Changing Trends in Axillary Management of Early Breast Cancer: From Radical to Conservative

Abstract

Background:In the last decade, surgical management of breast cancer has evolved from more extensive procedures like radical mastectomy to less invasive breast conserving surgery. Increasing evidence suggests that surgical removal of the axillary lymph nodes (ALN) in early breast cancer yields no advantage in terms of either overall or disease free survival. Significance of sentinel lymph node biopsy (SLNB) in neoadjuvant chemotherapy (NACT) is currently under discussion. A risk of non -sentinel lymph node ( non-SLN) involvement is always present despite negative SLN biopsy . There are various tumour characteristics and patients' factors that are associated with increased risk of non-SLN involvement. Methods: A literature search was performed in the PubMed Database for relevant articles on the role of axillary dissection in node positive early breast cancer, the role of SLNB, SLNB after NACT and the factors affecting involvement of axillary lymph nodes Results: The available literature increasingly cast doubt on the putative therapeutic benefit of axillary lymph node dissection (ALND) as a part of routine multimodal treatment strategy for breast cancer. Various clinicopathological features like lymphovascular invasion (LVI), tumour size, ER, PR, HER-2 status are associated with increased incidence of non -SLN involvement so ALND should be limited to patients with these characteristics inspite of negative SLNB. Conclusion: Current evidence indicates that the radicality of lymph node surgery in the treatment of breast cancer can be reduced, even if the node status is positive.LVI, increased tumour size , Infiltrating ductal carcinoma(IDC), Grade II&III and ER , PR, HER-2 overexpression significantly associated with positive axillary status .