Reply to Cytologically proven axillary lymph node metastases are eradicated in patients receiving preoperative chemotherapy with concurrent trastuzumab for HER2‐positive breast cancer
Bibliographic record
Abstract
We read with interest the case presented by Baena-Canada et al. Their patient was staged as having clinical N2 disease, which was presumably because of the presence of matted axillary adenopathy. It is possible, therefore, that lymphedema developed as a consequence of her disease burden. These authors have suggested that her lymphedema may have developed as a result of therapy-induced fibrosis. The development of fibrosis of the lymphatics in response to neoadjuvant chemotherapy has been hypothesized by other investigators to explain why fewer lymph nodes are obtained at the time of axillary lymph node dissection after primary systemic therapy.1 This hypothesis has recently been refuted by surgeons at the Mayo Clinic, who reported that oncologically trained surgeons obtained an equal number of lymph nodes at the time of axillary lymph node dissection performed in patients who received neoadjuvant chemotherapy as in patients undergoing upfront surgery.2 To our knowledge, there are no good data investigating the effects of neoadjuvant chemotherapy on axillary lymphatic channels. At our institution, we treat a significant number of patients with neoadjuvant chemotherapy. Only anecdotally have we identified a very few patients who developed lymphedema prior to undergoing surgery. The larger risk for developing lymphedema in this population arises from the need for axillary lymph node dissection and likely postoperative radiotherapy. We continue to recommend preoperative systemic therapy as the preferred approach for patients such as the one presented by Baena-Canada et al, because it provides in vivo sensitivity data for systemic therapy and important prognostic information. Laura S. Dominici MD*, Elizabeth A. Mittendorf MD , Henry M. Kuerer MD, PhD , * Department of Surgical Oncology, Brigham and Women's Hospital, Boston, Massachusetts, Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.020 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.015 | 0.015 |
| Insufficient payload (model declined to judge) | 0.003 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".