Background and Objectives: Artificial intelligence (AI) has shown promising performance in skin-lesion classification; however, its fairness, external validity, and real-world reliability remain uncertain. This systematic review and meta-analysis evaluated the diagnostic accuracy, equity, and generalizability of AI-based dermatology systems across diverse imaging modalities and clinical settings. Materials and Methods: A comprehensive search of PubMed, Embase, Web of Science, and ClinicalTrials.gov (inception-31 October 2025) identified diagnostic accuracy studies using clinical, dermoscopic, or smartphone images. Eighteen studies (11 melanoma-focused; 7 mixed benign-malignant) met inclusion criteria. Six studies provided complete 2 × 2 contingency data for bivariate Reitsma HSROC modeling, while seven reported AUROC values with extractable variance. Risk of bias was assessed using QUADAS-2, and evidence certainty was graded using GRADE. Results: Across more than 70,000 test images, pooled sensitivity and specificity were 0.91 (95% CI 0.74-0.97) and 0.64 (95% CI 0.47-0.78), respectively, corresponding to an HSROC AUROC of 0.88 (95% CI 0.84-0.92). The AUROC-only meta-analysis yielded a similar pooled AUROC of 0.88 (95% CI 0.87-0.90). Diagnostic performance was highest in specialist settings (AUROC 0.90), followed by community care (0.85) and smartphone environments (0.81). Notably, performance was lower in darker skin tones (Fitzpatrick IV-VI: AUROC 0.82) compared with lighter skin tones (I-III: 0.89), indicating persistent fairness gaps. Conclusions: AI-based dermatology systems achieve high diagnostic accuracy but demonstrate reduced performance in darker skin tones and non-specialist environments. These findings emphasize the need for diverse training datasets, skin-tone-stratified reporting, and rigorous external validation before broad clinical deployment.

Background and Objectives: Multiparametric MRI (mpMRI) has improved prostate cancer (PCa) detection, but the added value of cognitive fusion (CF) over systematic biopsy (SB) remains debated. This prospective study evaluated the diagnostic performance of SB, CF, and their combined use in patients with Prostate Imaging and Reporting Data System (PI-RADS) ≥3 lesions. Materials and Methods: A total of 282 patients underwent mpMRI followed by both SB and CF biopsy. Results: PCa was diagnosed in 154 patients. SB detected 112 cancers (24 ISUP 1 (International Society of Urological Pathology), 88 ISUP ≥ 2), and CF detected 135 cancers (16 ISUP 1, 119 ISUP ≥ 2), while the combined approach detected all 154 cancers (9 ISUP 1, 145 ISUP ≥ 2). CF identified 42 cancers missed by SB, whereas SB identified 19 cancers not detected by CF. CF upgraded 38 patients from low-risk to intermediate-risk (23)/high-risk (15) categories, while SB underestimated disease severity in 41 cases. No major biopsy-related complications were recorded. Conclusions: CF biopsy outperformed SB in detecting clinically significant PCa and improved risk stratification, while the combined approach provided the highest overall diagnostic performance, supporting its use in contemporary PCa assessment.

Background and Objectives: Cancer incidence patterns in South Korea have shifted markedly over the past two decades, with notable increases among younger generations. Despite growing concern regarding early-onset cancer, comprehensive assessments of long-term age-, period-, and cohort-specific trends across multiple cancer types remain limited. This study examined nationwide cancer incidence trends from 2001 to 2020 using Joinpoint regression and age-period-cohort (APC) modeling. Materials and Methods: A population-based analysis was conducted using Korea Central Cancer Registry (KCCR) data, including all primary malignant tumors diagnosed from 2001 to 2020. Incidence rates were calculated by sex and 5-year age groups and standardized to the mid-2000 Korean population. Joinpoint regression estimated annual percent change (APC) and average annual percent change (AAPC), accounting for overdispersion and autocorrelation. Independent temporal effects were evaluated through APC modeling using overlapping 10-year birth cohorts, with the 1961 cohort as the reference. Results: Incidence increased for prostate, kidney, breast, and pancreatic cancers, while stomach, liver, lung, and biliary cancers showed continued declines. Colon cancer rose until 2011 and decreased thereafter. More recent birth cohorts exhibited higher risks for prostate, kidney, and pancreatic cancers, whereas older cohorts showed elevated risks for stomach, liver, colon, and biliary cancers. Lung cancer trends diverged by sex, decreasing among men but increasing among women. Conclusions: Marked heterogeneity in long-term incidence patterns across cancer types and generations was identified. Rising rates of lifestyle- and obesity-associated cancers in more recent cohorts highlight the need for continued surveillance and targeted prevention strategies. APC-based evaluation provides essential insight into Korea's evolving cancer landscape and supports future public health planning.

Background and Objectives: The axillary lateral vessel thoracic junction (ALTJ) is a key lymphatic drainage pathway for the arm and a potential structure to spare during regional nodal irradiation (RNI) to reduce lymphedema risk in breast cancer patients. This study aims to demonstrate the feasibility of ALTJ-sparing radiation therapy (RT) planning using Tomotherapy. Materials and Methods: Ten breast cancer patients who had undergone axillary lymph node dissection and whose dissected axillary levels were excluded from the RNI target volume were included. A TomoDirect intensity-modulated RT plan was generated at a dose of 50 Gy in 25 fractions. The dissected axilla was not designated as an organ at risk (OAR) in the original treatment plan. For this study, the axillary lymph node level I (AXL1) and the ALTJ were delineated retrospectively, with the ALTJ considered an OAR in the newly generated study plan. A total of 20 RT plans (10 per group) were statistically compared using various dose-volume parameters. Results: Compared to the original plans, the study plans with ALTJ as an OAR significantly reduced the incidental dose to both the ALTJ (mean: 41.7 ± 3.4 Gy vs. 27.2 ± 1.3 Gy; p = 0.005) and the AXL1 (mean: 43.9 ± 2.0 Gy vs. 37.7 ± 1.9 Gy; p = 0.005). All other dosimetric parameters (V25Gy, V35Gy, V40Gy, Dmin, Dmax) for the ALTJ were also significantly lower in the study plans. This ALTJ sparing was achieved while maintaining all required dose-volume constraints for target volumes and standard OARs such as the lung and heart. Conclusions: This study demonstrates that simply excluding the dissected axilla from the target volume without designating it as an OAR still results in a substantial incidental dose to this region. Our findings also show the feasibility of using Tomotherapy to selectively spare the axilla, particularly the ALTJ subregion of AXL1, which is critical for lymphedema risk in breast cancer patients.

Background and Objectives: Cholangiocarcinoma (CCA) is an aggressive tumor that originates in the biliary tract and is subdivided anatomically into intrahepatic (iCCA) and extrahepatic (perihilar-pCCA and distal-dCCA). Diagnosis remains challenging, particularly for extrahepatic forms (pCCA and dCCA). We aimed to assess the relation between systemic inflammatory markers-specifically lymphocyte-related ratios-and tumor characteristics in a Romanian cholangiocarcinoma cohort. Materials and Methods: We conducted an exploratory single-center study including adult patients with a confirmed CCA histopathological diagnosis. We excluded patients with an uncertain diagnosis or tumors of the ampulla of Vater or gallbladder. Demographic and clinical data were retrospectively collected from medical records. Results: Tumor localization was the strongest predictor of metastatic disease. The odd of metastasis was 7.3 times higher for iCCA than dCCA and 4.5 times higher for iCCA than pCCA. Although several evaluated inflammatory biomarkers showed statistically significant associations, their clinical relevance was limited. The odds ratios for these biomarkers were characterized by lower bounds near the null value and wide confidence intervals, reflecting considerable patient heterogeneity, model instability, and inconclusive effect sizes. Conclusions: Our findings suggest a potential biological link between systemic inflammation, metastatic spread, and tumor differentiation grade that deserves further investigation using more accurate systemic inflammation biomarkers than those routinely collected.

Background and Objectives: Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a T-cell lymphoma that has shown an interest in the medical community in recent years. Given its emerging clinical relevance, accurate imaging plays a crucial role in diagnosis, staging, and follow-up. This systematic review aims to evaluate the role of Fluorine-18 Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in the staging and follow-up of patients with BIA-ALCL, focusing on its diagnostic accuracy and clinical impact. Materials and Methods: A systematic search of PubMed and National Center for Biotechnology Information (NCBI) was conducted to identify studies assessing the use of 18F-FDG PET/CT in BIA-ALCL up to and including 15 April 2024, using the following keywords "breast implant-associated anaplastic large cell lymphoma" AND "PET/CT" AND "BIA-ALCL". Data regarding the role of PET/CT in disease detection, staging, therapeutic guidance, and post-treatment surveillance was analyzed and synthesized in a tabulated format for comparative analysis. Given study heterogeneity, findings were synthesized narratively and diagnostic performance metrics were summarized descriptively, and no formal risk-of-bias assessment was performed due to the descriptive, case-based nature of evidence. Results: A total of 28 studies met the inclusion criteria, comprising 27 individual case reports and one case series that included seven patients. Across these studies, 18F-FDG PET/CT demonstrated diagnostic utility in the evaluation of BIA-ALCL, serving primarily for initial disease staging in 27 cases and for monitoring treatment response in 16 cases. Discussion: The review's limitations include potential search bias due to variable radiotracer terminology and the restriction to English-language studies, which may limit literature retrieval and generalizability. Conclusions: Thus, 18F-FDG PET/CT demonstrated significant value in early lesion detection, accurate staging, assisting in monitoring treatment response and detecting recurrence.

Background: The Hippo signaling pathway, a highly conserved regulatory cascade, regulates tissue homeostasis, organ size, and tumor suppression. Dysregulation of this pathway contributes to oncogenesis in various human malignancies; however, its clinicopathologic relevance in cervical cancer has not been completely elucidated. Therefore, this study aimed to investigate the expression patterns of key Hippo pathway proteins and analyze their associations with tumor behavior and clinicopathologic features in cervical carcinoma. Materials and Methods: Ninety-nine cervical cancer specimens obtained from hysterectomies performed at Gyeongsang National University Hospital (2012-2019) were retrospectively analyzed. Immunohistochemical staining for Yes-associated protein (YAP), phosphorylated YAP (p-YAP), mammalian sterile-20-like kinase-1 (MST1), and large tumor suppressor kinase-1 (LATS1) was performed on tissue microarrays. Chi-square or Fisher's exact tests and logistic regression were employed for assessing associations between marker expression and clinicopathologic variables. Functional validation was conducted via small interfering RNA-mediated YAP knockdown in Caski cervical cancer cells, with reverse transcription-polymerase chain reaction, Western blotting, and wound-healing assays assessing YAP suppression and cell migration. Results: YAP and p-YAP were expressed in 71.8% and 62.6% of tumors, respectively; MST1 in 82.8%; and LATS1 in 22.2%. YAP and p-YAP overexpression was correlated with larger tumor size (p = 0.013 and p = 0.011) and higher International Federation of Gynecology and Obstetrics stage (p = 0.007 and p < 0.001). YAP and p-YAP expression was positively correlated (odds ratio, 4.34; 95% confidence interval, 1.70-11.61). MST1 or LATS1 expression demonstrated no significant associations. In vitro, YAP silencing decreased mRNA and protein expression levels and significantly impaired cell migration, supporting its role in tumor aggressiveness. Conclusions: YAP and p-YAP overexpression are associated with advanced stage and larger tumor size in cervical cancer, indicating Hippo pathway dysregulation. YAP functional suppression attenuated migratory capacity, highlighting YAP as a promising prognostic biomarker and therapeutic target.

Background and Objectives: Sleep disturbance (SD) is common among cancer patients and may be influenced by immune-related mechanisms during immune checkpoint inhibitor (ICI) therapy. This study evaluated the prevalence and predictors of SD in patients receiving ICIs. Materials and Methods: This retrospective, two-center study included 187 patients with advanced or metastatic cancers. Sleep quality was assessed at three months using the Pittsburgh Sleep Quality Index (PSQI). Patients were categorized as having no SD (PSQI ≤ 5) or SD (PSQI > 5). Logistic regression analyses identified predictors of SD. Results: Clinically relevant SD was observed in 97 patients (51.9%), with a mean PSQI score of 7.54 ± 5.39. The most affected PSQI components were SD (1.33 ± 1.05) and daytime dysfunction (1.21 ± 1.04). In univariate analyses, Eastern Cooperative Oncology Group (ECOG) performance status ≥ 1 (Odds ratio [OR]: 3.29, 95% confidence interval [CI] 1.77-6.08, p < 0.001), second-line or beyond therapy (OR: 3.76, 95% CI 1.92-7.34, p < 0.001), ≥ 2 metastatic sites (OR: 2.69, 95% CI 1.47-4.92, p = 0.001), and ≥6 ICI cycles (OR: 1.85, 95% CI 1.04-3.32, p = 0.036) were associated with SD. In multivariate analysis, ECOG ≥ 1 (OR: 2.33, 95% CI 1.17-4.62, p = 0.015), second-line or beyond therapy (OR: 2.43, 95% CI 1.14-5.16, p = 0.021), and ≥ 2 metastatic sites (OR: 2.10, 95% CI 1.06-4.16, p = 0.032) remained independent predictors. Conclusions: Over half of patients treated with ICIs experienced SD. Poor performance status, advanced disease burden, and later-line therapy independently predicted impaired sleep, supporting the routine assessment of sleep during ICIs.

Background and Objectives: Pituitary adenomas are common intracranial tumors lacking specific non-invasive biomarkers. This study aimed to determine whether key metabolites and enzymes of the kynurenine pathway-including indoleamine 2,3-dioxygenase (IDO), kynurenine (KYN), kynurenic acid (KYNA), kynurenine aminotransferase (KAT), quinolinic acid, and picolinic acid-can serve as diagnostic biomarkers distinguishing patients with pituitary adenomas from healthy controls. Materials and Methods: We conducted a single-center, cross-sectional, case-control study with 50 patients with pituitary adenomas and 35 healthy controls. Serum levels of IDO, KYN, KYNA, KAT, quinolinic acid, and picolinic acid were measured via enzyme-linked immunosorbent assay (ELISA). Statistical analyses included group comparisons (t-test/Mann-Whitney U), multivariate logistic regression to identify independent predictors, receiver operating characteristic (ROC) curve analysis to evaluate diagnostic performance (area under the curve, AUC), and partial least squares discriminant analysis (PLS-DA) for multivariate metabolic profiling. Results: Serum kynurenine, kynurenic acid, 3-hydroxykynurenine, picolinic acid, IDO and kynureninase were significantly higher in the pituitary adenoma group than in healthy controls (p < 0.001), while tryptophan, kynurenine aminotransferase, anthranilic acid and quinolinic acid showed no significant differences. ROC analysis demonstrated excellent diagnostic accuracy, with KAT (AUC = 0.923) and KYNA (AUC = 0.901) showing the highest discrimination. Multivariate logistic regression identified IDO, KYN, and KYNA as independent predictors of pituitary adenoma (p < 0.05). PLS-DA of the combined metabolite data also demonstrated clear separation between patients and controls, confirming distinct metabolic profiles between the groups. Conclusions: Kynurenine pathway metabolites and enzymes show strong potential as non-invasive biomarkers for pituitary adenomas. In particular, elevated KAT and KYNA levels demonstrated high diagnostic performance. These findings suggest that a panel of kynurenine pathway metabolites could aid in the early, non-invasive detection of pituitary adenomas.

Ageing is sustained by a complex network of cellular and molecular mechanisms. The main mechanisms are cellular senescence, telomere attrition, gene expression changes, metabolic dysregulations, oxidative stress and epigenetic modifications such as DNA methylation. All these networks can harbor the initiation of age-related diseases, skin cancer included. The studies published in the last years linking ageing and skin cancers focus on basal and squamous carcinomas, melanomas and Merkel cell carcinomas. Our review will focus on skin melanomas as one of the aggressive skin cancers along with Merkel cell carcinomas. Several long-term studies conducted on large populations have shown that in elderly individuals melanoma related to photo-exposure has doubled in the last decade. The clinic-pathological pattern of skin melanomas is different in aged patients and is guided also by immune-related mechanisms. Besides sun exposure, metabolic deregulations and obesity can be risk factors in melanomas. Controversial results were published on obesity risk in melanomas; however, the adipose tissue favors increased cytokines and growth factors production contributing to melanoma aggressiveness. Moreover, immunotherapy that is not offered in geriatric patients as often as in young ones has proven to be as efficient as in younger ones, although the aged-related co-morbidities can impede the immunotherapy choice. Without being exhaustive, our review has synthesized current research and critically assessed the links between aging as a normal physiological process to the initiation and propagation of skin cancers, focusing on cutaneous melanoma. The review highlights the differences at various levels of skin melanoma developed in aged patients compared to younger one and gives the general outlines for diagnosis, prognosis and therapeutical approaches in aged patients.