Evidence map›Paper›PMID 42461556›Full record

ArticleAnnals of surgical oncology2026

Is It Time to Redefine Clinical Nodal Staging for Breast Cancer?

Pooja M Varman, David A Taft, Monik Patel, Rahul Rangan, Regina Matar-Ujvary, Caitlin Ilkanich, Zahraa Al-Hilli

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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.

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

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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

7 authors.

Pooja M VarmanDepartment of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA. varmanp@ccf.org.
David A TaftDepartment of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
Monik PatelDepartment of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
Rahul RanganBreast Center, Integrated Surgical Institute, Cleveland Clinic, Cleveland, OH, USA.
Regina Matar-UjvaryBreast Center, Integrated Surgical Institute, Cleveland Clinic, Cleveland, OH, USA.
Caitlin IlkanichDepartment of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
Zahraa Al-HilliBreast Center, Integrated Surgical Institute, Cleveland Clinic, Cleveland, OH, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe current American Joint Committee on Cancer (AJCC) staging system defines cN1 by node mobility rather than number, while pathologic staging stratifies by node count. Whether cN1 patients with four or more suspicious nodes on pretreatment imaging differ in pathologic stage and survival outcomes from those with fewer nodes is unclear. PATIENTS AND

methodsPatients with biopsy-proven cN1 or cN2a breast cancer diagnosed in 2018-2023 who received neoadjuvant chemotherapy (NAC) at a single institution were identified. Pretreatment imaging was reviewed and cases categorized as cN1a (1-3 mobile nodes), cN1b (≥ 4 mobile nodes), or cN2a (matted nodes). Clinicopathologic characteristics were compared using χ

resultsAmong 618 cases, 390 (63.1%) were cN1a, 166 (26.9%) cN1b, and 62 (10.0%) cN2a. Pathologic complete response (pCR) rates did not differ across groups (29.5%, 28.9%, 35.5%; P = 0.598). Among patients with residual nodal disease, mean positive nodes were 2.8, 4.6, and 5.5 in cN1a, cN1b, and cN2a (P < 0.001), respectively. Pathologic nodal stage was ypN2 or higher in 12.8%, 24.1%, and 29.0% (P = 0.001), and cN1b was independently associated with upstaging on multivariable analysis (OR 1.958, 95% CI 1.184-3.237, P = 0.009). At median follow-up of 41.4 months, 3-year DFS (88.0%, 89.0%, 80.6%; P = 0.949) and OS (91.6%, 92.3%, 91.6%; P = 0.947) did not differ across groups.

conclusionsIn cN1 breast cancer, imaging-defined nodal burden ≥ 4 nodes independently predicts upstaging and greater residual nodal burden after NAC, aligning pathologically with cN2a disease. Imaging-based subcategorization of cN1 disease may have implications for staging, surgical planning, and trial eligibility.

Indexed as

Breast NeoplasmsLymph NodesNeoadjuvant TherapyNeoplasm StagingAdultAgedAntineoplastic Combined Chemotherapy ProtocolsFemaleFollow-Up StudiesHumansLymphatic MetastasisMiddle AgedPathologic Complete ResponsePrognosisRetrospective StudiesSurvival RateAxillary imagingBreast cancerClinical nodal stagingNeoadjuvant chemotherapyPathologic nodal burdenSentinel lymph node biopsyUpstaging

Identifiers

PMID42461556
PMCPMC13630902

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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.