New concepts in axillary management of breast cancer

Abstract

In the last decades, surgical treatment of breast cancer has evolved from more extensive procedures like radical mastectomy to less invasive breast conserving surgery. Similarly, surgical management of axilla has enormously changed from routine axillary dissection to sentinel lymph node biopsy. Traditional surgical approach to the axilla in case of sentinel lymph node negativity is to avoid completion axillary dissection. However, surgeons even avoid performing axillary dissection in selected patients with positive sentinel lymph node in clinical practice depending on the recent randomized controlled studies supporting this concept. All of the recent changes in the management of positive axilla necessitate surgeons to refresh their knowledge on this challenging topic. Key words: Breast; Cancer; Axilla; Sentinel lymph node Core tip: In the last decades, surgical treatment of breast cancer has evolved from more extensive procedures like radical mastectomy to less invasive breast conserving surgery. Similarly, surgical management of axilla has enormously changed from routine axillary dissection to sentinel lymph node biopsy. Traditional surgical approach to the axilla in case of sentinel lymph node negativity is to avoid completion axillary dissection. However, surgeons even avoid performing axillary dissection in selected patients with positive sentinel lymph node in clinical practice depending on the recent randomized controlled studies supporting this concept. All of the recent changes in the management of positive axilla necessitate surgeons to refresh their knowledge on this challenging topic.Atalay C. New concepts in axillary management of breast cancer.

Clinicopathological relevance of kinesin family member 18A expression in invasive breast cancer

“…The axillary lymph node status is the most consistent prognostic factor used in adjuvant therapy decision-making (29). Currently, the sentinel node biopsy is a common surgical procedure to determine the stage of the cancer and select an appropriate treatment plan (30,31).…”

Local Treatment of Breast Cancer

“…Table 2 summarizes surgical interventions related to high-risk conditions and breast cancer. 5, 17,25,31,34,38,[40][41][42][43] Psychosocial support is critical throughout the treatment of breast cancer with navigators to guide the way. 53 Pre-and post-operative emotions can be diverse from a sense of relief to be 'rid' of the cancer, or to feelings of grief over loss of part or entire breast, a symbol of womanhood.…”

“…43 Axillary node dissection removes significantly more tissue than SLNB and can affect upper extremity lymphatic drainage because of disruption of axillary nodal chains. 42,43 SLNB significantly lowers the rate of axillary complications such as seroma, infection, pain, and edema as compared with axillary node dissection. 44 Lymphedema after neoadjuvant treatment with SLNB at surgery is increased as compared with adjuvant chemotherapy, 45 although it may be related to the initial advanced stage of disease.…”

“…The effect of axillary node dissection on treatment decisions is important because systemic treatment is based on presence or absence of nodal disease, although no longer the number of positive lymph nodes. 42,43 The value of axillary node dissection in locoregional control exists in the prevention of disease recurrence. 43 Axillary node dissection removes significantly more tissue than SLNB and can affect upper extremity lymphatic drainage because of disruption of axillary nodal chains.…”

“…40,41 AXILLARY NODE DISSECTION Axillary node dissection is the dissection of levels I and II lymph nodes with sparing of the axillary vein main trunk, long thoracic nerve, and thoracodorsal neurovascular bundle, which is performed under general anesthesia. 42 At closure, one or two suction drains are placed (e.g., Jackson-Pratt or Hemovac); drains are removed when total drainage decreases to 30 cc per 24-hour period. The effect of axillary node dissection on treatment decisions is important because systemic treatment is based on presence or absence of nodal disease, although no longer the number of positive lymph nodes.…”