The Adventure of Axillary Treatment in Early Stage Breast Cancer

Abstract

Axillary lymph node dissection (ALND) which was an essential part of breast cancer treatment and the gold standard in evaluation of the status ofaxillary lymph node had notorious with increased arm morbidity and reduction of quality of life. Sentinel lymph node biopsy (SLNB) accuratelystages the axilla in early breast cancer and ALND is omitted in SLNB negative patients. In patients with positive SLNB the omission of ALND withor without replacement of axillary radiotherapy has also been recommended by guidelines. The neoadjuvant chemotherapy (NAC) which has beenincreasingly used for large breast cancers to downstage the tumours for allowing breast conserving surgery and decreasing mastectomy rate has alsobeen used in axillary node positive patients to reduce the need for ALND. The issues surrounding the treatment of axilla in patients treated withNAC; application and false negative rate of SLNB, number of identified sentinel lymph nodes, and axillary radiotherapy instead of ALND are currentlythe discussed and practiced hot topics. The quests for decreasing arm morbidity without compromising outcome in breast cancer treatmentwhich have begun with the invention of SLNB continue for axilla conserving surgery. This article reviews the adventure of axillary treatment in breastcancer patients treated with or without NAC.