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Article History

Received: 25 June 2025

Revised: 12 January 2026

Accepted: 10 February 2026

First Online: 19 February 2026

Competing interests

: CD received personal fees from Novartis, Roche, MSD Oncology, Daiichi Sankyo, AstraZeneca, Molecular Health, and Merck, all outside the submitted work. CD is cofounder of Sividon Diagnostics. In addition, CD has a patent on VMScope digital pathology software with royalties paid; a patent WO2020109570A1—cancer immunotherapy pending; and patents WO2015114146A1 and WO2010076322A1—therapy response issued. PJ reports research grant and travel expenses from GILEAD Sciences GmbH out-side the submitted work. NH declares to be GBG Forschungs GmbH employee. GBG Forschungs GmbH reports financial funding from AstraZeneca and Myriad during the conduct of the study; received funding for research grants from Abbvie, Amgen, AstraZeneca, BMS, Daiichi-Sankyo, Gilead, Molecular Health, Stemline Menarini, Celgene/BMS, Novartis, Pfizer and Roche (paid to the institution); GBG Forschungs GmbH has licensing fees from VMscope GmbH. In addition, GBG Forschungs GmbH has a patent EP21152186.9 pending, a patent EP19808852.8 pending, and a patent EP14153692.0 pending. The other authors declare no conflicts of interest.

: Immunohistochemical staining and evaluation of breast cancer patient tissue samples were approved by the Ethics Committee of the Charité (Ethics Opinion No. EA1/139/05) and conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all patients for the use of their tissue samples in this study.