The status of the axillary nodes represents the single most important prognostic factor in the assessment of a newly diagnosed breast cancer. Traditionally, this was assessed by performing axillary lymph node dissection (ALND) and submitting the tissue for histologic examination. This approach is considered the gold standard for assessing the axilla. However, ALND incurs significant morbidity such as lymphedema, sensory loss, and shoulder immobility. With the advent of breast screening and the detection of smaller and more favorable cancers, a large number of newly diagnosed cancers are node negative, and full axillary clearance in these patients would lead to unnecessary long-term morbidity.
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