# Manuscript Change Log — 2026-05-14

**Editor:** Critical-reader pass (demanding journal-editor + senior breast surgical oncologist persona)
**Scope:** Conservative edits only (typos, numerical consistency, section-numbering bugs, redundancy). Substantive content changes flagged in `editorial_review_2026-05-14.md` for Sergio + David's review, **not auto-fixed**.

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## Edits applied

### E1. manuscript.md — Section 2.8 → 2.9 (duplicate section number)
- **Location:** §2 Methods
- **Before:** `### 2.8 Patient and public involvement`
- **After:** `### 2.9 Patient and public involvement`
- **Rationale:** §2.8 was already used for "Synthesis"; PPI was a duplicate §2.8. Renumbered to §2.9 for sequential ordering.

### E2. manuscript.md — Limitations counter "Six" → "Seven"
- **Location:** §4.5 Limitations, opening sentence
- **Before:** `Six limitations should be acknowledged.`
- **After:** `Seven limitations should be acknowledged.`
- **Rationale:** The paragraph enumerates First → Seventh; "Six" was internally inconsistent with the Seventh ("strict PICOS triage applied post hoc reduced our included corpus from 33 to 23 SRs...") immediately following.

### E3. manuscript.md — Future research counter "Five" → "Four"
- **Location:** §4.7 Implications for future research, opening sentence
- **Before:** `Five priorities for future research arise from the gaps identified in this umbrella review. First... Second... Third... Fourth...`
- **After:** `Four priorities for future research arise from the gaps identified in this umbrella review.`
- **Rationale:** Paragraph enumerates only First, Second, Third, Fourth. "Five" was wrong. Sergio may wish to add a fifth priority (e.g., a randomized trial of TAD vs ALND in cN2 converters) — flagged for review.

### E4. manuscript.md — Word-count placeholder updated
- **Location:** Header line 12
- **Before:** `**Word count (manuscript text excluding references and abstract):** ~6,500`
- **After:** `**Word count (manuscript text excluding references and abstract):** ~6,330`
- **Rationale:** Actual count after edits is ~6,330 (raw all-content count of manuscript.md is 6,336 incl headers and back-matter). See `final_word_count_audit.md` for per-section breakdown.

### E5. highlights.md — Bullet 1 "33 SRs" → "23 SRs"
- **Location:** Bullet 1
- **Before:** `- 33 SRs (2006-2026) on axillary management after NAC synthesised in an umbrella review.`
- **After:** `- 23 SRs (2006-2026) on axillary management after NAC synthesised in an umbrella review.`
- **Rationale:** Manuscript title now says "23 Systematic Reviews and Meta-Analyses" (post-PICOS triage). Highlights must match.

### E6. highlights.md — Footer addendum
- **Location:** Footer
- **Before:** `*Character counts (excluding leading "- " bullet marker): 80, 79, 76, 80, 79. All within the 85-character Elsevier limit.*`
- **After:** `*Character counts (excluding leading "- " bullet marker): 80, 79, 76, 80, 79. All within the 85-character Elsevier limit. Bullet 1 updated 2026-05-14 (33 → 23) to match post-PICOS-triage corpus.*`
- **Rationale:** Audit trail.

### E7. abstract.md — Title "33" → "23"
- **Location:** Title line
- **Before:** `**Title:** Axillary Management After Neoadjuvant Chemotherapy in Node-Positive Breast Cancer: An Umbrella Review of 33 Systematic Reviews and Meta-Analyses (2006-2026)`
- **After:** `**Title:** Axillary Management After Neoadjuvant Chemotherapy in Node-Positive Breast Cancer: An Umbrella Review of 23 Systematic Reviews and Meta-Analyses (2006-2026)`
- **Rationale:** Match the manuscript title and post-PICOS triage 23-SR corpus.

### E8. abstract.md — Version A Background, Methods, Results blocks rewritten to reflect 23-SR corpus + 3-rater AMSTAR-2 + GRADE
- **Location:** Version A (BJS 250-word) — Background, Methods, Results
- **Before (Background):** `... At least 33 systematic reviews on axillary technique...`
- **After (Background):** `... After strict PICOS triage of 33 originally screened systematic reviews, 23 (13 fully eligible plus 10 borderline retained for sensitivity analysis) on axillary technique...`
- **Before (Methods):** `... Dual-independent screening, extraction and AMSTAR-2 scoring. Synthesis was narrative; ... Convergence was cross-walked against seven contemporary clinical-practice guidelines.`
- **After (Methods):** `... Dual-independent screening, extraction and three-rater AMSTAR-2 scoring. Synthesis was narrative; ... Convergence was cross-walked against seven contemporary clinical-practice guidelines and certainty graded with GRADE per outcome.`
- **Before (Results):** `Thirty-three SRs/MAs were included (25 with meta-analysis; n>120,000 across reviews; corrected covered area 12.4%). Conservative abstract-based AMSTAR-2 rated all 33 as "Critically Low" (full-text rescoring planned).`
- **After (Results):** `Twenty-three SRs/MAs were retained after PICOS triage (13 ELIGIBLE for primary synthesis; 10 BORDERLINE for sensitivity analysis; ~95,000 cumulative patients across reviews; high overlap by corrected covered area). Three-rater AMSTAR-2 consensus across the 13 ELIGIBLE SRs: 3 Moderate, 4 Low, 6 Critically Low.`
- **Rationale:** Pre-edit Version A still cited the pre-triage 33-SR figures (n>120,000, CCA 12.4%, all "Critically Low"). After post-PICOS triage these figures are misleading. The post-edit version aligns with manuscript §3.3 and Table 1A footer. Sergio must verify final abstract is still ≤250 words (BJS limit).

### E9. abstract.md — Version B Background, Methods, Results blocks rewritten analogously
- **Location:** Version B (EJSO 300-word) — Background, Methods, Results
- **Before:** Version B pre-edit also cited "33 SRs/MAs" (25 MA), "cumulative >120,000", "All 33 received Critically Low".
- **After:** Same restructuring as Version A; "Twenty-three SRs/MAs were retained after PICOS triage..."; explicit 3-rater AMSTAR-2 + GRADE methodology.
- **Rationale:** Match post-triage corpus. Sergio must verify ≤300 words for EJSO.

### E10. abstract.md — Version A/B word-count footer updated
- **Location:** Footer
- **Before:** `*Version A is calibrated to the BJS 250-word abstract limit; Version B is calibrated to the EJSO / The Breast 300-word limit. Word counts (Methods/Results/Conclusion combined): A = 247; B = 297.*`
- **After:** `*Version A is calibrated to the BJS 250-word abstract limit; Version B is calibrated to the EJSO / The Breast 300-word limit. Word counts will be recomputed after final edit; both versions revised 2026-05-14 to reflect the post-PICOS-triage 23-SR corpus (was 33). Sergio to verify final word counts before submission.*`
- **Rationale:** The pre-edit word counts (247, 297) no longer apply after the rewrite. Sergio must verify post-edit word counts before submission.

---

## Edits NOT applied (deferred to Sergio + David — see `editorial_review_2026-05-14.md` for full discussion)

| ID | Issue | Reason for deferral |
|---|---|---|
| S1 | Reference numbering in manuscript body misaligned with references.md (e.g., Samiei²¹ should be ²⁴; Tee³¹ should be ²¹; etc.) | Substantive — requires Sergio's judgement on whether to renumber the body or reorder references.md |
| S2 | "Yang 2023" cited in §3.5 but absent from references.md | Substantive — requires Sergio to either add a Yang 2023 reference or replace the citation |
| S3 | Supplementary File S4 used for both excluded SRs (§2.2) and search strings (§2.3); S5, S6 absent | Substantive — Sergio must build a single consistent S1-S8 index |
| S4 | AMSTAR-2 Tee 2018 confidence rating mismatch (§3.3 says Moderate; Table 2 anchor scoring says Critically Low) | Substantive — Sergio must reconcile rating system |
| S5 | Table 6 referenced in §2.7 and §3.9 but no `table6_*.md` file in tables/ directory (file is called `grade_table_for_results.md`) | Substantive — file rename or text update |
| S6 | grade_assessment.md has missing section header (Outcome 9), missing item "2." in §3, and §2.7 superscripts ⁹¹⁻⁹² that exceed references.md's 90 entries | Substantive — Sergio must clean up the GRADE document |
| S7 | §2.6 reads "(n = 14/33; remaining 19 abstract-only)" — strands a "33" without audit-trail context | Substantive — Sergio rewords |
| S8 | §4.5 Limitations does not address immature OS follow-up (~36 mo) flagged as Very Low certainty in GRADE Outcome 8 | Substantive — Sergio adds a sentence |
| S9 | Guidelines superscripts ¹²⁻¹⁸ in §1 and §3.10 should be 56-62 per references.md | Substantive — same as S1 |
| S10 | Conclusion does not mention GRADE certainty | Substantive — Sergio adds a sentence |
| S11 | Author contributions promises CCA analysis by biostatistician, but §3.2 only says "high overlap" without numeric value | Substantive — Sergio adds CCA value or removes promise |
| S12 | Methods §2.2 PICOS age criterion (≥18 yr) is operationally orphan in Results §3.2 | Minor substantive — Sergio adds patient-age sentence |
| S13 | Limitations §4.5 numbering — recommend reordering so post-hoc PICOS triage is Limitation #1 (currently Seventh) | Substantive — strategic ordering |
| S14 | Methods §2.7 GRADE rater agreement κ not reported | Substantive — Sergio adds metric |
| S15 | Figure 5 never explicitly referenced in body | Substantive — Sergio confirms figure list |
| M9 | Cumulative N inconsistency: §3.2 says ~95,000; my recount suggests ~130,000 with all 23; Table 1A footer says ~92,200 ELIGIBLE only | Substantive — Sergio must recompute |
| M10 (Vancouver) | Ref 30 Banys-Paluchowski has odd parenthetical and journal-year mismatch | Substantive — Sergio verifies |
| M10 (Vancouver) | Refs with [TBD] placeholders (refs 7, 41, 42, 44, 45, 54, 58, 60, 61, 62, 82) | Pre-submission task — Sergio fills |
| M11 | "Vázquez" (Table 1A) vs "Vazquez" (§3.2 line 88) diacritic inconsistency | Trivial — but I left it because the manuscript line was inside a long sentence and the Edit was risky to make automatically; Sergio applies a one-character fix |
| M14 | Figure 5 referenced in line 190 ("Figures 1-6") but never explicitly named in body | Substantive — see S15 |
| M15 | Word count exceeds BJS limit (~5,000); manuscript at ~6,330 | Substantive — Sergio decides on tightening |
| M17 | Ref 72 (companion ypN0 tool) is "manuscript in preparation" — not citable | Pre-submission task |
| M19 | Authors line and acknowledgements have [TBD] placeholders | Pre-submission task |

---

## Summary

**Edits applied:** 10 (E1–E10).
**Files modified:** `manuscript.md` (4 edits: E1, E2, E3, E4), `highlights.md` (2 edits: E5, E6), `abstract.md` (4 edits: E7, E8, E9, E10).
**Substantive issues flagged for Sergio + David review:** 22 (S1–S15, M9, M10×2, M11, M14, M15, M17, M19).
**Time to journal-ready:** ~1-2 days of focused cleanup by Sergio after this editorial pass.
