Evidence map›Paper›PMID 40329152›Full record

ArticleBreast cancer research and treatment2025

How can we optimize the surgical management of the axilla in breast cancer since the MonarchE trial?

Clémentine Jankowski, Gilles Houvenaeghel, Celine Renaudeau, Jean Leveque, Frederic Marchal, Amélie Benbara, Emmanuel Barranger, Roman Rouzier, Monique Cohen, Jean-Marc Classe and 2 more

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In one paragraph

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, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing 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

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

  1. Guideline
  2. Evaluating total tumor load (TTL) to predict metastasis in four or more axillary lymph nodes in HR +/HER2- breast cancer patients: the TULIP4N + study.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2026
    Article
  3. Article
  4. Article
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

12 authors.

Clémentine JankowskiDepartement of Surgical Oncology, Georges-François Leclerc Cancer Center, 1 rue du Professeur Marion, 21000, Dijon, France. cjankowski@cgfl.fr.ORCID http://orcid.org/0000-0002-0152-8101
Gilles HouvenaeghelDepartment of Surgery, Institut Paoli Calmettes, 232 Bd de Sainte Marguerite, 13009, Marseille, France.
Celine RenaudeauDepartment of Surgery, Institut de Cancérologie de l'Ouest, Boulevard Professeur Jacques Monod, 44800, Saint Herblain, France.
Jean LevequeDepartment of Surgery, Eugène Marquis Cancer Center, Avenue de la Bataille, 35042, Rennes, France.
Frederic MarchalDepartment of Surgery, Institut de Cancérologie de Lorraine, 6 Avenue de Bourgogne, 54519, Vandoeuvre-les-Nancy, France.
Amélie BenbaraDepartment of Surgery, Jean-Verdier Hospital, Avenue du 14 Juillet, 93140, Bondy, France.
Emmanuel BarrangerDepartment of Surgery, Antoine Lacassagne Cancer Center, 33 Avenue de Valombrose, 06189, Nice, France.
Roman RouzierDepartment of Surgery, François Baclesse Cancer Center, 3 Avenue Général Harris, 14076, Caen, France.
Monique CohenDepartment of Surgery, Institut Paoli Calmettes, 232 Bd de Sainte Marguerite, 13009, Marseille, France.
Jean-Marc ClasseDepartment of Surgery, Institut de Cancérologie de l'Ouest, Boulevard Professeur Jacques Monod, 44800, Saint Herblain, France.
Sylvain LadoireDepartment of Medical Oncology, Georges-François Leclerc Cancer Center, 1 rue du Professeur Marion, 21000, Dijon, France.
Charles CoutantDepartement of Surgical Oncology, Georges-François Leclerc Cancer Center, 1 rue du Professeur Marion, 21000, Dijon, France.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeResults of MonarchE trial have changed adjuvant therapy for estrogen-receptor-positive (ER+), HER-2-negative breast cancer. Given the importance of the extent of nodal disease in this study, surgical management of the axilla has resurfaced as a question asked at multidisciplinary boards.

methodsUsing data from a cohort of Werkoff (JCO, 2009) in which patients underwent both sentinel lymph node(SLN) biopsy and axillary node dissection (ALND), we assessed the proportion of patients in whom the absence of ALND would have led to a lack of awareness of "high-risk" status. We evaluated the contribution of the Katz nomogram (that predict pN2/N3 stage) to guide possible indications for complementary ALND.

resultsAmong the 536 patients, 88 were excluded (ER- and/or isolated cells in SLN). Of patients with 1 or 2 SLN + (n = 352), only 7.9% were pN2/N3. When the ratio (number of SLN + /total number of SLN sampled) was less than 1, only 3.9% were pN2/N3. Patients with 1 or 2 SLN + met the ACOSOG Z0011 criteria so none would benefit from an ALND, but 7.9% of patients at high risk will not receive Abemaciclib. If we use the Katz nomogram (threshold ≤ 5%), this rate decrease at 3.3% but 116 patients will have an ALND with no benefit. With a threshold ≤ 20%, 5% patients at high risk will not receive Abemaciclib but 21 patients will have an ALND with no benefit.

conclusionThe indications for adjuvant Abemaciclib should not lead to surgical escalation in the management of the axilla.

Indexed as

Breast NeoplasmsAdultAgedAxillaFemaleHumansLymphatic MetastasisLymph Node ExcisionMiddle AgedNeoplasm StagingNomogramsReceptors, EstrogenSentinel Lymph Node BiopsyReceptors, EstrogenAxillary lymph node dissectionBreast cancerEndocrine therapyEstrogen-receptor positiveNomogramSurgery

Identifiers

PMID40329152

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Registered trials

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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.