Atilla Celik

Background: Radiotracer- and magnetic seed-based targeted axillary staging techniques are increasingly used after neoadjuvant chemotherapy (NAC) in patients with initially node-positive breast cancer who convert to clinical node-negative (ycN0) status. However, these technologies remain unavailable in many centres worldwide. We evaluated the effectiveness of radiotracer-free axillary staging using dual-tracer sentinel lymph node biopsy (SLNB) with indocyanine green (ICG) and methylene blue, with particular focus on the clinical implications of clipped node non-retrieval. Methods: This retrospective single-centre cohort study included 49 patients with biopsy-proven cN1 breast cancer who achieved ycN0 status following NAC and underwent dual-tracer SLNB using ICG and methylene blue between 2021 and 2024. Clipped node retrieval rates, tracer-specific detection patterns, recurrence outcomes, and disease-free survival (DFS) were analysed. Clinical outcomes, including recurrence and disease-free survival, were compared between patients with successful and unsuccessful clipped node retrieval. Results: Clipped node retrieval was achieved in 41 of 49 patients (83.7%). ICG outperformed methylene blue for clipped node identification (80.5% vs. 61.0%) and was the sole detecting tracer in 39.0% of cases. Using methylene blue alone would have reduced the retrieval rate to 51.0% (p = 0.001). ICG identified the clipped node in all six patients with axillary micrometastases (ypN1mi). Clipped node non-retrieval occurred in eight patients, all of whom had negative SLNB findings and did not undergo completion axillary lymph node dissection. Recurrence rates were similar between the retrieval and non-retrieval groups (17.1% vs. 12.5%, p = 1.000), and no isolated axillary recurrences were observed. Baseline tumour size was the only independent predictor of disease-free survival in multivariable analysis (HR 2.05, 95% CI 1.20–3.51; p = 0.008). Conclusions: Radiotracer-free axillary staging using ICG and methylene blue achieved a high clipped node retrieval rate in patients with ycN0 breast cancer after neoadjuvant chemotherapy. ICG significantly improved clipped node identification compared with methylene blue alone and identified the clipped node in all patients with residual nodal micrometastatic disease. Among patients with negative SLNB findings, clipped node non-retrieval was not associated with higher recurrence rates or worse disease-free survival during follow-up. However, given the small number of clipped node non-retrieval cases (n = 8) and recurrence events (n = 8), these findings should be interpreted with caution and require confirmation in larger prospective studies. These findings support the feasibility of a radiotracer-free dual-tracer approach in settings where radiotracer-based techniques are not available. Prospective multicentre studies are warranted to validate both the oncological performance of radiotracer-free axillary staging and the clinical implications of clipped node non-retrieval.

Background: Breast cancer-related lymphedema (BCRL) is one of the most debilitating long-term morbidities after axillary lymph node dissection (ALND), severely impairing quality of life through reduced mobility, independence, and chronic burden, especially in older women. Axillary reverse mapping (ARM) aims to preserve upper extremity lymphatics while maintaining oncologic safety. Evidence in older adult populations with long-term follow-up remains limited. Methods: This retrospective cohort study included 138 female patients (median age 72.5 years) undergoing ALND for invasive breast cancer between January 2018 and January 2024. Patients were divided into ARM (n = 72) and non-ARM (n = 66) groups. BCRL was graded 0–3 according to adapted International Society of Lymphology (ISL) criteria (2013 consensus document). Assessments were performed preoperatively and at 3, 6, 12, 24, 36, 48, and 60 months using blinded circumference measurements and bioimpedance spectroscopy. Results: Baseline characteristics were comparable. Mean follow-up was 46.5 ± 8.8 months. Clinically relevant BCRL (Grades 2–3) was dramatically lower in the ARM group (18.1% vs. 60.6%, p < 0.0001), while subclinical changes (Grade 1) were similar (31.9% vs. 27.3%, p = 0.55). Kaplan–Meier analysis showed significantly better clinically relevant lymphedema-free survival with ARM (log-rank p = 0.00019), with curve separation after 30–40 months—indicating a sustained long-term benefit for quality of life in this frail population. Recurrence rates were comparable (8.3% vs. 10.6%, p = 0.776). Multivariable Cox regression confirmed ARM as an independent protective factor (adjusted HR 0.22, 95% CI 0.11–0.44, p < 0.0001). Conclusions: In older women with breast cancer, ARM significantly reduces clinically relevant lymphedema—a major determinant of long-term quality of life—without compromising oncologic safety. These findings support the routine consideration of ARM during ALND to preserve upper-extremity function, mobility, and independence in this vulnerable population, thereby balancing aggressive oncologic treatment with enhanced long-term quality of life and reduced treatment-related morbidity.

Evaluating the Role of Artificial Intelligence in Enhancing Multidisciplinary Team Decisions for Breast Cancer Management - European Journal of Breast Health

Axillary lymph node dissection (ALND) is associated with a high risk of lymphedema. We assessed whether routine indocyanine green (ICG)-guided axillary reverse mapping (ARM) reduces the incidence and severity of lymphedema after ALND, while maintaining long-term oncological safety, in a propensity-matched cohort. In this retrospective study conducted between 2019 and 2024, 121 women undergoing ALND for invasive breast cancer were divided into an ARM group (n=62, from 2022 onward) and a non-ARM group (n=59). Lymphedema was assessed by blinded nurses using the Frustum formula (≥10% and ≥5% inter-limb volume difference) and International Society of Lymphology (ISL) staging at 3, 6, 12, 24, 36, 48, and 60 months. Propensity score matching (1:1) was used to balance age, BMI, neoadjuvant therapy, stage, surgery type, surgeon, and pandemic period (standardized mean difference <0.08). Sensitivity analysis was performed using inverse probability of treatment weighting (IPTW). Oncological safety was evaluated through histopathology of ICG-positive nodes and recurrence monitoring over a median follow-up of 54 months (IQR 36–72). After matching, the 60-month lymphedema incidence (≥10% threshold) was 8.1% in the ARM group versus 39.0% in the non-ARM group (p<0.001), yielding an absolute risk reduction of 30.9% and a number needed to treat of 3.2. Severe lymphedema (ISL stages 2–3) occurred in 6.5% versus 30.5% (p<0.001). Lymphedema-free survival significantly favored the ARM group (log-rank p=0.0003). Adjusted Cox regression demonstrated an 82% lower risk (hazard ratio 0.18, 95% CI 0.07–0.45; p<0.001; concordance 0.78), with robustness confirmed by IPTW (hazard ratio 0.20, p<0.001). No recurrences were observed (0/121; upper 95% CI 2.5%) over 54 months, despite 59% of patients having stage III disease. Routine ICG-guided ARM was associated with an 82% reduction in clinically significant lymphedema and appears oncologically safe over 54 months—the longest follow-up reported in a middle-income setting. Prospective randomized trials are warranted.

Modified radical mastectomy (MRM) is associated with persistent psychological and physical sequelae in geriatric breast cancer survivors. This study examin

Purpose Breast cancer is the most common cancer in women. Developments in breast cancer treatment have extended the life expectancy of these patients, raising the issue of morbidity of breast cancer surgery, the major cause of which is axillary dissection. The aim of the present study was to establish the safety of sentinel node biopsy (SLNB) in patients with a clinically node-negative axilla after neoadjuvant chemotherapy (NACT). Methods We recorded demographic data, as well as the findings of physical examination, imaging, and pathology before and after NACT. SLNB with indocyanine green + isosulfan blue and axillary dissection were performed and the surgical and pathology findings were recorded. Results A sentinel lymph node was detected in 80 of 90 patients who underwent surgery. When ≥ three sentinel lymph nodes were removed as negative in the patient group with cN0 after treatment, we evaluated the axilla as being negative with an accuracy of 100%. Conclusions Axillary lymph-node dissection may not be necessary for patients with cNO confirmed by physical and radiological examination using positron emission tomography (PET) computed tomography (CT), and breast magnetic resonance imaging (MRI) after NACT, if ≥ three negative SLNB are removed. Further studies are needed to confirm our findings.

Introduction. There is still minimal scientific understanding of effects of fulvic acid (FA) on breast cancer. We investigated the prophylactic, therapeutic, and combined effects of FA in a breast cancer model created using MCF‐7 cell line in severe combined immunodeficiency disease (SCID) mice. Results. Four experimental groups were established as the control group (Group C), prophylaxis group (Group P), therapeutic group (Group T), and prophylaxis + therapeutic group (Group P + T). Tumor growth was observed by the in vivo imaging system and macroscopically in mammary glands of all mice (100%) of Group C, microscopically in only one mouse of Group P (12.5%), in four mice in Group T (50%), but only one animal (12.5%) in Group P + T. Immunohistochemistry (IHC) showed that p53 staining was significantly higher in tissues of Group C compared to other groups (P < 0.05). No difference was found in IHC scores for p53 between Group P and P + T (P > 0.05). Bcl‐2 staining was significantly higher in Group C compared to Group P + T (P = 0.015) and higher in Group P + T compared to Group T (P = 0.021) but no significant difference was found between Group P and others (P > 0.05). Bax staining was significantly higher in Group C compared to others (P < 0.05) but no significant difference was found between FA groups (P > 0.05). Conclusion. Prophylactic FA treatment can prevent tumor formation by inducing variations in the expression of p53, BcL‐2, and Bax proteins in mammary glands of SCID mice before tumor formation. This suggests that FA may be a powerful inhibitory candidate for the prevention of tumorigenesis in breast cancer.

Objective:Breast cancer is the most common type of cancer among women, and risk-reducing treatments have gained importance in recent years with the detection of genetic mutations. Method: Patients who underwent prophylactic mastectomy in our clinic between January 2018 and January 2023 were evaluated retrospectively. Surgical procedures performed on all patients, complications developing secondary to the surgery, the time of sending the patients to adjuvant treatment, the necessity of secondary operation, and disease-free survival were evaluated. Results: In 4 of the 15 patients with genetic mutations who underwent prophylactic mastectomy, this surgery was performed before tumor formation. Complications such as capsular contracture, skin necrosis and nipple necrosis developed in 6 patients, and reoperation was required in 4 patients. In the follow-up of all patients, oncological principles were adhered to, and no recurrence or metastasis was observed in any of them. Conclusion:With the expansion of the genetic mutation panel, patients have started to gain time, and as physicians, we need to guide these people in accordance with oncological principles. Prophylactic mastectomy is the method we recommend in this study for tumor-free survival.