Axillary Lymph Node Dissection Extension in Breast Cancer Between Under and Overtreatment Analysis of a series of cases and literature review

Abstract

The surgical management of breast cancer tumors depends not only on knowing the right histological type of tumor, but also on identifying the grade of axillary node invasion and the presence of metastases. Unfortunately, due to a lack of general understanding of how these tumors actually spread and their path towards axillary lymph nodes, there is a tendency of over or undertreating patients in the surgical environment. Even though we now have the Sentinel Ganglion method to help us, we haven�t decided on a universally accepted algorithm in the management of this disease. Many studies are still needed in order to fully clarify the most appropriate surgical management for each type of tumor and the level of axillary node dissection. Multiple factors should be taken into account when managing the case of a patient suffering from breast cancer and faced with the need of an axillary lymph node dissection (ALND). We have tried to identify some of these factors based on the experience of our clinic and available literature. The factors identified are the positive SLN (Sentinel Lymphatic Node) aspect, the differentiation between micro and macrometastases, the use of the S classification of SLN and microanatomic location of SLN metastases and the microanatomic location (MAL) of the tumor deposit in the sentinel ganglion.