Breast最新文献

Introduction: Pleomorphic (PLCIS) and florid (FLCIS) lobular carcinoma in situ are uncommon entities, characterized by significant architectural distortion and cellular atypia. Their rarity poses three key clinical challenges: diagnostic variability, histologic upgrade and risk of local recurrence (LR). Currently, no standardized management guidelines exist. This systematic review provides the most comprehensive synthesis to date of the available evidence on clinical, radiologic, pathologic, and molecular characteristics of P/FLCIS, and evaluates outcomes associated with different treatment strategies.

Methods: A systematic literature search was conducted across major biomedical databases up to June 2025. Eligible studies were original case series reporting primary data on P/FLCIS.

Results: From 5402 screened records, 38 studies were included, comprising 629 total cases: 411 PLCIS, 98 FLCIS, and 120 categorized as LCIS with pleomorphic or non-classic features. The pooled upgrade rate was 35.3% (PLCIS 35.1%, FLCIS 33.3%; p = 0.843), predominantly to invasive carcinoma (28.8%). Among 258 pure P/FLCIS cases with available follow-up (median, 50 months) the overall LR rate was 12.4% (PLCIS 13.1%, FLCIS 9.1%; p = 0.618), with invasive recurrences representing the majority (62.5%; p = 0.04). Margin status was significantly associated with risk of LR (positive margins 38.2%, close margins (<2 mm) 20.0%, negative margins 3.0%; p < 0.001). Data on adjuvant treatments were inconsistent and heterogeneous.

Conclusions: Given the high upgrade rate and significant risk of LR for P/FLCIS, complete surgical excision with negative margins is strongly advised to ensure definitive diagnosis and reduce future breast events. The role of adjuvant therapies remains unclear, highlighting the urgent need for standardized, multicenter studies to guide optimal clinical management.

Background: The benefit of adjuvant ovarian function suppression (OFS) and aromatase inhibitors (AI) in premenopausal patients with hormone receptor positive, HER2 positive (HR+/HER2+) breast cancer (BC) is unclear. We aimed to investigate this question in a retrospective cohort, stratified by timing (adjuvant or neoadjuvant) of chemotherapy and trastuzumab and by response to neoadjuvant therapy.

Methods: Patients aged <45Y at diagnosis, with stage I-III HR + HER2+ BC, treated with (neo)adjuvant chemotherapy and trastuzumab ( ± pertuzumab) and endocrine therapy were included. LHRH-agonists and oophorectomy were considered OFS. We compared distant disease-free survival (DDFS) with tamoxifen, OFS + tamoxifen and OFS + AI in three cohorts: neoadjuvant-pathologic complete response (pCR), neoadjuvant-residual disease (RD) and adjuvant. Endocrine therapy (ET) was modeled as a time dependent covariate in cox logistic regression analyses.

Results: The study included 1124 patients with median follow-up of 72.6 months (range:0-205 months). DDFS rates at 5 years were 83.9 %, 86.8 % and 92.1 % with tamoxifen, OFS + tamoxifen and OFS + AI respectively in the RD group, 94.3 %, 97.6 % and 96.5 % in the pCR group, and 94.3 %, 93.4 % and 98.6 % in the adjuvant group. OFS + AI was associated with better DDFS compared to tamoxifen in the RD group (n = 366) (multivariable weighted HR 0.28. 95 % CI 0.11-.069, p = 0.006), but associations of ET with DDFS in the pCR (n = 307, p = 0.59) and adjuvant (n = 451, p = 0.18) cohorts were not detected. Stage III was associated with worse DDFS in all groups.

Conclusion: OFS + AI were associated with better DDFS in patients with RD after neoadjuvant therapy. Our findings can assist shared decision-making on adjuvant endocrine therapy of these patients.

Background: Potential infertility and premature ovarian insufficiency represent notable concerns for young women with breast cancer (YWBC) undergoing chemotherapy. Cryopreservation techniques and temporary ovarian suppression with GnRH agonists (GnRHa) can be offered for fertility preservation (FP) and/or ovarian protection. This joint analysis of the Joven & Fuerte and PREFER multicenter prospective studies compared the uptake of these strategies and associated factors among Mexican and Italian YWBC.

Methods: Females ≤40 years diagnosed with non-metastatic BC from 2014 to 2019, who were offered FP strategies before (neo)adjuvant chemotherapy were included. Uptake of GnRHa for ovarian protection and cryopreservation procedures and reasons for their non-utilization were examined.

Results: Among 485 patients (74 % from Mexico; 26 % from Italy), cryopreservation techniques were used in 8 % of Mexican patients and 25 % of Italian patients (p < 0.001). Methods in Mexico and Italy, respectively, comprised oocyte (50 % and 87 %), embryo (53 % and 0 %), and ovarian tissue (0 % and 16 %) cryopreservation. GnRHa were used in 98 % of Italian patients and 6 % of Mexican patients. Cryopreservation uptake was associated with younger age (OR 1.2, 95 %CI 1.1-1.2), childlessness (OR 21.8, 95 %CI 10.0-47.6), stage I-II BC (OR 3.1, 95 %CI 1.5-6.3), private healthcare in Mexico (OR 3.0, 95 %CI 1.1-8.1), and unpartnered status in Italy (OR 5.4, 95 %CI 2.2-13.2).

Conclusion: FP and ovarian protection uptake were markedly higher in Italy than Mexico, possibly reflecting divergent social and healthcare contexts, though cryopreservation remained underutilized in both countries. Improved access to oncofertility services is warranted to provide comprehensive care aligned with the personal needs and life plans of YWBC.

Background: In clinically node-positive patients, sentinel lymph node biopsy (SLNB), marking axillary lymph node with radioactive iodine seed (MARI), and combined SLNB/MARI (RISAS-procedure) can replace axillary lymph node dissection (ALND) after neoadjuvant systemic therapy. Surgical staging outcome can be combined with baseline axillary disease on ¹⁸F-FDG PET/CT. This study assessed whether baseline axillary disease on ¹⁸F-FDG PET/CT affects the accuracy of staging-procedures. Second, when staging-procedures detected residual disease, it was assessed whether baseline axillary disease on ¹⁸F-FDG PET/CT affected the probability of remaining positive nodes at completion ALND (cALND).

Method: Included were patients with baseline ¹⁸F-FDG PET/CT within the RISAStrial (NCT02800317). Patients underwent the RISAS-procedure followed by cALND. False negative rates were stratified by limited or advanced baseline axillary disease (1-3 vs. ≥4 hypermetabolic lymph nodes). When staging-procedures detected residual disease, the probability of remaining positive nodes at cALND was stratified by baseline axillary disease.

Results: Of 185 patients, 116 had limited and 69 had advanced baseline axillary disease. Staging-procedures had higher accuracy in limited than advanced baseline axillary disease. When the RISAS-procedure detected residual disease, the probability of remaining positive nodes at cALND was lower in limited than advanced baseline axillary disease (44.9% vs. 91.5%,p < .001). When SLNB or MARI detected residual disease, the probability of remaining positive nodes at cALND was >88.4%, irrespective of baseline axillary disease.

Conclusion: Staging-procedures had higher accuracy in patients with limited than advanced axillary disease on baseline ¹⁸F-FDG PET/CT. When staging-procedures detected residual disease, the probability of remaining positive nodes at cALND remained high.