A further survey of surgical management of the axilla in UK breast cancer patients.
BACKGROUND
The aims of this study were to investigate the practice of axillary lymph node management within different units throughout the UK, and to assess changes in practice since our previous survey in 2004.


METHODS
A structured questionnaire was sent to 350 members of the British Association of Surgical Oncology.


RESULTS
There were 177 replies from respondents who managed more than 100 patients a year with breast cancer. Of these: 12 did not perform axillary ultrasound at all in their centre; 17 (10%) employed axillary node clearance (ANC) on all patients; 122 (69%) performed sentinel node biopsy (SNB) with dual localisation; and 111 respondents had attended the New Start Course. Radioisotope was most frequently injected 2 h or more before operation. Just 13 surgeons were convinced of the value of dissecting internal mammary nodes visualised on a scan. Reasons for not using dual localisation included lack of nuclear medicine facilities, no local ARSAC licence holder, no probe, and no funding. Sixty-six surgeons stated that, if they had an ARSAC licence and could inject the radioactivity in theatre, this would be a major improvement. In addition, 83 (47%) did not perform SLNB in patients receiving neo-adjuvant chemotherapy.


CONCLUSIONS
Despite significant changes since 2004, substantial variation remains in management of the axilla. A number of surgeons are practicing outwith current guidelines.
Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK.
Ronan W
RW
Glynn
Linda
L
Williams
J Michael
JM
Dixon
D001365:Axilla / Q000000981:diagnostic imaging; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D020360:Neoadjuvant Therapy; D018579:Patient Selection; D011364:Professional Practice / Q000706:statistics & numerical data; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data; D014463:Ultrasonography