The purpose of this retrospective study was to investigate the incidence of MRONJ and its related risk factors in multiple myeloma (MM) patients undergoing dental extractions prior to autologous stem cell transplantation (ASCT).

This retrospective study evaluated patients treated January 1, 2011, to January 1, 2022. Medical and dental records of 1547 patients referred to the Dental Oncology Clinic at Princess Margaret Cancer Centre were reviewed, with 320 patients meeting the eligibility criteria and included in the analysis.

Among 320 patients, patients had on average 3 teeth removed prior to ASCT and 13 (4.1%) developed MRONJ. Periodontal disease was the most common reason for dental extraction among MRONJ cases. Patients prescribed zoledronic acid alone were nearly 5 times more likely to develop MRONJ than patients treated with pamidronate alone, with the highest risk observed in patients who were prescribed pamidronate and later changed to zoledronic acid. Even a single dose of bisphosphonate was sufficient to cause MRONJ following dental extraction and in some cases, onset to MRONJ following extraction was in the span of years.

The decision to recommend extractions in patients previously exposed to intravenous bisphosphonates should take into account the severity of dental disease versus risk of MRONJ. In particular, the type and duration of bisphosphonate therapy should be considered. When extractions are performed in patients at-risk of MRONJ, they should be warned of the risk (around 4% in this study) and followed for a period appropriate to detect complications.

Breast cancer is the most prevalent malignancy among women and frequently causes significant psychological distress, such as anxiety and depression. The perception and impact of social support in addressing these mental health challenges differ depending on cultural and societal factors, highlighting its crucial role.

This study aimed to evaluate the association between anxiety and depression in Palestinian women with breast cancer and perceived social support (PSS).

A descriptive, cross-sectional design was employed. The study included 257 patients with breast cancer. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale. PSS was measured using the Medical Outcomes Study Social Support Survey.

Most participants (95%) were married. The mean age was 51 ± 9.8 years. The total PSS was relatively mild to moderate (M = 69.7 ± 9.5). The scores for anxiety and depression were in the borderline range(M = 7.8 ± 3.3 and M = 8.3 ± 3.6, respectively). All subclasses of PSS were negatively correlated with anxiety and depression ( P < .05).

Every individual has a unique perception of social support. Depression and anxiety affect a sizable percentage of patients with breast cancer. Higher levels of social support may also assist in reducing depression and anxiety, as seen by the strong negative association found between these psychological states and PSS.

Background Complete pathologic necrosis (CPN) at liver transplant is a positive predictor of freedom from recurrence and overall survival for patients with hepatocellular carcinoma (HCC). Comprehensive authorized user parameters for yttrium 90 radiation segmentectomy CPN rates at explant remain undefined. Purpose To evaluate established outcomes for radiation segmentectomy before liver transplant and determine optimal parameters to achieve CPN among patients with treatment-naive HCC. Materials and Methods This multicenter retrospective study included patients with treatment-naive HCC who underwent glass microsphere radiation segmentectomy before liver transplant from January 2016 to December 2024. Treatment parameters were compared for patients that achieved CPN versus those without CPN using Mann-Whitney U or χ² tests. Receiver operating characteristic analysis was performed to determine treatment parameter thresholds and subsequently predict CPN. Results A total of 303 patients with 364 tumors were included in the study. Tumors had a median size of 2.4 cm (IQR, 2.0-3.1 cm) and demonstrated a CPN rate of 68% (246 of 364). Compared with tumors without CPN, those with CPN had a higher microsphere activity (median, 1242 Bq vs 1203 Bq; P < .03), microspheres per milliliter (median, 9000 per mL vs 7600 per mL; P = .02), single-compartment dose (median, 544 Gy vs 379 Gy; P < .001), and angiosome-to-tumor volume ratio (median, 25.2 vs 15.6; P = .02). Multivariable logistic regression showed that a microsphere activity of 1087 Bq or greater (P = .03), a dose of 440 Gy or greater (P < .001), and an angiosome-to-tumor volume ratio of 16 or greater (P < .001) were independent predictors of CPN. There was a positive association between the number of optimized parameters and CPN at liver transplant, with a positive predictive value of 74% (198 of 269) with one threshold met and 91% (57 of 63) with all thresholds met (P < .001). Conclusion Among patients with treatment-naive HCC, glass microsphere radiation segmentectomy before liver transplant achieved high rates of CPN, which was associated with optimized parameter thresholds determined for microsphere activity, microspheres per milliliter, dose, and angiosome-to-tumor volume ratio. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Gordon and Lewandowski in this issue.

Glioblastoma (GBM) is the most common and aggressive primary malignant brain tumor in adults and almost always recurs. In recurrent GBM, conventional MRI has limited ability to detect microscopic tumor infiltration and distinguish progression from treatment-related change. Spectroscopic MRI (sMRI) provides quantitative metabolic maps across much of the brain, including choline (Cho) and N-acetylaspartate (NAA), a marker of healthy tissue. Because Cho/NAA is commonly used to define metabolically abnormal tissue, and prior radiation therapy (RT) can alter metabolite levels, we evaluated whether prior RT shifts baseline Cho/NAA in recurrent disease. We retrospectively studied 20 patients with recurrent GBM previously treated with maximal safe resection, RT, and temozolomide who underwent whole-brain sMRI at recurrence. The median interval from RT completion to sMRI was 8.99 months. T1-weighted images were co-registered to sMRI in MIDAS and aligned with planning CT in MIM to generate radiation dose maps. MIDAS generated tissue-water-referenced Cho, NAA, and creatine (Cr) maps, and Cho/NAA was normalized to contralateral normal-appearing white matter. Voxel-wise linear regression was performed between prior radiation dose and metabolite values at recurrence. Higher prior dose was associated with reduced NAA (-0.26%/Gy, r² = 0.011, p < 0.001) and Cr (-0.18%/Gy, r² = 0.004, p < 0.001), while Cho changed minimally (-0.023%/Gy, r² = 0.001, p < 0.001). Accordingly, normalized Cho/NAA increased with dose, with a mean slope of 0.0018/Gy (p < 0.001). A standard Cho/NAA threshold of 2 corresponded to a median of 2.39 (range, 1.91-2.72) in tissue previously receiving 60 Gy. These findings suggest prior RT modestly elevates baseline Cho/NAA, primarily through NAA reduction, and that dose-corrected Cho/NAA maps may improve tumor delineation in recurrent GBM.

This study aimed to compare the incidence of postoperative ileus (POI) between end-to-end hand-sewn and side-to-side stapled ileo-ileal anastomoses and to identify independent risk factors associated with POI.

We conducted a retrospective analysis of patients who underwent radical cystectomy with urinary diversion at Ankara Etlik City Hospital between October 2022 and October 2024. Patients were categorized according to the anastomosis technique used: end-to-end hand-sewn or side-to-side stapled. Perioperative data, including demographic characteristics, comorbidities, preoperative laboratory parameters, operative variables, and postoperative outcomes, were collected. POI was defined as intolerance to oral intake accompanied by abdominal distension and absence of flatus or stool beyond postoperative day five, requiring medical or surgical management. Univariable and multivariable logistic regression analyses were performed to identify risk factors for POI.

A total of 71 patients were included in the analysis. POI occurred in nine patients (23.7%) in the hand-sewn group and in four patients (12.1%) in the stapled group, indicating a significantly lower incidence in the stapled group. Multivariable analysis identified side-to-side stapled anastomosis as an independent protective factor against POI. Additional independent predictors included age ≥65 years, abnormal body mass index (BMI), preoperative constipation, hypoalbuminemia, and prolonged operative time. Receiver operat-ing characteristic (ROC) curve analysis demonstrated good predictive performance of the model.

Side-to-side stapled ileo-ileal anastomosis is associated with a lower risk of POI compared to end-to-end hand-sewn anastomosis in patients undergoing radical cystectomy with urinary diversion.

Pancreaticoduodenectomy is one of the most technically demanding procedures in digestive surgery. Historically, laparoscopy in pancreatic surgery was limited to staging and palliative interventions. Since the first laparoscopic pancreaticoduodenectomy was completed in 1994, significant advances have improved perioperative safety, operative time, and lowered postoperative morbidity. Nevertheless, the complexity of pancreatic surgery paired with the technical challenges of pancreatic minimally invasive approach have restricted laparoscopic pancreatoduodenectomy to high-volume centers until recent times. The aim of this technical note presentation is to describe novel laparoscopic techniques of performing the three anastomoses - pancreaticojejunostomy and pancreaticogastrectomy, hepaticojejunostomy, and gastrojejunostomy- in an intracorporeal fashion, highlighting methods of facilitating the reconstructive process. This technical note s purpose is to also present new training models for surgeons, meant to reduce post-operative complications, such as pancreatic fistula or biliary leakage, to shorten operating times, and, ultimately, to increase the availability of laparoscopic pancreaticoduodenectomy as a safe and efficient treatment option.

Background: Breast cancer management has undergone an important evolution, from aggressive, invasive surgical interventions towards personalized, multidisciplinary strategies guided by tumor biology and patient oriented outcomes. Recent advances: Randomized trials have enabled the possibility of less invasive surgery in some cases, while advances in systemic therapy including targeted agents, antibody drug conjugates (ADCs) such as Trastuzumab emtansine (T-DM1) and Trastuzumab deruxtecan (T-Dxd), endocrine therapy and immunotherapy in selected cases have improved survival and quality of life. Emerging technologies such as oral selective estrogen receptor degraders (SERDs), selective estrogen receptor covalent antagonists (SERCAs), proteolysis targeting chimeric (PROTACs) and complete estrogen receptor antagonists (CERANs) are expanding therapeutic options. Conclusions: Modern breast cancer management is defined by precision medicine, multidisciplinary integration and less invasive surgical interventions in selected cases. Ongoing challenges include therapeutic resistance, toxicity, cost, and equitable access to innovation.

Introduction: Axillary lymph node dissection (ALND) has been the gold standard for axillary staging in breast cancer for over a century. The introduction of sentinel lymph node biopsy (SLNB) in the 1990s offered a minimally invasive alternative with comparable staging accuracy and significantly reduced morbidity. Multiple landmark randomized controlled trials have since demonstrated that completion ALND can be safely omitted in selected patients with positive sentinel lymph nodes without compromising oncologic outcomes. This narrative review aims to examine the evolution from ALND to SLNB, critically evaluate the landmark trials that shaped current practice, and discuss ongoing controversies and future directions in axillary management in early breast cancer. Materials and Methods: A comprehensive literature search was performed using PubMed/MEDLINE, Scopus, and Web of Science databases. Search terms included "sentinel lymph node biopsy", "axillary lymph node dissection", "breast cancer", and "axillary management." Landmark randomized controlled trials, systematic reviews, meta-analyses, and current clinical practice guidelines were identified and reviewed. Results: The NSABP B-32 trial validated SLNB as an accurate staging tool equivalent to ALND. The ACOSOG Z0011 trial demonstrated no survival benefit from completion ALND in patients with 1-2 positive sentinel lymph nodes undergoing breast-conserving surgery. The AMAROS trial demonstrated that irradiation of the axilla provides equivalent locoregional disease control compared to surgical dissection, while carrying a substantially more favorable morbidity profile.The IBCSG 23-01 trial confirmed that ALND can be omitted for sentinel node micrometastases. Most recently, the SENOMAC trial extended these findings to patients with 1-2 macrometastases in a broader population. Conclusions: SLNB has become the established standard for axillary staging in early breast cancer with a clinically negative axilla, superseding ALND entirely. Progressive de-escalation of axillary surgery has been consistently supported by high-level evidence without compromising survival. Future research will determine the feasibility of further de-escalation, particularly after neoadjuvant chemotherapy.

Introduction: Accurate risk stratification, essential for the therapeutic approach (especially surgical) of prostate cancer, is based on standard histopathological criteria. The biological heterogeneity of this neoplasm requires the identification of complementary markers that reflect the molecular mechanisms of tumor progression. The aim of this study was to evaluate the correlation between immunohistochemical markers of metabolism (AMACR, NKX3.1) and proliferation (Ki-67) and histopathological aggressiveness in ADK (prostate adenocarcinoma). Methods: This retrospective, single-center clinicopathological study included 385 patients with prostatic lesions from Sf. Apostol Andrei Emergency Clinical Hospital in Constanta (2023 2024). Of these, 198 cases of ADK were selected for the main immunohistochemical analysis. The cases were classified according to the Gleason system and Grade Groups. The expression of AMACR, NKX3.1 and Ki-67 markers was assessed by immunohistochemistry and correlated with Grade Groups, as well as with the presence of chronic inflammation and peritumoral glandular atrophy. Results: Increased AMACR expression (93.9% of cases) and increased Ki-67 index ( 20% in 29.3% cases) were significantly correlated with high Grade Groups (p 0.001). Loss of NKX3.1 expression increased from Grade Group 1 to Grade Group 4, followed by a lower frequency in Grade Group 5, indicating a non-linear association with histopathological grade (p for trend 0.001). The concomitant presence of chronic inflammation and glandular atrophy was associated with high Grade Groups and with a significantly higher Ki-67 index (p=0.001 and p 0.001). Triple staining (AMACR/p63/HMWCK) showed no discordant cases in distinguishing ADK from benign lesions that mimic prostate cancer. Conclusions: The extended immunohistochemical profile (AMACR, NKX3.1, Ki-67) provides valuable biological information correlated with tumor aggressiveness. Integrating these markers into the preoperative evaluation, along with standard histopathological evaluation and the peritumoral microenvironment, may contribute to a more accurate risk stratification. However, these findings are correlative, and their clinical applicability requires validation through further prospective studies.

Background: Sarcopenia is a frequent and clinically relevant condition in patients with pancreatic neoplasm, contributing to poor prognosis, reduced therapeutic tolerance, and increased mortality. The identification of reliable circulating biomarkers, alongside imaging-based muscle assessment, may improve early detection and risk stratification. Methods: This randomized prospective study included 61 patients, of whom 36 had pancreatic neoplasm associated with sarcopenia and 25 served as controls. Serum levels of osteonectin (SPARC), C-terminal agrin fragment (CAF), procollagen type III N-terminal peptide (P3NP), myostatin (MSTN), and insulin-like growth factor-1 (IGF-1) were measured using ELISA. Skeletal muscle index (SMI) and psoas muscle index (PMI) were assessed using CT at the L3 level. Results: Patients with pancreatic neoplasm and sarcopenia showed significantly altered biomarker profiles compared to controls. Osteonectin (median 936.4 vs. 539.9, p 0.001), CAF (2135.9 vs. 1165.5, p 0.001), P3NP (8.01 vs. 5.34, p 0.001), myostatin (47.71 vs. 7.85, p 0.001), and IGF-1 (142 vs. 106.7, p 0.001) were all elevated. The highest biomarker levels were consistently observed in the pancreatic neoplasm group compared to other disease groups. Additionally, 100% of patients with pancreatic neoplasm exhibited reduced SMI, confirming the high prevalence of sarcopenia. Biomarker levels were not significantly influenced by tumor location. Conclusions: The combined use of circulating biomarkers and CT-derived muscle indices provides a clinically relevant approach for identifying sarcopenia in pancreatic cancer.