MANAGEMENT OF THE AXILLA IN PATIENTS WITH BREAST CANCERS ONE CENTIMETER OR SMALLER

Very small breast cancers are being diagnosed with increased frequency , and, until recently, little information regarding the incidence of a xillary lymph node metastases in these most favorable tumors was avail able. Moreover, scarce data exist regarding axillary failure in this c ohort as a function of initial treatment, be it surgery, radiation, or simply observation. In the present study, limited to women with invas ive cancers measuring no more than 10 mm, the incidence of pathologica lly positive axillary nodes was 12.3%. The incidence of nodal metastas es was influenced by tumor size (albeit not quite significantly, p = . 08); not one patient with a tumor less than or equal to 5 mm had axill ary node metastases, compared to 14.7% in those with cancers 6 to 10 m m. The histologic grade and tumor location were also important in pred icting nodal positivity. The incidence of positive nodes was 38% in th ose with poorly differentiated cancers, compared to 8% and 7% in women with well and moderately differentiated cancers, respectively, p = .0 3. Axillary nodal positivity was seen in 17% of outer quadrant vs 3% o f central and inner quadrant primaries, p < .01. The axilla was manage d with surgery alone (76%), radiation alone (6%), surgery and radiatio n (6%), or simply observation (10%). With a median follow-up of 55 mon ths, not one patient has suffered a nodal recurrence, and in our exper ience, survival free of distant relapse was not adversely affected by the omission of axillary surgery.