{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T02:12:07Z","timestamp":1792548727992,"version":"4.5.0"},"reference-count":58,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Axillary de-escalation after neoadjuvant systemic therapy (NST) is established in cN1 breast cancer, but the trials validating sentinel lymph node biopsy (SLNB), targeted axillary dissection (TAD) and omission of regional nodal irradiation (RNI) largely excluded cN2\/N3 disease. In HER2-positive and triple-negative disease, NST achieves axillary pathological complete response (pCR) in about one-third of cN2\/N3 patients and 70\u201380% of those achieving breast pCR\u2014establishing biological plausibility, not technical or trial-validated eligibility. The prospective evidence base comprises 87 patients evaluated against completion axillary lymph node dissection (cALND), only 41 informative for false-negative rate. Much of this evidence is defined by node count rather than by matting or fixation, so it applies directly to patients with more than three suspicious but mobile nodes\u2014AJCC cN1 by fixation criteria, but sharing the same multi-node technical problem\u2014while being correspondingly less confined to AJCC-defined cN2\/N3 than the label implies. Across non-randomised cohorts, no oncological penalty has emerged after de-escalation in selected responders, though only three supply an axillary-recurrence numerator confined to advanced nodal disease. Within these limits, omission of cALND may reasonably be offered to selected excellent responders with cN2a or level I\/II-predominant disease and TAD-confirmed nodal pCR, provided RNI is retained, and the decision is multidisciplinary-team supported and documented. Omitting RNI as well rests on extrapolation from NSABP B-51\/RTOG 1304, which excluded this population, and should remain within prospective evaluation, as should cALND omission for residual disease. Level I\/II TAD\/SLNB does not sample the compartments defining cN2b, cN3a, or cN3c disease and samples only the axillary component of cN3b disease, which cALND does not sample either; comprehensive RNI remains indicated in these subgroups. In cN2b, the axilla is clinically uninvolved, so cALND is not required, and axillary staging by SLNB alone is appropriate. cN2\/N3-specific validation of false-negative rate and outcomes remains the priority.<\/jats:p>","DOI":"10.3390\/cancers18182986","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:23:53Z","timestamp":1789496633000},"page":"2986","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Axillary De-Escalation After Neoadjuvant Therapy in cN2\/N3 HER2-Positive and Triple-Negative Breast Cancer: Navigating Biological Promise and Clinical Uncertainty"],"prefix":"10.3390","volume":"18","author":[{"given":"Kefah","family":"Mokbel","sequence":"first","affiliation":[{"name":"London Breast Institute, The Princess Grace Hospital, London W1U 5NY, UK"},{"name":"Burjeel Cancer Institute, Abu Dhabi P.O. Box 92510, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Abugheida","sequence":"additional","affiliation":[{"name":"Burjeel Cancer Institute, Abu Dhabi P.O. Box 92510, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4924-6680","authenticated-orcid":false,"given":"Janhavi","family":"Venkataraman","sequence":"additional","affiliation":[{"name":"London Breast Institute, The Princess Grace Hospital, London W1U 5NY, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3819-0500","authenticated-orcid":false,"given":"Humaid O.","family":"Al-Shamsi","sequence":"additional","affiliation":[{"name":"Burjeel Cancer Institute, Abu Dhabi P.O. Box 92510, United Arab Emirates"},{"name":"Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA 02215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"234","DOI":"10.4274\/ejbh.galenos.2021.2021-4-3","article-title":"American Joint Committee on Cancer\u2019s Staging System for Breast Cancer, Eighth Edition: Summary for Clinicians","volume":"17","author":"Zhu","year":"2021","journal-title":"Eur. J. Breast Health"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Behzadi, S.T., Wider, J., Nano, J., Combs, S.E., Huber, T., and Borm, K.J. (Int. J. Radiat. Oncol. Biol. Phys., 2026). Response to neoadjuvant chemotherapy as a potential indicator of internal mammary node involvement in early breast cancer, Int. J. Radiat. Oncol. Biol. Phys., Epub ahead of printing.","DOI":"10.1016\/j.ijrobp.2026.07.050"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Izzo, P., Molle, M., Cello, P.D., Meloni, P., Lai, S., Izzo, L., Sibio, S., Messineo, D., and Izzo, S. (2026). Breast Cancer Surgery: Past, Present and Future\u2014A Narrative Review. J. Clin. Med., 15.","DOI":"10.3390\/jcm15103778"},{"key":"ref_4","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: The ACOSOG Z1071 (Alliance) clinical trial","volume":"310","author":"Boughey","year":"2013","journal-title":"JAMA"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/S1470-2045(13)70166-9","article-title":"Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): A prospective, multicentre cohort study","volume":"14","author":"Kuehn","year":"2013","journal-title":"Lancet Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1200\/JCO.2014.55.7827","article-title":"Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: The SN FNAC study","volume":"33","author":"Boileau","year":"2015","journal-title":"J. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1007\/s10549-018-5004-7","article-title":"Sentinel lymph node biopsy without axillary lymphadenectomy after neoadjuvant chemotherapy is accurate and safe for selected patients: The GANEA 2 study","volume":"173","author":"Classe","year":"2019","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e553","DOI":"10.1097\/SLA.0000000000004572","article-title":"A prospective, multicenter registry study to evaluate the clinical feasibility of targeted axillary dissection (TAD) in node-positive breast cancer patients","volume":"276","author":"Kuemmel","year":"2022","journal-title":"Ann. Surg."},{"key":"ref_9","unstructured":"Alliance for Clinical Trials in Oncology (2026, August 31). Alliance A011202: A Randomized Phase III Trial Comparing Axillary Lymph Node Dissection to Axillary Radiation in Breast Cancer Patients (cT1\u20133N1) Who Have Positive Sentinel Lymph Node Disease After Neoadjuvant Chemotherapy. ClinicalTrials.gov Identifier: NCT01901094, Available online: https:\/\/clinicaltrials.gov\/study\/NCT01901094."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2113","DOI":"10.1056\/NEJMoa2414859","article-title":"Omitting Regional Nodal Irradiation after Response to Neoadjuvant Chemotherapy","volume":"392","author":"Mamounas","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_11","unstructured":"National Comprehensive Cancer Network (2026, August 31). NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. Version 2026. Available online: https:\/\/www.nccn.org."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.annonc.2023.11.016","article-title":"Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up","volume":"35","author":"Loibl","year":"2024","journal-title":"Ann. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Jaen, D.M., Dougherty, C.E., Helseth, K.A., Harwell, P.A., Santamaria-Barria, J.A., and Millen, J.C. (Ann. Surg. Oncol., 2026). Nodal pathologic response after neoadjuvant systemic therapy in clinically advanced node-positive (cN2 and cN3) breast cancer: A National Cancer Database analysis, Ann. Surg. Oncol., Epub ahead of printing.","DOI":"10.1245\/s10434-026-20149-7"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1186\/s13063-018-3021-9","article-title":"Tailored axillary surgery with or without axillary lymph node dissection followed by radiotherapy in patients with clinically node-positive breast cancer (TAXIS): Study protocol for a multicenter, randomized phase-III trial","volume":"19","author":"Henke","year":"2018","journal-title":"Trials"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"TPS611","DOI":"10.1200\/JCO.2024.42.16_suppl.TPS611","article-title":"Tailored axillary surgery with or without axillary lymph node dissection followed by radiotherapy in patients with clinically node-positive breast cancer (OPBC-03\/SAKK 23\/16\/IBCSG 57-18\/ABCSG-53\/GBG-101-TAXIS)","volume":"42","author":"Weber","year":"2024","journal-title":"J. Clin. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1007\/s10549-020-05970-2","article-title":"Can we avoid axillary lymph node dissection in N2 breast cancer patients with chemo-sensitive tumours such as HER2 and TNBC?","volume":"185","author":"Ortega","year":"2021","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"103671","DOI":"10.1016\/j.breast.2024.103671","article-title":"Axillary lymph node dissection in triple-negative or HER2-positive breast cancer patients with clinical N2 achieving pathological complete response after neoadjuvant therapy: Is it necessary?","volume":"73","author":"Guo","year":"2024","journal-title":"The Breast"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1038\/s41523-025-00862-4","article-title":"Nomogram for predicting axillary pathologic complete response in cN2\u20133 breast cancer after neoadjuvant chemotherapy","volume":"11","author":"Oh","year":"2025","journal-title":"npj Breast Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1184","DOI":"10.1200\/GO.20.00195","article-title":"Sterilization Rate of the Axilla After Neoadjuvant Chemotherapy: The Scope for Conservative Surgery","volume":"6","author":"Noronha","year":"2020","journal-title":"JCO Glob. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/XCS.0000000000000872","article-title":"Long-term outcomes and predictors of response in breast cancer patients with advanced nodal involvement","volume":"238","author":"Sun","year":"2024","journal-title":"J. Am. Coll. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Seto, A., Port, E., Bernik, S., Sheng, T., and Balija, T. (Ann. Surg. Oncol., 2026). Preoperative Radiologic Assessment of the Axilla in Locally Advanced Breast Cancer After Neoadjuvant Systemic Therapy: A Contemporary Comparison, Ann. Surg. Oncol., Epub ahead of print.","DOI":"10.1245\/s10434-026-20257-4"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Lee, A.J.T., Cheung, B.H.H., Suen, D.T.K., and Kwong, A. (Ann. Surg. Oncol., 2026). Prospective Clinical Trial on Expanding the Eligibility Criteria for Targeted Axillary Dissection after Neoadjuvant Systemic Therapy in Breast Cancers with Advanced Nodal Disease, Ann. Surg. Oncol., Epub ahead of print.","DOI":"10.1245\/s10434-026-20132-2"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"104411","DOI":"10.1016\/j.breast.2025.104411","article-title":"Omitting axillary lymph node dissection in breast cancer patients with extensive nodal disease and excellent response to primary systemic therapy using the MARI protocol","volume":"80","author":"Baas","year":"2025","journal-title":"Breast"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Rangan, R., Deshpande, A., Chen, Y., Wu, V., and Al-Hilli, Z. (Surgery, 2026). Surgical Axillary Management Post Neoadjuvant Chemotherapy in Patients with Breast Cancer Presenting with Clinical Node N2 and N3 Disease, Surgery, Epub ahead of printing.","DOI":"10.1016\/j.surg.2026.110615"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Shin, E., Yoo, T.K., Kim, J., Chung, I.Y., Ko, B.S., Kim, H.J., Lee, J.W., Son, B.H., and Lee, S.B. (2025). Evaluating the survival outcomes in clinical node stage 2 and 3 breast cancer patients with negative sentinel lymph node biopsy after neoadjuvant chemotherapy: Sentinel lymph node biopsy alone vs. axillary lymph node dissection. Front. Oncol., 15.","DOI":"10.3389\/fonc.2025.1563586"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3019","DOI":"10.1245\/s10434-018-6587-2","article-title":"The Association of Extent of Axillary Surgery and Survival in Women with N2-3 Invasive Breast Cancer","volume":"25","author":"Park","year":"2018","journal-title":"Ann. Surg. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"4527","DOI":"10.1245\/s10434-024-15280-2","article-title":"The Role of Axillary Lymph Node Dissection versus Sentinel Lymph Node Dissection in Breast Cancer Patients with Clinical N2b-N3c Disease Who Receive Adjuvant Radiotherapy","volume":"31","author":"Roach","year":"2024","journal-title":"Ann. Surg. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"4795","DOI":"10.1245\/s10434-020-08900-0","article-title":"Oncologic Outcomes of Sentinel Lymph Node Surgery After Neoadjuvant Chemotherapy for Node-Positive Breast Cancer","volume":"27","author":"Piltin","year":"2020","journal-title":"Ann. Surg. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1001\/jamasurg.2024.5913","article-title":"De-Escalation of Nodal Surgery in Clinically Node-Positive Breast Cancer","volume":"160","author":"Uras","year":"2025","journal-title":"JAMA Surg."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Li, Z., Qu, Z., Pei, S., Xian, K., Zhang, H., Yang, X., Zhang, L., Zhang, J.Q., Fayanju, O.M., and Wang, J. (2026). Survival outcomes of axillary de-escalation following neoadjuvant chemo-immunotherapy in clinically node-positive triple-negative breast cancer: A national cancer database study. Front. Immunol., 17.","DOI":"10.3389\/fimmu.2026.1892648"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Qian, X., Xiu, M., Li, Q., Wang, J., Fan, Y., Luo, Y., Cai, R., Li, Q., Chen, S., and Yuan, P. (2022). Clinical N3 is an independent risk factor of recurrence for breast cancer patients achieving pathological complete response and near-pathological complete response after neoadjuvant chemotherapy. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.1019925"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e689","DOI":"10.1016\/j.ijrobp.2010.11.061","article-title":"Outcomes of positron emission tomography-staged clinical N3 breast cancer treated with neoadjuvant chemotherapy, surgery, and radiotherapy","volume":"81","author":"Park","year":"2011","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s41073-019-0064-8","article-title":"SANRA\u2014A Scale for the Quality Assessment of Narrative Review Articles","volume":"4","author":"Baethge","year":"2019","journal-title":"Res. Integr. Peer Rev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1093\/annonc\/mdz235","article-title":"Estimating the benefits of therapy for early-stage breast cancer: The St. Gallen International Consensus Guidelines for the primary therapy of early breast cancer 2019","volume":"30","author":"Burstein","year":"2019","journal-title":"Ann. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1097\/SLA.0000000000005671","article-title":"Impact of axillary lymph node dissection and sentinel lymph node biopsy on upper limb morbidity in breast cancer patients: A systematic review and meta-analysis","volume":"277","author":"Kwasnicki","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1016\/j.amjsurg.2016.07.018","article-title":"Is sentinel lymph node biopsy a viable alternative to complete axillary dissection following neoadjuvant chemotherapy in women with node-positive breast cancer at diagnosis? An updated meta-analysis involving 3,398 patients","volume":"212","author":"Headon","year":"2016","journal-title":"Am. J. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Swarnkar, P.K., Tayeh, S., Michell, M.J., and Mokbel, K. (2021). The Evolving Role of Marked Lymph Node Biopsy (MLNB) and Targeted Axillary Dissection (TAD) after Neoadjuvant Chemotherapy (NACT) for Node-Positive Breast Cancer: Systematic Review and Pooled Analysis. Cancers, 13.","DOI":"10.21203\/rs.3.rs-199729\/v1"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.annonc.2019.10.012","article-title":"Eliminating the breast cancer surgery paradigm after neoadjuvant systemic therapy: Current evidence and future challenges","volume":"31","author":"Heil","year":"2020","journal-title":"Ann. Oncol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1903","DOI":"10.1200\/JCO.21.02439","article-title":"Intelligent vacuum-assisted biopsy to identify breast cancer patients with pathologic complete response (ypT0 and ypN0) after neoadjuvant systemic treatment for omission of breast and axillary surgery","volume":"40","author":"Pfob","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Peng, Y., Zhang, S., Tie, J., Xiang, Y., Shi, C., Guo, C., Fan, Z., and Wang, W. (Int. J. Radiat. Oncol. Biol. Phys., 2026). MRI-based internal mammary node response after neoadjuvant therapy to guide postoperative internal mammary node radiotherapy boost in breast cancer, Int. J. Radiat. Oncol. Biol. Phys., Epub ahead of print.","DOI":"10.1016\/j.ijrobp.2026.08.029"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2070","DOI":"10.1245\/s10434-024-16630-w","article-title":"Outcomes and Trends in Axillary Management of Stage cN3b Breast Cancer Patients","volume":"32","author":"Selfridge","year":"2025","journal-title":"Ann. Surg. Oncol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/S1470-2045(25)00598-4","article-title":"Oncological outcomes with and without axillary lymph node dissection in patients with residual micrometastases after neoadjuvant chemotherapy (OPBC-07\/microNAC): An international, retrospective cohort study","volume":"27","author":"Montagna","year":"2026","journal-title":"Lancet Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1056\/NEJMoa1910549","article-title":"Pembrolizumab for Early Triple-Negative Breast Cancer","volume":"382","author":"Schmid","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e124507","DOI":"10.1172\/jci.insight.124507","article-title":"Tumor-draining lymph nodes are pivotal in PD-1\/PD-L1 checkpoint therapy","volume":"3","author":"Fransen","year":"2018","journal-title":"JCI Insight"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Chen, Y.Y., Ge, J.Y., Ma, D., Yu, K.D., Wu, X.Y., Chen, Y.Y., Yu, Y., and Shao, Z.M. (2020). Immune-Activated Regional Lymph Nodes Predict Favorable Survival in Early-Stage Triple-Negative Breast Cancer. Front. Oncol., 10.","DOI":"10.3389\/fonc.2020.570981"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"7472","DOI":"10.21037\/tcr-2025-1837","article-title":"Translating NSABP B-51 findings into practice: Rethinking regional nodal irradiation in breast cancer","volume":"14","author":"Mokbel","year":"2025","journal-title":"Transl. Cancer Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1056\/NEJMoa1415340","article-title":"Regional Nodal Irradiation in Early-Stage Breast Cancer (NCIC-CTG MA.20)","volume":"373","author":"Whelan","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1056\/NEJMoa1415369","article-title":"Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer (EORTC 22922\/10925)","volume":"373","author":"Poortmans","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1016\/S1470-2045(14)70460-7","article-title":"Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): A randomised, multicentre, open-label, phase 3 non-inferiority trial","volume":"15","author":"Donker","year":"2014","journal-title":"Lancet Oncol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2159","DOI":"10.1200\/JCO.22.01565","article-title":"Radiotherapy or Surgery of the Axilla After a Positive Sentinel Node in Breast Cancer: 10-Year Results of the Randomized Controlled EORTC 10981-22023 AMAROS Trial","volume":"41","author":"Bartels","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"RF2-01","DOI":"10.1158\/1557-3265.SABCS24-RF2-01","article-title":"Factors influencing additional nodal disease and pathologic nodal upstaging with axillary dissection in patients with residual node-positive breast cancer after neoadjuvant chemotherapy enrolled on Alliance A011202","volume":"31","author":"Boughey","year":"2025","journal-title":"Clin. Cancer Res."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.breast.2021.09.004","article-title":"Tailored axillary surgery in patients with clinically node-positive breast cancer: Pre-planned feasibility substudy of TAXIS (OPBC-03, SAKK 23\/16, IBCSG 57-18, ABCSG-53, GBG 101)","volume":"60","author":"Weber","year":"2021","journal-title":"Breast"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1200\/JCO-25-01921","article-title":"Marking Techniques for Target Lymph Nodes in Node-Positive Breast Cancer Treated With Neoadjuvant Therapy in the AXSANA\/EUBREAST-03\/AGO-B-053 Study","volume":"44","author":"Hartmann","year":"2026","journal-title":"J. Clin. Oncol."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Varghese, J., Patani, N., Wazir, U., Novintan, S., Michell, M.J., Malhotra, A., Mokbel, K., and Mokbel, K. (2024). Wire-free targeted axillary dissection: A pooled analysis of 1300+ cases post-neoadjuvant systemic therapy in node-positive early breast cancer. Cancers, 16.","DOI":"10.3390\/cancers16122172"},{"key":"ref_55","unstructured":"(2026, August 31). SenTa2: TAD in Primary Breast Cancer With Initially \u22653 Suspicious Lymph Nodes (SenTa2). ClinicalTrials.gov Identifier: NCT05462457. Kliniken Essen-Mitte, Available online: https:\/\/clinicaltrials.gov\/study\/NCT05462457."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1007\/s10434-001-0234-y","article-title":"Internal mammary lymph node drainage patterns in patients with breast cancer documented by breast lymphoscintigraphy","volume":"8","author":"Byrd","year":"2001","journal-title":"Ann. Surg. Oncol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1200\/JCO.2015.63.6456","article-title":"DBCG-IMN: A Population-Based Cohort Study on the Effect of Internal Mammary Node Irradiation in Early Node-Positive Breast Cancer","volume":"34","author":"Thorsen","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"108334","DOI":"10.1016\/j.esmoop.2026.108334","article-title":"Ultrasensitive circulating tumor DNA detection improves prognostication in triple-negative breast cancer postneoadjuvant therapy","volume":"11","author":"Cabel","year":"2026","journal-title":"ESMO Open"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/18\/2986\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:31:05Z","timestamp":1789497065000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/18\/2986"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,15]]},"references-count":58,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["cancers18182986"],"URL":"https:\/\/doi.org\/10.3390\/cancers18182986","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,15]]}}}