# Visual / Graphical Abstract — Specification Document

> **Note**: this document specifies the graphical abstract; it is not the artwork itself. Hand to medical illustrator (or generate via Adobe Illustrator / Affinity Designer / Inkscape) following the layout below.

---

## 1. File requirements (per BJS / EJSO / J Surg Oncol)

| Property              | Value                                                                          |
|-----------------------|--------------------------------------------------------------------------------|
| File format           | TIFF (preferred) or PDF (vector)                                               |
| Dimensions            | 200 mm wide × 100 mm high (2:1 ratio); landscape                               |
| Resolution            | 300 dpi (raster); vector for line art                                          |
| Colour mode           | CMYK for print submission; RGB sidecar for web                                 |
| Maximum file size     | 10 MB                                                                          |
| Fonts                 | Embedded; Helvetica or Arial 8-12 pt body, 14-16 pt headers                    |
| Whitespace margin     | ≥ 5 mm on all sides                                                            |
| Accessibility         | Colour-blind safe palette (no red/green pairs without secondary cue)           |

---

## 2. Layout — 2-panel design

```
+--------------------------------------------------------------+
| TITLE BAR (full width, height 12 mm)                         |
| "Axillary Management After NAC in cN+ Breast Cancer"         |
| Sub: "Umbrella Review of 23 SRs (2006-2026)"                 |
+----------------------------+---------------------------------+
| LEFT PANEL — METHODS       | RIGHT PANEL — KEY FINDINGS      |
| (95 mm × 80 mm)            | (95 mm × 80 mm)                 |
|                            |                                 |
| (see §4 for details)       | (see §5 for details)            |
|                            |                                 |
+----------------------------+---------------------------------+
| FOOTER (full width, height 8 mm)                             |
| Authors · journal · DOI · ganglio.cicatra.com                |
+--------------------------------------------------------------+
```

---

## 3. Colour palette (subtle, journal-friendly)

| Role                 | Hex       | Use                                                  |
|----------------------|-----------|------------------------------------------------------|
| Primary navy         | `#1F3A5F` | Title bar background, footer, headings               |
| Soft slate           | `#5B7A99` | Secondary text, axis labels                          |
| Anatomical blush     | `#E8C8C0` | Breast outline fill                                  |
| Lymph node teal      | `#5FA8A3` | Lymph node icons (negative)                          |
| Alert coral          | `#D97A5B` | Lymph node icons (positive / FNR markers)            |
| Neutral parchment    | `#F4ECE0` | Panel backgrounds                                    |
| Charcoal             | `#2B2B2B` | Body text                                            |
| Subtle gold accent   | `#C9A961` | Numerical highlights (sparingly)                     |

Avoid: pure red, pure green together; saturated Bauhaus primaries; gradients; drop shadows.

---

## 4. Left panel — Methods (with mock SVG positions)

Coordinate system: panel origin at top-left (0,0); panel size 95 × 80 mm; units in mm.

### Element M1 — Funnel/triage diagram (centered, 0,0 → 95,55)
Vertical funnel showing:
- (10, 5) Box: "1,847 records identified"
- (10, 18) Box: "187 full-text screened"
- (10, 31) Box: "33 SRs assessed"
- (10, 44) Three branches diverging:
  - left branch (5, 50): "13 ELIGIBLE" (navy)
  - center branch (35, 50): "10 BORDERLINE" (slate)
  - right branch (65, 50): "10 EXCLUDED" (light grey)

### Element M2 — Quality bar (0,58 → 95,67)
Horizontal stacked bar (95 mm wide, 6 mm tall) showing AMSTAR-2 distribution among 13 ELIGIBLE:
- 0% High (no fill)
- 23% Moderate (navy)
- 31% Low (slate)
- 46% Critically Low (parchment outlined in coral)
Labels above each segment: "0 H · 3 M · 4 L · 6 CL"

### Element M3 — Rater icons (0,70 → 95,78)
Three small circular icons left-aligned:
- (5,72) Surgeon icon labelled "Rater 1 — Surgeon"
- (35,72) Surgeon icon labelled "Rater 2 — Surgeon"
- (65,72) CPU/AI icon labelled "Rater 3 — LLM"
With caption beneath: "AMSTAR-2 + GRADE · κ pairwise 0.21-0.38"

---

## 5. Right panel — Key findings (with mock SVG positions)

### Element F1 — Subtype donut chart (0,0 → 50,50)
Three concentric arcs in a single donut:
- HER2+ arc: 65% filled in alert-coral, label "ypN0 56-72%"
- TNBC arc (offset): 45% filled in lymph-node-teal, label "ypN0 38-50%"
- HR+/HER2- arc (offset): 15% filled in soft-slate, label "ypN0 7-22%"
Center label: "ypN0 conversion by subtype"

### Element F2 — FNR comparison bars (52,0 → 95,30)
Horizontal bar chart comparing FNR:
- Bar A: TAD — 4% (lymph-node-teal)
- Bar B: SLNB dual + ≥3 nodes — 9% (soft-slate)
- Bar C: SLNB single tracer — 18% (alert-coral)
Threshold dashed line at 10% labelled "FNR threshold"

### Element F3 — Recurrence callout (52,32 → 95,55)
Large numeric callout:
- Big number "1.0%" in subtle gold
- Caption: "5-yr axillary recurrence in ypN0 sparing ALND (Montagna 2022, n=1,144)"

### Element F4 — Anatomical key (0,55 → 95,80)
Stylised right-axilla schematic (line art only):
- Breast outline (anatomical blush fill)
- Axillary tail
- Cluster of 6-8 lymph node ovals (lymph-node-teal)
- One node with overlay marker icon (clip + radioactive seed crossed → "TAD-clipped")
- One node with coral fill (residual disease)
- One node with arrow into pathology jar (specimen radiograph icon)

---

## 6. Suggested icons (specify to illustrator)

| Element                 | Icon description                                              |
|-------------------------|---------------------------------------------------------------|
| Breast outline          | Lateral or anterior anatomical line drawing, no nipple detail |
| Axilla anatomy          | Schematic showing levels I-II-III                             |
| Lymph node              | Bean/oval shape, smooth outline                               |
| Clip                    | Small horseshoe/clip icon overlaid on lymph node              |
| Iodine seed             | Tiny capsule shape                                            |
| Specimen radiograph     | Small X-ray plate icon                                        |
| Calculator (web tool)   | Minimal calculator glyph, footer reference                    |
| AI rater                | CPU/chip glyph, NOT a humanoid robot                          |
| Surgeon rater           | Stethoscope-and-cap minimal glyph                             |

---

## 7. Footer text (verbatim)

```
Cervera S, Duque D, et al. Axillary Management After Neoadjuvant Chemotherapy in
Node-Positive Breast Cancer: An Umbrella Review of 23 Systematic Reviews
(2006-2026). [Journal] 2026; XX:XX-XX. DOI: [placeholder]   |   ganglio.cicatra.com
```

---

## 8. Accessibility checklist

- All numeric findings duplicated in plain text (not solely in graphic)
- Colour-blind safe: alert-coral and lymph-node-teal differ in luminance + saturation
- Minimum text size 8 pt at final print scale
- No essential information conveyed by colour alone (icons + labels redundant)
- Alt text for journal web upload (~150 chars):
  > "Two-panel graphical abstract: methods funnel (1,847 → 23 SRs; 13 eligible, 10 borderline, 10 excluded) and key findings (subtype-stratified ypN0, FNR by technique, 1% axillary recurrence)."

---

## 9. Approval checklist before submission

- [ ] All numbers cross-checked against final manuscript Tables 2 and 3
- [ ] DOI placeholder replaced
- [ ] Author affiliations correct
- [ ] Journal logo NOT included (per most journal style guides)
- [ ] Vector source file (`.ai` or `.svg`) archived in `05_figuras/`
- [ ] CMYK proof printed and reviewed at 100% scale
- [ ] Web-resolution PNG sidecar exported to `05_figuras/web/`
