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Restaging axillary status and performing de\u2010escalated surgical procedures to replace routine axillary lymph nodes dissection (ALND) is urgently needed. Targeted axillary lymph node biopsy (TLNB) is a novel de\u2010escalated surgical strategy marking metastatic axillary nodes before NST and targeted dissection and biopsy intraoperatively to tailor individual axillary management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study provided a systematic review and meta\u2010analysis to evaluate the feasibility and diagnosis accuracy of TLNB. Prospective and retrospective clinical trials on TLNB were searched from Pubmed, Embase, and Cochrane. Identification rate (IFR), false\u2010negative rate (FNR), negative predictive value (NPV), and rate of ax\u2010pCR were the outcomes of this meta\u2010analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One thousand nine hundred and twenty patients attempted TLNB, with an overall IFR of 93.5% (95% confidence interval [CI] 90.1%\u201396.2%). IFR of three nodal marking methods, namely iodine seeds, clips, and carbon dye, was 95.6% (95% CI 91.2%\u201398.7%), 91.7% (95% CI 87.3%\u201395.4%), and 97.1% (95% CI 89.1%\u2013100.0%), respectively. Of them, 847 patients received ALND, with an overall FNR of 5.5% (95% CI 3.3%\u20138.0%), and NPV ranged from 90.1% to 96.1%. Regression analysis showed that the overlap of targeted and sentinel biopsied nodes might associate with IFRs and FNRs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>TLNB is a novel, less invasive surgical approach to distinguish initial node\u2010positive breast cancer that achieves negative axillary conversion after NST. It yields an excellent IFR with a low FNR and a high NPV. A combination of preoperative imaging, intraoperative TLNB with SLNB, and postoperative nodal radiotherapy might affect the future treatment paradigm of primary breast cancer with nodal metastases.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.4769","type":"journal-article","created":{"date-parts":[[2022,5,3]],"date-time":"2022-05-03T10:30:28Z","timestamp":1651573828000},"page":"4085-4103","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Diagnostic accuracy of de\u2010escalated surgical procedure in axilla for node\u2010positive breast cancer patients treated with neoadjuvant systemic therapy: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3961-7596","authenticated-orcid":false,"given":"Yu\u2010xin","family":"Song","sequence":"first","affiliation":[{"name":"The Department of General Surgery The First Affiliated Hospital of Nanjing 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