Using AI breast cancer detection scores to triage screening mammogram patients has been described in several studies. This type of triage could expedite a cancer diagnosis and significantly shorten the time from screening mammogram to treatment. However, the optimal operating point, or score value, above which patients should be triaged, has not been well defined. Identifying practical operating points is important because the Positive Predictive Value (PPV), sensitivity, specificity, and false-negative (FN) rate at different operating points can vary greatly.
Materials and Methond
Using patient datasets constructed from a clinical practice, the performance metrics of various AI scoring models were calculated at different operating point levels.
Results
Mathematical analysis of the very highest cancer detection case scores revealed that they are highly specific for the presence of breast cancer with few false positives. Therefore, if only the few highest case scores are used for clinical triage, the expectation is that most patients triaged will have cancer.
Conclusion
In clinical practice, this approach could be used to identify patients who would benefit from immediate diagnostic workup without overwhelming the clinic logistics with false-positive cases.
{"title":"Operating Point Optimization for Efficient Mammogram Triage Using Only Highly Elevated Probability scores","authors":"Mark Traill , Jensen Jantz , Blair Richards , Shokoufeh Khalatbari , Jeffrey Hoffmeister , Julie Shisler , Crystal Snyder","doi":"10.1016/j.clbc.2025.11.007","DOIUrl":"10.1016/j.clbc.2025.11.007","url":null,"abstract":"<div><h3>Backgroud</h3><div>Using AI breast cancer detection scores to triage screening mammogram patients has been described in several studies. This type of triage could expedite a cancer diagnosis and significantly shorten the time from screening mammogram to treatment. However, the optimal operating point, or score value, above which patients should be triaged, has not been well defined. Identifying practical operating points is important because the Positive Predictive Value (PPV), sensitivity, specificity, and false-negative (FN) rate at different operating points can vary greatly.</div></div><div><h3>Materials and Methond</h3><div>Using patient datasets constructed from a clinical practice, the performance metrics of various AI scoring models were calculated at different operating point levels.</div></div><div><h3>Results</h3><div>Mathematical analysis of the very highest cancer detection case scores revealed that they are highly specific for the presence of breast cancer with few false positives. Therefore, if only the few highest case scores are used for clinical triage, the expectation is that most patients triaged will have cancer.</div></div><div><h3>Conclusion</h3><div>In clinical practice, this approach could be used to identify patients who would benefit from immediate diagnostic workup without overwhelming the clinic logistics with false-positive cases.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 1","pages":"Pages 73-85"},"PeriodicalIF":2.5,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145748372","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 : 2025-11-16DOI: 10.1016/j.clbc.2025.10.019
Gaelle Kramer , José Volders , Femke den Haring , Roza Opperman , Pauline Spronk , Petrousjka van den Tol , Marie-Jeanne Vrancken Peeters
Introduction
The use of neoadjuvant systemic therapy (NST) in primary breast cancer has increased worldwide. This study provides real-time data of the reasons and variation in NST, conversion rate of mastectomy to BCS and conversion rate of ALND to radiation or omission of axillary treatment.
Methods
This is a Breast Cancer Surgery Snapshot study, multicenter prospective cross-sectional study in 70 breast cancer hospitals in the Netherlands. For 2 months the reason for NST is registered with patient- and tumor characteristics. The expectation of the surgical procedure in breast and axilla before and after NST is noted and the actual surgical outcome after NST is registered.
Results
Four hundred sixty seven patients receiving NST were registered. The 3 main reasons for NST were in 26% axillary down-staging, 25% a triple negative (TN) tumor and 25% HER2+. Before NST, 219 patients (47%) were eligible for BCS. In 210 patients (45%) initially assigned to receive a mastectomy, 99 patients (47%) underwent BCS. Triple negativity had the highest conversion rate with 68%. Of all mastectomy patients, 30% showed a pCR of the breast. Axillary conversion from ALND to axillary sparing surgery was achieved in 87% cN+ patients.
Conclusion
In the Netherlands the main reasons for NST were subtype (triple negative, HER2+) and axillary down staging. Additional reasons for NST focused more on down staging to convert to BCS and improve cosmetic outcomes. Real time data showed that NST lead to very high conversion rates from mastectomy to BCS as well as high rates of omission of ALND after NST.
{"title":"National Breast Cancer Surgery Snapshot Study: Breast Cancer Surgery after Neoadjuvant Systemic Therapy in Primary Breast Cancer (MANS Study)","authors":"Gaelle Kramer , José Volders , Femke den Haring , Roza Opperman , Pauline Spronk , Petrousjka van den Tol , Marie-Jeanne Vrancken Peeters","doi":"10.1016/j.clbc.2025.10.019","DOIUrl":"10.1016/j.clbc.2025.10.019","url":null,"abstract":"<div><h3>Introduction</h3><div>The use of neoadjuvant systemic therapy (NST) in primary breast cancer has increased worldwide. This study provides real-time data of the reasons and variation in NST, conversion rate of mastectomy to BCS and conversion rate of ALND to radiation or omission of axillary treatment.</div></div><div><h3>Methods</h3><div>This is a Breast Cancer Surgery Snapshot study, multicenter prospective cross-sectional study in 70 breast cancer hospitals in the Netherlands. For 2 months the reason for NST is registered with patient- and tumor characteristics. The expectation of the surgical procedure in breast and axilla before and after NST is noted and the actual surgical outcome after NST is registered.</div></div><div><h3>Results</h3><div>Four hundred sixty seven patients receiving NST were registered. The 3 main reasons for NST were in 26% axillary down-staging, 25% a triple negative (TN) tumor and 25% HER2+. Before NST, 219 patients (47%) were eligible for BCS. In 210 patients (45%) initially assigned to receive a mastectomy, 99 patients (47%) underwent BCS. Triple negativity had the highest conversion rate with 68%. Of all mastectomy patients, 30% showed a pCR of the breast. Axillary conversion from ALND to axillary sparing surgery was achieved in 87% cN+ patients.</div></div><div><h3>Conclusion</h3><div>In the Netherlands the main reasons for NST were subtype (triple negative, HER2+) and axillary down staging. Additional reasons for NST focused more on down staging to convert to BCS and improve cosmetic outcomes. Real time data showed that NST lead to very high conversion rates from mastectomy to BCS as well as high rates of omission of ALND after NST.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 1","pages":"Pages 64-72"},"PeriodicalIF":2.5,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145748415","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 : 2025-11-14DOI: 10.1016/j.clbc.2025.11.006
Níamh M. Smyth , Alexandra M. Zaborowski , Bukola V. Bolarinwa , Sandra Hembrecht , Rose Joyce Culhane , Abhi Narsiman , Clodagh T. Canavan , Jan Sørensen , Eithne Downey , Michael Allen , Abeeda Butt , Colm Power , Orla McArdle , Patrick G. Morris , Nuala Healy , Laura McKenna , Arnold D.K. Hill
Introduction
Recent data suggest that sentinel lymph node biopsy (SLNB) can be omitted in select patients with early breast cancer. The aim of this study was to determine the utility of SLNB for patients with early breast cancer.
Methods
A retrospective analysis of patients diagnosed with breast cancer in a Level IV hospital in Dublin, Ireland, between December 2013 and March 2024 was conducted. Inclusion criteria included: female patients ≥ 18 years, with cT1 disease and a negative preoperative axillary ultrasound, who underwent breast conserving surgery and a SLNB.
Results
In total, 334 patients were included. The median age was 59 years (26-91 years). The majority had invasive ductal carcinoma (261 patients, 78.1%) and were hormone receptor-postive and human epidermal growth factor receptor 2-negative (274 patients, 82%). Final N stage was N0 in 282 (84%) of patients. Fifty-two patients (16%) had a positive-SLNB, despite a negative preoperative axilla. Twenty-four patients underwent an axillary clearance, of which 7 (14%) were positive, with only 3 patients (12.5%) upstaged following axillary clearance. Eighty-four patients (25%) received chemotherapy due to positive-SLNB. In line with contemporary data, 9 patients (2.7%) were eligible for CDK4/6 inhibitors, 48 patients (14%) for escalation to nodal radiation, or 275 patients (82%) for de-escalation to partial breast radiation.
Conclusion
While SLNB may be safely omitted in specific contexts, its omission carries the risk of under- and over-treatment. Our findings demonstrate that SLNB continues to guide adjuvant therapy for breast cancer patients, and thus, support the ongoing use of SLNB.
{"title":"Do Not Rush to Omit Sentinel Lymph Node Biopsy for Early Breast Cancer Patients","authors":"Níamh M. Smyth , Alexandra M. Zaborowski , Bukola V. Bolarinwa , Sandra Hembrecht , Rose Joyce Culhane , Abhi Narsiman , Clodagh T. Canavan , Jan Sørensen , Eithne Downey , Michael Allen , Abeeda Butt , Colm Power , Orla McArdle , Patrick G. Morris , Nuala Healy , Laura McKenna , Arnold D.K. Hill","doi":"10.1016/j.clbc.2025.11.006","DOIUrl":"10.1016/j.clbc.2025.11.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Recent data suggest that sentinel lymph node biopsy (SLNB) can be omitted in select patients with early breast cancer. The aim of this study was to determine the utility of SLNB for patients with early breast cancer.</div></div><div><h3>Methods</h3><div>A retrospective analysis of patients diagnosed with breast cancer in a Level IV hospital in Dublin, Ireland, between December 2013 and March 2024 was conducted. Inclusion criteria included: female patients ≥ 18 years, with cT1 disease and a negative preoperative axillary ultrasound, who underwent breast conserving surgery and a SLNB.</div></div><div><h3>Results</h3><div>In total, 334 patients were included. The median age was 59 years (26-91 years). The majority had invasive ductal carcinoma (261 patients, 78.1%) and were hormone receptor-postive and human epidermal growth factor receptor 2-negative (274 patients, 82%). Final N stage was N0 in 282 (84%) of patients. Fifty-two patients (16%) had a positive-SLNB, despite a negative preoperative axilla. Twenty-four patients underwent an axillary clearance, of which 7 (14%) were positive, with only 3 patients (12.5%) upstaged following axillary clearance. Eighty-four patients (25%) received chemotherapy due to positive-SLNB. In line with contemporary data, 9 patients (2.7%) were eligible for CDK4/6 inhibitors, 48 patients (14%) for escalation to nodal radiation, or 275 patients (82%) for de-escalation to partial breast radiation.</div></div><div><h3>Conclusion</h3><div>While SLNB may be safely omitted in specific contexts, its omission carries the risk of under- and over-treatment. Our findings demonstrate that SLNB continues to guide adjuvant therapy for breast cancer patients, and thus, support the ongoing use of SLNB.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 1","pages":"Pages 58-63"},"PeriodicalIF":2.5,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145741081","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 : 2025-11-10DOI: 10.1016/j.clbc.2025.11.004
Asim Armagan Aydin , Erkan Kayikcioglu
{"title":"Beyond BMI: Metabolic and Inflammatory Determinants of Recurrence After Neoadjuvant Therapy in Breast Cancer","authors":"Asim Armagan Aydin , Erkan Kayikcioglu","doi":"10.1016/j.clbc.2025.11.004","DOIUrl":"10.1016/j.clbc.2025.11.004","url":null,"abstract":"","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 1","pages":"Pages 47-48"},"PeriodicalIF":2.5,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647190","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 : 2025-11-10DOI: 10.1016/j.clbc.2025.11.005
Helya Kargar , Seyed Alireza Javadinia
{"title":"Response to “Cryotherapy in Taxane-Induced Peripheral Neuropathy: The Need for Objective Validation”","authors":"Helya Kargar , Seyed Alireza Javadinia","doi":"10.1016/j.clbc.2025.11.005","DOIUrl":"10.1016/j.clbc.2025.11.005","url":null,"abstract":"","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 1","pages":"Page 49"},"PeriodicalIF":2.5,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145667211","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 : 2025-11-09DOI: 10.1016/j.clbc.2025.10.011
Gabrielle Maria Kramer MD , Eva Heeling MD, PhD , José Henriette Volders MD, PhD , Marie-Jeanne Tertia Francoise Daphne Vrancken Peeters MD, PhD
Introduction
Snapshot studies have emerged as valuable research design in cancer research, offering rapid, multicenter evaluation of clinical practice on an (inter)national scale. Compared to randomized controlled trials, which are time- and resource-intensive, snapshot studies collect large-scale real-world data in reduced timeframe. In breast cancer care, snapshot studies are particularly effective identifying variations in clinical practice, guideline adherence, and surgical outcomes. Through the MANS and DECIDE studies, nationwide snapshot research on real-world surgical outcomes in breast cancer care is taking shape in the Netherlands.
Methods
This article outlines the design and implementation of snapshot studies within breast cancer research as prospective, cross-sectional, multicenter observational design without interventions. Key steps include defining a focused research question, establishing a multidisciplinary steering committee, developing a structured database, and outlining statistical considerations. Participating centers obtain local ethical approval and contribute pseudonymized patient data during a predefined inclusion period. Participation is promoted through coordinated recruitment, and collaborative authorship ensures recognition for all contributors.
Results
Lessons learned:
• Clearly define research questions to prevent data overload and maintain focus.
• Early multidisciplinary involvement improves study design and execution.
• Structured databases prevent data duplication and inconsistencies.
• Common challenges such as workload and data quality can be addressed through standardized templates and proactive communication.
• Experience from the MANS and DECIDE studies underline importance of structured planning, consistent data collection and team engagement.
Conclusion
Snapshot studies provide an efficient design for evaluating breast cancer care, as they generate valuable insights into clinical practice and contribute to evidence-based improvements in breast cancer treatment.
{"title":"Enhancing Breast Cancer Research Through Snapshot Studies: Benefits and Challenges","authors":"Gabrielle Maria Kramer MD , Eva Heeling MD, PhD , José Henriette Volders MD, PhD , Marie-Jeanne Tertia Francoise Daphne Vrancken Peeters MD, PhD","doi":"10.1016/j.clbc.2025.10.011","DOIUrl":"10.1016/j.clbc.2025.10.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Snapshot studies have emerged as valuable research design in cancer research, offering rapid, multicenter evaluation of clinical practice on an (inter)national scale. Compared to randomized controlled trials, which are time- and resource-intensive, snapshot studies collect large-scale real-world data in reduced timeframe. In breast cancer care, snapshot studies are particularly effective identifying variations in clinical practice, guideline adherence, and surgical outcomes. Through the MANS and DECIDE studies, nationwide snapshot research on real-world surgical outcomes in breast cancer care is taking shape in the Netherlands.</div></div><div><h3>Methods</h3><div>This article outlines the design and implementation of snapshot studies within breast cancer research as prospective, cross-sectional, multicenter observational design without interventions. Key steps include defining a focused research question, establishing a multidisciplinary steering committee, developing a structured database, and outlining statistical considerations. Participating centers obtain local ethical approval and contribute pseudonymized patient data during a predefined inclusion period. Participation is promoted through coordinated recruitment, and collaborative authorship ensures recognition for all contributors.</div></div><div><h3>Results</h3><div>Lessons learned:</div><div>• Clearly define research questions to prevent data overload and maintain focus.</div><div>• Early multidisciplinary involvement improves study design and execution.</div><div>• Structured databases prevent data duplication and inconsistencies.</div><div>• Common challenges such as workload and data quality can be addressed through standardized templates and proactive communication.</div><div>• Experience from the MANS and DECIDE studies underline importance of structured planning, consistent data collection and team engagement.</div></div><div><h3>Conclusion</h3><div>Snapshot studies provide an efficient design for evaluating breast cancer care, as they generate valuable insights into clinical practice and contribute to evidence-based improvements in breast cancer treatment.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 1","pages":"Pages 50-57"},"PeriodicalIF":2.5,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145691208","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 : 2025-11-08DOI: 10.1016/j.clbc.2025.11.003
Matthew F. Covington , Samantha Salmon , Andrew Kozlov , Zane Archibald , Regan Butterfield , Sophie Stolk , Sam Mitchell , Kenneth Boucher , Regina Rosenthal , Jane Porretta , Kirstyn E. Brownson , Cindy Matsen , Mei Wei , Saundra Buys , Christos Vaklavas , Namita Chittoria , Brandon Buckway , Angela Meite , Jeffrey Yap
Background
Invasive lobular carcinoma (ILC) often presents diagnostic challenges on conventional imaging, necessitating advanced imaging strategies for accurate staging. [18F]Fluoroestradiol (FES), a PET radiopharmaceutical, targets estrogen receptor-positive (ER+) lesions, which are prevalent in ILC. This study evaluates the utility of FES-PET/CT compared to standard-of-care (SOC) imaging for staging ER+ ILC.
Patients and Methods
This IRB-approved prospective trial (October 2022-October 2024) enrolled adults with histologically confirmed ER+ ILC at a National Cancer Institute-designated Comprehensive Cancer Center. Participants underwent FES-PET/CT, with optional [18F]Fluorodeoxyglucose (FDG)-PET/CT. The primary endpoint was the percentage of stage changes post-FES-PET/CT compared to SOC imaging, analyzed using a 1-sided binomial proportions test. Imaging was interpreted by a blinded nuclear and breast radiology specialist, with staging per AJCC eighth edition guidelines.
Results
Of 27 enrolled participants, 25 underwent FES-PET/CT (2 excluded due to synthesis failure). Mean age was 60.3 years. Pre-FES-PET/CT staging was stage I (16%), II (60%), III (20%), and IV (4%). FES-PET/CT altered clinical staging in 32% of cases (P = .036), identifying occult stage IV disease in 12.5% and histologically confirmed axillary lymph node metastases in 8%. However, it missed axillary metastases in 28% compared to surgical staging. FDG-PET/CT, performed in 15 participants, showed 40% discordance with FES-PET/CT.
Conclusion
FES-PET/CT significantly enhances staging accuracy for ER+ ILC, detecting occult metastases that impact clinical management. Its limitations in axillary nodal detection suggest it complements, rather than replaces, surgical staging. Larger trials are needed to validate these findings.
背景：浸润性小叶癌（ILC）通常对常规影像学诊断提出挑战，需要先进的影像学策略来准确分期。[18F]氟雌二醇（Fluoroestradiol， FES）是一种PET放射性药物，靶向雌激素受体阳性（ER+）病变，这种病变在ILC中普遍存在。本研究评估了FES-PET/CT与标准护理（SOC）成像对ER+ ILC分期的效用。患者和方法：这项经irb批准的前瞻性试验（2022年10月至2024年10月）在国家癌症研究所指定的综合癌症中心招募组织学证实的ER+ ILC成人。参与者接受FES-PET/CT，可选择[18F]氟脱氧葡萄糖(FDG)-PET/CT。主要终点是fes - pet /CT与SOC成像后的分期变化百分比，使用单侧二项比例检验进行分析。成像由盲核和乳腺放射学专家解释，分期按照AJCC第八版指南。结果在27名入组参与者中，25人接受了FES-PET/CT检查（2人因合成失败而被排除）。平均年龄60.3岁。fes - pet /CT前分期为I期（16%）、II期（60%）、III期（20%）和IV期（4%）。FES-PET/CT改变了32%的病例的临床分期（P = 0.036）， 12.5%的病例发现了隐匿的IV期疾病，8%的病例在组织学上证实了腋窝淋巴结转移。然而，与手术分期相比，它错过腋窝转移的比例为28%。对15名参与者进行FDG-PET/CT检查，结果显示与FES-PET/CT有40%的不一致。结论fes - pet /CT可显著提高ER+ ILC的分期准确性，发现影响临床管理的隐匿性转移。它在腋窝淋巴结检测方面的局限性表明它是对手术分期的补充，而不是替代。需要更大规模的试验来验证这些发现。
{"title":"Staging Invasive Lobular Carcinoma: A Prospective Study on the Efficacy of 18F-Fluoroestradiol (FES)-PET/CT","authors":"Matthew F. Covington , Samantha Salmon , Andrew Kozlov , Zane Archibald , Regan Butterfield , Sophie Stolk , Sam Mitchell , Kenneth Boucher , Regina Rosenthal , Jane Porretta , Kirstyn E. Brownson , Cindy Matsen , Mei Wei , Saundra Buys , Christos Vaklavas , Namita Chittoria , Brandon Buckway , Angela Meite , Jeffrey Yap","doi":"10.1016/j.clbc.2025.11.003","DOIUrl":"10.1016/j.clbc.2025.11.003","url":null,"abstract":"<div><h3>Background</h3><div>Invasive lobular carcinoma (ILC) often presents diagnostic challenges on conventional imaging, necessitating advanced imaging strategies for accurate staging. [18F]Fluoroestradiol (FES), a PET radiopharmaceutical, targets estrogen receptor-positive (ER+) lesions, which are prevalent in ILC. This study evaluates the utility of FES-PET/CT compared to standard-of-care (SOC) imaging for staging ER+ ILC.</div></div><div><h3>Patients and Methods</h3><div>This IRB-approved prospective trial (October 2022-October 2024) enrolled adults with histologically confirmed ER+ ILC at a National Cancer Institute-designated Comprehensive Cancer Center. Participants underwent FES-PET/CT, with optional [18F]Fluorodeoxyglucose (FDG)-PET/CT. The primary endpoint was the percentage of stage changes post-FES-PET/CT compared to SOC imaging, analyzed using a 1-sided binomial proportions test. Imaging was interpreted by a blinded nuclear and breast radiology specialist, with staging per AJCC eighth edition guidelines.</div></div><div><h3>Results</h3><div>Of 27 enrolled participants, 25 underwent FES-PET/CT (2 excluded due to synthesis failure). Mean age was 60.3 years. Pre-FES-PET/CT staging was stage I (16%), II (60%), III (20%), and IV (4%). FES-PET/CT altered clinical staging in 32% of cases (<em>P</em> = .036), identifying occult stage IV disease in 12.5% and histologically confirmed axillary lymph node metastases in 8%. However, it missed axillary metastases in 28% compared to surgical staging. FDG-PET/CT, performed in 15 participants, showed 40% discordance with FES-PET/CT.</div></div><div><h3>Conclusion</h3><div>FES-PET/CT significantly enhances staging accuracy for ER+ ILC, detecting occult metastases that impact clinical management. Its limitations in axillary nodal detection suggest it complements, rather than replaces, surgical staging. Larger trials are needed to validate these findings.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 1","pages":"Pages 36-46"},"PeriodicalIF":2.5,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621861","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 : 2025-11-06DOI: 10.1016/j.clbc.2025.11.001
Michelle Sinclair, G Bruce Mann, Christina Kozul, Allan Park, Lesley Stafford
Background: Ductal carcinoma in situ (DCIS) is frequently identified during mammographic screening and treated to minimize the risk of development of invasive cancer. Local recurrence is a recognised risk after breast conserving surgery (BCS), and radiotherapy (RT) is frequently used to reduce this, despite having no impact on overall survival. Little is known about the impact of RT on patient-reported outcomes. We conducted a retrospective study to assess differences in health-related quality of life (HRQoL), fear of recurrence or progression (FRP), risk perceptions, and illness beliefs in women with DCIS, based on RT status.
Patients and methods: Women with DCIS diagnosed or treated at a tertiary hospital in Melbourne from 2010 to 2022 who underwent BCS were eligible. HRQoL (QLQ-C30; BR45), FRP (FCRI-SF), illness perceptions (BIPQ) and perceptions of risk of DCIS recurrence or progression were assessed by self-report.
Results: Questionnaires from 160 women (RT n = 80, no RT n = 80) were analysed. Median age was 65 and median time since diagnosis was 7.7 years. Overall impact on HRQoL of treatment was low irrespective of treatment. There was no difference in FRP according to RT status. Women who received RT had larger tumours (P < .001), more breast symptoms (P = .015) and stronger beliefs in the effectiveness of treatment (P = .034). In multivariate analysis, neuroticism, perceived likelihood of DCIS progression to invasive disease and emotional impact of DCIS predicted FRP.
Conclusion: DCIS treatment was associated with minimal long-term HRQoL impact and low FRP, irrespective of RT. Improving understanding of recurrence/progression risk may protect against persistent FRP in these women.
{"title":"Quality of Life and Fear of Recurrence or Progression in Women With DCIS Who Did and Did Not Receive Radiotherapy.","authors":"Michelle Sinclair, G Bruce Mann, Christina Kozul, Allan Park, Lesley Stafford","doi":"10.1016/j.clbc.2025.11.001","DOIUrl":"https://doi.org/10.1016/j.clbc.2025.11.001","url":null,"abstract":"<p><strong>Background: </strong>Ductal carcinoma in situ (DCIS) is frequently identified during mammographic screening and treated to minimize the risk of development of invasive cancer. Local recurrence is a recognised risk after breast conserving surgery (BCS), and radiotherapy (RT) is frequently used to reduce this, despite having no impact on overall survival. Little is known about the impact of RT on patient-reported outcomes. We conducted a retrospective study to assess differences in health-related quality of life (HRQoL), fear of recurrence or progression (FRP), risk perceptions, and illness beliefs in women with DCIS, based on RT status.</p><p><strong>Patients and methods: </strong>Women with DCIS diagnosed or treated at a tertiary hospital in Melbourne from 2010 to 2022 who underwent BCS were eligible. HRQoL (QLQ-C30; BR45), FRP (FCRI-SF), illness perceptions (BIPQ) and perceptions of risk of DCIS recurrence or progression were assessed by self-report.</p><p><strong>Results: </strong>Questionnaires from 160 women (RT n = 80, no RT n = 80) were analysed. Median age was 65 and median time since diagnosis was 7.7 years. Overall impact on HRQoL of treatment was low irrespective of treatment. There was no difference in FRP according to RT status. Women who received RT had larger tumours (P < .001), more breast symptoms (P = .015) and stronger beliefs in the effectiveness of treatment (P = .034). In multivariate analysis, neuroticism, perceived likelihood of DCIS progression to invasive disease and emotional impact of DCIS predicted FRP.</p><p><strong>Conclusion: </strong>DCIS treatment was associated with minimal long-term HRQoL impact and low FRP, irrespective of RT. Improving understanding of recurrence/progression risk may protect against persistent FRP in these women.</p>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145630357","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 : 2025-11-03DOI: 10.1016/j.clbc.2025.11.002
Caroline Oska , Eleni Kohilakis , Sheldon Feldman , Wolfgang Tome , Ying Jin , Ryung Kim , Keyur Mehta , Maureen McEvoy , Jana Fox
Background
Intraoperative radiotherapy (IORT) allows early-stage breast cancer patients to complete adjuvant radiation at the time of breast conserving surgery (BCS). In this study, we provide updated outcomes of women treated with IORT in the Bronx, New York.
Methods
This is a single-centre, prospective, institutional review-board-approved registry trial of patients treated with IORT using the Intrabeam system. Patients included women aged 45 years and older with estrogen-receptor positive, cT1-2N0 invasive carcinoma or grade 1-2, ductal carcinoma in-situ (DCIS). Exclusion criteria included BRCA mutation, neoadjuvant chemotherapy, or multicentric disease. Patients received a single dose of 20 Gy to the lumpectomy surface with 50kVp x-rays. Those with high-risk pathological features were recommended adjuvant whole breast irradiation (WBI). The primary outcome was locoregional recurrence. Secondary outcomes were overall survival and wound-healing complications.
Results
Between January 2018 and January 2024, 257 women were treated with IORT. The median age was 65.7, and most patients (76.7%) did not identify as white. Nine patients were treated bilaterally, yielding 266 treated lumpectomy cavities. Most tumors were pathologically T1 (n =195, 73.3%), followed by Tis (n =38, 14.2%), then T2 (n =31, 11.6%). Forty-three patients (16.6%) were recommended adjuvant WBI. Median follow-up was 3.7 years, during which there were 7 (2.6%) biopsy-proven ipsilateral breast tumor recurrences. Overall survival was 97.3%, and 10 patients (3.9%) had wound-healing complications.
Conclusion
IORT demonstrated a 97.4% locoregional control rate and spared 83.4% of women from the toxicity of WBI. IORT may serve as a safe alternative for women seeking more personalized treatment.
{"title":"Intra-Operative Radiotherapy with Photons – Update of a Single Institution Registry Trial","authors":"Caroline Oska , Eleni Kohilakis , Sheldon Feldman , Wolfgang Tome , Ying Jin , Ryung Kim , Keyur Mehta , Maureen McEvoy , Jana Fox","doi":"10.1016/j.clbc.2025.11.002","DOIUrl":"10.1016/j.clbc.2025.11.002","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative radiotherapy (IORT) allows early-stage breast cancer patients to complete adjuvant radiation at the time of breast conserving surgery (BCS). In this study, we provide updated outcomes of women treated with IORT in the Bronx, New York.</div></div><div><h3>Methods</h3><div>This is a single-centre, prospective, institutional review-board-approved registry trial of patients treated with IORT using the Intrabeam system. Patients included women aged 45 years and older with estrogen-receptor positive, cT1-2N0 invasive carcinoma or grade 1-2, ductal carcinoma in-situ (DCIS). Exclusion criteria included BRCA mutation, neoadjuvant chemotherapy, or multicentric disease. Patients received a single dose of 20 Gy to the lumpectomy surface with 50kVp x-rays. Those with high-risk pathological features were recommended adjuvant whole breast irradiation (WBI). The primary outcome was locoregional recurrence. Secondary outcomes were overall survival and wound-healing complications.</div></div><div><h3>Results</h3><div>Between January 2018 and January 2024, 257 women were treated with IORT. The median age was 65.7, and most patients (76.7%) did not identify as white. Nine patients were treated bilaterally, yielding 266 treated lumpectomy cavities. Most tumors were pathologically T1 (n =195, 73.3%), followed by Tis (n =38, 14.2%), then T2 (n =31, 11.6%). Forty-three patients (16.6%) were recommended adjuvant WBI. Median follow-up was 3.7 years, during which there were 7 (2.6%) biopsy-proven ipsilateral breast tumor recurrences. Overall survival was 97.3%, and 10 patients (3.9%) had wound-healing complications.</div></div><div><h3>Conclusion</h3><div>IORT demonstrated a 97.4% locoregional control rate and spared 83.4% of women from the toxicity of WBI. IORT may serve as a safe alternative for women seeking more personalized treatment.</div></div>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":"26 1","pages":"Pages 28-35"},"PeriodicalIF":2.5,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145621862","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 : 2025-11-01DOI: 10.1016/j.clbc.2025.10.017
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
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":"https://doi.org/10.1016/j.clbc.2025.10.017","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":10197,"journal":{"name":"Clinical breast cancer","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","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}
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