{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T20:55:22Z","timestamp":1762980922245,"version":"3.37.3"},"reference-count":23,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2020,6,24]],"date-time":"2020-06-24T00:00:00Z","timestamp":1592956800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,6,24]],"date-time":"2020-06-24T00:00:00Z","timestamp":1592956800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2020,6,24]],"date-time":"2020-06-24T00:00:00Z","timestamp":1592956800000},"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":[[2020,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In the majority of cases, the sentinel node is the only positive node in the axilla and completion ALND (cALND) is a futile procedure. However, refraining from cALND will lead to less accurate staging and, possibly, undertreatment. To help resolve this dilemma, we examined the clinical value of cALND in staging and determining adjuvant treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a retrospective cohort, all consecutive patients over a five\u2010year period with primary breast cancer who received ALND were identified and grouped based on timing of ALND. Total nodal yield and positive lymph nodes were defined and factors with possible impact identified. In the case of cALND, N\u2010status upstaging and possible impact on adjuvant treatment were studied in detail.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 280 patients were selected of whom 204 underwent primary ALND (pALND) and 76 cALND. pALND resulted in a significantly higher total nodal yield and more positive nodes when compared to cALND (<jats:italic>p<\/jats:italic>\u2009=\u20090.003, and <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001, respectively). Neoadjuvant chemotherapy (NAC) had no effect on total nodal yield (<jats:italic>p<\/jats:italic>\u2009=\u20090.413), but resulted in fewer positive nodes (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Due to the results of cALND, only 11 patients (14%) had upstaging of N\u2010status. All these patients were advised more extensive adjuvant radiotherapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In the majority of patients, cALND does not lead to upstaging. cALND should be performed only after a careful discussion with the patient about the pros and cons of this procedure, and most probably only in the presence of multiple risk factors for axillary disease in the absence of systemic therapy.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-020-05650-8","type":"journal-article","created":{"date-parts":[[2020,6,24]],"date-time":"2020-06-24T14:03:20Z","timestamp":1593007400000},"page":"3801-3809","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Dilemma After an Unforeseen Positive Sentinel Node in Primary Breast Cancer: Is Completion Axillary Dissection Necessary?"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6924-9275","authenticated-orcid":false,"given":"S.","family":"van Bekkum","sequence":"first","affiliation":[{"name":"Department of Surgery Albert Schweitzer Hospital P.O. Box 444 3300 AK Dordrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A. C.","family":"Kraima","sequence":"additional","affiliation":[{"name":"Department of Surgery Albert Schweitzer Hospital P.O. Box 444 3300 AK Dordrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. J.","family":"Westenend","sequence":"additional","affiliation":[{"name":"Department of Pathology Laboratory of Pathology Dordrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. W.","family":"Plaisier","sequence":"additional","affiliation":[{"name":"Department of Surgery Albert Schweitzer Hospital P.O. Box 444 3300 AK Dordrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. B. E.","family":"Menke\u2010Pluijmers","sequence":"additional","affiliation":[{"name":"Department of Surgery Albert Schweitzer Hospital P.O. Box 444 3300 AK Dordrecht The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,6,24]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434\u2010008\u20109863\u20108"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2007.07.198"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","unstructured":"SenkusE KyriakidesS OhnoS Penault\u2010LlorcaF PoortmansP RutgersE ZackrissonS CardosoFPrimary breast cancer: ESMO clinical practice guidelines for diagnosis treatment and follow\u2010up.Ann Oncol(2015)10.1093\/annonc\/mdv29826314782","DOI":"10.1093\/annonc\/mdv298"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.277804"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.11470"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2010.10.005"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1006\/jsre.1999.5629"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.90"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520\u2010018\u20104186\u20101"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clbc.2018.08.002"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2015.07.005"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002440"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10549\u2010017\u20104405\u20103"},{"key":"e_1_2_9_15_1","unstructured":"KragDN WeaverDL AlexJC FairbankJTSurgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe.Surg Oncol(1993)10.1016\/0960\u20107404(93)90064\u201068130940"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2017.03.039"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470\u20102045(14)70460\u20107"},{"key":"e_1_2_9_18_1","doi-asserted-by":"crossref","unstructured":"ByrneBE CutressRI GillJ WiseMH YiangouC AgrawalAThe axillary nodal harvest in breast cancer surgery is unchanged by sentinel node biopsy or the timing of surgery.Int J Breast Cancer(2012)10.1155\/2012\/467825226936733369471","DOI":"10.1155\/2012\/467825"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.15.5630"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010200305000\u201000002"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clbc.2016.02.015"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002\u20109610(02)00959\u20105"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2005.08.041"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.1992.25"}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-020-05650-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00268-020-05650-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00268-020-05650-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00268-020-05650-8","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,23]],"date-time":"2023-12-23T16:13:33Z","timestamp":1703348013000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1007\/s00268-020-05650-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,24]]},"references-count":23,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2020,11]]}},"alternative-id":["10.1007\/s00268-020-05650-8"],"URL":"https:\/\/doi.org\/10.1007\/s00268-020-05650-8","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"type":"print","value":"0364-2313"},{"type":"electronic","value":"1432-2323"}],"subject":[],"published":{"date-parts":[[2020,6,24]]},"assertion":[{"value":"24 June 2020","order":1,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Consent was given for registration of medical data for anonymous research.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}