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ALMANAC is the name of a major breast cancer
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...

 trial. The acronym stands for "Axillary Lymphatic Mapping Against Nodal Axillary Clearance." This major randomized trial performed in several centres in the UK
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...

 produced clear evidence that sentinel node biopsy (SNB), used to stage axillary spread of disease, can be used with low failed localization and false negative rates, provided both radioisotope and blue dye are used to locate the sentinel nodes.

Compared to standard axillary management, SNB results in greatly decreased arm problems and increased quality of life, without any increase in cancer-related anxiety. There is no evidence of a difference in local recurrence rates, though longer-term evidence on this is awaited from other studies.