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\":\"Sentinel Lymph Node Biopsy: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Sentinel Lymph Node Biopsy (modality). Clinician-written summaries and actionable practice insights. 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By contrast, female patients saw significant shifts in nearly every treatment domain; adjuvant chemotherapy use fell in females over time (OR 1.10, 95% CI 1.10–1.11, p<0.001 favoring the earlier decade), while it remained stable in males.","limitations":"- BQA relies on surgical teams to record adjuvant therapies, so post-surgical treatments (e.g., chemotherapy referred but not yet started) may be undercounted.\n- Observational design over a wide time span introduces potential unmeasured biases.\n- Male breast cancer numbers are small (n=1,542), limiting statistical power for subgroup analyses.","practice_takeaway":"Male breast cancer treatment in Australia and New Zealand has barely changed over 20 years — SLNB adoption is the main advance, while surgical and adjuvant therapy de-escalation seen in females has not occurred in males. Clinicians should be aware that male patients are managed without sex-specific evidence-based guidelines, and extrapolation from female data may not be appropriate."}},{"doi":"10.1097/pas.0000000000002575","pmid":"42231653","title":"Clinical Outcomes and Prognostication of CRTC1::TRIM11 Fusion Cutaneous Tumors","journal_title":"American Journal of Surgical Pathology","journal_issn":"0147-5185","published_at":"2026-06-03T00:00:00.000Z","url":"https://doi.org/10.1097/pas.0000000000002575","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-09T13:50:19.599Z","updated_at":"2026-06-09T13:50:19.599Z","tags":[{"paper_doi":"10.1097/pas.0000000000002575","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1097/pas.0000000000002575","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1097/pas.0000000000002575","tag_type":"condition","value":"CRTC1::TRIM11 Fusion Cutaneous Tumor","value_numeric":null},{"paper_doi":"10.1097/pas.0000000000002575","tag_type":"condition","value":"Cutaneous Soft Tissue Tumor","value_numeric":null},{"paper_doi":"10.1097/pas.0000000000002575","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1097/pas.0000000000002575","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1097/pas.0000000000002575","tag_type":"modality","value":"Sentinel Lymph Node Biopsy","value_numeric":null},{"paper_doi":"10.1097/pas.0000000000002575","tag_type":"modality","value":"Surgical Excision","value_numeric":null},{"paper_doi":"10.1097/pas.0000000000002575","tag_type":"sample_size","value":"n=21","value_numeric":21},{"paper_doi":"10.1097/pas.0000000000002575","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1097/pas.0000000000002575","tag_type":"study_design","value":"Case Series with Meta-Analysis","value_numeric":null},{"paper_doi":"10.1097/pas.0000000000002575","tag_type":"warning","value":"Age and sex distributions are not reported in the available abstract; mixed tags are inferred from the general nature of cutaneous tumor studies.","value_numeric":null},{"paper_doi":"10.1097/pas.0000000000002575","tag_type":"warning","value":"Sample size (n=21) refers to the new series only; total meta-analysis N is not specified in the abstract, so a single sample_size tag reflects the primary series.","value_numeric":null},{"paper_doi":"10.1097/pas.0000000000002575","tag_type":"warning","value":"Study design is described as a case series plus meta-analysis; the meta-analysis component was not independently verifiable from the provided text.","value_numeric":null},{"paper_doi":"10.1097/pas.0000000000002575","tag_type":"warning","value":"The full text of the paper was not accessible — only the abstract was available for analysis; all extracted data derives solely from the abstract.","value_numeric":null}],"summaries":{"what_studied":"A case series of 21 patients with CRTC1::TRIM11 fusion cutaneous tumors (CTCT) plus a meta-analysis of all published cases, evaluating morphologic, molecular, and clinical outcome data to identify prognostic parameters for metastatic risk.","key_result":"Metastatic tumors were larger (P=0.038), more mitotically active (P<0.001), more often ulcerated (P=0.001), and exclusively harbored TERT promoter mutations (P=0.005); 23% of all cases had metastatic events. No metastases occurred when all three criteria were met: size <1.2 cm, <7 mitoses/mm², and absent TERT promoter mutation. Distant metastases always involved the lungs; regional lymph nodes were the most common first site.","limitations":"Small series (n=21) with meta-analysis limited by heterogeneous reporting across prior case reports; therapeutic response data is sparse given rarity of the tumor; retrospective design limits causal inference.","practice_takeaway":"For CTCT meeting all low-risk criteria (size <1.2 cm, <7 mitoses/mm², no TERT promoter mutation), excision alone may suffice. For larger, more mitotically active, or TERT-mutated tumors, consider sentinel lymph node biopsy and imaging given the 23% metastatic rate and consistently poor responses to reported therapies."}},{"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 York"}]},{"given":"Melissa","family":"Pilewskie","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Michigan, Ann Arbor"}]},{"given":"Niamey","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hartford HealthCare, Hartford, Connecticut"}]},{"given":"Heiwon","family":"Chung Whang","sequence":"additional","affiliation":[{"name":"Lehigh Valley Topper Cancer Institute, Lehigh Valley Health Network, Lehigh Valley, Pennsylvania"}]},{"given":"Andrea V.","family":"Barrio","sequence":"additional","affiliation":[{"name":"Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}]},{"given":"Leah","family":"Bassin","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hartford HealthCare, Hartford, Connecticut"}]},{"given":"Deborah","family":"Capko","sequence":"additional","affiliation":[{"name":"Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}]},{"given":"Daniel X.","family":"Choi","sequence":"additional","affiliation":[{"name":"Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}]},{"given":"Hiram S.","family":"Cody","sequence":"additional","affiliation":[{"name":"Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}]},{"given":"Stephanie","family":"Downs-Canner","sequence":"additional","affiliation":[{"name":"Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}]},{"given":"Mahmoud","family":"El-Tamer","sequence":"additional","affiliation":[{"name":"Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}]},{"given":"Mary L.","family":"Gemignani","sequence":"additional","affiliation":[{"name":"Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"},{"name":"Department of 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 York, New York"}]},{"given":"Tracy-Ann","family":"Moo","sequence":"additional","affiliation":[{"name":"Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}]},{"given":"Jacqueline","family":"Oxenberg","sequence":"additional","affiliation":[{"name":"Lehigh Valley Topper Cancer Institute, Lehigh Valley Health Network, Lehigh Valley, Pennsylvania"}]},{"given":"George","family":"Plitas","sequence":"additional","affiliation":[{"name":"Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York"}]},{"given":"Michael","family":"Sabel","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Michigan, Ann Arbor"}]},{"given":"Virgilio","family":"Sacchini","sequence":"additional","affiliation":[{"name":"Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New 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 York"}]}],"issued":{"date-parts":[[2026,5,6]]},"member":"10","prefix":"10.1001","source":"Crossref","volume":null,"created":{"date-time":"2026-05-06T15:31:47Z","timestamp":1778081507000,"date-parts":[[2026,5,6]]},"indexed":{"date-time":"2026-05-06T16:14:22Z","timestamp":1778084062921,"date-parts":[[2026,5,6]]},"subject":[],"abstract":"$31","language":"en","relation":{},"resource":{"primary":{"URL":"https://jamanetwork.com/journals/jamasurgery/fullarticle/2848645"}},"subtitle":["A Nonrandomized Clinical Trial"],"deposited":{"date-time":"2026-05-06T15:31:48Z","timestamp":1778081508000,"date-parts":[[2026,5,6]]},"issn-type":[{"type":"print","value":"2168-6254"}],"published":{"date-parts":[[2026,5,6]]},"publisher":"American Medical Association (AMA)","reference":[{"DOI":"10.1001/jama.2017.11470","key":"soi260022r1","year":"2017","issue":"10","author":"Giuliano","volume":"318","first-page":"918","unstructured":null,"article-title":"Effect of axillary dissection vs no axillary dissection on 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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."}},{"doi":"10.1001/jamasurg.2026.1258","pmid":"42090161","title":"De-Escalating Axillary Surgery in Select Patients With Clinically Palpable Nodal Disease","journal_title":"JAMA Surgery","journal_issn":"2168-6254","published_at":"2026-05-06T00:00:00.000Z","url":"https://doi.org/10.1001/jamasurg.2026.1258","source_score":7,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-14T15:13:26.918Z","updated_at":"2026-05-17T13:21:30.835Z","tags":[{"paper_doi":"10.1001/jamasurg.2026.1258","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1258","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1258","tag_type":"condition","value":"Breast Cancer","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1258","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1258","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1258","tag_type":"modality","value":"Axillary Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1258","tag_type":"modality","value":"Sentinel Lymph Node Biopsy","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1258","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1258","tag_type":"study_design","value":"Invited Commentary","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1258","tag_type":"warning","value":"Only citation details are available here; no abstract, methods, or results were provided.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1258","tag_type":"warning","value":"Only the publisher landing page was available — full commentary text was behind a paywall. Summaries are based solely on the visible abstract and introduction excerpt. Key arguments, specific patient criteria, and cited evidence within the body of the commentary could not be reviewed.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1258","tag_type":"warning","value":"Study design, population, and sample size cannot be determined from the title alone.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1258","tag_type":"warning","value":"The impact flag 'practice_changing' reflects the topic's known clinical significance (based on ACOSOG Z0011 legacy and expanding indications), not a specific finding from this commentary alone.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1258","tag_type":"warning","value":"The specific disease context is not stated in the title; avoid assuming without the full text.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2026.1258","tag_type":"warning","value":"This is an invited commentary (level 7 evidence), not a primary research study. No original data or sample size are reported.","value_numeric":null}],"summaries":{"what_studied":"This invited commentary discusses de-escalation of axillary surgery in breast cancer patients with clinically palpable nodal disease, in the context of expanding on findings from trials like ACOSOG Z0011.","key_result":"The commentary highlights that sentinel lymph node staging with omission of axillary lymph node dissection (ALND) is now routine for clinical N0 patients with limited nodal burden, and discusses extending this approach to broader populations including those with larger tumors and those undergoing mastectomy.","limitations":"Only the publisher page and abstract text were available — the full commentary text was not accessible, so specific arguments, cited studies, and conclusions within the body of the piece cannot be fully extracted.","practice_takeaway":"De-escalation of axillary surgery beyond cT1-2N0 disease is an evolving area; clinicians should follow emerging evidence on omitting ALND in select patients with clinically palpable nodal disease."}}],"initialOffset":4,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"Sentinel Lymph Node Biopsy"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"Sentinel Lymph Node Biopsy"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"Sentinel Lymph Node Biopsy"}}}]]

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