Role of axillary surgery in early breast cancer: Review of the current evidence

Background: Controversy continues to surround the best practice for managem ent of the axilla in patients with early breast cancer (EBC), particularly the clinically negative axilla. The balance between therapeutic and staging roles of axillary surgery (with the consequent morbidity of the procedures utilized) has altered. This is due to the increasing frequency of women pr esenting with early stage disease, the more widespread utilization of adjuv ant chemoendocrine therapy and, more recently, the advent of alternative st aging procedures, principally sentinel node biopsy (SNB). The aim of the pr esent review is to critically analyse the current literature concerning the preferred management of the axilla in early boast cancer and make evidence -based recommendations on current management. Methods: A review was undertaken of the English language medical literature , using MEDLINE database software and cross-referencing major articles on t he subject, focusing on the last 10 years. The following combinations of ke y words have been searched: breast neoplasms, axilla, axillary dissection, survival, prognosis, and sentinel node biopsy. Results: Despite the trend to more frequent earlier stage diagnosis, levels I and II axillary dissection remain the treatment of choice in the majorit y of women with EBC and a clinically negative axilla. Conclusions: Sentinel node biopsy has no proven superiority over axillary d issection because no randomized controlled trials have been completed to da te. Despite this, SNB will become increasingly utilized due to encouraging results from major centres responsible for its development, and patient dem and. Therefore if patients are not bring enrolled in clinical trials strict quality controls need to be established at a local level before SNB is all owed to replace standard treatment of the axilla. Unless this is strictly a dhered to there is a significant risk of an increase in the frequency of ax illary relapse and possible increased understaging and resultant inadequate treatment of patients.