Evidence map›Paper›PMID 39776333›Full record

ArticleBreast cancer research and treatment2025

Shifting from axillary dissection to targeted axillary surgery after neoadjuvant treatment: the evolving management of occult breast cancer in a monoinstitutional series of 114 patients.

Elisa Vicini, Viviana Galimberti, Maria Cristina Leonardi, Sabrina Kahler-Ribeiro-Fontana, Andrea Polizzi, Salvatore Petitto, Eleonora Pagan, Vincenzo Bagnardi, Emilia Montagna, Matteo Cavallone and 3 more

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Article in Breast cancer research and treatment, 2025. 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. Observational
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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

13 authors.

Elisa ViciniDivision of Breast Surgery, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy. elisa.vicini@ieo.it.
Viviana GalimbertiDivision of Breast Surgery, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
Maria Cristina LeonardiDepartment of Radiation Oncology, European Institute of Oncology IRCCS, Milan, Italy.
Sabrina Kahler-Ribeiro-FontanaDivision of Breast Surgery, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
Andrea PolizziDivision of Breast Surgery, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
Salvatore PetittoDivision of Breast Surgery, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
Eleonora PaganDepartment of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
Vincenzo BagnardiDepartment of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
Emilia MontagnaDivision of Medical Senology, European Institute of Oncology IRCCS, Milan, Italy.
Matteo CavalloneDepartment of Oncology and Hemato-Oncology, University of Milano, Milan, Italy.
Pietro CaldarellaDivision of Breast Surgery, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
Mattia IntraDivision of Breast Surgery, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
Paolo VeronesiDivision of Breast Surgery, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThe use of neoadjuvant systemic therapy for primary breast cancer can achieve tumor shrinkage, enabling less invasive surgical treatments, such as breast-conserving surgery instead of mastectomy, and sentinel node biopsy instead of axillary dissection. In recent years, an increasing number of studies have explored the use of primary systemic therapy for occult breast cancer with axillary presentation. These studies suggest that a more conservative approach, involving targeted axillary surgery could be cautiously proposed for occult breast cancer after neoadjuvant chemotherapy in selected patients. In cases where a complete pathological response in the lymph nodes is achieved, there may also be the possibility to omit radiotherapy.

methodsWe retrospectively reviewed surgical interventions for carcinoma of unknown primary (CUP) syndrome with axillary presentation at the European Institute of Oncology from April 2004 to October 2022. Demographic and clinicopathological characteristics of the patients were collected and follow-up information has been updated.

resultsA total of 114 patients who underwent axillary surgery for occult breast cancer were included. The 5-year disease-free survival was 74.5%, while overall survival was 88.5%. A total of 22.8% of patients underwent neoadjuvant treatment. Complete pathological response was achieved in 38.5%. Patients with complete nodal pathological response showed fewer events compared to patients with no complete pathological response after neoadjuvant treatment.

conclusionAlthough the sample size is limited, recent advances in breast cancer multimodal treatment indicate that targeted axillary surgery may be considered for the rare clinical presentation of occult breast cancer after neoadjuvant treatment. TRIAL REGISTRY: Trial registration number UID 4184 24/07/2024 "retrospectively registered".

Indexed as

Breast NeoplasmsLymph Node ExcisionNeoplasms, Unknown PrimaryAdultAgedAxillaFemaleHumansLymphatic MetastasisMiddle AgedNeoadjuvant TherapyRetrospective StudiesSentinel Lymph Node BiopsyTreatment OutcomeAxillary presentationCUP syndromeNeoadjuvant chemotherapyOccult breast cancerOmitting axillary surgery

Identifiers

PMID39776333

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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.