{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T20:27:28Z","timestamp":1793824048588,"version":"4.6.1"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"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>Recent studies suggest that selective omission of sentinel lymph node biopsy (SLNB) in early-stage breast cancer may reduce morbidity without compromising oncologic outcomes. The impact of SLNB omission on eligibility for adjuvant therapies, including CDK4\/6 inhibitors and partial breast irradiation (PBI),\u00a0remains\u00a0unclear, as both depend on nodal status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a single-institution\u00a0registry (2012\u20132024), we\u00a0identified\u00a0women with cT1N0, ER+\/HER2\u2212, grade 1\u20132 breast cancer who would\u00a0have been\u00a0candidates for SLNB omission. Pathologic nodal status and eligibility for\u00a0CDK4\/6 inhibitors\u00a0and PBI were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1,194 patients, 130 (10.9%) had \u22651 positive sentinel lymph nodes, including five (0.4%) with \u22654 positive nodes. Nodal positivity decreased with age\u00a0(18%\u00a0&lt;50\u00a0years\u00a0vs.\u00a07.4%\u00a0\u226570\u00a0years\u00a0(\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001).\u00a0Nodal positivity increased with tumor size\u00a0(6.2% (cT1a), 6.6% (cT1b),\u00a014.4% (cT1c);\u00a0\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001)\u00a0and with tumor grade\u00a0(8.5% (grade 1)\u00a0vs.\u00a012.4% (grade 2);\u00a0\n                      <jats:italic>p<\/jats:italic>\n                      = 0.03). In women aged 50\u201359 years with\u00a0cT1a\/b tumors, nodal positivity\u00a0did not differ by grade (6.8% grade 1 vs.\u00a011.1%\u00a0grade 2;\u00a0\n                      <jats:italic>p<\/jats:italic>\n                      = 0.43). In women aged \u226560 years with cT1a\/b tumors, rates were 3.1 and 2.1%, respectively (\n                      <jats:italic>p<\/jats:italic>\n                      = 1.00).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Under current guidelines, SLNB omission would have excluded 18% of women &lt;50 and 8.8% of women \u226550 from consideration for\u00a0CDK4\/6 inhibitors\u00a0and PBI. Sentinel lymph node biopsy omission is unlikely to affect adjuvant treatment selection in carefully selected older women with small, low-grade tumors, particularly those aged \u226560 years with grade 1 cT1a\/b disease, in whom occult nodal positivity was only 2.1%. In contrast, younger patients, those with cT1c tumors, and those with higher-grade disease demonstrated substantially higher rates of nodal involvement, suggesting that SLNB continues to provide clinically actionable information that may influence eligibility for CDK4\/6 inhibitors and partial breast irradiation. These findings support a risk-adapted rather than universal approach to SLNB omission.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1245\/s10434-026-20145-x","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T18:42:37Z","timestamp":1784832157000},"page":"9828-9833","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of Sentinel Node Omission in Early-Stage Breast Cancers on Adjuvant Therapy Decision-Making"],"prefix":"10.1245","volume":"33","author":[{"given":"Jordan E","family":"Jackson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Hartman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Barkin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hemi","family":"Thaker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Chandler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Alvarado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"issue":"11","key":"20145_CR1","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":"20145_CR2","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 - primary results of the INSEMA trial. N Engl J Med. 2025;392(11):1051\u201364. https:\/\/doi.org\/10.1056\/NEJMoa2412063.","journal-title":"N Engl J Med."},{"issue":"12","key":"20145_CR3","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.1056\/NEJMoa2305488","volume":"390","author":"D Slamon","year":"2024","unstructured":"Slamon D, Lipatov O, Nowecki Z, et al. Ribociclib plus endocrine therapy in early breast cancer. N Engl J Med. 2024;390(12):1080\u201391. https:\/\/doi.org\/10.1056\/NEJMoa2305488.","journal-title":"N Engl J Med."},{"issue":"34","key":"20145_CR4","doi-asserted-by":"publisher","first-page":"3987","DOI":"10.1200\/JCO.20.02514","volume":"38","author":"SRD Johnston","year":"2020","unstructured":"Johnston SRD, Harbeck N, Hegg R, et al. Abemaciclib combined with endocrine therapy for the adjuvant treatment of HR+, HER2-, node-positive, high-risk, early breast cancer (monarchE). J Clin Oncol. 2020;38(34):3987\u201398. https:\/\/doi.org\/10.1200\/JCO.20.02514.","journal-title":"J Clin Oncol."},{"issue":"2","key":"20145_CR5","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.annonc.2025.10.005","volume":"37","author":"S Johnston","year":"2026","unstructured":"Johnston S, Martin M, O\u2019Shaughnessy J, et al. Overall survival with abemaciclib in early breast cancer. Ann Oncol. 2026;37(2):155\u201365. https:\/\/doi.org\/10.1016\/j.annonc.2025.10.005.","journal-title":"Ann Oncol."},{"issue":"2","key":"20145_CR6","first-page":"121","volume":"20","author":"Shah C Florence","year":"2014","unstructured":"Florence Shah C, Vicini F, et al. The cost-effectiveness of accelerated partial breast irradiation. Breast J. 2014;20(2):121\u20137.","journal-title":"Breast J."},{"issue":"2","key":"20145_CR7","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/j.prro.2016.09.007","volume":"7","author":"C Correa","year":"2017","unstructured":"Correa C, Harris EE, Leonardi MC, et al. Accelerated partial breast irradiation: executive summary for the update of an ASTRO evidence-based consensus statement. Pract Radiat Oncol. 2017;7(2):73\u20139. https:\/\/doi.org\/10.1016\/j.prro.2016.09.007.","journal-title":"Pract Radiat Oncol."},{"issue":"10099","key":"20145_CR8","doi-asserted-by":"publisher","first-page":"1048","DOI":"10.1016\/S0140-6736(17)31145-5","volume":"390","author":"CE Coles","year":"2017","unstructured":"Coles CE, Griffin CL, Kirby AM, et al. Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial. Lancet. 2017;390(10099):1048\u201360. https:\/\/doi.org\/10.1016\/S0140-6736(17)31145-5.","journal-title":"Lancet."},{"issue":"4","key":"20145_CR9","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1016\/j.ijrobp.2009.02.031","volume":"74","author":"BD Smith","year":"2009","unstructured":"Smith BD, et al. Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys. 2009;74(4):987\u20131001.","journal-title":"Int J Radiat Oncol Biol Phys."},{"issue":"3","key":"20145_CR10","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/j.clbc.2025.10.003","volume":"26","author":"JD Kandzi","year":"2026","unstructured":"Kandzi JD, Englisch A, Boeer B, et al. Reconciling sentinel node omission with CDK4\/6 inhibitor eligibility in HR+\/HER2\u2212 early breast cancer: a real-world cohort analysis. Clin Breast Cancer. 2026;26(3):169\u201375. https:\/\/doi.org\/10.1016\/j.clbc.2025.10.003.","journal-title":"Clin Breast Cancer."},{"key":"20145_CR11","doi-asserted-by":"publisher","first-page":"104641","DOI":"10.1016\/j.breast.2025.104641","volume":"85","author":"M Heidinger","year":"2026","unstructured":"Heidinger M, Zwimpfer TA, Halbeisen FS, et al. Omission of sentinel lymph node biopsy in early stage luminal breast cancer: impact on adjuvant CDK4\/6 inhibitor recommendation and oncological outcomes. Breast. 2026;85:104641. https:\/\/doi.org\/10.1016\/j.breast.2025.104641.","journal-title":"Breast."}],"container-title":["Annals of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-026-20145-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1245\/s10434-026-20145-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-026-20145-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T15:15:29Z","timestamp":1790867729000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1245\/s10434-026-20145-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":11,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["20145"],"URL":"https:\/\/doi.org\/10.1245\/s10434-026-20145-x","relation":{},"ISSN":["1068-9265","1534-4681"],"issn-type":[{"value":"1068-9265","type":"print"},{"value":"1534-4681","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]},"assertion":[{"value":"23 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"There are no conflicts of interest to disclose.","order":1,"name":"Ethics","label":"Disclosure","group":{"name":"EthicsHeading","label":"Ethics"}}]}}