To identify the predictive factors for axillary pathological complete response (apCR) in initially node-positive (cN+) breast cancer patients treated with neoadjuvant treatment (NAT).

Data of cN+ breast cancer patients treated with NAT at the Breast Department of Sichuan Cancer Hospital from June 2016 to April 2023 were retrospectively reviewed. Clinicopathological characteristics were compared between patients with and without apCR. Univariate and multivariate analyses were conducted for identifying the predictive factors for apCR.

A total of 486 patients were included and the overall apCR rate was 50.4% (245/486). In the univariate analysis, histological grade, estrogen receptor status, progesterone receptor status, human epidermal growth factor receptor 2 status, Ki-67 index, clinical response, and breast pathological complete response (bpCR) were associated with apCR (P<0.05). Multivariate analysis demonstrated that HER2 positivity (P<0.001), better clinical response, (P=0.047), and bpCR (P<0.001) were independent predictors of apCR. The area under the receiver operating characteristic curve of the prediction model of apCR in cN+ breast cancer patients treated with NAT was 0.793 (95% confidence interval: 0.753-0.833), with a sensitivity of 68.0% and specificity of 81.1%.

In cN+ breast cancer patients treated with NAT, those with HER2 positive disease, better clinical response, or bpCR have a lower risk of axillary residual disease, and can be candidates for de-escalating surgical research.

To analyze the ultrasound features of non-mass lesions (NMLs) of the breast by logistic regression, to establish a predictive model for the malignancy risk of NMLs in nomogram, and to improve the diagnostic ability of sonographers for NMLs.

The ultrasound image features of 493 cases of NMLs from 488 people in Xijing Hospital were retrospectively analyzed and divided into a training set and an internal validation set in a ratio of 7:3, and an independent external validation set of 72 cases from Taizhou Hospital in Zhejiang Province. The malignant risk factors of NMLs were screened out, a nomogram prediction model was constructed, and the model was evaluated using ROC and calibration curves.

Multifactorial analysis showed that calcification, structural distortion, age, and size were independent risk factors for malignancy in NMLs (P<0.05). The training set, internal validation set, and external validation set AUCs of the nomogram prediction model were 0.91, 0.89, and 0.94, respectively, with sensitivities of 86%, 86%, and 95%, and specificities of 80%, 77%, and 87%. The calibration curves of the model showed good agreement, with mean absolute errors of 0.014, 0.034, and 0.058, respectively.

The malignant risk nomogram prediction model constructed based on the independent risk factors mentioned above has a reliable clinical reference value, and it can assist sonographers in improving their diagnostic ability for NMLs.

To investigate the effect of using normal saline and guide wire as conductive media for intracavitary electrocardiogram-guided arm port implantation among breast cancer patients.

A total of 184 breast cancer patients who chose arm port as chemotherapy access were recruited at the Department of Thyroid Breast Surgery of Peking University First Hospital, and they were randomly divided into a guide wire electrode group and a liquid electrode group. The accuracy of catheter tip position, the occurrence rate of characteristic P wave, P wave height, QRS wave height, stability of electrocardiogram, nurse satisfaction, and length of operation were compared between two groups.

The accuracy of catheter tip position was 95.6% in the liquid electrode group, while it was 98.9% in the guide wire electrode group, without significant difference between the two groups (χ²=0.209, P=0.177). No significant difference was found in the occurrence rate of characteristic P wave, P wave height, QRS wave height, stability of electrocardiogram, nurse satisfaction, or length of operation between the two groups (P＞0.05).

It is recommended to use intracavitary electrocardiogram to guide tip position in arm port implantation. Both guide wire electrode and liquid electrode can lead to a success of the surgery. The intravenous specialist nurses can choose either of them according to their own habit and medium availability.

To assess the value of human epidermal growth factor receptor 2 (HER2) protein expression levels in predicting the efficacy of trastuzumab plus pertuzumab (HP) as a basic neoadjuvant therapy for HER2-positive breast cancer patients, so as to provide a basis for the rational selection of HER2-targeted therapy mode.

The clinical data of HER2-positive breast cancer patients who received neoadjuvant therapy with trastuzumab plus pertuzumab chemotherapy and underwent subsequent surgery at 11 tertiary hospitals in Hebei Province, including Baoding No.1 Central Hospital,,were retrospectively collected to analyze the association between HER2 expression levels and clinicopathological characteristics and total pathological complete response (tpCR) rate.

A total of 180 patients were enrolled, including 157 (87.2%) in the HER2 IHC3+ group and 23 (12.8%) in the HER2 IHC2+/FISH+ group. The tpCR rate in the HER2 IHC3+ group was significantly higher than that in the HER2 IHC2+/FISH+ group (65.0% vs 17.4%, P＜0.001). The expression levels of HER2 protein were related to hormone receptor (HR) status, and the positive rate of HR in the HER2 IHC2+/FISH+ group was significantly higher than that in the HER2 IHC 3+ group (87.0% vs 49.7%, P=0.001), and the expression levels of HER2 protein had no correlation with age, menstrual status, tumor size, lymph node status, tumor clinical stage, or Ki-67 proliferation index.

The expression level of HER2 protein in breast cancer has appreciated predictive value for the efficacy of neoadjuvant therapy with trastuzumab and pertuzumab in combination with chemotherapy, and HER2 IHC2+ patients have poor efficacy. It is necessary to explore anti-HER2-targeted therapy mode which is suitable for HER2 IHC2+ patients.

To explore the clinicopathological features and prognosis of breast cancer patients with primary lung cancer, in order to provide help for the diagnosis and differential diagnosis of such patients.

The clinicopathological data of breast cancer patients with or without primary lung cancer (double primary cancer group and breast cancer group) treated at the Fourth Hospital of Hebei Medical University from September 2009 to January 2021 were retrospectively analyzed, and differences were analyzed. Survival curves were drawn using the Kaplan-Meier method, and single-multivariate logistic regression analysis was used to explore the risk or protective factors for lung cancer in breast cancer patients. Single and multivariate Cox regression analyses were used to explore the risk or protective factors affecting the overall survival of patients.

The two groups of patients were matched using the propensity score matching method, including 40 patients in the double primary cancer group and 100 patients in the breast cancer group. There were significant differences in estrogen receptor (ER) expression, progesterone receptor (PR) expression, human epidermal growth factor receptor 2 (HER2) expression, and Ki67 expression between the two groups (P＜0.05). Single multivariate Logistic regression analysis showed that PR negativity, HER2 negativity, and low Ki67 expression were independent risk factors for lung cancer in breast cancer patients (P＜0.05). Survival curve analysis demonstrated that the overall survival of patients in the double primary cancer group was shorter than that of the breast cancer group. Multivariate Cox analysis demonstrated that tumor grade was an independent protective factor for the overall survival of patients (P＜0.05).

Breast cancer patients with PR-negative, HER2-negative, and low Ki67 expression have a higher probability of developing primary lung cancer. N stage, M stage, tumor stage, tumor grade, and ER negativity are risk factors affecting the overall survival of these patients. The above factors may play an important role in the dual primary breast cancer and lung cancer.

Breast cancer is the malignant tumor with the highest incidence in the world. At present, breast cancer treatment has entered the era of classified treatment guided by molecular markers. Androgen receptor (AR) is a commonly expressed molecular marker in breast cancer, which regulates breast cancer cell activities. In clinical practice, AR expression has an appreciated correlation with the prognosis of breast cancer patients, and AR-targeted therapy and related combination therapies are under investigation. This article summarizes the application of AR in breast cancer from the aspects of mechanism, expression and clinical value, and related therapies, by reviewing the relevant literature in recent years.

Breast cancer is a common malignant tumor with significant heterogeneity. After standard treatment, most patients have a good prognosis, but there are still some breast cancer cases with rapid progression and poor prognosis, especially triple negative breast cancer. Therefore, some new treatment strategies are required. Trophoblast cell surface antigen 2 (Trop2) has a high expression rate in breast cancer and may become a potential therapeutic target. At present, there are some developments in drug research and tumor treatment, and some have been approved for clinical application, especially anti-Trop2 antibody–drug conjugate drugs. This article will review the biological function of Trop2 and the latest progress in the anti-Trop-2 targeted treatment of breast cancer.

Because of the physiological changes and the possible affection of diagnostic and treatment measures, the clinical management of breast cancer during pregnancy and lactation is unique and complex. However, there is only little related research and no standardized clinical diagnosis and treatment procedures exist in China. Therefore, the Chinese Society of Breast Surgery evaluated the level of evidence in clinical research of breast cancer during pregnancy and lactation by referring to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Based on the currently available high-quality level Ⅰ or Ⅱ evidence, the clinical characteristics of patients, and the accessibility of the clinical practice of breast surgery, the Clinical Practice Guideline for Breast Cancer during Pregnancy and Lactation 2022 was formulated. This article interprets the basic contents of the guidelines to provide reference for the clinical work of breast surgeons in China.

With the reformation of axillary management for patients with newly diagnosed breast cancer, imaging only being used for diagnosis of lymph node metastases hardly meets the requirement of clinical need. The role of imaging is to assess the axillary nodal involvement at baseline, to monitor the in vivo nodal response to drug therapy, and finally to help determine the surgical technique to perform based on the final imaging findings after systemic neoadjuvant treatment. This paper briefly introduces the imaging features of metastatic lymph nodes in breast cancer, the relative advantages and limitations of various imaging methods, and reviews the important clinical trials involving axillary management of breast cancer.

To evaluate the efficacy and safety of trastuzumab and pertuzumab combined with chemotherapy in neoadjuvant therapy for human epidermal growth factor receptor 2 (HER2) positive breast cancer.

A retrospective study was performed on cases of HER2-positive breast cancer treated with neoadjuvant therapy at Peking University Shenzhen Hospital from January 2019 to December 2021. The patients were divided into two groups to receive either the TCbHP regimen or the EC-THP regimen for neoadjuvant chemotherapy, respectively. All patients underwent neoadjuvant and surgical treatment. The clinicopathological parameters were compared between patients with pathological complete response (pCR) and those with non-complete response (non-PCR) after neoadjuvant chemotherapy.

The mean age of the patients was (45.22±9.17) years. Twenty-five patients received the TCbHP regimen and 24 received the EC-THP regimen. The overall pCR rate was 65.3% (32/49). The pCR rate was 76.0% (19/25) among patients receiving the TCbHP regimen and 54.2% (13/24) among those receiving the EC-THP regimen (P＞0.05). The proportion of patients with positive ER and PR status in the PCR group was lower than that of the non-PCR group after neoadjuvant chemotherapy (P＜0.05 for both), though there was no significant difference in age, tumor stage, Ki67 index, molecular type, or chemotherapy regimens between the two groups (P＞0.05 for all). There were significant differences in ER status and molecular type between the TCbHP regimen group and EC-THP regimen group (P＜0.05 for both). Compared with the EC-THP group, the incidence of thrombocytopenia and renal injury was higher in the TCbHP group (P＜0.05 for both), but there was no significant difference in the incidence of other adverse events between the two groups (P＞0.05 for all).

Both the TCbHP and EC-THP regimens may be useful neoadjuvant treatments for HER2-positive breast cancer. The pCR rate to the TCbHP regimen was higher than that to the EC-THP regimen. The incidence of thrombocytopenia and renal injury is higher in the TCbHP regimen. Both regimens have very good cardiac safety.

To investigate the significance of sentinel lymph node (SLN) biopsy (SLNB) using contrast-enhanced ultrasonography (CEUS) combined with blue dye in neoadjuvant-treated human epidermal growth factor receptor 2 (HER2)-positive or triple-negative breast cancer with initially biopsy-proven nodal metastasis.

From June 2020 to April 2022, HER2-positive or triple negative breast cancer patients with baseline stage cT1~3N1M0 and negative axillary status after neoadjuvant therapy were prospectively included at Sichuan Cancer Hospital. All the patients received SLNB and subsequent axillary lymph node dissection. SLNB was conducted using CEUS combined with blue dye. Using the final pathological results as the golden standard, the detection rate, sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and false negative rate (FNR) of the combination method were calculated.

Twenty-nine patients were included, with a median age of 51 years (range, 28-64 years); 24 cases were HER2 positive and 5 were triple-negative. The overall rate of axillary pathological complete response was 72.4% (21/29). The detection rate of the combination method was 96.6% (28/29). Twenty-eight patients underwent SLNB successfully using the combination method. Compared with the pathological diagnosis, the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and FNR of the combination method were 100% (7/7), 100% (21/21), 100% (7/7), 100% (21/21), 100% (28/28), and 0% (0/7), respectively.

The combination of CEUS with blue dye for SLNB has a meaningful detection rate and FNR in neoadjuvant-treated HER2-positive or triple-negative breast cancer with initial nodal involvement.

To investigate the adverse events of trastuzumab (H) + pertuzumab (P) combined with taxanes (T) + carboplatin (C) (TCHP) neoadjuvant therapy in patients with human epidermal growth factor receptor 2 (HER2) positive breast cancer.

The clinical data of patients with HER2 positive breast cancer who received neoadjuvant therapy with the TCHP regimen and underwent surgery at the Breast Disease Center of Peking University First Hospital from March 2019 to October 20120 were analyzed retrospectively. The TCHP regimen was repeated every 21 days and granulocyte colony stimulating factor (G-CSF) was used prophylactically. A retrospective analysis of the adverse events was conducted during the treatment period. Adverse events were evaluated with Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Full-time clinical pharmacists were responsible for following, recording, and evaluating the adverse reactions in each cycle.

A total of 56 patients were included in the analysis; all of them were female. The average age was 48 years (range, 24-68 years), and the average number of treatment cycles were 3.7. Among the patients included, only one had no adverse events related to the TCHP regimen, and the patient was followed for only one cycle. Overall, the incidence of treatment-related adverse events was 98.2% (55/56), and the incidence of grade adverse events of grade 3 or above was 35.7% (20/56). Adverse events with a high incidence are listed as follows: diarrhea (49/56, 87.5%), fatigue (47/56, 83.9%), nausea (44/56, 78.5%), anorexia (37/56, 66.0%), and constipation (34/56, 60.7%). Under the monitoring and follow-up by pharmacists and doctors, the patients were treated with G-CSF every cycle, and the incidence of leukopenia and neutropenia was low.

The incidence of adverse events in breast cancer patients who receive the TCHP regimen is high. The common adverse events associated with this regimen are diarrhea, fatigue, nausea, anorexia, and constipation. Treatment-related adverse events of grade 3 or above include anorexia, nausea, diarrhea, and neutropenia.

To explore the relationship of the expression of CK5/6 with clinicopathological features, prognosis, and efficacy of neoadjuvant chemotherapy (NAC) in triple-negative breast cancer (TNBC).

A retrospective analysis for CK5/6 expression, clinicopathological features, prognosis, and efficacy of NAC was performed on 452 patients treated at Peking University First Hospital from 2009 to 2020 with non-metastatic breast cancer who were confirmed to be triple-negative by pathological examination and had relatively complete clinicopathological data.

The age of the patients ranged from 21 to 88 years (mean age, 52.9 years). The positive rate of CK5/6 in the overall group of patients was 65.3%, and early stage, higher histological grade, and Ki67 expression were factors related to higher CK5/6 expression. There was no significant correlation between CK5/6 expression and pathological complete response rate (pCR), event-free survival (EFS), and breast cancer-specific survival (BCSS). The pCR rate in CK5/6-positive patients was 27.5%. The 3-year and 5-year EFS rates were 86.1% and 84.1%, respectively; the 3-year and 5-year BCSS rates were 94.3% and 91.1%, respectively. EFS and BCSS were higher in CK5/6-positive patients treated with platinum-based neoadjuvant chemotherapy.

CK5/6 is an important biomarker of TNBC, whose expression is correlated with histological grade and tumor proliferation ability, but it has no significant correlation with prognosis. CK5/6 positivity may be associated with the benefit of platinum-based chemotherapy.

To retrospectively assess the efficacy and safety of short-term filgrastim in supporting dose-dense neoadjuvant chemotherapy (ddEC) for primary breast cancer based on a single database, in order to examine the feasibility of this method.

Data of patients who received dose-dense neoadjuvant chemotherapy with support of short-term filgrastim at Peking University Cancer Hospital Breast Cancer Prevention and Treatment Center from July 2015 to June 2018 were retrospectively collected. All of these patients were planned to receive four cycles of ddEC (Epirubicin 100 mg/m² and cyclophosphamide 600 mg/m²) with the usage of rhG-CSF as follows: Filgrastim 200-300 μg/d on days 4, 6, 8, and 10. The relative dose intensity (RDI) was calculated based on chemotherapy delay and the number of dosage reductions, as well as febrile neutropenia (FN).

A total of 301 patients were enrolled in this study. Chemotherapy induced neutropenia related chemotherapy delay occurred in 15 patients (5.0%; 95% confidence interval [CI]: 2.5%~7.5%), 289 patients achieved an RDI≥85% (96%; 95CI: 93.8%~98.2%), and FN occurred in 14 patients (4.7%; 95%CI: 2.3%~7.1%).

According to this study, short-term filgrastim is feasible in supporting four cycles of neoadjuvant chemotherapy for primary breast cancer.

To study the value in the diagnosis of benign and malignant nodules of shear wave elastography (SWE) in the surrounding tissues of the breast.

Female patients who underwent needle biopsy or surgery for breast masses in the Fourth Affiliated Hospital, Zhejiang University School of Medicine from January 2020 to December 2020 were selected. They were performed SWE inspection and got the average (E-mean), maximum (E-max), minimum (E-min) and standard deviation (E-SD) of Young's modulus inside the mass. Then, we started the "shell" function and adjusted the "shell" value to 0.5 mm, 1 mm, and 2 mm successively to obtain E-mean, E-max, E-min and E-SD of 0.5 mm, 1 mm, 2 mm around the mass. According to the final pathology results, the four sets of data were compared and the ROC curves were drawn.

A total of 68 patients with 76 lesions were included. Pathologically, among 76 masses, there were 44 benign masses and 32 malignant masses. E-mean, E-max and E-SD of 0.5 mm, 1 mm, 2 mm around and inside the malignant mass were higher than those of benign masses. The difference was statistically significant (P＜0.05). There was no significant difference in E-min between benign and malignant tumors within and 0.5mm, 1mm, and 2mm around the tumor (P＞0.05). According to the ROC curve separately, it could be seen that the best cut-off values of E-mean, E-max and E-SD inside the tumor for diagnosing benign and malignant tumors were 35.14 kPa, 80.46 kPa, 11.67 kPa, respectively. At this time, the AUC were 0.785, 0.824, 0.801, respectively. The best cut-off values of E-mean, E-max, and E-SD in the 0.5 mm area around the mass for diagnosing benign and malignant masses were 39.44 kPa, 86.15 kPa, and 14.02 kPa, respectively. At this time, the AUC were 0.770, 0.835, 0.817, respectively. The best cut-off values of E-mean, E-max, and E-SD in the 1mm area around the tumor for diagnosing benign and malignant tumors were 41.68 kPa, 90.46 kPa, and 15.98 kPa, respectively. At this time, the AUC were 0.806, 0.886, 0.825, respectively. The best cut-off values of E-mean, E-max, and E-SD in the 2mm area around the mass for diagnosing benign and malignant masses were 44.16 kPa, 95.45 kPa, and 16.81 kPa, respectively. At this time, the AUC were 0.821, 0.926, 0.842, respectively. Combining all the data, the AUC of E-max in the 2 mm area around the mass was the largest and the diagnostic value was the highest. At this time, the sensitivity was 93.75% and the specificity was 93.18%.

The effectiveness of SWE in the diagnosis of benign and malignant nodules in the surrounding tissues of the breast is higher than that of the internal tissues. Among them, when the "shell" takes 2 mm, the diagnostic efficiency is the highest and E-max is used as the diagnostic parameter.

To explore the therapeutic effect of home-based rehabilitation exercise on postoperative lymphedema in patients with breast cancer.

Eighty breast cancer patients with postoperative lymphedema at Department of Cancer Chemotherapy, Haikou Hospital, Xiangya School of Medicine, Central South University from October 2021 to April 2019 were selected and randomly divided into either a control group or an exercise group. The control group was subjected to usual self-care, and the exercise group underwent home-based rehabilitation exercise on the basis of usual self-care. The therapeutic effect of rehabilitation exercise on lymphedema was evaluated by measuring the size of arm circumference, volume difference between affected limbs, range of motion of the shoulder joint, arm muscle strength, quality of life, and other indicators.

After at least 6 weeks of intervention and rehabilitation, compared with the control group, the arm circumference size and arm volume decreased significantly in the exercise group (P＜0.05). The recovery of shoulder motion range in the exercise group was significantly better than that of the control group (P＜0.05). In addition, the muscle strength levels of the flexor, abductor, external pronator, internal pronator, and horizontal adductor were significantly increased in the exercise group (P＜0.05). The exercise group had improved quality of life in all dimensions, according to Functional Assessment of Cancer Therapy-Breast assessment.

Rehabilitation exercise is safe and effective in the treatment of postoperative lymphedema in breast cancer patients, which provides a reference for home-based rehabilitation exercise in the treatment of lymphedema after breast cancer surgery.

To investigate the changing trends and influencing factors of chemotherapy-induced taste alteration in breast cancer patients, in order to provide a reference for the formulation of targeted intervention measures.

A prospective longitudinal design was used to recruit 90 breast cancer patients undergoing chemotherapy at a tertiary hospital in Beijing. Assessments were performed before the first cycle, before the second cycle, and before the last cycle with the chemotherapy-induced taste alteration scale. Generalized estimating equations were used to analyze the changing trends of taste alteration during chemotherapy, and the influencing factors of taste alteration.

Eighty-nine patients were included in this study, with an average age of (53.5±9.4) years, of whom 26 (29.21%) underwent neoadjuvant chemotherapy and 63 (70.79%) underwent adjuvant chemotherapy. The scores of taster alteration were (18.69±1.59), (22.53±4.24), and (25.14±5.68) before the first cycle, before the second cycle, and before the last cycle, respectively. Results of generalized estimating equations showed that the taster alteration score, general taste alteration score, and basic taste score were getting worse with the prolongation of chemotherapy (P＜0.01). The scores of phantogeusia, parageusia, and discomfort were significantly increased after the first cycle (P＜0.01), but there was no obvious increase during chemotherapy (P＞0.05). Age and chemotherapy regimen were related to the taste alteration score.

Breast cancer patients experience gradually worsening taste changes during chemotherapy, and age and chemotherapy regimen are the influencing factors of taste changes related to chemotherapy. It is suggested that more attention be paid to the health education and intervention of taste change, in order to reduce the taste change in breast cancer patients undergoing chemotherapy.

To explore the effect of scalp cooling caps in preventing alopecia in breast cancer patients undergoing chemotherapy.

From January 2020 to December 2020, 202 breast cancer patients on chemotherapy were recruited in a tertiary hospital in Beijing, of whom 127 were included into an intervention group wearing scalp cooling cap during chemotherapy, and 75 was used as a control group to receive routine care. Photographs of the anterior, posterior, lateral, and top aspects of the head were taken before the first cycle and the last cycle of chemotherapy. The study nurses, who were not aware of the group of patients, assessed the degree of alopecia according to the toxicity classification criteria of the World Health Organization (WHO) for anti-cancer drugs before the last cycle of chemotherapy.

Before the last cycle of chemotherapy, there were 86 cases (67.7%) without hair in the intervention group and 12 cases (16.0%) in the control group; the difference was significant (P＜0.001). The effective rate of wearing scalp cooling cap to alleviate hair loss in patients in the intervention group on different chemotherapy regimens was 60.9%-73.9%.

Wearing scalp cooling caps could effectively alleviate hair loss of breast cancer patients undergoing chemotherapy,and it is easy for the medical staff to operate, showing strong advantages in the clinical practice.