Background: The omission of axillary lymph node dissection (ALND) remains controversial for patients with residual axillary disease after neoadjuvant chemotherapy (NAC), regardless of the residual burden. This study evaluated the oncologic safety and factors associated with outcomes in patients with residual axillary disease. These patients were treated solely with sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD), without ALND, after NAC.Methods: A joint analysis of two different multicenter cohorts—the retrospective cohort registry MF18‐02 and the prospective observational cohort registry MF18‐03 (NCT04250129)—was conducted between January 2004 and August 2022. All patients received regional nodal irradiation.Results: Five hundred and one patients with cT1‐4, N1‐3M0 disease who achieved a complete clinical response to NAC underwent either SLNB alone (n = 353) or TAD alone (n = 148). At a median follow‐up of 42 months, axillary and locoregional recurrence rates were 0.4% (n = 2) and 0.8% (n = 4). No significant difference was found in disease‐free survival (DFS) and disease‐specific survival (DSS) rates between patients undergoing TAD alone versus SLNB alone, those with breast positive versus negative pathologic complete response, SLN methodology, total metastatic LN of one versus ≥2, or metastasis types as isolated tumor cells with micrometastases versus macrometastases. In the multivariate analysis, patients with nonluminal pathology were more likely to have a worse DFS and DSS, respectively, without an increased axillary recurrence.Conclusions: The omission of ALND can be safely considered for patients who achieve a complete clinical response after NAC, even if residual disease is detected by pathologic examination. Provided that adjuvant radiotherapy is administered, neither the SLNB method nor the number of excised LNs significantly affects oncologic outcomes.

Sentinel lymph node biopsy (SLNB) is widely used in patients who receive neoadjuvant chemotherapy (NAC). Still, axillary lymph node dissection (ALND) is recommended for patients with any axillary residual disease after NAC. The necessity of ALND in patients with minimal axillary disease is unclear. We aim to investigate regional recurrence rates in patients with limited axillary residual disease after NAC underwent SLNB + image-tailored axillary surgery and adjuvant radiotherapy (RT). Patients with clinical stages were T1-3 and N1 at the time of diagnosis, clinically good or complete axillary response after NAC, and limited axillary residue (≤ 3 pathological lymph nodes) with favorable response to NAC in the final pathological examination were included in the study. All patients underwent SLNB + image-tailored axillary surgery. Peripheral lymphatic radiotherapy was applied, and no further surgery was performed in patients with compatible radiology and pathology results. Our study, which evaluated 139 patients with a median age of 47 years, found that the median number of excised lymph nodes was 4. Notably, 46% of patients had between 1 and 3 lymph nodes excised, while 45% had between 4 and 6. Only 9% of patients had ≥ 7 lymph nodes. 83(60%) of the patients underwent breast-conserving surgery (BCS), and 56(40%) underwent mastectomy. The study’s median follow-up period was 44 months. During this duration, one breast recurrence (0.7%), one supraclavicular recurrence (0.7%), and six systemic recurrences (4.3%) were observed. No axillary recurrence occurred within the follow-up period. Patients presenting with pathological-suspicious ≤ 3 lymph nodes on imaging and showing a good response to NAC can be considered suitable candidates for SLNB + image-tailored axillary surgery, followed by adjuvant RT instead of ALND.

Background: Gynecomastia is a benign condition that develops due to the proliferation of breast tissue in men. Surgical excision is the most effective treatment method. Minimally invasive techniques can be used to avoid visible scarring. We evaluated the efficacy and safety of air-assisted subcutaneous mastectomy in the treatment of gynecomastia. Patient and Methods: 10 patients with gynecomastia underwent air-assisted subcutaneous mastectomy and liposuction through a single axillary incision, between June 2022 and February 2023. Demographic and clinical data of the patients, duration of surgery, and complications were recorded. The satisfaction levels of the patients regarding physical appearance, mental status, and social environment were measured. The body Q questionnaire was performed preoperatively and in the postoperative third month. Results: The median age was 26 (range, 18-54). Surgical excision was measured as a median of 69 gr (range, 41-177), and liposuction volume was measured as a median of 210 ccs (range, 63-400). The median operation time was 50 minutes (range, 21-60) for excision and 21 minutes (range, 20-75) for liposuction. Body, chest, and nipples related appearance satisfaction levels were measured preoperatively as a median of 44 (range, 36.5-52), 31 (range, 27.5-39), and 51.5 (range, 21-69.8) points vs postoperatively as 92 (range, 92-100), 93 (range, 93-94.8) and 90 (range, 90-100) points, respectively. The patients had a median follow-up of 6 months (range, 3-11). No complications were observed during the follow-up period. Conclusion: Air-assisted subcutaneous mastectomy and liposuction is a feasible technique that may provide good cosmetic outcomes by avoiding anterior chest wall scarring.

This study aims to develop and validate a multisequence MRI-based radiomics approach for distinguishing metaplastic breast cancer (MBC) from non-metaplastic triple-negative breast cancer (TNBC) at the initial diagnosis, which could facilitate optimal treatment selection. In this retrospective study, we analyzed 105 patients (27 MBC, 78 non-metaplastic TNBC) who underwent standardized breast magnetic resonance imaging (MRI), which included T1-weighted contrast-enhanced (T1W-CE) and short-tau inversion recovery (STIR) sequences. Two radiologists performed ground truth lesion segmentation, verified by a senior radiologist. We extracted 214 radiomic features (using PyRadiomics) and used least absolute shrinkage and selection operator (LASSO) regression for feature selection. Seven machine learning classifiers were thoroughly evaluated using five-fold cross-validation, with performance assessed through ROC analysis and accuracy metrics. The combined T1W-CE and STIR analysis demonstrated superior diagnostic performance for distinguishing MBC from non-metaplastic TNBC (AUC = 0.845; accuracy = 81%) compared with either sequence alone (T1W only AUC = 0.805; accuracy = 80%; STIR only AUC:0.768; accuracy = 77%). Multisequence MRI radiomics can reliably distinguish between MBC and TNBC at the time of initial diagnosis. This could potentially facilitate the selection of more appropriate treatments and help avoid ineffective chemotherapy for MBC patients.

Accuracy of Intraoperative Sentinel Lymph Node Evaluation by Imprint Cytology in Breast Cancer: A 12-Year Single Center Experience With 2,528 Patients - European Journal of Breast Health