{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T21:14:04Z","timestamp":1786482844343,"version":"build-2736575974"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2022,9,6]],"date-time":"2022-09-06T00:00:00Z","timestamp":1662422400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,11,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>De-escalation of axillary surgery in breast cancer has progressively taken place when appropriate. Data supporting surgical de-escalation in patients with clinically node-positive (cN+) disease remains scarce. Here, survival among patients with cN+ T1\u20132 tumours undergoing sentinel lymph node biopsy (SLNB) and regional nodal irradiation (RNI) was investigated and compared with that among patients undergoing axillary lymph node dissection (ALND) with or without RNI.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The National Cancer Data Base was used to identify three groups of patients with cN+ tumours according to axillary management among those treated between 2010 and 2016: patients who underwent SLNB and RNI (cN+ SLNB\/RNI group); those who had ALND and RNI (cN+ ALND\/RNI group); and those who had ALND alone (cN+ ALND\/no RNI group). Patients who underwent neoadjuvant chemotherapy, and those who had stage IV breast cancer or pN2\u20133 disease were excluded.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 12 560 patients met the inclusion criteria: 3030 in the cN+ SLNB\/RNI, 5446 in the cN+ ALND\/RNI, and 4084 in the cN+ ALND\/no RNI group. The sizes of cN + SLNB\/RNI and cN+ ALND\/RNI groups increased over the study interval, whereas the cN+ ALND\/no RNI group decreased in size (P &amp;lt; 0.001). There was a median of one positive node in the cN+ SLNB\/RNI group and two nodes in the cN+ ALND\/RNI and cN+ ALND\/no RNI groups. The median number of nodes examined was three, 14, and 14, respectively (P &amp;lt; 0.001). Median follow-up was 57.9 (range 0.8\u2013114) months. The overall survival rate was 97, 97, and 92 per cent respectively at two years, and 88, 86, and 78 per cent at five years (P &amp;lt; 0.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Patients with limited cN+ T1\u20132 breast cancer undergoing upfront SLNB and RNI have favourable survival outcomes that are not inferior to those of patients undergoing ALND with or without RNI. Prospective studies are warranted to assess locoregional control and long-term outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjs\/znac305","type":"journal-article","created":{"date-parts":[[2022,10,5]],"date-time":"2022-10-05T10:50:27Z","timestamp":1664967027000},"page":"1293-1299","source":"Crossref","is-referenced-by-count":18,"title":["Axillary lymph node dissection can be omitted in patients with limited clinically node-positive breast cancer: a National Cancer Database analysis"],"prefix":"10.1093","volume":"109","author":[{"given":"Daniela","family":"Cocco","sequence":"first","affiliation":[{"name":"Division of Breast Surgery, Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic , Cleveland, Ohio , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chirag","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic , Cleveland, Ohio , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic , Cleveland, Ohio , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avia","family":"Wilkerson","sequence":"additional","affiliation":[{"name":"Division of Breast Surgery, Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic , Cleveland, Ohio , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen R","family":"Grobmyer","sequence":"additional","affiliation":[{"name":"Cancer Institute, Cleveland Clinic Abu Dhabi , Abu Dhabi , United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahraa","family":"Al-Hilli","sequence":"additional","affiliation":[{"name":"Division of Breast Surgery, Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic , Cleveland, Ohio , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,9,6]]},"reference":[{"key":"2023063011232208900_znac305-B1","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1053\/ejso.2002.1385","article-title":"Comparison of morbidity between axillary lymph node dissection and sentinel node biopsy","volume":"29","author":"Schijven","year":"2003","journal-title":"Eur J Surg Oncol (EJSO)"},{"key":"2023063011232208900_znac305-B2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1477-7819-12-67","article-title":"Morbidity after conventional dissection of axillary lymph nodes in breast cancer patients","volume":"12","author":"Soares","year":"2014","journal-title":"World J Surg Oncol"},{"key":"2023063011232208900_znac305-B3","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1016\/S1470-2045(10)70207-2","article-title":"Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial","volume":"11","author":"Krag","year":"2010","journal-title":"Lancet Oncol"},{"key":"2023063011232208900_znac305-B4","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S1470-2045(13)70035-4","article-title":"Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23\u201301): a phase 3 randomised controlled trial","volume":"14","author":"Galimberti","year":"2013","journal-title":"Lancet Oncol"},{"key":"2023063011232208900_znac305-B5","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1245\/s10434-012-2569-y","article-title":"Complete axillary lymph node dissection versus clinical follow-up in breast cancer patients with sentinel node micrometastasis: final results from the multicenter clinical trial AATRM 048\/13\/2000","volume":"20","author":"Sol\u00e1","year":"2013","journal-title":"Ann Surg Oncol"},{"key":"2023063011232208900_znac305-B6","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1001\/jama.2011.90","article-title":"Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial","volume":"305","author":"Giuliano","year":"2011","journal-title":"JAMA"},{"key":"2023063011232208900_znac305-B7","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1016\/S1470-2045(14)70460-7","article-title":"Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial","volume":"15","author":"Donker","year":"2014","journal-title":"Lancet Oncol"},{"key":"2023063011232208900_znac305-B8","author":"Rutgers"},{"key":"2023063011232208900_znac305-B9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13063-018-3021-9","article-title":"Tailored axillary surgery with or without axillary lymph node dissection followed by radiotherapy in patients with clinically node-positive breast cancer (TAXIS): study protocol for a multicenter, randomized phase-III trial","volume":"19","author":"Henke","year":"2018","journal-title":"Trials"},{"key":"2023063011232208900_znac305-B10","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1007\/s10549-020-05636-z","article-title":"Axillary lymph node dissection is not obligatory in breast cancer patients with biopsy-proven axillary lymph node metastasis","volume":"181","author":"Yoo","year":"2020","journal-title":"Breast Cancer Res Treat"},{"key":"2023063011232208900_znac305-B11","author":"National Comprehensive Cancer 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era","volume":"268","author":"Poodt","year":"2018","journal-title":"Ann Surg"},{"key":"2023063011232208900_znac305-B18","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.breast.2019.03.002","article-title":"Trends in axillary lymph node dissection for early-stage breast cancer in Europe: impact of evidence on practice","volume":"45","author":"Garcia-Etienne","year":"2019","journal-title":"Breast"},{"key":"2023063011232208900_znac305-B19","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.jss.2020.05.073","article-title":"National trend of axillary management in clinical T3\/T4 N0 patients having breast conserving therapy","volume":"255","author":"Morris","year":"2020","journal-title":"J Surg Res"},{"key":"2023063011232208900_znac305-B20","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1016\/j.ejso.2015.04.003","article-title":"Impact of axillary dissection in women with invasive breast cancer who do not fit the Z0011 ACOSOG trial because of three or more metastatic sentinel lymph nodes","volume":"41","author":"Bonneau","year":"2015","journal-title":"Eur J Surg Oncol"},{"key":"2023063011232208900_znac305-B21","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1245\/s10434-015-4944-y","article-title":"Does a positive axillary lymph node needle biopsy result predict the need for an axillary lymph node dissection in clinically node-negative breast cancer patients in the ACOSOG Z0011 era?","volume":"23","author":"Pilewskie","year":"2016","journal-title":"Ann Surg Oncol"},{"key":"2023063011232208900_znac305-B22","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1056\/NEJMoa1415340","article-title":"Regional nodal irradiation in early-stage breast cancer","volume":"373","author":"Whelan","year":"2015","journal-title":"N Eng J Med"},{"key":"2023063011232208900_znac305-B23","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1200\/JCO.2015.63.6456","article-title":"DBCG-IMN: a population-based cohort study on the effect of internal mammary node irradiation in early node-positive breast cancer","volume":"34","author":"Thorsen","year":"2016","journal-title":"J Clin Oncol"},{"key":"2023063011232208900_znac305-B24","doi-asserted-by":"crossref","first-page":"e054365","DOI":"10.1136\/bmjopen-2021-054365","article-title":"POSNOC-POsitive Sentinel NOde: adjuvant therapy alone versus adjuvant therapy plus clearance or axillary radiotherapy: a randomised controlled trial of axillary treatment in women with early-stage breast cancer who have metastases in one or two sentinel nodes","volume":"11","author":"Goyal","year":"2021","journal-title":"BMJ Open"}],"container-title":["British Journal of 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