2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:Ta47,Randomized trials established the safety of omitting axillary lymph node dissection (ALND) among patients with clinically node-negative breast cancer and less than 3 positive sentinel lymph nodes (+SLNs) having upfront surgery and adjuvant radiation. Patients with palpable mobile level I/II axillary adenopathy (cN1) were not eligible for these studies. Presently, more than 80% of patients with HR+/HER2- cN1 disease undergo ALND either at upfront surgery or after neoadjuvant therapy, despite evidence that 50% to 60% will have only 1 or 2 positive nodes. To determine upfront sentinel lymph node biopsy (SLNB) feasibility and evaluate ALND rate among patients with HR+/HER2- cN1 breast cancer selected with axillary ultrasound (AUS). This nonrandomized clinical trial involved patients with cTx/cT1-2 cN1 HR+/HER2- breast cancer with 3 or fewer morphologically abnormal nodes on AUS at 4 centers. The trial began on April 20, 2021, and the database for this report was frozen on September 26, 2024. Patients underwent upfront lumpectomy/mastectomy and SLNB, with single/dual-tracer mapping. ALND was indicated for 3 or more positive SLNs. The primary outcome was ALND rate. Secondary outcomes were frequency of palpable nodes being radioactive/blue and locoregional recurrence. Among 78 enrolled patients, the median (IQR) age was 58 (49.0-66.5) years. Most tumors were cT1 (37 [47%]) or cT2 (40 [51%]), 56 patients (72%) had ductal histology, and 59 tumors (76%) were moderately differentiated. On AUS, 39 patients (50%) had 1 abnormal-appearing node, 33 (42%) had 2, and 6 (8%) had 3. Median (IQR) pathologic tumor size was 2.3 (1.6-3.3) cm, 50 patients (64%) had lymphovascular invasion, and 54 (69%) had extracapsular extension. SLNB was performed with dual tracer in 68 (87%), and 3 or more SLNs were retrieved in 75 (96%). The palpable diseased nodes were blue and/or radioactive in 107 of 161 instances (66.5%). Overall, 24 patients (31%) had 1 +SLN, 30 patients (38%) had 2 +SLNs, and 24 patients (31%) had 3 or more +SLNs. SLNB alone was performed in 59 patients (76%), while 19 (24%) had ALND; indicated ALND was deferred in 5 cases. Among those with 12 months or more follow-up (n = 68; median, 25 months), there have been no isolated axillary or locoregional recurrences. This study found that SLNB is feasible among patients with cN1 HR+/HER2- disease and that resection of palpable nodes is necessary to minimize false-negative rates. This approach affords the opportunity to omit ALND and minimize morbidity among patients with cN1 cancer and limited nodal burden. ClinicalTrials.gov Identifier: NCT04854005.31:T1013, Importance Randomized trials established the safety of omitting axillary lymph node dissection (ALND) among patients with clinically node-negative breast cancer and less than 3 positive sentinel lymph nodes (+SLNs) having upfront surgery and adjuvant radiation. Patients with palpable mobile level I/II axillary adenopathy (cN1) were not eligible for these studies. Presently, more than 80% of patients with HR+/HER2− cN1 disease undergo ALND either at upfront surgery or after neoadjuvant therapy, despite evidence that 50% to 60% will have only 1 or 2 positive nodes. Objective To determine upfront sentinel lymph node biopsy (SLNB) feasibility and evaluate ALND rate among patients with HR+/HER2− cN1 breast cancer selected with axillary ultrasound (AUS). Design, Setting, and Participants This nonrandomized clinical trial involved patients with cTx/cT1-2 cN1 HR+/HER2− breast cancer with 3 or fewer morphologically abnormal nodes on AUS at 4 centers. The trial began on April 20, 2021, and the database for this report was frozen on September 26, 2024. Interventions Patients underwent upfront lumpectomy/mastectomy and SLNB, with single/dual-tracer mapping. ALND was indicated for 3 or more positive SLNs. Main Outcomes and Measures The primary outcome was ALND rate. Secondary outcomes were frequency of palpable nodes being radioactive/blue and locoregional recurrence. Results Among 78 enrolled patients, the median (IQR) age was 58 (49.0-66.5) years. Most tumors were cT1 (37 [47%]) or cT2 (40 [51%]), 56 patients (72%) had ductal histology, and 59 tumors (76%) were moderately differentiated. On AUS, 39 patients (50%) had 1 abnormal-appearing node, 33 (42%) had 2, and 6 (8%) had 3. Median (IQR) pathologic tumor size was 2.3 (1.6-3.3) cm, 50 patients (64%) had lymphovascular invasion, and 54 (69%) had extracapsular extension. SLNB was performed with dual tracer in 68 (87%), and 3 or more SLNs were retrieved in 75 (96%). The palpable diseased nodes were blue and/or radioactive in 107 of 161 instances (66.5%). Overall, 24 patients (31%) had 1 +SLN, 30 patients (38%) had 2 +SLNs, and 24 patients (31%) had 3 or more +SLNs. SLNB alone was performed in 59 patients (76%), while 19 (24%) had ALND; indicated ALND was deferred in 5 cases. Among those with 12 months or more follow-up (n = 68; median, 25 months), there have been no isolated axillary or locoregional recurrences. Conclusions and Relevance This study found that SLNB is feasible among patients with cN1 HR+/HER2− disease and that resection of palpable nodes is necessary to minimize false-negative rates. This approach affords the opportunity to omit ALND and minimize morbidity among patients with cN1 cancer and limited nodal burden. Trial Registration ClinicalTrials.gov Identifier: NCT04854005 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Axillary Lymph Node Metastasis: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Axillary Lymph Node Metastasis (condition). Clinician-written summaries and actionable practice insights. 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A prospective single arm trial","journal_title":"The Breast","journal_issn":"0960-9776","published_at":"2026-07-20T00:00:00.000Z","url":"https://doi.org/10.1016/j.breast.2026.104875","source_score":2,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-31T13:36:55.541Z","updated_at":"2026-07-31T13:36:55.541Z","tags":[{"paper_doi":"10.1016/j.breast.2026.104875","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104875","tag_type":"brand","value":"FDG","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104875","tag_type":"category","value":"Obstetrics & Gynecology","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104875","tag_type":"condition","value":"Axillary Lymph Node Metastasis","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104875","tag_type":"condition","value":"Breast Cancer","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104875","tag_type":"generic","value":"fluorodeoxyglucose F-18","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104875","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104875","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104875","tag_type":"modality","value":"Axillary Ultrasound","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104875","tag_type":"modality","value":"PET/MRI","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104875","tag_type":"sample_size","value":"n=68","value_numeric":68},{"paper_doi":"10.1016/j.breast.2026.104875","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104875","tag_type":"study_design","value":"Prospective Single-Arm Trial","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104875","tag_type":"warning","value":"Only 68 of 109 screened patients reached final analysis; reasons for exclusion are not detailed in the abstract, which may introduce selection bias.","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104875","tag_type":"warning","value":"Subtype-specific findings (e.g., PPV 85.7% in luminal, NPV 83.3% in HER2+/TNBC) are based on subgroups whose sizes are not reported — treat these estimates cautiously.","value_numeric":null},{"paper_doi":"10.1016/j.breast.2026.104875","tag_type":"warning","value":"The full text was inaccessible; all extracted data are based solely on the abstract.","value_numeric":null}],"summaries":{"what_studied":"This prospective single-arm trial evaluated [18F]FDG PET/MRI as a non-invasive post-treatment axillary staging tool in 68 node-positive breast cancer patients receiving primary systemic therapy (PST), comparing its performance to axillary ultrasound (A-US) against surgical pathology as the reference standard.","key_result":"PET/MRI sensitivity was 53.3% and specificity 68.4% (PPV 57.1%, NPV 65.0%) for residual axillary disease in 30/68 (44.2%) patients with pathologically confirmed disease; performance did not significantly differ from A-US (p > 0.05). PPV was higher in luminal subtypes (85.7%) and NPV was higher in HER2+ and triple-negative tumors (83.3%).","limitations":"- Single-center study with a modest sample size (n=68), limiting generalizability.\n- Only 68 of 109 screened patients were included, raising selection bias concerns.\n- Overall diagnostic accuracy was low, and the study was not powered to formally compare performance across molecular subtypes.","practice_takeaway":"PET/MRI does not offer a clear advantage over axillary ultrasound for post-PST nodal staging in unselected node-positive breast cancer patients. Subtype-tailored imaging strategies — particularly leveraging PET/MRI's higher NPV in HER2+ and triple-negative disease — may be worth exploring in future trials before changing surgical decision-making."}},{"doi":"10.1001/jamasurg.2026.1268","pmid":"42090164","title":"Sentinel Lymph Node Biopsy for Patients With cN1 HR+/HER2− Breast Cancer and Palpable Adenopathy","journal_title":"JAMA Surgery","journal_issn":"2168-6254","published_at":"2026-05-06T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13150728/","source_score":10,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-05-11","doi":"10.1001/jamasurg.2026.1268","days":"7","issn":"2168-6254","rank":"5","field":"Clinical Medicine","score":"10","category":"Surgery","categories":["Surgery"],"_categories":["Surgery"]},"pubmed":{"doi":"10.1001/jamasurg.2026.1268","title":"Sentinel Lymph Node Biopsy for Patients With cN1 HR+/HER2- Breast Cancer and Palpable Adenopathy: A Nonrandomized Clinical Trial.","journal":"JAMA surgery","methods":"","results":"Among 78 enrolled patients, the median (IQR) age was 58 (49.0-66.5) years. Most tumors were cT1 (37 [47%]) or cT2 (40 [51%]), 56 patients (72%) had ductal histology, and 59 tumors (76%) were moderately differentiated. On AUS, 39 patients (50%) had 1 abnormal-appearing node, 33 (42%) had 2, and 6 (8%) had 3. Median (IQR) pathologic tumor size was 2.3 (1.6-3.3) cm, 50 patients (64%) had lymphovascular invasion, and 54 (69%) had extracapsular extension. SLNB was performed with dual tracer in 68 (87%), and 3 or more SLNs were retrieved in 75 (96%). The palpable diseased nodes were blue and/or radioactive in 107 of 161 instances (66.5%). Overall, 24 patients (31%) had 1 +SLN, 30 patients (38%) had 2 +SLNs, and 24 patients (31%) had 3 or more +SLNs. SLNB alone was performed in 59 patients (76%), while 19 (24%) had ALND; indicated ALND was deferred in 5 cases. Among those with 12 months or more follow-up (n = 68; median, 25 months), there have been no isolated axillary or locoregional recurrences.","abstract":"$30","keywords":[],"pubmed_id":"42090164","conclusions":"","publication_date":"2026-05-06T00:00:00"},"crossref":{"DOI":"10.1001/jamasurg.2026.1268","URL":"https://doi.org/10.1001/jamasurg.2026.1268","ISSN":["2168-6254"],"link":[{"URL":"https://jamanetwork.com/journals/jamasurgery/articlepdf/2848645/jamasurgery_mamtani_2026_oi_260022_1777474148.97529.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Sentinel Lymph Node Biopsy for Patients With cN1 HR+/HER2− Breast Cancer and Palpable Adenopathy"],"author":[{"given":"Anita","family":"Mamtani","sequence":"first","affiliation":[{"name":"Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New 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Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, New York"}]},{"given":"Alexandra S.","family":"Heerdt","sequence":"additional","affiliation":[{"name":"Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}]},{"given":"Laurie","family":"Kirstein","sequence":"additional","affiliation":[{"name":"Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}]},{"given":"Minna K.","family":"Lee","sequence":"additional","affiliation":[{"name":"Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}]},{"given":"Victoria L.","family":"Mango","sequence":"additional","affiliation":[{"name":"Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York"}]},{"given":"Giacomo","family":"Montagna","sequence":"additional","affiliation":[{"name":"Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New 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York"}]},{"given":"Lisa","family":"Sclafani","sequence":"additional","affiliation":[{"name":"Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}]},{"given":"Varadan","family":"Sevilimedu","sequence":"additional","affiliation":[{"name":"Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York"}]},{"given":"Audree B.","family":"Tadros","sequence":"additional","affiliation":[{"name":"Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}]},{"given":"Kimberly J.","family":"Van Zee","sequence":"additional","affiliation":[{"name":"Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}]},{"given":"Monica","family":"Morrow","sequence":"additional","affiliation":[{"name":"Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New 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Surgery"],"reference-count":24,"published-online":{"date-time":null,"timestamp":null,"date-parts":[[2026,5,6]]},"references-count":24,"short-container-title":["JAMA Surg"],"is-referenced-by-count":0},"unpaywall":{"doi":"10.1001/jamasurg.2026.1268","is_oa":true,"title":"Sentinel Lymph Node Biopsy for Patients With cN1 HR+/HER2− Breast Cancer and Palpable Adenopathy","updated":"2026-05-12T08:54:10+00:00","published_date":"2026-05-06","best_oa_location":{"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13150728/","pmh_id":"oai:pubmedcentral.nih.gov:13150728","url_for_pdf":null,"url_for_landing_page":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13150728/"}}},"created_at":"2026-05-12T13:18:08.744Z","updated_at":"2026-05-14T15:13:26.918Z","tags":[{"paper_doi":"10.1001/jamasurg.2026.1268","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1268","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1268","tag_type":"condition","value":"Axillary Lymph Node Metastasis","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1268","tag_type":"condition","value":"Breast Cancer","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1268","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1268","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1268","tag_type":"modality","value":"Axillary Lymph Node Dissection","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1268","tag_type":"modality","value":"Axillary Ultrasound","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1268","tag_type":"modality","value":"Sentinel Lymph Node Biopsy","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1268","tag_type":"sample_size","value":"n=78","value_numeric":78},{"paper_doi":"10.1001/jamasurg.2026.1268","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1268","tag_type":"study_design","value":"Nonrandomized Clinical Trial","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1268","tag_type":"warning","value":"Five patients who met the ALND indication had it deferred; their outcomes are not fully described in the available abstract, which may slightly inflate the apparent safety of SLNB-alone management.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1268","tag_type":"warning","value":"Follow-up duration (median 25 months) is short for a breast cancer locoregional recurrence endpoint; the impact_flag 'practice_changing' reflects the high ALND-avoidance rate but should be interpreted cautiously pending longer follow-up.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1268","tag_type":"warning","value":"Full text is under embargo until May 2027; structured data was extracted from the abstract and results section only — additional methods details, subgroup analyses, and adverse event data may be present in the full paper.","value_numeric":null}],"summaries":{"what_studied":"This nonrandomized clinical trial evaluated the feasibility of upfront sentinel lymph node biopsy (SLNB) and the rate of axillary lymph node dissection (ALND) avoidance in 78 patients with cTx/cT1-2 cN1 HR+/HER2− breast cancer who had ≤3 morphologically abnormal nodes on axillary ultrasound (AUS), across 4 centers (April 2021–September 2024).","key_result":"SLNB alone was achieved in 76% of patients (59/78), avoiding ALND; only 24% (19/78) required ALND (≥3 positive SLNs). At a median follow-up of 25 months, there were **no isolated axillary or locoregional recurrences** among the 68 patients with ≥12 months of follow-up. Palpable diseased nodes were captured by tracer (blue/radioactive) in only 66.5% of instances (107/161), underscoring the need to manually resect palpable nodes.","limitations":"- Short median follow-up (25 months) is insufficient to assess long-term locoregional control.\n- Small sample size (n=78) at 4 centers limits generalizability.\n- Nonrandomized design with no comparator arm; 5 patients deferred indicated ALND, complicating outcome interpretation.","practice_takeaway":"For patients with cN1 HR+/HER2− breast cancer and ≤3 abnormal nodes on AUS, upfront SLNB can spare 3 in 4 patients from ALND — but surgeons must manually excise palpable nodes, as tracers alone miss them about one-third of the time."}}],"initialOffset":2,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"Axillary Lymph Node Metastasis"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"Axillary Lymph Node Metastasis"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"Axillary Lymph Node Metastasis"}}}]]

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