This study examined national trends in the use of accelerated partial-breast irradiation (APBI) for ductal carcinoma in situ (DCIS) and evaluated how practice patterns changed after the 2017 updated American Society for Radiation Oncology (ASTRO) consensus, which broadened the criteria for considering APBI in DCIS. The 2017 update expanded the "suitable" patient group to include DCIS cases meeting specific criteria: age 50 years or older, screen-detected lesions, low to intermediate nuclear grade, tumor size 25 mm or smaller, and resection margins 3 mm or greater. A retrospective analysis of the National Cancer Database was performed including patients with DCIS diagnosed between 2011 and 2021. The study compared APBI utilization before (2011-2017) and after (2018-2021) the guideline update. Overall APBI utilization increased from 7.2% (2011-2017) to 13.0% (2018-2021) after the consensus update. Among patients 50 years old or older with low- to intermediate-grade DCIS (≤25 mm), APBI use rose from 8.8% to 15.5%. After 2017, the strongest predictors of APBI use were age, facility type, tumor grade and size, and estrogen receptor (ER) status. Utilization was higher among patients 50 years old or older (13.6% vs 9.7%), those treated at academic centers (15.4% vs 12.0%), those with low-grade (15.8%) and intermediate-grade (13.5%) compared with high-grade (11.4%) disease, those with tumors 25 mm or smaller (13.7% vs 9.7%), and ER-positive cases (13.9% vs 10.7%). Since the updated guidelines in 2017, utilization of APBI for DCIS has increased. Key factors influencing APBI use align with the updated guidelines.

Preoperative magnetic resonance imaging evaluation improves breast conserving surgery rate but not local disease control in patients with ductal carcinoma in situ.

The NRG Oncology research organization and NSABP B-35 randomized clinical trial prospectively collected margin width data on postmenopausal women with hormone receptor (HR)-positive ductal carcinoma in situ (DCIS) who underwent lumpectomy, whole-breast irradiation (WBI), and randomly assigned adjuvant anastrozole or tamoxifen therapy. This permitted analysis of outcomes per margin width. To analyze the effect of margin width on ipsilateral breast tumor recurrence (IBTR). NSABP B-35 was a phase 3, double-blind, randomized clinical trial in which patients were randomized to either 5 years of tamoxifen or anastrozole. Postmenopausal women with HR-positive DCIS and tumor-free margins were eligible. Enrollment was from January 6, 2003, to June 15, 2006, in academic and community hospital members of the NSABP. Study data were analyzed from July 2024 to April 2025. There were no specific interventions based on lumpectomy margin width. Lumpectomy margin width data were prospectively collected within 3 months of randomization. A pathology form classified margins as positive (ink on tumor), close (<1 mm), or negative (≥1 mm). For the negative margin subgroup, closest margin width was stated separately. Thus, an ancillary analysis using 1-mm and 2-mm margin width partitions was performed. A total of 3104 postmenopausal women (mean [SD] age, 61 [7.8] years) were enrolled in NSABP B-35. In an ancillary analysis, 2707 patients were included in the 1-mm margin width partition group, and 2546 patients were included in the 2-mm margin width partition group. IBTR was the most common first event, occurring in 90 of 2707 patients (3.3%): 24 of 502 patients (4.8%) with a margin width less than 1 mm and 66 of 2205 patients (3.0%) with a margin width greater than or equal to 1 mm. Ten-year unadjusted cumulative incidence of IBTR events was 5.6% vs 4.0% for margins less than 1 mm vs margins greater than or equal to 1 mm (P = .04). Using 2 mm as the discriminant threshold for margin width, 39 of 879 patients (4.4%) with margins less than 2 mm and 49 of 1667 patients (2.9%) with margins greater than or equal to 2 mm experienced an IBTR first. Ten-year unadjusted cumulative incidence of IBTR events with margins less than or equal to 2 mm was 5.3% vs 3.8% for those with margins greater than 2 mm (P = .05). In models adjusting for other patient and tumor factors, margin width was not a significant predictor of IBTR risk (2-mm threshold hazard ratio, 1.33; 95% CI, 0.86-2.06). Results of this ancillary analysis of the NSABP B-35 trial show that absolute differences in IBTR rates using margin width groupings of less than 1 mm or greater than or equal to 1 mm and margin width groupings of less than 2 mm or greater than or equal to 2 mm in postmenopausal women with HR-positive DCIS receiving lumpectomy, WBI, and adjuvant endocrine therapy were small. Omission of reexcision lumpectomies based on margin widths of less than 1 mm or less than 2 mm can be reconsidered in appropriate patients. ClinicalTrials.gov Identifier: NCT00053898.

Spatially Resolved Obesity-Driven Molecular Changes in Early Breast Cancer.

Background With the widespread availability of whole-slide imaging, many studies have utilized digital images of hematoxylin and eosin (H&E)-stained breast cancer tissues and applied convolutional neural networks (CNNs) for pathological diagnosis. However, CNN-based diagnosis is largely a black box and may be limited in quantitative morphological research. In this study, we developed a simple algorithm for morphometric analysis of three nuclear atypia features on H&E-stained whole-slide images to predict nuclear grade, hormone receptor status, and Ki-67 levels in breast cancer.Materials and Methods Using 43,183H&E-stained nuclear images larger than 20 µm2 from 131 invasive ductal breast carcinomas, we calculated the following features of nuclear atypia using a computer vision algorithm: anisonucleosis (variation in nuclear size), inhomogeneous chromatin density, and the average size of prominent nucleoli. Anisonucleosis was quantified as the percentage of nuclei larger than 47μm². Inhomogeneous chromatin was defined as the percentage of blue-saturated structures with 0.92-fold luminance or less than the average nuclear luminance. Prominent nucleoli were identified based on blue-saturated structures with 0.87-fold luminance or less, circularity greater than 0.65, and size greater than 1.15μm². Using these values of nuclear atypia features, the thresholds that were the most associated with grade and biomarkers were calculated using receiver operating characteristic curves by Youden index.Results The morphometric algorithm using these thresholds predicted nuclear grade (grade 1 and 3), Ki-67 index ≧ 20%, and hormone receptor negative status with sensitivities of 52.1 to 100% and specificities from 34.3 to 85.3%. Two multivariable logistic regression models combining these three thresholds predicted nuclear grade, Ki-67, and hormone receptor negative with much better accuracy, sensitivities ranging from 57.1 to 91.3%, specificities from 50.9 to 82.2%, and area under curve of 0.70-0.82. The algorithm was applied to an independent set of 42 tumors.Conclusion The present morphological algorithm of nuclear atypia might provide new insights into the computational grading of invasive breast cancer.

Long-term quality of life after surgery for intraductal papillary mucinous neoplasms in young patients.

Introduction: Breast cancer is the most frequently encountered malignant tumour in women around the world with high incidence and mortality rates worldwide. The concept of being able to prognosticate breast cancer based on routine peripheral blood examinations is attractive given the ease of access, replicability, and lower cost. Aim: To estimate the Systemic Immune-inflammatory Index (SII) and Systemic Inflammatory Response Index (SIRI) in invasive ductal carcinoma of breast and to study association between SII and SIRI with prognostic parameters such as molecular subtypes, Grade and Stage of the disease. Materials and Methods: This retrospective cross-sectional analytical study was conducted at Departments of Pathology and Surgical Oncology, Sri Devaraj Urs Medical college, Tamaka, Karnataka, India, from February 2024 to August 2024 it included 90 histopathologically confirmed cases of invasive ductal carcinoma of the breast diagnosed between January 2018 and December 2020. Clinicopathological data such as age, tumour grade, stage, and molecular subtype were obtained from medical records. Neutrophil, lymphocyte, monocyte, and platelet counts were obtained from case files. The SII and SIRI were calculated using standard formulas. Optimal cut-off values were derived using Receiver Operating Characteristic (ROC) curve analysis, and patients were categorised into high and low index groups. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 22.0. Associations between inflammatory indices and prognostic parameters were assessed using the Chi-square test, with p&lt;0.05 considered statistically significant. Results: A total of 90 patients with invasive ductal carcinoma of the breast were included in the study. Based on ROC analysis, the cut-off values for SII and SIRI were 568.83 and 0.831, respectively. High SII levels showed a statistically significant association with histological grade (p=0.002). However, no significant association was observed between SII and tumour stage (p=0.235) or molecular subtype (p=0.770). Similarly, elevated SIRI levels were significantly associated with histological grade (p=0.013) and tumour stage (p=0.022). No significant association was observed between SIRI and molecular subtypes (p=0.734). Conclusion: Systemic inflammatory indices such as the SII and SIRI represent accessible, inexpensive, and non invasive tools that may aid in prognostic assessment and risk stratification in patients with invasive ductal carcinoma of the breast. Their evaluation using routine peripheral blood parameters highlights the potential clinical utility of inflammation-based biomarkers in the overall management and prognostication of breast cancer.

Squamoid eccrine ductal carcinoma (SEDC) is an exceptionally rare malignant adnexal tumor that remains frequently underrecognized due to its overlapping clinical and histopathologic features with more common cutaneous neoplasms. This study presents a monocentric retrospective analysis of 16 patients with histologically confirmed SEDC diagnosed over a ten-year period. Clinical data, histopathologic parameters, immunohistochemical profiles, treatment approaches, and outcomes were systematically reviewed. The cohort predominantly comprised elderly individuals, with a male predominance and lesions arising mainly on sun-exposed areas of the head and neck. Clinically, SEDC manifested as erythematous or hyperkeratotic plaques or nodules often leading to an initial impression of squamous cell carcinoma. Histologically, tumors displayed the characteristic biphasic architecture with superficial squamoid differentiation and deeper ductal structures, frequently accompanied by subcutaneous infiltration or perineural involvement. Treatment consisted primarily of conventional excision, with complete margin clearance achieved in most cases; however, local recurrence occurred in 25% of patients, often within the first year. One patient developed distant metastases and died of disease. Clinical morphology, particularly erythematous plaque presentation, showed significant association with mortality, whereas deeper invasion demonstrated a trend toward worse outcomes. Despite its low metastatic potential, SEDC exhibits locally aggressive behavior, and diagnostic challenges remain common, especially on superficial biopsies. This series represents one of the largest single-center cohorts reported to date and underscores the importance of deep sampling, accurate histopathologic evaluation, and close clinical follow-up to optimize management of this rare adnexal carcinoma.

ASO Author Reflections: From Consensus to Practice: Increasing Use of Partial Breast Irradiation for Ductal Carcinoma In Situ.

During final cell division, the cleaved midbody is either released or asymmetrically retained as a midbody remnant (MBR). MBRs play critical roles in cell communication, signal transduction, and translation regulation, influencing cellular fate. Here, we synthesize their functions as RNA-processing granules, polarity regulators, and signaling platforms, emphasizing their role in primary cilia formation. In polarized epithelial cells, the MBR moves along the apical surface to the centrosome, delivering membrane components to permit ciliogenesis. In ductal carcinoma cells, MBR-localized Shc1-binding protein (SHCBP1) interacts with TBC1 domain family member 30 (TBC1D30 to antagonize Ras-related protein Rab-8 (Rab8) GTPase activity, blocking MBR-centrosome proximity and silencing ciliogenesis. Beyond ciliary regulation, MBRs integrate Wnt, PDGF, TGF-β, and genomic stability networks, acting as dynamic signaling hubs during cancer development. Regarding therapeutic strategies targeting MBRs, High SHCBP1 expression correlates with ciliary loss and poor prognosis in breast, pancreatic, and cholangiocarcinoma. Targeting the SHCBP1/Rab8 axis to restore ciliogenesis by reestablishing MBR-centrosome proximity offers a potential therapeutic strategy. In addition, secreted MBRs are enriched in signaling components and transcripts, serving as intercellular carriers of oncogenic cargoes and promising liquid biopsy biomarkers. In summary, by tracing MBRs from their postmitotic origin to their pathogenic roles, we highlight vulnerabilities within MBR regulatory networks and provide novel insights for cancer therapeutics.

Radiation-induced angiosarcomas of the breast are rare malignancies that carry a poor prognosis. Expected immunohistochemical profiles reflect vascular differentiation: CD31 and ERG positivity, with variable CD34 positivity. GATA-3 is a transcription factor important for mammary gland development, playing a role in ductal epithelial cell differentiation. It serves as an important immunohistochemical marker of breast-origin carcinomas and is not associated with angiosarcomas. We report a case of an 83-year-old woman with breast radiation-induced angiosarcoma, which displayed diffuse GATA-3 positivity, which has not been previously reported in the literature. The patient had a history of inflammatory carcinoma of the left breast (histologically a high-grade invasive ductal carcinoma of no special type) treated with lumpectomy and radiation therapy. Ten years later, she presented with skin thickening and 3 tender nodules (ranging from 0.6 to 2 cm) confined to the left breast skin. Biopsy showed a high-grade, epithelioid dermal neoplasm with abundant hemorrhage. The tumor was diffusely positive for GATA-3, CD31, and ERG, with focal CD34 positivity. Strong and diffuse MYC positivity with an increased Ki-67 proliferative index was also demonstrated. CK5/6, AE1/AE3, MOC-31, CK5/6, CK7, ER, PR, S100, Melan A, and synaptophysin were all negative. The histopathologic features and immunohistochemical profile were consistent with radiation-induced angiosarcoma. With this case, we highlight a diffusely positive GATA-3 staining pattern in radiation-induced angiosarcoma of the breast, which has not been previously documented. Awareness of this potential staining pitfall is essential for arriving at the correct diagnosis particularly when recurrent or metastatic high-grade carcinoma is a diagnostic consideration.

Single fraction based-partial breast irradiation: 10-year results of the SiFEBI phase 2 prospective trial.

Axillary management in early-stage breast cancer is increasingly shifting toward de-escalation. While sentinel lymph node biopsy (SLNB) remains standard, evidence suggests axillary ultrasound (AUS) may safely replace SLNB in selected patients. The SOUND trial demonstrated noninferior oncologic outcomes with AUS-based staging among clinically node-negative patients with small (≤ 2 cm), unifocal invasive breast cancers and negative preoperative AUS. However, the economic and health system impact of implementing this strategy in routine practice remains unclear. We conducted a retrospective cohort analysis of 221 SOUND-eligible patients who underwent breast-conserving surgery with SLNB at four affiliated hospitals between January and June 2023. Costs were modeled using 2025 Medicare reimbursement rates, comparing the observed SLNB pathway with a theoretical AUS-only approach. Estimates included procedural, anesthesia, pathology, and complication-related costs, analyzed from both hospital and patient perspectives. Total estimated hospital costs were $1192,159.56 for SLNB versus $111,825.65 for AUS-only staging, a 90.6% reduction. Mean patient out-of-pocket costs decreased similarly (from $1078.88 to $101.20 per patient). SLNB added an average of 15.1 min of operative time and increased pathology workload owing to lymph node processing. In SOUND-eligible patients, axillary staging with ultrasound alone provides substantial reductions in cost, operative time, and resource utilization while supporting a less invasive, value-based approach to breast cancer care. Together with existing evidence, these findings support broader implementation of the SOUND strategy in appropriately selected populations, particularly postmenopausal patients over 50 years undergoing breast-conserving surgery for cT1N0, ER-positive, HER2-negative invasive ductal carcinoma with a negative AUS.

Breast cancer treatment is rapidly evolving toward precision-based de-escalation strategies for oncological safety and minimizing treatment-related morbidity. In early stage disease, minimally invasive approaches, such as non-surgical ablation techniques, including cryoablation and radiofrequency ablation, potentially constitute alternatives to conventional surgery for carefully selected low-risk tumors. Active surveillance trials challenge the necessity of immediate surgery for low-risk ductal carcinoma in situ, reflecting a paradigm shift toward risk-adapted management. In the neoadjuvant setting, achieving radiologic and pathologic complete responses, particularly in HER2-positive and triple-negative subtypes, is being investigated to determine the feasibility of omitting breast surgery under strict imaging and biopsy-guided protocols. Circulating tumor DNA-based minimal residual disease assays offer a promising tool for refining risk stratification and potentially guiding the extent of surgery and adjuvant therapy. These strategies represent a transformative movement toward biologically tailored, response-adapted, less invasive treatments for early breast cancer to optimize quality of life without compromising long-term outcomes.

The role of stereotactic body radiotherapy in oligoprogressive breast cancer: A site-specific analysis of the prospective, phase-II RADIANT trial.

Pathological response to herceptin-containing neoadjuvant therapy in HER2 IHC2+/ISH+ and IHC3+ early-stage invasive ductal carcinoma.

Oncocytic Intraductal Carcinoma of the Parotid Gland with STRN::ALK Fusion.

IntroductionVirtual consultations are increasingly being used in cancer rehabilitation, yet little is known about how the virtual consultation format shapes patients' sense of embodied presence and relational care. This study explores how women diagnosed with breast cancer or ductal carcinoma in situ experience rehabilitative virtual consultations with nurses and focuses on how virtual consultations influence bodily presence, body modalities, and relational interaction.MethodsAn exploratory qualitative study was conducted using semi-structured telephone interviews with fourteen women who had participated in a nurse-led rehabilitative virtual consultation one year after treatment. Using Braun and Clarke's Reflexive Thematic Analysis, we analysed the data with particular attention to how digital mediation reconfigured embodied presence and relational care.ResultsAcross the dataset, virtual consultations were experienced as altering body modalities and reducing embodied presence when bodily matters were addressed on-screen. Patients experienced vulnerability associated with the absence of physical co-presence and touch but also highlighted how the home environment created a sense of calm and safety. The analysis generated one overarching theme, The Body's Vulnerabilities in the Virtual Space, with four subthemes showing how virtual consultations continuously shifted between connection and disconnection, and how familiarity with the nurse supported relational grounding.DiscussionThe findings demonstrate that virtual consultations reconfigure embodied presence in cancer rehabilitation, which requires patients and nurses to negotiate new body modalities shaped by technology and by the environments from which they participate in the virtual consultation. These dynamics influence vulnerability, trust, and relational care, which underscores the need for digital health practices that recognize spatial embodiment and actively support embodied engagement at a distance.

We demonstrate that broadband coherent anti-Stokes Raman scattering (BCARS) on hematoxylin and eosin (H&E)-stained tissue generates a hybrid vibrational-electronic spectroscopic contrast arising from coupled Raman-active vibrations and chromatin-hematoxylin electronic resonances. This hybrid response, inaccessible to conventional spontaneous Raman or infrared microscopy due to fluorescence and substrate interference, transforms routine histology slides into sources of quantitative molecular information. The resulting spectra encode both Raman-active vibrations and resonance-modulated four-wave-mixing contributions arising from hemalum-chromatin interactions, thereby linking histological color contrast to quantitative, machine-readable spectral features. In breast tissue microarrays, we show (i) pixel-wise wavenumber-shift mapping that resolves subnuclear domains and highlights necrosis-associated nuclear shrinkage; (ii) phase-retrieved Raman-like spectra that separate hemalum-associated resonant features from nonpigmented contributions attributable to processing reagents; and (iii) nucleus-level discrimination of ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), and invasive lobular carcinoma (ILC) using a PCA-LDA workflow. This study is a feasibility demonstration rather than a clinical validation, but establishes electronically enhanced BCARS on routine H&E slides as a route to unlock archival repositories for molecular phenotyping and AI-enabled histopathology.

Sleep disorders and anxiety-depression symptoms can significantly impair the quality of life and treatment adherence among breast cancer patients undergoing chemotherapy, while also increasing the risk of disease recurrence and mortality. Early identification of the progression trajectory and underlying causes of these symptoms is essential for providing personalized interventions for deteriorating cases. This study aims to analyze the trajectories of sleep disorders and anxiety-depression symptoms in breast cancer patients during chemotherapy using a group-based Multi-Trajectory Model (GBMTM) and to identify influencing factors through machine learning. Prospective data from 150 breast cancer patients undergoing four cycles of chemotherapy were collected. A GBMTM was employed to identify distinct trajectories, with 70 predictive variables included in the analysis. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to select the optimal subset of variables. Seven machine learning models were compared, and the optimal model was chosen for result interpretation using SHAP (SHapley Additive exPlanations) analysis. Among breast cancer patients undergoing chemotherapy, two distinct trajectories of sleep disorders and anxiety-depression symptoms were identified: the "stable group" (74.7%) and the "deteriorating group" (25.3%). SHAP analysis revealed that high levels of C-reactive protein, high uric acid, high hemoglobin, smoking, presence of invasive cancer with ductal carcinoma in situ, prior chemotherapy, being married, regular menstrual cycles in the past, and lack of family history were significant risk factors associated with the "deteriorating group." Our findings indicate two distinct trajectories of sleep disorders and anxiety-depression symptoms in breast cancer patients undergoing chemotherapy, with the majority falling into the "stable group". The identified risk factors associated with the "deteriorating group" should be closely monitored to facilitate early intervention and improve patient outcomes. The trial was registered on Chinese Clinical Trial Registry (Trial ID: ChiCTR2300077667 on 15 November 2023; available at https://www.chictr.org.cn/).