Management of the axilla in primary breast cancer

Treatment of the axilla is an integral part of the management of patients w ith invasive breast cancer. In general, the standard treatment of the axill a involves level I and level II axillary lymph node dissection (ALND). Curr ently, there is no evidence that ALND improves survival, although the issue remains controversial. ALND, however, is an effective staging procedure an d is essential for local control of disease in the axilla. Several studies have shown that the sentinel lymph node biopsy (SLNB) can predict the statu s of the axillary nodes reliably. Ln the future, axillary dissection might be avoided in patients who have no metastatic involvement of the sentinel n ode; however, the efficacy of SLNB in the setting of randomized, prospectiv e trials must be tested first before abandoning ALND as the standard of car e.