Role of axillary clearance for patients with sentinel node-positive early breast cancer.

摘要

Surgical techniques for early-stage breast cancer have become progressively less extensive in terms of both breast and axillary components. Despite the introduction of breast conservation surgery, axillary lymph node dissection (ALND) has remained standard treatment for women with node-positive disease detected clinically and/or confirmed pathologically, irrespective of the primary tumour characteristics. Removal of axillary nodes containing tumour foci provides regional control and may remove a potential source of distant metastases. The extent of nodal involvement has historically guided the choice of adjuvant therapies (including chemotherapy and radiotherapy) and is the single most important prognostic factor3. Increased rates of node negativity coupled with failure of ALND to confer any clear survival advantage have prompted exploration of less intrusive methods for surgical staging of the axilla. Sentinel lymph node (SLN) biopsy is widely practised. It is an accepted standard of care with level I evidence confirming that it is safe and effective for clinically node-negative disease.