Simple mastectomy and axillary node sampling (pectoral node biopsy) in the management of primary breast cancer

Axillary node sampling was introduced as a means of defining those patients whose primary breast cancer was treated by simple mastectomy in whom postoperative radiotherapy could be avoided safely. The authors have initiated controlled randomized trials in Cardiff and Edinburgh which have indicated that, provided that nodes are identified for histologic examination, simple mastectomy, node sampling, and selective radiotherapy give equal survival rates to routine radical treatment, whether this is by surgery or radiotherapy. Provided sampling of nodes is adequate and histologically proven, locoregional control also is satisfactory. A current randomized trial comparing this policy with Patey mastectomy has allowed comparative studies of axillary node status. These and follow-up data indicate that for a valid assessment, three to four nodes should be identified by the surgeon for histologic examination, the false negative rate being less than 10%.