ABSTRACT
Axillary lymph-node dissection (ALND) has traditionally been part of the surgical treatment for infiltrating breast carcinoma.1 The information obtained from ALND is an important prognostic indicator, is used to guide treatment decisions, and may provide regional control for women with axillary metastases.1 It remains controversial, however, whether or not ALND
improves survival. Also, ALND has associated morbidity, including numbness, scarring, and lymphedema. Women with small breast carcinomas, such as those detected by screening mammography, are least likely to have axillary metastases and therefore are least likely to benefit from ALND (Table 27.1).2-9
Sentinel lymph-node biopsy has recently
been introduced into the management of women with breast carcinoma.10-66 The sentinel lymph node (SLN) hypothesis states that the SLNs are the first nodes draining a tumor, and that the histologic status of the SLNs predicts the status of the regional nodes. The SLNs can be identified with blue dye, radioisotope, or a combination of methods, excised, and analyzed. If the SLN is correct, women with infiltrating breast carcinoma and negative SLNs may be spared the morbidity of an ALND.
