title: Nodal status assessment in breast cancer: strategies of clinical grounds and quality of life implications.
abstract: Even in the era of gene-expression profiling, the nodal status still remains the primary prognostic discriminant in breast cancer patients. The exclusion of node involvement using noninvasive methods could reduce the rate of axillary surgery, thereby preventing from suffering complications. However, lymphatic mapping with sentinel node biopsy (SNB) is one of the most interesting recent developments in surgical oncology. Optimization of procedure could be implemented by dual mapping injection site skills, resection of all hot or blue nodes through tracer combination, and improvement in atypical drainage patterns mapping. This anatomical analysis suggests safety measures in patients with high probability of node metastasis through a renewed interest in surgical management. The perspective of a guided axillary sampling (GAS) could represent a potential development of recent anatomical and functional acquisitions, offering a dynamic technique shared according to clinical and anatomical disease parameters. Furthermore, the surgical staging procedures may adopt a conservative approach through the evaluation of upper arm lymphatics, thus defining a functional model aimed at the reduction of short- and long-term adverse events. Quality results in breast cancer surgery need to generate oncological safety devoid of complications through renewed clinical experience.
authors.affiliation: Department of Surgery, Tor Vergata University Hospital, 00133 Rome, Italy.
authors.forename: Paolo
authors.identifier: 0000-0002-6224-7784
authors.initials: P
authors.lastname: Orsaria
authors.affiliation: Department of Surgery, Tor Vergata University Hospital, 00133 Rome, Italy.
authors.forename: Dimitrios
authors.identifier: 0000-0002-0614-0392
authors.initials: D
authors.lastname: Varvaras
authors.affiliation: Department of Surgery, Tor Vergata University Hospital, 00133 Rome, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Vanni
authors.affiliation: Department of Surgery, Tor Vergata University Hospital, 00133 Rome, Italy.
authors.forename: Giampiero
authors.identifier: 0000-0001-5932-1915
authors.initials: G
authors.lastname: Pagnani
authors.affiliation: Department of Surgery, Tor Vergata University Hospital, 00133 Rome, Italy.
authors.forename: Jacopo
authors.identifier: 0000-0002-9531-9131
authors.initials: J
authors.lastname: Scaggiante
authors.affiliation: Department of Surgery, Tor Vergata University Hospital, 00133 Rome, Italy.
authors.forename: Federico
authors.identifier: 0000-0001-8947-3928
authors.initials: F
authors.lastname: Frusone
authors.affiliation: Department of Surgery, Tor Vergata University Hospital, 00133 Rome, Italy.
authors.forename: Alessandra Vittoria
authors.initials: AV
authors.lastname: Granai
authors.affiliation: Department of Surgery, Tor Vergata University Hospital, 00133 Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Petrella
authors.affiliation: Department of Surgery, Tor Vergata University Hospital, 00133 Rome, Italy.
authors.forename: Oreste Claudio
authors.initials: OC
authors.lastname: Buonomo