The goals of axillary management in early breast cancer have changed substantially in recent years. Whereas axillary surgery was once viewed primarily as a means of local control, current practice asks whether axillary staging information changes subsequent treatment decisions. With advances in antibody-drug conjugates, novel endocrine therapies, and radiotherapy techniques, selected patients may achieve favorable regional control and quality of life despite less extensive axillary surgery. This review summarizes evidence for three approaches to axillary de-escalation. The first is omission of sentinel lymph node biopsy in carefully selected, low-risk patients with clinically node-negative disease. The second is omission of axillary lymph node dissection or its replacement with axillary radiotherapy in selected patients with positive sentinel nodes. The third is restaging with targeted axillary dissection in initially node-positive patients who become clinically node-negative after neoadjuvant therapy. Axillary de-escalation should be based on reliable imaging, standardized pathologic assessment, and multidisciplinary discussion. Molecular subtypes, including HER-2-positive and triple negative breast cancer, should inform whether less extensive surgery would alter systemic therapy, regional radiotherapy or follow-up.

Breast-conserving surgery is an important therapeutic approach that aims to preserve breast appearance and quality of life while ensuring oncological safety. Accurate lesion localization and achievement of negative margins are key factors affecting local control and decisions regarding reoperation. At present, localization and margin assessment in breast-conserving surgery are evolving from experience-based judgment to image-guided decision-making, from two-dimensional localization to three-dimensional spatial assessment, from purely morphological recognition to the integration of functional and molecular information, and from manual interpretation to artificial intelligence-assisted decision support. Techniques such as wire-guided and clip-based localization, intraoperative ultrasound, specimen radiography, and intraoperative frozen pathological assessment have been widely used in clinical practice. However, these techniques still have certain limitations in assessing non-palpable lesions, microcalcifications, multifocal disease, and residual lesions after neoadjuvant therapy. In recent years, dye tracing, three-dimensional specimen imaging, radiofrequency spectroscopy, optical imaging, molecularly targeted fluorescence imaging, and artificial intelligence-assisted interpretation have gradually been applied in breast-conserving surgery, providing new approaches to improving the objectivity of lesion identification, margin assessment, and intraoperative decision-making. In patients at increased risk of positive margins, including those with invasive lobular carcinoma, multifocal disease, or unclear residual disease extent after neoadjuvant therapy, comprehensive evaluation should integrate intraoperative multimodal imaging reassessment, specimen imaging, rapid pathological assessment, and, when necessary, emerging imaging techniques. This review summarized commonly used and emerging techniques for precise localization and margin assessment in breast-conserving surgery for breast cancer patients, with the aim of providing a reference for the rational selection and clinical translation of these technologies.

Sentinel lymph node biopsy is important for axillary staging and de-escalated axillary management in early breast cancer. The selection and optimization of tracing techniques directly affect the sentinel lymph node detection rate, false-negative risk and clinical decision-making. Currently, there are many tracing techniques for sentinel lymph nodes in breast cancer, including blue and other visible dyes, radioactive tracers, near-infrared fluorescence, magnetic nanoparticle tracers, contrast-enhanced ultrasound and multimodal tracing. These tracing techniques vary in their clinical applications. This article reviews recent advances in sentinel lymph node tracing techniques for breast cancer, focusing on the principles, advantages, limitations and clinical applicability of each tracing technique. Based on breast surgery practice in China, this article analyzes the current application of tracers highly available or domestically developed in China, such as methylene blue, carbon nanoparticles and indocyanine green, and further discusses sentinel lymph node tracing strategies in patients who have received neoadjuvant therapy. In China, the development of SLN tracing techniques should take into account both the available evidence and the disparities in medical resources, strengthen standardized training, quality control, and multicenter studies, and promote both the dissemination of appropriate technologies to lower-tier institutions and the translation of new techniques, thereby advancing axillary management in breast cancer toward a more precise, minimally invasive, and individualized approach.

To investigate the application value of donor-site perfusion via turbocharging in immediate deep inferior epigastric perforator (DIEP) flap breast reconstruction following breast cancer surgery.

A retrospective analysis was conducted on the clinical data of 12 female patients with breast cancer who underwent nipple-sparing mastectomy followed by immediate DIEP flap breast reconstruction perfused by turbocharging (turbocharged DIEP) in the Shenzhen Hospital of Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between January 2024 and December 2025. There were 3 cases of stage Ⅰ, 8 cases of stage Ⅱ and 1 case of stage Ⅲ. Preoperative computed tomography angiography (CTA) was performed in all patients to accurately locate the number and anatomical positions of DIEP. The number of donor perforator vessels, the diameters of arteries and veins, and the number of vessels used for turbocharging anastomosis were systematically recorded during surgery. Postoperative follow-up was conducted to assess flap survival rate and the incidence of complications, and the BREAST-Q Questionnaire was used to quantitatively evaluate patient satisfaction with reconstructed breast appearance and functional recovery of the donor and recipient sites.

Double-pedicle DIEP flap transplantation was successfully performed in all 12 patients. The flap harvest area ranged from 12.0 cm×24.0 cm to 14.0 cm×30.0 cm, with an average weight of (759.17±99.91) g and operative time of (487.67±97.21) min. Intraoperative anatomical dissection identified 3 perforator vessels in 8 cases and 4 perforator vessels in 4 cases; among them, single-artery turbocharging was used in 8 cases and double-artery turbocharging in 4 cases. The diameter of turbocharged arteries was (0.75±0.19) mm, and the venous diameter was (0.94±0.12) mm. All patients were followed up for 3.0-14.5 months with a median follow-up of 6.3 months. All transplanted flaps survived completely, with no perioperative complications such as flap necrosis, hematoma or infection. The mean BREAST-Q score was (91.83±2.52), indicating high patient satisfaction with the appearance of reconstructed breasts and the functional recovery of donor and recipient sites. No local recurrence or distant metastasis occurred during the follow-up period.

Under strict patient selection, turbocharged-DIEP breast reconstruction has good safety, feasibility and aesthetic effects, which can be used for immediate breast reconstruction after breast cancer surgery.

To evaluate the feasibility and short-term safety of domestic single-port snake-arm robot in transaxillary robot-assisted nipple-sparing mastectomy combined with immediate prepectoral implant breast reconstruction (rNSM+IBR) .

A prospective study enrolled on the clinical data of 23 breast cancer patients who underwent rNSM+IBR from March 2025 to April 2026, including 9 patients in the Huashan Hospital, Fudan University and 14 patients in the International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine. The following parameters were recorded: pathological findings, surgical procedures, operative duration, and perioperative complications.Primary endpoints were surgical feasibility and early postoperative safety;secondary outcomes included operative parameters, postoperative recovery, and learning-curve characteristics. The cumulative sum (CUSUM) curve was adopted to characterize the surgeon's learning curve.

All 23 patients successfully completed the procedure via transaxillary incision, without conversion to open surgery or additional incisions. The operative time was 260 (170, 290) min. No Clavien-Dindo grade Ⅲ or higher complications occurred within 30 days postoperatively. No skin flap necrosis, nipple-areolar complex necrosis, severe infection, or prosthetic displacement was observed. Operative time decreased with experience, and the CUSUM analysis confirmed a stable learning curve within 10 cases.

The use of domestic single-port snake-arm robot is feasible and safe for transaxillary rNSM+IBR, with favorable perioperative profiles and a manageable learning curve.

To explore the efficacy of indocyanine green (ICG) fluorescence navigation for assessing the pedicled omental flap in endoscopic breast-conserving plastic surgery.

A retrospective analysis was performed on the clinical data of 70 breast cancer patients who underwent endoscopic breast-conserving plastic surgery with a pedicled omental flap at the Department of Breast Surgery, Zhujiang Hospital of Southern Medical University between August 2021 and August 2025. The patients were divided into the ICG group (35 patients) and the control group (35 patients) based on whether ICG fluorescence guidance was used during surgery. The control group comprised 35 patients treated between August 2021 and May 2024, in whom flap perfusion was assessed intraoperatively by the surgeon's naked-eye observation alone, without imaging guidance. The ICG group comprised 35 patients treated between June 2024 and August 2025, who received preoperative intravenous ICG injection and intraoperative fluorescence endoscopy employed for real-time visualization of the omental vascular anatomy and blood flow patterns to precisely guide the resection of the omental flap. The operative time, postoperative hospital stay, incidence of upper abdominal discomfort at 3 days postoperatively, incidence of omental flap necrosis at 2 weeks postoperatively, incidence of omental flap sclerosis at 1 month postoperatively, and breast aesthetic outcome at 3 months postoperatively were compared between the two groups. Breast aesthetic outcomes were evaluated at 3 months postoperatively using the Harris criteria. Continuous variables were analyzed using the independent samples t-test or Mann-Whitney U test; categorical variables were analyzed using the χ² test or Fisher's exact test; multivariate logistic regression was employed to adjust for confounding factors.

There were no statistically significant differences in baseline characteristics between the two groups (all P>0.05), except for N-stage. Surgery was completed successfully in both groups. Compared with the control group, the operative time was significantly shorter in the ICG group [(343.89±83.84) min vs (274.57±79.75) min, t=−3.544, P=0.001], and the postoperative hospital stay was significantly reduced [(8.97±2.15) d vs (6.74±0.74) d, t=−5.801, P<0.001]. The ICG group also showed significantly lower incidences of upper abdominal discomfort (CTCAE ≥ grade 2) at 3 days postoperatively (14.29% vs 51.43%, χ²=10.944, P=0.001) and omental flap sclerosis at postoperative one month (22.86% vs 60.00%, χ²=9.950, P=0.002) compared with the control group. No significant difference was observed in the incidence of omental flap necrosis at 2 weeks postoperatively (5.71% vs 0, P=0.235). Multivariate logistic regression analysis identified ICG fluorescence navigation as an independent protective factor against upper abdominal discomfort (adjusted OR=0.156, 95%CI: 0.047-0.521, P=0.003) and omental flap sclerosis (adjusted OR=0.171, 95%CI: 0.056-0.527, P=0.002). At 3 months postoperatively, breast aesthetic outcomes evaluated by the Harris criteria were excellent in all 35 patients (100%) in the ICG group, compared with 29 excellent (82.86%), 4 good (11.43%), and 2 fair (5.71%) in the control group, indicating superior outcomes in the ICG group (Z=-2.541, P=0.011).

ICG fluorescence navigation provides real-time, intuitive imaging guidance for assessing omental flap perfusion during endoscopic breast-conserving oncoplastic surgery with a pedicled omental flap. It can shorten operative time, reduce perioperative complications, and improve postoperative breast aesthetic outcomes, demonstrating favorable clinical application value.

To explore the application value of the Yokohama reporting system in rapid on-site evaluation (ROSE) of touch imprints from core-needle biopsy (CNB) of breast masses, and to evaluate the clinical significance of patient triage management based on ROSE classification according to this reporting system.

According to the inclusion and exclusion criteria, the data of 1 475 patients who underwent ultrasound-guided CNB for breast masses at the Baoji Central Hospital from January 2024 to December 2025 were enrolled in this prospective study. Touch imprints were simultaneously prepared from biopsy specimens for ROSE. ROSE interpretation was performed with the Yokohama reporting system by the International Academy of Cytology as the classification standard, and the results were divided into benign lesion, atypical lesion, suspicious for malignancy and malignant tumour. Using histological diagnosis as the gold standard, the concordance between ROSE classification results based on the Yokohama reporting system and histological diagnosis was compared and analysed. The Kappa consistency test was adopted to evaluate the diagnostic efficacy of ROSE for breast masses, and patient triage was guided according to the classification results.

Among the 1 475 specimens, ROSE classifications based on the Yokohama reporting system showed 770 benign lesions, 74 atypical lesions, 43 suspicious malignancies and 588 malignant tumours. The diagnostic accuracy compared with histological diagnosis was 99.5% (766/770), 55.4% (41/74), 93.0% (40/43) and 100% (588/588), respectively. The sensitivity, specificity and overall accuracy of ROSE classification based on the Yokohama reporting system against the histopathological gold standard were 94.58% (628/664), 99.63% (808/811) and 97.36% (1 436/1 475), respectively. The positive predictive value and negative predictive value were 99.52% (628/631) and 95.73% (808/844). The ROSE classification of breast masses had good consistency with histological diagnosis (κ=0.946, P<0.05). All 770 patients with ROSE classification of benign lesion received day-case surgery. Intraoperative frozen pathology revealed 3 cases of malignancy and 1 case of desmoid fibromatosis, for which extended surgery was subsequently performed. The remaining 766 patients consistent with ROSE results were discharged on the next day. Patients with ROSE results of atypical lesion, suspicious malignancy and malignant tumour waited for the final histological report on the following day. Patients with histologically confirmed benign lesions underwent minimally invasive surgery; patients with borderline tumours received extended surgery; patients with malignant tumours received neoadjuvant therapy, modified radical mastectomy or breast-conserving surgery.

The Yokohama reporting system can be applied to ROSE of touch imprints from CNB of breast masses. The categories of benign lesion, suspicious malignancy and malignant tumour demonstrate high concordance with histological diagnosis. This system exhibits high diagnostic efficacy in evaluating the nature of breast masses and helps optimise the diagnosis and treatment workflow for patients with breast masses.

To compare the effects of totally implantable venous access port (TIVAP) and peripherally inserted central catheter (PICC) on the quality of life in breast cancer patients undergoing chemotherapy, and analyze the overall satisfaction, psychosocial status, and procedural pain.

A retrospective cohort study was conducted, enrolling 153 breast cancer patients who received chemotherapy in the Fourth People's Hospital of Sichuan Province between March 2023 and August 2024. Patients were divided into the TIVAP group (n=91) and the PICC group (n=62) based on catheter type. Baseline characteristics, catheter-related parameters and complication rates were recorded and the quality of life was assessed via the Quality of Life Assessment for Venous Devices (QLAVD) questionnaire. For between-group comparisons, independent samples t test was used for normally distributed continuous variables, and χ² test or Fisher's exact test was used for unpaired categorical variables.

The TIVAP group demonstrated significantly higher overall satisfaction scores than the PICC group (8.99±0.97 vs 7.85±1.38, t=5.603, P<0.001). After adjusting for age, BMI, chemotherapy type, and chemotherapy cycle using multiple linear regression, the between-group difference remained statistically significant (β=-1.354, 95%CI: -1.788 to -0.921, P<0.001). Regarding psychosocial dimensions, the TIVAP group showed significantly lower proportions of patients affected in terms of clothing adaptability (17.6% vs 67.7%, χ²=39.417, P<0.001), daily showering (11.0% vs 59.7%, χ²=41.074, P<0.001), and exercise (18.7% vs 41.9%, χ²=9.869, P=0.002). Additionally, fewer patients in the TIVAP group reported appearance-related distress (13.2% vs 27.4%, χ²=4.863, P=0.027) and unwanted attention from others (12.1% vs 33.9%, χ²=10.579, P=0.001). However, TIVAP insertion was associated with greater procedural pain (2.99±1.08 vs 1.74±1.07, t=7.037, P<0.001). The overall complication rate in the TIVAP group was significantly lower than that in the PICC group (3.3% vs 16.1%, χ²=7.810, P=0.005).

For breast cancer patients receiving chemotherapy, TIVAP offers distinct advantages in improving quality of life and reducing complications; although the insertion procedure is more painful, overall acceptance is higher.