Article of the Month -- April 1997

THE ROLE OF AXILLARY DISSECTION IN MAMMOGRAPHICALLY DETECTED CARCINOMA

Steven M. Pandelidis, MD,* Kristi L. Peters, MS,† Mbaga S. Walusimbi, MD,* Roger L. Casady, MD,* Shelli V. Laux, RRA, CTR,‡ Sally H. Cavanaugh, PhD,† and Thomas L. Bauer, MD, FACS*

CONCLUSIONS
Patients with ductal carcinoma in situ and microscopic invasive tumors do not require node dissections. Possibly patients with T1a tumors and patients with well-differentiated, estrogen-receptor positive, progesterone-receptor positive, T1b tumors can also be spared axillary node dissection. By following this approach on occasion, patients with positive nodes might not undergo axillary lymph node dissection, but they may still be offered adjuvant therapy. J. Am. Coll. Surg., 1997, 184: 341-345.

Axillary lymph node dissection is traditionally a necessary component of the treatment of carcinoma of the breast. Knowledge of the status of the lymph nodes aids in prognosis and helps determine the need for adjuvant chemotherapy or adjuvant hormonal therapy. Additionally, the resection of involved lymph nodes may effect a surgical cure, without the aid of adjuvant therapy (1, 2).

The widespread use of mammography has resulted in the detection of small and even microscopic invasive tumors (3, 4). In our previously reported series, axillary lymph nodes contained metastases in only 11.6 percent of all cases (4).

Before 1989, chemotherapy usually was not offered to patients with axillary lymph nodes that were negative for metastases. The results of the National Surgical Adjuvant Breast and Bowel Project (NSABP)-13 and NSABP-14 demonstrated a significant benefit from adjuvant chemotherapy or hormonal therapy in certain patients with uninvolved lymph nodes (5, 6). The increasing number of small, mammographically detected, and often node-negative tumors, along with the tendency to offer adjuvant therapy to patients without positive nodes, calls into question the routine use of axillary lymph node dissection. The current retrospective study was undertaken to try to identify subgroups of patients who could be spared the morbidity of axillary lymph node dissection without compromising treatment outcome.

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Journal of the American College of Surgeons
April 1997, Volume 184, Number 4

BACKGROUND, STUDY DESIGN, AND RESULTS

METHODS

RESULTS

DISCUSSION

REFERENCES

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