For example, the National Comprehensive Cancer Network (NCCN) notes routine systemic staging is not indicated in the absence of signs or symptoms of metastatic disease, but rather considered “for patients who are clinically high risk”, or prior to preoperative systemic therapy and can include T1cN0 for HER2-positive or TNBC [7]. This evidence concerns the gene ERBB2 and metastatic neoplasm.