Omission of Axillary Dissection with Breast Conservation in Early Breast Cancer

Abstract

xillary lymph node dissection (ALND) has been an integral part of the surgical treatment of breast cancer since the popularization of the radical mastectomy by William Halsted in 1894. It was suggested that breast cancer first spreads locoregionally via lymphatics to the axillary lymph nodes and then metastasizes more distantly. The role of ALND in survival of breast cancer patients has been a subject of debate. The status of the axillary nodes has long been considered to be the strongest prognostic factor in breast cancer and one of the most important determinants in the decision to use adjuvant systemic chemotherapy. However, as further understanding of breast tumor biology has been gained, the recommendation for adjuvant systemic therapy has shifted from nodal status as the major factor to other indicators of outcome such as tumor size, grade, receptor status, and breast cancer subtype. Acceptance of the SLN procedure as a standard approach in surgical management raises the question of whether complete ALND is necessary in all patients with positive SLN. It has been shown that SLN is the only positive lymph node in 38-67 % of patients when ALND followed . This finding not only provides strong support for the SLN concept, but also suggests that unnecessary ALND can be avoided in patients with T1 tumor, because removal of negative lymph nodes does not provide any significant benefit.