How Much of the Axilla Should Be Dissected?

  • Robert T. Osteen
Part of the Medical Radiology book series (MEDRAD)

Abstract

The spread of breast cancer from the primary tumor in the breast to regional lymph nodes is an indication of the capacity of cancer cells to implant and grow, as well as a comment on the host-tumor relationship; it also is a potential source of morbidity. Despite the clear impact of axillary nodal metastases on prognosis, there is no evidence that axillary treatments significantly affect survival. Al- though the possibility of a small therapeutic benefit cannot be excluded by the studies to date, the primary benefits of removing axillary lymph nodes are to gather information on Staging and to prevent complications arising from uncontrolled tumor growth in the axilla. Information on axillary Staging is vital when the axillary node status is a major determinant of the use of systemic therapy.

Keywords

Estrogen Oncol Assure Tamoxifen Tral 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Adami HO, Graffman S, Johansson H, Rimsan A (1978) Survival and recurrence five years after selective treatment for breast cancer. Br J Cancer 38: 624–630PubMedCrossRefGoogle Scholar
  2. Almarick R, Santamaria F, Robert F et al (1982) Radiation therapy with or without primary limited surgery for operable breast cancer: a 20-year experience at the Marseilles Cancer Institute. Cancer 49: 30–34CrossRefGoogle Scholar
  3. Cancer Research Campaign Work Party (1980) Cancer Research Campaign ( King’s/Cambridge) trial for early breast cancer. Lancet ii: 55–60Google Scholar
  4. Carter CL, Allen C, Henson DE (1989) Relation of tumor size, lymph node status, and survival in 24740 breast cancer cases. Cancer 63: 181–187PubMedCrossRefGoogle Scholar
  5. Clarke D, Martinez A, Cox R et al (1982) Breast edema following Staging axillary node dissection in patients with breast carcinoma by radical radiotherapy. Cancer 49: 2295PubMedCrossRefGoogle Scholar
  6. Clarke DH, Le MG, Sarrazin D et al (1985) Analysis of local-regional relapses in patients with early breast cancers treated by excision and radiotherapy: experience of the Institute Gustave-Roussy. Int J Radiat Oncol Biol Phys 11: 137–145PubMedCrossRefGoogle Scholar
  7. Cody HS, Egeli RA, Urban JA (1984) Rotter’s node metastases: therapeutic and prognostic considerations in early breast carcinoma. Ann Surg 199: 266–270PubMedCrossRefGoogle Scholar
  8. Danforth DN, Findlay PA, McDonald HD et al (1986) Complete axillary lymph node dissection for Stage I–II carcinoma of the breast. J Clin Oncol 4: 655–662PubMedGoogle Scholar
  9. Davies GC, Millis RR, Hayward JL (1980) Assessment of axillary lymph node status. Ann Surg 192: 148–151PubMedCrossRefGoogle Scholar
  10. Dewar JA, Sarrazin D, Benhamou E et al (1987) Management of the axilla in conservatively treated breast cancer: 592 patients treated at the Institute Gustave-Roussy. Int J Radiat Oncol Biol Phys 13: 475–481PubMedCrossRefGoogle Scholar
  11. Fisher B, Redmond C, Fisher ER et al (1985) Ten-year results of a randomized trial comparing radical mastectomy and total mastectomy with or without radiation. N Engl J Med 312: 674–681PubMedCrossRefGoogle Scholar
  12. Fisher ER, Swamidoss S, Lee CH et al (1978) Detection and significance of occult axillary node metastases in patients with invasive breast cancer. Cancer 42: 2025–2031PubMedCrossRefGoogle Scholar
  13. Forrest APM, Roberts MM, Cant E, Shivas AA (1976) Simple mastectomy and pectoral node biopsy. Br J Surg 63: 569–575PubMedCrossRefGoogle Scholar
  14. Fowble B, Gray R, Gilchrist K et al (1988) Identification of a subgroup of patients with breast cancer and histologically positive axillary nodes receiving adjuvant chemotherapy who may benefit from postoperative radiotherapy. J Clin Oncol 6: 1107–1117PubMedGoogle Scholar
  15. Graversen HP, Blichert-Toff M, Andersen JA et al (1988) Breast cancer: risk of axillary recurrence in node-negative patients following partial dissection of the axilla. Eur J Surg Oncol 14: 407–412PubMedGoogle Scholar
  16. Griem KL, Henderson IC, Gelman R et al (1987) The 5-year results of a randomized trial of adjuvant radiation therapy after chemotherapy in breast cancer patients treated with mastectomy. J Clin Oncol 5: 1546–1555PubMedGoogle Scholar
  17. Haffty BG, Fischer D, Rose M et al (1991) Prognostic factors for local recurrence in the conservatively treated breast cancer patient: a cautious interpretation of the data. J Clin Oncol 9: 997–1003PubMedGoogle Scholar
  18. Hayward J (1984) The principles of breast cancer surgery. Breast Cancer Res Treat 4: 61–68PubMedCrossRefGoogle Scholar
  19. Hayward J, Caleffi M (1987) The significance of local control in the primary treatment of breast cancer. Arch Surg 122: 1244–1247PubMedCrossRefGoogle Scholar
  20. Kinne DW, Petrek JA, Osborne MP et al (1989) Breast carcinoma in situ. Arch Surg 124: 33–36PubMedCrossRefGoogle Scholar
  21. Kissin MW, Price AB, Thompson EM et al (1982) The inadequacy of axillary sampling in breast cancer. Lancet 1: 1210–1211PubMedCrossRefGoogle Scholar
  22. Kissin MW, Querci della Rovere G, Easton D, Westburg G (1986) Lymphoedema and breast cancer. Br J Surg 73: 580–584PubMedCrossRefGoogle Scholar
  23. Kitchen PRB, McLennan R, Mursell A (1980) Node-positive breast cancer: a comparison of clinical and pathological findings and assessment of axillary clearance. Aust NIJ Surg 50: 580–583CrossRefGoogle Scholar
  24. Lagios MD, Westdahl PR, Margolin FR, Rose MR (1982) Duct carcinoma in situ: relationship of extent of noninvasive disease to the frequency of occult invasion, multicentricity, lymph node metastases, and short-term treatment failures. Cancer 50: 1209–1314CrossRefGoogle Scholar
  25. Larson D, Weinstein M, Goldberg I et al (1988) Edema of the arm as a function of the extent of axillary surgery in patients with Stage I–II carcinoma of the breast treated with primary radiotherapy. Int J Radiat Oncol Biol 12: 1575–1582CrossRefGoogle Scholar
  26. McCready DR, Hortobagyi GN, Kau SW et al (1989) The prognostic significance of lymph node metastases after preoperative chemotherapy for locally advanced breast cancer. Arch Surg 124: 21–25PubMedCrossRefGoogle Scholar
  27. Osborne MP, Orniston N, Harmer CL et al (1984) Breast conservation in the treatment of early breast cancer: a 20-year follow-up. Cancer 53: 349–355PubMedCrossRefGoogle Scholar
  28. Osteen RT, Smith B (1990) Results of conservative surgery and radiation therapy for breast cancer. Surg Clin N Am 70: 1005–1021PubMedGoogle Scholar
  29. Pari FF, Schmidt BP, Dupont WD, Wagner RK (1984) Prognostic significance of estrogen receptor status in breast cancer in relation to tumor stage, axillary node metastases and histopathologic grading. Cancer 54: 2237–2242CrossRefGoogle Scholar
  30. Recht A, Pierce SM, Abner A et al (1991) Regional nodal failure after conservative surgery and radiotherapy for early-stage breast carcinomas. J Clin Oncol 9: 988–996PubMedGoogle Scholar
  31. Rose CM, Botnick LE, Weinstein M et al (1983) Axillary sampling in the definitive treatment of breast cancer by radiation therapy and lumpectomy. Radiat Oncol Biol Phys 9: 339–344Google Scholar
  32. Rose MA, Henderson IC, Gelman R et al (1989) Pre- menopausal breast cancer patients treated with conservative surgery, radiotherapy, and adjuvant chemotherapy have a low risk of local failure. Int J Radiat Oncol Biol Phys 17: 711–717PubMedCrossRefGoogle Scholar
  33. Rose MA, Olivotto I, Koufman C et al (1989) Conservative surgery and radiation therapy for early breast cancer: long-term cosmetic results. Arch Surg 124: 153–157PubMedCrossRefGoogle Scholar
  34. Rosen PP (1980) Axillary lymph node metastases in patients with occult noninvasive breast carcinoma. Cancer 46: 1298–1306PubMedCrossRefGoogle Scholar
  35. Rosen PP, Saigo PE, Braun DW et al (1981) Axillary micro- and macrometastases in breast cancer: prognostic significance of tumor size. Ann Surg 194: 585–591.PubMedCrossRefGoogle Scholar
  36. Rosen PP, Lesser ML, Kinne DW, Beattie EJ (1983) Dis- continuous or “skip” metastases in breast carcinomas: analysis of 1228 axillary dissections. Ann Surg 197: 276–287PubMedCrossRefGoogle Scholar
  37. Rosner D, Lane WW (1991) Should all patients with node- negative breast cancer receive adjuvant therapy? Identifying additional subsets of low-risk patients who are highly curable by surgery alone. Cancer 68: 1482–1494PubMedCrossRefGoogle Scholar
  38. Sarrazin D, Le M, Arriagada R et al (1989) Ten year results of a randomized trial comparing a conservative treatment to mastectomy in early breast cancer. Radiother Oncol 14: 177PubMedCrossRefGoogle Scholar
  39. Senofsky GM, Moffat FL, Davis K et al (1991) Total axillary lymphadenectomy in the management of breast cancer. Arch Surg 126: 1336–1342PubMedCrossRefGoogle Scholar
  40. Silverstein MJ, Rosser RJ, Gierson ED (1987) Axillary lymph node dissection for intraductal breast carcinoma — is it indicated? Cancer 59: 1819–1824PubMedCrossRefGoogle Scholar
  41. Silverstein MJ, Waisman JR, Gamagami P et al (1990) Intraductal carcinoma of the breast (208 cases): clinical factors influencing treatment choice. Cancer 66: 102–108PubMedCrossRefGoogle Scholar
  42. Temple WJ, Jenkins M, Alexander F et al (1989) Natural history of in situ breast cancer in a defined population. Ann Surg 210: 653–657PubMedCrossRefGoogle Scholar
  43. Veronesi U, Saccozzi R, Del Vecchio M et al (1981) Comparing radical mastectomy with quadrantectomy, axillary dissection and radiotherapy in patients with small cancers of the breast. N Engl J Med 305: 6–11PubMedCrossRefGoogle Scholar
  44. Winchester DP (1991) Adjuvant therapy for node-negative breast cancer: the use of prognostic factors in selecting patients. Cancer 67: 1741–1743PubMedGoogle Scholar
  45. Wolmark N, Fisher B (1982) Surgery in the primary treatment of breast cancer. Brest Cancer Res Treat 1: 339–348CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • Robert T. Osteen
    • 1
  1. 1.Brigham and Women’s HospitalBostonUSA

Personalised recommendations