Migration of the localization wire to the back in patient with nonpalpable breast carcinoma: A case report

BACKGROUND Due to the increasing number of diagnosed nonpalpable breast cancer cases,wire localization has been commonly performed for surgical guidance to remove nonpalpable breast lesions.This report presents a rare case of localized wire migration to a subcutaneous lesion of the upper back in a breast cancer patient undergoing breast-conserving surgery.CASE SUMMARY A 48-year-old female was scheduled for breast-conserving surgery for left breast cancer.Ultrasonography guided wire localization was performed intraoperatively by surgeon to localize the nonpalpable breast cancer.After axilla sentinel lymph node biopsy,we realized that the wire was not visualized.The wire was not found in the operation field,including the breast and axilla.Breast-conserving surgery was performed after wire re-localization.Intraoperative chest posteroanterior view revealed that the wire was located on the level of midaxillary line.Two days after the operation,a serial simple X-ray revealed that the wire was located on the subcutaneous lesion of the back.The wire tip was palpable under the skin of the upper back,and the wire was removed under local anesthesia.CONCLUSION Hooked wire misplacement can lead to fatal complications.Surgeons must consider the possibility of wire migration during breast cancer surgery.

Ipsilateral and contralateral patent processus vaginalis in pediatric patients with a unilateral nonpalpable testis

This study aimed to investigate the incidence of patent processus vaginalis(PPV)in pediatric patients with a unilateral nonpalpable testis and explore the associated factors.From May 2014 to April 2017,152 boys who were diagnosed with a unilateral nonpalpable testis and underwent laparoscopy in Shanghai Children’s Hospital(Shanghai,China)were included in this study.The data were collected and reviewed,and the results were analyzed regarding the age at operation,side,development,and position of the nonpalpable testis.The mean age of the patients was 2.6(standard deviation:2.3)years.The testis was absent in 14 cases,nonviable in 81 cases,and viable in 57 cases.The incidence of PPV was 37.5%(57 of 152)on the ipsilateral side and 16.4%(25 of 152)on the contralateral side.The ipsilateral PPV was more prevalent when the nonpalpable testis occurred on the right side(P<0.01).Besides,patients with a viable testis had a greater incidence of ipsilateral PPV than those with a nonviable or absent testis(P<0.01).Moreover,this rate was the highest when the testis was in the abdominal cavity and the lowest when the testis was in the scrotum(both P<0.01).However,the incidence of contralateral PPV was independent of all the factors.In conclusion,in children with a nonpalpable testis,the incidence of an ipsilateral PPV was significantly related to the side,development,and position of the testis,while it was independent of these factors on the contralateral side.

Predicting the pathological status of mammographic microcalcifications through a radiomics approach

Objective The study aimed to develop a machine learning(ML)-coupled interpretable radiomics signature to predict the pathological status of non-palpable suspicious breast microcalcifications(MCs).Methods We enrolled 463 digital mammographical view images from 260 consecutive patients detected with non-palpable MCs and BI-RADS scored at 4(training cohort,n=428;independent testing cohort,n=35)in the First Affiliated Hospital of Nanjing Medical University between September 2010 and January 2019.Subsequently,837 textures and 9 shape features were subsequently extracted from each view and finally selected by an XGBoostembedded recursive feature elimination technique(RFE),followed by four machine learning-based classifiers to build the radiomics signature.Results Ten radiomic features constituted a malignancy-related signature for breast MCs as logistic regression(LR)and support vector machine(SVM)yielded better positive predictive value(PPV)/sensitivity(SE),0.904(95%CI,0.865–0.949)/0.946(95%CI,0.929–0.977)and 0.891(95%CI,0.822–0.939)/0.939(95%CI,0.907–0.973)respectively,outperforming their negative predictive value(NPV)/specificity(SP)from 10-fold crossvalidation(10FCV)of the training cohort.The optimal prognostic model was obtained by SVM with an area under the curve(AUC)of 0.906(95%CI,0.834–0.969)and accuracy(ACC)0.787(95%CI,0.680–0.855)from 10FCV against AUC 0.810(95%CI,0.760–0.960)and ACC 0.800 from the testing cohort.Conclusion The proposed radiomics signature dependens on a set of ML-based advanced computational algorithms and is expected to identify pathologically cancerous cases from mammographically undecipherable MCs and thus offer prospective clinical diagnostic guidance.