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Management of the axillary nodes

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Abstract

The increasing use of screening mammography has resulted in the identification of smaller breast cancers with a lower risk of axillary node metastases than those seen in the past. In spite of this, imaging studies and currently availability prognostic markers cannot reliably identify those patients with axillary node disease. Although, in many cases, the need for adjuvant systemic therapy can be determined on the basis of primary tumor characteristics, knowledge of axillary node status remains the best predictor of the risk of breast cancer recurrence. Axillary dissection provides excellent local control, and may have a survival benefit for some patients, but these benefits are limited to patients with nodal involvement. Sentinel node biopsy has the potential to allow axillary dissection to be limited to patients with nodal involvement who will benefit from the procedure. The initial studies have proved that the status of the sentinel node reliably predicts the status of the remainder of the axillary nodes. The challenge for the future is to determine how to teach this procedure to large numbers of surgeons and to define its accuracy in a wider variety of clinical circumstances.

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Abbreviations

CT:

Computerized tomography

LVI:

Lymphatic or vascular invasion

MRI:

Magnetic resonance imaging

NSABP:

National Surgical Adjuvant Breast Project

PET:

Positron emission tomography

RT-PCR:

Reverse transcriptase polymerase chain reaction

References

  1. Halsted WS: A clinical and histological study of certain adenocarcinomata of the breast.Ann Surg 28:557–576, 1898.

    PubMed  CAS  Google Scholar 

  2. Halsted WS: The results of radical operations for the cure of carcinoma of the breast.Ann Surg 46:1–19, 1907.

    Article  PubMed  CAS  Google Scholar 

  3. Turner-Warwick R: The lymphatics of the breast.Br J Surg 46:574–582, 1959.

    Article  PubMed  CAS  Google Scholar 

  4. Veronesi U, Valagussa P: Inefficacy of internal mammary node dissection in breast cancer surgery.Cancer 47:170–175, 1981.

    Article  PubMed  CAS  Google Scholar 

  5. Rosen PR, Lesser ML, Kinne DWet al: Discontinuous or ’skip’ metastases in breast carcinoma; Analysis of 1228 axillary dissections.Ann Surg 197:276–283, 1983.

    Article  PubMed  CAS  Google Scholar 

  6. Veronesi U, Rilke F, Luini A,et al: Distribution of nodal metastases by level of invasion.Cancer 59:682–687, 1987.

    Article  PubMed  CAS  Google Scholar 

  7. Danforth DN, Findlay PA, McDonald HD,et al: Complete axillary lymph node dissection for Stage III carcinoma of the breast.J Clin Oncol 4:655–662, 1985.

    Google Scholar 

  8. Pigott J, Nicholas R, Maddox WA,et al: Metastases to the upper levels of the axillary nodes in carcinoma of the breast and its implications for nodal sampling procedures.Surg Gynecol Obstet 158:255–259, 1984.

    PubMed  CAS  Google Scholar 

  9. Smith J, Gomez-Araujo J, Gallager H,et al: Carcinoma of the breast; Analysis of total lymph node involvement versus level of metastasis.Cancer 39:527–532, 1997.

    Article  Google Scholar 

  10. Chevinsky A, Ferrara J, James A,et al: Prospective evaluation of clinical and pathologic detection of axillary metastases in patients with carcinoma of the breast.Surgery 108:612–618, 1990.

    PubMed  CAS  Google Scholar 

  11. Boova R, Bonanni R, Rosato F: Patterns of axillary nodal involvement in breast cancer.Ann Surg 196:642–646, 1982.

    Article  PubMed  CAS  Google Scholar 

  12. Haagensen C: The surgical treatment of mammary carcinoma. In: Diseases of the Breast, 2nd ed, WB Saunders, Philadelphia, pp704–709, 1971.

    Google Scholar 

  13. Fisher B, Redmond C, Fisher ER,et al: Ten year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with and without irradiation.N Engl J Med 312:674–681, 1985.

    PubMed  CAS  Google Scholar 

  14. Renolleau C, Merviel P, Clough KB,et al: Isolated axillary recurrences after conservative treatment of breast cancer.Eur J Cancer 32A:617–621, 1996.

    Article  PubMed  CAS  Google Scholar 

  15. Halverson KJ, Taylor ME, Perez CA,et al: Regional nodal management and patterns of failure following conservative surgery and radiation therapy for Stage I and II breast cancer.Int J Radiat Oncol Biol Phys 26:593–599, 1993.

    PubMed  CAS  Google Scholar 

  16. Steele RJ, Forrest AP, Gibson T,et al: The effect of lower axillary sampling in obtaining lymph node status in breast cancer; A controlled randomized trial.Br J Surg 72:368–369, 1985.

    Article  PubMed  CAS  Google Scholar 

  17. Forrest A, Stewart H, Roberts M,et al: Simple mastectomy and axillary node sampling (pectoral node biopsy) in the management of primary breast cancer.Ann Surg 196:371–377, 1982.

    Article  PubMed  CAS  Google Scholar 

  18. Kissin MW, Price AB, Thompson EM,et al: The inadequacy of axillary sampling in breast cancer.Lancet 1:1210–1212, 1982.

    Article  PubMed  CAS  Google Scholar 

  19. Graverson MP, Blichert-Toft B, Andersen JA,et al: Breast cancer; Risk of axillary recurrence in node negative patients following partial dissection of the axilla.Eur J Surg Oncol 14:407–412, 1988.

    Google Scholar 

  20. Fowble B, Solin LJ, Schultz D,et al: Frequency, site of relapse, and outcome of regional node failures following surgery and radiation for early breast cancer.Int J Radiat Oncol Biol Phys 17:703–710, 1989.

    PubMed  CAS  Google Scholar 

  21. National Institutes of Health Consensus Conference: Treatment of early stage breast cancer.JAMA 265: 391–395, 1991.

    Google Scholar 

  22. Ivens D, Moe AL, Podd TJ,et al: Assessment of morbidity from complete axillary dissection.Br J Cancer 66:136–138, 1992.

    PubMed  CAS  Google Scholar 

  23. Tasmuth T, von Smitten K, Kalso E: Pain and other symptoms during the first year after radical and conservative therapy for breast cancer.Br J Cancer 74:2024–2031, 1996.

    PubMed  CAS  Google Scholar 

  24. Lin PP, Alison DC, Wainstock J,et al: Impact of axillary lymph node dissection on the therapy of breast cancer patients.J Clin Oncol 11:1536–1544, 1993.

    PubMed  CAS  Google Scholar 

  25. Hladuik M, Huchcroft S, Temple W,et al: Arm function after axillary dissection for breast cancer. A pilot study to provide parameter estimates.J Surg Oncol 50:47–52, 1992.

    Article  Google Scholar 

  26. Keramopoulos A, Tsionou C, Minaretzis D,et al: Arm morbidity following treatment of breast cancer with total axillary dissection; A multivariated approach.Oncology 50:445449, 1993.

    Article  Google Scholar 

  27. Wood K: Intercostobrachial nerve entrapment syndrome.South Med J 71:662–663, 1978.

    PubMed  CAS  Google Scholar 

  28. Britton RC, Nelson PA: Cause and treatment of post-mastectomy lymphedema of the arm; Report of 114 cases.JAMA 180:95–102, 1962.

    PubMed  CAS  Google Scholar 

  29. Hughes JH, Patel AR: Swelling of the arm following radical mastectomy.Br J Surg 53:4–14, 1966.

    PubMed  CAS  Google Scholar 

  30. Werner R, McCormick B, Petrek J,et al: Arm edema in conservatively managed breast cancer; Obesity is a major predictive factor.Radiology 180:177–184, 1991.

    PubMed  CAS  Google Scholar 

  31. Kiel KD, Rademacker AW: Early stage breast cancer; Arm edema after wide excision and breast irradiation.Radiology 198:279–283, 1996.

    PubMed  CAS  Google Scholar 

  32. Bau AB, Waters R, Fish S,et al: Radical axillary dissection in the staging and treatment of breast cancer.Ann Royal Coll Surg Engl 74:126–129, 1992.

    Google Scholar 

  33. Liljegren G, Uolonberg L, and the Uppsala-Orebro Breast Cancer Study Group: Arm morbidity after sector resection and axillary dissection with and without postoperative radiotherapy in breast cancer stage I; Results from a randomized trial.Eur J Cancer 33:193–199, 1997.

    Article  PubMed  CAS  Google Scholar 

  34. Pezner RD, Patterson MP, Hill LR,et al: Arm lymphedema in patients treated conservatively for breast cancer; Relationship to age and axillary node dissection technique.Int J Radiat Oncol Biol Phys 12:2079–2083, 1986.

    PubMed  CAS  Google Scholar 

  35. Fisher B, Wolmark N, Bauer M,et al: The accuracy of clinical node staging and of limited axillary dissection as a determinant of histologic nodal status in carcinoma of the breast.Surg Gynecol Obstet 152:765–771, 1981.

    PubMed  CAS  Google Scholar 

  36. Haagensen CD: Clinical classification and choice of treatment. In: Diseases of the Breast, 3rd ed, WB Saunders, Philadelphia, pp617–668, 1986.

    Google Scholar 

  37. Dershaw DD, Panicek DM, Osborne MP: Significance of lymph nodes visualized by the mammographic axillary view.Breast Dis 4:271–280, 1991.

    Google Scholar 

  38. March DE, Wechsler RJ, Kurtz AB,et al: CT-path-ology correlation of axillary lymph nodes in breast carcinoma.J Comput Assist Tomogr 15:440–444, 1991.

    Article  PubMed  CAS  Google Scholar 

  39. Venta L: Evaluation of axillary node status with imaging modalities.Semin Breast Dis. In press.

  40. Weiner JI, Chako AC, Merten CW,et al: Breast and axillary tissue MR imaging; Correlation of signal intensities and relaxation time with pathologic findings.Radiology 160:229–305, 1986.

    Google Scholar 

  41. Fossel ET, Brodsky G, DeLayre JL,et al: Nuclear magnetic resonance imaging for the differentiation of benign and malignant breast tissue and axillary lymph nodes.Ann Surg 198:541–544, 1983.

    Article  PubMed  CAS  Google Scholar 

  42. Mussurakis S, Buckley DL, Horsman A: Prediction of axillary lymph node status in invasive breast cancer with dynamic contrast-enhanced MR imaging.Radiology 203:317–321, 1997.

    PubMed  CAS  Google Scholar 

  43. Avril N, Dose J, Janicke F,et al: Assessment of axillary lymph node involvement in breast cancer patients with positron emission tomography using radiolabeled 2-(Fluorine-18) flouro-2-deoxy-D-glucose.J Natl Cancer Inst 88:1204–1209, 1996.

    Article  PubMed  CAS  Google Scholar 

  44. Adler LP, Faulhaber PF, Schnur KC,et al: Axillary lymph node metastases; Screening with [F-18] 2-deoxy-2-fluoro-d-glucose (FDG) PET.Radiology 203:323–327, 1997.

    PubMed  CAS  Google Scholar 

  45. Chu KC, Tarone RE, Kessler LG,et al: Recent trends in US breast cancer incidence, survival, and mortality rates.J Natl Cancer Inst 88:1571–1579, 1996.

    Article  PubMed  CAS  Google Scholar 

  46. Cady B: Case against axillary lymphadenectomy for most patients with infiltrating breast carcinoma.J Surg Oncol 66:7–10, 1997.

    Article  PubMed  CAS  Google Scholar 

  47. Silverstein MJ, Gierson ED, Waisman JR,et al: Axillary lymph node dissection for T1a breast carcinoma; Is it indicated?Cancer 73:664–667, 1994.

    Article  PubMed  CAS  Google Scholar 

  48. Barth A, Craig PM, Silverstein MJ: Predictors of axillary lymph node metastases in patients with T1 breast carcinoma.Cancer 79:1856–1864, 1997.

    Article  Google Scholar 

  49. Nemoto T, Vans J, Bedwani RN,et al: Management and survival of female breast cancer; Results of a national survey by the American College of Surgeons.Cancer 45:2917–2924, 1980.

    Article  PubMed  CAS  Google Scholar 

  50. Ravdin PM, DeLaurentis M, Vendely T,et al: Prediction of axillary lymph node status in breast cancer patients by use of prognostic indicators.J Natl Cancer Inst 86:1771–1775, 1994.

    Article  PubMed  CAS  Google Scholar 

  51. McGee JM, Youmans R, Clingan F,et al: The value of axillary dissection in T1a breast cancer.Am J Surg 172:501–505, 1996.

    Article  PubMed  CAS  Google Scholar 

  52. Reger V, Beito G, Jolly PC: Factors affecting the incidence of lymph node metastases in small cancers of the breast.Am J Surg 157:501–502, 1989.

    Article  PubMed  CAS  Google Scholar 

  53. Carter CL, Allen C, Henson DE: Relation of tumor size, lymph node status, and survival in 24, 740 breast cancer cases.Cancer 63:181–187, 1989.

    Article  PubMed  CAS  Google Scholar 

  54. Halverson KJ, Perez CA, Myerson R,et al: Management of the axilla in patients with breast cancers one centimeter or smaller.Am J Clin Oncol 417:461–466, 1994.

    Google Scholar 

  55. Holland PA Walls J, Boggis CRM,et al: A comparison of axillary node status between cancers detected at the prevalence and first incidence breast screening rounds.Br J Cancer 74:1643–1646, 1996.

    PubMed  CAS  Google Scholar 

  56. Seidman JD, Schnaper LA, Aisner SC: Relationship of the size of the invasive component of the primary breast carcinoma to axillary lymph node metastasis.Cancer 75:65–71, 1995.

    Article  PubMed  CAS  Google Scholar 

  57. Brenin DR, Morrow M: Is AJCC staging for breast cancer accurate for patients undergoing re-excision for positive margins?J Surg Oncol 5:719–723, 1998.

    Article  CAS  Google Scholar 

  58. Chadha M, Chabon AB, Friedmann P,et al: Predictors of axillary lymph node metastases in patients with Tl breast cancer; A multivariate analysis.Cancer 73:350–353, 1994.

    Article  PubMed  CAS  Google Scholar 

  59. Wong J, Kopald K, Morton D: The impact of microinvasion on axillary node metastases and survival in patients with intraductal breast cancer.Arch Surg 125:1298–1302, 1990.

    PubMed  CAS  Google Scholar 

  60. Solin L, Fowble B, Yeh IT,et al: Microinvasive ductal carcinoma of the breast treated with breast-conserving surgery and definitive irradiation.Int J Radiat Oncol Biol Phys 23:961–968, 1992.

    PubMed  CAS  Google Scholar 

  61. Frazier T, Copeland E, Gallagher M,et al: Prognosis and treatment in minimal breast cancer.Am J Surg 133:697–701, 1977.

    Article  PubMed  CAS  Google Scholar 

  62. Nevin J, Pinzon G, Morton T,et al: Minimal breast cancer.Am J Surg 139:357–359, 1980.

    Article  PubMed  CAS  Google Scholar 

  63. McDivitt R, Boyce W, Gersell D: Tubular carcinoma of the breast; Clinical and pathological observations concerning 135 cases.Am J Surg Pathol 6:401–411, 1982.

    PubMed  CAS  Google Scholar 

  64. Peters G, Wolff M, Haagensen C: Tubular carcinoma of the breast; Clinical-pathologic correlations based on 100 cases.Ann Surg 193:138–149, 1981.

    Article  PubMed  CAS  Google Scholar 

  65. Schuh ME, Nemoto T, Penetrante RB,et al: Intraductal carcinoma; Analysis of presentation, pathologic findings and outcome of disease.Arch Surg 121:1303–1307, 1986.

    Article  PubMed  CAS  Google Scholar 

  66. Kinne DW, Petrek JA, Osborne MP,et al: Breast carcinoma in situ.Arch Surg 124:33–36, 1989.

    PubMed  CAS  Google Scholar 

  67. Fisher B: The evolution of paradigms for the management of breast cancer; A personal perspective.Cancer Res 52:2371–2376, 1992.

    PubMed  CAS  Google Scholar 

  68. Adair F, Berg J, Joubert L,et al: Long term follow up of breast cancer patients; The 30 year report.Cancer 33:1145–1150, 1974.

    Article  PubMed  CAS  Google Scholar 

  69. Brinkley D, Haybittle JL: The curability of breast cancer.Lancet 2:95–97, 1975.

    Article  PubMed  CAS  Google Scholar 

  70. Rosen PP, Groshen S, Saigo PE,et al: A long-term follow-up study of survival in stage I (T1N0M0) and stage II (T1N1M0) breast carcinoma.J Clin Oncol 7:355–366, 1989.

    PubMed  CAS  Google Scholar 

  71. Hayward JL: The Guy’s trial of treatment of early breast cancer.World J Surg 1:314–316, 1998.

    Article  Google Scholar 

  72. Hayward J, Caleffi M: The significance of local control in the primary treatment of breast cancer.Arch Surg 122:1244–1248, 1987.

    PubMed  CAS  Google Scholar 

  73. Overgaard M, Hansen PS, Overgaard J,et al: Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy.N Engl J Med 337:949–955, 1997.

    Article  PubMed  CAS  Google Scholar 

  74. Ragaz J, Jackson SM, Le N,et al: Adjuvant radiotherapy and chemotherapy in node positive premenopausal women with breast cancer.N Engl J Med 337:956–962, 1997.

    Article  PubMed  CAS  Google Scholar 

  75. Cabanes PA, Salmon RJ, Vilcoq JR,et al: Value of axillary dissection in addition to lumpectomy and radiotherapy in early breast cancer.Lancet 339:1245–1248, 1992.

    Article  PubMed  CAS  Google Scholar 

  76. Morton DC, Duan-Ren W, Wong JH: Technical details of intraoperative lymphatic mapping and sentinel node biopsy in the management of primary melanoma.Arch Surg 127:392–399, 1992.

    PubMed  CAS  Google Scholar 

  77. Krag DN, Weaver OJ, Alex JC,et al: Surgical resection and radiolocalization of the sentinel node in breast cancer using a gamma probe.Surg Oncol 2:335–340, 1993.

    Article  PubMed  CAS  Google Scholar 

  78. Giuliano AE, Kirgan DM, Guenther JM,et al: Lymphatic mapping and sentinel lymphadenectomy for breast cancer.Ann Surg 220:391–401, 1994.

    Article  PubMed  CAS  Google Scholar 

  79. Giuliano AE, Jones RC, Brennan M,et al: Sentinel lymphadenectomy in breast cancer.J Clin Oncol 15:2345–2350, 1997.

    PubMed  CAS  Google Scholar 

  80. Albertini JJ, Lyman GH, Cox C,et al: Lymphatic mapping and sentinel node biopsy in the patient with breast cancer.JAMA 276:1818–1822, 1996.

    Article  PubMed  CAS  Google Scholar 

  81. Veronesi U, Paganelli G, Galimberti V,et al: Sentinel node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph nodes.Lancet 349:1864–1867, 1997.

    Article  PubMed  CAS  Google Scholar 

  82. Shons A, Joseph E, Cox CE,et al: Predictors of sentinel lymph node metastases in the lymphatic mapping of breast cancer patients.Breast Cancer Res Treat 46:24, 1997.

    Google Scholar 

  83. Galimberti V, Zurrida S, Verones P,et al: Can sentinel lymph node biopsy avoid axillary dissection in No breast cancer patients?Breast Cancer Res Treat 46:24, 1997.

    Google Scholar 

  84. Guenther JM, Krishnamoorthy M, Tan LR: Sentinel lymphadenectomy for breast cancer in a community managed care setting.Cancer J Sci Am 3:336–340, 1997.

    PubMed  CAS  Google Scholar 

  85. Borgstein PJ, Pijpers R, Cormans EF,et al: Sentinel lymph node biopsy in breast cancer; Guidelines and pitfalls on lymphoscintigraphy and gamma probe detection.J Am Coll Surg 186:275–283, 1998.

    Article  PubMed  CAS  Google Scholar 

  86. Kag D, Weaver D, Ashikaga T,et al: The sentinel node in breast cancer; A multicenter validation study.N Engl J Med 337:941–946, 1998.

    Google Scholar 

  87. Morrow M, Foster RS: Staging of breast cancer; A new rationale for internal mammary node biopsy.Arch Surg 116:748–751, 1981.

    PubMed  CAS  Google Scholar 

  88. Valagussa P, Bonnadonna G, Veronesi U: Patterns of relapse and survival following radical mastectomy; Analysis of 716 consecutive patients.Cancer 41:1170–1177, 1978.

    Article  PubMed  CAS  Google Scholar 

  89. Saphir O, Amromin GD: Obscure axillary lymph node metastases in carcinoma of the breast.Cancer 1:238–241, 1948.

    Article  CAS  PubMed  Google Scholar 

  90. Fisher ER, Swamidoss S, Lee CH,et al: Detection and significance of occult axillary node metastases in patients with invasive breast cancer.Cancer 42:2025–2031, 1978.

    Article  PubMed  CAS  Google Scholar 

  91. Pickren JW: Significance of occult metastases; A study of breast cancer.Cancer 14:1266–1271, 1961.

    Article  PubMed  CAS  Google Scholar 

  92. Hainsworth PJ, Tjandra JJ, Stillwell RG: Detection and significance of occult metastases in node-negative breast cancer.Br J Surg 80:459–463, 1993.

    Article  PubMed  CAS  Google Scholar 

  93. Trojani M, de Mascarel I, Bonichon F,et al: Micro-metastases to axillary lymph nodes from carcinoma of breast; Detection by immunohistochemistry and prognostic significance.Br J Cancer 55:303–306, 1987.

    PubMed  CAS  Google Scholar 

  94. Trojani M, de Mascarel I, Coindre J,et al: Micrometastases to axillary nodes from invasive lobular carcinoma of the breast; Detection by immunohistochemistry and prognostic significance.Br J Cancer 56:838–839, 1987.

    PubMed  CAS  Google Scholar 

  95. McGuckin MA, Cummings MC, Walsh MD,et al: Occult axillary lymph node metastases in breast cancer; Their detection and prognostic significance.Br J Cancer 73:88–95, 1996.

    PubMed  CAS  Google Scholar 

  96. International (Ludwig) Breast Cancer Study Group: Prognostic importance of occult axillary lymph node micrometastases from breast cancer.Lancet 335:1565–1568, 1990.

    Google Scholar 

  97. de Mascarel I, Bonichon F, Coindre JM,et al: Prognostic significance of breast cancer axillary lymph node micrometastases assessed by two special techniques; Reevaluation with longer follow up.Br J Cancer 66:523–527, 1992.

    PubMed  CAS  Google Scholar 

  98. Turner RR, Oilila DW, Krasne DL,et al: Histopathologic validation of the sentinel node hypothesis for breast carcinoma.Ann Surg 226:271–278, 1997.

    Article  PubMed  CAS  Google Scholar 

  99. Hartveit F, Lilleng PK: Breast cancer; Two micrometastatic variants in the axilla that differ in prognoses.Histopathology 28:241–246, 1996.

    Article  PubMed  CAS  Google Scholar 

  100. Mori M, Mimori K, Inoue M,et al: Detection of cancer micrometastases in lymph nodes by reverse transcriptase-polymerase chain reaction.Cancer Res 55:3417–3420, 1995.

    PubMed  CAS  Google Scholar 

  101. Schoenfeld A, Lugmani Y, Sinnett MD,et at: Keratin 19mRNA measurement to detect micrometastases in lymph nodes in breast cancer patients.Br J Cancer 74:1639–1642, 1996.

    PubMed  CAS  Google Scholar 

  102. Cox CE, Haddad F, Cox JM,et al: Lymphatic mapping in the treatment of breast cancer.Oncology 12:1283, 1998.

    PubMed  CAS  Google Scholar 

  103. Morrow M, Bethke K, Talamonti M,et al: Intraoperative lymphatic mapping and sentinel node biopsy; Re-sults of a randomized trial comparing blue dye to blue dye plus radioactivity. Submitted for publication.

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  1. Lynn Sage Comprehensive Breast Program, Department of Surgery, Northwestern University Medical School, 333 East Superior Street, Suite 250, 60611, Chicago, IL, USA

    Monica Morrow

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  1. Monica Morrow
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Morrow, M. Management of the axillary nodes. Breast Cancer 6, 1–12 (1999). https://doi.org/10.1007/BF02966900

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