ArticleThe oncologist2020
Would Removal of All Ultrasound Abnormal Metastatic Lymph Nodes Without Sentinel Lymph Node Biopsy Be Accurate in Patients with Breast Cancer with Neoadjuvant Chemotherapy?
Article in The oncologist, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 3 of them syntheses that pooled it.
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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.
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Who cites it
17 citing papers in PubMed, 3 syntheses or guidelines pooled it, 26 citations in OpenAlex.
- Oncologic Outcomes of Sentinel Lymph Node Biopsy Versus Targeted Axillary Dissection for Node-Positive Breast Cancer Patients After Neoadjuvant Chemotherapy: A Systematic Review and Meta-Analysis.Annals of surgical oncology · 2026Pooled it
- Different strategies in de-escalation of axillary surgery in node-positive breast cancer following neoadjuvant treatment: a systematic review and meta-analysis of long-term outcomes.Breast cancer (Tokyo, Japan) · 2025Pooled it
- False Negativity of Targeted Axillary Dissection in Breast Cancer.Breast care (Basel, Switzerland) · 2021Pooled it
- Prospective Clinical Trial on Expanding the Eligibility Criteria for Targeted Axillary Dissection after Neoadjuvant Systemic Therapy in Breast Cancers with Advanced Nodal Disease.Annals of surgical oncology · 2026Trial
- Stained region lymph node biopsy for axillary restaging after neoadjuvant systemic therapy in node-positive breast cancer: a cohort study.Journal of cancer research and clinical oncology · 2026Article
- Two step procedures: sequels are never any good.Gland surgery · 2024Article
- Clipping a Positive Lymph Node Improves Accuracy of Nodal Staging After Neoadjuvant Chemotherapy for Breast Cancer Patients, but Does It Drive Management Changes?Annals of surgical oncology · 2024Article
- Use of axillary ultrasound to guide breast cancer management in the genomic assay era.Breast disease · 2024Article
- Oncologic outcomes in breast cancer patients with metastatic nodes and pathological nodal response following neoadjuvant chemotherapy without axillary dissection: a literature review.Annals of translational medicine · 2023Review
- Feasibility and accuracy of targeted axillary dissection in breast cancer patients; single center experience.Frontiers in surgery · 2023Article
- Initial experience with targeted axillary dissection after neoadjuvant therapy in breast cancer patients.Breast cancer (Tokyo, Japan) · 2022Observational
- Determining the benefit of neoadjuvant chemotherapy in reduction of axillary dissection rates in Z0011 trial cohort with high nodal burden.Gland surgery · 2022Article
- Targeted Removal of Axillary Lymph Nodes After Carbon Marking in Patients with Breast Cancer Treated with Primary Chemotherapy.Geburtshilfe und Frauenheilkunde · 2021Article
- Targeted axillary biopsy and sentinel lymph node biopsy for axillary restaging after neoadjuvant chemotherapy.Annals of surgical treatment and research · 2021Article
- Review
- Review
- Predictors of Nodal Pathological Complete Response in Asian Women with Stage II-III Node-Positive Breast Cancer.Oncology · 2021Article
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Authors and funding
8 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
lessons learnedRemoval of sonographically abnormal (up to 3) metastatic clipped nodes, without sentinel lymph node biopsy, could accurately predict axillary status in breast cancer patients receiving neoadjuvant chemotherapy. ypT and the first clipped node status were statistically significant factors for nodal pathologic complete response. This novel approach requires validation in larger studies.
backgroundIn patients who have node-positive breast cancer, neoadjuvant chemotherapy could result in nodal pathologic complete response (pCR) and avoid an axillary lymph node dissection (ALND). Axillary staging, in such cases, can be performed using targeted axillary dissection (TAD) with a low false negative rate. However, identification of sentinel lymph nodes (SLNs) after chemotherapy can be difficult, and currently, it is the standard to remove only one clipped node in TAD. We aimed to determine if removal of all sonographically abnormal metastatic clipped nodes, without SLN biopsy, could accurately predict the axillary status post neoadjuvant chemotherapy.
methodsPatients with breast cancer with one to three sonographically abnormal metastatic axillary nodes were prospectively recruited. Each abnormal node had histology and clip insertion before neoadjuvant chemotherapy. After chemotherapy, the patients underwent removal of clipped nodes using the Skin Mark clipped Axillary nodes Removal Technique (SMART) and ALND.
resultsFourteen patients were recruited, having a total of 21 sonographically abnormal metastatic nodes, with nine, three, and two patients having 1, 2, and 3 malignant nodes clipped, respectively. Mean age was 55.5 years; 92.9% and 57.1% of patients had invasive ductal carcinoma and grade III tumors, respectively; and 35.7% patients achieved nodal pCR. The first clipped node predicted the axillary status with a false negative rate of 7.1%. Adding to this another second clipped node, the false negative rate was 0%. Pathologic tumor staging after neoadjuvant chemotherapy (ypT) (p = .0390) and the first clipped node pathological response status (p = .0030) were statistically significant predictors for nodal pCR.
conclusionRemoval of sonographically abnormal metastatic clipped nodes using SMART, without sentinel lymph node biopsy, could accurately predict axillary status. This finding needs validation in larger studies.
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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.