Axillary lymph node dissection in breast cancer: An evolving question?

Axillary lymph node dissection (ALND) is performed for staging purposes, Se ntinel lymph node biopsy may decrease the cost and morbidity of ALND. Are t here patients that the procedure is not indicated avoiding cost and morbidi ty? We retrospectively studied the incidence of lymph node metastasis in 42 3 patients with T-1 breast cancer. Thirty-one T-1a, 146 T-1b, and 246 T-1c tumors were seen. The mean age was 61 years. Ten per cent were premenopausa l, and 84 per cent were postmenopausal. Tumor size averaged 1.29 cm. Eighty -one per cent of the tumors were node negative and 19 per cent were node po sitive. One T-1a patient (3 per cent) had an axillary metastasis, 19 T-1b p atients (13%), and 61 T-1c patients (25%) were node positive, respectively. Seventy-three per cent were ER positive. Thirty-three patients (8%) died f rom cancer. Eighty-seven per cent received surgery with axillary lymph node dissection (ALND), and three per cent had surgery without ALND. Younger ag e, increased tuner size, premenopausal status, and ER negativity affected n ode positivity rates (P < 0.05). Death from breast cancer was more common a mong node-positive patients (P < 0.05). No difference was found regarding t he performance of ALND and survival (P > 0.05). We feel that ALND can be sa fely omitted in T-1a to reduce the morbidity and the expense of breast canc er treatment. In T-1b and T-1c tumors, the use of ALND is necessary, but mo rbidity and cost can be reduced by the use of sentinel lymph node biopsy.