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Article History

Received: 16 October 2025

Revised: 23 February 2026

Accepted: 22 March 2026

First Online: 23 April 2026

Declarations

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: P. Jank reports grants and travel expenses from Gilead Sciences GmbH outside the submitted work. C. Denkert reports other support from MSD Oncology, personal fees from Daiichi Sankyo and AstraZeneca, and grants from Myriad Genetics and German Breast Group outside the submitted work. C. Denkert also reports a patent for VMscope digital pathology software with royalties paid, a patent for WO2020109570A1 issued, a patent for WO2015114146A1 issued, and a patent for WO2010076322A1 issued. W. D. Schmitt received speakers’ honoraria from AstraZeneca, Bundesverband Deutscher Pathologen, Deutsche Akademie für Senologie, GlaxoSmithKline, NOGGO, and Roche outside of this study and adboard honoraria from AstraZeneca and Myriad outside of this study, and financial funding from Myriad outside of this study. K. Saeger is CEO of VMscope GmbH, which is the producer and distributor of the CMPS software and its modules “Ki67 Quantifier clinical” and “Scan Connect.” J. Huober received honoraria from Lilly, Novartis, Roche, Pfizer, AstraZeneca, Gilead, Daiichi, Stemline, MSD, and AbbVie and reports consulting or advisory relationships with Lilly, Novartis, Roche, Pfizer, AstraZeneca, Gilead, Daiichi, and AbbVie and received travel expenses from Roche, Daiichi, Gilead, and AstraZeneca. M. Reinisch reports honoraria and/or consultancy fees from AstraZeneca, Daiichi Sankyo, Gilead, Lilly, MSD, Novartis, Pfizer, Roche, OnkowissenTV, Seagen, Streamed Up, and Somatex. M. Reinisch also reports travel support from AstraZeneca, Daiichi Sankyo, Gilead, Lilly, Novartis, Pfizer, and Roche. T. Link reports Honoraria for Lectures or presentations from Amgen, Roche, MSD, Novartis, Pfizer, Lilly, GSK, Gilead, Astra Zeneca, Daiichi Sankyo, Stemline, Seagen; Advisory Board/Advise from MSD, Roche, Pfizer, Lilly, Myriad, Esai, GSK, Gilead, Daiichi Sankyo, Roche, Astra Zeneca and support for attending meetings and/or travel from Pfizer, Astra Zeneca, Gilead, Daiichi Sankyo, Stemline, Seagen, MSD. C. Hanusch reports Speakers Bureau from Astra Zeneca, Novartis, Roche. S. declares to be GBG Forschungs GmbH employee (CEO); The institution receives grants and/or contracts from the following entities: AbbVie, AICME, AstraZeneca, Agendia, Amgen, Bayer, BeiGene, Bicycle, BioNTech, Celgene/BMS, Cellcuity, Chugai Pharmaceuticals, Corcept Therapeutics, DSI, Exact Science, Gilead, GSK, Incyte, Lilly, Medscape, MICE ideas, Molecular Health, Jiangsu Hengrui, MSD, Novartis, Olema, Peerview, Pierre Fabre, Pfizer, Relay, Roche, Sanofi, Seagen, Stemline/Menarini, JAZZ Pharmaceuticals; receives support for attending meetings and/or travel from DSI, Gilead, Roche, Lilly, ESMO, SGBCC, ASCO, AGO Kommission Mamma; GBG Forschungs GmbH has following /patents planned, issued or pending: EP14153692.0, EP21152186.9, EP18209672 and EP24210258 and receives licensing fees from VM Scope GmbH. B. Felder declares to be GBG Forschungs GmbH employee; The institution receives grants and/or contracts from the following entities: AbbVie, AICME, AstraZeneca, Agendia, Amgen, Bayer, BeiGene, Bicycle, BioNTech, Celgene/BMS, Cellcuity, Chugai Pharmaceuticals, Corcept Therapeutics, DSI, Exact Science, Gilead, GSK, Incyte, Lilly, Medscape, MICE ideas, Molecular Health, Jiangsu Hengrui, MSD, Novartis, Olema, Peerview, Pierre Fabre, Pfizer, Relay, Roche, Sanofi, Seagen, Stemline/Menarini, JAZZ Pharmaceuticals; receives support for attending meetings and/or travel from DSI, Gilead, Roche, Lilly, ESMO, SGBCC, ASCO, AGO Kommission Mamma; GBG Forschungs GmbH has following /patents planned, issued or pending: EP14153692.0, EP21152186.9, EP18209672 and EP24210258 and receives licensing fees from VM Scope GmbH.

: During the preparation of this work, the authors used ChatGPT OpenAI (OpenAI Ireland Ltd., Dublin, Ireland) for spell and grammar checking. After using this tool/service, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.