{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T04:56:19Z","timestamp":1790916979186,"version":"4.1.0"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Young Investigator Pilot Award","award":["Fox Chase Cancer Center"],"award-info":[{"award-number":["Fox Chase Cancer Center"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann Surg Oncol"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Recent trials have expanded eligibility for omission of sentinel lymph node biopsy (SLNB) in early-stage breast cancer, while adjuvant cyclin-dependent kinase 4\/6 (CDK4\/6) inhibitors improve outcomes in patients with high-risk features that often rely on pathologic nodal status. The impact of SLNB omission on identifying candidates for CDK4\/6 inhibitor therapy remains unclear. We evaluated how omission affects eligibility under Choosing Wisely and American Society of Clinical Oncology (ASCO) criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From the National Cancer Database (2018\u20132022), we identified women aged \u2265 50 years with hormone-receptor-positive, HER2-negative, clinical T1\u20132N0M0 breast cancer treated with upfront surgery and SLNB. Omission-eligible cohorts were defined based on Choosing Wisely and ASCO criteria. CDK4\/6 inhibitor (abemaciclib and ribociclib) eligibility was assessed using tumor features alone (modeling omission), SLNB findings, and axillary lymph node dissection (ALND) findings. Multivariable logistic regression identified predictors of SLNB determining eligibility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 150,629 patients, 73% met SLNB omission criteria. Positive SLNs were found in 9\u201310%, and only 2% had pN2\u20133 disease. SLNB omission would miss 4% (abemaciclib) and 8% (ribociclib) of eligible patients in the Choosing Wisely cohort, and 1 and 8%, respectively, in the ASCO cohort. ALND increased candidacy by only 1%. Approximately 13 SLNBs were required to identify one CDK4\/6-eligible patient, and 299 SLNBs were required to identify one patient expected to derive a 5-year invasive disease-free survival benefit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>SLNB omission excludes few patients eligible for adjuvant CDK4\/6 inhibitor therapy. These findings support shared decision-making and suggest SLNB should not be performed solely to determine CDK4\/6 eligibility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1245\/s10434-026-20131-3","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T16:38:05Z","timestamp":1783528685000},"page":"9620-9629","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Role of Sentinel Node Surgery in Identifying Candidates for Adjuvant CDK4\/6 Inhibitors: Implications of Choosing Wisely and ASCO Omission Criteria"],"prefix":"10.1245","volume":"33","author":[{"given":"Austin D.","family":"Williams","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walker","family":"Lyons","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey B.","family":"Taylor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Jain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"McShane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison A.","family":"Aggon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alycia","family":"So","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Winn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Bleicher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"20131_CR1","unstructured":"Choosing Wisely: An Initiative of the ABIM Foundation. Accessed December 11, 2023. https:\/\/www.choosingwisely.org\/"},{"issue":"10","key":"20131_CR2","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1056\/NEJMoa040587","volume":"351","author":"KS Hughes","year":"2004","unstructured":"Hughes KS, Schnaper LA, Berry D, et al. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. New England J Med. 2004;351(10):971\u20137.","journal-title":"New England J Med."},{"issue":"11","key":"20131_CR3","doi-asserted-by":"publisher","first-page":"1557","DOI":"10.1001\/JAMAONCOL.2023.3759","volume":"9","author":"OD Gentilini","year":"2023","unstructured":"Gentilini OD, Botteri E, Sangalli C, et al. sentinel lymph node biopsy vs no axillary surgery in patients with small breast cancer and negative results on ultrasonography of axillary lymph nodes: the SOUND randomized clinical trial. JAMA Oncol. 2023;9(11):1557\u201364. https:\/\/doi.org\/10.1001\/JAMAONCOL.2023.3759.","journal-title":"JAMA Oncol."},{"issue":"11","key":"20131_CR4","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.1056\/NEJMOA2412063","volume":"392","author":"T Reimer","year":"2025","unstructured":"Reimer T, Stachs A, Veselinovic K, et al. Axillary surgery in breast cancer \u2014 primary results of the insema trial. New Engl J Med. 2025;392(11):1051\u201364. https:\/\/doi.org\/10.1056\/NEJMOA2412063.","journal-title":"New Engl J Med."},{"key":"20131_CR5","doi-asserted-by":"crossref","unstructured":"Smidt M, Schipper R, van Roozendaal V, Wintraecken J, Simons M, Moossdorff E. Omission of sentinel lymph node biopsy in clinically T1-2 node-negative breast cancer patients treated with breast-conserving therapy: results of the Dutch BOOG 2013-08 randomized controlled trial after a median follow-up of 5 years. . 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M.M. declares AstraZeneca Consulting and Gilead Advisory Board.","order":1,"name":"Ethics","label":"Disclosure","group":{"name":"EthicsHeading","label":"Ethics"}}]}}