Evidence map›Paper›PMID 39633166›Full record

ArticleAnnals of surgical oncology2025

Risk of Surgical Overtreatment in cN1 Breast Cancer Patients who Become ypN0 After Neoadjuvant Chemotherapy: SLNB Versus TAD.

Alison Laws, Saskia Leonard, Julie Vincuilla, Tonia Parker, Olga Kantor, Elizabeth A Mittendorf, Anna Weiss, Tari A King

Abstract readComparative Study
PubMed Publisher
In one paragraph

Article in Annals of surgical oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
–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

9 citing papers in PubMed, 1 synthesis or guideline pooled it.

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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

8 authors.

Alison LawsDivision of Breast Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Saskia LeonardJohn A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA.
Julie VincuillaDivision of Breast Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Tonia ParkerDivision of Breast Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Olga KantorDivision of Breast Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Elizabeth A MittendorfDivision of Breast Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Anna WeissDepartment of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
Tari A KingDivision of Breast Surgery, Brigham and Women's Hospital, Boston, MA, USA. tking7@bwh.harvard.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTwo surgical approaches have emerged for axillary staging in cN1 breast cancer patients after neoadjuvant chemotherapy (NAC): sentinel lymph node biopsy (SLNB) and targeted axillary dissection (TAD). Direct comparisons of technical and oncological outcomes with SLNB versus TAD are lacking.

methodsWe routinely performed SLNB from 2017 to 2018 for cN1 breast cancer patients who converted to cN0 after NAC, then adopted TAD from 2019 to 2022. To minimize the false-negative rate (FNR), we required retrieval of ≥3 sentinel lymph nodes (SLN) (2017-2018) or retrieval of the clipped node (CN) and ≥2 SLN (2019-2022). In ypN0 cases meeting these criteria, axillary lymph node dissection (ALND) was omitted. We compared the rate of per-protocol required ALND due to technical failure of SLNB versus TAD and reported axillary recurrence rates.

resultsAmong 191 cN1 ypN0 patients, 77 underwent SLNB and 114 underwent TAD. The overall rate of required ALND due to technical failure was 14.7% and did not differ between SLNB versus TAD (16.9% vs. 13.2%, p = 0.38). The most common technical failure with SLNB was retrieving <3 SLN (10.4%); for TAD, it was not retrieving the CN (7.1%). Median follow-up was 3.9 years for SLNB patients and 1.7 years for TAD patients; there were 1 (1.3%) and 0 (0.0%) axillary recurrences, respectively.

conclusionsSentinel lymph node biopsy and TAD for cN1 patients after NAC showed equivalent technical failure rates and low axillary recurrence rates. When applying strict criteria to minimize FNR of axillary staging surgery, approximately 15% of ypN0 patients may be overtreated with ALND.

Indexed as

Breast NeoplasmsLymph Node ExcisionNeoadjuvant TherapyOvertreatmentSentinel Lymph Node BiopsyAdultAgedAxillaFemaleFollow-Up StudiesHumansMiddle AgedNeoplasm StagingPrognosisRetrospective StudiesAxillary recurrenceAxillary surgeryBreast cancerNeoadjuvant chemotherapySentinel lymph node biopsyTargeted axillary dissection

Identifiers

PMID39633166

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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.