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Original Article |
1 Research and Development Department, Lincoln County Hospital, Greetwell Road, Lincoln LN2 5QY, UK
2 Department of Clinical Oncology, Lincoln County Hospital, Lincoln LN2 5QY, UK
3 Lincoln Breast Unit, Lincoln County Hospital, Lincoln LN2 5QY, UK
4 Faculty of Health, Life and Social Sciences Department, University of Lincoln, Lincoln LN6 7TS, UK
5 Division of Surgery, Queen’s Medical Center, Nottingham NG7 2UH, UK
Correspondence: Address correspondence and reprint requests to: Srila Samphao, MD, FRCST; E-mail: ssamphao{at}hotmail.com
Background: Axillary nodal status is the most important prognostic factor for patients with breast cancer. Clinical assessment and imaging modalities are not always reliable. Surgical removal and histopathological examination of axillary lymph nodes remain essential methods of staging the axilla. However, the optimal management of the axilla remains uncertain.
Methods: We performed Medline searches to identify relevant systematic reviews, meta-analysis, and nonrandomized and randomized controlled trials for the past 5 years (up to December 2007), as well as important historical articles and clinical guidelines relating to management of the axilla in women with breast cancer.
Results: Axillary lymph node dissection (ALND) has been the standard surgical approach for many years. It is, however, associated with marked morbidity; survival benefit remains uncertain. Axillary node sampling, widely practiced in the United Kingdom, is a reliable alternative procedure in staging the axilla, with less morbidity. Sentinel lymph node biopsy (SLNB) has become an accurate method for staging the axilla in women with operable, clinically node-negative breast cancer. SLNB alone appears to be a safe and acceptable procedure for patients with uninvolved SLNs. Completion ALND or axillary radiotherapy remains the standard treatment for patients with tumor-involved SLNs. SLNB is associated with less morbidity than ALND. However, long-term follow-up and therapeutic outcomes are being awaited from randomized controlled trials.
Conclusions: Several procedures are available for staging and treating the axilla. A tailored surgical approach, with careful assessment of risk-benefit and patient preference, is guiding the evolving modern management of the axilla for women with breast cancer.
Key Words: Breast cancer • Axillary lymph node dissection • Sentinel lymph node biopsy • Lymphatic mapping • Radiotherapy
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