Ebru Şen

Background/Objectives: Axillary lymph node dissection (ALND) remains common in patients presenting with a high baseline axillary nodal burden despite substantial nodal downstaging after neoadjuvant chemotherapy (NAC). This study evaluated whether post-neoadjuvant radiologic axillary response could support selective axillary de-escalation in patients with clinically staged cN2 breast cancer and pathologically confirmed axillary metastasis. Methods: This retrospective single-center cohort included 166 cases treated between October 2020 and August 2024. All had pathologically confirmed axillary metastasis, completed neoadjuvant systemic therapy, underwent post-treatment axillary ultrasound, and received definitive surgery. Radiologic node-negative status (radN0) was defined by restoration of benign nodal morphology. Surgical management and pathological nodal outcomes were evaluated according to radiologic response. Results: Radiologic nodal clearance occurred in 61/166 cases (36.7%), while axillary pathological complete response [ypN0(i−)] was achieved in 59/166 (35.5%). ypN0(i−) was observed in 53/61 radN0 cases (86.9%) versus 6/105 radN+ cases (5.7%; p < 0.001). Among radN0 cases, 47/61 (77.0%) underwent limited sentinel lymph node biopsy/targeted axillary dissection (SLNB/TAD) without ALND, of whom 43/47 (91.5%) achieved ypN0(i−). Axillary pCR rates varied by molecular subtype, ranging from 20.5% in HR+/HER2− disease to 72.2% in triple-negative disease (p < 0.001). No ipsilateral axillary recurrence occurred in the limited SLNB/TAD group during a median follow-up of 36 months. Conclusions: Post-neoadjuvant radiologic nodal clearance was strongly associated with pathologically node-negative findings and may support consideration of carefully selected responders with cN2 breast cancer for SLNB/TAD-based staging. Radiologic response should complement, rather than replace, surgical staging and multidisciplinary decision-making.

Background/Objectives: D-dimer, a fibrin degradation product, is associated with tumor growth and metastasis. In breast cancer, high concentrations of D-dimer are linked to more advanced disease stages and metastatic spread. This research aimed to examine the relevance of D-dimer levels in estrogen and progesterone hormone receptor (HR)-positive breast cancer. Methods: This retrospective single-center cohort study included patients with HR-positive breast carcinoma who underwent adjuvant or palliative radiotherapy in Türkiye. Pre- and post-radiotherapy blood test results, including D-dimer levels, were required. D-dimer, lymphocyte percentage, and interleukin-6 levels were measured for evaluation. All statistical analyses were performed using R software (version 4.4.2) to evaluate associations between D-dimer levels and other laboratory parameters. Univariate and multivariate Cox proportional hazards regression were performed to identify prognostic factors for progression-free survival (PFS) and overall survival (OS). Statistical significance was defined as p < 0.05. Results: Elevated D-dimer levels were associated with worse Eastern Cooperative Oncology Group performance status, advanced disease stages, metastasis, elevated IL-6 and CRP levels, and lower lymphocyte counts. Pre-RT D-dimer was a strong prognostic factor. Patients with D-dimer ≤ 0.3 µg/mL showed significantly superior OS and PFS (>60 months; p < 0.001), with only one event, and this remained significant in multivariate analysis (OS: HR 4.55, 95% CI 1.89–11.3; p = 0.002; PFS: HR 3.43, 95% CI 1.54–7.8; p = 0.004). Similarly, D-dimer ≤ 0.5 µg/mL was associated with improved OS (4/72 vs. 19/40 events; p < 0.001) and longer PFS, confirmed in multivariate analysis (OS: HR 4.37, 95% CI 1.72–9.86; p = 0.002; PFS: HR 3.88, 95% CI 1.67–9.1; p = 0.003), whereas levels > 0.5 µg/mL predicted worse outcomes. Using a 0.65 µg/mL cutoff, patients with D-dimer > 0.65 µg/mL had significantly shorter OS (median 25.5 months; 95% CI, 18–NA) compared with those ≤0.65 µg/mL (median not reached; p < 0.001), and this remained independently significant (OS: HR 5.10, 95% CI 1.9–13.6; p < 0.001; PFS: HR 4.68, 95% CI 1.83–11.9; p = 0.002). Conclusions: D-dimer is an accessible, non-invasive biomarker with predictive and prognostic significance in HR-positive breast cancer. Elevated D-dimer levels are suggestive of a more aggressive disease and poorer survival outcomes. This has the potential to facilitate early assessment of treatment efficacy and disease progression. This study has several limitations. Its retrospective, single-center design may introduce selection bias and limit generalizability. Although the sample size was sufficient to detect significant associations, validation in larger, multi-center cohorts is warranted to confirm the prognostic value of D-dimer.

Background and Objectives: This study aimed to identify clinicopathological factors associated with axillary pathological complete response (ApCR) in patients with HER2-positive breast cancer presenting with clinically node-positive disease (cN+) confirmed by biopsy who received neoadjuvant therapy (NAT), and to assess the prognostic significance of ApCR on survival outcomes. Materials and Methods: A total of 221 patients with clinically node-positive (cN+) HER2-positive invasive breast cancer, with nodal involvement confirmed by fine-needle aspiration or core needle biopsy, who received neoadjuvant therapy (NAT) and subsequently underwent surgery at three centers between January 2015 and January 2025 were retrospectively reviewed. The association between clinicopathological factors and axillary pathological complete response (ApCR) was analyzed using logistic regression. Survival analyses were performed using the Kaplan–Meier method. Results: The median follow-up duration was 34.3 months. Axillary pathological complete response (ApCR) was achieved in 67.9% of patients. The ApCR rate was higher in stage II disease compared with stage III (76.9% vs. 62.9%). Patients with HER2 3+ tumors demonstrated a higher ApCR rate (70.8%) than those with HER2 2+/FISH+ tumors (46.2%). In multivariable logistic regression, HER2 3+ status (OR = 2.745; 95% CI: 1.138–6.619; p = 0.025) and lower clinical stage (OR = 2.251; 95% CI: 1.182–4.287; p = 0.014) were independently associated with a higher likelihood of achieving ApCR. In survival analyses, the 3-year event-free survival rate was 92% (95% CI: 86–98%) in the ApCR group, compared with 75% (95% CI: 63–87%) in the non-ApCR group. Kaplan–Meier analysis demonstrated that ApCR was a significant prognostic factor for EFS (p = 0.001). Median overall survival (OS) was not reached in either group due to the limited number of death events. Conclusions: ApCR was frequent in node-positive HER2-positive breast cancer after neoadjuvant therapy. HER2 3+ status and lower clinical stage independently predicted ApCR, which in turn was associated with improved event-free survival. These findings underscore the prognostic relevance of ApCR in this setting.

Background and Objectives: Among breast cancer molecular types, HER2 positive and triple negative (TN) subtypes have the highest likelihood of pathological complete response (pCR), which is a surrogate marker for reduced recurrence and improved patient survival after neoadjuvant systemic treatment (NST). Preoperative pathological identification of these exceptional responders is a new era. Therefore, we aimed to determine the accuracy of trucut biopsy in identifying the exceptional responders in selected molecular subtypes of breast cancer patients. Materials and Methods: This two-centre, observational, single-arm, prospective, pilot study was conducted between January and September 2024. The patients with TN or HER2 positive breast cancer whose breast tumour had completely disappeared on the radiological assessment including MRI after neoadjuvant therapy were enrolled. To assess neoadjuvant treatment response, a standardised biopsy protocol was used, consisting of 10 samples from the marked tumour area per patient by 12 G core needle. Then, all patients underwent surgery. The pathological results of both postchemo-presurgical biopsy and surgical breast specimen were compared. Results: The study included 20 patients. The mean age of the patients was 47.3 years. The median tumour size at diagnosis was 23.1 mm. All biopsy results were concordant with the findings of surgical specimen. Seventeen patients had a complete response. The remaining 3 patients had residual disease. Conclusions: Along with thorough patient selection, post-chemo radiological assessment and the reliable biopsy technique are the key points in accurately predicting response to neoadjuvant treatment. If an image-guided core biopsy confirms elimination of tumour tissue at the marked tumour area with a radiological complete response on MRI after NST in breast cancer patients with selected molecular subtypes, these may be suitable patients as exceptional responders in whom we can omit breast surgery.

Angiotropism/perivascular invasion (PVI) is an emerging topic in various types of cancer, with studies primarily focusing on melanoma. However, limited data are available on the significance of PVI in breast cancer. This study aimed to assess the prognostic significance of PVI in breast cancer and its correlation with traditional clinicopathological prognostic parameters. A total of 150 patients with breast cancer diagnosed between July 2020 and January 2022 were included. Clinicopathological data were retrieved from the hospital records. The presence of PVI was evaluated on hematoxylin&eosin stained slides, and the association between PVI and clinicopathological parameters was statistically analyzed. A p-value of <0.05 was regarded as statistically significant. All patients were female. The mean age was 54.0±13.6 years (range 26-97 years). PVI was significantly more common in patients with ≥2.5 cm tumors and the absence of PVI showed a significant correlation with a lower histologic grade (p=0.004 and p=0.040, respectively). Lymphovascular invasion (LVI) and perineural invasion (PNI) were also significantly more frequent in tumors with PVI (p=0.001 and 0.02, respectively). There was a statistically significant association between the absence of both PVI and extranodal extension (ENE) (p=0.035). The specific role of PVI in different types of cancer has not yet been clarified. Our findings showed that PVI was significantly associated with tumor size, histological grade, LVI, PNI, and ENE, all of which are well-known negative prognostic factors in breast cancer. The presence of PVI is a promising topic in breast cancer research, and the PVI status in pathology reports may help oncologists perform better risk assessments for patients with breast carcinoma.

The aim of this study was to evaluate the correlation between clinical histopathologic features and micropapillary (MP) ratio with the maximum standardized uptake value (SUV_max) derived from ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) in treatment naïve breast cancer. Twenty-nine patients diagnosed with breast cancer with a MP component who underwent PET/CT imaging before any local and/or systemic treatment were included in this retrospective study. All clinical histopathological features were recorded. SUV_max values were measured from ¹⁸F-FDG PET images for primary tumors and metastatic axillary lymph nodes. MP component percentage did not correlate with any clinical histopathological features except age. At early ages, the MP component ratio was significantly higher. Our results showed that there is no significant correlation between the SUV_max value and MP component percentage. A high SUV_max value is generally expected in aggressive malignancies. However, this assumption may not be valid for the MP subgroup, which has an aggressive course compared to other subgroups in breast cancer.