Evidence map›Paper›PMID 38995451›Full record

ArticleAnnals of surgical oncology2024

Clipping the Positive Lymph Node in Patients with Clinically Node Positive Breast Cancer Treated with Neoadjuvant Chemotherapy: Impact on Axillary Surgery in the ISPY-2 Clinical Trial.

Kayla M Switalla, Judy C Boughey, Katrina Dimitroff, Christina Yau, Velle Ladores, Hongmei Yu, Julia Tchou, Mehra Golshan, Gretchen Ahrendt, Lauren M Postlewait and 17 more

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Article in Annals of surgical oncology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
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

4 citing papers in PubMed.

  1. Trial
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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

27 authors.

Kayla M SwitallaUniversity of Minnesota Medical School, Minneapolis, MN, USA.
Judy C BougheyDepartment of Surgery, Mayo Clinic, Rochester, MN, USA.
Katrina DimitroffQuantum Leap Healthcare Collaborative, San Francisco, CA, USA.
Christina YauQuantum Leap Healthcare Collaborative, San Francisco, CA, USA.
Velle LadoresDepartment of Surgery, University of California San Francisco, San Francisco, CA, USA.
Hongmei YuQuantum Leap Healthcare Collaborative, San Francisco, CA, USA.
Julia TchouDepartment of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Mehra GolshanDepartment of Surgery, Yale School of Medicine, New Haven, CT, USA.
Gretchen AhrendtDepartment of Surgery, University of Colorado, Aurora, CO, USA.
Lauren M PostlewaitDepartment of Surgery, Emory University, Atlanta, GA, USA.
Mara PiltinDepartment of Surgery, Mayo Clinic, Rochester, MN, USA.
Chantal R ReynaDepartment of Surgery, Loyola University Medical Center, Chicago, IL, USA.
Cindy B MatsenDepartment of Surgery, University of Utah, Salt Lake City, UT, USA.
Todd M TuttleDepartment of Surgery, University of Minnesota, Minneapolis, MN, USA.
Anne M WallaceDepartment of Surgery, University of California San Diego, San Diego, CA, USA.
Cletus A ArcieroDepartment of Surgery, Emory University, Atlanta, GA, USA.
Marie Catherine LeeDepartment of Surgery, Moffitt Cancer Center, Tampa, FL, USA.
Jennifer TsengDepartment of Surgery, City of Hope, Irvine, CA, USA.
Jennifer SonDepartment of Surgery, MedStar Georgetown University, Washington, DC, USA.
Roshni RaoDepartment of Surgery, Columbia University Medical Center, New York, NY, USA.
Candice SauderDepartment of Surgery, UC Davis Health Comprehensive Cancer Center, Sacramento, CA, USA.
Arpana NaikDepartment of Surgery, Oregon Health and Science University, Portland, OR, USA.
Marissa Howard-McNattDepartment of Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Rachael LancasterDivision of Surgical Oncology, The University of Alabama at Birmingham Medical Center, Birmingham, AL, USA.
Peter NorwoodQuantum Leap Healthcare Collaborative, San Francisco, CA, USA.
Laura J EssermanDepartment of Surgery, University of California San Francisco, San Francisco, CA, USA.
Rita A MukhtarDepartment of Surgery, University of California San Francisco, San Francisco, CA, USA. rita.mukhtar@ucsf.edu.

Funding

The I SPY 2.2 TRIAL: Evolving to Imaging and Molecular Biomarker Response Directed Adaptive Sequential Treatment to Optimize Breast Cancer OutcomesP01CA210961 · NCI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Nola M. Hylton-Watson · 2017 to 2026
$22.9M
NCI NIH HHS P01 CA210961
6 · The paper itself

Abstract

backgroundFor patients with clinically node-positive (cN+) breast cancer undergoing neoadjuvant chemotherapy (NAC), retrieving previously clipped, biopsy-proven positive lymph nodes during sentinel lymph node biopsy [i.e., targeted axillary dissection (TAD)] may reduce false negative rates. However, the overall utilization and impact of clipping positive nodes remains uncertain. PATIENTS AND

methodsWe retrospectively analyzed cN+ ISPY-2 patients (2011-2022) undergoing axillary surgery after NAC. We evaluated trends in node clipping and associations with type of axillary surgery [sentinel lymph node (SLN) only, SLN and axillary lymph node dissection (ALND), or ALND only] and event-free survival (EFS) in patients that were cN+ on a NAC trial.

resultsAmong 801 cN+ patients, 161 (20.1%) had pre-NAC clip placement in the positive node. The proportion of patients that were cN+ undergoing clip placement increased from 2.4 to 36.2% between 2011 and 2021. Multivariable logistic regression showed nodal clipping was independently associated with higher odds of SLN-only surgery [odds ratio (OR) 4.3, 95% confidence interval (CI) 2.8-6.8, p < 0.001]. This was also true among patients with residual pathologically node-positive (pN+) disease. Completion ALND rate did not differ based on clip retrieval success. No significant differences in EFS were observed in those with or without clip placement, both with or without successful clip retrieval [hazard ratio (HR) 0.85, 95% CI 0.4-1.7, p = 0.7; HR 1.8, 95% CI 0.5-6.0, p = 0.3, respectively].

conclusionClip placement in the positive lymph node before NAC is increasingly common. The significant association between clip placement and omission of axillary dissection, even among patients with pN+ disease, suggests a paradigm shift toward TAD as a definitive surgical management strategy in patients with pN+ disease after NAC.

Indexed as

AxillaBreast NeoplasmsLymph Node ExcisionNeoadjuvant TherapySentinel Lymph Node BiopsyAdultAgedAntineoplastic Combined Chemotherapy ProtocolsChemotherapy, AdjuvantFemaleFollow-Up StudiesHumansLymphatic MetastasisLymph NodesMiddle AgedPrognosisBreast cancerClipped nodeNeoadjuvant chemotherapySentinel lymph node surgeryTargeted axillary dissection

Identifiers

PMID38995451
PMCPMC11452431

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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.