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Cervical Cancer

Key 2023–2024 Developments Highlighted by the Retrieved Evidence

2026-05-08
Falcon MONDO:0002974 Model: Edison Scientific Literature 40 citations

1. Disease Information

1.1 Concise overview

Cervical cancer is a malignancy arising from the cervix uteri, typically preceded by detectable precursor lesions (e.g., high-grade CIN) and strongly driven by persistent infection with oncogenic (“high-risk”) human papillomavirus (HPV). Reviews emphasize that the disease is largely preventable through HPV vaccination and effective screening programs. (goldstein2024thefutureof pages 1-2, manso2024seomgeicoclinicalguidelines pages 1-2)

1.2 Common synonyms / alternative names (not exhaustive)

Common clinical labels include: “cancer of the cervix,” “cervical carcinoma,” “cervix uteri cancer.” These synonyms were not enumerated in the retrieved sources and are provided as standard clinical terminology (unsourced in-tool).

1.3 Evidence provenance

The information presented here is derived from aggregated disease-level resources and peer‑reviewed studies/guidelines (GLOBOCAN analyses, international guidelines, and population-based implementation studies), rather than individual patient EHR extracts. (bray2024globalcancerstatistics pages 5-6, teixeira2024transitionfromopportunistic pages 1-2, fischerova2024theroleof pages 1-2, manso2024seomgeicoclinicalguidelines pages 1-2)

2. Etiology

2.1 Primary causal factors

Persistent high-risk HPV infection is the dominant causal factor in cervical cancer. - A 2024 screening-technology review states that “over 95% of cervical cancer cases are attributable to HPV” and that HPV‑16/18 account for ~71% of global cases. (goldstein2024thefutureof pages 1-2) - Mechanistically, reviews describe HPV oncogenesis via viral oncoproteins E6/E7, including inactivation of tumor suppressors p53 and Rb, and note the role of HPV genome integration during progression. (nagdev2026advancesinscreening pages 2-4)

2.2 Risk factors and co-factors (evidence available in retrieved sources)

The retrieved evidence emphasizes population-level and biologic drivers rather than a comprehensive quantified list of co-factors. - Multi-type HPV infection is described as clinically relevant; one review reports co-infection prevalence ranges ~18.5–46% among HPV-positive women (context: HPV infection epidemiology and screening triage). (goldstein2024thefutureof pages 1-2) - Broader prevention context: the GLOBOCAN 2022 analysis describes HPV as a “necessary (but not sufficient)” cause and highlights elimination-strategy targets and screening ages (35 and 45), implying programmatic focus on preventing persistent infection and progression. (bray2024globalcancerstatistics pages 26-26)

2.3 Protective factors

Evidence in retrieved sources supports: - HPV vaccination and screening as key protective interventions; high-income countries with HPV vaccination and screening have experienced “dramatic reductions” in incidence in guideline summaries. (manso2024seomgeicoclinicalguidelines pages 1-2)

2.4 Gene–environment interactions

Specific gene–environment interaction findings were not identified in the retrieved sources for this run.

3. Phenotypes (clinical presentation)

The retrieved sources for this run focus primarily on screening, staging, imaging, and systemic therapy rather than symptom prevalence. As a result: - Comprehensive phenotype lists, frequencies, and quality-of-life impacts with primary citations could not be extracted. - HPO term suggestions are therefore not provided as evidence-backed entries in this run.

4. Genetic / Molecular Information

4.1 Key molecular concepts (HPV-driven carcinogenesis)

Recent reviews reiterate HPV-driven transformation mechanisms and host genomic/epigenetic alterations: - HPV E6/E7 perturbation of p53/Rb is highlighted as a core axis for malignant transformation. (nagdev2026advancesinscreening pages 2-4) - Reviews summarize that somatic alterations (including PIK3CA mutations and APOBEC signatures) are recurrent in cervical cancer, providing a rationale for targeted therapy exploration and biomarker-guided approaches. (nagdev2026advancesinscreening pages 2-4)

4.2 Epigenetics and methylation biomarkers (2024 primary research)

A major 2024 real-world screening study evaluated DNA methylation triage: - WID-qCIN assay measures methylation of DPP6, RALYL, GSX1 in HPV-positive screening samples. (schreiberhuber2024cervicalcancerscreening pages 1-2, schreiberhuber2024cervicalcancerscreening pages 2-3) - In 28,017 screened women (Stockholm; ≥30 years; 2,377 HPV-positive), WID-qCIN + HPV16/18 detected 93.4% of CIN3 and 100% of invasive cervical cancers. (schreiberhuber2024cervicalcancerscreening pages 1-2, schreiberhuber2024cervicalcancerscreening pages 2-3)

5. Environmental Information

The retrieved sources emphasize infectious etiology and screening-system factors rather than detailed chemical/toxin exposures. Infectious agent: - High-risk HPV is the principal infectious driver. (goldstein2024thefutureof pages 1-2, manso2024seomgeicoclinicalguidelines pages 1-2)

6. Mechanism / Pathophysiology

6.1 Causal chain (high-level)

  1. High-risk HPV infection of cervical epithelium; persistent infection over years is a prerequisite for progression. (goldstein2024thefutureof pages 1-2, nagdev2026advancesinscreening pages 2-4)
  2. Viral genome integration and expression of E6/E7 oncoproteins drives dysregulated cell-cycle control (p53/Rb pathway interference) and supports malignant transformation. (nagdev2026advancesinscreening pages 2-4)
  3. Accumulation of host genomic/epigenetic alterations and tumor microenvironment remodeling contributes to invasion and metastasis, motivating biomarker-driven and immunotherapy approaches. (nagdev2026advancesinscreening pages 2-4)

6.2 Immune system involvement and implications

Immune checkpoint blockade has become clinically important in advanced disease, indicating that immune evasion and immune contexture are therapeutically actionable in a subset of patients. (martinezcannon2024theevolvingrole pages 1-3, manso2024seomgeicoclinicalguidelines pages 1-2)

7. Anatomical Structures Affected

Primary site: cervix uteri. (Implied throughout cervical-cancer-focused guidelines and imaging papers; explicit ontology mapping not retrieved.) (fischerova2024theroleof pages 1-2)

Staging spread assessed by imaging: parametrial extension; invasion of bladder/rectal wall; pelvic and paraaortic nodal metastases; distant metastases (lung, liver, bone, peritoneum). (fischerova2024theroleof pages 7-8, fischerova2024theroleof pages 26-27, fischerova2024theroleof pages 6-7)

8. Temporal Development

The retrieved sources describe long preclinical windows enabling prevention: - Screening and prevention frameworks emphasize that effective programs can detect precancers and early cancers and shift stage distribution toward earlier disease. A Brazilian organized HPV DNA screening program reported earlier-stage detection (majority Stage I) compared with prior cytology-era advanced-stage predominance. (teixeira2024transitionfromopportunistic pages 1-2)

9. Inheritance and Population

9.1 Epidemiology (recent authoritative statistics)

Global burden (GLOBOCAN 2022; published 2024): - 661,021 new cases and 348,189 deaths worldwide in 2022 (Table 1, cervix uteri). (bray2024globalcancerstatistics pages 5-6)

Disparities by development level (rates): - GLOBOCAN 2022 analysis reports higher incidence and mortality in “transitioning” vs “transitioned” countries (incidence 19.3 vs 12.1 per 100,000; mortality 12.4 vs 4.8 per 100,000). (bray2024globalcancerstatistics pages 26-26)

9.2 Sex ratio

Cervical cancer occurs in individuals with a cervix; sex ratio data were not extracted from retrieved sources in this run.

10. Diagnostics

10.1 Screening tests and triage (recent advances)

HPV-based screening (systems and implementation): - A 2024 review highlights emerging approaches including rapid/low-cost HPV testing, digital colposcopy with AI interpretation, DNA methylation assays, and dual-stain cytology. (goldstein2024thefutureof pages 1-2)

Real-world methylation triage (Nature Medicine 2024): - In HPV-positive samples, WID-qCIN/HPV16/18 improved triage efficiency: cytology triage would require 4.1 colposcopy referrals per CIN2+ vs 2.4 referrals per CIN2+ for WID-qCIN/HPV16/18 over follow-up. (schreiberhuber2024cervicalcancerscreening pages 1-2, schreiberhuber2024cervicalcancerscreening pages 4-5) - Visual evidence: Table summarizing colposcopy referral efficiency and detection performance is available from the paper. (schreiberhuber2024cervicalcancerscreening media 23da8e40)

10.2 Imaging and staging (ESGO/ESTRO/ESP update 2023; published 2024)

Modern guidelines incorporate imaging into staging and treatment planning: - Transvaginal/transrectal ultrasound or pelvic MRI is recommended for local staging; ultrasound can be a valid alternative to MRI in expert hands. (fischerova2024theroleof pages 1-2) - For early-stage tumors (T1a–T2a1 excluding T1b3) with negative nodes on ultrasound/MRI, surgicopathological staging is recommended because imaging has limited sensitivity for small-volume nodal disease. (fischerova2024theroleof pages 1-2) - For locally advanced disease or suspicious nodes, contrast-enhanced CT or FDG PET/CT is recommended for extrapelvic spread assessment; the guideline emphasizes high specificity but limited sensitivity for micrometastases across modalities. (fischerova2024theroleof pages 26-27)

11. Outcome / Prognosis

The retrieved evidence base in this run emphasizes stage shift through screening and survival improvements in advanced disease trials.

11.1 Screening-associated stage shift (population implementation)

In the PREVENTIVO organized HPV DNA screening program in Brazil: - 29 cancers were detected with 83% Stage I; in the prior opportunistic cytology period, 67% were advanced stage. (teixeira2024transitionfromopportunistic pages 1-2)

11.2 Advanced/recurrent metastatic disease outcomes (selected trial outcomes as summarized in authoritative reviews)

12. Treatment

12.1 Guideline-based treatment framework (2024 European/Spanish and national guidance)

12.2 Systemic therapy and immunotherapy integration

  • The SEOM-GEICO guideline notes that immunotherapy has significantly improved OS in recurrent/metastatic disease when added to chemotherapy (± bevacizumab) in first line and as monotherapy after platinum in second line. (manso2024seomgeicoclinicalguidelines pages 1-2)
  • The Polish PSGO guideline (v2024.0) describes PD‑L1 testing to select pembrolizumab candidates and references immunotherapy incorporation for higher-risk locally advanced disease (pembrolizumab with CCRT and maintenance). (sznurkowski2024thepolishsociety pages 1-2)

12.3 Targeted therapy / ADC

  • Reviews highlight tisotumab vedotin (tissue factor–directed ADC) as a preferred later-line option in recurrent/metastatic disease, with characteristic toxicities including ocular events. (nagdev2026advancesinscreening pages 13-15)

12.4 MAXO (Medical Action Ontology) suggestions (non-exhaustive; ontology IDs not retrieved)

  • HPV vaccination; cervical cancer screening; HPV DNA testing; colposcopy; conization; hysterectomy; radiotherapy; brachytherapy; concurrent chemoradiotherapy; immune checkpoint inhibitor therapy; antibody–drug conjugate therapy.

13. Prevention

13.1 Primary prevention

13.2 Secondary prevention (screening)

  • HPV-based screening and effective triage are central; a major 2024 review highlights self-sampling, AI-assisted colposcopy, methylation, and other approaches to improve detection and risk stratification. (goldstein2024thefutureof pages 1-2)
  • GLOBOCAN-related discussion references elimination-strategy screening targets at ages 35 and 45 and emphasizes improving participation (including self-sampling). (bray2024globalcancerstatistics pages 26-26)

13.3 Real-world implementation example (organized screening)

14. Other Species / Natural Disease

Not addressed in the retrieved sources for this run.

15. Model Organisms

Model-organism and experimental-system details (e.g., HPV transgenic mice, organoids) were not captured in the retrieved sources excerpted in this run; therefore, evidence-backed model summaries are not provided.

Key 2023–2024 Developments Highlighted by the Retrieved Evidence

  1. Updated global burden quantification (2024 publication of GLOBOCAN 2022 statistics) with explicit 2022 cervical cancer incidence/mortality counts. (bray2024globalcancerstatistics pages 5-6)
  2. Real-world validation of DNA methylation triage (WID-qCIN) demonstrating high CIN3 and invasive-cancer detection and improved colposcopy efficiency vs cytology triage (Nature Medicine 2024). (schreiberhuber2024cervicalcancerscreening pages 1-2, schreiberhuber2024cervicalcancerscreening media 23da8e40)
  3. Health-system implementation evidence for organized HPV DNA screening showing improved coverage, diagnostic follow-through, and earlier-stage cancer detection (Scientific Reports 2024). (teixeira2024transitionfromopportunistic pages 1-2)
  4. Imaging/staging guidance (ESGO/ESTRO/ESP update 2023; published 2024) reinforcing ultrasound/MRI for local staging and PET/CT/CT for extrapelvic assessment, with explicit discussion of sensitivity limits for micrometastases. (fischerova2024theroleof pages 1-2, fischerova2024theroleof pages 26-27)
  5. Therapy landscape consolidation in guidelines and reviews: integration of immune checkpoint blockade (pembrolizumab; cemiplimab) and ADCs (tisotumab vedotin) into recurrent/metastatic management frameworks. (manso2024seomgeicoclinicalguidelines pages 1-2, martinezcannon2024theevolvingrole pages 1-3, nagdev2026advancesinscreening pages 13-15)

URLs and publication dates (where available in retrieved sources)

References

  1. (bray2024globalcancerstatistics pages 5-6): Freddie Bray, Mathieu Laversanne, Hyuna Sung, Jacques Ferlay, Rebecca L. Siegel, Isabelle Soerjomataram, and Ahmedin Jemal. Global cancer statistics 2022: globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 74:229-263, Apr 2024. URL: https://doi.org/10.3322/caac.21834, doi:10.3322/caac.21834. This article has 35815 citations and is from a domain leading peer-reviewed journal.

  2. (goldstein2024thefutureof pages 1-2): Amelia R Goldstein, Mallory Gersh, Gabriela Skovronsky, and Chailee Moss. The future of cervical cancer screening. International Journal of Women's Health, 16:1715-1731, Oct 2024. URL: https://doi.org/10.2147/ijwh.s474571, doi:10.2147/ijwh.s474571. This article has 43 citations and is from a peer-reviewed journal.

  3. (manso2024seomgeicoclinicalguidelines pages 1-2): Luis Manso, Avinash Ramchandani-Vaswani, Ignacio Romero, Luisa Sánchez-Lorenzo, María José Bermejo-Pérez, Purificación Estévez-García, Lorena Fariña-Madrid, Yolanda García García, Marta Gil-Martin, and María Quindós. Seom-geico clinical guidelines on cervical cancer (2023). Clinical & Translational Oncology, 26:2771-2782, Aug 2024. URL: https://doi.org/10.1007/s12094-024-03604-3, doi:10.1007/s12094-024-03604-3. This article has 19 citations and is from a peer-reviewed journal.

  4. (schreiberhuber2024cervicalcancerscreening pages 1-2): Lena Schreiberhuber, James E. Barrett, Jiangrong Wang, Elisa Redl, Chiara Herzog, Charlotte D. Vavourakis, Karin Sundström, Joakim Dillner, and Martin Widschwendter. Cervical cancer screening using dna methylation triage in a real-world population. Nature Medicine, 30:2251-2257, Jun 2024. URL: https://doi.org/10.1038/s41591-024-03014-6, doi:10.1038/s41591-024-03014-6. This article has 85 citations and is from a highest quality peer-reviewed journal.

  5. (schreiberhuber2024cervicalcancerscreening pages 2-3): Lena Schreiberhuber, James E. Barrett, Jiangrong Wang, Elisa Redl, Chiara Herzog, Charlotte D. Vavourakis, Karin Sundström, Joakim Dillner, and Martin Widschwendter. Cervical cancer screening using dna methylation triage in a real-world population. Nature Medicine, 30:2251-2257, Jun 2024. URL: https://doi.org/10.1038/s41591-024-03014-6, doi:10.1038/s41591-024-03014-6. This article has 85 citations and is from a highest quality peer-reviewed journal.

  6. (schreiberhuber2024cervicalcancerscreening pages 4-5): Lena Schreiberhuber, James E. Barrett, Jiangrong Wang, Elisa Redl, Chiara Herzog, Charlotte D. Vavourakis, Karin Sundström, Joakim Dillner, and Martin Widschwendter. Cervical cancer screening using dna methylation triage in a real-world population. Nature Medicine, 30:2251-2257, Jun 2024. URL: https://doi.org/10.1038/s41591-024-03014-6, doi:10.1038/s41591-024-03014-6. This article has 85 citations and is from a highest quality peer-reviewed journal.

  7. (schreiberhuber2024cervicalcancerscreening media 23da8e40): Lena Schreiberhuber, James E. Barrett, Jiangrong Wang, Elisa Redl, Chiara Herzog, Charlotte D. Vavourakis, Karin Sundström, Joakim Dillner, and Martin Widschwendter. Cervical cancer screening using dna methylation triage in a real-world population. Nature Medicine, 30:2251-2257, Jun 2024. URL: https://doi.org/10.1038/s41591-024-03014-6, doi:10.1038/s41591-024-03014-6. This article has 85 citations and is from a highest quality peer-reviewed journal.

  8. (fischerova2024theroleof pages 1-2): Daniela Fischerova, Filip Frühauf, Andrea Burgetova, Ingfrid S. Haldorsen, Elena Gatti, and David Cibula. The role of imaging in cervical cancer staging: esgo/estro/esp guidelines (update 2023). Cancers, 16:775, Feb 2024. URL: https://doi.org/10.3390/cancers16040775, doi:10.3390/cancers16040775. This article has 50 citations.

  9. (fischerova2024theroleof pages 26-27): Daniela Fischerova, Filip Frühauf, Andrea Burgetova, Ingfrid S. Haldorsen, Elena Gatti, and David Cibula. The role of imaging in cervical cancer staging: esgo/estro/esp guidelines (update 2023). Cancers, 16:775, Feb 2024. URL: https://doi.org/10.3390/cancers16040775, doi:10.3390/cancers16040775. This article has 50 citations.

  10. (nagdev2026advancesinscreening pages 13-15): Priyanka Nagdev and Mythri Chittilla. Advances in screening, immunotherapy, targeted agents, and precision surgery in cervical cancer: a comprehensive clinical review (2018–2025). Current Oncology, Jan 2026. URL: https://doi.org/10.3390/curroncol33010048, doi:10.3390/curroncol33010048. This article has 1 citations.

  11. (martinezcannon2024theevolvingrole pages 1-3): Bertha Alejandra Martinez-Cannon and Ilaria Colombo. The evolving role of immune checkpoint inhibitors in cervical and endometrial cancer. Cancer Drug Resistance, Jun 2024. URL: https://doi.org/10.20517/cdr.2023.120, doi:10.20517/cdr.2023.120. This article has 18 citations.

  12. (sznurkowski2024thepolishsociety pages 1-2): Jacek J. Sznurkowski, Lubomir Bodnar, Łukasz Szylberg, Agnieszka Zołciak-Siwinska, Anna Dańska-Bidzińska, Dagmara Klasa-Mazurkiewicz, Agnieszka Rychlik, Artur Kowalik, Joanna Streb, Mariusz Bidziński, and Włodzimierz Sawicki. The polish society of gynecological oncology guidelines for the diagnosis and treatment of cervical cancer (v2024.0). Journal of Clinical Medicine, 13:4351, Jul 2024. URL: https://doi.org/10.3390/jcm13154351, doi:10.3390/jcm13154351. This article has 10 citations.

  13. (teixeira2024transitionfromopportunistic pages 1-2): Julio Cesar Teixeira, Diama Bhadra Vale, Cirbia Silva Campos, Ilana Polegatto, Joana Froes Bragança, Michelle Garcia Discacciati, and Luiz Carlos Zeferino. Transition from opportunistic cytological to organized screening program with dna-hpv testing detected prevalent cervical cancers 10 years in advance. Scientific Reports, Sep 2024. URL: https://doi.org/10.1038/s41598-024-71735-2, doi:10.1038/s41598-024-71735-2. This article has 22 citations and is from a peer-reviewed journal.

  14. (teixeira2024transitionfromopportunistic pages 2-4): Julio Cesar Teixeira, Diama Bhadra Vale, Cirbia Silva Campos, Ilana Polegatto, Joana Froes Bragança, Michelle Garcia Discacciati, and Luiz Carlos Zeferino. Transition from opportunistic cytological to organized screening program with dna-hpv testing detected prevalent cervical cancers 10 years in advance. Scientific Reports, Sep 2024. URL: https://doi.org/10.1038/s41598-024-71735-2, doi:10.1038/s41598-024-71735-2. This article has 22 citations and is from a peer-reviewed journal.

  15. (teixeira2024transitionfromopportunistic pages 5-5): Julio Cesar Teixeira, Diama Bhadra Vale, Cirbia Silva Campos, Ilana Polegatto, Joana Froes Bragança, Michelle Garcia Discacciati, and Luiz Carlos Zeferino. Transition from opportunistic cytological to organized screening program with dna-hpv testing detected prevalent cervical cancers 10 years in advance. Scientific Reports, Sep 2024. URL: https://doi.org/10.1038/s41598-024-71735-2, doi:10.1038/s41598-024-71735-2. This article has 22 citations and is from a peer-reviewed journal.

  16. (teixeira2024transitionfromopportunistic pages 5-6): Julio Cesar Teixeira, Diama Bhadra Vale, Cirbia Silva Campos, Ilana Polegatto, Joana Froes Bragança, Michelle Garcia Discacciati, and Luiz Carlos Zeferino. Transition from opportunistic cytological to organized screening program with dna-hpv testing detected prevalent cervical cancers 10 years in advance. Scientific Reports, Sep 2024. URL: https://doi.org/10.1038/s41598-024-71735-2, doi:10.1038/s41598-024-71735-2. This article has 22 citations and is from a peer-reviewed journal.

  17. (teixeira2024transitionfromopportunistic pages 4-5): Julio Cesar Teixeira, Diama Bhadra Vale, Cirbia Silva Campos, Ilana Polegatto, Joana Froes Bragança, Michelle Garcia Discacciati, and Luiz Carlos Zeferino. Transition from opportunistic cytological to organized screening program with dna-hpv testing detected prevalent cervical cancers 10 years in advance. Scientific Reports, Sep 2024. URL: https://doi.org/10.1038/s41598-024-71735-2, doi:10.1038/s41598-024-71735-2. This article has 22 citations and is from a peer-reviewed journal.

  18. (nagdev2026advancesinscreening pages 2-4): Priyanka Nagdev and Mythri Chittilla. Advances in screening, immunotherapy, targeted agents, and precision surgery in cervical cancer: a comprehensive clinical review (2018–2025). Current Oncology, Jan 2026. URL: https://doi.org/10.3390/curroncol33010048, doi:10.3390/curroncol33010048. This article has 1 citations.

  19. (bray2024globalcancerstatistics pages 26-26): Freddie Bray, Mathieu Laversanne, Hyuna Sung, Jacques Ferlay, Rebecca L. Siegel, Isabelle Soerjomataram, and Ahmedin Jemal. Global cancer statistics 2022: globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 74:229-263, Apr 2024. URL: https://doi.org/10.3322/caac.21834, doi:10.3322/caac.21834. This article has 35815 citations and is from a domain leading peer-reviewed journal.

  20. (fischerova2024theroleof pages 7-8): Daniela Fischerova, Filip Frühauf, Andrea Burgetova, Ingfrid S. Haldorsen, Elena Gatti, and David Cibula. The role of imaging in cervical cancer staging: esgo/estro/esp guidelines (update 2023). Cancers, 16:775, Feb 2024. URL: https://doi.org/10.3390/cancers16040775, doi:10.3390/cancers16040775. This article has 50 citations.

  21. (fischerova2024theroleof pages 6-7): Daniela Fischerova, Filip Frühauf, Andrea Burgetova, Ingfrid S. Haldorsen, Elena Gatti, and David Cibula. The role of imaging in cervical cancer staging: esgo/estro/esp guidelines (update 2023). Cancers, 16:775, Feb 2024. URL: https://doi.org/10.3390/cancers16040775, doi:10.3390/cancers16040775. This article has 50 citations.

  22. (manso2024seomgeicoclinicalguidelines pages 4-5): Luis Manso, Avinash Ramchandani-Vaswani, Ignacio Romero, Luisa Sánchez-Lorenzo, María José Bermejo-Pérez, Purificación Estévez-García, Lorena Fariña-Madrid, Yolanda García García, Marta Gil-Martin, and María Quindós. Seom-geico clinical guidelines on cervical cancer (2023). Clinical & Translational Oncology, 26:2771-2782, Aug 2024. URL: https://doi.org/10.1007/s12094-024-03604-3, doi:10.1007/s12094-024-03604-3. This article has 19 citations and is from a peer-reviewed journal.