{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T06:33:40Z","timestamp":1778567620104,"version":"3.51.4"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2005,1,25]],"date-time":"2005-01-25T00:00:00Z","timestamp":1106611200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2005,3,19]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Indiscriminate removal of axillary nodes may not be justified as it may potentially worsen the morbidity of the sentinel lymph node biopsy (SNB) procedure. This study examined the factors associated with removal of multiple sentinel lymph nodes and determined whether there was an upper threshold for the number of sentinel nodes that should be removed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A total of 803 patients with breast cancer underwent successful SNB using peritumoral injection of 99mTc-labelled albumin colloid and Patent Blue V dye. SNB was followed by standard axillary treatment at the same operation in all patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The mean number of sentinel nodes removed per procedure was 2\u00b72 (range 1\u20139). Multiple sentinel nodes (mean 2\u00b79, range 2\u20139) were found in 501 patients (62\u00b74 per cent). The false-negative rate in patients who had one sentinel node harvested was 10 per cent, compared with 1 per cent in patients who had three or more nodes removed (P = 0\u00b7010). Factors associated with finding multiple sentinel nodes were age less than 50 years (P = 0\u00b7004), low body mass index (P &amp;lt; 0\u00b7001), tumour in the outer half of the breast (P = 0\u00b7013), sentinel node visualization on lymphoscintigraphy (P &amp;lt; 0\u00b7001) and an interval of 12 h or less between radioisotope injection and SNB (P = 0\u00b7014). For 99\u00b76 per cent of node-positive tumours, metastasis was detected within the first four sentinel nodes removed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The identification of multiple sentinel nodes, when present, reduced the false-negative rate. These data suggested that removal of more than four nodes was unnecessary.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/bjs.4906","type":"journal-article","created":{"date-parts":[[2005,1,25]],"date-time":"2005-01-25T18:47:23Z","timestamp":1106678843000},"page":"438-442","source":"Crossref","is-referenced-by-count":56,"title":["Clinical relevance of multiple sentinel nodes in patients with breast cancer"],"prefix":"10.1093","volume":"92","author":[{"given":"A","family":"Goyal","sequence":"first","affiliation":[{"name":"Department of Surgery, Statistics and Public Health, Cardiff University, Cardiff, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R G","family":"Newcombe","sequence":"additional","affiliation":[{"name":"Epidemiology, Statistics and Public Health, Cardiff University, Cardiff, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R E","family":"Mansel","sequence":"additional","affiliation":[{"name":"Department of Surgery, Statistics and Public Health, Cardiff University, Cardiff, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2005,1,25]]},"reference":[{"key":"2021070906104060600_bib1","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1056\/NEJMoa012782","article-title":"A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer","volume":"349","author":"Veronesi","year":"2003","journal-title":"N Engl J Med"},{"key":"2021070906104060600_bib2","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1200\/jco.2004.22.90140.506","article-title":"Sentinel node biopsy in breast cancer: the first results of the randomized multicenter ALMANAC Trial","volume":"22","author":"Mansel","year":"2004","journal-title":"J Clin Oncol"},{"key":"2021070906104060600_bib3","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/1477-7819-2-9","article-title":"Current status of sentinel lymph node biopsy in solid malignancies","volume":"2","author":"Goyal","year":"2004","journal-title":"World J Surg Oncol"},{"key":"2021070906104060600_bib4","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1056\/NEJM199810013391401","article-title":"The sentinel node in breast cancer\u2014a multicenter validation study","volume":"339","author":"Krag","year":"1998","journal-title":"N Engl J Med"},{"key":"2021070906104060600_bib5","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1097\/00000658-199904000-00012","article-title":"Lessons learned from 500 cases of lymphatic mapping for breast cancer","volume":"229","author":"Hill","year":"1999","journal-title":"Ann Surg"},{"key":"2021070906104060600_bib6","doi-asserted-by":"crossref","first-page":"2345","DOI":"10.1200\/JCO.1997.15.6.2345","article-title":"Sentinel lymphadenectomy in breast cancer","volume":"15","author":"Giuliano","year":"1997","journal-title":"J Clin Oncol"},{"key":"2021070906104060600_bib7","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1053\/j.seminoncol.2004.03.003","article-title":"European studies on breast lymphatic mapping","volume":"31","author":"Mansel","year":"2004","journal-title":"Semin Oncol"},{"key":"2021070906104060600_bib8","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1007\/s10434-001-0192-4","article-title":"Sentinel lymph node biopsy for melanoma: how many radioactive nodes should be removed?","volume":"8","author":"McMasters","year":"2001","journal-title":"Ann Surg Oncol"},{"key":"2021070906104060600_bib9","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1007\/s10434-999-0012-9","article-title":"Will the true sentinel node please stand?","volume":"6","author":"Morton","year":"1999","journal-title":"Ann Surg Oncol"},{"key":"2021070906104060600_bib10","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1007\/s10434-999-0514-5","article-title":"Will the true sentinel node please stand?","volume":"6","author":"Nathanson","year":"1999","journal-title":"Ann Surg Oncol"},{"key":"2021070906104060600_bib11","doi-asserted-by":"crossref","first-page":"211S","DOI":"10.1245\/ASO.2004.12.924","article-title":"The learning curve in sentinel node biopsy: the ALMANAC experience","volume":"11","author":"Clarke","year":"2004","journal-title":"Ann Surg Oncol"},{"key":"2021070906104060600_bib12","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1016\/S1072-7515(01)00858-4","article-title":"Sentinel lymph node biopsy for breast cancer: impact of the number of sentinel nodes removed on the false-negative rate","volume":"192","author":"Wong","year":"2001","journal-title":"J Am Coll Surg"},{"key":"2021070906104060600_bib13","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1067\/msy.2000.108064","article-title":"Practical guidelines for optimal gamma probe detection of sentinel lymph nodes in breast cancer: results of a multi-institutional study. For the University of Louisville Breast Cancer Study Group","volume":"128","author":"Martin","year":"2000","journal-title":"Surgery"},{"key":"2021070906104060600_bib14","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1148\/radiology.220.1.r01jn2347","article-title":"Breast cancer: variables affecting sentinel lymph node visualization at preoperative lymphoscintigraphy","volume":"220","author":"Birdwell","year":"2001","journal-title":"Radiology"},{"key":"2021070906104060600_bib15","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1097\/00000658-200101000-00009","article-title":"Multicenter trial of sentinel node biopsy for breast cancer using both technetium sulfur colloid and isosulfan blue dye","volume":"233","author":"Tafra","year":"2001","journal-title":"Ann Surg"},{"key":"2021070906104060600_bib16","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1097\/00000658-200109000-00003","article-title":"Defining the optimal surgeon experience for breast cancer sentinel lymph node biopsy: a model for implementation of new surgical techniques","volume":"234","author":"McMasters","year":"2001","journal-title":"Ann Surg"},{"key":"2021070906104060600_bib17","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s10434-999-0083-7","article-title":"Filtered versus unfiltered technetium sulfur colloid in lymphatic mapping: a significant variable in a pig model","volume":"6","author":"Tafra","year":"1999","journal-title":"Ann Surg Oncol"},{"key":"2021070906104060600_bib18","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1016\/S1072-7515(01)00847-X","article-title":"The breast cancer patient with multiple sentinel nodes: when to stop?","volume":"192","author":"McCarter","year":"2001","journal-title":"J Am Coll Surg"},{"key":"2021070906104060600_bib19","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1016\/j.ejso.2004.02.006","article-title":"ALMANAC Trialists Group. Sentinel lymph node biopsy in male breast cancer patients","volume":"30","author":"Goyal","year":"2004","journal-title":"Eur J Surg Oncol"}],"container-title":["British Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fbjs.4906","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/academic.oup.com\/bjs\/article-pdf\/92\/4\/438\/36732177\/bjs4906.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/bjs\/article-pdf\/92\/4\/438\/36732177\/bjs4906.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,9]],"date-time":"2021-07-09T14:38:40Z","timestamp":1625841520000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjs\/article\/92\/4\/438\/6144194"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2005,1,25]]},"references-count":19,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2005,1,25]]},"published-print":{"date-parts":[[2005,3,19]]}},"URL":"https:\/\/doi.org\/10.1002\/bjs.4906","relation":{},"ISSN":["0007-1323","1365-2168"],"issn-type":[{"value":"0007-1323","type":"print"},{"value":"1365-2168","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2005,4]]},"published":{"date-parts":[[2005,1,25]]}}}