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Gizem Oner,1– 3 Marleen Marguerite Praet,4 Hans Stoop,4 Gayathri R Devi,5 Nuh Zafer Canturk,3 Sevilay Altintas,1,2 Christophe Van Berckelaer,1,2 Zwi Berneman,6 Wiebren Tjalma,1,2 Senada Koljenovic,4 Peter A van Dam1,2 1Multidisciplinary Oncologic Centre Antwerp (MOCA), Antwerp University Hospital, Edegem, Belgium; 2Center for Oncological Research (CORE), University of Antwerp, Wilrijk, Belgium; 3Department of General Surgery, Kocaeli University, Kocaeli, Turkey; 4Department of Histopathology, Antwerp University Hospital, Edegem, Belgium; 5Department of Surgery, Duke University, Durham, NC, USA; 6Department of Hematology, Antwerp University Hospital, Edegem, BelgiumCorrespondence: Gizem Oner, University of Antwerp, Wilrijkstraat 10, Edegem, 2650, Belgium, Tel +32 498 53 18 33, Email onergizem@hotmail.comBackground: Tumor-associated macrophages (TAMs) constitute an important part of the tumor microenvironment of breast cancer (BC), and they play an essential role in modulating tumor growth and invasion. However, the role of TAMs in neoadjuvant chemotherapy (NAC) has not been fully elucidated. Therefore, the aim of this study was to assess the function of TAM subtypes and investigate their role in the response to NAC in BC.Methods: Presence of TAMs was examined immunohistochemically (IHC) in pre- and post- NAC treatment tumor tissue in a cohort of 138 BC patients. IHC staining with monoclonal antibodies for CD68 and CD163 were performed. Positivity was defined as staining > 1% TAMs in stroma and tumor cell nests. Response to NAC was evaluated according to tumor size change and Residual Cancer Burden (RCB) index.Results: CD68+ and CD163+ TAMs decreased significantly in both the stroma and tumor nests (TN) after NAC. The median CD68+ TAMs in the stroma decreased significantly from 5% to 1% (p < 0.005), while CD163+ TAMs showed a marked reduction from 20% to 5% (p < 0.001). Post-NAC, the persistence of CD68+ and CD163+ TAMs in the stroma was strongly correlated with larger residual tumor size (p < 0.005 and p < 0.001, respectively). Changes in CD163+ TAM levels in the stroma were significantly associated with RCB classes (p < 0.005). Pre-NAC, CD163+ TAMs in the stroma and TN showed a significant association with TILs; however, no correlations with TILs were observed post-NAC.Conclusion: This study highlights the critical role of TAMs dynamics in shaping NAC response in BC. Notably, CD163+ TAMs may emerge as pivotal players in mechanisms of chemotherapy resistance and response, underscoring their potential as biomarkers and therapeutic targets in breast cancer treatment.Keywords: tumor-associated macrophages, CD68, CD163, breast cancer, neoadjuvant chemotherapy

Background: The sentinel lymph node biopsy (SLNB) is the standard procedure to assess the lymph node status in women with early stage breast cancer. It is uncertain whether SLNB is useful after neo-adjuvant chemotherapy (NACT) given to women with locally advanced breast cancer. Materials and Methods: A literature search was conducted over a timeframe of 22 years (1994-2016). Forty-three studies evaluating the feasibility and accuracy of SLNB after NACT were identified. Results: The pooled identification rate was 88% and the pooled false negative ratio was 12%. Conclusion: SLNB could be considered as a standard procedure after NACT. [ABSTRACT FROM AUTHOR]

Staging of the axillary lymph nodes is an essential step to determine the appropriate treatment for breast cancer. Sentinel lymph node biopsy (SLNB) is currently the first step in staging and the gold standard. However, if the sentinel node is positive, a full dissection of the axillary lymph nodes should be performed (axillary lymph node dissection or ALND). This technique used to be the gold standard but had considerable sequelae which diminished quality of life. SLNB still has sequelae but the incidence is much lower. The goal of this systematic review is to assess whether MRI can replace or assist the current gold standard for axillary lymph node staging in breast cancer. With the use of these non-invasive techniques, the risk of morbidity could be reduced even more. A comprehensive search and an additional brief search in several databases has been performed using PRISMA. Studies were selected based on titles and abstracts and were included or excluded using predetermined criteria. The studies were assessed for validity and applicability using the QUADAS-2 tool by two readers. Data of three studies using diffusion-weighted imaging (DWI) were pooled and statistical analysis was performed. A total of seven studies were included for review. Three studies used DWI, others used T2-weighted imaging, contrast-enhanced imaging, T1-weighted imaging or an MRI scoring system. Due to the heterogeneously divided MRI modalities, a small meta-analysis of DWI was performed. Other studies were evaluated qualitatively. DWI reached a sensitivity of 87.67% (95% CI 77.88-94.20) and a specificity of 59.31% (95% CI 50.85-67.38), a positive predictive value (PPV) of 52.03% (95 CI 42.84-61.12), and a negative predictive value (NPV) of 90.53% (95% CI 82.78-95.58). MRI can aid in the detection of axillary lymph node metastasis, but it cannot replace the current gold standard (SLNB/ALND). [ABSTRACT FROM AUTHOR]