Changes in significance of axillary lymph node dissection for patients with breast cancer

Axillary lymph node dissection has been a routine part of breast cancer treatment for more than 100 years. As so few patients have been shown to have positive nodes, more consideration should be given to eliminating axillary node dissection for duct carcinoma in situ (DCIS) and T1a lesions. And for patients with T1/2N0M0 cancer of the breast, lumpectomy alone without axillary dissection followed by radiation therapy of the intact breast and regional lymph nodes should be a reasonable treatment without any arm morbidity. Between September 1989 and September 1994, we have treated 40 breast cancer patients with this method and no local recurrence nor distant metastasis has been encountered so far. Therefore, it is concluded that axillary dissection should be performed routinely only for N1b lesions and larger.