We agree with the need to reexamine the routine use of axillary
dissection in the management of breast cancer patients, as advocated
by Manjeet Chadha and Deborah Axelrod, in their article, "Is
Axillary Dissection Always Indicated in Invasive Breast Cancer?"
(11:1463-1479, 1997). No patient with tumor-free axillary lymph
nodes, however, derives a therapeutic benefit from either axillary
irradiation or dissection. Axillary irradiation may be equivalent to
dissection in terms of locoregional control, but it offers no staging
information. Thus, clinicians should continue to pursue the least
morbid method available to accurately stage the axilla histopathologically.
Sentinel lymphadenectomy achieves this goal. Sentinel lymphadenectomy
in breast cancer patients has been well-described by our group[1,2]
and other investigators,[3-5] and the removal of one or two sentinel
nodes has virtually no associated morbidity.
A patient with a tumor-free sentinel node or nodes probably needs no
further local treatment of the axilla, either irradiation or
dissection. The clinically intriguing question is, what should be
done with the rest of the axilla in patients with tumor-involved
sentinel node(s)--completion axillary dissection, axillary
irradiation, or no regional therapy?
1. Giuliano AE, Kirgan DM, Guenther JM, et al: Lymphatic mapping and
sentinel lymphadenectomy for breast cancer. Ann Surg 220:391-401, 1994.
2. Giuliano AE, Dale PS, Turner RR, et al: Improved axillary staging
of breast cancer with sentinel lymphadenectomy. Ann Surg 222:394-401, 1995.
3. Krag DN, Weaver DL, Alex JC, et al: Surgical resection and
radiolocalization of the sentinel node in breast cancer using gamma
probe. Surg Oncol 2:335-340, 1993.
4. Albertini JJ, Cruse CW, Rappaport D, et al: Intraoperative
radiolymphoscintigraphy improves sentinel node identification for
patients with melanoma. Ann Surg 223:217-224, 1996.
5. Veronesi U, Paganelli G, Galimberti V, et al: Sentinel-node biopsy
to avoid axillary dissection in breast cancer with clinically
negative lymph-nodes. Lancet 349:1864-1867, 1997.