{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T13:02:28Z","timestamp":1758632548635},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,11,27]],"date-time":"2018-11-27T00:00:00Z","timestamp":1543276800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2018,11,27]],"date-time":"2018-11-27T00:00:00Z","timestamp":1543276800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2018,11,27]],"date-time":"2018-11-27T00:00:00Z","timestamp":1543276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2019,4,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>False\u2010negative rate (FNR) of sentinel lymph node dissection (SLND) has not been eliminated. The study was conducted to optimize the surgical resection of axilla in patients with negative sentinel lymph node (SLN) for the purpose of eradicating false\u2010negative (FN) events of SLND.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 312 clinically node\u2010negative patients without neoadjuvant therapy underwent SLND with indocyanine green (ICG), methylene blue and the combination of ICG and methylene blue. Axillary dissection was performed subsequently regardless of the status of SLN. Lymph nodes were sent for pathological examination separately by serial resection every 0.5\u00a0cm away from marginally visualized SLNs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>SLND was successfully conducted in 98.1% (306\/312) of patients using methylene blue, ICG, and its combination. Further examination revealed 97 true\u2010positive, 189 true\u2010negative, and 13 FN results. The overall FNR was 11.8% (13\/110). A horizontal line 1.5\u00a0cm away from the superior vSLN and a vertical line 1.5\u00a0cm away from the medial vSLN formed a zone of lower outer quadrant (LOQ) in axilla. Surgical resection of LOQ \u2018en bloc\u2019 showed a FNR of zero.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The surgical management of axilla may benefit negative SLN patients with potential nodal involvement, reducing the FNR of SLND to zero.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number and agency<\/jats:title><jats:p>This study was registered with the Chinese Clinical Trial Registry (ChiCTR1800014247).<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-018-4865-6","type":"journal-article","created":{"date-parts":[[2018,11,26]],"date-time":"2018-11-26T23:03:01Z","timestamp":1543273381000},"page":"1047-1053","update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Surgical Management of the Axilla in Breast Cancer Patients with Negative Sentinel Lymph Node: A Method to Reduce False\u2010Negative Rate"],"prefix":"10.1002","volume":"43","clinical-trial-number":[{"clinical-trial-number":"chictr1800014247","registry":"10.18810\/chictr"}],"author":[{"given":"Qianqian","family":"Yuan","sequence":"first","affiliation":[{"name":"Department of Thyroid and Breast Surgery Zhongnan Hospital of Wuhan University 169 Donghu Road 430071 Wuhan Hubei People\u2019s Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaosong","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Thyroid and Breast Surgery Zhongnan Hospital of Wuhan University 169 Donghu Road 430071 Wuhan Hubei People\u2019s Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shu\u2010Yuan","family":"Xiao","sequence":"additional","affiliation":[{"name":"Wuhan University Center for Pathology and Molecular Diagnostics 169 Donghu Road 430071 Wuhan Hubei People\u2019s Republic of China"},{"name":"Department of Pathology University of Chicago 60637 Chicago IL USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukun","family":"He","sequence":"additional","affiliation":[{"name":"Department of Thyroid and Breast Surgery Zhongnan Hospital of Wuhan University 169 Donghu Road 430071 Wuhan Hubei People\u2019s Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Thyroid and Breast Surgery Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology 1095 Jiefang Avenue 430030 Wuhan Hubei People\u2019s Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Thyroid and Breast Surgery Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology 1095 Jiefang Avenue 430030 Wuhan Hubei People\u2019s Republic of 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