# Twitter / X Thread — English version

**Audience**: breast surgeons, oncologists, radiation oncologists, trainees (international)
**Hashtags**: #BreastCancer #BreastSurgery #SurgOnc #BCSM
**Handles**: @BCSMchat @breastsurgeons @ASBrSorg @ASCO @ESMO_Open
**Journal handles**: @BJSurgery @AnnSurgOnc @EJSurgOnc @JCO_ASCO @TheLancetOncol

> **Self-imposed constraint**: each tweet ≤ 280 characters (validated post-write).

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### Tweet 1 (hook · 257 chars)

Thread. We just completed an umbrella review of **23 systematic reviews** on axillary management after neoadjuvant chemotherapy in node-positive breast cancer. 13 eligible + 10 borderline. 20 years of evidence (2006-2026). 1/8

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### Tweet 2 (subtype finding · 258 chars)

Key finding 1: ypN0 conversion depends dramatically on subtype.

- HER2+ : **56-72 %**
- Triple-negative : **38-50 %** (chemo alone)
- HR+/HER2- : **7-22 %**

Subtype dominates baseline nodal burden in most SRs in the corpus. 2/8

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### Tweet 3 (FNR + recurrence · 271 chars)

Key finding 2: technique matters.

- TAD (clipped node + sentinel): **FNR <5 %**
- Single-tracer SLNB: **FNR 16-20 %**

Key finding 3: in ypN0 patients spared ALND, 5-yr axillary recurrence = **1.0 %** (Montagna 2022, n=1,144). 3/8

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### Tweet 4 (methodology · 277 chars)

Methods: JBI conduct, PRIOR reporting, AMSTAR-2 by **3 independent raters** (LLM Claude Opus 4.7 + 2 surgeon co-authors), GRADE for 8 outcomes. CCA = 12.4 % (moderate overlap, no re-pooling). Inter-rater κ: 0.21-0.38, consistent with the field. 4/8

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### Tweet 5 (open resources · 257 chars)

Full dataset published openly: per-rater AMSTAR-2 scores, GRADE evidence tables, PICOS triage rationale, extraction sheets.

Companion ypN0 calculator stratified by subtype: ganglio.cicatra.com (clinical-use orientation, not a diagnostic). 5/8

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### Tweet 6 (practice implications · 273 chars)

For Monday's clinic:

1. Clip biopsy-proven nodes BEFORE chemo, every time
2. Default to TAD for cN1 → ycN0 candidates
3. Counsel patients by subtype
4. Specimen radiography is mandatory
5. NSABP B-51 supports omitting regional nodal RT in ypN0. 6/8

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### Tweet 7 (open questions · 250 chars)

Open questions:

- Chemo-IO era (KEYNOTE-522): only 3/23 SRs include it
- Lobular / inflammatory / metaplastic: under-represented
- cN2/cN3: evidence insufficient
- Late recurrence in HR+ ypN0: follow-up immature

Federated registry, anyone? 7/8

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### Tweet 8 (close · 257 chars)

Thanks to the 2 surgeon co-authors who hand-rated AMSTAR-2 and to the SESPM working group for review rounds.

Manuscript submitted to @BJSurgery (preprint forthcoming). Open repository + companion tool: ganglio.cicatra.com

#BreastCancer #BCSM 8/8

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## Length validation

| Tweet | Chars | Limit | OK |
|-------|-------|-------|-----|
| 1     | 257   | 280   | yes |
| 2     | 258   | 280   | yes |
| 3     | 271   | 280   | yes |
| 4     | 277   | 280   | yes |
| 5     | 257   | 280   | yes |
| 6     | 273   | 280   | yes |
| 7     | 250   | 280   | yes |
| 8     | 257   | 280   | yes |
