Hilar lymph nodes with dense adhesion to the bronchus and pulmonary artery ("doornail" nodes) can be encountered unexpectedly during robot-assisted pulmonary resection. We report our experience managing these nodes and associated factors. This retrospective single-center cohort study included 1,185 patients undergoing robot-assisted pulmonary resection (March 2021-September 2024). Preoperative factors were analyzed using Firth penalized logistic regression in a clinically selected model (age, maximal voluntary ventilation [MVV], and tumor diameter). Operative time and blood loss were compared using robust regression models. Perioperative outcomes were compared descriptively between attempted separate dissection and en bloc stapling. Doornail hilar lymph nodes occurred in 48 of 1,185 patients (4.05%; 95% CI, 3.07-5.33%). Older age remained associated with this finding after adjusting for MVV and tumor diameter (adjusted OR per 10 years, 2.316; 95% CI, 1.533-3.596; P<0.001). Operative time was longer unadjusted (105 vs 92 min; P=0.027) but not after adjustment. Among these 48 patients, 45 (93.8%) received en bloc stapling with no blood loss exceeding 200 mL, transfusion, or prespecified in-hospital complication, whereas all 3 (6.3%) who underwent attempted separate dissection had substantial bleeding (700-2,400 mL), and 2 required transfusion. No conversion to thoracotomy occurred. Doornail hilar lymph nodes occurred in about 4% of patients; older age remained associated with this finding after adjusting for MVV and tumor diameter. Because strategy selection was non-random and groups differed in resection extent, comparative safety cannot be established; en bloc stapling after tissue thinning may be feasible when a node cannot be safely separated.

Rationale: Trophoblast cell-surface antigen 2 (Trop2) is an essential therapeutic target in breast cancer, yet non-invasive methods for assessing its expression and predicting response to Trop2-directed antibody-drug conjugates (ADCs) remain limited. We aimed to evaluate the diagnostic accuracy of [68]Ga-MY6349 positron emission tomography/computed tomography (PET/CT) in patients with breast cancer and assess its impact on clinical decision-making. Methods: We prospectively enrolled 73 patients with suspected or confirmed breast cancer who underwent both [68]Ga-MY6349 and [18]F-fluorodeoxyglucose ([18]F-FDG) PET/CT from December 2024 to April 2025. Lesion-based diagnostic performance was compared using histopathology and follow-up imaging as reference standards. Treatment decisions were recorded before and after [68]Ga-MY6349 PET/CT. Serial [68]Ga-MY6349 PET/CT was performed to assess the early metabolic response in three patients with triple-negative breast cancer receiving sacituzumab tirumotecan. Results: [68]Ga-MY6349 PET/CT identified more malignant lesions (564 vs. 436) and fewer false positives (2 vs. 40) than [18]F-FDG PET/CT. In the initial-staging cohort (n = 30), [68]Ga-MY6349 PET/CT led to TNM stage upgrades in 6/30 patients (20%) and treatment modifications in 4/30. In the restaging cohort (n = 43), clinical management was altered in 5/43 patients (12%) owing to the identification of additional metastatic lesions or rectification of false-positive findings via [68]Ga-MY6349 PET/CT. [68]Ga-MY6349 PET/CT yielded higher overall tumor uptake (median maximum standardized uptake value (SUVmax), 5.9 vs. 4.1; P < 0.001) and improved lesion conspicuity, particularly in lymph node and metastatic lesions. Exploratory analysis in three patients receiving Trop2-ADC therapy showed that early changes in [68]Ga-MY6349 uptake after two treatment cycles were concordant with the subsequent clinical response. Conclusions: [68]Ga-MY6349 PET/CT demonstrated superior diagnostic performance to [18]F-FDG PET/CT in breast cancer staging and diagnosis, directly influencing therapeutic strategies. Preliminary findings from the triple-negative breast cancer cases suggest that early changes in SUVmax may be associated with the treatment response to Trop2-targeted ADC therapy, warranting further prospective validation in larger patient populations.

[This corrects the article DOI: 10.3389/fendo.2025.1728045.].

Isolated bone marrow involvement in sarcoidosis is a rare condition, mostly manifested by cytopenia, hypercalcemia and/or hypercalciuria. We present the case of a 48-year-old man with a prolonged fever meeting the criteria for fever of unknown origin, in whom a suspicion of sarcoidosis only emerged after non-necrotizing granulomas were identified in the bone marrow, one year after the onset of the disease. The patient exhibited only mild anemia, moderate leukocytosis, thrombocytosis, and increased erythrocyte sedimentation rate, C-reactive protein levels. Other potential causes of fever of unknown origin and bone marrow non-necrotizing granulomas were ruled out. Although serum angiotensin-converting enzyme levels were elevated, they did not reach diagnostic thresholds. The diagnosis of sarcoidosis was confirmed by newly detected intra-abdominal lymphadenopathy on computed tomography and whole-body 18F-fluorodeoxyglucose positron emission tomography with computed tomography, along with the presence of multiple sarcoid-type non-necrotizing granulomas in the intra-abdominal lymph nodes. Treatment with prednisolone normalized the patient's body temperature, improved laboratory-inflammatory profile, and enhanced the patient's quality of life. In cases where fever of unknown origin is present and sarcoidosis is suspected, a bone marrow biopsy may be considered, even in the absence of cytopenia, hypercalcemia, or hypercalciuria.