The demand for minimally invasive diagnostic techniques for peripheral pulmonary lesions (PPL) is rising. Augmented fluoroscopy (AF) provides real-time guidance by overlaying CT-derived virtual targets onto fluoroscopic images, yet its diagnostic value remains poorly defined.

We retrospectively analyzed 226 PPLs targeting procedures performed with navigational bronchoscopy supplemented by AF and R-EBUS between December 2019 and March 2024. TIVL was assessed across 5 standard planes (posteroanterior, 30 degrees toward, 30 degrees away, 30 degrees clockwise, and 30 degrees counterclockwise). Diagnostic yield was defined according to the ATS/ACCP strict criteria. Multivariable logistic regression identified predictors of diagnostic success.

Of the 226 analyzed PPLs, 101 (44.7%) showed no R-EBUS signal. In lesions without an R-EBUS signal, diagnostic yield increased from 0% with ≤1 plane to 42% with ≥4 planes. In multivariable analysis, TIVL in 3 planes was associated with a >5-fold higher likelihood of diagnostic success (OR: 5.57; P<0.05), and in ≥4 planes with an almost 14-fold increase (OR: 13.6; P=0.01). Lesions within 16 mm of the point of entry demonstrated stepwise yield improvements up to 89% with ≥4 confirmed planes, while more distant lesions showed no significant benefit. In the ≥3-TIVL-plane subgroup, BMI showed a negative trend toward lower diagnostic yield (OR: 0.92; P=0.059).

The number of fluoroscopic planes with confirmed TIVL is a significant determinant of diagnostic yield in AF-guided navigational bronchoscopy, particularly in lesions lacking R-EBUS signals. Multiplane TIVL assessment may enhance diagnostic performance in centers without cone-beam CT or digital tomosynthesis availability.

In the AQuIRE trial, most cases (83.6%) did not involve transbronchial needle aspiration (TBNA), often underutilized due to challenges in accessing peripheral pulmonary lesions (PPLs). Advances in robotic bronchoscopy with shape-sensing technology (ssRAB) have mitigated these challenges, but the optimal number of needle and cryoprobe passes for reliable diagnosis remains undefined.

This retrospective study compares the diagnostic yield (DY) of TBNA and transbronchial cryoprobe biopsy (TBCB) and their adequacy for molecular testing in PPLs.

We performed a retrospective analysis of 166 patients who underwent ssRAB with both TBNA and TBCB from May to August 2024. Fisher exact tests and McNemar χ2 tests were used to compare prevalence differences in DY and molecular testing adequacy between discordant cases. Odds ratios (OR) and 95% CIs of associations between the number of passes and diagnostic yield and rates of obtaining adequate samples for molecular testing were obtained using generalized linear mixed models (GLMMs) with a logit link.

TBCB demonstrated a higher diagnostic rate than TBNA (89% vs. 80%, OR=2.04, 95% CI=1.06-4.03; P=0.032), as well as better rates of obtaining samples adequate for molecular testing (60% vs. 20%, OR=5.94, 95% CI=2.31-16.38, P<0.001). TBCB provided diagnostic yields in 55% (χ2=9.33, P=0.002) of cases where TBNA failed to provide a diagnosis and was able to obtain adequate samples for molecular testing in 42% (χ2=15.06, P<0.001) of cases where TBNA was unable to.

TBCB suggests a higher diagnostic yield and higher cellular adequacy for molecular testing compared with TBNA, underscoring its potential value as a reliable and versatile diagnostic tool in PPLs.

Metastatic colorectal cancer (mCRC) remains a major contributor to cancer-related mortality worldwide. Real-world data from low- and middle-income countries remain limited.

This bidirectional observational study included 60 patients with histologically confirmed mCRC treated at a tertiary care center between January 2019 and December 2025. Demographic, clinicopathological, molecular, treatment, and survival data were analyzed. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Cox proportional hazards regression was used to identify prognostic factors.

The median age was 48.5 years, and 63.3% of patients were male. Extensive metastatic disease was present in 96.7% of patients. Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations were detected in 20.7% of patients, whereas microsatellite instability-high (MSI-high) status was identified in one patient. Median PFS and OS were 10.6 and 22.3 months, respectively. On multivariable analysis, peritoneal metastasis independently predicted inferior PFS [hazard ratio (HR) 4.45, 95% confidence interval (CI) 2.16-9.19; p < 0.001] and OS (HR 2.83, 95% CI 1.13-7.07; p = 0.026). Poorly differentiated histology independently predicted worse OS (HR 3.05, 95% CI 1.03-9.06; p = 0.045).

This study highlights the substantial burden of advanced disease in Indian patients with colorectal cancer. Peritoneal metastasis and poor differentiation were associated with adverse outcomes. Improved early detection and wider access to targeted therapies may improve survival outcomes in resource-limited settings.

Thrombotic events are a major morbidity among Philadelphia chromosome-negative myeloproliferative neoplasm (Ph-MPN) patients. There is a lack of data from Kerala regarding the profile of Ph-MPN and the prevalence of thrombosis among these patients.

To study the clinical profile, driver mutations, incidence of thrombotic events among Ph-MPN patients, and the response to hydroxyurea therapy.

We reviewed the medical records of 84 Ph-MPN patients who were on follow-up from April 2019 to June 2023 in a tertiary care hospital in Kerala.

There were 48 polycythemia vera (PV), 16 essential thrombocythemia (ET), 14 primary myelofibrosis (PMF), and six unclassifiable MPN (MPN-u) patients. The incidence of Janus kinase 2 (JAK2) mutation was 96, 62.5, and 79% among PV, ET, and PMF patients, respectively. The incidence of calreticulin (CALR) mutation was 37.5 and 21% among ET and PMF patients, respectively. The incidence of thrombotic events was 23/48 (48%), 7/16 (43.5%), and 6/14 (42.8%) among PV, ET, and PMF patients, respectively. All ET and PMF patients with thrombotic events were JAK2V617F-mutated. Eighty-seven percent of the evaluable patients on hydroxyurea for PV achieved freedom from therapeutic phlebotomies. ET patients who were on hydroxyurea achieved a median platelet count of 4.3 lakhs/µL (3.16-6.08).

There is a higher incidence of thrombosis among Ph-MPN patients from Kerala, which needs to be ascertained in a population-based study. JAK2V617F mutation is the major determinant of thrombotic episodes in ET and PMF. Hydroxyurea is an effective cytoreductive therapy in PV and ET.

Pituitary neuroendocrine tumors (PitNETs) account for up to 15% of intracranial tumors. Patients commonly present with various emotional and cognitive impairments, including a high prevalence of anxiety and depression. Therefore, this study aimed to identify the latent subtypes of negative emotions in patients with PitNETs and examine their associations with quality of life.

A total of 422 patients diagnosed with PitNETs who were scheduled for neurosurgical treatment at a tertiary hospital between September 2023 and September 2025 were enrolled. Multidimensional assessments were conducted, including a general information questionnaire, the Hospital Anxiety and Depression Scale (HADS), the 12-Item Short Form Health Survey (SF-12), the Pittsburgh Sleep Quality Index (PSQI), and neuroendocrine hormonal function classification. Latent class analysis was applied to identify subtypes of negative emotions, and multivariable regression was performed to compare psychological and clinical characteristics across classes.

Three distinct latent subtypes of negative emotions were identified: the low negative-emotion class (C1; n = 75, 18%); moderate-distress class (C2; n = 218, 52%); and high dual-negative-emotion class (C3; n = 129, 30%). Multivariable regression showed significant differences between C1 and C3 in educational level, employment status, alcohol consumption, headache symptoms, and PSQI scores (p < 0.05). Significant differences were also found between C2 and C3 in pituitary hormone function, headache symptoms, and PSQI scores (p < 0.05).

Negative emotions in patients with PitNETs demonstrated marked heterogeneity. Therefore, identifying the distinct emotional subtypes may facilitate more precise psychological interventions, thereby improving quality of life and perioperative management.

Robotic right hemicolectomy has been widely adopted, but the impact of extraction-site location on postoperative pain in single-port (SP) surgery remains unclear. We aimed to compare short-term outcomes between SP and multiport robotic surgery and to evaluate postoperative wound pain according to extraction-site location.

This retrospective single-center study included 49 consecutive patients who underwent robotic right hemicolectomy (January 2024-December 2025): 25 in the SP group and 24 in the Xi group. Postoperative pain was assessed using the cumulative pain score (sum of daily maximum NRS values, POD1-POD7). Pain outcomes were compared among SP_P (Pfannenstiel, n = 13), SP_Umb (umbilical, n = 12), and Xi_P (Pfannenstiel, n = 22).

Perioperative and oncological outcomes were comparable between the groups. The SP group had significantly shorter operative time (244 vs. 309 min, p = 0.0013) and console time (167 vs. 239 min, p = 0.0014). Postoperative pain differed significantly among the three subgroups (p = 0.0049). Pairwise comparisons showed significantly lower pain in SP_P than in SP_Umb (p = 0.0062), with no significant difference for the other two comparisons. The difference between SP_P and SP_Umb remained significant after adjusting for anastomotic technique and surgical procedure in multiple regression analysis.

SP-assisted right hemicolectomy was safe, with short-term outcomes comparable to the Xi platform. These findings suggest that postoperative pain following robotic right hemicolectomy may be influenced not only by the number of abdominal ports but also by the location of the extraction incision.

Objective To explore the change trajectories of frailty in middle-aged and elderly patients undergoing radiotherapy for lung cancer and their influencing factors,thus providing a theoretical basis for targeted frailty management. Methods A prospective longitudinal study was conducted.Middle-aged and elderly patients with lung cancer who received radiotherapy in Yunnan Cancer Hospital were recruited by convenience sampling from January 2023 to December 2024.The general information questionnaire was used to investigate the baseline and disease-related data of patients at three time points:1 day before radiotherapy,at the end of radiotherapy,and 1 month after radiotherapy.The Fried Frailty scale was adopted to identify frailty at each time point.A latent class growth model was employed to analyze the change trajectories of frailty in middle-aged and elderly patients undergoing radiotherapy for lung cancer.Multinomial logistic regression was performed to analyze the influencing factors of different trajectories. Results A total of 327 middle-aged and elderly patients completed the follow-up.The incidence of frailty was 27.83% before radiotherapy,48.32% at the end of radiotherapy,and 29.36% one month after radiotherapy.The frailty trajectory categories of patients undergoing radiotherapy for lung cancer could be classified into a pre-frailty-decline group (56.58%),a frailty-gentle increase group (27.83%),and a severe frailty-continuous increase group (15.60%).Age,nutritional score,disease stage,and the therapy received were the influencing factors of frailty trajectory category (all P<0.05). Conclusions There is heterogeneity in the frailty trajectories of middle-aged and elderly patients with lung cancer before and one month after radiotherapy.Medical staff can formulate targeted frailty management strategies according to the heterogeneity and influencing factors of frailty trajectories to help patients prevent or reverse the occurrence of frailty and further improve the quality of life of patients.

Congenital brain tumors (CBTs), defined as intracranial neoplasms initially presented within the first year of life, are rare and biologically heterogeneous, with outcomes largely derived from high-income country data. Evidence from low- and middle-income countries (LMICs) remains sparse, limiting contextual understanding of disease burden and survival.

We conducted a retrospective single-center cohort study of infants with surgically managed intracranial tumors presenting within the first year of life at a tertiary referral center in Pakistan between January 1, 1988, and July 31, 2025. Vascular and metastatic lesions were excluded. Demographic, clinical, radiological, histopathological, operative, and adjuvant-treatment data were extracted from medical records. Tumors were classified according to WHO 2021 nomenclature where feasible. Overall survival was estimated using Kaplan-Meier methods, and factors associated with survival were explored using Firth-penalized Cox regression because of low event counts.

Fifty infants were included; median age at surgery was 420.00 days (interquartile range 198.50-566.00 days), and 26 were male. Supratentorial tumors comprised 20 (40.0%) cases, and 25 (50.0%) were high-grade (WHO grade III-IV). Gross total resection was achieved in 11 (22.0%) patients and subtotal resection in 20 (40.0%). Postoperative complications occurred in 8 (16.0%). Among 33 patients with available survival follow-up, estimated overall survival was 93.9% at 30 days, 82.5% at 6 months, 74.2% at 1 year, and 58.6% at both 5 and 10 years. No clinicopathological variable was independently associated with survival in penalized Cox regression.

In this single-center LMIC cohort, survival after surgical management of CBTs appeared lower than that generally reported in high-income settings. These findings highlight the need for earlier diagnosis, improved access to specialized pediatric neuro-oncology care, and multicenter collaborative studies to better define prognostic determinants and improve outcomes.

To assess the determinants and clinical impact of missed incidental lung cancers on neck CT and explore the potential role of artificial intelligence-based computer-aided detection (AI-CAD).

This study retrospectively screened adults who underwent neck CT at a tertiary care hospital between 2008 and 2024. Patients with prior lung cancer, prior or concurrent chest CT, absence of visible lung lesions on neck CT, lack of histological confirmation, or indeterminate staging or stage shift were excluded. Determinants of missed detection and their impact on diagnostic intervals and stage shift (progression in any T, N, or M category) were evaluated. AI-CAD was retrospectively applied to the missed cases.

Of 81,794 patients screened, 123 with lung cancer visible on neck CT were identified (mean age, 65.1 ± 10.5 years; 63 male), of whom 80 (65.0%) were not described in the original reports. Missed detection was more common with CT examinations including CT angiography (odds ratio [OR], 3.40 [95% confidence interval {CI}: 1.13, 11.69]; P = 0.037) and squamous cell carcinoma (OR, 6.84 [95% CI: 1.32, 55.16]; P = 0.037) and was less common with double reading (OR, 0.16 [95% CI: 0.03, 0.81]; P = 0.031), lymphadenopathy (OR, 0.11 [95% CI: 0.04, 0.32]; P < 0.001), and lobulated margins (OR, 0.29 [95% CI: 0.11, 0.79]; P = 0.016). Missed detection was associated with a longer diagnostic interval to pathologic confirmation (median, 27.5 vs. 0 months; P < 0.001) and more frequent stage shift (47.5% vs. 11.6%, P < 0.001), including numerically more frequent progression from stage I-II to III-IV (11.3% vs. 2.3%, P = 0.146). AI-CAD detected 41 of 80 missed lesions (51.3%), without significant variations across imaging or lesion characteristics.

Incidental lung cancers on neck CT are rare but are frequently overlooked. Missed detection is associated with substantially longer diagnostic intervals and more frequent stage shifts. AI-CAD has the potential to reduce diagnostic oversight, warranting further validation.

To evaluate the feasibility of diffusion-derived vessel density (DDVD) for the preoperative prediction of lymphovascular space invasion (LVSI) in endometrial cancer (EC) and to explore whether the integration of DDVD with intravoxel incoherent motion (IVIM)-derived parameters and clinicopathologic (CP) variables could improve the prediction.

This exploratory retrospective study included 194 patients with histopathologically confirmed EC (126 LVSI-negative and 68 LVSI-positive) who underwent preoperative multi-b-value diffusion-weighted magnetic resonance imaging. The apparent diffusion coefficient, true diffusion coefficient (D), pseudodiffusion coefficient (D*), perfusion fraction (f), and DDVD_b0b10 (derived from b = 0 and 10 s/mm² images) were calculated. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of LVSI and to develop predictive models. The predictive performance was assessed using receiver operating characteristic (ROC) curve analysis. Differences in areas under the ROC curves (AUCs) among models were evaluated using DeLong's test, with the Bonferroni correction applied to adjust for multiple comparisons.

The f, DDVD_b0b10, and three CP factors, including the depth of myometrial invasion, histologic grade, and tumor stage, emerged as independent predictors of LVSI. DDVD_b0b10 yielded a higher AUC than f (0.772 vs. 0.692), although the difference was not statistically significant after Bonferroni correction (adjusted P = 1.000). Predictive performance improved significantly when DDVD_b0b10 was combined with the retained CP factors (AUC, 0.895 vs. 0.772; P < 0.001). The model combining the f, DDVD_b0b10, and CP predictors achieved the highest AUC of 0.904, although it was not significantly different from that of the DDVD_b0b10 + CP model after Bonferroni correction (adjusted P = 1.000).

DDVD_b0b10 may be a feasible imaging biomarker for the preoperative prediction of LVSI in EC. Multivariable approaches integrating DDVD_b0b10 with CP features and IVIM-derived f may enhance preoperative risk stratification in EC. Further prospective multicenter validation is warranted.