Subclavicular biopsy as a guideline for the treatment of breast cancer

Abstract

AbstractTo better select patients with breast cancer for radical surgery, all operable patients at the Netherlands Cancer Institute are subjected to exploration of the medial apex of the axilla as the initial step in the mastectomy operation, and lymph nodes in the subclavicular fat pad are examined by frozen section. Patients with positive apex biopsies are treated by primary radiotherapy rather than by mastectomy, since the 10‐year survival rate of such patients who were treated by mastectomy in our previous series was only 5%. In about 1600 cases of operable breast cancer treated by our staff since 1956, the incidence of positive apex biopsy has been 16%. In 6% of the cases with a positive apex biopsy, the tumor was small and there were no suspicious lymph nodes on clinical examination. Survival rate and duration of survival of patients with a positive apex biopsy has been the same after treatment by primary irradiation as after treatment by radical mastectomy.