title: Does Conservative Surgery for Breast Carcinoma Still Require Axillary Lymph Node Evaluation? A Retrospective Analysis of 1156 Consecutive Women With Early Breast Cancer.
abstract: The role of axillary surgery for early breast carcinoma treated with conservative surgery and radiotherapy is currently the subject of considerable investigation. Recent studies have supported the noninferiority of avoiding axillary surgery in terms of overall survival when sentinel lymph node biopsy (SLNB) presents ≤ 2 positive lymph nodes, thus sparing the patients from complications. There are some ongoing studies investigating the possibility of omitting SLNB. Axillary study seems to be sufficiently replaced by SLNB for staging the disease. Axillary surgery maintains a therapeutic role in the presence of > 2 metastatic lymph nodes at SLNB.
  
  
  
  We performed a retrospective analysis of 1156 patients with early breast cancer to estimate the real incidence of patients with T1 tumors presenting > 2 metastatic lymph nodes.
  
  
  
  Of the 1156 cases, only 106 (9.2%) had > 2 axillary metastatic lymph nodes. More specifically, 38 (4.3%) of 884 T1 cases, and 6 (2.3%) of 257 of T1b cases had > 2 metastatic lymph nodes.
  
  
  
  The advantage of axillary surgery seems to be limited only to a specific subgroup of T1 patients who are undergoing conservative surgery plus radiotherapy. The ongoing studies on avoiding SLNB will likely prove the noninferiority of omitting biopsy because these studies are conducted in the whole population of early breast cancers. It is necessary to identify more accurately the subpopulation of patients who may benefit from axillary surgery.
authors.affiliation: Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy; Breast Unit, Macchiarella Clinic, Palermo, Italy. Electronic address: marrazzoantonio@libero.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Marrazzo
authors.affiliation: Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Damiano
authors.affiliation: Breast Unit, Macchiarella Clinic, Palermo, Italy.
authors.forename: Pietra
authors.initials: P
authors.lastname: Taormina
authors.affiliation: Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Buscemi
authors.affiliation: Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy.
authors.forename: Attilio Ignazio
authors.initials: AI
authors.lastname: Lo Monte
authors.affiliation: Breast Unit, Humanitas Research Hospital, Rozzano, Italy.
authors.forename: Emilia
authors.initials: E
authors.lastname: Marrazzo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000072700:Conservative Treatment / Q000379:methods*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D000071036:Sentinel Lymph Node / Q000473:pathology*; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data*
keywords: Axillary lymph node dissection; More than two metastatic axillary lymph nodes; Not axillary surgery staging; Sentinel lymph node biopsy; T1 tumors