Skip to main content

Advertisement

SpringerLink
Log in

Conservative axillary surgery is emerging in the surgical management of breast cancer

  • Review Article
  • Published:
Breast Cancer Aims and scope Submit manuscript

Abstract

Axillary lymph node dissection (ALND) has been the standard axillary treatment for breast cancer for a long time. However, ALND is associated with postoperative morbidities, including local sensory dysfunction, reduced shoulder mobility and most notably arm lymphedema. Recently, ALND can be avoided not only in clinically node-negative (cN0) patients with negative sentinel lymph nodes (SLNs), but also in patients with less than 3 positive SLNs receiving breast radiation, axillary radiation, or a combination of the two. Moreover, SLN biopsy has been adopted for use in clinically node-positive (cN +) patients presenting as cN0 after neoadjuvant chemotherapy (NAC); ALND may be avoided in cN + patients who convert to SLN-negative following NAC. Patients who undergo SLN biopsy alone have less postsurgical morbidities than those who undergo ALND. Nevertheless, ALND is still required in a select group of patients. A variety of conservative approaches to ALND have been developed to spare arm lymphatics to minimize arm lymphedema. These conservative procedures seem to decrease the incidence of lymphedema without increasing axillary recurrence. In the era of effective multimodality therapy, full conventional ALND removing all microscopic axillary disease may now be unnecessary in both cN0 patients and cN + patients. Regardless, emerging procedures for ALND should still be considered as investigational approaches, as further studies with longer follow-up are necessary to determine the safety of conservative ALND to spare arm lymphatics.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Noguchi M, Miwa K, Michigishi T, Yokoyama K, Nishijima H, Tanaka H, et al. The role of axillary lymph node dissection in breast cancer management. Breast Cancer. 1997;4:143–53.

    Article  CAS  Google Scholar 

  2. Noguchi M, Katev N, Miyazaki I. Diagnosis of axillary lymph node metastases in patients with breast cancer. Breast Cancer Res Treat. 1996;40(3):283–93. https://doi.org/10.1007/BF01806817.

    Article  CAS  Google Scholar 

  3. Aktas A, Gurleyik MG, Aksu SA, Aker F, Gungor S. Diagnostic value of axillary ultrasound, MRI, and 18F-FDG-PET/CT in determining axillary lymph node status in breast cancer patients. Eur J Breast Health. 2022;18(1):37–47. https://doi.org/10.4274/ejbh.galenos.2021.2021-3-10.

    Article  Google Scholar 

  4. Krag DN, Weaver DL, Alex LC, Fairbank JT. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol. 1993;2(6):335–9. https://doi.org/10.1016/0960-7404(93)90064-6.

    Article  CAS  Google Scholar 

  5. Giuliano AE, Kirgan DM, Guenther JM, Morton DL. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg. 1994;220:391–8. https://doi.org/10.1097/00000658-199409000-00015 (discussion 398-401).

    Article  CAS  Google Scholar 

  6. Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Ashikaga T, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11(10):927–33. https://doi.org/10.1016/S1470-2045(10)70207-2.

    Article  Google Scholar 

  7. Veronesi U, Viale G, Paganelli G, Zurrida S, Luini A, Galimberti V, et al. Sentinel lymph node biopsy in breast cancer. Ten-year results of a randomized controlled study. Ann Surg. 2010;251:595–600. https://doi.org/10.1097/SLA.0b013e3181c0e92a.

    Article  Google Scholar 

  8. Giuliano AE, Hunt KK, Ballman KV, Beitsch PD, Whitworth PW, Blumencranz PW, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305(6):569–75. https://doi.org/10.1001/jama.2011.90.

    Article  CAS  Google Scholar 

  9. Donker M, van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981–22023 AMAROS): a randomized, multicenter open-label. Phase 3 non-inferiority trial. Lancet Oncol. 2014;15(12):1303–10. https://doi.org/10.1016/S1470-2045(14)70460-7.

    Article  Google Scholar 

  10. Morrow M. It is not always necessary to do axillary dissection for T1 and T2 breast cancer. Cancer Res. 2013;73(24):7151–4. https://doi.org/10.1158/0008-5472.CAN-13-1888.

    Article  CAS  Google Scholar 

  11. Mamtani A, Barrio AV, King TA, Van Zee KJ, Plitas G, Pilewskie M, et al. How often does neoadjuvant chemotherapy avoid axillary dissection in patient with histologically confirmed nodal metastases? Results of a prospective study. Ann Surg Oncol. 2016;23(11):3467–74. https://doi.org/10.1245/s10434-016-5246-8.

    Article  Google Scholar 

  12. Tausch C, Baege A, Dietrich D, Vergin I, Heuer H, Heusler RH, et al. Can axillary reverse mapping avoid lymphedema in node positive breast cancer? Eur J Surg Oncol. 2013;39:880–6. https://doi.org/10.1016/j.ejso.2013.05.009.

    Article  CAS  Google Scholar 

  13. Noguchi M, Morioka E, Ohno Y, Noguchi M, Nakano Y, Kosaka T. The changing role of axillary lymph node dissection for breast cancer. Breast Cancer. 2013;20:41–6. https://doi.org/10.1007/s12282-0120-04116-4.

    Article  Google Scholar 

  14. Gennaro M, Listorti C, Mariani L, Maccauro M, Bianchi G, Capri G, et al. Oncological safety of selective axillary dissection after axillary reverse mapping in node-positive breast cancer. Eur J Surg Oncol. 2021;47:1606–10. https://doi.org/10.1016/j.ejso.2020.10.031.

    Article  Google Scholar 

  15. Lin Y, Xu Y, Wang C, Song Y, Huang X, Zhang X, et al. Loco-regional therapy and the risk of breast cancer-related lymphedema: a systemic review and meta-analysis. Breast Cancer. 2021;28:1261–72. https://doi.org/10.1007/s12282-021-01263-8.

    Article  CAS  Google Scholar 

  16. Maggi N, Nussbaumer R, Holzer L, Weber WP. Axillary surgery in node-positive breast cancer. The Breast. 2022;62:S50–3. https://doi.org/10.1016/j.breast.2021.08.018.

    Article  Google Scholar 

  17. Ashikaga T, Krag DN, Land SR, Julian TB, Anderson SJ, Brown AM, et al. Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol. 2010;102(2):111–8. https://doi.org/10.1002/jso.21535.

    Article  Google Scholar 

  18. Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003;349(6):546–53. https://doi.org/10.1056/NEJMoa012782.

    Article  Google Scholar 

  19. Lucci A, McCall LM, Beitsch PD, Whitworth PW, Reintgen DS, Blumerncranz P, et al. Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American college of surgeons oncology group trial Z0011. J Clin Oncol. 2007;25:3657–63. https://doi.org/10.1200/JCO.2006.07.4062.

    Article  Google Scholar 

  20. Giuliano A, McCall L, Beitsch P, Whitworth PW, Blumencranz P, Leitch AM, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases. The American college of surgeons oncology group z0011 randomized trial. Ann Surg. 2010;252:426–33. https://doi.org/10.1097/SLA.0b013e3181f08f32.

    Article  Google Scholar 

  21. Dengel L, van Zee KJ, King TA, Stempel M, Cody HS, El-Tamer M, et al. Axillary dissection can be avoided in the majority of clinically node-negative patients undergoing breast-conserving therapy. Ann Surg Oncol. 2014;21(1):22–7. https://doi.org/10.1245/s10434-013-3200-6.

    Article  Google Scholar 

  22. Fisher CS, Margenthaler JA, Hunt KK, Schwartz T. The landmark series: axillary management in breast cancer. Ann Surg Oncol. 2020;27:724–9. https://doi.org/10.1245/s10434-019-08154-5.

    Article  Google Scholar 

  23. Pilewskie M, Mautner SK, Stempel M, Eaton A, Morrow M. Does a positive axillary lymph node needle biopsy result predict the need for an axillary lymph node dissection in clinically node-negative breast cancer patients in the ACOSOG Z0011 era? Ann Surg Oncol. 2016;23:1123–8. https://doi.org/10.1245/s10434-015-4944-y.

    Article  Google Scholar 

  24. Pilewskie M, Jochelson M, Gooch JC, Patil S, Stempel M, Morrow M. Is preoperative axillary imaging beneficial in identifying clinically node-negative patients requiring axillary lymph node dissection? J Am Coll Surg. 2016;222:138–45. https://doi.org/10.1016/j.jamcollsurg.2015.11.013.

    Article  Google Scholar 

  25. Morrow M, Van Zee KJ, Patil S, Petruolo O, Mamtani A, Barrio AV, et al. Axillary dissection and nodal irradiation can be avoided for most node-positive Z0011-eligible breast cancers. Ann Surg. 2017;266:457–62. https://doi.org/10.1097/SLA.0000000000002354.

    Article  Google Scholar 

  26. Hammond JB, Kosiorek HE, Cronin PA, Rebecca AM, Casey WJ 3rd, Wong WW, et al. Capsular contracture in the modern era: a multidisciplinary look at the incidence and risk factors after mastectomy and implant-based breast reconstruction. Am J Surg. 2021;221(5):1005–10. https://doi.org/10.1016/j.amjsurg.2020.09.020.

    Article  Google Scholar 

  27. Ascherman JA, Hanasono MM, Newman MI, Hughes DB. Implant reconstruction in breast cancer patients treated with radiation therapy. Plast Reconstr Surg. 2006;117(2):359–65. https://doi.org/10.1097/01.prs.0000201478.64877.87.

    Article  CAS  Google Scholar 

  28. Vandeweyer E, Deraemaeker R. Radiation therapy after immediate breast reconstruction with implants. Plastic and Reconstuctive Surgey. 2000;106(1):56–8. https://doi.org/10.1097/00006534-200007000-00009.

    Article  CAS  Google Scholar 

  29. Liu X, Zhou L, Pan F, Gao Y, Yuan X, Fan D. Comparison of the postoperative incidence rate of capsular contracture among different breast implants: a cumulative meta-analysis. PLoS ONE. 2015;10(2): e0116071. https://doi.org/10.1371/journal.pone.0116071.

    Article  CAS  Google Scholar 

  30. DeCoster RC, Lynch EB, Bonaroti AR, Miranda RN, Hunt KK, Clemens MW. Breast implant-associated anaplastic large cell lymphoma, defining future research priorities. Clin Plastic Surg. 2021;48(1):33–43. https://doi.org/10.1016/j.cps.2020.09.0011.

    Article  Google Scholar 

  31. Hurkmans CW, Borger JH, Th REJ, van Tienhoven G. On behalf of the EORTC breast cancer cooperative group and the radiotherapy cooperative group. Quality assurance of axillary radiotherapy in the EORTC AMAROS trial 10981/22023: the dummy run. Radiol Oncol. 2003;68:233–40.

    Article  Google Scholar 

  32. Yue T, Zhuang D, Zhou P, Zheng L, Fan Z, Zhu J, et al. A prospective study to assess the feasibility of axillary reverse mapping and evaluate its effect on preventing lymphedema in breast cancer patients. Clin Breast Cancer. 2015;15(4):301–6. https://doi.org/10.1016/j.clbc.2015.01.010.

    Article  Google Scholar 

  33. Yuan Q, Wu G, Xiao SY, Hou J, Ren Y, Wang H, et al. Identification and preservation of arm lymphatic system in axillary dissection for breast cancer to reduce arm lymphedema events: a randomized clinical trial. Ann Surg Oncol. 2019;26(1):3446–3354. https://doi.org/10.1245/s10434-019-07569-4.

    Article  Google Scholar 

  34. Fisher B, Jeong JH, Anderson S, Bryant J, Fisher ER, Wolmark N. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med. 2002;347(8):567–75. https://doi.org/10.1056/NEJMoa020128.

    Article  Google Scholar 

  35. Deutsch M, Land S, Begovic M, Sharif S. The incidence of arm edema in women with breast cancer randomized on the national surgical adjuvant breast and bowel project study B-04 to radical mastectomy versus total mastectomy and radiotherapy versus total mastectomy alone. Int J Radiation Oncology Biol Phys. 2008;70(4):1020–4. https://doi.org/10.1016/j.ijrobp.2007.07.2376.

    Article  Google Scholar 

  36. Montagna G, Mamtani A, Knezevic A, Brogi E, Barrio AV, Morrow M. Selecting node-positive patients for axillary downstaging with neoadjuvant chemotherapy. Ann Surg Oncol. 2020;27:4515–22. https://doi.org/10.1245/s10434-020-08650-z.

    Article  Google Scholar 

  37. Kuehn T, Bauerfeind I, Fehm T, Fleige B, Hausschild M, Helms G, et al. Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre, cohort study. Lancet Oncol. 2013;14(7):609–18. https://doi.org/10.1016/s1470-2045(13)70166-9.

    Article  Google Scholar 

  38. Boileau JF, Poirier B, Basik M, Holloway CMB, Gaboury L, Sideris L, et al. Sentinel node biopsy after neoadjuvant chemotherapy in biopsy-proven node-positive breast cancer: the SN FNAC study. J Clin Oncol. 2015;33(3):258–64. https://doi.org/10.1200/JCO.2014.55.7827.

    Article  Google Scholar 

  39. Boughey JC, Suman VJ, Mittendorf EA, Ahrendt GM, Wilke LG, Taback B, et al. Alliance for clinical trials in oncology. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310(14):1455–61. https://doi.org/10.1001/jama.2013.278932.

    Article  CAS  Google Scholar 

  40. Morrow M, Khan AJ. Locoregional management after neoadjuvant chemotherapy. J Clin Oncol. 2020;38(20):2281–22290. https://doi.org/10.1200/jco.19.02576.

    Article  Google Scholar 

  41. Moo TA, Edelweiss M, Hajiyeva S, Stempel M, Raiss M, Zabor EC, et al. Is low-volume disease in the sentinel node after neoadjuvant chemotherapy an indication for axillary dissection? Ann Surg Oncol. 2018;25:1488–94. https://doi.org/10.1245/s10434-018-6429-2.

    Article  Google Scholar 

  42. Boneti C, Korourian S, Diaz Z, Santiago C, Mumford S, Adkins L, et al. Scientific impact award: axillary reverse mapping (ARM) to identify and protect lymphatics draining the arm during axillary lymphadenectomy. Am J Surg. 2009;198(4):482–7. https://doi.org/10.1016/j.amjsurg.2009.06.008.

    Article  Google Scholar 

  43. Li J, Zhang Y, Zhang W, Jia S, Gu X, Ma Y, et al. Intercostobrachial nerves as a novel anatomic landmark for dividing the axillary space in lymph node dissection. ISRN Oncology. 2013. https://doi.org/10.1155/2013/279013.

    Article  Google Scholar 

  44. Ponzone R, Cont NT, Maggiorotto F, Cassina E, Mininanni P, Biglia N, et al. Extensive nodal disease may impair axillary reverse mapping in patients with breast cancer. J Clin Oncol. 2009;27:5547–51. https://doi.org/10.1200/JCO.2009.22.1846.

    Article  Google Scholar 

  45. Kodama H, Mise K, Kan N. Partial lower axillary dissection for patients with clinically node-negative breast cancer. J Int Med Res. 2012;40(6):2336–45. https://doi.org/10.1177/030006051204000632.

    Article  CAS  Google Scholar 

  46. Li J, Jia S, Zhang W, Qiu F, Zhang Y, Gu X, et al. Partial axillary lymph node dissection inferior to the intercostobrachial nerves complements sentinel node biopsy in patients with clinically node-negative breast cancer. BMC Surg. 2015;15:79. https://doi.org/10.1186/s12893-015-0067-4.

    Article  Google Scholar 

  47. Clough KB, Nasr R, Nos C, Vieira M, Inguenault C, Poulet B. New anatomical classification of the axilla with implications for sentinel node biopsy. Br J Surg. 2010;97(11):1659–65. https://doi.org/10.1002/bjs.7217.

    Article  CAS  Google Scholar 

  48. Cowher MS, Grobmyer SR, Lyons J, O’Rourke C, Baynes D, Crowe JP. Conservative axillary surgery in breast cancer patients undergoing mastectomy: long-term results. J Am Coll Surg. 2014;218:819–26. https://doi.org/10.1016/j.jamcollsurg.2013.12.041.

    Article  Google Scholar 

  49. Weber WP, Matrai Z, Hayoz S, Tausch C, Henke G, Zwahlen DR, et al. Tailored axillary surgery in patients with clinically node-positive breast cancer: pre-planned feasibility substudy of TAXIS (OPBC-03, SAKK 23/16, IBCSG 57–18, ABCSG-53, GBG 101). The Breast. 2021;60:98–110. https://doi.org/10.1016/j.breast.2021.09.004.

    Article  Google Scholar 

  50. Noguchi M, Morioka E, Noguchi M, Inokuchi M, Kurose N, Shioya A, Yamada S. The role of axillary reverse mapping in intraoperative nodal palpation during sentinel lymph node biopsy. Breast J. 2021. https://doi.org/10.1111/tbj.14260.

    Article  Google Scholar 

  51. Lyman GH, Giuliano AE, Somerfield MR, Benson AB III, Bodurka DC, Burstein HJ, Cochran AJ, et al. American society of clinical oncology guideline Recommendations for sentinel lymph node biopsy in early-stage breast cancer. J Clin Oncol. 2005;23(30):7703–20. https://doi.org/10.1200/JCO.2005.08.001.

    Article  Google Scholar 

  52. Thompson M, Korourian S, Henry-Tillman R, Adkin L, Mumford S, Westbrook KC, et al. Axillary reverse mapping (ARM): a new concept to identify and enhance lymphatic preservation. Ann Surg Oncol. 2007;14(6):1890–5. https://doi.org/10.1245/s10434-007-9412-x.

    Article  Google Scholar 

  53. Nos C, Lesieur B, Clough KB, Lecuru F. Blue dye injection in the arm in order to conserve the lymphatic drainage of the arm in breast cancer patients requiring an axillary dissection. Ann Surg Oncol. 2007;14(9):2490–6. https://doi.org/10.1245/s10434-007-9450-4.

    Article  Google Scholar 

  54. Beek MA, Gobardhan PD, Klompenhouwer EG, Menke-Pluijmers M, Steenvoorde P, Merkus JWS, et al. A patient- and assessor-blinded randomized controlled trial of axillary reverse mapping (ARM) in patients with early breast cancer. Eur J Surg Oncol. 2020;46:59–64. https://doi.org/10.1016/j.ejso.2019.08.003.

    Article  Google Scholar 

  55. Klompenhouwer EG, Gobardhan PD, Beek MA, Voogd AC, Luitan EJT. The clinical relevance of axillary reverse mapping (ARM): study protocol for a randomized controlled trial. Trial. 2013;14:111.

    Article  Google Scholar 

  56. Beek MA, Gobardhan PD, Klompenhouwer EG, Rutten HJT, Voogd AC, Luiten EJT. Axillary reverse mapping (ARM) in clinically node positive breast cancer patients. EJSO. 2015;41:59–63. https://doi.org/10.1016/j.ejso.2014.09.012.

    Article  CAS  Google Scholar 

  57. Noguchi M, Inokuchi M, Yokoi-Noguchi M, Morioka E. The involvement of axillary reverse mapping nodes in patients with clinically node-negative breast cancer. Breast Cancer. 2022;29:209–15. https://doi.org/10.1007/s12282-021-01300-6.

    Article  CAS  Google Scholar 

  58. Noguchi M, Yokoi M, Nakano Y. Axillary reverse mapping with indocyanine fluorescence imaging in patients with breast cancer. J Surg Oncol. 2010;101(3):217–21. https://doi.org/10.1002/jso.21473.

    Article  Google Scholar 

  59. Rubio IT, Cebrecos I, Peg V, Esgueva A, Mendoza C, Cortadellas T, et al. Extensive nodal involvement increases the positivity of blue nodes in the axillary reverse mapping procedure in patients with breast cancer. J Surg Oncol. 2012;106:89–93. https://doi.org/10.1002/jso.23048.

    Article  Google Scholar 

  60. Gobardhan PD, Wijsman JH, van Dalen Th, Klompenhouwer EG, van der Schelling GP, Los J, et al. ARM: axillary reverse mapping –The need for selection of patients. EJSO. 2012;38:657–61. https://doi.org/10.1016/j.ejso.2012.04.012.

    Article  CAS  Google Scholar 

  61. Ngui NK, French J, Kilby CJ, Pathmanathan N, Elder EE. Axillary reverse mapping in patients with breast cancer: Is it concologically safe? J Surg Oncol. 2016;113(7):726–31. https://doi.org/10.1002/jso.24231.

    Article  Google Scholar 

  62. Nos C, Clough KB, Bonnier P, Lasry S, Bouedec GL, Flipo B, et al. Upper outer boundaries of the axillary dissection. Results of the SENTIBRAS protocol: multicentric protocol using axillary reverse mapping in breast cancer patients requiring axillary dissection. EJSO. 2016;42(12):1827–33. https://doi.org/10.1016/j.ejso.2016.07.138.

    Article  CAS  Google Scholar 

  63. Noguchi M, Inokuchi M, Yokoi-Noguchi M, Morioka M. Axillary reverse mapping in patients undergoing axillary dissection -a short review of the literature. Eur J Surg Oncol. 2020;46(12):2218–20.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku 1-1, Kahoku, Uchinada, Ishikawa, 920-0293, Japan

    Masakuni Noguchi, Masafumi Inokuchi, Miki Yokoi-Noguchi, Emi Morioka & Yusuke Haba

  2. Breast Center, Kanazawa Medical University Hospital, Daigaku 1-1, Kahoku, Uchinada, Ishikawa, 920-0293, Japan

    Masakuni Noguchi, Masafumi Inokuchi, Miki Yokoi-Noguchi, Emi Morioka & Yusuke Haba

Authors
  1. Masakuni Noguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masafumi Inokuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Miki Yokoi-Noguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emi Morioka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yusuke Haba
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MN: conceptualization, writing-review and editing. MI: review and editing. MY-N: investigation. EM: investigation. YH: investigation.

Corresponding author

Correspondence to Masakuni Noguchi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Noguchi, M., Inokuchi, M., Yokoi-Noguchi, M. et al. Conservative axillary surgery is emerging in the surgical management of breast cancer. Breast Cancer 30, 14–22 (2023). https://doi.org/10.1007/s12282-022-01409-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12282-022-01409-2

Keywords

Search

Navigation