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01-05-2008 | Breast Oncology

Management of the Axilla in Women With Breast Cancer: Current Clinical Practice and a New Selective Targeted Approach

Authors: Srila Samphao, MD, FRCST, Jennifer M. Eremin, MBChB, DMRT, FRCR, Mohamed El-Sheemy, MBChB, MSc, PhD, Oleg Eremin, MBChB, MD, FRACS, FRCSEd, FRCST (Hon), FMedSci, DSc (Hon)

Published in: Annals of Surgical Oncology | Issue 5/2008

Abstract

Background

Axillary nodal status is the most important prognostic factor for patients with breast cancer. Clinical assessment and imaging modalities are not always reliable. Surgical removal and histopathological examination of axillary lymph nodes remain essential methods of staging the axilla. However, the optimal management of the axilla remains uncertain.

Methods

We performed Medline searches to identify relevant systematic reviews, meta-analysis, and nonrandomized and randomized controlled trials for the past 5 years (up to December 2007), as well as important historical articles and clinical guidelines relating to management of the axilla in women with breast cancer.

Results

Axillary lymph node dissection (ALND) has been the standard surgical approach for many years. It is, however, associated with marked morbidity; survival benefit remains uncertain. Axillary node sampling, widely practiced in the United Kingdom, is a reliable alternative procedure in staging the axilla, with less morbidity. Sentinel lymph node biopsy (SLNB) has become an accurate method for staging the axilla in women with operable, clinically node-negative breast cancer. SLNB alone appears to be a safe and acceptable procedure for patients with uninvolved SLNs. Completion ALND or axillary radiotherapy remains the standard treatment for patients with tumor-involved SLNs. SLNB is associated with less morbidity than ALND. However, long-term follow-up and therapeutic outcomes are being awaited from randomized controlled trials.

Conclusions

Several procedures are available for staging and treating the axilla. A tailored surgical approach, with careful assessment of risk-benefit and patient preference, is guiding the evolving modern management of the axilla for women with breast cancer.

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Title: Management of the Axilla in Women With Breast Cancer: Current Clinical Practice and a New Selective Targeted Approach
Authors: Srila Samphao, MD, FRCST
Jennifer M. Eremin, MBChB, DMRT, FRCR
Mohamed El-Sheemy, MBChB, MSc, PhD
Oleg Eremin, MBChB, MD, FRACS, FRCSEd, FRCST (Hon), FMedSci, DSc (Hon)
Publication date: 01-05-2008
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 5/2008
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-008-9863-8

At a glance: The STEP trials

Springer Medicine

Management of the Axilla in Women With Breast Cancer: Current Clinical Practice and a New Selective Targeted Approach

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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Other articles of this Issue 5/2008

Tumor-Positive Sentinel Node Biopsy of the Groin in Clinically Node-Negative Melanoma Patients: Superficial or Superficial and Deep Lymph Node Dissection?

Sentinel Lymph Node Biopsy After Neoadjuvant Chemotherapy Is Accurate in Breast Cancer Patients with a Clinically Negative Axillary Nodal Status at Presentation

Survival After Pancreatectomy With Major Arterial Resection and Reconstruction

Local Control, Aggressive Surgery, and Overall Survival for Breast Cancer

Two Subtypes of Mucinous Adenocarcinoma of The Colorectum: Clinicopathological and Genetic Features

Pseudomyxoma Peritonei: Is Disease Progression Related to Microbial Agents? A Study of Bacteria, MUC2 and MUC5AC Expression in Disseminated Peritoneal Adenomucinosis and Peritoneal Mucinous Carcinomatosis