Lymph-node dissection in breast cancer |
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Authors: | A Bembenek P M Schlag |
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Institution: | Surgery and Surgical Oncology, Robert-R?ssle-Klinik, Charité Humboldt-University, Lindenberger Weg 80, D-13122 Berlin, Germany Tel.: +49-30-94171400 Fax: +49-30-94171404, DE
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Abstract: | Background: Along with the ongoing modifications in treatment of primary breast cancer, the purpose and extent of lymph-node dissection
has changed. The following is an overview of the current knowledge and practice of lymph-node dissection in breast cancer,
with special regard to expected developments in the near future. Axillary dissection is described as a ten-step procedure,
including dissection of level-I and -II and Rotter’s nodes, without level-III nodes, providing at least ten lymph nodes for
accurate staging information. Discussion: Axillary dissection still offers the most efficient local control in node-positive patients, whereas, in primarily node-negative
patients, irradiation seems to be equally effective. In general, lymph-node dissection does not alter overall survival but
there is no doubt that surgical therapy still contributes to cure in early-breast-cancer patients and seems to be curative
for certain patients with stage-I carcinoma. The lymph node status of the axilla is crucial for the indication of adjuvant
therapy in early invasive breast cancer, but an increasing number of clinical node-negative patients could be managed with
information based on features of the primary tumor, regardless of the nodal status. The most promising new concept for the
selection of node-positive patients, while avoiding unnecessary morbidity of axillary dissection in early-breast-cancer patients,
is the sentinel-node concept. The principle is based on the identification of the first ”sentinel” lymph node reached by lymphatic
flow. Thus, only proven node-positive patients undergo axillary dissection. Local failure of internal mammary lymph nodes
is rarely recognized; however, internal mammary lymph nodes seem to have an underestimated prognostic significance in about
10–20% of axillary node-negative patients. This may lead to the withholding of systemic therapy for patients with early breast
cancer. Nevertheless, there is no indication for a routine parasternal dissection today. The sentinel-node concept may also
support the selection of diagnostic internal lymph-node biopsy and subsequent adjuvant therapy in cases with no axillary lymph-node
metastases but with internal lymph-node metastases.
Received: 25 September 1998 Accepted: 17 October 1998 |
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Keywords: | Breast cancer Lymph-node dissection Lymph-node status Lymphonodectomy Sentinel-node biopsy |
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