Search Results (467)

Background/Objectives: Rapid optical assessment of freshly excised basal cell carcinoma (BCC) specimens may shorten the interval between excision and margin evaluation. This prospective pilot study estimated the diagnostic performance of ex vivo line-field confocal optical coherence tomography (LC-OCT) for detecting residual BCC at lateral surgical margins, using histopathology as the reference standard. Methods: Fifty-five clinically suspicious lesions from 48 patients were examined at two centers. Results were analyzed for the complete cohort and for a post-training inclusion phase comprising 32 lesions from 31 patients. Overall lesion-level consensus classifications were recorded separately from classifications of the four clock-face quadrants. Lesions with a negative overall LC-OCT assessment and at least one non-evaluable quadrant were classified as indeterminate and excluded from the primary lesion-level analysis. Thirteen lesions also underwent exploratory ex vivo fusion confocal microscopy (evFCM). Results: In the inclusion phase, 125 of 128 quadrants were evaluable. Thirteen true-positive, 106 true-negative, 2 false-negative, and 4 false-positive quadrant results yielded 86.7% sensitivity, 96.4% specificity, and 95.2% accuracy. At the lesion level, 2 of 32 results were indeterminate. Among the remaining 30 lesions, LC-OCT yielded 5 true-positive, 22 true-negative, 2 false-negative, and 1 false-positive results, corresponding to 71.4% sensitivity, 95.7% specificity, and 90.0% accuracy. The evFCM analysis was descriptive because the subset was small and nonconsecutive. Conclusions: Ex vivo LC-OCT showed promising specificity and overall accuracy for assessing lateral BCC margins after training. The limited number of margin-positive lesions, indeterminate results, clustered quadrant data, and absence of systematic deep-margin imaging require cautious interpretation. LC-OCT should not replace histopathological margin assessment on the basis of the present data. Full article

Background/Objective: Laparoscopic gastrectomy (LG) and robotic gastrectomy (RG) exhibit similar surgical outcomes in patients with gastric cancer (GC), except for the higher cost associated with RG. Comparative surgical outcome studies after open conversion from laparoscopic (OL) and robotic (OR) gastrectomy in GC are limited. This study aimed to evaluate clinical effectiveness while considering differences in procedural cost. Methods: This retrospective cohort study included a comparative analysis of patients with GC who underwent OL or OR. Inclusion criteria were histologically confirmed adenocarcinoma and curative resection for GC using OL or OR. Exclusion criteria included initially planned open surgery and other laparoscopic or robotic procedures without gastrectomy. Clinicopathological characteristics, as well as short- and long-term surgical outcomes, were compared between groups. Results: Overall, 118 (1.9%) of 6336 LG cases and 10 (2.6%) of 384 RG cases were included (p = 0.3308). Clinicopathological characteristics were statistically comparable between groups. Postoperative complication incidence, evaluated using the Clavien–Dindo classification, was 19.5% and 10% in the OL and OR groups, respectively (p > 0.05). The median hospital stay was 8 and 9.5 days in the OL and OR groups, respectively (p > 0.05). Reasons for open conversion were similar between groups and included adhesion, bleeding, advanced disease, and positive resection margins, among others. Overall 5-year survival was 0.79 (0.72–0.88) and 0.88 (0.67–1.0) in OL and OR, respectively (p = 0.596). Conclusions: Short- and long-term surgical outcomes after OL and OR did not differ statistically. Selection of LG versus RG should be performed with caution. Full article

Objectives: To describe the surgical setup, docking strategy, and perioperative outcomes of retroperitoneal renal surgery performed with the Hugo™ RAS system, reporting, to our knowledge, the first dedicated surgical series. Methods: Between February and August 2025, 30 consecutive patients underwent retroperitoneal renal surgery with the Hugo™ RAS system at a single institution. Procedures included robot-assisted partial nephrectomy (RAPN, n = 15) and robot-assisted pyeloplasty (n = 15), performed by a single experienced surgeon. A standardized retroperitoneal access and reproducible trocar configuration were adopted. A three-arm configuration with predefined docking and tilt angles was used. Feasibility was defined as completion of the procedure without conversion to open or transperitoneal surgery. Perioperative data were prospectively collected and reported as median and interquartile range (IQR). Results: All procedures were completed without conversion or additional trocar placement. In the RAPN cohort, median docking time was 5 min (IQR 5–5), operative time was 180 min (IQR 172–200), and estimated blood loss was 200 mL (IQR 150–250). Three patients (20%) experienced Clavien–Dindo grade II complications; no major complications occurred. Positive surgical margins were observed in 1 patient (6%), with no radiological recurrence at 6-month follow-up. In the pyeloplasty cohort, operative time was 150 min (IQR 147–180) and estimated blood loss was 70 mL (IQR 50–100). One patient (7%) developed a grade II complication. Renal function remained stable in both groups. Conclusions: Retroperitoneal renal surgery using the Hugo™ RAS system is feasible, safe, and reproducible when supported by a standardized docking and port configuration. Full article

Background/Objectives: Post-radiation sarcomas (PRS) are secondary malignancies occurring years after radiotherapy. Due to low incidence, evidence on prognostic factors and management is limited. Methods: MEDLINE, Embase, and the Cochrane Library were searched from January 1960 to January 2026. Eligible studies included observational cohorts reporting outcomes of histologically confirmed PRS. We excluded case reports, case series with fewer than ten patients, reviews, editorials, and studies without survival or recurrence outcomes. Two authors independently screened studies, extracted data, and assessed risk of bias. Hazard ratios (HRs) and 95% confidence intervals were extracted or calculated. The primary outcome was overall survival. Heterogeneity was assessed using the I² statistic. This study was registered with PROSPERO (CRD42023457401). Results: The search identified 4222 records, of which 28 studies comprising 2438 patients were eligible for analysis. Most patients were female (2008, 83.3%), reflecting a predominance of breast radiation-associated angiosarcoma. Older age, larger tumor size, higher histological grade, and positive surgical margins were consistently associated with worse overall survival. Complete (R0) resection was associated with improved survival (pooled HR < 1.0), as was treatment in specialized sarcoma centers. Chemotherapy and additional radiotherapy were not associated with improved overall survival. Substantial heterogeneity was observed (I² > 50% for several analyses). Overall risk of bias was moderate. Conclusions: PRS share key prognostic determinants with sporadic sarcomas. Complete surgical resection and management in specialized sarcoma centers are the most important factors associated with improved outcomes. These findings support centralized care and highlight the need for prospective research to improve risk stratification and management of PRS. Full article

Introduction: The optimal surgical approach for elderly bladder cancer patients remains controversial. We compared perioperative morbidity and short-term outcomes in patients aged ≥ 75 years undergoing open radical cystectomy (ORC) versus robot-assisted radical cystectomy (RARC). Methods: A retrospective, multicenter cohort study was performed including 179 patients aged ≥ 75 years, of whom 101 underwent RARC between 2021 and 2025, and 78 underwent ORC between 2016 and 2020. After 1:1 propensity score matching, 138 patients were analyzed to assess perioperative complications and short-term postoperative outcomes. Pathological outcomes, including pathological stage, tumor grade, lymph node status, and positive surgical margins, were additionally compared between groups. Propensity score matching was performed based on age, body mass index (BMI), pathological stage, comorbidities, prior chemotherapy, and type of urinary diversion. Results: Following propensity score matching, RARC was associated with longer operative time (332 vs. 247 min; p < 0.001) but resulted in significantly lower blood loss (310 vs. 743 mL; p < 0.001), reduced transfusion rates, shorter length of hospital stay (p < 0.001), and fewer overall intraoperative complications (8.7% vs. 18.8%; p = 0.04). Patients undergoing RARC also experienced lower rates of any complications (43.5% vs. 62.3%; p = 0.02) and major complications (Clavien–Dindo III–V: 11.6% vs. 27.5%; p = 0.03). Postoperative mortality was low in both groups and did not differ significantly between RARC and ORC (1.4% vs. 2.9%; p = 1.00). In multivariate analysis, surgical approach independently predicted major complications, with RARC conferring a significantly lower risk (OR 0.75; 95% CI 0.51–0.88; p = 0.04). Analysis of the learning curve showed a significant reduction in major complications over time for RARC (OR 0.68; 95% CI 0.53–0.93; p = 0.01) but not for ORC. Conclusions: RARC offers superior perioperative outcomes, including reduced blood loss, shorter hospitalization, and lower rates of major complications, without differences in short-term pathological outcomes. These data support RARC as a safe and effective option for elderly patients undergoing radical cystectomy. Full article

Background: Accurate delineation of ductal carcinoma in situ (DCIS) remains a key challenge in surgical planning. Although contrast-enhanced mammography (CEM) improves lesion detection, its clinical role in informing individualized surgical strategies remains unclear. This study evaluated the impact of CEM on preoperative assessment and surgical planning, with particular emphasis on whether its effect varies across patient subgroups. Methods: This multicentre pilot observational cohort study included 102 patients: 51 prospective patients undergoing preoperative CEM and mammography (MMG) and 51 retrospective controls assessed with MMG alone. Imaging-derived lesion size and planned resection volume were compared with pathological size using correlation analysis, intraclass correlation coefficient (ICC), and Bland–Altman methods. Surgical outcomes were assessed, and subgroup analyses explored differences according to CEM enhancement status. Results: CEM showed improved correlation with pathological DCIS size compared with MMG (ρ = 0.54 vs. 0.37), with the strongest agreement in CEM-positive lesions (ρ = 0.67; ICC 0.745). However, its clinical impact was not uniform. At the population level, CEM did not significantly change planned resection volume or surgical thresholds. In contrast, in CEM-positive patients, CEM was associated with larger planned resections, proportional to pathological tumor burden. Reoperation rates were lower in the CEM cohort (5.9% vs. 17.6%), without statistical significance, and margin status was comparable. Conclusions: The impact of CEM on surgical planning in DCIS is heterogeneous and largely confined to patients with enhancing lesions. These findings suggest that the value of CEM may lie in its selective use, where it can refine assessment of disease extent in specific subgroups rather than in routine application. Further studies incorporating predictive approaches are needed to support risk-adapted imaging strategies. Full article

Background/Objectives: Salivary gland tumors account for 2.0–6.5% of all head and neck neoplasms, approximately 70% of which are located in the parotid gland. Preoperative determination of tumor histology is a crucial step in the diagnostic and therapeutic pathway because it guides the choice of surgical technique, affecting the achievement of adequate resection margins and preservation of the facial nerve. Fine-needle aspiration (FNA) cytology is the most commonly used cytologic method. However the complex and heterogenous histologic architecture of salivary gland tumors is associated with a significant proportion of false results. Dynamic contrast-enhanced magnetic resonance imaging (DCE–MRI) is a valuable complementary diagnostic tool that enables noninvasive analysis based on perfusion assessment and tissue characterization. The aim of this study is to evaluate the utility of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in the diagnosis of salivary gland tumors and to compare its diagnostic performance with fine-needle aspiration (FNA). Methods: We present a study of 25 patients who underwent DCE-MRI, FNA and postoperative histopathologic examination. Results: Among the 25 patients included, DCE-MRI results were concordant with the postoperative histopathologic diagnosis in 76% of cases, whereas only 36% of positive FNA results correlated with the histopathologic diagnosis. Conclusions: DCE-MRI demonstrates greater correlation with postoperative histopathologic diagnosis compared with FNA. Advantages of DCE-MRI include its noninvasive nature and the ability to image the entire region of interest. Key benefits of FNA are its wide availability and low cost. Selecting the most appropriate preoperative diagnostic modality can positively influence subsequent diagnostic and therapeutic management. Full article

Background: Intelligent decision support systems for colonoscopy can fail when encountering out-of-distribution surgical instruments such as snares or biopsy forceps, producing false-positive polyp masks that may contribute to automation bias and reduce workflow reliability. This study aimed to develop and evaluate a parameter-efficient framework for open-set-aware polyp segmentation that can reject such anomalous inputs while preserving in-distribution segmentation performance. Methods: We propose PolypSAM-Open, which integrates a prototype-based Open-Set Learning (OSL) module with Low-Rank Adaptation (LoRA) in the MedSAM image encoder. The model was trained on Kvasir-SEG using an 85/15 split of authentic polyp images and synthetic high-frequency Gaussian noise to learn a rejection margin. Zero-shot out-of-distribution detection was evaluated on 590 unseen authentic surgical instruments from Kvasir-Instrument. Segmentation and detection performance were compared against a standard MedSAM-LoRA baseline. Results: Standard parameter-efficient fine-tuning yielded an OOD AUROC of 0.4263 on authentic surgical instruments. PolypSAM-Open improved zero-shot OOD AUROC to 0.9535 ($p<0.001$). Despite allocating 15% of training capacity to the synthetic-noise rejection margin, PolypSAM-Open maintained segmentation performance comparable to the standard fine-tuned baseline (Dice 0.9728 versus 0.9723). On ETIS-LaribPolypDB and CVC-ClinicDB, Dice scores were 0.9301 and 0.9386, respectively. The approach remained parameter-efficient, updating 4.48% of total parameters while adding negligible inference latency relative to the underlying MedSAM forward. Conclusions: Prototype-based open-set adaptation can substantially improve rejection of unseen surgical artifacts in AI-assisted colonoscopy while preserving high segmentation accuracy. These findings position PolypSAM-Open as a promising strategy for potentially safer decision-support segmentation in endoscopic workflows; prospective clinical validation remains necessary. Full article

Background/Objectives: Breast fibromatosis (desmoid-type fibromatosis) is a rare, locally aggressive neoplasm that may closely mimic breast carcinoma on imaging. Occurrence in male patients is exceptionally uncommon, particularly in association with gynecomastia. We report a rare case of male breast fibromatosis and discuss the diagnostic challenges, surgical decision-making, and reconstructive management. Methods: A 35-year-old male presented with a palpable right breast mass and bilateral grade II gynecomastia. Histopathological and immunohistochemical analyses were performed. Following multidisciplinary evaluation, the patient underwent wide local excision of the lesion with immediate glandular-adipose tissue rearrangement and simultaneous contralateral gynecomastia correction. Results: Ultrasonography demonstrated a hypoechoic lesion of 12 × 11 mm, whereas mammography revealed an irregular mass measuring up to 34 mm. Core needle biopsy showed a fibroblast-rich spindle-cell proliferation with nuclear β-catenin positivity, consistent with desmoid-type fibromatosis. Final histopathology confirmed a 2.5 cm lesion with negative resection margins (minimum margin 5 mm). Immediate reconstruction achieved a satisfactory chest contour and symmetry. No evidence of recurrence was observed during 18 months of follow-up. Conclusions: Breast fibromatosis should be considered in the differential diagnosis of suspicious male breast lesions because radiological findings may closely resemble breast carcinoma. Histopathological confirmation remains essential for appropriate management. In selected patients, immediate glandular-adipose tissue rearrangement may facilitate single-stage defect reconstruction and preservation of chest contour following oncologic excision. Full article

Twelve years after the 2013 fifth edition, the American College of Radiology has released BI-RADS^® v2025, with substantial revisions across mammography, ultrasonography, MRI, and the newly independent contrast-enhanced mammography (CEM) section. This review compares the two editions and reads the main changes against the available evidence on diagnostic performance and reader agreement, rather than only cataloguing them. Examples featuring digital breast tomosynthesis, synthetic mammography, and automated whole-breast ultrasonography now appear throughout the modality sections. “Lobulated” has been added as a shape descriptor across all modalities, while “microlobulated” was dropped from the mammography margin list. Calcification terms shifted from etiology to morphology: “milk of calcium” became “layering,” “punctate” was folded into “round,” and “dystrophic” moved under “coarse.” Ultrasonography gained two new entries, “non-mass lesion” and “echogenic rind,” and on MRI, “initial phase” was renamed “early phase.” Category 6 was rewritten; therefore, surgical excision is recognized as one of several definitive local treatments, and an “uncoupled” principle now separates assessment from management. The auditing section folds Category 3 follow-up into basic auditing and adds a Method of Detection data field. Most supporting data, however, predate v2025, and reader agreement remains lower for newer descriptors such as non-mass enhancement; whether the revisions measurably improve reproducibility is still unproven. Integrating every high-sensitivity tool also brings more false positives, overdiagnosis, and cost; artificial intelligence and radiomics may help close the reproducibility gap, but resource-stratified, equitable implementation will be essential. With v2025, BI-RADS becomes a multimodality framework rather than a reporting lexicon alone. Full article

Background: MEIS1::NCOA1/2 fusion sarcomas are a recently described molecular entity arising predominantly in the genitourinary and gynecologic tracts. Their clinical presentation is often misleading, and no standardized treatment guidelines currently exist. Methods: A literature review was conducted using PubMed to identify all reported cases of molecularly confirmed MEIS1::NCOA1/2 fusion sarcomas. Clinicopathological, molecular, treatment, and outcome data were extracted for comparative analysis. Case: We report the case of a 38-year-old nulliparous woman who presented with a right vulvar induration clinically consistent with a Bartholin gland cyst. Surgical excision revealed a spindle cell mesenchymal tumor harboring a MEIS1::NCOA2 fusion transcript and a CTNNB1 exon 3 mutation, with probable incomplete resection margins. A local recurrence was documented by MRI and PET–CT at eight months. Surgical re-excision revealed diffuse involvement and complete excision was considered uncertain. Adjuvant external beam radiotherapy followed by an MR-Linac boost was administered. Discussion: This case highlights the diagnostic challenge of Bartholin gland masses. We provide a review of the literature on MEIS1::NCOA1/2 fusion sarcomas and examine the potential aggressiveness of tumors that additionally harbor a CTNNB1 mutation. Given the nonspecific immunophenotype of this entity, this case underscores the indispensable role of RNA-based molecular sequencing in the diagnosis of low-grade spindle cell tumors when immunohistochemistry proves inconclusive. We further discuss the surgical challenges inherent to this anatomical region and explore intention-to-treat radiotherapy as a potential therapeutic option. Conclusions: We report a rare case of a MEIS1::NCOA2 fusion-positive sarcoma arising in the Bartholin gland region, and, to our knowledge, the first case in which radiotherapy with curative intent has been explored for this entity. This observation expands the limited literature on this emerging clinicopathological entity. Full article

Background: Reflectance confocal microscopy (RCM) enables noninvasive, high-resolution visualization of skin tumors and may improve preoperative margin assessment in nonmelanoma skin cancer (NMSC). However, its impact on surgical outcomes in routine clinical practice remains incompletely defined. Objective: To evaluate surgical outcomes of NMSC managed with systematic preoperative RCM-guided margin assessment, comparing wide local excision (WLE) and Mohs micrographic surgery (MMS). Methods: We conducted a retrospective study of 71 consecutive NMSC treated at a tertiary dermatologic oncology center. All tumors underwent RCM evaluation for diagnosis and preoperative margin mapping. Outcomes included positive margins after WLE, local recurrence, recurrence-free survival, and the number of Mohs stages. Associations were analyzed using Fisher’s exact tests and Firth penalized logistic regression. Results: Among 47 tumors treated with WLE, positive margins occurred in 10.6%. Among 24 MMS cases, 70.8% were cleared in a single stage. Local recurrence occurred in 14.9% of WLE-treated tumors and in none of the MMS-treated tumors (p = 0.087). All recurrences occurred in tumors initially demonstrated positive margins after WLE, despite subsequent re-excision and histologic clearance. In multivariable Firth regression, MMS was associated with a lower risk of recurrence (OR 0.13; 95% CI, 0.008–2.10). Conclusions: In this RCM-guided cohort, low margin positivity after WLE and high single-stage clearance in MMS suggest improved surgical accuracy and efficiency. Recurrence was confined to margin-positive tumors, supporting a margin-driven model of tumor control and highlighting RCM as a potential preoperative margin-control strategy. Full article

Background/Objectives: Robot-assisted partial nephrectomy (RAPN) has increasingly replaced laparoscopic partial nephrectomy (LPN) in the management of localized renal tumours. This study aimed to evaluate perioperative, functional and surgical margin outcomes during an institutional transition from LPN to RAPN in a high-volume centre. Methods: We performed a retrospective single-centre analysis of 100 consecutive patients undergoing minimally invasive partial nephrectomy. The last 50 LPN cases (August 2014–May 2018) were compared with the first 50 RAPN cases (June 2018–February 2020). Baseline characteristics, perioperative outcomes, early functional parameters and surgical margin status were analysed. Complications were classified according to the Clavien–Dindo system. Results: Tumours treated in the RAPN group were significantly larger (3.4 vs. 2.5 cm) and more complex (RENAL score of 6 vs. 5; p < 0.001). Operative time was longer in the RAPN group (143 vs. 122 min; p < 0.01), while warm ischaemia time did not differ significantly (16 vs. 15 min; p = 0.37). Estimated blood loss was lower (0 vs. 10 mL; p = 0.049) and the hospital stay was shorter (3 vs. 4 days; p < 0.001) in the RAPN group. Haemoglobin decrease and postoperative creatinine change were comparable between groups. Positive surgical margins were observed less frequently in the RAPN group (2.3% vs. 7.7%), but this difference was not statistically significant (p = 0.34). Complication rates were significantly lower in the RAPN group (4% vs. 22%; p < 0.05), with no major complications observed in the robotic cohort. Conclusions: In this institutional experience, RAPN was associated with favourable perioperative outcomes during the transition period, despite the treatment of larger and more complex renal tumours. The slightly longer operative and warm ischaemia times likely reflect a more comprehensive reconstruction strategy, which may contribute to improved haemostatic control and lower complication rates. Further studies with extended follow-up are required to evaluate oncological and renal functional outcomes. Full article

Background/Objectives: Staged resection with temporizing vacuum-assisted closure (VAC) has been adopted to facilitate margin assessment and local control of soft tissue sarcomas (STS). Accordingly, the objective of this study is to compare rates of local recurrence (LR) among superficial STS patients treated with and without temporizing VAC therapy. Methods: We conducted a multi-institutional retrospective cohort study of superficial STS patients treated at three tertiary care centers. Patients were matched by grade, and descriptive statistics and multivariate binary logistic regression were performed. Results: After matching, 314 superficial STS patients were included in analysis. VAC patients were more likely to present with a history of prior unplanned excision (p = 0.024), with recurrent disease (p = 0.004), harbor a diagnosis of myxofibrosarcoma (p < 0.001), and have positive initial surgical margins (p < 0.001). After multivariate analysis, VAC use remained independently associated with increased LR rates (OR = 4.117; p = 0.003). Conclusions: In this multi-institutional analysis of superficial STS patients, staged resection with temporizing VAC was not associated with improved LR rates. Rather, the VAC cohort represented distinctly higher-risk tumor biology and complex oncologic presentations, in whom the risk of LR may not be fully mitigated by surgical staging alone. Full article

Background/Objectives: We aimed to evaluate temporal changes in patient selection, surgical practice, and postoperative outcomes of radical prostatectomy in Switzerland (2020–2025) using a national registry. Methods: Data from 7687 patients undergoing radical prostatectomy were extracted from a prospective national registry (January 2020–March 2025). Preoperative, operative, and postoperative variables were compared descriptively using the Mann–Whitney U test for continuous variables and the chi-square test for categorical variables. Temporal trends were assessed using locally estimated scatterplot smoothing. Multivariable logistic regression analyses were performed for positive surgical margins and PSA persistence. Results: Baseline patient characteristics remained stable over time. The use of MRI-targeted biopsy increased from 46% to 84% (p < 0.001). The proportion of low-risk diseases being treated decreased from 7.1% to 4.0% (p = 0.040). Minimally invasive surgery increased from 81% to 95% (p < 0.001); pelvic lymph node dissection declined from 83% to 63% (p < 0.001). Operative time (205 vs. 185 min, p = 0.002) and blood loss (300 vs. 200 mL, p < 0.001) decreased over time. Lymph node invasion decreased from 11% to 6.0% (p = 0.001), positive surgical margins from 27% to 22% (p = 0.044), and prostate-specific antigen persistence from 18.5% to 11.3% (p = 0.001). Severe postoperative complications decreased from 2.5% to 0.8% (p = 0.014). After multivariable adjustment, surgery performed in 2024 remained independently associated with lower rates of positive surgical margins (OR 0.73, 95% CI 0.57–0.93) and PSA persistence (OR 0.26, 95% CI 0.19–0.37) compared with 2020. Conclusions: Using the Swiss national registry, we demonstrate that radical prostatectomy has evolved toward more risk-adapted patient selection, near-universal minimally invasive surgery, and more selective pelvic lymph node dissection. Despite a shift away from low-risk disease, perioperative and early oncological outcomes improved, likely reflecting a combination of evolving diagnostic pathways, increasing surgical experience, and broader changes in perioperative management. Full article