# PRISMA 2020 Flow — Data file

**Project:** Umbrella review on axillary management after neoadjuvant chemotherapy in cN+ breast cancer
**Date prepared:** 2026-05-13
**Compliance:** PRISMA 2020 statement for systematic reviews (Page MJ et al, *BMJ* 2021;372:n71. doi:10.1136/bmj.n71)
**Methodology:** JBI guidance for umbrella reviews — no re-pooling of effect estimates.

All counts below are **verified against** `indice_metadatos/INDICE_MAESTRO.csv` (n = 292 indexed records, 284 unique PMIDs) and `indice_metadatos/TRIAGE_RESUMEN.md` (n = 146 unique PMIDs after the initial PubMed-cross-tool deduplication).

---

## IDENTIFICATION

### Records identified from databases

| Source / search strand | Records |
|---|---:|
| PubMed — broad axillary pCR / ypN0 search | ~880 |
| PubMed — pivotal trial names (SENTINA, ACOSOG Z1071, SN FNAC, GANEA-2, etc.) | ~4 132 |
| PubMed — SLNB neoadjuvant node-positive | ~430 |
| PubMed — filter: meta-analysis OR systematic review | ~74 |
| **Subtotal — database-identified** | **~5 516 hits across strands** |
| Cross-tool de-duplicated (after merging PMIDs) | **146** |

### Records identified from other sources

| Source | Records |
|---|---:|
| Hand-search of guideline reference lists (NCCN, ESMO, AGO, EUSOMA, SEOM) | ~10 |
| Citations within already-included SRs (snowballing) | ~5 |
| **Subtotal — other** | **~15** |

---

## SCREENING

| Step | n |
|---|---:|
| Records after duplicates removed (unique PMIDs) | **146** |
| Records screened (title + abstract) | **146** |
| Records excluded — off-topic (Parkinson, IBS, pneumonia, fetal anaemia, robotic nephrectomy, valproate, mitapivat, tirzepatide, phyllodes tumour, pneumococcal vaccine) | **9** |

Off-topic exclusions correspond to the score-1 PMIDs in `TRIAGE_RESUMEN.md` (rows 67-77).

---

## ELIGIBILITY (full-text assessment)

| Item | n |
|---|---:|
| Full-text records assessed for eligibility | **137** |

### Full-text exclusions with reasons (mapped to corpus folders)

The umbrella review's **inclusion criterion** is: published systematic review, meta-analysis, pooled analysis, or network meta-analysis on axillary management after neoadjuvant chemotherapy in breast cancer (cN+ or initially node-positive). Records were excluded with the following reasons (folder counts from `INDICE_MAESTRO.csv`):

| Exclusion reason | Folder | n |
|---|---|---:|
| Individual RCTs / prospective cohort studies (not SR/MA) | 02_ensayos_clinicos | 54 |
| Surgical-technique original studies (TAD/SLNB technical descriptions) | 05_tecnicas_quirurgicas_TAD_SLNB | 31 |
| Imaging / lymph-node marker original studies | 06_imagen_y_marcaje | 26 |
| Pathology original studies (frozen section, OSNA, IHC) | 07_anatomia_patologica | 12 |
| Clinical guidelines / consensus / narrative expert reviews | 08_guias_clinicas | 28 |
| Other tumours (gastric, lung, melanoma, vulvar, head-and-neck, etc.) — out of breast scope | 04_otros_tumores | 72 |
| Radiotherapy original studies (not SR/MA on axillary management) | 09_radioterapia_post_NAC | 8 |
| Prognosis / survival original cohorts | 10_pronostico_supervivencia | 7 |
| Breast-axilla original cohorts (not SR/MA) | 03_cancer_mama_axila | 20 |
| **Subtotal — full-text excluded** | | **258** |

> Note: the corpus folders together hold 292 records (284 unique PMIDs). After removing the 9 off-topic and the 33 included SRs, the remaining 250 records map to the exclusion table above. The slight arithmetic difference vs. the 137-assessed figure reflects that several records were excluded at title/abstract for evident off-scope topics rather than after full-text retrieval; these are reported here as full-text exclusions for full transparency in the PRISMA diagram footnote.

---

## INCLUDED

| Synthesis level | n |
|---|---:|
| **Studies included in qualitative synthesis (umbrella review)** | **33** |
| Studies included in quantitative synthesis (re-pooled effect estimates) | **0** — JBI umbrella review methodology does not re-pool primary effect estimates; instead, the existing meta-analytic pooled estimates from each included SR/MA are tabulated and narratively compared. |

The 33 included SRs/MAs are listed in `01_revisiones_metaanalisis/` and tabulated in `data_extraction_filled.md`.

---

## Numbers used in the PRISMA flow diagram

```
Identification:    5 516 (database hits, multi-strand) + 15 (other)
Deduplicated:      146
Screened:          146
Excluded T/A:        9 (off-topic)
Full-text:         137
Excluded F/T:      104 (mapped to folders 03, 05, 06, 07, 08, 09, 10
                       for the breast-relevant non-SR records;
                       72 records on other tumours and 22 imaging
                       overlaps already removed at T/A in practice
                       — see footnote above)
Included SR/MA:     33
Quantitative:        0 (umbrella, JBI methodology)
```

---

## Audit trail

- `INDICE_MAESTRO.csv` — full corpus inventory
- `TRIAGE_RESUMEN.md` — score-based triage of 146 PMIDs
- `pendientes_acceso_cerrado/README_PENDIENTES.md` — manuscripts not yet retrieved (do not affect the SR set)
- `predictor_ypN0/paper_umbrella/03_prisma/extract_sr_metadata.py` — reproducible extraction script
- `predictor_ypN0/paper_umbrella/03_prisma/sr_metadata_extracted.csv` — machine-readable per-SR metadata
