Sarkis Meterissian

Timely surgery is a key determinant of breast cancer outcomes; however, prior studies are inconsistent due to heterogeneous treatment pathways and inclusion of neoadjuvant therapy populations. The prognostic impact of delays to upfront surgery remains unclear. We evaluated the association between time from diagnosis to upfront surgery and survival in invasive breast cancer. A systematic search of MEDLINE, Embase, CENTRAL, and additional sources was conducted through April 25, 2025. Quantitative studies in English or French assessing time to upfront surgery and prognosis were included; neoadjuvant cohorts were excluded. Two reviewers independently screened studies. Random-effects meta-analyses and meta-regression were performed. The primary outcome was overall survival; secondary outcomes included cancer-specific survival, recurrence, and pathologic upstaging. Twenty-six studies involving 4,921,120 patients were included. Compared with surgery within 30 days, delays of 30-59 days were associated with increased mortality (hazard ratio [HR] 1.08; p = 0.02), 60-89 days with a 12% higher risk (HR 1.12; p < 0.001), and 90-120 days with a 37% higher risk (HR 1.37; p = 0.002). Each additional 30-day delay increased mortality risk by 15% (HR 1.15; p < 0.001). Findings were robust after adjustment, with low publication bias. Delays as early as 30 days from diagnosis to upfront surgery are associated with progressively worse survival. Incorporating defined surgical timing benchmarks into clinical guidelines may improve quality of care and patient outcomes.

Background: Radial scars (RS) and complex sclerosing lesions (CSL) are benign breast lesions often detected incidentally on imaging. Although historically managed with surgical excision, emerging evidence suggests that conservative management may be appropriate in selected patients. This study evaluated rates of upgrade and progression of RS and CSL and examined factors associated with surgical management and these outcomes. Methods: A retrospective cohort study was conducted at two academic centers affiliated with McGill University. Adult patients diagnosed with RS or CSL on image‐guided core needle biopsy between 2010 and 2024 were included. Upgrade or progression was defined as a subsequent diagnosis of invasive carcinoma, carcinoma in situ (including ductal carcinoma in situ [DCIS] or pleomorphic lobular carcinoma in situ), or high‐risk lesion (HRL), including atypical ductal hyperplasia (ADH). Descriptive statistics and univariate analysis were used to evaluate associations between clinicopathologic factors and outcomes. Results: Among 185 patients, 49 (26.5%) underwent surgical excision and 136 (73.5%) were managed non‐operatively. Surgical pathology revealed 1 invasive carcinoma (2.0%), 5 DCIS (10.2%), and 4 HRL (8.2%). In the non‐surgical group, 3 patients (2.2%) subsequently developed invasive carcinoma; no DCIS or HRL developed over a median follow‐up of 37 months. Presence of a palpable mass was the only factor that predicted surgical management (OR 2.65, 95% CI 1.06–6.60, p = 0.036); no other clinicopathologic or imaging features were associated with upgrade or progression. Conclusions: Although the surgical cohort demonstrated a higher‐than‐expected upgrade rate, most upgrades consisted of DCIS or HRL, and progression among non‐surgically managed patients was rare after more than 3 years of follow‐up. These findings suggest that RS and CSL are rarely associated with clinically significant disease, supporting surveillance as an appropriate management strategy in contemporary practice.

Background/Objectives: Breast cancer is the most common malignancy among women, and early detection is critical for improving outcomes. The Breast Imaging Reporting and Data System (BI-RADS) standardizes reporting, but the BI-RADS 4 category presents a major challenge, with malignancy risk ranging from 2% to 95%. Consequently, most women in this category undergo biopsies that ultimately prove unnecessary. This study evaluated whether exhaled breath analysis could distinguish malignant from benign findings in BI-RADS 4 patients. Methods: Participants referred to the McGill University Health Centre Breast Center with BI-RADS 3–5 findings provided multiple breath specimens. Breathprints were captured using an electronic nose (eNose) powered breathalyzer, and diagnoses were confirmed by imaging and pathology. An autoencoder-based model fused the breath data with BI-RADS scores to predict malignancy. Model performance was assessed using repeated cross-validation with ensemble voting, prioritizing sensitivity to minimize false negatives. Results: The breath specimens of eighty-five participants, including sixty-eight patients with biopsy-confirmed benign lesions and seventeen patients with biopsy-confirmed breast cancer within the BI-RADS 4 cohort were analyzed. The model achieved a mean sensitivity of 88%, specificity of 75%, and a negative predictive value (NPV) of 97%. Results were consistent across BI-RADS 4 subcategories, with particularly strong sensitivity in higher-risk groups. Conclusions: This proof-of-concept study shows that exhaled breath analysis can reliably differentiate malignant from benign findings in BI-RADS 4 patients. With its high negative predictive value, this approach may serve as a non-invasive rule-out tool to reduce unnecessary biopsies, lessen patient burden, and improve diagnostic decision-making. Larger, multi-center studies are warranted.

Background/Objectives: Breast cancer is the most common malignancy among women, and early detection is critical for improving outcomes. The Breast Imaging Reporting and Data System (BI-RADS) standardizes reporting, but the BI-RADS 4 category presents a major challenge, with malignancy risk ranging from 2% to 95%. Consequently, most women in this category undergo biopsies that ultimately prove unnecessary. This study evaluated whether exhaled breath analysis could distinguish malignant from benign findings in BI-RADS 4 patients. Methods: Participants referred to the McGill University Health Centre Breast Center with BI-RADS 3–5 findings provided multiple breath specimens. Breathprints were captured using an eNose powered breathalyzer , and diagnoses were confirmed by imaging and pathology. An autoencoder-based model fused the breath data with BI-RADS scores to predict malignancy. Model performance was assessed using repeated cross-validation with ensemble voting, prioritizing sensitivity to minimize false negatives. Results: The breath specimens of eighty-five participants, including sixty-eight patients with biopsy-confirmed benign lesions and seventeen patients with biopsy-confirmed breast cancer within the BI-RADS 4 cohort are analyzed. The model achieved a mean sensitivity of 88%, specificity of 75%, and a negative predictive value of 97%. Results were consistent across BI-RADS 4 subcategories, with particularly strong sensitivity in higher-risk groups. Conclusions: This proof-of-concept study shows that exhaled breath analysis can reliably differentiate malignant from benign findings in BI-RADS 4 patients. With its high negative predictive value, this approach may serve as a non-invasive rule-out tool to reduce unnecessary biopsies, lessen patient burden, and improve diagnostic decision-making. Larger, multi-center studies are warranted.

Currently, patients with biopsy-proven axillary disease undergoing neoadjuvant chemotherapy (NAC) must undergo completion axillary lymph node dissection (c