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Fig. 5 —Graph shows staging strategy preference as function of long-term quality-of-life sequelae from sentinel lymph node (SLN) biopsy and axillary lymph node dissection. Strategy preference was sensitive to utility adjustments that accounted for potential long-term adverse effects of SLN biopsy and axillary lymph node dissection. For most utility values considered, MR lymphangiography alone was preferred (MR lymphangiography had greater associated quality-adjusted life expectancy than other strategies and was not strongly or weakly dominated). If both procedural utility values were very high, combined MR lymphangiography and SLN biopsy was preferred. However, if post–SLN biopsy utilities were very high and if post–axillary lymph node dissection utilities were relatively slightly lower, SLN biopsy alone was preferred. Because of lack of published data to inform values, no utility adjustments were made in base-case analysis.