(53-55) Initially, this phenomenon was attributed to understaging
of tumors, based on the assumption that positive lymph nodes are missed in a proportion of stage II tumors when the yield is low.
Timing of the first postnatal ultrasound has been studied in a limited fashion, yet the practice standard has become to avoid doing an US in the first 2 days of life due to a concern of understaging
secondary to neonatal oliguria (1, 21).
More recently, some authors suggested a routinary nodal sampling in PanNETs in order to reduce the possibility of tumor understaging
rather than to prolong survival itself .
Altorki, "POINT: clinical stage IA non-small cell lung cancer determined by computed tomography and positron emission tomography is frequently not pathologic IA non-small cell lung cancer: the problem of understaging
," Journal of Thoracic and Cardiovascular Surgery, vol.
Nonetheless, AS has raised several concerns, among them, the clinical understaging
and undergrading, and the presence of unfavorable histological findings in certain patients that previously met very low risk criteria.
Indeed, the poor preoperative/intraoperative staging concordance indicates the understaging
of our patients.
Systematic cytology at diagnosis could be more accurate to evaluate peritoneal extension in order to avoid understaging
and adjust adjuvant locoregional treatment .
Additionally, the liver biopsy samples obtained by transjugular biopsy were small, with 6 (26%) suboptimal for grading, likely resulting in understaging
and undergrading of fibrosis  and potentially attenuating relationships between biopsy parameters and noninvasive markers.
SN detection allows a more detailed and accurate histological analysis, reducing the possibility of understaging
lymph node involvement (7,8).
The observation implied that preoperative unfavorable numbers of CTM in peripheral blood might reflect the aggressiveness of tumor or the understaging
of PDCA by the current staging modality.
Of the patients who achieved cT0 after NC, 7 (33%) had evidence of residual disease within the resected specimen at PC, which is close to 30% of understaging
with TURBT alone reported by our institution's Herr and Scher study .
False-negative SLNB results might impair patient outcomes for several reasons since missed nodes might lead to axillary recurrence that is difficult to treat and understaging
could affect decisions about systemic and radiation therapy.