{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T04:52:31Z","timestamp":1776919951439,"version":"3.51.2"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2020,5,8]],"date-time":"2020-05-08T00:00:00Z","timestamp":1588896000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,5,8]],"date-time":"2020-05-08T00:00:00Z","timestamp":1588896000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Dermatol Res"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Squamous cell carcinomas are among the most common skin tumors and show a risk of metastasis depending on various factors such as tumor thickness, localization, histological subtype and immune status of the patient. Sentinel lymph node biopsy (SLNB) SLNB represents a possibility for assessing the locoregional lymph node status. In this study, the role of the SLNB in lymph node status and survival was analyzed. Retrospectively, 720 patients with high-risk squamous cell carcinoma (tumor thickness\u2009&gt;\u20095\u00a0mm) were examined. 150 patients agreed to SLNB, 570 patients did not undergo histologic confirmation of lymph node status and were included directly in follow-up. In 101 patients, a sentinel lymph node was successfully marked and extirpated, followed by regular follow-up examinations.<\/jats:p><jats:p>A total of 11.11% of the patients showed lymph node metastasis in the course of their treatment, with no difference in the proportion of patients in the SLNB group (11.9%) and the observation group (11.4%) (<jats:italic>p<\/jats:italic>\u2009=\u20090.873). The proportion of distant metastasis also did not differ between the groups (<jats:italic>p<\/jats:italic>\u2009=\u20090.898). In 3.96% of the patients in the SLNB group, a metastasis was found in the sentinel lymph node. Tumor-specific death was observed in 7.14% of the patients in the SLNB group and 4.74% in the observation group (<jats:italic>p<\/jats:italic>\u2009=\u20090.269). Although SLNB is a principally suitable method for determining lymph node status, the available data do not provide any benefit regarding further metastasis or tumor-specific survival.<\/jats:p>","DOI":"10.1007\/s00403-020-02082-1","type":"journal-article","created":{"date-parts":[[2020,5,8]],"date-time":"2020-05-08T09:02:49Z","timestamp":1588928569000},"page":"119-126","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Sentinel lymph node biopsy for high-thickness cutaneous squamous cell carcinoma"],"prefix":"10.1007","volume":"313","author":[{"given":"Lukas","family":"Kofler","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katrin","family":"Kofler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Schulz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helmut","family":"Breuninger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans-Martin","family":"H\u00e4fner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,5,8]]},"reference":[{"key":"2082_CR1","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1001\/jamadermatol.2017.4169","volume":"154","author":"O Ahadiat","year":"2018","unstructured":"Ahadiat O, Higgins S, Kwon S, Wysong A (2018) Underuse of the sentinel lymph node biopsy for high-risk squamous cell carcinoma of the skin. JAMA Dermatol 154:101\u2013101. https:\/\/doi.org\/10.1001\/jamadermatol.2017.4169","journal-title":"JAMA Dermatol"},{"key":"2082_CR2","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1097\/00000658-199602000-00016","volume":"223","author":"JJ Albertini","year":"1996","unstructured":"Albertini JJ, Cruse CW, Rapaport D, Wells K, Ross M, DeConti R, Berman CG, Jared K, Messina J, Lyman G, Glass F, Fenske N, Reintgen DS (1996) Intraoperative radio-lympho-scintigraphy improves sentinel lymph node identification for patients with melanoma. Ann Surg 223:217\u2013224","journal-title":"Ann Surg"},{"key":"2082_CR3","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/S1055-3207(18)30403-4","volume":"5","author":"JC Alex","year":"1996","unstructured":"Alex JC, Krag DN (1996) The gamma-probe-guided resection of radiolabeled primary lymph nodes. Surg Oncol Clin N Am 5:33\u201341","journal-title":"Surg Oncol Clin N Am"},{"key":"2082_CR4","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/j.ejso.2014.10.055","volume":"41","author":"JE Allen","year":"2015","unstructured":"Allen JE, Stolle LB (2015) Utility of sentinel node biopsy in patients with high-risk cutaneous squamous cell carcinoma. Eur J Surg Oncol 41:197\u2013200. https:\/\/doi.org\/10.1016\/j.ejso.2014.10.055","journal-title":"Eur J Surg Oncol"},{"key":"2082_CR5","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1016\/S1470-2045(08)70178-5","volume":"9","author":"KD Brantsch","year":"2008","unstructured":"Brantsch KD, Meisner C, Sch\u00f6nfisch B, Trilling B, Wehner-Caroli J, R\u00f6cken M, Breuninger H (2008) Analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: a prospective study. Lancet Oncol 9:713\u2013720. https:\/\/doi.org\/10.1016\/S1470-2045(08)70178-5","journal-title":"Lancet Oncol"},{"issue":"Suppl 3","key":"2082_CR6","doi-asserted-by":"publisher","first-page":"37\u201345","DOI":"10.1111\/ddg.12015_7","volume":"11","author":"H Breuninger","year":"2013","unstructured":"Breuninger H, Eigentler T, Bootz F, Hauschild A, Kortmann R-D, Wolff K, Stockfleth E, Szeimies R-M, Rompel R, Garbe C, Grabbe S (2013) Brief S2k guidelines\u2013cutaneous squamous cell carcinoma. J Dtsch Dermatol Ges 11(Suppl 3):37\u201345\u201339\u201347. https:\/\/doi.org\/10.1111\/ddg.12015_7","journal-title":"J Dtsch Dermatol Ges"},{"key":"2082_CR7","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1002\/(SICI)1097-0142(19970301)79:5<915::AID-CNCR7>3.0.CO;2-A","volume":"79","author":"H Breuninger","year":"1997","unstructured":"Breuninger H, Schaumburg-Lever G, Holzschuh J, Horny HP (1997) Desmoplastic squamous cell carcinoma of skin and vermilion surface: a highly malignant subtype of skin cancer. Cancer 79:915\u2013919","journal-title":"Cancer"},{"key":"2082_CR8","doi-asserted-by":"publisher","first-page":"2154","DOI":"10.1007\/s00259-007-0614-z","volume":"34","author":"J Buscombe","year":"2007","unstructured":"Buscombe J, Paganelli G, Burak ZE, Waddington W, Maublant J, Prats E, Palmedo H, Schillaci O, Maffioli L, Lassmann M, Chiesa C, Bombardieri E, Chiti A, European Association of Nuclear Medicine Oncology Committee, and Dosimetry Committee (2007) Sentinel node in breast cancer procedural guidelines. Eur J Nucl Med Mol Imaging 34:2154\u20132159. https:\/\/doi.org\/10.1007\/s00259-007-0614-z","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"2082_CR9","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1111\/j.1610-0378.2005.04738.x","volume":"3","author":"FC Eberle","year":"2005","unstructured":"Eberle FC, Schippert W, Trilling B, R\u00f6cken M, Breuninger H (2005) Cosmetic results of histographically controlled excision of non-melanoma skin cancer in the head and neck region. J Dtsch Dermatol Ges 3:109\u2013112","journal-title":"J Dtsch Dermatol Ges"},{"key":"2082_CR10","doi-asserted-by":"publisher","first-page":"548","DOI":"10.1016\/j.jaad.2018.09.006","volume":"81","author":"M Fox","year":"2019","unstructured":"Fox M, Brown M, Golda N, Goldberg D, Miller C, Pugliano-Mauro M, Schmults C, Shin T, Stasko T, Xu YG, Nehal K, High Risk Squamous Cell Carcinoma Workgroup, Dermatologic Surgery Section of the Association of Professors of Dermatology (2019) Nodal staging of high-risk cutaneous squamous cell carcinoma. J Am Acad Dermatol 81:548\u2013557. https:\/\/doi.org\/10.1016\/j.jaad.2018.09.006","journal-title":"J Am Acad Dermatol"},{"key":"2082_CR11","doi-asserted-by":"publisher","first-page":"2647","DOI":"10.1002\/cncr.22320","volume":"107","author":"CJ Gannon","year":"2006","unstructured":"Gannon CJ, Rousseau DL, Ross MI, Johnson MM, Lee JE, Mansfield PF, Cormier JN, Prieto VG, Gershenwald JE (2006) Accuracy of lymphatic mapping and sentinel lymph node biopsy after previous wide local excision in patients with primary melanoma. Cancer 107:2647\u20132652. https:\/\/doi.org\/10.1002\/cncr.22320","journal-title":"Cancer"},{"key":"2082_CR12","doi-asserted-by":"publisher","first-page":"643","DOI":"10.14336\/AD.2017.0503","volume":"8","author":"S Garcovich","year":"2017","unstructured":"Garcovich S, Colloca G, Sollena P, Andrea B, Balducci L, Cho WC, Bernabei R, Peris K (2017) Skin cancer epidemics in the elderly as an emerging issue in geriatric oncology. Aging Dis 8:643\u2013661. https:\/\/doi.org\/10.14336\/AD.2017.0503","journal-title":"Aging Dis"},{"key":"2082_CR13","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1111\/j.1610-0387.2007.06569.x","volume":"6","author":"R Gutzmer","year":"2008","unstructured":"Gutzmer R, Satzger I, Thoms K-M, V\u00f6lker B, Mitteldorf C, Kapp A, Bertsch HP, Kretschmer L (2008) Sentinel lymph node status is the most important prognostic factor for thick (%3e or = 4 mm) melanomas. J Dtsch Dermatol Ges 6:198\u2013203. https:\/\/doi.org\/10.1111\/j.1610-0387.2007.06569.x","journal-title":"J Dtsch Dermatol Ges"},{"key":"2082_CR14","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1007\/s00105-013-2541-1","volume":"64","author":"H-M H\u00e4fner","year":"2013","unstructured":"H\u00e4fner H-M, Schnabl S, Breuninger H, Schulz C (2013) Surgical treatment of epithelial skin tumors and their precursors. Hautarzt 64:558\u2013566. https:\/\/doi.org\/10.1007\/s00105-013-2541-1","journal-title":"Hautarzt"},{"key":"2082_CR15","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1684\/ejd.2011.1290","volume":"21","author":"W Hoetzenecker","year":"2011","unstructured":"Hoetzenecker W, Guenova E, B\u00f6ttinger TU, H\u00e4fner H-M, Breuninger H (2011) Mapping of specific sentinel node locations for skin cancer of the head. Eur J Dermatol 21:354\u2013358. https:\/\/doi.org\/10.1684\/ejd.2011.1290","journal-title":"Eur J Dermatol"},{"key":"2082_CR16","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.ejca.2019.02.004","volume":"111","author":"P Jansen","year":"2019","unstructured":"Jansen P, Petri M, Merz SF, Brinker TJ, Schadendorf D, Stang A, Stoffels I, Klode J (2019) The prognostic value of sentinel lymph nodes on distant metastasis-free survival in patients with high-risk squamous cell carcinoma. Eur J Cancer 111:107\u2013115. https:\/\/doi.org\/10.1016\/j.ejca.2019.02.004","journal-title":"Eur J Cancer"},{"key":"2082_CR17","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1111\/bjd.13508","volume":"172","author":"JT Krediet","year":"2015","unstructured":"Krediet JT, Beyer M, Lenz K, Ulrich C, Lange-Asschenfeldt B, Stockfleth E, Terhorst D (2015) Sentinel lymph node biopsy and risk factors for predicting metastasis in cutaneous squamous cell carcinoma. Br J Dermatol 172:1029\u20131036. https:\/\/doi.org\/10.1111\/bjd.13508","journal-title":"Br J Dermatol"},{"key":"2082_CR18","doi-asserted-by":"publisher","first-page":"4073","DOI":"10.1245\/s10434-015-4439-x","volume":"22","author":"U Leiter","year":"2015","unstructured":"Leiter U, Eigentler TK, H\u00e4fner H-M, Krimmel M, Uslu U, Keim U, Weide B, Breuninger H, Martus P, Garbe C (2015) Sentinel lymph node dissection in head and neck melanoma has prognostic impact on disease-free and overall survival. Ann Surg Oncol 22:4073\u20134080. https:\/\/doi.org\/10.1245\/s10434-015-4439-x","journal-title":"Ann Surg Oncol"},{"key":"2082_CR19","doi-asserted-by":"publisher","first-page":"1860","DOI":"10.1016\/j.jid.2017.04.020","volume":"137","author":"U Leiter","year":"2017","unstructured":"Leiter U, Keim U, Eigentler T, Katalinic A, Holleczek B, Martus P, Garbe C (2017) Incidence, mortality, and trends of nonmelanoma skin cancer in Germany. J Invest Dermatol 137:1860\u20131867. https:\/\/doi.org\/10.1016\/j.jid.2017.04.020","journal-title":"J Invest Dermatol"},{"key":"2082_CR20","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1111\/j.1610-0387.2012.07963.x","volume":"10","author":"M Leverkus","year":"2012","unstructured":"Leverkus M (2012) Malignant epithelial tumors: Part I. Pathophysiology and clinical features. J Dtsch Dermatol Ges 10:457\u2013471. https:\/\/doi.org\/10.1111\/j.1610-0387.2012.07963.x(quiz 472)","journal-title":"J Dtsch Dermatol Ges"},{"key":"2082_CR21","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1001\/jamainternmed.2013.639","volume":"173","author":"E Linos","year":"2013","unstructured":"Linos E, Parvataneni R, Stuart SE, Boscardin WJ, Landefeld CS, Chren M-M (2013) Treatment of nonfatal conditions at the end of life: nonmelanoma skin cancer. JAMA Intern Med 173:1006\u20131012. https:\/\/doi.org\/10.1001\/jamainternmed.2013.639","journal-title":"JAMA Intern Med"},{"key":"2082_CR22","doi-asserted-by":"publisher","first-page":"942","DOI":"10.1111\/ddg.12665","volume":"13","author":"CR L\u00f6ser","year":"2015","unstructured":"L\u00f6ser CR, Rompel R, M\u00f6hrle M, H\u00e4fner H-M, Kunte C, Hassel J, Hohenleutner U, Podda M, Sebastian G, Hafner J, Kaufmann R, Breuninger H (2015) S1 guideline: microscopically controlled surgery (MCS). J Dtsch Dermatol Ges 13:942\u2013951. https:\/\/doi.org\/10.1111\/ddg.12665","journal-title":"J Dtsch Dermatol Ges"},{"key":"2082_CR23","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1016\/S0140-6736(09)61196-X","volume":"375","author":"V Madan","year":"2010","unstructured":"Madan V, Lear JT, Szeimies R-M (2010) Non-melanoma skin cancer. Lancet 375:673\u2013685. https:\/\/doi.org\/10.1016\/S0140-6736(09)61196-X","journal-title":"Lancet"},{"key":"2082_CR24","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1016\/j.jaad.2012.01.010","volume":"67","author":"C Metchnikoff","year":"2012","unstructured":"Metchnikoff C, Mully T, Singer JP, Golden JA, Arron ST (2012) The 7th edition AJCC staging system for cutaneous squamous cell carcinoma accurately predicts risk of recurrence for heart and lung transplant recipients. J Am Acad Dermatol 67:829\u2013835. https:\/\/doi.org\/10.1016\/j.jaad.2012.01.010","journal-title":"J Am Acad Dermatol"},{"key":"2082_CR25","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1016\/j.jaad.2015.03.039","volume":"73","author":"C Navarrete-Dechent","year":"2015","unstructured":"Navarrete-Dechent C, Veness MJ, Droppelmann N, Uribe P (2015) High-risk cutaneous squamous cell carcinoma and the emerging role of sentinel lymph node biopsy: a literature review. J Am Acad Dermatol 73:127\u2013137. https:\/\/doi.org\/10.1016\/j.jaad.2015.03.039","journal-title":"J Am Acad Dermatol"},{"key":"2082_CR26","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1111\/j.1365-2133.2011.10507.x","volume":"165","author":"S Rangwala","year":"2011","unstructured":"Rangwala S, Tsai KY (2011) Roles of the immune system in skin cancer. Br J Dermatol 165:953\u2013965. https:\/\/doi.org\/10.1111\/j.1365-2133.2011.10507.x","journal-title":"Br J Dermatol"},{"key":"2082_CR27","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1159\/000312649","volume":"44","author":"M Rastrelli","year":"2010","unstructured":"Rastrelli M, Soteldo J, Zonta M, Trifir\u00f2 G, Mazzarol G, Vitali GC, Mosconi M, Testori A (2010) Sentinel node biopsy for high-risk cutaneous nonanogenital squamous cell carcinoma: a preliminary result. Eur Surg Res 44:204\u2013208. https:\/\/doi.org\/10.1159\/000312649","journal-title":"Eur Surg Res"},{"key":"2082_CR28","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1016\/j.ejso.2006.10.017","volume":"33","author":"C Renzi","year":"2007","unstructured":"Renzi C, Caggiati A, Mannooranparampil TJ, Passarelli F, Tartaglione G, Pennasilico GM, Cecconi S, Potenza C, Pasquini P (2007) Sentinel lymph node biopsy for high risk cutaneous squamous cell carcinoma: case series and review of the literature. Eur J Surg Oncol 33:364\u2013369. https:\/\/doi.org\/10.1016\/j.ejso.2006.10.017","journal-title":"Eur J Surg Oncol"},{"key":"2082_CR29","doi-asserted-by":"publisher","first-page":"417","DOI":"10.2340\/00015555-1501","volume":"93","author":"MH Roozeboom","year":"2013","unstructured":"Roozeboom MH, Lohman BGPM, Westers-Attema A, Nelemans PJ, Botterweck AA, van Marion AMW, Kelleners-Smeets NWJ (2013) Clinical and histological prognostic factors for local recurrence and metastasis of cutaneous squamous cell carcinoma: analysis of a defined population. Acta Derm Venereol 93:417\u2013421. https:\/\/doi.org\/10.2340\/00015555-1501","journal-title":"Acta Derm Venereol"},{"key":"2082_CR30","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1111\/j.1524-4725.2006.32300.x","volume":"32","author":"AS Ross","year":"2006","unstructured":"Ross AS, Schmults CD (2006) Sentinel lymph node biopsy in cutaneous squamous cell carcinoma: a systematic review of the English literature. Dermatol Surg 32:1309\u20131321. https:\/\/doi.org\/10.1111\/j.1524-4725.2006.32300.x","journal-title":"Dermatol Surg"},{"key":"2082_CR31","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1001\/jamadermatol.2013.6675","volume":"150","author":"AR Schmitt","year":"2014","unstructured":"Schmitt AR, Brewer JD, Bordeaux JS, Baum CL (2014) Staging for cutaneous squamous cell carcinoma as a predictor of sentinel lymph node biopsy results: meta-analysis of American Joint Committee on Cancer criteria and a proposed alternative system. JAMA Dermatol 150:19\u201324. https:\/\/doi.org\/10.1001\/jamadermatol.2013.6675","journal-title":"JAMA Dermatol"},{"key":"2082_CR32","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1001\/jamadermatol.2013.2139","volume":"149","author":"CD Schmults","year":"2013","unstructured":"Schmults CD, Karia PS, Carter JB, Han J, Qureshi AA (2013) Factors predictive of recurrence and death from cutaneous squamous cell carcinoma: a 10-year, single-institution cohort study. JAMA Dermatol 149:541\u2013547. https:\/\/doi.org\/10.1001\/jamadermatol.2013.2139","journal-title":"JAMA Dermatol"},{"key":"2082_CR33","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1001\/jamadermatol.2015.4994","volume":"152","author":"AK Thompson","year":"2016","unstructured":"Thompson AK, Kelley BF, Prokop LJ, Murad MH, Baum CL (2016) Risk factors for cutaneous squamous cell carcinoma recurrence, metastasis, and disease-specific death: a systematic review and meta-analysis. JAMA Dermatol 152:419\u2013428. https:\/\/doi.org\/10.1001\/jamadermatol.2015.4994","journal-title":"JAMA Dermatol"},{"key":"2082_CR34","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1016\/S1470-2045(05)70423-X","volume":"6","author":"JF Thompson","year":"2005","unstructured":"Thompson JF, Uren RF (2005) Lymphatic mapping in management of patients with primary cutaneous melanoma. Lancet Oncol 6:877\u2013885. https:\/\/doi.org\/10.1016\/S1470-2045(05)70423-X","journal-title":"Lancet Oncol"}],"container-title":["Archives of Dermatological Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00403-020-02082-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00403-020-02082-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00403-020-02082-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,7]],"date-time":"2021-05-07T23:47:40Z","timestamp":1620431260000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00403-020-02082-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,8]]},"references-count":34,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,3]]}},"alternative-id":["2082"],"URL":"https:\/\/doi.org\/10.1007\/s00403-020-02082-1","relation":{},"ISSN":["0340-3696","1432-069X"],"issn-type":[{"value":"0340-3696","type":"print"},{"value":"1432-069X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,8]]},"assertion":[{"value":"14 September 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 April 2020","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 April 2020","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 May 2020","order":4,"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 that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was approved by the Ethics Commission of the University of T\u00fcbingen (Project Number: 706\/2017BO2). The study was conducted in accordance with good clinical practice and the Declaration of Helsinki.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}