Re-Excision After Positive Margins in Breast-Conserving Surgery: Can a Risk-Based Strategy Avoid Unnecessary Surgery?

Re-excision after breast-conserving surgery (BCS) is routinely recommended when positive margins are found. However, secondary surgery often reveals no residual disease, exposing patients to unnecessary interventions that compromise cosmetic outcomes, increase costs, and reduce quality of life. This study investigates clinicopathological predictors of a residual tumour to identify low-risk patients who may safely avoid re-excision.

Prepectoral Breast Reconstruction: Early and Long-term Complications and Outcomes of Total Coverage ADM and Implants vs Polyurethane-Coated Implants Without Use of Acellular Dermal Matrix.

Background: Immediate prepectoral breast reconstruction (IPBR) has emerged as a prominent alternative to subpectoral techniques, offering favorable outcomes in selected patients. Among available options, implant coverage with acellular dermal matrix (ADM) and the use of polyurethane (PU)-coated implants without ADM represent two widely adopted strategies.

Objectives: The aim of this study was to examine the comparative efficacy and complication profiles of implant coverage with acellular dermal matrix (ADM) and the use of polyurethane (PU)-coated implants without ADM.

The e-BRAVE study: A prospective web-based cohort and biobank of women carriers of BRCA mutations.

Background: Women carriers of mutations face a very high lifetime risk (penetrance) of developing breast and/or ovarian cancer. A sizeable proportion of carriers, however, does not develop cancer at all or develop it only late in life, thus suggesting a potential modulation of this risk. Epidemiological studies have suggested that other genetic (polymorphisms) and environmental factors (lifestyle) affect penetrance.

Immediate Breast Reconstruction with Prepectoral Polyurethane-Covered Implant After Conservative Mastectomy in Large and Ptotic Breasts.

Introduction: Immediate breast reconstruction in patients with large and ptotic breasts represents a significant challenge due to the presence of skin redundancy and potential uncertain vascularization. This study investigates an innovative approach of performing immediate reconstruction using prepectoral polyurethane-covered (PU) implants after nipple-sparing mastectomy (NSM) or skin-sparing mastectomy (SSM) with the aim of avoiding potential complications related to skin-reducing approaches and enhancing cosmetic outcomes.

Materials And Methods: This retrospective study analyzed 62 patients who underwent NSM or SSM followed by immediate prepectoral reconstruction with polyurethane-covered implants between December 2018 and May 2024.

Long term outcomes of breast primary sarcomas and malignant phyllodes tumors: 20 years observational analysis of the BEAM∗ study group. (∗the breast European association for mesenchymal tumors).

Background: Primary breast sarcomas (PBS) and malignant phyllodes tumors (MPT) represent less than 1 % of breast malignancies. Current evidence relies on heterogeneous retrospective series, resulting in controversial therapeutic approaches. This study aimed to analyze long-term outcomes in a large multicentric cohort treated with consistent strategies.

Use of membrane lipidome, body weight, and composition in stratification of early breast cancer patients.

Fat quality and quantity have a strong impact on cancer metabolism, however, in oncology practice, only body mass index (BMI) is evaluated. The observational prospective study performed at Fondazione Policlinico Gemelli explored the combination of membrane lipidome, BMI, and body composition, together with nutritional information, as evaluation criteria of fifty newly diagnosed early breast cancer patients (BRECALIP study). The fatty acid content of red blood cell membrane phospholipids, dividing patients by the BMI, individuated normal weight subjects for their molecular signatures different from the other groups, pointing to increased membrane fluidity and inflammation (saturated fatty acid decrease, omega-6 fatty acid increase), known to sustain cancer proliferation.

Predictive risk factors of recurrence in breast cancer after neoadjuvant treatment: the NEORISK study.

Background: Neoadjuvant chemotherapy (NACT) improves oncologic and cosmetic outcomes in breast cancer (BC), yet recurrence remains a concern. This study identifies factors associated with recurrence at 3 and 5 years in BC patients receiving NACT.

Methods: A retrospective analysis of 933 stage I - III BC patients (2014-2021) evaluated event-free survival (EFS) predictors using multivariate analyses.

Personalizing Neoadjuvant Chemotherapy: The Impact of BRCA Variants on Pathologic Complete Response in Luminal B Breast Cancer.

: Neoadjuvant chemotherapy (NACT) is effective in downstaging locally advanced breast cancer, improving surgical and oncological outcomes. However, luminal B breast cancer typically exhibits a poorer response to NACT, with only 10-15% of patients achieving a pathologic complete response (pCR). This study investigates whether BRCA pathogenic variants (BRCA PVs) influence pCR rates in luminal B breast cancer patients, aiming to identify potential predictors for personalized treatment strategies.

Simultaneous integrated boost intensity-modulated radiotherapy for treatment of bone metastases: analysis of a breast cancer cohort.

Background: Bone metastases occur in up to 75% of metastatic breast cancer (MBC) cases. Advances in imaging now allow earlier detection, even during the oligometastatic phase. Radiotherapy (RT) is increasingly used in asymptomatic patients with ≤5 bone lesions, however standardised guidelines for dose and target volumes remain lacking.

Malignant Mesenchymal Tumors of the Breast: Current Challenges and New Perspectives on Primary Sarcomas and Malignant Phyllodes Tumors.

Mesenchymal tumors of the breast constitute a rare and heterogeneous group of neoplasms, representing only 0.5% to 1% of all breast tumors. Originating from mesenchymal tissues, these tumors include various histological subtypes.

Activity and Efficacy of Neoadjuvant Chemotherapy in Luminal-HER2 Negative Early Breast Cancer According to HER2 Score (Low vs. Score 0): A Retrospective Study.

Background: The predictive and prognostic role of HER2 status in patients with luminal-HER2 negative early breast cancer (BC) undergoing neoadjuvant chemotherapy is unclear. A retrospective analysis evaluating the correlation between HER2 status (low vs. score 0) and pCR/IDFS was conducted.

Oncological Safety of Prepectoral Implant-Based Breast Reconstruction After Conservative Mastectomy: Insights from 842 Consecutive Breast Cancer Patients.

Background: Implant-based breast reconstruction (IBBR) following conservative mastectomy is the most common approach for women undergoing breast cancer surgery. The aim of this study was to compare the oncological outcomes of conservative mastectomy combined with prepectoral IBBR to the subpectoral technique.

Methods: The clinical and demographic data of consecutive breast cancer patients who underwent conservative mastectomy with either prepectoral or subpectoral IBBR between January 2018 and December 2023 were retrospectively analyzed.

Personalizing Breast Cancer Surgery: Harnessing the Power of ROME (Radiological and Oncoplastic Multidisciplinary Evaluation).

Breast cancer treatment has evolved significantly in recent decades, with personalized care models gaining prominence both for the optimization of oncological outcomes and aesthetic results. At the Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome, Italy, we have developed a multidisciplinary, evidence-based model for the management of breast cancer patients, called ROME (Radiological and Oncoplastic Multidisciplinary Evaluation). This innovative model integrates the expertise of various specialists in a seamless, patient-centered approach to improve treatment planning and outcomes.

Advancing Breast Cancer Care in Patients Aged 80 and Above: A Personalized and Multidisciplinary Management to Better Outcomes.

Breast cancer in women aged 80 years and older accounts for about 12% of cases, but its management is challenging due to the population's heterogeneity and the lack of relevant evidence-based guidelines. Treatment decisions must consider biological age, comorbidities, life expectancy, therapy-related toxicities, and tumor biology. This study evaluates the clinical outcomes of elderly breast cancer patients treated with a multidisciplinary approach, including oncologists, surgeons, and geriatric specialists.

Role of radiomics in predicting early disease recurrence in locally advanced breast cancer patients: integration of radiomic features and RECIST criteria.

Background: Breast cancer (BC) is a major global health issue with significant heterogeneity among its subtypes. Neoadjuvant treatment (NAT) has been extended to include early BC patients, particularly those with HER2 + and triple-negative subtypes, to achieve pathological complete response and improve long-term outcomes. However, disease recurrence remains a challenge, highlighting the need for predictive biomarkers.

Surgery of the Primary Tumor in de novo Metastatic Breast Cancer: A Palliative Approach or a Potential Survival Game-Changer?

Approximately 5-10% of primary breast cancer cases present as de novo stage IV disease, characterized by distant metastases at diagnosis. Traditionally, systemic therapies such as chemotherapy, endocrine therapy and targeted treatments have formed the cornerstone of treatment for metastatic breast cancer (MBC), focusing on disease control, symptom palliation and quality of life improvement. While systemic therapies remain crucial, the role of local treatments, particularly surgery for the primary tumor, is increasingly debated.

The LYMPH trial: comparing microsurgical with conservative treatment for chronic breast cancer-associated lymphoedema - study protocol of a pragmatic randomised international multicentre superiority trial.

Introduction: Up to one-fifth of breast cancer survivors will develop chronic breast cancer-related lymphoedema (BCRL). To date, complex physical decongestion therapy (CDT) is the gold standard of treatment. However, it is mainly symptomatic and often ineffective in preventing BCRL progression.

Accessible model predicts response in hormone receptor positive HER2 negative breast cancer receiving neoadjuvant chemotherapy.

Hormone receptor-positive/HER2-negative breast cancer (BC) is the most common subtype of BC and typically occurs as an early, operable disease. In patients receiving neoadjuvant chemotherapy (NACT), pathological complete response (pCR) is rare and multiple efforts have been made to predict disease recurrence. We developed a framework to predict pCR using clinicopathological characteristics widely available at diagnosis.

Navigating the Uncertainty of B3 Breast Lesions: Diagnostic Challenges and Evolving Management Strategies.

B3 breast lesions, classified as lesions of uncertain malignant potential, present a significant diagnostic and therapeutic challenge due to their heterogeneous nature and variable risk of progression to malignancy. These lesions, which include atypical ductal hyperplasia (ADH), papillary lesions (PLs), flat epithelial atypia (FEA), radial scars (RSs), lobular neoplasia (LN), and phyllodes tumors (PTs), occupy a "grey zone" between benign and malignant pathologies, making their management complex and often controversial. This article explores the diagnostic difficulties associated with B3 lesions, focusing on the limitations of current imaging techniques, including mammography, ultrasound, and magnetic resonance imaging (MRI), as well as the challenges in histopathological interpretation.

Real life outcome analysis of breast cancer brain metastases treated with Trastuzumab Deruxtecan.

Tumor dissemination to the central nervous system (CNS) is almost a rule in the treatment journey of advanced HER2+ breast cancer (BC). Recent results demonstrated high intracranial efficacy with Trastuzumab Deruxtecan (T-DXd). However, a real-world evidence is lacking in literature.

Assessing Malignant Risk in B3 Breast Lesions: Clinical Insights and Implications.

: B3 breast lesions, characterized by uncertain malignant potential, pose a significant challenge for clinicians. With the increasing use of preoperative biopsies, there is a need for careful management strategies, including watchful waiting, vacuum-assisted excision (VAE), and surgery. This study aims to assess the concordance between preoperative biopsy findings and postoperative histology, with a focus on evaluating the positive predictive value (PPV) for malignancy in B3 lesions.