Abstract
Background: Debate regarding axillary dissection in the treatment of women with small invasive cancers of the breast has been increasing. Recently, omission of axillary dissection has been proposed because of the reported low incidence of nodal metastases in women with such cancers. Variation in the incidence of nodal metastases in T1 breast cancers is examined and discussed with regard to a selective approach to lymphadenectomy.
Methods: The literature was reviewed, and cases of 2185 women with T1 breast cancers in Rhode Island and Massachusetts were analyzed.
Results: The incidence of axillary nodal metastases in T1 breast cancer varies among series and ranges from 3% to 37%. The probability of nodal metastases depends on tumor grade and patient age as well as tumor size.
Conclusions: T1 breast cancers are not equivalent in their risk of associated axillary metastases. A treatment algorithm for selective axillary node dissection in patients with T1 breast cancers is proposed. Future applications of this type of algorithm are discussed with respect to sentinel node biopsy.
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References
Silverstein MJ, Gierson ED, Waisman JR, et al. Axillary lymph node dissection for T1a breast carcinoma: is it indicated?Cancer 1994;73:664–7.
Mustafa IA, Cole B, Wanebo HJ, et al. The impact of histopathology on nodal metastases in minimal breast cancer.Arch Surg 1997;132:384–91.
Fisher B, Redmond C, Fisher ER. Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without irradiation.New Engl J Med 1985;32:674–81.
Early Breast Cancer Trialists' Cooperative Group. Effects of radiotherapy and surgery in early breast cancer.N Engl J Med 1995;333:1444–55.
White RE, Vezeridis MP, Konstadoulakis M, et al. Therapeutic options and results for the management of minimally invasive carcinoma of the breast: Influence of axillary dissection for treatment of T1a and T1b lesions.J Am Coll Surg 1996;183:575–82.
Cabanes PA, Salamon RJ, Vilcoq JR, et al. Value of axillary dissection in addition to lumpectomy and radiotherapy in early breast cancer.Lancet 1992;339:1245–8.
Lin PP, Allison DC, Wainstock J, et al. Impact of axillary lymph node dissection on the therapy of breast cancer patients.J Clin Oncol 1993;11:1536–44.
Halverson KJ, Taylor ME, Perez CA, et al. Management of the axilla in patients with breast cancers one centimeter or smaller.Am J Clin Oncol 1994;17:461–6.
Baxter N, McCready D, Chapman JA, et al. Clinical behavior of untreated axillary nodes after local treatment for primary breast cancer.Ann Surg Oncol 1996:3:235–40.
Cady B, Stone MD, Wayne J. New therapeutic possibilities in primary invasive breast cancer.Ann Surg 1993;218:338–49.
Recht A, Houlihan MJ. Axillary lymph nodes and breast cancer: A review.Cancer 1995;76:1491–1512.
Fisher B, Wolmark N, Bauer M, Redmond C, Gebhart M. The accuracy of clinical nodal staging and of limited axillary dissection as a determinant of histological nodal status in carcinoma of the breast.Surg Gynecol Obstet 1981;152:765–72.
Giuliano AE, Dale PS, Turner RR, et al. Improved axillary staging of breast cancer with sentinel lymphadenectomy.Ann Surg 1995;222:394–401.
Danforth DN, Findlay PA, McDonald HP, et al. Complete axillary node dissection for stages I and II carcinoma of the breast.J Clin Oncol 1986;4:655–62.
Giuliano AE, Barth AM, Spivack B, Beitsch PD, Evans SW. Incidence and predictors of axillary metastases in T1 carcinoma of the breast.J Am Coll Surg 1996:183:185–9.
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Annals of Surgical Oncology is pleased to present the first article in a new series. The Surgical Oncology Forum will feature state-of-the-art reviews on the diagnosis and multidsciplinary treatment of malignancies.
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Mustafa, I.A., Bland, K.I. Indications for axillary dissection in T1 breast cancer. Annals of Surgical Oncology 5, 4–8 (1998). https://doi.org/10.1007/BF02303756
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DOI: https://doi.org/10.1007/BF02303756