With the in-depth researches on the biological behaviors of breast cancer， continuous improvement of clinical systematic treatment and patients' higher requirement for quality of life，breast cancer surgery shows a trend of de-escalation treatment. The non-radical resection is proposed， aiming to provide more treatment options for certain patient groups. Under the premise of ensuring the prognosis， it can reduce surgical trauma and achive the dual protection of the appearance and function of the breast. This article systematically reviews the existing clinical studies and analyzes the feasibility of non-radical surgery for breast cancer in two dimensions： breast parenchyma and regional lymph nodes. From practical and technical perspectives， we propose a novel surgical classification model tailored to specific patient groups， in order to provide more precise and personalized treatment schemes for breast cancer patients.

The key to successful treatment of breast cancer lies in the prompt diagnosis and effective therapeutic strategies. HER-2 plays a pivotal role in the biological behavior and pathogenesis of breast cancer，exerting significant influence on its progression and development. The development of novel antibody-drug conjugates （ADC） has disrupted the situation where traditional anti-HER-2 targeted therapy relied on receptor expression or gene amplification， bringing HER-2-low and HER-2-ultralow subtypes of breast cancer increasingly into the public view. This has sparked a renewed research focus and inaugurated a new era in the treatment of breast cancer. This article aims to provide a comprehensive review from clinical and pathological perspectives regarding the necessity of detecting HER-2-low and HER-2-ultralow expression in breast cancer，detection methods， as well as the factors influencing the precise detection of HER-2-low and HER-2-ultralow subtypes.

Systemic therapy constitutes a critical therapy of the comprehensive treatment strategy for breast cancer. Systemic treatment has substantial advancements in 2024.However， several challenges persist that warrant further consideration and exploration. This paper summarizes several hot topics on systemic therapy of breast cancer， including optimization of neoadjuvant treatment for triple negative breast cancer in the era of immunotherapy， optimal strategies for intensive adjuvant therapy in patients without pCR following neoadjuvant treatment and first-line therapy for metastatic breast cancer， selection of optimal populations for intensive adjuvant therapy with cyclin-dependent kinase 4/6 （CDK4/6） inhibitors， subsequent strategies after the failure of CDK4/6 inhibitor， precision first-line therapy for HER-2-positive advanced breast cancer， drug therapy for brain metastases， development landscape of antibody-drug conjugates， and clinical significance of genetic testing. These topics are proposed for discussion

Objective

ToanalyzetheimpactofAR/p53/Ki-67expressionbeforeneoadjuvant chemotherapy on the efficacy and prognosis of triple negative breast cancer （TNBC） patients with HER-2 zero or low expression.

Methods

Clinical data of 122 patients with primary TNBC treated in the Department of Breast Surgery， Gansu Maternal and Child Health Hospital from January 2015 to December 2023 were retrospectively analyzed. Patients were divided into two groups based on HER-2 expression status： zero expression and low expression. Differences in AR/p53/Ki-67 expression and pCR rate after neoadjuvant chemotherapy between the two groups were compared using χ²test. Factors with statistically significant differences in univariate analysis are included in binary logistic regression analysis. Kaplan-Meier survival curves were plotted and compared using the log-rank test. Univariate and multivariate Cox proportional hazards models were used to analyze factors affecting disease-free survival （DFS）.

Results

Ki-67， HER-2， AR， and p53 expression were correlated with pCR rate in TNBC patients （χ²=6.829， 3.909， 4.483， 4.031， P=0.009， 0.048， 0.034， 0.045）. Multivariate logistic regression showed Ki-67 （OR=6.690， 95%CI：2.157-20.749， P＜0.001）， HER-2 （OR=0.404， 95%CI：0.172-0.950， P=0.038）， AR （OR=4.974， 95%CI：1.653-14.963， P=0.004）， and p53 （OR=2.450， 95%CI：1.027-5.844， P=0.043） were associated with pCR rate in TNBC patients. In HER-2-zero expression group， the pCR rate showed a significant difference between AR and Ki-67 negative or positive patients （40.4% vs 72.2%， χ²=5.426， P=0.020；22.2% vs 57.7%，χ²=6.735，P=0.009）. In HER-2-low expression group， AR/p53/Ki-67 expression was not correlated with pCR rates. The Cox regression showed clinical T stage was an independent factor for DFS（HR=0.203， 95%CI：0.084-0.493， P＜0.001）. In HER-2-zero expression group， DFS showed a significant difference between p53-positive and p53-negative patients （χ²=5.351， P=0.021）. AR/p53/Ki-67 expression was not correlated with DFS regardless of HER-2 status.

Conclusion

HER-2-low and HER-2-zero TNBC patients show a significant difference in pCR rates and prognosis， suggesting distinct underlying pathological and biological features that warrant further investigation.

Objective

Toexplorethestrategyofaxillarystaginginbreast-conservingpatientswith early invasive breast cancer （cT_1-2N_0-1M₀）.

Methods

A-ccording to the inclusion and exclusion criteria， a total of 701 breast-conserving patients with early invasive breast cancer （cT_1-2N_0-1M₀） in the Department of Breast Surgery， Peking University International Hospital from January 2016 to September 2023 were included for a retrospective study. Ultrasound examination of axillary lymph node （ALN） was performed in 701 patients.Ultrasound-guided fine-needle aspiration biopsy （FNAB） was performed in cN₁ patients. The cN₀ patients or cN₁ patients with negative results of FNAB underwent sentinel lymph node biopsy （SLNB）. Patients with 1-2 positive sentinel lymph nodes （SLNs） were exempted from axillary lymph node dissection （ALND）. Patients with ≥3 positive SLNs underwent ALND. cN₁ patients with positive results of FNAB ［cN_1（f）］underwent ALND.

Results

Among these 701 patients （cT_1-2N_0-1M₀）， 539 cN₀ patients （76.9%） underwent SLNB and 162 cN₁ patients （23.1%） underwent ultrasound-guided FNAB. The 105 （64.8%） patients with negative results of FNAB underwent SLNB， and 57 （35.2%） patients with positive results of FNAB underwent ALND.Among these 57 cN_1（f） patients， 49 patients （86.0%） had 1-2 positive ALNs confirmed by postoperative pathology and could not have undergone ALND if SLNB was performed preferentially. Totally 644 patients （539 cN₀ patients and 105 cN₁ patients with negative findings in FNAB） underwent SLNB. The results of SLNB showed that 519 （80.6%） patients with negative SLN did not require subsequent ALND， and 113 （17.5%）patients with 1-2 positive SLNs were exempted from ALND. The sensitivity of ultrasonography in detecting ALNs of cN_0-1 patients was 47.3% （86/182）， and the misdiagnosis rate was 14.6% （76/519）.

Conclusion

The ultrasonography is not sensitive enough for axillary staging in cT_1-2N_0-1M₀ breast cancer patients. SLNB is suggested to be performed preferentially for axillary staging， which can not only simplify the staging process，but also further improve the ALN-preservation rate in cN_1（f） patients.

Objective

To investigate the expression of the forkhead box C1 （FOXC1） and the tight junction protein claudin-4 in triple-negative breast cancer （TNBC） and their relationships with the tumor microenvironment （TME）-related and inflammatory factors.

Methods

According to the inclusion and exclusion criteria， a retrospective study was conducted on 72 TNBC patients in the Maternal and Children's Hospital of Qinhuangdao from January 2021 to June 2023. According to the immunohistochemical results， the patients were divided into the FOXC1-positive group （40 cases） and the FOXC1-negative group （32 cases） or they were divided into the claudin-4-positive group （50 cases） and the claudin-4-negative group （22 cases）.In addition， 30 cases of non-TNBC patients admitted during the same period served as control. The levels of tumor microenvironment-related factors ［transforming growth factor-β1 （TGF-β1）， α-smooth muscle actin （α-SMA）， and type I collagen］and inflammation-related factors ［interleukin-6 （IL-6）， white blood cell count（WBC）， and tumor necrosis factor-α （TNF-α）］were compared among three groups. One-way analysis of variance was used for comparisons between groups， and the Bonferroni method was used for pairwise comparisons， with the significance level adjusted to 0.017. The Pearson method was used to analyze the correlations between FOXC1/ claudin-4 and TME-related and inflammatory factors.

Results

There were significant differences in the levels of TGF-β1， α-SMA， and type I collagen，TNF-α， IL-6， and WBC count among the FOXC1-positive group， the FOXC1-negative group and the control group （F=16.792， 18.160，14.255， 32.401， 27.269， 25.507； all P＜0.001）. The levels of all the above-mentioned parameters in the FOXC1-positive group were significantly higher than those in the FOXC1-negative group and the control group，and the values in the FOXC1-negative group were significantly higher than those in the control group （all P＜0.017）. There were significant differences in the levels of TGF-β1， α-SMA， and type I collagen，TNF-α， IL-6，and WBC count among the claudin-4-positive group， the claudin-4-negative group， and the control group （F=17.535， 13.640， 20.900， 21.351， 27.353， 24.180； all P＜0.001）. The levels of all the above-mentioned parameters in the claudin-4-positive group were significantly higher than those in the FOXC1-negative group and the control group， and the values in the claudin-4-negative group were significantly higher than those in the control group （P＜0.017）. Both FOXC1 and claudin-4 expressions were positively correlated with the expressions of TGF-β1， α-SMA and type I collagen and the levels of serum TNF-α， IL-6， and WBC count（r=0.632， 0.710， 0.667， 0.684， 0.598， 0.601， all P＜0.001； r=0.723， 0.611， 0.621， 0.702， 0.582，0.570， all P＜0.001）.

Conclusion

The proteins FOXC1 and claudin-4 are highly expressed in the TNBC tissues， which may be related to the TME-related and inflammatory factors.

Objective

To investigate the effects of myofascial release technique on shoulder joint function and quality of life in patients after radical mastectomy for breast cancer.

Methods

A prospective analysis was conducted on 82 breast cancer patients who underwent radical mastectomy in the Xindu District Hospital of Traditional Chinese Medicine， Chengdu， from October 2021 to February 2023. Patients were randomly divided into a control group and an observation group （41 cases each） using a random number table method. The control group received manual lymphatic drainage postoperatively， while the observation group received myofascial release therapy. Shoulder joint flexion， extension， internal rotation， and external rotation angles， as well as Visual Analogue Scale （VAS） scores， were measured before treatment， immediately after treatment， and one month after treatment. Repeated measures ANOVA was used for intergroup comparisons.The Patient Health Questionnaire-9 （PHQ-9）， Disabilities of the Arm， Shoulder and Hand （DASH） scale，and Functional Assessment of Cancer Therapy-Breast （FACT-B） scores were assessed before treatment， after treatment， and one month after treatment， with intergroup comparisons performed using t-tests.

Results

The observation group showed significantly lower VAS scores than the control group （between-group： F=17.869，P＜0.001； time effect： F=105.517，P＜0.001；interaction： F=32.303，P＜0.001）. Shoulder joint mobility（flexion， extension， internal rotation， and external rotation angles） was significantly better in the observation group （flexion： between-group： F=5.636， P=0.020； time effect： F=33.024， P＜0.001； interaction： F=7.635， P=0.007； extension angle： between-group： F=8.829， P=0.004； time effect： F=197.515， P＜0.001； interaction F=23.266， P＜0.001； internal rotation angle： between-group： F=5.409， P=0.023； time effect： F=73.649， P＜0.001； interaction effect： F=24.294， P＜0.001； external rotation angle： betweengroup： F=7.970， P=0.006； time effect： F=84.163，P＜0.001； interaction： F=14.369，P＜0.001）. The scores of the PHQ-9 and the DASH in the observation group were significantly lower than those in the control group （t=5.937，P＜ 0.001；t=3.034，P=0.003）， and the score of the FACT-B scale was significantly higher than that of the control group （t=3.166，P=0.002）.

Conclusion

Myofascial release therapy improves overall shoulder mobility， reduces pain and depressive symptoms， and enhances quality of life in post-mastectomy patients， demonstrating promising clinical efficacy and application potential.