SynthesisWorld journal of surgical oncology2026
Carbon (charcoal) tattoo localization of biopsy-proven metastatic axillary lymph nodes for targeted axillary dissection after neoadjuvant therapy in breast cancer: a systematic review and single -arm meta-analysis.
Synthesis in World journal 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.
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.
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.
Who cites it
1 citing paper in PubMed.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTargeted axillary dissection (TAD) using carbon tattooing aims to localize and excise biopsy-proven metastatic axillary nodes after neoadjuvant systemic therapy (NAST), potentially improving post-NAST axillary staging while enabling the de-escalation of axillary surgery.
methodsWe systematically searched Scopus, Embase, PubMed, Web of Science, Cochrane CENTRAL, and ClinicalTrials.gov, supplemented by screening reference lists. Prospective and retrospective clinical studies evaluating carbon tattooing-guided targeted tattooed lymph node (TLN) excision in initially node-positive breast cancer patients treated with NAST were included. Random-effects generalized linear mixed models (GLMM) were used to pool the proportions of dichotomous outcomes. Continuous outcomes were pooled using a random-effects inverse variance model. The risk of bias was assessed using the ROBINS-I tool. Leave-one-out sensitivity analyses and a pre-specified clinical subgroup analysis (completion-ALND verification cohort vs. feasibility/no-mandatory-ALND cohort) were also performed.
resultsNine studies were included in this review. The pooled TLN identification rate was 0.94 (95% CI: 0.88-0.97). The pooled sentinel lymph node (SLN) identification rate was 0.754 (95% CI 0.541-0.888), with substantial heterogeneity between studies. TLN-SLN concordance was 0.554 (95% CI 0.333-0.755), indicating a moderate overlap between the tattooed node and SLN. In the completion-ALND verification cohorts, the pooled false-negative rate (FNR) of the targeted procedure versus ALND for residual nodal disease was 0.068 (95% CI 0.042-0.108). The pooled mean number of retrieved nodes was 3.25 (95% CI 2.54-3.96), and the pooled tattoo-to-surgery interval was 153.0 days (95% CI 131.9-174.2). Sensitivity analyses showed that no single study unduly influenced pooled estimates.
conclusionCarbon tattooing-guided targeted axillary procedures after NAST demonstrated high TLN retrieval and low verification-cohort FNR, supporting procedural feasibility for post-NAST axillary staging in initially node-positive breast cancer patients. However, variable SLN identification, moderate TLN-SLN concordance, and heterogeneity in technique and reporting support implementation within standardized multidisciplinary workflows with local audits. Further prospective comparative studies are required.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.