Abstract
In recent years, low axillary lymph node involvement is beginning to lose its importance. The treatment plan still depends on TNM (AJCC 2018 8th Edition) staging together with the biology of the tumor. Sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection (ALND) in clinically node-negative early-stage breast cancer patients. ALND was previously considered to be mandatory in sentinel node-positive patients, but recent data with 10 years of follow-up have demonstrated that breast-conserving surgery and radiotherapy are equivalent to ALND of micro-/macro-metastatic SLNs. This approach will reduce the morbidity of dissection without decreasing disease-free survival and overall survival. SLNB is also used in locally advanced breast cancer patients (clinically node-positive, stage II or III) treated with neoadjuvant chemotherapy. Due to great pathologic response rates, axilla can become negative in up to 60% of cases depending on tumor biology, and SLNB can be performed with a low false-negative rate either using the targeted (clip-seed) technique or in the classic fashion (lympho-blue dye). In patients with positive SLNB (with limited involvement) after neoadjuvant therapy, radiation therapy without axillary dissection is the subject of clinical trial and developments shows ALND can be aboandoned near future like early breast cancer.
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Müslümanoğlu, M. (2019). Evaluation of Axillary Nodes. In: Aydiner, A., Igci, A., Soran, A. (eds) Breast Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-16792-9_5
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