{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T02:12:08Z","timestamp":1792548728448,"version":"4.5.0"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"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":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Targeted axillary dissection (TAD) is an established axillary restaging approach in breast cancer after neoadjuvant chemotherapy (NAC), but evidence to date has focused largely on clinical N1 disease with limited nodal involvement. For higher nodal burden patients, axillary dissection (AD) is still frequently performed despite high axillary pathologic complete response (pCR) rates. We hypothesized that TAD is noninferior to AD for nodal staging in patients with advanced nodal disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>Patients with higher nodal burden breast cancer planned for NAC followed by curative surgery were included. Higher nodal burden was defined as &gt; 3 metastatic nodes up to clinical N3 stage. Patients underwent TAD followed by AD during the same operation. The primary outcome was the false negative rate (FNR) of TAD. Secondary outcomes included clipped node detection rate, concordance between clipped and sentinel nodes, and axillary pCR rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 65 patients were prospectively recruited from February 2023 to October 2025; 10 withdrew, leaving 55 for analysis. The technical success rate of TAD was 96%, with clipped node detection\u00a0rate of 100% and sentinel node detection\u00a0rate of 96%. The clipped node was identified as an additional sentinel node in 68%. Axillary pCR occurred in 49%. In non-pCR patients, TAD demonstrated a FNR of 0%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In clinical N1 (&gt; 3 nodes), N2, and N3 patients, a 0% FNR suggests TAD is highly accurate for detecting residual axillary disease in the setting of higher nodal burden. These results support expanding TAD eligibility in appropriately selected patients to potentially reduce AD and its morbidities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1245\/s10434-026-20132-2","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T11:13:54Z","timestamp":1787915634000},"page":"9596-9603","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Prospective Clinical Trial on Expanding the Eligibility Criteria for Targeted Axillary Dissection after Neoadjuvant Systemic Therapy in Breast Cancers with Advanced Nodal Disease"],"prefix":"10.1245","volume":"33","author":[{"given":"A. J. T.","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. H. H.","family":"Cheung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. T. K.","family":"Suen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Kwong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"issue":"6","key":"20132_CR1","doi-asserted-by":"publisher","first-page":"e210891","DOI":"10.1001\/jamasurg.2021.0891","volume":"156","author":"S Samiei","year":"2021","unstructured":"Samiei S, Simons JM, Engelen SM, et al. Axillary pathological complete response after neoadjuvant systemic therapy by breast cancer subtype in patients with initially clinically node-positive disease\u2013A systemic review and meta-analysis. JAMA Surg. 2021;156(6):e210891.","journal-title":"JAMA Surg."},{"issue":"14","key":"20132_CR2","doi-asserted-by":"publisher","first-page":"1455","DOI":"10.1001\/jama.2013.278932","volume":"310","author":"JC Boughey","year":"2013","unstructured":"Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310(14):1455\u201361.","journal-title":"JAMA."},{"issue":"7","key":"20132_CR3","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1016\/S1470-2045(13)70166-9","volume":"14","author":"T Kuehn","year":"2013","unstructured":"Kuehn T, Bauerfeind I, Fehm T, et al. Sentinel-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicenter cohort study. 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Ann Surg. 2022;276(5):e553\u201362.","journal-title":"Ann Surg."},{"key":"20132_CR8","unstructured":"National Comprehensive Cancer Network. Breast Cancer. Version 5.2025. Accessed January 9, 2026. https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/breast.pdf"},{"issue":"2","key":"20132_CR9","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.annonc.2023.11.016","volume":"35","author":"S Loibl","year":"2024","unstructured":"Loibl S, Andre F, Bachelot T, et al. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2024;35(2):159\u201374.","journal-title":"Ann Oncol"},{"issue":"1","key":"20132_CR10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2025.110445","volume":"51","author":"T Reimer","year":"2025","unstructured":"Reimer T, Kuehn T, Mueller V, et al. AGO Breast Commission recommendations for the surgical therapy of breast cancer: Working Group on Gynecologic Cancers (AGO) update 2025. 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Ann Surg Oncol. 2023;30(6):3237\u201344.","journal-title":"Ann Surg Oncol."}],"container-title":["Annals of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-026-20132-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1245\/s10434-026-20132-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-026-20132-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T04:51:44Z","timestamp":1790916704000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1245\/s10434-026-20132-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":13,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["20132"],"URL":"https:\/\/doi.org\/10.1245\/s10434-026-20132-2","relation":{},"ISSN":["1068-9265","1534-4681"],"issn-type":[{"value":"1068-9265","type":"print"},{"value":"1534-4681","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]},"assertion":[{"value":"21 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ava Kwong reports institutional clinical trial research funding for breast cancer\u00a0 from Roche Hong Kong Limited, Merck Sharp & Dohme (Asia) Limited, Gilead Sciences Inc. and Olema Pharmaceuticals Inc; institutional research funding for genetic testing\u00a0from AstraZeneca; and donation of Probes and IceCure Machine to The University of Hong Kong (HKU)\u00a0from IceCure Medical Ltd\u00a0for a cryosurgery study.","order":1,"name":"Ethics","label":"Disclosure","group":{"name":"EthicsHeading","label":"Ethics"}}]}}