Management of the axillary nodes.

Overview

The increasing use of screening mammography has resulted in the identification of smaller breast cancers with a lower risk of axillary node metastases than those seen in the past. In spite of this, imaging studies and currently availability prognostic markers cannot reliably identify those patients with axillary node disease. Although, in many cases, the need for adjuvant systemic therapy can be determined on the basis of primary tumor characteristics, knowledge of axillary node status remains the best predictor of the risk of breast cancer recurrence. Axillary dissection provides excellent local control, and may have a survival benefit for some patients, but these benefits are limited to patients with nodal involvement. Sentinel node biopsy has the potential to allow axillary dissection to be limited to patients with nodal involvement who will benefit from the procedure. The initial studies have proved that the status of the sentinel node reliably predicts the status of the remainder of the axillary nodes. The challenge for the future is to determine how to teach this procedure to large numbers of surgeons and to define its accuracy in a wider variety of clinical circumstances.