# Table 1A. Systematic reviews and meta-analyses fully ELIGIBLE for primary synthesis (n=13)

Sorted by year of publication. These 13 SRs satisfied every criterion of the strict PICOS eligibility triage applied to the originally screened 33-SR corpus (per Aromataris JBI 2015 framework, anchored on the PROSPERO protocol §10–13). All restrict their population to biopsy-proven cN+ disease and report quantitative pooled data on FNR, IR, ypN0 conversion, axillary recurrence, or survival outcomes after post-NAC surgical staging. PMID and DOI are provided for one-click verification; full per-SR justifications are catalogued in `_amstar2_toolkit/eligibility_triage.json`.

| # | First author (year) | Journal | Design | k (primary studies) | N (participants) | Primary outcome reported | Verdict notes | PMID / DOI |
|---|---|---|---|---|---|---|---|---|
| 1  | van Nijnatten (2015)   | Eur J Surg Oncol      | SR/MA           | 8   | see SR text | FNR of SLNB after NAST in pathologically confirmed cN+; pooled IR 92.3%, FNR 15.1%, ax-pCR 36.8% | Exact PICO match — population restricted to pathologically confirmed cN+ | 26329781 / 10.1016/j.ejso.2015.07.020 |
| 2  | El Hage Chehade (2016) | Am J Surg             | MA              | 19  | 3,398       | FNR of SLNB after NAC in biopsy-proven cN+; pooled FNR 13%, IR 91%, adjusted ax-pCR 47% | Exact PICO match with stratification by clinical N stage | 27671032 / 10.1016/j.amjsurg.2016.07.018 |
| 3  | Tee (2018)             | Br J Surg             | SR/MA           | 13  | 1,921       | FNR of SLNB after NAC in initial biopsy-proven cN+; pooled IR 90%, FNR 14% | Exact protocol match; subgroup analyses by mapping technique and node count | 30311642 / 10.1002/bjs.10986 |
| 4  | Simons (2019)          | Ann Surg              | SR/MA           | 20  | 2,217       | FNR/IR/NPV of SLNB, MARI, and combination procedures vs ALND in pathologically confirmed cN+ | Anchor SR — directly addresses protocol PICOS for marker-based techniques | 30312200 / 10.1097/SLA.0000000000003075 |
| 5  | Cao (2021)             | Breast                | MA              | 27  | 3,578       | FNR of SLNB after NACT in cN+ at initial diagnosis; pooled IR 91%, FNR 15% | Directly matches protocol population with subgroup analyses | 34325383 / 10.1016/j.breast.2021.07.015 |
| 6  | Samiei (2021)          | JAMA Surg             | Pooled MA       | 33  | 57,531      | Axillary pCR by molecular subtype in initially clinically node-positive disease (HR-/HER2+ 60% to luminal A 13%) | Anchor SR — provides subtype-stratified ax-pCR for de-escalation candidate selection | 33881478 / 10.1001/jamasurg.2021.0891 |
| 7  | Swarnkar (2021)        | Cancers (Basel)       | Pooled MA       | 9 (MLNB) / 13 (TAD) | 366 (MLNB) / 521 (TAD) | Pooled FNR of MLNB (6.28%) vs TAD (5.18%) in node-positive BC after NACT | Anchor SR — matches protocol intervention and population | 33810544 / 10.3390/cancers13071539 |
| 8  | Song (2022)            | Cancer Med            | SR/MA           | see SR text | 1,920 | FNR of TLNB in initial cN+ treated with NST; pooled IFR 93.5%, FNR 5.5%, NPV reported | Directly aligned with protocol PICOS for targeted lymph node biopsy | 35502768 / 10.1002/cam4.4769 |
| 9  | Vázquez (2022)         | Clin Transl Oncol     | SR/MA           | 20  | see SR text | SLNB outcomes in cN+ → ycN0 trajectory; pooled FNR 14%, SLNIR 89%, NPV 83%, accuracy 92% | Exact cN+ → ycN0 trajectory match | 36153763 / 10.1007/s12094-022-02953-1 |
| 10 | de Wild (2024)         | Br J Surg             | SR (with MA)    | 51  | 4,512       | TAD identification rates by marker type and timing in cN+ post-NAST; explicitly excludes cN0 | Anchor SR — comprehensive TAD synthesis restricted to cN+ | 38531689 / 10.1093/bjs/znae071 |
| 11 | Man (2025)             | Breast Cancer         | Pooled MA       | 14  | 4,268       | SLNB vs MARI/TAD in node-positive converters; axillary recurrence and 5-year DFS/OS | Directly addresses protocol PICOS with long-term oncologic outcomes | 40186790 / 10.1007/s12282-025-01692-9 |
| 12 | Wang (2025)            | Oncology              | SR/MA           | 16  | 5,249       | SLNB alone in cN+ patients with nodal pCR after NACT; pooled 5-year OS 94%, DFS 89% | Exact PICOS alignment; explicit search strategy across 5 databases through July 2024 | 39899993 / 10.1159/000543662 |
| 13 | Abdulla (2026)         | Ann Surg Oncol        | SR/MA           | 5   | 2,849       | SLNB vs TAD in cN+ → ycN0 after NAC; axillary recurrence (OR 1.23), 3-year DFS (OR 1.53), OS | Exact match to protocol PICOS for de-escalation comparison | 41545613 / 10.1245/s10434-025-19070-2 |

**Footer.** Designs: SR = systematic review; MA = meta-analysis; Pooled MA = pooled analysis with explicit search strategy and meta-analytic estimation. Twelve of the 13 eligible SRs (92%) include a meta-analytic synthesis. Five SRs are pre-designated as **anchors** for AMSTAR-2 detailed scoring (Table 2): Simons 2019, Tee 2018, Samiei 2021, Swarnkar 2021, de Wild 2024 — selected for breadth across umbrella outcomes (FNR, ax-pCR by subtype, MLNB/TAD pooled performance, comprehensive TAD scope, oncologic safety). Cumulative reported denominators across the 13 SRs ≈ 92,200 patients (range 1,920–57,531); because all 13 share at least one primary study, the corrected covered area (CCA) is reported in Section 3.3 of the manuscript. PMIDs and DOIs are linked in `references.md` (Vancouver-numbered).
