Axillary lymph nodes and breast cancer. A review

Abstract

Background. The value of surgical staging and treatment of the axillary lymph nodes with either surgery or radiotherapy in the initial management of patients with Stage I or II invasive breast cancer is controversial. Methods. A review of retrospective and prospective clinical studies was performed to assess the risks of axillary lymph node involvement and the effectiveness and morbidity of various treatment options. Results. The risk of axillary lymph node involvement is substantial for most patients, even those with small tumors. The morbidity resulting from a careful Level I/II axillary dissection or moderate‐dose axillary radiotherapy is limited. Such treatment is highly effective in preventing axillary recurrence. The symptoms resulting from axillary failure can be controlled in many, but not all, patients. The available data suggest, but do not prove, that the initial use of effective axillary treatment may result in a small improvement in long term outcome in some patient subgroups. Conclusions. Most patients should be treated with either axillary surgery or irradiation. Highly selected subgroups of patients may have such low risks of involvement that specific axillary treatment is of little value. However, such subgroups have not yet been well defined. Treatment approaches that do not involve specific axillary treatment should be considered investigational at present, and the patients should be informed as to their potential risks. Prospective clinical studies of these issues should be pursued. Cancer 1995; 76:1491–512.

200 Sentinel lymph node biopsies without axillary lymph node dissection – no axillary recurrences after a 3-year follow-up

“…This may be a rather short follow-up period, but in a study on outcome of axillary recurrences after ALND (Newman et al, 2000) a median time interval of 19 months for local recurrence after ALND is reported. Axillary recurrence after ALND ranges between 0 and 3% (Recht and Houlihan, 1995). We could observe no axillary recurrence in 200 patients with a median follow-up of 36 months after SLNB only.…”

Determination of sentinel lymph node (SLN) status in primary breast cancer by prospective use of immunohistochemistry increases the rate of micrometastases and isolated tumour cells: Analysis of 174 patients after SLN biopsy

“…Histopathological examination after surgical removal of at least ten axillary lymph nodes (ALN) is the standard staging procedure for determination of the axillary lymph node status (3). Today the sentinel lymph node (SLN) biopsy technique is introduced as an accurate staging procedure for small unifocal breast tumours with clinically negative axilla (4).…”

Late morbidity after treatment of breast cancer in relation to daily activities and quality of life: a systematic review

“…25,26 Axillary lymph node dissection is therefore an important diagnostic and treatment procedure. 27 This dissection may also result in long-term upper limb morbidity. 6,8,24,27±31 Recently the sentinel node procedure was introduced to reduce the number of unnecessary axillary lymph node dissections, and thereby reducing treatment morbidity from a complete axillary lymph node dissection.…”