Lumpectomy and axillary dissection for breast cancer: Surgical, pathological, and radiation considerations

Abstract Recently, the first results were disclosed from a trial carried out by the National Surgical Adjuvant Breast and Bowel Project (NSABP) to evaluate the efficacy of breast conservation. These observations indicate that lumpectomy and axillary dissection plus radiation can be employed instead of total mastectomy for the treatment of a large proportion of women with primary breast cancer. The present report describes the technique of operation (lumpectomy), how the pathological examination of the resected specimen is carried out, and the manner in which radiation therapy is administered to the operated breast. The methodologies are those utilized in more than 1,200 women who for almost a decade have been participants in the NSABP study. It is emphasized that the outcome of patients exposed to breast preservation relates to the expertise of the surgeon, pathologist, and radiation and medical oncologists. The orchestration of care that will result in a satisfactory cosmesis and control of disease in the breast is more complex than is necessary for carrying out a mastectomy. Above all it is emphasized that, although the Halstedian concept for cancer surgery has been displaced, that change does not provide the imprimatur for haphazard surgery .