{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T10:10:59Z","timestamp":1788430259244,"version":"build-2803163510"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2024,7,12]],"date-time":"2024-07-12T00:00:00Z","timestamp":1720742400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,7,12]],"date-time":"2024-07-12T00:00:00Z","timestamp":1720742400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Quantum Leap Healthcare Collaborative"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann Surg Oncol"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>For patients with clinically node-positive (cN+) breast cancer undergoing neoadjuvant chemotherapy (NAC), retrieving previously clipped, biopsy-proven positive lymph nodes during sentinel lymph node biopsy [i.e., targeted axillary dissection (TAD)] may reduce false negative rates. However, the overall utilization and impact of clipping positive nodes remains uncertain.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Patients and Methods<\/jats:title>\n                <jats:p>We retrospectively analyzed cN+ ISPY-2 patients (2011\u20132022) undergoing axillary surgery after NAC. We evaluated trends in node clipping and associations with type of axillary surgery [sentinel lymph node (SLN) only, SLN and axillary lymph node dissection (ALND), or ALND only] and event-free survival (EFS) in patients that were cN+ on a NAC trial.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Among 801 cN+ patients, 161 (20.1%) had pre-NAC clip placement in the positive node. The proportion of patients that were cN+ undergoing clip placement increased from 2.4 to 36.2% between 2011 and 2021. Multivariable logistic regression showed nodal clipping was independently associated with higher odds of SLN-only surgery [odds ratio (OR) 4.3, 95% confidence interval (CI) 2.8\u20136.8, <jats:italic>p<\/jats:italic> &lt; 0.001]. This was also true among patients with residual pathologically node-positive (pN+) disease. Completion ALND rate did not differ based on clip retrieval success. No significant differences in EFS were observed in those with or without clip placement, both with or without successful clip retrieval [hazard ratio (HR) 0.85, 95% CI 0.4\u20131.7, <jats:italic>p<\/jats:italic> = 0.7; HR 1.8, 95% CI 0.5\u20136.0, <jats:italic>p<\/jats:italic> = 0.3, respectively].<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Clip placement in the positive lymph node before NAC is increasingly common. The significant association between clip placement and omission of axillary dissection, even among patients with pN+ disease, suggests a paradigm shift toward TAD as a definitive surgical management strategy in patients with pN+ disease after NAC.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1245\/s10434-024-15792-x","type":"journal-article","created":{"date-parts":[[2024,7,12]],"date-time":"2024-07-12T12:02:34Z","timestamp":1720785754000},"page":"7249-7259","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Clipping the Positive Lymph Node in Patients with Clinically Node Positive Breast Cancer Treated with Neoadjuvant Chemotherapy: Impact on Axillary Surgery in the ISPY-2 Clinical Trial"],"prefix":"10.1245","volume":"31","author":[{"given":"Kayla M.","family":"Switalla","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judy C.","family":"Boughey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrina","family":"Dimitroff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Yau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Velle","family":"Ladores","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongmei","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Tchou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehra","family":"Golshan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gretchen","family":"Ahrendt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren M.","family":"Postlewait","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mara","family":"Piltin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal R.","family":"Reyna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy B.","family":"Matsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd M.","family":"Tuttle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne M.","family":"Wallace","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cletus A.","family":"Arciero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie Catherine","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Tseng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Son","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roshni","family":"Rao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Candice","family":"Sauder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arpana","family":"Naik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marissa","family":"Howard-McNatt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael","family":"Lancaster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Norwood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura J.","family":"Esserman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita A.","family":"Mukhtar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,12]]},"reference":[{"issue":"6","key":"15792_CR1","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1016\/s1072-7515(99)00056-3","volume":"188","author":"KI Bland","year":"1999","unstructured":"Bland KI, Scott-Conner CE, Menck H, Winchester DP. 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C.Y. reports institutional research grant from NCI\/NIH; salary and travel support from Quantum Leap Healthcare Collaborative (QLHC); University of California Inventor Share; and patent \u201cBreast cancer response prediction subtypes\u201d (no. 18\/174,491). M.G. reports funding from the Breast Cancer Research Foundation. M.P. reports institutional research funding and travel support from Intuitive Surgical; honoraria from Kubtec Medical Imaging and OncLive; participation on DSMB at Mayo Clinic; and co-development contract with Optiscan. M.H.M. reports roles on the SSO Development Committee and ASBrS Scientific Committee. M.C.L. reports institutional research grant and honoraria from Elucent Medical; participation on the Provepharm Advisory Board; and owns stock in J&J. S.F. reports consulting fees from Stryker and institutional equipment support from Montefiore. I.G. reports consulting fees from Abbvie and honoraria from OncLive\/MJH Life Sciences. K.H. reports publishing royalties from UpToDate and participation in the QLHC DSMB. C.S. reports participation on the Executive Committee for AJCC. L.J.E. reports institutional research funding from Moderna for DCIS trial; publishing royalties from UpToDate; and travel support from and participation on Medical Advisory Board at Blue Cross Blue Shield. R.M. reports research support and honoraria from GE Healthcare and NCI; institutional research funding from UCSF; and is an unpaid member of the Scientific Advisory Board for the Lobular Breast Cancer Alliance. C.R. reports previous consultant for Elucent Medical (localizing device), terminated association 12\/2022, and consultant for agenda, terminated 12\/2022. J.T. reports institutional primary investigator on clinical trial for Intuitive Surgical.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosure"}}]}}