Axillary Reverse Mapping: Five Year Experience
Identifieur interne : 001D30 ( Pmc/Checkpoint ); précédent : 001D29; suivant : 001D31Axillary Reverse Mapping: Five Year Experience
Auteurs : Daniela Ochoa [États-Unis] ; Soheila Korourian [États-Unis] ; Cristiano Boneti [États-Unis] ; Laura Adkins [États-Unis] ; Brian Badgwell ; V. Suzanne Klimberg [États-Unis]Source :
- Surgery [ 0039-6060 ] ; 2014.
Abstract
We hypothesize that mapping the lymphatic drainage of the arm with blue dye (axillary reverse mapping, ARM) during axillary lymphadenectomy decreases the likelihood of disruption of lymphatics and subsequent lymphedema.
This institutional review board-approved study from May 2006 to October 2011 involved 360 patients undergoing SLNB and/or ALND. Technetium sulfur colloid (4 mL) was injected subareolarly and 5 mL of blue dye was injected subcutaneously in the volar surface ipsilateral upper extremity (ARM). Data were collected on variations in lymphatic drainage, successful identification and protection of arm lymphatics, crossover, and occurrence of lymphedema.
A group of 360 patients underwent SLNB and/or ALND. A total of 348 patients underwent a SLNB. Of those, 237/348(68.1%) had a SLNB only and 111/348(31.9%) went on to an ALND due to a positive axilla. An additional 12/360(3.3%) axilla had ALND due to a clinically positive axilla/preoperative core needle biopsy. In 96%(334/348) of patients with SLNB, breast SLNs were hot but not blue; crossover (SLN hot and blue) was seen in 14/348(4%). Blue lymphatics were identified in 80/237(33.7%) of SLN incisions and in 93/123(75.4%) ALND. Average follow-up was 12 months (range 3 to 48 months) and resulted in a SLNB lymphedema rate of 1.7%(4/237) and ALND of 2.4%(3/123).
ARM identified significant lymphatic variations draining the upper extremities and facilitated preservation. Metastases in ARM-identified lymph nodes were acceptably low indicating that ARM is safe. ARM added to present-day ALND and SLNB may be useful to lower lymphedema rates.
Url:
DOI: 10.1016/j.surg.2014.05.011
PubMed: 25444319
PubMed Central: 4354953
Affiliations:
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Rockefeller Institute, Little Rock, Arkansas</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Arkansas</region></placeName><wicri:cityArea>Department of Pathology, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Institute, Little Rock</wicri:cityArea></affiliation></author><author><name sortKey="Boneti, Cristiano" sort="Boneti, Cristiano" uniqKey="Boneti C" first="Cristiano" last="Boneti">Cristiano Boneti</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Surgery, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Institute, Little Rock, Arkansas</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Arkansas</region></placeName><wicri:cityArea>Department of Surgery, University of Arkansas for Medical Sciences and the Winthrop P. 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Rockefeller Institute, Little Rock, Arkansas</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Arkansas</region></placeName><wicri:cityArea>Department of Surgery, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Institute, Little Rock</wicri:cityArea></affiliation></author><author><name sortKey="Korourian, Soheila" sort="Korourian, Soheila" uniqKey="Korourian S" first="Soheila" last="Korourian">Soheila Korourian</name><affiliation wicri:level="2"><nlm:aff id="A2">Department of Pathology, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Institute, Little Rock, Arkansas</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Arkansas</region></placeName><wicri:cityArea>Department of Pathology, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Institute, Little Rock</wicri:cityArea></affiliation></author><author><name sortKey="Boneti, Cristiano" sort="Boneti, Cristiano" uniqKey="Boneti C" first="Cristiano" last="Boneti">Cristiano Boneti</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Surgery, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Institute, Little Rock, Arkansas</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Arkansas</region></placeName><wicri:cityArea>Department of Surgery, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Institute, Little Rock</wicri:cityArea></affiliation></author><author><name sortKey="Adkins, Laura" sort="Adkins, Laura" uniqKey="Adkins L" first="Laura" last="Adkins">Laura Adkins</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Surgery, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Institute, Little Rock, Arkansas</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Arkansas</region></placeName><wicri:cityArea>Department of Surgery, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Institute, Little Rock</wicri:cityArea></affiliation></author><author><name sortKey="Badgwell, Brian" sort="Badgwell, Brian" uniqKey="Badgwell B" first="Brian" last="Badgwell">Brian Badgwell</name><affiliation><nlm:aff id="A3">Department of Surgical Oncology, M.D. Anderson Cancer Center</nlm:aff><wicri:noCountry code="subfield">M.D. Anderson Cancer Center</wicri:noCountry></affiliation></author><author><name sortKey="Klimberg, V Suzanne" sort="Klimberg, V Suzanne" uniqKey="Klimberg V" first="V. Suzanne" last="Klimberg">V. Suzanne Klimberg</name><affiliation wicri:level="2"><nlm:aff id="A1">Department of Surgery, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Institute, Little Rock, Arkansas</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Arkansas</region></placeName><wicri:cityArea>Department of Surgery, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Institute, Little Rock</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff id="A2">Department of Pathology, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Institute, Little Rock, Arkansas</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Arkansas</region></placeName><wicri:cityArea>Department of Pathology, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Institute, Little Rock</wicri:cityArea></affiliation></author></analytic><series><title level="j">Surgery</title><idno type="ISSN">0039-6060</idno><idno type="eISSN">1532-7361</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>BACKGROUND</title><p id="P1">We hypothesize that mapping the lymphatic drainage of the arm with blue dye (axillary reverse mapping, ARM) during axillary lymphadenectomy decreases the likelihood of disruption of lymphatics and subsequent lymphedema.</p></sec><sec id="S2"><title>METHODS</title><p id="P2">This institutional review board-approved study from May 2006 to October 2011 involved 360 patients undergoing SLNB and/or ALND. Technetium sulfur colloid (4 mL) was injected subareolarly and 5 mL of blue dye was injected subcutaneously in the volar surface ipsilateral upper extremity (ARM). Data were collected on variations in lymphatic drainage, successful identification and protection of arm lymphatics, crossover, and occurrence of lymphedema.</p></sec><sec id="S3"><title>RESULTS</title><p id="P3">A group of 360 patients underwent SLNB and/or ALND. A total of 348 patients underwent a SLNB. Of those, 237/348(68.1%) had a SLNB only and 111/348(31.9%) went on to an ALND due to a positive axilla. An additional 12/360(3.3%) axilla had ALND due to a clinically positive axilla/preoperative core needle biopsy. In 96%(334/348) of patients with SLNB, breast SLNs were hot but not blue; crossover (SLN hot and blue) was seen in 14/348(4%). Blue lymphatics were identified in 80/237(33.7%) of SLN incisions and in 93/123(75.4%) ALND. Average follow-up was 12 months (range 3 to 48 months) and resulted in a SLNB lymphedema rate of 1.7%(4/237) and ALND of 2.4%(3/123).</p></sec><sec id="S4"><title>CONCLUSIONS</title><p id="P4">ARM identified significant lymphatic variations draining the upper extremities and facilitated preservation. Metastases in ARM-identified lymph nodes were acceptably low indicating that ARM is safe. ARM added to present-day ALND and SLNB may be useful to lower lymphedema rates.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Ivens, D" uniqKey="Ivens D">D Ivens</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Somers, Rg" uniqKey="Somers R">RG Somers</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Passik, Sd" uniqKey="Passik S">SD Passik</name></author><author><name sortKey="Mcdonald, Mv" uniqKey="Mcdonald M">MV McDonald</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tobin, Mb" uniqKey="Tobin M">MB Tobin</name></author><author><name sortKey="Lacey, Hj" uniqKey="Lacey H">HJ Lacey</name></author><author><name sortKey="Meyer, L" uniqKey="Meyer L">L Meyer</name></author><author><name sortKey="Mortimer, Ps" uniqKey="Mortimer P">PS Mortimer</name></author></analytic></biblStruct><biblStruct><analytic><author><name 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<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">0417347</journal-id><journal-id journal-id-type="pubmed-jr-id">7662</journal-id><journal-id journal-id-type="nlm-ta">Surgery</journal-id><journal-id journal-id-type="iso-abbrev">Surgery</journal-id><journal-title-group><journal-title>Surgery</journal-title></journal-title-group><issn pub-type="ppub">0039-6060</issn><issn pub-type="epub">1532-7361</issn></journal-meta><article-meta><article-id pub-id-type="pmid">25444319</article-id><article-id pub-id-type="pmc">4354953</article-id><article-id pub-id-type="doi">10.1016/j.surg.2014.05.011</article-id><article-id pub-id-type="manuscript">NIHMS661681</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Axillary Reverse Mapping: Five Year Experience</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Ochoa</surname><given-names>Daniela</given-names></name><degrees>M.D.</degrees><xref ref-type="aff" rid="A1">1</xref><xref ref-type="fn" rid="FN2">*</xref></contrib><contrib contrib-type="author"><name><surname>Korourian</surname><given-names>Soheila</given-names></name><degrees>M.D.</degrees><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Boneti</surname><given-names>Cristiano</given-names></name><degrees>M.D.</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Adkins</surname><given-names>Laura</given-names></name><degrees>MS.</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Badgwell</surname><given-names>Brian</given-names></name><degrees>M.D., MPH</degrees><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Klimberg</surname><given-names>V. Suzanne</given-names></name><degrees>M.D.</degrees><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A2">2</xref><xref ref-type="fn" rid="FN3">**</xref></contrib></contrib-group><aff id="A1"><label>1</label>Department of Surgery, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Institute, Little Rock, Arkansas</aff><aff id="A2"><label>2</label>Department of Pathology, University of Arkansas for Medical Sciences and the Winthrop P. Rockefeller Institute, Little Rock, Arkansas</aff><aff id="A3"><label>3</label>Department of Surgical Oncology, M.D. Anderson Cancer Center</aff><author-notes><corresp id="cor1"><bold>Address for correspondence</bold>: V. Suzanne Klimberg, MD, Rockefeller Cancer Institute, UAMS, Slot 725, Little Rock, Arkansas 72212, <email>klimbergsuzanne@uams.edu</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>25</day><month>2</month><year>2015</year></pub-date><pub-date pub-type="epub"><day>17</day><month>10</month><year>2014</year></pub-date><pub-date pub-type="ppub"><month>11</month><year>2014</year></pub-date><pub-date pub-type="pmc-release"><day>01</day><month>11</month><year>2015</year></pub-date><volume>156</volume><issue>5</issue><fpage>1261</fpage><lpage>1268</lpage><pmc-comment>elocation-id from pubmed: 10.1016/j.surg.2014.05.011</pmc-comment>
<permissions><copyright-statement>© 2014 Published by Mosby, Inc.</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/4.0/"><license-p>This manuscript version is made available under the
CC BY-NC-ND 4.0 license.</license-p></license></permissions><abstract><sec id="S1"><title>BACKGROUND</title><p id="P1">We hypothesize that mapping the lymphatic drainage of the arm with blue dye (axillary reverse mapping, ARM) during axillary lymphadenectomy decreases the likelihood of disruption of lymphatics and subsequent lymphedema.</p></sec><sec id="S2"><title>METHODS</title><p id="P2">This institutional review board-approved study from May 2006 to October 2011 involved 360 patients undergoing SLNB and/or ALND. Technetium sulfur colloid (4 mL) was injected subareolarly and 5 mL of blue dye was injected subcutaneously in the volar surface ipsilateral upper extremity (ARM). Data were collected on variations in lymphatic drainage, successful identification and protection of arm lymphatics, crossover, and occurrence of lymphedema.</p></sec><sec id="S3"><title>RESULTS</title><p id="P3">A group of 360 patients underwent SLNB and/or ALND. A total of 348 patients underwent a SLNB. Of those, 237/348(68.1%) had a SLNB only and 111/348(31.9%) went on to an ALND due to a positive axilla. An additional 12/360(3.3%) axilla had ALND due to a clinically positive axilla/preoperative core needle biopsy. In 96%(334/348) of patients with SLNB, breast SLNs were hot but not blue; crossover (SLN hot and blue) was seen in 14/348(4%). Blue lymphatics were identified in 80/237(33.7%) of SLN incisions and in 93/123(75.4%) ALND. Average follow-up was 12 months (range 3 to 48 months) and resulted in a SLNB lymphedema rate of 1.7%(4/237) and ALND of 2.4%(3/123).</p></sec><sec id="S4"><title>CONCLUSIONS</title><p id="P4">ARM identified significant lymphatic variations draining the upper extremities and facilitated preservation. Metastases in ARM-identified lymph nodes were acceptably low indicating that ARM is safe. ARM added to present-day ALND and SLNB may be useful to lower lymphedema rates.</p></sec></abstract><kwd-group><kwd>breast</kwd><kwd>breast cancer</kwd><kwd>lymphadenectomy</kwd><kwd>sentinel</kwd><kwd>axillary reverse mapping</kwd></kwd-group></article-meta></front><floats-group><fig id="F1" orientation="portrait" position="float"><label>Figure 1</label><caption><p id="P34">Confluence of breast and ARM lymphatics typically seen at level III, but variations may place ARM lymphatics within operative field of dissection (Level I or II) or in juxtaposition to SLN. RA=radioactive.</p></caption><graphic xlink:href="nihms661681f1"></graphic></fig><fig id="F2" orientation="portrait" position="float"><label>Figure 2</label><caption><p id="P35">Blue node seen juxtaposed to radioactive SLN (identified by gamma probe and in Babcock) without crossover and able to be spared. Afferent blue lymphatic seen connecting to blue node as well.</p></caption><graphic xlink:href="nihms661681f2"></graphic></fig><table-wrap id="T1" position="float" orientation="landscape"><label>Table</label><caption><p id="P36">Summary Comparison of ARM publications.</p></caption><table frame="box" rules="all"><thead><tr><th align="left" rowspan="1" colspan="1"></th><th align="left" rowspan="1" colspan="1">N of<break></break>pts</th><th align="left" valign="top" rowspan="1" colspan="1">SLNB</th><th align="left" valign="top" rowspan="1" colspan="1">ALND</th><th align="left" rowspan="1" colspan="1">Blue lymphatics or<break></break>nodes ID</th><th align="left" rowspan="1" colspan="1">N nodes<break></break>resected</th><th align="left" rowspan="1" colspan="1">ARM nodes<break></break>removed</th><th align="left" valign="top" rowspan="1" colspan="1">ARM nodes +</th><th align="left" valign="top" rowspan="1" colspan="1">Crossover</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Thompson<break></break>Jun 2007 <sup><xref rid="R34" ref-type="bibr">34</xref></sup></td><td align="left" valign="top" rowspan="1" colspan="1">40</td><td align="left" valign="top" rowspan="1" colspan="1">36</td><td align="left" valign="top" rowspan="1" colspan="1">18</td><td align="left" valign="top" rowspan="1" colspan="1">61% (11/18) with<break></break>ALND</td><td align="left" valign="top" rowspan="1" colspan="1">12.5</td><td align="left" valign="top" rowspan="1" colspan="1">7 nodes</td><td align="left" valign="top" rowspan="1" colspan="1">0</td><td align="left" valign="top" rowspan="1" colspan="1">0</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Nos Sep<break></break>2008 <sup><xref rid="R54" ref-type="bibr">54</xref></sup></td><td align="left" valign="top" rowspan="1" colspan="1">23</td><td align="left" valign="top" rowspan="1" colspan="1">-</td><td align="left" valign="top" rowspan="1" colspan="1">23</td><td align="left" valign="top" rowspan="1" colspan="1">91% (21/23)</td><td align="left" valign="top" rowspan="1" colspan="1">10.7</td><td align="left" valign="top" rowspan="1" colspan="1">1.6(21<break></break>cases)</td><td align="left" valign="top" rowspan="1" colspan="1">14% (3/21) all in N=>9;<break></break>Radioactivity to ID ARM<break></break>+Blue dye in node</td><td align="left" valign="top" rowspan="1" colspan="1">-</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Kang Dec<break></break>2008 <sup><xref rid="R53" ref-type="bibr">53</xref></sup></td><td align="left" valign="top" rowspan="1" colspan="1">129</td><td align="left" valign="top" rowspan="1" colspan="1">124</td><td align="left" valign="top" rowspan="1" colspan="1">48</td><td align="left" valign="top" rowspan="1" colspan="1">71.6% (58/81) SLN<break></break>field<break></break>89.5% (43/48)<break></break>ALND</td><td align="left" valign="top" rowspan="1" colspan="1">-</td><td align="left" valign="top" rowspan="1" colspan="1">1.5 (96 SLNB<break></break>cases and 5<break></break>ALND cases</td><td align="left" valign="top" rowspan="1" colspan="1">36% (7/19) when there<break></break>is crossover<break></break>1.3% (1/77) in<break></break>nonconcordant axilla</td><td align="left" valign="top" rowspan="1" colspan="1">18.9%<break></break>(19/96)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Casabona<break></break>Jun 2009 <sup><xref rid="R55" ref-type="bibr">55</xref></sup></td><td align="left" valign="top" rowspan="1" colspan="1">72</td><td align="left" valign="top" rowspan="1" colspan="1">72</td><td align="left" valign="top" rowspan="1" colspan="1">9</td><td align="left" valign="top" rowspan="1" colspan="1">37.5% (27/72) in<break></break>the SLN field<break></break><break></break>88.9% (8/9) in<break></break>ALND</td><td align="left" valign="top" rowspan="1" colspan="1">SLNB<break></break>1.3<break></break><break></break>ALND 16</td><td align="left" valign="top" rowspan="1" colspan="1">3 nodes</td><td align="left" valign="top" rowspan="1" colspan="1">0</td><td align="left" valign="top" rowspan="1" colspan="1">-</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Boneti Oct<break></break>2009 <sup><xref rid="R33" ref-type="bibr">33</xref></sup></td><td align="left" valign="top" rowspan="1" colspan="1">220</td><td align="left" valign="top" rowspan="1" colspan="1">214</td><td align="left" valign="top" rowspan="1" colspan="1">40</td><td align="left" valign="top" rowspan="1" colspan="1">40.6% (87/214) in<break></break>the SLN field</td><td align="left" valign="top" rowspan="1" colspan="1">12.7</td><td align="left" valign="top" rowspan="1" colspan="1">15</td><td align="left" valign="top" rowspan="1" colspan="1">0</td><td align="left" valign="top" rowspan="1" colspan="1">2.8%<break></break>(6/214)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Ponzone<break></break>Nov 2009 <sup><xref rid="R56" ref-type="bibr">56</xref></sup></td><td align="left" valign="top" rowspan="1" colspan="1">49</td><td align="left" valign="top" rowspan="1" colspan="1">6 of<break></break>49</td><td align="left" valign="top" rowspan="1" colspan="1">49<break></break>43 Ø<break></break>Tc</td><td align="left" valign="top" rowspan="1" colspan="1">73.5% (34/49) ID<break></break>blue Lymphatics <break></break>55.1% (27/49) ID<break></break>blue nodes</td><td align="left" valign="top" rowspan="1" colspan="1">-</td><td align="left" valign="top" rowspan="1" colspan="1">27 cases</td><td align="left" valign="top" rowspan="1" colspan="1">3 cases (18, 18 and 7 +<break></break>LNs, respectively)</td><td align="left" valign="top" rowspan="1" colspan="1">-</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Noguchi<break></break>Mar 2010 <sup><xref rid="R57" ref-type="bibr">57</xref></sup></td><td align="left" valign="middle" rowspan="1" colspan="1">20</td><td align="left" valign="top" rowspan="1" colspan="1">12</td><td align="left" valign="top" rowspan="1" colspan="1">8</td><td align="left" valign="top" rowspan="1" colspan="1">ALND 88% (7/8)<break></break>SLNB 75% (9/12)</td><td align="left" valign="top" rowspan="1" colspan="1">23</td><td align="left" valign="top" rowspan="1" colspan="1">All cases<break></break>average 2.7</td><td align="left" valign="top" rowspan="1" colspan="1">None in the SLN group;<break></break>43% of ALND (3/8) (3,<break></break>13, 14+LNs) No Isotope</td><td align="left" valign="top" rowspan="1" colspan="1">14%<break></break>(2/14)</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Bedrosian<break></break>Jun 2010 <sup><xref rid="R58" ref-type="bibr">58</xref></sup></td><td align="left" valign="top" rowspan="1" colspan="1">30</td><td align="left" valign="top" rowspan="1" colspan="1">-</td><td align="left" valign="top" rowspan="1" colspan="1">30</td><td align="left" valign="top" rowspan="1" colspan="1">70% (21/30)<break></break>lymphatic<break></break>50% (15/30)nodes</td><td align="left" valign="top" rowspan="1" colspan="1">26</td><td align="left" valign="top" rowspan="1" colspan="1">1 av</td><td align="left" valign="top" rowspan="1" colspan="1">18% (2/11 with mets)<break></break>No isotope used to<break></break>detect crossover</td><td align="left" valign="top" rowspan="1" colspan="1">-</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">Ochoa<break></break>2012</td><td align="left" valign="top" rowspan="1" colspan="1">360</td><td align="left" valign="top" rowspan="1" colspan="1">237</td><td align="left" valign="top" rowspan="1" colspan="1">123</td><td align="left" valign="top" rowspan="1" colspan="1">80/237(33.7%)<break></break>SLN;<break></break>93/123 (75.4%)<break></break>ALND</td><td align="left" valign="top" rowspan="1" colspan="1">-</td><td align="left" valign="top" rowspan="1" colspan="1">27 cases</td><td align="left" valign="top" rowspan="1" colspan="1">5/27(18.5%)</td><td align="left" valign="top" rowspan="1" colspan="1">4.3%<break></break>(15/348)</td></tr></tbody></table></table-wrap></floats-group></pmc><affiliations><list><country><li>États-Unis</li></country><region><li>Arkansas</li></region></list><tree><noCountry><name sortKey="Badgwell, Brian" sort="Badgwell, Brian" uniqKey="Badgwell B" first="Brian" last="Badgwell">Brian Badgwell</name></noCountry><country name="États-Unis"><region name="Arkansas"><name sortKey="Ochoa, Daniela" sort="Ochoa, Daniela" uniqKey="Ochoa D" first="Daniela" last="Ochoa">Daniela Ochoa</name></region><name sortKey="Adkins, Laura" sort="Adkins, Laura" uniqKey="Adkins L" first="Laura" last="Adkins">Laura Adkins</name><name sortKey="Boneti, Cristiano" sort="Boneti, Cristiano" uniqKey="Boneti C" first="Cristiano" last="Boneti">Cristiano Boneti</name><name sortKey="Klimberg, V Suzanne" sort="Klimberg, V Suzanne" uniqKey="Klimberg V" first="V. Suzanne" last="Klimberg">V. Suzanne Klimberg</name><name sortKey="Klimberg, V Suzanne" sort="Klimberg, V Suzanne" uniqKey="Klimberg V" first="V. Suzanne" last="Klimberg">V. Suzanne Klimberg</name><name sortKey="Korourian, Soheila" sort="Korourian, Soheila" uniqKey="Korourian S" first="Soheila" last="Korourian">Soheila Korourian</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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