Intraoperative ultrasound (IOUS), also potentially as contrast-enhanced (CE)-IOUS, is a versatile tool for surgical decision-making. It enhances intraoperative orientation, enables precise resection guidance and helps prevent complications and follow-up procedures; however, in Germany, IOUS is currently only selectively used, often in nonsurgical disciplines. While this is reasonable in certain scenarios, it reaches its limits when imaging directly influences surgical actions. The clinical benefits of IOUS are well-documented in several specialties, particularly liver surgery, neurosurgery and surgical senology. Nevertheless, a systematic integration into surgical training, clinical practice, and guidelines is still lacking. In visceral surgery only a few surgeons have their own IOUS experience. In other fields, such as vascular or transplantation surgery, its use is already standard, although this has not been confirmed by randomized studies. The German Society for Ultrasound in Medicine (DEGUM), as the leading professional society for ultrasound in medicine, advocates a broader and structured integration of IOUS into surgical medicine. It provides practical modular training formats, promotes scientific projects and works with guidelines to make existing evidence visible and future evidence usable. The goal is to establish IOUS as a fixed component of quality-assured surgical care both interdisciplinary and cooperative but with independent sonographic expertise on the surgical side. Therefore, DEGUM recommends the use of IOUS for control and guidance during tumor resections, for navigation in anatomically unclear situations, for assessment of vascular anastomoses or organ perfusion and for extended diagnostics, particularly in liver surgery, potentially with the supplementary use of contrast-enhanced ultrasound. Der intraoperative Ultraschall (IOUS), ggf. als „contrast-enhanced intraoperative ultrasound“ (CE-IOUS), ist ein vielseitiges Instrument der chirurgischen Entscheidungsfindung. Er verbessert die intraoperative Orientierung, ermöglicht eine präzise Resektionsführung und trägt zur Vermeidung von Komplikationen und Folgeeingriffen bei. In Deutschland wird IOUS bislang jedoch nur selektiv eingesetzt – häufig durch nicht-operativ tätige Disziplinen. Dies ist in bestimmten Konstellationen sinnvoll, stößt jedoch an Grenzen, sobald die Bildgebung unmittelbar in die chirurgische Handlung einfließt. Der klinische Nutzen des IOUS ist in mehreren Fachgebieten – insbesondere der Leberchirurgie, Neurochirurgie und operativen Senologie – gut belegt. Dennoch fehlt bislang eine systematische Verankerung in der chirurgischen Ausbildung, im klinischen Alltag und in den Leitlinien. In der Viszeralchirurgie verfügen bislang nur wenige Operateure über eigene IOUS-Erfahrung. In anderen Bereichen wie der Gefäß- oder Transplantationschirurgie gehört der Einsatz bereits zum Standard, jedoch ohne dass dieser durch randomisierte Studien abgesichert wäre. Die DEGUM als führende Fachgesellschaft für Ultraschall in der Medizin spricht sich daher für eine breitere und strukturierte Integration des IOUS in der operativen Medizin aus. Sie bietet praxisnahe Weiterbildungsformate in Modulform an, fördert wissenschaftliche Projekte und setzt sich in der Leitlinienarbeit dafür ein, bestehende Evidenz sichtbar und zukünftige nutzbar zu machen. Ziel ist es, IOUS als festen Bestandteil qualitätsgesicherter chirurgischer Versorgung zu etablieren – interdisziplinär kooperativ, aber mit eigener sonographischer Kompetenz auf operativer Seite. Daher empfiehlt die DEGUM die Anwendung von IOUS zur Kontrolle und Steuerung bei Tumorresektionen, zur Navigation bei anatomisch unklaren Situs, zur Beurteilung von Gefäßanastomosen bzw. der Organperfusion und zur erweiterten Diagnostik, insbesondere in der Leberchirurgie, ggf. unter ergänzendem Einsatz von Kontrastmittelsonographie.
Germline BRCA1 and BRCA2 mutations enable targeted therapies in human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer (ABC). The two poly (adenosine diphosphate-ribose) polymerase (PARP) inhibitors olaparib and talazoparib were introduced into clinical practice in 2018. Limited evidence about their routine clinical use highlights the importance of this analysis. We provide a real-world analysis for PARP-inhibitor use in ABC patients treated within the prospective German PRAEGNANT registry (NCT02338167). 152 patients with ABC receiving a PARP-inhibitor were included. Real-world progression-free survival (rwPFS) and real-world overall survival (rwOS) were calculated for all patients using the Kaplan-Meier method. Subgroups (line of therapy, metastasis timing, hormone receptor (HR) status, treatment: olaparib, talazoparib, among others), germline BRCA1, BRCA2 and PALB2 mutations and adverse events (AEs) were analyzed. The median rwPFS was 6.2 months (95% CI, 4.8-7.9) and the median rwOS was 17.1 months (95% CI, 14.4-22.3). Line of therapy, HR status and treatment (olaparib versus talazoparib) appeared to especially affect both rwPFS and rwOS. Among patients with a reported germline mutation, 36.1% had a BRCA1, 62.9% a BRCA2 and 1.0% a PALB2 mutation. In summary, outcomes were comparable to those reported in pivotal trials despite later-line use of PARP-inhibitors in this analysis.
The Breast Committee of the Arbeitsgemeinschaft Gynäkologische Onkologie (German Gynecological Oncology Group, AGO) presents the 2026 update of the evidence-based recommendations for the diagnosis and treatment of patients with locally advanced and metastatic breast cancer.
Despite the paucity of outcome data, axillary lymph node dissection (ALND) is increasingly being omitted in patients with positive sentinel lymph nodes after neoadjuvant chemotherapy, particularly in those with low-volume residual disease. We investigated oncological outcomes in patients with breast cancer and residual micrometastases in the sentinel lymph nodes treated with or without ALND. OPBC-07/microNAC was a retrospective cohort study, using data obtained from the institutional databases of 84 cancer centres in 30 countries. Patients aged 18 years or older with clinical T1-4, N0-3 breast cancer at diagnosis treated with neoadjuvant chemotherapy followed by surgery between Jan 1, 2013, and May 31, 2023, who were found to have residual micrometastases (metastasis measuring >0·2 mm or >200 cells, not exceeding 2·0 mm in size) on frozen section or on final paraffin sections as determined by sentinel lymph node biopsy, targeted axillary dissection (sentinel lymph node biopsy with single or dual-tracer mapping plus image-guided localisation of the initially biopsy-proven and clipped node), or the marking axillary lymph nodes with radioactive iodine seeds (MARI) procedure were eligible for inclusion. The primary endpoint was the 5-year rate of any axillary recurrence (isolated or combined with local or distant recurrence) stratified by type of axillary surgery. Given the median follow-up, here we report 3-year rates and exploratory 5-year estimates. This study was registered with ClinicalTrials.gov, NCT06529302. 1585 female patients with ypN1mi disease were analysed, of whom 804 (50·7%) underwent ALND and 781 (49·3%) did not. Of 1585 women, 238 (15·0%) self-identified as Asian, 65 (4·1%) as Black, 200 (12·6%) as Hispanic, 968 (61·1%) as White, and 114 (7·2%) as unknown race and ethnicity. 925 (58·4%) of 1585 women had cT2 tumours, 1054 (66·5%) were node positive, and 1267 (79·9%) received nodal radiotherapy. The median follow-up was 3·1 years (IQR 1·8-5·2). The 3-year rate of any axillary recurrence (isolated or combined with local or distant recurrence) for the entire cohort was 2·0% (95% CI 1·3-2·9), with no statistical difference identified by extent of axillary surgery. However, patients with triple-negative disease who did not receive ALND had significantly higher rates of any axillary recurrence than women treated with ALND (8·7% [95% CI 4·4-15·0] vs 2·4% [95% CI 0·7-6·5], p=0·018). On multivariable analysis, triple-negative breast cancer (hazard ratio 3·83 [95% CI 1·72-8·52]) and omission of nodal radiotherapy (2·62 [1·19-5·73]) but not omission of ALND (0·86 [0·37-2·00]) were independently associated with an increased risk of any axillary recurrence. Overall, these results do not support ALND for all patients with ypN1mi on sentinel lymph node biopsy treated with nodal radiotherapy; however, tumour biology should be taken into account when considering ALND omission. US National Institutes of Health, National Cancer Institute.
Hemoglobin A1c (HbA1c) measurement is crucial for diabetes monitoring. Validation of analytical methods ensures the reliability of results. We verified the analytical performance of HbA1c measurement in each capillary of the Capillarys OCTA3 automated capillary analyzer, following the French accreditation committee guide. For each capillary and each HbA1c level, we evaluated repeatability, intermediate precision, accuracy, robustness, and measurement uncertainty. Results were compared to acceptance limits from French Society of Clinical Biology (SFBC), European Federation of Clinical Chemistry and Laboratory Medicine (EFLM), Réseau d'identification et de Communication en Oncologie et Sénologie (RICOS), and Clinical Laboratory Improvement Amendments (CLIA). A comparison with the high-performance liquid chromatography (HPLC) method was performed on 37 samples using linear regression and Bland-Altman analysis. Repeatability coefficient of variations (CVs) were less than 1.1% for both levels, consistent with supplier and SFBC (3.8%) thresholds. Precision CVs were 1.24% (normal) and 1.3% (pathological), below SFBC and supplier limits but above the strict EFLM standard. Accuracy showed consistent biases between 0% and 1.02%. Method comparison showed acceptable agreement. Expanded uncertainties were 3.10% (normal) and 2.89% (pathological), exceeding EFLM recommendations (1.8%). Westgard and CLIA sigma indices confirmed satisfactory robustness; EFLM indices were lower for some capillaries, limiting Six Sigma use. The OCTA3 analyzer demonstrated excellent analytical performance. Individual capillary verification yielded satisfactory results. Despite uncertainty exceeding EFLM recommendations and variable robustness, this method is reliable for routine clinical use.
The aim of this study was to assess clinicopathologic characteristics, treatment modalities used and outcome of patients with locally advanced breast cancer (LABC). we searched the European Society of Breast Cancer Specialists (EUSOMA) data warehouse for clinically LABC cT4a-d - in the 2013-2022 timeframe. Of a total of 132269 patients, we identified 2427 patients with cT4abc BC (1.83 %) and 977 with inflammatory (T4d) BCs (0.74 %), of whom 542/2427 (20.1 %) and 251/977 (25.6 %), respectively, had metastatic disease at presentation (p = 0.054. Ninety percent of patients with cT4abcM0 and 88.8 % of patients with cT4dM0 disease had surgery (p = 0.369) and 90.9 % and 88.7 % (p = 0.187) endocrine therapy. Neoadjuvant chemotherapy (CT), adjuvant CT, biological drugs and radiotherapy were given in 33.2 %, 47.0 %, 67.1 % and 61.1 % of cT4abcM0 cases compared to 77.3 %, 80.4 %, 87.7 % and 80.2 % of cT4dM0 cases (all p < 0.001). Multivariable analysis showed that age <70 years, luminal A and HER-2 pure subtype, surgical treatment, radiotherapy, and systemic treatment (all p ≤ 0.034) were determinants of better overall survival (OS). Local recurrence rate (LRR) was significantly lower in patients receiving radiotherapy or endocrine therapy (p ≤ 0.012). Cox analyses showed no difference in OS or LRR between patients with cT4abc and those with T4d BCs, neither at univariable or multivariable analysis. The current study confirms well-known features of cLABCs and underscores the importance of multimodal treatment, which is often underused in these patients.
Accurate assessment of Ki67, a marker of cellular proliferation, is critical for breast cancer diagnostics and treatment decision-making. This study evaluates an automated Ki67-area identification approach, combined with digital image analysis (DIA) for exact Ki67 quantification. A total of 61 tissue samples from breast cancer patients from two clinical trials (GeparSixto and GeparSepto) were analyzed. The supervised DIA workflow employed automated Ki67-stained tumor area identification, followed by automated Ki67 scoring and was quality-controlled by trained pathologists. Comparisons with manual assessments were conducted to evaluate concordance and scoring precision. The DIA approach identified 232 tumor areas across 61 whole slide images (WSIs). The supervised system demonstrated a high correlation with manual scores (r = 0.78), and improved precision (standard deviation between evaluated tumor areas) was noted in therapy-naïve samples (p < 0.001). While manual assessments predominantly employed stepwise increments (5%), DIA provided finer, more continuous scoring, optimally reflecting the continuous nature of tumor proliferation. Overall, DIA scoring was more robust, with reduced inter-ROI variability and improved reproducibility compared with manual assessment. In conclusion, the study highlights the potential of supervised DIA to enhance Ki67 scoring accuracy and standardization. The methodology's effectiveness in addressing standardized Ki67 scoring suggests its utility in clinical diagnostic workflows. This approach contributes towards improved integration of computational pathology into routine practice for improved breast cancer management.
Contrast-enhanced mammography is an increasingly used breast imaging technique that offers significant advantages in terms of accessibility, patient tolerance, and cost. Its diagnostic performance has been shown to be comparable to that of breast magnetic resonance imaging, particularly for the detection and characterization of enhancing lesions. Given its growing clinical relevance, this article aims to illustrate the main enhancement patterns encountered in contrast-enhanced mammography and to compare them with their corresponding appearances on breast MRI. L’angio-mammographie est une technique d’imagerie mammaire en pleine évolution, suscitant un intérêt croissant en raison de ses performances diagnostiques prometteuses. Elle offre plusieurs avantages significatifs, notamment une meilleure accessibilité, une bonne tolérance pour les patientes et un coût inférieur à celui de l’imagerie par résonance magnétique (IRM) mammaire. Les études récentes montrent que sa sensibilité et sa spécificité sont globalement comparables à celles de l’IRM mammaire. L’objectif de cet article est de présenter et d’illustrer les principaux types de rehaussement observés en angio-mammographie, tout en les comparant aux patterns de rehaussement bien établis et plus familiers de l’IRM mammaire.
This study evaluated the experiences of patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative early-stage breast cancer (EBC) in France, Germany, Italy, Spain, and the UK, including satisfaction with how well they are coping with their EBC, their wellbeing, knowledge and awareness of their disease, symptoms of treatment, and factors associated with coping. Data were collected cross-sectionally using a real-world, multinational, point-in-time observational study (2019 Adelphi EBC Disease Specific Programme™ [DSP]) during June-October 2019. Physicians who manage/treat EBC completed online patient record forms (PRFs) and their patients were asked to complete a paper-based voluntary patient self-completion (PSC) form. Regression analyses were used to identify factors associated with coping with EBC. Of 1,859 patients with PRFs, 925 (49.8%) completed a PSC and were the focus of this analysis. The majority (69.9%) of patients reported being satisfied with their coping with EBC and reported overall mean Functional Assessment of Cancer Therapy-Breast scores (scale 0-28) of 21.6 for physical wellbeing and 14.4 for functional wellbeing. Most patients (87.3%) reported being informed about at least one disease characteristic. Half of patients reported being actively involved in their breast cancer treatment decisions, although some patients (23.1% overall) reported being involved in these decisions, but they did not want to be. Physicians were a source of information on breast cancer for 89.9% of patients. Patients reported a wide range of symptoms, and 68.6% of patients reported that EBC had affected their ability to work. Ability to work (including work at home) was also the only actionable factor clearly associated with positive coping in our regression analysis. Significant differences among countries were found for almost all aspects evaluated. Most patients were satisfied with how well they were coping, which is encouraging. Despite the overall symptom burden, high health-related quality of life (HRQoL) was generally maintained, providing reassurance that adjuvant treatment approaches can be administered without detrimental effects on HRQoL. Joint decision-making may help some patients, but others may prefer less involvement in treatment decisions. Helping patients continue employment may be beneficial from both a personal and an economic perspective. This study evaluated the experiences of patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative early-stage breast cancer (EBC) in five European countries. Data were collected cross-sectionally (at a single point in time) from 925 patients during June–October 2019. Most patients (69.9%) reported being satisfied with their coping with EBC, which is encouraging, and reported scores (on a scale of 0 [low] to 28 [high]) on average of 21.6 for physical wellbeing and 14.4 for functional wellbeing. Most patients (87.3%) reported being informed about at least one disease characteristic. Half of patients were actively involved in their treatment decisions, although some patients (23.1% overall) reported being involved in these decisions, but they did not want to be. This emphasizes the need for better understanding of individual patients’ needs for being informed and involved. Physicians were a source of information on breast cancer for 89.9% of patients. Patients reported a wide range of symptoms and 68.6% of patients reported that EBC had affected their ability to work. Our analysis of factors associated with coping found the ability to work (including work at home) was the only actionable factor clearly associated with positive coping. Our study showed that, despite the overall symptom burden, high health-related quality of life (HRQoL) was generally maintained, providing reassurance that treatment can be administered without detrimental effects on HRQoL. Helping patients continue employment may be beneficial from both a personal and an economic perspective.
The aim of this preclinical study was to test if the organic coating of two breast tissue clip markers (HydroMARK and UltraClip) can be sampled selectively by an ultrasound-guided core cut biopsy. Ten clip markers of each type were inserted in four turkey breasts. Sonographic visibility was graded by the performing physicians. Core cut biopsy was performed, aiming to sample only the organic coating while leaving the clip marker in situ. Mammography, specimen radiography and gross inspection of the biopsy samples were conducted to evaluate dislocation or removal of the clips. The specimens were examined histopathologically to detect fragments of the coating material. HydroMARK was superior regarding biopsy feasibility and detectability of the coating. The organic coating of HydroMARK could be sampled selectively without dislocating the clip marker. Fragments of the coating material were visible macroscopically in 7 out of 10 biopsy specimens and could be detected in the histopathologic workup in 5 out of 10 specimens. The coating material of the UltraClip was not visible in any sample. This study showed that the organic coating could be identified in core cut biopsy samples, both on a macroscopic and microscopic level. This could potentially be used to verify representativity of minimal invasive biopsies.
Digital breast tomosynthesis (DBT) increases sensitivity and specificity compared to digital mammography (DM) in the early detection of breast cancer. The potential of artificial intelligence (AI) for mammographic interpretation resulting in workload reduction is increasingly being reported. Presentation of the current evidence on the efficacy of DBT versus DM in population-based breast cancer screening and its support by AI. Narrative review with topic-led literature search of comparative studies of DBT and DM and review of the use of AI in PubMed from 01/2016 to 09/2025. In 42 international studies, the breast cancer detection rate was significantly higher with DBT + DM (6.4‰) and DBT + synthetic mammography (SM) (7.4‰) than with DM (4.7‰). Concordantly, the randomized TOSYMA study reported a higher invasive breast cancer detection rate with DBT + SM (7.1‰) versus DM (4.8‰) with a lower false-positive recall rate (first round -15.6‰). The positive predictive value (PPV) of recall was - consistent with meta-analyses - higher (+4.9%), as was the reading time. With a smaller number of AI studies on DBT than DM, a DBT meta-analysis reported a higher sensitivity of AI alone (89%) than by readers (78%), with a lower specificity of AI. DBT with AI-assisted reading compared to human reading alone increased the detection rate in a prospective study by +3.8‰ without a marked change in the recall rate (+0.8%). DBT increases breast cancer detection compared to DM with more favorable process parameters. AI reporting strategies can further increase sensitivity and reduce human workload. The influence of DBT and AI on reducing the interval cancer rate as a measure of efficiency has not yet been proven. · DBT implementation in population-based breast cancer screening is being reviewed internationally.. · In case of DM replacement, AI reading concepts will become more important.. · Evidence of the long-term effectiveness of DBT and AI is limited.. · Weigel S, Wunderlich P, Sommer A et al. Digital breast tomosynthesis and reading with artificial intelligence. Rofo 2026; DOI 10.1055/a-2796-5225. Die digitale Brust-Tomosynthese (DBT) erhöht die Sensitivität und Spezifität im Vergleich zur digitalen Mammografie (DM) in der Brustkrebs-Früherkennung. Potenziale künstlicher Intelligenz (KI) in der mammografischen Befundung einschließlich einer Reduktion der Arbeitslast werden zunehmend berichtet.Darstellung der aktuellen Evidenz zur Wirksamkeit von DBT versus DM in der bevölkerungsbezogenen Brustkrebs-Früherkennung und deren Unterstützung durch KI. Narrative Übersichtsarbeit mit themengeleiteter Literatursuche vergleichender Studien von DBT und DM sowie zum KI-Einsatz in PubMed von 01/2016 bis 09/2025.In 42 internationalen Studien lag die Brustkrebsdetektionsrate mit DBT + DM (6,4‰) und DBT + synthetischer Mammografie (SM) (7,4‰) signifikant höher als mit DM (4,7‰). Konkordant berichtete die größte randomisierte TOSYMA-Studie eine höhere invasive Brustkrebsdetektionsrate mit DBT + SM (7,1‰) versus DM (4,8‰) bei niedrigerer falsch-positiver Rückrufrate (Erstteilnahme –15,6‰). Der positive prädiktive Wert (PPV) des Rückrufs war – konsistent mit Metaanalysen – höher (+4,9%), gleichzeitig stieg die Befundungszeit. Bei geringerer Anzahl von KI-Studien mit DBT als DM berichtete eine DBT-Metaanalyse eine höhere Sensitivität durch KI allein (89%) als durch Befunder (78 %) bei geringerer Spezifität der KI. DBT mit KI-unterstützter Befundung im Vergleich zur alleinigen menschlichen Befundung steigerte die Detektionsrate in einer prospektiven Studie um +3,8‰ ohne relevante Änderung der Rückrufrate (+0,8%).DBT erhöht in der Früherkennung die Brustkrebsdetektionsrate im Vergleich zur DM bei günstigeren Prozessparametern. KI-Befundungsstrategien können die Sensitivität weiter erhöhen und menschliche Arbeitszeit reduzieren. Der Einfluss von DBT und KI auf die Intervallkarzinomrate als Effektivitätsparameter ist noch nicht belegt. · Die DBT-Implementierung in der bevölkerungsbezogenen Brustkrebs-Früherkennung wird international geprüft.. · Im Falle eines Ersatzes der DM werden Befundungskonzepte mit KI-Integration bedeutsamer werden.. · Die Evidenz zur Langzeiteffektivität von DBT und KI ist limitiert.. · Weigel S, Wunderlich P, Sommer A et al. Digital breast tomosynthesis and reading with artificial intelligence. Rofo 2026; DOI 10.1055/a-2796-5225.
The randomized controlled, multicenter TOSYMA study showed a superiority of the combination of digital breast tomosynthesis and synthetic mammography (DBT+SM) over digital mammography (DM) in the detection rate of invasive breast cancer at stage UICC I. In this subanalysis, we compared the mammographic tumor signs of UICC I stage breast cancers detected in each study arm and stratified according to histological grade.This subanalysis included 49,462 women in the DBT+SM arm and 49,669 women in the DM arm after 1:1 randomization from July 2018 to December 2020. The mammographic abnormalities documented at the consensus conference were collected for breast cancers in stage UICC I based on various tumor signs (such as masses, microcalcifications, architectural distortions, or their combinations). The detection rates (per 10,000 screened women) were calculated with differentiation of grade 1 and grade 2 or 3 cancers.Grade 1 cancers were detected using DBT+SM in 6.5/10,000 screened women only by masses (+1.5/10,000 versus DM), in 2.4/10,000 (+1.6/10,000) by architectural distortions, and in 1.2/10,000 (+0.8/10,000) by microcalcifications. Combinations of tumor signs were present in 7.9/10,000 (+6.1/10,000) screened women. Grade 2 or 3 cancers were detected by DBT+SM in 13.7/10,000 by masses (+2.6/10,000 versus DM), in 4.9/10,000 by microcalcifications (+2.3/10,000), and in 3.6/10,000 by architectural distortions (+2.0/10,000). Combinations were present in 10.1/10,000 (+6.3/10,000) screened women.In DBT+SM screening, the detection rate of UICC I breast cancers is higher compared to DM: both, individual tumor signs and their combinations contribute to this finding. The detection rate of UICC I grade 2 or 3 cancers is higher in DBT+SM screening than in DM screening mainly due to the combination of tumor signs. · DBT+SM detects more grade 2 or 3-UICC I breast cancers than DM.. · This increase in detection rate results mainly from a combination of tumor signs.. · Nearly half of the increase relates to individual signs: masses, microcalcifications, and architectural distortions.. · Weigel S, Hense HW, Weyer-Elberich V et al. Radiological Tumor Signs of Breast Cancer in UICC Stage I: Subanalysis of the Randomized Controlled Trial TOSYMA. Rofo 2026; 198: 85-92. Die randomisierte kontrollierte, multizentrische TOSYMA-Studie zeigte eine Überlegenheit der Kombination aus digitaler Brust-Tomosynthese und synthetischer Mammografie (DBT+SM) gegenüber der digitalen Mammografie (DM) hinsichtlich der Detektionsrate invasiver Mammakarzinome im Stadium UICC I. In dieser Subanalyse wurden die mammografischen Tumorzeichen der in jedem Studienarm entdeckten Mammakarzinome im Stadium I, stratifiziert nach dem histologischen Grad, verglichen.Diese Subanalyse inkludierte im DBT+SM-Arm 49 462 Frauen und im DM-Arm 49 669 Frauen nach 1:1 Randomisierung von 7/2018 bis 12/2020. Die in der Konsensuskonferenz dokumentierten mammografischen Auffälligkeiten wurden für Mammakarzinome im Stadium UICC I basierend auf verschiedenen Tumorzeichen (wie Herdbefunde, Mikroverkalkungen, Architekturstörungen bzw. deren Kombination) erhoben. Berechnet wurden die Detektionsraten (pro 10 000 gescreenter Frauen) mit Differenzierung des Grads 1 von den Graden 2 oder 3.G1-Karzinome wurden mit DBT+SM bei 6,5/10 000 gescreenter Frauen allein durch Herdbefunde (+1,5/10 000 versus DM), bei 2,4/10 000 (+1,6/10 000) durch Architekturstörungen und bei 1,2/10 000 (+0,8/10 000) durch Mikroverkalkungen detektiert. Mehrere Tumorzeichen (Kombinationen) lagen bei 7,9/10 000 (+6,1/10 000) vor. Grad-2- oder -3-Karzinome wurden mit DBT+SM bei 13,7/10 000 allein durch Herdbefunde (+2,6/10 000 versus DM), bei 4,9/10 000 durch Mikroverkalkungen (+2,3/10 000) und bei 3,6/10 000 durch Architekturstörungen (+2,0/10 000) detektiert. Kombinationen von Tumorzeichen lagen bei 10,1/10 000 (+6,3/10 000) vor.Die Detektionsrate von Mammakarzinomen im UICC-Stadium I ist im DBT+SM-Screening höher als im DM-Screening: Dazu tragen sowohl singuläre Tumorzeichen als auch ihre Kombinationen bei. Dabei werden im DBT+SM-Screening vor allem häufiger Mammakarzinome Grad 2 oder 3 im UICC-Stadium I entdeckt, was überwiegend auf Kombinationen radiologischer Tumorzeichen zurückzuführen ist. · DBT+SM detektiert mehr Grad-2- oder -3-UICC I-Mammakarzinome als DM.. · Dieser Zugewinn an Detektionsrate resultiert vor allem aus Kombinationen einzelner Tumorzeichen.. · Nahezu hälftig beruht dieser Zugewinn auf singulären Zeichen: Herdbefunden, Mikroverkalkungen und Architekturstörungen.. · Weigel S, Hense HW, Weyer-Elberich V et al. Radiological Tumor Signs of Breast Cancer in UICC Stage I: Subanalysis of the Randomized Controlled Trial TOSYMA. Rofo 2026; 198: 85–92.
BACKGROUND: Incisional hernias are a relevant complication after abdominal surgery, but data on their occurrence after open liver resection, particularly via inverted L-incision, are limited. METHODS: We conducted a retrospective single-centre cohort study including 231 patients, who underwent open liver resection with an inverted L-incision at Goethe University Frankfurt between December 2015 and December 2020. The primary endpoint was the incidence of incisional hernias, confirmed clinically or radiologically. Secondary endpoints included the identification of potential risk factors. Time-to-event analysis was performed using the Kaplan–Meier method with follow-up of up to five years. RESULTS: The cohort comprised 59.7% men and 40.3% women with a mean age of 60.3 years (range 20–87). Hepatocellular carcinoma (33.8%) and cholangiocarcinoma (30.3%) were the most common indications, and major resections were performed in 44.6% of cases. Overall, 28 patients (12.1%) developed an incisional hernia during follow-up, 20 of which occurred within the first postoperative year (8.7%). Kaplan–Meier analysis estimated the cumulative incidence of incisional hernia to be 18% at 5 years. Most hernias occurred along the midline (85.7%). In the multivariable analysis, no independent risk factors for incisional hernia could be identified. CONCLUSION: Incisional hernia represents a relevant long-term complication after open liver resection via inverted L-incision. The cumulative incidence increased over time, reaching approximately 18% at five years, suggesting that structured follow-up may be warranted. Future prospective multicentre studies with longer follow-up are required to further clarify risk factors and evaluate preventive strategies. TRIAL REGISTRATION: Not applicable.
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Cancer patients prone to toxicities might benefit from dose reduction over fixed-dose recommendations. We develop a predictive index to identify patients with increased probability of dose reduction, intolerable toxicities, or therapy discontinuation (hereafter: dose reduction) in metastatic breast cancer (MBC) and compare real-world effectiveness of reduced (RSD) versus full starting dose (FSD) using this index. This analysis included 618 patients with HR-positive, HER2-negative MBC from the prospective, observational, multicenter registry OPAL (NCT03417115), receiving first-line palbociclib (n = 386) or ribociclib (n = 232) plus endocrine therapy. A logistic regression model was employed to derive the predictive index. Inverse probability of treatment weighting was used to emulate a head-to-head comparison of RSD and FSD by analyzing progression-free (PFS) and overall survival (OS). Within 6 months, 215 patients (35%) underwent dose reduction, including 109 (51%) with RSD. Predictors for dose reduction were age ≥65 years and Charlson comorbidity index (CCI) ≥1. Among patients with increased probability of dose reduction (index ≥1: ≥65 years and/or CCI ≥ 1), median PFS and OS were 30.1 [21.7, 54.0] and 57.6 [40.0, NA] months with RSD vs. 29.3 [24.9, 32.0] and 43.1 [38.8, 50.3] months with FSD. For low-probability patients (index = 0: <65 years and CCI = 0), median PFS and OS were 17.6 [9.1, 29.8] and 32.9 [23.1, 40.9] months with RSD vs. 24.5 [19.8, 32.0] and 54.2 [48.8, NA] months with FSD. In this real-world MBC setting, patients ≥65 years and/or with CCI ≥ 1 had an increased probability of dose reduction and may benefit from RSD, as this yielded outcomes comparable to FSD. Younger, fitter patients may require full dosing. Future studies, ideally randomized controlled trials, should aim to confirm these findings.
BACKGROUND: The American Society of Anaesthesiologists Physical Status (ASA-PS) classification system is the most widely used tool for estimating perioperative risk. Despite its widespread application, the ASA-PS is based solely on the subjective assessment of the patient’s clinical condition and comorbidities, which leads to considerable inter-rater variability. The aim of this study was to investigate interprofessional differences in ASA-PS scoring between surgeons and anaesthesiologists. METHODS: This prospective observational study involved patients who were scheduled for elective or emergency surgery. The patients were independently evaluated using the ASA-PS classification by treating anaesthesiologists and surgeons with varying levels of experience. Following data collection, an interdisciplinary board comprising senior anaesthesiologists and surgeons retrospectively assigned reference ASA-PS scores. Inter-rater agreement was analysed using Cohen’s kappa (κ). RESULTS: In total, 684 were included in the study. Surgeons assigned lower ASA-PS classes more frequently, with 16.81% of ratings corresponding to ASA-PS I and 52.05% to ASA-PS II, compared to 6.29% vs. 40.50% among anaesthesiologists. In contrast, anaesthesiologists more often classified patients as ASA-PS III (50.88%), than surgeons (28.51%). Agreement with the reference board was higher among anaesthesiologists (κ = 0.36) than among surgeons (κ = 0.21). The interprofessional agreement between surgeons and anaesthesiologists was low (κ = 0.25), which highlights the significant variability in clinical judgment between disciplines. ASA-PS assessments were more frequently performed by residents among surgeons than among anaesthesiologists (90.35% vs. 69.74%; p < 0.0001). CONCLUSION: The findings underscore the substantial inter-rater variability in ASA-PS scoring between surgical and anaesthesiological teams. While ASA-PS classification of ≥III remain clinically relevant and is widely used as a predictor for perioperative risk, the observed discrepancies may affect risk stratification in clinical practice. As most of ASA-PS assessments, especially in the surgeon group, were performed by residents, these results highlight the importance of structured training, and potentially supplementary objective tools to improve consistency and reliability in preoperative risk assessment. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (No. NCT02995499) and the German Clinical Trial register (No. 00011311, 12/2016).
Oncological plastic surgery plays a central role in the management of cancers requiring complex reconstruction. Recent years have seen significant advances in oncology, both therapeutic and technological. The aim of this article is to provide an overview of major recent developments in oncological plastic surgery, through a selection of impactful recent studies chosen by national experts in three of the main fields of this specialty. Between October and November 2024, national experts and/or representatives of French scientific societies were invited to participate in this analysis. The covered domains included senology, soft tissue sarcoma surgery, and oncological dermatologic surgery. Each expert selected two recent articles (≤5years) deemed relevant within their field of expertise. Selected studies had to have a direct impact on clinical practice in oncological plastic surgery. Each article was validated, analyzed, and synthesized with a focus on its practical implications for reconstructive plastic surgery. Recent developments in oncological plastic surgery show profound changes in treatment strategies, largely influenced by the emergence of neoadjuvant immunotherapy and an increasingly personalized approach to reconstruction. In senology, there is a reduction in surgical indications, particularly with the decreasing use of sentinel lymph node biopsy in early breast cancer and reconsideration of axillary dissection in the presence of positive sentinel nodes (but normal axillary ultrasound). In soft tissue sarcomas, the role of the plastic surgeon is reinforced to ensure clear resection margins, and a risk-based reconstruction algorithm now guides the use of flaps in high-risk patients. In oncological dermatology, neoadjuvant immunotherapy is gaining a growing role in the treatment of advanced stages of melanoma and squamous cell carcinoma, reshaping the timing and indications for surgical intervention. Oncological plastic surgery is moving towards more targeted, less invasive approaches, integrated within multidisciplinary therapeutic strategies. In this context, understanding recent oncological advances - particularly in immunotherapy, neoadjuvant protocols, and patient selection criteria - is essential for plastic surgeons to ensure optimal and up-to-date patient care.
Therapy adherence is critical, particularly for patients with breast cancer undergoing oral endocrine therapies. The use of combination regimes, such as CDK4/6 inhibitors, has introduced additional side effects, which can affect adherence. A structured patient coaching and communication tool may positively affect therapy adherence. The IMPACT study (NCT04030728) was a randomized trial including patients with advanced breast cancer (aBC) receiving abemaciclib as part of routine clinical care. The study examined the influence of structured coaching on patient adherence. Participants were randomized to receive therapy management incorporating the Multinational Association of Supportive Care in Cancer (MASCC) Oral Agent Teaching Tool (MOATT©) or local standard of care practice (LSOC). The primary endpoint was the persistence rate at week 24 (PR24). Secondary endpoints included time to therapy discontinuation (TTD) and quality of life. A total of 201 patients were randomized and initiated abemaciclib therapy. By week 24, 22 (10.9 %) patients had permanently discontinued abemaciclib for reasons other than progression or death: 14 (14.1 %) in the LSOC arm and 8 (7.8 %) in the MOATT© arm. PR24 was 68.9 % (95 % CI: 58.3-78.2) in the LSOC arm and 81.6 % (95 % CI: 72.5-88.7) in the MOATT© arm, yielding an odds ratio of 2.01 (95 % CI: 1.02-3.96; P = 0.04). TTD showed a hazard ratio of 0.59 (95 % CI: 0.32-1.07), favoring the MOATT© arm. No significant differences in quality of life between study arms were observed. Individual patient coaching based on MOATT© demonstrated improved PR24 for patients undergoing abemaciclib treatment for aBC.
The diagnosis of breast cancer and the several treatments lead to sexual disorders in 40 to 60% of patients, impacting their quality of life and the one of the couple, even years after cancer. For a long time, the subject was ignored and these disorders untreated. This study aimed to carry out an inventory of information and screening for sexual disorders after breast cancer and to identify potential barriers to their application. A survey was conducted using questionnaires intended for patients with non-metastatic breast cancer and caregivers at the University Cancer Institute of Toulouse-Oncopole. Among 147 patients, 47% declared having received information at some point in their course while 92% would have liked to have a systematic information. Only 20% of patients pretend they had a screening for sexual disorders by a professional, whereas 78% would have liked it to be systematic. Although professionals declare that they are aware of the consequences of breast cancer on the sexual life of women, barriers to information and screening have been identified: difficulties felt in approaching this subject by professionals (lack of time during consultation, forgetting) and a lack of training on the subject. Freeing the speech by informing and screening for sexual disorders secondary to the diagnosis and treatment of breast cancer, is essential to improve the patients' support, their quality of life and the one of their couple.