title: Axillary nodal yields: a comparison between primary clearance and completion clearance after sentinel lymph node biopsy in the management of breast cancer.
abstract: OBJECTIVE
  Axillary nodal status is the most important prognostic indicator which in turn influences adjuvant therapy and long term outcomes. The aim of this study was to compare total nodal yields from primary axillary lymph node dissection (pALND) with completion ALND after a cancer positive SLNB: either concurrently (cALND) following intra-operative assessment (IOA) of the SLN's or as a delayed procedure (dALND) when the SLN was found to be cancer positive on post-operative histological examination.
  
  
  METHODS
  All axillary procedures performed between May 2006 and September 2009 were identified from a prospective database and categorised into four groups: SLNB with no further axillary surgery, pALND, cALND and dALND. Total nodal yield was the sum of SLN/s and ALND yields.
  
  
  RESULTS
  Of 1025 axillary procedures, ALND accounted for 332 (32.4%) of which 207 (62.3%) underwent pALND, 43 (12.9%) cALND, and 82 (24.6%) dALND. Median nodal yields were 15.0, 16.0 and 14.5 respectively (p = 0.3).
  
  
  CONCLUSIONS
  Total nodal yields for primary, concurrent and delayed ALND were comparable suggesting completion dALND performed as a second operation does not compromise axillary staging.
authors.affiliation: Academic Surgical Unit, The Royal Marsden Hospital, London, UK. arunmoy@aol.com
authors.forename: A
authors.initials: A
authors.lastname: Chakravorty
authors.forename: N
authors.initials: N
authors.lastname: Sanmugalingam
authors.forename: A
authors.initials: A
authors.lastname: Shrestha
authors.forename: E
authors.initials: E
authors.lastname: Thomee
authors.forename: J
authors.initials: J
authors.lastname: Rusby
authors.forename: N
authors.initials: N
authors.lastname: Roche
authors.forename: F
authors.initials: F
authors.lastname: MacNeill
mesh_terms: D001365:Axilla / Q000601:surgery; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D021701:Sentinel Lymph Node Biopsy