Health-related quality of life and patient-related outcome measures for patients with cancer have gained increased interest over the last decade. However, few prospective studies with longitudinal data evaluated health-related quality of life in patients with breast cancer. This study aimed to investigate how health-related quality of life changed from the time of diagnosis to 1 year after breast cancer surgery for the main surgical techniques. This prospective longitudinal single-centre study included patients with primary breast cancer diagnosed in 2019–2020 who underwent surgery. Patients completed a health-related quality of life questionnaire (Breast-Q) at baseline. One year after surgery, they completed the Breast-Q a second time, the EORTC (European Organization for Research and Treatment of Cancer) quality of life questionnaire-C30 and the quality of life questionnaire-BR23. Analysis of variance and Kruskal–Wallis tests were used to evaluate the differences in health-related quality of life between surgical groups. Analysis of covariance with robust standard errors was used to adjust for confounders. In total, 340 patients were included in the study; 160 patients received oncoplastic partial mastectomy, 112 received partial mastectomy, 42 received mastectomy and 26 had mastectomy with immediate reconstruction. Patients that had partial mastectomy or oncoplastic partial mastectomy were more satisfied with their breasts (P < 0.001), had a better body image (P = 0.006) and higher sexual functioning scores (P = 0.027) than patients who had a mastectomy with/without reconstruction. The oncoplastic and mastectomy with reconstruction groups had more breast symptoms than other groups (P < 0.001), and the mastectomy group had the least symptoms from the chest area. Partial mastectomy and oncoplastic partial mastectomy have the best outcomes in terms of breast satisfaction, body image and sexual functioning. This highlights the importance of preserving the breast when feasible and underscores that breast reconstruction is not equal to breast conservation. Registration number: NCT04227613 (http://www.clinicaltrials.gov).

Background: Breast‐reduction techniques are increasingly used in oncoplastic breast surgery. Bilateral therapeutic mammoplasty has the benefit of decreasing breast volume, enabling resection of larger tumors, and the potential to assure good postoperative symmetry. The aims of this study were to objectively asses the cosmetic outcomes of therapeutic mammoplasty in patients with breast cancer, using the breast cancer conservative treatment cosmetic results (BCCT.core) software, to compare this score with the surgeon's score and the patient's assessment, and to evaluate if other defined parameters have an impact on cosmetic outcomes. The secondary aim was to compare breast symmetry pre‐ and postoperatively.Materials and Methods: We enrolled 146 consecutive patients with primary breast cancer who underwent therapeutic mammoplasty between 2011 and 2018 in Kristianstad Central Hospital, Sweden. We retrospectively collected data from patients’ records. We analyzed the BCCT.core score using postoperative photographs to objectively evaluate cosmetic outcomes on a four‐grade scale and compared with preoperative photographs to evaluate symmetry. Cosmetic outcomes were also assessed subjectively by patients and surgeons, using a 10‐point Likert scale.Results: The majority of patients (89%) had good or excellent BCCT.core scores, which correlated with surgeons’ scores, rs = − 0.22 (p < 0.001). Overall, patients were more satisfied with the cosmetic outcomes than the surgeons (p < 0.001). Evidence supporting an association between the defined clinicopathological variables, for example, tumor size, and cosmetic outcomes, was weak.Conclusion: Therapeutic mammoplasty yields a very good cosmetic outcome, evaluated both by subjective and objective measurements. Importantly, symmetry can be improved in patients with asymmetry.

Neoadjuvant chemotherapy (NAC) is an established treatment option for early breast cancer, potentially downstaging the tumor and increasing the eligibility for breast-conserving surgery (BCS). The primary aim of this study was to assess the rate of BCS after NAC, and the secondary aim was to identify predictors of application of BCS after NAC. This was an observational prospective cohort study of 226 patients in the SCAN-B (Clinical Trials NCT02306096) neoadjuvant cohort during 2014-2019. Eligibility for BCS was assessed at baseline and after NAC. Uni- and multivariable logistic regression analyses were performed using covariates with clinical relevance and/or those associated with outcome (BCS versus mastectomy), including tumor subtype, by gene expression analysis. The overall BCS rate was 52%, and this rate increased during the study period (from 37% to 52%). Pathological complete response was achieved in 69 patients (30%). Predictors for BCS were smaller tumor size on mammography, visibility on ultrasound, histological subtype other than lobular, benign axillary status, and a diagnosis of triple-negative or HER2-positive subtype, with a similar trend for gene expression subtypes. Mammographic density was negatively related to BCS in a dose-response pattern. In the multivariable logistic regression model, tumor stage at diagnosis and mammographic density showed the strongest association with BCS. The rate of BCS after NAC increased during the study period to 52%. With modern treatment options for NAC the potential for tumor response and BCS eligibility might further increase.

Background: With a trend toward de-escalation of axillary surgery in breast cancer, prediction models incorporating imaging modalities can help reassess the need for surgical axillary staging. Although mammography is routinely performed for breast cancer imaging, its potential in nodal staging remains underutilized. This study aims to employ advancements in deep learning (DL) to comprehensively evaluate the potential of routine mammograms for predicting lymph node metastasis (LNM) in preoperative clinical settings. Methods: This retrospective study included 1,265 cN0 T1-T2 breast cancer patients, comprising 368 node-positive and 897 node-negative cases, diagnosed from 2009-2017 at three Swedish institutions. Patients diagnosed in 2017 were assigned to the independent test set (n=123, site 2) and the external test set (n=103, site 3), while the remaining patients (n=1,039, site 1 and 2) were used for model development and double cross-validation. A neck module, in conjunction with a ResNet backbone pretrained on unlabeled mammograms, was developed to extract global information from full-breast or region-of-interest (ROI) mammograms by predicting five cancer outcomes. Clinicopathological characteristics were combined with the learned mammogram features to predict LNM collaboratively. The models were evaluated using area under the receiver operating characteristic (ROC) curve (AUC), calibration, and decision curve analysis. Results: Compared to models using only clinical variables, incorporating full-breast mammograms with preoperative clinical variables improved the ROC AUC from 0.690 ± 0.063 (SD) to 0.774 ± 0.057 in the independent test set and from 0.584 ± 0.068 to 0.637 ± 0.063 in the external test set. The combined model showed good calibration and, at sensitivity ≥ 90%, achieved a better net benefit, and a higher sentinel lymph node biopsy reduction rate of 41.7% in the independent test set. Full-breast mammograms showed comparable ability to tumor ROIs in predicting LNM. Conclusion: Our findings underscore that routine mammograms, particularly full-breast images, can enhance preoperative nodal status prediction. They may substitute key postoperative predictors such as pathological tumor size and multifocality, aiding patient stratification before surgery. Interestingly, the added predictive value of mammography was consistent across all sites, whereas the overall performance varied over time periods and sites, likely due to advancements in equipment and procedures.

Background Invasive lobular carcinoma (ILC) is a risk factor for positive margins after breast-conserving surgery (BCS). This retrospective observational study examined whether the presence of residual cancer cells in re-excision is associated with ILC or locoregional recurrence. Methods Patients (aged > 18 years) who underwent BCS for invasive or in situ cancer at two sites (2015–2017) were included. Data were retrieved from medical records and the Swedish National Breast Cancer Register. The primary endpoint was residual cancer cells in first re-excision, and secondary endpoints were locoregional recurrence-free interval (LRFi), distant recurrence-free interval, and breast cancer-specific survival. Results In total, 770 patients were included, of whom 132 (17.1%) had positive margins; 130/132 underwent re-excision, and residual cancer cells were detected in 80 (61.5%). Residual cancer cells were weakly and not significantly associated with histological subtype (ILC versus invasive carcinoma of no special type (NST)), but associated with number of positive margins, mammographic lesion size, and pathological extent (all P < 0.05). After a median follow-up time of 7.0 years, locoregional recurrence was diagnosed in 34/721 patients (4.7%). There was no evidence of a difference in LRFi by margin status, residual cancer cells, or histological subtype (all P > 0.4). Molecular subtypes and adjuvant therapies were associated with the risk of locoregional recurrence. Conclusion The presence of residual cancer cells in the first re-excision is not associated with locoregional recurrence risk and only weakly associated with ILC. Number of margins involved and lesion size are predictive of residual cancer cells and might support surgical decision-making at re-excision.