THE EDINBURGH RANDOMIZED TRIAL OF AXILLARY SAMPLING OR CLEARANCE AFTER MASTECTOMY

Between January 1980 and October 1983, 417 patients were randomized fo r mastectomy followed by axillary node sampling or full axillary clear ance. The aim of the study was to determine whether a standard 'four-n ode' axillary sample, followed by careful dissection of removed tissue , could accurately indicate the extent of local treatment required. Ax illary radiotherapy was given only to patients with histological invol vement of sampled nodes and not to any having axillary clearance. The incidence of involved nodes was similar for both groups, as were dista nt relapse and survival rates. Currently 62.6 per cent are alive after clearance and 65.0 per cent after sampling. A non-significant increas e in the rate of locoregional relapse was observed for those treated b y axillary node clearance, this being due mainly to increased relapse on the unirradiated chest wall (clearance 21 per cent versus sampling 12 per cent in patients with node-positive disease). There was only a minor difference in axillary relapse, favouring axillary clearance (3. 0 versus 5.4 per cent). In patients with operable breast cancer, maste ctomy with axillary node sampling gives equal control to mastectomy wi th axillary node clearance but, as morbidity is greater, surgical clea rance of the axilla is the preferred option.