{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T14:02:40Z","timestamp":1789394560181,"version":"build-2803163510"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T00:00:00Z","timestamp":1782518400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":79,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Cancer Res Clin Oncol"],"DOI":"10.1007\/s00432-026-06545-2","type":"journal-article","created":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T16:05:05Z","timestamp":1782576305000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Stained region lymph node biopsy for axillary restaging after neoadjuvant systemic therapy in node-positive breast cancer: a cohort study"],"prefix":"10.1007","volume":"152","author":[{"given":"Rui","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hailing","family":"Zha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiannan","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinpei","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lifeng","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cuiying","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jue","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2604-811X","authenticated-orcid":false,"given":"Xiaoming","family":"Zha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,27]]},"reference":[{"issue":"12","key":"6545_CR1","doi-asserted-by":"publisher","first-page":"1851","DOI":"10.1001\/jamaoncol.2021.4394","volume":"7","author":"AV Barrio","year":"2021","unstructured":"Barrio AV, Montagna G, Mamtani A, Sevilimedu V, Edelweiss M, Capko D et al (2021) Nodal recurrence in patients with node-positive breast cancer treated with sentinel node biopsy alone after neoadjuvant chemotherapy-a rare event. JAMA Oncol 7(12):1851\u20131855","journal-title":"JAMA Oncol"},{"issue":"14","key":"6545_CR2","doi-asserted-by":"publisher","first-page":"1455","DOI":"10.1001\/jama.2013.278932","volume":"310","author":"JC Boughey","year":"2013","unstructured":"Boughey JC, Suman VJ, Mittendorf EA, Ahrendt GM, Wilke LG, Taback B et al (2013) Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA 310(14):1455\u20131461","journal-title":"JAMA"},{"issue":"10","key":"6545_CR3","doi-asserted-by":"publisher","first-page":"1541","DOI":"10.1093\/annonc\/mdz235","volume":"30","author":"HJ Burstein","year":"2019","unstructured":"Burstein HJ, Curigliano G, Loibl S, Dubsky P, Gnant M, Poortmans P et al (2019) Estimating the benefits of therapy for early-stage breast cancer: the St. Gallen International Consensus Guidelines for the primary therapy of early breast cancer 2019. Ann Oncol 30(10):1541\u20131557","journal-title":"Ann Oncol"},{"issue":"3","key":"6545_CR4","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1001\/jamasurg.2024.5913","volume":"160","author":"N Cabioglu","year":"2026","unstructured":"Cabioglu N, Ko\u00e7er HB, Karanlik H, G\u00fcl\u00e7elik MA, Igci A, M\u00fcsl\u00fcmanoglu M et al (2026) De-escalation of nodal surgery in clinically node-positive breast cancer. JAMA Surg 160(3):257\u2013266","journal-title":"JAMA Surg"},{"issue":"10","key":"6545_CR5","doi-asserted-by":"publisher","first-page":"1674","DOI":"10.1093\/annonc\/mdz189","volume":"30","author":"F Cardoso","year":"2019","unstructured":"Cardoso F, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, Rubio IT et al (2019) Early breast cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 30(10):1674","journal-title":"Ann Oncol"},{"issue":"10","key":"6545_CR6","doi-asserted-by":"publisher","first-page":"1072","DOI":"10.1200\/JCO.2015.64.0094","volume":"34","author":"AS Caudle","year":"2016","unstructured":"Caudle AS, Yang WT, Krishnamurthy S, Mittendorf EA, Black DM, Gilcrease MZ et al (2016) Improved axillary evaluation following neoadjuvant therapy for patients with node-positive breast cancer using selective evaluation of clipped nodes: implementation of targeted axillary dissection. J Clin Oncol 34(10):1072\u20131078","journal-title":"J Clin Oncol"},{"issue":"10","key":"6545_CR7","doi-asserted-by":"publisher","first-page":"2925","DOI":"10.1245\/s10434-017-5958-4","volume":"24","author":"AS Caudle","year":"2017","unstructured":"Caudle AS, Bedrosian I, Milton DR, DeSnyder SM, Kuerer HM, Hunt KK et al (2017) Use of sentinel lymph node dissection after neoadjuvant chemotherapy in patients with node-positive breast cancer at diagnosis: practice patterns of american society of breast surgeons members. Ann Surg Oncol 24(10):2925\u20132934","journal-title":"Ann Surg Oncol"},{"issue":"5","key":"6545_CR8","doi-asserted-by":"publisher","first-page":"1283","DOI":"10.1148\/rg.2021210053","volume":"41","author":"HL Chung","year":"2021","unstructured":"Chung HL, Le-Petross HT, Leung J (2021) Imaging updates to breast cancer lymph node management. Radiographics 41(5):1283\u20131299","journal-title":"Radiographics"},{"issue":"2","key":"6545_CR9","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1007\/s10549-018-5004-7","volume":"173","author":"JM Classe","year":"2019","unstructured":"Classe JM, Loaec C, Gimbergues P, Alran S, de Lara CT, Dupre PF et al (2019) Sentinel lymph node biopsy without axillary lymphadenectomy after neoadjuvant chemotherapy is accurate and safe for selected patients: the GANEA 2 study. Breast Cancer Res Treat 173(2):343\u2013352","journal-title":"Breast Cancer Res Treat"},{"issue":"3","key":"6545_CR10","doi-asserted-by":"publisher","first-page":"znae071","DOI":"10.1093\/bjs\/znae071","volume":"111","author":"SR de Wild","year":"2024","unstructured":"de Wild SR, Koppert LB, van Nijnatten TJA, Kooreman LFS, VranckenPeeters MTFD, Smidt ML et al (2024) Systematic review of targeted axillary dissection in node-positive breast cancer treated with neoadjuvant systemic therapy: variation in type of marker and timing of placement. Br J Surg 111(3):znae071","journal-title":"Br J Surg"},{"issue":"2","key":"6545_CR11","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1097\/SLA.0000000000000558","volume":"261","author":"M Donker","year":"2015","unstructured":"Donker M, Straver ME, Wesseling J, Loo CE, Schot M, Drukker CA et al (2015) Marking axillary lymph nodes with radioactive iodine seeds for axillary staging after neoadjuvant systemic treatment in breast cancer patients: the MARI procedure. Ann Surg 261(2):378\u2013382","journal-title":"Ann Surg"},{"issue":"5","key":"6545_CR12","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1016\/j.amjsurg.2016.07.018","volume":"212","author":"CH El Hage","year":"2016","unstructured":"El Hage CH, Headon H, El Tokhy O, Heeney J, Kasem A, Mokbel K (2016) Is sentinel lymph node biopsy a viable alternative to complete axillary dissection following neoadjuvant chemotherapy in women with node-positive breast cancer at diagnosis? An updated meta-analysis involving 3,398 patients. Am J Surg 212(5):969\u2013981","journal-title":"Am J Surg"},{"issue":"13","key":"6545_CR13","doi-asserted-by":"publisher","first-page":"4381","DOI":"10.1245\/s10434-019-07915-6","volume":"26","author":"A Glaeser","year":"2019","unstructured":"Glaeser A, Sinn HP, Garcia-Etienne C, Riedel F, Hug S, Schaefgen B et al (2019) Heterogeneous responses of axillary lymph node metastases to neoadjuvant chemotherapy are common and depend on breast cancer subtype. Ann Surg Oncol 26(13):4381\u20134389","journal-title":"Ann Surg Oncol"},{"issue":"5","key":"6545_CR14","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1111\/tbj.13736","volume":"26","author":"E Khallaf","year":"2020","unstructured":"Khallaf E, Wessam R, Abdoon M (2020) Targeted axillary dissection of carbon-tattooed metastatic lymph nodes in combination with post-neo-adjuvant sentinel lymph node biopsy using 1% methylene blue in breast cancer patients. Breast J 26(5):1061\u20131063","journal-title":"Breast J"},{"issue":"7","key":"6545_CR15","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1016\/S1470-2045(13)70166-9","volume":"14","author":"T Kuehn","year":"2013","unstructured":"Kuehn T, Bauerfeind I, Fehm T, Fleige B, Hausschild M, Helms G et al (2013) Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol 14(7):609\u2013618","journal-title":"Lancet Oncol"},{"issue":"5","key":"6545_CR16","doi-asserted-by":"publisher","first-page":"e553","DOI":"10.1097\/SLA.0000000000004572","volume":"276","author":"S Kuemmel","year":"2022","unstructured":"Kuemmel S, Heil J, Rueland A, Seiberling C, Harrach H, Schindowski D et al (2022) A prospective, multicenter registry study to evaluate the clinical feasibility of targeted axillary dissection (TAD) in node-positive breast cancer patients. Ann Surg 276(5):e553\u2013e562","journal-title":"Ann Surg"},{"key":"6545_CR17","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2023.1772","author":"S Kuemmel","year":"2023","unstructured":"Kuemmel S, Heil J, Bruzas S, Breit E, Schindowski D, Harrach H et al (2023) Safety of targeted axillary dissection after neoadjuvant therapy in patients with node-positive breast cancer. JAMA Surg. https:\/\/doi.org\/10.1001\/jamasurg.2023.1772","journal-title":"JAMA Surg"},{"issue":"5","key":"6545_CR18","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1159\/000492437","volume":"13","author":"T K\u00fchn","year":"2018","unstructured":"K\u00fchn T, Classe JM, Gentilini OD, Tinterri C, Peintinger F, de Boniface J (2018) Current status and future perspectives of axillary management in the neoadjuvant setting. Breast Care (Basel) 13(5):337\u2013341","journal-title":"Breast Care (Basel)"},{"issue":"9","key":"6545_CR19","doi-asserted-by":"publisher","first-page":"znaf180","DOI":"10.1093\/bjs\/znaf180","volume":"112","author":"T K\u00fchn","year":"2025","unstructured":"K\u00fchn T, Banys-Paluchowski M, Ditsch N, Stickeler E, Hauptmann M, Schroth J et al (2025) Axillary dissection for low-volume nodal involvement after neoadjuvant therapy in breast cancer: multicentre AXSANA cohort study. Br J Surg 112(9):znaf180","journal-title":"Br J Surg"},{"issue":"8","key":"6545_CR20","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1002\/bjs.9545","volume":"101","author":"S K\u00fcmmel","year":"2014","unstructured":"K\u00fcmmel S, Holtschmidt J, Loibl S (2014) Surgical treatment of primary breast cancer in the neoadjuvant setting. Br J Surg 101(8):912\u2013924","journal-title":"Br J Surg"},{"key":"6545_CR21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2024.105311","volume":"107","author":"Z Li","year":"2024","unstructured":"Li Z, Gao J, Zhou H, Li X, Zheng T, Lin F et al (2024) Multiregional dynamic contrast-enhanced MRI-based integrated system for predicting pathological complete response of axillary lymph node to neoadjuvant chemotherapy in breast cancer: multicentre study. EBioMedicine 107:105311","journal-title":"EBioMedicine"},{"key":"6545_CR22","doi-asserted-by":"publisher","first-page":"11119","DOI":"10.2147\/IJN.S541016","volume":"20","author":"J Li","year":"2025","unstructured":"Li J, Zhang N, Yan Z, Luo Y, Feng G, Hou Z et al (2025) Peri-lymph node tattooing with carbon nanoparticles suspension: a novel strategy for targeted axillary dissection in breast cancer. Int J Nanomedicine 20:11119\u201311126","journal-title":"Int J Nanomedicine"},{"issue":"11","key":"6545_CR23","doi-asserted-by":"publisher","first-page":"e1621","DOI":"10.1634\/theoncologist.2020-0494","volume":"25","author":"GH Lim","year":"2020","unstructured":"Lim GH, Gudi M, Teo SY, Ng RP, Yan Z, Lee YS et al (2020) Would removal of all ultrasound abnormal metastatic lymph nodes without sentinel lymph node biopsy be accurate in patients with breast cancer with neoadjuvant chemotherapy. Oncologist 25(11):e1621\u2013e1627","journal-title":"Oncologist"},{"key":"6545_CR24","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2021.106165","volume":"96","author":"G Mathew","year":"2021","unstructured":"Mathew G, Agha R, Albrecht J, Goel P, Mukherjee I, Pai P et al (2021) STROCSS 2021: Strengthening the reporting of cohort, cross-sectional and case-control studies in surgery. Int J Surg 96:106165","journal-title":"Int J Surg"},{"issue":"6","key":"6545_CR25","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1001\/jamaoncol.2024.0578","volume":"10","author":"G Montagna","year":"2024","unstructured":"Montagna G, Mrdutt MM, Sun SX, Hlavin C, Diego EJ, Wong SM et al (2024) Omission of axillary dissection following nodal downstaging with neoadjuvant chemotherapy. JAMA Oncol 10(6):793\u2013798","journal-title":"JAMA Oncol"},{"issue":"3","key":"6545_CR26","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1016\/j.clbc.2019.01.013","volume":"19","author":"I Natsiopoulos","year":"2019","unstructured":"Natsiopoulos I, Intzes S, Liappis T, Zarampoukas K, Zarampoukas T, Zacharopoulou V et al (2019) Axillary lymph node tattooing and targeted axillary dissection in breast cancer patients who presented as cN+ before neoadjuvant chemotherapy and became cn0 after treatment. Clin Breast Cancer 19(3):208\u2013215","journal-title":"Clin Breast Cancer"},{"issue":"14","key":"6545_CR27","doi-asserted-by":"publisher","first-page":"1720","DOI":"10.1200\/JCO-25-00099","volume":"43","author":"KU Park","year":"2025","unstructured":"Park KU, Somerfield MR, Anne N, Brackstone M, Conlin AK, Couto HL et al (2025) Sentinel lymph node biopsy in early-stage breast cancer: ASCO guideline update. J Clin Oncol 43(14):1720\u20131741","journal-title":"J Clin Oncol"},{"issue":"4","key":"6545_CR28","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1001\/jamaoncol.2016.4163","volume":"3","author":"M Pilewskie","year":"2017","unstructured":"Pilewskie M, Morrow M (2017) Axillary nodal management following neoadjuvant chemotherapy: a review. JAMA Oncol 3(4):549\u2013555","journal-title":"JAMA Oncol"},{"issue":"3","key":"6545_CR29","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1097\/SLA.0000000000003075","volume":"269","author":"JM Simons","year":"2019","unstructured":"Simons JM, van Nijnatten T, van der Pol CC, Luiten E, Koppert LB, Smidt ML (2019) Diagnostic accuracy of different surgical procedures for axillary staging after neoadjuvant systemic therapy in node-positive breast cancer: a systematic review and meta-analysis. Ann Surg 269(3):432\u2013442","journal-title":"Ann Surg"},{"issue":"11","key":"6545_CR30","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1001\/jamasurg.2022.3907","volume":"157","author":"JM Simons","year":"2022","unstructured":"Simons JM, van Nijnatten TJA, van der Pol CC, van Diest PJ, Jager A, van Klaveren D et al (2022) Diagnostic accuracy of radioactive iodine seed placement in the axilla with sentinel lymph node biopsy after neoadjuvant chemotherapy in node-positive breast cancer. JAMA Surg 157(11):991\u2013999","journal-title":"JAMA Surg"},{"issue":"8","key":"6545_CR31","doi-asserted-by":"publisher","first-page":"1226","DOI":"10.1002\/bjs.7073","volume":"97","author":"ME Straver","year":"2010","unstructured":"Straver ME, Loo CE, Alderliesten T, Rutgers EJ, VranckenPeeters MT (2010) Marking the axilla with radioactive iodine seeds (MARI procedure) may reduce the need for axillary dissection after neoadjuvant chemotherapy for breast cancer. Br J Surg 97(8):1226\u20131231","journal-title":"Br J Surg"},{"issue":"6","key":"6545_CR32","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1002\/bjs.12026","volume":"108","author":"MEM van der Noordaa","year":"2021","unstructured":"van der Noordaa MEM, van Duijnhoven FH, Cuijpers FNE, van Werkhoven E, Wiersma TG, Elkhuizen PHM et al (2021) Toward omitting sentinel lymph node biopsy after neoadjuvant chemotherapy in patients with clinically node-negative breast cancer. Br J Surg 108(6):667\u2013674","journal-title":"Br J Surg"},{"issue":"10","key":"6545_CR33","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.1001\/jamaoncol.2025.2752","volume":"11","author":"AKE van Hemert","year":"2026","unstructured":"van Hemert AKE, van Loevezijn AA, Baas MPD, Stokkel MPM, Groen EJ, van der Noort V et al (2026) Iodine seed-marking protocol for response-guided axillary treatment after systemic therapy for node-positive breast cancer. JAMA Oncol 11(10):1204\u20131211","journal-title":"JAMA Oncol"},{"issue":"10","key":"6545_CR34","doi-asserted-by":"publisher","first-page":"1278","DOI":"10.1016\/j.ejso.2015.07.020","volume":"41","author":"TJ van Nijnatten","year":"2015","unstructured":"van Nijnatten TJ, Schipper RJ, Lobbes MB, Nelemans PJ, Beets-Tan RG, Smidt ML (2015) The diagnostic performance of sentinel lymph node biopsy in pathologically confirmed node positive breast cancer patients after neoadjuvant systemic therapy: A systematic review and meta-analysis. Eur J Surg Oncol 41(10):1278\u20131287","journal-title":"Eur J Surg Oncol"},{"issue":"7","key":"6545_CR35","first-page":"1863","volume":"109","author":"SY Wu","year":"2023","unstructured":"Wu SY, Li JW, Wang YJ, Jin KR, Yang BL, Li JJ et al (2023) Clinical feasibility and oncological safety of non-radioactive targeted axillary dissection after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: a prospective diagnostic and prognostic study. Int J Surg 109(7):1863\u20131870","journal-title":"Int J Surg"}],"container-title":["Journal of Cancer Research and Clinical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00432-026-06545-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00432-026-06545-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00432-026-06545-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T13:03:19Z","timestamp":1789390999000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00432-026-06545-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,27]]},"references-count":35,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["6545"],"URL":"https:\/\/doi.org\/10.1007\/s00432-026-06545-2","relation":{},"ISSN":["1432-1335"],"issn-type":[{"value":"1432-1335","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,27]]},"assertion":[{"value":"16 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study protocol was approved by the Ethics Committee of the First Affiliated Hospital of Nanjing Medical University (Approval No. 2020-SR-311) and was conducted in accordance with the Declaration of Helsinki. This study was registered at\u00a0\n                      ClinicalTrials.gov\n                      \u00a0(NCT04482803). All the procedures were followed in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and those of the Helsinki Declaration, and informed consent was obtained from all the participants.","order":2,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"178"}}