Background:Sclerosing adenosis (SA) and breast cancer (BC) often exhibit overlapping clinical, imaging, and pathological characteristics, making them difficult to differentiate. SA may also coexist with BC (SA + BC), including ductal carcinoma in situ (SA-DCIS) and invasive breast cancer (SA-IBC), which complicates diagnosis even when core-needle biopsy (CNB) suggests SA. This study aimed to develop interpretable AI-based binary and ternary classification models that leverage clinical and imaging features to distinguish SA-only from SA + BC and to further differentiate among SA-only, SA-DCIS, and SA-IBC. Methods:We retrospectively analyzed a cohort of 726 patients with SA (January 2006 to December 2021), comprising 537 SA-only and 189 SA + BC cases (90 SA-DCIS, 99 SA-IBC). Multiple machine learning algorithms-logistic regression, support vector machine, decision tree, XGBoost, and random forest-were compared using AUC, accuracy, F1-score, and C-index. Model interpretability was assessed with SHAP to elucidate feature contributions and identify key predictors. Additionally, we incorporated an independent external validation cohort consisting of 113 patients to verify the model's effectiveness. Results:XGBoost consistently outperformed other algorithms in both tasks. Eight features emerged as most informative: age, ultrasound BI-RADS category, maximum and minimum ultrasound diameters, ultrasound margin characteristics, biopsy procedure, mammographic density, and microcalcifications. For binary classification (SA-only vs. SA + BC), XGBoost achieved an AUC of 0.925, accuracy of 0.883, and C-index of 0.844. For ternary classification (SA-only, SA-DCIS, SA-IBC), the model achieved an AUC of 0.888, accuracy of 0.811, and C-index of 0.813. Age, ultrasound BI-RADS, and minimum lesion diameter were consistently top predictors. We further proposed a three-tier interpretability framework (global, cohort-level; local, subgroup-level; and individual, case-level) to facilitate clinical translation. Conclusion:Given the substantial risk of coexisting of SA with DCIS or IBC, and the potential for CNB to underestimate disease due to limited sampling, lesions diagnosed as SA on CNB should be evaluated with additional modalities before determining the need for surgical excision. The proposed interpretable AI model enhances discrimination between SA-only and SA with concomitant breast cancer (SA + BC), thereby supporting more informed clinical decision-making in breast disease management.

Clinical management of breast cancer lung metastasis is challenging because of the complexity of dynamic lesion assessment. Traditional methods based on RECIST1.1 rely on size measurement, and existing studies require image registration and are limited to lesion-level assessment. In this study, we proposed a patient-level spatiotemporal assessment framework without registration to comprehensively analyze multiple lesions evolvement based on longitudinal CT images. Our method considers metastatic lesions that vary in size and often overlap with complex structures such as blood vessels and bones, and avoids potential registration errors. Our method outperforms state-of-the-art methods on both the Peking Union Medical College Hospital breast cancer lung metastasis dataset and the publicly available dataset. The model also showed excellent performance in a multicenter validation across four medical centers. We established a patient-level metastatic breast cancer assessment framework, providing a practical solution for longitudinal treatment monitoring.

Human epidermal growth factor receptor 2 (HER2) is overexpressed in 15–20

Abstract Objectives Axillary lymph node (ALN) status is a crucial prognostic factor in breast cancer. Accurate, non-invasive methods for evaluating axillary lymph node metastasis after neoadjuvant therapy (NAT) are needed to optimize surgical decisions and minimize patient morbidity. Fibroblast activation protein inhibitor (FAPI) PET/CT targets cancer-associated fibroblasts and may improve diagnostic accuracy. This study aims to assess the diagnostic performance and clinical utility of 18 F-FAPI PET/CT in detecting ALN metastasis after NAT in breast cancer patients. Methods This prospective, single-center study will enroll breast cancer patients with cT1-4N0-1M0 stage before NAT, who will undergo pre-surgical 18 F-FAPI PET/CT followed by sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) guided by protocol stratification based on FAPI PET/CT and clinical findings. The primary endpoint is the diagnostic accuracy of 18 F-FAPI PET/CT for ALN metastasis vs. pathology. Secondary endpoints include false-negative rates (FNR) of SLNB, lymphedema rates, and long-term outcomes such as local recurrence and survival rates. Discussion This study will provide evidence on the efficacy of 18 F-FAPI PET/CT in accurately assessing ALN status post-NAT, potentially enabling de-escalation and reducing complications, thereby advancing personalized breast cancer care. Trial registration ClinicalTrials.gov, identification number: NCT07012707.

Background:Breast-conserving surgery (BCS) combined with sentinel lymph node biopsy (SLNB) is a standard treatment for early-stage breast cancer. However, surgical variability and patient discomfort under regional anesthesia present challenges for training programs and consistent clinical outcomes. To address this, we implemented a breast modular resection (BMR) surgical teaching course designed to deconstruct BCS + SLNB into standardized modules and evaluated its impact on training effectiveness and patient outcomes in the day surgery setting under regional anesthesia. Methods:A total of 273 patients underwent BCS with SLNB between 2019 and 2022, performed by six attending breast surgeons. Patients were divided into a classical procedure resection group (n = 124) and a BMR group (n = 149). All surgeries were performed under regional anesthesia. Clinical and subjective outcome indicators, such as re-excision rate, pain scores, cosmetic satisfaction, and hospital stay, were analyzed. Results:The BMR group showed significantly more favorable perioperative outcomes, including lower re-excision rates (3.85% vs. 11.88%, p = 0.038), reduced intraoperative pain (p < 0.05), decreased seroma incidence (9.62% vs. 20.79%, p = 0.032), and enhanced breast symmetry satisfaction (p = 0.008). A substantially higher proportion of BMR patients were discharged on postoperative Day 1 (79.81% vs. 31.68%, p < 0.001), confirming the feasibility of safe, same-day BCS + SLNB. There were no differences in long-term complications or recurrence. Conclusions:The BMR-based teaching model improved surgical performance, standardized the technique, and enhanced the patient experience for BCS + SLNB under regional anesthesia. This structured modular approach provides a replaceable framework for surgical education and may facilitate broader adoption of day-case breast cancer surgery without compromising oncologic safety or patient comfort.

BACKGROUND:BOS172722, a selective TTK inhibitor, shows promise for Breast Cancer (BC) treatment. The role of gut microbiota as a potential mediator in this process has not been established. This Mendelian Randomization (MR) study investigated the causal effect of TTK inhibition on BC and conducted an exploratory analysis of potential mediation by gut microbiota. METHODS:A two-step, two-sample drug target MR analysis used IEU Open GWAS project datasets. The inverse-variance-weighted method estimated causal effects, with sensitivity tests confirming robustness. False Discovery Rate (FDR) correction was applied to analyses for all microbial taxa. RESULTS:Genetically predicted TTK inhibition significantly reduced BC risk (OR = 0.667, 95 % CI 0.543-0.819; FDR-adjusted p < 0.001). In secondary analyses, initial uncorrected results indicated nominal associations between TTK inhibition and 20 gut microbial taxa, and between 6 taxa and BC risk. However, none of these microbiota-related associations remained statistically significant after FDR correction (all q-values >0.1). An exploratory mediation analysis on Genus Anaerostipes id.1991, which showed the strongest nominal signals (TTK inhibition on Anaerostipes: uncorrected p = 0.003; Anaerostipes on BC: uncorrected p = 0.025), was performed for hypothesis generation only; no statistically significant mediation was observed. CONCLUSION:This study provides robust genetic evidence that TTK inhibition is causally associated with a decreased risk of breast cancer. The exploratory analysis of gut microbiota as a mediator did not yield statistically significant results after correction for multiple testing. The potential role of specific microbes, such as Genus Anaerostipes, remains inconclusive and requires further dedicated investigation.

533 Background: While dual anti-HER2 therapy is standard in the adjuvant setting for HER2-positive early breast cancer, treatment de-escalation is an attractive strategy for patients with low-risk disease. Previous studies (e.g., APT, ATEMPT) of adjuvant trastuzumab plus chemotherapy or T-DM1 monotherapy in this population reported 3-year invasive disease-free survival (iDFS) rates of 93.4%-98.7%. Pyrotinib, an irreversible pan-HER2 tyrosine kinase inhibitor, is effective in HER2-positive breast cancer; however, data supporting its use in the adjuvant setting for low-risk disease are limited. This study evaluated the efficacy and safety of adjuvant pyrotinib plus nab-paclitaxel in this population. Methods: This multicenter, single-arm, phase II trial enrolled women aged 18-75 with primary tumor size ≤3 cm and node-negative (N0) or micrometastases (N1mi), histologically confirmed HER2-positive early breast cancer. Patients received nab-paclitaxel (260 mg/m² IV, q3w) plus pyrotinib (400 mg PO, qd) for 12 weeks (4 cycles), followed by pyrotinib monotherapy (400 mg, qd) for one year. The primary endpoint was iDFS. Secondary endpoint was adverse events (AEs) graded by CTCAE v5.0. Results: From January 8, 2021, to September 21, 2023, 263 patients were enrolled and received treatment. Median age was 51 years; 60.8% (160/263) were hormone receptor-positive, and 97.7% (257/263) were node-negative. At the data cutoff (December 30, 2025), with a median follow-up of 36.2 months, 9 iDFS events were observed. The estimated 3-year iDFS rate was 96.8% (95% CI 93.4-98.5). One death occurred and overall survival data were immature. The most common grade ≥3 treatment-related AEs were diarrhea (50.6%), neutropenia (14.4%), and decreased white blood cell count (14.4%). No serious AEs were reported. Treatment interruption, dose reduction, and discontinuation due to AEs occurred in 12.2%, 3.4%, and 1.5% of patients, respectively. Conclusions: Adjuvant pyrotinib combined with nab-paclitaxel showed promising 3-year iDFS and a manageable safety profile in patients with low-risk, HER2-positive early breast cancer. This regimen represents a potential oral de-escalation strategy for this population. Clinical trial information: NCT 04659499 . Efficacy outcomes. Efficacy outcomes Pyrotinib + nab-Paclitaxel（n=263） Events, n(%) 9 (3.4) 24 months 36 months 48 months iDFS rate, (95% CI) 98.77(96.24, 99.60) 96.83(93.42, 98.49) 93.17(85.03, 96.96) DDFS rate, (95% CI) 99.18(96.76, 99.79) 98.77(96.23, 99.60) 95.03(86.00, 98.29) LRFS rate, (95% CI) 99.18(96.75, 99.79) 98.18(95.18, 99.32) 94.47(85.76, 97.92) iDFS: invasive disease-free survival; DDFS: distant disease-free survival; LRFS: locoregional recurrence-free survival.

BACKGROUND:Breast cancer in women aged 40 years or younger is clinically heterogeneous, yet risk stratification within this already-young population and rigorously validated disease-free survival (DFS) tools remain limited. METHODS:We retrospectively analyzed 2069 women aged 40 years or younger who underwent surgery between 2006 and 2021. Patients were compared as younger than 35 versus 35-40 years to assess the prognostic relevance of very young age. Age was additionally modeled continuously using restricted cubic splines, and the optimal cutpoint was examined using maximally selected rank statistics. DFS was evaluated with Kaplan-Meier estimates and multivariable Cox models. We developed a Cox nomogram for 3- and 5-year DFS using age, molecular subtype, pathologic T stage, pathologic N stage, histologic grade, Ki-67 category, and calendar period. Missing covariates were handled by multiple imputation by chained equations (20 imputations), with internal validation by 1000 bootstrap resamples and temporal validation of a reduced model. RESULTS:Of 2069 women, 779 were younger than 35 years. Very young patients had more aggressive features, including higher frequencies of HER2-positive and triple-negative disease, grade 3 tumors, high Ki-67, and advanced T/N stage. Overall 5-year DFS was 88.9%; patients younger than 35 years had worse 5-year DFS (85.0% vs 91.4%; log-rank P = .0005; absolute difference 6.4 percentage points). Spline modeling showed a continuous, monotonic increase in risk with younger age without evidence of non-linearity (P = .88), and maximally selected rank statistics identified 35 years as the optimal cutpoint (standardized log-rank z = 3.51, P < .001). After adjustment for molecular subtype and pathologic T and N stage, age younger than 35 years remained independently associated with worse DFS (hazard ratio 1.34, 95% CI 1.03-1.76; P = .032). The multiple-imputation nomogram had an apparent C-index of 0.660, a bootstrap-corrected C-index of 0.636, and a temporal-validation C-index of 0.617. CONCLUSION:Very young age identifies a higher-risk subgroup among women aged 40 years or younger with breast cancer. A multiple-imputation Cox nomogram based on routinely available variables provided moderate discrimination and acceptable calibration and is best suited to broad risk-group stratification rather than precise individual-level prediction.

The identification of reliable biomarkers for the Cyclin-dependent kinase (CDK) 4/6 inhibitor efficacy is crucial for optimizing treatment strategies in patients with advanced hormone receptor-positive (HR+) /human epidermal growth factor receptor 2-negative (HER2-) breast cancer. This study aimed to evaluate the prognostic value of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) parameters in patients treated with CDK4/6 inhibitor abemaciclib with endocrine therapy. We conducted a retrospective study of patients with advanced HR+/HER2- breast cancer who received abemaciclib plus endocrine therapy and underwent 18F-FDG PET/CT examination. Parameters such as maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of PET/CT and clinicopathological parameters were assessed. A total of 72 consecutive patients were included. Most patients (79.2

Background Cyclinu2010dependent kinase 4/6 (CDK4/6) inhibitors have become a cornerstone in the firstu2010line management of hormone receptoru2010positive, human epidermal growth factor receptor 2u2010negative (HR+/HER2u2212) advanced breast cancer. Despite their clinical efficacy, most patients eventually experience disease progression, and optimal treatment strategies following CDK4/6 inhibitor resistance remain unclear. Emerging evidence suggests that switching endocrine therapy (ET) while continuing cyclin inhibition may provide additional clinical benefit. Dalpiciclib, a selective CDK4/6 inhibitor, in combination with physicianu2010selected ET, represents a potential option in this setting. Concurrently, 16u03B1u2010[18F]fluorou201017u03B2u2010estradiol ([18F]FES) PET/CT, a novel imaging modality targeting estrogen receptors (ER), enables nonu2010invasive, wholeu2010body assessment of ER expression in metastatic lesions, offering a personalized approach to treatment selection. Methods This is a prospective, singleu2010center, singleu2010arm Phase u2161 clinical trial evaluating the efficacy and safety of dalpiciclib plus ET in HR+/HER2u2212 advanced breast cancer patients who progressed on prior CDK4/6 inhibitor therapy. Forty eligible patients with confirmed metastases and at least one [18F]FESu2010positive lesion will be enrolled. Participants will receive dalpiciclib combined with ET as determined by the treating physician. The primary endpoint is progressionu2010free survival (PFS). Secondary endpoints include objective response rate (ORR), disease control rate (DCR), and overall survival (OS). Discussion Beyond evaluating efficacy, this singleu2010center phase u2161 trial will provide practical insight into the feasibility of [18F]FES PET/CTu2010guided patient selection, including standardized imaging workflows and multidisciplinary implementation in routine clinical research. Positive outcomes may support a personalized, imagingu2010guided strategy to prolong disease control after prior CDK4/6 inhibitor progression. Ethical Approval and Trial Registration Approved by the Ethics Committee of Peking Union Medical College Hospital (Approval number: K3629); registered at ClinicalTrials. gov (NCT05613270).

Background:Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors have become a cornerstone in the first-line management of hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR+/HER2-) advanced breast cancer. Despite their clinical efficacy, most patients eventually experience disease progression, and optimal treatment strategies following CDK4/6 inhibitor resistance remain unclear. Emerging evidence suggests that switching endocrine therapy (ET) while continuing cyclin inhibition may provide additional clinical benefit. Dalpiciclib, a selective CDK4/6 inhibitor, in combination with physician-selected ET, represents a potential option in this setting. Concurrently, 16α-[18F]fluoro-17β-estradiol ([18F]FES) PET/CT, a novel imaging modality targeting estrogen receptors (ER), enables non-invasive, whole-body assessment of ER expression in metastatic lesions, offering a personalized approach to treatment selection. Methods:This is a prospective, single-center, single-arm Phase II clinical trial evaluating the efficacy and safety of dalpiciclib plus ET in HR+/HER2- advanced breast cancer patients who progressed on prior CDK4/6 inhibitor therapy. Forty eligible patients with confirmed metastases and at least one [18F]FES-positive lesion will be enrolled. Participants will receive dalpiciclib combined with ET as determined by the treating physician. The primary endpoint is progression-free survival (PFS). Secondary endpoints include objective response rate (ORR), disease control rate (DCR), and overall survival (OS). Discussion:Beyond evaluating efficacy, this single-center phase II trial will provide practical insight into the feasibility of [18F]FES PET/CT-guided patient selection, including standardized imaging workflows and multidisciplinary implementation in routine clinical research. Positive outcomes may support a personalized, imaging-guided strategy to prolong disease control after prior CDK4/6 inhibitor progression. Ethical Approval and Trial Registration:Approved by the Ethics Committee of Peking Union Medical College Hospital (Approval number: K3629); registered at ClinicalTrials. gov (NCT05613270).

Breast cancer is posing a serious threat to the health of the female workforce as one of the most prevalent malignancies. Emerging epidemiological evidence suggests that insufficient intake of the trace element, iodine, is associated with breast oncogenesis. In this paper, we propose a potential link between iodine deficiency and increased breast cancer risk. A central element of this mechanism may involve the cytoplasmic mislocalization and oncogenic function of the sodium/iodide symporter (NIS), which primarily mediates iodine transport under physiological conditions in the human body. We propose a three-stage model: (1) Initiation: Iodine deficiency triggers systemic alterations in the hypothalamic-pituitary-thyroid (HPT) and gonadal (HPG) axes, as well as lactogenic signaling, establishing a proliferative and inflamed breast microenvironment. (2) Heterogeneous subtype-specific evolution: For hormone receptor-positive (HR+) breast cancer, sustained PI3K/AKT activation driven by the relative dominance of estrogen disrupts normal glycosylation, leading to the cytoplasmic retention of NIS. For triple-negative breast cancer, TP53 and FOXA1 mutations primarily contribute to significant upregulation of NIS. (3) Malignant evolution: Cytoplasmic NIS associates with the leukemia-associated RhoA guanine exchange factor (LARG) and hyperactivates the RhoA-ROCK signaling pathway, driving cytoskeletal rearrangement, tumor invasion and metastasis. Deciphering the contributions of iodine status toward breast carcinoma development is assumed to open new avenues for novel therapeutic measures for breast cancer.

Antibody-drug conjugates (ADCs) have transformed cancer treatment by covalently linking the monoclonal antibody with cytotoxic payload, yet their clinical potential remains constrained by intrinsic limitations: heterogeneous drug-to-antibody ratios, linker instability, manufacturing complexity, and drug resistance. These challenges highlight the need for fundamentally different drug formulation and delivery platforms. Antibody-encapsulated drugs (AEDs) leverage the single protein encapsulation technology to enable one antibody to noncovalently encapsulate a predefined number of payload molecules. AEDs allow for a fixed drug-to-antibody ratio, mitigate premature drug release, simplify manufacturing, and expand the range of compatible payloads and protein molecules. Preclinical investigation of trastuzumab-encapsulated actinomycin D, a HER2-targeted AED, has demonstrated potent antitumor activity across cancer models with varying HER2 expression levels, alongside a favorable toxicity profile in animal models. The broader translational feasibility of the single protein encapsulation platform is further supported by ongoing clinical trials of albumin-encapsulated therapeutics. Together, these advances position AED as a promising next-generation targeted cancer therapy that complements and potentially extends beyond conventional ADCs, offering a compelling strategy to overcome existing resistance mechanisms and therapeutic limitations.

As one of the leading causes of cancer-related mortality among women globally, breast cancer (BC) has been increasingly linked to environmental risk factors. Among these, Benzophenone-3 (BP3)-a ubiquitous ultraviolet filter-has drawn research interest, yet its specific contributions to BC pathogenesis remain poorly defined. Here we report that BP3 exposure potently stimulates both proliferative and migratory capacities of BC cells, concomitantly accelerating the acquisition of aggressive malignant traits. Through transcriptomic profiling, we identified a set of differentially regulated transcripts upon BP3 treatment, with Gene Ontology analysis pointing to enhanced epithelial proliferation, induction of epithelial-mesenchymal transition, and suppressed cell-adhesion programs. A prognostic risk model derived from LASSO regression of BP3-responsive genes demonstrated significant association with patient survival outcomes. Mechanistically, we pinpoint replication protein A3 (RPA3) as an essential downstream effector, since its depletion largely abolished the pro-tumorigenic effects elicited by BP3. Further dissection of the regulatory circuit revealed that BP3 drives RPA3 upregulation through the ERα/E2F1 transcriptional axis. Collectively, these data establish BP3 as an environmental promoter of BC malignancy and implicate the ERα/E2F1/RPA3 cascade as a potential therapeutic vulnerability. Given its widespread use, these findings raise public health concerns about chronic BP3 exposure and support further evaluation of its long-term safety.

IntroductionThe US plays a crucial role in screening Asian women for breast disease. ABUS offers several advantages over traditional HHUS, including quicker examination, objectivity, and the ability to store and reconstruct images. This study marks the first large-scale opportunistic screening of ABUS in the population.MethodsBetween January 1, 2016, and December 31, 2019, 10,537 women aged 35–75 years from nine districts were randomly assigned to either HHUS or ABUS groups. Diagnostic methods were quantified, and comparisons were made using the Chi-square test.ResultsThe screening groups consisted of 5,445 participants for HHUS and 4,936 for ABUS. The HHUS and ABUS groups identified 90 carcinomas and 292 benign lesions or 71 carcinomas and 178 benign lesions, respectively. SE), SP, AC, PPV, and NPV for HHUS were 51.11%, 93.84%, 93.13%, 12.23%, and 99.13%, respectively, while for ABUS, they were 66.20%, 93.77%, 93.38%, 13.43%, and 98.98%. The area under the curve (AUC) values for HHUS and ABUS were 0.72 (95% CI: 0.67–0.78) and 0.86 (95% CI: 0.82–0.91), respectively, indicating superior diagnostic performance of ABUS over HHUS (Delong test p < 0.05).DiscussionABUS is user-friendly, requires minimal training, reduces reliance on examiner experience, and demonstrates potential for superior sensitivity compared to HHUS in breast cancer screening.

Calreticulin (CALR) preserves reticular homeostasis by maintaining correct protein folding within the endoplasmic reticulum. Immunogenic cell death (ICD) is a regulated form of cell death and could activate adaptive immune response. As one of the damage-associated molecular patterns during ICD process, surface-exposed CALR resulted in the activation of adaptive immune response. Here, we evaluated the expression patterns of CALR in a cohort of 231 untreated triple-negative breast cancer (TNBC) and determined correlations between CALR expression and clinicopathologic parameters, programmed cell death ligand 1 (PD-L1) expression in immune cells (ICs), and survival. In addition, we analyzed a TNBC data set from The Cancer Genome Atlas to explore the relationship between mRNA expression of CALR and clinicopathologic features, IC infiltration, and survival. Tissue microarray results showed that high CLAR was strongly correlated with advanced stage ( P = 0.022), shorter disease-free survival ( P = 0.008) and overall survival ( P = 0.002), and independently predicted prognosis in TNBC. Spearman analyses demonstrated that CALR negatively correlated with PD-L1 in ICs ( r = -0.198, P = 0.003). Patients with low CALR and high PD-L1 in ICs had the best disease-free survival ( P = 0.013) and overall survival ( P = 0.004) compared with other patients, especially the patients with high CALR and low PD-L1 in ICs. In the "The Cancer Genome Atlas" cohort, CALR mRNA expression in tumors was significantly higher than that in normal tissues ( P < 0.001). CALR expression was strongly and positively related to other ICD-related genes. These findings demonstrated that the expression of CALR could independently predict the prognosis in patients with TNBC, and it may play a potential synergistic role in treatments involving immunotherapy.

Luminal-type breast cancer (BC) was characterized as hormonal receptor positive human epidermal receptor 2 negative (HR+/HER2-). The 70-gene signature (70-GS, MammaPrint) test is recommended for assessing recurrence risk and guiding adjuvant chemotherapy decisions for Luminal-type BC. This study updates previously established nomogram models to predict binary 70-GS risk for lymph node positive (LN+) and lymph node negative (LN-) luminal-type BC patients. This retrospective study included 301 consecutive female patients with HR+/HER2- BC treated at Peking Union Medical College Hospital from November 2019 to December 2023. Patients’ medical history, imaging reports, and clinicopathological features were reviewed. Forty risk parameters were compared between 70-GS high and low-risk patients among LN + and LN- groups. High risk stratification criterion in MonarchE and Natalee were compared between low and high 70-GS risk for the first time. Logistic regression was utilized to establish nomogram models predicting binary 70-GS risk for LN + and LN- patients. The models’ prediction performance was evaluated utilizing accuracy, AUC of ROC curves, C-index, calibration curves, and decision curve analysis. Significant differences were found between 70-GS high and low-risk patients in both LN + and LN- groups. Among LN + patients, parameters including childbirth number (p = 0.024), cardiovascular diseases (p = 0.037), US min. diameter of tumor (p = 0.034), Ki67 index (p < 0.001) and PR positivity (p = 0.007) were significant predictors. Among LN- patients, micro-calcifications (p = 0.011), PR positivity (p = 0.021), and Ki67 index (p < 0.001) were significant. The nomogram models showed high predictive accuracy, with AUC of 0.948 in the training set (C-index 0.948, 0.914–0.982, accuracy 0.907) and 0.923 in the testing set (C-index 0.923, 0.919–0.927, accuracy 0.828) for LN + patients and 0.917 in the training set (C-index 0917, 0.861–0.972, accuracy 0.870) and 0.917 in the testing sets (C-index 0917, 0.912–0.922, accuracy 0.808) among LN- patients. Calibration and decision curve analyses confirmed model reliability and clinical utility. The updated nomogram models for predicting 70-GS risk in LN + and LN- luminal-type BC patients demonstrated improved prediction performance. The models facilitate individualized risk assessment and treatment decision-making, emphasizing tailored approaches based on lymph node status.

In China, breast surgery training lacks standardization due to regional disparities and its short establishment time. This variability in curricula and competencies threatens surgical consistency, treatment outcomes, and implementation of advanced multidisciplinary strategies. We performed a national survey to evaluate the backgrounds, experience, and education requirements of young breast surgeons in China. An online questionnaire survey targeting young breast surgeons (< 40 years old) was conducted from April 18 to May 2, 2024. Data on baseline information, academic background, department status, previous training, surgery experience, research involvements, and continuing education requirements were collected. A total of 240 valid responses from 69 hospitals were gathered. Compared with surgeons in western China, those in eastern China had more training opportunities (covering breast surgery, breast cancer surgery, participation in operations, breast surgery training, mentorship, and publications), whereas those in the west had less access to specialized education. These training opportunities varied among surgeons of different sexes and educational backgrounds. The top three preferences for continuing education were research projects, endoscopic training, and English Writing Guidance (with 146, 117, and 106 person-times choosing, respectively). Our results preliminarily revealed significant disparities in educational backgrounds and continuing education interests among surgeons of different sexes and academic degrees across regions. Targeted standardized training models and special education programs for breast diseases, applicable on a national level are warranted with attention to regional disparities.