Pub Date : 2026-02-01DOI: 10.1016/j.clbc.2025.12.003
Fuzesi Sarah , Paily Jacienta , Ha Richard , Wiechmann Lisa , Sun Luona , Rao Roshni , Taback Bret
Purpose
To determine the accuracy of radioisotope, blue dye and implanted fiducial marker for identification of the histopathologically positive percutaneous/previously biopsied lymph node (PBLN) following neoadjuvant chemotherapy (NAC). Detection of the PBLN is critical for monitoring disease response and guiding subsequent treatment decisions. However, conventional sentinel lymph node biopsy (SLNB) techniques have shown unacceptable false negative rates. Recommendations for improvement suggest using dual tracers, removing more lymph nodes and implantable markers in the PBLN. This study evaluated the accuracy of PBLN identification using each of the 3 most common localization techniques: blue dye (lymphazurin), radioisotope (Technetium-99m sulfur colloid), and implanted fiducial marker (SAVI SCOUT).
Methods
Patients with PBLN marked with a SAVI SCOUT, with or without a metallic clip, and who received NAC were identified from our breast cancer surgery database. The accuracy of the 3 localizing techniques was evaluated. Secondary outcomes included total number of lymph nodes retrieved and number of sampling events per patient for each technique.
Results
We identified 65 patients who underwent percutaneous lymph node biopsy prior to NAC. The clip marking the PBLN was identified in 64 patients (98%). The PBLN was identified by the SAVI SCOUT in 61 (95%) of 64 patients, radioisotope in 44 (71%) of 62 patients and blue dye in 28 (64%) of 44 patients. A SAVI SCOUT was placed at the time of biopsy instead of a clip in 13 patients and identification of the PBLN was 100% for those patients. The mean number of lymph nodes removed with the SAVI SCOUT was 2.7, with radioisotope was 4.3 and with blue dye was 3.6 (P = .004). The mean number of SLN sampling events with the SAVI SCOUT was 1, with radioisotope was 2.0 (range: 0-6) and with blue dye was 1.8 (range: 0-5) (P < .005). When radioisotope was used, the clip was found in the hottest lymph node 40% of the time, in the second and third hottest lymph node 5% and 11% of the time, respectively. The clipped node was not hot in 29% of cases.
Conclusions
This study demonstrates that the most accurate method for identifying the PBLN is with placement of a fiducial marker. Furthermore, the addition of radioisotope and blue dye may result in an excessive number of lymph nodes removed and more retrieval events during SLNB following NAC. Placement of the SAVI SCOUT marker at the time of percutaneous lymph node biopsy may subsequently obviate the need for additional mapping techniques of blue dye and radioisotope during sentinel lymph node surgery.
{"title":"Triple Technique (Radioisotope, Blue Dye, and Embedded Fiducial Marker) for Identifying Sentinel Lymph Nodes Following Neoadjuvant Chemotherapy for Clinical Lymph Node Positive Breast Cancer; Is More Really Better?","authors":"Fuzesi Sarah , Paily Jacienta , Ha Richard , Wiechmann Lisa , Sun Luona , Rao Roshni , Taback Bret","doi":"10.1016/j.clbc.2025.12.003","DOIUrl":"10.1016/j.clbc.2025.12.003","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the accuracy of radioisotope, blue dye and implanted fiducial marker for identification of the histopathologically positive percutaneous/previously biopsied lymph node (PBLN) following neoadjuvant chemotherapy (NAC). Detection of the PBLN is critical for monitoring disease response and guiding subsequent treatment decisions. However, conventional sentinel lymph node biopsy (SLNB) techniques have shown unacceptable false negative rates. Recommendations for improvement suggest using dual tracers, removing more lymph nodes and implantable markers in the PBLN. This study evaluated the accuracy of PBLN identification using each of the 3 most common localization techniques: blue dye (lymphazurin), radioisotope (Technetium-99m sulfur colloid), and implanted fiducial marker (SAVI SCOUT).</div></div><div><h3>Methods</h3><div>Patients with PBLN marked with a SAVI SCOUT, with or without a metallic clip, and who received NAC were identified from our breast cancer surgery database. The accuracy of the 3 localizing techniques was evaluated. Secondary outcomes included total number of lymph nodes retrieved and number of sampling events per patient for each technique.</div></div><div><h3>Results</h3><div>We identified 65 patients who underwent percutaneous lymph node biopsy prior to NAC. The clip marking the PBLN was identified in 64 patients (98%). The PBLN was identified by the SAVI SCOUT in 61 (95%) of 64 patients, radioisotope in 44 (71%) of 62 patients and blue dye in 28 (64%) of 44 patients. A SAVI SCOUT was placed at the time of biopsy instead of a clip in 13 patients and identification of the PBLN was 100% for those patients. The mean number of lymph nodes removed with the SAVI SCOUT was 2.7, with radioisotope was 4.3 and with blue dye was 3.6 (<em>P</em> = .004). The mean number of SLN sampling events with the SAVI SCOUT was 1, with radioisotope was 2.0 (range: 0-6) and with blue dye was 1.8 (range: 0-5) (<em>P</em> < .005). When radioisotope was used, the clip was found in the hottest lymph node 40% of the time, in the second and third hottest lymph node 5% and 11% of the time, respectively. The clipped node was not hot in 29% of cases.</div></div><div><h3>Conclusions</h3><div>This study demonstrates that the most accurate method for identifying the PBLN is with placement of a fiducial marker. Furthermore, the addition of radioisotope and blue dye may result in an excessive number of lymph nodes removed and more retrieval events during SLNB following NAC. Placement of the SAVI SCOUT marker at the time of percutaneous lymph node biopsy may subsequently obviate the need for additional mapping techniques of blue dye and radioisotope during sentinel lymph node surgery.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 2","pages":"Pages 87-92"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.clbc.2026.01.003
Hervé Bischoff, Thierry Petit
HR +/HER2 + breast cancer (BC) represents a unique clinical entity distinct from HR−/HER2 + BC, with specific molecular characteristics and resistance mechanisms. The interaction between estrogen receptor (ER) and HER2 signaling pathways promotes tumor growth and therapeutic resistance, highlighting the need for tailored approaches. This review focuses on the clinical and molecular features of HR + /HER2 + metastatic BC, with an emphasis on recent data exploring the integration of CDK4/6 inhibitors (CDK4/6i) into anti-HER2 therapeutic strategies. Key findings from metastatic trials are summarized. HR + /HER2 + metastatic BC is characterized by a predominance of luminal molecular subtypes, associated with distinct patterns of metastatic spread and prolonged progression-free survival compared to nonluminal subtypes. Despite the efficacy of dual HER2 blockade, resistance remains a challenge, driven by crosstalk between ER and HER2 pathways. CDK4/6i disrupt the cell cycle at the G1/S checkpoint and have shown promise in overcoming resistance, inducing sustained senescence, and improving outcomes in luminal subtypes. Recent trials suggest that CDK4/6i may play a key role in maintenance therapy and chemotherapy-free regimens for selected patients with HR + /HER2 + metastatic BC. The integration of CDK4/6 inhibitors into anti-HER2 treatment strategies represents a promising approach to address the unique biology of HR + /HER2 + BC. Molecular profiling and personalized treatment strategies are essential to optimize patient outcomes and reduce unnecessary toxicity.
{"title":"CDK4/6 Inhibitors in HER2-positive Metastatic Breast Cancer","authors":"Hervé Bischoff, Thierry Petit","doi":"10.1016/j.clbc.2026.01.003","DOIUrl":"10.1016/j.clbc.2026.01.003","url":null,"abstract":"<div><div>HR +/HER2 + breast cancer (BC) represents a unique clinical entity distinct from HR−/HER2 + BC, with specific molecular characteristics and resistance mechanisms. The interaction between estrogen receptor (ER) and HER2 signaling pathways promotes tumor growth and therapeutic resistance, highlighting the need for tailored approaches. This review focuses on the clinical and molecular features of HR + /HER2 + metastatic BC, with an emphasis on recent data exploring the integration of CDK4/6 inhibitors (CDK4/6i) into anti-HER2 therapeutic strategies. Key findings from metastatic trials are summarized. HR + /HER2 + metastatic BC is characterized by a predominance of luminal molecular subtypes, associated with distinct patterns of metastatic spread and prolonged progression-free survival compared to nonluminal subtypes. Despite the efficacy of dual HER2 blockade, resistance remains a challenge, driven by crosstalk between ER and HER2 pathways. CDK4/6i disrupt the cell cycle at the G1/S checkpoint and have shown promise in overcoming resistance, inducing sustained senescence, and improving outcomes in luminal subtypes. Recent trials suggest that CDK4/6i may play a key role in maintenance therapy and chemotherapy-free regimens for selected patients with HR + /HER2 + metastatic BC. The integration of CDK4/6 inhibitors into anti-HER2 treatment strategies represents a promising approach to address the unique biology of HR + /HER2 + BC. Molecular profiling and personalized treatment strategies are essential to optimize patient outcomes and reduce unnecessary toxicity.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 2","pages":"Pages 93-104"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1016/j.clbc.2025.12.011
Riccardo Ray Colciago, Carlotta Giandini, Anna Cavallo, Maria Grazia Carnevale, Giuseppe Fotia, Giacomo Mazzoli, Giulia Valeria Bianchi, Serena Di Cosimo, Daniele Presti, Riccardo Lobefaro, Laura Lozza, Maria Carmen De Santis
<p><strong>Purpose: </strong>Oligoprogressive advanced breast cancer (aBC) is becoming an increasingly frequent scenario in which prognosis can be meaningfully improved through targeted local interventions. However, evidence is still lacking. In this study, we aimed to evaluate the role of progression-directed radiation therapy (PDRT) in the management of oligoprogressive aBC.</p><p><strong>Material and methods: </strong>We performed a single-institution retrospective analysis of consecutive patients with oligoprogressive aBC who underwent progression-directed radiation therapy (PDRT) between January 2018 and December 2024. Oligoprogression was defined as emergence of up to 5 progressing lesions across a maximum of 3 distinct organs, after at least 1 line of systemic therapy. The primary endpoint was the event-free survival (EFS), defined as interval from the completion of PDRT to one of the following: change of systemic therapy [which is also called time to next treatment (TNT)], progression < 6 months, or ≥ 3 new or progressing lesions, death, or last follow-up. Secondary endpoints included progression-free survival (PFS), and overall survival (OS).</p><p><strong>Results: </strong>We analyzed 56 patients, with 17 months [interquartile range (IQR): 8-27] of median follow-up. Median age at PDRT was 58 years (IQR: 49-68). Prior to PDRT, 28 patients (50%) had received only 1 line of treatment, 12 (21.4%) had received 2 lines, and 16 (28.6%) had undergone 3 or more lines. Before the onset of oligoprogression, in response to systemic therapy, 31 patients (55.4%) had achieved stable disease, 9 patients (16.0%) a partial response, and 16 patients (28.6%) a complete response at all disease sites. In 39 patients (69.6%) an event occurred after PDRT, with a median event free survival (EFS) of 7 months (IQR: 3-15). The 1-year and 2-year actuarial EFS rates were 39% (95% CI, 33.1%-45.9%) and 24% (95% CI, 17.2%-30.8%), respectively. Among these 39 patients, thirty-three (84.6%) initiated a new line of systemic therapy after PDRT, with a median TNT of 8 months (IQR 4-17), with a 1-year actuarial rate of 46.6%. At the multivariate analysis, HER2 positive and Luminal A subtypes were confirmed as significant predictive factors for increased EFS (adjusted HR = 0.31, P = .01; aHR = 0.27, P = .01, respectively). Furthermore, lymph nodal PDRT appeared to be associated with a protective effect in the univariate analysis (P = .04); however, this association was not retained in the multivariate analysis. Median PFS was 7 months (IQR: 3-12), with 41 patients (73.2%) experiencing disease progression, while the median OS was 17 months (IQR: 8-27). Multivariate analysis confirmed lobular histology as an independent adverse prognostic factor (HR = 9.05, P = .006).</p><p><strong>Conclusion: </strong>Our findings suggest that PDRT may delay the occurrence of events and the need to change systemic therapy in selected patients. This benefit appears more prominent in cases of HE
{"title":"Event-Free Survival After Stereotactic Body Radiation Therapy for Oligoprogressive Metastatic Breast Cancer.","authors":"Riccardo Ray Colciago, Carlotta Giandini, Anna Cavallo, Maria Grazia Carnevale, Giuseppe Fotia, Giacomo Mazzoli, Giulia Valeria Bianchi, Serena Di Cosimo, Daniele Presti, Riccardo Lobefaro, Laura Lozza, Maria Carmen De Santis","doi":"10.1016/j.clbc.2025.12.011","DOIUrl":"https://doi.org/10.1016/j.clbc.2025.12.011","url":null,"abstract":"<p><strong>Purpose: </strong>Oligoprogressive advanced breast cancer (aBC) is becoming an increasingly frequent scenario in which prognosis can be meaningfully improved through targeted local interventions. However, evidence is still lacking. In this study, we aimed to evaluate the role of progression-directed radiation therapy (PDRT) in the management of oligoprogressive aBC.</p><p><strong>Material and methods: </strong>We performed a single-institution retrospective analysis of consecutive patients with oligoprogressive aBC who underwent progression-directed radiation therapy (PDRT) between January 2018 and December 2024. Oligoprogression was defined as emergence of up to 5 progressing lesions across a maximum of 3 distinct organs, after at least 1 line of systemic therapy. The primary endpoint was the event-free survival (EFS), defined as interval from the completion of PDRT to one of the following: change of systemic therapy [which is also called time to next treatment (TNT)], progression < 6 months, or ≥ 3 new or progressing lesions, death, or last follow-up. Secondary endpoints included progression-free survival (PFS), and overall survival (OS).</p><p><strong>Results: </strong>We analyzed 56 patients, with 17 months [interquartile range (IQR): 8-27] of median follow-up. Median age at PDRT was 58 years (IQR: 49-68). Prior to PDRT, 28 patients (50%) had received only 1 line of treatment, 12 (21.4%) had received 2 lines, and 16 (28.6%) had undergone 3 or more lines. Before the onset of oligoprogression, in response to systemic therapy, 31 patients (55.4%) had achieved stable disease, 9 patients (16.0%) a partial response, and 16 patients (28.6%) a complete response at all disease sites. In 39 patients (69.6%) an event occurred after PDRT, with a median event free survival (EFS) of 7 months (IQR: 3-15). The 1-year and 2-year actuarial EFS rates were 39% (95% CI, 33.1%-45.9%) and 24% (95% CI, 17.2%-30.8%), respectively. Among these 39 patients, thirty-three (84.6%) initiated a new line of systemic therapy after PDRT, with a median TNT of 8 months (IQR 4-17), with a 1-year actuarial rate of 46.6%. At the multivariate analysis, HER2 positive and Luminal A subtypes were confirmed as significant predictive factors for increased EFS (adjusted HR = 0.31, P = .01; aHR = 0.27, P = .01, respectively). Furthermore, lymph nodal PDRT appeared to be associated with a protective effect in the univariate analysis (P = .04); however, this association was not retained in the multivariate analysis. Median PFS was 7 months (IQR: 3-12), with 41 patients (73.2%) experiencing disease progression, while the median OS was 17 months (IQR: 8-27). Multivariate analysis confirmed lobular histology as an independent adverse prognostic factor (HR = 9.05, P = .006).</p><p><strong>Conclusion: </strong>Our findings suggest that PDRT may delay the occurrence of events and the need to change systemic therapy in selected patients. This benefit appears more prominent in cases of HE","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 3","pages":"27-38"},"PeriodicalIF":2.5,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146140839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1016/j.clbc.2026.01.006
Maria Gosein, Edwin Khoo, Charlotte Yong-Hing, Janette Sam, Tetyana Martin
Objective: To evaluate the diagnostic performance of contrast-enhanced mammography (CEM) for breast cancer surveillance in patients with dense breast tissue and a personal history of breast cancer.
Methods: In this single-center retrospective study, we reviewed consecutive CEM surveillance examinations performed between April 2022 and April 2025 in asymptomatic patients with a personal history of breast cancer and dense breasts. BI-RADS classifications, lesion characteristics, follow-up imaging, and histopathology were reviewed. Sensitivity, specificity, cancer detection rate (CDR), positive predictive values (PPV), and negative predictive values (NPV) were calculated using biopsy or at least 12 months imaging follow-up as reference standards.
Results: A total of 176 patients underwent 376 CEM studies. Of the initial exams, 29.5% of patients (52 of 176) were classified as positive (BI-RADS 3 or 4; no BI-RADS 5 cases), with a CDR of 34 per 1000 exams. Sensitivity and specificity were 100% and 72.9%, respectively, with a PPV 1 of 11.5% and NPV of 100%. Over the study period, 39 biopsies yielded 8 malignancies in 7 patients, corresponding to a PPV3 of 20.5%. Three of the eight CEM-detected cancers (37.5%) were visible only on recombined images. Palpable axillary recurrences in two patients were outside the CEM field of view. One mild contrast reaction was recorded.
Conclusion: Although recall rates were higher than in prior studies, CEM demonstrated high sensitivity and NPV and substantial CDR; all of which were early-stage, node-negative cancers. These findings support broader consideration of CEM in intermediate- to high-risk surveillance settings, particularly where access to MRI is limited.
{"title":"Surveillance Contrast-Enhanced Mammography in Patients With Dense Breasts and a Personal History of Breast Cancer.","authors":"Maria Gosein, Edwin Khoo, Charlotte Yong-Hing, Janette Sam, Tetyana Martin","doi":"10.1016/j.clbc.2026.01.006","DOIUrl":"https://doi.org/10.1016/j.clbc.2026.01.006","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the diagnostic performance of contrast-enhanced mammography (CEM) for breast cancer surveillance in patients with dense breast tissue and a personal history of breast cancer.</p><p><strong>Methods: </strong>In this single-center retrospective study, we reviewed consecutive CEM surveillance examinations performed between April 2022 and April 2025 in asymptomatic patients with a personal history of breast cancer and dense breasts. BI-RADS classifications, lesion characteristics, follow-up imaging, and histopathology were reviewed. Sensitivity, specificity, cancer detection rate (CDR), positive predictive values (PPV), and negative predictive values (NPV) were calculated using biopsy or at least 12 months imaging follow-up as reference standards.</p><p><strong>Results: </strong>A total of 176 patients underwent 376 CEM studies. Of the initial exams, 29.5% of patients (52 of 176) were classified as positive (BI-RADS 3 or 4; no BI-RADS 5 cases), with a CDR of 34 per 1000 exams. Sensitivity and specificity were 100% and 72.9%, respectively, with a PPV 1 of 11.5% and NPV of 100%. Over the study period, 39 biopsies yielded 8 malignancies in 7 patients, corresponding to a PPV3 of 20.5%. Three of the eight CEM-detected cancers (37.5%) were visible only on recombined images. Palpable axillary recurrences in two patients were outside the CEM field of view. One mild contrast reaction was recorded.</p><p><strong>Conclusion: </strong>Although recall rates were higher than in prior studies, CEM demonstrated high sensitivity and NPV and substantial CDR; all of which were early-stage, node-negative cancers. These findings support broader consideration of CEM in intermediate- to high-risk surveillance settings, particularly where access to MRI is limited.</p>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 3","pages":"17-26"},"PeriodicalIF":2.5,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146140822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-09DOI: 10.1016/j.clbc.2025.12.006
Changzai Li, Pan Zhang, Jiaxing Wang, Cuizhi Geng
Background: Whether axillary lymph node dissection (ALND) can be safely omitted clinically node-negative (cN0) breast cancer with limited sentinel lymph (SLN) metastasis remains uncertain, particularly after mastectomy.
Methods: This retrospective cohort included women with T1-T2 cN0 breast cancer and positive SLN between 2015 and 2020. Patents underwent sentinel lymph node biopsy (SLNB) alone or ALND. Propensity score matching (1:1, nearest neighbor, caliper 0.02 on logit) balanced age, T stage, tumor grade, vascular invasion, number of positive SLNs, ER/PR/HER2, Ki-67, surgery type, chemotherapy, and radiotherapy. Kaplan-Meier and Cox regression estimated overall survival (OS) recurrence-free survival (RFS).
Results: Of 1244 patients screened, 1038 were analyzed (577 ALND, 461 SLNB alone; median follow-up 68 months), After matching (283 pairs), 5-year OS was 97.1% (95% CI, 95.0-99.3) for ALND and 96.1% (93.8-98.5) for SLNB alone. Five-year RFS was 96.8% (94.7-99.0) versus 97.0% (94.9-99.0). No statistically significant difference was found in OS (HR, 1.14, 95% CI, 0.51-2.54, P = .75) and RFS (HR, 0.86, 95% CI, 0.36-2.05, P = .74) between the ALND and SLNB alone. Findings were consistent among patients with 1 to 3 positive SLNs, regardless of surgery type. All 22 patients with 4 to 6 positive SLNs underwent ALND, precluding comparison.
Conclusion: In cN0 breast cancer patients with 1 to 3 positive SLNs, omitting ALND did not compromise OS or RFS after mastectomy or breast-conserving surgery. These results support broader application of de-escalated axillary surgery while prospective validation for higher nodal burden remains necessary.
{"title":"Omission of Axillary Lymph Node Dissection in Early-Stage Breast Cancer With Limited Sentinel Lymph Node Metastasis: A Propensity Score-Matched Analysis.","authors":"Changzai Li, Pan Zhang, Jiaxing Wang, Cuizhi Geng","doi":"10.1016/j.clbc.2025.12.006","DOIUrl":"https://doi.org/10.1016/j.clbc.2025.12.006","url":null,"abstract":"<p><strong>Background: </strong>Whether axillary lymph node dissection (ALND) can be safely omitted clinically node-negative (cN0) breast cancer with limited sentinel lymph (SLN) metastasis remains uncertain, particularly after mastectomy.</p><p><strong>Methods: </strong>This retrospective cohort included women with T1-T2 cN0 breast cancer and positive SLN between 2015 and 2020. Patents underwent sentinel lymph node biopsy (SLNB) alone or ALND. Propensity score matching (1:1, nearest neighbor, caliper 0.02 on logit) balanced age, T stage, tumor grade, vascular invasion, number of positive SLNs, ER/PR/HER2, Ki-67, surgery type, chemotherapy, and radiotherapy. Kaplan-Meier and Cox regression estimated overall survival (OS) recurrence-free survival (RFS).</p><p><strong>Results: </strong>Of 1244 patients screened, 1038 were analyzed (577 ALND, 461 SLNB alone; median follow-up 68 months), After matching (283 pairs), 5-year OS was 97.1% (95% CI, 95.0-99.3) for ALND and 96.1% (93.8-98.5) for SLNB alone. Five-year RFS was 96.8% (94.7-99.0) versus 97.0% (94.9-99.0). No statistically significant difference was found in OS (HR, 1.14, 95% CI, 0.51-2.54, P = .75) and RFS (HR, 0.86, 95% CI, 0.36-2.05, P = .74) between the ALND and SLNB alone. Findings were consistent among patients with 1 to 3 positive SLNs, regardless of surgery type. All 22 patients with 4 to 6 positive SLNs underwent ALND, precluding comparison.</p><p><strong>Conclusion: </strong>In cN0 breast cancer patients with 1 to 3 positive SLNs, omitting ALND did not compromise OS or RFS after mastectomy or breast-conserving surgery. These results support broader application of de-escalated axillary surgery while prospective validation for higher nodal burden remains necessary.</p>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146099664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-06DOI: 10.1016/j.clbc.2026.01.001
Yongxin Li , Dexiang Li , Xinlong Tao , Yinyin Ye , Xiao Liang , Xingchang Qiu , Junjie Ma , Zhibo Liu , Jiuda Zhao
Background
Extensive research has explored racial differences in breast cancer survival, particularly between Black and White patients. However, few studies have included comparisons with Asian American and White populations.
Methods
We conducted a retrospective cohort study using data from the SEER database (2010-2021) for Asian American and White patients with breast cancer. Propensity score matching (PSM) was applied to balance baseline characteristics including age, stage, molecular subtype, and treatment. Survival analyses included Kaplan–Meier (KM) curves, Cox proportional hazards models, and subgroup analyses. Outcomes were overall survival (OS) and breast cancer-specific survival (BCSS).
Results
This study included 374,930 patients with breast cancer, with 44,092 Asian American patients with breast cancer and 330,838 White patients with breast cancer. After PSM balanced baseline characteristics, Asian American patients with breast cancer showed significantly better OS (HR = 0.78, 95% CI, 0.75-0.81) and BCSS (HR = 0.88, 95% CI, 0.84-0.93) than White patients with breast cancer. Consistent survival advantages were observed across all clinical and demographic subgroups. After adjustment for key prognostic factors including stage, age, and treatment, Asian American patients with breast cancer remained independently associated with significantly improved survival (OS, HR = 0.77; BCSS, HR = 0.86).
Conclusions
Asian American patients with breast cancer demonstrated significantly better survival than White patients with breast cancer after adjusting for multiple factors, with a consistent advantage across subgroups. This suggests intrinsic biological or lifestyle protective factors, warranting further investigation.
{"title":"Differences in Survival and Associated Characteristics Between Asian American and White Patients With Breast Cancer","authors":"Yongxin Li , Dexiang Li , Xinlong Tao , Yinyin Ye , Xiao Liang , Xingchang Qiu , Junjie Ma , Zhibo Liu , Jiuda Zhao","doi":"10.1016/j.clbc.2026.01.001","DOIUrl":"10.1016/j.clbc.2026.01.001","url":null,"abstract":"<div><h3>Background</h3><div>Extensive research has explored racial differences in breast cancer survival, particularly between Black and White patients. However, few studies have included comparisons with Asian American and White populations.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using data from the SEER database (2010-2021) for Asian American and White patients with breast cancer. Propensity score matching (PSM) was applied to balance baseline characteristics including age, stage, molecular subtype, and treatment. Survival analyses included Kaplan–Meier (KM) curves, Cox proportional hazards models, and subgroup analyses. Outcomes were overall survival (OS) and breast cancer-specific survival (BCSS).</div></div><div><h3>Results</h3><div>This study included 374,930 patients with breast cancer, with 44,092 Asian American patients with breast cancer and 330,838 White patients with breast cancer. After PSM balanced baseline characteristics, Asian American patients with breast cancer showed significantly better OS (HR = 0.78, 95% CI, 0.75-0.81) and BCSS (HR = 0.88, 95% CI, 0.84-0.93) than White patients with breast cancer. Consistent survival advantages were observed across all clinical and demographic subgroups. After adjustment for key prognostic factors including stage, age, and treatment, Asian American patients with breast cancer remained independently associated with significantly improved survival (OS, HR = 0.77; BCSS, HR = 0.86).</div></div><div><h3>Conclusions</h3><div>Asian American patients with breast cancer demonstrated significantly better survival than White patients with breast cancer after adjusting for multiple factors, with a consistent advantage across subgroups. This suggests intrinsic biological or lifestyle protective factors, warranting further investigation.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 3","pages":"Pages 1-8"},"PeriodicalIF":2.5,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-06DOI: 10.1016/j.clbc.2026.01.002
Francesca Accomasso, Gaia Ruggeri, Silvia Actis, Elena Paradiso, Pier Giorgio Spanu, Luca Giuseppe Sgro, Annamaria Ferrero, Valentina Elisabetta Bounous
Purpose: To assess whether lobular histology independently predicts sentinel lymph node biopsy (SLNB) positivity in early-stage clinically node-negative (cN0) breast cancer (BC), to identify other predictive factors of SLNB positivity, and to evaluate the diagnostic performance of preoperative axillary imaging. The cumulative incidence of local and distant recurrences were also evaluated.
Methods: We retrospectively analyzed 661 patients with early-stage, cN0 BC undergoing surgery with SLNB. Clinical, pathological, and radiological data were assessed. Univariate and multivariate analyses were performed to identify predictors of SLNB positivity. The cumulative incidence of axillary and distant recurrences were calculated including only patients with at least 2 years follow up, for a total of 495 patients.
Results: ILC was present in 16.9% of cases. SLNB positivity occurred in 16.1% of invasive lobular cancers (ILC) and 20% of nonspecial type tumors (NST) (P = .3). No significant differences in axillary lymph node dissection (ALND) rates or nodal upstaging were found between histologies. Tumor size > 20 mm and vascular invasion were independent predictors of SLNB positivity. Axillary ultrasound and magnetic resonance (MRI) showed high specificity (95% and 79%) and negative predictive value (80% and 98%) in identifying node-negative patients. No axillary recurrences occurred after a median follow-up of 49.3 months.
Conclusions: ILC does not independently predict SLNB positivity or nodal upstaging. Tumor size and vascular invasion remain the strongest predictors. Axillary ultrasound and MRI are reliable tools to guide de-escalation. SLNB omission in well-selected cN0 patients, including those with ILC, may be considered in tailored and selected patients.
{"title":"Is Lobular Histology a Predictor of Sentinel Node Positivity in Early Breast Cancer? An Integrated Analysis of Histological Subtype and Preoperative Imaging.","authors":"Francesca Accomasso, Gaia Ruggeri, Silvia Actis, Elena Paradiso, Pier Giorgio Spanu, Luca Giuseppe Sgro, Annamaria Ferrero, Valentina Elisabetta Bounous","doi":"10.1016/j.clbc.2026.01.002","DOIUrl":"https://doi.org/10.1016/j.clbc.2026.01.002","url":null,"abstract":"<p><strong>Purpose: </strong>To assess whether lobular histology independently predicts sentinel lymph node biopsy (SLNB) positivity in early-stage clinically node-negative (cN0) breast cancer (BC), to identify other predictive factors of SLNB positivity, and to evaluate the diagnostic performance of preoperative axillary imaging. The cumulative incidence of local and distant recurrences were also evaluated.</p><p><strong>Methods: </strong>We retrospectively analyzed 661 patients with early-stage, cN0 BC undergoing surgery with SLNB. Clinical, pathological, and radiological data were assessed. Univariate and multivariate analyses were performed to identify predictors of SLNB positivity. The cumulative incidence of axillary and distant recurrences were calculated including only patients with at least 2 years follow up, for a total of 495 patients.</p><p><strong>Results: </strong>ILC was present in 16.9% of cases. SLNB positivity occurred in 16.1% of invasive lobular cancers (ILC) and 20% of nonspecial type tumors (NST) (P = .3). No significant differences in axillary lymph node dissection (ALND) rates or nodal upstaging were found between histologies. Tumor size > 20 mm and vascular invasion were independent predictors of SLNB positivity. Axillary ultrasound and magnetic resonance (MRI) showed high specificity (95% and 79%) and negative predictive value (80% and 98%) in identifying node-negative patients. No axillary recurrences occurred after a median follow-up of 49.3 months.</p><p><strong>Conclusions: </strong>ILC does not independently predict SLNB positivity or nodal upstaging. Tumor size and vascular invasion remain the strongest predictors. Axillary ultrasound and MRI are reliable tools to guide de-escalation. SLNB omission in well-selected cN0 patients, including those with ILC, may be considered in tailored and selected patients.</p>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 3","pages":"9-16"},"PeriodicalIF":2.5,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-05DOI: 10.1016/j.clbc.2025.12.010
Sirui Huang, Yiqing Xi, Jingbo Gao, Shilong Yu, Le Chen, Yuxia Duan, Zelin Yang, Yu Peng, Lei Wei, Jingwei Zhang
Background: Breast cancer remains a significant health issue, with a persistent annual increase in incidence rates and high mortality. MYC, a critical transcription factor, is often dysregulated in breast cancer, driving tumor progression. Long noncoding RNAs (lncRNAs) have emerged as key regulators in cancer, influencing gene expression through various mechanisms. This study investigates the role of lncRNAs in mediating MYC function and their impact on breast cancer progression.
Methods: We analyzed 1212 breast cancer samples from The Cancer Genome Atlas (TCGA) database to identify lncRNAs related to MYC targets. The expression levels of lncRNAs were correlated with MYC-TARGET scores to develop a prognostic model. Functional studies were performed on LINC00511, a key lncRNA identified in the model, to elucidate its role in breast cancer progression. RNA Immunoprecipitation (RIP), Chromatin Immunoprecipitation (ChIP) and Dual-Luciferase Reporter Gene Assay assays were used to validate interactions between LINC00511, MYC, and the target gene VASP (vasodilator-stimulated phosphoprotein).
Results: MYC-TARGET scores were significantly correlated with poor prognosis in breast cancer patients. We identified 38 lncRNAs associated with MYC targets, and LINC00511 was selected for further analysis due to its high expression and correlation with poor prognosis. A prognostic model composed of 5 lncRNAs (including LINC00511) was developed, with a risk score that independently predicted patient outcomes . Functional experiments showed that LINC00511 promoted breast cancer cell proliferation, migration, and invasion. Mechanistically, LINC00511 interacted with MYC to upregulate VASP expression. VASP knockdown significantly reduced breast cancer cell proliferation and migration. Overexpression of MYC rescued the inhibitory effects of LINC00511 knockdown on VASP expression and cell invasion/migration.
Conclusions: LINC00511 promotes breast cancer progression by mediating MYC to regulate VASP expression. This study highlights the importance of lncRNAs in cancer transcriptional networks and identifies LINC00511 as a potential therapeutic target for breast cancer.
{"title":"LINC00511 Promotes Breast Cancer Cell Proliferation and Invasion by Mediating MYC-Mediated Regulation of VASP.","authors":"Sirui Huang, Yiqing Xi, Jingbo Gao, Shilong Yu, Le Chen, Yuxia Duan, Zelin Yang, Yu Peng, Lei Wei, Jingwei Zhang","doi":"10.1016/j.clbc.2025.12.010","DOIUrl":"https://doi.org/10.1016/j.clbc.2025.12.010","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer remains a significant health issue, with a persistent annual increase in incidence rates and high mortality. MYC, a critical transcription factor, is often dysregulated in breast cancer, driving tumor progression. Long noncoding RNAs (lncRNAs) have emerged as key regulators in cancer, influencing gene expression through various mechanisms. This study investigates the role of lncRNAs in mediating MYC function and their impact on breast cancer progression.</p><p><strong>Methods: </strong>We analyzed 1212 breast cancer samples from The Cancer Genome Atlas (TCGA) database to identify lncRNAs related to MYC targets. The expression levels of lncRNAs were correlated with MYC-TARGET scores to develop a prognostic model. Functional studies were performed on LINC00511, a key lncRNA identified in the model, to elucidate its role in breast cancer progression. RNA Immunoprecipitation (RIP), Chromatin Immunoprecipitation (ChIP) and Dual-Luciferase Reporter Gene Assay assays were used to validate interactions between LINC00511, MYC, and the target gene VASP (vasodilator-stimulated phosphoprotein).</p><p><strong>Results: </strong>MYC-TARGET scores were significantly correlated with poor prognosis in breast cancer patients. We identified 38 lncRNAs associated with MYC targets, and LINC00511 was selected for further analysis due to its high expression and correlation with poor prognosis. A prognostic model composed of 5 lncRNAs (including LINC00511) was developed, with a risk score that independently predicted patient outcomes . Functional experiments showed that LINC00511 promoted breast cancer cell proliferation, migration, and invasion. Mechanistically, LINC00511 interacted with MYC to upregulate VASP expression. VASP knockdown significantly reduced breast cancer cell proliferation and migration. Overexpression of MYC rescued the inhibitory effects of LINC00511 knockdown on VASP expression and cell invasion/migration.</p><p><strong>Conclusions: </strong>LINC00511 promotes breast cancer progression by mediating MYC to regulate VASP expression. This study highlights the importance of lncRNAs in cancer transcriptional networks and identifies LINC00511 as a potential therapeutic target for breast cancer.</p>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-03DOI: 10.1016/j.clbc.2025.12.012
Arianne Duong , Dane Fritzsche , Amy Ly Indorf
Early breast cancer treatment commonly includes highly emetogenic chemotherapy and immunotherapy regimens. Both pregnancy and chemotherapy treatment are associated with nausea and vomiting, and many agents used to treat pregnancy-associated nausea have limited data for CINV. Guidelines recommend a 4-drug antiemetic regimen for highly emetogenic chemotherapy regimens. Designing antiemetic regimens for pregnant women undergoing treatment for early breast cancer remains a challenge because of a lack of safety data for commonly used antiemetics as well as physiologic changes that occur throughout pregnancy This review aims to discuss current literature and guideline recommendations and provide practical considerations for agents used in chemotherapy-induced nausea and vomiting prevention in pregnant patients with breast cancer. A literature search on nausea pathophysiology, treatment of pregnant breast cancer patients, antiemetic use in pregnancy and chemotherapy-induced nausea and vomiting was conducted. Primary and tertiary literature sources were reviewed and cited. An overview of nausea pathophysiology and general treatment principles of treatment and supportive care in pregnant breast cancer patients is outlined. Five major antiemetic drug classes are reviewed in this article. When designing antiemetic regimens for pregnant patients undergoing chemotherapy treatment, clinicians must consider the current evidence, including safety, side effects, and pharmacokinetics of various agents, as well as pregnancy trimester and associated physiologic changes. Optimal management and prevention of chemotherapy-induced nausea and vomiting is crucial to avoid treatment delays and hospitalization, and to maximize patient quality of life.
{"title":"Practical Considerations for the Use of Antiemetics in Pregnant Patients With Breast Cancer","authors":"Arianne Duong , Dane Fritzsche , Amy Ly Indorf","doi":"10.1016/j.clbc.2025.12.012","DOIUrl":"10.1016/j.clbc.2025.12.012","url":null,"abstract":"<div><div>Early breast cancer treatment commonly includes highly emetogenic chemotherapy and immunotherapy regimens. Both pregnancy and chemotherapy treatment are associated with nausea and vomiting, and many agents used to treat pregnancy-associated nausea have limited data for CINV. Guidelines recommend a 4-drug antiemetic regimen for highly emetogenic chemotherapy regimens. Designing antiemetic regimens for pregnant women undergoing treatment for early breast cancer remains a challenge because of a lack of safety data for commonly used antiemetics as well as physiologic changes that occur throughout pregnancy This review aims to discuss current literature and guideline recommendations and provide practical considerations for agents used in chemotherapy-induced nausea and vomiting prevention in pregnant patients with breast cancer. A literature search on nausea pathophysiology, treatment of pregnant breast cancer patients, antiemetic use in pregnancy and chemotherapy-induced nausea and vomiting was conducted. Primary and tertiary literature sources were reviewed and cited. An overview of nausea pathophysiology and general treatment principles of treatment and supportive care in pregnant breast cancer patients is outlined. Five major antiemetic drug classes are reviewed in this article. When designing antiemetic regimens for pregnant patients undergoing chemotherapy treatment, clinicians must consider the current evidence, including safety, side effects, and pharmacokinetics of various agents, as well as pregnancy trimester and associated physiologic changes. Optimal management and prevention of chemotherapy-induced nausea and vomiting is crucial to avoid treatment delays and hospitalization, and to maximize patient quality of life.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 2","pages":"Pages 80-86"},"PeriodicalIF":2.5,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146035522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.clbc.2025.07.011
Rodrigo Vaz Reis , Paula Pinto , Bárbara Peleteiro , José Luís Fougo
Background
The present study aims to evaluate the volume of residual axillary nodal disease after neoadjuvant chemotherapy (NACT) in breast cancer.
Methods
Predictive factors for low-volume residual axillary nodal disease were analyzed in patients with histologically proven breast cancer (cT1-3 cN0-2) who were treated with NACT and surgery between 2015 and 2019.
Results
A total of 734 patients were analyzed. Breast pathological complete response (pCR) was achieved in 35.1%, with 31.5% showing no residual tumor in the breast or axillary lymph nodes (LNs). Breast and axillary pCR rates varied according to receptor subtype, with the highest rates found in HER2+ and hormone receptor (HR) negative tumors. Among 385 patients presenting with axillary metastases at diagnosis, 41.0% achieved axillary pCR, and 38.4% had 1–3 metastatic LNs. Predictive factors for axillary pCR included cN stage, HR status, ycN status, and breast pCR. For breast pCR patients with cN+ at presentation, the rate of axillary pCR was 81.1%. After NACT, 68.7% of patients with >2 metastatic LNs at diagnosis had 0-3 residual LNs.
Conclusion
We conclude that breast pCR, HER2+, HR negative breast cancer, <3 metastatic axillary LNs at diagnosis, and complete axillary imaging response after NACT were associated with axillary pCR rates and low probability of >3 positive LNs. Similarly, our study showed that axillary pCR in patients with more than 2 metastatic LNs was comparable to that of patients with 1-2 metastatic LNs highlighting an opportunity to tailor axillary surgery in this subgroup.
{"title":"Evaluation of Residual Axillary Lymph Node Metastases After Neoadjuvant Treatment in Breast Cancer","authors":"Rodrigo Vaz Reis , Paula Pinto , Bárbara Peleteiro , José Luís Fougo","doi":"10.1016/j.clbc.2025.07.011","DOIUrl":"10.1016/j.clbc.2025.07.011","url":null,"abstract":"<div><h3>Background</h3><div>The present study aims to evaluate the volume of residual axillary nodal disease after neoadjuvant chemotherapy (NACT) in breast cancer.</div></div><div><h3>Methods</h3><div>Predictive factors for low-volume residual axillary nodal disease were analyzed in patients with histologically proven breast cancer (cT1-3 cN0-2) who were treated with NACT and surgery between 2015 and 2019.</div></div><div><h3>Results</h3><div>A total of 734 patients were analyzed. Breast pathological complete response (pCR) was achieved in 35.1%, with 31.5% showing no residual tumor in the breast or axillary lymph nodes (LNs). Breast and axillary pCR rates varied according to receptor subtype, with the highest rates found in HER2+ and hormone receptor (HR) negative tumors. Among 385 patients presenting with axillary metastases at diagnosis, 41.0% achieved axillary pCR, and 38.4% had 1–3 metastatic LNs. Predictive factors for axillary pCR included cN stage, HR status, ycN status, and breast pCR. For breast pCR patients with cN+ at presentation, the rate of axillary pCR was 81.1%. After NACT, 68.7% of patients with >2 metastatic LNs at diagnosis had 0-3 residual LNs.</div></div><div><h3>Conclusion</h3><div>We conclude that breast pCR, HER2+, HR negative breast cancer, <3 metastatic axillary LNs at diagnosis, and complete axillary imaging response after NACT were associated with axillary pCR rates and low probability of >3 positive LNs. Similarly, our study showed that axillary pCR in patients with more than 2 metastatic LNs was comparable to that of patients with 1-2 metastatic LNs highlighting an opportunity to tailor axillary surgery in this subgroup.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 1","pages":"Pages 195-203"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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