To compare duration and rates of underestimation and complete excision for nonpalpable breast lesions using either intraoperative ultrasonographically guided excisioned biopsy (IUGE) or directional vacuum-assisted biopsy (DVAB). Percutaneous ultrasonography-guided core needle biopsy is preferable to stereotactic biopsy for treatment of nonpalpable breast lesions; however, underestimation and false-negative results can occur, and rebiopsy may be required. To date, however, there has been no comparison of these two procedures in terms of diagnostic accuracy and duration. For 4 consecutive years, IUGE was performed for 104 nonpalpable breast lesions and DVAB for 128 lesions at Chang Gung Memorial Hospital. Of the DVAB cases, the handheld mammotome was used for 53 procedures, with all lesions removed as completely as possible. The duration of the two procedures was calculated from initial skin incision until completion of wound closure. Most of the patients with benign pathology underwent ultrasonographic examination at 3 months after surgery, with a follow-up examination at 1 year. Surgery was performed subsequently for all of the malignancy cases. The average ages and mean tumor sizes for patients undergoing IUGE or DVAB were 46 and 47 years and 1.1 and 1.0 cm, respectively. The average IUGE and DVAB surgery durations for 88 benign tumors and 117 benign lesions were 44.3 and 21.5 minutes, respectively (P < 0.001), and 43.5 and 20.6 minutes for the malignant tumors (n = 16 and n = 11), respectively (P = 0.036). The IUGE and DVAB surgery durations for tumors <1 cm in diameter were 43.5 and 20.6 minutes, respectively, and 44.2 and 23.6 minutes for tumors over that size (P < 0.001). An older-model mammotome was used for 75 patients, with an average duration of 24 minutes in comparison to 18 minutes for the handheld variant (P < 0.001). No false-negative results were noted and, except in the case of the malignant tumors, there was no need for reexcisional biopsy. Further, there were no underestimates of the disease for the 4 cases of atypical ductal hyperplasia and the 12 of noninvasive carcinoma. No further ultrasonographic evidence of tumors was noted for 95% of the benign pathologies, with no residual abnormality detected for 13 of the 27 malignant tumors after IUGE or DVAB. For treatment of nonpalpable breast lesions, both IUGE and DVAB eliminate false-negative results, underestimates, and the requirement for reexcisional biopsies. In comparison to IUGE, DVAB is more convenient and time efficient for excisional biopsy of nonpalpable breast lesions.

WNT1 inducible signaling pathway protein 1 (WISP1) plays a key role in many cellular functions in a highly tissue-specific manner; however the role of WISP1 in breast cancer is still poorly understood. Here, we demonstrate that WISP1 acts as an oncogene in human breast cancer. We demonstrated that human breast cancer tissues had higher WISP1 mRNA expression than normal breast tissues and that treatment of recombinant WISP1 enhanced breast cancer cell proliferation. Further, ectopic expression of WISP1 increased the growth of breast cancer cells in vitro and in vivo. WISP1 transfection also induced epithelial-mesenchymal-transition (EMT) in MCF-7 cells, leading to higher migration and invasion. During this EMT-inducing process, E-cadherin was repressed and N-cadherin, snail and β-catenin were upregulated. Filamentous actin (F-actin) remodeling and polarization were also observed after WISP1 transfection into MCF-7 cells. Moreover, forced overexpression of WISP1 blocked the expression of NDRG1, a breast cancer tumor suppressor gene. Our study provides novel evidence that WISP1-modulated NDRG1 gene expression is dependent on a DNA fragment (−128 to +46) located within the human NDRG1 promoter. Thus, we concluded that WISP1 is a human breast cancer oncogene and is a potential therapeutic target.

Objective: To analyze the value of various sonographic features in differentiating benign from malignant breast tumors of different sizes to improve the diagnostic accuracy in small lesions.Methods: The sonographic features of 1203 histologically confirmed solid breast lesions were prospectively documented with respect to anteroposterior (AP) diameter/width ratio, shape, margin, echogenicity, echotexture, posterior echo and bilateral refraction sign. The sensitivity, specificity and accuracy of breast ultrasound were calculated for lesions grouped according to size (≤ 1, 1.1–2 and > 2 cm). Univariate and multiple logistic regression analyses including calculation of odds ratios for single sonographic features were used to analyze the significance of the different diagnostic features.Results: The accuracy of breast sonography in differentiating between benign and malignant tumors ≤ 1, 1.1–2 and > 2 cm in size was 75.6%, 86.4% and 88.4%, respectively. Univariate analysis demonstrated that all sonographic features were significant in tumors ≥ 1.1 cm. Shape, margin, echogenicity and echotexture were the significant factors in those tumors ≤ 1 cm. Multiple logistic regression analysis demonstrated that margin, shape, posterior echo and echogenicity were the significant factors for differential diagnosis in tumors > 2 cm. Echogenicity, margin, shape, bilateral refraction sign and echotexture were the significant factors for tumors 1.1–2 cm. On multiple regression analysis, margin was the only significant factor for tumors ≤ 1 cm.Conclusion: Tumor margin is the most important sonographic feature in evaluating breast lesions in any size group. With the combination of significant factors and emphasis on specific features according to size of lesion, the diagnostic accuracy of ultrasound for the differential diagnosis of malignant and benign tumors may be improved. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.

Prognosis is poor and treatment options are limited for patients with previously untreated, advanced triple-negative breast cancer (TNBC), especially for those who are not candidates for immunotherapy. In the randomised, open-label, phase III TROPION-Breast02 trial, patients with previously untreated, locally recurrent inoperable or metastatic TNBC for whom immunotherapy was not an option were randomised 1:1 to datopotamab deruxtecan (Dato-DXd; 6 mg/kg intravenously every 3 weeks) or investigator's choice of chemotherapy. Randomisation was stratified by geographic location, disease-free interval and programmed cell death ligand-1 status. Dual primary endpoints were progression-free survival (PFS; blinded independent central review per Response Evaluation Criteria in Solid Tumors, version 1.1) and overall survival (OS). Efficacy analyses were performed in the intention-to-treat population. Safety analyses included all patients who received ≥1 dose of study treatment. Between 16 May 2022 and 11 June 2024, 644 patients were randomised to Dato-DXd (n = 323) or chemotherapy (n = 321). Median PFS was 10.8 months (95% confidence interval [CI] 8.6-13.0) with Dato-DXd and 5.6 months (95% CI 5.0-7.0) with chemotherapy (hazard ratio 0.57 [99% CI 0.44-0.73]; P < 0.0001). Median OS was 23·7 months (95% CI 19.8-25.6) and 18.7 months (95% CI 16.0-21.8) with Dato-DXd and chemotherapy, respectively (hazard ratio 0.79 [95.01% CI 0.64-0.98]; P = 0.029). Treatment-related adverse events (TRAEs) of grade ≥3 were reported in 105 (33%) and 89 (29%) patients who received Dato-DXd and chemotherapy, respectively, and TRAEs led to treatment discontinuation in 14 (4%) and 23 (7%) patients. There were no treatment-related deaths in either arm. Dato-DXd demonstrated significantly improved PFS and OS versus chemotherapy in patients with previously untreated, locally recurrent inoperable or metastatic TNBC for whom immunotherapy was not an option. Safety was consistent with the known profile for Dato-DXd.