Axillary Lymph Node Dissection in Breast Cancer Patients

In the last decades, surgical treatment of breast cancer has evolved from more extensive procedures like radical mastectomy to less invasive breast conserving surgery. Similarly, surgical management of axilla has enormously changed from routine axillary lymph node dissection (ALND) to sentinel lymph node biopsy (SLNB). Introduction of modern imaging modalities and the increase in public awareness about breast cancer resulted in higher number of early breast cancer cases. This achievement helped more conservative surgical methods to overwhelm classic radical procedures in clinical practice. Axillary lymph node staging remains one of the most important prognostic indicators in women with breast cancer. A complete ALND for patients with breast cancer was introduced in the 1800s, both for staging and to achieve regional disease control. The impact of ALND on survival remains, however, unclear with available data showing conflicting results. ALND is associated with an increased risk of adverse outcomes, including lymphedema, neuropathic pain and limited shoulder/arm motion. A desire to minimize morbidity led to the development of the SLNB technique and SLNB has largely replaced ALND. Currently, ALND is not performed in patients with negative SLNB. On the other hand, traditional surgical approach to the axilla in case of SLNB positivity is to perform completion axillary dissection. However, surgeons avoid performing axillary dissection in selected patients in clinical practice. In addition, recent studies suggest that application of radiotherapy including the axillary field may be an alternative to axillary dissection in the near future. Recent changes in the management of axilla necessitate physicians to refresh their knowledge.