Evidence map›Paper›PMID 42406218›Full record

Observational studyAnnals of surgical oncology2026

Is Mastectomy Necessary in Patients with Occult Breast Cancer and Advanced (N2/N3) Nodal Disease?

Courtney M Lattimore, Kerollos Nashat Wanis, Henry M Kuerer, Kelly K Hunt, Sharon H Giordano, Melissa P Mitchell, Simona F Shaitelman, Nina Tamirisa, Yu Shen, Wenli Dong and 1 more

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study 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.

0numbers the graph read from it
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

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

11 authors.

Courtney M LattimoreDivision of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Kerollos Nashat WanisDivision of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Henry M KuererDivision of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Kelly K HuntDivision of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Sharon H GiordanoDivision of Cancer Prevention and Population Sciences, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Melissa P MitchellDivision of Radiation Oncology, Department of Breast Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Simona F ShaitelmanDivision of Radiation Oncology, Department of Breast Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Nina TamirisaDivision of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Yu ShenDepartment of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Wenli DongDepartment of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Helen M JohnsonDivision of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. hmjohnson1@mdanderson.org.

Funding

Tumor Evolution and Metastasis ProgramP30CA016672 · NCI · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI Fabien Delerue · 1985 to 2026
$290.8M
National Cancer Institute of the National Institutes of Health P30 CA016672NCI NIH HHS P30 CA016672
6 · The paper itself

Abstract

background/purposeOptimal surgical management of occult breast cancer (OBC) with N2/N3 nodal disease remains uncertain, but current National Comprehensive Cancer Network guidelines recommend mastectomy. We aimed to evaluate whether oncologic outcomes differ by local therapy. PATIENTS AND

methodsWe conducted an observational cohort study of patients with cT0N1-3M0 OBC treated at our institution between 2010 and 2025. We also analyzed data from patients registered in the National Cancer Database (NCDB) from 2006 to 2022. All patients included underwent neoadjuvant systemic therapy. Overall survival (OS) was estimated using Kaplan-Meier methods.

resultsAmong 85 patients treated at our institution, 42 (49.4%) had cN1 disease, 15 (17.6%) had cN2 disease, and 28 (32.9%) had cN3 disease. A total of 14 (16.5%) underwent mastectomy. Over a median follow-up of 3.6 years [IQR: 1.8, 7.9], no in-breast or chest wall recurrences occurred. The 5-year OS and disease-free survival (DFS) were similar among patients undergoing whole-breast radiation versus mastectomy, regardless of nodal status. The NCDB analysis included 632 patients, of whom 558 (88.3%) underwent mastectomy and 74 (11.7%) had radiation without breast surgery. For patients with cN2/N3 disease, 5-year OS was 96.3% (95% CI: 77.7-99.9%) with whole-breast radiation versus 84.3% (95% CI: 78.3-89.0%) with mastectomy.

conclusionsThere is not strong evidence for improved local control or survival with mastectomy in patients with OBC, even among those with advanced nodal disease. This lack of evidentiary support should be discussed in shared decision-making when mastectomy is presented as the default recommendation for all patients with OBC and N2/N3 disease.

Indexed as

Breast NeoplasmsMastectomyNeoplasms, Unknown PrimaryAgedFemaleFollow-Up StudiesHumansLymphatic MetastasisMiddle AgedPrognosisSurvival RateAxillary lymph node metastasisLocal therapyMastectomyOccult breast cancerWhole-breast radiation

Identifiers

PMID42406218
PMCPMC13630894

What OpenQuestion holds

Textmetadata
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Registered trials

None linked

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.