![]() Patients undergoing SNB have a 22% higher odds ratio of having a positive SLN, due to the more intensive pathological examination which utilises multiple sections and immunohistochemistry (IHC). Furthermore, a trend towards an improved detection of LN metastases was shown when SNB is used. demonstrated that SNB is equivalent to ALND for the detection of lymph node metastasis with the additional advantage of reduction of up to 75% in morbidity in patients with early stage breast cancer. Ī meta-analysis of seven prospective randomised controlled trials by Kell et al. Although accuracy and appropriateness of SNB were disputed by the finding of 5–10% false-negative cases when SNB was followed by axillary dissection at high-risk patients for axillary nodal disease, false-negative SNB results seem to have decreased with the increasing experience of surgeons, and it is expected that the utilisation of SNB in the future will be increased. Several randomised studies have established that sentinel node biopsy (SNB) is a safe and accurate procedure for detecting tumour cells in SLN and predicting the status of the other axillary nodes (non-SLN). evaluating a cohort of 923 women with 20 years follow up, it was shown that breast-cancer-related lymphoedema following ALND occurred maximally in the first 3 years following surgery however, up to 23% of patients may still develop arm swelling during the rest of their lives. ALND is associated with acute complication rates of 20–30% including seroma formation, local swelling, numbness, impaired shoulder movement, neuropathy, infection, and chronic lymphoedema rates of 7–37%. It is evident now that 60–70% of patients with early breast cancer are node negative at the time of diagnosis and ALND puts them at significant risk of short- and long-term morbidities without benefit. The combination of the introduction of population-based mammographic screening for breast cancer, modern imaging methods, and increased public awareness resulted in patients being diagnosed more often with smaller-size tumours and less likelihood of axillary lymph node metastases. ![]() Additionally, it has been recently shown that the molecular profile of the primary tumour is a more significant prognostic indicator in terms of disease-free survival (DFS) and overall survival (OS) than lymph node metastases. Diagnostic imaging modalities such as ultrasound, magnetic resonance mammography, positron emission tomography, and 99 m Technetium (Tc) sestamibi scintimammography are not reliable for staging the axilla, particularly with lymph node metastases 5% had negative axilla, a fact suggesting that metastases do not occur exclusively via the axillary lymph nodes, but rather lymph node status serves as an indicator of the tumour's ability to spread. Axillary status is the most important prognostic factor in breast cancer providing staging information and therefore largely defining treatment strategy. Traditionally the surgical management of breast cancer comprised wide local resection of the primary tumour and axillary lymph node dissection (ALND). The surgical approach for breast cancer treatment evolved from the extensive radical mastectomy and the Patey modified radical mastectomy to breast conserving and minimally invasive techniques. Nowadays gene expression profiling arrays can delineate tumour types with different prognoses. ![]() Subsequently Fisher postulated that the extent of micrometastases at diagnosis of breast cancer is an indicator of outcome, with biological behaviour of cancer predetermining the likelihood of progression of the disease. In accordance with this concept, Halsted developed radical mastectomy as the gold standard for breast cancer surgery. Initially it was suggested that breast cancer first spreads locoregionally via lymphatics to the axillary lymph nodes and then metastasises more distantly. Several theories exist concerning the mechanism of breast cancer cell invasion and metastasis. ![]() For patients with operable breast cancer, the major prognostic determinant is whether there has or has not been spread to the axilla and the number of involved axillary nodes.
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