BackgroundAdequate margin clearance is a key determinant of local control after breast-conserving surgery (BCS), yet dedicated intraoperative margin assessment is not available in all settings. Intraoperative specimen ultrasonography (IOUS) is widely accessible and can be performed by the surgeon. We evaluated the diagnostic accuracy of IOUS for detecting close or positive margins against permanent pathology, and its concordance with intraoperative pathological assessment.MethodsIn this prospective observational study, 60 consecutive patients undergoing BCS for invasive breast cancer were enrolled. The surgeons measured tumor-to-margin distances in six orientations by IOUS, while the pathologist, blinded to the measurements, performed gross assessment and the intraoperative re-excision decision. The permanent paraffin margin of the primary specimen served as the reference standard, with a close margin defined a priori as <2 mm. Diagnostic performance was assessed at the patient level using ROC analysis and at the 2 mm threshold, and at the margin level using generalized estimating equations to account for within-patient correlation. Agreement was evaluated with Bland–Altman analysis and the intraclass correlation coefficient (ICC).ResultsAmong 60 patients a positive margin was present in 5 (8.3%) and a close margin (<2 mm) in 17 (360 margins) (28.3%). The minimum IOUS margin discriminated close margins with an AUC of 0.779 (95% CI 0.637–0.921). At the patient level, using the 2 mm threshold, IOUS correctly identified 10 of 17 close-margin patients, with a sensitivity of 58.8% and specificity of 86.0%. Compared with the pathologist’s re-excision recommendation (sensitivity 76.5%, specificity 76.7%), no significant difference was detected (McNemar, p = 0.167), although the study was not powered for equivalence; IOUS was less sensitive but more specific. At the margin level, each 1 mm increase in the IOUS margin distance was associated with a 36% reduction in the odds of that margin being in the close (OR 0.64, 95% CI 0.50–0.82; p <0.001).ConclusionSurgeon-performed IOUS provides intraoperative margin assessment with no significant difference from the pathologist’s evaluation. It may serve as a practical, accessible adjunct where immediate intraoperative pathology is not available, though it cannot fully replace definitive histopathological assessment.

BackgroundBreast cancer is the most common cancer among women worldwide. Despite the availability of screening services, participation remains suboptimal in Türkiye, and evidence on the determinants of screening behaviors and men’s supportive role is limited. This study aimed to assess BC awareness among women and men, identify factors associated with screening behaviors, and explore men’s attitudes toward supporting their partners’ participation in screening.MethodsA cross-sectional survey was conducted between June 2022 and December 2024 using a convenience sampling approach among 725 participants at Koç University Hospital and affiliated institutions. The questionnaire developed by the authors based on a literature review was administered either in person or via email. Sociodemographic characteristics, health literacy, knowledge of risk factors and symptoms, screening behaviors, and self-breast examination practices were assessed through structured questionnaires.ResultsKnowledge of breast cancer screening was high, with 90.5% of women recognizing that mammography enables early detection. However, among women aged ≥40 years, only 69.6% had undergone at least one mammogram. Screening uptake was significantly higher among women with a family or social history of breast cancer than among those without (70.6% vs. 29.4%, p = 0.002). The most frequently reported barriers to screening were the absence of symptoms (56.0%), negligence (30.3%), and difficulties accessing healthcare services (17.1%). Although 81.0% of women reported performing breast self-examination, only 22.9% did so monthly, as recommended. Among men, awareness of breast cancer symptoms was moderate, while 87.8% reported supporting their partners’ participation in screening.ConclusionImproving access to screening services and addressing barriers such as neglect and the absence of symptoms may increase breast cancer screening uptake in Türkiye. Engaging partners and families in awareness initiatives could further support participation and facilitate earlier detection.

ImportanceIncreasing evidence supports the oncologic safety of de-escalating axillary surgery for patients with breast cancer after neoadjuvant chemotherapy (NAC).ObjectiveTo evaluate the oncologic outcomes of de-escalating axillary surgery among patients with clinically node (cN)–positive breast cancer and patients whose disease became cN negative after NAC (ycN negative).Design, Setting, and ParticipantsIn the NEOSENTITURK MF-1803 prospective cohort registry trial, patients from 37 centers with cT1-4N1-3M0 disease treated with sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD) alone or with ypN-negative or ypN-positive disease after NAC were recruited between February 15, 2019, and January 1, 2023, and evaluated.ExposureTreatment with SLNB or TAD after NAC.Main Outcomes and MeasuresThe primary aim of the study was axillary, locoregional, or distant recurrence rates; disease-free survival; and disease-specific survival. Number of axillary lymph nodes removed was also evaluated.ResultsA total of 976 patients (median age, 46 years [range, 21-80 years]) with cT1-4N1-3M0 disease underwent SLNB (n = 620) or TAD alone (n = 356). Most of the cohort had a mapping procedure with blue dye alone (645 [66.1%]) with (n = 177) or without (n = 468) TAD. Overall, no difference was found between patients treated with TAD and patients treated with SLNB in the median number of total lymph nodes removed (TAD, 4 [3-6] vs SLNB, 4 [3-6]; P = .09). Among patients with ypN-positive disease, those who underwent TAD were more likely to have a lower median lymph node ratio (TAD, 0.28 [IQR, 0.20-0.40] vs SLNB, 0.33 [IQR, 0.20-0.50]; P = .03). At a median follow-up of 39 months (IQR, 29-48 months), no significant difference was found in the rates of ipsilateral axillary recurrence (0.3% [1 of 356] vs 0.3% [2 of 620]; P ≥ .99) or locoregional recurrence (0.6% [2 of 356] vs 1.1% [7 of 620]; P = .50) between the TAD and SLNB groups, with an overall locoregional recurrence rate of 0.9% (9 of 976). The initial clinical tumor stage, pathologic complete response, and use of blue dye alone as a mapping procedure were not associated with the outcome. Even though patients with TAD demonstrated an increased disease-free survival rate compared with the SLNB group, this difference did not reach statistical significance (94.9% vs 92.6%; P = .07). Factors associated with decreased 5-year disease-specific survival were cN2-3 axillary stage (cN1, 98.7% vs cN2-3, 96.8%; P = .03) and nonluminal type tumor pathologic characteristics (luminal, 98.9% vs nonluminal, 96.9%; P = .007).Conclusions and RelevanceThe short-term results suggest very low rates of axillary and locoregional recurrence in a select group of patients with cN-negative disease after NAC treated with TAD alone or SLNB alone followed by regional nodal irradiation regardless of the SLNB technique or nodal pathology. Whether TAD might provide a clear survival advantage compared with SLNB remains to be proven in studies with longer follow-up.

BACKGROUND:This study aims to identify factors predicting recurrence and unfavorable prognosis in cN+ patients who have undergone sentinel lymph node biopsy (SLNB) following neoadjuvant chemotherapy (NAC). METHODS:The retrospective multi-centre "MF18-02" and the prospective multi-centre cohort registry trial "MF18-03" (NCT04250129) included patients with cT1-4N1-3M0 with SLNB+/- axillary lymph node dissection (ALND) post-NAC. RESULTS:A total of 2407 cN+ patients, who later achieved cN0 status after NAC and subsequently underwent SLNB, were studied. The majority had cT1-2 (79.1%) and N1 (80.7%). After a median follow-up time of 41 months, the rates of locoregional recurrence and axillary recurrence (AR) were 1.83% and 0.37%, respectively. No significant difference in locoregional recurrence or AR rates was observed between the SLNB/targeted axillary dissection-only (n = 1470) and ALND (n = 937) groups. Factors significantly linked with AR included age younger than 45 years, nonpathological complete response (non-pCR) in the breast, and nonluminal pathology. Locoregional recurrences were associated with nonluminal or HER2(+) pathology, non-pCR in the breast, and ALND. Poor prognostic factors for disease-free survival (DFS) included having cT3-T4, no breast pCR (non-pCR), ypN(+), and nonluminal pathology. No significant difference was found in DFS or disease-specific survival (DSS) rates among ypN0, ypN-isolated tumour cells, ypNmic, and ypN1. However, significant decreases in DFS and DSS rates were observed when comparing ypN2 or ypN3 disease with ypN0. CONCLUSIONS:The present large registry data indicate that younger patients (<45), those with nonluminal pathology, and those who only partially respond in the breast are more susceptible to axillary and locoregional recurrences.

Delays in breast cancer (BC) diagnosis and treatment negatively impact survival outcomes. Understanding patient- and provider-related factors behind these delays is crucial. This study aimed to identify nationwide reasons for delayed diagnosis and treatment of locally advanced BC in Turkiye. A prospective, multicenter hospital-based survey was conducted across 35 institutions between 2023 and 2024. Patient- and provider-related delays were assessed via a structured 61-item face-to-face survey, supplemented by clinical data from electronic health records. Delays exceeding 3 months were clinically categorized as significant. A total of 1322 women participated from seven regions across Turkiye. Factors contributing to diagnostic delays on a national level included economic reasons (5.5%), lack of family support (3.3%), lack of knowledge (12.4%), lack of time due to household work (3.8%), difficulty in finding an appointment (6.7%), pregnancy-related reasons (1.1%), fear of losing the breast (8.9%), fear of death (9.8%), and transportation difficulties (5.1%). Provider-related delays were infrequent. About 89.3% of the patients had the initial doctor appointment and 89.6% had the first specialist consultation within one month. Treatment planning was predominantly based on a multidisciplinary team decision in 88.3% of patients. Regarding treatment initiation, 93.2% started required treatment within 1 month of decision. Patient-related factors are the major causes of diagnostic delay in Turkiye. On the other hand, from the provider's perspective, the presence of multidisciplinary teams, including dedicated breast surgeons, represents a key factor in ensuring the timely implementation of diagnostic procedures and treatment strategies.

Abstract Background: Previous prospective studies reported decreased false negative rates in patients presenting with T1-3/cN1 disease, with the removal of 2 or more sentinel lymph nodes (SLNs), using combined technique for SLN biopsy (SLNB), and by targeted axillary dissection (TAD) in initially clinically node-positive patients after neoadjuvant chemotherapy (NAC). The aim of this prospective study is to compare the feasibility and the oncological safety of TAD with SLNB in patients with cN-positive/ycN0 breast cancer following NAC in a prospective study. Methods: This study included patients with a cT1-4N1-3M0 disease from the prospective multicenter MF1803 NEOSENTITURK registry study who were treated either SLNB- or TAD-alone without ALND. TAD included removing the biopsy-proven positive LN marked mostly with a clip as SLN or non-SLN. All patients had nodal and regional irradiation. Results: Between 2019 to 2021, 976 patients with cT1-4N1-3M0 disease from 37 centers underwent either SLNB-alone (n=620) or TAD-alone (n=356). Patients with TAD (median age: 46, range: 24-76) and SLNB (median age:46, range: 21-80) have shown a similar age distribution. The median number (range, 25%-75%) of SLNs and total LNs and total metastatic LNs removed were 3 (2-4), 4(3-6), and 1 (1-2), respectively. Patients with TAD were more likely to have cT1-2 disease (91.9% vs 78.7%, p< 0.001), cN1 disease (85.7% vs 78.5%, p< 0.006), a breast conservative surgery (66.0% vs 51.3%, p< 0.001), the combined technique for mapping (44.1% vs 22.3%, p< 0.0001), and a decreased median (IQR) lymph node ratio as calculated by the total positive lymph node number to the total lymph node number (0.29:0.20-0.40 vs 0.33: 0.20-0.50; p=0.033). Of note, there was a trend for the decreased non-sentinel lymph node positivity in the TAD-group compared to the SLNB-group that did not reach the statistical significance (TAD: 10% vs SLNB: 19%, p=0.07). However, no significant difference could be found in pathological characteristics including tumor type, breast pCR, non-luminal disease such as HER2-positivity or triple negative disease or presence of low volume metastatic disease (ITC or micrometastasis), and extracapsular extension (Table 1). Of note, patients with ypN-positive disease (n=351) were more likely to have SLNs (ypN+, 3.7±1.7 vs ypN0, 3.4±1.7, p=0.008) or total LNs (ypN+, 4.7±1.9 vs ypN0, 3.4±1.9, p=0.001) removed compared to those with ypN0 (n=635). Among those with ypN0 disease, patients with TAD were more likely to have LNs removed compared to those with SLNB (TAD, 4.2±1.9 vs 3.9±1.9, p=0.034) (Table 2). Of those with ypN+, patients with TAD were more likely to have SLNs compared to those with SLNB (TAD, 3.9±1.7 vs 3.5±1.7, p=0.062), whereas patients with SLNB were more likely to have non-SLNs removed compared to those with TAD (TAD, 2.3±1.4 vs 2.9±1.5, p=0.028). At a mean follow-up of 28.8 months (±12.1), the ipsilateral axillary and locoregional recurrence rates were 0.2% (n=2) and 0.4% (n=4) in the TAD-group and SLNB_group, respectively. Of note, no significant difference could be found in ipsilateral axillary, locoregional, and systemic recurrences between cohorts treated with TAD-alone vs SLNB-alone (Table 3). Conclusion: Our findings suggest that TAD might be more feasible in ypN+ patients which resulted in a decreased lymph node ratio and decreased non-SLN positivity. In ypN0 patients, TAD may contrary cause unnecessary lymph node removal that might be important in arm function and lymphedema development. Furthermore, our findings with short-term follow-up indicate that axillary and locoregional recurrences were observed at very low rates in a selected group of ycN0 patients treated with SLN- or TAD without ALND. Therefore, omission of ALND could be safely considered for patients with limited nodal involvement ( <2 LNs) as long as <3 LNs removed and nodal radiotherapy provided. Table 1. Clinicopathologic Characteristics According to the Axillary Surgery: Targeted Axillary Dissection (=TAD) versus Sentinel Lymph Node Biopsy (=SLNB) Table 2. Clinicopathologic Characteristics According to the Pathological Nodal Status Table 3. Locoregional and systemic recurrences in cT1-4N1-3 patients treated with Targeted Axillary Dissection (=TAD) or Sentinel Lymph Node Biopsy (=SLNB) (Nf976) Citation Format: Neslihan Cabıoğlu, Hasan Karanlik, Mehmet Ali Gulcelik, Havva Belma Kocer, Mahmut Muslumanoglu, Abdullah İgci, Mustafa Tukenmez, Cihan Uras, Enver Ozkurt, Gokhan Giray Akgul, Selman Emiroglu, Süleyman Bademler, Ahmet Dağ, Didem Can Trabulus, Nilufer Yıldirim, Guldeniz Karadeniz Cakmak, Ebru Sen Oran, Halil Kara, Gul Basaran, Ayse Altinok, M. Umit Ugurlu, Kazim Senol, Baha Zengel, Niyazi Karaman, Ecenur Varol, Ece Dilege, Yasemin Bolukbasi, Alper Akcan, Yeliz Emine Ersoy, Aykut Soyder, Serdar Ozbas, Mehmet Velidedeoglu, Beyza Ozcinar, N. Zafer Utkan, Bulent Citgez, Burak Celik, Leyla Zer, Gurhan Sakman, Levent Yeniay, Lutfi Dogan, Mutlu Dogan, Fazilet Erozgen, BERK GOKTEPE, Orhan Agcaoglu, Taner Kivilcim, Fatih Levent Balci, Bahadir M. Gulluoglu, Ayfer Kamali Polat, Kamuran Ibis, Vahit Ozmen. Feasibility and oncological safety of targeted axillary dissection or sentinel lymph node biopsy in patients with clinically node-positive disease after neoadjuvant chemotherapy in the prospective MF-1803 NEOSENTITURK-study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PS01-01.

Objective:Breast cancer (BC) is a significant health concern and one of the most diagnosed cancers in women, both in Turkey and globally. Despite advances in the management of BC, axillary lymph node involvement remains a significant consideration for treatment planning, local recurrence, and prognosis. We aimed to evaluate the contribution of F-18 fluorodeoxyglucose-positron emission tomography/computed tomography (F-18 FDG-PET/CT) in detecting axillary lymph node metastasis compared to ultrasound (US).Materials and Methods:Eighty patients who were diagnosed with stage I and II BC and underwent US and F-18 FDG-PET/CT scans before surgery were enrolled in this study. Those who did not undergo F-18 FDG-PET/CT imaging, patients with distant metastases at the time of diagnosis and patients with micrometastases in the axilla were excluded from the analysis. Imaging results of the status of axillary lymph nodes were verified with the final pathology report of axillary lymph nodes.Results:The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of F-18 FDG-PET/CT for the detection of ipsilateral axillary lymph node metastases were 75%, 77.27%, 72.97%, 79.07%, and 76.25%. The corresponding values for US were 72.22%, 81.82%, 76.47%, 78.26%, and 77.50%, respectively. When US finding is negative or suspicious in axillary lymph node evaluation, the accuracy of F-18 FDG-PET/CT for the detection of ipsilateral axillary lymph node metastases were 65.38%, 83.33%, 70.83%, and 79.55%, respectively.Conclusion:This study found that F-18 FDG-PET/CT does not provide an additional advantage over US in assessing the axilla in early-stage disease.

BackgroundThe omission of axillary lymph node dissection (ALND) remains controversial for patients with residual axillary disease after neoadjuvant chemotherapy (NAC), regardless of the residual burden. This study evaluated the oncologic safety and factors associated with outcomes in patients with residual axillary disease. These patients were treated solely with sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD), without ALND, after NAC.MethodsA joint analysis of two different multicenter cohorts-the retrospective cohort registry MF18-02 and the prospective observational cohort registry MF18-03 (NCT04250129)-was conducted between January 2004 and August 2022. All patients received regional nodal irradiation.ResultsFive hundred and one patients with cT1-4, N1-3M0 disease who achieved a complete clinical response to NAC underwent either SLNB alone (n = 353) or TAD alone (n = 148). At a median follow-up of 42 months, axillary and locoregional recurrence rates were 0.4% (n = 2) and 0.8% (n = 4). No significant difference was found in disease-free survival (DFS) and disease-specific survival (DSS) rates between patients undergoing TAD alone versus SLNB alone, those with breast positive versus negative pathologic complete response, SLN methodology, total metastatic LN of one versus >= 2, or metastasis types as isolated tumor cells with micrometastases versus macrometastases. In the multivariate analysis, patients with nonluminal pathology were more likely to have a worse DFS and DSS, respectively, without an increased axillary recurrence.ConclusionsThe omission of ALND can be safely considered for patients who achieve a complete clinical response after NAC, even if residual disease is detected by pathologic examination. Provided that adjuvant radiotherapy is administered, neither the SLNB method nor the number of excised LNs significantly affects oncologic outcomes.

Purpose The aim of this study was to evaluate the impact of SPECT/CT lymphoscintigraphy on targeted axillary dissection (TAD) in node-positive breast cancer (BC) patients who had undergone neoadjuvant chemotherapy (NAC). Methods Sixty-two female BC patients with biopsy-confirmed axillary nodal metastases underwent NAC, followed by breast surgery with TAD. A metallic clip was placed in the sampled LN before NAC. On the day of surgery, a periareolar intradermal 99m Tc-nanocolloid injection was administered, followed by SPECT/CT lymphoscintigraphy. The clipped nodes were localized on CT images, assessed for 99m Tc uptake before surgery, and confirmed during the procedure. Results T1–4, N1–2 patients were enrolled in the study. All patients underwent sentinel lymph node (SLN) biopsy. The clipped node was the SLN in 54 (88.5%) patients. In 3 patients (4.9%), a clip was found in a nonsentinel lymph node. In 4 patients, the clips were not visible on SPECT/CT images, and lymph nodes were not found during the procedure. SPECT/CT correctly localized the clipped lymph node in all patients. The overall false-negative rate for TAD was 3.33%. The mean follow-up duration was 29 months, and there were no axillary recurrences. Conclusions SPECT/CT lymphoscintigraphy can accurately localize clipped nodes and SLNs after NAC in patients with node-positive BC.

Macroautophagy/autophagy is an evolutionarily conserved cellular stress response mechanism. Autophagy induction in the tumor microenvironment (stroma) has been shown to support tumor metabolism. However, cancer cell-derived secreted factors that initiate communication with surrounding cells and stimulate autophagy in the tumor microenvironment are not fully documented. We identified CTF1/CT-1 (cardiotrophin 1) as an activator of autophagy in fibroblasts and breast cancer-derived carcinoma-associated fibroblasts (CAFs). We showed that CTF1 stimulated phosphorylation and nuclear translocation of STAT3, initiating transcriptional activation of key autophagy proteins. Additionally, following CTF1 treatment, AMPK and ULK1 activation was observed. We provided evidence that autophagy was important for CTF1-dependent ACTA2/α-SMA accumulation, stress fiber formation and fibroblast activation. Moreover, promotion of breast cancer cell migration and invasion by activated fibroblasts depended on CTF1 and autophagy. Analysis of the expression levels of CTF1 in patient-derived breast cancer samples led us to establish a correlation between CTF1 expression and autophagy in the tumor stroma. In line with our in vitro data on cancer migration and invasion, higher levels of CTF1 expression in breast tumors was significantly associated with lymph node metastasis in patients. Therefore, CTF1 is an important mediator of tumor-stroma interactions, fibroblast activation and cancer metastasis, and autophagy plays a key role in all these cancer-related events. Abbreviations: ACTA2/α-SMA: actin, alpha 2, smooth muscle CAFs: cancer- or carcinoma-associated fibroblasts CNT Ab.: control antibody CNTF: ciliary neurotrophic factor CTF1: cardiotrophin 1 CTF1 Neut. Ab.: CTF1-specific neutralizing antibody GFP-LC3 MEF: GFP-fused to MAP1LC3 protein transgenic MEF LIF: leukemia inhibitory factor IL6: interleukin 6 MEFs: mouse embryonic fibroblasts MEF-WT: wild-type MEFs OSM: oncostatin M TGFB/TGFβ: transforming growth factor beta

The aim of this study was to provide an update on ovarian function and the mechanisms of gonadal damage after exposure to chemotherapy in breast cancer survivors. The alkylating agents are toxic to both primordial and growing follicles. However, anti-metabolite drugs are more likely to destroy preantral and antral follicles. Younger patients are more likely to have a higher ovarian reserve, and therefore, more likely to retain some residual ovarian function after exposure to gonadotoxic regimens. However, there can be significant variability in ovarian reserve among patients of the same age. Furthermore, patients with critically diminished ovarian reserve may continue to menstruate regularly. Therefore age and menstrual status are not reliable indicators of good ovarian reserve and might give a false sense of security and result in an adverse outcome if the patient is consulted without considering more reliable quantitative markers of ovarian reserve (antral follicle count and anti-Müllerian hormone) and fertility preservation is not pursued. In contrast to well-documented ovarian toxicity of older chemotherapy regimens, data for newer taxane-containing protocols have only accumulated in the last decade and data are still very limited regarding the impact of targeted therapies on ovarian function.

Background: Whether axillary lymph node dissection (ALND) following sentinel lymph node biopsy (SLNB) could be spared in patients with initially clinically positive axilla after neoadjuvant chemotherapy (NAC) is still controversial even though recent studies indicate that axillary recurrence seems to be a rare event. Our aim is to find out whether omitting ALND could be oncologically safe in patients undergoing SLNB after NAC. Material and Methods: Of patients presented with c T1-4N1-3M0 disease, those undergoing SLNB after NAC were included in the prospective multicentre registry trial " MF18-03/BHWG" (ClinicalTrials.gov/NCT04250129). Cases with inflammatory breast cancer, distant metastases, pregnancy, bilateral breast cancer, or other cancers and those without adjuvant nodal radiotherapy were excluded from the study. The end points of the present report are the axillary nodal recurrence (AR) and locoregional recurrence (LRR) rates at a median follow-up more than 2 years, and determine factors associated with AR and LRR . The locoregional recurrences included ipsilateral, and contralateral axillary recurrences, infra-and supraclavicular recurrences, and recurrences in the mammaria interna region. Results: Between January 2018 to January 2021, 2358 patients with cN(+) disease, who became cN0 after NAC, and underwent SLNB, were analyzed. Median age was 47 (range, 21-86). Of those, the majority of patients had cT1-2 (80.5%) and N1 (80.3%) disease. Following NAC, half of the patients (50%) had breast conserving surgery, whereas the remaining half had mastectomy (50%). Of 2358 patients, 908 (38.5%) had ALND following SLN (ypN+, 85%) and 1450 (61.5%) underwent SLNB alone (ypN0, 72%). SLNB was performed by using the blue dye technique-alone in 66.6% of patients and by targeted axillary dissection in 659 patients (27.9%). Of those, 819 (34.8%) were HER2(+) and 373 (15.8%) were triple negative. The pCR rates for the axilla, breast and both for the axilla and breast were 50%, 35% and 28%, respectively. At a median follow-up time of 28 months (range, 12-62), the LRR, AR and isolated AR rates were 0.6% (n=14), 0.25% (n=6) and 0.13% (n=3), respectively. Furthermore, no significant difference could be found in LRR- and AR- rates between SLNB-alone and ALND groups regardless of the definitive nodal pathology (Table 1). Nodal recurrences were seen at a median of 12 months after the surgery. Of 6 cases with AR, 3 had synchronous local recurrences in breast, and 2 of them also had lung metastases in addition to local recurrence. All patients with AR were interestingly found to have HER2(+) or triple negative breast cancer at the initial diagnosis, and had residual invasive cancer in the breast surgical specimen. Logistic regression analyses revealed that patients with AR were significantly more likely to be younger than 45 (RR=7.81 ; 95% CI, 0.91-66.91) and have a cN2-3 (RR=4.1; 95% CI, 0.83-20.38), and non-luminal breast cancer (RR=12.47; 95% CI, 1.45-106.9) at the initial diagnosis (Table 2). Similarly, patients with LRR were more likely to present with cN2-3 disease (RR=3.09; 95% CI, 1.07-8.94) and non-luminal pathology (RR=6.27; 95%CI, 1.96-20.06) . Conclusion: This large prospective registry data also suggest that nodal recurrences can be detected at very low rates within 3 years after surgery in patients with clinically node-positive disease following NAC regardless of the extent of axillary surgery or nodal pathology as long as regional nodal radiation is provided. Since patients with early nodal recurrences have an agressive tumor biology with a potential of systemic recurrences, effective adjuvant systemic therapies should be considered in those with HER2(+) or triple negative residual breast cancer after surgery following adjuvant nodal radiation. Table 1. Local locoregoinal and systemic recurrences in cT1-4N1-3 patients with ypN0/ypN(+) diseases (n =2358) Table 2. Factors associated with axillary and locoregoinal recurrences (AR = axillary recurrences, LRR = locoregoinal recurrences, pCR = pathologic complete response) Citation Format: Neslihan Cabıoğlu, Hasan Karanlik, Mehmet Ali Gulcelik, Abdullah İgci, Mahmut Muslumanoglu, Havva Belma Kocer, Cihan Uras, Gokhan Giray Akgul, Mustafa Tukenmez, Serkan Ilgun, Didem Can Trabulus, Guldeniz Karadeniz Cakmak, Ahmet Dağ, Nilufer Yıldirim, Baha Zengel, Ebru Sen Oran, Kazim Senol, Halil Kara, Selman Emiroglu, M. Umit Ugurlu, Bulent Citgez, Yeliz Emine Ersoy, Atilla Celik, Ece Dilege, Yasemin Bolukbaşı, Niyazi Karaman, Gul Basaran, Aykut Soyder, Ayfer Kamali Polat, Gurhan Sakman, Serdar Ozbas, Ayse Altınok, Leyla Zer, Alper Akcan, Ibrahim Ali Ozemir, Levent Yeniay, N. Zafer Utkan, Lutfi Dogan, Mutlu Dogan, Mehmet Velidedeoglu, Beyza Ozcinar, Fazilet Erozgen, Abut Kebudi, Kemal Atahan, Vafa Valiyeva, Serdar Yormaz, Ali Sevinc, Cumhur Arici, Atilla Soran, Vahit Ozmen. PD15-01 AXILLARY NODAL RECURRENCE IS RARE IN PATIENTS WITH NODE-POSITIVE BREAST CANCER UNDERGOING SLNB FOLLOWING NEOADJUVANT CHEMOTHERAPY : EARLY RESULTS OF THE NEOSENTITURK-TRIAL/MF-18-03 [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD15-01.

AIM:Angiolipoma is uncommon lesion in the breast and has clinical importance due to the potential of confusion with malignant breast lesions. To date, there is no defined diagnosis and treatment algorithm for breast angiolipomas. We aim to contribute to the literature for the diagnosis and treatment of angiolipomas with this case report and literature review.CASE REPORT:A 29-year-old male patient presented with a newly emerged palpable mass in the right breast. Physical examination revealed a palpable mass in the lower inner quadrant of the right breast without any presence of skin changes, nipple discharge or palpable axillary lymph nodes. The lesion was found to be 3 cm in diameter and showed minimal vascularization on Doppler Ultrasound examination. Surgical excision of the lesion was performed and the lesion was diagnosed as angiolipoma.CONCLUSION:Angiolipomas of the breast in male are rare pathological entities and must always be considered during differential diagnosis, as it can be confused clinically, radiologically and pathologically with other lesions, especially with malignant lesions KEY WORDS: Angiolipoma, Breast, Male breast lesions.

BACKGROUND:We aimed to assess the feasibility and short-term clinical outcomes of surgical procedures for cancer at an institution using a coronavirus disease 2019 (COVID-19)-free surgical pathway during the peak phase of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.MATERIALS AND METHODS:This was a single-center study, including cancer patients from all surgical departments, who underwent elective surgical procedures during the first peak phase between March 10 and June 30, 2020. The primary outcomes were the rate of postoperative SARS-CoV-2 infection and 30-day pulmonary or non-pulmonary related morbidity and mortality associated with SARS-CoV-2 disease.RESULTS:Four hundred and four cancer patients fulfilling inclusion criteria were analyzed. The rate of patients who underwent open and minimally invasive procedures was 61.9% and 38.1%, respectively. Only one (0.2%) patient died during the study period due to postoperative SARS-CoV2 infection because of acute respiratory distress syndrome. The overall non-SARS-CoV2 related 30-day morbidity and mortality rates were 19.3% and 1.7%, respectively; whereas the overall SARS-CoV2 related 30-day morbidity and mortality rates were 0.2% and 0.2%, respectively.CONCLUSIONS:Under strict institutional policies and measures to establish a COVID-19-free surgical pathway, elective and emergency cancer operations can be performed with acceptable perioperative and postoperative morbidity and mortality.