title: Reassessing the role of axillary lymph-node dissection in patients with early-stage breast cancer.
abstract: BACKGROUND
  There is considerable controversy regarding the value of axillary lymph-node dissection in the adjuvant systemic therapy of patients with early-stage breast cancer. Our objective was to assess the impact of nodal status in assigning adjuvant chemotherapy to these patients.
  
  
  METHODS
  We carried out a review of all patients with stage I or II breast cancer treated at 3 university-affiliated hospitals in Saskatoon between Jan. 1, 1998, and Dec. 31, 2000. Data collected included: patient age, sex, tumour size, hormone receptor status, nuclear grade and presence of lymphovascular invasion. Patients were categorized as being at low, high or intermediate risk for recurrence based on Canadian consensus guidelines and at low or high risk according to criteria established by the United States National Institutes of Health (NIH). The influence of nodal status on subsequent treatment was determined assuming that all patients younger than 70 years at high risk of recurrence would receive chemotherapy.
  
  
  RESULTS
  We identified 327 women with stage I or II breast cancer in whom all prognostic factors were available for analysis. Applying the Canadian criteria to determine the need for adjuvant chemotherapy, 68% of women would receive chemotherapy regardless of lymph-node status. Applying the NIH criteria, 82.5% of women younger than 70 years would receive adjuvant chemotherapy regardless of nodal status.
  
  
  CONCLUSIONS
  Nodal status has little influence on subsequent management. Adoption of a selective approach to axillary lymph-node dissection could avoid the potential morbidities of this procedure in many patients with early-stage breast cancer.
authors.affiliation: Department of Surgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Sask. jeffmarschall@hotmail.com
authors.forename: Jeff
authors.initials: J
authors.lastname: Marschall
authors.forename: Patrik
authors.initials: P
authors.lastname: Nechala
authors.forename: Patrick
authors.initials: P
authors.lastname: Colquhoun
authors.forename: Rajni
authors.initials: R
authors.lastname: Chibbar
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D015412:Mastectomy, Segmental; D011379:Prognosis