Axillary lymph node dissection: does it have a role in primary breast cancer?

The role of elective lymph node dissection has been increasingly questioned for the treatment of primary breast cancer. In an attempt to evaluate whether or not axillary lymph node dissection is of value in early breast cancer, a retrospective review of all breast cancers treated at Eisenhower Army Medical Center was conducted. During that time, 434 patients with breast cancer were treated. Eighty-six of those patients had lesions that were 2.0 cm or smaller. Eighty-one patients underwent axillary lymph node dissection. Twenty-four patients were found to have positive axillary nodes (28%). If the patients were further divided into those with lesions 1.0 centimeters or less versus 1.1-2.0 cm, the incidence of node positivity was 19 per cent and 35 per cent, respectively. Of the patients who underwent axillary lymph node dissection, 60 per cent of those whose lymph nodes were negative received no further treatment, whereas those whose lymph nodes were positive received additional therapy 92 per cent of the time. An additional 8 per cent of the node-negative patients received radiation therapy as the only added therapy after segmental mastectomy with axillary lymph node dissection. Our study demonstrates, or at least suggests, that node positivity did influence subsequent therapy. In addition, the relatively high incidence of positive axillary nodes (28%) in these early breast cancers supports the potential therapeutic benefit of axillary node dissection.