{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T11:35:24Z","timestamp":1774438524366,"version":"3.50.1"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2000,2,1]],"date-time":"2000-02-01T00:00:00Z","timestamp":949363200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100006792","name":"The Lord Hartwell Fund","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006792","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010772","name":"Lady Sarah Percy Fund","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010772","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2000,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In the treatment of operable breast cancer by breast conservation, the extent of axillary dissection, the need for radiotherapy to the axilla and the morbidity associated with these procedures have not been assessed adequately.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Patients with operable breast cancer were randomized to have level III axillary node clearance (232 patients) or axillary node sample (234 patients). Radiotherapy to the axilla was given selectively. Radiotherapy was not given to those who had an axillary clearance. In the early part of the study all patients who had node sample were treated by radiotherapy (54 patients); subsequently this was modified to include only those who were node positive. The morbidity to the shoulder and arm was assessed before and after operation by measuring upper limb volume and circumference, and combined glenohumeral and scapular movement and muscle power.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Comparing the two surgical policies, no difference was found in local (axillary clearance 14 versus sample 15), axillary (eight versus seven) or distant (29 versus 29) recurrence. There was no statistically significant difference in 5-year survival rate (clearance 82\u00b71 versus sample 88\u00b76 per cent). Morbidity was least in those who had a node sample and no radiotherapy to the axilla. Radiotherapy to the axilla in patients who had a node sample resulted in a significant reduction in range of movement of the shoulder, e.g. mean(s.e.) 2\u00b72(0\u00b76) cm reduction in lateral rotation at 3 years. Surgical axillary clearance was associated with significant lymphoedema of the upper limb, e.g. 4\u00b71(0\u00b77) per cent increase in arm volume at 3 years.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>A selective policy for the management of the axilla is associated with no increase in axillary recurrence or mortality rate compared with routine axillary node clearance. Patients who are node negative after axillary sample can avoid radiotherapy or axillary clearance.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1046\/j.1365-2168.2000.01345.x","type":"journal-article","created":{"date-parts":[[2003,3,11]],"date-time":"2003-03-11T07:13:28Z","timestamp":1047366808000},"page":"163-169","source":"Crossref","is-referenced-by-count":110,"title":["Management of the axilla in operable breast cancer treated by breast conservation: a randomized clinical trial"],"prefix":"10.1093","volume":"87","author":[{"given":"U","family":"Chetty","sequence":"first","affiliation":[{"name":"Edinburgh Breast Unit, Western General Hospital , Edinburgh EH4 2XU,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W","family":"Jack","sequence":"additional","affiliation":[{"name":"Edinburgh Breast Unit, Western General Hospital , Edinburgh EH4 2XU,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R J","family":"Prescott","sequence":"additional","affiliation":[{"name":"Edinburgh Breast Unit, Western General Hospital , Edinburgh EH4 2XU,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C","family":"Tyler","sequence":"additional","affiliation":[{"name":"Edinburgh Breast Unit, Western General Hospital , Edinburgh EH4 2XU,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Rodger","sequence":"additional","affiliation":[{"name":"Edinburgh Breast Unit, Western General Hospital , Edinburgh EH4 2XU,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2000,2,1]]},"reference":[{"key":"2024093005140100400_bib1","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.1056\/NEJM199306033282202","article-title":"Radiotherapy after breast-preserving surgery in women with localized cancer of the breast","volume":"328","author":"Veronesi","year":"1993","journal-title":"N Engl J Med"},{"key":"2024093005140100400_bib2","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1056\/NEJM198903303201302","article-title":"Eight-year results of a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer","volume":"320","author":"Fisher","year":"1989","journal-title":"N Engl J Med"},{"key":"2024093005140100400_bib3","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1002\/1097-0142(19840301)53:5<1209::AID-CNCR2820530531>3.0.CO;2-Y","article-title":"Conservative treatment versus mastectomy in breast cancer tumors with macroscopic diameter of 20 millimetres or less","volume":"50","author":"Sarrazin","year":"1984","journal-title":"Cancer"},{"key":"2024093005140100400_bib4","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/0140-6736(91)92172-X","article-title":"The axilla: not a no-go zone","volume":"337","author":"Fentiman","year":"1991","journal-title":"Lancet"},{"key":"2024093005140100400_bib5","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1002\/1097-0142(19890101)63:1<181::AID-CNCR2820630129>3.0.CO;2-H","article-title":"Relation of tumor size, lymph node status and survival in 24 740 breast cancer cases","volume":"63","author":"Carter","year":"1989","journal-title":"Cancer"},{"key":"2024093005140100400_bib6","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/S0140-6736(80)92892-5","article-title":"Prediction of axillary metastases in breast cancer by lymphoscintigraphy","volume":"11","author":"Black","year":"1980","journal-title":"Lancet"},{"key":"2024093005140100400_bib7","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1038\/bjc.1998.21","article-title":"99mTc-labelled SM3 in the preoperative evaluation of axillary lymph nodes and primary breast cancer with change detection statistical processing as an aid to tumor detection","volume":"77","author":"Biassoni","year":"1998","journal-title":"Br J Cancer"},{"key":"2024093005140100400_bib8","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1016\/S0140-6736(84)92798-3","article-title":"Immunoscintigraphy for the detection of lymph node metastases from breast cancer","volume":"ii","author":"Thompson","year":"1984","journal-title":"Lancet"},{"key":"2024093005140100400_bib9","first-page":"1600","article-title":"Immunolymphoscintigraphy for the detection of lymph node metastases from breast cancer","volume":"49","author":"Tjandra","year":"1989","journal-title":"Cancer Res"},{"key":"2024093005140100400_bib10","first-page":"55","article-title":"Studies of breast cancer imaging with radiolabeled antibodies to carcinoembryonic antigen. 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