V. Suzanne Klimberg, MD

Despite the much higher risk of local recurrence with lumpectomy and radiation compared with mastectomy, multiple retrospective studies and prospective randomized trials have established that survival is the same; however, this may not be so for the individual patient, depending on the type of recurrence.

Breast-conserving therapy (BCT), which includes wide local excision of the tumor followed by irradiation, has become a standard treatment option for women with early-stage invasive breast cancer.

The biologic rationale for sentinellymph node biopsy, althoughit may ultimately stagethe axilla more accurately, is essentiallythat a positive lymph node representssystemic disease. Removal ofaxillary lymph nodes is of little, if any,therapeutic value, and most patients with tumors greater than 1 cm are offeredchemotherapy regardless ofnodal status. Thus, the risks of lymphedemaand neurologic deficit outweighany prognostic information derivedfrom an axillary node dissection whenthis same information can be accuratelyobtained in a less invasive, lessmorbid procedure.