Axillary dissection

Summary

Axillary dissection remains an important aspect of breast cancer treatment. No other factor has been demonstrated to be of more prognostic significance in breast cancer than the presence or absence of axillary metastases.^12–14 An axillary sampling that excises fewer than 6 nodes is inadequate for staging and should not be substituted for a complete axillary dissection. Note that directed sentinel node biopsy is different than random axillary lymph node sampling, and these 2 procedures should not be confused. Generally, the pathologist will identify and examine some 15 to 25 nodes in an axillary dissection specimen. The absolute number of axillary nodes varies from individual to individual and with the diligence of pathological examination. Recently, it has been our practice to process the axillary nodes for permanent sections, allowing multiple levels of each node to be studied. Cytokeratin staining is also used selectively.

As axillary dissection enters its third century, it must continue to provide complete staging information, combined with preservation of function and cosmetic acceptance. The impact of sentinel lymph node biopsy on axillary dissection is currently being defined.¹⁵ However, it is clear that precise, reliable axillary staging information will remain an indispensable part of surgery for primary breast cancer.^16,17