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Axillary dissection over the years: where to from here?
1Academic Department of Surgery, Royal Free and University College Medical School, 67-73 Riding House Street, London W1P 7LD, UK.
World Journal of Surgery
|May 29, 2001
Summary
Axillary lymph node dissection (ALND) in breast cancer management causes significant morbidity, even in node-negative patients. Sentinel node biopsy offers a less invasive alternative for axillary staging.
Area of Science:
- Oncology
- Surgical Oncology
- Breast Cancer Research
Background:
- Axillary lymph node status is a critical prognostic indicator in breast cancer.
- Axillary lymph node dissection (ALND) has been a standard but controversial procedure for over a century.
- Significant morbidity and cost are associated with ALND, particularly in node-negative patients (up to 70% of T1/T2 tumors).
Purpose of the Study:
- To re-evaluate axillary management strategies in breast carcinoma.
- To incorporate findings from global sentinel node biopsy trials.
- To propose an updated management plan for the breast cancer axilla.
Main Methods:
- Review of historical milestones in axillary management.
- Analysis of various modalities used for axillary staging.
- Discussion of the sentinel node biopsy (SNB) concept for breast carcinoma.
Main Results:
- ALND is often performed unnecessarily in node-negative breast cancer patients.
- Over 50% of node-negative patients experience ALND-related morbidity.
- The morbidity and cost of ALND can exceed that of primary tumor treatment.
Conclusions:
- The current approach to axillary management requires re-evaluation.
- Sentinel node biopsy presents a less morbid alternative for staging.
- An updated, evidence-based management plan is proposed.