Surgical Evaluation of the Axilla in Breast Cancer

  • A physical examination alone:
    • Cannot accurately predict the presence of axillary disease
  • The accuracy of a physical examination to detect axillary metastasis:
    • Ranges from 61% to 68%:
      • When compared with resection
  • Ultrasonography, magnetic resonance imaging, and positron emission tomography–computed tomography:
    • Have all been used to evaluate the axilla:
      • And although these imaging modalities may improve on physical examination:
        • They are not as accurate as lymphadenectomy for small deposits:
          • And have a higher rate of false positives
  • A level I and II axillary lymph node dissection (ALND):
    • Has been the gold standard:
      • For evaluating the extent of axillary disease
    • Unfortunately, the incidences of:
      • Lymphedema, chronic pain, seroma development, future cellulitis, numbness, and limits to mobility:
        • Are all significant sequelae following ALND
  • Approximately 70% of patients who are clinically node negative:
    • Will have no evidence of disease detected with ALND:
      • Putting these patients needlessly at risk for complications
  • In 1991, the technique of sentinel lymph node biopsy (SLNB) was proposed as an alternative to ALND in breast cancer patients:
    • The development of SLNB has now replaced ALND:
      • As a highly accurate and less morbid axillary staging procedure for most patients

#Arrangoiz #BreastSurgeon #CancerSurgeon #SurgicalOncologist #Surgeon #Teacher #BreastCancer #BreastDiseases #AxillaryDissection #BreastSurgery #MountSinaiMedicalCenter #MSMC #Miami #Mexico

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