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ALMANAC is the name of a major breast cancer trial. It stands for "Axillary Lymphatic Mapping Against Nodal Axillary Clearance." This major randomised trial performed in several centres in the UK produced clear evidence that sentinel node biopsy (SNB), used to stage axillary spread of disease, can be used with low failed localisation 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.

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