New concepts in Axillary Management of Breast cancer

Abstract

Background: In the last decades, surgical treatment of breast cancer has evolved from more extensive procedures like radical mastectomy to less invasive breast conserving surgery. Similarly, surgical management of axilla has enormously changed from routine axillary dissection to sentinel lymph node biopsy. Traditional surgical approach to the axilla in case of sentinel lymph node negativity is to avoid completion axillary dissection. However, surgeons even avoid performing axillary dissection in selected patients with positive sentinel lymph node in clinical practice depending on the recent randomized controlled studies supporting this concept. All of the recent changes in the management of positive axilla necessitate surgeons to refresh their knowledge on this challenging topic. Aim of the Work: This work aims to summarize new concepts in axillary management of breast cancer. Summary: Based on the considerations that we have summarized in this review, we strongly believe that the decision whether to omit or not ALND after a positive SLNB, even in patients who fulfill the criteria for ALND omission, be dealt by a multidisciplinary team at the time of surgical planning. Indeed, each specialist may influence the final outcome of axillary treatment, either by detecting positive axillary nodes at preoperative imaging (radiologist), or excising a larger number of sentinel nodes and clinically suspicious nonsentinel nodes (surgeon), or suggesting a high risk of nonsentinel node metastasis (pathologist), or requesting the total number of positive nodes for adjuvant treatment decisions (medical oncologist and radiotherapist). Key words: Breast Axailla – ALND – SLNB – Sentinle – Biopsy – Breast Cancer.