Walking the Fine Line of Axillary Management in Mastectomy Patients

Excerpt

While breast-conservation surgery (BCS) represented tremendous progress for breast cancer patients in the 1990s, the twenty first century has been significant for advancements in how we manage the axilla for these same patients. Axillary lymph node dissection (ALND) was previously the standard of care for the management of node-positive disease, but carefully selected patients may now undergo sentinel lymph node biopsy (SLNB) alone1^–3 or axillary radiation,4,5 with oncologically equivalent results and less morbidity. In contrast to the de-escalation of axillary surgery, the role of postmastectomy radiation therapy (PMRT) has increased.6 As a result, the management of the axilla and use of PMRT in node-positive patients undergoing mastectomy is complex and variable. In this issue of Annals of Surgical Oncology, the inconsistency in how we manage these patients is highlighted. …