{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T12:06:07Z","timestamp":1789387567031,"version":"build-2803163510"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2020,7,7]],"date-time":"2020-07-07T00:00:00Z","timestamp":1594080000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Trial Information<\/jats:title>\n                  <jats:p>Click here to access other published clinical trials.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Lessons Learned<\/jats:title>\n                  <jats:p>Removal of sonographically abnormal (up to 3) metastatic clipped nodes, without sentinel lymph node biopsy, could accurately predict axillary status in breast cancer patients receiving neoadjuvant chemotherapy. ypT and the first clipped node status were statistically significant factors for nodal pathologic complete response. This novel approach requires validation in larger studies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In patients who have node-positive breast cancer, neoadjuvant chemotherapy could result in nodal pathologic complete response (pCR) and avoid an axillary lymph node dissection (ALND). Axillary staging, in such cases, can be performed using targeted axillary dissection (TAD) with a low false negative rate. However, identification of sentinel lymph nodes (SLNs) after chemotherapy can be difficult, and currently, it is the standard to remove only one clipped node in TAD. We aimed to determine if removal of all sonographically abnormal metastatic clipped nodes, without SLN biopsy, could accurately predict the axillary status post neoadjuvant chemotherapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Patients with breast cancer with one to three sonographically abnormal metastatic axillary nodes were prospectively recruited. Each abnormal node had histology and clip insertion before neoadjuvant chemotherapy. After chemotherapy, the patients underwent removal of clipped nodes using the Skin Mark clipped Axillary nodes Removal Technique (SMART) and ALND.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Fourteen patients were recruited, having a total of 21 sonographically abnormal metastatic nodes, with nine, three, and two patients having 1, 2, and 3 malignant nodes clipped, respectively. Mean age was 55.5\u2009years; 92.9% and 57.1% of patients had invasive ductal carcinoma and grade III tumors, respectively; and 35.7% patients achieved nodal pCR. The first clipped node predicted the axillary status with a false negative rate of 7.1%. Adding to this another second clipped node, the false negative rate was 0%. Pathologic tumor staging after neoadjuvant chemotherapy (ypT) (p = .0390) and the first clipped node pathological response status (p = .0030) were statistically significant predictors for nodal pCR.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Removal of sonographically abnormal metastatic clipped nodes using SMART, without sentinel lymph node biopsy, could accurately predict axillary status. This finding needs validation in larger studies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1634\/theoncologist.2020-0494","type":"journal-article","created":{"date-parts":[[2020,6,15]],"date-time":"2020-06-15T05:21:24Z","timestamp":1592198484000},"page":"e1621-e1627","source":"Crossref","is-referenced-by-count":22,"title":["Would Removal of All Ultrasound Abnormal Metastatic Lymph Nodes Without Sentinel Lymph Node Biopsy Be Accurate in Patients with Breast Cancer with Neoadjuvant Chemotherapy?"],"prefix":"10.1093","volume":"25","author":[{"given":"Geok Hoon","family":"Lim","sequence":"first","affiliation":[{"name":"Breast Department, KK Women's and Children's Hospital, Singapore"},{"name":"Duke-NUS Medical School, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihir","family":"Gudi","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sze Yiun","family":"Teo","sequence":"additional","affiliation":[{"name":"Department of Diagnostic & Interventional Imaging, KK Women's and Children's Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruey Pyng","family":"Ng","sequence":"additional","affiliation":[{"name":"Division of Nursing, KK Women's and Children's Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyan","family":"Yan","sequence":"additional","affiliation":[{"name":"Breast Department, KK Women's and Children's Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yien Sien","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Diagnostic & Interventional Imaging, KK Women's and Children's Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"John C.","family":"Allen","sequence":"additional","affiliation":[{"name":"Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lester Chee Hao","family":"Leong","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,7,7]]},"reference":[{"key":"2021122511251963300_onco13402-bib-0001","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1097\/SLA.0000000000001375","article-title":"Identification and resection of clipped node decreases the false-negative rate of sentinel lymph node surgery in patients presenting with node-positive breast cancer (T0\u2013T4, N1\u2013N2) who receive neoadjuvant chemotherapy: Results from ACOSOG Z1071 (Alliance)","volume":"263","author":"Boughey","year":"2016","journal-title":"Ann Surg"},{"key":"2021122511251963300_onco13402-bib-0002","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1097\/COC.0b013e3182354bda","article-title":"Complication rates in patients with negative axillary nodes 10\u2009years after local breast radiotherapy after either sentinel lymph node dissection or axillary clearance","volume":"36","author":"Wernicke","year":"2013","journal-title":"Am J Clin Oncol"},{"key":"2021122511251963300_onco13402-bib-0003","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1001\/jama.2013.278932","article-title":"Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer. 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