Differentiating benign from malignant salivary gland tumors (SGTs) preoperatively remains a clinical challenge due to overlapping morphological and radiologic features. Systemic inflammatory biomarkers such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) have emerged as potential adjuncts reflecting tumor-associated immune dysregulation. This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy of these biomarkers for SGTs.

A systematic search was conducted in PubMed, SCOPUS, EBSCOhost, and Google Scholar up to September 2025 following the PRISMA-DTA guidelines (PROSPERO registration: CRD420251173943). Studies assessing the diagnostic accuracy of inflammatory biomarkers with histopathology as the reference standard were included. Data on sensitivity, specificity, area under the curve (AUC), and diagnostic odds ratio (DOR) were pooled using a random-effects model, and heterogeneity was assessed using Higgins I² statistics.

Six studies comprising 338 patients met the inclusion criteria. The pooled sensitivity and specificity were 0.71 and 0.81 for NLR, 0.61 and 0.72 for PLR, 0.74 and 0.78 for SII, and 0.71 and 0.73 for SIRI, respectively. Corresponding AUCs ranged from 0.73 to 0.83, indicating moderate-to-excellent diagnostic accuracy. Among the  evaluated indices, SIRI showed the highest pooled sensitivity, while SII demonstrated the best discriminative capacity. The integration of SIRI with fine-needle aspiration cytology (FNAC) further improved diagnostic performance (accuracy 81.2%). Heterogeneity across studies was low (I² = 0%).

Inflammatory biomarkers, particularly SII and SIRI, exhibit promising diagnostic value for diagnosing various SGTs and may complement cytological evaluation in indeterminate cases. Prospective multicentric studies with standardized cut-offs are recommended to validate their clinical application.

Skin cancer is the most common malignancy worldwide and can be lethal if not detected early, especially melanoma. Primary care is often the first point of contact, but limited dermoscopy expertise and increasing service pressure can delay diagnosis. Artificial intelligence (AI) offers a route to expand access to earlier detection by supporting assessment and triage decisions in primary care.

We conducted a narrative review of peer-reviewed literature on AI systems for skin-lesion analysis, including traditional machine-learning pipelines, convolutional neural networks (CNNs), vision transformers, ensemble and hybrid models, and mobile/on-device tools. We prioritized studies that compared AI with clinicians, reported diagnostic performance and calibration, evaluated subgroup performance (e.g., skin tone and device), and examined implementation in primary care, teledermatology, or real-world outpatient workflows.

AI systems can achieve high sensitivity for melanoma and other malignant lesions on curated image sets, often approaching specialist-level discrimination. Reader studies and pragmatic evaluations suggest AI assistance can improve non-dermatologists' sensitivity and diagnostic confidence, but specificity, calibration, and robustness across devices and under-represented populations remain variable. Recent deployment-focused evidence highlights risks of automation bias, alert fatigue, and inequitable performance, underscoring the need for careful threshold selection, external validation, and post-deployment monitoring.

AI-enabled skin cancer detection can support earlier diagnosis and more efficient triage in primary care, but clinical benefit depends on evaluation beyond headline accuracy. Diverse training data, robust external and prospective validation, explicit calibration and equity reporting, and governance frameworks with human oversight and continuous monitoring are essential for safe implementation.

Serum tumor markers such as CA 125, CA 19-9, carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), and CA 15-3 are widely available, inexpensive, and easily measured, which has led to their inappropriate use for cancer screening in asymptomatic individuals. Despite guideline recommendations against this practice, these tests remain common, contributing to false positives, unnecessary anxiety, and avoidable invasive procedures.

We conducted a systematic review of PubMed, Cochrane Library, and LILACS from inception to May 10, 2025, identifying studies evaluating the use of the aforementioned tumor markers in asymptomatic populations. Eligible studies reported diagnostic accuracy or clinical outcomes. Two reviewers independently screened, extracted data, and assessed risk of bias using study design-specific tools (ROBINS-I, Newcastle-Ottawa, QUADAS-2, RoB-2). The GRADE assessment was used for certainty of evidence.

Of 1,179 records, 38 studies were included (10 retrospective, 18 prospective, 3 cross-sectional, 3 RCTs, others). CA 125 was the most frequently assessed marker, followed by CA 19-9, CEA, CA 15-3, and AFP. Across studies, sensitivity and specificity varied, but positive predictive value (PPV) was consistently low in general asymptomatic populations. False-positive results frequently led to imaging, invasive procedures, and surgery, with complication rates up to 15%. No mortality benefit was demonstrated in large RCTs. Certain subgroups (e.g., new-onset diabetes with elevated CA 19-9) showed improved PPVs, but evidence was insufficient to support population screening.

Routine use of serum tumor markers for cancer screening in asymptomatic individuals is unsupported by evidence and may cause harm. We propose a structured follow-up framework to guide the evaluation of incidentally elevated tumor markers, aiming to reduce unnecessary interventions and optimize resource use.

Oral cancer is a significant health issue in the country, accounting for one-fourth of all cases worldwide. A shortage of specialized healthcare, limited access to screening tools, and diagnostic facilities are key contributors to delayed diagnosis. Artificial Intelligence can be a promising tool for the early screening of oral cancer. However, its application in India remains underexplored and lacks systematic evaluation.

A scoping review was conducted using the Arksey and O'Malley (2005) framework and the approach by Peters et al. (2015). The PRISMA framework was adopted for selecting relevant studies on AI applications for oral cancer screening in India. Studies were systematically searched in PubMed, CINAHL, Scopus, and Google Scholar. Reviewers extracted relevant data and systematically mapped them to identify strengths, weaknesses, opportunities, and threats of AI applications in oral cancer screening within India.

Of the 265 identified studies, 33 were selected for final review. Various designs were used, including cross-sectional field evaluations, pilot and prospective studies, scoping and systematic reviews, narrative reviews, and experimental studies. AI methodologies demonstrated high diagnostic accuracy, with strengths in portability, scalability, and affordability in low-resource settings. Weaknesses reported were a lack of standardized data, limited digital literacy, and infrastructural gaps. AI models offer opportunities to enhance screening coverage, integrate multimodal datasets, and support personalized treatment planning. Key threats observed were data variability, lack of regulatory and ethical frameworks, and data privacy concerns.

AI offers strengths in improving oral cancer screening in India through early detection and reducing inequities. Despite its promising strengths, AI faces challenges such as scalability, infrastructure gaps, and ethical issues when implemented for oral cancer screening in the Indian context. For the successful integration of AI, technological innovation, robust digital infrastructure, adequate workforce training, and regulatory guidelines are required.

Epithelial ovarian cancer (EOC) presents at an advanced stage in the majority of women. These women require a combination of surgery and chemotherapy for optimal treatment. Conventional treatment has been to perform surgery first and then give chemotherapy. However, there may be advantages to using chemotherapy before surgery. This is an update of a review first published in 2007 and last updated in 2025.

To assess the advantages and disadvantages of treating women with advanced EOC with chemotherapy before cytoreductive surgery (neoadjuvant chemotherapy (NACT)) compared with conventional treatment where chemotherapy follows cytoreductive surgery (primary cytoreductive surgery (PCRS)).

We searched CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform on 9 October 2025. We also checked the reference lists of relevant papers for further studies. We contacted the principal investigators of relevant studies for further information.

Randomised controlled trials (RCTs) of women with advanced EOC (International Federation of Gynecology and Obstetrics (FIGO) stage III/IV) who were randomly allocated to treatment groups that compared platinum-based chemotherapy before cytoreductive surgery with platinum-based chemotherapy following cytoreductive surgery.

We extracted data on overall survival and progression-free survival, adverse events, surgically related mortality and morbidity, and quality-of-life outcomes.

We used the Cochrane Risk of Bias 1 tool (RoB 1) to assess risk of bias in RCTs.

We conducted meta-analyses using random-effects models (due to heterogeneity between studies) to calculate hazard ratios (HR), risk ratios (RR), mean differences (MD), and 95% confidence intervals (CI) for all outcomes. We assessed the certainty of evidence according to the GRADE approach.

A total of seven RCTs of varying quality and size met the inclusion criteria, with two new completed studies in this update. The studies assessed a total of 2650 women with stage III/IV ovarian cancer randomised to NACT followed by interval cytoreductive surgery (ICRS) or PCRS followed by chemotherapy. We included data from five studies in the meta-analyses (2380 participants).

Survival We found little or no difference between groups in overall survival (HR 1.00, 95% CI 0.91 to 1.10; I² = 2%; 5 studies, 2380 participants; high-certainty evidence) and likely little or no difference between groups in progression-free survival (HR 1.03, 95% CI 0.92 to 1.15; I² = 34%; 5 studies, 2380 participants; moderate-certainty evidence). Adverse events Adverse events, surgical morbidity, and quality-of-life outcomes were variably and incompletely reported across studies. NACT reduces postoperative mortality (0.5% in the NACT group versus 2.6% in the PCRS group) (RR 0.25, 95% CI 0.10 to 0.63; I² = 0%; 5 studies, 2201 participants; high-certainty evidence). There are probably clinically meaningful differences in favour of NACT compared to PCRS in overall surgically related adverse effects (grade 3+ (G3+)) (6.4% in the NACT group versus 29.4% in the PCRS group) (RR 0.34, 95% CI 0.14 to 0.82; I² = 82%; 3 studies, 1094 participants; moderate-certainty evidence). Organ resection NACT probably results in a large reduction in the need for stoma formation (6.9% in the NACT group versus 20.1% in the PCRS group) (RR 0.34, 95% CI 0.20 to 0.57; I² = 54%; 3 studies, 1291 participants; moderate-certainty evidence) and probably reduces the risk of needing bowel resection at the time of surgery (18.9% in the NACT group versus 38.6% in the PCRS group) (RR 0.49, 95% CI 0.35 to 0.69; I² = 79%; 5 studies, 2237 participants; moderate-certainty evidence). Quality of life Global quality of life on the EORTC QLQ-C30 produced imprecise results in three studies, with high levels of heterogeneity (quality of life at 6 months: MD 6.62, 95% CI -2.89 to 16.13; I² = 92%; 3 studies, 559 participants; very low-certainty evidence) and any differences might not be clinically meaningful.

The available high- to moderate-certainty evidence shows there is likely little or no difference in primary survival outcomes between PCRS and NACT for those with advanced EOC who are suitable for either treatment option. NACT reduces the risk of postoperative mortality, and probably reduces the risk of serious adverse events around the time of surgery, and the need for stoma formation. These data are consistent across ~20 years of studies, through significant changes in surgical radicality, and should inform women and clinicians (involving specialist gynaecological multidisciplinary teams) to allow treatment to be tailored to the individual patient, taking into account surgical resectability, age, histology, stage, and performance status. Further data from studies unpublished in peer-reviewed journals and ongoing studies are awaited, but are unlikely to significantly change the results of this review.

This Cochrane review update had no dedicated funding.

Protocol (2005): DOI: 10.1002/14651858.CD005343 Original review (2007): DOI: 10.1002/14651858.CD005343.pub2 Review update (2012): DOI: 10.1002/14651858.CD005343.pub3 Review update (2019): DOI: 10.1002/14651858.CD005343.pub4 Review update (2021): DOI: 10.1002/14651858.CD005343.pub5 Review updated (2021a): DOI: 10.1002/14651858.CD005343.pub6 Review updated (2025): DOI: 10.1002/14651858.CD005343.pub7.

Nucleos(t)ide analog (NA) therapy suppresses hepatitis B virus (HBV) DNA, but residual hepatocellular carcinoma (HCC) risk persists. O-glycosylated hepatitis B surface antigen glycan isomer (HBsAgGi) uniquely reflects virion burden. We evaluated the impact of tenofovir alafenamide (TAF) versus entecavir (ETV) on 48-week HBsAgGi kinetics and its utility in stratifying HCC risk in 90 NA-naïve patients (ETV: 73; TAF: 17). A favourable response was defined as a reduction or maintenance of low HBsAgGi levels. TAF independently predicted a favourable response compared with ETV (penalised odds ratio 3.60, p = 0.030). A significant interaction occurred between HBeAg status and HBsAgGi response in relation to HCC development (p = 0.038). In HBeAg-positive patients, a poor response was associated with increased HCC risk (hazard ratio 7.34, 95% confidence interval [CI] 1.96-20.35, p = 0.001); however, the exact magnitude warrants cautious interpretation due to wide CIs. This association was absent in HBeAg-negative cases. Adding HBsAgGi response to the aMAP score improved long-term HCC prediction exclusively in the HBeAg-positive cohort. As the assay targets genotype C-specific O-glycosylation, the findings cannot be generalised to genotypes A, B, or D. In conclusion, on-treatment HBsAgGi response is a specific surrogate marker for stratifying residual HCC risk in HBeAg-positive patients, and TAF is more effective than ETV in inducing these favourable kinetics.

This study evaluated whether multimodal spectroscopic analysis of saliva can differentiate patients with lung cancer from healthy individuals. Unstimulated saliva samples were collected from 57 patients with lung cancer and 36 healthy controls. TEM and DLS revealed increased heterogeneity of the salivary colloidal fraction and a shift toward larger particle populations in lung cancer. UV-Vis spectroscopy showed a hypsochromic shift of the main absorption peak (279-261 nm), while fluorescence intensity at 510 nm increased 1.9-fold with additional emission bands at 617 and 680 nm. Reflectance decreased across the measured spectral range. ATR-FTIR identified the Amide III/asymmetric PO₂ ^- region (1350-1180 cm^-1) as the most discriminative interval (AUC = 0.854). Fluorescence-based classification achieved an AUC of 0.706, with 73.1% sensitivity and 76.3% specificity. ¹H NMR revealed alterations in metabolites associated with metabolic reprogramming.

The effect of dutasteride on benign prostate lesions and Prostate Imaging-Reporting and Data System (PI-RADS) scores remains uncertain. We evaluated its impact on pathologically benign transition zone (TZ) PI-RADS 3 lesions.

We reviewed 3104 multiparametric magnetic resonance imaging (mp-MRI) scans (March 2019-November 2023). Patients undergoing MRI-ultrasound fusion biopsy for PI-RADS 3 lesions with ≥ 2 mp-MRI scans were evaluated. After exclusions, dutasteride users formed the study group (n = 24) and non-users the control group (n = 60). Demographics, prostate-specific antigen (PSA), PSA density, prostate volume, pre-biopsy/control mp-MRI characteristics and PI-RADS scores were compared.

Mean dutasteride use was 12.1 months. Lesion size decreased in both groups, more so in the study group. Within the study group, mean lesion apparent diffusion coefficient (ADC) increased and the T2-weighted (T2WI) lesion/transition-zone ROI ratio decreased whereas neither changed in controls; on between-group comparison, the ADC increase was significantly greater but the T2WI ratio change was not. Complete lesion disappearance was significantly more frequent in the study group and remained an independent predictor on multivariable analysis; PI-RADS up/downgrading and new-lesion rates were similar.

In benign TZ PI-RADS 3 lesions, dutasteride did not affect PI-RADS up-/downgrading of persistent lesions but was independently associated with a higher rate of complete lesion disappearance, a greater reduction in lesion size, and a greater increase in lesion ADC; the T2WI ratio change did not differ between groups. Because these changes can make benign lesions appear less conspicuous, dutasteride use should be conveyed to the radiologist interpreting follow-up mp-MRI.

We evaluate whether preoperative tumor shape irregularity (TSI) is associated with pathological upstaging to pT3 in clinical T1 renal cell carcinoma (RCC) after partial nephrectomy or radical nephrectomy.

We retrospectively reviewed 435 patients with clinical T1 RCC that underwent partial nephrectomy or radical nephrectomy between April 2007 and December 2025. TSI was graded as 1, 2, or 3 on preoperative computed tomography by three urologists. Inter-observer agreement was assessed using the complete agreement rate and overall kappa coefficient. Logistic regression analyses were performed to identify independent preoperative predictors of upstaging to pT3.

Complete agreement for TSI was observed in 315 cases (72.4%), and the overall kappa coefficient was 0.64. Upstaging to pT3 occurred in 44 patients (10.1%), including one patient with pT3b. The rate of upstaging significantly increased across TSI categories, from 2.3% in TSI 1 to 15.7% in TSI 2, and to 63.6% in TSI 3 (p < 0.01). In multivariable analysis, higher TSI remained independently associated with upstaging, with ORs of 5.16 for TSI 2 and 32.30 for TSI 3 compared with TSI 1 (both p < 0.01). Clinical T1b stage was also an independent predictor (OR 4.93, p < 0.01).

Preoperative TSI was independently associated with pathological upstaging to pT3 in clinical T1 RCC and may aid preoperative risk assessment when considering nephron-sparing surgery.

Café-au-lait macules (CALMs) are often the earliest visible sign of neurofibromatosis type 1 (NF1), a genetic disorder with marked clinical variability. Early characterization of CALM patterns may aid in anticipating systemic disease burden.

To analyze the early appearance, anatomical distribution, and number of CALMs in children with genetically confirmed NF1 and explore associations with central nervous system (CNS) and skeletal manifestations.

We retrospectively reviewed children with genetically confirmed NF1 at a tertiary pediatric hospital in Athens, Greece (2018-2023). Demographic data, CALM count and distribution, mutation type, and systemic involvement were recorded. CALMs were documented through standardized dermatologic assessment and clinical photography. Statistical correlations were evaluated using nonparametric tests.

Sixty-three children (33 males, 30 females; mean age 7.5 ± 4.6 years) were included. All had more than 6 CALMs (mean 18.1 per child), most frequently on the thoracic region (53.6%). In 38.1% of patients, more than 6 CALMs were present by 6 months; among those with 6 or fewer at 6 months, 94.9% exceeded this threshold by 24 months. Children with 7-12 CALMs at 12 months had significantly higher frequencies of CNS and skeletal manifestations (P < .05).

CALMs were predominantly thoracic and showed the steepest increase between 6 and 12 months. Children with 7-12 CALMs at 12 months had greater systemic involvement, supporting early, risk-adapted surveillance strategies in pediatric NF1.