Evidence map›Paper›PMID 32020394›Full record

SynthesisAnnals of surgical oncology2020

Comparing Observation, Axillary Radiotherapy, and Completion Axillary Lymph Node Dissection for Management of Axilla in Breast Cancer in Patients with Positive Sentinel Nodes: A Systematic Review.

Matthew Castelo, Shu Yang Hu, Fahima Dossa, Sergio A Acuna, Adena S Scheer

Abstract readSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Annals of surgical oncology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 2 pooled it
0.9field-weighted citation impact, top 32% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 2 syntheses or guidelines pooled it, 16 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Article
  5. Article
  6. Review
  7. Review
  8. Addressing the problem of overtreatment in breast cancer.Expert review of anticancer therapy · 2022
    Review
  9. Modern surgical treatment of breast cancer.Annals of medicine and surgery (2012) · 2020
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 2 countries.

Matthew CasteloDivision of General Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Shu Yang HuSchool of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
Fahima DossaDivision of General Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Sergio A AcunaDivision of General Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Adena S ScheerDivision of General Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. adena.scheer@unityhealth.to.
University of Toronto · CARoyal College of Surgeons in Ireland · IESt. Michael's Hospital · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeSeveral randomized controlled trials (RCTs) have investigated observation or axillary radiotherapy (ART) in place of completion axillary lymph node dissection (cALND) for management of positive sentinel nodes (SNs) in clinically node-negative women with breast cancer. The optimal treatment strategy for this population is not known.

methodsMEDLINE, Embase, and EBM Reviews-NHS Economic Evaluation Database were searched from inception until July 2019. A systematic review and narrative summary was performed of RCTs comparing observation or ART versus cALND in clinically node-negative female breast cancer patients with positive SNs. The Cochrane risk of bias tool for RCTs was used to assess risk of bias. Outcomes of interest included overall survival (OS), disease-free survival (DFS), axillary recurrence, and axillary surgery-related morbidity.

resultsThree trials compared observation with cALND, and two trials compared ART with cALND. No studies blinded participants or personnel, and there was heterogeneity in inclusion criteria, study design, and follow-up. Neither observation nor ART resulted in statistically inferior 5- or 8-year OS or DFS compared with cALND. There was also no statistically significant increase in axillary recurrences associated with either approach. Four trials reported morbidity outcomes, and all showed cALND was associated with significantly more lymphedema, paresthesia, and shoulder dysfunction compared with observation or ART.

conclusionsWomen with clinically node-negative breast cancer and positive SNs can safely be managed without cALND.

Indexed as

Breast NeoplasmsSentinel Lymph NodeWatchful WaitingAxillaFemaleHumansLymphatic MetastasisLymph Node ExcisionLymph NodesRandomized Controlled Trials as TopicSentinel Lymph Node Biopsy

Identifiers

PMID32020394
OpenAlexW3005276386

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.