Evaluating the Role of Artificial Intelligence in Enhancing Multidisciplinary Team Decisions for Breast Cancer Management - European Journal of Breast Health

Modified radical mastectomy (MRM) is associated with persistent psychological and physical sequelae in geriatric breast cancer survivors. This study examin

Background/Objectives: We compared the prognostic performance of preoperative prognostic nutritional index (PNI) and Gustave Roussy Immune Score (GRIm-s) after curative-intent gastrectomy. Methods: This retrospective cohort included 168 patients, including five postoperative in-hospital deaths. Continuous PNI and ordinal GRIm-s were compared using censoring-adjusted time-dependent AUC and concordance, with paired bootstrap confidence intervals. Preoperative prediction models underwent bootstrap internal validation; restricted mean survival time and time-varying Cox analyses addressed non-proportional hazards. Results: There were 92 deaths and 107 disease-free survival (DFS) events. At 36 months, overall survival (OS) AUC was 0.659 for PNI and 0.527 for GRIm-s (difference 0.132, 95% CI 0.039–0.226); corresponding DFS values were 0.650 and 0.516 (difference 0.134, 95% CI 0.035–0.228). After optimism correction, preoperative PNI-model AUCs were 0.610 for OS and 0.595 for DFS. PNI associations weakened over time. The cohort-derived 49.6 threshold was used only in secondary exploratory analyses. Conclusions: PNI showed better unadjusted discrimination than GRIm-s at three years, but modest internally validated model performance limits clinical interpretation. These findings do not establish clinical utility, a validated cutoff, or a substitute for pathological assessment. External validation is required.

Axillary lymph node dissection (ALND) is associated with a high risk of lymphedema. We assessed whether routine indocyanine green (ICG)-guided axillary reverse mapping (ARM) reduces the incidence and severity of lymphedema after ALND, while maintaining long-term oncological safety, in a propensity-matched cohort. In this retrospective study conducted between 2019 and 2024, 121 women undergoing ALND for invasive breast cancer were divided into an ARM group (n=62, from 2022 onward) and a non-ARM group (n=59). Lymphedema was assessed by blinded nurses using the Frustum formula (≥10% and ≥5% inter-limb volume difference) and International Society of Lymphology (ISL) staging at 3, 6, 12, 24, 36, 48, and 60 months. Propensity score matching (1:1) was used to balance age, BMI, neoadjuvant therapy, stage, surgery type, surgeon, and pandemic period (standardized mean difference <0.08). Sensitivity analysis was performed using inverse probability of treatment weighting (IPTW). Oncological safety was evaluated through histopathology of ICG-positive nodes and recurrence monitoring over a median follow-up of 54 months (IQR 36–72). After matching, the 60-month lymphedema incidence (≥10% threshold) was 8.1% in the ARM group versus 39.0% in the non-ARM group (p<0.001), yielding an absolute risk reduction of 30.9% and a number needed to treat of 3.2. Severe lymphedema (ISL stages 2–3) occurred in 6.5% versus 30.5% (p<0.001). Lymphedema-free survival significantly favored the ARM group (log-rank p=0.0003). Adjusted Cox regression demonstrated an 82% lower risk (hazard ratio 0.18, 95% CI 0.07–0.45; p<0.001; concordance 0.78), with robustness confirmed by IPTW (hazard ratio 0.20, p<0.001). No recurrences were observed (0/121; upper 95% CI 2.5%) over 54 months, despite 59% of patients having stage III disease. Routine ICG-guided ARM was associated with an 82% reduction in clinically significant lymphedema and appears oncologically safe over 54 months—the longest follow-up reported in a middle-income setting. Prospective randomized trials are warranted.

Background: Breast cancer-related lymphedema (BCRL) is one of the most debilitating long-term morbidities after axillary lymph node dissection (ALND), severely impairing quality of life through reduced mobility, independence, and chronic burden, especially in older women. Axillary reverse mapping (ARM) aims to preserve upper extremity lymphatics while maintaining oncologic safety. Evidence in older adult populations with long-term follow-up remains limited. Methods: This retrospective cohort study included 138 female patients (median age 72.5 years) undergoing ALND for invasive breast cancer between January 2018 and January 2024. Patients were divided into ARM (n = 72) and non-ARM (n = 66) groups. BCRL was graded 0–3 according to adapted International Society of Lymphology (ISL) criteria (2013 consensus document). Assessments were performed preoperatively and at 3, 6, 12, 24, 36, 48, and 60 months using blinded circumference measurements and bioimpedance spectroscopy. Results: Baseline characteristics were comparable. Mean follow-up was 46.5 ± 8.8 months. Clinically relevant BCRL (Grades 2–3) was dramatically lower in the ARM group (18.1% vs. 60.6%, p < 0.0001), while subclinical changes (Grade 1) were similar (31.9% vs. 27.3%, p = 0.55). Kaplan–Meier analysis showed significantly better clinically relevant lymphedema-free survival with ARM (log-rank p = 0.00019), with curve separation after 30–40 months—indicating a sustained long-term benefit for quality of life in this frail population. Recurrence rates were comparable (8.3% vs. 10.6%, p = 0.776). Multivariable Cox regression confirmed ARM as an independent protective factor (adjusted HR 0.22, 95% CI 0.11–0.44, p < 0.0001). Conclusions: In older women with breast cancer, ARM significantly reduces clinically relevant lymphedema—a major determinant of long-term quality of life—without compromising oncologic safety. These findings support the routine consideration of ARM during ALND to preserve upper-extremity function, mobility, and independence in this vulnerable population, thereby balancing aggressive oncologic treatment with enhanced long-term quality of life and reduced treatment-related morbidity.

Background: Radiotracer- and magnetic seed-based targeted axillary staging techniques are increasingly used after neoadjuvant chemotherapy (NAC) in patients with initially node-positive breast cancer who convert to clinical node-negative (ycN0) status. However, these technologies remain unavailable in many centres worldwide. We evaluated the effectiveness of radiotracer-free axillary staging using dual-tracer sentinel lymph node biopsy (SLNB) with indocyanine green (ICG) and methylene blue, with particular focus on the clinical implications of clipped node non-retrieval. Methods: This retrospective single-centre cohort study included 49 patients with biopsy-proven cN1 breast cancer who achieved ycN0 status following NAC and underwent dual-tracer SLNB using ICG and methylene blue between 2021 and 2024. Clipped node retrieval rates, tracer-specific detection patterns, recurrence outcomes, and disease-free survival (DFS) were analysed. Clinical outcomes, including recurrence and disease-free survival, were compared between patients with successful and unsuccessful clipped node retrieval. Results: Clipped node retrieval was achieved in 41 of 49 patients (83.7%). ICG outperformed methylene blue for clipped node identification (80.5% vs. 61.0%) and was the sole detecting tracer in 39.0% of cases. Using methylene blue alone would have reduced the retrieval rate to 51.0% (p = 0.001). ICG identified the clipped node in all six patients with axillary micrometastases (ypN1mi). Clipped node non-retrieval occurred in eight patients, all of whom had negative SLNB findings and did not undergo completion axillary lymph node dissection. Recurrence rates were similar between the retrieval and non-retrieval groups (17.1% vs. 12.5%, p = 1.000), and no isolated axillary recurrences were observed. Baseline tumour size was the only independent predictor of disease-free survival in multivariable analysis (HR 2.05, 95% CI 1.20–3.51; p = 0.008). Conclusions: Radiotracer-free axillary staging using ICG and methylene blue achieved a high clipped node retrieval rate in patients with ycN0 breast cancer after neoadjuvant chemotherapy. ICG significantly improved clipped node identification compared with methylene blue alone and identified the clipped node in all patients with residual nodal micrometastatic disease. Among patients with negative SLNB findings, clipped node non-retrieval was not associated with higher recurrence rates or worse disease-free survival during follow-up. However, given the small number of clipped node non-retrieval cases (n = 8) and recurrence events (n = 8), these findings should be interpreted with caution and require confirmation in larger prospective studies. These findings support the feasibility of a radiotracer-free dual-tracer approach in settings where radiotracer-based techniques are not available. Prospective multicentre studies are warranted to validate both the oncological performance of radiotracer-free axillary staging and the clinical implications of clipped node non-retrieval.