Rice-growing areas in the northern part of Hainan Province in China are a source area for seasonal migration of the brown planthopper Nilaparvata lugens (Stål).

Sentinel lymph node biopsy (SLNB) has been the standard approach to axillary staging in early-stage breast cancer for decades. The SOUND trial demonstrated that, among women with clinically node-negative, early-stage breast cancer and a negative axillary ultrasound, omission of SLNB does not compromise 5-year distant disease-free survival. The oncologic safety of SLNB omission has since been confirmed by additional international trials, including INSEMA and BOOG 2013-08, and adopted into the American Society of Clinical Oncology guideline supporting de-escalation of axillary surgery in carefully selected patients. Implementing SLNB omission in routine practice is complex. Axillary staging may influence decisions about radiation and systemic therapy. As a result, translating trial evidence into real-world practice requires alignment among surgeons, medical oncologists, and radiation oncologists and may be influenced by local practice culture and regional norms. This was particularly evident in the implementation of omission of SLNB in patients aged ≥ 70 years, per the 2016 Choosing Wisely statement. Despite the Choosing Wisely statement recommending avoidance of routine use of SLNB in patients aged ≥ 70 years with early-stage breast cancer undergoing lumpectomy, SLNB continues to be performed in up to 87% of these older patients for whom SLNB omission is recommended. The SOUND trial concept was first published in 2012, with subsequent reports on trial design and arm function outcomes in 2015–2016. However, the primary oncologic results were not presented until 2021 and published in 2023, more than a decade after the initial concept. This extended interval raises the important question of whether earlier awareness of a de-escalation trial—through concept papers, conference presentations, or professional networks—facilitates earlier acceptance and adoption of trial results that support practice change.