{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T02:38:53Z","timestamp":1785465533265,"version":"3.56.0"},"reference-count":29,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Current practices in axillary treatment for patients with breast cancer who receive a mastectomy for node-positive disease are unknown. For patients who receive postmastectomy radiotherapy (PMRT), the addition of axillary lymph node dissection (ALND) may result in significant overtreatment.<\/jats:p><\/jats:sec>Objectives<\/jats:title>To evaluate trends in axillary treatment for patients with limited nodal metastases who receive a mastectomy and identify factors that can be targeted to reduce axillary overtreatment.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>A retrospective cohort study was conducted of patients identified from the National Cancer Database who received a diagnosis of breast cancer from January 1, 2012, to December 31, 2021. Patients included were women aged 18 years or older with clinical (c) T1-T2N0 breast cancer who underwent mastectomy with axillary staging with sentinel lymph node biopsy (SLNB) and\/or ALND and had 1 to 2 positive lymph nodes. Patients who received neoadjuvant therapies were excluded. Statistical analysis was performed from December 2023 to July 2024.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Axillary management based on ALND and PMRT receipt: (1) ALND alone, (2) PMRT alone, (3) both ALND and PMRT, and (4) neither ALND nor PMRT.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Axillary management strategies were evaluated, and clinicopathologic characteristics based on treatment type were compared with multivariable analysis.<\/jats:p><\/jats:sec>Results<\/jats:title>In total, 62\u202f332 patients were included (median age, 58 years [IQR, 48-68 years]; 82.2% with Charlson-Deyo comorbidity score 0). The proportion of patients who received ALND alone decreased from 47.1% to 17.6% from 2012 to 2021, while the percentage of patients who received PMRT alone increased from 9.8% to 36.8%. Overall, 21.3% of patients received treatment with both ALND and PMRT, with little change over time (from 21.7% in 2012 to 17.7% in 2021). Most patients (88.4%) who received both PMRT and ALND underwent ALND at the same operation as SLNB. Younger age (odds ratio [OR] per year increase, 0.98 [95% CI, 0.98-0.98]; P<\/jats:italic>\u2009&amp;lt;\u2009.001), high-grade tumors (grade 2: OR, 1.18 [95% CI, 1.09-1.29]; P<\/jats:italic>\u2009&amp;lt;\u2009.001; grade 3: OR, 1.34 [95% CI, 1.22-1.48]; P<\/jats:italic>\u2009&amp;lt;\u2009.001), presence of lymphovascular invasion (OR, 1.26 [1.19-1.33]; P<\/jats:italic>\u2009&amp;lt;\u2009.001), and larger tumor size (cT2 tumors compared with cT1: OR, 1.10 [95% CI, 1.03-1.17]; P<\/jats:italic>\u2009=\u2009.004; upstaging to pathologic T3 tumors: OR, 2.29 [95% CI, 1.15-4.99]; P<\/jats:italic>\u2009=\u2009.03) were associated with increased likelihood of concurrent treatment with ALND and PMRT.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this retrospective cohort study of patients with breast cancer who received a mastectomy, a substantial proportion of those with 1 to 2 positive lymph nodes were treated with both ALND and PMRT. Delaying the decision for ALND until after multidisciplinary input may reduce overtreatment.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.59692","type":"journal-article","created":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T16:14:58Z","timestamp":1739463298000},"page":"e2459692","source":"Crossref","is-referenced-by-count":11,"title":["Trends in Axillary Lymph Node Dissection After Mastectomy Among Patients With Limited Nodal Burden"],"prefix":"10.1001","volume":"8","author":[{"given":"Ton","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Surgery, Duke University Medical Center, Durham, North Carolina"},{"name":"Duke Cancer Institute, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Jones","sequence":"additional","affiliation":[{"name":"Duke Cancer Institute, Duke University, Durham, North Carolina"},{"name":"Biostatistics and Bioinformatics, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha M.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Duke Cancer Institute, Duke University, Durham, North Carolina"},{"name":"Biostatistics and Bioinformatics, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid Botty","family":"Van den Bruele","sequence":"additional","affiliation":[{"name":"Department of Surgery, Duke University Medical Center, Durham, North Carolina"},{"name":"Duke Cancer Institute, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura H.","family":"Rosenberger","sequence":"additional","affiliation":[{"name":"Department of Surgery, Duke University Medical Center, Durham, North Carolina"},{"name":"Duke Cancer Institute, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akiko","family":"Chiba","sequence":"additional","affiliation":[{"name":"Department of Surgery, Duke University Medical Center, Durham, North Carolina"},{"name":"Duke Cancer Institute, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kendra J. Modell","family":"Parrish","sequence":"additional","affiliation":[{"name":"Department of Surgery, Duke University Medical Center, Durham, North Carolina"},{"name":"Duke Cancer Institute, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesly A.","family":"Dossett","sequence":"additional","affiliation":[{"name":"Department of Surgery, Michigan Medicine, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer K.","family":"Plichta","sequence":"additional","affiliation":[{"name":"Department of Surgery, Duke University Medical Center, Durham, North Carolina"},{"name":"Duke Cancer Institute, Duke University, Durham, North Carolina"},{"name":"Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"McDuff","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maggie L.","family":"DiNome","sequence":"additional","affiliation":[{"name":"Department of Surgery, Duke University Medical Center, Durham, North Carolina"},{"name":"Duke Cancer Institute, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. 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