A Multidisciplinary Approach to Locoregional Management of the Axilla for Primary Operable Breast Cancer

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Abstract
Background: Lymph node metastasis is the single most important factor in assessing breast cancer prognosis and planning systemic therapy. However, lymph node dissection portends significant morbidity, with little or no therapeutic benefit if the nodes prove to be negative for cancer. Methods: The authors review indications for avoiding axillary dissection, and they analyze the results from lower-level axillary lymphadenectomy together with the morbidity from full axillary dissection. Results: Limited level I dissection depends on surgical technique and limits prognostic information. Three approaches have evolved to identify the sentinel node in breast cancer: perilesional breast injection of radiocolloid alone, blue dye alone, or a combination of radiocolloid and blue dye. These techniques provide high diagnostic accuracy, few false-negative results, and less morbidity. Conclusions: Knowledge of axillary status is critical to current breast cancer management and cannot be foregone in the preponderance of patients with advanced breast cancer. Results from lymphatic mapping and sentinel node biopsy are highly encouraging.