Evidence map›Paper›PMID 41913016›Full record

ArticleAnnals of surgical oncology2026

Economic and Health System Impact of Implementing the SOUND Trial Approach in Early-Stage Breast Cancer.

Tyler P Shern, Logan R Holt, Kate Lloyd, Abigail E Daly, Michele A Gadd, Francys C Verdial, Rebecca M Kwait, Michelle C Specht, Barbara L Smith, Tolga Ozmen

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Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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0cells of the map it votes in
1citing 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

1 citing paper in PubMed.

  1. Article
4 · The record

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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

10 authors.

Tyler P ShernDivision of Breast Surgery, Massachusetts General Hospital, Boston, MA, USA.
Logan R HoltDivision of Breast Surgery, Massachusetts General Hospital, Boston, MA, USA.
Kate LloydDivision of Breast Surgery, Massachusetts General Hospital, Boston, MA, USA.
Abigail E DalyDivision of Breast Surgery, Massachusetts General Hospital, Boston, MA, USA.
Michele A GaddDivision of Breast Surgery, Massachusetts General Hospital, Boston, MA, USA.
Francys C VerdialDivision of Breast Surgery, Massachusetts General Hospital, Boston, MA, USA.
Rebecca M KwaitDivision of Breast Surgery, Massachusetts General Hospital, Boston, MA, USA.
Michelle C SpechtDivision of Breast Surgery, Massachusetts General Hospital, Boston, MA, USA.
Barbara L SmithDivision of Breast Surgery, Massachusetts General Hospital, Boston, MA, USA.
Tolga OzmenDivision of Breast Surgery, Massachusetts General Hospital, Boston, MA, USA. tozmen@mgh.harvard.edu.ORCID http://orcid.org/0000-0002-7136-6195

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAxillary management in early-stage breast cancer is increasingly shifting toward de-escalation. While sentinel lymph node biopsy (SLNB) remains standard, evidence suggests axillary ultrasound (AUS) may safely replace SLNB in selected patients. The SOUND trial demonstrated noninferior oncologic outcomes with AUS-based staging among clinically node-negative patients with small (≤ 2 cm), unifocal invasive breast cancers and negative preoperative AUS. However, the economic and health system impact of implementing this strategy in routine practice remains unclear. PATIENTS AND

methodsWe conducted a retrospective cohort analysis of 221 SOUND-eligible patients who underwent breast-conserving surgery with SLNB at four affiliated hospitals between January and June 2023. Costs were modeled using 2025 Medicare reimbursement rates, comparing the observed SLNB pathway with a theoretical AUS-only approach. Estimates included procedural, anesthesia, pathology, and complication-related costs, analyzed from both hospital and patient perspectives.

resultsTotal estimated hospital costs were $1192,159.56 for SLNB versus $111,825.65 for AUS-only staging, a 90.6% reduction. Mean patient out-of-pocket costs decreased similarly (from $1078.88 to $101.20 per patient). SLNB added an average of 15.1 min of operative time and increased pathology workload owing to lymph node processing.

conclusionsIn SOUND-eligible patients, axillary staging with ultrasound alone provides substantial reductions in cost, operative time, and resource utilization while supporting a less invasive, value-based approach to breast cancer care. Together with existing evidence, these findings support broader implementation of the SOUND strategy in appropriately selected populations, particularly postmenopausal patients over 50 years undergoing breast-conserving surgery for cT1N0, ER-positive, HER2-negative invasive ductal carcinoma with a negative AUS.

Indexed as

Breast NeoplasmsHospital CostsMastectomy, SegmentalSentinel Lymph Node BiopsyAgedAxillaFemaleFollow-Up StudiesHumansNeoplasm StagingPrognosisRetrospective StudiesAxillary ultrasoundCost savingsEarly-stage breast cancerHigh-value careLumpectomySentinel lymph node biopsySOUND trialSurgical de-escalation

Identifiers

PMID41913016

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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.