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Breast Cancer

, Volume 20, Issue 1, pp 41–46 | Cite as

The changing role of axillary lymph node dissection for breast cancer

  • Masakuni NoguchiEmail author
  • Emi Morioka
  • Yukako Ohno
  • Miki Noguchi
  • Yasuharu Nakano
  • Takeo Kosaka
Review Article

Abstract

Currently, it is standard practice that patients with negative sentinel lymph nodes (SLNs) do not undergo axillary lymph node dissection (ALND), whereas ALND is mandated in those with positive SLNs. However, the Z0011 trial showed that ALND could be safely omitted in selected patients with positive SLNs. This article presents a review and discussion of the current role and practice of ALND in the surgical management of breast cancer. A review of the English-language medical literature was performed using the MEDLINE database and cross-referencing major articles on the subject. It may be concluded that ALND can be avoided not only in patients with negative SLNs but also in those with positive SLNs who undergo breast-conserving therapy with whole-breast irradiation and appropriate systemic therapy. However, the omission of ALND would be indicated only in patients with a low axillary tumor burden. On the other hand, ALND remains a standard method of treating regional disease not only in patients with clinically positive nodes but also in other SLN-positive patients who do not meet the above criteria. Although the role of ALND has been limited to the prevention of axillary recurrence, SLN biopsy with whole-breast irradiation and systemic therapy can replace ALND in patients with a low axillary tumor burden.

Keywords

Breast cancer Axillary lymph node dissection Sentinel lymph node biopsy ACOSOG Z0011 

Abbreviations

ACOSOG

American College of Surgeons Oncology Group

AJCC

American Joint Committee on Cancer

ALND

Axillary lymph node dissection

H&E

Hematoxylin–eosin

ITC

Isolated tumor cells

MSKCC

Memorial Sloan-Kettering Cancer Center

NSABP

National Surgical Adjuvant Breast and Bowel Project

SLN

Sentinel lymph node

Notes

Conflict of interest

The author indicated no potential conflicts of interest.

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Copyright information

© The Japanese Breast Cancer Society 2012

Authors and Affiliations

  • Masakuni Noguchi
    • 1
    Email author
  • Emi Morioka
    • 1
  • Yukako Ohno
    • 1
  • Miki Noguchi
    • 1
  • Yasuharu Nakano
    • 1
  • Takeo Kosaka
    • 1
  1. 1.Department of Breast and Endocrine SurgeryKanazawa Medical University HospitalUchinadaJapan

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