Eugeniu Darii

Background/Objectives: In patients with clinically node-positive breast cancer, axillary response to neoadjuvant systemic treatment is heterogeneous and might depend on tumor biology. In patients with cN2 disease, the identification of factors linked to nodal response could improve risk stratification and contribute to the development of individualized post-neoadjuvant axillary management strategies. Methods: This cohort study has a retrospective design and included 560 female patients with invasive breast cancer (proven via biopsy) and cN2 disease. All patients received neoadjuvant systemic treatment accompanied by breast and axillary surgery at the Institute of Oncology “Prof. Dr. Ion Chiricuță” Cluj-Napoca (IOCN), Romania, between 2017 and 2025. The primary endpoint was the rate of axillary pathological complete response (pCR) following neoadjuvant systemic therapy, defined as ypN0. Secondary endpoints included breast pCR (ypT0), overall pCR (ypT0N0), the association between breast and axillary pathological response and survival analysis, including overall survival (OS) and disease-free survival (DFS). Clinicopathological predictors were assessed using univariate and multivariate logistic regression, while survival outcomes were evaluated with time-to-event analyses. Results: Complete axillary pathological response occurred in 282/560 patients (50.4%), and it increased to 53.2% when ypN0, including ypN0(i+). Breast pathological complete response was achieved in 31.2%, while overall pCR was 27.0%. Axillary response was significantly different in terms of molecular subtype, as ypN0 rates were 26.6% in Luminal A-like, 32.5% in Luminal B-like, 78.9% in HER2-positive and 72.6% in TNBC (p < 0.001). Nottingham grade 3 and HER2-positive disease were independently related to increased odds of ypN0, while TILs p = 0.040), while ypN0 and ypT0 were not significantly associated with DFS. No significant OS differences were noticed regarding pathological response. Conclusions: Nearly half of patients with cN2 breast cancer presented a complete axillary response after the completion of neoadjuvant treatment. Molecular subtype, histological grade and TILs were strongly associated with axillary response. In our cohort, breast pathological response alone was insufficient in order to be regarded as a predictor of nodal clearance, further supporting independent assessments of breast and axillary response. Further prospective studies are needed to determine whether these findings can inform individualized axillary management after neoadjuvant treatment.

Background/Objectives: Breast cancer management relies on multidisciplinary team (MDT) decisions that integrate clinical, radiological, pathological, and patient-related factors. Large language models (LLMs) may support such decisions, but evidence based on real-world cases remains limited. Methods: We evaluated the agreement between ChatGPT-5.5 (OpenAI, San Francisco, CA, USA) and real MDT management of patients with invasive breast cancer. In this single-center, retrospective, proof-of-concept study, standardized preoperative clinical vignettes for 86 patients with invasive breast carcinoma were independently evaluated by GPT-5.5 (frozen prompt, Medium reasoning mode, Web Search enabled). AI-generated recommendations were compared with the MDT reference standard across eight therapeutic domains (four surgical, four non-surgical), yielding 688 individual decisions. Agreement was summarized descriptively and with Cohen’s κ. Results: GPT-5.5 produced complete recommendations for all vignettes. Overall concordance was 90.8% (625/688). Agreement was highest for endocrine therapy, radiotherapy, and targeted therapy (100% each) and for axillary surgery (93.0%, κ = 0.86), and lowest for breast reconstruction (80.2%), oncoplastic surgery (82.6%) and neoadjuvant chemotherapy (83.7%). Surgical concordance was 85.8% (295/344). Discordances occurred predominantly in individualized surgical decisions; none were observed for endocrine therapy, radiotherapy, or targeted therapy. Conclusions: GPT-5.5 showed high overall concordance with real MDT decisions, particularly for guideline-driven systemic therapy, but was less reliable for individualized surgical planning. These findings should be regarded as exploratory and cannot be assumed to be generalizable across institutions or clinical settings. LLMs should complement, not replace, multidisciplinary expertise; prospective multicenter validation is warranted.

Background/Objectives: Robotic-assisted breast reconstruction with deep inferior epigastric perforator (DIEP) flap has been developed as a minimally invasive alternative to conventional open DIEP harvest, having the primary goal of reducing donor-site morbidity while preserving flap reliability. Methods: A targeted literature search was performed in PubMed using the keywords “robotic” AND “DIEP”. Following title, abstract and reference screening, 10 studies were included in the final analysis. The current narrative review summarizes the existing literature regarding robotic versus conventional DIEP flap reconstruction, concentrating on abdominal wall preservation, postoperative pain and recovery, operative time, flap survival, and complication rates, with respect to learning curve and feasibility. Results: The included studies demonstrate significantly shorter fascial incisions, together with reduced abdominal wall disruption in robotic DIEP harvest compared with conventional techniques. However, current evidence has not demonstrated that this anatomical difference translates into clinically significant reductions in donor-site morbidity. Some comparative studies also report lower postoperative pain scores and shorter hospital stay in robotic cohorts. Flap survival and overall complication rates appear comparable between robotic and conventional DIEP reconstruction. However, robotic surgery remains linked to longer operative times and higher infrastructural requirements. Conclusions: Robotic DIEP reconstruction represents a feasible and potentially advantageous evolution in autologous breast reconstruction, but larger prospective multicenter studies with long-term follow-up are necessary to establish definitive superiority over conventional techniques.

The primary objective of this study was to identify preoperative factors that could be associated with positive resection margins. We also tried to analyze the local recurrence and overall survival in patients who received conservative treatment for early-stage breast cancer and correlate these parameters with preoperative factors. A retrospective examination was conducted on the medical records and pathological reports of 143 patients who underwent breast-conserving surgery (BCS) for breast cancer in our department from 2009 to 2017. Postoperative outcomes were assessed through phone contact and statistical analyses, including GraphPad Prism, and Fisher’s exact test, the Chi-square test, and the log-rank test were employed. The results revealed positive resection margins in 7.69% (11 cases) of the 143 patients, with an overall mortality rate of 16.66% for those with positive margins and 6.59% for those with negative margins. Statistical analysis indicated no significant differences in the overall (p = 0.5) or specific (p = 0.53) survival between the positive and negative margin groups. The positive margins were significantly associated with neoadjuvant chemotherapy (p < 0.0001) and the presence of ductal carcinoma in situ (DCIS) (p = 0.01). Among the analyzed factors, two out of sixteen were significantly linked to positive resection margins in BCS, emphasizing their importance in surgical management planning for early-stage breast cancer.