Surgical axillary lymph node dissection. Still standard procedure or obsolete method?

Axillary lymph node status remains the single most important prognostic par ameter and has crucial therapeutic implications in patients with breast car cinoma. Surgical dissection of the axilla is commonly regarded as the stand ard procedure of axillary staging, its sensitivity and specificity being 99 % and 100 %, respectively. Apart from giving reliable information on the i ndividual prognosis axillary dissection also contributes to efficient local tumor control in the axilla, as it reduces the risk of local recurrence to less than 1.4 % if more than 10 lymph nodes are removed. Alternative, less or non-invasive axillary staging methods have either not yet been sufficie ntly standardized (immunoscintigraphy, PET-scan, prediction of axillary lym ph node status by means of individual risk factors) or are associated with a considerable risk of false-negative staging (up to 50 % of patients with positive axillary lymph nodes are not detected by palpation alone, ultrason ography or CT-scan). The basic principles of axillary sampling and axillosc opic dissection are questionable because the number of lymph nodes removed during these procedures is commonly less than 10. With its sensitivity/spec ificity being comparable to that of standard axillary dissection sentinel l ymph node biopsy represents a highly promising approach which will in the f uture potentially lead to significant optimization of the clinical manageme nt of patients with breast cancer, especially those diagnosed in early stag es (T1 a, T1 b and T1 c).