ABSTRACT
A National Institutes of Health (NIH) consensus conference on treatment of breast cancer recommended routine Level I and II axillary lymph-node dissection (ALND) as the “gold standard” for axillary staging.1 This procedure’s false-negative rate of less than 2% has clearly stood the test of time. In addition, ALND offers excellent regional control with a low risk of axillary recurrence. The role of ALND for patients with clinically negative axillae has recently become controversial, however. Because only about one-third of these patients have histopathologic evidence of nodal metastases, routine ALND may subject many patients to potential operative morbidity without likely benefit. On the other hand, one-third of patients with clinically occult axillary metastases, many of whom have primary tumors less than 1 cm in diameter, cannot receive appropriate chemotherapy until the tumor status of the axillary basin has been established.
