Should we consider limited axillary dissection for node positive breast cancer

Breast cancer as the most prevalent malignancies in females worldwide, isunder more consideration for applied researches. The axillary investigation andsurgery is an integral part of breast cancer management since ancient world.Investigation of the axilla,ranging from removal of all axillary lymph nodesextended to level iii and even sub clavicula, to very limited axillaryinvestigation by sentinel lymph node biopsy and no more interventions; may bebeneficial for the purpose of treatment,prognosis and identification. Here wepresent the new idea for limited axillary dissection based on surgeon clinicaljudgment , as a prospective randomized trial with more than twenty yearsfollow up. 254 cases of breast cancer patients who were clinically axillarylymph node positive were divided in two arms ;group 1 with classic AXLNDremoving at least ten LNs and group 2 with limited AXLND undergoneremoving maximum nine LNs. The patients were followed in a establishedmanner.Results: Five years overall survival were 85% and 90% in group 1,classicALND and group 2 Limited ALND,(p=0.57)respectively while Disease FreeSurvival were 78% versus 84% respectively,(P=0.42)Conclusion: Because of limited resources in many part of the world such asavaibility of gamma probe and gamma camera and frequency of axillarydissection morbidity, limited axillary dissection based on surgeon judgement isrecommended.

Keywords:

limited axillary dissection , breast cancer , Iran