[Breast cancer: can axillary dissection be restricted to Berg stages 1 and 2? Study of 895 cases]

895 axillary clearances were carried out in 3 years between 1986 and 1988 on 878 patients with primary breast cancer. Two procedures were used: either direct total axillary clearance (in stages 1, 2 and 3 of Berg) or inferior axillary clearance (stages 1 and 2 of Berg). This was carried out in association with frozen section diagnosis of the lymph node followed by clearance in Berg stage 3 if the diagnosis on frozen section was positive. The authors found a higher frequency of late complications, particularly of arm lymphoedema in patients who had complete axillary clearance than in patients who only had an inferior axillary clearance. The survival rate actuarilly calculated was not significantly different in the two groups of patients. The carrying out of total axillary clearance was "beneficial" for only 3 patients who had negative inferior axillary clearance and positive sub-clavicular clearance. Finally the frozen section diagnosis of the state of the axillary nodes shown to be correct (specificity -99% and sensitivity -76%) but it was difficult to carry out routinely.