INTRODUCTION:Literature data indicate a correlation between vitamin D deficiency and thyroid cancer (TC). We conducted this observational study to test this hypothesis. METHODS:We studied 327 consecutive thyroidectomy cases, and compared patients with TC and those who had benign thyroid disease (BTD). In total, 183 cases with well-differentiated TC (group B) were compared with 144 cases of BTD (group A). We defined 25-hydroxyvitamin D (25(OH)VitD) values <10ng/ml as severe vitamin D deficiency (15.4%), 10-30ng/ml as inadequacy (70.4%) and >30ng/ml as adequate (14.2%). We further used a cut-off point of 30ng/ml (used in a recent meta-analysis) to classify patients as vitamin D deficient or not. RESULTS:There was no statistically significant difference in the following: age, size of the thyroid gland, preoperative calcium levels, preoperative parathormone and vitamin D levels, body mass index and anti-thyroid antibodies. Only thyroid-stimulating hormone and weight of the thyroid gland were found to differ. There was no significant difference in mean vitamin D levels (group A = 19.82ng/ml [sd 9.59] vs group B = 19.69ng/ml [sd 11.34]; p = 0.917). The same was found when we compared the two groups according to the three categories of vitamin D values (deficiency, inadequacy, adequacy; p = 0.485) and when we performed the analysis based on all threshold levels (10, 20 and 30ng/ml; p = 0.328). Using various statistical methods, no correlation was found between vitamin D deficiency and differentiated TC (overall, microcarcinomas, macrocarcinomas). CONCLUSIONS:Based on our results, no correlation between vitamin D deficiency and TC was confirmed, contradicting and questioning the results of two recent meta-analyses.

Background: Luminal , Her2- tumours are biologically better than the non-luminal ones and usually we rely on genetic signatures to decide about the optimal systemic therapy. Occasionally though, there are surprisingly aggressive ones that need special management. In this study we tried to compare the high risk (HR) with the low risk (LR) Luminal tumours as defined in MONARCHE study in order to find special characteristics of differences between the 2 groups.

Background: The last few years there have been major evolution in the management of aggressive forms of breast cancer (BC). The management of HER2(+) as well as that of the Triple negative tumours (ΤΝ) has changed dramatically after the publication of KATHΕRINE and CREATE-X while the CDK4/6 inhibitors were added in the management of high risk HR+, HER2(-) tumours. Finally, new optimistic data emerged for the managemen of Her2 low HER2 low metastatic tumours (Destiny-Breast04). The purpose of theis study was to assess the percentage of newly diagnosed BC affected by these new treatments.

Background: Invasive lobular carcinoma (ILC) is the most common "special" breast cancer subtype and usually presents with particular morphology and behavior when compared to non-specific type (NST) breast carcinomas. ILCs usually have histologic characteristics commonly correlated with a good prognosis, as they are commonly intermediate grade and hormone receptor positive. The purpose of the study is to determine whether ILC behaves differently than the non-ILC (NILC).

Silicone implants or tissue expanders placed under the pectoralis major (PM) muscle are often used for breast reconstruction. However, the disruption of PM insertions, which is often an inevitable part of the surgical procedure, is known to cause PM morbidity and, subsequently, problems with the use of the ipsilateral arm. In this systematic review, we present current knowledge regarding the effect of submuscular silicone-based breast reconstruction on the function of PM and the ipsilateral arm. A search of the relevant English literature was performed through PubMed and ten eligible studies were identified. Articles reporting breast augmentation were accepted as the techniques of implant insertion are similar to reconstruction. Questionnaires reporting the status of the arm, analysis of the range of motion of the shoulder with 3-D video, isometric or isokinetic dynamometry, ultrasound shear-wave elastography, volumetric MRI, electromyography and light and electron microscopy of the PM fibers were used for the assessment of PM and arm status. The insertion of implants under the PM, especially when combined with dissection of some of its insertions, seems to be associated with measurable abnormal microscopic, imaging, and dynamometric findings. However, the intact part of the muscle and possibly other nearby muscular structures are able to compensate for the lost part of PM. Thus, the insertion of implants fully or partially under the PM seems to have no or little effect on the function of the ipsilateral upper limb in daily life.

INTRODUCTION:Bilateral neck exploration (BNE) has been the gold standard for the treatment of primary hyperparathyroidism (PHPT). Minimally invasive parathyroidectomy (MIP) has emerged as an alternative procedure for localised solitary adenomas. The most popular MIP techniques are the open MIP (OMIP) and the minimally invasive video-assisted parathyroidectomy (MIVAP). This study aims to assess whether we achieved a smooth transition from OMIP to MIVAP without compromising the results or increasing the cost.METHODS:A parathyroid adenoma was successfully localised preoperatively in 77/86 patients with PHPT. MIP was contraindicated in 27/86 cases. For MIVAP, a 5mm, 30 degree camera was employed, along with special instruments.RESULTS:Median preoperative parathyroid hormone (PTH) level was 145.9pg/dl (59-2,151) and median calcium (Ca) was 10.8mg/dl (9.3-19). Comparing MIVAP (N=31) with OMIP (N=28), there was no significant difference in the age, sex, location of the adenoma, preoperative PTH and Ca levels as well as in all the other factors compared, apart from the size of adenomas, which were bigger in the OMIP group (1.85cm vs 1.4cm, p=0.032). Moreover, cure rates, operating time, hospital stay and rates of postoperative normocalcaemia were similar between the two groups.CONCLUSIONS:Despite the learning curve, MIVAP was not found to be inferior to OMIP for localised adenomas. The final cost was no higher for MIVAP than OMIP with the use of common reusable instruments. This, along with surgeons' experience in parathyroid and endoscopic surgery facilitates a smooth and cost-effective transition from OMIP to MIVAP.

Mastectomy and immediate reconstruction may be challenging in patients with large breasts, especially when significant ptosis is also present. Skin-reducing mastectomy (SRM) is usually indicated in these cases, although with increased morbidity. The aims of the study were to introduce 2 modifications of the classic technique and to incorporate them in the management algorithm to improve the outcomes. Twenty patients fulfilling the criteria for SRM underwent mastectomy and reconstruction either with the "classic SRM" (8 patients) or with 1 of the 2 modifications described here: modification A "vertical limb bridging" (for patients with very large breasts, 2 patients) and modification B "dual coverage" (for patients with moderate breasts, 10 patients). All reconstructions were performed using a slow progressive expansion of the implant. Herein, we describe the techniques along with the proposed indications for each one of them. There was no reconstruction failure, and all patients were satisfied with the final results. There were 2 cases with T junction, lateral skin flap partial ischemia managed with delayed revision of the wound on the fifth postoperative day to allow less skin excision. One patient (smoker) developed severe lower pole cellulitis, which was managed conservatively. Finally, 1 patient who underwent radiotherapy developed a late infected seroma, which was managed successfully with drainage and antibiotics. Overall, there was good lower pole projection even with the dual-coverage modification. Skin-reducing mastectomy can be tailored according to individual patient anatomy, and the high reported complication rate associated with this technique can be minimized using certain surgical modifications, tissue expanders with progressive inflation, and good patient selection.

INTRODUCTION: Within the last 50 years the management of patients with breast cancer has changed dramatically with a significant de-escalation of the role and magnitude of surgery, both for the management of the primary tumor and for the management of the axilla. In the management of the axilla of patients with early stage breast cancer (EBC) and clinically uninvolved axilla (cN0), axillary lymph node dissection (ALND) was gradually replaced by sentinel lymph node biopsy (SLNB) saving more than 60-70% of patients from an unnecessary dissection. Further studies confirmed that isolated tumor cells or micrometastases found on the SLN had no further benefit from ALND sparing even more patients from an unnecessary ALND. Eventually, the Z0011 and other studies showed that even patients with 1-2 positive SLN can be spared from ALND provided they fulfill certain criteria. Still though there were many flaws in these studies and further research was necessary to generalize the results of these studies to a wider target group. Meanwhile, there is a clear view that many low risk patients if they have their axilla evaluated via US and are not found to have suspicious nodes, it is highly unlikely to have involved axilla. This let to studies evaluating the non-surgical management of the axilla. Finally, in the post neoadjuvant setting 3 randomized controlled trials showed that under certain circumstances SLNB can be done after the NAC even in patients who initially had involved axilla and was converted to clinically uninvolved (cN1→cN0).EVIDENCE ACQUISITION: PubMed, Medline, the Cochrane Library Controlled Trials Register as well as National Institutes of Health ClinicalTrials.Gov database have been consulted up to May 2020.EVIDENCE SYNTHESIS: We studied and described the ongoing trials on patients not undergoing neoadjuvant chemotherapy and we discussed the eligibility criteria, the comparison arms and the expected outcomes. We further examined the ongoing trials on patients undergoing neoadjuvant chemotherapy in the same manner.CONCLUSIONS: Although we have covered a long way in the journey of eliminating axillary surgery, there are still lots of questions to be answered and trials to be conducted. We anticipate the results of the ongoing trials to provide the necessary evidence to safely de-escalate more the axillary surgery, both in the non-neoadjuvant as well as in the neoadjuvant setting, hoping that in the not so far future the axillary surgery will eventually perish.