Intraoperative hemorrhage is the most frequent complication of endoscopic submucosal dissection (ESD). We aim to develop and externally validate a preoperative risk-scoring model for predicting intraoperative hemorrhage during ESD for gastric neoplasms.

Patients who underwent ESD for gastric neoplasms from four endoscopy centers were enrolled in this retrospective study, with 1123 patients in derivation cohort and 345 patients in validation cohort. In derivation cohort, univariable and multivariable logistic regression analysis were used to identify independent preoperative predictors of intraoperative hemorrhage. A risk-scoring model was created by assigning weighted points to selected predictors. External validation was conducted to analyse the discrimination and calibration of the prediction model.

A prediction model for intraoperative hemorrhage included 5 variables: upper-third location (5 points), large lesion size (≥ 25 mm) (4 points), current HP infection (3 points), junior endoscopist (3 points) and middle-third location (2 points). Patients were stratified into low- (0-2 points), intermediate- (3-4 points), high- (5-6 points), and very high-risk (≥ 7 points) groups, with corresponding bleeding rates of 4.8%, 35.9%, 80.2% and 98.5%, respectively. In external validation cohort, the model showed excellent discrimination, with a c-statistic of 0.96 (95% CI 0.95-0.98), and good calibration (calibration-in-the-large, - 0.04; calibration slope, 0.94).

We developed a preoperative risk-scoring model to predict intraoperative hemorrhage of ESD for gastric neoplasms. For lesions of large size or located on the upper-third of the stomach, ESD should be performed by senior endoscopists after successful HP eradication to minimize the occurrence of bleeding.

The role of bidirectional endoscopy in younger women with iron deficiency anemia (IDA) and no alarm features remains uncertain.

To describe gastrointestinal (GI) codes recorded through 3 months after same-day bidirectional endoscopy in women aged 18-44 years with biochemically supported IDA and without selected coded alarm features.

We conducted a retrospective descriptive TriNetX study. The first colonoscopy defined index; esophagogastroduodenoscopy was required the same day. An IDA code, hemoglobin ≤12 g/dL, and ferritin ≤45 ng/mL were required within 3 months on or before index. Outcomes were codes recorded from index through 3 months afterward. A sensitivity analysis excluded prior colorectal malignancy and inflammatory bowel disease (IBD) codes.

The cohort included 769 women from 57 organizations (mean age, 37 [SD, 6] years); the condition-specific denominator was 768. Common upper-GI codes were gastritis/duodenitis (343/768, 44.7%), hiatal hernia (84/768, 10.9%), Helicobacter pylori (78/768, 10.2%), and gastric/duodenal ulcer (48/768, 6.3%); no upper-GI malignancy code was recorded. Lower-GI codes included hemorrhoids (246/768, 32.0%), D12-coded benign colorectal/anal neoplasm (93/768, 12.1%), and IBD (67/768, 8.7%). The colorectal malignancy code count was privacy suppressed (1-10/768; ≤1.3%). After excluding prior IBD codes, 13/710 (1.8%) had an IBD code recorded.

These coded diagnoses cannot be assumed to represent newly detected lesions or causes of IDA. Without a non-endoscoped comparison group, the study cannot establish the benefit of routine or selective endoscopy.

Stereotactic radiosurgery (SRS) effectively treats brain metastases, yet some lesions ultimately require post-SRS surgery due to local failure. We examined whether the use of volumetric changes in FLAIR hyperintensity and/or necrosis in conjunction with enhancing volumetric changes after Gamma Knife SRS correlate with pathological outcome at subsequent surgery.

We queried our institutional database for patients who received first-time SRS for a single brain metastasis and later underwent surgical resection of the same lesion. Tumor volumes were measured manually before SRS and at 6 weeks, 3 months, and 6 months post-treatment. FLAIR:enhancing (FER) and enhancing:necrotic ratios were analyzed. Linear mixed-effects models assessed variables influencing volume trajectories; Pearson correlation examined associations with pathological outcome.

Thirty-six patients met inclusion criteria. Mean enhancing volume changed - 28.5%, - 25.8%, and - 18.9% from baseline at 6 weeks, 3 months, and 6 months, respectively. Mean FLAIR volume changed - 16.9%, - 22.2%, and - 2.4% at the same intervals. Percent changes in FLAIR and enhancing volume correlated significantly at 6 weeks (p = 0.004) and 3 months (p < 0.001). FER trended differently between RN and recurrent tumor with patients who developed radiation necrosis (RN) having significantly lower FLAIR volumes at 6 weeks compared to those with recurrent tumor. Baseline lesion size, FLAIR volume, FER (all p < 0.001), primary cancer type, and sex (both p = 0.02) influenced FLAIR trajectories.

Perilesional edema and enhancement trajectories after SRS are variable but may help distinguish RN from recurrent tumor, particularly at early follow-up. Incorporation of automated edema volumetry should be considered in routine post-SRS surveillance.

Radiomics extracts quantitative features from medical images that may provide non-invasive biomarkers of tumor biology and heterogeneity. However, few studies have explored radiomics on micro-computed tomography (micro-CT) or its transferability to clinical CT. This study investigates the reproducibility and the potential biological correlation of radiomic features across in vivo CT, ex vivo CT, and ex vivo micro-CT in non-small-cell lung cancer (NSCLC).

A retrospective cohort of 60 NSCLC patients with preoperative CT scans and surgical specimens was analyzed. Ex vivo CT and micro-CT images were acquired and compared with in vivo CT using standardized preprocessing, including normalization, resampling, and registration. Tumor regions of interest (ROIs) were semi-automatically segmented, and 93 radiomic features were extracted with Pyradiomics. Cross-modality reproducibility and associations with histotype were evaluated using Spearman correlation, intraclass correlation coefficient, Bland-Altman analysis, and Mann-Whitney U test.

Normalization and volume matching improved feature repeatability, with the highest agreement observed in normalized datasets using subsampled ROIs. Four texture-based features consistently showed high reproducibility and potential biological correlation, likely reflecting intratumoral heterogeneity and variation in cell density: DependenceNonUniformity, GrayLevelNonUniformity (GLDM and GLRLM), and Coarseness (NGTDM). These features reliably distinguished adenocarcinoma from squamous cell carcinoma across modalities, confirming their stability and potential as candidate features for transferable biomarkers.

Harmonization and volume standardization are essential for cross-modality radiomic analyses. Stable texture features provide a potential transferable signature bridging micro-CT and clinical CT imaging in NSCLC, supporting their role as candidate features for further investigation in biologically oriented studies.

Question Micro-CT serves as an intermediate imaging scale enabling radiomic feature extraction from ex vivo NSCLC tumors, allowing direct comparison with in vivo and ex vivo CT. Findings Intensity normalization and volume-matched subsampling between in vivo CT, ex vivo CT, and micro-CT reduced cross-modality feature variability, improving feature reproducibility. Relevance statement Normalization, volume matching, and cross-modality analysis support the identification of candidate texture features with consistent cross-scale behavior and exploratory associations with NSCLC histotype.

This study aimed to systematically characterize clinical manifestations, diagnostic findings (including imaging, endocrine laboratory evaluation, and histopathology), and clinical outcomes among patients with primary adrenal lymphoma (PAL), to refine diagnostic strategies and clinical management for this rare endocrine neoplasm.

This retrospective cohort study recruited 28 patients diagnosed with primary adrenal diffuse large B-cell lymphoma (DLBCL) at the First Affiliated Hospital of Zhengzhou University between April 2013 and December 2024. All baseline characteristics were systematically analyzed.

Twenty-eight patients were enrolled in this cohort, with a median age of 62 years; 18 patients (64%) were male. Clinical manifestations were heterogeneous, with weight loss being the most common symptom, followed by lumbar or abdominal pain and anorexia. Bilateral adrenal masses were detected in 18 of the 28 participants, and tumor diameter exceeded 4 cm in 21 cases. Morning serum adrenocorticotropin (ACTH) and cortisol concentrations were measured in 19 patients. Seven individuals displayed normal ACTH and cortisol profiles, while 6 presented with early primary adrenal insufficiency (PAI). All 28 subjects underwent adrenal pathological testing, confirming DLBCL as the definitive histological subtype. Twenty-five patients received chemotherapy.

In conclusion, PAL predominantly affects elderly male patients, who often present with bilateral adrenal masses, weight loss, and early PAI. Our cohort demonstrates substantial interindividual heterogeneity in endocrine phenotypes. High clinical suspicion and prompt adrenal biopsy are therefore vital to facilitate early intervention and optimize patient outcomes.

The study assessed the effect of a postoperative fluid restriction on the incidence of delayed hyponatremia (DH) following transsphenoidal pituitary surgery (TSS). The incidence of DH in the prospective cohort was compared to that of a published retrospective cohort from our centre managed according to the standard postoperative protocol without fluid restriction.

This prospective interventional study included patients aged ≥18 years who underwent TSS for pituitary neuroendocrine tumors (PitNETs). A structured postoperative fluid restriction of ≤1.5 L/day was implemented from post-operative day 5 (POD5) to POD14, with daily intake/output monitoring. Serum sodium was measured at defined postoperative intervals. DH incidence in the prospective cohort was compared with a previously published retrospective cohort managed without fluid restriction. Patient adherence and satisfaction were assessed using a study-specific questionnaire.

The study included 78 patients with a mean(SD) age of 42.6(11.9) years. Seventy-two (92.3%) patients had macroadenomas and 35.9% of the tumors were invasive. Twelve (15.4%) patients developed early transient AVP deficiency. Eleven (14.1%) patients developed DH between POD 5-14, compared to 36% in the retrospective cohort (p = 0.001). None in the prospective cohort required readmission or prolonged hospitalization for hyponatremia and the hyponatremia resolved with further tighter fluid restriction. Seven patients developed mild asymptomatic hypernatremia/increased serum osmolarity which resolved with relaxation of fluid intake.

A structured fluid restriction protocol of ≤1.5 L/day in the post-operative period may be safe and effective in reducing the incidence of delayed hyponatremia and readmissions following transsphenoidal pituitary surgery for PitNETs in a tropical setting.

Psammoma bodies are characteristic calcified structures of papillary thyroid carcinoma (PTC), but their pathogenesis and prognostic significance remain unclear. This study evaluated their association with clinicopathological features at diagnosis and long-term recurrence in classic PTC.

This retrospective study analyzed 102 patients with classic-type PTC followed for a minimum five-year period. Patients were stratified according to psammoma body presence or absence in histopathological specimens.

The cohort included 102 patients (77 female, 25 male) with a mean diagnostic age of 40.4 (± 13.9) years. Psammoma bodies were identified in 66 cases (64.7%). Patients with psammoma bodies were diagnosed at a younger age (p = 0.015). Although psammoma body presence did not differ by gender, the rate of stromal coarse calcification was significantly higher in male patients (36.0%) than in female patients (13.0%) (p = 0.030). On univariable analysis, the prevalence of lymph node metastasis at diagnosis was significantly higher in the psammoma body-positive group (p = 0.001). In multivariable logistic regression analysis, the number of metastatic lymph nodes showed a positive trend toward an association with psammoma body presence, although this did not reach statistical significance (p = 0.078, OR = 1.745, 95% CI: 0.939-3.241). The presence of lymphocytic thyroiditis in non-tumorous thyroid tissue was associated with a reduced incidence of lymph node metastasis (37.1% versus 62.9%). Concerning long-term outcomes, recurrence rates were numerically higher in the psammoma body-positive group without achieving statistical significance (p = 0.532).

Psammoma body presence was significantly associated with lymph node metastasis at diagnosis in classic PTC; however, this association was not independently confirmed in multivariable analysis. Psammoma bodies may be associated with nodal disease, but their independent clinical significance remains unclear.

Pancreatic ductal adenocarcinoma (PDAC) remains one of the deadliest cancers in the United States, with most patients not being diagnosed until they present with symptomatic, advanced-stage disease. National trends in stage-specific PDAC incidence were analyzed to assess trends in stage-at-diagnosis over time and to evaluate whether advances in diagnosis and high-risk screening programs have helped shift detection towards earlier stages.

A retrospective cohort study was conducted using the Surveillance, Epidemiology, and End Results (SEER) database. Patients diagnosed with PDAC between the years 2004 and 2023 were included. Age-adjusted incidence rates were calculated per 100,000 people. Trends were assessed using Joinpoint regression to estimate the average annual percent change (AAPC). Multivariable Negative Binomial regression was used to estimate incidence rate ratios (IRRs) with stage-specific cases, adjusting for age, sex, race/ethnicity, and calendar year.

Between the years 2004 and 2023, age-adjusted incidence rates of localized, regional, and distant-stage PDAC were 1.04, 1.26, and 4.94 per 100,000 population, respectively. Localized PDAC demonstrated the greatest increase over time, with an AAPC of 6.00% (95% CI: 4.96-7.49; p < 0.001), while distant-stage disease exhibited a small increase over time (AAPC 1.11%; 95% CI: 1.02-1.21; p < 0.001) and regional-stage disease did not change significantly (AAPC 0.27%; 95% CI: -1.18 to 1.92; p = 0.62). Localized-stage incidence accelerated further after approximately 2015, with APC increasing to 14.7% between 2015 and 2019. Similar localized-stage increases were observed across sex and racial/ethnic subgroups. In multivariable Negative Binomial regression, increasing age and Non-Hispanic Black race were associated with higher PDAC incidence, while female sex was associated with lower regional and distant incidence rates.

The findings suggest a stage shift toward increased diagnosis of localized PDAC over time. These trends may reflect improvements in imaging, surveillance of high-risk individuals, advances in endoscopic detection, and increasing diagnostic intensity, although rising underlying PDAC burden may also contribute. Further prospective studies are needed to determine whether these trends ultimately translate into meaningful improvements in survival outcomes.

Hepatitis B virus (HBV) infection poses increased risks for cancer patients due to immunosuppression and potential viral reactivation. We evaluated the seroprevalence and temporal trends of HBV exposure in a large cohort of cancer patients in Brazil.

Adult patients who underwent anti-HBc testing at a quaternary oncology center between 2010 and 2023 were included in this retrospective study, and HBV exposure was defined as anti-HBc positivity. Temporal trends were assessed by using linear regression, whereas associated factors were evaluated by using multivariable logistic regression.

Anti-HBc testing was performed in 22.9% (28,869/125,985) of admitted cancer patients, and seroprevalence was 13.4% (3,857/28,869), declining from 16.5 in 2010 to 9.9% in 2023 (p < 0.001). Decreasing trends were observed across sexes and age groups (p < 0.001 for both), with a more pronounced decline among men (25.1%-12.3%). Seroprevalence also decreased significantly among White patients (16.7%-7.9%; p < 0.001) and those with solid tumors (18.8%-9.0%; p < 0.001), but not among non-White individuals (21.4%-17.7%; p = 0.246) or those with hematological malignancies (13.1%-12.8%; p = 0.136). Age ≥ 60 years (OR = 4.40; 95%CI: 3.77-5.12; p < 0.001), men (OR = 1.89; 95%CI: 1.76-2.04; p < 0.001), and non-White ethnicity/color (OR = 1.25; 95%CI: 1.15-1.35; p < 0.001) were independently associated with HBV exposure.

Despite the declining seroprevalence over time, HBV exposure remains common among cancer patients, as persistent disparities across demographic groups underscore the need for expanded vaccination and systematic screening.

Oropharyngeal dysphagia is a frequent long-term sequela in survivors of oropharyngeal cancer treated with chemoradiotherapy (CRT), with significant impact on quality of life (QoL). Flexible endoscopic evaluation of swallowing (FEES) provides objective information on swallowing physiology, whereas patient-reported outcome measures (PROMs) capture perceived dysphagia burden. This study explored how FEES findings and PROMs provide complementary information regarding dysphagia in disease-free survivors treated with CRT.

A cross-sectional study was conducted in 38 disease-free survivors of oropharyngeal cancer treated with CRT. Swallowing was assessed using FEES, including measures of swallowing safety, efficiency and temporal physiology. Swallowing-related QoL and symptom burden were assessed using the EORTC QLQ-C30, EORTC QLQ-H&N43, and SWAL-QOL questionnaires. Associations between objective and subjective outcomes were explored using correlation and comparative analyses.

FEES identified frequent swallowing impairments, particularly pharyngeal residue, increased number of swallows for solid consistencies and penetration-aspiration events. PROMs also revealed substantial dysphagia-related burden, with the SWAL-QOL identifying the highest proportion of altered results. Associations between FEES findings and QoL domains were observed; however, no consistent one-to-one relationship between physiological impairment and patient-reported burden was identified.

FEES and PROMs capture complementary dimensions of dysphagia in disease-free survivors of oropharyngeal cancer after CRT. FEES identifies physiological swallowing impairments, whereas PROMs reflect the functional and psychosocial impact of dysphagia. Combined use of instrumental and patient-reported assessments may improve supportive care and long-term follow-up in this population.