{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,8]],"date-time":"2026-11-08T06:16:03Z","timestamp":1794118563842,"version":"4.8.0"},"reference-count":15,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Oncol"],"published-print":{"date-parts":[[2024,6,1]]},"abstract":"Importance<\/jats:title>Data on oncological outcomes after omission of axillary lymph node dissection (ALND) in patients with breast cancer that downstages from node positive to negative with neoadjuvant chemotherapy are sparse. Additionally, the best axillary surgical staging technique in this scenario is unknown.<\/jats:p><\/jats:sec>Objective<\/jats:title>To investigate oncological outcomes after sentinel lymph node biopsy (SLNB) with dual-tracer mapping or targeted axillary dissection (TAD), which combines SLNB with localization and retrieval of the clipped lymph node.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>In this multicenter retrospective cohort study that was conducted at 25 centers in 11 countries, 1144 patients with consecutive stage II to III biopsy-proven node-positive breast cancer were included between April 2013 and December 2020. The cumulative incidence rates of axillary, locoregional, and any invasive (locoregional or distant) recurrence were determined by competing risk analysis.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Omission of ALND after SLNB or TAD.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary end points were the 3-year and 5-year rates of any axillary recurrence. Secondary end points included locoregional recurrence, any invasive (locoregional and distant) recurrence, and the number of lymph nodes removed.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 1144 patients (median [IQR] age, 50 [41-59] years; 78 [6.8%] Asian, 105 [9.2%] Black, 102 [8.9%] Hispanic, and 816 [71.0%] White individuals; 666 SLNB [58.2%] and 478 TAD [41.8%]) were included. A total of 1060 patients (93%) had N1 disease, 619 (54%) had ERBB2<\/jats:italic> (formerly HER2<\/jats:italic>)\u2013positive illness, and 758 (66%) had a breast pathologic complete response. TAD patients were more likely to receive nodal radiation therapy (85% vs 78%; P<\/jats:italic>\u2009=\u2009.01). The clipped node was successfully retrieved in 97% of TAD cases and 86% of SLNB cases (without localization). The mean (SD) number of sentinel lymph nodes retrieved was 3 (2) vs 4 (2) (P<\/jats:italic>\u2009&amp;lt;\u2009.001), and the mean (SD) number of total lymph nodes removed was 3.95 (1.97) vs 4.44 (2.04) (P<\/jats:italic>\u2009&amp;lt;\u2009.001) in the TAD and SLNB groups, respectively. The 5-year rates of any axillary, locoregional, and any invasive recurrence in the entire cohort were 1.0% (95% CI, 0.49%-2.0%), 2.7% (95% CI, 1.6%-4.1%), and 10% (95% CI, 8.3%-13%), respectively. The 3-year cumulative incidence of axillary recurrence did not differ between TAD and SLNB (0.5% vs 0.8%; P<\/jats:italic>\u2009=\u2009.55).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>The results of this cohort study showed that axillary recurrence was rare in this setting and was not significantly lower after TAD vs SLNB. These results support omission of ALND in this population.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoncol.2024.0578","type":"journal-article","created":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T15:35:48Z","timestamp":1714059348000},"page":"793","source":"Crossref","is-referenced-by-count":99,"title":["Omission of Axillary Dissection Following Nodal Downstaging With Neoadjuvant Chemotherapy"],"prefix":"10.1001","volume":"10","author":[{"given":"Giacomo","family":"Montagna","sequence":"first","affiliation":[{"name":"Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary M.","family":"Mrdutt","sequence":"additional","affiliation":[{"name":"Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susie X.","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Callie","family":"Hlavin","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia J.","family":"Diego","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie M.","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Surgery, McGill University Medical School, Montreal, Quebec, Canada"},{"name":"Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea V.","family":"Barrio","sequence":"additional","affiliation":[{"name":"Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}],"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"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neslihan","family":"Cabioglu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Istanbul Medical Faculty, Breast Surgery Service, Istanbul University, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varadan","family":"Sevilimedu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura H.","family":"Rosenberger","sequence":"additional","affiliation":[{"name":"Department of Surgery, Duke University Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. Shelley","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Surgery, Duke University Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail","family":"Ingham","sequence":"additional","affiliation":[{"name":"University of Glasgow and National Health Service Greater Glasgow and Clyde, Department of Academic Surgery, Glasgow, Scotland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00e4rbel","family":"Papassotiropoulos","sequence":"additional","affiliation":[{"name":"Breast-Center Zurich AG, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bich Doan","family":"Nguyen-Str\u00e4uli","sequence":"additional","affiliation":[{"name":"Department of Gynecology, University Hospital Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Kurzeder","sequence":"additional","affiliation":[{"name":"Breast Center, University Hospital of Basel, Basel, Switzerland"},{"name":"University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danilo D\u00edaz","family":"Aybar","sequence":"additional","affiliation":[{"name":"Breast Service, Department of Surgery, Guillermo Almenara Irigoyen National Hospital, Lima, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Vorburger","sequence":"additional","affiliation":[{"name":"Breast Cancer Unit, Comprehensive Cancer Center Zurich, University Hospital Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dieter Michael","family":"Matlac","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus L\u00fcbeck, L\u00fcbeck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edvin","family":"Ostapenko","sequence":"additional","affiliation":[{"name":"Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria"},{"name":"Faculty of Medicine, Vilnius University, Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Riedel","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Breast Unit, Heidelberg University Hospital, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Fitzal","sequence":"additional","affiliation":[{"name":"Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria"},{"name":"Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Meani","sequence":"additional","affiliation":[{"name":"Centro di Senologia della Svizzera Italiana, Ente Ospedaliero Cantonale, Lugano, Switzerland"},{"name":"Gruppo Ospedaliero Moncucco, Ticino, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franziska","family":"Fick","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus L\u00fcbeck, L\u00fcbeck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"Sagasser","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University Hospital of Augsburg, Augsburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Heil","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Breast Unit, Heidelberg University Hospital, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasan","family":"Karanl\u0131k","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantin J.","family":"Dedes","sequence":"additional","affiliation":[{"name":"Department of Gynecology, University Hospital Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laszlo","family":"Romics","sequence":"additional","affiliation":[{"name":"University of Glasgow and National Health Service Greater Glasgow and Clyde, Department of Academic Surgery, Glasgow, Scotland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maggie","family":"Banys-Paluchowski","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus L\u00fcbeck, L\u00fcbeck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmut","family":"Muslumanoglu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Istanbul Medical Faculty, Breast Surgery Service, Istanbul University, Istanbul, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Del Rosario Cueva","family":"Perez","sequence":"additional","affiliation":[{"name":"Breast Service, Department of Surgery, Guillermo Almenara Irigoyen National Hospital, Lima, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo Ch\u00e1vez","family":"D\u00edaz","sequence":"additional","affiliation":[{"name":"Breast Service, Department of Surgery, Guillermo Almenara Irigoyen National Hospital, Lima, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Heidinger","sequence":"additional","affiliation":[{"name":"Breast Center, University Hospital of Basel, Basel, Switzerland"},{"name":"University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias K.","family":"Fehr","sequence":"additional","affiliation":[{"name":"Breast Center Thurgau, Frauenfeld, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattea","family":"Reinisch","sequence":"additional","affiliation":[{"name":"Interdisciplinary Breast Cancer Center\/Breast Unit, Kliniken Essen-Mitte, Germany"},{"name":"Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Tukenmez","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Istanbul Medical Faculty, Breast Surgery Service, Istanbul University, Istanbul, 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Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"11","key":"cbr240005r1","doi-asserted-by":"publisher","first-page":"4515","DOI":"10.1245\/s10434-020-08650-z","article-title":"Selecting node-positive patients for axillary downstaging with neoadjuvant chemotherapy.","volume":"27","author":"Montagna","year":"2020","journal-title":"Ann Surg Oncol"},{"issue":"4","key":"cbr240005r2","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1001\/jamaoncol.2016.4163","article-title":"Axillary nodal management following neoadjuvant chemotherapy: a review.","volume":"3","author":"Pilewskie","year":"2017","journal-title":"JAMA Oncol"},{"issue":"4","key":"cbr240005r3","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1016\/j.ejso.2020.10.014","article-title":"Long-term standard sentinel node biopsy after neoadjuvant treatment in breast cancer: a single institution ten-year 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