Late Toxicities and Quality of Life After a Radiation Boost for Breast Ductal Carcinoma In Situ: Boost or No Boost in DCIS Randomized Trial.

Mortality Risk and Cause of Death Associated With Removal of the Adult Thymus: Analysis of the U.S. Thymoma Population.

Introduction: Breast lesions comprise about 34-40% of lesions evaluated by fine-needle aspiration in surgical practice. FineNeedle Aspiration Cytology (FNAC) is increasingly used as a simple and cost-effective method to assess the nature of breast lesions, with high sensitivity and reasonable specificity, which helps in planning further treatment. However, a small percentage of breast lesions cannot be confidently diagnosed as benign or malignant and are termed grey-zone lesions. These include reactive atypia seen in some benign conditions and atypia of malignancy. Aim: To analyse the cytological features of atypical proliferative breast diseases associated with a malignant diagnosis on histopathologic examination. Materials and Methods: This was a cross-sectional study involving FNAC smears of all patients diagnosed as proliferative breast disease with atypia in the Department of Pathology, Government Medical College, Kozhikode, Kerala, India, from January 2018 to June 2021. Clinical and cytological features were studied, and patients were followed-up until June 2022. The lesions were classified histologically into benign and malignant lesions. The cytological features in the FNAC smears were studied. The data were entered into spreadsheets in Microsoft Excel, and the variables were analysed using Statistical Package for the Social Sciences (SPSS) version 16.0 for Windows. The Chi-square test was used to evaluate features significantly associated with a histological diagnosis of malignancy. Results: The study included a total of 162 cases diagnosed as proliferative breast disease with atypia on FNAC. Histopathological follow-up was available for these cases, with 73 benign and 89 malignant. Clinical features that were statistically significant in subjects with malignant histopathological diagnoses included age over 40 years, presence of a hard and fixed breast lump, and nipple changes. Cytological features predictive of a malignant histological diagnosis included clusters with ill-defined borders, loosely cohesive or cribriform clusters, clusters with markedly reduced or absent myoepithelial cells, reduced stromal fragments, numerous singly scattered atypical cells, markedly reduced or absent bipolar bare nuclei in the background, high mitotic rate, and necrosis. The nuclear features that were statistically significant included marked nuclear enlargement, nuclear pleomorphism, irregular nuclear contour, nuclear overlapping, and coarse nuclear chromatin. Conclusion: The diagnosis of malignancy requires a multifaceted approach, including correlation with clinical, radiological, and pathological features. For an unequivocal cytological diagnosis of malignancy, a constellation of cytomorphological features is needed; a single morphological feature cannot reliably distinguish between benign and malignant lesions. Proper knowledge of the various cytomorphological features of malignancy can help predict malignancy even if all classical cytological features are not present. Cytological study can be a useful adjunct in triaging cases where prompt histopathological assessment is mandatory.

Many women around the world suffer from Benign Breast Diseases (BBD).

Background Granulomatous mastitis (GM) is a rare benign inflammatory breast disease that may mimic carcinoma. Etiology remains unclear, but emerging evidence suggests a role for both breast and gut microbiota. Methods Between June 2022 and June 2024, 32 women with histopathology-confirmed GM and 44 non-GM controls (benign and non-granulomatous inflammatory conditions) were enrolled. Granulomatous tissue, adjacent normal breast tissue, and stool samples were collected. Microbiota composition was analyzed using 16S rRNA sequencing. Clinical variables were documented. Diversity analyses and receiver operating characteristic (ROC) curves assessed microbial differences and diagnostic potential. Results The GM cohort had a mean age of 36.8 years and BMI of 27.6 ± 3.9 kg/m2; 86.2% were postpartum, with no autoimmune or malignant conditions. GM lesions showed enrichment of Corynebacterium (notably C. kroppenstedtii), Staphylococcus, and Microbacterium, whereas Lactobacillus and Bifidobacterium were higher in normal tissue. Fecal samples exhibited reduced microbial diversity in GM compared with controls but did not replicate breast microbial profiles. ROC analysis indicated that Corynebacterium discriminated GM from controls with excellent accuracy (AUC = 0.87), while Staphylococcus was moderate (AUC = 0.78) and Lactobacillus inversely associated (AUC = 0.11). Conclusions GM demonstrates distinct microbial signatures, including pro-inflammatory taxa enrichment and protective commensal depletion, along with systemic dysbiosis. These findings support a microbiota-driven pathogenesis and highlight the potential of microbial biomarkers and therapeutic modulation.

BackgroundMalignant phyllodes tumors (MPT) are rare, aggressive fibroepithelial breast neoplasms with limited consensus on optimal management. While wide local excision (WLE) with ≥1cm margins is standard, recurrence remains common, and the role of adjuvant therapy remains unclear.MethodsWe conducted a 28-year retrospective review of 14 histologically confirmed MPTs in 11 patients at a single urban safety-net hospital. Clinical, pathologic, and treatment data were analyzed to assess recurrence, metastasis, and treatment outcomes.ResultsThe median tumor size was 7.6cm. Most patients (73%) presented with stage II disease. Surgical management included WLE alone (45.5%), WLE with radiation (27.3%), mastectomy alone (9.1%), and mastectomy with adjuvant radiation (18.2%). Local recurrence occurred in 3 patients (27.3%), all of whom were initially treated with surgery alone. Those who recurred received adjuvant radiation; no recurrences occurred after adjuvant radiation. One patient developed metastases and received systemic chemotherapy. Only 1 patient underwent genetic testing, which revealed a TP53 mutation.ConclusionsRecurrence occurred often despite margin-negative resections, highlighting the limitations of current surgical guidelines and the potential importance of tumor biology. These findings support a more individualized treatment approach that incorporates histologic features and, when appropriate, genetic testing. Adjuvant radiation may reduce the risk of recurrence in high-risk cases, although our small cohort precludes definitive conclusions. These findings should be considered hypothesis-generating and highlight the need for prospective or registry-based studies.

Vacuum-assisted breast biopsy (VABB) and its therapeutic evolution, vacuum-assisted excision (VAE), represent pivotal advancements in the percutaneous diagnosis and management of breast lesions. This review provides a comprehensive overview of the historical development, technical execution, clinical indications, and applications of these minimally invasive procedures. Initially introduced to overcome the limitations of fine needle aspiration cytology and core needle biopsy, VABB has established itself as a superior diagnostic modality, particularly in the assessment of mammographically detected lesions such as microcalcifications and architectural distortions. VAE, an extension of the same principle, enables complete excision of select benign and high-risk lesions, thereby reducing the need for open surgical intervention. Techniques guided by mammography, ultrasound, and magnetic resonance imaging are discussed, highlighting procedural nuances, safety profiles, and tissue adequacy. Emerging applications, including the treatment of gynecomastia and potential roles in surgical de-escalation for early-stage malignancies, underscore the expanding clinical relevance of these techniques. Overall, VABB and VAE signify a paradigm shift in breast disease management, fostering earlier diagnosis, improved patient outcomes, and healthcare cost containment.

Premature and very low birth weight infants are at a greater risk of acquiring postnatal cytomegalovirus (CMV) infection and developing symptomatic disease, including a sepsis-like syndrome. This systematic review was designed to assess the burden of breast milk-acquired CMV infection and disease in premature or very low birth weight infants born to CMV-positive mothers. Studies reporting data on preterm infants born before 32 weeks of gestation and/or with birth weight less than 1500 g, published between 2002 and 2022, were included. Random effects meta-analysis was performed using R software. Fourteen studies were included in the present review. The proportion of CMV seropositivity among the tested mothers was 75.9% (95% confidence interval [CI] 68.2-82.2), and 82.1% (95% CI 68.9-90.5) of seropositive mothers excreted CMV in breast milk. The proportion of infants acquiring postnatal CMV from CMV immunoglobulin (Ig)G-positive mothers was estimated to be 14.7% (CI 95% 9.6-21.8). Of all infants with postnatal CMV infection, 29.6% (CI 95% 20.8-40.1) presented with sepsis-like symptoms. Breast milk-handling methods varied widely among studies. We found a high CMV seropositivity and a high rate of CMV excretion in the breast milk of mothers of premature and very low birth weight infants. In these high-risk infants, the benefits of untreated breast milk should be considered, along with the risk of CMV transmission and severe disease.

Preoperative mammography in patients under 40 undergoing nononcologic breast reduction surgery is not recommended by national guidelines, including the 2014 ASPS Choosing Wisely statement. This study evaluated national trends, predictors, and downstream consequences of preoperative mammography in this population. We performed a retrospective cohort study using the 2014-2021 Merative MarketScan database to identify women undergoing reduction mammaplasty for macromastia. We excluded patients with any prior breast disease or family history. Mammograms within 12 months preoperatively were identified and stratified by age and type (screening vs. diagnostic). Downstream imaging, biopsies, and new breast-related diagnoses within 3 months were assessed. Multivariable logistic regression was used to identify predictors of mammography among patients under 40. Among 15,394 reduction mammaplasty patients, 31% received a preoperative mammogram, including 9.3% of women under 40. In this younger cohort, rates decreased from 12.9% in 2014 to 7.7% in 2021. Women ages 18-29 and 30-39 undergoing surgery were 8- and 3-times more likely, respectively, to receive a mammogram compared to age-matched general populations. Among women under 40, increasing age, urban residence, and Southern location predicted higher mammography use. Downstream testing occurred in 15% of screening mammograms and 43% of diagnostic mammograms in this group. Despite improvements since 2014, preoperative mammography remains overused in women under 40 undergoing breast reduction, exposing patients to low-value care and potential harm. Targeted deimplementation strategies are needed to align practice with evidence-based guidelines.

Human milk contains viable mammary epithelial cells (MECs), providing a unique, non-invasive source of primary breast cells. As these cells originate from the lactating breast, they enable direct insights into mammary epithelial biology in vivo, and on the maternal influence on epithelial composition and function potential. Yet, such influences remain poorly characterized. We analyzed 127 milk samples to investigate how lactation stage, maternal age, and parity affect milk-derived MECs abundance, phenotype, and functional properties. Cells were characterized by flow cytometry, gene expression profiling, and protein quantification at isolation and after 21 days of in vitro culture. The lactation stage significantly influenced milk's cellular composition: total cell counts declined over time, while epithelial cell proportion and expression of lactation-related genes increased. Advanced maternal age was associated with lower prolactin receptor expression, fewer epithelial cells, and reduced proliferative potential in vitro. MECs from multiparous women exhibited a higher luminal-to-basal ratio, supporting the existence of parity-associated epithelial imprinting. Such shifts in epithelial subtypes may contribute to long-term breast remodeling and disease risk. This study provides a comprehensive characterization of milk-derived MECs. It highlights human milk as a valuable model to study lactation, epithelial plasticity, and the cellular contexts relevant to breast cancer risk.

Background: Granulomatous lobular mastitis (GLM) is a chronic inflammatory breast disease with poorly understood etiology. Current wound management lacks standardized protocols, highlighting the need for evidence synthesis to inform clinical decision-making.Objectives: To comprehensively search the relevant literature on wound treatment and nursing in patients with granulomatous lobular mastitis at home and abroad, to sort out and analyze the included literature, and to extract, sort out and integrate the items of wound-related interventions, so as to provide a framework and basis for the construction of breast wound care programs for patients with granulomatous lobular mastitis.Methods: We conducted a systematic review following the 6S evidence pyramid model (Jan 2023 version). Twelve databases were searched from inception to January 2025, including: BMJ Best Practice, Up to Date, The Journal of the American Medical Association (JAMA), Scottish Intercollegiate Guidelines Network (SIGN), CNKI, Wan fang, CBM. Inclusion criteria covered clinical studies and guidelines addressing GLM wound care. Two reviewers independently performed quality assessment using AMSTAR-2 (for reviews) and JBI tools (for primary studies), with evidence graded (Level 1-5) and recommendations categorized (Grade A/B).Results: From 1,333 screened records, 19 studies met inclusion criteria:3 systematic reviews,3 consensus guidelines,6 RCTs,6 quasi-experimental studies,1 cohort study. Key findings were synthesized into 38 evidence statements across four domains: Assessment (8 items): Recommended use of GMDAI for inflammatory activity monitoring, Wound care (20 items): Strong evidence (Grade A) for TCM patching in chronic phases. Education (5 items): Structured self-care programs reduced recurrence by 30%. Follow-up (5 items): Combined digital and clinic follow-ups improved compliance.Conclusion: This study summarized the evidence of wound care for GLM patients through evidence-based nursing methods, and provided evidence support for the clinical formulation of breast wound care programs for GLM patients. Healthcare professionals can apply evidence to the clinic based on the clinical context to improve breast wounds and quality of life.

OBJECTIVE: To evaluate patient acceptance of cabergoline and efficacy in reducing breast symptoms after dilation and evacuation (D&E) from 14 to 24 weeks of gestation. METHODS: We conducted a prospective cohort study evaluating the practice of routinely offering cabergoline to patients at 14–24 weeks of gestation after D&E for any indication at an urban academic medical center. We recorded acceptance and collected demographic and clinical characteristics. We administered the Bristol Breast Symptom Inventory during a routine postoperative phone call. We compared patient demographic and clinical characteristics by cabergoline and intake using χ 2 and t tests. We evaluated the association between cabergoline acceptance and intake with presence of breast symptoms using the Fisher exact test. We used Stata BE18.0. RESULTS: Of 144 sequential patients offered cabergoline from July 21, 2023, to October 18, 2024, 134 (93.1%) accepted and 124 (86.1%) took cabergoline. We obtained breast symptom data for 119 patients (82.6%) at a mean 3.5 days postoperatively. Demographic and clinical characteristics were similar except for ethnicity, with non-Hispanic patients more likely to decline than Hispanic patients. Patients who took cabergoline were less likely to report the presence of breast symptoms compared with those who did not (26.4% vs 77.8%, risk ratio 0.35, 95% CI, 0.21–0.58, P =.001). Among non-Hispanic patients, the association between cabergoline intake and lower incidence of breast symptoms remained (31.6% vs 87.5%, P =.004). In the overall population, regardless of cabergoline use, there was no association between gestational age and presence of breast symptoms. Among the 44 patients at less than 18 weeks of gestation, 16.6% of those who took cabergoline and 100% of those who did not take cabergoline reported breast symptoms. CONCLUSION: Routinely offering cabergoline was frequently accepted by patients after D&E. Cabergoline intake was associated with lower incidence of breast symptoms. Our results are limited by the small number who declined cabergoline. Our findings support the use of cabergoline among patients after D&E from 14 to 24 weeks of gestation.

The mammogram risk score (MRS), an AI-driven mammographic texture feature, strongly predicts breast cancer risk independently of breast density, though underlying mechanisms remain unclear. Using data from the Nurses' Health Study II (292 cases, 561 controls), we validated MRS's association with breast cancer and evaluated its relationships with established breast cancer risk factors through observational analyses, polygenic score analyses, and Mendelian randomization. MRS was significantly associated with breast cancer risk before (OR=1.92 per SD increase; 95% CI:1.57 to 2.35; 10-year AUC=0.69) and after adjustment for predicted BI-RADS density (OR=1.85; 95% CI:1.49 to 2.30). Early life body size and adult body mass index (BMI) were inversely associated with MRS, while benign breast disease history and predicted BI-RADS density showed positive associations; after adjusting for density, associations between MRS and the other three risk factors were attenuated. Polygenic score analyses and Mendelian randomization consistently demonstrated significant positive associations between genetic predictors of breast density measures (dense area, percent density, predicted BI-RADS density) and MRS. After adjusting for predicted BI-RADS density and BMI, genetic predictors of higher waist-to-hip ratio were significantly associated with increased MRS. Our findings reveal robust associations between breast density measures and MRS and suggest a potential impact of central obesity on MRS. Future larger-scale validation studies are needed.

IntroductionThis quasi-experimental study examined the effectiveness of integrating virtual reality (VR)-based training into the medical imaging curriculum, particularly in enhancing eHealth literacy, health-related behaviors, and academic outcomes.MethodsA total of 96 students participated, divided into a VR-based training group (n = 35) and a traditional training group (n = 61). Grounded in Kolb’s Experiential Learning Theory, Sweller’s Cognitive Load Theory, and the Cognitive-Affective Model of Immersive Learning (CAMIL), the study aimed to explore how immersive, student-centered learning environments influence health education outcomes. Data were collected using the eHealth Literacy Scale (eHEALS), Health-Related Behaviors Scale (HBS), Center for Epidemiological Studies Depression Scale (CES-D), and Breast Health and Examination (BHE) test in both groups. The VR-based group also completed the Student Satisfaction and Self-Confidence in Learning Scale (SCLS).ResultsPost-training BHE scores increased significantly in both groups (p < 0.001), though no statistically significant difference was observed between the groups in eHEALS, HBS, CES-D, or BHE scores. The VR-based group reported high satisfaction and self-confidence (SCLS mean = 54.1 ± 4.1).ConclusionThe use of scenario-based virtual patients and simulated breast models created a reflective, low-risk, and student-centered learning environment aligned with experiential and cognitive learning theories. The VR-supported breast health curriculum was associated with comparable learning outcomes to the traditional course, suggesting that immersive methods can provide an alternative mode of delivery in health education to foster motivation, self-efficacy, and clinical competence.

Granulomatous mastitis (GM) is a refractory chronic inflammatory breast disease. Current first-line treatments, such as intralesional triamcinolone acetonide (TA) injections, are limited by short duration of efficacy, systemic side effects, and poor patient compliance. This study aimed to develop a novel chitosan (CS)-based TA-loaded polyvinyl alcohol (PVA) microneedle delivery system (MNs@TA-CS) for localized and sustained transdermal therapy. TA-CS nanoparticles were prepared using ionic gelation and subsequently incorporated into PVA microneedles. The resulting MNs@TA-CS was characterized for morphology, mechanical strength, and drug release profile. A rat GM model was induced by hyperprolactinemia and tissue homogenate-Freund's adjuvant. Therapeutic efficacy was evaluated through lesion size measurement, cytokine analysis, histopathological examination, and macrophage polarization assessment. The MNs@TA-CS exhibited excellent mechanical properties and a biphasic drug release profile. In the GM rat model, MNs@TA-CS demonstrated comparable therapeutic efficacy to conventional TA injections, significantly reducing lesion area (82.7% reduction), downregulating pro-inflammatory cytokines (IL-1β, TNF-α, and IL-6), and modulating macrophage polarization. Histopathological and immunohistochemical analyses confirmed marked reduction in granulomatous inflammation and fibrosis. Notably, the MNs@TA-CS showed good biocompatibility with no signs of liver or kidney toxicity. The MNs@TA-CS achieves comparable efficacy to traditional injections while offering sustained drug release and minimized systemic exposure. Its biphasic release mode provides both rapid onset and prolonged therapeutic effect, making it a promising minimally invasive, patient-friendly alternative for GM treatment.

Breast cancer is the most common cancer among women, making accurate diagnostic imaging essential for evaluating focal breast complaints. Standard breast imaging includes mammography (MG), digital breast tomosynthesis (DBT), and targeted ultrasound (US). Little information is known about the added value of MG/DBT compared to targeted US alone in women with focal breast complaints. This review provides a systematic overview of the (relative) sensitivity of MG/DBT, next to the use of targeted US in women with focal breast complaints, while emphasizing the variations of the reported guidelines. A comprehensive PubMed search was conducted to identify articles published between January 2002 and February 2024 that assessed the diagnostic performance of MG/DBT and targeted US in women presenting with focal breast complaints. Of the 985 identified studies, 10 met the inclusion criteria after full-text evaluation. Palpable lumps and focal pain are the more frequent symptoms. Most studies show a high sensitivity (range 84.6-100%, the largest study reported 98.3%) of targeted US alone in relatively young women (30-39 years). Mammograms show added value, particularly when it comes to determining the extent of breast cancer and when confirming a benign abnormality. Targeted US is a reliable initial imaging modality, particularly in younger women (≤ 40). When the US suggests a benign finding in low/average-risk women, the added value of MG is minimal. Routine use should be weighed against the risk of overdiagnosis, unnecessary biopsies, and radiation exposure. Question The best imaging strategy for women aged 30-40 with focal breast complaints is uncertain, and whether US alone suffices remains unresolved. Findings Initial targeted US shows high accuracy in this diagnostic setting, with MG/DBT adding value mainly in determination of tumor extent and from a screening perspective. Clinical relevance Using US as the primary imaging for women < 40 with focal breast symptoms may reduce MG, radiation, and discomfort, while maintaining cancer detection; however, any discordance between clinical and imaging findings should always prompt further evaluation.

BACKGROUND. By reliably classifying screening mammograms as negative, artificial intelligence (AI) could minimize radiologists' time spent reviewing high volumes of normal examinations and help prioritize examinations with high likelihood of malignancy. OBJECTIVE. The purpose of this study was to compare performance of AI, classifying examinations as positive at different thresholds, with that of radiologists, focusing on NPV and recall rates, in large population-based digital mammography (DM) and digital breast tomosynthesis (DBT) screening cohorts. METHODS. This retrospective single-institution study included women enrolled in the observational population-based Athena Breast Health Network. Stratified random sampling was used to identify cohorts of DM and DBT screening examinations performed from January 2010 through December 2019. Radiologists' interpretations were extracted from clinical reports. A commercial AI system classified examinations as low, intermediate, or elevated risk. Breast cancer diagnoses within 1 year after screening examinations were identified from a state cancer registry. AI and radiologist performance were compared. RESULTS. The DM cohort included 26,693 examinations in 20,409 women (mean age, 58.1 years). AI classified 58.2%, 27.7%, and 14.0% of examinations as low, intermediate, and elevated risk, respectively. Sensitivity, specificity, recall rate, and NPV for radiologists were 88.6%, 93.3%, 7.2%, and 99.9%; for AI defining positive results as elevated risk, 74.4%, 86.3%, 14.0%, and 99.8%; and for AI defining positive results as intermediate or elevated risk, 94.0%, 58.6%, 41.8%, and 99.9%. The DBT cohort included 4824 examinations in 4379 women (mean age, 61.3 years). AI classified 68.1%, 19.8%, and 12.1% of examinations as low, intermediate, and elevated risk, respectively. Sensitivity, specificity, recall rate, and NPV for radiologists were 83.8%, 93.7%, 6.9%, and 99.9%; for AI defining positive results as elevated risk, 78.4%, 88.4%, 12.1%, and 99.8%; and for AI defining positive results as intermediate or elevated risk, 89.2%, 68.5%, 31.9%, and 99.8%. CONCLUSION. In large DM and DBT cohorts, AI at either diagnostic threshold achieved high NPV but had higher recall rates than radiologists. Defining positive AI results to include intermediate-risk examinations, versus only elevated-risk examinations, detected additional cancers but yielded markedly increased recall rates. CLINICAL IMPACT. The findings support AI's potential to aid radiologists' workflow efficiency. However, strategies are needed to address frequent false-positive results, particularly in the intermediate-risk category.

BackgroundGranulomatous lobular mastitis (GLM) is a nonspecific chronic inflammatory breast disorder with an obscure etiology and pathogenesis. Neutrophil extracellular traps (NETs), which are extracellular web-like structures composed of decondensed chromatin and granular proteins released by activated neutrophils, disrupt normal tissue architecture and perpetuate inflammatory responses. The aim of the present study was to explore the role of NETs in GLM and the underlying regulatory mechanisms.MethodsNeutrophils were isolated from the blood of GLM patients and healthy controls (HCs) to assess NET formation. The presence of NETs in GLM tissues was detected using Western blot, immunohistochemistry, and immunofluorescence analyses. A mouse model of GLM was established to determine whether the inhibition of NET production, which is dependent on S100A8/S100A9, alleviates mammary gland inflammation. The potential mechanisms and therapeutic implications were further explored through in vitro and in vivo assays.ResultsNETs were significantly increased in GLM tissues, as characterized by elevated levels of citrullinated histone H3 (CitH3) and myeloperoxidase (MPO). S100A8/S100A9 was highly expressed in GLM and demonstrated significant diagnostic value alongside NET markers. Mechanistically, S100A8/S100A9 promoted NETosis through interactions with peptidylarginine deiminase 4 (PAD4). Both paquinimod (an S100A8/S100A9 inhibitor) and Cl-amidine (a PAD4 inhibitor) effectively suppressed NET formation in vitro. In the GLM mouse model, both inhibitors reduced mammary gland inflammation, NET accumulation, and tissue damage.ConclusionsThe present findings indicated that NETs contribute to the pathogenesis of GLM. S100A8/S100A9 plays a critical role in promoting NET formation via PAD4 activation. Targeting this axis with paquinimod effectively inhibits NETosis and alleviates GLM, suggesting a promising therapeutic strategy for GLM and other inflammatory diseases.

A professional sports bra fitting and issue service was introduced for women entering British Army basic training (BT) in 2020 to address breast health and bra-related issues. However, the suitability of commercial off-the-shelf sports bras for female tactical athletes, designed primarily for short-duration use, remains unclear. We aimed to develop evidence-based recommendations to inform British Army sports bra policy and establish a framework applicable to other female tactical athlete populations. A mixed-method multi-study approach was employed (May 2021- September 2023). First, a cross-sectional study was conducted with BT recruits to assess the bra fitting and issue service using questionnaires (n = 244) and semi-structured interviews (n = 7). A concurrent task analysis with subject matter experts (n = 8) identified BT activities that were both physically demanding and challenging for the breast. Second, a controlled laboratory study with recruit-matched civilians (n = 25) examined the performance of various sports bra characteristics during short-duration simulations of military-specific tasks. Finally, a 14-week longitudinal field study of BT recruits (n = 93) monitored sports bra performance during sustained wear, enabling comparisons between laboratory-based simulations and real-world use. Despite implementing a bra fitting and issue service, 61% of recruits still reported at least one breast or bra-related issue. None of the four sports bra designs tested fully met the varied demands of BT tasks. Ten key bra design characteristics (e.g. strap configuration, ease of use, support level) were identified across five different BT tasks (physical training, field exercise, military tasks, foot drill and classroom sessions), combining insights from short-duration laboratory simulations and long-duration field use. These evidence-based recommendations can enhance breast health, comfort and performance in female military recruits. Findings have broader implications for female tactical athletes in physically demanding occupations, supporting the development of optimised female-specific equipment.

Rosai-Dorfman disease (RDD) is a rare, benign, idiopathic histiocytic proliferative disorder, primarily affecting the lymph nodes but also involving extranodal sites. RDD confined to the breast is extremely rare, with fewer than 100 cases reported in the literature, and it often mimics malignancy on imaging. We report a case of a 45-year-old male presenting with bilateral breast lumps, more prominent on the right. Mammography and ultrasound demonstrated features suspicious for malignancy, including irregular margins, internal vascularity, and mild surrounding edema. Histopathological analysis revealed lymphoplasmacytic infiltration, large histiocytes exhibiting emperipolesis, and strong positivity for S-100 and CD68. Early recognition of RDD prevented unnecessary surgical intervention. This report highlights key imaging and pathological features that differentiate RDD from malignancy.