{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T04:45:37Z","timestamp":1791780337319,"version":"4.3.4"},"reference-count":0,"publisher":"Ovid Technologies (Wolters Kluwer Health)","funder":[{"name":"NIH\/NCI Cancer Center Support Grant","award":["P30 CA08748"],"award-info":[{"award-number":["P30 CA08748"]}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To prospectively evaluate how often axillary staging can successfully be omitted in postmenopausal HR+\/HER2- patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Three randomized trials showed no difference in recurrence or survival outcomes with omission of sentinel lymph node biopsy (SLNB) in cT1-T2N0 patients with a negative axillary ultrasound (AUS) undergoing breast-conserving surgery (BCS). We prospectively evaluated applicability of this approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>From 3\/1\/24 to 9\/1\/25, SLNB was omitted in postmenopausal women age 50\u201370 years with unicentric or multifocal, clinical stage 1, grade 1\/2, HR+\/HER2- cancers and a normal AUS undergoing BCS. After the results of INSEMA were reported, tumors up to 2.5\u00a0cm were included. Patients with pathology showing grade 3, T\u22653\u00a0cm, or HR- or HER2+ underwent multidisciplinary discussion regarding the need for SLNB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>In 437 patients with 442 cancers, the median patient age was 63 years, median mammographic tumor size was 0.9\u00a0cm, and 74% were grade 2. A total of 34 patients (8%) had high-risk features on final pathology (grade 3, n=20; T\u22653\u00a0cm, n=11; HER2+, n=3) and 14 (3.2%) had SLNB. Of these, 2 had SLN metastases. A total of 96% of patients received radiotherapy (40% whole breast, 56% partial breast), 415 (95%) received adjuvant endocrine therapy, and 31 (7%) received chemotherapy. At 7.7-month median follow-up, there have been no axillary recurrences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Adoption of the SOUND, INSEMA, and BOOG 13-08 data allowed omission of SLNB in 97% of postmenopausal patients age \u226470 years with cT1-2N0, grade 1\/2, HR+\/HER2- cancers and a normal AUS, reducing the burden of treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/sla.0000000000007232","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T04:00:56Z","timestamp":1791777656000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["De-escalation of Axillary Surgery in Early Breast Cancer"],"prefix":"10.1097","author":[{"given":"Lisa R.","family":"Allen","sequence":"first","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Plitas","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross","family":"Sawka","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea V.","family":"Barrio","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly N.","family":"Feigin","sequence":"additional","affiliation":[{"name":"Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana A.","family":"Roth O\u2019Brien","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Capko","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel X.","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Downs-Canner","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"El-Tamer","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Giannakou","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neha","family":"Goel","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra S.","family":"Heerdt","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurie J.","family":"Kirstein","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minna K.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"Mamtami","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Montagna","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy-Ann","family":"Moo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate R.","family":"Pawloski","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virgilio","family":"Sacchini","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audree B.","family":"Tadros","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Varadan Sevilimedu","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Morrow","sequence":"additional","affiliation":[{"name":"Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,10,12]]},"container-title":["Annals of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1097\/SLA.0000000000007232","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T04:00:57Z","timestamp":1791777657000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1097\/SLA.0000000000007232"}},"subtitle":["Translating SOUND and INSEMA into Clinical Practice"],"short-title":[],"issued":{"date-parts":[[2026,10,12]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1097\/sla.0000000000007232","relation":{},"ISSN":["0003-4932","1528-1140"],"issn-type":[{"value":"0003-4932","type":"print"},{"value":"1528-1140","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,12]]},"assertion":[{"value":"2026-05-11","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-29","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}