Background/Objectives: The parapharyngeal space is a complex anatomical region that houses critical neurovascular structures and serves as the origin of rare tumors, which account for 0.5–1% of head and neck neoplasms. Magnetic resonance imaging (MRI) is useful for their preoperative assessment. However, its accuracy in real-world clinical settings remains underexplored. This study aimed to investigate the diagnostic accuracy of MRI for parapharyngeal tumors at two tertiary centers. Methods: This retrospective study included patients who underwent MRI and surgical excision at two tertiary centers in Saudi Arabia between 2018 and 2024. Two reviewers independently extracted their MRI data and compared them with the final pathological data to determine the diagnostic performance of MRI. Results: Of the 31 patients (58.1% female; median age, 37.5 years), 90.3% had benign tumors. Neurogenic (41.9%) and salivary (25.8%) tumors were most common; 61.3% were located within the pre-styloid space. The benign and malignant groups had comparable baseline characteristics. MRI demonstrated moderate overall diagnostic agreement (κ = 0.525) and near-perfect concordance for schwannomas (κ = 0.912) and paragangliomas (κ = 0.839) but poor agreement for hemangiopericytomas (κ = −0.051). It had high accuracy (90.3%), specificity (92.9%), and negative predictive value (96.3%) for detecting malignancy but limited sensitivity (66.7%) or positive predictive value (50.0%). Nonetheless, cautious interpretation is required due to the limited prevalence of malignancy in the cohort (n = 3). Conclusions: MRI demonstrated high specificity for benign parapharyngeal space lesions in routine clinical reporting within this retrospective cohort, reflecting strong radiologic–pathologic agreement. Estimates of sensitivity and positive predictive value for malignancy were influenced by the limited number of malignant cases. Accordingly, the reported diagnostic performance measures should be interpreted as descriptive and exploratory, characterizing real-world MRI performance rather than definitive diagnostic accuracy.

Background/Objectives: To evaluate whether the interval between diagnosis and surgery is associated with aggressive histopathological features in papillary thyroid carcinoma (PTC) among patients treated at a tertiary hospitals in Saudi Arabia. Methods: This retrospective study was conducted at King Fahad Medical City, Riyadh, Saudi Arabia, from November 2009 to November 2024. A total of 350 adult patients who underwent surgical intervention for PTC were included based on predefined inclusion and exclusion criteria. Data were collected from medical records and included demographic, clinical, and histopathological characteristics. The primary outcome was the presence of aggressive histopathological features, assessed through tumor subtype, tumor size, extrathyroidal extension (ETE), lymph-node involvement, extracapsular extension (ECE), multifocality, goitrous tumor, thyroiditis, perineural invasion, lymphovascular invasion, and margin status. Surgical timing was categorized into two groups: less than six months and six months or more from diagnosis. Results: Most patients were female (76.6%), with a mean age of 40.7 years, and 78.3% were classified as overweight or obese. The analysis showed no statistically significant differences in histopathological outcomes between the two surgical timing groups. A significant association was found between positive lymph-node involvement and surgery performed within the first six months of diagnosis (p = 0.004). Conclusions: This study showed that surgical timing does not significantly affect histopathological outcomes in papillary thyroid carcinoma, particularly in patients without aggressive disease features. The association between early surgery and positive lymph-node involvement may reflect the prioritization of patients with preoperative lymph-node disease for earlier surgical intervention, highlighting the importance of individualized treatment planning. Further research is needed to explore the long-term impact of surgical timing and potential subgroup differences.

Background Lymph node ratio (LNR), defined as the ratio of positive lymph nodes to the total nodes harvested, has emerged as a potential prognostic marker in oral tongue squamous cell carcinoma (OTSCC). This study aimed to evaluate the prognostic significance of LNR in patients with OTSCC and its association with overall survival (OS), disease-free survival (DFS), and pathological features. Methods A retrospective cohort study was conducted, including 127 patients with biopsy-proven OTSCC treated between 2008 and 2023. LNR was calculated and stratified into two groups using a cutoff value of 0.01 determined by receiver operating characteristic (ROC) analysis. Survival outcomes were assessed using Kaplan–Meier analysis and Cox regression models. Results The median LNR was 0.01 (n = 59 for LNR < 0.01; n = 68 for LNR ≥ 0.01), and ROC analysis identified 0.01 as the optimal cutoff (AUC = 0.748). Patients with LNR ≥ 0.01 demonstrated significantly worse 5-year OS (43.3%) compared to those with LNR < 0.01 (84.9%) (p = 0.001). Similarly, DFS was significantly reduced in the high-LNR group. Median OS for the cohort was 177 months. On multivariate analysis, LNR ≥ 0.01 was independently associated with increased mortality risk (HR: 4.51; 95% CI 1.91–10.6; p = 0.001). Elevated LNR was also significantly associated with adverse pathological features, including perineural invasion, lymphovascular space invasion, positive surgical margins, recurrence, and distant metastasis. Conclusion LNR is significantly associated with survival outcomes in patients with OTSCC. A low cutoff value (0.01) effectively stratifies patients into distinct risk groups and may provide improved prognostic insight beyond traditional nodal staging. Incorporation of LNR into clinical practice may enhance risk stratification and guide postoperative management.