{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T21:39:32Z","timestamp":1785015572036,"version":"3.55.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"vor","delay-in-days":50,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Emerging evidence supports axillary de-escalation in patients with clinically node-positive breast cancer with low-volume residual disease following neoadjuvant chemotherapy, avoiding axillary node clearance in selected patients. Targeted axillary dissection, which retrieves a known metastatic, clipped node alongside standard sentinel node biopsy aims to reduce false-negative rates. This study evaluated axillary surgery after neoadjuvant chemotherapy across NHS Greater Glasgow and Clyde, and examined 10-year trends.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with node-positive breast cancer receiving neoadjuvant chemotherapy between 2017 and 2024 were identified from multidisciplinary team records. Clinicopathological and surgical data were collected. Outcomes were compared using \u03c72 tests and logistic regression. Additional data from 2015\u20132016 were extracted from the Regional Cancer Registry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 498 patients, primary axillary surgery included Magseed\u00ae-localized targeted axillary dissection (27.5%), wire-localized targeted axillary dissection (0.4%), non-localized targeted axillary dissection (7.0%), sentinel node biopsy (14.3%), and axillary node clearance (50.8%). The clipped node retrieval rate was 100% with Magseed\u00ae-localized and 91.4% with non-localized targeted axillary dissection; sentinel node concordance rates were 85.8 and 66.7%, respectively. Completion axillary node clearance was undertaken in 27 patients (11.0%) and was associated with an increased risk of complications including seroma, restricted shoulder movement, and wound infection, compared with de-escalated surgery (odds ratio (OR) 2.88, 95% confidence interval (CI) 1.28 to 6.49; P = 0.011) and upfront axillary node clearance (OR 1.86, 95% CI 1.27 to 2.72; P = 0.001). Use of axillary de-escalation increased over 10 years, surpassing 50% recently (\u03c7\u00b2(4) = 25.3, P &amp;lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Targeted axillary dissection enables safe de-escalation of axillary surgery in patients with low-volume residual disease. Localization enhances clipped node retrieval. Completion axillary node clearance carries higher morbidity, reinforcing the need for careful patient selection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zraf172","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T13:04:39Z","timestamp":1765544679000},"source":"Crossref","is-referenced-by-count":2,"title":["De-escalation of axillary surgery and targeted axillary dissection following neoadjuvant chemotherapy: multicentre prospective regional audit"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6177-135X","authenticated-orcid":false,"given":"Mhairi","family":"Mactier","sequence":"first","affiliation":[{"name":"Wolfson Wohl Cancer Research Centre, College of Medicine and Veterinary Science, University of Glasgow , Glasgow ,","place":["UK"]},{"name":"General Surgery Department, Golden Jubilee National Hospital , Clydebank ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Arthur","sequence":"additional","affiliation":[{"name":"General Surgery Department, Royal Alexandra Hospital , Paisley ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Magill","sequence":"additional","affiliation":[{"name":"General Surgery Department, University Hospital Wishaw , Glasgow ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Duncan","sequence":"additional","affiliation":[{"name":"General Surgery Department, Royal Alexandra Hospital , Paisley ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Mansell","sequence":"additional","affiliation":[{"name":"General Surgery Department, Gartnavel General Hospital , Glasgow ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther Jennifer","family":"Campbell","sequence":"additional","affiliation":[{"name":"General Surgery Department, Gartnavel General Hospital , Glasgow ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Doughty","sequence":"additional","affiliation":[{"name":"General Surgery Department, Gartnavel General Hospital , Glasgow ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laszlo","family":"Romics","sequence":"additional","affiliation":[{"name":"General Surgery Department, Gartnavel General Hospital , Glasgow ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"key":"2026021709583806500_zraf172-B1","doi-asserted-by":"crossref","first-page":"e210891","DOI":"10.1001\/jamasurg.2021.0891","article-title":"Axillary pathologic complete response after neoadjuvant systemic therapy by breast cancer subtype in patients with 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