{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:50:13Z","timestamp":1787021413686,"version":"build-2736575974"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T00:00:00Z","timestamp":1747958400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T00:00:00Z","timestamp":1747958400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann Surg Oncol"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Two-dimensional histologic features have demonstrated independent prognostic value for survival in primary cutaneous melanoma, but their predictive value for sentinel node (SN) status has yet to be validated. We aimed to demonstrate the predictive value of the previously described calculated tumor area (CTA), and the novel Simplified Breslow Area (SBA), for SN metastasis and survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>A total of 177 primary melanomas were assessed for standard histological characteristics, maximum invasive width (IW) of the primary tumor and CTA. We simplified CTA measurement by transforming IW with Breslow thickness (BT) [ln(IW)\u2009+\u2009ln (BT)], yielding SBA. Multivariate analysis was undertaken to assess the performance of CTA and SBA, respectively, as independent predictors of both SN status and survival outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The SN\u2009+\u2009rate was 18.1% (32\/177). The median CTA for SN\u2212patients was 3.2\u00a0mm\n                      <jats:sup>2<\/jats:sup>\n                      (IQR 1.2\u201310.9) compared with 6.7\u00a0mm\n                      <jats:sup>2<\/jats:sup>\n                      (IQR 4.2\u201326.9) for SN\u2009+\u2009patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). Maximum threshold analysis identified an optimal CTA cutoff point of 6.3\u00a0mm\n                      <jats:sup>2<\/jats:sup>\n                      for disease-specific (DSS) [HR 1.01 (1.00\u20131.02);\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008], distant metastasis-free [HR 1.01 (1.00\u20131.02);\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005], and disease-free survival [HR 1.01 (1.00\u20131.02);\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005]. The 5-year DSS for low-risk CTA tumors was 91.2% versus 61.3% for high-risk tumors. Cox regression showed CTA [HR 3.5 (1.21\u201310.81);\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.021] and ulceration status (US) were independent predictors of DSS. Similar results were obtained for SBA, which, on multivariate analysis, was the single most important predictor of SN status outperforming lymphovascular invasion, US, and BT.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The two-dimensional histologic features CTA and SBA are independently prognostic for survival in primary cutaneous melanoma, and SBA may be a better predictor of SN status than BT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1245\/s10434-025-17442-2","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T07:38:33Z","timestamp":1747985913000},"page":"6927-6935","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Validation of Invasive Area for Predicting Sentinel Node Status and Survival in Primary Cutaneous Melanoma"],"prefix":"10.1245","volume":"32","author":[{"given":"Sophie E.","family":"Orme","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Bamford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"O\u2019Riordan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip D.","family":"Da Forno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Snelling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin J.","family":"Heaton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael","family":"Stanley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxanne","family":"Brunton-Sim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc D.","family":"Moncrieff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Saldanha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,23]]},"reference":[{"issue":"1","key":"17442_CR1","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.bjps.2019.06.020","volume":"73","author":"H Peach","year":"2020","unstructured":"Peach H, Board R, Cook M, et al. Current role of sentinel lymph node biopsy in the management of cutaneous melanoma: a UK consensus statement. J Plast Reconstr Aesthet Surg. 2020;73(1):36\u201342.","journal-title":"J Plast Reconstr Aesthet Surg."},{"key":"17442_CR2","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/j.ejca.2023.03.011","volume":"186","author":"AHR Varey","year":"2023","unstructured":"Varey AHR, Thompson JF, Howle JR, Lo SN, Ch\u2019ng S, Carlino SM. Has the advent of modern adjuvant systemic therapy for melanoma rendered sentinel node biopsy unnecessary? Eur J Cancer. 2023;186:166\u201371. https:\/\/doi.org\/10.1016\/j.ejca.2023.03.011.","journal-title":"Eur J Cancer."},{"key":"17442_CR3","doi-asserted-by":"crossref","first-page":"2211","DOI":"10.1056\/NEJMoa1613210","volume":"376","author":"MB Faries","year":"2017","unstructured":"Faries MB, Thompson JF, Cochran AJ, et al. Completion dissection or observation for sentinel-node metastasis in melanoma. N Engl J Med. 2017;376:2211\u201322.","journal-title":"N Engl J Med."},{"issue":"6","key":"17442_CR4","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/S1470-2045(16)00141-8","volume":"17","author":"U Leiter","year":"2016","unstructured":"Leiter U, Stadler R, Mauch C, et al. Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial. Lancet Oncol. 2016;17(6):757\u201367.","journal-title":"Lancet Oncol."},{"issue":"1","key":"17442_CR5","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1245\/s10434-019-07830-w","volume":"27","author":"DM Bello","year":"2020","unstructured":"Bello DM, Faries MB. The landmark series: MSLT-1, MSLT-2 and DeCOG (management of lymph nodes). Ann Surg Oncol. 2020;27(1):15\u201321.","journal-title":"Ann Surg Oncol."},{"key":"17442_CR6","unstructured":"National Comprehensive Cancer Network (NCCN). Melanoma Guidelines Version 3.2023. 2023. https:\/\/www.nccn.org\/guidelines\/guidelines-detail?category=1&id=1492. Accessed 16 June 2023."},{"issue":"5","key":"17442_CR7","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/S1470-2045(21)00065-6","volume":"22","author":"AMM Eggermont","year":"2021","unstructured":"Eggermont AMM, Blank CU, Mandal\u00e0 M, et al. Adjuvant pembrolizumab versus placebo in resected stage III melanoma (EORTC 1325-MG\/KEYNOTE-054): distant metastasis-free survival results from a double-blind, randomised, controlled, phase 3 trial. Lancet Oncol. 2021;22(5):643\u201354.","journal-title":"Lancet Oncol."},{"issue":"19","key":"17442_CR8","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1056\/NEJMoa1802357","volume":"378","author":"AMM Eggermont","year":"2018","unstructured":"Eggermont AMM, Blank CU, Mandala M, et al. Adjuvant pembrolizumab versus placebo in resected stage III melanoma. N Engl J Med. 2018;378(19):1789\u2013801.","journal-title":"N Engl J Med."},{"issue":"19","key":"17442_CR9","doi-asserted-by":"crossref","first-page":"1824","DOI":"10.1056\/NEJMoa1709030","volume":"377","author":"J Weber","year":"2017","unstructured":"Weber J, Mandala M, Del Vecchio M, et al. Adjuvant nivolumab versus ipilimumab in resected stage III or IV melanoma. N Engl J Med. 2017;377(19):1824\u201335.","journal-title":"N Engl J Med."},{"key":"17442_CR10","volume-title":"AJCC Cancer Staging Manual","author":"MB Amin","year":"2017","unstructured":"Amin MB, Edge S, Greene F, et al. AJCC Cancer Staging Manual. 8th edn. Berlin: Springer; 2017.","edition":"8"},{"issue":"4","key":"17442_CR11","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1016\/j.jamcollsurg.2018.12.030","volume":"228","author":"ME Egger","year":"2019","unstructured":"Egger ME, Stevenson M, Bhutiani N, et al. Should sentinel lymph node biopsy be performed for all T1b melanomas in the new 8th edition American Joint Committee on Cancer Staging System? J Am Coll Surg. 2019;228(4):466\u201372. https:\/\/doi.org\/10.1016\/j.jamcollsurg.2018.12.030.","journal-title":"J Am Coll Surg."},{"issue":"9","key":"17442_CR12","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1001\/jamadermatol.2017.2497","volume":"153","author":"AJ Sinnamon","year":"2017","unstructured":"Sinnamon AJ, Neuwirth MG, Yalamanchi P, et al. Association between patient age and lymph node positivity in thin melanoma. JAMA Dermatol. 2017;153(9):866\u201373.","journal-title":"JAMA Dermatol."},{"issue":"7","key":"17442_CR13","doi-asserted-by":"crossref","first-page":"1276","DOI":"10.1002\/jso.25720","volume":"120","author":"C Friedman","year":"2019","unstructured":"Friedman C, Lyon M, Torphy RJ, et al. A nomogram to predict node positivity in patients with thin melanomas helps inform shared patient decision making. J Surg Oncol. 2019;120(7):1276\u201383.","journal-title":"J Surg Oncol."},{"issue":"13","key":"17442_CR14","doi-asserted-by":"crossref","first-page":"4178","DOI":"10.1245\/s10434-016-5137-z","volume":"23","author":"E Cordeiro","year":"2016","unstructured":"Cordeiro E, Gervais MK, Shah PS, Look Hong NJ, Wright FC. Sentinel lymph node biopsy in thin cutaneous melanoma: a systematic review and meta-analysis. Ann Surg Oncol. 2016;23(13):4178\u201388.","journal-title":"Ann Surg Oncol."},{"issue":"3","key":"17442_CR15","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1245\/ASO.2004.03.044","volume":"11","author":"VK Sondak","year":"2004","unstructured":"Sondak VK, Taylor JM, Sabel MS, et al. Mitotic rate and younger age are predictors of sentinel lymph node positivity: lessons learned from the generation of a probabilistic model. Ann Surg Oncol. 2004;11(3):247\u201358.","journal-title":"Ann Surg Oncol."},{"issue":"1","key":"17442_CR16","first-page":"32","volume":"53","author":"A Cadili","year":"2010","unstructured":"Cadili A, Dabbs K. Predictors of sentinel lymph node metastasis in melanoma. Can J Surg. 2010;53(1):32\u20136.","journal-title":"Can J Surg."},{"issue":"12","key":"17442_CR17","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1001\/jamadermatol.2015.2235","volume":"151","author":"S Ribero","year":"2015","unstructured":"Ribero S, Gualano MR, Osella-Abate S, et al. Association of histologic regression in primary melanoma with sentinel lymph node status: a systematic review and meta-analysis. JAMA Dermatol. 2015;151(12):1301\u20137.","journal-title":"JAMA Dermatol."},{"issue":"7","key":"17442_CR18","doi-asserted-by":"crossref","first-page":"2120","DOI":"10.1245\/s10434-015-4538-8","volume":"22","author":"MW Cavanaugh-Hussey","year":"2015","unstructured":"Cavanaugh-Hussey MW, Mu EW, Kang S, Balch CM, Wang T. Older Age is associated with a higher incidence of melanoma death but a lower incidence of sentinel lymph node metastasis in the SEER Databases (2003\u20132011). Ann Surg Oncol. 2015;22(7):2120\u20136.","journal-title":"Ann Surg Oncol."},{"issue":"3","key":"17442_CR19","doi-asserted-by":"crossref","first-page":"308","DOI":"10.6004\/jnccn.2009.0023","volume":"7","author":"RH Andtbacka","year":"2009","unstructured":"Andtbacka RH, Gershenwald JE. Role of sentinel lymph node biopsy in patients with thin melanoma. J Natl Compr Canc Netw. 2009;7(3):308\u201317.","journal-title":"J Natl Compr Canc Netw."},{"issue":"14","key":"17442_CR20","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.1200\/JCO.19.01902","volume":"38","author":"A Maurichi","year":"2020","unstructured":"Maurichi A, Miceli R, Eriksson H, et al. Factors affecting sentinel node metastasis in thin (T1) cutaneous melanomas: development and external validation of a predictive nomogram. J Clin Oncol. 2020;38(14):1591\u2013601.","journal-title":"J Clin Oncol."},{"issue":"8","key":"17442_CR21","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1001\/jamadermatol.2019.0621","volume":"155","author":"G Saldanha","year":"2019","unstructured":"Saldanha G, Yarrow J, Elsheikh S, O\u2019Riordan M, Uraiby H, Bamford M. Development and initial validation of calculated tumor area as a prognostic tool in cutaneous malignant melanoma. JAMA Dermatol. 2019;155(8):890\u20138.","journal-title":"JAMA Dermatol."},{"issue":"1","key":"17442_CR22","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.jaad.2023.03.012","volume":"89","author":"A Meves","year":"2023","unstructured":"Meves A, Todd A, Johnson EF. Tumor width and calculated tumor area do not outperform Breslow thickness in predicting sentinel lymph node biopsy positivity. J Am Acad Dermatol. 2023;89(1):188\u201390.","journal-title":"J Am Acad Dermatol."},{"issue":"1","key":"17442_CR23","doi-asserted-by":"crossref","first-page":"73","DOI":"10.2307\/2532740","volume":"48","author":"B Lausen","year":"1992","unstructured":"Lausen B, Schumacher M. Maximally selected rank statistics. Biometrics. 1992;48(1):73\u201385.","journal-title":"Biometrics"},{"issue":"6","key":"17442_CR24","doi-asserted-by":"publisher","first-page":"472","DOI":"10.3322\/caac.21409","volume":"67","author":"JE Gershenwald","year":"2017","unstructured":"Gershenwald JE, Scolyer RA, Hess KR, et al. Melanoma staging: evidence\u2010based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017;67(6):472\u201392. https:\/\/doi.org\/10.3322\/caac.21409.","journal-title":"CA Cancer J Clin."},{"issue":"24","key":"17442_CR25","doi-asserted-by":"crossref","first-page":"2719","DOI":"10.1200\/JCO.19.02362","volume":"38","author":"SN Lo","year":"2020","unstructured":"Lo SN, Ma J, Scolyer RA, et al. Improved risk prediction calculator for sentinel node positivity in patients with melanoma: the Melanoma Institute Australia nomogram. J Clin Oncol. 2020;38(24):2719\u201327.","journal-title":"J Clin Oncol."},{"key":"17442_CR26","doi-asserted-by":"crossref","DOI":"10.1016\/j.ejca.2024.113989","volume":"202","author":"J K\u00f6tt","year":"2024","unstructured":"K\u00f6tt J, Zimmermann N, Zell T, et al. Sentinel lymph node risk prognostication in primary cutaneous melanoma through tissue-based profiling, potentially redefining the need for sentinel lymph node biopsy. Eur J Cancer. 2024;202:113989.","journal-title":"Eur J Cancer."},{"issue":"11","key":"17442_CR27","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.2217\/fon-2018-0912","volume":"15","author":"JT Vetto","year":"2019","unstructured":"Vetto JT, Hsueh EC, Gastman BR, et al. Guidance of sentinel lymph node biopsy decisions in patients with T1\u2013T2 melanoma using gene expression profiling. Future Oncol. 2019;15(11):1207\u201317.","journal-title":"Future Oncol."},{"key":"17442_CR28","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1200\/PO.19.00206","volume":"4","author":"D Bellomo","year":"2020","unstructured":"Bellomo D, Arias-Mejias SM, Ramana C, et al. Model combining tumor molecular and clinicopathologic risk factors predicts sentinel lymph node metastasis in primary cutaneous melanoma. JCO Precis Oncol. 2020;4:319\u201334.","journal-title":"JCO Precis Oncol."},{"key":"17442_CR29","doi-asserted-by":"publisher","DOI":"10.1200\/PO.21.00162","author":"ED Whitman","year":"2021","unstructured":"Whitman ED, Koshenkov VP, Gastman BR, et al. Integrating 31-gene expression profiling with clinicopathologic features to optimize cutaneous melanoma sentinel lymph node metastasis prediction. JCO Precis Oncol. 2021. https:\/\/doi.org\/10.1200\/PO.21.00162.","journal-title":"JCO Precis Oncol."},{"issue":"10","key":"17442_CR30","doi-asserted-by":"crossref","first-page":"4511","DOI":"10.21873\/anticanres.16644","volume":"43","author":"M Tassavor","year":"2023","unstructured":"Tassavor M, Martin BJ, Glazer AM. The integrated i31-GEP test outperforms the MSKCC nomogram at predicting SLN status in melanoma patients. Anticancer Res. 2023;43(10):4511\u20136.","journal-title":"Anticancer Res."},{"issue":"2","key":"17442_CR31","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1056\/NEJMoa1804710","volume":"379","author":"JA Sparano","year":"2018","unstructured":"Sparano JA, Gray RJ, Makower DF, et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med. 2018;379(2):111\u201321.","journal-title":"N Engl J Med."},{"issue":"9","key":"17442_CR32","first-page":"1004","volume":"156","author":"D Grossman","year":"2020","unstructured":"Grossman D, Okwundu N, Bartlett EK, et al. Prognostic gene expression profiling in cutaneous melanoma: identifying the knowledge gaps and assessing the clinical benefit. Clin Rev Educ. 2020;156(9):1004\u201311.","journal-title":"Clin Rev Educ."},{"issue":"2","key":"17442_CR33","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1245\/s10434-021-11099-3","volume":"29","author":"MS Sabel","year":"2022","unstructured":"Sabel MS. Genomic expression profiling in melanoma and the road to clinical practice. Ann Surg Oncol. 2022;29(2):764\u20136.","journal-title":"Ann Surg Oncol."},{"issue":"5","key":"17442_CR34","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1097\/00000658-197011000-00017","volume":"172","author":"A Breslow","year":"1970","unstructured":"Breslow A. Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma. Ann Surg. 1970;172(5):902\u20138.","journal-title":"Ann Surg."},{"issue":"5","key":"17442_CR35","first-page":"226","volume":"94","author":"RG Walton","year":"2014","unstructured":"Walton RG, Kim J, Velasco C, Swetter SM. Tumor volume: an adjunct prognostic factor in cutaneous melanoma. Cutis. 2014;94(5):226\u201330.","journal-title":"Cutis."},{"issue":"1","key":"17442_CR36","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1159\/000356121","volume":"228","author":"B Voss","year":"2014","unstructured":"Voss B, Wilop S, Jonas S, et al. Tumor volume as a prognostic factor in resectable malignant melanoma. Dermatology. 2014;228(1):66\u201370.","journal-title":"Dermatology."},{"issue":"4","key":"17442_CR37","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/S0733-8635(18)30368-1","volume":"9","author":"RJ Friedman","year":"1991","unstructured":"Friedman RJ, Rigel DS, Kopf AW, et al. Volume of malignant melanoma is superior to thickness as a prognostic indicator. Preliminary observation. Dermatol Clin. 1991;9(4):643\u20138.","journal-title":"Dermatol Clin."},{"issue":"10","key":"17442_CR38","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1038\/modpathol.2017.64","volume":"30","author":"BE Rosenbaum","year":"2017","unstructured":"Rosenbaum BE, Schafer CN, Han SW, Osman I, Zhong H, Brinster N. Computer-assisted measurement of primary tumor area is prognostic of recurrence-free survival in stage IB melanoma patients. Mod Pathol. 2017;30(10):1402\u201310.","journal-title":"Mod Pathol."}],"container-title":["Annals of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-025-17442-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1245\/s10434-025-17442-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-025-17442-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T16:01:14Z","timestamp":1754150474000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1245\/s10434-025-17442-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,23]]},"references-count":38,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["17442"],"URL":"https:\/\/doi.org\/10.1245\/s10434-025-17442-2","relation":{},"ISSN":["1068-9265","1534-4681"],"issn-type":[{"value":"1068-9265","type":"print"},{"value":"1534-4681","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,23]]},"assertion":[{"value":"4 September 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 April 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 May 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"No conflicts of interest to declare.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosure"}}]}}