{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T05:50:33Z","timestamp":1777009833557,"version":"3.51.4"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:00:00Z","timestamp":1774569600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100009647","name":"Ministry of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009647","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Neoadjuvant chemotherapy (NAC) in up to 40%\u201360% of node\u2010positive (cN+) breast cancer patients allows nodal pathological complete response, particularly in Her2+ and triple\u2010negative subtypes. Accurate post\u2010NAC axillary restaging is therefore critical to identify candidates for surgical de\u2010escalation. Axillary ultrasound (AUS) remains the most widely used tool, but prior studies report highly variable performance, with false\u2010negative rates approaching 25%, raising concerns about its reliability as a standalone guide.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively evaluated 413 patients with biopsy\u2010proven cN+ breast cancer treated with NAC (2000\u20132024). All underwent AUS before surgery. AUS results (ycN0 vs. ycN+) were compared with final pathology (ypN0 vs. ypN+). Diagnostic performance was assessed, and predictors of false\u2010negative AUS were identified using logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>AUS classified 51.6% of patients as ycN0, whereas only 45% achieved nodal pathologic complete response. Overall, AUS demonstrated 68% sensitivity, 76% specificity, 72% accuracy, positive predictive value 78%, and negative predictive value 66%. Performance differed by subtype: accuracy was highest in ER\u2010\/Her2 tumors (75%), but markedly lower in Her2+ (69%) and lobular carcinoma (67%). On multivariate analysis, absence of breast clinical complete response (OR 2.38, 95% CI [1.14\u20134.93]) independently predicted false\u2010negative AUS findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>AUS following NAC provides only moderate accuracy, with a clinically relevant risk in patients lacking breast response. AUS alone should not determine omission of axillary surgery. A multimodal, biology\u2010informed strategy combining AUS with other imaging techniques is needed to safely guide axillary de\u2010escalation and minimize both overtreatment and undertreatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71759","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T11:13:50Z","timestamp":1774610030000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Post\u2010Neoadjuvant Chemotherapy Axillary Ultrasound in\n                    <scp>cN<\/scp>\n                    + Breast Cancer: Can It Reliably Support de\u2010Escalation of Axillary Surgery?"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8764-3919","authenticated-orcid":false,"given":"Sara","family":"Albasini","sequence":"first","affiliation":[{"name":"Breast Unit Istituti Clinici Scientifici Maugeri IRCCS  Pavia Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camilla","family":"Rossetti","sequence":"additional","affiliation":[{"name":"General Surgery Residency Program University of Milan  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberta","family":"Brancaccio","sequence":"additional","affiliation":[{"name":"General Surgery Residency Program University of Milan  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Orvieto","sequence":"additional","affiliation":[{"name":"General Surgery Residency Program University of Milan  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Bossi","sequence":"additional","affiliation":[{"name":"Breast Unit Istituti Clinici Scientifici Maugeri IRCCS  Pavia Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matilde","family":"Pelizzola","sequence":"additional","affiliation":[{"name":"General Surgery Residency Program University of Milan  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Truffi","sequence":"additional","affiliation":[{"name":"Nanomedicine and Molecular Imaging LabIstituti Clinici Scientifici Maugeri IRCCS  Pavia Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serena","family":"Mazzucchelli","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Clinical Sciences University of Milan  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina","family":"Zanella","sequence":"additional","affiliation":[{"name":"Breast Unit Istituti Clinici Scientifici Maugeri IRCCS  Pavia Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arianna","family":"Bonizzi","sequence":"additional","affiliation":[{"name":"Nanomedicine and Molecular Imaging LabIstituti Clinici Scientifici Maugeri IRCCS  Pavia Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"Morasso","sequence":"additional","affiliation":[{"name":"Nanomedicine and Molecular Imaging LabIstituti Clinici Scientifici Maugeri IRCCS  Pavia Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabio","family":"Corsi","sequence":"additional","affiliation":[{"name":"Breast Unit Istituti Clinici Scientifici Maugeri IRCCS  Pavia Italy"},{"name":"Department of Biomedical and Clinical Sciences University of Milan  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.278932"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.55.7827"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470\u20102045(13)70166\u20109"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001375"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2014.1086"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010012\u20102484\u20102"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.07.032"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.breast.2017.05.015"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010017\u20105766\u2010x"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404\u2010019\u201005428\u2010x"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.2147\/BCTT.S541732"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2025.115607"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.47391\/JPMA.AKU\u201006"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12957\u2010023\u201003174\u20108"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.6691"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2019.01.219"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.5812\/ijcm\u2010162212"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.4274\/ejbh.galenos.2021.2021\u20103\u201010"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010018\u201021554\u2010z"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2023.1332142"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2023.1772"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13071565"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2025.110253"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.64.0094"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13193\u2010020\u201001242\u2010z"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2023.11.016"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics11122361"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.70096"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330\u2010025\u201011408\u20104"}],"container-title":["Cancer Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.71759","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cam4.71759","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.71759","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T05:10:18Z","timestamp":1777007418000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/cam4.71759"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,27]]},"references-count":29,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1002\/cam4.71759"],"URL":"https:\/\/doi.org\/10.1002\/cam4.71759","archive":["Portico"],"relation":{},"ISSN":["2045-7634","2045-7634"],"issn-type":[{"value":"2045-7634","type":"print"},{"value":"2045-7634","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,27]]},"assertion":[{"value":"2025-09-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71759"}}