{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T09:07:00Z","timestamp":1784020020732,"version":"3.55.0"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["R25 CA056452"],"award-info":[{"award-number":["R25 CA056452"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["MD Anderson Cancer Center Center Support Grant P30CA016672"],"award-info":[{"award-number":["MD Anderson Cancer Center Center Support Grant P30CA016672"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Breast Cancer Res Treat"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Surgical excision of radial sclerosing lesions (RSLs) has historically been recommended to rule out malignancy. Contemporary guidelines support imaging surveillance instead whenever these lesions are \u201cadequately sampled.\u201d However, uncertainty exists around what suffices for sampling prior to observation, and the outcomes of imaging surveillance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted an observational cohort study including all RSLs diagnosed on image-guided needle biopsy performed at our institution from 2020 to 2025. We excluded lesions with a concurrent diagnosis of invasive cancer, ductal carcinoma in situ, or epithelial atypia in the ipsilateral breast. For lesions that underwent repeat percutaneous biopsy or surgical excision, we estimated the probability that additional sampling revealed malignancy. For the entire population, whether excision was performed or not, we estimated the cumulative incidence of malignancy at the site of RSL during follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 419 RSLs were diagnosed in 390 patients. 262 (62.5%) lesions were diagnosed by stereotactic-guided vacuum-assisted biopsy (VAB), 100 (23.9%) by MRI-guided VAB, and 57 (13.6%) by ultrasound-guided core needle biopsy. During initial work-up or follow-up, 35 lesions underwent repeat image-guided biopsy and 28 underwent surgical excision. None of these additional sampling procedures revealed malignancy. The estimated 3-year cumulative incidence of malignancy at the RSL site was 0% (95% CI: 0, 2.0%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings support a management strategy of imaging surveillance when radiologic-pathologic concordance is established. Even for less extensively sampled lesions, routine repeat biopsy or surgical excision may not be necessary for RSLs without atypia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10549-026-07990-w","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T06:04:06Z","timestamp":1780898646000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk of malignancy after diagnosis of radial sclerosing lesion without atypia"],"prefix":"10.1007","volume":"217","author":[{"given":"Lorena Beatriz","family":"Delgado Casanova","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sagar","family":"Dhamne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Resetkova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary S.","family":"Guirguis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avanthi","family":"Puvvala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Therese B.","family":"Bevers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Bedrosian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Huo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerollos Nashat","family":"Wanis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"7990_CR1","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1136\/jcp.56.10.721","volume":"56","author":"M Kennedy","year":"2003","unstructured":"Kennedy M, Masterson AV, Kerin M, Flanagan F (2003) Pathology and clinical relevance of radial scars: a review. J Clin Pathol 56:721\u2013724. https:\/\/doi.org\/10.1136\/jcp.56.10.721","journal-title":"J Clin Pathol"},{"key":"7990_CR2","doi-asserted-by":"publisher","first-page":"e230022","DOI":"10.1148\/rg.230022","volume":"43","author":"BZ Manzar","year":"2023","unstructured":"Manzar BZ, Phillips J, Dibble EH et al (2023) Imaging and Management of Radial Scars and Complex Sclerosing Lesions. Radiogr Rev Publ Radiol Soc N Am Inc 43:e230022. https:\/\/doi.org\/10.1148\/rg.230022","journal-title":"Radiogr Rev Publ Radiol Soc N Am Inc"},{"key":"7990_CR3","doi-asserted-by":"publisher","first-page":"1397","DOI":"10.2214\/AJR.18.19658","volume":"211","author":"C Vijapura","year":"2018","unstructured":"Vijapura C, Yang L, Xiong J, Fajardo LL (2018) Imaging Features of Nonmalignant and Malignant Architectural Distortion Detected by Tomosynthesis. AJR Am J Roentgenol 211:1397\u20131404. https:\/\/doi.org\/10.2214\/AJR.18.19658","journal-title":"AJR Am J Roentgenol"},{"key":"7990_CR4","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1007\/s10549-018-4973-x","volume":"173","author":"A Phantana-Angkool","year":"2019","unstructured":"Phantana-Angkool A, Forster MR, Warren YE et al (2019) Rate of radial scars by core biopsy and upgrading to malignancy or high-risk lesions before and after introduction of digital breast tomosynthesis. Breast Cancer Res Treat 173:23\u201329. https:\/\/doi.org\/10.1007\/s10549-018-4973-x","journal-title":"Breast Cancer Res Treat"},{"key":"7990_CR5","doi-asserted-by":"publisher","first-page":"2720","DOI":"10.1002\/ijc.32353","volume":"145","author":"JD Luiten","year":"2019","unstructured":"Luiten JD, Korte B, Voogd AC et al (2019) Trends in frequency and outcome of high-risk breast lesions at core needle biopsy in women recalled at biennial screening mammography, a multiinstitutional study. Int J Cancer 145:2720\u20132727. https:\/\/doi.org\/10.1002\/ijc.32353","journal-title":"Int J Cancer"},{"key":"7990_CR6","first-page":"589","volume":"110","author":"C Zuiani","year":"2005","unstructured":"Zuiani C, Londero V, Bestagno A et al (2005) Proliferative high-risk lesions of the breast: contribution and limits of US-guided core biopsy. Radiol Med (Torino) 110:589\u2013602","journal-title":"Radiol Med (Torino)"},{"key":"7990_CR7","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1148\/radiology.210.3.r99mr19799","volume":"210","author":"RJ Jackman","year":"1999","unstructured":"Jackman RJ, Nowels KW, Rodriguez-Soto J et al (1999) Stereotactic, automated, large-core needle biopsy of nonpalpable breast lesions: false-negative and histologic underestimation rates after long-term follow-up. Radiology 210:799\u2013805. https:\/\/doi.org\/10.1148\/radiology.210.3.r99mr19799","journal-title":"Radiology"},{"key":"7990_CR8","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1097\/PAS.0000000000000393","volume":"39","author":"N Conlon","year":"2015","unstructured":"Conlon N, D\u2019Arcy C, Kaplan JB et al (2015) Radial Scar at Image-guided Needle Biopsy. Am J Surg Pathol 39:779\u2013785. https:\/\/doi.org\/10.1097\/PAS.0000000000000393","journal-title":"Am J Surg Pathol"},{"key":"7990_CR9","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1016\/j.surg.2023.02.028","volume":"174","author":"S Warwar","year":"2023","unstructured":"Warwar S, Kulkarni S (2023) Selective surgical excision of high-risk lesions. Surgery 174:125\u2013128. https:\/\/doi.org\/10.1016\/j.surg.2023.02.028","journal-title":"Surgery"},{"key":"7990_CR10","doi-asserted-by":"publisher","first-page":"e2532737","DOI":"10.2214\/AJR.25.32737","volume":"224","author":"DL Nguyen","year":"2025","unstructured":"Nguyen DL, Langman EL, Johnson KS, Grimm LJ (2025) Architectural Distortions Detected by DBT Alone With No Ultrasound Correlate and Nonmalignant Results on Core Needle Biopsy: Outcomes From an Imaging-Focused Management Strategy. AJR Am J Roentgenol 224:e2532737. https:\/\/doi.org\/10.2214\/AJR.25.32737","journal-title":"AJR Am J Roentgenol"},{"key":"7990_CR11","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1111\/his.15233","volume":"85","author":"A Grabenstetter","year":"2024","unstructured":"Grabenstetter A, Brennan SB, Jochelson MS et al (2024) Radial sclerosing lesions found on core needle biopsy: excision can be safely avoided. Histopathology 85:397\u2013404. https:\/\/doi.org\/10.1111\/his.15233","journal-title":"Histopathology"},{"key":"7990_CR12","doi-asserted-by":"publisher","first-page":"5149","DOI":"10.1245\/s10434-021-09713-5","volume":"28","author":"E Kraft","year":"2021","unstructured":"Kraft E, Limberg JN, Dodelzon K et al (2021) Radial Scars and Complex Sclerosing Lesions of the Breast: Prevalence of Malignancy and Natural History Under Active Surveillance. Ann Surg Oncol 28:5149\u20135155. https:\/\/doi.org\/10.1245\/s10434-021-09713-5","journal-title":"Ann Surg Oncol"},{"key":"7990_CR13","unstructured":"The American Society of Breast Surgeons Resource Guide Surgical Management of Benign or High-Risk Lesions"},{"key":"7990_CR14","unstructured":"National Comprehensive Cancer Network Breast Cancer Screening and Diagnosis (Version 2.2025)"},{"key":"7990_CR15","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1007\/s10549-018-5040-3","volume":"174","author":"G Farshid","year":"2019","unstructured":"Farshid G, Buckley E (2019) Meta-analysis of upgrade rates in 3163 radial scars excised after needle core biopsy diagnosis. Breast Cancer Res Treat 174:165\u2013177. https:\/\/doi.org\/10.1007\/s10549-018-5040-3","journal-title":"Breast Cancer Res Treat"},{"key":"7990_CR16","doi-asserted-by":"publisher","first-page":"1177","DOI":"10.1016\/j.amjsurg.2021.03.029","volume":"221","author":"RQ Liu","year":"2021","unstructured":"Liu RQ, Chen L, Padilla-Thornton A et al (2021) Upstage rate of radial scar\/complex sclerosing lesion identified on core needle biopsy. Am J Surg 221:1177\u20131181. https:\/\/doi.org\/10.1016\/j.amjsurg.2021.03.029","journal-title":"Am J Surg"},{"key":"7990_CR17","doi-asserted-by":"publisher","first-page":"1179","DOI":"10.2214\/ajr.179.5.1791179","volume":"179","author":"RJ Brenner","year":"2002","unstructured":"Brenner RJ, Jackman RJ, Parker SH et al (2002) Percutaneous core needle biopsy of radial scars of the breast: when is excision necessary? AJR Am J Roentgenol 179:1179\u20131184. https:\/\/doi.org\/10.2214\/ajr.179.5.1791179","journal-title":"AJR Am J Roentgenol"},{"key":"7990_CR18","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-025-12299-1","author":"N Sharma","year":"2026","unstructured":"Sharma N, Theis S, Vogelmann T, Pijnappel R (2026) Vacuum-assisted breast biopsy vs core needle biopsy: a systematic review and meta-analysis. Eur Radiol. https:\/\/doi.org\/10.1007\/s00330-025-12299-1","journal-title":"Eur Radiol"},{"key":"7990_CR19","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.breast.2011.09.005","volume":"21","author":"S Bianchi","year":"2012","unstructured":"Bianchi S, Giannotti E, Vanzi E et al (2012) Radial scar without associated atypical epithelial proliferation on image-guided 14-gauge needle core biopsy: analysis of 49 cases from a single-centre and review of the literature. Breast 21:159\u2013164. https:\/\/doi.org\/10.1016\/j.breast.2011.09.005","journal-title":"Breast"},{"key":"7990_CR20","unstructured":"Fay MP, Mateja A, Grieco M (2026) bpcp: beta product confidence procedure for right censored data"},{"key":"7990_CR21","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1093\/biostatistics\/kxt016","volume":"14","author":"MP Fay","year":"2013","unstructured":"Fay MP, Brittain EH, Proschan MA (2013) Pointwise confidence intervals for a survival distribution with small samples or heavy censoring. Biostatistics 14:723\u2013736. https:\/\/doi.org\/10.1093\/biostatistics\/kxt016","journal-title":"Biostatistics"},{"key":"7990_CR22","doi-asserted-by":"publisher","first-page":"5010","DOI":"10.1016\/j.acra.2025.06.014","volume":"32","author":"R Ferre","year":"2025","unstructured":"Ferre R, Kuzmiak C (2025) Malignancy Rates of Pure Radial Scars Detected on Digital Breast Tomosynthesis: A Meta-analysis. Acad Radiol 32:5010\u20135015. https:\/\/doi.org\/10.1016\/j.acra.2025.06.014","journal-title":"Acad Radiol"},{"key":"7990_CR23","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1016\/j.crad.2018.04.004","volume":"73","author":"SE Pinder","year":"2018","unstructured":"Pinder SE, Shaaban A, Deb R et al (2018) NHS Breast Screening multidisciplinary working group guidelines for the diagnosis and management of breast lesions of uncertain malignant potential on core biopsy (B3 lesions). Clin Radiol 73:682\u2013692. https:\/\/doi.org\/10.1016\/j.crad.2018.04.004","journal-title":"Clin Radiol"},{"key":"7990_CR24","doi-asserted-by":"publisher","first-page":"107292","DOI":"10.1016\/j.ejso.2023.107292","volume":"50","author":"IT Rubio","year":"2024","unstructured":"Rubio IT, Wyld L, Marotti L et al (2024) European guidelines for the diagnosis, treatment and follow-up of breast lesions with uncertain malignant potential (B3 lesions) developed jointly by EUSOMA, EUSOBI, ESP (BWG) and ESSO. Eur J Surg Oncol 50:107292. https:\/\/doi.org\/10.1016\/j.ejso.2023.107292","journal-title":"Eur J Surg Oncol"},{"key":"7990_CR25","doi-asserted-by":"publisher","unstructured":"Elfgen C, Leo C, Kubik-Huch RA et al (2023) Third international consensus conference on lesions of uncertain malignant potential in the breast (B3 lesions). Virchows Arch 483:5\u201320. https:\/\/doi.org\/10.1007\/s00428-023-03566-x","DOI":"10.1007\/s00428-023-03566-x"},{"key":"7990_CR26","doi-asserted-by":"publisher","first-page":"76","DOI":"10.4274\/ejbh.galenos.2022.2022-9-3","volume":"19","author":"DS Polat","year":"2023","unstructured":"Polat DS, Seiler SJ, Goldberg J et al (2023) Radial Scars Without Atypia Diagnosed at Percutaneous Core Needle Breast Biopsy: Support for Imaging Surveillance. Eur J Breast Health 19:76\u201384. https:\/\/doi.org\/10.4274\/ejbh.galenos.2022.2022-9-3","journal-title":"Eur J Breast Health"},{"key":"7990_CR27","doi-asserted-by":"publisher","first-page":"8399","DOI":"10.1007\/s00330-023-09877-6","volume":"33","author":"C Darras","year":"2023","unstructured":"Darras C, Uchida M (2023) Upgrade risk of image-targeted radial scar and complex sclerosing lesions diagnosed at needle-guided biopsy: a retrospective study. Eur Radiol 33:8399\u20138406. https:\/\/doi.org\/10.1007\/s00330-023-09877-6","journal-title":"Eur Radiol"},{"key":"7990_CR28","doi-asserted-by":"publisher","first-page":"1506","DOI":"10.1111\/iwj.13224","volume":"16","author":"M Fang","year":"2019","unstructured":"Fang M, Liu G, Luo G, Wu T (2019) Feasibility and safety of image-guided vacuum-assisted breast biopsy: A PRISMA-compliant systematic review and meta-analysis of 20 000 population from 36 longitudinal studies. Int Wound J 16:1506\u20131512. https:\/\/doi.org\/10.1111\/iwj.13224","journal-title":"Int Wound J"},{"key":"7990_CR29","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1002\/cncr.11887","volume":"100","author":"U Kettritz","year":"2004","unstructured":"Kettritz U, Rotter K, Schreer I et al (2004) Stereotactic vacuum-assisted breast biopsy in 2874 patients: a multicenter study. Cancer 100:245\u2013251. https:\/\/doi.org\/10.1002\/cncr.11887","journal-title":"Cancer"},{"key":"7990_CR30","first-page":"3831","volume":"34","author":"A Eller","year":"2014","unstructured":"Eller A, Janka R, Lux M et al (2014) Stereotactic vacuum-assisted breast biopsy (VABB)--a patients\u2019 survey. Anticancer Res 34:3831\u20133837","journal-title":"Anticancer Res"},{"key":"7990_CR31","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1007\/s10549-025-07826-z","volume":"214","author":"W Yang","year":"2025","unstructured":"Yang W, Alongi A, Ma Z et al (2025) Long-term follow-up confirms patients with high-risk breast lesions can be successfully managed at a multidisciplinary conferences. Breast Cancer Res Treat 214:409\u2013418. https:\/\/doi.org\/10.1007\/s10549-025-07826-z","journal-title":"Breast Cancer Res Treat"},{"key":"7990_CR32","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1007\/s10549-008-0119-x","volume":"127","author":"E Resetkova","year":"2011","unstructured":"Resetkova E, Edelweiss M, Albarracin CT, Yang WT (2011) Management of radial sclerosing lesions of the breast diagnosed using percutaneous vacuum-assisted core needle biopsy: recommendations for excision based on seven years\u2019 of experience at a single institution. Breast Cancer Res Treat 127:335\u2013343. https:\/\/doi.org\/10.1007\/s10549-008-0119-x","journal-title":"Breast Cancer Res Treat"},{"key":"7990_CR33","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1016\/j.acra.2019.05.012","volume":"27","author":"S Martaindale","year":"2020","unstructured":"Martaindale S, Omofoye TS, Teichgraeber DC et al (2020) Imaging Follow-up Versus Surgical Excision for Radial Scars Identified on Tomosynthesis-Guided Core Needle Biopsy. Acad Radiol 27:389\u2013394. https:\/\/doi.org\/10.1016\/j.acra.2019.05.012","journal-title":"Acad Radiol"},{"key":"7990_CR34","doi-asserted-by":"publisher","first-page":"e2430845","DOI":"10.2214\/AJR.24.30845","volume":"222","author":"C Crowley","year":"2024","unstructured":"Crowley C, Bahl M (2024) Radial Scars on Screening Digital Breast Tomosynthesis: Upstaging Rates and Management Strategies. Am J Roentgenol 222:e2430845. https:\/\/doi.org\/10.2214\/AJR.24.30845","journal-title":"Am J Roentgenol"},{"key":"7990_CR35","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1111\/tbj.12645","volume":"22","author":"ET Kalife","year":"2016","unstructured":"Kalife ET, Lourenco AP, Baird GL, Wang Y (2016) Clinical and Radiologic Follow-up Study for Biopsy Diagnosis of Radial Scar\/Radial Sclerosing Lesion without Other Atypia. Breast J 22:637\u2013644. https:\/\/doi.org\/10.1111\/tbj.12645","journal-title":"Breast J"},{"key":"7990_CR36","doi-asserted-by":"publisher","first-page":"e273","DOI":"10.1016\/j.clbc.2024.01.020","volume":"24","author":"A Reyes","year":"2024","unstructured":"Reyes A, Sun L, Ha R et al (2024) A Comprehensive Assessment of Radial Scars on Core Needle Biopsy in Patients with or without Breast Cancer: Upgrade Rate and Implications on Management. Clin Breast Cancer 24:e273\u2013e278. https:\/\/doi.org\/10.1016\/j.clbc.2024.01.020","journal-title":"Clin Breast Cancer"}],"container-title":["Breast Cancer Research and Treatment"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10549-026-07990-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10549-026-07990-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10549-026-07990-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T08:30:16Z","timestamp":1784017816000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10549-026-07990-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":36,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["7990"],"URL":"https:\/\/doi.org\/10.1007\/s10549-026-07990-w","relation":{},"ISSN":["0167-6806","1573-7217"],"issn-type":[{"value":"0167-6806","type":"print"},{"value":"1573-7217","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"9 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The University of Texas MD Anderson Cancer Center institutional review board approved the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"46"}}