title: Axillary lymph node dissection for T1a breast carcinoma. Is it indicated?
abstract: BACKGROUND
  Axillary dissection has been a routine part of breast cancer treatment for more than 100 years. Axillary node involvement is the single most important prognostic variable in patients with breast cancer. Recently, routine node dissection has been eliminated for intraductal carcinoma because so few patients had positive nodes. With the availability of numerous histologic prognosticators and the development of new immunochemical prognostic indicators, it is time to consider eliminating routine node dissection for lesions more advanced than duct carcinoma in situ (DCIS) but with extremely low likelihood of axillary involvement.
  
  
  METHODS
  Axillary node positivity, disease-free survival, and breast cancer-specific survival were determined for six breast cancer subgroups by T category: Tis (DCIS), T1a, T1b, T1c, T2, and T3.
  
  
  RESULTS
  Nodal positivity for DCIS was 0%; for T1a lesions, 3%. A large increase in nodal positivity was seen in lesions larger than 5 mm. (T1b, 17%; T1c, 32%; T2, 44%; T3, 60%). The rate of nodal positivity was statistically different as each T category was compared with the next more advanced T category. The disease-free survival and breast cancer-specific survival decreased with every increment in T value.
  
  
  CONCLUSIONS
  Axillary node positivity increases as the size of the invasive component increases and is an excellent predictor of DSF and breast cancer-specific survival. Consideration should be given to eliminating axillary node dissection for T1a lesions because of the low yield of positive nodes. Axillary node dissection should be performed routinely for T1b lesions and larger.
authors.affiliation: Breast Center, Van Nuys, California 91405.
authors.forename: M J
authors.initials: MJ
authors.lastname: Silverstein
authors.forename: E D
authors.initials: ED
authors.lastname: Gierson
authors.forename: J R
authors.initials: JR
authors.lastname: Waisman
authors.forename: G M
authors.initials: GM
authors.lastname: Senofsky
authors.forename: W J
authors.initials: WJ
authors.lastname: Colburn
authors.forename: P
authors.initials: P
authors.lastname: Gamagami
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002278:Carcinoma in Situ / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D009361:Neoplasm Invasiveness; D015996:Survival Rate