This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Axillary staging during surgery for breast cancer. BJS 2007; 94: 304-309.
Published: 29th January 2007
Authors: C. K. Axelsson, H. T. Mouridsen, M. Düring, S. Møller
Background
Axillary lymph node status remains the single most important prognostic parameter in patients with breast cancer. In approximately half of operations sentinel lymph node biopsy cannot be employed and axillary dissection is indicated. Retrieval of ten nodes has hitherto been considered sufficient, but it remains questionable whether the removal of more lymph nodes might improve staging.
Method
Data from 31 679 breast cancer operations in Denmark were analysed.
Results
The number of axillary lymph nodes retrieved was an independent and strong predictor of node positivity. The more lymph nodes retrieved, the better the staging of the disease; this was evident for all sizes of tumour. Dissection of 20 or more nodes rather than ten to 14 increased the probability of node positivity from 14·2 to 25·9 per cent for 1–5‐mm tumours, from 38·6 to 47·9 per cent for 11–20‐mm tumours, and from 80·6 to 90·0 per cent for tumours with diameter greater than 50 mm.
Conclusion
The number of metastatic lymph nodes increased as more nodes were retrieved. These findings underline the need for high‐quality specialist surgical and pathological services in breast cancer treatment. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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