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Background: Disagreement in assessments of Ki67 expression based on core‐needle biopsy and matched surgical samples complicates decisions in the treatment of breast cancer. Purpose: To examine whether preoperative breast MRI could be useful in predicting Ki67 discordance between core‐needle biopsy and surgical samples. Study Type: Retrospective. Population: Three hundred and sixty‐five breast cancer patients with MRI scans and having both core‐needle biopsy and surgical samples from 2017 to 2019. Field Strength/Sequence: 3.0 T, T2‐weighted iterative decomposition of water and fat with echo asymmetry and least squares estimation sequence, diffusion‐weighted sequence using b‐values 0/1000, dynamic contrast enhanced image by volume imaged breast assessme NT. Assessment: We collected clinicopathologic variables and preoperative MRI features (tumor size, lesion type, shape of mass, spiculated margin, internal enhancement, peri‐tumoral edema, intra‐tumoral necrosis, multifocal/multicentric, apparent diffusion coefficient [ADC] minimum, ADC mean, ADC maximum, ADC difference). Statistical Tests: K‐means clustering, multivariable logistic regression, receiver operating characteristic curve. Results: Sixty‐one patients showed Ki67 discordance and 304 patients show Ki67 concordance according to our definition using K‐means clustering. Multivariable regression analysis showed that the following parameters were independently associated with Ki67 discordance: peri‐tumoral edema, odds ratio (OR) 2.662, 95% confidence interval (CI) 1.432–4.948; ADCmin ≤ 0.829 × 10−3 mm2/sec, OR 2.180, 95% CI 1.075–4.418; and ADCdiff > 0.317 × 10−3 mm2/sec, OR 3.365, 95% CI 1.698–6.669. This multivariable model resulted in an AUC of 0.758 (95% CI 0.711–0.802) with sensitivity and specificity being 0.803 and 0.621, respectively. Conclusion: Presence of peri‐tumoral edema, smaller ADCmin and greater ADCdiff in preoperative breast MRI may indicate high risk of Ki67 discordance between core‐needle biopsy and surgical samples. For patients with these MRI‐based risk factors, clinicians should not rely on Ki67 assessment only from core‐needle biopsy. [ABSTRACT FROM AUTHOR]

Background: The anti-Programmed Death-Ligand 1 (termed aPD-L1) immune checkpoint blockade therapy has emerged as a promising treatment approach for various advanced solid tumors. However, the effect of aPD-L1 inhibitors limited by the tumor microenvironment makes most patients exhibit immunotherapy resistance., Methods: We conjugated the Sialyl Lewis X with a polyethylene glycol-coated ultrasmall superparamagnetic iron oxide (USPIO-PEG) to form UPS nanoparticles (USPIO-PEG-SLe x , termed UPS). The physicochemical properties of UPS were tested and characterized. Transmission electron microscopy and ICP-OES were used to observe the cellular uptake and targeting ability of UPS. Flow cytometry, mitochondrial membrane potential staining, live-dead staining and scratch assay were used to verify the in vitro photothermal effect of UPS, and the stimulation of UPS on immune-related pathways at the gene level was analyzed by sequencing. Biological safety analysis and pharmacokinetic analysis of UPS were performed. Finally, the amplification effect of UPS-mediated photothermal therapy on aPD-L1-mediated immunotherapy and the corresponding mechanism were studied., Results: In vitro experiments showed that UPS had strong photothermal therapy ability and was able to stimulate 5 immune-related pathways. In vivo, when the PTT assisted aPD-L1 treatment, it exhibited a significant increase in CD4 + T cell infiltration by 14.46-fold and CD8 + T cell infiltration by 14.79-fold, along with elevated secretion of tumor necrosis factor-alpha and interferon-gamma, comparing with alone aPD-L1. This PTT assisted aPD-L1 therapy achieved a significant inhibition of both primary tumors and distant tumors compared to the alone aPD-L1, demonstrating a significant difference., Conclusion: The nanotheranostic agent UPS has been introduced into immunotherapy, which has effectively broadened its application in biomedicine. This photothermal therapeutic approach of the UPS nanotheranostic agent enhancing the efficacy of aPD-L1 immune checkpoint blockade therapy, can be instructive to address the challenges associated with immunotherapy resistance, thereby offering potential for clinical translation., Competing Interests: The authors declare no competing interests for this work., (© 2024 Li et al.)