Axillary staging during surgery for breast cancer

Background: Axillary lymph node status remains the single most important prognostic parameter in patients with breast cancer. In approximately half of operations sentinel lymph node biopsy cannot be employed and axillary dissection is indicated. Retrieval of ten nodes has hitherto been considered su...

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Bibliographic Details
Published in:British journal of surgery 2007-03, Vol.94 (3), p.304-309
Main Authors: Axelsson, C. K., Mouridsen, H. T., Düring, M., Møller, S.
Format: Article
Language:English
Subjects:
Adult
Aged
Axilla
Biological and medical sciences
Breast Neoplasms - pathology
Breast Neoplasms - surgery
Denmark
Female
General aspects
Gynecology. Andrology. Obstetrics
Humans
Lymph Node Excision - methods
Lymphatic Metastasis
Mammary gland diseases
Mastectomy - methods
Medical sciences
Middle Aged
Neoplasm Staging - methods
Prognosis
Prospective Studies
Sentinel Lymph Node Biopsy - methods
Tumors
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Summary:Background: Axillary lymph node status remains the single most important prognostic parameter in patients with breast cancer. In approximately half of operations sentinel lymph node biopsy cannot be employed and axillary dissection is indicated. Retrieval of ten nodes has hitherto been considered sufficient, but it remains questionable whether the removal of more lymph nodes might improve staging. Methods: Data from 31 679 breast cancer operations in Denmark were analysed. Results: The number of axillary lymph nodes retrieved was an independent and strong predictor of node positivity. The more lymph nodes retrieved, the better the staging of the disease; this was evident for all sizes of tumour. Dissection of 20 or more nodes rather than ten to 14 increased the probability of node positivity from 14·2 to 25·9 per cent for 1–5‐mm tumours, from 38·6 to 47·9 per cent for 11–20‐mm tumours, and from 80·6 to 90·0 per cent for tumours with diameter greater than 50 mm. Conclusion: The number of metastatic lymph nodes increased as more nodes were retrieved. These findings underline the need for high‐quality specialist surgical and pathological services in breast cancer treatment. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. At least 20 nodes should be removed during dissection
ISSN:0007-1323
1365-2168
DOI:10.1002/bjs.5599