Changes in immunohistochemical (IHC) profiles following neoadjuvant chemotherapy (NAC) may impact therapeutic decisions and prognosis in breast cancer patients. However, the clinical significance of these biomarker conversions remains uncertain. To evaluate the frequency of IHC marker conversion (estrogen receptor [ER], progesterone receptor [PR], and HER2) after NAC and its association with pathological complete response (pCR), overall survival (OS), and disease-free survival (DFS). We conducted a systematic review and meta-analysis of cohort studies reporting pre- and post-NAC IHC profiles in breast cancer. A comprehensive search was performed in PubMed, Embase, Scopus, and Web of Science. The ROBINS-I tool was used to assess risk of bias. Random-effects models were applied to calculate pooled conversion rates and assess the prognostic impact of IHC changes. Twenty-four studies (n = 5891 patients) were included. The pooled conversion rates were 9.2% for ER, 15.1% for PR, 8.6% for HER2. Loss of hormone receptor positivity was associated with a lower pCR rate and worse DFS (HR 1.42; 95% CI, 1.11-1.81). HER2 gain correlated with improved pCR. High heterogeneity was observed, and sensitivity analyses confirmed the robustness of the results. IHC profile changes after NAC are frequent and clinically relevant. Loss of hormone receptor expression may indicate poorer prognosis, while HER2 gain suggests improved treatment sensitivity. Reassessment of IHC markers post-NAC should be considered to optimize adjuvant therapy decisions.
{"title":"Immunohistochemical Changes After Neoadjuvant Chemotherapy and Their Impact on Breast Cancer Survival: A Systematic Review and Meta-analysis","authors":"Marcelo Antonini , André Mattar , Gil Facina , Francisco Pimentel Cavalcante , Felipe Zerwes , Fabricio Palermo Brenelli , Antônio Luis Frasson , Eduardo Camargo Millen , Rodrigo Caires Campos , Letícia Xavier Félix , Juliana Calado Vieira , Marina Diógenes Teixeira , Marcelo Madeira , Rogério Fenile , Henrique Lima Couto , Leonardo Ribeiro Soares , Ruffo de Freitas Junior , Renata Arakelian , Renata Montarroyos Leite , Vitoria Rassi Mahamed Rocha , Luiz Henrique Gebrim","doi":"10.1016/j.clbc.2025.10.017","DOIUrl":"10.1016/j.clbc.2025.10.017","url":null,"abstract":"<div><div>Changes in immunohistochemical (IHC) profiles following neoadjuvant chemotherapy (NAC) may impact therapeutic decisions and prognosis in breast cancer patients. However, the clinical significance of these biomarker conversions remains uncertain. To evaluate the frequency of IHC marker conversion (estrogen receptor [ER], progesterone receptor [PR], and HER2) after NAC and its association with pathological complete response (pCR), overall survival (OS), and disease-free survival (DFS). We conducted a systematic review and meta-analysis of cohort studies reporting pre- and post-NAC IHC profiles in breast cancer. A comprehensive search was performed in PubMed, Embase, Scopus, and Web of Science. The ROBINS-I tool was used to assess risk of bias. Random-effects models were applied to calculate pooled conversion rates and assess the prognostic impact of IHC changes. Twenty-four studies (<em>n</em> = 5891 patients) were included. The pooled conversion rates were 9.2% for ER, 15.1% for PR, 8.6% for HER2. Loss of hormone receptor positivity was associated with a lower pCR rate and worse DFS (HR 1.42; 95% CI, 1.11-1.81). HER2 gain correlated with improved pCR. High heterogeneity was observed, and sensitivity analyses confirmed the robustness of the results. IHC profile changes after NAC are frequent and clinically relevant. Loss of hormone receptor expression may indicate poorer prognosis, while HER2 gain suggests improved treatment sensitivity. Reassessment of IHC markers post-NAC should be considered to optimize adjuvant therapy decisions.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 3","pages":"Pages 208-222.e11"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145630313","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 : 2026-03-01Epub Date: 2026-01-12DOI: 10.1016/j.clbc.2026.01.006
Maria Gosein FRCR , 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 FRCR , Edwin Khoo , Charlotte Yong-Hing , Janette Sam , Tetyana Martin","doi":"10.1016/j.clbc.2026.01.006","DOIUrl":"10.1016/j.clbc.2026.01.006","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 3","pages":"Pages 17-26"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","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 : 2026-03-01Epub Date: 2025-10-13DOI: 10.1016/j.clbc.2025.10.003
Jannik Daniel Kandzi , Alexander Englisch , Bettina Boeer , Markus Hahn , Markus Wallwiener , Léa Volmer , Sara Brucker , Andreas Hartkopf , Tobias Engler
Purpose
Omission of sentinel lymph node biopsy (SLNB) in selected hormone receptor-positive (HR+), HER2-negative (HER2−) early breast cancer patients has demonstrated safety in prospective trials. However, accurate axillary staging remains important for identifying candidates for adjuvant CDK4/6 inhibitor therapy. We quantified the impact of SLNB omission on CDK4/6 eligibility and explored predictors of occult nodal disease in a real-world cohort.
Methods
We retrospectively analyzed 948 patients treated 2014 to 2022 at Tübingen University Hospital who met criteria proposed for potential SLNB omission: age ≥ 50 years, cT1 cN0, HR+/HER2−, grade 1 to 2 tumors treated with breast-conserving surgery and whole-breast irradiation. We assessed the prevalence of occult nodal metastases and potential eligibility for adjuvant abemaciclib (monarchE-criteria) or ribociclib (NATALEE-criteria) based on final pathology and fitted multivariable logistic models.
Results
Among 948 patients meeting SLNB omission criteria, 143 (15.1%) harbored occult nodal disease. Of these node-positive patients, 17 fulfilled the criteria for abemaciclib eligibility. For ribociclib, 105 node-positive patients were eligible. On multivariable analysis, multifocality (OR = 2.3; P ≤ .001) and cT1c tumor stage (OR = 1.76; P = .008) predicted axillary upstaging; invasive lobular carcinoma (ILC) showed higher crude upstaging than IDC/NST (22.6% vs. 14.0%) but did not retain independent significance after adjustment.
Conclusions
Omitting sentinel node biopsy in selected patients leads to under-detection of nodal metastasis in a relevant proportion of patients, particularly with cT1c tumors, multi-focal tumors and ILC. As these patients may benefit from more intensive adjuvant treatment, omission of sentinel-node biopsy should be part of decision-making. Future trials should investigate the impact of adjuvant treatment for patients with occult lymph node metastases.
{"title":"Reconciling Sentinel Node Omission with CDK4/6 Inhibitor Eligibility in HR+/HER2- Early Breast Cancer: A Real-World Cohort Analysis","authors":"Jannik Daniel Kandzi , Alexander Englisch , Bettina Boeer , Markus Hahn , Markus Wallwiener , Léa Volmer , Sara Brucker , Andreas Hartkopf , Tobias Engler","doi":"10.1016/j.clbc.2025.10.003","DOIUrl":"10.1016/j.clbc.2025.10.003","url":null,"abstract":"<div><h3>Purpose</h3><div>Omission of sentinel lymph node biopsy (SLNB) in selected hormone receptor-positive (HR+), HER2-negative (HER2−) early breast cancer patients has demonstrated safety in prospective trials. However, accurate axillary staging remains important for identifying candidates for adjuvant CDK4/6 inhibitor therapy. We quantified the impact of SLNB omission on CDK4/6 eligibility and explored predictors of occult nodal disease in a real-world cohort.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 948 patients treated 2014 to 2022 at Tübingen University Hospital who met criteria proposed for potential SLNB omission: age ≥ 50 years, cT1 cN0, HR+/HER2−, grade 1 to 2 tumors treated with breast-conserving surgery and whole-breast irradiation. We assessed the prevalence of occult nodal metastases and potential eligibility for adjuvant abemaciclib (monarchE-criteria) or ribociclib (NATALEE-criteria) based on final pathology and fitted multivariable logistic models.</div></div><div><h3>Results</h3><div>Among 948 patients meeting SLNB omission criteria, 143 (15.1%) harbored occult nodal disease. Of these node-positive patients, 17 fulfilled the criteria for abemaciclib eligibility. For ribociclib, 105 node-positive patients were eligible. On multivariable analysis, multifocality (OR = 2.3; <em>P</em> ≤ .001) and cT1c tumor stage (OR = 1.76; <em>P</em> = .008) predicted axillary upstaging; invasive lobular carcinoma (ILC) showed higher crude upstaging than IDC/NST (22.6% vs. 14.0%) but did not retain independent significance after adjustment.</div></div><div><h3>Conclusions</h3><div>Omitting sentinel node biopsy in selected patients leads to under-detection of nodal metastasis in a relevant proportion of patients, particularly with cT1c tumors, multi-focal tumors and ILC. As these patients may benefit from more intensive adjuvant treatment, omission of sentinel-node biopsy should be part of decision-making. Future trials should investigate the impact of adjuvant treatment for patients with occult lymph node metastases.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 3","pages":"Pages 169-175"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145512322","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 : 2026-03-01Epub Date: 2025-12-29DOI: 10.1016/j.clbc.2025.12.009
Jennifer D. Brooks , Kristina M. Blackmore , Nguyet N.M. Ngo , Meghan J. Walker , Amy Chang , Laurence Lambert-Côté , Annie Turgeon , Aisha K. Lofters , Hermann Nabi , Antonis C. Antoniou , Kathleen A. Bell , Mireille J.M. Broeders , Tim Carver , Jocelyne Chiquette , Philippe Després , Douglas F. Easton , Andrea Eisen , Laurence Eloy , D. Gareth Evans , Samantha Fienberg , Anna M. Chiarelli
Background
Risk-stratified breast cancer screening has been proposed as an alternative to the age-based approach currently used by most screening programs. This study, part of the Canadian PERSPECTIVE I&I project, examined perceived advantages and disadvantages of learning your breast cancer risk category and associated screening plans.
Method
Women aged 40 to 69 from Ontario and Quebec (N = 3319) had multifactorial risk assessments using the CanRisk tool. Risk categories (average [78.9%], higher than average [16.4%], high [4.6%]) were communicated along with screening plans. Participants completed questionnaires on attitudes toward learning their risk before, at the time of, and 1 year later risk communication. Participant characteristics associated with these attitudes were assessed using multinomial logistic regression.
Results
At the time of risk communication, most participants (72.9%) perceived ``Easing worry'' as an advantage of learning their risk. However, participants at higher risk were more likely to report that it did not ease their worry. Visible minority participants (OR = 1.86, 95% CI, 1.16, 2.98) and those with lower education attainment were more likely to view “complicated information” as a disadvantage (College/Apprenticeship/Trades: OR = 1.54, 95% CI, 1.24, 1.92; High School or below: OR = 1.77, 95% CI, 1.29, 2.42). Ontario participants were more likely to view risk communication as “information I do not want to know” (OR = 0.44, 95% CI, 0.32, 0.59) compared to Quebec participants.
Conclusion
Most women responded positively to learning their breast cancer risk category and screening plan. Successful implementation of risk-stratified screening will require clear communication, healthcare provider support, and adaptation to regional resources.
{"title":"Canadian Women’s Attitudes Toward Receiving Personalized Breast Cancer Risk Information: Insights From the PERSPECTIVE I&I Project","authors":"Jennifer D. Brooks , Kristina M. Blackmore , Nguyet N.M. Ngo , Meghan J. Walker , Amy Chang , Laurence Lambert-Côté , Annie Turgeon , Aisha K. Lofters , Hermann Nabi , Antonis C. Antoniou , Kathleen A. Bell , Mireille J.M. Broeders , Tim Carver , Jocelyne Chiquette , Philippe Després , Douglas F. Easton , Andrea Eisen , Laurence Eloy , D. Gareth Evans , Samantha Fienberg , Anna M. Chiarelli","doi":"10.1016/j.clbc.2025.12.009","DOIUrl":"10.1016/j.clbc.2025.12.009","url":null,"abstract":"<div><h3>Background</h3><div>Risk-stratified breast cancer screening has been proposed as an alternative to the age-based approach currently used by most screening programs. This study, part of the Canadian PERSPECTIVE I&I project, examined perceived advantages and disadvantages of learning your breast cancer risk category and associated screening plans.</div></div><div><h3>Method</h3><div>Women aged 40 to 69 from Ontario and Quebec (<em>N</em> = 3319) had multifactorial risk assessments using the CanRisk tool. Risk categories (average [78.9%], higher than average [16.4%], high [4.6%]) were communicated along with screening plans. Participants completed questionnaires on attitudes toward learning their risk before, at the time of, and 1 year later risk communication. Participant characteristics associated with these attitudes were assessed using multinomial logistic regression.</div></div><div><h3>Results</h3><div>At the time of risk communication, most participants (72.9%) perceived ``Easing worry'' as an advantage of learning their risk. However, participants at higher risk were more likely to report that it did not ease their worry. Visible minority participants (OR = 1.86, 95% CI, 1.16, 2.98) and those with lower education attainment were more likely to view “complicated information” as a disadvantage (College/Apprenticeship/Trades: OR = 1.54, 95% CI, 1.24, 1.92; High School or below: OR = 1.77, 95% CI, 1.29, 2.42). Ontario participants were more likely to view risk communication as “information I do not want to know” (OR = 0.44, 95% CI, 0.32, 0.59) compared to Quebec participants.</div></div><div><h3>Conclusion</h3><div>Most women responded positively to learning their breast cancer risk category and screening plan. Successful implementation of risk-stratified screening will require clear communication, healthcare provider support, and adaptation to regional resources.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 3","pages":"Pages 267-278.e6"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146123890","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 : 2026-03-01Epub 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":"10.1016/j.clbc.2026.01.002","url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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) (<em>P</em> = .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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 3","pages":"Pages 9-16"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","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 : 2026-03-01Epub Date: 2026-01-16DOI: 10.1016/j.clbc.2025.11.016
Swati Bhardwaj , Shabnam Jaffer
Background
The Destiny B04 trial led to the recognition of HER2 low as a new entity defined as HER2 immunohistochemistry (IHC) score of 1 +/2 + and negative in situ hybridization (ISH) requiring detailed HER2 IHC scoring (negative = 0 & 1 +, equivocal = 2 +, and positive = 3 +). As per ASCO–CAP guidelines, biomarkers need not be repeated on excisions when done on core biopsy with some exceptions. The goal of our study was to compare the concordance of HER2 low between core biopsies and excisions and assess the need to repeat on excision.
Methods
At the study institution biomarkers are first performed on core biopsies and then repeated on all excisions in negative cases. We identified 301 cases of primary breast carcinomas with matched HER2 IHC on core biopsies and excisions. We reviewed and scored all HER2 IHC slides as per 2018 ASCO/CAP guidelines.
Results
The incidence of HER2 low on core biopsies decreased from 64% to 46% on excisions. The best concordance was seen in HER2 + (82%) and negative cases (84%), with most variability in predominantly 1 + and some 2 + cases in both directions. There was a greater loss (38%) than gain (16%) in HER2 low values from core biopsy to excision.
Conclusions
HER2 low discordance in our series was predominantly due to loss from core biopsies to excisions, which maybe attributed to better meeting the pre analytic criteria on core biopsy. In contrast, the gain maybe due to intratumoral heterogeneity and or interobserver variability and despite low, worth repeating HER2 IHC on excisions in negative cases.
{"title":"A Comparative Analysis of HER2 Immunohistochemistry in Core Biopsy Versus Excision in the Era of HER2 ``Low'' Breast Cancers","authors":"Swati Bhardwaj , Shabnam Jaffer","doi":"10.1016/j.clbc.2025.11.016","DOIUrl":"10.1016/j.clbc.2025.11.016","url":null,"abstract":"<div><h3>Background</h3><div>The Destiny B04 trial led to the recognition of HER2 low as a new entity defined as HER2 immunohistochemistry (IHC) score of 1 +/2 + and negative in situ hybridization (ISH) requiring detailed HER2 IHC scoring (negative = 0 & 1 +, equivocal = 2 +, and positive = 3 +). As per ASCO–CAP guidelines, biomarkers need not be repeated on excisions when done on core biopsy with some exceptions. The goal of our study was to compare the concordance of HER2 low between core biopsies and excisions and assess the need to repeat on excision.</div></div><div><h3>Methods</h3><div>At the study institution biomarkers are first performed on core biopsies and then repeated on all excisions in negative cases. We identified 301 cases of primary breast carcinomas with matched HER2 IHC on core biopsies and excisions. We reviewed and scored all HER2 IHC slides as per 2018 ASCO/CAP guidelines.</div></div><div><h3>Results</h3><div>The incidence of HER2 low on core biopsies decreased from 64% to 46% on excisions. The best concordance was seen in HER2 + (82%) and negative cases (84%), with most variability in predominantly 1 + and some 2 + cases in both directions. There was a greater loss (38%) than gain (16%) in HER2 low values from core biopsy to excision.</div></div><div><h3>Conclusions</h3><div>HER2 low discordance in our series was predominantly due to loss from core biopsies to excisions, which maybe attributed to better meeting the pre analytic criteria on core biopsy. In contrast, the gain maybe due to intratumoral heterogeneity and or interobserver variability and despite low, worth repeating HER2 IHC on excisions in negative cases.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 3","pages":"Pages 39-43"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146178201","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 : 2026-03-01Epub Date: 2025-10-13DOI: 10.1016/j.clbc.2025.10.002
Zhi Ouyang, Songlian Li, Ai Quan
Post-operative radiation therapy (PORT) following breast-conserving surgery (BCS) has become a conventional care for early-stage breast cancer (EBC). This meta-analysis aimed to compare overall survival (OS) between patients receiving PORT and those not receiving PORT and to identify clinicopathologic features of low-risk patients with EBC who may be suitable for PORT omission after BCS with respect to OS. Comparative studies investigating PORT versus non-PORT in EBC patients after BCS were included, focusing on hazard ratio (HRs) for OS. Medline, Embase, and the Cochrane Central Library were searched from First January 2014 to First January 2025. A meta-analysis was performed to determine the HR for OS between PORT and non-PORT groups. Subgroup analyses were conducted to identify potential clinicopathologic features associated with low-risk patients suitable for PORT omission. A total of 28 studies (2 randomized controlled trials and 26 retrospective cohort studies) with 589,508 patients were included in the final analysis. According to the meta-analysis, patients with EBC derived an OS benefit from PORT (pooled HR = 0.60 [95% CI, 0.55-0.65]). Subgroup analyses identified clinicopathologic features associated with low-risk patients suitable for PORT omission. This systematic review and meta-analysis demonstrated that PORT is associated with improved OS in patients with EBC following BCS. However, certain clinicopathologic features, including age 65-70 years, progesterone receptor (−), luminal B subtype, triple-negative breast cancer, and low-risk 21-gene recurrence score, were identified as potential low-risk factors in patients who may be considered for PORT omission.
{"title":"Overall Survival and Related Clinicopathologic Features to Identify Low-Risk Patients With Early Breast Cancer Suitable For Radiation Therapy Omission After Conservative Surgery: A Meta-Analysis","authors":"Zhi Ouyang, Songlian Li, Ai Quan","doi":"10.1016/j.clbc.2025.10.002","DOIUrl":"10.1016/j.clbc.2025.10.002","url":null,"abstract":"<div><div>Post-operative radiation therapy (PORT) following breast-conserving surgery (BCS) has become a conventional care for early-stage breast cancer (EBC). This meta-analysis aimed to compare overall survival (OS) between patients receiving PORT and those not receiving PORT and to identify clinicopathologic features of low-risk patients with EBC who may be suitable for PORT omission after BCS with respect to OS. Comparative studies investigating PORT versus non-PORT in EBC patients after BCS were included, focusing on hazard ratio (HRs) for OS. Medline, Embase, and the Cochrane Central Library were searched from First January 2014 to First January 2025. A meta-analysis was performed to determine the HR for OS between PORT and non-PORT groups. Subgroup analyses were conducted to identify potential clinicopathologic features associated with low-risk patients suitable for PORT omission. A total of 28 studies (2 randomized controlled trials and 26 retrospective cohort studies) with 589,508 patients were included in the final analysis. According to the meta-analysis, patients with EBC derived an OS benefit from PORT (pooled HR = 0.60 [95% CI, 0.55-0.65]). Subgroup analyses identified clinicopathologic features associated with low-risk patients suitable for PORT omission. This systematic review and meta-analysis demonstrated that PORT is associated with improved OS in patients with EBC following BCS. However, certain clinicopathologic features, including age 65-70 years, progesterone receptor (−), luminal B subtype, triple-negative breast cancer, and low-risk 21-gene recurrence score, were identified as potential low-risk factors in patients who may be considered for PORT omission.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 3","pages":"Pages 154-168.e4"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145494620","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 : 2026-03-01Epub Date: 2025-10-04DOI: 10.1016/j.clbc.2025.10.001
Diana Roth O’Brien , Lillian Boe , Andrea Barrio , Boris Mueller , J. Isabelle Choi , John Cuaron , Beryl McCormick , Atif J. Khan , Simon N. Powell , Lior Z. Braunstein
Purpose/Objectives
Suitability criteria for partial breast irradiation (PBI) are narrowly constrained for those with ductal carcinoma in situ (DCIS). In comparison to invasive disease, guidance is limited regarding the optimal application of PBI to treat DCIS. Here, we report disease outcomes for a heterogeneous cohort of patients with DCIS who received PBI.
Materials/Methods
Using a prospectively maintained institutional database, we identified patients with DCIS who underwent lumpectomy and adjuvant PBI from 2008 to 2022. Based on clinicopathologic characteristics patients were classified as suitable, cautionary, or unsuitable for PBI by American Society for Radiation Oncology (ASTRO) criteria. The primary endpoint was local recurrence (LR).
Results
The cohort comprised 176 patients with DCIS who received PBI, median age 60 years (interquartile range (IQR) 52, 66). Median DCIS size was 9 mm (IQR 4, 15 mm), and approximately 20% had multifocal disease. Most patients had negative (≥ 2 mm) final surgical margins (n = 160, 91%), 10 had < 2 mm margins and 6 had ≤ 1 mm margins for DCIS. 18 (10%) patients had nuclear grade 1 disease, 111 (63%) had grade 2 disease, and 33 (19%) had grade 3 disease, with a small subset classified as grade 1-2 or 2-3. Most patients (n = 161, 91%) had estrogen receptor (ER) positive DCIS, and 72 (41%) received endocrine therapy. By ASTRO criteria, 118 (67%) patients were suitable for PBI, 57 (32%) were considered cautionary, and 1 (0.6%) was unsuitable. At a median 24 months of follow up (range 2-127 months) we observed a single LR, yielding a 2-year LR rate of 0.6%. The LR occurred in a patient classified as cautionary, yielding a 2-year LR rate of 1.8% for the cautionary subset. No breast cancer mortality events were observed.
Conclusions
These early-term results exhibit excellent local control for patients with DCIS who received lumpectomy and PBI, even among those classified as “cautionary” by national guidelines. Although our findings are limited by short follow up, these results suggest that broadening the application of PBI for patients with DCIS may warrant further investigation.
{"title":"Accelerated Partial Breast Irradiation (APBI) For Ductal Carcinoma In Situ","authors":"Diana Roth O’Brien , Lillian Boe , Andrea Barrio , Boris Mueller , J. Isabelle Choi , John Cuaron , Beryl McCormick , Atif J. Khan , Simon N. Powell , Lior Z. Braunstein","doi":"10.1016/j.clbc.2025.10.001","DOIUrl":"10.1016/j.clbc.2025.10.001","url":null,"abstract":"<div><h3>Purpose/Objectives</h3><div>Suitability criteria for partial breast irradiation (PBI) are narrowly constrained for those with ductal carcinoma in situ (DCIS). In comparison to invasive disease, guidance is limited regarding the optimal application of PBI to treat DCIS. Here, we report disease outcomes for a heterogeneous cohort of patients with DCIS who received PBI.</div></div><div><h3>Materials/Methods</h3><div>Using a prospectively maintained institutional database, we identified patients with DCIS who underwent lumpectomy and adjuvant PBI from 2008 to 2022. Based on clinicopathologic characteristics patients were classified as suitable, cautionary, or unsuitable for PBI by American Society for Radiation Oncology (ASTRO) criteria. The primary endpoint was local recurrence (LR).</div></div><div><h3>Results</h3><div>The cohort comprised 176 patients with DCIS who received PBI, median age 60 years (interquartile range (IQR) 52, 66). Median DCIS size was 9 mm (IQR 4, 15 mm), and approximately 20% had multifocal disease. Most patients had negative (≥ 2 mm) final surgical margins (<em>n</em> = 160, 91%), 10 had < 2 mm margins and 6 had ≤ 1 mm margins for DCIS. 18 (10%) patients had nuclear grade 1 disease, 111 (63%) had grade 2 disease, and 33 (19%) had grade 3 disease, with a small subset classified as grade 1-2 or 2-3. Most patients (<em>n</em> = 161, 91%) had estrogen receptor (ER) positive DCIS, and 72 (41%) received endocrine therapy. By ASTRO criteria, 118 (67%) patients were suitable for PBI, 57 (32%) were considered cautionary, and 1 (0.6%) was unsuitable. At a median 24 months of follow up (range 2-127 months) we observed a single LR, yielding a 2-year LR rate of 0.6%. The LR occurred in a patient classified as cautionary, yielding a 2-year LR rate of 1.8% for the cautionary subset. No breast cancer mortality events were observed.</div></div><div><h3>Conclusions</h3><div>These early-term results exhibit excellent local control for patients with DCIS who received lumpectomy and PBI, even among those classified as “cautionary” by national guidelines. Although our findings are limited by short follow up, these results suggest that broadening the application of PBI for patients with DCIS may warrant further investigation.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 3","pages":"Pages 147-153"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145387603","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 : 2026-03-01Epub 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":"10.1016/j.clbc.2025.12.006","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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).</div></div><div><h3>Results</h3><div>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, <em>P</em> = .75) and RFS (HR, 0.86, 95% CI, 0.36-2.05, <em>P</em> = .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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 3","pages":"Pages 257-266.e3"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","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 : 2026-03-01Epub Date: 2026-01-18DOI: 10.1016/j.clbc.2026.01.008
Zhijian He , Xiaoyang Li , Jun He , Peizhen Huang , Rizeng Li , Jian Yu
Background
The evaluation of axillary sentinel lymph node (SLN) is integral to the treatment of breast cancer. This study aims to build a noninvasive prediction model of SLN metastasis based on percutaneous contrast-enhanced ultrasound (p-CEUS) for low-risk patients.
Materials and Methods
Patients with breast cancer were enrolled in this study at Wenzhou Central Hospital between June 2023 and October 2024. The patients were divided into a modeling group and a validation group in a 2:1 ratio. Clinical and pathological features were assessed with univariate analysis and multivariate logistic regression. A nomogram based on p-CEUS enhancement patterns and other independent predictors for the SLN metastasis identified by multivariate logistic regression was constructed.
Results
A total of 120 patients were included, comprising 80 in the modeling group (mean age, 55.01 ± 9.91 years) and 40 in the validation group (mean age, 55.20 ± 8.35 years). Independent predictors of SLN metastasis by the multivariate logistic regression analysis included tumor size, Ki-67 status and p-CEUS enhancement pattern. The areas under the receiver operating characteristic (ROC) curve of the modeling group and the validation group were 0.855 and 0.873, respectively. At a ≤ 20% probability threshold, the false-negative rate was 6.5%.
Conclusions
The p-CEUS-based nomogram can accurately predict the risk of SLN metastasis in early breast cancer patients with negative-node status. Patients with predicted metastasis probability ≤ 20%, especially those with tumor size ≤ 2 cm, Ki-67 ≤ 20%, and p-CEUS Type I enhancement, can safely omit SLNB.
{"title":"Noninvasive Prediction of Axillary Sentinel Lymph Node Metastasis via Contrast-Enhanced Ultrasound to Guide Omission of SLNB in Breast Cancer","authors":"Zhijian He , Xiaoyang Li , Jun He , Peizhen Huang , Rizeng Li , Jian Yu","doi":"10.1016/j.clbc.2026.01.008","DOIUrl":"10.1016/j.clbc.2026.01.008","url":null,"abstract":"<div><h3>Background</h3><div>The evaluation of axillary sentinel lymph node (SLN) is integral to the treatment of breast cancer. This study aims to build a noninvasive prediction model of SLN metastasis based on percutaneous contrast-enhanced ultrasound (p-CEUS) for low-risk patients.</div></div><div><h3>Materials and Methods</h3><div>Patients with breast cancer were enrolled in this study at Wenzhou Central Hospital between June 2023 and October 2024. The patients were divided into a modeling group and a validation group in a 2:1 ratio. Clinical and pathological features were assessed with univariate analysis and multivariate logistic regression. A nomogram based on p-CEUS enhancement patterns and other independent predictors for the SLN metastasis identified by multivariate logistic regression was constructed.</div></div><div><h3>Results</h3><div>A total of 120 patients were included, comprising 80 in the modeling group (mean age, 55.01 ± 9.91 years) and 40 in the validation group (mean age, 55.20 ± 8.35 years). Independent predictors of SLN metastasis by the multivariate logistic regression analysis included tumor size, Ki-67 status and p-CEUS enhancement pattern. The areas under the receiver operating characteristic (ROC) curve of the modeling group and the validation group were 0.855 and 0.873, respectively. At a ≤ 20% probability threshold, the false-negative rate was 6.5%.</div></div><div><h3>Conclusions</h3><div>The p-CEUS-based nomogram can accurately predict the risk of SLN metastasis in early breast cancer patients with negative-node status. Patients with predicted metastasis probability ≤ 20%, especially those with tumor size ≤ 2 cm, Ki-67 ≤ 20%, and p-CEUS Type I enhancement, can safely omit SLNB.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 3","pages":"Pages 74-83"},"PeriodicalIF":2.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146186190","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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