Z-11 trial and rethinking axillary reverse mapping

Excerpt

Axillary lymph node dissection (ALND) was an integral part of the surgical procedure of breast cancer in the era of radical mastectomy. However, a randomized clinical trial has demonstrated that it does not reduce systemic recurrence or improve survival. Therefore, ALND was regarded as a surgical procedure for assessing nodal status and preventing axillary recurrence. Recently, sentinel lymph node (SLN) biopsy has become a standard method for assessing nodal status in breast cancer. Several randomized studies confirmed that SLN biopsy achieves the same survival and regional control as ALND in SLN-negative patients with invasive breast cancer. This procedure can avoid unnecessary ALND in SLN-negative patients, thereby minimizing arm lymphedema. However, SLN-positive patients who undergo ALND do not benefit from SLN biopsy. …