Exploring the perspectives and challenges of general surgery residents in Türkiye: Insights from a survey on surgical training - Turkish Journal of Surgery

Background and Objectives: We investigated how pretreatment body-composition parameters relate to pathologic complete response (pCR), disease-free survival (DFS), and overall survival (OS) in women with non-metastatic breast cancer who received neoadjuvant chemotherapy (NAC). Materials and Methods: We retrospectively analyzed 278 women treated with NAC at a single institution between January 2010 and December 2022. On computed tomography (CT) or PET-CT, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), skeletal muscle mass (SMM), and skeletal muscle density (SMD) were measured at the third lumbar vertebra (L3) with a semi-automated technique. Receiver operating characteristic (ROC) analysis was used to define optimal SMM cut-offs, and survival was examined by Kaplan–Meier estimation and Cox proportional-hazards regression. Results: The median follow-up was about 62 months. BMI was correlated with VAT (r = 0.449) and SAT (r = 0.482) but not with SMM (r = 0.075; p = 0.211). SMM was higher in women who attained pCR (107.4 ± 14.4 vs. 101.1 ± 16.1; p = 0.003). Derived by ROC analysis against distant metastasis—the event defining DFS—the SMM cut-off was 105 cm² (AUC = 0.725); values below it predicted poorer DFS on both univariable (HR = 4.80; p < 0.001) and multivariable testing (adjusted HR = 3.83; 95% CI 1.78–8.26; p = 0.001). The recurrence/metastasis rate was far higher among sarcopenic obese women (n = 34) than non-sarcopenic obese women (n = 56) (41.2% vs. 10.7%; log-rank p = 0.0004). With adjustment for molecular subtype, greater SMM remained an independent correlate of pCR (adjusted OR 1.26 per 10-cm² increment; 95% CI 1.04–1.53; p = 0.020). SMM was not significantly related to OS (univariable HR 1.75; p = 0.081). Sensitivity and specificity of the 105-cm² cut-off were 92.3% and 48.2%, respectively. Conclusions: In this retrospective cohort, greater pretreatment skeletal muscle area was independently linked to pathologic complete response and lower area to worse disease-free survival, while no significant link emerged with overall survival. Since BMI captures muscle mass poorly, body composition obtained from CT/PET-CT may add complementary prognostic information; nevertheless, because the design was observational and the cut-offs internally derived, these hypothesis-generating results need prospective external validation before clinical adoption.

Background and Objectives: Intraoperative sentinel lymph node (SLN) assessment is a pivotal step in early-stage breast cancer surgery. Frozen section (FS) analysis remains a widely utilised technique; however, its limitations, particularly in the detection of micrometastases, are well-documented. The process is both time-consuming and costly. The objective of this study was to investigate the potential of ex vivo shear-wave elastography (SWE) as a rapid and reproducible method for quantifying lymph node stiffness and predicting metastatic involvement. Materials and Methods: Between January 2022 and January 2024, 100 patients with biopsy-confirmed invasive breast cancer undergoing SLNB were enrolled in the study. A total of 384 excised axillary lymph nodes were subjected to ex vivo SWE immediately following excision, prior to the standard histopathological procedure. The mean stiffness (Emean) values were recorded, and the diagnostic performance was evaluated with the use of ROC analysis. Results: Of the 384 nodes examined, 45 (11.6%) were found to have metastases on final histopathology. It was demonstrated that Emean exhibited excellent discriminatory power, with an Area Under the Curve (AUC) value of 0.957. At the optimal cut-off of 28 kPa, the sensitivity and specificity levels were recorded as 91% and 87%, respectively. Conclusions: The findings of this study indicate that ex vivo SWE is a highly accurate and reproducible method for identifying metastatic sentinel lymph nodes. The technique has the potential to complement or selectively replace intraoperative FS, thereby reducing unnecessary tissue processing. The logical next step is multicentre validation.