complications. Positive sentinel lymph nodes were identified in 8 patients (21.1%). Two false-negative events occurred, resulting in a false-omission rate of 6.7% and a negative predictive value of 93.3%. SLN-negative patients demonstrated longer RFS and OS, although differences were not statistically significant. Among patients with intermediate-risk melanoma (pT1b–pT3a), 18.5% had a positive SLN. Conclusions: SLNB is a safe and clinically meaningful staging procedure for H&N melanoma in a medium-volume regional center. Sentinel node status provides important prognostic information and supports appropriate patient selection for contemporary adjuvant therapy.

Sentinel lymph node biopsy is the standard procedure in the treatment of breast cancer. After neodjuvant therapy, patients with initially positive axillary nodes (cN1) may convert to clinically negative status (ycN0). In these cases, the use of sentinel lymph node biopsy alone may be questionable due to its relatively high false-negative rate exceeding 10%. To observe whether targeted axillary dissection combining with biopsy of a previously marked lymph node, offers a potential solution. Between June 20, 2023 and November 6, 2024, SAVI SCOUT® radar reflector localization was used in 18 breast cancer patients with cT1-cT2cN1cM0 status. Sentinel lymph node biopsy was performed using dual tracers, while marked lymph node biopsy was guided by the SAVI SCOUT® system. If conversion from cN1 to ycN0 was confirmed after neoadjuvant therapy, targeted axillary dissection was performed. When no metastasis was detected in the excised lymph nodes, no further axillary surgery was carried out; if micrometastasis or macrometastasis was confirmed histologically, axillary lymph node dissection followed. Before neoadjuvant therapy, 18 patients had metastatic axillary lymph nodes marked. Surgery has been completed in 10 patients. In 1 case, cN1 status persisted after neoadjuvant treatment, leading to axillary lymph node dissection. In 9 patients, conversion from cN1 to ycN0 occurred, and targeted axillary dissection was performed. The marked lymph node was successfully identified in all cases. In 4 cases, axillary lymph node dissection was avoided, and 2 patients achieved a pathological complete response. In the remaining 5 cases, micro- or macrometastases were detected, necessitating axillary lymph node dissection. No targeted axillary dissection-related complications occurred. The SAVI SCOUT® radar reflector localization technique proved to be a safe and feasible method, allowing for the precise removal of metastatic lymph nodes marked prior to neoadjuvant treatment. Targeted axillary dissection was found to be an accurate and reliable staging procedure that may help avoid axillary lymph node dissection and reduce surgical morbidity. Orv Hetil. 2026; 167(1): 2-8.

One-Year Functional Patency and Comparison of Superficialization Techniques for Brachiobasilic Arteriovenous Fistulas.