[REGIONAL NODAL SURGERY IN THE MANAGEMENT OF BREAST CANCER]

Management of the regional lymph nodes is an essential element of breast cancer care and has changed dramatically over the years. At its beginning in the last century, radical axillary lymph node dissection was the only type of surgery accepted. Due to the high and significant morbidity associated with the radical procedure, the magnitude of the dissection was decreased by omitting level III resection. Nevertheless, the morbidity was still significant. With the beginning of mass screening along with improvements in the understanding of the biology of the disease and improvements in medical treatments and radiotherapy, the importance of axillary lymph node dissection decreased together with the decrease in the number of patients needing this procedure for node-positive disease. This prompted the development of sentinel lymph node biopsy as a more selective approach for defining the nodal status and need for dissection. The accuracy of sentinel lymph node biopsy was validated, omitting the need for axillary dissection in node-negative women, leaving the need for dissection mainly for locally advanced disease and following primary medical treatment. However, in recent years some new large scale controlled studies have shed further information that may permit avoiding axillary dissection in some node-negative patients and following neoadjuvant therapy for node-positive patients. Here, we will review the history of regional lymph node surgery and the modern approach in breast cancer.