The 11th Korean Breast Cancer Society (KBCS) Consensus Meeting was convened to discuss the current expert opinions and practice patterns regarding controversial issues in the axillary management of early breast cancer in Korea. Fifty-three multidisciplinary experts participated in the panel voting. The case-based questions addressed three major domains: 1) omission of sentinel lymph node biopsy (SLNB) in clinically node-negative disease, 2) management of sentinel lymph node (SLN) micrometastases after upfront surgery, and 3) axillary management after neoadjuvant chemotherapy (NAC) for biopsy-proven node-positive disease. The panelists showed a cautious attitude toward SLNB omission in relatively younger postmenopausal patients, even when the clinicopathologic features were consistent with contemporary de-escalation trials, whereas support for omission increased substantially in older low-risk patients. For SLN micrometastases after upfront surgery, completion of axillary lymph node dissection (ALND) is rarely supported, although opinions vary regarding the need for axillary radiotherapy. In the neoadjuvant setting, routine clip placement in biopsy-proven positive nodes has not yet been universally adopted. However, there is strong support for omitting ALND in patients who convert to a clinically node-negative status with negative SLNs after NAC. The management of residual nodal disease after NAC remains controversial, particularly in cases of residual macrometastasis. The 11th KBCS Consensus Meeting demonstrated broad acceptance of axillary surgical de-escalation in selected clinical scenarios, while highlighting a persistently uncertain area. These findings emphasize the need for individualized, multidisciplinary decision-making and further prospective evidence to refine the axillary management of early breast cancer.
The effectiveness of adjuvant endocrine therapy for hormone receptor-positive (HR+) breast cancer (BC) varies according to menopausal status, body mass index (BMI), and tumor biology. We evaluated the association between selective estrogen receptor modulators (SERMs), aromatase inhibitors (AIs), and BC-specific mortality according to menopausal status, BMI, and molecular subtype in a nationwide Korean cohort. We analyzed data from 31,030 patients with HR+ BC who were registered in the Korean Breast Cancer Society Registry, diagnosed between 2000 and 2008, and followed through 2013. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for BC-specific mortality after adjusting for demographic and clinical factors. Of the 31,030 patients, 19,634 received SERM therapy, and 3,354 received AI therapy. SERM use was associated with lower BC-specific mortality in premenopausal women (HR, 0.75; 95% CI, 0.63-0.91), whereas AI therapy was more strongly associated with lower BC-specific mortality among postmenopausal women (HR, 0.76; 95% CI, 0.61-0.94). Lower BC-specific mortality was observed among patients with a BMI ≥ 23 kg/m² who received SERM (HR, 0.84; 95% CI, 0.72-0.98) or AI therapy (HR, 0.78; 95% CI, 0.62-0.99). The strongest association with lower BC-specific mortality was observed in postmenopausal women with luminal B tumors (HR, 0.59; 95% CI, 0.42-0.83). The association between adjuvant endocrine therapy and BC-specific mortality differed according to menopausal status, BMI, and molecular subtype. These findings suggest that menopausal status, BMI, and molecular subtype are important considerations when evaluating endocrine treatment strategies.
PURPOSE:This study evaluated long-term postoperative outcomes and complications after breast-conserving surgery (BCS) with acellular dermal matrix (ADM) insertion. METHODS:We retrospectively reviewed the data of patients treated between July 2015 and August 2021. Patients who did not undergo postoperative follow-up were excluded. Clinical characteristics, treatment information, and postoperative complications were collected from the electronic medical records. Complications were classified as major (requiring hospitalization or surgical intervention) or minor (manageable in an outpatient setting). ADM removals were categorized as early (≤ 6 months postoperatively) or delayed (> 6 months). RESULTS:Among the 236 patients (median follow-up, 71.7 months), complications occurred in 119 (50.4%): 22 major (9.3%) and 97 minor (41.1%). Infection was the most common major complication (13/22, 59.2%), whereas seroma was the predominant minor complication (87/97, 89.7%). In univariate analysis, no clinicopathological or treatment-related factors were associated with major complications. ADM removal was performed in 28 patients (11.9%), including nine with local recurrence and 19 unrelated to recurrence (8.1%). Among the 19 nonrecurrent removals, 13 (68.4%) occurred > 6 months after surgery, most commonly due to infection (12/19, 63.2%). CONCLUSION:Complications after BCS with ADM insertion were common during the long-term follow-up. The 9.3% major complication rate and 8.1% reoperation rate for ADM removal are not negligible. These findings highlight the need for careful patient selection and long-term surveillance of patients undergoing BCS with ADM insertion.
PURPOSE:Long-term outcome comparisons between invasive lobular carcinoma (ILC) and invasive carcinoma of no special type (NST, historically referred to as invasive ductal carcinoma) remain inconsistent, particularly in patients with low-proliferative hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) disease. This study evaluated the long-term outcomes of ILC and NST in a pathologically defined, low-proliferative, HR+/HER2- (luminal A-like) cohort. METHODS:This retrospective, single-institution study included patients with HR+/HER2- breast cancer and Ki-67 ≤ 20% who underwent surgery between 2008 and 2015. Patients with mixed histopathology, those who underwent palliative surgery, or those who received neoadjuvant chemotherapy were excluded. Survival was analyzed using the Kaplan-Meier method and multivariable Cox regression. A secondary 24-month landmark analysis included patients who were alive, disease-free, under observation, and receiving endocrine therapy 24 months after surgery. RESULTS:Among 3,439 patients, 3,156 had NST and 283 had ILC. Compared with NST, ILC was associated with a higher rate of synchronous bilateral breast cancer, a more advanced pathological stage, and a lower nuclear grade. In the comprehensive cohort, breast cancer-specific survival did not differ significantly (log-rank p = 0.081), whereas disease-free survival (DFS) and distant metastasis-free survival (DMFS) were worse in patients with ILC (log-rank p < 0.001 and p = 0.005, respectively). After adjustment for measured clinicopathological factors, these differences were no longer statistically significant (DFS: adjusted hazard ratio [HR], 1.27; 95% confidence interval [CI], 0.91-1.79; p = 0.164; DMFS: adjusted HR, 1.38; 95% CI, 0.83-2.30; p = 0.210). Detailed biomarker analyses showed similarly high estrogen receptor expression in both groups and lower exact Ki-67 values in ILC. The 24-month landmark analysis revealed the same overall pattern. CONCLUSION:In this low-proliferative HR+/HER2- cohort, ILC showed less favorable unadjusted long-term DFS and DMFS than NST, but these differences were attenuated and were no longer statistically significant after adjustment for measured clinicopathological characteristics.
PURPOSE:Despite advances in neoadjuvant chemotherapy (NACT) for breast cancer, surgical outcomes following immediate breast reconstruction (IBR) remain inconsistent, and institutional protocols vary widely. Although patients exhibit heterogeneous physiological responses to chemotherapy, few studies have evaluated treatment-related toxicity as an objective risk marker of postoperative complications. The aim of this study was to assess whether patient-specific responses to NACT can serve as clinically relevant markers of complication risk and guide individualized surgical planning. METHODS:A retrospective analysis was conducted of 299 patients who underwent IBR, including 47 who underwent NACT. Chemotherapy-related toxicities and preoperative laboratory values were reviewed to determine the physiological burden. Postoperative complications and delays in the initiation of adjuvant therapy were assessed, and multivariate logistic regression was performed to identify independent factors associated with surgical morbidity. RESULTS:NACT and smoking were significantly associated with an increased risk of complications. NACT was also strongly associated with major wound complications. Patients with hematologic toxicity during NACT or preoperative hypoalbuminemia had substantially higher odds of developing major wound complications. In addition, NACT and diabetes were associated with delayed initiation of adjuvant therapy. NACT was not associated with minor wound complications, such as hematoma or seroma formation. CONCLUSION:This study suggests that treatment-related toxicity and preoperative physiological reserve may serve as clinically relevant, response-based markers for risk stratification after NACT. This approach provides a conceptual framework for future studies with larger sample sizes and well-controlled designs.
The clinical significance of residual mammographic microcalcifications after neoadjuvant systemic therapy in human epidermal growth factor receptor 2 (HER2)-positive (HER2+) breast cancer remains unclear. Traditionally, persistent calcifications have prompted wide excisions or mastectomies under the assumption that they indicate residual disease. However, accumulating evidence suggests that calcifications may persist as treatmentrelated or biologically-attenuated changes, rather than as viable carcinomas, particularly in the era of dual HER2-directed therapy. Recent Korean studies demonstrate that patients with favorable radiologic response who achieve pathologic complete response maintain excellent local control after breast-conserving surgery, even when residual calcifications are present. A large multicenter cohort study reported a 5-year local recurrence-free survival rate of 97.4% and a validated prediction model showed strong discriminatory performance. This Brief Communication synthesizes emerging evidence on the biological basis and clinical implications of residual calcifications after neoadjuvant therapy, with emphasis on recent Korean data. Current evidence supports a response-adapted surgical approach in selected patients, emphasizing clip-guided excision of the invasive index lesion and consistent delivery of whole-breast irradiation rather than routine removal of the entire pretreatment calcification field in patients with HER2+ breast cancer. Prospective validation with a longterm follow-up is warranted to further refine patient selection and confirm the safety of this strategy in clinical practice.
PURPOSE:Triple-negative breast cancer (TNBC) is recognized as the most aggressive subtype of breast cancer. Due to the absence of established molecular targets, treatment options remain limited. In this study, we investigated the anticancer effects of α-viniferin in TNBC cells. METHODS:The impact of α-viniferin on cell viability was evaluated across several breast cancer cell lines representing different molecular subtypes, as well as in human dermal fibroblasts, using MTT assays. Apoptotic cell death, mitochondrial membrane potential (MMP), and reactive oxygen species (ROS) levels were assessed through flow cytometry. The involvement of signaling pathways was investigated via western blotting and small interfering RNA (siRNA)-mediated knockdown of p38α and p38β. RESULTS:Our findings revealed that α-viniferin induced apoptotic cell death in a time- and dose-dependent manner more effectively in TNBC cells than in other breast cancer subtypes. α-Viniferin triggered intrinsic apoptotic cell death in TNBC cells by downregulating anti-apoptotic Bcl-2 family proteins, disrupting MMP, and cleaving poly(ADP-ribose) polymerase and caspase-3, which is accompanied by increased intracellular ROS levels. Notably, SB203580, a selective p38 inhibitor, synergistically enhanced α-viniferin-induced cytotoxicity. However, this synergistic effect was independent of p38 mitogen-activated protein kinase (MAPK) signaling, as siRNA-mediated knockdown of p38α and p38β did not replicate the observed synergistic cell death in TNBC cells. CONCLUSION:Collectively, these findings indicate that α-viniferin induces apoptotic cell death in TNBC cells and that SB203580 enhances this cytotoxic effect through a mechanism independent of p38 MAPK signaling, suggesting a potential combination strategy for the treatment of TNBC.
PURPOSE:The prognostic relevance of the detection mode for regional lymph node recurrence (LNR) remains unclear. We aimed to identify the risk factors associated with isolated regional LNR and to evaluate the impact of the mode of detection on distant metastasis-free survival (DMFS) and overall survival (OS). METHODS:This retrospective cohort study included women who underwent surgery for stage I-III invasive breast cancer between January 2011 and December 2019, with follow-up until December 2024. Isolated regional LNR was categorized according to the detection method (imaging vs. symptoms). Risk factors were identified using the Fine-Gray sub-distribution hazard model, and DMFS and OS were compared using Kaplan-Meier analysis and log-rank tests. RESULTS:Among 13,406 women (median age, 49 years; range, 20-87 years), 126 (0.9%) developed isolated regional LNR during a median follow-up of 6.3 years. Of these, 118 (93.7%) were detected through imaging and 8 (6.3%) through symptoms. Independent risk factors for isolated regional LNR included higher T stages (T2: hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.11-2.64; T3: HR, 3.08; 95% CI, 1.68-5.65), higher N stages (N2: HR, 2.97; 95% CI, 1.54-5.75; N3: HR, 3.12; 95% CI, 1.36-7.13), triple-negative subtype (HR, 1.71; 95% CI, 1.09-2.67), and omission of adjuvant radiotherapy (HR, 4.35; 95% CI, 2.86-6.67). Radiological patterns varied by detection, with ultrasound usually detecting level I nodes (51.6%) and computed tomography detecting internal mammary nodes (58.1%). Symptom-detected recurrence frequently occurred in the supraclavicular region (50.0%). Symptom-detected LNRs were associated with significantly worse DMFS (p < 0.05) than imaging-detected LNRs; however, OS did not differ between the groups. CONCLUSION:The detection mode was associated with DMFS, but not OS, suggesting that long-term outcomes are driven more by disease biology than by how recurrence is detected.
Purpose: International guidelines, including the American Society of Breast Surgeons, American Society of Clinical Oncology-Society of Surgical Oncology (ASCO-SSO), and National Comprehensive Cancer Network (NCCN), have broadened the eligibility for germline testing in breast cancer (BC), whereas the Korean Health Insurance Review and Assessment Service (K-HIRA) criteria remain more restrictive. This study evaluated the prevalence of pathogenic variants (PVs) and compared the diagnostic yield of Korean versus international criteria in a high-risk hereditary BC cohort from a single-institution. Methods: We retrospectively analyzed 2,188 individuals referred for genetic counseling between January 2015 and June 2025. Germline testing included BRCA1/2 sequencing, multiplex ligation-dependent probe amplification, and multigene panels. Eligibility was determined according to the ASCO-SSO (Recommendation 1.1), NCCN (v3.2025), and K-HIRA. The prevalence, sensitivity, and number of missed cases of PVs were compared. Results: PVs were identified in 178 (8.1%) patients. Among patients with BC (n = 1,796), 159 carried PVs (8.9%), 131 (82.4%) carried BRCA1/2, and 28 (17.6%) carried non-BRCA genes. Across the frameworks, the prevalence of PV among eligible patients was comparable (ASCO-SSO, 8.7%; NCCN, 9.5%; K-HIRA, 10.2%). The sensitivity differed (NCCN, 96.9%; ASCO-SSO, 92.5%; K-HIRA, 89.3%): the sensitivity of NCCN was significantly higher than that of K-HIRA (p = 0.001), whereas the differences were not significant for NCCN vs. ASCO-SSO (p = 0.071) and ASCO-SSO vs. K-HIRA (p = 0.336). Missed carriers were more frequent under K-HIRA (17/159, 10.7%) than under ASCO-SSO (12/159, 7.5%) and NCCN (5/159, 3.1%), and those missed by K-HIRA often had non-specific family histories (58.8%) or no family history (23.5%). Conclusion: In this cohort, K-HIRA criteria showed lower sensitivity than the international guidelines, leading to missed opportunities for prevention and treatment. Broader eligibility criteria and the integration of multigene testing may improve the detection of hereditary cancer and optimize clinical management in Korea.
It is ideal to remove areas where breast cancer existed before neoadjuvant chemotherapy (NAC) in breast-conserving surgery (BCS) after NAC to ensure a pathological response. However, this becomes challenging, particularly when NAC is effective. It is also important to determine the appropriate resection line to maintain breast cosmesis in the absence of residual cancer cells. We aimed to identify magnetic resonance imaging (MRI) findings that enable the removal of the original cancer extent without additional margins outside the cancer boundary in BCS after NAC using an MRI projection mapping system (PMS). We enrolled 36 women with breast cancer in the study. Contrast-enhanced MRI was performed in the prone and supine positions before NAC. Supine unenhanced MRI with skin markers for registration was performed after NAC, one day before surgery. A maximum intensity projection image visualizing both the tumor extent before NAC and skin markers was projected onto the breast using PMS, and BCS was performed. We compared the clinical, pathological, and MRI findings between patients who required additional margins and those who did not require additional margins during BCS using MRI-PMS. Nineteen of the 36 patients did not require additional margins for BCS after NAC using MRI-PMS. These patients had a higher tumor diameter reduction rate and a lower signal ratio between the tumor bed and normal tissue after NAC than those who required additional margins. This study indicates that MRI-PMS allows BCS without additional margins and may facilitate the conservation of normal breast tissue in patients with a greater diameter reduction rate or a lower signal ratio between the tumor bed and normal tissue after NAC.
Tall cell carcinoma with reversed polarity (TCCRP) of the breast is a rare malignant neoplasm that shares morphological similarities with the tall-cell variant of papillary thyroid carcinoma, which may lead to diagnostic confusion. Immunohistochemical and molecular analyses are essential to confirm mammary origin and exclude metastatic thyroid carcinoma. Herein, we report a case of a 62-year-old woman, who was diagnosed with TCCRP based on characteristic histomorphological features and immunohistochemical findings in a breast mass. Despite exhibiting a triple-negative immunophenotype, TCCRP is associated with an indolent clinical course. Accurate diagnosis requires integration of morphological, immunohistochemical, and molecular features, which are critical for appropriate classification and may help support a more conservative management approach.
PURPOSE:Ductal carcinoma in situ (DCIS) presents a challenge in risk stratification, raising concerns regarding both undertreatment and overtreatment. This study investigated the relationships among estrogen receptor (ER) status, human epidermal growth factor receptor 2 (HER2) status, clinicopathological features, and recurrence in DCIS, with a particular focus on the prognostic roles of calcification and surgical modality. METHODS:A retrospective analysis was conducted in 365 patients who underwent surgery for DCIS at The Catholic University of Korea, Seoul St. Mary's Hospital between 1997 and 2020. Ipsilateral breast tumor recurrence (IBTR) and contralateral breast tumor recurrence (CBTR) were evaluated as the primary and secondary endpoints, respectively. Multivariable Cox models were implemented, incorporating radiotherapy, endocrine therapy, and margin status. 1:1 propensity score matching (PSM) was performed to adjust for selection bias between breast-conserving surgery and mastectomy. RESULTS:ER-negative and HER2-positive DCIS were associated with older age, more frequent calcification, and higher nuclear grade (all p < 0.001). In the multivariable analysis for IBTR, surgical modality (mastectomy: hazard ratio [HR], 0.021; p = 0.014) and margin status (≥ 2 mm: HR, 0.192; p = 0.013) were the only independent predictors. Conversely, the presence of calcification was independently associated with more favorable outcomes for CBTR (HR, 0.103; p = 0.013). Subgroup analysis revealed that calcification was significantly associated with improved CBTR-free survival, particularly in the estrogen receptor-positive (ER+) cohort (p = 0.010). PSM analysis confirmed that mastectomy significantly reduced IBTR risk (p = 0.038) but was not significantly associated with CBTR risk (p = 0.246). CONCLUSION:Calcification and surgical modality demonstrated divergent prognostic implications for IBTR and CBTR according to molecular subtype. Although calcification is traditionally considered a high-risk feature prevalent in aggressive subtypes, its presence was associated with favorable contralateral events in ER+ DCIS. These findings emphasize the importance of integrating molecular markers with clinical features to support more personalized approaches to DCIS management.
Purpose: Langer's axillary arch (LAA) is a common muscular variant that may affect the assessment of axillary lymph nodes in breast cancer. We investigated whether the presence of the LAA had a meaningful clinical impact in a large cohort of Korean patients with breast cancer. Methods: The medical records and imaging of 2,904 patients (2,953 cases) who underwent axillary surgery for breast cancer were reviewed. The presence of LAA was determined using chest computed tomography scans. The number of retrieved lymph nodes, the accuracy of axillary ultrasonography, and survival outcomes were compared between the LAA and non-LAA groups. Results: The LAA muscle was identified in 301 patients (10.2%). Preoperative ultrasound evaluation showed a lower specificity in the LAA group (77.9% vs. 83.6%, p = 0.031). Additionally, invasive disease-free survival (iDFS) was significantly worse in the 'LAA-positive patients' after adjusting for stage, histologic grade, and treatment (adjusted hazard ratio, 2.00; 95% confidence interval, 1.00-4.01; p = 0.048), with regional axillary recurrence being notably more frequent in patients with the LAA muscle (p = 0.005). Conclusion: The presence of the LAA muscle was associated with reduced specificity on preoperative ultrasound. Patients with LAA muscle-associated tumors had worse iDFS, with regional axillary recurrence occurring more frequently. Recognition of the LAA muscle during axillary staging and surgery may improve nodal assessment accuracy and outcomes, especially in the era of axillary surgery de-escalation.
Ado-trastuzumab emtansine (T-DM1) is an effective adjuvant therapy for human epidermal growth factor receptor 2-positive breast cancer; however, its surgical safety profile remains unclear. We observed delayed bleeding with variable and often subtle clinical manifestations during implant-based breast reconstruction (IBBR). Two patients who received adjuvant T-DM1 therapy after IBBR were retrospectively reviewed. The patient in Case 1 developed a recurrent seroma and liquefied hematoma requiring repeated aspirations, with platelet counts decreasing from 218 × 10⁹/L to 33 × 10⁹/L before expander removal. The patient in Case 2 experienced an acute massive hematoma on postoperative day (POD) 2, prior to T-DM1 initiation, which resolved after re-exploration; a temporally distinct delayed hemorrhagic event occurred on POD 175 during T-DM1 therapy after radiotherapy, accompanied by a platelet nadir of 34 × 10⁹/L. Both patients required plateletpheresis and prolonged drainage. Delayed bleeding during T-DM1 therapy may reflect a combination of hematological suppression and vascular vulnerability. Therefore, vigilant surveillance and cautious postoperative rehabilitation are warranted.
PURPOSE:Exosome-surface enhanced Raman spectroscopy-artificial intelligence platform (exosome-SERS-AI) is an innovative liquid biopsy method that acquires SERS signals from plasma exosomes and analyzes them using deep learning models to diagnose cancer. This study aimed to evaluate whether exosome-SERS-AI could increase the diagnostic accuracy of ultrasonography (US) for suspicious breast lesions. METHODS:This prospective multicenter study enrolled 500 patients between November 2024 and December 2025. Eligible participants will be women aged ≥ 40 years who will undergo US performed by specialized breast radiologists and have suspicious breast lesions assigned to a Breast Imaging Reporting and Data System (BI-RADS) category 3-5 assessment. A 6 mL whole blood sample was collected from each participant. After plasma separation, SERS, which is highly sensitive to exosomes, was employed to measure Raman signals, and the acquired data were processed using artificial intelligence algorithms. Following sampling, all patients underwent US-guided core needle biopsy for breast lesions classified as BI-RADS category 4 and 5, and 12-months of follow-up US for lesions classified as BI-RADS category 3. Histopathological examination was used as the reference standard for BI-RADS 4 and 5 lesions, whereas stability on 12-month follow-up US was used as the reference standard for BI-RADS 3 lesions. The cohort is expected to have an equal distribution of benign and malignant cases. The following outcome measures were compared between US alone and the combination of exosome-SERS-AI with US: sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristic curve. Enrollment is expected to be completed by 2025, and the study results are expected to be presented in 2026. DISCUSSION:This prospective multicenter study will evaluate the performance of exosome-SERS-AI compared to US in women with BI-RADS categories 3-5. Participant enrollment is ongoing. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT06672302. Registered on November 4, 2024.
Purpose: Lobular carcinoma in situ (LCIS) is a noninvasive lesion associated with an increased risk of invasive cancer. Since its removal from the tumor, node, metastasis classification in the 8th edition of the American Joint Committee on Cancer (AJCC) guidelines, the clinical management of LCIS has shifted from surgery to surveillance. However, studies focusing on the risk and associated factors for invasive cancer development in pure LCIS without ductal carcinoma in situ (DCIS) or invasive cancer remain limited. Methods: We retrospectively analyzed 106 patients diagnosed with pure LCIS between 2008 and 2018. This study evaluated the effect of tamoxifen use and histologic type on the development of invasive cancer. Results: All 106 patients underwent surgery, and nine (8.5%) developed invasive cancer over a median follow-up of 67.5 months. The incidence of invasive cancer was lower in the tamoxifen group (6.3%, n = 4) than in the non-tamoxifen group (11.9%, n = 5), although this difference was not statistically significant (p = 0.266). Pleomorphic LCIS had a significantly higher incidence of invasive cancer (30.0%, n = 3) than classic LCIS (6.3%, n = 6) (p = 0.045). Multivariable Cox regression analysis showed no significant difference in the risk of invasive cancer according to tamoxifen use (hazard ratio [HR], 2.031; 95% confidence interval [CI], 0.544-7.579; p = 0.292). However, pleomorphic LCIS showed a trend toward an increased risk of invasive cancer compared to classic LCIS (HR, 3.856; 95% CI, 0.922-16.126; p = 0.064). Conclusion: Postoperative tamoxifen did not significantly lower invasive cancer development in patients with pure LCIS. Pleomorphic LCIS may carry a higher risk than classic LCIS. These findings require tailored follow-up and treatment strategies based on the histologic subtype of LCIS.
PURPOSE:Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms most commonly found in the pleura, but may also arise in other locations. Breast SFTs are extremely rare and infrequently reported. Descriptive data on the clinical, radiological, and pathological characteristics of breast SFTs are important for improving understanding of the disease, treatment strategies, and follow-up planning. METHODS:The pathology databases of major surgical centers in Hong Kong, covering January 2020 to June 2023, were assessed to identify cases with a diagnostic code for SFT. A systematic literature search was conducted to identify all reported cases of breast SFTs. The search was performed using multiple scientific databases, including PubMed, Web of Science, Embase, and Scopus. RESULTS:We report two cases of breast SFTs in Chinese female patients without a family history of breast cancer. Both patients presented with a palpable breast lump that appeared suspicious on ultrasonography (Breast Imaging-Reporting and Data System 4). Both patients underwent surgical excision of the lesions with negative margins. The diagnosis of SFT was established based on immunohistochemical findings in tumor samples obtained from surgical excision. No signs of recurrence were observed at follow-up. A literature review yielded 62 cases of breast SFT, including the two cases reported here. No clinically distinguishing features have been reported in the literature, other than that the majority of patients presented with a mass. SFTs were more commonly found in females (n = 47) than in males (n = 15), although the female-to-male ratio was lower than that observed in other breast cancers. CONCLUSION:We describe two patients with breast SFTs, together with a comprehensive literature review, to contribute to the currently limited knowledge of this disease. A complete picture of the clinical, radiological, and pathological features of breast SFTs could help improve understanding of the condition and guide appropriate management.
In breast cancer, sentinel lymph nodes (SLNs) represent the first site of interaction between tumor-derived antigens and the host immune system. However, descriptive data on immune cell subsets within the SLN remains limited. This exploratory study evaluated immune cell populations in SLN samples from women with invasive breast cancer (IBC) using flow cytometry, and assessed their distribution according to clinicopathological characteristics. SNL scrapings were collected from 22 patients with IBC. SNL cells were evaluated using flow cytometry, and the results were compared with clinical and pathological variables, such as tumor subtype, axillary status, lymphovascular invasion (LVI), histological grades, and expression of estrogen receptors (ERs) and human epidermal growth factor receptor 2 (HER2). The frequencies of monocytes and neutrophils were not significantly correlated with the clinical variables analyzed. In patients with LVI, there was an increase in the frequency of CD4⁺ T cells and programmed death-1 (PD-1) expression in CD8⁺ T-cells. Furthermore, a reduction in central memory CD4⁺ T cells and an increase in terminal effector memory CD4⁺ T cells were observed in patients with histological grade III disease compared to those with histological grade I disease. It was also observed that in patients expressing ERs and HER2, there was an increase in PD-1 and programmed death-ligand 1 expression in CD8⁺ T-cells. These findings provide a descriptive overview of immune cell distribution in SLNs according to their clinicopathological features. These results are preliminary and hypothesis-generating, supporting the need for larger longitudinal studies to further characterize the immune profiles within tumor-draining lymph nodes.
PURPOSE:Assessing the metastatic status of axillary lymph nodes is critical in breast cancer to determine disease progression and guide treatment. Axillary lymph node dissection (ALND) is performed when sentinel lymph nodes (SLNs) are undetectable; however, this can lead to overtreatment and complications. This study investigated whether limited axillary lymph node dissection (L-ALND) provides outcomes comparable to those of standard axillary lymph node dissection (S-ALND) in patients with early stage breast cancer. METHODS:Medical records of 2,461 patients were reviewed, focusing on 304 cases with undetectable SLNs. After excluding those with three or more metastatic nodes, 217 patients with early-stage disease were analyzed. They were classified into L-ALND (≤ 9 nodes removed) and S-ALND (≥ 10 nodes removed) groups. RESULTS:The L-ALND group had a lower local recurrence rate (1.6% vs. 3.4%) and fewer complications than the S-ALND group. Similarly, the five- and ten-year recurrence-free survival rates were higher in the L-ALND group than in the S-ALND group (95.0% vs. 89.1% and 94.2% vs. 49.5%). Factors affecting recurrence included the ALND type (S-ALND vs. L-ALND), type of operation, and tumor subtype. The incidence of lymphedema was also lower in the L-ALND group than in the S-ALND group (4.8% vs. 10.3%). CONCLUSION:L-ALND offers outcomes comparable to S-ALND in early-stage breast cancer, reducing complications without compromising oncological outcomes.
