PURPOSE: Adenoid hypertrophy is a common cause of pediatric upper-airway obstruction and is suspected to contribute to "adenoid facies", but longitudinal thresholds and causal dose-response relations between the adenoid-...PURPOSE: Adenoid hypertrophy is a common cause of pediatric upper-airway obstruction and is suspected to contribute to "adenoid facies", but longitudinal thresholds and causal dose-response relations between the adenoid-nasopharyngeal (A/N) ratio and craniofacial growth indices remain unclear. METHODS: We performed a two-center longitudinal cohort study of children aged 3-10 years who underwent clinically indicated lateral nasopharyngeal or cephalometric radiography between July 2021 and July 2024 at tertiary pediatric hospitals in Shanghai and Chongqing, China. Children with at least two eligible radiographic visits were included. The exposure was the distance-based A/N ratio at the earlier visit. Outcomes were annualized changes in standard cephalometric angles and mesh-based vertex angles, with emphasis on cranial-base and posterior maxillary/nasopharyngeal angles. Thresholds were screened using single-break segmented regression, and causal dose-response functions were estimated using generalized propensity score models stratified by sex and age. RESULTS: A total of 4,271 children contributed 4,907 temporally ordered within-child radiograph visit pairs (each pair links an earlier and a later visit; children with ≥ 3 visits contribute multiple pairs). The median baseline A/N ratio was 0.601 (interquartile range, 0.549-0.652). Across 189 angles, segmented regression identified a reproducible breakpoint band around A/N ≈ 0.62-0.69. Generalized propensity score analyses showed positive, approximately linear dose-response functions for multiple cranial-base and posterior maxillary/nasopharyngeal angles, with global slopes typically 10-25°/year per 1.0 increase in A/N and 80th-20th percentile contrasts of about 1-4°/year. Baseline two-group comparisons showed synchronous reductions of about 3° in SNA (sella-nasion-A angle) and SNB (sella-nasion-B angle) in children with adenoid hypertrophy, with ANB (A-nasion-B angle) largely unchanged. CONCLUSION: Higher radiographic A/N ratios were associated with threshold-sensitive, age- and sex-dependent craniofacial remodeling. As a 2D radiographic surrogate, A/N does not replace endoscopic or functional assessment. Combining A/N with selected cephalometric angles may help identify children who warrant closer follow-up and endoscopic evaluation during sensitive growth windows.
PURPOSE: Sinonasal malignancies (SNMs) are rare, heterogeneous, and aggressive. High-quality evidence to guide management is limited, and the prognostic value of multidisciplinary team (MDT) management remains incomplete...PURPOSE: Sinonasal malignancies (SNMs) are rare, heterogeneous, and aggressive. High-quality evidence to guide management is limited, and the prognostic value of multidisciplinary team (MDT) management remains incompletely characterized. This study aims at evaluating the association of MDT management with survival outcomes and treatment selection among patients with SNMs. METHODS: Retrospective cohort study including 304 consecutive patients with histologically confirmed SNMs treated at the First Affiliated Hospital of Sun Yat-sen University between September 2017 and December 2023. Patients were classified according to whether their cases underwent a formal MDT review process before the definitive treatment plan was initiated. The primary outcome was overall survival (OS). Baseline differences were addressed using stabilized inverse probability of treatment weighting (IPTW). Survival was analyzed with Kaplan-Meier estimates and weighted Cox proportional hazards models. Treatment patterns were compared using weighted logistic regression. Secondary outcomes included length of hospital stay and hospitalization costs. RESULTS: Of 304 included patients, 106 (34.9%) received MDT management. After weighting, 3-year and 5-year OS rates were 85.9% and 75.8% with MDT versus 74.8% and 63.3% without MDT (P = 0.034 and 0.125 respectively). MDT management was associated with longer OS (hazard ratio, 0.52; 95% CI, 0.30-0.91; P = 0.020). Subgroup analyses suggested consistent associations across all predefined subgroups. MDT involvement was also associated with shorter hospital stay without increased hospitalization costs. CONCLUSIONS: In this single-center cohort, MDT management was associated with optimized treatment selection and improved overall survival in patients with SNMs, with consistent effects across clinical subgroups. Establishing efficient, standardized MDT workflows may help improve outcomes for sinonasal and skull base malignancies; prospective multicenter studies are warranted to validate these associations.
PURPOSE: This study examines the prevalence and characteristics of obstructive sleep apnea (OSA) in the general population of a rural-provincial region of Denmark. Additionally, it assesses associations between OSA and v...PURPOSE: This study examines the prevalence and characteristics of obstructive sleep apnea (OSA) in the general population of a rural-provincial region of Denmark. Additionally, it assesses associations between OSA and various demographic, socioeconomic, and health-related factors. METHODS: This cross-sectional study linked data from the Lolland-Falster Health Study (LOFUS) with nationwide Danish health registries. LOFUS provided data on age, sex, body mass index (BMI), cardiac autonomic neuropathy (CAN), socioeconomic status, smoking, alcohol consumption, snoring, and irregular breathing during sleep from participants recruited between 2016 and 2020. Data on OSA and related chronic comorbidities were obtained from The Danish National Patient Registry and Danish National Prescription Registry. RESULTS: Among 16,138 LOFUS participants, we observed a prevalence of OSA of 2.9%, compared to 2.5% in Lolland-Falster and 2.2% in Denmark. Male sex was associated with OSA (OR = 3.42), as was higher age peaking in the age group 60-79 years old (OR = 6.54) compared to 18-39-year-olds. Age and sex-adjusted estimates showed higher BMI (OR = 2.60 for overweight; OR = 7.67 for obesity), unemployment due to long-term sickness or rehabilitation (OR = 2.70), early retirement due to invalidity (OR = 2.64), divorced/separated/widowed status (OR = 1.89 cohabiting; OR = 1.35 not cohabiting), and former smoking (OR = 1.33) to be significantly associated with OSA. The risk of having OSA was significantly increased if diagnosed with atrial fibrillation and flutter (OR = 2.40), diabetes mellitus (OR = 3.15), essential hypertension (OR = 2.66), or ischemic stroke (OR = 1.82). CONCLUSION: OSA disproportionately affects specific population groups, warranting increased awareness, particularly in patients with OSA-related chronic comorbidities.
IMPORTANCE: Pharyngocutaneous fistula (PCF) is the most common and morbid complication after total laryngectomy (TL). OBJECTIVE: To systematically identify predictive factors and effective interventions for PCF. DATA SOU...IMPORTANCE: Pharyngocutaneous fistula (PCF) is the most common and morbid complication after total laryngectomy (TL). OBJECTIVE: To systematically identify predictive factors and effective interventions for PCF. DATA SOURCES: PubMed search of English-language studies published between 2010 and 2024. STUDY SELECTION: Twenty-one observational cohort studies involving ≥25 adult patients undergoing TL and reporting PCF outcomes. DATA SYNTHESIS: Narrative synthesis and descriptive analysis were performed due to heterogeneity in study design and outcome measures. Risk of bias was assessed using the ROBINS-I tool, and the certainty of evidence for each risk factor was rated according to GRADE methodology. FINDINGS: Prior radiotherapy (OR 1.6-4.2), hypoalbuminemia, preoperative tracheostomy, and surgical closure without flap reinforcement were major risk factors for PCF. Conservative management succeeded in ~70% of cases. Flap reconstruction had higher success rates (~90%). Evidence certainty ranged from high (e.g., prior radiotherapy, hypoalbuminemia) to very low (e.g., antibiotic protocols), as summarized in a GRADE-based synthesis. CONCLUSIONS AND RELEVANCE: Risk stratification, preoperative optimization, and surgical techniques such as flap reinforcement reduce PCF risk and improve postoperative outcomes.
PURPOSE: To propose a novel, standardized, and safety-centered tool for Large Language Models (LLMs) evaluation. METHODS: The Medical Evaluation of Large Language Model Answers Questionnaire (MELMA-Q) was developed as a...PURPOSE: To propose a novel, standardized, and safety-centered tool for Large Language Models (LLMs) evaluation. METHODS: The Medical Evaluation of Large Language Model Answers Questionnaire (MELMA-Q) was developed as a 30-item clinician-rated instrument spanning seven domains: Medical Accuracy/Groundedness, Clinical Reasoning/Management, Safety/Ethics/Trustworthiness, Linguistic Quality/Semantic Fidelity, Understandability/Literacy Adaptation, Usefulness/Decision Support, and Performance/Answer Behavior. The MELMA Clinical Acceptability Framework (MELMA-CAF) is a two-tier system that incorporates a non-compensatory safety gate and weighted scoring. Five standardized otolaryngology scenarios were posed to three LLMs (ChatGPT 5.2, Gemini Flash 3, DeepSeek v3.2), generating 15 responses, which were independently scored by five blinded ENT specialists. A web-based implementation (MELMA-W) operationalized rubric-based scoring and was compared with clinician ratings. RESULTS: All responses passed Tier A safety screening. Mean total MELMA-Q scores ranged from 72.4 to 85.6 across models; inter-rater reliability was excellent (ICC 0.89; 95% CI 0.84-0.93). MELMA-W validation using paired model × domain observations showed systematically higher clinician scores (bias of 0.804 Likert points). CONCLUSIONS: MELMA-Q and MELMA-W provide a structured, safety-centered pilot framework for evaluating LLM-generated medical responses in otolaryngology; however, broader validation across larger datasets, additional raters, and other clinical specialties remains required.
Georgescu BM, Maniaci A, Radulesco T
… +10 more, Michel J, Iannella G, Salzano G, Lazzeroni M, Chiesa-Estomba CM, Cammaroto G, Barillari MR, Coman C, Vaira L, Lechien JR
BACKGROUND: Artificial intelligence (AI)-powered large language models (LLMs) are increasingly used as adjunctive tools in education, research, and patient care. This systematic review aimed to investigate the current li...BACKGROUND: Artificial intelligence (AI)-powered large language models (LLMs) are increasingly used as adjunctive tools in education, research, and patient care. This systematic review aimed to investigate the current literature on the applications, performance, and ethical considerations regarding the use of artificial intelligence (AI), including large language models (LLM) in plastic and reconstructive surgery. METHODS: A comprehensive search of PubMed, Scopus, and Cochrane Library was conducted by two independent investigators for studies published in English in peer-reviewed journals reporting findings about applications (education, clinical decision-making, research process), ethical and practical challenges (bias, data privacy, and accountability), and performance of LLMs in facial plastic and reconstructive surgery practice. PRISMA statements and PICOTS frameworks were used for conducting the search and summarizing the literature findings. RESULTS: Twenty-one studies met inclusion criteria, including 11 examining practical uses of ChatGPT and other LLMs, 8 evaluating performance on medical and surgical tasks, and 7 assessing ethical issues and potential limitations. Based on several performance tools, LLMs demonstrated moderate-to-high accuracy, ranging from 54.96% to 77.3%, for generating operative notes, improving patient communication, and conducting literature synthesis. The following concerns were identified in the literature: risk of hallucination or misinformation, lack of data protection compliance, and insufficient transparency. More robust evidence-based longitudinal investigations are needed to establish not only safety and effectiveness but also real-world feasibility. CONCLUSION: LLMs report promising application results in plastic and reconstructive surgery, particularly for educational and administrative purposes. The use of LLMs in plastic and reconstructive surgical practice remains limited by the lack of evidence-based longitudinal investigations and unclear data protection and ethical frameworks.
BACKGROUND: Chronic rhinitis that does not respond well to drug therapy remains a major challenge in clinical treatment. Inferior turbinate reduction can improve nasal obstruction symptoms, while posterior nasal nerve (P...BACKGROUND: Chronic rhinitis that does not respond well to drug therapy remains a major challenge in clinical treatment. Inferior turbinate reduction can improve nasal obstruction symptoms, while posterior nasal nerve (PNN) ablation can reduce symptoms caused by neurogenic hypersecretion. Blue laser technology provides precise tissue coagulation and minimizes intraoperative bleeding. METHODS: This retrospective comparative study, conducted at Shuang Ho Hospital between 2024 and 2025, aimed to compare the efficacy and safety of blue laser inferior turbinate reduction (BITR) combined with blue laser posterior nasal nerve neurolysis (BPN3) versus BITR alone. A total of Ninety-nine adult patients with chronic rhinitis who had not responded adequately to at least three months of drug therapy (≥ 3 months) were included. Among them, forty-eight patients received BITR combined with BPN3, and fifty-one patients received BITR only. The primary endpoints were the 24-hour reflective total nasal symptoms score (rTNSS) and the nasal obstruction symptoms evaluation scale (NOSE) score, which were compared and analyzed at baseline, 1 month and 6 months postoperatively. RESULTS: At 6 months post-surgery, the mean Responsive Total Nasal Symptom Score (rTNSS) decreased by 77.6% in the BITR combined with BPN3 group (from 7.6 ± 1.9 to 1.7 ± 1.6), while the BITR alone group saw a 48% decrease (from 7.5 ± 1.6 to 3.9 ± 1.7), with a statistically significant difference between the two groups (p < 0.05). The Nasal Obstruction Symptom Assessment Scale (NOSE) scores improved by 91.9% and 85.5%, respectively, with a statistically significant difference between the two groups (p < 0.05). Overall, no serious complications occurred during the study period. CONCLUSION: Blue laser posterior nasal nerve neurolysis combined with inferior turbinate reduction provides superior symptom relief compared with BITR alone, particularly for rhinorrhea, with excellent safety and tolerability. This dual-target approach offers a promising minimally invasive treatment for medication-refractory chronic rhinitis.
INTRODUCTION: Lower cranial nerve (LCN) palsy may develop following tumor resection in the cerebellopontine angle or jugular foramen, often resulting in dysphagia and dysphonia. Although many patients recover with rehabi...INTRODUCTION: Lower cranial nerve (LCN) palsy may develop following tumor resection in the cerebellopontine angle or jugular foramen, often resulting in dysphagia and dysphonia. Although many patients recover with rehabilitation, some exhibit persistent functional deficits. In such cases, detailed pathophysiologic evaluation may assist in guiding surgical intervention to improve outcomes. CASE PRESENTATION: A 77-year-old woman presented with severe dysphagia and hoarseness after resection of a right cerebellopontine angle meningioma, which caused glossopharyngeal, vagus, and accessory nerve palsies. Despite initial recovery, she developed repeated aspiration pneumonia and malnutrition. Comprehensive reassessment using high-resolution manometry (HRM) and dynamic swallowing computed tomography (CT) revealed right-sided velopharyngeal insufficiency, pharyngeal constrictor dysfunction, vocal fold paralysis with paramedian fixation, and impaired upper esophageal sphincter relaxation. A tailored multi-procedural surgical approach was performed, including right pharyngeal flap, arytenoid adduction, right hypopharyngeal pharyngoplasty with expanded polytetrafluoroethylene mesh reinforcement, right cricopharyngeal myotomy, and tracheostomy. Postoperatively, swallowing and phonation significantly improved. The patient resumed oral intake, and tracheostoma closure was performed on postoperative day (POD) 25. Maximum phonation time improved sevenfold by POD 32. She was discharged on POD 33, and resumed a regular diet with some limitations by 3 months postoperatively. CONCLUSIONS: Intractable dysphagia due to complex LCN dysfunction requires individualized surgical strategies. Multimodal functional assessment, including dynamic swallowing CT and HRM, aids precise evaluation and helps refine surgical planning in selected complex cases, potentially leading to significant improvements in quality of life.
OBJECTIVES: Screening for hearing impairments is part of the mandatory medical visits for infants at nine months and two years in France, however adherence to guidelines is low, diagnostic methods are varied and accuracy...OBJECTIVES: Screening for hearing impairments is part of the mandatory medical visits for infants at nine months and two years in France, however adherence to guidelines is low, diagnostic methods are varied and accuracy is undocumented. The aim of this research was to evaluate the diagnostic accuracy of the Petale behavioral auditory test for infants aged nine months to three years who were screened for hearing impairments by a general practitioner (GP) or pediatrician. METHODS: In this prospective diagnostic accuracy study, infants in France aged nine months to three years were tested with Petale (index test) during a GP or pediatrician consultation and a specialist hearing assessment with a conditioned orientation reflex (COR) test carried out by an Ear-Nose-Throat specialist (reference test). RESULTS: Overall, 157 infants were included in the analysis population and 119 had both an index test and a reference test. Median age was 1.5 years (IQR 1.0;2.0). A hearing impairment was identified with Petale for 58 (36.9%) infants. Sensitivity was 66.67% (95%CI 44.89-88.44), specificity was 71.29% (62.46-80.11), PPV was 29.27% (15.34-43.20), NPV 92.31% (86.39-98.22) and accuracy 70.59% (62.40-78.77). The Kappa index for concordance was 0.249 (95%CI 0.079-0.418) indicating a weak concordance between the two diagnostic tests. Overall, 98.7% of practitioners and 99.1% of parents were satisfied or very satisfied with Petale. CONCLUSIONS: The diagnostic accuracy of Petale is unsatisfactory. Nevertheless, parents' and practitioners' satisfaction with the test is high and the test was shown to be an easy, quick-to-use, cost-effective solution for this population where data on proven audiometry testing protocols are lacking.
PURPOSE: In sinonasal squamous cell carcinoma (SNSCC), evidence regarding the efficacy of immune checkpoint inhibitors (ICIs) and predictive biomarkers remains limited. Immune-related adverse events (irAEs) have been rep...PURPOSE: In sinonasal squamous cell carcinoma (SNSCC), evidence regarding the efficacy of immune checkpoint inhibitors (ICIs) and predictive biomarkers remains limited. Immune-related adverse events (irAEs) have been reported as potential indicators of antitumor response and clinical benefit in multiple malignancies; however, their prognostic significance in SNSCC has not been well defined. METHODS: We retrospectively analyzed 37 patients with recurrent or metastatic (R/M) SNSCC who received ICIs at two institutions. Clinical outcomes, including objective response rate (ORR), overall survival (OS), and progression-free survival (PFS), were assessed. The association between irAE occurrence and OS was evaluated using both landmark analysis and time-dependent Cox proportional hazards models treating irAE occurrence as a time-varying covariate. RESULTS: Among the 37 patients, the ORR was 40.5%, with a median OS of 32.1 months and median PFS of 6.6 months. Twenty-one patients (56.8%) experienced a total of 25 irAEs. In the 3-month landmark analysis, patients with irAEs had significantly better OS and PFS (P = 0.0009 and 0.0008, respectively). However, in the time-dependent Cox model, irAE occurrence was not significantly associated with OS (hazard ratio 0.98, 95% confidence interval 0.38-2.54, P = 0.9627), likely reflecting the influence of late-onset events and the small cohort size. CONCLUSIONS: Although irAEs were associated with improved survival in landmark analysis, this association was not confirmed in time-dependent analysis, suggesting a potential influence of immortal time bias. Further prospective studies are warranted.
PURPOSE: Pediatric tracheostomy tubes (TT) are frequently colonized by bacteria and biofilm, and evidence regarding optimal cleaning methods remains limited, particularly in the context of recent global shortages encoura...PURPOSE: Pediatric tracheostomy tubes (TT) are frequently colonized by bacteria and biofilm, and evidence regarding optimal cleaning methods remains limited, particularly in the context of recent global shortages encouraging tube reuse. The primary aim of this study was to evaluate the effectiveness of a standardized cleaning protocol for pediatric TT by comparing microbiological cultures obtained before and after cleaning. Secondary objectives included characterizing TT microbiology and exploring the use of a dental plaque disclosing solution as a qualitative marker of biofilm presence. METHODS: A before-and-after study was conducted in 23 pediatric patients with tracheostomies at a tertiary children's hospital. TT were cultured from internal and external surfaces prior to cleaning and again after undergoing a standardized cleaning protocol using water, dishwashing detergent, and mechanical brushing. Biofilm presence was qualitatively assessed using a dental plaque disclosing solution. Pre- and post-cleaning culture results were compared using McNemar's test. RESULTS: Before cleaning, 95.5% of TT demonstrated positive bacterial cultures, most commonly Pseudomonas aeruginosa (60.9%). After cleaning, all external surface cultures were negative, and internal lumen cultures were negative in 95.8% of cases (p < 0.05). Visible staining with the disclosing solution was present in all TT prior to cleaning and absent in all cases after cleaning. CONCLUSION: A standardized cleaning protocol using water, detergent, and mechanical brushing was effective in significantly reducing bacterial colonization and eliminating visible biofilm from pediatric TT. Dental plaque disclosing solution may represent a useful qualitative tool for assessing biofilm presence.
PURPOSE: This prospective pilot study aimed to evaluate whether dupilumab therapy induces measurable changes in the sinonasal microbiome of patients with chronic rhinosinusitis with nasal polyps (CRSwNP). METHODS: Eight...PURPOSE: This prospective pilot study aimed to evaluate whether dupilumab therapy induces measurable changes in the sinonasal microbiome of patients with chronic rhinosinusitis with nasal polyps (CRSwNP). METHODS: Eight CRSwNP patients fulfilling criteria for biologic therapy were treated with dupilumab 300 mg biweekly for six months. Nasal swabs from the middle meatus were collected immediately before therapy initiation and after six months. Alpha diversity and beta diversity metrics were assessed, and differential abundance analysis was performed. RESULTS: Dupilumab therapy did not result in significant changes in alpha diversity, beta diversity, or taxonomic composition. Minor, non-significant reductions in richness and Shannon diversity were observed. Principal coordinate analysis showed extensive overlap between pre- and post-treatment samples, supported by a non-significant PERMANOVA. No statistically significant differentially abundant taxa were detected. In contrast to the microbiome results, clinical outcomes improved markedly over the same period, with all patients showing a reduction in SNOT-22 of at least 12 points and a decrease in Nasal Polyp Score of at least 1 point. CONCLUSION: In this pilot CRSwNP cohort, no significant changes in sinonasal microbial diversity or composition were detected over six months of dupilumab therapy, despite marked clinical improvement. Larger, controlled studies are required to detect subtle or delayed microbial changes.
BACKGROUND: Post-intubation tracheal stenosis (PITS) is a common late complication of prolonged endotracheal intubation or tracheostomy, leading to progressive airway obstruction. Endoscopic management with Montgomery T-...BACKGROUND: Post-intubation tracheal stenosis (PITS) is a common late complication of prolonged endotracheal intubation or tracheostomy, leading to progressive airway obstruction. Endoscopic management with Montgomery T-tube placement provides a less invasive alternative to tracheal resection. This study evaluates clinical factors influencing outcomes following endoscopic treatment with T-tube stenting. METHODOLOGY: A retrospective chart review was conducted on patients with PITS managed at the Department of Otorhinolaryngology, AIIMS Jodhpur, between January 2019 and December 2023. Patients undergoing endoscopic management followed by Montgomery T-tube insertion, and completing at least 6 months postdecannulation follow-up, were included. Pre-operative assessment included Fibreoptic Laryngoscopy, CT imaging, and voice evaluation (VHI-10 and VRQOL). Outcome measures included need for repeated interventions, successful decannulation, and voice improvement. RESULTS: Of 27 patients who underwent T-tube placement, 18 met the inclusion criteria of complete follow-up, 17 achieved successful decannulation and formed the final study cohort. Nine of these (52%) required repeated procedures. Significant predictors for repeated interventions were length of stenosis (p < 0.001) and percentage of stenosis (p = 0.01). ROC analysis showed high predictive ability for stenosis length (AUC 0.889) and percentage (AUC 0.819), with cut-off values of >17 mm and >72.5% respectively. Voice outcomes significantly improved at 6 months postdecannulation (p < 0.001). CONCLUSION: Endoscopic management with Montgomery T-tube provides effective airway restoration and voice improvement in PITS. Stenosis length and severity are key predictors of the need for repeat interventions. Proper patient counselling, compliance, and careful consideration are essential for favourable outcomes.
PURPOSE: Indeterminate Thy3a (Bethesda III equivalent) thyroid nodules pose significant diagnostic and therapeutic dilemmas. This study evaluates a novel institutional approach that utilizes cytological subcategorization...PURPOSE: Indeterminate Thy3a (Bethesda III equivalent) thyroid nodules pose significant diagnostic and therapeutic dilemmas. This study evaluates a novel institutional approach that utilizes cytological subcategorization by nuclear atypia, to refine malignancy risk and guide management between active surveillance (AS) and surgery. METHODS: A retrospective cohort of adult patients with Thy3a cytology following ultrasound-guided aspiration (2019-2023) was reviewed. Exclusion criteria were incomplete records or < 2 years follow-up for the AS subgroup. Patients with non-nuclear atypia were offered surveillance unless symptomatic, while those with nuclear atypia were recommended for surgery. Primary outcomes included both histopathology-based (hROM) and overall estimated risk of malignancy (oROM), oncological outcomes including disease-free (DFS) and disease-specific survival (DSS). RESULTS: 188 patients with 190 thy3a thyroid nodules met inclusion criteria (female = 66%, median age = 49 years). AS was followed in 56.4% (n = 71) of the non-nuclear atypia subgroup, while 89.1% (n = 57) of the nuclear atypia subgroup underwent surgery. From the AS Thy3a non-nuclear cohort, 95.8% (n = 68/71) remained stable for ≥ 24 months. hROM and oROM were significantly higher in the nuclear than non-nuclear atypia nodules (59.6% versus 23.6% and 55.6% versus 11.3%, both p<.001). On multivariable analysis, nuclear atypia was an independent predictor of malignancy. Overall, 95.7%, (n = 45/47) of malignant Thy3a nodules were low-risk differentiated thyroid cancers. Over a median 42-month follow-up, 5-year DFS and DSS were 95.3% and 97.9% respectively. CONCLUSION: Cytological subcategorization of Thy3a thyroid nodules by nuclear atypia offers a valuable tool for risk stratification, enabling a tailored management approach, minimizing unnecessary surgeries, while ensuring prompt surgical intervention for high-risk cases.
PURPOSE: The literature has revealed considerable discrepancies in the nodal extension (ENE) definition and risk stratification. This study aimed to assess the extent of ENE in patients with lateral cervical lymph node m...PURPOSE: The literature has revealed considerable discrepancies in the nodal extension (ENE) definition and risk stratification. This study aimed to assess the extent of ENE in patients with lateral cervical lymph node metastases (pN1b) and evaluate its relationship with survival outcomes. METHODS: A retrospective cohort analysis was conducted involving patients with pN1b PTC who underwent initial surgery between January 2000 and December 2018. Disease-specific survival (DSS) was analyzed using Kaplan-Meier survival curves, and compared using the log-rank test. The association between the extent of ENE and DSS was examined using Cox proportional hazards regression models. RESULTS: The study included 3,382 patients. Microscopic ENE (miENE) was identified in 808 patients (23.9%). Macroscopic ENE (maENE) was divided into maENEa (499 patients, 14.8%) and maENEb (84 patients, 2.5%). The overall 5-year DSS rate was 98.9%. Stratification by ENE extent revealed 5-year DSS rates of 99.8% for no ENE, 99.5% for miENE, 97.5% for maENEa, and 82.2% for maENEb, indicating significant differences (p < 0.001). Cox regression analysis for DSS revealed significant associations with ENE extent, showing adjusted hazard ratios (HRs) of 3.49 (95% CI 1.28-9.51; P = 0.015) for the miENE group, 4.54 (95% CI 1.73-11.88; P = 0.002) for the maENEa group, and 20.54 (95% CI 7.95-53.10; p < 0.001) for the maENEb group, compared to the no-ENE group. CONCLUSION: The prognostic significance of ENE in PTC is highly variable and contingent on its extent. We propose stratification of maENE into maENEa and maENEb, with distinct DSS outcomes.