Can axillary dissection be avoided by improved molecular biological diagnosis?

Axillary dissection is presently a routine staging procedure in the managem ent of breast cancer. The use of adjuvant systemic treatment is largely bas ed on the diagnosis of axillary metastases. Routine axillary dissection lea ds to acute and chronic side-effects in a large proportion of patients. The sentinel node technique is presently explored with the aim of decreasing t he need for standard axillary dissection. A complementary way forward is to analyse the primary breast cancer for molecular markers with prognostic si gnificance with reference to the risk for metastatic capacity and thereby o btain a 'biological staging' and identify those patients in need of systemi c adjuvant therapy. A large number of molecular biological factors have bee n shown to have prognostic significance in breast cancer e.g. c-erbB-2, p53 , uPA, PAI-1 and VEGF. This article reviews the expression of these and oth er factors in the primary breast cancers in relation to the risk for axilla ry and systemic metastatic disease, with the long-term aim of excluding rou tine axillary dissection.